JP2018033657A - Medical image system and program - Google Patents

Abstract

PROBLEM TO BE SOLVED: To communicate a clinical position of an attention region appropriately.SOLUTION: In a medical image system 100, a control section 31 of a server device 3 estimates a position (clinical position) of an attention region when a breast is seen from the front if the attention region is designated from a breast image in an image display device 4, generates clinical position information indicating the position of the designated attention region, and causes a display section 43 of an image display device 4 to display the generated estimated clinical position information. The control section 31 edits clinical position information according to operation of a user on the image display device 4.SELECTED DRAWING: Figure 5A

Description

  The present invention relates to a medical image system and a program.

  Breast cancer testing is based on mammography (MMG) testing and ultrasound (US) testing, and the characteristics of the two modalities are complementary. In recent years, the results of a national project called J-START (Japan Strategic Anti-cancer Randomized Trial) have shown the effectiveness of combined screening, and the practice of breast imaging using both mammography and ultrasonography has become widespread. I'm starting to do it.

  In the combined examination of mammography examination and ultrasonic examination, mammography examination is not simply added with ultrasound examination, but the result of examination is not output independently, but mammography examination (hereinafter simply referred to as breast image) It is said that an improvement in sensitivity and an increase in specificity can be expected by performing an ultrasonic inspection on a position corresponding to a region of interest such as an abnormal shadow candidate on the above and comprehensively determining the results of each inspection. ing.

  In general, therefore, in a combined examination, first, a radiographer or the like performs a mammography examination, and obtains a bird's-eye view of position information of a region of interest such as an abnormal shadow candidate on the obtained breast image. Thereafter, an ultrasound examiner (clinical laboratory technician or the like) conducts an ultrasonic examination mainly, aiming at the position in the actual breast corresponding to the region of interest on the breast image obtained by mammography examination. When there is an abnormal shadow in the ultrasonic inspection, the ultrasonic examiner saves the ultrasonic image and gives a body mark at the position where the shadow is present. The doctor associates the region of interest on the breast image with the body mark of the ultrasound image, and makes a diagnosis after comprehensively determining the results of the mammography examination and the ultrasound examination.

However, in general, mammography is an examination in the standing position and breast compression, and an ultrasonography of the breast is an examination in the supine position and no breast compression. It is difficult to find the corresponding actual breast position (it takes time and accuracy is poor).
In general, engineers (radiologists, etc.) who take and interpret breast images are often different from engineers (clinical technicians, etc.) who perform ultrasound examinations. Often they do not have sufficient knowledge. For this reason, it is more difficult for the sonographer to estimate the position corresponding to the region of interest in the actual breast from the breast image as compared to the estimation by the radiologist.

  Therefore, for example, in Patent Document 1, attention is given when the breast is viewed from the front from the position of the region of interest designated for each of the breast images taken by CC (vertical direction) imaging and MLO (oblique direction) imaging. It is described that the position of a region (clinical position) is estimated, and clinical position information indicating the position of the region of interest when the estimated breast is viewed from the front is generated and displayed on the display means.

JP2015-104465A

  By the way, as described above, the sonographer often does not have sufficient knowledge about interpretation of a breast image. Therefore, when using the technique of Patent Document 1, the radiographer performs the designation of the attention area on the breast image and the confirmation of the estimation result of the clinical position, and the sonographer performs the clinical position information of the estimated attention area. Ideally, the case of performing an ultrasonic inspection while referring to FIG.

  However, in Patent Document 1, when a radiographer determines that a position different from the estimated position is to be sent to the sonographer as the clinical position of the region of interest (for example, the estimated clinical position is incorrect). Even if it is judged or if it is judged that the inspection with the expanded range is good), it cannot be dealt with. Therefore, the judgment of the radiologist is not reflected and the correct clinical position cannot be sent. As a result, the sonographer aims at a position that is different from the position of the actual area of interest, and the examination time lengthens due to the examiner's anxiety recall and the search range expansion due to the absence of a lesion in the sonography. Time can occur.

  An object of the present invention is to enable appropriate reporting of the clinical position of a region of interest.

In order to solve the above-described problem, a medical image system according to claim 1 is provided.
Display means for displaying one or more medical images obtained by imaging a subject region;
Designation means for designating a region of interest from the medical image;
Estimating means for estimating the position of the attention area when the subject part is viewed from the front, based on the position of the attention area of the medical image;
Generating means for generating clinical position information indicating the position of the region of interest when the subject part estimated by the estimating means is viewed from the front;
Display control means for displaying the generated clinical position information on the display means;
Editing means for editing the clinical position information displayed on the display means;
Is provided.

The invention according to claim 2 is the invention according to claim 1,
The editing unit changes the position of the region of interest in the clinical position information displayed on the display unit according to a user operation.

The invention according to claim 3 is the invention according to claim 1 or 2,
The editing means adds the position of the attention area in the clinical position information displayed on the display means in response to a user operation.

The invention according to claim 4 is the invention according to any one of claims 1 to 3,
The editing unit deletes the clinical position information displayed on the display unit according to a user operation.

The invention according to claim 5 is the invention according to any one of claims 1 to 4,
The clinical position information is an image showing the position of the region of interest on a schema image when the subject part used in ultrasonic examination is viewed from the front.

The invention according to claim 6 is the invention according to any one of claims 1 to 5,
When the clinical position information is not edited by the editing unit with respect to the position of the region of interest on the medical image, the editing unit displays the clinical position information of the region of interest generated by the generating unit. When the clinical position information is edited, there is provided storage means for storing the edited clinical position information of the attention area in association with each other.

The invention according to claim 7 is the invention according to any one of claims 1 to 6,
When the clinical position information is not edited by the editing means with respect to the position of the attention area on the medical image, the editing means displays the clinical position information of the attention area generated by the generating means. A second generating unit configured to generate an image in which the clinical position information of the region of interest after editing is associated with the edited clinical position information;
Transmitting means for transmitting the image generated by the second generating means to a diagnostic terminal;
Is provided.

The invention according to claim 8 is the invention according to any one of claims 1 to 7,
Detecting means for detecting an abnormal shadow candidate from the medical image;
The display means displays the abnormal shadow candidate area detected by the detection means on the medical image.

The invention according to claim 9 is the invention according to any one of claims 1 to 8,
The subject region is a breast, and the medical image is a breast image obtained by X-raying the breast.

The invention according to claim 10 is the invention according to any one of claims 1 to 9,
There is provided auxiliary information generating means for generating auxiliary information regarding the subject part.

The invention according to claim 11 is the invention according to claim 10,
The display control means displays the clinical position information and / or the incidental information on the same screen as the medical image on which the region of interest is displayed.

The invention according to claim 12 is the invention according to claim 10 or 11,
Comprising an input means for a user to input the incidental information;
The supplementary information generating means generates the supplementary information based on an input from the input means.

The invention according to claim 13 is the invention according to claim 12,
The incidental information includes at least one of visual and tactile information on the subject part and finding information on the attention area.

The invention according to claim 14 is the invention according to any one of claims 10 to 13,
The supplementary information generation unit generates the supplementary information by analyzing the medical image.

The invention according to claim 15 is the invention according to claim 14,
When the subject part is a breast and the medical image is a breast image obtained by X-raying the breast, the incidental information generation means analyzes the breast image to evaluate the configuration of the breast And the evaluation result is generated as the incidental information.

The program of the invention described in claim 16 is:
Computer
Display means for displaying one or more medical images obtained by imaging a subject region;
A designation means for designating a region of interest from the medical image;
Estimating means for estimating the position of the attention area when the subject part is viewed from the front based on the position of the attention area of the medical image;
Generating means for generating clinical position information indicating the position of the region of interest when the subject portion estimated by the estimating means is viewed from the front;
Display control means for displaying the generated clinical position information on the display means;
Editing means for editing the clinical position information displayed on the display means;
To function as.

  According to the present invention, it is possible to appropriately report the clinical position of the region of interest.

It is a figure which shows the example of whole structure of the medical image system in this embodiment. It is a block diagram which shows the functional structure of the server apparatus of FIG. It is a block diagram which shows the functional structure of the image display apparatus of FIG. (A) is an image in which left and right MLO images are arranged with the chest wall aligned, and (b) is a diagram showing an image in which the left and right CC images are aligned with the chest wall. It is a flowchart which shows the clinical position information generation process performed by the control part of FIG. It is a flowchart which shows the clinical position information generation process performed by the control part of FIG. It is a figure which shows an example of the viewer screen displayed on the image display apparatus of FIG. It is a flowchart which shows the estimation process of the clinical position of the attention area | region performed in step S7 of FIG. 5A. (A) is a figure for demonstrating the coordinate of a breast image, (b) is a figure for demonstrating the detection of a nipple position. It is a figure for demonstrating conversion to the breast area | region in which ideal estimation is possible. It is a figure for demonstrating the production | generation method of the clinical position information of an attention area. (A) is a front schema image of a right breast, (b) is a figure which shows a front schema image of a left breast. It is a figure for demonstrating the 1 direction estimation method. (A) is the figure which divided | segmented the area | region of the front schema image, and attached the number, (b) is an example of the clinical position information produced | generated when a clinical position exists in each area | region of (a). FIG. It is a figure which shows the example of clinical position information. It is a figure which shows the example of clinical position information. It is a figure which shows the example of clinical position information. It is a figure which shows an example of a finding entry screen. It is a figure which shows the example of the viewer screen on which the clinical position information of the attention area was displayed. It is a figure for demonstrating the operation method for changing the clinical position in clinical position information. It is a figure which shows an example of the input screen of the visual tactile information at the time of imaging | photography. It is a figure for demonstrating the operation method for adding the clinical position in clinical position information. It is a figure which shows an example of a test result image. It is a figure which shows the example of a display of the evaluation result regarding the structure of a breast.

(Configuration of Medical Image 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 system 100 in the present embodiment.
As shown in FIG. 1, the medical image system 100 includes an image generation device 1, an abnormal shadow candidate detection device 2, a server device 3, an image display device 4, an ultrasonic diagnostic device 5, and a diagnostic terminal 6. Yes. These devices 1 to 6 are connected to each other via a communication network N constructed in a medical facility 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.

  The medical image system 100 X-rays a subject region, stores and manages the obtained medical image, estimates the clinical position of a region of interest such as an abnormal shadow candidate on the medical image, and estimates the attention This is a system that supports examination and the like in the ultrasonic diagnostic apparatus 5 performed in the supine position by generating and displaying clinical position information indicating the clinical position of the region. The clinical position refers to position information when the subject part is viewed from the front of the human body. The medical image system 100 handles medical images of various object parts. In the present embodiment, the breast is mainly X-rayed, and ultrasound examination of the breast is supported based on the obtained breast image. A case will be described as an example.

Hereinafter, each component apparatus 1-6 is demonstrated.
The image generation device 1 includes a photographing device 11 and a console 12.
The imaging apparatus 11 is an apparatus that performs X-ray imaging of a subject region in a human body and generates digital data of the captured image (medical image). For example, a modality such as a CR (Computed Radiography) apparatus or an FPD (Flat Panel Detector) apparatus. Is applicable. In the present embodiment, an FPD apparatus that performs X-ray imaging of the left and right breasts is applied as the imaging apparatus 11, and breast image data is generated as a medical image.

  The console 12 includes a storage unit configured by a CPU (Central Processing Unit), a RAM (Random Access Memory), an HDD (Hard Disk Drive), and the like, a pointing device such as a mouse, an operation unit configured by a keyboard, a touch panel, and the like. This is a computer device that includes a display unit configured by an LCD (Liquid Crystal Display) or the like, a communication unit configured by a LAN card, or the like. The console 12 displays a list of imaging order information transmitted from a RIS (Radiology Information System) or the like (not shown) on the display unit, and based on the inspection conditions included in the imaging order information selected by the operation unit from the displayed list. Radiation irradiation conditions and image reading conditions are set in the photographing apparatus 11 and photographing is performed. In addition, the medical image transmitted from the imaging device 11 is displayed for confirmation by the radiographer, and patient information, examination information, a UID (Unique ID) for identifying the image, etc. are added to the received medical image as header information. Then, the data is transmitted to the abnormal shadow candidate detection device 2 and the server device 3 via the communication network N.

  Here, the imaging order information includes patient information and examination information. The patient information includes information such as patient identification information (for example, patient ID) for identifying a patient (subject), patient name, sex, date of birth, and the like. The examination information includes a patient ID, examination identification information (for example, examination ID) for identifying the examination, examination date and time, examination conditions (examination site, laterality (left, right), direction (eg, vertical direction (CC)) , Oblique direction (MLO)), imaging angle, modality type, etc. In this embodiment, the examination ID is a series of images (two left and right MLOs) acquired by mammography examination of the same patient. (Image, CC image) are assigned the same inspection ID and managed.

  An abnormal shadow candidate detection device (CAD) 2 as a detection means 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 suspected of a lesion. The abnormal shadow candidate detection apparatus 2 includes a storage unit configured by a CPU, a RAM, an HDD, and the like, and a communication unit configured by a LAN card and the like. 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, the abnormal shadow candidate detection apparatus 2 detects an abnormal shadow candidate of a tumor or a microcalcification cluster in a breast image.

  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.

  When the detection of the abnormal shadow candidate is completed, the CPU of the abnormal shadow candidate detection apparatus 2 generates abnormal shadow candidate information based on the detection result of the abnormal shadow candidate. The abnormal shadow candidate information includes, for example, positional information (coordinate information on the medical image) of each detected abnormal shadow candidate area and information on the type of abnormal shadow candidate (for example, a tumor, a microcalcification cluster, etc.). . Then, the abnormal shadow candidate detection device 2 adds the header information (at least the UID) of the detection source medical image to the generated abnormal shadow candidate information and transmits it to the server device 3 by the communication unit.

  The server device 3 constitutes a PACS (Picture Archiving and Communication System) together with the image display device 4 as a client. The server apparatus 3 uses the medical image generated by the image generation apparatus 1 as abnormal shadow candidate information generated based on the medical image, attention area information (coordinate information of the attention area), clinical position information, incidental information, and examination results. It is stored in a database (image DB 351) in association with images and managed. The supplementary information and the inspection result image will be described later. The server device 3 also has a function as a Web server for providing various Web screens to the Web browser by communicating with the Web browser mounted on the image display device 4 using the HTTP protocol. A selection screen for selecting the medical image for the examination, a viewer screen for displaying the medical image for the selected examination, and the like are displayed on the image display device 4, and according to the operation information transmitted from the image display device 4 Various processes including a clinical position information generation process to be described later are executed.

FIG. 2 shows a functional configuration example of the server device 3.
As shown in FIG. 2, the server device 3 includes a control unit 31, an operation unit 32, a display unit 33, a communication unit 34, and a storage unit 35, and each unit is connected by a bus 36.

  The control unit 31 includes a CPU (Central Processing Unit), a RAM (Random Access Memory), and the like. The CPU of the control unit 31 reads out various programs such as a system program and a processing program stored in the storage unit 35, expands them in the RAM, and executes various processes according to the expanded programs. The control unit 31 functions as an estimation unit, a generation unit, a display control unit, a second generation unit, and an incidental information generation unit by executing clinical position information generation processing described later. Also, it functions as an editing unit in cooperation with the image display device 4.

  The operation unit 32 includes a keyboard provided with character input keys, numeric input keys, various function keys, and the like, and a pointing device such as a mouse, and a key press signal pressed by the keyboard and an operation signal by the mouse. To the control unit 31 as an input signal.

  The display unit 33 includes, for example, a monitor such as an LCD, and displays various screens in accordance with display signal instructions input from the control unit 31.

  The communication unit 34 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 35 includes, for example, an HDD or a semiconductor nonvolatile memory. The storage unit 35 stores various programs as described above. The storage unit 35 stores user authentication information (for example, a user ID and password) of a user who can log in to the medical image system 100 and authority granted to the user in association with each other. In this embodiment, the radiological technician is authorized to change clinical position information, delete authority, finding record authority, and input authority for visual and tactile information, and the ultrasonic examiner is provided with the clinical position information in the clinical position information. It is assumed that additional authority is granted.

The storage unit 35 is provided with an image DB 351.
The image DB 351 is a database for storing medical images in association with abnormal shadow candidate information, attention area information, clinical position information, supplementary information, examination result images, and the like generated based on the 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. Management information includes UID, patient information, examination information, file information (medical image file name, corresponding abnormal shadow candidate information, attention area information, clinical position information, supplementary information, and examination result image file names. , File storage location of each file, update date, file size, etc.). The supplementary information and the inspection result image will be described later.

When the communication unit 34 receives a medical image from the image generation device 1, the control unit 31 stores the received medical image in the image DB 351 and also receives management information based on the received medical image header information. Created and stored in the image management table of the image DB 351. When the abnormal shadow candidate information is received from the abnormal shadow candidate detection device 2 by the communication unit 34, the received abnormal shadow candidate information is stored in the image DB 351 and included in the abnormal shadow candidate information from the image management table. A record with a matching UID is searched, and the file name, storage location, etc. of the abnormal shadow candidate information are written in the searched record. In addition, the control unit 31 stores attention area information, clinical position information, supplementary information, and examination result images generated in a clinical position information generation process, which will be described later, in the image DB 351, and the UID of the medical image to be processed from the image management table. The attention area information, clinical position information, incidental information, the file name of the test result image, the storage location, and the like are written in the retrieved record.
In this way, the image DB 351 corresponds to the medical image, the abnormal shadow candidate information of the abnormal shadow candidate detected from the medical image, the clinical position information generated based on the medical image, the incidental information, and the test result image. It is stored so that it can be searched.

  The image display device 4 displays the selection screen, the viewer screen, and the like transmitted from the server device 3 via a Web browser, and transmits operation information input from these screens to the server device 3. Display the processing result sent according to the operation on the viewer screen. The image display apparatus 4 may be any terminal that can be connected to the server apparatus 3 via a Web browser. For example, a general-purpose PC (Personal Computer) or a mobile terminal is applicable. The image display device 4 may be configured integrally with the console 12, the ultrasonic diagnostic device 5, an electronic medical record terminal (not shown), and the like. The image display device 4 functions as display means, designation means, and input means.

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.

  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 an LCD, and displays various screens in accordance with display signal instructions 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 a system program, a web browser, and the like as described above.

  The ultrasonic diagnostic apparatus 5 includes an ultrasonic probe that outputs ultrasonic waves, an electronic device that is connected to the ultrasonic probe and converts sound waves (echo signals) received by the ultrasonic probe into image data (ultrasonic images), and (Both not shown). The ultrasonic diagnostic apparatus 5 sends ultrasonic waves from the ultrasonic probe to the inside of the subject, receives again the sound waves (echo signal) reflected by the body tissue, and receives the ultrasonic image corresponding to the echo signals electronically. Generated by the device.

  The diagnostic terminal 6 is a terminal for displaying a breast image or an ultrasonic image and performing a diagnostic interpretation by a doctor.

(Operation of Medical Image System 100)
Next, the operation of the medical image system 100 will be described.
Here, in the breast cancer test, a combined test using both the mammography test and the ultrasonic test is performed. In the combined examination, generally, a radiologist first performs a mammography examination, and obtains overhead position information of a region of interest such as an abnormal shadow candidate on the obtained breast image. Thereafter, the clinical laboratory technician observes the breast image and conducts an ultrasonic examination focusing on the position of the breast corresponding to the region of interest on the breast image. When both examinations are completed, the doctor interprets the breast image and the ultrasound image and makes a final diagnosis.

  In mammography examinations, in general, the image generation apparatus 1 is used to capture one patient in the oblique (MLO) and vertical (CC) imaging directions for each of the left and right breasts in a standing and breast-compressed state. A total of four times of imaging are performed, and two breast images are generated on each of the left and right sides. On the other hand, in the ultrasonic examination, the examination is performed in the supine position and the breast not compressed. Therefore, the sonographer who performs the ultrasound examination must perform the examination by intuitively converting the position of the region of interest on the breast image to the clinical position that is the position when the breast is viewed from the front of the human body. I must.

  FIG. 4A shows an image in which left and right MLO images are arranged side by side with the chest wall aligned, and FIG. 4B shows an image in which the left and right CC images are arranged side by side aligned with the chest wall. In general, when observing a breast image, as shown in FIGS. 4A and 4B, observation is performed in a state where the image end is arranged in parallel with the end of the display unit (monitor).

  Since the CC image is an image taken by irradiating radiation from directly above the breast in the image generation apparatus 1 as shown in FIG. 4B, the left and right CC images are arranged with the chest wall aligned. When the image edge is placed parallel to the edge of the monitor and the MLO image and the position where the left and right breasts are displayed correspond to each other (the image of the right breast is left when viewed from the front, the image of the left breast is right ), The upper direction of the CC image is the outer direction of the breast, and the lower direction of the CC image is the inner direction of the breast. That is, from the CC image, the observer can infer whether the region of interest is inside or outside the breast. For example, it can be seen from the CC image shown in FIG. 4B that there is a region P to be noted outside the right breast.

  On the other hand, the MLO image is obtained by photographing the breast from an oblique direction with an optimum photographing angle for each photographing. Here, if the MLO image is an image of the breast taken from the side (when the CC image is taken and the radiation irradiation direction is orthogonal), the image end shown in FIG. 4A is the end of the monitor. The position of the attention area P in the vertical direction (head-foot direction) in the breast can be estimated from the MLO image arranged so as to be parallel to the attention area P. It is possible to roughly grasp the position where the exists. However, as described above, the MLO image is obtained by photographing the subject breast from an oblique direction. Therefore, in practice, it is difficult to estimate the vertical position of the breast by looking at the MLO image arranged as shown in FIG. Although the information on the imaging angle is included in the header information of the breast image, it takes time to estimate the position based on the imaging angle even if the imaging angle is known, and the examination efficiency is reduced. In addition, there is a high possibility that the guess is wrong.

  Even if the probe is placed in the wrong position and the ultrasonic examination is performed, the shadow corresponding to the attention area is not obtained, the patient is anxious, the examiner is impatient, the examination time is prolonged, and the incompleteness is incomplete. It brings various disadvantages such as a serious inspection.

  Therefore, in the medical image system 100 of the present embodiment, the clinical position of the attention area is estimated based on the breast image obtained by the mammography examination, and the clinical position information is displayed, thereby corresponding to the attention area in the breast. Make the position easily recognizable by the tester.

  In general, the sonographer often does not have sufficient knowledge about interpretation of breast images. Therefore, the radiographer performs the attention area designation on the breast image and the confirmation of the estimation result of the clinical position, and the sonographer performs the ultrasonic examination while referring to the estimated clinical position information of the attention area. Although it is preferable, for example, when it is determined that the estimation result is incorrect, the radiologist may determine that a position different from the estimated clinical position is to be sent to the sonographer as the clinical position of the region of interest. . In the medical image system 100 of the present embodiment, the clinical position information can be edited so that appropriate clinical position information can be sent to the sonographer.

  Further, conventionally, a doctor estimates a clinical position corresponding to a region of interest on a breast image in his / her head and focuses on an ultrasonic image to which a body mark (see FIG. 11) corresponding to the estimated position is given. It was necessary to make a diagnosis in association with a region, which was inefficient with time and effort. Also, if there is no ultrasound image with a body mark corresponding to the region of interest in the breast image, the sonographer has examined the clinical position corresponding to the region of interest in the breast and there was no shadow in the first place. Since it is not known whether the clinical position corresponding to the region of interest is not being examined, the doctor may perform additional examinations, which may increase the examination time. In the medical image system 100 according to the present embodiment, when the clinical position sent from the radiologist is different from the clinical position where the ultrasonic examination is actually performed, the actual clinical position is kept while the original clinical position is left. By making it possible to add the clinical position that was performed to the clinical position information, the clinical position where the ultrasound image was actually acquired can be sent to the doctor for the region of interest on the breast image. The upper attention area and the ultrasonic image can be efficiently associated with each other.

  5A to 5B show flowcharts of the clinical position information generation process executed by the server device 3. In the clinical position information generation process, when the breast image of the examination to be processed is selected from the image display device 4 and information (examination ID or the like) specifying the breast image of the selected examination is received by the communication unit 34, The program is executed in cooperation with the control unit 31 and the program stored in the storage unit 35.

First, the control unit 31 searches and reads out the breast image of the selected examination from the image DB 351, generates screen information of the viewer screen 431 on which the read breast image is displayed, and requests the screen information from the communication unit 34. A viewer screen 431 that is transmitted to the original image display device 4 and displays a breast image of the selected examination is displayed on the display unit 43 of the image display device 4 (step S1).
The control unit 31 of the server device 3 temporarily stores the examination ID and UID of the breast image being displayed on the image display device 4 in the memory until an end instruction is received from the image display device 4.

  FIG. 6 shows an example of the viewer screen 431 displayed on the image display device 4. On the viewer screen 431, an image display field 431a, an R button 431b for instructing to display the right breast image, an L button 431c for instructing to display the left breast image, and display of abnormal shadow candidates CAD button 431d for instructing an image, estimation mode selection button 431e for selecting an estimation mode, confirmation mode selection button 431f for selecting a confirmation mode, breast palpation information at the time of imaging such as induration / secretion A consolidation / secretion button 431g for instructing input (hereinafter referred to as visual tactile information at the time of imaging), an area 431h for displaying clinical position information and incidental information, a save button 431i for instructing storage, An ROI selection completion button 431j for instructing the completion of the designation of the attention area is provided. By pressing the R button 431b or the L button 431c, the left and right of the breast image displayed in the image display field 431a can be changed. In step S1, the right or left breast image set by default is displayed.

Here, the estimation mode is a mode for mainly generating information to be sent to the sonographer by the radiologist. Specifically, in the estimation mode, the user designates a region of interest on the breast image by operating the operation unit 42 and causes the server device 3 to perform the estimation process of the clinical position of the designated region of interest, or the estimated clinical It is possible to edit (change or delete) the clinical position information indicating the position, and to input incidental information such as the visual tactile information at the time of imaging and the user's findings on the region of interest.
On the other hand, the confirmation mode is a mode mainly for the ultrasonic examiner to confirm the clinical position information generated in the estimation mode and to leave a log of the ultrasonic examination. Specifically, in the confirmation mode, the clinical position information generated in the estimation mode is displayed and ultrasonic examination is performed, and there is no shadow at the clinical position specified by the displayed clinical position information, and the shadow is displayed at a different position. Can be added to the clinical position information while leaving the original clinical position. Furthermore, it is possible to transmit an image (examination result image) indicating the correspondence between the position of the region of interest on the breast image and the clinical position information to the diagnostic terminal 6.

  The control unit 31 determines whether the communication unit 34 has received operation information indicating selection of the estimation mode or operation information indicating selection of the confirmation mode from the image display device 4 (step S2). When operation information indicating selection of the estimation mode is received from the image display device 4 by the communication unit 34 (step S2; estimation mode), the control unit 31 proceeds to step S3.

  In step S3, the control unit 31 determines whether or not operation information indicating an instruction to display an abnormal shadow candidate is received from the image display device 4 by the communication unit 34 (step S3). When it is determined that the operation information indicating the display instruction of the abnormal shadow candidate is not received from the image display device 4 by the communication unit 34 (step S3; NO), the control unit 31 proceeds to step S5. When it is determined that the operation information indicating the display instruction of the abnormal shadow candidate is received from the image display device 4 by the communication unit 34 (step S3; YES), the control unit 31 applies the breast image displayed on the image display device 4 to the breast image. Corresponding abnormal shadow candidate information is retrieved from the image DB 351 and read out, and screen information in which an annotation indicating the position of the abnormal shadow candidate is displayed on the breast image displayed on the viewer screen 431 is generated. Then, the screen information is transmitted to the request source image display device 4 by the communication unit 34, and the viewer screen 431 on which the annotation indicating the position of the abnormal shadow candidate is displayed on the breast image is displayed on the display unit 43 of the image display device 4. Display (step S4), the process proceeds to step S5.

  In step S5, the control unit 31 determines whether or not the position information of the attention area has been received from the image display device 4 by the communication unit 34 (step S5). In the image display device 4, when an MLO image and a CC image exist, if the attention area is specified by the operation unit 42 from both breast images of the MLO image and the CC image displayed on the viewer screen 431, The position information of the attention area thus transmitted is transmitted as operation information to the server device 3 by the communication unit 44. For the attention area that can be confirmed only in one of the images, when the attention area is designated by the operation unit 42 and the ROI selection completion button 431j is pressed, the communication section uses the position information of the designated attention area as operation information. 44 to the server device 3. In the case where only one of the MLO image and the CC image is present, if the attention area is designated from the one breast image by the operation unit 42, the communication unit 44 uses the position information of the designated attention area as operation information. Is transmitted to the server device 3. The region of interest is a region that should be noted by ultrasonic examination, such as the region of an abnormal shadow candidate, for example, and if the radiological engineer can confirm the same abnormal shadow candidate in the MLO image and the CC image, For an abnormal shadow candidate that can be confirmed only in one of the images, the operation unit 42 designates that one region as a region of interest.

  When it is determined that the position information of the region of interest from the image display device 4 has been received by the communication unit 34 (step S5; YES), the control unit 31 displays the breast image (MLO image, CC) displayed on the image display device 4 The imaging angle included in each header information of the image is acquired (step S6), and the estimation process of the clinical position of the attention area on the breast image is executed based on the imaging angle and the position information of the attention area (step S7). ). The imaging angle is an angle (inclination in the X-ray irradiation direction) at which the imaging apparatus 11 is tilted at the time of breast image imaging. In the imaging apparatus 11, in the initial state, a radiation source that irradiates X-rays, a subject table on which a subject is arranged, and an FPD that detects X-rays transmitted through the subject are arranged in this order in the vertical direction. These are integrally tilted by an angle corresponding to the subject breast. At the time of CC image shooting, since the image generation apparatus 1 is shot without being tilted in the initial state, the shooting angle is 0 °.

  FIG. 7 shows a flowchart of the estimation process of the clinical position of the region of interest in step S7.

First, in step S7, the control unit 31 detects a skin line and a nipple from each of the breast images (MLO image and CC image) (step S701).
Here, as shown in FIG. 8 (a), the position of each pixel in each breast image is represented by coordinates (X, Y) where the vertical direction of the breast in the breast image is the X axis and the direction perpendicular thereto is the Y axis. ). Also, the pixel value of coordinates (X, Y) is represented as V (X, Y), 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.

In step S <b> 701, the control unit 31 first performs a filtering process using a Sobel filter with each pixel as a target pixel in each breast image. Next, the control unit 31 performs a search in the Y direction for each X coordinate (0 to Xmax) of the breast image subjected to the Sobel filter, and determines the coordinate (S) that maximizes V (X, Y) for each X coordinate. Extract as an edge in coordinates. The extracted edge constitutes a skin line SL that is a boundary between the breast region and the non-breast region.
Next, as shown in FIG. 8B, the control unit 31 connects S (X) and S (X + d (d is, for example, 10)) for each point S (X) on the skin line SL. The distance D between the straight line and each point (S (X + 1), S (X + 2)... S (X + d-1)) between S (X) and S (X + d) is calculated, and the calculated distance D The position of S (X) having the largest value among the maximum values D (X) is detected as the nipple position.

  Next, the control unit 31 converts the breast area of each breast image into a breast area where ideal estimation is possible (step S702). Here, in a breast region that can be ideally estimated in the processing after step S703, a line perpendicular to the tangent line of the nipple is perpendicular to the chest wall (image end). However, as shown in FIG. 9, the breast is actually deformed by the gravity at the time of photographing and the photographing technique of the engineer, and the line is perpendicular to the tangent (tangent at the contact point between the nipple and the skin line) of the nipple (indicated by 601 in FIG. 9). Will not be perpendicular to the chest wall (image edge) and will be inclined by an angle α [°]. Therefore, in step S702, the inclination α is calculated, and based on the inclination α, the breast is converted so that a line perpendicular to the tangent of the nipple is perpendicular to the chest wall (image end).

  Next, as shown in FIG. 10, the control unit 31 stores the frontal schema image of the breast (see FIG. 10) on the RAM based on the angle difference θ [°] between the imaging angle at the time of MLO image capturing and the imaging angle at the time of CC image capturing. 10 of 500), an MLO image (600 of FIG. 10), and a CC image (700 of FIG. 10) are arranged (step S703). Note that θ [°] corresponds to the shooting angle at the time of MLO image shooting.

  Here, FIG. 11A shows an example of a frontal schema image of the right breast, and FIG. 11B shows an example of a frontal schema image of the left breast. The frontal schema images of the left and right breasts schematically show the state of each breast viewed from the front, and are images for superimposing and displaying the clinical position of the region of interest. The circle in the front schema image represents the breast, and the center O of the circle represents the nipple position. Region A represents a region on the inside of the breast, region B represents a region on the inside of the breast, region C represents a region on the outside of the breast, and region D represents a region on the outside of the breast. A region C ′ adjacent to the region C represents the bottom of the heel. The frontal schema image of the breast has the same configuration as the body mark for indicating the position where the ultrasonic probe (ultrasonic probe) is placed in the ultrasonic image obtained by ultrasonic diagnosis, that is, the inspection position. The display makes it easy for the sonographer to grasp the position of the breast.

  As shown in FIG. 10, in step S702, first, a front schema image 500 is arranged on the RAM. Next, each of the perpendicular line 602 lowered from the nipple 601 of the MLO image 600 to the chest wall and the perpendicular line 702 lowered from the nipple 701 of the CC image 700 to the chest wall pass through the nipple 501 of the front schema image 500, and the angle of the perpendicular to each other The MLO image 600 and the CC image 700 are arranged so that the difference is the angle difference θ [°] between the shooting angle at the time of MLO image shooting and the shooting angle at the time of CC image shooting. That is, the MLO image 600 and the CC image 700 are arranged so as to be inclined with respect to the front schema image 500 by the shooting angle.

  Next, the control unit 31 normalizes the MLO image 600 and the CC image 700 in accordance with the front schema image 500 (step S704). Specifically, the CC image 700 maintains a state in which a perpendicular 702 lowered from the nipple 701 to the chest wall intersects the nipple 501 of the front schema image 500, and both ends 703 of the breast region match both ends of the circle of the front schema image 500. Are scaled up or down. The MLO image 600 maintains a state in which the perpendicular 602 lowered from the nipple 601 to the chest wall intersects the nipple 501 of the front schema image 500, while the perpendicular 603 lowered from the lower end of the breast region to the chest wall contacts the circle of the front schema image 500. Are scaled up or down. Note that both ends 703 of the breast region in the CC image 700 and the lower end of the breast region in the MLO image 600 can be specified based on the detected skin line.

  Next, the control unit 31 projects the attention area 604 of the MLO image 600 and the attention area 704 of the CC image 700 onto the front schema image 500, and estimates the position of the overlapped projection area as the clinical position of the attention area (step) S705). Specifically, first, straight lines 605a and 605b perpendicular to the chest wall are drawn from the head end 604a and the tail end 604b of the attention area 604 after the movement of the MLO image 600, and a straight line 605a is drawn on the front schema image 500. A band-like region surrounded by 605b is projected. Similarly, straight lines 705a and 705b perpendicular to the chest wall are drawn from the outer end 704a and the inner end 704b of the attention area 704 after the CC image 700 is moved, and are surrounded by the straight lines 705a and 705b on the front schema image 500. A band-like area is projected. Then, the region 502 where the two projection regions overlap is estimated as the clinical position of the region of interest.

  When the attention area is specified only from either the MLO image or the CC image, the processing in steps S701 to S705 is performed on the image in which the attention area is specified, and the above-described band-shaped area is used as the clinical area of the attention area. Estimated as position. Alternatively, the clinical position of the region of interest may be estimated by the following one-direction estimation method.

  FIG. 12A schematically shows a first method of the one-direction estimation method based on the CC image. FIG. 12B schematically shows a second method of the one-direction estimation method based on the CC image. In the following description, a CC image will be described as an example, but an MLO image can be estimated using a similar method.

In the first method, a distance Rc between the centers of the nipple 701 and the attention area 704 of the CC image 700 is obtained, and a circle 706 having a radius Rc centered on the nipple 501 is drawn on the front schema image. The region where the donut-shaped region in the range and the band-like region obtained by projecting the region of interest 704 of the CC image 700 onto the front schema image 500 (the region indicated by the dots in FIG. 12A) is the clinical position of the region of interest. presume. Note that the width of the donut-shaped region is, for example, a width corresponding to the size of the region of interest 704.
In the first method, since the distance from the nipple is almost the same even when the lesion in the breast region is moved by compression, the estimated position is narrowed down based on the distance between the nipple and the region of interest. It is.

In the second method, the distance Ro between the nipple 701 of the CC image 700 and the attention area 704 (after movement of the deformation amount) (for example, the distance between the end of the attention area 704 farthest from the nipple 701). Ro), and a circle 707 having a radius Ro centered on the nipple 501 is drawn on the front schema image 500, and a region of this circle 707 and a band-like region in which the region of interest 704 of the CC image 700 is projected onto the front schema image 500 (The region indicated by the dark dots in FIG. 12B) is estimated as the clinical position of the region of interest.
The second method is that the lesion in the breast region does not change the distance from the nipple even if it is moved by compression, and the mammary gland is hardly stretched, so the lesion hardly moves away from the nipple. Based on the absence, the estimated position is narrowed down.

  When the estimation of the clinical position corresponding to the region of interest is completed, the control unit 31 proceeds to step S8 in FIG. 5A and generates clinical position information indicating the estimated clinical position (step S8).

  For example, the frontal schema image is divided into nine regions 1 to 9 shown in FIG. 13A, and the center coordinates of the estimated clinical position in the region of FIG. 13A are 1 (2) in FIG. 3, 4,... 9), a front schema image in which a region indicated by dots in 1 (2, 3, 4,... 9) in FIG. Generate as clinical location information.

For example, as shown in FIG. 14 (a), the center coordinates of the estimated clinical position are included in the center, and the fan-shaped region annotation with the nipple as the apex of the central angle is overlaid on the front schema image. Then, the clinical position information may be generated. In addition, since lesions in the breast region have different easiness of movement depending on the location, the angle of the central angle may be changed according to the location where the estimated clinical position is present (the angle is increased as the location becomes easier to move). . Further, as shown in FIG. 14 (b), a probability distribution in which a region of interest exists is obtained based on the estimated clinical position, and an annotation indicating this probability distribution is overlaid on the front schema image to display clinical position information. It is good. Here, in FIG. 14B, the higher the probability that the region of interest exists, the higher the density.
Moreover, you may produce | generate as a clinical position information what showed the center coordinate of the estimated clinical position on a front schema image with the point and numerical value (x, y).

  Further, for example, as shown in FIG. 15 (a), the estimated clinical position (parallelogram region) in the frontal schema image is surrounded, the color or the like is superimposed on the estimated clinical position, and the estimated clinical position is Clinical position information may be an annotation in which a mark such as a circle or the like is superimposed on a position and attached to the front schema image (drawn in an overlapping manner). Further, as shown in FIG. 15B, an elliptical annotation including the estimated clinical position region and having the same diagonal as the long side of the parallelogram indicating the clinical position and the principal axis (major axis) is inclined. The clinical position information may be generated by overlapping and drawing on the front schema image. Further, as shown in FIG. 15C, the area occupied by the clinical position area in each of the areas A to D on the front schema image is calculated (the number of pixels is counted), and the area with the largest calculated area is calculated. Information indicating (or information indicating the rank order of the calculated area) may be generated as clinical position information.

Further, for example, as shown in FIGS. 16A and 16B, clinical position information in which the area and shape of the annotation are changed depending on the estimated position of the clinical position may be generated. For example, since the lesion is difficult to move in the breast region corresponding to the oblique circumference of the front schema image, the center portion of the estimated clinical position of the front schema image is relatively small as shown in FIG. As shown in FIG. 16 (b), the estimated clinical position of the frontal schema image is obtained because the lesion is easy to move in the vertical direction near the lower part of the nipple. A relatively large oval annotation centered on the vertical direction as the center may be drawn on the front schema image as clinical position information.
In the following description, the case where clinical position information is shown in the mode shown in FIG. 13B will be described as an example.

  If the region of interest is specified only from either the MLO image or the CC image, an annotation that surrounds the estimated clinical position in the frontal schema image or overlays the color or the like on the estimated clinical position is clinical. Generated as position information.

Next, the control unit 31 analyzes the selected breast image and evaluates the configuration of the breast (step S9).
Here, in the breast image obtained by mammography examination, the mammary gland and the lesion (tumor, etc.) are expressed at the same density, so that it is difficult to find the lesion in the case of a patient having a high density mammary gland. On the other hand, the fat region is expressed at a density different from that of the lesion on the breast image. Therefore, the more the fat region, the easier the lesion is found. Therefore, in order to provide an indication of the risk of missing a lesion in the displayed breast image to a radiologist and a doctor, an evaluation regarding the structure of the breast is performed. In order from the region where the risk of missing a lesion is low, Fatty, 2. 2. scattered mammary glands; 3. Non-uniform high concentration Evaluated as high concentration.
The evaluation regarding the structure of the breast in step S9 can be performed by using a known image processing technique as described in Reference Document 1, for example (Reference 1: Tomoko Matsubara, Tamiko Tsuchimoto, Takeshi Hara, Hiroshi Fujita, Takushi Iwase and Tokiko Endo, “Automated Mammogram Classification Based on Evaluation of Mammary Gland Concentration”, Medical Electronics and Biotechnology, Vol. 38, No. 2 (June 2000)).

  Next, the control unit 31 generates screen information of the viewer screen 431 on which the clinical position information and the evaluation result regarding the breast configuration are displayed, and transmits the screen information to the image display device 4 by the communication unit 34, and the viewer screen 431 of the display unit 43. The evaluation result regarding the clinical position information and the structure of the breast is displayed on the top (step S10, see FIG. 18).

  In addition, when the evaluation regarding the structure of the breast has already been performed using the displayed breast image, the determination in step S9 is omitted.

  Next, the control unit 31 refers to the storage unit 35 and determines whether or not the user of the image display device 4 is a user who has been granted the finding recording authority (step S11). Here, when logging in to the medical image system 100 from the image display device 4, the user inputs user authentication information (here, user ID and password) through the operation unit 42, and the control unit 31 inputs the input user ID and password. Login authentication is performed. In step S <b> 11, the control unit 31 refers to the storage unit 35, and the user of the image display device 4 is a user to whom the finding recording authority is given based on the user ID of the user who has logged in from the image display device 4. Determine whether or not.

  When it is determined that the user of the image display device 4 is a user who has been granted the finding recording authority (step S11; YES), the control unit 31 causes the communication unit 34 to send the screen information of the finding entry screen 432 to the image display device 4. Then, the finding entry screen 432 is popped up on the display unit 43 (step S12).

FIG. 17 shows an example of the finding entry screen 432 displayed in step S12. The observation entry screen 432 is a screen for recording the observation on the attention area by the user. As shown in FIG. 17, the finding entry screen 432 includes a finding recording region 432a for recording the lesion name and category of the region of interest, an OK button 432b for inputting an instruction to complete finding recording, and a finding record. A Cancel button 432c for canceling is provided. When a finding is input to the finding recording area 432a by the operation unit 42 and the OK button 432b is pressed, the control unit 41 of the image display device 4 sends the instruction recording completion instruction and the inputted finding information to the server via the communication unit 44. Transmit to device 3.

  When the communication unit 34 receives an instruction record completion instruction and finding information from the image display device 4 (step S13; YES), the control unit 31 displays a viewer displaying the finding information recorded in the image display device 4. The screen information of the screen 431 is generated and transmitted to the image display device 4 by the communication unit 34, and the finding information is displayed on the viewer screen 431 of the display unit 43 (step S14).

FIG. 18 shows an example of the viewer screen 431 on which the estimated clinical position information, the recorded finding information, and the evaluation result regarding the structure of the breast are displayed. As shown in FIG. 18, an area 431 h on the viewer screen 431 includes clinical position information 4311 and finding information 4312 of the attention area (indicated by 1) designated on the breast image displayed in the image display field 431 a. The evaluation result 4313 related to the structure of the breast based on the breast image displayed in the image display field 431a is displayed.
Thus, on the viewer screen 431, the attention area on the breast image, the estimated clinical position information of the attention area, and the incidental information (evaluation results and findings information on the structure of the breast) for the subject part are displayed. Therefore, the user (radiologist) can determine whether or not the estimated clinical position is correct by comparing the attention area on the breast image with the clinical position information on the viewer screen 431. In addition, since the evaluation result regarding the composition of the breast, which is an index of the risk of missing a lesion, is displayed, for example, when the evaluation result regarding the composition of the breast is a nonuniform high concentration or high concentration with a high risk of missing a lesion, the user It is possible to call attention to be careful when searching for other regions of interest on the breast image.

  Next, the control unit 31 refers to the storage unit 35 and determines whether or not the user of the image display device 4 is a user who is given a change / deletion authority among the editing authority of the clinical position information (step S15). ). Editing of clinical position information refers to changing, deleting, or adding clinical position information. In the estimation mode, clinical position information can be changed or deleted during editing.

When it is determined that the user of the image display device 4 is a user who has been given change / addition authority (step S15; YES), the control unit 31 is displayed on the image display device 4 via the communication unit 34. On the viewer screen 431, a change button B1 for instructing start of changing the displayed clinical position information and a delete button B2 for instructing deletion of the displayed clinical position information are displayed (step S16).
By pressing the change button B <b> 1 from the viewer screen 431 by the operation unit 42, a clinical position information change start instruction can be transmitted to the server device 3. Further, the clinical position can be changed on the front schema image which is clinical position information. By pressing the delete button B <b> 2, a clinical position information deletion instruction can be transmitted to the server device 3.

  The control unit 31 determines whether or not a change start instruction is received from the image display device 4 by the communication unit 34 (step S17). If it is determined that the change start instruction has not been received (step S17; NO), the control unit 31 proceeds to step S20.

  When it is determined that the change start instruction has been received by the communication unit 34 (step S17; YES), the control unit 31 displays clinical position information (estimated clinical position information) displayed in the region 431h via the communication unit 34. Is obtained, and the clinical position information is changed according to the obtained operation information and displayed in the region 431h (step S18).

  For example, as shown in FIG. 19A, when an arbitrary position of the clinical position information displayed by the operation unit 42 is pressed, the control unit 31 displays the pressed position (the area shown in FIG. 19A). The clinical position is changed to a position corresponding to 1 to 9), and the clinical position information with the changed clinical position is displayed in the area 431h. The changed position is preferably displayed by distinguishing the estimated clinical position from the color and pattern so that it can be seen later that the position has been changed. Further, for example, as shown in FIG. 19 (c), two points P1 and P2 are displayed on the clinical position information, and the clinical point can be freely changed by moving the two points P1 and P2 by the operation unit 42. Also good. The operation of pressing the change button B1 again becomes the operation information for the change completion instruction.

  Thus, in the present embodiment, the clinical position in the estimated clinical position information can be changed. For example, when the user (radiologist) determines that the estimation result in step S7 is incorrect, When it is thought that it is better to perform an ultrasonic examination of the expanded range, the clinical position of the region of interest can be appropriately sent to the sonographer, reflecting the user's judgment.

  When the change completion instruction is received from the image display device 4 by the communication unit 34 (step S19; YES), the control unit 31 proceeds to step S20.

In step S20, the control unit 31 determines whether or not a deletion instruction is received from the image display device 4 by the communication unit 34 (step S20).
If it is determined that the delete instruction has not been received (step S20; NO), the control unit 31 proceeds to step S22.

When it is determined that the deletion instruction has been received (step S20; YES), the control unit 31 deletes the estimated clinical position information displayed in the area 431h, the attention area and the finding information corresponding to the clinical position information. (Step S21), the process proceeds to Step S22.
As described above, in this embodiment, the estimated clinical position information can be deleted. For example, when the attention area is designated at an incorrect position on the breast image, the incorrect information is directly used as the ultrasonic wave. It is possible to prevent sending to the inspector.

When the confirmation and editing of the estimated clinical position information is completed, the user can designate another region of interest from the breast image displayed on the viewer screen 431 by the operation unit 42. It is also possible to designate another region of interest by pressing the R button 431b or the L button 431c using the operation unit 42 to switch the left and right of the breast image to be displayed. When another attention area is designated, the control unit 41 of the image display device 4 transmits the position information of the designated attention area to the server device 3 through the communication unit 44.
When the user wants to input visual / tactile information at the time of photographing, the user can instruct the start of inputting visual / tactile information at the time of photographing by pressing the consolidation / secretion button 431g using the operation unit 42. When the consolidation / secretion button 431g is pressed, the control unit 41 of the image display device 4 transmits an instruction to start inputting tactile information at the time of photographing to the server device 3 through the communication unit 44.
When the processing for the inspection is finished and the processing result is stored in the DB 351, the user presses the save button 431i by the operation unit 42 and inputs a save instruction. When the save button 431 i is pressed by the operation unit 42, the control unit 41 of the image display device 4 transmits a save instruction to the server device 3 by the communication unit 44.

In step S22, after displaying the clinical position information, the control unit 31 determines whether the communication unit 34 has received the position information of the next attention area from the image display device 4 (step S22). When it is determined that the position information of the next attention area has been received from the image display device 4 (step S22; YES), the control unit 31 returns to step S6.
When it is determined that the position information of the next attention area has not been received from the image display device 4 (step S22; NO), the control unit 31 proceeds to step S23.

  In step S23, the control unit 31 refers to the storage unit 35 and determines whether or not the user of the image display device 4 is a user who has been given the authority to input visual touch information (step S23). When it is determined that the user who has logged in from the image display device 4 is not a user who has been given the right to input visual / tactile information (step S23; NO), the control unit 31 proceeds to step S27.

  When it is determined that the user who has logged in from the image display device 4 is a user who has been given the right to input visual and tactile information (step S23; YES), the control unit 31 causes the communication unit 34 to start from the image display device 4. It is determined whether or not an instruction to start inputting visual touch information at the time of shooting is received (step S24). When it is determined that the instruction to start inputting visual touch information at the time of shooting is not received from the image display device 4 (step S24; NO), the control unit 31 proceeds to step S27.

  When it is determined from the image display device 4 that an instruction to start the input of visual tactile information at the time of shooting has been received (step S24; YES), the control unit 31 displays the screen information of the input screen 433 by the communication unit 34. And the input screen 433 is displayed in a pop-up on the display unit 43 (step S25).

  FIG. 20 shows an example of the input screen 433 displayed in step S25. The input screen 433 is a screen for inputting visual / tactile information at the time of shooting. As shown in FIG. 20, on the input screen 433, for each of the right (R) and left (L), a tactile information input area 433a for inputting a nipple secretion state and a hardened part at the time of photographing, and an input An OK button 433b for inputting a completion instruction and a Cancel button 433c for canceling the input of visual and tactile information are provided. When input is performed from the visual / tactile information input area 433a by the operation unit 42 and the OK button 433b is pressed, the control unit 41 of the image display device 4 instructs the input completion and the visual / tactile sense at the time of shooting. Information is transmitted to the server device 3 by the communication unit 44.

  When the communication unit 34 receives an input completion instruction and visual tactile information at the time of shooting from the image display device 4 (step S26; YES), the control unit 31 proceeds to step S27.

In step S27, the control unit 31 determines whether or not a save instruction is received from the image display device 4 by the communication unit 34 (step S27). When determining that the save instruction has not been received (step S27; NO), the control unit 31 returns to step S22.
When it is determined that the save instruction has been received (step S27; YES), the control unit 31 associates the breast image with each region of interest information, clinical position information, and incidental information (steps S6 to S26). Finding information on the region of interest, evaluation results of the structure of the breast, visual tactile information at the time of imaging, etc.) are stored in the image DB 351 (step S28), and the clinical position information generation process is terminated. The control unit 31 stores the estimated clinical position information in the image DB 351 when the clinical position information is not edited (changed here), and when edited, the edited position information is edited. The clinical position information is stored in the image DB 351. In addition, each region of interest designated on the breast image and the corresponding clinical position information, finding information, and visual and tactile information at the time of imaging are assigned the same identification information and stored in association with each other.

  On the other hand, when the operation information indicating selection of the confirmation mode is received from the image display device 4 by the communication unit 34 in step S2 (step S2; confirmation mode), the control unit 31 proceeds to step S29.

  In step S29, the control unit 31 reads attention area information, clinical position information, and incidental information corresponding to the displayed breast image from the image DB 351, and displays an annotation in the attention area in the image display field 431a. The screen information of the viewer screen 431 in which clinical position information and incidental information corresponding to each attention area (finding information on the attention area, evaluation results regarding the breast) are displayed in a list in the area 431 h is generated, and the image display device is displayed by the communication unit 34. 4 and displayed on the display unit 43 (step S29). Note that the region of interest and the corresponding clinical position information and incidental information are displayed in association with each other, for example, by adding the same identification information.

Here, since the attention area on the breast image and the clinical position information thereof are displayed in association with each other on the viewer screen 431, the user (ultrasound examiner) can select the attention area on which the ultrasonic examination should be focused on. The clinical position can be easily grasped, and the examination efficiency can be improved. The viewer screen 431 displays the evaluation results related to the breast based on the displayed breast image. When the risk of missing a lesion is high, the user is warned to perform an ultrasound examination carefully. can do.
When one clinical position information is selected from the clinical position information listed in the area 431h by the operation unit 42, identification information corresponding to the selected clinical position information is transmitted to the server device 3 and selected. It is possible to add the information on the clinical position where the ultrasonic examination is actually performed with reference to the clinical position information to the selected clinical position information.

  Next, the control unit 31 determines whether the identification information of the clinical position information selected from the image display device 4 has been received by the communication unit 34 (step S30). In the image display device 4, when the clinical position information is selected from the clinical position information displayed on the viewer screen 431 by the operation unit 42, the server unit receives identification information of the selected clinical position information by the communication unit 44. 3 to send.

When it is determined that the identification information of the clinical position information selected from the image display device 4 is received by the communication unit 34 (step S30; YES), the control unit 31 refers to the storage unit 35 and the user of the image display device 4 It is determined whether or not the user has the authority to add the clinical position in the clinical position information (step S31).
When it is determined that the user of the image display device 4 is not a user who has the authority to add the clinical position in the clinical position information (step S31; NO), the control unit 31 proceeds to step S34.

  When it is determined that the user of the image display device 4 is a user who has the authority to add the clinical position in the clinical position information (step S31; YES), the control unit 31 is displayed in the area 431h via the communication unit 34. The operation information for the clinical position information is acquired, the clinical position is added to the clinical position information in accordance with the acquired operation information, and is displayed in the region 431h (step S32).

  For example, as shown in FIG. 21A, when an arbitrary position on the front schema image is pressed by the operation unit 42 in the displayed clinical position information, the control unit 31 displays the pressed position (FIG. 21). A clinical position is added to a position (see FIGS. 13A and 13B) corresponding to the areas 1 to 9 shown in FIG. 13A, and the clinical position information with the added clinical position is displayed in the area 431h. It is preferable to display the added clinical position by distinguishing the color and pattern from the original clinical position so that the added clinical position can be seen later. Further, for example, as shown in FIG. 21B, two points P1 and P2 may be displayed on the clinical position information, and the position and the two points may be moved to freely add the clinical position.

  As described above, in this embodiment, the clinical position of the clinical position information can be added. For example, the user (ultrasound examiner) performed the inspection while referring to the clinical position information, and there is a shadow. However, when an ultrasonic image of a shadow is acquired by performing an examination in an expanded range, the clinical position where the shadow actually exists can be added to the clinical position information. In addition, the original clinical position can be left as a history of positions at which the sonographer has performed the examination.

Next, the control unit 31 determines whether or not identification information of other clinical position information is received from the image display device 4 by the communication unit 34 (step S33). When determining that the identification information of other clinical position information has been received (step S33; YES), the control unit 31 returns to step S32.
When it is determined that the identification information of other clinical position information is not received (step S33; NO), the control unit 31 proceeds to step S34.

  In step S34, the control unit 31 determines whether or not a save instruction is received from the image display device 4 by the communication unit 34 (step S34). When determining that the save instruction has not been received (step S34; NO), the control unit 31 ends the clinical position information generation process.

  On the other hand, when it is determined that the save instruction has been received from the image display device 4 by the communication unit 34 (step S34; YES), the control unit 31 has the latest clinical position information (if edited, after editing). The clinical position information stored in the image DB 351 is overwritten and stored by (clinical position information) (step S35). The control unit 31 also includes the position of the attention area of the breast image obtained by the mammography examination, the latest clinical position information of the attention area (if edited, the edited clinical position information, if not edited) Is generated in association with the estimated clinical position information) and transmitted to the diagnosis terminal 6 by the communication unit 34 (step S36), and the clinical position information generation process is terminated.

  FIG. 22 shows an example of the inspection result image. As shown in FIG. 22, in the examination result image, the position of the attention area of the breast image obtained by the mammography examination and the clinical position information of the attention area are displayed in association with each other by the same identification number. The clinical position indicated by the clinical position information of the region of interest is displayed as <ultrasound inspection position> in order to indicate the clinical position actually inspected by the sonographer. By transmitting this test result image to the doctor's diagnostic terminal 6, it is not necessary for the doctor to estimate the clinical position corresponding to the region of interest on the breast image in the head and associate it with the ultrasound image, thereby improving the diagnostic efficiency. It becomes possible to improve. Moreover, since the range which the doctor inspected by the ultrasonic examiner can be easily grasped, it is possible to prevent an additional additional inspection.

As described above, according to the medical image system 100, when the attention area is designated from the breast image in the image display device 4, the control unit 31 of the server apparatus 3 determines the attention area when the breast is viewed from the front. The position (clinical position) is estimated, clinical position information indicating the position of the estimated region of interest is generated, and the generated estimated clinical position information is displayed on the display unit 43 of the image display device 4. In addition, the control unit 31 edits the clinical position information displayed on the display unit 43 in accordance with a user operation on the image display device 4.
For example, the control unit 31 changes the position of the attention area in the clinical position information displayed on the image display device 4 according to the user operation. Therefore, for example, when the user determines that the estimated clinical position is incorrect, the position of the region of interest in the clinical position information can be changed, and an ultrasound examination is performed by looking at the clinical position information later It is possible to appropriately send the clinical position of the attention area to the person or the like.
Further, for example, the control unit 31 deletes the clinical position information displayed on the image display device 4 in response to a user operation. Therefore, for example, when the user mistakenly designates the attention area, the clinical position information can be deleted, and the wrong information is sent to an examiner who performs an ultrasonic examination by looking at the clinical position information later. Can be prevented.
Further, for example, the control unit 31 adds the position of the attention area in the clinical position information displayed on the image display device 4 according to the user operation. Therefore, for example, when there is no shadow at the clinical position indicated by the clinical position information at the time of ultrasonic examination and another position is examined as the clinical position of the attention area and a shadow corresponding to the attention area is detected, the attention is actually paid. The position where the shadow corresponding to the area is detected can be added to the clinical position information, and the clinical position where the shadow corresponding to the attention area actually exists can be appropriately sent to the doctor who makes the diagnosis based on the test result. It becomes possible.

  Further, since the clinical position information is an image showing the position of the attention area on the schema image when the subject part used in the ultrasonic examination is viewed from the front, the ultrasonic examiner determines the clinical position of the attention area. It can be displayed so that it is easy to understand at first glance.

  Further, the control unit 31 generates an image in which the position of the region of interest on the breast image is associated with the clinical position of the region of interest and transmits the image to the diagnosis terminal 6, so that the doctor corresponds to the region of interest on the breast image. It is not necessary to estimate the clinical position to be performed in the head, and the diagnostic efficiency can be improved.

  Moreover, since the control part 31 displays the area | region of the abnormal shadow candidate detected in the abnormal shadow candidate detection apparatus 2 on a breast image, the user can designate an attention area easily.

  Further, since the control unit 31 generates and displays at least one of the visual tactile information at the time of photographing and the finding information on the region of interest based on the input by the user, it can be displayed to the sonographer or doctor at the time of photographing. It is possible to provide visual / tactile information and findings on the region of interest.

  Further, since the control unit 31 analyzes the breast image and evaluates the structure of the breast, and displays the evaluation result as supplementary information, it is easy for the radiologist, the sonographer, and the doctor to overlook the lesion in the breast image. Information can be provided.

  Further, since the control unit 31 displays clinical position information and / or incidental information on the same screen as the breast image on which the attention area is displayed, the sonographer refers to the attention area and incidental information on the breast image. Therefore, ultrasonic inspection can be performed, and the inspection efficiency at the time of ultrasonic inspection can be improved.

  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-described embodiment, the evaluation result relating to the structure of the breast is displayed in characters, but the present invention is not limited to this.
For example, as shown in FIG. 23 (a), the color of the clinical position on the front schema image as clinical position information may be displayed in monochrome shades or colors according to the evaluation result regarding the breast configuration. For example, the “high density” with the highest evaluation score may be displayed with the density (luminance) closest to white, and may be displayed with the display density (luminance) close to black as the score decreases.
Further, for example, as shown in FIG. 23 (b), the line drawing of the breast region of the frontal schema image as the clinical position information may be displayed in monochrome shades or colors according to the score of the evaluation result regarding the structure of the breast. .
Further, for example, as shown in FIG. 23C, a diagram in which the amount of breast filling is changed according to the score of the evaluation result regarding the configuration of the breast may be displayed.
Further, as shown in FIG. 23 (d), a score indicating an evaluation result regarding the structure of the breast may be displayed.

  The viewer screen 431 shown in the above embodiment is an example. For example, the layout, size, and CAD mark (annotation) may be changed according to the monitor size of the image display device 4.

  In the above embodiment, the image display device 4 has been described as selecting the examination to be processed. However, the viewer screen 431 relating to the examination selected by another device may be displayed on the image display device 4. . For example, in the console 12 or the ultrasonic diagnostic apparatus 5 having a function of displaying a list of examinations (imaging order information) on the display unit, when the examination (imaging order information) is selected by the operation unit, the examination of the selected examination ID or the like is transmitted to the server apparatus 3, and the server apparatus 3 generates a viewer screen 431 for the inspection of the received inspection ID and transmits it to the image display apparatus 4 by the communication unit 34, and the console 12 or the ultrasonic diagnostic apparatus 5. The viewer screen 431 for the examination selected in (3) may be displayed on the image display device 4. Thereby, for example, when a radiographer (ultrasound examiner) selects an examination (imaging order information) to be performed on the console 12 (ultrasound diagnostic apparatus 5), a viewer screen 431 for the examination is displayed on the image display apparatus 4. Therefore, it is not necessary to perform the selection operation redundantly in the image display device 4, and the operability is improved. Note that the initial screen (estimation mode screen, confirmation mode screen) displayed on the viewer screen 431 may be changed by the user.

  In addition, for example, when the console 12 and the image display device 4 are installed in the vicinity, such as when the image display device 4 is a mobile terminal, the cursor is shared between the console 12 and the image display device 4 with one pointing device. Both operations may be performed. The sharing of the cursor between the console 12 and the image display device 4 can be realized, for example, by registering the image display device 4 in the console 12 as a sub display. As a result, the radiologist only needs to operate one pointing device when performing the estimation operation of the clinical position while confirming the image captured by the console 12, so that the work efficiency can be improved.

  For example, when an attention area of a breast image is designated on the console 12, the position information of the designated attention area is transmitted to the server device 3, and the clinical position is estimated based on the position information received by the server device 3. Alternatively, the clinical position information of the estimated clinical position may be generated and transmitted to the image display device 4 for display. Thereby, for example, when the image display device 4 is a mobile terminal, the position of the region of interest on the breast image can be specified on an easy-to-view screen (large screen) of the console 12.

  Further, for example, the generated (edited) clinical position information may be displayed on the ultrasonic diagnostic apparatus 5 as a default body mark. For example, when patient information of a patient to be examined is selected by the ultrasonic diagnostic apparatus 5, the ultrasonic diagnostic apparatus 5 transmits a patient ID or the like to the server apparatus 3 and clinical position information corresponding to the patient ID (latest May be acquired from the server device 3 and the acquired clinical position information may be displayed by default. As a result, it is possible to save the error of the body mark and the trouble of recording at the time of ultrasonic inspection.

  Further, in the above-described embodiment, as the incidental information regarding the subject region, it has been described that the visual tactile information at the time of photographing, the observation information regarding the region of interest, and the evaluation result regarding the structure of the breast are generated and displayed. There is no need to generate it as incidental information.

  Further, for example, in the above embodiment, the server apparatus 3 and the image display apparatus 4 are configured as separate apparatuses, but the client server system may be realized as a single apparatus. Good. That is, a program for causing a computer to function as a display unit, a specification unit, an estimation unit, a generation unit, a display control unit, and an editing unit is stored in the storage unit of the apparatus, and the control unit such as a CPU cooperates with the program. It is good also as implement | achieving these functions by. Further, the function of the abnormal shadow candidate detection device 2 may be incorporated in the same device.

  In the above-described embodiment, the case where the region designated by the operation unit 42 on the breast image displayed on the viewer screen 431 on the image display device 4 is designated as the attention region has been described as an example. The region of the abnormal shadow candidate detected from the breast image by the device 2 may be designated as the attention region.

  In the above-described embodiment, the case where the subject part is the breast has been described as an example. However, the present invention may be applied to support the combined examination of the X-ray examination and the ultrasonic examination for other parts.

  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 apparatus constituting the medical image system can be changed as appropriate without departing from the spirit of the present invention.

DESCRIPTION OF SYMBOLS 100 Medical image system 1 Image generation apparatus 2 Abnormal shadow candidate detection apparatus 3 Server apparatus 31 Control part 32 Operation part 33 Display part 34 Communication part 35 Storage part 351 Image DB
36 Bus 4 Image display device 41 Control unit 42 Operation unit 43 Display unit 431 Viewer screen 432 Finding entry screen 433 Input screen 44 Communication unit 45 Storage unit 46 Bus 5 Ultrasound diagnostic device 6 Diagnosis terminal

Claims (16)

Display means for displaying one or more medical images obtained by imaging a subject region;
Designation means for designating a region of interest from the medical image;
Estimating means for estimating the position of the attention area when the subject part is viewed from the front, based on the position of the attention area of the medical image;
Generating means for generating clinical position information indicating the position of the region of interest when the subject portion estimated by the estimating means is viewed from the front;
Display control means for displaying the generated clinical position information on the display means;
Editing means for editing the clinical position information displayed on the display means;
A medical image system comprising:   The medical image system according to claim 1, wherein the editing unit changes the position of the region of interest in the clinical position information displayed on the display unit according to a user operation.   The medical image system according to claim 1, wherein the editing unit adds the position of the attention area in the clinical position information displayed on the display unit according to a user operation.   The medical image system according to any one of claims 1 to 3, wherein the editing unit deletes the clinical position information displayed on the display unit according to a user operation.   The said clinical position information is an image which showed the position of the said attention area | region on the schema image when the said object site | part used in an ultrasonic examination is seen from the front. Medical imaging system.   When the clinical position information is not edited by the editing unit with respect to the position of the region of interest on the medical image, the editing unit displays the clinical position information of the region of interest generated by the generating unit. The medical image system according to any one of claims 1 to 5, further comprising a storage unit that stores the edited clinical position information of the attention area in association with each other when the clinical position information is edited. When the clinical position information is not edited by the editing means with respect to the position of the attention area on the medical image, the editing means displays the clinical position information of the attention area generated by the generating means. A second generating unit configured to generate an image in which the clinical position information of the region of interest after editing is associated with the edited clinical position information;
Transmitting means for transmitting the image generated by the second generating means to a diagnostic terminal;
A medical image system according to any one of claims 1 to 6. Detecting means for detecting an abnormal shadow candidate from the medical image;
The medical image system according to claim 1, wherein the display unit displays an abnormal shadow candidate area detected by the detection unit on the medical image.   The medical image system according to any one of claims 1 to 8, wherein the subject part is a breast, and the medical image is a breast image obtained by X-raying the breast.   The medical image system according to any one of claims 1 to 9, further comprising incidental information generation means for generating incidental information related to the subject part.   The medical image system according to claim 10, wherein the display control unit displays the clinical position information and / or the incidental information on the same screen as the medical image on which the region of interest is displayed. Comprising an input means for a user to input the incidental information;
The medical image system according to claim 10 or 11, wherein the auxiliary information generation unit generates the auxiliary information based on an input from the input unit.   The medical image system according to claim 12, wherein the incidental information includes at least one of visual and tactile information of the subject part and finding information for the attention area.   The medical image system according to any one of claims 10 to 13, wherein the auxiliary information generation unit generates the auxiliary information by analyzing the medical image.   When the subject part is a breast and the medical image is a breast image obtained by X-raying the breast, the incidental information generation means analyzes the breast image to evaluate the configuration of the breast 15. The medical image system according to claim 14, wherein the evaluation result is generated as the incidental information. Computer
Display means for displaying one or more medical images obtained by imaging a subject region;
A designation means for designating a region of interest from the medical image;
Estimating means for estimating the position of the attention area when the subject part is viewed from the front based on the position of the attention area of the medical image;
Generating means for generating clinical position information indicating the position of the region of interest when the subject portion estimated by the estimating means is viewed from the front;
Display control means for displaying the generated clinical position information on the display means;
Editing means for editing the clinical position information displayed on the display means;
Program to function as.