JP2009226044A - Medical image display system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a medical image display system can adjust a medical image and easily obtain the image suitable for diagnosisa in a user terminal the throughput of which is limited. <P>SOLUTION: The medical image display system includes: the user terminal 2; and a medical image management device 1 for generating and transmitting an adjustment image suitable for display from the medical image in accordance with a request from the user terminal. The medical image management device 1 includes: an image keeping database 11; a setting storage part 13 for storing a reference pixel value WL, a reference pixel value range WW, and a step size in response to an affected region object; a calculation control part 12; and a communication part 14. The calculation control part 12 includes: adjustment image generating means 121 for generating the adjustment image with the WL and the WW corresponding to the affected region object; and sample image generating means 122 for generating a sample adjustment image by deviating the adjustment image for the portion of the step size, and then, receives a designation signal from the user terminal and also transmits the adjustment image and the sample adjustment image to the user terminal. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a medical image display system, and more particularly to a medical image display system for displaying a medical image on a user terminal with limited processing performance such as a mobile terminal.

  In recent years, advances in computer technology have led to the use of computer systems in hospitals and clinics. In most large hospitals, medical image diagnostic apparatuses such as CT and MRI are widely used. With the spread of such image diagnostic apparatuses, in many hospital computer systems, an image archiving communication system (PACS) has been introduced to manage accumulated image data. PACS accumulates medical image data in a database on a file server, and makes it possible to access a desired image online via a network from an in-hospital examination room, an out-of-hospital hospital, a doctor's home, or the like. .

  FIG. 1 is a diagram showing a schematic configuration of PACS. The PACS includes a center server device 1, a plurality of user terminals 4A, 4B, 4C, and a LAN 5. The center server device 1 is composed of one or a plurality of computers, and constructs a database of medical digital image data acquired by a medical image acquisition device such as CT or MRI (not shown). The user terminals 4A, 4B, 4C,... Are constituted by a processing device 41 and a monitor 42 in a personal computer, a workstation, etc., and are respectively arranged in an examination room or the like. The LAN 5 is a network provided in a hospital, for example, and can perform high-speed communication of medical digital image data. In addition, in the case of PACS for a plurality of hospitals as well as in the hospital, a public line may be used instead of the LAN 5.

A user (physician) who uses the PACS inputs the ID number from any of the user terminals 4A, 4B, and 4C, accesses a desired medical image of the PACS, observes the image displayed on the monitor 42, and diagnoses I do. This is called interpretation.
For communication of medical digital images, a standard called DICOM (Digital Imaging and Communication in Medicine) has been established and widely used. Here, the case where the target image is a DICOM image will be described as an example, but the present invention is not limited to this.

In order to enable diagnosis (interpretation), a medical image is generally high-resolution image data having a density level (pixel value) of 5000 or more for each pixel. For example, in digital image data obtained by a CT apparatus, a pixel value is referred to as a CT value and can take a value of 5000 or more.
Then, the center server device 1 transmits the medical image to the designated medical image user terminal, and the user terminal stores all the transmitted medical images, and the image is changed according to the operation of the user (doctor). Based on the processing conditions, the medical image is processed and displayed on the monitor. As the image processing, processing for changing the gradation display characteristic, which is the relationship between the pixel value of the medical image and the monitor display luminance, to enable display on the monitor, processing for changing the contrast, filter processing, and the like are performed.

  FIG. 2 is a diagram illustrating an example of image processing for adjusting the display gradation of a medical image. The medical image is, for example, data with pixel values from −1500 to 4000. If such an image is displayed such that the highest pixel value (4000) corresponds to the highest luminance of the monitor and the lowest pixel value (−1500) corresponds to the lowest luminance of the monitor, an image suitable for diagnosis is displayed. Is not limited. For example, the lesioned part has a pixel value different from that of the surrounding tissue, but the difference is minute, and this is a minute luminance difference when displayed on the monitor, and it is difficult to determine the lesioned part. Therefore, a center level WL that is the center value of the pixel values when this medical image is displayed on the monitor and a pixel value range WW to be displayed from the pixel values above and below the center level WL are set, and among the pixel values of the medical image Window processing for displaying the range of WL-WW / 2 to WL + WW / 2 is performed. WL represents the window level, WW represents the window width, and both are information for setting the display gradation of the medical image. For example, in FIG. 2, what is shown on the upper right side is a display gradation under the conditions of WL = 60 and WW = 150, that is, a pixel value range of −15 to 135 with a minimum luminance of 0 to a maximum luminance of 255 on the monitor. Is displayed. Similarly, the lower right side shows a case where the pixel value range of −10 to 70 is displayed as a display gradation of 0 to 255 on the monitor under the conditions of WL = 30 and WW = 80. Show. Accordingly, the upper right side displays a wider pixel value range than the lower right side. Thus, by adjusting the display characteristics of the medical image, an image display more suitable for diagnosis can be performed.

For example, in the first stage, WW is set so as to display a wide pixel value range, and the most appropriate pixel value for diagnosing a diagnostic part is changed by changing WL, and then WW is changed. Observe the presence of lesions. Actually, such an operation is performed while changing WL and WW, and a diagnosis is performed by sequentially displaying a slightly different state between WL and WW. Normally, the time required to set the optimal WL and WW for diagnosis decreases as the diagnosis becomes more proficient.
The operation of changing WL and WW is generally performed by operating a cursor displayed on a monitor with a pointing device such as a mouse.

  In the PACS constructed in the hospital shown in FIG. 1, the processing device 41 of the user terminals 4A, 4B, 4C,... Uses a data processing device having a high processing capacity such as a workstation or a high-performance personal computer. As for 42, the thing of high definition is generally used. Therefore, an image corresponding to WL and WW changed by the user as described above can be displayed on the monitor 42 immediately (in real time).

  Further, even if the user (doctor) is out of the hospital, such as at the home, if a high-performance personal computer that can access the center server device 1 through a public line is used, it is possible to transmit a large amount of medical digital image data. Although it takes a little time, if the data transmission is completed, an image corresponding to the WL and WW changed by the user can be displayed on the monitor in real time. As a result, for example, when a doctor who has a home in a remote place requests a diagnosis of an image taken at a hospital and stored in the PACS, the requested doctor accesses the image in the PACS using a personal computer at home. Can be diagnosed.

Furthermore, with the recent popularization and high functionality of mobile phones, etc., we would like to send medical images in an emergency to a doctor's mobile phone, etc. and request a diagnosis or advice from a doctor who cannot use a high-performance personal computer during a business trip etc. Needs are increasing.
Japanese Patent Application Laid-Open No. 2004-151867 is a system that transmits a medical image to a portable terminal held by a doctor and requests a diagnosis from the doctor, and converts the transmitted medical image into an image suitable for the display function of the portable terminal. Alternatively, a configuration is described in which a medical image is converted into an image suitable for the display function of the mobile terminal in the mobile terminal and then transmitted to the mobile terminal held by the doctor.

JP 2005-278755 A

If a high-performance personal computer or workstation is used, the doctor (interpretation doctor) observes the display on the monitor and adjusts display characteristics and display contrast from a medical image with a large pixel value range using a pointing device. It is possible to make adjustments in real time so that an image suitable for diagnosis is displayed by changing, and it is easy to use.
However, when a diagnosis is performed using a mobile terminal, since the processing capability of the mobile terminal is insufficient, a medical image having a large pixel value range is handled or a fine image adjustment process is performed quickly. Is difficult. For this reason, when using a portable terminal, it takes time for a doctor to obtain an image suitable for observing a diagnostic part. Furthermore, the portable terminal is difficult to operate because it has small keys and screens, and is not easy to use. There was a problem.

  Patent Document 1 describes adjusting a medical image so as to be suitable for display characteristics of a mobile terminal, but does not describe image adjustment for obtaining an image suitable for observation of a diagnostic region. Therefore, in order to obtain an image suitable for observation of a diagnostic site in Patent Document 1, it is necessary to perform image processing on a portable terminal, as is conventionally done with a personal computer. This causes a problem when adjusting the image.

  The present invention relates to a medical image management apparatus and a medical image that can easily obtain an image suitable for diagnosis (interpretation) by adjusting a medical image in a user terminal such as a portable terminal in which the operating environment and processing capability are limited. An object is to provide a display system.

In order to solve the above problems, the present invention is suitable for display from a medical image in response to a request from a user terminal that requests an adjustment image from the medical image management apparatus and displays the received adjustment image. A medical image display system including a medical image management device that generates and transmits an adjustment image, and a user terminal is an operation unit that causes a user to specify a lesion target and to transmit a specification signal for requesting an adjustment image And a display unit that displays the adjustment image received from the medical image management apparatus, and the medical image management apparatus includes an image storage database that stores medical images having a wide pixel value range obtained by imaging the subject. A setting storage unit that stores a reference pixel value, a reference pixel value range, and a step size corresponding to a lesion target, a calculation control unit, and a communication unit with a user terminal, and the calculation control unit includes: ,Recieved In the reference pixel value and the reference pixel value range corresponding to the lesion target included in the constant signal, the adjustment image generation unit that generates the adjustment image from the medical image, and the reference pixel value of the adjustment image generated by the adjustment image generation unit Sample image generation means for generating a sample adjustment image from a medical image by shifting the width, and the medical image management apparatus receives a designation signal from the user terminal via the communication unit, Provided is a medical image display system for transmitting a sample adjustment image to a user terminal.
With this configuration, an adjustment image of a reference pixel value range including a reference pixel value corresponding to a lesion target is generated from a medical image having a very large pixel value range in the medical image management apparatus. Even if the terminal is used, it is possible to display an adjustment image corresponding to the lesion to be diagnosed by the user. Furthermore, since the adjustment image and the sample adjustment image in the vicinity thereof can be confirmed on the user terminal, the sample adjustment image of the pixel values around the adjustment image can also be confirmed, and the diagnostic accuracy can be improved.

  In addition, since the adjustment image has the first resolution and the sample adjustment image is generated at the second resolution lower than the first resolution, the sample adjustment image can be used even in a user terminal with limited processing capability. It is possible to increase the number of users, and the user can make a quick decision.

In addition, when a selection operation of the sample adjustment image displayed on the display unit is performed on the operation unit of the user terminal, the adjustment includes information that can specify the reference pixel value and the reference pixel value range of the selected sample adjustment image. When the image change signal is transmitted and the adjusted image change signal is received by the medical image management apparatus, it is preferable that an adjusted image is generated with the reference pixel value and the reference pixel value range and transmitted to the user terminal.
With this configuration, if the user selects a sample adjustment image on the user terminal, the user can confirm an adjustment image with a high resolution, so that usability is improved.

In addition, the user terminal can perform a selection operation for requesting a history at the operation unit. When a history request is selected at the operation unit, the user terminal transmits a history request, and the calculation control unit transmits the history request. When this is received, it is preferable to generate a sample adjustment image with the reference pixel value and the reference pixel value range in the history information stored in the setting storage unit and transmit the sample adjustment image to the user terminal.
With this configuration, since the sample adjustment image of the medical image can be displayed in the same reference pixel value and reference pixel value range as the adjustment image selected in the past by the user, the usability for the user is improved.

Further, the user terminal can select one of a plurality of sample adjustment images displayed on the display unit by the operation unit, and when the sample adjustment image is selected by the operation unit, the selected sample is selected. When the adjustment image change signal including the reference pixel value and the reference pixel value range of the adjustment image is transmitted and the arithmetic control unit of the medical image management apparatus receives the adjustment image change signal, the received reference pixel value and the reference pixel value range are received. It is preferable to update the reference pixel value and the reference pixel value range in the setting storage unit, generate an adjustment image with the reference pixel value and the reference pixel value range, and transmit the adjustment image to the user terminal.
With this configuration, the medical image adjustment image can be displayed with the same reference pixel value and reference pixel value range as the previous adjustment image without being stored as history information, so that user convenience is improved.

Embodiments of the present invention will be described with reference to the drawings.
FIG. 3 is a diagram showing the configuration of the medical image communication display system according to the embodiment of the present invention. As shown in the figure, this system is connected to a center server device (medical image management device) 1, a mobile terminal device 2 connected to the center server device 1 via a public network 3, and a center server device 1 via a LAN 5. The fixed terminal device 4 is configured. Although not shown, a plurality of portable terminal devices 2 may exist.
The center server device 1 is realized on one or a plurality of computers, and the mobile terminal device 2 can be a mobile phone having a Web browser function. The fixed terminal device 4 and the LAN 5 have a configuration similar to that of the conventional example described in FIG. However, the fixed terminal device 4 includes a terminal device having a low processing capability, and medical images can be communicated between the fixed terminal device 4 and the center server device 1 in the same manner as the portable terminal device 2 described later.

The center server device 1 constructs a database of medical digital image data acquired by a medical image acquisition device such as CT or MRI. Each fixed terminal device 4 is connected to the center server device 1 via a LAN 5 capable of high-speed communication of medical digital image data. A user (doctor) makes a diagnosis by using the fixed terminal devices 4 respectively disposed in an examination room or the like. Since these processes are the same as those in the conventional example, detailed description thereof is omitted.
The mobile terminal device 2 has a limited operating environment and processing capacity compared to the fixed terminal device 4, and the public line network 3 has a lower data transmission rate than the LAN 5. For this reason, it is difficult for the mobile terminal device 2 to perform the same diagnosis as the fixed terminal device 4. Therefore, in the present embodiment, the center server device 1 uses an “adjustment image” and a “sample adjustment image” (hereinafter referred to as “sample image”) that are suitable for diagnosis and can be displayed as they are on the mobile terminal device 2 from medical images. (Not shown) is generated and supplied to the mobile terminal device 2. The adjusted image is an image that displays a medical image in WL and WW suitable for diagnosis. The sample image is an image obtained by slightly shifting the WL and / or WW of the adjustment image (step size described later), and the resolution may be lower than that of the adjustment image.
When a doctor requesting an emergency diagnosis cannot use the fixed terminal device 4 and can use only the mobile terminal device 2, the doctor requests the doctor to make a diagnosis on the mobile terminal device 2 by telephone or e-mail. The doctor who has received the request requests the center server device 1 to transmit a necessary medical image using the mobile terminal device 2. On the other hand, the center server device 1 generates an adjustment image and, if necessary, a sample image and transmits it to the mobile terminal device 2. The portable terminal device 2 displays the transmitted adjustment image and sample image as they are. The doctor makes a diagnosis using the adjustment image displayed on the mobile terminal device 2. If it is determined that the displayed adjustment image is not suitable for diagnosis, a sample image is displayed, a condition more suitable for diagnosis is instructed by selecting the sample image, and an adjustment image is generated and displayed again. Let
Hereinafter, each part which comprises the medical image communication display system of embodiment is demonstrated.

  As illustrated in FIG. 3, the center server device 1 includes an image storage database 11, a calculation control unit 12, a setting storage unit 13, and a communication unit 14. The communication unit 14 includes a public line communication unit 141 that performs communication with the mobile terminal device 2 and a LAN communication unit 142 that is an interface with the LAN 5. The configurations and operations of the public line communication unit 141 and the LAN communication unit 142 are the same as those in the conventional example, and thus description thereof is omitted.

The image storage database 11 stores medical images acquired by medical image diagnosis (examination) equipment (not shown) such as CT and MRI in the medical facility where the center server device 1 is located or other medical facilities through the LAN communication unit 142 or the like. And store as image data conforming to the DICOM standard. Information such as an image ID, an examination ID, a patient ID, and an examination device is assigned to the DICOM image data, and arbitrary DICOM image data can be taken out by designating the image ID. The inspection device has an ID issuing unit. When an image is generated, a unique ID is issued and attached to the image as header information.
FIG. 4 is a diagram illustrating an example of header information of image data stored in the image storage database 11. As illustrated, the header information includes an image ID, an examination ID, a patient ID, an examination device, a pixel value range, and the like, and is stored in association with the image data. Since a plurality of examinations such as CT and MRI may be performed in one examination, the same examination ID may be attached to different image IDs.

The setting storage unit 13 stores inspection information, an adjustment image generation table, and setting history information. These pieces of information are information related to the header information of the image data stored in the image storage database 11 and can be referred to by the user (doctor).
The examination information includes a doctor ID, examination ID, and the like, and is used to search image data stored in the image storage database 11. For convenience of search, the examination information can include examination date and time, examination equipment, patient information, etc. If the examination ID can be specified, these can be identified from the header of the image data stored in the image storage database 11. It is possible to obtain information. The inspection information is referred to, for example, when a web page is presented on the mobile terminal in response to a request from the mobile terminal device 2. However, it is also possible to refer to not only a request from the mobile terminal device 2 but also a request from the fixed terminal device 4.

The adjustment image generation table stores information for generating an adjustment image to be displayed on the mobile terminal device 2.
FIG. 5 is a diagram illustrating an example of the adjustment image generation table. As shown in FIG. 5, the adjusted image generation table includes a lesion target, an examination device, a reference pixel value, a reference pixel value range, a step value, and the like.
The lesion target indicates a lesion to be diagnosed. When the suspicious lesion is clear, it is specifically designated as “lung tumor”, “gastric ulcer” or the like, and when the lesion is indefinite, the site is designated as “head”.
The reference pixel value and the reference pixel value range are used when generating the “adjusted image”, and recommended values of WL and WW are determined for each lesion target so that the lesion target becomes clear, and the values are stored. Has been. For example, in the case of the head, the value is such that the contrast between white matter and gray matter becomes clear.
Since the image data differs depending on the inspection device so that the pixel value range is different between CT and MRI, it is preferable to include information on the inspection device.
The step size is used when generating a sample image. A sample image is generated by shifting the WL and WW values by the set step values from the adjusted image WL and WW. WL and WW may be set to different numerical values. For each lesion, there is a range of variation (according to past knowledge) depending on individual differences such as patient age and physique. Collect the reference pixel value and reference pixel value range used by the doctor for diagnosis and the change step amount and change range data at the time of adjustment, and divide the change range equally by the change step amount for each lesion target The step size is set.
In any case, the reference pixel value, the reference pixel value range, and the step value are initially determined based on empirical values so far, and thereafter, at the time of diagnosis in the fixed terminal device 4 or the mobile terminal device 2 Data is collected and updated from time to time.

The setting history information includes a setting history information table describing past setting information for medical images. FIG. 6 shows an example of the setting history information table.
As shown in FIG. 6, the setting history information table includes the latest predetermined number (for example, nine excluding the same setting in the example of FIG. 6) among the same doctor ID, the same device, and the same lesion target WL and WW. Minutes are memorized. Further, setting history information may be stored for each patient ID. In the history use mode and the specific doctor correspondence mode described later, up to nine sample images are generated using the setting history.

  The arithmetic control unit 12 controls the entire center server device 1 and supplies the DICOM image stored in the image storage database 11 to the fixed terminal device 4 connected via the LAN 5. This process is the same as in the prior art. The arithmetic control unit 12 collects, as history information, the conditions (for example, WL and WW) used by the user (doctor) for displaying the medical image in the fixed terminal device 4 and stores them as setting history information in the setting storage unit 13. Or the adjusted image generation table is individually updated based on the information. In addition, the arithmetic control unit 12 performs processing for a medical image transmission request from the mobile terminal device 2.

As illustrated in FIG. 3, the arithmetic control unit 12 includes an adjustment image generation unit 121 that generates an adjustment image, a sample image generation unit 122 that generates a sample image, and a web server unit 123 that generates a web page. .
In response to the image request from the mobile terminal device 2, the adjustment image generation unit 121 generates an adjustment image from the DICOM image stored in the image storage database 11 based on the requested condition. As described above, the adjustment image is an image that displays a medical image with WL and WW determined so that the lesion target becomes clear for each lesion target. The adjusted image generation unit 121 reads the reference pixel value (WL) and the reference pixel value range (WW) corresponding to the requested medical image from the adjusted image generation table in the setting storage unit 13, and based on the reference pixel value (WL) from the DICOM image An adjusted image is generated. The method for generating the adjusted image is the same as the method for generating the display image according to the WL and WW adjusted by the doctor in the fixed terminal device 4.
The adjusted image is an image for diagnosis in which the mobile terminal device 2 displays a specific affected part on the screen in the display unit 21, and an example thereof is shown in FIG. As shown in FIG. 7, on the display screen, WL, WW, Zoom values, etc. are displayed together with the adjustment image, and a pull-down menu for requesting display of sample images, use of history, change of diagnostic part, etc. is displayed. Is done.

In response to a sample image display request from the mobile terminal device 2, the sample image generation unit 122 generates a sample image from the DICOM image corresponding to the adjustment image. As will be described later, there are a plurality of methods for creating a sample image. In the lesion target mode, the adjustment image is an image obtained by shifting the WL and / or WW in increments. The sample image generation unit 122 reads the step value of the adjustment image generation table in the setting storage unit 13, and calculates one or more pairs of WL and WW obtained by changing the WL and / or WW of the adjustment image by the step value. Based on this, a sample image is generated from the DICOM image. The generated one or more sample images are transmitted to the mobile terminal device 2. The sample image is an image for facilitating a doctor to determine an optimal adjustment image in the mobile terminal device 2, and does not need to be displayed as large as a diagnosis adjustment image. In other words, the resolution of the sample image may be lower than the resolution of the adjusted image.
Display examples of sample images in the mobile terminal device 2 are shown in the lower right of the screen of FIG. 8A and the screen of FIG. 8B.
In FIG. 8A, one small sample image is displayed at the edge of the screen on which the adjusted image is displayed large, and the sample image to be displayed is 1 by the operation of the operation unit 22 (for example, operation of the cross key). The images are switched and displayed one by one, and a desired image is selected from the displayed images. In the display of FIG. 8A, the doctor can search for the optimal sample images of WL and WW while comparing the adjustment image and the sample image.
In FIG. 8B, a plurality of sample images are displayed in a tile shape on the screen without displaying the adjustment image. At this time, it is desirable to display the adjusted image with the same size as the sample image, for example, in the center. The doctor operates the cross key on the operation unit 22 so that the cursor moves on the displayed image, and selects the optimal WL and WW images from the displayed plurality of sample images and adjustment images. .

When the doctor determines from the adjustment image and the sample image displayed as described above that the sample image is more suitable for diagnosis than the adjustment image, the WL and WW of the selected sample image are notified to the adjustment image generation unit 121. Then, the adjusted image generation means 121 generates and outputs an adjusted image with the notified WL and WW. The new adjusted image is transmitted to the mobile terminal device 2 and displayed. The doctor makes a diagnosis with a new adjustment image displayed largely on the screen of the display unit 21 of the mobile terminal device 2.
When there is a change in WL and WW of the adjustment image as described above, the arithmetic control unit 12 stores the information in the setting storage unit 13 as setting history information. In addition, when a certain set of values is frequently used as WL and WW of the adjustment image for a certain lesion target generated by a certain inspection device, the arithmetic control unit 12 determines the reference pixel value of the adjustment image generation table and The reference pixel value range is changed to this set of values. This is not limited to the change of the WL and WW of the adjustment image in the mobile terminal device 2, and a set of WL and WW values different from the reference pixel value and the reference pixel value range are frequently used in the diagnosis in the fixed terminal device 4. The same applies when used.

  The web server unit 123 is an HTML document (web page) that publishes each content of examination information, in-test image information, adjustment images, and sample images in response to an operation when a doctor accesses from the mobile terminal device 2. ) And transmitted to the mobile terminal device 2 via the public line communication unit 141. The web page is embedded with hyperlinks and buttons for requesting content information, a page, an input field in which an input function is set, a pull-down menu for request input, and the like. The web server unit 123 can use a conventional one, and the contents of the web page to be created are different. 5A and 5B described above are web pages when the adjustment image and the sample image are displayed. FIG. 9 is an example of a web page of an examination list.

The mobile terminal device 2 includes a display unit 21 and an operation unit 22 and is a wireless communication terminal that can access the center server device 1 by a browser function, and is configured by a mobile phone, PHS, PDA, or the like. Also, a dedicated terminal prepared for this system may be used.
The display unit 21 displays an examination list, an adjustment image, a sample image, etc. downloaded from the center server device 1 as a web page.
The operation unit 22 includes input devices such as a numeric keypad, a cursor key, a cross key, and a touch panel.

  FIG. 10 is a flowchart illustrating a processing procedure of the arithmetic processing unit 12 in the embodiment. Using this, for example, a case will be described in which a laboratory technician communicates an image taken by CT, MRI, etc. by telephone, mail, etc. requesting a remote doctor to make a diagnosis.

In step S1, login authentication is performed. The doctor who received the notification accesses a web page that operates in the web server unit 13 of the calculation control unit 12 of the center server device 1 on the portable terminal device 2 and inputs an ID and a password registered in advance on the login screen. To do. In response to this, the arithmetic control unit 12 authenticates whether the logged-in user (doctor) is a doctor who has an access right.
In step S <b> 2, the arithmetic control unit 12 transmits an examination list to be displayed on the display unit 21 to the mobile terminal device 2, and the examination list as illustrated in FIG. 9 is displayed on the display unit 21. When the doctor selects an examination ID or the like in the examination list displayed by the doctor, it is also possible to display such that selection is performed in a plurality of steps, such as further displaying and selecting a list of image IDs associated therewith.
In step S <b> 3, it is determined whether an operation for requesting generation of an adjustment image is performed in the operation unit 22 of the mobile terminal device 2 and a designation signal corresponding to the operation is transmitted from the mobile terminal device 2. The designation signal includes information for designating the lesion target. If the designation signal is not transmitted, the process proceeds to step S8, and if it is transmitted, the process proceeds to step S4.
In step S4, the calculation control unit 12 acquires the image ID of the lesion target requested by the designation signal.
In step S5, the reference pixel value (WL) and the reference pixel value range (WW) corresponding to the image ID are read from the adjusted image generation table of the setting storage unit 13.
In step S6, a high-resolution adjustment image is generated based on WL and WW read from the medical image (DICOM image) indicated by the image ID.
In step S <b> 7, the generated adjustment image is transmitted to the mobile terminal device 2. The transmitted adjustment image is displayed on the display unit 21 of the mobile terminal device 2.

In step S <b> 8, it is determined whether an operation for requesting generation of a sample image is performed in the operation unit 22 of the mobile terminal device 2 and a generation designation signal corresponding thereto is transmitted from the mobile terminal device 2. The generation designation signal includes information for designating the lesion target and the sample image generation mode. If the generation designation signal is not transmitted, the process proceeds to step S17, and if it is transmitted, the process proceeds to step S9.
In step S9, a sample image having a lower resolution than the adjusted image is generated. This will be described later.
In step S <b> 10, the generated sample image is transmitted to the mobile terminal device 2. The transmitted sample image is displayed on the display unit 21 of the mobile terminal device 2.

In step S11, when the doctor views the display on the display unit 21 of the mobile terminal device 2 and wants to confirm the high resolution image from the sample images, the adjustment image is changed using the operation unit 22 of the mobile terminal device 2. Since the signal is transmitted to the center server device 1, the communication unit 14 determines whether the adjusted image change signal has been received from the mobile terminal device 2. This signal includes WL and WW of the designated sample image. However, if WL and WW can be specified from the code of the sample image, the code of the sample image may be used. If the adjustment image change signal has not been received, the process proceeds to step S17, and if it has been received, the process proceeds to step S12.
In step S12, the image ID of the sample image to be changed to the adjusted image is acquired. If the image ID of the sample image is the same as the image ID of the adjustment image, this step is unnecessary.
In step S13, an adjustment image is generated using WL and WW of the sample image as WL and WW of the new adjustment image.
In this embodiment, the reference pixel value WL and the reference pixel value range WW stored in the adjustment image generation table of the setting storage unit 13 are not updated, but adjustment is performed using the values of WL and WW included in the adjustment image change signal. The value of the image generation table may be updated, and the adjusted image may be generated with the updated WL and WW values.
In step S14, the history that the sample image has been changed to the adjusted image, that is, the WL and WW of the sample image is stored as setting history information in the setting storage unit 13.
In step S <b> 15, the newly generated adjustment image is transmitted to the mobile terminal device 2.
In step S <b> 16, it is determined again whether the doctor has received from the portable terminal device 2 a signal indicating that an operation for changing the adjustment image to any one of the sample images has been performed. If not received, the process proceeds to step S17, and if received, the process returns to step S12.
In step S17, it is determined whether or not the access from the portable terminal device 2 by the doctor has been completed, that is, whether or not the user has been logged out. If not logged out, the process returns to step S8.

Next, the sample image generation process in step S9 will be described.
There are four methods for generating the sample image, and the sample image generation mode can be selected on the display screen of the mobile terminal device 2. Specifically, selection is made possible by the pull-down menu at the lower left of the screen shown in FIGS. 7 and 8A and 8B.
・ Lesion handling mode: The value set for each lesion target is used.
History use mode: Uses the image adjustment history of the user (doctor).
Specific doctor correspondence mode: The image adjustment history of a specific user designated in advance is used.
-Specified value mode: Uses the value entered by the user.

FIG. 11 is a flowchart showing sample image generation processing in the arithmetic control unit 12.
In step S21, an image ID is acquired.
In step S22, it is determined whether or not the WL / WW value input by the user with the portable terminal device 2 is included when the generation of the sample image is requested. If included, the designated value mode is selected and step S23 is selected. If not included, the process proceeds to step S31.
In step S23, the WL / WW value input by the user (doctor) is acquired.
In step S24, the DICOM image is adjusted with the acquired WL / WW value to generate a sample image.
Similarly, the inspection device is determined from the image ID. When there is no input of a lesion target, the imaging part of the DICOM image is used as it is as a lesion target.

In step S31, the lesion target is determined from the content of the received signal. When there is no input of a lesion target, the imaging region of the DICOM image is determined as a lesion target.
In step S32, the logged-in user ID is acquired.
In step S33, an image adjustment history (WL / WW used to generate the adjustment image) when the diagnosis was performed in the past with the same image examination (acquisition) device and diagnosis part using the image adjustment history of a specific doctor set in advance. Is stored, and if stored, the process proceeds to step S34 (specific doctor handling mode), and if not stored, the process proceeds to step S41.
In step S34, the DICOM image is adjusted with the set value of WL / WW stored as the history to generate a sample image.
In the specific doctor handling mode in step S34, if the user ID is linked with the user ID of a skilled doctor, the doctor with a low experience value who does not know how to change the WL / WW value to observe It is possible to present an image adjustment result predicted to be desired with reference to an operation history of a skilled doctor.

In step S41, the image setting information includes an image adjustment history (a set value of WL / WW used to generate an adjustment image) when the same ID as the logged-in user ID is used to make a diagnosis in the past with the same image inspection device and diagnostic part. ), The process proceeds to step S42 if stored, and to step S51 if not stored.
In step S42, the DICOM image is adjusted with the set value of WL / WW stored as the history to generate a sample image.
If a plurality of setting values for WL / WW are stored, a plurality of sample images are generated with the plurality of setting values and transmitted to the mobile terminal device 2.
As the image adjustment history, WL and WW values used for generating the adjustment image are held in the setting storage unit 13 by the latest predetermined number (for example, 9) corresponding to the user ID, the image inspection device, and the diagnostic part. The
In the history use mode in step S42, a sample image can be generated using values that are frequently used by the doctor, and an image adjustment result predicted to be desired by the doctor can be presented. By designating, an easily observable image of the lesion target can be easily obtained.
Note that the image adjustment history may be updated (a new value is held) only when the difference is large with respect to the already stored WL / WW value. For example, for WL, this adjustment history is stored only when there is a change of ± 80 or more with respect to the value held as the image adjustment history, and for WW, this adjustment is performed only when there is a change of ± 50 or more. A history may be set to be stored.

In step S51, the type of the inspection device and the set values of WL and WW corresponding to the lesion target are read from the adjustment image generation table.
In step S52, the DICOM image is adjusted with this set value to generate a sample image.
In the lesion target mode in steps S51 and S52, it is possible to present an image adjustment result that is predicted to be desired for each lesion target, and it is easy to observe the diagnosis site by designating a set value of image adjustment from the sample image. Can be easily obtained.

  In the sample image generation mode other than the lesion target mode, the sample image is generated based on the stored or input WL / WW value. In the lesion target mode, the WL / WW value of the adjustment image is changed by the increment value. A sample image is generated using the WL and WW. This sample image generation process will be described with reference to FIG.

In the case of a CT image, the WL / WW range suitable for each diagnostic site is roughly determined. As described with reference to FIG. 5, the reference pixel value and the reference pixel value range used by the doctor for diagnosis, and the change step amount and change range data during adjustment are collected. Then, the step size is set by equally dividing the change range by the change step amount for each lesion target. For example, assume that the step size is set as follows.
Head (head condition) WL: 30-40 (step size = 1) / WW: 80-100 (step size = 2). In this case, the stored setting value WL / WW = (35/90)
Head (orbit) WL: 30-50 (step size = 2) / WW: 300-350 (step size = 5). In this case, the stored setting value WL / WW = (40/325)
-Chest (mediastinum) WL: 30-50 (step size = 2) / WW: 300-400 (step size = 10). In this case, the stored setting value WL / WW = (40/350)
For example, if the adjusted image is generated with WL = 300 and WW = 1500, WL = 350 and WW = 1520, WL = 350 and WW = 1500, WL = 350 and WW = 1480, WL = 300 and WW = 1520, WL = 300 and WW = 1480, WL = 250 and WW = 1520, WL = 250 and WW = 1500, WL = 250 and WW = 1480 A plurality of sample images are transmitted to the mobile terminal device 2.
FIG. 12 is a diagram for explaining an example of creating a sample image in the case of the head (orbit). A point indicated by “0” in FIG. 12 is a set value serving as a base point or an input value WL = 40 / WW = 325. Points indicated by numbers 1 to 3 other than “0” indicate WL / WW points of the sample image within a distance of 3 when the WW step size is 5 and the WL step size is 2. Here, the distance is the number of times that WW or WL is increased or decreased by one increment from the base point indicated by “0”, and is a point that is further away from the base point as the distance increases. If the sample image is a distance 1, 4 sample images are generated. If the sample image is a distance 2 or less, 12 sample images are generated. If the sample image is a distance 3 or less, 24 sample images are generated. Will be generated.
In the mobile terminal device 2, when displaying 12 sample images having a distance of 2 or less, the sample images are displayed in a 4 × 4 tile shape. Further, twelve sample images may be displayed in a layout as shown in FIG. 12 in a 5 × 5 tile display. In the present embodiment, the center server device 1 receives the designation signals requesting the adjustment image and the sample image from the mobile terminal device 2, generates each image, and transmits it to the mobile terminal device 2. When receiving the designation signal requesting the adjustment image from the mobile terminal device 2, the center server device 1 may generate the adjustment image and the sample image, and transmit them to the mobile terminal device 2.

As described above, in the embodiment of the present invention, the medical image is transmitted to the terminal device as an adjustment image suitable for diagnosis and displayed as it is, so that the processing in the terminal device can be greatly reduced. Along with the adjustment image, a plurality of sample images around the adjustment image predicted to be desired by the doctor are transmitted and displayed together. Therefore, it is easier to specify the setting value of the image more suitable for diagnosis than the adjustment image. It is possible to easily obtain an image for easily observing a lesion target.
In the above-described embodiment, as an example, a sample image in which WL / WW is changed is generated. However, as an application example, a plurality of images obtained by performing processing such as a low-pass filter and a high-pass filter on the image are generated. You may do it. In the filtering process, as with WL / WW adjustment, it is often not intuitive to know how much the change will be due to the frequency setting, and settings frequently used by doctors are memorized and the history is used. By generating a sample image, the same effect as WL / WW can be obtained.
Moreover, it will be apparent to those skilled in the art that the described embodiments are merely examples for explaining the present invention, and the present invention is not limited thereto.

  The present invention is applied to a system for accessing a medical image database constructed in a center server device and performing diagnosis at a user terminal, and particularly to a system using a user terminal with insufficient processing capability such as a mobile phone. Is done.

It is a figure which shows schematic structure of PACS. It is a figure explaining the example of the image process which adjusts the display gradation of a medical image. It is a figure which shows the structure of the medical image communication display system of embodiment of this invention. It is a figure which shows the content of the medical image storage database. It is a figure which shows the content of the adjustment image production | generation table. It is a figure which shows the content of setting log | history information. It is a figure which shows the example of a display of an adjustment image. It is a figure which shows the example of a display of a sample image. It is a figure which shows the example of a display of a test | inspection list. It is a flowchart which shows operation | movement of the calculation control part in embodiment. It is a flowchart which shows the production | generation process of the sample image in embodiment. It is a figure which shows the example of a production | generation of a sample image.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Center server apparatus 2 Portable terminal device 3 Public line network 4 Fixed user terminal 5 LAN
DESCRIPTION OF SYMBOLS 11 Image storage database 12 Operation control part 13 Setting memory | storage part 14 Communication part 21 Display part 22 Operation part 121 Adjustment image generation means 122 Sample image generation means 123 Web server part 141 Public line communication part 142 LAN communication part

Claims (5)

A user terminal that requests an adjustment image from the medical image management apparatus and displays the received adjustment image, and a medical image that generates and transmits an adjustment image suitable for display from the medical image in response to a request from the user terminal A medical image display system comprising a management device,
User terminal
An operation unit that allows a user to send a designation signal that designates a lesion target and requests an adjustment image;
A display unit for displaying the adjustment image received from the medical image management apparatus,
The medical image management apparatus includes:
An image storage database storing medical images having a wide pixel value range obtained by imaging a subject;
A setting storage unit that stores a reference pixel value, a reference pixel value range, and a step size corresponding to the lesion target;
An arithmetic control unit;
A communication unit with the user terminal,
The arithmetic control unit is
Adjustment image generation means for generating an adjustment image from the medical image in the reference pixel value and the reference pixel value range corresponding to the lesion target included in the received designation signal;
Sample image generation means for generating a sample adjustment image from the medical image by shifting the reference pixel value of the adjustment image generated by the adjustment image generation means by the step size;
The medical image management apparatus receives the designation signal from the user terminal via the communication unit, and transmits the adjustment image and the sample adjustment image to the user terminal. system.   The adjustment image generation unit generates the adjustment image at a first resolution, and the sample image generation unit generates the sample adjustment image at a second resolution lower than the first resolution. The medical image display system described. The user terminal can perform a selection operation of the sample adjustment image displayed on the display unit by the operation unit. When the sample adjustment image is selected by the operation unit, the reference of the selected sample adjustment image is selected. Send an adjustment image change signal containing information that can identify the pixel value and the reference pixel value range,
When the arithmetic control unit receives the adjustment image change signal, the medical image management device generates an adjustment image with the reference pixel value and the reference pixel value range, and sends the adjustment image to the user terminal. The medical image display system according to claim 1, which transmits the medical image. The user terminal can perform a selection operation to request a history at the operation unit, and when there is a history request selection at the operation unit, transmits a history request,
When the arithmetic control unit receives the history request, the arithmetic control unit generates a sample adjustment image with a reference pixel value and a reference pixel value range in the history information stored in the setting storage unit, and transmits the sample adjustment image to the user terminal. The medical image display system according to claim 3. The user terminal can select one of a plurality of sample adjustment images displayed on the display unit by the operation unit, and when the sample adjustment image is selected by the operation unit, the selected sample Send an adjustment image change signal including the reference pixel value and reference pixel value range of the adjustment image,
Upon receiving the adjustment image change signal, the arithmetic control unit of the medical image management apparatus updates the reference pixel value and the reference pixel value range of the setting storage unit with the received reference pixel value and the reference pixel value range, The medical image display system according to any one of claims 1 to 4, wherein an adjustment image is generated with the reference pixel value and the reference pixel value range, and the adjustment image is transmitted to the user terminal.