JP2019081074A - Medical image diagnostic device and guide device - Google Patents

Abstract

To provide a medical image diagnostic device and a guide system that enable flexible support by which a subject, especially a hearing-impaired subject can receive an examination with an ease of mind by providing a guide display that reflects a medical worker's intension sufficiently.SOLUTION: A medical image diagnostic device A provided with a display unit 1gc in a trestle 2e for acquiring internal information on a subject M that generates a medical image of the subject M based on the internal information includes: a guide display content input unit 20 for an operator who operates the medical image diagnostic device A to input a free description sentence; and a guide display control unit 30 for causing the display unit 1g to display guide information on an examination for the subject M and a content input by the guide display content input unit 20.SELECTED DRAWING: Figure 3

Description

  Embodiments of the present invention relate to a medical image diagnostic apparatus and a guide apparatus.

  BACKGROUND In recent years, a medical image diagnostic apparatus has been used which collects information inside a subject and images the inside of the subject based on the collected information to generate a medical image. As this medical image diagnostic apparatus, for example, an X-ray CT apparatus (computed tomography: computed tomography apparatus), a magnetic resonance diagnostic apparatus (MRI: magnetic resonance imaging) or the like corresponds. The generated medical image is used, for example, at the time of image interpretation or medical examination.

  In order to generate the medical image, it is necessary to image a subject using a medical image diagnostic apparatus, but it is necessary to appropriately guide a subject who is not accustomed to imaging. In particular, when the subject is a hearing impaired person, it is often difficult to guide the subject by voice from a medical worker such as a doctor or an engineer. That is, it is necessary to perform guidance by displaying the guide and the contents using any display means.

  Up to now, for example, words used frequently as guide display are described in advance in paper, and the paper is dealt with by showing the paper to a subject who is a person with hearing impairment in a necessary scene. Further, as described in Patent Document 1 below, a method is also adopted in which a necessary guide or the like is displayed on a gantry mounted display provided in the gantry.

JP, 2014-028317, A

  However, in the invention disclosed in Patent Document 1, the following points are not taken into consideration.

  That is, the contents to be displayed on the gantry mounted display can be obtained by reading out the audio or the image from the audio file reproduced according to the control signal representing the inspection stage or the image file associated with the audio file. Become. Reading out an audio file or the like in this manner means that a plurality of audio files or the like relating to voice instructions to the subject ordered according to the progress status of the examination are set or the like by the administrator. In such a method, although there is a great advantage in providing the subject with a display according to the progress of the examination as appropriate, on the other hand, it is possible to display only so-called routine words prepared in advance. In other words, it is not possible to display a detailed guide in consideration of the place of examination and the characteristics of the subject.

  Further, when audio files and the like are ordered and stored in the audio file and the like, it is difficult to freely change the display on the subject when the order of examinations and the like are changed. That is, from the viewpoint of providing a flexible guide display according to the inspection of the subject, it is inevitable that the display becomes somewhat rigid.

  Furthermore, considering that medical workers often can not touch the input unit etc. of the medical image diagnostic apparatus during a procedure such as examination, a NUI (Natural User Interface) can communicate its intention without touching the input unit. There are advantages to using).

  The present invention has been made to solve the above-mentioned problems, and the object of the present invention is to provide a guide display sufficiently reflecting the intention of a medical worker, thereby causing impairment in a subject, in particular hearing. It is an object of the present invention to provide a medical image diagnostic apparatus and a guide apparatus which enable flexible support so that a subject can receive an examination with ease.

  A feature of the invention according to claim 1 is a medical image diagnostic apparatus for generating a medical image of a subject based on internal information of the subject in a medical image diagnostic apparatus, wherein guidance to a subject by a medical worker is provided. And a guide display content input unit that generates a guide display for the subject based on the information stored in the storage unit of the medical image diagnostic apparatus and the information on the inspection process created based on the scan plan for the subject And a guide display control unit that causes the display unit to display the content input by the content input unit.

  The feature of the invention according to claim 7 is that in the guide apparatus, a scan plan for the subject stored in the storage unit of the medical image diagnostic apparatus for generating guidance to the subject by the medical worker and the medical image of the subject A guide display content input unit for generating a guide display for the subject based on the information of the inspection process created on the basis of the inspection process, and the content input by the guide display content input unit is displayed on the display unit for the subject And a guide display control unit for displaying a guide.

FIG. 1 is an overall view showing an entire configuration of a medical image diagnostic apparatus in a first embodiment. It is a block diagram showing an internal configuration of a control device in a 1st embodiment. It is a block diagram which shows the internal structure of the guide display content input part in 1st Embodiment. FIG. 2 is a block diagram mainly showing an internal configuration of a scanner device in the medical image diagnostic device in the first embodiment. It is a flow chart which shows a flow of performing guide display of an inspection to a subject in an embodiment. It is a flow chart which shows a flow of performing guide display of an inspection to a subject in an embodiment. It is a flow chart which shows a flow of performing guide display of an inspection to a subject in an embodiment. It is explanatory drawing which shows an example of the test process produced based on scan data in embodiment. It is an explanatory view showing arrangement of a display which constitutes a medical image diagnostic device in an embodiment. It is an example of a screen which shows an example of a screen of a guide display displayed to a subject in an embodiment. It is an example of a screen which shows an example of a screen of a guide display displayed to a subject in an embodiment. It is an explanatory view showing a display mode of a guide display displayed on a subject in an embodiment. It is an explanatory view showing a display mode of a guide display displayed on a subject in an embodiment. It is an explanatory view showing a display mode of a guide display displayed on a subject in an embodiment. It is an explanatory view showing a display mode of a guide display displayed on a subject in an embodiment. It is a block diagram which shows another internal structure of the guide display content input part in 1st Embodiment. It is a general view showing the whole guide system composition containing a guide device in a 2nd embodiment. It is a block diagram showing an internal configuration of a guide device in a 2nd embodiment.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

First Embodiment
FIG. 1 is an overall view showing an entire configuration of a medical image diagnostic apparatus A in the first embodiment. The medical image diagnostic apparatus A includes the control apparatus 1 for controlling the medical image diagnostic apparatus A, the scanner apparatus 2 installed in the examination room R and acquiring internal information of the subject M to be examined, and the subject M mounted thereon. And a bed apparatus B to be placed.

  Here, the medical image diagnostic apparatus A is an apparatus that acquires internal information of the subject M and generates a medical image. Although various apparatuses (modalities) as described above can be considered as the medical image diagnostic apparatus A, in the embodiment of the present invention, an X-ray CT apparatus will be described below as an example.

  FIG. 2 is a block diagram showing an internal configuration of the control device 1 in the first embodiment. The control device 1 controls the entire device of the medical image diagnostic device A.

  In the control device 1, a central processing unit (CPU) 1a, a read only memory (ROM) 1b, a random access memory (RAM) 1c, and an input / output interface 1d are connected via a bus 1e. An input unit 1 f, a display unit 1 g, a communication control unit 1 h, a storage unit 1 i, a removable disk 1 j, and a drive unit control unit 1 k are connected to the input / output interface 1 d. The drive unit control unit 1k controls the movement of each drive unit that drives each unit constituting the scanner device 2 described later.

  Furthermore, the sensor 10, the guide display content input unit 20, and the guide display control unit 30 are connected via the input / output interface 1d.

  The CPU 1a reads and executes a boot program for activating the control device 1 from the ROM 1b based on an input signal from the input unit 1f, and reads out various operating systems stored in the storage unit 1i. The CPU 1a also controls various devices based on input signals from other external devices (not shown in FIG. 2) via the input unit 1f and the input / output interface 1d.

  Furthermore, the CPU 1a reads the program and data stored in the RAM 1c, the storage unit 1i, etc. and loads the read program and data into the RAM 1c, and displays the guide for the subject M based on the program command read from the RAM 1c. It is a processing device that realizes a series of processes such as calculation and processing of data.

  The input unit 1 f is configured of an input device such as a keyboard or a dial through which an operator of the control device 1 (for example, a medical worker such as a doctor or a test engineer) inputs various operations, and based on the operator's operation An input signal is generated and transmitted to the CPU 31 via the bus 1 e.

  The display unit 1g is, for example, a liquid crystal display. The display unit 1g receives an output signal from the CPU 1a via the bus 1e, and displays various guide displays performed on the subject M during the examination, the processing result of the CPU 1a, and the like.

  Here, as a configuration of the display unit 1g instead of the liquid crystal display, for example, a configuration may be adopted in which a guide display is displayed on the screen using a projector (projectors 1ga and 1gb shown in FIG. 1). Further, in the medical image diagnostic apparatus A shown in FIG. 1, the display unit 1 gc is provided on the top of the gantry 2 e of the scanner device 2. The display unit 1gc is, for example, a monitor, and is used when the medical worker confirms the guide display given by the user and the response of the subject M.

  The communication control unit 1 h is a means such as a LAN card or a modem, and is a means capable of connecting the control device 1 to a communication network such as the Internet or a LAN. Data transmitted to and received from the communication network via the communication control unit 1 h is transmitted to and received from the CPU 1 a via the input / output interface 1 d and the bus 1 e as an input signal or an output signal.

  The storage unit 1i is configured of a semiconductor or a magnetic disk, and stores programs and data executed by the CPU 1a. In addition, a scan plan and the like regarding an examination performed by the medical image diagnostic apparatus A are also stored.

  The removable disk 1 j is an optical disk or a flexible disk, and signals read and written by the disk drive are transmitted to and received from the CPU 1 a via the input / output interface 1 d and the bus 1 e.

  Further, the medical image diagnostic apparatus A is connected to a sensor 10 for detecting voice and an action of a medical worker who performs an examination of the subject M using the subject M and the medical image diagnostic apparatus A. The sensor 10 includes, for example, an RGB camera, a depth sensor, a microphone and the like, and information detected by the sensor 10 is transmitted to the control device 1.

  For example, the sensor 10 emits infrared light to the surroundings, and the light receiving element detects a reflected wave that the irradiation wave has reflected on the surface of the subject M or a medical worker. Then, the sensor 10 obtains the distance between the subject M or the medical worker and the sensor 10 based on the phase difference between the irradiation wave and the reflected wave and the time from irradiation to detection, and the distance of one frame corresponding to the imaging range Information of an image (position information (hereinafter, such position information is referred to as “distance image”) having information of a distance from the sensor 10 to the subject M or a medical worker is generated.

  In this distance image information for one frame, for example, the distance between the object M corresponding to the pixel and the medical worker and the sensor 10 is associated with each pixel included in the information of the imaging time and the imaging range. Information is included. The sensor 10 shoots a moving image of a shooting range by generating range image information of a plurality of continuous frames from reflected waves detected one after another.

  The method for the sensor 10 to detect the voice or the motion of the subject M or a medical worker is not limited to the method described above. For example, Kinect (registered trademark) or the like can be used.

  The guide display content input unit 20 has a function of generating a guide display to be performed on the subject M based on the voice and the motion of the medical worker who is the operator during the examination. FIG. 3 is a block diagram showing an internal configuration of the guide display content input unit 20 in the first embodiment.

  The guide display content input unit 20 receives the information necessary to generate a guide display to be displayed on the subject M, the recognition unit 22, the analysis unit 23, the judgment unit 24, and process creation It comprises a unit 25, a state management unit 26, and a transmission unit 27 for transmitting the guide display to the display unit 1g in order to display the generated guide display on the display unit 1g. The detailed functions of the units constituting the guide display content input unit 20 will be described together with the flow of guide display generation and display.

  Further, the guide display generated by the guide display content input unit 20 is transmitted to the guide display control unit 30. The guide display control unit 30 displays the received guide display on the display unit 1g or the display unit 1gc provided on the top of the gantry 2e.

  The internal configuration of the control device 1 has been described above, but the control device 1 is indicated by a broken line in FIG. This is because the control device 1 does not have to be installed in the examination room R in which the scanner device 2 and the bed device B are installed. Therefore, the control device 1 may be installed in the examination room R or, for example, may be installed in a room adjacent to the examination room R.

  The medical image diagnostic device A includes a scanner device 2 controlled by the control device 1. FIG. 4 is a block diagram mainly showing the internal configuration of the scanner device 2 in the medical image diagnostic device in the first embodiment. The scanner device 2 is usually installed in the examination room R, and generates X-ray transmission data on the subject M.

  The scanner device 2 includes an X-ray tube (X-ray source) 2a, an aperture 2b, an X-ray detector 2c, a DAS (Data Acquisition System) 2d, a gantry (base) 2e, a high voltage power source 2f, an aperture It comprises a driving device 2g, a gantry driving device 2h, and a top driving device B2.

  The X-ray tube 2a generates an X-ray by causing an electron beam to collide with a metal target in accordance with a tube voltage supplied from the high voltage power supply 2f, and irradiates it toward the X-ray detector 2c. A fan beam X-ray or a cone beam X-ray is formed by the X-ray irradiated by the X-ray tube 2a.

  The diaphragm 2b adjusts the irradiation range in the slice direction of the X-ray irradiated from the X-ray tube 2a by the diaphragm driving device 2g. By this, the irradiation range of the X-ray in the slice direction can be changed to any direction.

  The X-ray detector 2c detects an X-ray that has been irradiated from the X-ray tube 2a and transmitted through the subject M. The X-ray detector 2c may be, for example, a one-dimensional array detector having a plurality of detection elements in the channel direction and a single detection element in the row (slice) direction. Alternatively, it may be a matrix, that is, a two-dimensional array detector having a plurality of detection elements in the channel direction and a plurality of detection elements in the column direction.

  The DAS 2 d amplifies signals of transmission data detected by the respective X-ray detection elements constituting the X-ray detector 2 c and converts them into digital signals. Output data from the DAS 2 d is transmitted to the control device 1.

  The gantry 2e irradiates the subject M with X-rays and detects the transmitted X-rays. Therefore, in order to enable entry and exit of the subject M, a tunnel-like opening 2i is provided at the center of the gantry 2e. The gantry 2e holds the X-ray tube 2a, the diaphragm 2b, the X-ray detector 2c, and the DAS 2d integrally therein.

  Here, the X-ray tube 2a and the X-ray detector 2c are disposed at mutually opposing positions in the gantry 2e. Further, the gantry 2e performs imaging by rotating the X-ray tube 2a, the diaphragm 2b, the X-ray detector 2c, and the DAS 2d as a single unit around the subject M at the rotation center.

  The high voltage power supply 2 f is controlled by the control device 1 to supply the X-ray tube 2 a with the power necessary for the X-ray irradiation from the X-ray tube 2 a.

  The diaphragm driving device 2g includes a mechanism for adjusting the irradiation range of the diaphragm 2b in the slice direction of the X-ray. The diaphragm driving device 2g adjusts the irradiation range under the control of the control device 1.

  Under the control of the control device 1, the gantry driving device 2h is placed on the top B1 in the opening 2i of the gantry 2e while maintaining the positional relationship of the equipment held by the gantry 2e inside. The gantry 2e is rotated so as to rotate around the sample M.

  In addition, the gantry 2e itself is moved to perform imaging at an optimal position when imaging the subject M. That is, in the medical image diagnostic apparatus A according to the embodiment of the present invention, the top board B1 constituting the bed apparatus B installed on the floor surface of the examination room R adopts a configuration in which the opening 2i of the scanner apparatus 2 penetrates. There is. Therefore, instead of moving the bed apparatus B (top board B1) on which the subject M is placed to enter and leave the opening 2i, the scanner apparatus 2 itself is left and right in the overall view shown in FIG. By moving, the gantry 2e is moved to a position suitable for imaging to cope with it.

  The couch device B includes a top B1 and a top drive B2. When acquiring internal information of the subject M using the X-ray CT apparatus 1, that is, when imaging, the subject M is in direct contact with the top B1. When the subject M is in direct contact with the top B1, the posture may be other than lying. The top driving device B2 is provided under the top B1 under the control of the control device 1, and along the height direction, the top B1 on which the subject M is placed along with the progress of imaging with the gantry 2e. Raise and lower.

  In addition, projector 1ga, 1gb which comprises the display part 1g is installed in the both ends of the long side direction of the bed apparatus B in embodiment of this invention. The projectors 1ga and 1gb are used when performing guide display on the subject M on the bed apparatus B.

  Next, the flow of the guide display on the subject M who receives the examination will be described. FIG. 5 to FIG. 7 are flowcharts showing the flow of guide display of the examination on the subject M in the embodiment.

  First, the process creation unit 25 in the guide display content input unit 20 acquires a scan plan grasped by the control device 1 of the medical image diagnostic device A (ST1 in FIG. 5). That is, in the medical image diagnostic apparatus A, a scan plan is determined in advance when performing an examination (scan) of the subject M. The scan plan defined in the medical image diagnostic apparatus A is stored, for example, in the storage unit 1i.

  The scan plan is created in consideration of various conditions such as, for example, a disease and a region to be examined. Alternatively, in consideration of the constitution and the like of the subject M, it may be created for each subject M to be an inspection target. Then, the examination of the actual subject M using the medical image diagnostic apparatus A is performed in accordance with the created scan plan. That is, by referring to the scan plan, it is possible to grasp the entire flow of the examination and the contents of each treatment. Therefore, the guide display content input unit 20 of the medical image diagnostic apparatus A uses the scan plan when providing guide display in an examination performed on the subject M.

  The process creation unit 25 acquires the scan plan stored in the storage unit 1i, and creates an inspection process based on the scan plan (ST2). As described above, the medical image diagnostic apparatus A performs voice guidance on the subject M based on the created process (ST3).

  FIG. 8 is an explanatory view showing an example of an inspection process created based on scan data in the embodiment. Here, for convenience of explanation, although the inspection process of an aspect like an explanatory view is shown, the process creation part 25 does not necessarily need to create an inspection process like this explanatory view.

  In the explanatory view shown in FIG. 8, the time concerning the whole inspection is shown at the top. That is, the “total inspection required time”, which is the time taken for the entire inspection, is indicated as “26 minutes”. In addition, the scheduled start time and the scheduled end time of the examination are also shown, which are “10:30 am” and “10:56 am”, respectively.

  On the other hand, in the middle and lower sections, individual treatments to be performed in the present examination are shown along with their order and required time. That is, in the present inspection process, first, “scano” is performed, and then “whole body” imaging is performed. Then, imaging before the contrast agent is administered ("before imaging") and imaging after the contrast agent is administered ("after imaging") are scheduled. The time taken for each treatment is "20 seconds", "20 seconds", "10 seconds" and "10 seconds", respectively. In addition, the time (interval) between each treatment is 5 minutes except for 15 minutes between imaging before and after contrast agent administration.

  The process creation unit 25 creates such an examination process based on the scan plan provided in the medical image diagnostic apparatus A. In addition, guide display is performed using this inspection process.

  When voice guidance to the subject M is performed in the medical image diagnostic apparatus A, the sensor 10 grasps the guidance (ST4). In the following, the flow of guide display on the subject M will be described on the premise that the medical image diagnostic apparatus A performs the process of voice guidance in this manner. However, there is no voice guidance by the medical image diagnostic apparatus A, and the medical staff directly performs voice guidance (guidance) on the subject M in accordance with the prepared examination process, and based on the guidance. A flow may be employed such that guide display is performed on the display unit 1g.

  The guidance information grasped in the sensor 10 is sent to the recognition unit 22 through the reception unit 21 of the guide display content input unit 20, and the guidance display content input unit 20 recognizes the voice guidance by the medical image diagnostic apparatus A. (ST5). The recognition unit 22 further sends information on the guidance to the analysis unit 23, and the analysis unit 23 analyzes the recognized guidance (ST6). The analysis unit 23 analyzes the voice guidance recognized by the recognition unit 22 and grasps the content thereof.

  At the same time, the state management unit 26 of the guide display content input unit 20 grasps the current state of the medical image diagnostic apparatus A (ST7). As described above, in the medical image diagnostic apparatus A, each unit is controlled by the control device 1 based on the scan plan. Therefore, by grasping the control content of the control device 1, the medical image diagnostic apparatus A actually performs what kind of examination at present, or how to control each part such as the driving part to carry out the examination. Can recognize the

  Further, the state management unit 26 may obtain information for grasping the state of the medical image diagnostic apparatus A by communicating with the process creation unit 25.

  About the content of the guidance of the medical image diagnostic apparatus A analyzed in the analysis unit 23, the information on the inspection process created in the process creation unit 25, and the current state of the medical image diagnostic apparatus A grasped by the state management unit 26 Information is collected in the determination unit 24. Based on these pieces of information, the determination unit 24 determines whether the analysis result matches the current state of the medical image diagnostic apparatus A (ST 8). This determination is made here because if the content of the guidance and the current state of the medical image diagnostic apparatus A do not match, it may lead to the display of an inappropriate guide on the subject M.

  As a result of the determination, if the analysis result and the current state of the medical image diagnostic apparatus A do not match (NO in ST8), the state management unit 26 again determines the current state of the medical image diagnostic apparatus A, It is determined whether the analysis result grasped by the unit 24 matches the current state of the medical image diagnostic apparatus A or not.

  On the other hand, when the analysis result matches the current state of the medical image diagnostic apparatus A (YES in ST8), the determination unit 24 performs medical image diagnosis based on the analysis result with respect to the guide display control unit 30 via the transmission unit 27. It instructs to display the contents of the guidance made by the device A on the display unit 1g (ST9). By performing such processing, the audio guidance by the medical image diagnostic apparatus A becomes a guide display represented by characters on the display unit 1g.

  The voice guidance by the medical image diagnostic apparatus A is displayed as characters, so that the subject M can check, for example, what posture with respect to the subject M, with what contents the examination to be performed now or next. You can check if you are requesting to take. In particular, in the case where the subject M is a deaf person, the guide display by characters smoothly conducts the examination, and it is a tool capable of reducing the anxiety of the subject M during the examination even by a little.

  FIG. 9 is an explanatory view showing the arrangement of the display unit 1g constituting the medical image diagnostic apparatus A according to the embodiment. The display unit 1g here is configured of, for example, a projector and a screen on which a display guide projected by the projector is displayed.

  In the explanatory view shown in FIG. 9, the scanner device 2 is shown at the center. That is, the gantry 2e is shown in color, and the top plate B1 and the head of the subject M lying on the top plate B1 are visible in the opening 2i. That is, FIG. 9 is a view looking in the direction from the head of the subject M facing the foot. A projector 1 ga is installed in the vicinity of the head of the subject M and at the end of the top B 1 (see also the general view of FIG. 1). Then, for example, the projector 1ga causes the screen 1gd to the projector 1gf to display a guide display, thereby providing necessary information to the subject M.

  In FIG. 9, one on the ceiling of the examination room R in which the scanner device 2 of the medical image diagnostic device A is installed, and a position facing each other with the scanner device 2 interposed therebetween, and the bed device B (top plate B1) Two screens 1 gd to 1 gf are provided parallel to the longitudinal direction of the screen.

  The screen 1gd provided on the ceiling is used when the subject M is lying on the top B1 in a supposing manner. When the guide display is made, the screen 1gd can be seen just in front of the subject M lying on his back. On the other hand, the screens 1ge and 1gf are used, for example, when the subject M is in any direction.

  Any of the screens 1gd to 1gf is provided to correspond to various body positions of the subject M on the top B1, and the subject M is displayed at a position where the guide display can be easily viewed regardless of the body position. Therefore, the guide display can be accurately grasped.

  The installation positions of the screens 1gd to 1gf are determined in consideration of the physical position which the subject M can take in the examination, the installation situation of various devices in the examination room R, and the like. Further, although the projector 1ga and the screens 1gd to 1gf have been described as an example here, the screens 1gd to 1gf may be monitors, for example. In this case, the projectors 1ga and 1gb provided at both ends in the longitudinal direction of the bed apparatus B become unnecessary.

  FIGS. 10 and 11 are screen examples showing an example of a guide display screen displayed on the subject in the embodiment. Here, although “screen example” is shown, the display unit 1g may be a screen or a monitor.

  The screen example of FIG. 10 shows the flow of the entire inspection and the current position of the flow of the entire inspection using the inspection process generated by the process generation unit 25. The entire screen configuration is substantially the same as the inspection process described in FIG.

  According to the screen example, in the examination process, “scano” and “whole body” have been completed so far, and it is in the midst of transition from “whole body” to “before contrast”. This is because a vertical bar is shown at this position to indicate where in the inspection process it is located. This bar moves to the right on the screen, which is the direction of the arrow connecting each treatment, as the test progresses. In addition, about the display mode which shows in which position of all the inspection processes now, it is possible to set freely.

  In addition, an interval of 5 minutes is provided between "whole body" and "before imaging", but that time is 5 minutes. In the screen example of FIG. 10, the display of "5 minutes" is blinking. The blinking display makes it possible to grasp the current position in the entire process of the inspection. In addition, although the present position is shown here by blinking time, for example, a display aspect may be what kind of aspect, such as changing and displaying a color.

  Furthermore, for each treatment that constitutes an examination, a solid line is shown for the treatment being performed or completed, and a broken line is shown for the treatment that has not been performed. Therefore, since “scano” and “whole body” are ended, they are displayed surrounded by a solid line. On the other hand, the unexecuted “before contrast” and “after contrast” are displayed surrounded by dashed lines.

  FIG. 11 is a detailed guide displayed while the procedure is being performed. In the screen example shown in FIG. 11, the correspondence required for the subject M in the treatment is shown under the display of “detail display”. Here, three correspondences are shown: "breathe in," "breathe in," and "please ease."

  The correspondence indicated by the solid line is the correspondence during or corresponding to the correspondence, and the correspondence indicated by the broken line is the non-corresponding. Each correspondence proceeds from right to left, and as far as the display in FIG. 11 is seen, the subject M is currently inhaling based on the instruction “breathe in”.

  At the bottom of the screen, a bar indicating the degree of progress of the correspondence is displayed, and the degree of progress can be understood by moving the triangular display from the left to the right. In addition, time is shown between the bar and the corresponding display, and it can be understood that the "breathing time" is "10 seconds".

  Next, the guide display content input unit 20 confirms whether the medical worker has any movement (ST10). The movement of the medical worker here is based on the fact that the voice guidance of the medical image diagnostic apparatus A is guided and displayed as character information, and it is linked to the guide display performed by the medical image diagnostic apparatus A, so to speak. .

  Specifically, the motion of the medical staff is grasped by the sensor 10 (ST11). Note that the “movement” here includes not only a movement related to a so-called gesture such as a medical worker swinging an arm or returning a wrist, for example, a voice emitted by a medical worker or the like.

  Information on the movement of the medical worker grasped by the sensor 10 is sent to the recognition unit 22 through the reception unit 21 of the guide display content input unit 20, and the movement of the medical worker is recognized in the guide display content input unit 20. (ST12). The recognition unit 22 further sends information on the movement to the analysis unit 23, and the analysis unit 23 analyzes the movement recognized by the recognition unit 22 (ST13 in FIG. 6). The analysis unit 23 analyzes the movement of the medical staff and grasps the contents.

  Here, the point is that the analysis unit 23 grasps the movement of the medical staff, in particular, the contents that the medical staff instructed (guided) in a voice, as it is.

  That is, until now, for example, the fixed display contents prepared in advance in accordance with the movement of the medical staff are selected each time and are only displayed mechanically. This is the same as when a medical worker displays a guide display by pressing a button, for example.

  The fixed guide display has an advantage in that it does not select the subject to be the target of the guide display, but it can not display the contents considered by the medical staff until its fine nuance. Although it depends on the subject, particularly when the hearing impaired person becomes the subject, the instruction from the medical staff may basically be only from the characters displayed on the display unit 1g. In such a case, it may be considered that the subject can not sufficiently grasp the meaning of the guide by the medical staff only by the standard guide display.

  Therefore, in the embodiment of the present invention, the contents expressed by the medical staff are displayed not as a fixed form but as much as possible without shifting the intention. Therefore, the analysis unit 23 analyzes the movement of the medical worker so that the expression content of the medical worker can be freely described and displayed on the display unit 1g.

  In addition, for example, in the case where a certain guide display is assigned in advance to the movement of a medical worker, the guide display has to be a fixed form, and a free display is not performed until such a case. It means that the expression contents of the medical staff can be freely described and displayed as much as possible.

  As described above, since it is possible to perform non-standard guide display from the movement of the medical worker, it is possible to more appropriately convey the medical worker's intention to the subject M. In addition, it becomes easy to understand the intention as the subject M.

  At the same time, the state management unit 26 of the guide display content input unit 20 grasps the current state of the medical image diagnostic apparatus A (ST14).

  Information on the movement of the medical worker analyzed in the analysis unit 23, information on the inspection process created in the process creation unit 25, and information on the current state of the medical image diagnostic apparatus A grasped by the state management unit 26 Are collected in the determination unit 24. Based on these pieces of information, the determination unit 24 determines whether the analysis result matches the current state of the medical image diagnostic apparatus A (ST15).

  As a result of the determination, if the analysis result and the current state of the medical image diagnostic apparatus A do not match (NO in ST15), the state management unit 26 again determines the current state of the medical image diagnostic apparatus A, It is determined whether the analysis result grasped by the unit 24 matches the current state of the medical image diagnostic apparatus A or not.

  On the other hand, when the analysis result and the current state of the medical image diagnostic apparatus A agree with each other as a result of determination (YES in ST15), the determination unit 24 transmits the analysis result to the guide display control unit 30 via the transmission unit 27. And instructs the display unit 1g to display the contents of the movement of the medical worker (ST16). By performing such a process, the movement of the medical worker becomes text information and becomes a guide display displayed on the display unit 1g.

  In the embodiment of the present invention, the guide display indicating the movement of the medical worker is not displayed as a fixed sentence as described above, but is displayed with an appropriate word according to the scene. . For this reason, the medical staff performs an optimal guide to see the characteristics of each subject who receives the examination, and the guide is displayed as a guide display without losing the optimality of the guide. Therefore, as in the past, for example, a guide to be displayed for each examination is determined, and all the subjects who undergo the examination based on the displayed definite wording without considering the characteristics etc. of the individual subjects It is possible to avoid the situation where the subject has to respond, and the subject feels it difficult to cope.

  Further, the guide display content input unit 20 confirms whether or not the subject M has some movement (ST17). That is, the movement of the subject M here is an answer to the guide display made by the medical staff.

  Specifically, as the sensor 10 acquires the motion of the subject M, it is understood that there is an answer from the subject M (ST18). Note that the “answer” here includes not only the motion of the subject M swinging his arm, and sign language, for example, but also the voice and the like emitted by the subject M, for example.

  Information on the response of the subject M acquired by the sensor 10 is sent to the recognition unit 22 through the receiving unit 21 of the guide display content input unit 20, and the guide display content input unit 20 recognizes the response of the subject M. (ST19). The recognition unit 22 further sends information on the response to the analysis unit 23, and the analysis unit 23 analyzes the response recognized by the recognition unit 22 (ST20). The analysis unit 23 analyzes the response of the subject M and grasps the content thereof. Here, the content that the subject M answers is obtained by the analysis unit 23 as it is.

  Information on the response of the subject M analyzed in the analysis unit 23 is transmitted to the determination unit 24. Based on this information, the determination unit 24 instructs the guide display control unit 30 via the transmission unit 27 to display the contents of the reply of the subject M on the display unit 1g based on the analysis result (ST21). By performing such processing, the reply of the subject M is displayed as character information on the display unit 1g.

  Here, although the processing for directly displaying the response of the subject M is described here, for example, when displaying the response of the subject M, as in the case of displaying the movement of the medical worker, the treatment in the medical image diagnostic apparatus A It is also possible to display the reply of the subject M on the display unit 1g after confirming the current state of the subject.

  The medical worker grasps the answer of the subject M displayed in characters by looking at the display 1g, for example, the monitor 1gc provided on the upper part of the gantry 2e, and displays the guide displayed by himself or the medical image diagnostic apparatus A It can be confirmed whether or not the information is properly transmitted to the subject M. The medical worker confirms the display and moves on to the next operation such as continuation of the examination.

  Further, the medical image diagnostic apparatus A also proceeds to the next process of the inspection process based on the instruction of the medical staff. Then, when the guide display content input unit 20 also proceeds to the next process, the guide display content input unit 20 confirms the next inspection process again (ST22). Further, the state management unit 26 confirms the current state of the treatment in the medical image diagnostic apparatus A (ST23), and transmits these pieces of information to the judgment unit 24. The determination unit 24 determines whether a new guide display is necessary in the next step (ST24). As a result, when the guide display is required even in the new process (YES in ST24), the medical image diagnostic apparatus A performs guidance (ST3 in FIG. 5), and the guide display as described above is performed again.

  On the other hand, when all the examinations based on the scanner plan are finished, the guide display does not need to be displayed on the subject M any more (NO in ST24), and the guide display is ended.

  The flow of the display of the guide display presented to the subject M during the examination has been described above. The guide display on the subject M is performed, for example, by displaying on the screens 1gd to 1gf provided at positions as shown in FIG.

  Next, an inspection is actually performed on the subject M, and an aspect of the display of the guide display on the subject M while the scanner device 2 is moving will be described using the drawings.

  12 to 15 are explanatory diagrams showing display modes of the guide display displayed on the subject M in the embodiment. Here, as shown in the overall view of FIG. 1, projectors 1 ga and 1 gb are provided at both ends in the long side direction of the bed apparatus B. Further, the display of the control device 1 shown in FIG. 1 is omitted.

  Furthermore, in this case, when displaying the guide display using the projectors 1ga and 1gb, it is displayed on the wall (ceiling) as it is without using a screen in particular. That is, even when the projectors 1ga and 1gb constituting the display unit 1g are used, the screen is not necessarily required. For example, a flat area having a certain size on the ceiling or the wall surface of the inspection room R If it can be secured, the area can be regarded as a screen to display a guide display.

  FIG. 12 shows the display mode of the guide display at the time when the examination starts. The scanner device 2 is in the vicinity of the head of the subject M and moves from left to right as indicated by the large arrow in the drawing. Since the top board B1 of the bed apparatus B is installed so as to penetrate the opening 2i of the scanner apparatus 2, the subject M remains lying on the top board B1 without moving during the examination.

  In this state, the guide display for the subject M is projected and displayed from the projector 1gb toward the ceiling which looks like a screen. In FIG. 12, the projection of the guide display is indicated by a dotted line extending from the projector 1gb, and the line of sight of the subject M is indicated by a broken arrow. In this state, the guide display is displayed on the ceiling seen at the end of the line of sight of the subject M.

  As shown in FIG. 13, even if the scanner apparatus 2 moves and the head of the subject M enters the opening 2 i, the projector can be viewed if the guide display displayed on the ceiling is visible from the position of the subject M. The display by 1 gb continues as it is. However, the area on the ceiling where the guide display is made is displayed at a position different from the area shown in FIG. 12 so as not to be blocked by the upper part of the opening 2i which has moved. That is, the area where the guide display is displayed is a position closer to the projector 1 gb than the area displayed in FIG. 12. Therefore, the angle formed by the line of sight of the subject M and the table-top B1 is also acuter in the case of FIG. 13 than in the case of FIG.

  FIG. 14 shows the case where the scanner device 2 further moves. Here, many of the upper body, as well as the head of the subject M, are in the opening 2i. In this state, the guide display on the ceiling using the projector 1gb is at a position close to the projector 1gb. This is because, in the case of the subject M in the opening 2i of the scanner device 2, it can not be seen unless the guide display is displayed in the area above its own foot. However, since it is conceivable that it is difficult to look under one's own foot in this state, the projector 1 ga provided near the head of the subject M also displays a guide display on the ceiling this time.

  As described above, by performing the guide display in two places, it is sufficient for the subject M to look at whichever one is easy to view. This also leads to the provision of the guide display on the subject M without omission.

  In the guide display displayed on the ceiling using the projectors 1ga and 1gb, the same contents are displayed on any of the projectors 1ga and 1gb, as described above. However, the guide display displayed for each projector may be changed. For example, in the projector 1gb, the contents which have been displayed up to now are continuously displayed, and in the projector 1ga, the contents of the examination to be performed next, attention points, and the like are displayed.

  As described above, in the case where guide displays are displayed at a plurality of locations, it is possible to promptly notify the subject M of the examination content in the previous process after the current examination is completed by displaying different guide displays as appropriate. Because it can, it contributes to removing the anxiety of the subject M.

  In FIG. 15, the scanner device 2 is further moved, and the head of the subject M has come out of the opening 2i. In this state, as shown in FIG. 12 to FIG. 14, to look at the guide display displayed on the ceiling so as to look at its own foot would interrupt the guide display on which the scanner device 2 is displayed. It is difficult because

  Therefore, the display by the projector 1gb is ended, and the display is switched to the display by the projector 1ga. In addition, the projector 1 ga displays the display position at an angle more than that shown in FIG. By displaying in this manner, the subject M is shaped to look up at the ceiling slightly on the top plate B1, but the guide display is displayed at a position where it is easy to view.

  As described above, by providing a guide display that fully reflects the intention of the medical staff, flexible support is provided so that the subject, in particular a subject with hearing impairment, can be safely tested. It is possible to provide a medical image diagnostic device and a guide device that make it possible.

  In particular, the movement of the medical worker can be displayed as a guide display with a free expression (free description) according to the situation of the place, not the predetermined fixed word. The subject can also fully grasp the intention of the medical staff. In addition, when the subject is a hearing impaired person, guidance by voice is difficult, so it can not but be guided display in words, but even in such a case, the intention of the medical worker is Since the information can be accurately transmitted to the subject, anxiety and the like in the examination of the subject can be wiped out.

  In addition, even a medical worker can provide guide display on the subject only by its own movement without operating the input unit of the medical image diagnostic apparatus, for example. Therefore, the usability of the medical image diagnostic apparatus is further improved, and the examination can be smoothly advanced.

  By the way, in the first embodiment described above, the voice and the like of the operator (medical worker) who received the guide display content input unit 20 are collectively analyzed by the analysis unit 23. For this process, for example, another method is also conceivable.

  FIG. 16 is a block diagram showing another internal configuration of the guide display content input unit 20A in the first embodiment. Here, portions to be analyzed differ depending on the content received by the guide display content input unit 20. For example, when the operator guides by voice, after the recognition unit 22 recognizes the voice, the voice emitted by the operator is analyzed by the voice analysis unit 23-1, and for example, the voice is converted into a sentence. It is set as the aspect which can be displayed on the display part 1g etc. In addition, when the operator guides by the sign language, the sign language (action) grasped by the sensor 10 is recognized by the recognition unit 22, and this time, it is sent to the motion analysis unit 23-2. In the operation analysis unit 23-2, the recognized sign language is converted into a sentence, and the display unit 1g or the like can display the sentence.

  On the other hand, when the operator inputs the contents of the guide display to be displayed on the subject via the input device, such as the input unit 1 f or a portable information terminal which is a device different from the medical image diagnostic device, The sentence reception unit 23-3 of the guide display content input unit 20A receives the inputted sentence. In this case, since the received text can be displayed on the display unit 1g or the like as it is, no particular conversion processing is necessary.

  As described above, by providing the parts to be analyzed respectively in accordance with the mode of guide display from the operator (medical worker), the intention (instruction) from the operator (medical worker) can be received promptly and accurately. It becomes possible to transmit to the sample.

Second Embodiment
Next, a second embodiment of the present invention will be described. In the second embodiment, the same components as those described in the first embodiment are denoted by the same reference numerals, and the description of the same components will be omitted.

  The medical image diagnostic apparatus A in the first embodiment described above is provided with a guide display content input unit 20, and the guide display content input unit 20 displays a guide display to be displayed on the subject. It was The second embodiment is characterized in that a guide device serving as the guide display content input unit 20 is installed independently of the medical image diagnostic apparatus and configured as a guide system S as a whole.

  FIG. 17 is an overall view showing an entire configuration of a guide system S including a guide device G in the second embodiment. The guide system S displays a guide on the subject M when performing an examination using the medical image diagnostic apparatus A1 that acquires internal information of the subject M and generates a medical image, and the medical image diagnostic apparatus A1. And a guide device G to be displayed.

  As the medical image diagnostic device A1, various devices (modalities) as described above can be considered. And, unlike the first embodiment, it does not have the function of performing guide display on the subject M during the examination, but merely plays a purely role as a modality. On the other hand, the guide device G is a device having a function of displaying a guide display provided to the subject M when an examination using the medical image diagnostic apparatus A1 is performed.

  FIG. 18 is a block diagram showing an internal configuration of the guide device G in the second embodiment. The guide device G has a CPU 1G, a ROM 2G, a RAM 3G, and an input / output interface 4G connected via a bus 5G. The input / output interface 4G includes an input unit 6G, a display unit 7G, a communication control unit 8G, a storage unit 9G, a guide display control unit 10G, a recognition unit 11G, an analysis unit 12G, a determination unit 13G, The process creation unit 14G and the state management unit 15G are connected.

  Further, a signal from a sensor 16G provided in the inspection room R is input to the guide device G via the communication control unit 8G. The functions of the above-described units constituting the guide device G are as described in the first embodiment.

  The medical image diagnostic device A1 and the guide device G are connected to the communication network N, respectively. The guide device G acquires, for example, a scan plan necessary for displaying a guide display from the medical image diagnostic device A1 via the communication network N. As an example of the communication network N, networks, such as LAN (Local Area Network) and the internet, can be mentioned. Further, the standard regarding the information exchanged via the communication network N may be any standard such as DICOM (Digital Imaging and Communication in Medicine).

  In FIG. 17, two medical image diagnostic devices A1A and A1B and two guide devices G1 and G2 are connected to the communication network N. However, the numbers of the medical image diagnostic devices A1 and the guide devices G connected to the communication network N are not limited to the numbers shown in FIG. 17, but may be one or more.

  As described above, the medical image diagnostic device A1 for generating a medical image and the guide device G for performing guide display on the subject M share roles, and the both constitute a guide system S. With such a configuration, the medical image diagnostic apparatus A1 can sufficiently play a role of acquiring internal information of the subject M to be originally performed and generating a medical image. In particular, if a process of displaying a guide on the subject M is performed during the examination, the ability is dispersed for the guide display during the examination, and it becomes impossible to pour all of the ability of the subject M into the examination.

  On the other hand, since the guide device G specializes in guide display on the subject M, it can concentrate on guide display without losing its ability to the process of generating a medical image performed by the medical image diagnostic apparatus A1.

  Further, by adopting such a configuration, when using various medical image diagnostic apparatuses installed in medical institutions up to now, for a subject who receives an examination using the medical image diagnostic apparatus. The guide device G can provide a guide display. Therefore, the guide display which can not be provided by the medical image diagnostic apparatus A provided with the guide display content input unit 20 can be provided even when using a medical image diagnostic apparatus without the guide display content input unit. . This is a very useful configuration from the viewpoint of equally removing the anxiety of the subject in the test.

  In addition, by providing the guide display sufficiently reflecting the medical worker's intention described in the first embodiment, the subject, particularly a subject having hearing impairment can be safely tested. Naturally, it is possible to provide a medical image diagnostic apparatus and a guide apparatus that enable flexible support as possible.

  Although the embodiments of the present invention have been described, this embodiment is presented as an example and is not intended to limit the scope of the invention. This embodiment can be implemented in other various forms, and various omissions, replacements, and changes can be made without departing from the scope of the invention. This embodiment and its modifications are included in the scope and the gist of the invention, and are included in the invention described in the claims and the equivalents thereof.

Reference Signs List 1 control device 2 scanner device 10 sensor 20 guide display content input unit 21 reception unit 22 recognition unit 23 analysis unit 24 determination unit 25 process creation unit 26 state management unit 27 transmission unit

A feature of the invention according to claim 1 is a medical image diagnostic apparatus for generating a medical image of a subject based on internal information of the subject in a medical image diagnostic apparatus, wherein a voice of a medical worker to the subject is used. Guide display contents for generating a guide display for the subject based on the guidance or the operation of the subject and the information of the inspection process created based on the scan plan for the subject stored in the storage unit of the medical image diagnostic apparatus An input unit and a guide display control unit that causes the display unit to display the content input by the guide display content input unit. The guide display content input unit includes a voice guidance recognized by a sensor or a recognition unit that recognizes the motion of the subject, an analysis unit that analyzes the voice guidance or motion of the subject recognized by the recognition unit, and a scan for the subject Based on the plan, a process creation unit for creating an inspection process, a state management unit for grasping the state of each unit constituting the medical image diagnostic apparatus during execution of a scan plan, voice guidance or an object analyzed by the analysis unit And a determination unit that generates and displays a guide display for the subject based on the information on the operation, the information on the inspection process, and the information indicating the state of the medical image diagnostic apparatus.

A feature of the invention according to claim 6 is that in the guide device, the storage unit of the medical image diagnostic apparatus for generating voice guidance to the subject by the medical worker or the operation of the subject and the medical image of the subject A guide display content input unit that generates a guide display for the subject based on the information of the inspection process created based on the scan plan for the subject, and the content input by the guide display content input unit are displayed on the display unit And a guide display control unit for displaying a guide for the subject. The guide display content input unit is based on voice recognition or a recognition unit that recognizes the motion of the subject, an analysis unit that analyzes the voice guidance or the motion of the subject recognized by the recognition unit, and a scan plan for the subject. Information regarding the operation of the voice guidance or the subject analyzed by the process creation unit that creates the inspection process, the state management unit that grasps the state of each part that composes the medical image diagnostic device during execution of the scan plan, the examination And a determination unit that generates and displays a guide display on the subject based on the information on the process and the information indicating the state of the medical image diagnostic apparatus.

Claims (11)

A medical image diagnostic apparatus that generates a medical image of a subject based on internal information of the subject, comprising:
A guide for the subject based on guidance by the medical worker to the subject and information of an inspection process created based on the scan plan for the subject stored in the storage unit of the medical image diagnostic apparatus. A guide display content input unit that generates a display;
A guide display control unit that causes the display unit to display the content input by the guide display content input unit;
A medical image diagnostic apparatus comprising: A medical image diagnostic apparatus that generates a medical image of a subject based on internal information of the subject, comprising:
Guide display contents for generating a guide display for the subject based on the guidance to the subject by the medical worker and the information indicating the state of each part constituting the medical image diagnostic apparatus during execution of the scan plan for the subject An input unit,
A guide display control unit that causes the display unit to display the content input by the guide display content input unit;
A medical image diagnostic apparatus comprising: The medical image diagnostic apparatus includes the guidance or a sensor for grasping the voice or the motion of the subject or the medical staff.
The medical image diagnosis according to claim 1, wherein the guide display content input unit generates a guide display to be displayed on the subject based on the guidance or a voice or an operation grasped by the sensor. apparatus. The guide display content input unit is
A recognition unit that recognizes the voice or the motion of the guidance or the subject or the medical worker grasped by a sensor;
An analysis unit that analyzes the voice or the motion of the guidance or the subject or the medical worker recognized by the recognition unit;
A process creation unit for creating an inspection process based on a scan plan for the subject known by the medical image diagnostic apparatus;
A state management unit for grasping the state of each unit constituting the medical image diagnostic apparatus during execution of the scan plan;
The subject based on the guidance analyzed by the analysis unit or information on the voice or operation of the subject or the medical worker, information on the inspection process, and information indicating the state of the medical image diagnostic apparatus A determination unit that generates and displays the guide display for
The medical image diagnostic apparatus according to any one of claims 1 to 3, further comprising: The guide display content input unit is
A voice analysis unit that analyzes the voice of the medical worker and converts it into a sentence, a motion analysis unit that analyzes an image obtained by capturing the medical worker and converts a sign to a sentence, or a text input by the medical worker The medical image diagnostic apparatus according to any one of claims 1 to 3, further comprising at least one of a sentence reception unit to receive.   The display unit displays the guide display at a position at which the subject is easily viewable, in consideration of the state of the examination on the subject and the state of the medical image diagnostic apparatus. The medical image diagnostic apparatus according to any one of the above. Guidance based on a scan plan for the subject stored in the storage unit of the medical image diagnostic apparatus that generates a medical image of the subject and guidance of the subject to a subject by a medical worker, based on the information of the inspection process created based on the scan plan for the subject A guide display content input unit for generating a guide display for the subject;
A guide display control unit that displays the content input by the guide display content input unit on a display unit and displays a guide for the subject;
A guide device comprising: A guide for the subject based on the guidance on the subject by a medical worker and information indicating the state of each part of the medical image diagnostic apparatus that generates the medical image of the subject during execution of the scan plan for the subject A guide display content input unit that generates a display;
A guide display control unit that displays the content input by the guide display content input unit on a display unit and displays a guide for the subject;
A guide device comprising: The guide display content input unit is
A recognition unit that recognizes voice or motion of the guidance or the subject or the medical staff;
An analysis unit that analyzes the voice or the motion of the guidance or the subject or the medical worker recognized by the recognition unit;
A process creation unit that creates an inspection process based on the scan plan for the subject;
A state management unit for grasping the state of each unit constituting the medical image diagnostic apparatus during execution of the scan plan;
The subject based on the guidance analyzed by the analysis unit or information on the voice or operation of the subject or the medical worker, information on the inspection process, and information indicating the state of the medical image diagnostic apparatus A determination unit that generates and displays a guide display based on a free description with respect to
A display unit for displaying the guide display;
The guide device according to claim 7 or 8, further comprising:   The guide device according to any one of claims 7 to 9, further comprising a sensor for grasping the voice or the motion of the subject or the medical worker. The guide display content input unit is
A voice analysis unit that analyzes the voice of the medical worker and converts it into a sentence, a motion analysis unit that analyzes an image obtained by capturing the medical worker and converts a sign to a sentence, or a text input by the medical worker 11. The guide device according to claim 9, further comprising at least one of a sentence reception unit to receive.