JP2012143368A - Medical image display device and program - Google Patents

Abstract

PROBLEM TO BE SOLVED: To prevent a radiologist from being incapable of believing his/her own determination or feeling a sense of distrust of Computer-Aided Detection (CAD), when the CAD does not detect that an attention region suspected to be an abnormal shadow candidate by the radiologist is the abnormal shadow candidate.SOLUTION: A control section 41 of an image display device 4 determines whether the attention region designated by an operation section 42 is included among the abnormal shadow candidates detected by an abnormal shadow candidate detector 2. When determining that the designated attention region is not included among the abnormal shadow candidates, the control section 41 of the image display device 4 identifies the reason why the designated intention region is not detected as the abnormal shadow candidate, and makes the reason displayed on a display section 43.

Description

  The present invention relates to a medical image display device and a program.

  In recent years, with an increase in the incidence of breast cancer in women, interest in breast cancer screening has increased. In breast cancer screening, a medical interpreter interprets a medical image obtained by photographing a breast to diagnose the presence or absence of an abnormality. However, the number of interpretation doctors who perform diagnosis is insufficient, and there is a problem that diagnosis is delayed.

  In order to improve such problems, for the purpose of assisting diagnosis work, an abnormal shadow candidate detecting device (CAD (Computer-) that automatically detects an abnormal shadow candidate that is a region showing a feature of a lesion such as breast cancer from a medical image. Aided Detection)) has been developed. In general, a mark is displayed at the position of an abnormal shadow candidate detected by CAD.

  By the way, abnormal shadow candidate detection by CAD makes it difficult to distinguish between abnormal shadows and normal tissues, and abnormal shadow candidates cannot be detected due to the detection sensitivity of algorithms used in CAD, or normal tissues are detected as abnormal shadows by mistake. Sometimes When a mark is displayed at the position of an abnormal shadow candidate detected by CAD, the time required for interpretation by the interpreting physician tends to increase according to the number of marks. In addition, if a mark is displayed at a position where an error is detected, there is a possibility that an interpreting doctor will be confused and make a wrong diagnosis. Therefore, in CAD, it is preferable to reduce the number of marks as much as possible after increasing the true positive rate.

Therefore, for example, in Patent Document 1, by performing control so that abnormal shadow candidate detection processing is performed on an area where an abnormal shadow candidate is to be detected, which is selected by the selection unit, an area where no abnormal shadow originally exists is disclosed. A technique for reducing the erroneous detection of abnormal shadow candidates is described.
Moreover, generally, the false detection is suppressed by performing a deletion process for deleting a false positive for a candidate initially detected as an abnormal shadow candidate.

JP 2003-275196 A

  However, as described above, if it is attempted to reduce false detection in CAD, a detection failure may occur. However, if the CAD does not detect the attention area that the interpreting doctor has determined to be suspected of an abnormal shadow as a candidate for an abnormal shadow, the certainty of the interpreting doctor's own diagnosis decreases and the diagnosis result is correct. There is a risk of withdrawal. There is also a possibility that the interpreting doctor has distrust in CAD.

  The problem of the present invention is that if the CAD does not detect a region of interest that the interpreting doctor determines that there is a suspicion of an abnormal shadow candidate as the abnormal shadow candidate, the interpreting doctor can no longer be confident in his / her judgment. It is to prevent being distrusted by.

In order to solve the above-mentioned problem, the invention described in claim 1
The medical image and the position information of the abnormal shadow candidate are acquired from a storage device that stores the medical image and the position information of the abnormal shadow candidate detected from the medical image in the abnormal shadow candidate detection apparatus in association with each other, and the acquisition A medical image display device for displaying a medical image
Display means for displaying a medical image acquired from the storage device;
In the medical image displayed on the display means, an operation means for designating a region of interest that the operator has determined to be suspected of an abnormal shadow;
It is determined whether or not the attention area designated by the operation means is included in the abnormal shadow candidate detected by the abnormal shadow candidate detection apparatus, and when it is determined that the attention area is not included, the designated attention area Control means for specifying the reason why is not detected as an abnormal shadow candidate and displaying on the display means;
Is provided.

The invention according to claim 2 is the invention according to claim 1,
In the storage device, the medical image and the primary candidate initially detected when the abnormal shadow candidate detection process is performed on the medical image in the abnormal shadow candidate detection device are deleted from the abnormal shadow candidate in any processing step. Detection process progress information indicating whether or not
The control means acquires detection process progress information corresponding to the medical image from the storage device, and the designated region of interest is deleted in any processing step after initial detection in the acquired detection process progress information. If it is included in the primary candidate, the processing unit that has deleted the region of interest is identified, and the display means that the region of interest has not been detected as an abnormal shadow candidate because the region of interest has been deleted by the processing step To display.

The invention according to claim 3 is the invention according to claim 1 or 2,
Storage means for storing detection processing characteristic information indicating conditions of an abnormal shadow candidate that may not be detected by the abnormal shadow candidate detection process in the abnormal shadow candidate detection device;
The control unit acquires the detection processing characteristic information from the storage unit, analyzes the medical image, and sets the specified region of interest as a condition of an abnormal shadow candidate that may not be detected in the detection processing characteristic information. If the region of interest matches the condition of an abnormal shadow candidate that may not be detected by the abnormal shadow candidate detection device, the reason for the region of interest not being detected as an abnormal shadow candidate is Display on the display means.

The invention according to claim 4 is the invention according to any one of claims 1 to 3,
The storage device stores an interpretation report for the medical image in association with the medical image,
When the designated attention area is not detected by the abnormal shadow candidate detection device, the control means transmits information indicating the reason to the storage device, stores the information in association with the medical image, and newly stores the information. If it is determined that the attention area designated by the operation means has not been detected by the abnormal shadow candidate detection device, the same reason as that for not detecting the new attention area is associated with the medical area. An image and an interpretation report are acquired from the storage device and displayed on the display means.

The invention according to claim 5 is the invention according to any one of claims 1 to 3,
The control means stores, in the storage device, information indicating that the attention area has not been detected by the abnormal shadow candidate detection device when the designated attention area has not been detected by the abnormal shadow candidate detection device. And when the designated attention area is designated by another operator, the attention area is an attention area that has been previously designated based on information stored in the storage device. Is displayed on the display means.

The program of the invention described in claim 6 is:
The medical image and the position information of the abnormal shadow candidate are acquired from a storage device that stores the medical image and the position information of the abnormal shadow candidate detected from the medical image in the abnormal shadow candidate detection apparatus in association with each other, and the acquisition A computer used in a medical image display device for displaying a medical image
Display means for displaying a medical image acquired from the storage device;
In the medical image displayed on the display means, an operating means for designating a region of interest that the operator has determined is suspected of an abnormal shadow,
It is determined whether or not the attention area designated by the operation means is included in the abnormal shadow candidate detected by the abnormal shadow candidate detection apparatus, and when it is determined that the attention area is not included, the designated attention area Control means for identifying the reason why is not detected as an abnormal shadow candidate and displaying on the display means,
To function as.

  According to the present invention, when the CAD does not detect an attention area that the interpreting doctor has determined to be an abnormal shadow candidate as the abnormal shadow candidate, the interpreting doctor becomes unsure of his / her judgment, or the CAD It is possible to prevent a person from having a distrust of.

It is a figure which shows the example of whole structure of the medical image display system in this Embodiment. It is a figure which shows the data structural example of detection process progress information. It is a block diagram which shows the functional structure of the image display apparatus of FIG. It is a figure which shows the example of data storage of a detection process characteristic information table. It is a flowchart which shows the medical image display process performed by the control part of FIG. (A) is a figure which shows an example of the viewer screen displayed by step S5 of FIG. 5, (b) is a figure which shows an example of the viewer screen displayed by step S7 of FIG. 5, (c) is a figure. It is a figure which shows an example of the viewer screen displayed by step S10 of 5. FIG. It is a figure for demonstrating the extraction method of a skin line. It is a figure for demonstrating the extraction method of a nipple position.

(Configuration of Medical Image Display System 100)
First, the configuration of the embodiment of the present invention will be described.
FIG. 1 shows a system configuration of a medical image display system 100 in the present embodiment.
The medical image display system 100 is a system that captures a medical image, detects an abnormal shadow candidate from the medical image, and provides detection result information to the interpretation doctor together with the medical image.

  As shown in FIG. 1, the medical image display system 100 includes an image generation device 1, an abnormal shadow candidate detection device 2, an image server 3, and an image display device 4. These devices 1 to 4 are connected to each other through a communication network N constructed in a medical institution such as a LAN (Local Area Network) so that data can be transmitted and received between them. The DICOM (Digital Imaging and Communication in Medicine) standard is applied to the communication network N. The number of each device is not particularly limited.

Hereinafter, each component apparatus 1-4 is demonstrated.
The image generation apparatus 1 captures a human body and generates digital data of the captured image (medical image). For example, CR (Computed Radiography), FPD (Flat Panel Detector), CT (Computed Tomography), MRI (MRI) Modality such as Magnetic Resonance Imaging), US (ultrasonography), cassette-dedicated reader, film digitizer, etc. can be applied. In the present embodiment, it is assumed that breast image data is generated by applying a breast-specific CR that performs X-ray imaging of the left and right breasts as the image generation apparatus 1.

  The image generation apparatus 1 is an apparatus that complies with the above-mentioned DICOM standard, and can input various information attached to the generated medical image, for example, patient information and examination information from the outside, and can also automatically generate the information. it can. The patient information includes information such as patient identification information (for example, patient ID) for identifying the patient, patient name, sex, date of birth, and the like. The inspection information includes inspection identification information (for example, inspection ID), inspection date and time, inspection conditions (inspection site, laterality (left, right), direction (for example, vertical direction (CC), oblique direction) (MLO)), modality type, etc. The image generating apparatus 1 adds the above patient information, examination information, UID (Unique ID) for identifying the image as header information to the generated medical image. To the abnormal shadow candidate detection device 2 and the image server 3 via the communication network N. If the DICOM standard is not complied with, the accompanying information is transmitted to the image generation device 1 using a DICOM conversion device (not shown). It is also possible to make it input.

  The abnormal shadow candidate detection device (CAD) 2 is a computer that performs image analysis of a medical image supplied from the image generation device 1 and performs detection processing of an abnormal shadow candidate. The abnormal shadow candidate detection device 2 includes a storage unit such as a CPU (Central Processing Unit), a RAM (Random Access Memory), and an HDD (Hard Disk Drive), and a communication unit such as a LAN card. The storage unit of the abnormal shadow candidate detection device 2 stores a detection algorithm detection algorithm corresponding to the type of abnormal shadow, and the CPU of the abnormal shadow candidate detection device 2 stores the detection program stored in the storage unit. An abnormal shadow candidate detection process is executed in cooperation with each other, and an abnormal shadow candidate is detected from each medical image input via the communication unit. For example, an abnormal shadow candidate of a tumor or a microcalcification cluster in a breast image is detected.

  As an abnormal shadow candidate detection algorithm, a known algorithm can be applied. For example, as an algorithm for a tumor shadow candidate in a breast image, a method using an iris filter disclosed in Japanese Patent Laid-Open No. 10-91758, a method using a Laplacian filter (Journal of the Institute of Electronics, Information and Communication Engineers (D-II) , Vol. J76-D-II, no. 2, pp. 241-249, 1993), etc. are applicable. In addition, as a detection algorithm for micro-calcification cluster shadow candidates, for example, Morphology filter (The Institute of Electronics, Information and Communication Engineers (D-II), Vol.J71-D-II, no.7, pp.1170-1176, 1992), Laplacian filter (The Institute of Electrical, Information and Communication Engineers Journal (D-II), Vol. J71-D-II, no. 10, pp. 1994-2001, 1998) Applicable.

  In general, in the abnormal shadow candidate detection process, initial detection is first performed, and a false positive candidate deletion process (FP deletion process) that deletes false positive candidates from the initially detected abnormal shadow candidates (referred to as primary candidates). ) To determine the final abnormal shadow candidate. The FP deletion process is performed in a plurality of steps using a plurality of parameters such as the area, contrast, and edge complexity of the initially detected primary candidate. Candidates that have not been deleted after passing through all the FP deletion processes are detected as final abnormal shadow candidates.

  Here, in the abnormal shadow candidate detection process according to the present embodiment, the CPU of the abnormal shadow candidate detection apparatus 2 determines the position information of the region (contour) and the processing result of each FP deletion process for each primary candidate initially detected. (Information indicating whether it has been passed or deleted) and detection process progress information indicating the result of whether or not it has been detected as a final candidate are recorded. FIG. 2 shows an example of detection process progress information. When the abnormal shadow candidate detection process ends, the CPU of the abnormal shadow candidate detection device 2 generates detection result information (hereinafter referred to as CAD information) of the abnormal shadow candidate. The CAD information includes, for example, position information of each detected area (contour) of abnormal shadow candidates and information on the types of abnormal shadow candidates (for example, tumors, microcalcification clusters, etc.). Then, the abnormal shadow candidate detection device 2 adds the header information (at least UID) of the medical image of the detection source to the generated CAD information and the above-described detection processing progress information, and transmits it to the image server 3 by the communication unit.

  The image server 3 is a computer including a storage unit such as a CPU, a RAM, and an HDD, and a communication unit such as a LAN card. The storage unit of the image server 3 includes an image DB (Data Base) 351, a detection process progress information DB 352, a non-detection area information DB 353, and the like. The image server 3 adds to the medical image received from the image generation device 1 CAD information, detection process progress information, and non-detection transmitted from the image display device 4 regarding the medical image received from the abnormal shadow candidate detection device 2. Area information, interpretation reports, etc. are stored in association with each other and their input / output is managed.

The image DB 351 is a database for storing medical images. For example, the image DB 351 has an image management table that stores management information regarding each medical image stored in the image DB 351. In the image management table, management information for each medical image is stored as one record. The management information includes UID, patient information, examination information, file information (medical image file name, corresponding CAD information and interpretation report file name, file storage location, update date, file size, etc.).
In the image server 3, when a medical image is received from the image generation device 1, the received medical image is stored in the image DB 351, and management information is created based on the received medical image header information. Stored in the image management table. When the CAD information from the abnormal shadow candidate detection device 2 is received, the received CAD information is stored in the image DB 351, and a record in which the CAD information and the UID match is searched from the image management table. The file name, storage location, etc. of the CAD information are additionally written in each record. When an interpretation report is received from the image display device 4, the received interpretation report is stored in the image DB 351, and a record whose UID matches the interpretation report is searched from the image management table. The file name, storage location, etc. of the interpretation report are additionally written. In this way, in the image DB 351, the medical image, the detection result information of the abnormal shadow candidate detected from the medical image, and the interpretation report are stored in association with each other so as to be searchable.

The detection process progress information DB 352 is a database that stores the detection process progress information transmitted from the abnormal shadow candidate detection apparatus 2 in association with a medical image using a UID.
The non-detection area information DB 353 is a database that stores non-detection area information transmitted from the image display device 4 in association with a medical image by a UID. The non-detection region information is information on a region of interest that is not detected as a final abnormal shadow candidate by the abnormal shadow candidate detection device 2 in the medical image and is designated as an abnormal shadow candidate by the interpretation doctor. Non-detection area information includes, for example, a UID for identifying a medical image, attention area identification information (such as an identification number), position information of the attention area, an interpreting doctor ID of an interpreting doctor who has designated the attention area, and the attention attention. The reason why the region is not detected by the abnormal shadow candidate detection device 2 is included.

  Returning to FIG. 1, the image display device 4 is a medical image display device that acquires and displays a medical image designated by an operation of an interpreting doctor and CAD information corresponding thereto from the image server 3.

FIG. 3 shows a functional configuration example of the image display device 4.
As shown in FIG. 3, the image display device 4 includes a control unit 41, an operation unit 42, a display unit 43, a communication unit 44, and a storage unit 45, and each unit is connected by a bus 46.

The control unit 41 includes a CPU, a RAM, and the like. The CPU of the control unit 41 reads out various programs such as system programs and processing programs stored in the storage unit 45, expands them in the RAM, and executes various processes according to the expanded programs.
For example, the control unit 41 executes a medical image display process described later.

  The operation unit 42 includes a keyboard having character input keys, numeric input keys, various function keys, and the like, and a pointing device such as a mouse, and a key pressing signal pressed by the keyboard and an operation signal by the mouse. Are output to the control unit 41 as an input signal.

  The display unit 43 includes, for example, a monitor such as a CRT (Cathode Ray Tube) or an LCD (Liquid Crystal Display), and displays various screens according to instructions of a display signal input from the control unit 41.

  The communication unit 44 is configured by a LAN card or the like, and transmits / receives data to / from an external device connected to the communication network N via a switching hub.

  The storage unit 45 includes, for example, an HDD (Hard Disk Drive), a semiconductor nonvolatile memory, or the like. The storage unit 45 stores various programs as described above. In addition, the storage unit 45 stores image processing parameters (a lookup table defining a gradation curve used for gradation processing, an enhancement degree of frequency processing, and the like) for adjusting a medical image to an image quality suitable for diagnosis. is doing.

  The storage unit 45 stores a detection processing characteristic information table 451. Here, the detection algorithm of the abnormal shadow candidate detection apparatus 2 has a detection processing characteristic (weak point) that there is a possibility that an abnormal shadow candidate that matches a certain matching condition may not be detected. For example, an abnormal shadow candidate near the nipple cannot be detected, an abnormal shadow candidate near the skin line cannot be detected, or an abnormal shadow candidate cannot be detected when the background density is high. The detection processing characteristic information table 451 is a table that stores detection processing characteristic information (detection processing characteristic information) of the abnormal shadow candidate detection device 2. FIG. 4 shows a data storage example of the detection processing characteristic information table 451. As shown in FIG. 4, the detection processing characteristic information table 451 includes items such as “characteristic number”, “conformance condition”, and “display message”. “Applicable condition” is information indicating a condition of an abnormal shadow candidate that may not be detected by the detection algorithm of the abnormal shadow candidate detection apparatus 2. The “display message” is information on a message indicating the reason why the attention area corresponding to the “matching condition” cannot be detected.

  In the present embodiment, the detection processing characteristic information is stored in the storage unit 45. However, the detection processing characteristic information may be stored in the storage unit of the image server 3 and acquired from the image server 3 when necessary. Then, it may be stored in the storage unit of the abnormal shadow candidate detection device 2 and acquired from the abnormal shadow candidate detection device 2 when necessary.

(Operation of Medical Image Display System 100)
Next, the operation of the medical image display system 100 will be described.
FIG. 5 shows a flowchart of a medical image display process executed by the image display device 4. The medical image display process is executed in cooperation with the control unit 41 and a program stored in the storage unit 45. As a premise for executing the medical image display process, an interpreting doctor who is an operator of the image display device 4 inputs authentication information such as an interpreting doctor ID and a password through the operation unit 42 and is logged in and authenticated by the image server 3. Yes.

  First, a medical image to be interpreted is selected by operating the operation unit 42 (step S1). Specifically, a medical image search screen is displayed on the display unit 43 in response to an operation by the operation unit 42. When a search condition (patient ID, examination site, laterality, etc.) is input by the operation unit 42 on the search screen, the input search condition and search request are transmitted to the image server 3 by the communication unit 44. In the image server 3, medical image management information that matches the search condition is searched from the image management table of the image DB 351, and list data of medical images that match the search condition is created and transmitted to the image display device 4. In the image display device 4, when list data is received by the communication unit 44, an image selection screen based on the list data is displayed on the display unit 43. In the image selection screen, for example, a list having items such as examination ID, patient ID, patient name, examination date and time, modality type, examination site, laterality, direction, and the like is displayed for each examination unit. The medical image to be selected can be selected via the operation unit 42. The interpretation doctor selects a medical image to be interpreted by the operation of the operation unit 42.

  When a medical image to be interpreted is selected, an acquisition request for the selected medical image to be interpreted is transmitted to the image server 3 by the communication unit 44, and the medical image to be interpreted, CAD information of the medical image, and the medical Image detection process progress information is acquired from the image server 3 (step S2). In the image server 3, when a request for acquiring a medical image to be interpreted is received, the requested medical image to be interpreted and CAD information corresponding to the medical image are retrieved from the medical image DB 351 and read out. Detection process progress information corresponding to the medical image is retrieved from the detection process progress information DB 352 and read out, and transmitted to the image display device 4.

When the medical image to be interpreted, CAD information, and detection process progress information are acquired, a viewer screen 431 on which the acquired medical image is displayed is displayed on the display unit 43 (step S3).
When a medical image is displayed on the viewer screen 431 of the display unit 43, the interpretation doctor observes the displayed medical image and diagnoses whether or not there is a region of interest (which is a region suspected of having an abnormal shadow). Do. When the attention area exists, the attention area is designated by clicking with the mouse of the operation unit 42 or the like.

  When a region of interest is designated from the medical image displayed on the display unit 43 by the operation unit 42 (step S4; YES), the position information of the designated region of interest is stored in the RAM and displayed on the displayed medical image. The mark M1 is displayed in the designated attention area (step S5), and the process proceeds to step S6. If the attention area is not designated by the operation unit 42, the process proceeds to step S6.

  FIG. 6A shows an example of the viewer screen 431 displayed in step S5. As shown in FIG. 6A, on the medical image displayed on the viewer screen 431, the mark M1 is superimposed on the attention area designated by the operation unit. The mark M1 is information indicating the attention area designated by the image interpretation doctor. Symbols such as ○ and arrows indicating the representative points (for example, the center of gravity) of the attention area, and drawing information representing the designated attention area with lines. Etc. are included.

  In step S6, it is determined whether or not display of the CAD detection result (that is, the abnormal shadow candidate detected by the abnormal shadow candidate detection device 2) is instructed by the operation unit 42 (step S6). For example, the CAD result display button B1 displayed on the viewer screen 431 of the display unit 43 can be pressed to instruct display of the CAD result.

When the display of the CAD result is instructed by the operation unit 42 (step S6; YES), the mark M2 is displayed at the position of the abnormal shadow candidate included in the CAD information on the medical image displayed on the display unit 43. (Step S7).
The mark M2 is information indicating an abnormal shadow candidate detected by CAD, and a symbol such as a circle or an arrow indicating a representative point (for example, the center of gravity) of the abnormal shadow candidate, or a region of the abnormal shadow candidate is represented by a line. Drawing information and the like are included. The mark M2 may be displayed in the same manner as the mark M1, but a different display is preferable because the interpretation doctor can easily recognize the attention area and other abnormal shadow candidates.

  FIG. 6B shows an example of the viewer screen 431 displayed in step S7. As shown in FIG. 6B, in step S7, the mark M2 is superimposed on the abnormal shadow candidate detected by CAD on the medical image.

  Next, it is determined whether or not the attention area specified in step S4 is included in the CAD information, that is, whether or not it has been detected by the abnormal shadow candidate detection device 2 (step S8). If it is determined that the designated region of interest has been detected by the abnormal shadow candidate detection device 2 (step S8; YES), the process proceeds to step S14. If it is determined that the designated region of interest is not detected by the abnormal shadow candidate detection device 2 (step S8; NO), the detection process progress information received from the image server 3 and the detection process characteristic information table of the storage unit 45 Based on the detection processing characteristic information stored in 451, the reason why the attention area is not detected is specified (step S9).

In step S9, the reason why the attention area has not been extracted by the following procedures (1) to (3) is specified.
(1) First, in the detection process progress information received in step S <b> 2, candidate records whose position information matches (including a substantially approximate one) specified by the operation unit 42 are searched.
(2) When a candidate record whose position information matches the region of interest is searched, the searched record is referred to, and it is specified which deletion process has been deleted from the candidate. For example, according to the detection process progress information shown in FIG. 2, it can be identified that the candidate 3 has been deleted by the FP deletion process 3, and this FP deletion process 3 is an FP deletion process by contrast. It is specified as the reason why the deletion by the process was not detected.
(3) When a candidate record whose position information matches the attention area is not extracted in the detection process progress information, the detection processing characteristic information table 451 is read from the storage unit 45, and the matching conditions satisfying the attention area are satisfied. The content of the corresponding display message is specified as the reason.
For example, when the detection processing characteristic information has the contents shown in FIG. 4, the distance from the nipple of the attention area, the distance from the skin line, and the background density are respectively calculated, and it is determined whether or not each matching condition is met. The If any of the matching conditions is met, the display message associated with the matching condition is acquired as the reason. If none of the matching conditions is met, a display message with characteristic number = 0 is specified as the reason.

Here, the position of the nipple and the skin line in the medical image can be extracted using, for example, a method described in JP-A-2009-82564.
First, each pixel of the medical image to be processed is subjected to filter processing by a Sobel filter with the pixel of interest as a target pixel. Each pixel value after the Sobel filter processing indicates edge strength.
Hereinafter, as shown in FIG. 7, the position of each pixel of the medical image after the Sobel filter processing is represented by coordinates (X, Y) where the vertical direction of the breast is the X axis and the vertical direction is the Y axis. In addition, the pixel value of the coordinates (X, Y) is represented as V (X, Y). Further, the coordinates of the image end in the X-axis direction are represented as Xmax, and the image end in the Y-axis direction is represented as Ymax.

  Next, in each X coordinate (0 to Xmax) of the medical image after the Sobel filter processing, a search is performed in the Y-axis direction, and a coordinate S (X) that maximizes V (X, Y) is extracted. Thereby, an edge at each X coordinate of the medical image after the Sobel filter processing is extracted. As shown in FIG. 7, the extracted edge is a boundary point between the breast region Sa and the extramammary region Sb (background) in the medical image, and constitutes a skin line SL.

  Next, as shown in FIG. 8, for each extracted S (X), a straight line connecting S (X) and S (X + d (d is, for example, 10)), and S (X) to S (X + d ) Are calculated, and a maximum value D (X) of the calculated distance D is calculated. Then, S (X) having the largest value among D (X) calculated for each S (X) is extracted as the nipple coordinates (a, b) representing the nipple position.

  The shortest distance obtained by connecting the extracted nipple position and, for example, the position of the center of gravity of the designated attention area with a straight line is acquired as the distance d1 between the nipple and the attention area. Further, for example, the shortest distance connecting the position of the center of gravity and the skin line SL of the designated attention area with a straight line is acquired as the distance d2 to the skin line. Based on the calculated distances d1 and d2 and the calculated background density, the reason why the attention area is not detected by CAD is specified.

When the reason why the attention area is not detected is acquired, a message indicating the acquired reason is created and displayed on the display unit 43 (step S10).
FIG. 6C shows an example of the viewer screen 431 on which a message MSG indicating the reason why the designated attention area is not detected by the abnormal shadow candidate detection device 2 is shown. For example, as shown in Candidate 3 in FIG. 2, when an interpreting doctor designates a region deleted by contrast-based FP deletion processing as a region of interest, a message such as “Deleted by contrast-based FP deletion processing” is displayed. Is done. Further, for example, when the attention area is a distance <10 mm from the nipple and cannot be detected by the abnormal shadow candidate detection apparatus 2, a message such as “a finding near the nipple may not be detected” is displayed. In addition, the viewer screen 431 includes a message indicating the reason why it cannot be detected, a button B2 for acquiring a case that has not been detected for the same reason as the current attention area, and a button B3 for proceeding to create an interpretation report. Is displayed.

  Here, if the attention area designated as having the possibility of an abnormal shadow is not detected by CAD, the interpretation doctor may be less sure of his / her diagnosis and may withdraw his / her diagnosis result. is there. In addition, there is a possibility that the CAD detection performance is poor and there is a distrust of CAD. However, if you understand the reason why the region of interest you specified was not detected by CAD, you can determine whether or not your diagnosis was appropriate. Thus, it is possible to withdraw the diagnosis that has been found once and miss an important finding, or to feel untrustworthy with respect to CAD, and to use the CAD result as a diagnosis support with peace of mind. This will also improve the mental aspects of the interpreting physician.

  Next, non-detection area information is created (step S11). Non-detection area information includes, for example, a UID for identifying a medical image, identification information of an attention area (identification number, etc.), position information of the attention area, an interpreting doctor ID of a designated interpreting doctor, a reason for not being detected, etc. Is included.

  Next, it is determined whether or not the operation unit 42 has pressed the button B2 for acquiring a case that has not been detected for the same reason as the designated attention area (step S12). If it is determined by the operation unit 42 that the button B2 has not been pressed (step S12; NO), the process proceeds to step S14. When it is determined that the button B2 is pressed by the operation unit 42 (step S12; YES), medical images and interpretation reports of cases that are not detected for the same reason as the region of interest specified this time are acquired from the image server 3. Is displayed on the display unit 43 (step S13). Specifically, information for identifying the reason why the current attention area is not detected is transmitted to the image server 3 by the communication unit 44, and the attention area designated this time is identified. Queries for cases not detected for similar reasons are made. In the image server 3, for example, a UID of a medical image that is not detected for the same reason as the current attention area is searched from the non-detection area information DB 353, and a medical image and an interpretation report of the UID are read from the image DB 351. Then, the read medical image and interpretation report are transmitted to the image display device 4 by the communication unit.

  An interpretation report of a medical image to be interpreted is created by pressing the button B3 by the operation unit 42 (step S14). When the operation unit 42 instructs the end of diagnosis (step S15), the created interpretation report and The non-detection area information is associated with the UID of the medical image and transmitted to the image server 3 by the communication unit 44 (step S16), and this process ends.

  In the image server 3, when the interpretation report and the non-detection area information are received from the image display device 4, the received interpretation report is stored in the image DB 351. The received non-detection area information is stored in the non-detection area information DB 353.

  As described above, according to the medical image display system 100, the control unit 41 of the image display device 4 includes the attention area specified by the operation unit 42 as the abnormal shadow candidates detected by the abnormal shadow candidate detection device 2. If it is determined that it is not included, the reason why the designated attention area is not detected as an abnormal shadow candidate is specified and displayed on the display unit 43.

  Therefore, when the CAD does not detect a region of interest that the interpreting doctor determines that there is a suspicion of an abnormal shadow as the abnormal shadow candidate, the interpreting doctor can recognize the reason. It is possible to prevent the user from being unsure or having distrust in CAD.

For example, the image server 3 deletes the medical image and the primary candidate initially detected when the abnormal shadow candidate detection processing is performed on the medical image in the abnormal shadow candidate detection apparatus 2 from the abnormal shadow candidate in any processing step. The detection process progress information indicating whether or not the detection process has been performed is stored in association with each other, and the control unit 41 acquires the detection process progress information corresponding to the medical image to be interpreted from the image server 3 and is designated by the operation unit 42. When the attention area is included in the primary candidate deleted in any processing process after the initial detection, the processing process in which the attention area is deleted is identified, and the attention area is deleted by the processing process. The reason why the region is not detected as an abnormal shadow candidate is displayed on the display unit 43.
Therefore, the interpreting physician can know in what processing steps the area that he / she has designated as an abnormal shadow candidate has been deleted, so that he / she can judge whether his / her diagnosis was appropriate and his / her own. This makes it impossible to withdraw from the diagnosis once given because of anxiety about the diagnosis and to miss an important finding or to feel distrust with the abnormal shadow candidate detection device 2.

In addition, for example, the storage unit 45 stores detection processing characteristic information indicating conditions of abnormal shadow candidates that may not be detected by the abnormal shadow candidate detection process in the abnormal shadow candidate detection device 2. The detection processing characteristic information is acquired from the storage unit 45, the medical image is analyzed, and the attention area specified by the operation unit 42 matches the abnormal shadow candidate condition that may not be detected in the detection processing characteristic information. In this case, the display unit 43 displays that the attention area is not detected as an abnormal shadow candidate because the attention area matches the condition of an abnormal shadow candidate that may not be detected by the abnormal shadow candidate detection device 2. Let
Therefore, the interpretation doctor can know that there is a possibility that the area designated as an abnormal shadow candidate by the abnormal shadow candidate detection apparatus 2 may not be detected. And oversight of important findings or distrust of the abnormal shadow candidate detection device 2 is eliminated.

In addition, the image server 3 stores an interpretation report for the medical image in association with the medical image, and the control unit 41 determines that the attention area specified by the operation unit 42 is the abnormal shadow candidate detection device 2. If not detected, information indicating the reason is transmitted to the image server 3 to be stored in association with the medical image, and the attention area newly designated by the operation unit 42 is detected by the abnormal shadow candidate detection device 2. If it is determined that the new attention area has not been detected, a medical image and an interpretation report associated with a reason similar to the reason that the new attention area has not been detected are acquired from the image server 3 and displayed on the display unit 43.
Therefore, when the attention area designated by the interpretation doctor is not detected as an abnormal shadow candidate, what attention area is not detected for the same reason, and what diagnosis is made for this attention area. It can be used as a diagnostic support by referring to

In addition, the description content in the said embodiment is a suitable example of this invention, and is not limited to this.
For example, in the above embodiment, the abnormal shadow candidate detection device 2 that detects abnormal shadow candidates, the image server 3 as a storage device that stores medical images, and the image display device 4 that displays medical images are separate devices. However, the present invention is not limited to this. For example, it is good also as a structure provided with the function of all the apparatuses in one apparatus, and it is good also as comprising by the apparatus which combined the function of any two apparatuses, and the apparatus provided with the function of the remaining apparatuses.

  In the above embodiment, a breast image has been described as an example. However, the present invention may be applied to a case where detection results detected for other parts are displayed.

  Further, in the above-described embodiment, it has been described that the interpretation doctor displays the CAD detection result after designating the attention area. However, the CAD detection result is displayed first, and the attention area that is not detected by CAD is displayed. It is good also as a structure which an interpretation doctor designates.

  The control unit 41 acquires non-detection area information corresponding to the medical image from the image server 3 when the attention area designated from the medical image to be interpreted is not detected by the abnormal shadow candidate detection device 2. Alternatively, when the non-detection area information is acquired together with the acquisition of the medical image in advance, and the same attention area has been previously designated by another interpreting doctor (for example, a primary interpreter), the attention area may be The display unit 43 may display information indicating that the region of interest has been previously designated by the image interpretation doctor. As a result, for example, it is possible to provide a reference when a secondary interpretation doctor performs interpretation, and convenience is improved.

  In the above embodiment, first, the reason why the attention area is not detected as an abnormal shadow candidate is searched based on the detection process progress information, and if the reason cannot be specified, the attention process is performed using the detection process characteristic information. Although the reason why the region was not detected as an abnormal shadow candidate was specified, the reason may be specified using only one of the information, or the detection process based on the search result based on the detection process progress information You may give priority to the search result based on characteristic information.

  In the above description, an example in which a hard disk, a semiconductor nonvolatile memory, or the like is used as a computer-readable medium of the program according to the present invention is disclosed, but the present invention is not limited to this example. As another computer-readable medium, a portable recording medium such as a CD-ROM can be applied. A carrier wave is also applied as a medium for providing program data according to the present invention via a communication line.

  In addition, the detailed configuration and detailed operation of each device constituting the medical image display system can be changed as appropriate without departing from the spirit of the present invention.

DESCRIPTION OF SYMBOLS 100 Medical image display system 1 Image generation apparatus 2 Abnormal shadow candidate detection apparatus 3 Image server 351 Image DB
4 image display device 41 control unit 42 operation unit 43 display unit 44 communication unit 45 storage unit 46 bus

Claims (6)

The medical image and the position information of the abnormal shadow candidate are acquired from a storage device that stores the medical image and the position information of the abnormal shadow candidate detected from the medical image in the abnormal shadow candidate detection apparatus in association with each other, and the acquisition A medical image display device for displaying a medical image
Display means for displaying a medical image acquired from the storage device;
In the medical image displayed on the display means, an operating means for designating a region of interest that the operator has determined is suspected of an abnormal shadow;
It is determined whether or not the attention area designated by the operation means is included in the abnormal shadow candidate detected by the abnormal shadow candidate detection apparatus, and when it is determined that the attention area is not included, the designated attention area Control means for specifying the reason why is not detected as an abnormal shadow candidate and displaying on the display means;
A medical image display device comprising: In the storage device, the medical image and the primary candidate initially detected when the abnormal shadow candidate detection process is performed on the medical image in the abnormal shadow candidate detection device are deleted from the abnormal shadow candidate in any processing step. Detection process progress information indicating whether or not
The control means acquires detection process progress information corresponding to the medical image from the storage device, and the designated region of interest is deleted in any processing step after initial detection in the acquired detection process progress information. If it is included in the primary candidate, the processing unit that has deleted the region of interest is identified, and the display means that the region of interest has not been detected as an abnormal shadow candidate because the region of interest has been deleted by the processing step The medical image display apparatus according to claim 1, wherein the medical image display apparatus is displayed. Storage means for storing detection processing characteristic information indicating conditions of an abnormal shadow candidate that may not be detected by the abnormal shadow candidate detection process in the abnormal shadow candidate detection device;
The control unit acquires the detection processing characteristic information from the storage unit, analyzes the medical image, and sets the specified region of interest as a condition of an abnormal shadow candidate that may not be detected in the detection processing characteristic information. If the region of interest matches the condition of an abnormal shadow candidate that may not be detected by the abnormal shadow candidate detection device, the reason for the region of interest not being detected as an abnormal shadow candidate is The medical image display device according to claim 1, wherein the medical image display device is displayed on a display unit. The storage device stores an interpretation report for the medical image in association with the medical image,
When the designated attention area is not detected by the abnormal shadow candidate detection device, the control means transmits information indicating the reason to the storage device, stores the information in association with the medical image, and newly stores the information. If it is determined that the attention area designated by the operation means has not been detected by the abnormal shadow candidate detection device, the same reason as that for not detecting the new attention area is associated with the medical area. The medical image display apparatus according to claim 1, wherein an image and an interpretation report are acquired from the storage device and displayed on the display unit.   The control means stores, in the storage device, information indicating that the attention area has not been detected by the abnormal shadow candidate detection device when the designated attention area has not been detected by the abnormal shadow candidate detection device. And when the designated attention area is designated by another operator, the attention area is an attention area that has been previously designated based on information stored in the storage device. The medical image display apparatus as described in any one of Claims 1-4 on which the information which shows is displayed on the said display means. The medical image and the position information of the abnormal shadow candidate are acquired from a storage device that stores the medical image and the position information of the abnormal shadow candidate detected from the medical image in the abnormal shadow candidate detection apparatus in association with each other, and the acquisition A computer used in a medical image display device for displaying a medical image
Display means for displaying a medical image acquired from the storage device;
In the medical image displayed on the display means, an operating means for designating a region of interest that the operator has determined is suspected of an abnormal shadow,
It is determined whether or not the attention area designated by the operation means is included in the abnormal shadow candidate detected by the abnormal shadow candidate detection apparatus, and when it is determined that the attention area is not included, the designated attention area Control means for identifying the reason why is not detected as an abnormal shadow candidate and displaying on the display means,
Program to function as.