Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The heart is normal in size . The hilar and mediastinal contours are within normal limits . Multiple pulmonary nodules are again noted bilaterally . These , however , have increased in number since prior chest radiograph from ___ . Lung fields are otherwise clear . There are no pleural effusions or pneumothorax . A right - sided Port - A - Cath tip terminates in the lower SVC . The osseous structures are grossly unremarkable .
    OUTPUT:
    
Substantial increase of multiple lung nodules bilaterally .