Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is a BIV ICD with the shielded lead traversing the tricuspid valve . The proximal portion of the lead appears to be in the right atrium with the tip of the shielded lead appearing to be in the right ventricle . The left ventricular and right atrial leads appear to be in appropriate position . There is no evidence of a pneumothorax . There may be a small right pleural effusion . No focal concerning consolidations are identified . The cardiomediastinal contours are overall unchanged from ___ , with evidence of mild cardiomegaly .
    OUTPUT:
    
1 . The shielded right ventricular lead appears to traverse the tricuspid valve with the proximal portion in the right atrium and the tip in the right ventricle . Recommend advancement to ensure this lead is in the right ventricle . 2 . No pneumothorax . Findings were discussed with Dr . ___ by Dr . ___ by telephone at ___ : ___am on ___ .