Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Right chest wall dual lead pacing device is again seen with lead tips in the right atrium and right ventricle . Mitral valve replacement and median sternotomy wires are again noted . The lungs are clear without focal consolidation , effusion , or pneumothorax . The cardiomediastinal silhouette is stable . No acute osseous abnormalities .
    OUTPUT:
    
No acute cardiopulmonary process .