Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There are low lung volumes and a suboptimal inspiratory effort . Again seen is a left chest cardiac device with associated dual leads in grossly appropriate in unchanged location . The cardiac silhouette is mild to moderately enlarged , similar to prior . The thoracic aorta is moderately tortuous , with aortic arch calcifications , as on prior . The bilateral hila are within normal limits . The lungs are clear . There is no pulmonary vascular congestion . There is no pneumothorax or pleural effusion .
    OUTPUT:
    
No acute cardiopulmonary process . No evidence of pneumonia .