Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The left pacemaker is seen with two leads that follow an expected course to the lower right atrium and right ventricle is unchanged in appearance . The lungs are clear . The heart is top size normal and the hilar contours are normal . The pleural surfaces are normal without effusion or pneumothorax . There are moderate degenerative changes of the thoracic spine . No evidence of other metallic foreign body .
    OUTPUT:
    
Left pacemaker and leads in appropriate position .