JP2022013865A - Ultrasonic diagnostic apparatus, output method and output program - Google Patents

Abstract

To reduce overlooking of a disease.SOLUTION: An ultrasonic diagnostic apparatus includes an estimation unit, a determination unit and an output control unit. The estimation unit estimates a health status on the basis of a measured value that is measured using ultrasonic image data. The determination unit determines an additional inspection used for diagnosis on the health status on the basis of the estimated health status. The output control unit outputs information indicating the health status and the additional inspection.SELECTED DRAWING: Figure 1

Description

Embodiments disclosed herein and in the drawings relate to ultrasonic diagnostic equipment, output methods, and output programs.

The ultrasonic diagnostic device is a device that images (imaging) the state in the living body by irradiating the living body with ultrasonic waves generated from a piezoelectric vibrator and receiving the ultrasonic waves reflected in the living body. Since imaging with an ultrasonic diagnostic device is real-time and non-invasive, it is widely used in the examination of various diseases.

In the ultrasonic diagnostic apparatus, a plurality of imaging modes (also referred to as "scan mode", "shooting mode", etc.) having different imaging methods are used. The imaging modes include B mode for capturing image data in B mode, M mode for capturing image data in M mode, color Doppler mode for capturing color Doppler image data, and Doppler waveform data by the Pulse Wave (PW) Doppler method. PW Doppler mode that captures images of PW Doppler mode, CW Doppler mode that captures Doppler waveform data by the continuous wave (CW) Doppler method, and Elast mode that captures hardness images that represent the hardness of living tissue by elastography. There are various imaging modes. These imaging modes are used properly according to the inspection purpose.

Japanese Unexamined Patent Publication No. 2013-000517 Japanese Unexamined Patent Publication No. 2001-061836 JP-A-2015-116331A

One of the challenges to be solved by the embodiments disclosed herein and in the drawings is to reduce the oversight of diseases. However, the problems to be solved by the embodiments disclosed in the present specification and the drawings are not limited to the above problems. The problem corresponding to each effect by each configuration shown in the embodiment described later can be positioned as another problem.

The ultrasonic diagnostic apparatus according to the embodiment includes an estimation unit, a determination unit, and an output control unit. The estimation unit estimates the health condition based on the measured values measured using the ultrasonic image data. The determination unit determines an additional test used for diagnosing the health condition based on the estimated health condition. The output control unit outputs information representing the health condition and the additional test.

FIG. 1 is a diagram showing a configuration example of an ultrasonic diagnostic apparatus according to an embodiment. FIG. 2 is a flowchart showing a processing procedure in the ultrasonic diagnostic apparatus according to the embodiment. FIG. 3 is a diagram showing a display example of ultrasonic image data according to the embodiment. FIG. 4 is a diagram for explaining the processing of the estimation function according to the embodiment. FIG. 5 is a diagram for explaining the processing of the determination function according to the embodiment. FIG. 6 is a diagram showing an example of a display screen according to the embodiment. FIG. 7 is a diagram showing an example of a display screen after the additional inspection according to the embodiment. FIG. 8 is a flowchart showing a processing procedure in the ultrasonic diagnostic apparatus according to the application example of the embodiment. FIG. 9 is a flowchart showing a processing procedure in the ultrasonic diagnostic apparatus according to the application example of the embodiment. FIG. 10 is a flowchart showing a processing procedure in the ultrasonic diagnostic apparatus according to the application example of the embodiment. FIG. 11 is a diagram showing an example of an input screen according to an application example of the embodiment. FIG. 12 is a diagram showing an example of an input screen according to an application example of the embodiment.

Hereinafter, the ultrasonic diagnostic apparatus, the output method, and the output program according to the embodiment will be described with reference to the drawings. The embodiment is not limited to the following embodiments. Moreover, the content described in one embodiment can be similarly applied to other embodiments in principle.

(Embodiment)
A configuration example of the ultrasonic diagnostic apparatus 1 according to the embodiment will be described with reference to FIG. FIG. 1 is a diagram showing a configuration example of the ultrasonic diagnostic apparatus 1 according to the embodiment. As shown in FIG. 1, the ultrasonic diagnostic apparatus 1 according to the embodiment includes an apparatus main body 100, an ultrasonic probe 101, an input interface 102, and a display 103. The ultrasonic probe 101, the input interface 102, and the display 103 are connected to the apparatus main body 100. The subject P is not included in the configuration of the ultrasonic diagnostic apparatus 1.

The ultrasonic probe 101 has a plurality of oscillators (for example, a piezoelectric oscillator), and these plurality of oscillators generate ultrasonic waves based on a drive signal supplied from a transmission / reception circuit 110 of the apparatus main body 100, which will be described later. do. Further, the plurality of oscillators included in the ultrasonic probe 101 receive the reflected wave from the subject P and convert it into an electric signal. Further, the ultrasonic probe 101 has a matching layer provided on the vibrator, a backing material for preventing the propagation of ultrasonic waves from the vibrator to the rear, and the like.

When ultrasonic waves are transmitted from the ultrasonic probe 101 to the subject P, the transmitted ultrasonic waves are reflected one after another on the discontinuity surface of the acoustic impedance in the body tissue of the subject P, and the reflected wave signal (echo signal). It is received by a plurality of transducers included in the ultrasonic probe 101. The amplitude of the received reflected wave signal depends on the difference in acoustic impedance in the discontinuity where the ultrasonic waves are reflected. The reflected wave signal when the transmitted ultrasonic pulse is reflected on the moving blood flow or the surface of the heart wall or the like depends on the velocity component of the moving body with respect to the ultrasonic transmission direction due to the Doppler effect. And undergo frequency shift.

In the embodiment, the ultrasonic probe 101 shown in FIG. 1 is a one-dimensional ultrasonic probe in which a plurality of piezoelectric vibrators are arranged in a row, or a plurality of piezoelectric vibrators arranged in a row are mechanically arranged. In the case of a one-dimensional ultrasonic probe that is oscillated in a manner, it can be applied to any case of a two-dimensional ultrasonic probe in which a plurality of piezoelectric vibrators are arranged in a two-dimensional manner in a grid pattern.

The input interface 102 includes a mouse, keyboard, buttons, panel switches, touch command screens, foot switches, trackballs, joysticks, and the like, and receives various setting requests from the operator of the ultrasonic diagnostic apparatus 1 and causes the apparatus main body 100 to receive various setting requests. The various setting requests received are transferred.

The display 103 displays a GUI (Graphical User Interface) for the operator of the ultrasonic diagnostic apparatus 1 to input various setting requests using the input interface 102, ultrasonic image data generated by the apparatus main body 100, and the like. Or display.

The device main body 100 is a device that generates ultrasonic image data based on the reflected wave signal received by the ultrasonic probe 101, and as shown in FIG. 1, a transmission / reception circuit 110, a signal processing circuit 120, and an image generation circuit. It has 130, an image memory 140, a storage circuit 150, and a processing circuit 160. The transmission / reception circuit 110, the signal processing circuit 120, the image generation circuit 130, the image memory 140, the storage circuit 150, and the processing circuit 160 are connected to each other so as to be communicable with each other.

The transmission / reception circuit 110 executes ultrasonic scanning (ultrasonic scanning) by controlling the ultrasonic probe 101. The transmission / reception circuit 110 includes a pulse generator, a transmission delay unit, a pulser, and the like, and supplies a drive signal to the ultrasonic probe 101. The pulse generator repeatedly generates rate pulses for forming transmitted ultrasonic waves at a predetermined rate frequency. Further, in the transmission delay unit, the pulse generator generates a delay time for each piezoelectric vibrator required for focusing the ultrasonic waves generated from the ultrasonic probe 101 in a beam shape and determining the transmission directivity. Give for each rate pulse. Further, the pulsar applies a drive signal (drive pulse) to the ultrasonic probe 101 at a timing based on the rate pulse. That is, the transmission delay unit arbitrarily adjusts the transmission direction of the ultrasonic wave transmitted from the piezoelectric vibrator surface by changing the delay time given to each rate pulse.

The transmission / reception circuit 110 has a function of instantaneously changing the transmission frequency, transmission drive voltage, and the like in order to execute a predetermined scan sequence based on the instruction of the processing circuit 160 described later. In particular, the change of the transmission drive voltage is realized by a linear amplifier type transmitter circuit that can switch the value instantaneously or a mechanism that electrically switches a plurality of power supply units.

Further, the transmission / reception circuit 110 includes a preamplifier, an A / D (Analog / Digital) converter, a reception delay unit, an adder, and the like, and performs various processes on the reflected wave signal received by the ultrasonic probe 101 to reflect the reflected wave signal. Generate wave data. The preamplifier amplifies the reflected wave signal for each channel. The A / D converter A / D converts the amplified reflected wave signal. The reception delay unit provides the delay time required to determine the reception directivity. The adder generates reflected wave data by performing addition processing of the reflected wave signal processed by the reception delay unit. The addition process of the adder emphasizes the reflection component from the direction corresponding to the reception directivity of the reflected wave signal, and the reception directivity and the transmission directivity form a comprehensive beam for ultrasonic transmission and reception.

When scanning the two-dimensional region of the subject P, the transmission / reception circuit 110 causes the ultrasonic probe 101 to transmit an ultrasonic beam in a two-dimensional direction. Then, the transmission / reception circuit 110 generates two-dimensional reflected wave data from the reflected wave signal received by the ultrasonic probe 101. Further, when scanning the three-dimensional region of the subject P, the transmission / reception circuit 110 causes the ultrasonic probe 101 to transmit an ultrasonic beam in the three-dimensional direction. Then, the transmission / reception circuit 110 generates three-dimensional reflected wave data from the reflected wave signal received by the ultrasonic probe 101.

For example, the signal processing circuit 120 performs logarithmic amplification, envelope detection processing, etc. on the reflected wave data received from the transmission / reception circuit 110, and the signal strength for each sample point is expressed by the brightness of the brightness (data (). B mode data) is generated. The B mode data generated by the signal processing circuit 120 is output to the image generation circuit 130. The B mode data is an example of scan data.

Further, the signal processing circuit 120 generates data (Doppler data) obtained by extracting motion information based on the Doppler effect of the moving body at each sample point in the scanning region from the reflected wave data received from the transmission / reception circuit 110, for example. .. Specifically, the signal processing circuit 120 frequency-analyzes velocity information from reflected wave data, extracts blood flow, tissue, and contrast agent echo components due to the Doppler effect, and obtains moving object information such as average velocity, dispersion, and power. Generate data (Dopla data) extracted from multiple points. Here, the moving body is, for example, a blood flow, a tissue such as a heart wall, or a contrast medium. The motion information (blood flow information) obtained by the signal processing circuit 120 is sent to the image generation circuit 130, and is displayed in color on the display 103 as an average velocity image, a distributed image, a power image, or a combination image thereof. The Doppler data is an example of scan data.

The image generation circuit 130 generates ultrasonic image data from the data generated by the signal processing circuit 120. The image generation circuit 130 generates B-mode image data in which the intensity of the reflected wave is represented by luminance from the B-mode data generated by the signal processing circuit 120. Further, the image generation circuit 130 generates Doppler image data representing mobile information from the Doppler data generated by the signal processing circuit 120. The Doppler image data is speed image data, distributed image data, power image data, or image data in which these are combined.

Here, the image generation circuit 130 generally converts (scan-converts) a scanning line signal string of ultrasonic scanning into a scanning line signal string of a video format typified by a television or the like, and ultrasonic waves for display. Generate image data. Specifically, the image generation circuit 130 generates ultrasonic image data for display by performing coordinate conversion according to the scanning form of ultrasonic waves by the ultrasonic probe 101. Further, the image generation circuit 130 uses various image processes other than the scan conversion, for example, an image process (smoothing process) for regenerating an average value image of brightness by using a plurality of image frames after the scan conversion. Image processing (edge enhancement processing) using a differential filter in the image is performed. Further, the image generation circuit 130 synthesizes incidental information (character information of various parameters, scales, body marks, etc.) with the ultrasonic image data.

That is, the B mode data and the Doppler data are ultrasonic image data before the scan conversion process, and the data generated by the image generation circuit 130 is ultrasonic image data for display after the scan conversion process. When the signal processing circuit 120 generates three-dimensional scan data (three-dimensional B mode data and three-dimensional Doppler data), the image generation circuit 130 performs coordinate conversion according to the scanning form of ultrasonic waves by the ultrasonic probe 101. By doing, volume data is generated. Then, the image generation circuit 130 performs various rendering processes on the volume data to generate two-dimensional image data for display.

The image memory 140 is a memory for storing image data (display image) for display generated by the image generation circuit 130. Further, the image memory 140 can also store the data generated by the signal processing circuit 120. The B-mode data and Doppler data stored in the image memory 140 can be called by the operator after diagnosis, for example, and become ultrasonic image data for display via the image generation circuit 130.

The storage circuit 150 stores control programs for ultrasonic transmission / reception, image processing, and display processing, diagnostic information (for example, patient ID, doctor's findings, etc.), and various data such as diagnostic protocols and various body marks. .. The storage circuit 150 is also used for storing image data stored in the image memory 140, if necessary. Further, the data stored in the storage circuit 150 can be transferred to an external device via an interface (not shown).

The processing circuit 160 controls the entire processing of the ultrasonic diagnostic apparatus 1. Specifically, the processing circuit 160 is a transmission / reception circuit 110 and a signal processing circuit based on various setting requests input from the operator via the input interface 102, various control programs read from the storage circuit 150, and various data. It controls the processing of 120 and the image generation circuit 130. Further, the processing circuit 160 controls the display 103 to display the ultrasonic image data for display stored in the image memory 140.

Further, as shown in FIG. 1, the processing circuit 160 executes a measurement function 161, an estimation function 162, a determination function 163, an output control function 164, and a switching function 165. The measurement function 161 is an example of a measurement unit. The estimation function 162 is an example of an estimation unit. The determination function 163 is an example of a determination unit. The output control function 164 is an example of an output control unit. The switching function 165 is an example of a switching unit.

Here, for example, each processing function executed by the measurement function 161, the estimation function 162, the determination function 163, the output control function 164, and the switching function 165, which are the components of the processing circuit 160 shown in FIG. 1, can be executed by a computer. It is recorded in the storage device (for example, the storage circuit 150) of the ultrasonic diagnostic apparatus 1 in the form of a program. The processing circuit 160 is a processor that realizes a function corresponding to each program by reading each program from a storage device and executing the program. In other words, the processing circuit 160 in the state where each program is read out has each function shown in the processing circuit 160 of FIG. The processing functions executed by the measurement function 161, the estimation function 162, the determination function 163, the output control function 164, and the switching function 165 will be described later.

The wording "processor (circuit)" used in the above description is, for example, a CPU (Central Processing Unit), a GPU (Graphics Processing Unit), an integrated circuit for a specific application (ASIC), or a programmable logic device. (For example, it means a circuit such as a simple programmable logic device (SPLD), a complex programmable logic device (CPLD), and a field programmable gate array (FPGA)). The processor realizes the function by reading and executing the program stored in the storage circuit 150. Instead of storing the program in the storage circuit 150, the program may be directly incorporated in the circuit of the processor. In this case, the processor realizes the function by reading and executing the program embedded in the circuit. It should be noted that each processor of the present embodiment is not limited to the case where each processor is configured as a single circuit, and a plurality of independent circuits may be combined to form one processor to realize its function. good. Further, a plurality of components in each figure may be integrated into one processor to realize the function.

By the way, doctors may make a diagnosis according to the guidelines. For example, when a doctor suspects a circulatory disorder from the patient's symptoms or interviews, the doctor first evaluates the left ventricular diastolic function according to a predetermined guideline. As an example, the volume of the left ventricle, the blood flow velocity at the mitral valve opening, the mitral valve annulus movement speed, etc. are measured according to the guidelines, and a diagnosis is made by a doctor.

However, it is up to the physician to decide for himself whether the measured value is defined as abnormal in the guidelines. For this reason, a doctor with little experience or knowledge may not be able to recognize whether or not the measured value corresponds to an abnormal value, and may overlook the disease.

Therefore, the ultrasonic diagnostic apparatus 1 according to the present embodiment executes the following processing in order to reduce oversight of diseases. In the following description, the case where the ultrasonic diagnostic apparatus 1 is used for diagnosing a disease of the circulatory system will be described, but the present invention is not limited to this. The ultrasonic diagnostic apparatus 1 according to the present embodiment can be applied to the diagnosis of any disease. In addition, each inspection item described below is just an example, and any inspection item can be applied.

The processing procedure in the ultrasonic diagnostic apparatus 1 according to the embodiment will be described with reference to FIG. FIG. 2 is a flowchart showing a processing procedure in the ultrasonic diagnostic apparatus 1 according to the embodiment. FIG. 2 will be described with reference to FIGS. 3 to 7.

The processing procedure shown in FIG. 2 is started, for example, by inputting an instruction to start imaging (ultrasonic scanning) by the operator. The processing procedure shown in FIG. 2 is not limited to the order shown in FIG. 2, and can be arbitrarily changed within a range that does not contradict the processing content.

As shown in FIG. 2, when the operator inputs an instruction to start imaging (step S101 affirmative), the ultrasonic diagnostic apparatus 1 starts the processing after step S102. The processing after step S102 is not started until the instruction to start imaging is input (step S101 is denied), and the processing in FIG. 2 is in a standby state.

When the instruction to start imaging is input (step S101 affirmative), the transmission / reception circuit 110 executes an ultrasonic scan (step S102). For example, the transmission / reception circuit 110 controls the ultrasonic probe 101 to transmit ultrasonic waves into the body of the subject P. Further, the transmission / reception circuit 110 performs various processing on the reflected wave signal received by the ultrasonic probe 101 to generate reflected wave data. Then, the signal processing circuit 120 generates scan data from the reflected wave data generated by the transmission / reception circuit 110.

Subsequently, the image generation circuit 130 generates and displays ultrasonic image data (step S103). For example, the image generation circuit 130 generates ultrasonic image data from the scan data generated by the signal processing circuit 120. Then, the processing circuit 160 (output control function 164) displays the generated ultrasonic image data on the display 103.

A display example of the ultrasonic image data according to the embodiment will be described with reference to FIG. FIG. 3 is a diagram showing a display example of ultrasonic image data according to the embodiment. B-mode image data is illustrated in the upper part of FIG. Velocity image data is illustrated in the lower part of FIG.

As shown in FIG. 3, for example, the output control function 164 causes the display 103 to display the B mode image data and the speed image data. In the B mode image data, a measurement caliper indicating the measurement position of the blood flow velocity is drawn. The velocity image data shows the time series change of the blood flow velocity measured by the CW Doppler mode at the measurement position indicated by the measurement caliper.

Then, the measurement function 161 executes the measurement using the ultrasonic image data (step S104). For example, the measurement function 161 measures each of a plurality of measurement items based on the ultrasonic image data, and obtains a measured value.

As an example, the measurement function 161 measures each of the three measurement items of "EF", "MV E / e'", and "MV e'Vel sep". Here, "EF" represents the ejection fraction (EF) of the left ventricle. Further, "MV E / e'" represents the ratio of the dilated early wave (E) of the mitral valve opening blood flow velocity waveform and the dilated early wave (e') of the mitral valve annulus motion velocity waveform. Further, "MV e'Vel sep" represents the kinetic velocity on the septal side (Sep) of the mitral valve annulus.

The types of measurement items are not limited to "EF", "MV E / e'", and "MV e'Vel sep", and any measurement item can be set. Further, as for the measurement method of each measurement item, a known technique can be arbitrarily applied.

Then, the estimation function 162 estimates the disease based on the measured value (step S105). For example, the estimation function 162 estimates a disease from the measured values measured by the measurement function 161 by referring to information (disease estimation table) in which the disease and the condition of the measured value are associated with each other.

The processing of the estimation function 162 according to the embodiment will be described with reference to FIG. FIG. 4 is a diagram for explaining the processing of the estimation function 162 according to the embodiment. FIG. 4 illustrates a disease estimation table referenced by estimation function 162. The disease estimation table is stored in advance in, for example, the storage circuit 150.

As shown in FIG. 4, in the disease estimation table, two or more of the suspected disease "left ventricular diastolic dysfunction" and the measurement value conditions "EF, MV E / e', MV e'Vel sep" are normal values. Is associated with "deviation". This indicates that left ventricular diastolic dysfunction is suspected when two or more of "EF", "MV E / e'", and "MV e'Vel sep" deviate from the normal values. Although an example of left ventricular diastolic dysfunction is shown in FIG. 4, other diseases are also memorized in the same manner.

For example, the estimation function 162 collates the measured value measured by the measurement function 161 with the “measured value condition” of the disease estimation table. Specifically, for each measured value, a normal value / an abnormal value is determined by a threshold value. For example, for "EF", 50 [%] or more is a normal value, and less than 50 [%] is an abnormal value. Further, in "MV E / e'", less than 14 is a normal value, and 14 or more is an abnormal value. Further, in "MV e'Vel sep", 7 [cm / s] or more is a normal value, and less than 7 [cm / s] is an abnormal value.

Here, for example, when "EF" is a normal value and "MV E / e'" and "MV e'Vel sep" are abnormal values, "EF, MV E / e', MV e'" Two or more items in Vel sep deviate from normal values. " In this case, the estimation function 162 estimates that the subject P is "left ventricular diastolic dysfunction".

The above-mentioned processing of the estimation function 162 is merely an example, and the embodiment is not limited to this. For example, the processing of the estimation function 162 can be arbitrarily set according to the guideline. Further, the process of estimating the disease is not limited to the process using the threshold value, and for example, a trained model constructed for estimating the disease can be applied.

Further, the disease (name of the disease) estimated by the estimation function 162 is estimated to help the diagnosis by the doctor, and is not for confirming the diagnosis. The final diagnosis is made by the doctor.

Then, the determination function 163 determines an additional test based on the estimated disease (step S106). For example, the determination function 163 determines the additional test corresponding to the disease estimated by the estimation function 162 by referring to the information (additional test table) in which the disease and the additional test are associated with each other.

The process of the determination function 163 according to the embodiment will be described with reference to FIG. FIG. 5 is a diagram for explaining the processing of the determination function 163 according to the embodiment. FIG. 5 illustrates an additional inspection table referenced by the determination function 163. The additional inspection table is stored in advance in, for example, the storage circuit 150.

As shown in FIG. 5, the additional test table is associated with the suspected disease "left ventricular diastolic dysfunction" and the additional test "TR Velocity, LA Volume". This indicates that when left ventricular diastolic dysfunction is suspected, two test items, "TR Velocity" and "LA Volume", are determined as additional tests. Although an example of left ventricular diastolic dysfunction is shown in FIG. 5, other diseases are also memorized in the same manner.

For example, the determination function 163 refers to the additional test table and determines the additional test corresponding to the disease estimated by the estimation function 162. In the example of FIG. 5, the determination function 163 determines two inspection items of "TR Velocity" and "LA Volume" as an additional inspection of "left ventricular diastolic dysfunction".

Here, the determination function 163 determines the additional inspection based on the current imaging mode in which the ultrasonic image data is captured. For example, the determination function 163 determines the priority of each of the plurality of additional inspection candidates when there are a plurality of additional inspection candidates.

As an example, the determination function 163 determines the priority of each of the plurality of additional inspection candidates based on whether or not the additional inspection is performed in the same imaging mode as the current imaging mode. The additional inspection "TR Velocity" determined in FIG. 5 is measured by the CW Doppler mode, and the "LA Volume" is measured by the B mode.

Here, when the current imaging mode is the CW Doppler mode, the determination function 163 determines that the priority of "TR Velocity" measured by the same imaging mode is high, and determines that the "LA Volume" measured by a different imaging mode has a high priority. Is judged to have a low priority. As a result, the priority of "TR Velocity" becomes "1", and the priority of "LA Volume" becomes "2". As for the priority, the lower the numerical value, the higher the priority.

The process of the determination function 163 described above is merely an example, and the embodiment is not limited to this. For example, in the above description, the case where the high and low priorities are indicated by the priority order has been described, but the present invention is not limited to this. For example, the priority may be defined as a higher value as the numerical value is higher.

Then, the output control function 164 displays information representing the disease and the additional test (step S107). For example, the output control function 164 causes the display 103 to display information indicating the priority of each of the candidates for the plurality of additional inspections and the information indicating the plurality of additional inspections.

An example of the display screen according to the embodiment will be described with reference to FIG. FIG. 6 is a diagram showing an example of a display screen according to the embodiment. FIG. 6 illustrates a window containing "measurement results", "suspected disease", and "additional tests".

As shown in FIG. 6, the output control function 164 causes the display 103 to display a window including the “measurement result”, the “suspected disease”, and the “additional test”. Here, the "measurement result" includes the measurement items measured by the processing up to this point, the measured values, and information indicating that each measured value is abnormal.

For example, the output control function 164 displays three measurement items of "EF", "MV E / e'", and "MV e'Vel sep" measured by the measurement function 161 as "measurement results". In the example of FIG. 6, "EF" is 50.8 [%], "MV E / e'" is 12.8, and "MV e'Vel sep" is 6.4 [cm / s]. be. Further, the output control function 164 displays "*" as information indicating that each measured value is abnormal. In the example of FIG. 6, the output control function 164 displays "*" on the right side of "MV E / e'" and "MV e'Vel sep". This indicates that "MV E / e'" and "MV e'Vel sep" were abnormal values.

Although the case where the fact that the measured value is abnormal is displayed by "*" has been described for the convenience of illustration, the embodiment is not limited to this. For example, the color of the measured value may be indicated by a color different from other characters (for example, red), or may be displayed by using an underline or a border.

In addition, the output control function 164 displays the "left ventricular diastolic dysfunction" estimated by the estimation function 162 as the "suspected disease". When it is estimated that a plurality of diseases are suspected by the estimation function 162, a plurality of diseases may be displayed.

Further, the output control function 164 displays the additional inspection determined by the determination function 163 together with the priority as the "additional inspection". As an example, the output control function 164 displays "1. TR Velocity" and "2. LA Volume" in the order of priority.

The processing of the output control function 164 described above is merely an example, and the embodiment is not limited to this. For example, the output form by the output control function 164 is not limited to the display, and may be output by means such as voice or vibration pattern. Further, the output control function 164 may transmit the information to be output to an external device (arbitrary device different from the ultrasonic diagnostic device 1) and output it in an arbitrary output form by the transmission destination external device. ..

Then, the switching function 165 determines whether or not the imaging mode of the additional inspection is different from the current imaging mode (step S108). At this time, when there are a plurality of additional inspections, the switching function 165 determines whether or not the imaging mode of the additional inspection having the highest priority is different from the current imaging mode.

Here, when it is determined that the imaging mode of the additional inspection and the current imaging mode are different (step S108 affirmative), the switching function 165 switches the imaging mode (step S109). For example, when the imaging mode of the additional inspection is "B mode" and the current imaging mode is "CW Doppler mode", the switching function 165 changes the imaging mode from "CW Doppler mode" to "B mode". Switch. On the other hand, if it is not determined that the imaging mode of the additional inspection is different from the current imaging mode (denial of step S108), the switching function 165 shifts to the process of step S110 without executing the process of step S109.

Then, the transmission / reception circuit 110 executes an ultrasonic scan for additional inspection (step S110). Then, the image generation circuit 130 generates and displays ultrasonic image data for additional inspection. Further, the measurement function 161 executes measurement using the ultrasonic image data of the additional inspection. When the measurement of the additional inspection is executed, the output control function 164 updates the display screen.

An example of the display screen after the additional inspection according to the embodiment will be described with reference to FIG. 7. FIG. 7 is a diagram showing an example of a display screen after the additional inspection according to the embodiment. The display screen shown in FIG. 7 is the display screen shown in FIG. 6 updated by executing the additional inspection “TR Velocity”.

As shown in FIG. 7, the output control function 164 adds the measured value by the additional inspection “TR Velocity” to the “measurement result” column. In the example shown in FIG. 7, the measured value of "TR Velocity" is 3.0 [m / s]. Further, the output control function 164 displays "*" as information indicating that each measured value is abnormal. In addition, "TR Velocity" is determined to be abnormal at 2.8 [m / s] or more.

Further, the output control function 164 deletes "TR Velocity" from the item of "Additional inspection" along with the execution of the additional inspection "TR Velocity", and raises the priority of the remaining additional inspections one by one. As a result, the output control function 164 displays "1. LA Volume" as the "additional inspection" in FIG. 7.

Then, the processing circuit 160 determines whether or not all the additional inspections have been completed (step S111). If the additional inspection remains (denial in step S111), the processing circuit 160 shifts to the processing in step S108. When all the additional inspections are completed (affirmation in step S111), the processing circuit 160 ends the processing of FIG.

As described above, in the ultrasonic diagnostic apparatus 1 according to the embodiment, the estimation function 162 estimates the disease based on the measured values measured using the ultrasonic image data. The determination function 163 determines additional tests used in the diagnosis of the disease based on the presumed disease. The output control function 164 outputs information representing the disease and additional tests. According to this, the ultrasonic diagnostic apparatus 1 can reduce the oversight of the disease. For example, even a doctor with little experience or knowledge can reduce the oversight of a disease by referring to the disease and additional tests presented by the ultrasonic diagnostic apparatus 1.

Further, for example, the ultrasonic diagnostic apparatus 1 determines an additional examination based on the current imaging mode. For example, the ultrasonic diagnostic apparatus 1 preferentially presents the same imaging mode as the current imaging mode when there are a plurality of candidates for additional examination. As a result, the ultrasonic diagnostic apparatus 1 can minimize the number of times the imaging mode is switched even when there are a plurality of additional examinations, so that a series of examinations can be smoothly performed.

Further, for example, the ultrasonic diagnostic apparatus 1 automatically switches the imaging mode when the imaging mode of the additional examination is different from the current imaging mode. As a result, the ultrasonic diagnostic apparatus 1 can reduce the trouble of switching by the operator (doctor).

Conventionally, in an ultrasonic diagnostic apparatus, various imaging modes have been used according to the purpose of examination. However, the more diverse the types of imaging modes, the more experience and knowledge of the operator is required to master them. Since the ultrasonic diagnostic apparatus 1 according to the present embodiment can smoothly perform necessary additional examinations while appropriately presenting them, the advantage of having various imaging modes can be utilized without depending on the experience and knowledge of the operator. Can be

(Application example)
An application example of the above-described embodiment will be described. Here, a case where the ultrasonic diagnostic apparatus 1 according to the above-described embodiment is applied to the diagnosis of heart failure will be described.

8, 9, and 10 are flowcharts showing a processing procedure in the ultrasonic diagnostic apparatus according to the application example of the embodiment. Note that FIG. 9 is a flowchart showing a detailed processing procedure in the processing of step S207 of FIG. Further, FIG. 10 is a flowchart showing a detailed processing procedure in the processing of step S212 of FIG. Further, in FIGS. 8 to 10, the description will be given with reference to FIGS. 11 and 12. 11 and 12 are diagrams showing an example of an input screen according to an application example of the embodiment.

The processing procedure shown in FIG. 8 is started, for example, by inputting an instruction to start imaging (ultrasonic scanning) by the operator.

As shown in FIG. 8, the ultrasonic diagnostic apparatus 1 starts the processing after step S202 when the operator inputs an instruction to start imaging (step S201 affirmative). The processing after step S202 is not started until the instruction to start imaging is input (step S201 is denied), and the processing in FIG. 8 is in a standby state.

When the instruction to start imaging is input (step S201 affirmative), the transmission / reception circuit 110 executes the B mode scan (step S202). Then, the image generation circuit 130 generates and displays B-mode image data. The process of step S202 corresponds to the process of steps S102 to S103 of FIG.

Subsequently, the measurement function 161 measures the EF using the B mode image data (step S203). Here, "EF" represents the ejection fraction of the left ventricle as described above, and is measured based on the volume change of the left ventricle calculated from the B mode image data. The process of step S203 corresponds to the process of step S104 of FIG.

Then, the estimation function 162 determines whether or not the EF is less than 50 (step S204). Here, when the EF is less than 50 (step S204 affirmative), the estimation function 162 estimates that the heart failure has decreased contractility (step S205), and proceeds to the process of step S213. On the other hand, when the EF is 50 or more (step S204 denial), the estimation function 162 estimates that there is a possibility of heart failure in which the left ventricular contractility is maintained (step S206), and proceeds to the process of step S207. ..

The disease estimated by the estimation function 162 does not necessarily have to be a specific “disease name”. For example, as shown in FIG. 8, the estimation function 162 can also estimate "health status" such as "heart failure with reduced contractility" or "possible heart failure with maintained left ventricular contractility". Is. These estimation processes are realized by, for example, a preset table, a predetermined function, a threshold value process, or the like.

Then, the estimation function 162 executes a process (process A) for confirming the possibility of another heart disease (step S207). The processing procedure of processing A will be described with reference to FIG. It should be noted that "A" in FIG. 9 is associated with "A" in FIG. 8 and indicates that the process proceeds to step S213.

As shown in FIG. 9, the estimation function 162 accepts preset finding information (step S301). For example, the estimation function 162 displays the input screen shown in FIG. 11 on the display 103, and receives preset finding information using the input screen. The finding information is an example of "non-image information" different from the ultrasonic image data.

In the example shown in FIG. 11, various findings and radio buttons for inputting the presence / absence of the findings are displayed in association with each other on the input screen. Specifically, on the input screen, the presence or absence of findings of congenital heart disease, valvular disease, left ventricular enlargement, pericardial disease, and pulmonary arterial hypertension is input. A radio button for is displayed. For example, the operator (doctor) refers to the input screen shown in FIG. 11, and if there is a finding corresponding to the subject P, selects a radio button indicating that there is a corresponding finding, and presses the OK button. As a result, the estimation function 162 receives finding information indicating whether or not the subject P has various findings. The findings of pulmonary arterial hypertension are determined based on pulmonary hypertension, marked enlargement of the right ventricle, and lack of enlargement of the left atrium.

Subsequently, the estimation function 162 determines whether or not there is a finding of congenital heart disease (step S302). Here, if there is a finding of congenital heart disease (step S302 affirmative), the estimation function 162 presumes that it is congenital heart disease (step S303), and proceeds to step S213.

On the other hand, when there is no finding of congenital heart disease (step S302 denial), the estimation function 162 determines whether or not there is a finding of valvular disease (step S304). Here, if there is a finding of valvular disease (step S304 affirmative), the estimation function 162 presumes that it is valvular disease (step S305), and proceeds to step S213.

On the other hand, when there is no finding of valvular disease (step S304 denial), the estimation function 162 determines whether or not there is a finding of left ventricular enlargement (step S306). Here, if there is a finding of enlargement of the left ventricle (step S306 affirmative), the estimation function 162 estimates that the heartbeat is in a high heart rate state (step S307), and proceeds to step S213.

On the other hand, when there is no finding of left ventricular enlargement (step S306 denial), the estimation function 162 determines whether or not there is a finding of pericardial disease (step S308). Here, if there is a finding of pericardial disease (step S308 affirmative), the estimation function 162 presumes that it is pericardial disease (step S309), and proceeds to step S213.

On the other hand, when there is no finding of pericardial disease (step S308 denial), the estimation function 162 determines whether or not there is a finding of pulmonary arterial hypertension (step S310). Here, if there is a finding of pulmonary arterial hypertension (step S310 affirmative), the estimation function 162 presumes that it is pulmonary arterial hypertension (step S311), and proceeds to step S213.

On the other hand, when there is no finding of pulmonary arterial hypertension (negation of step S310), the estimation function 162 ends the process A shown in FIG. 9 and proceeds to step S208 of FIG. The processes of steps S204 to S207 correspond to the processes of step S105 of FIG.

That is, as shown in FIG. 9, the estimation function 162 estimates the health state based on the non-image information.

Returning to the description of FIG. Then, the determination function 163 determines E / e'and RAd-Ad as an additional inspection (step S208). For example, the determination function 163 is considered to have a possibility of heart failure in which left ventricular contractility is maintained and a low possibility of other heart diseases. Therefore, as additional tests, E / e'and RAd-Ad To determine.

Here, "E / e'" is the same as "MV E / e'" described above. Further, "RAd-Ad" represents the difference between the width of the atrial systolic wave of the pulmonary vein blood flow velocity waveform (RAd) and the width of the atrial systolic wave of the left ventricular inflow blood flow velocity waveform (Ad). Both E / e'and RAd-Ad can be measured based on velocity image data (data collected by the CW Doppler mode). The process of step S208 corresponds to the process of step S106 of FIG.

Then, the switching function 165 switches the imaging mode to the CW Doppler mode (step S209). For example, the imaging mode in which E / e'and RAd-Ad can be measured is the "CW Doppler mode", which is different from the imaging mode (current imaging mode) "B mode" executed in step S202, so that the switching function 165 Switches the imaging mode to the CW Doppler mode. The process of step S209 corresponds to the process of steps S108 to S109 of FIG.

Then, the transmission / reception circuit 110 executes a CW Doppler mode scan (step S210). Then, the image generation circuit 130 generates and displays velocity image data based on the data collected by the CW Doppler mode scan. The process of step S210 corresponds to the process of step S111 of FIG.

Then, the measurement function 161 measures E / e'and RAd-Ad using the velocity image data (step S211). As the method for measuring E / e'and RAd-Ad, known techniques can be arbitrarily applied.

Then, the estimation function 162 executes a process (process B) for confirming the possibility of heart failure in which the left ventricular contractility is maintained (step S212). The processing procedure of processing B will be described with reference to FIG.

As shown in FIG. 10, the estimation function 162 determines whether or not E / e'is 15 or more (step S401). When E / e'is 15 or more (step S401 affirmative), the estimation function 162 estimates that the heart failure maintains left ventricular contractility (step S407), and ends the process B.

On the other hand, when E / e'is less than 15 (negation of step S401), the estimation function 162 accepts the input of BNP (step S402). Here, "BNP" represents the amount of brain natriuretic peptide in blood and is measured by a blood test (or BNP test). For example, the estimation function 162 displays the input screen shown in FIG. 12 on the display 103, and accepts the input of BNP using this input screen.

In the example shown in FIG. 12, an input field for accepting input of a numerical value of BNP is displayed on the input screen. For example, the operator (doctor) inputs the BNP value of the subject P measured by the blood test performed in advance in the input field shown in FIG. 12, and presses the OK button. As a result, the estimation function 162 accepts the input of the BNP value of the subject P. BNP is an example of "non-image information".

Then, the estimation function 162 determines whether or not E / e'is 8 or more and less than 15, and BNP is 200 pg / mL or more (step S403). When E / e'is 8 or more and less than 15, and BNP is 200 pg / mL or more (step S403 affirmative), the estimation function 162 estimates that the heart failure maintains left ventricular contractility (step S407). , End process B.

On the other hand, when E / e'is 8 or more and less than 15, and BNP is not 200 pg / mL or more (step S403 negation), the estimation function 162 has E / e'8 or more and less than 15, and RAd-Ad. Is determined to be 30 msec or more (step S404). When E / e'is 8 or more and less than 15, and RAd-Ad is 30 msec or more (step S404 affirmative), the estimation function 162 estimates that the heart failure maintains left ventricular contractility (step S407). , End process B.

On the other hand, when E / e'is 8 or more and less than 15, and RAd-Ad is not 30 msec or more (step S404 negative), the estimation function 162 has a BNP of 200 pg / mL or more and a RAd-Ad of 30 msec or more. (Step S405). When BNP is 200 pg / mL or more and RAd-Ad is 30 msec or more (step S405 affirmative), the estimation function 162 estimates that the heart failure maintains left ventricular contractility (step S407), and processes B. To finish.

On the other hand, when BNP is 200 pg / mL or more and RAd-Ad is not 30 msec or more (step S405 denied), the estimation function 162 estimates that the possibility of heart failure is low (step S406) and ends process B. do.

That is, as shown in FIG. 10, the estimation function 162 estimates the health state based on the non-image information.

Returning to the description of FIG. The output control function 164 outputs the estimation result of the heart disease (step S213). For example, the output control function 164 causes the display 103 to display the estimation result estimated by the estimation function 162. Then, the ultrasonic diagnostic apparatus 1 ends the processing procedure shown in FIG.

The processing procedures shown in FIGS. 8 to 10 are merely examples, and the embodiments are not limited thereto. For example, the order of each process shown in FIGS. 8 to 10 can be appropriately changed within a range in which there is no contradiction in the process contents. For example, the process of accepting the input of finding information (step S301) and the process of accepting the input of BNP (step S402) may be executed at an earlier stage.

Further, in FIGS. 8 to 10, a case where the process of accepting the input of the finding information (step S301) and the process of accepting the input of the BNP (step S402) are input by the manual operation of the operator has been described. The embodiments are not limited to this. For example, if the finding information or BNP has been inspected, it may be automatically acquired from the inspection result. For example, when the reservation information for the ultrasonic examination of heart disease is transmitted from the examination reservation system to the ultrasonic diagnostic apparatus 1 for a certain subject P, if the finding information or the BNP has been examined, the finding information. And BNP values may also be transmitted from the examination reservation system to the ultrasonic diagnostic apparatus 1.

Further, in the above example, the case where "BNP" is used has been described, but "NT-proBNP" may be used. In addition, "NT-proBNP" is a hormone produced by decomposing proBNP, which is a prohormone, and is released into the blood together with BNP at a ratio of 1: 1 and is used for assisting diagnosis in heart failure like BNP. It is an index value.

Further, in the above example, the case where "RAd-Ad" is used has been described, but the "left atrial volume coefficient", "left atrium diameter", "left ventricular weight coefficient", and "findings of atrial fibrillation" have been described. At least one of them may be used. The "left atrium volume factor", "left atrium diameter", and "left ventricle weight factor" can be measured based on the B-mode image data of the left ventricle. Further, "atrial fibrillation findings" are information determined by an electrocardiogram examination, and can be automatically obtained by manual operation by an operator or from an examination reservation system or the like.

(Modification example)
In the above embodiment, the case where the priority of the additional inspection is determined based on whether or not it is the same as the current imaging mode has been described, but the embodiment is not limited to this. For example, the priority may be determined based on whether or not the additional inspection is performed in the B mode.

Since the B-mode image data images a tomographic image in the living body, it is the optimum imaging mode for the operator to grasp the state of the subject P in the body. The B-mode image data is also used as a background image in another imaging mode in order to specify the positions of the region of interest, the measurement caliper, the annotation, and the like. For these reasons, it can be said that the B mode is one of the main imaging modes in the ultrasonic diagnostic apparatus.

Therefore, the determination function 163 may determine the priority of each of the plurality of additional inspection candidates based on whether or not the additional inspection is performed in the "B mode". For example, when there are an additional inspection performed in the "B mode" and an additional inspection performed in another imaging mode as candidates for a plurality of additional inspections, the determination function 163 is performed in the other imaging mode. It is determined that the priority of the additional inspection performed in the "B mode" is higher than that of the additional inspection to be performed.

If additional inspections performed in "the same imaging mode as the current imaging mode" and "B mode" coexist as candidates for multiple additional inspections, "the same imaging mode as the current imaging mode". It is preferable to give priority to. That is, in the determination function 163, when there is no additional inspection performed in the same imaging mode as the current imaging mode among the candidates for the plurality of additional inspections, the priority of the additional inspection performed in the "B mode" is set. Judged as high. However, when the B mode is not executed in the initial imaging mode, the determination function 163 has a priority of the additional inspection performed in the "B mode" rather than the "same imaging mode as the current imaging mode". It may be determined that it is high.

(Other embodiments)
In addition to the above-described embodiments, various different embodiments may be performed.

Further, each component of each of the illustrated devices is a functional concept, and does not necessarily have to be physically configured as shown in the figure. That is, the specific form of distribution / integration of each device is not limited to the one shown in the figure, and all or part of them may be functionally or physically distributed / physically in arbitrary units according to various loads and usage conditions. Can be integrated and configured. Further, each processing function performed by each device may be realized by a CPU and a program analyzed and executed by the CPU, or may be realized as hardware by wired logic.

Further, among the processes described in the above-described embodiment, all or part of the processes described as being automatically performed can be manually performed, or the processes described as being manually performed. It is also possible to automatically perform all or part of the above by a known method. In addition, the processing procedure, control procedure, specific name, and information including various data and parameters shown in the above document and drawings can be arbitrarily changed unless otherwise specified.

Further, the output method (ultrasonic imaging method) described in the above-described embodiment can be realized by executing an output program (ultrasonic imaging program) prepared in advance on a computer such as a personal computer or a workstation. .. This ultrasonic imaging method can be distributed via a network such as the Internet. Further, this ultrasonic imaging method is recorded on a non-transient recording medium such as a hard disk, a flexible disk (FD), a CD-ROM, MO, or a DVD that can be read by a computer, and is read from the recording medium by the computer. Can also be done by.

Further, in the above-described embodiment and modification, "real time" means that each process is performed immediately each time each data to be processed is generated. For example, the process of displaying an image in real time is not limited to the case where the time when the subject is imaged and the time when the image is displayed completely match, and the image is slightly delayed depending on the time required for each process such as image processing. It is a concept including the case where it is displayed.

According to at least one embodiment described above, oversight of a disease can be reduced.

Although some embodiments have been described, these embodiments are presented as examples and are not intended to limit the scope of the invention. These embodiments can be implemented in various other embodiments, and various omissions, replacements, changes, and combinations of embodiments can be made without departing from the gist of the invention. These embodiments and variations thereof are included in the scope of the invention described in the claims and the equivalent scope thereof, as are included in the scope and gist of the invention.

1 Ultrasonic diagnostic device 160 Processing circuit 161 Measurement function 162 Estimation function 163 Judgment function 164 Output control function 165 Switching function

Claims (9)

An estimation unit that estimates the health condition based on the measured values measured using ultrasonic image data,
A determination unit that determines an additional test used for diagnosing the health condition based on the estimated health condition.
An output control unit that outputs information indicating the health condition and the additional test, and
An ultrasonic diagnostic device. The determination unit further determines the additional inspection based on the current imaging mode in which the ultrasound image data is imaged.
The ultrasonic diagnostic apparatus according to claim 1. When there are a plurality of candidates for the additional inspection, the determination unit determines the priority of each of the plurality of candidates for the additional inspection.
The output control unit outputs information indicating the priority of each of the plurality of additional inspection candidates and the plurality of additional inspections.
The ultrasonic diagnostic apparatus according to claim 1 or 2. The determination unit determines the priority of each of the plurality of additional inspection candidates based on whether or not the additional inspection is performed in the same imaging mode as the current imaging mode.
The ultrasonic diagnostic apparatus according to claim 3. The determination unit determines the priority of each of the plurality of additional inspection candidates based on whether or not the additional inspection is performed in the B mode.
The ultrasonic diagnostic apparatus according to claim 3 or 4. Further, a switching unit for switching the imaging mode when the imaging mode of the additional inspection is different from the current imaging mode is provided.
The ultrasonic diagnostic apparatus according to any one of claims 1 to 5. The estimation unit further estimates the health state based on non-image information different from the ultrasonic image data.
The ultrasonic diagnostic apparatus according to any one of claims 1 to 6. Estimate the health condition based on the measured values measured using ultrasonic image data,
Based on the estimated health condition, additional tests used to diagnose the health condition are determined.
An output method comprising outputting information representing the health condition and the additional test. Estimate the health condition based on the measured values measured using ultrasonic image data,
Based on the estimated health condition, additional tests used to diagnose the health condition are determined.
An output program that causes a computer to perform each process that outputs information indicating the health condition and the additional test.

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