JP2008295804A - Fundus examination device and program - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a fundus examination device and program, capable of making the fundus examination more efficient. <P>SOLUTION: When lesion areas in the examination area R in a fundus image G are specified, the fundus examination device 1 generates information on the distribution of the lesion areas in the examination area R. The information on the distribution is generated by classifying the lesion areas according to the size (C0-C4) and the position of each lesion area in the examination area R, and by counting the number of the lesion areas belonging to each class. In this way, the information on the distribution is the information indicating the state of distribution of the lesion areas in the examination area R. The fundus examination device 1 displays the generated information on the distribution in a table form or in a map form. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to a fundus inspection apparatus and program for inspecting the fundus, and more particularly to a technique applicable to an inspection for age-related macular degeneration.

  One of the fundus diseases that has been attracting attention in recent years is age-related macular degeneration (including age-related macular degeneration). Age-related macular degeneration is a disease that causes progressive visual impairment. Age-related macular degeneration occurs due to aging changes in the retinal pigment epithelium layer, Bruch's membrane (Brook's membrane), and choroid. Initially, pigment abnormalities in the retinal pigment epithelium and deposits (drusen) between the retinal pigment epithelium and Bruch's membrane are observed. As the disease progresses, degeneration / dropping / pigmentation of the retinal pigment epithelium, choroidal neovascularization, and the like become visible.

  In examinations such as age-related macular degeneration, methods for observing the macular region and evaluating the distribution (number, size, position, etc.) of the lesion are widely used (for example, see Non-Patent Documents 1 and 2).

  For example, Non-Patent Document 2 defines five classes C0 to C4 in order to classify sizes such as drusen, pigment abnormality, map-like atrophy, and degeneration. Here, class C0 has a diameter of less than 63 μm, class C1 has a size of 63 to 124 μm, class C2 has a size of 125 to 174 μm, class C3 has a size of 175 to 249 μm, class C4 has a diameter of 250 μm or more (and (Less than 500 μm).

  Patent Document 1 discloses an apparatus for inspecting macular diseases using the Haidinger's brush phenomenon. The Heidinger brush phenomenon is an endoscopic phenomenon in which a bundle-like pattern appears at the center of the visual field when viewing visible light that is polarized.

JP-A-5-31076 R. Klein, 5 others, "The Wisconsin Age-related Maculopathy Grading System", OPHTHALMOLOGY, JULY 1991, VOLUME 98, NUMBER 7, p.1128-1134 A.C. Bird, 15 others, `` An International Classification and Grading System for Age-related maculopathy and Age-related Macular Degeneration '', SURVEY OF OPHTHALMOLOGY, MARCH-APRIL 1995, VOLUME 39, NUMBER 5, P.367-374

  In the method of evaluating the distribution of the lesion, many complicated manual operations such as marking the lesion on the fundus image and measuring the size of the lesion are necessary, and the examination is efficient. This could not be done and the burden on the examiner was also large. In addition, human error may occur in such manual work. In particular, when a large number of patients are inspected, for example, in a group examination or clinical examination, there is a high risk of mistakes, and the burden on the examiner is great.

  Moreover, since the apparatus described in Patent Document 1 requires a relatively long time for examination of each patient, it is not suitable for group examination or the like. Furthermore, this apparatus can test patients who have already suffered from visual impairment, but cannot test early patients who have not yet suffered from visual impairment, and therefore cannot be used for early detection and early treatment.

  The present invention has been made to solve the above-described problems, and an object thereof is to provide a fundus examination apparatus and program capable of improving the efficiency of examination of the fundus.

  In order to achieve the above object, the invention according to claim 1 generates designation means for designating a lesion area in an examination area including a foveal position in a fundus image, and generates distribution information of the lesion area in the examination area. A fundus examination apparatus comprising: generating means for outputting; and output means for outputting the distribution information.

  The invention according to claim 2 is the fundus examination apparatus according to claim 1, wherein the designation means stores storage means for storing eyeball information including information on the eyeball optical system of the eye to be examined, and the eyeball. And determining means for determining the size of the examination region in the fundus image based on the information.

  The invention according to claim 3 is the fundus examination apparatus according to claim 1 or 2, wherein the specifying means stores in advance classification information for classifying a lesion area into a plurality of classes, It is possible to designate a lesion area for each class of classification information, and the generation unit generates the distribution information indicating the number of lesion areas classified into each class based on a lesion area designation result by the designation unit. It is characterized by generating.

  The invention according to claim 4 is the fundus examination apparatus according to claim 3, wherein the classification information is information for classifying a lesion area according to size, and the designation means A class according to the size of the area can be selected and specified from the plurality of classes.

  Further, the invention according to claim 5 is the fundus examination apparatus according to claim 4, wherein the designation means selects a class of the smallest size among classes of sizes greater than or equal to the lesion area based on the classification information. The feature is that it can be specified.

  The invention according to claim 6 is the fundus examination apparatus according to claim 4 or claim 5, wherein the designation means includes display means for displaying a fundus image and a cursor having a predetermined shape and a predetermined size. And operating means for operating the cursor to designate a lesion area in the examination area in the displayed fundus image.

  The invention according to claim 7 is the fundus examination apparatus according to any one of claims 4 to 6, wherein the generation unit provides the distribution information as each of the plurality of classes. Table information that displays a list of the number of classified lesion areas is generated.

  The invention according to claim 8 is the fundus examination apparatus according to claim 3, wherein the classification information is used to divide the examination area of the fundus image into a plurality of partial areas as the plurality of classes. Information, and the generation means generates the distribution information representing the number of lesion areas classified into the partial areas, based on a lesion area designation result by the designation means.

  The invention according to claim 9 is the fundus examination apparatus according to claim 8, wherein the designation means includes a display means for displaying a fundus image, a cursor having a predetermined shape and a predetermined size, and the display And an operation means for operating the cursor to designate a lesion area in an examination area in a fundus image.

  The invention according to claim 10 is the fundus examination apparatus according to claim 8 or claim 9, wherein the generation means is a lesion classified into each of the plurality of partial regions as the distribution information. Table information that lists the number of areas is generated.

  The invention according to claim 11 is the fundus examination apparatus according to claim 8 or claim 9, wherein the generation means is a lesion classified into each of the plurality of partial regions as the distribution information. Image information representing the number of regions is generated.

  The invention according to claim 12 is the fundus examination apparatus according to claim 3, wherein the classification information classifies the lesion area into the plurality of classes according to both the position and the size in the examination area. The designation means displays a fundus image and a cursor having a predetermined shape and size, and specifies the lesion area by operating the cursor on the examination area in the displayed fundus image The generation means includes table information and / or image information indicating the number of lesion areas corresponding to both the position and the size based on a result of designation of the lesion area by the operation means. It is generated as the distribution information.

  The invention according to claim 13 is the fundus examination apparatus according to claim 1 or 2, wherein the generating means examines the fundus image based on a lesion area designation result by the designation means. The distribution information representing the calculation result of the area ratio is generated.

  The invention according to claim 14 is the fundus examination apparatus according to claim 13, wherein the designation means includes display means for displaying a fundus image, a cursor having a predetermined shape and a predetermined size, and the display. And operating means for operating the cursor to designate a lesion area in the examination area in the fundus image.

  The invention according to claim 15 is the fundus examination apparatus according to claim 14, characterized in that the shape and size of the cursor can be changed by the operation means.

  The invention according to claim 16 is the fundus examination apparatus according to claim 1 or 2, wherein the designation unit selects a lesion area in the examination area based on a pixel value of a pixel of the fundus image. Extraction means for extracting, wherein the generation means generates the distribution information based on the extracted lesion area.

  The invention according to claim 17 is the fundus examination apparatus according to claim 1 or 2, wherein the specifying means includes a display means for displaying a fundus image and a cursor having a predetermined shape and a predetermined size. Operating means for operating the cursor on the examination area in the displayed fundus image to designate a lesion area; and when the one or more lesion areas are designated by the operation means, the one or more lesions Extracting means for extracting other lesion areas based on pixel values of the pixels of the area, wherein the generation means generates the distribution information representing the distribution of the one or more lesion areas and the other lesion areas; It is characterized by.

  The invention according to claim 18 is a program for controlling a computer that processes a fundus image, and the computer functions as a designation unit that designates a lesion area in an examination area including a foveal position in a fundus image. And functioning as generation means for generating distribution information of the lesion area in the examination area, and functioning as output means for outputting the distribution information.

  According to this invention, it is possible to automatically generate distribution information of a lesion area in an examination area and output the distribution information. As a result, it is not necessary to perform complicated manual work as in the prior art, and it is possible to improve the efficiency of examination of the fundus.

  An example of a preferred embodiment of a fundus examination apparatus and program according to the present invention will be described in detail with reference to the drawings. The present invention is used for examining the distribution of lesions near the fovea of the fundus. In the following first embodiment, a technique for making a diagnosis based on the number of lesions will be described. In the second embodiment, a technique for making a diagnosis based on the ratio (area ratio) of lesions in a predetermined region will be described. In the third embodiment, an example in which examination contents can be switched according to the type of lesion will be described.

<First Embodiment>
A first embodiment of the present invention will be described. This embodiment is a technique suitable for making a diagnosis based on the number of lesions in the vicinity of the fovea as in the diagnosis of age-related macular degeneration. Examples of lesions associated with age-related macular degeneration include drusen, pigment abnormalities / degeneration / dropout / pigmentation of the retinal pigment epithelium, map-like atrophy, and choroidal neovascularization.

[Constitution]
An example of the configuration of the fundus examination apparatus according to this embodiment is shown in FIGS. The fundus examination apparatus 1 is connected to the ophthalmologic image database 400 via a communication line such as a LAN (Local Area Network).

  The ophthalmic image database 400 is a filing system that manages image data of images in the ophthalmic field. The ophthalmic image database 400 includes, for example, a large-capacity storage device that stores digital image data, and database software that manages data stored in the large-capacity storage device. The ophthalmologic image database 400 may include a filing system for other uses such as an electronic medical record, in addition to a filing system for image data.

  Image data stored in the ophthalmic image database 400 is acquired by the fundus imaging apparatus 300. Although only one fundus photographing apparatus is shown in FIG. 1, it is possible to install two or more fundus photographing apparatuses.

  The fundus imaging apparatus 300 is an apparatus that can acquire image data (digital data) G by capturing a fundus image of the eye to be examined. Image data G of the fundus image acquired by the fundus imaging apparatus 300 is transmitted to and stored in the ophthalmologic image database 400 via a communication line such as a LAN. Since “image” and “image data” correspond one-to-one, they may be identified in this specification.

  As the fundus imaging apparatus 300, any apparatus capable of acquiring a fundus image such as a fundus camera, an optical coherence tomography apparatus, a scanning laser ophthalmoscope, or the like can be applied.

  The fundus camera is a device that irradiates illumination light toward the fundus, receives the fundus reflection light by a light receiving element such as a CCD (Charge Coupled Devices) image sensor, and acquires image data G of a fundus image. It is also possible to use a stereoscopic fundus camera (for example, refer to Japanese Patent Laid-Open No. 5-15499: referred to as a stereoscopic fundus camera) having left and right independent optical systems.

  An optical coherence tomography (OCT) device divides low-coherence light into two parts, irradiates one of the fundus, makes the backscattered light interfere with the other light, and receives it with a CCD image sensor or the like. It is an apparatus which acquires the image data G of this. As the optical coherence tomography apparatus, an apparatus of an arbitrary system such as a Fourier domain (also referred to as a frequency domain) system, a time domain (time domain) system, or a swept source system (swept source) system can be used ( For example, refer to JP 2006-184284 A).

  A scanning laser opthalmoscope (SLO) scans a light beam to irradiate the fundus and receives reflected light or fluorescence at a predetermined portion with a CCD or the like to acquire image data G of the fundus image. Device (see, for example, JP-A-11-197109).

  The fundus image image data G is stored in the ophthalmic image database 400 in association with various incidental information such as patient information and imaging conditions. Here, the patient information is information such as the patient ID and patient name of the patient to be imaged. The shooting conditions are information such as shooting date and time, shooting magnification (shooting angle of view), left and right eye, image direction (upward, downward, nose side, ear side, etc.). The operator of the fundus examination apparatus 1 can read and observe a desired fundus image of a desired patient by designating a patient ID, a patient name, and the like.

  When the fundus image is a monochrome image, the image data G is data in which the coordinate value of the pixel forming the fundus image is associated with the luminance value of each pixel. When the fundus image is a color image, the image data G is data in which the coordinate values of the pixels forming the fundus image are associated with the RGB values (R value, G value, B value) of each pixel.

  Note that the fundus examination apparatus according to the present invention is not limited to the configuration for reading the captured image stored in the ophthalmologic image database 400. For example, the fundus inspection apparatus directly accepts an image captured by the fundus imaging apparatus 300. May be. Further, the fundus examination apparatus according to the present invention may include a drive device that reads image data G recorded on a medium (recording medium) such as a CD-R or a DVD-R.

  Further, the image data G of the fundus image is image data of a (pseudo) three-dimensional fundus image generated based on the luminance value of the image data of the fundus image as described in Japanese Patent Application No. 2005-217876. There may be. The image data of the three-dimensional fundus image may be generated by the fundus photographing apparatus 300 or may be generated by the fundus examination apparatus 1.

[Hardware configuration]
A hardware configuration of the fundus examination apparatus 1 will be described. The fundus inspection apparatus 1 includes, for example, a general-purpose computer. As shown in FIG. 2, the fundus examination apparatus 1 includes a microprocessor 200, a RAM 201, a nonvolatile storage device 202, a display 203, a keyboard 204, a mouse 205, and a communication interface (I / F) 206.

  The microprocessor 200 is configured by an arbitrary microprocessor such as a CPU (Central Processing Unit) or an MPU (Micro Processing Unit) that executes various arithmetic processes and control processes.

  A RAM (Random Access Memory) 201 is a volatile storage device, and a program and data being executed by the microprocessor 200 are expanded.

  The nonvolatile storage device 202 includes a storage device (external storage device) such as a hard disk drive (Hard Disk Drive) or a ROM (Read Only Memory). The non-volatile storage device 202 stores a program P in advance. The microprocessor 200 causes the fundus examination apparatus 1 to execute processing characteristic of this embodiment by developing the program P on the RAM 201. Further, image data G of the fundus image received from the ophthalmologic image database 400 is stored in the nonvolatile storage device 202 (particularly, a hard disk drive). The program P is an example of the “program” of the present invention.

  When the computer constituting the fundus examination apparatus 1 constitutes a client in a client server system (Client-Server System), the program P may be stored in the server, and the program P may be appropriately called to execute the processing. .

  In addition, the fundus examination apparatus 1 includes a display 203, a keyboard 204, and a mouse 205 as in a normal computer.

  The display 203 includes an arbitrary display device such as an LCD (Liquid Crystal Display) or a CRT (Cathode Ray Tube) display. The display 203 constitutes the display unit 141 shown in FIG. The display unit 141 corresponds to an example of the “display unit” of the present invention.

  A keyboard 204 and a mouse 205 are used as input devices for an operator to input various types of information based on display information such as images and screens displayed on the display 203. The keyboard 204 and the mouse 205 are used as operation devices for an operator to instruct execution of a desired operation based on display information. The keyboard 204 and the mouse 205 constitute the operation unit 142 shown in FIG. Note that the operation unit 142 is not limited to a keyboard and a mouse, and may include a trackball, a joystick, a dedicated control panel, and the like. The operation unit 142 corresponds to an example of the “operation means” of the present invention.

  The communication interface 206 performs data communication with other devices such as the ophthalmic image database 400 via a communication line such as a LAN. The communication interface 206 includes a network adapter such as a LAN card, for example. Further, in the case where connection to a WAN (Wide Area Network) such as the Internet is possible, the communication interface 206 includes a communication device such as a modem.

[Control system configuration]
Next, the configuration of the control system of the fundus examination apparatus 1 will be described with reference to FIG. The fundus examination apparatus 1 includes a control unit 10, an image receiving unit 11, an image storage unit 12, a data processing unit 13, a user interface 14, and a data output unit 15.

(Control part)
The control unit 10 functions as the center of the control system of the fundus examination apparatus 1. The control unit 10 includes a microprocessor 200 that operates based on the program P. The control unit 10 controls the operation of each unit of the fundus examination apparatus 1. In particular, the control unit 10 causes the display unit 141 to display various display screens, fundus images, and information. Further, when the operation unit 142 is operated, the control unit 10 controls each unit of the fundus examination apparatus 1 according to the operation content.

(Image reception department)
For example, the image receiving unit 11 transmits information such as a patient ID and an imaging date and time designated by the operator of the fundus examination apparatus 1 to the ophthalmic image database 400. Further, the image receiving unit 11 receives the image data G of the fundus image transmitted from the ophthalmologic image database 400 based on this information and inputs it to the control unit 10. The control unit 10 causes the image storage unit 12 to store the image data G input from the image receiving unit 11. The image receiving unit 11 includes a communication interface 206.

  As described above, when the image data G is received directly from the fundus imaging apparatus 300, the image reception unit 11 includes a connection interface with the fundus imaging apparatus 300.

(Image storage unit)
The image storage unit 12 stores image data G of a fundus image. The image storage unit 12 includes a nonvolatile storage device 202 (particularly a hard disk drive). The control unit 10 performs a process of writing the image data G to the image storage unit 12 and a process of reading the image data G stored in the image storage unit 12.

(Data processing part)
The data processing unit 13 executes various data processing based on the image data G of the fundus image. The data processing unit 13 includes a microprocessor 200, a RAM 201, a nonvolatile storage device 202, and the like.

  The data processing unit 13 is provided with a lesion area designation unit 131. The lesion area designation unit 131 is provided with a storage unit 132, an examination area determination unit 133, and a designation processing unit 134. The data processing unit 13 is provided with a distribution information generation unit 135. Hereinafter, the units 131 to 135 included in the data processing unit 13 will be described.

(Lesion area designation part)
The lesion area designation unit 131 operates to designate a lesion area in the fundus image. Here, the lesion area means an area in the fundus image corresponding to the lesion area of the fundus. The lesion area is an image area recognized as such by the operator (doctor) or the fundus examination apparatus 1.

(Memory part)
The storage unit 132 stores eyeball information of the eye to be examined. In this eyeball information, information relating to the eyeball optical system of the eye to be examined, such as the refractive index, the axial length, and the corneal curvature (radius), is recorded. These pieces of information may be actual measurement data of the eye to be examined, statistical data obtained clinically, or model values of an eyeball model such as a Gullstrand model eye.

  When actually measured data is used, information may be automatically acquired from the patient's electronic medical record or the like, or an operator may manually input the information.

  Further, when storing a plurality of eyeball information, additional information such as patient identification information such as a patient ID and left and right eye identification information (information for identifying the left eye / right eye) is given to each eyeball information. It is desirable to be able to search for desired eyeball information based on this.

  Further, the storage unit 132 stores classification information. This classification information is information for classifying a lesion area, and defines a plurality of classes in this classification. As classification of a lesion area, there is classification according to size as described in Non-Patent Documents 1 and 2.

  Here, the classification method described in Non-Patent Document 2 is used. In this classification method, a circular region having a diameter of 6000 μm centering on the fovea of the fundus is considered as an inspection object (examination region), and a lesion part (lesion region) in this inspection region is classified into five classes C0, C1, C2 having different sizes. , C3, and C4.

  The classification information defines information (for example, a diameter) indicating the size of each class C0 to C4. Class C0 is defined as a circle having a diameter of 63 μm, and a lesion area having a maximum diameter of less than 63 μm is classified as class C0. Class C1 is defined as a circle having a diameter of 125 μm, and a lesion area having a maximum diameter of 63 to 124 μm is classified into class C1. Class C2 is defined as a circle having a diameter of 175 μm, and a lesion area having a maximum diameter of 125 to 174 μm is classified into class C2. Class C3 is defined as a circle having a diameter of 250 μm, and a lesion area having a maximum diameter of 175 to 249 μm is classified into class C3. Class C4 is defined as a circle having a diameter of 500 μm, and a lesion area having a maximum diameter of 250 μm to 499 μm is classified as class C4.

  The classification of the lesion area having a maximum diameter of 500 μm or more will be described later in the second embodiment.

  The storage unit 132 also stores information that defines the size of the inspection region (eg, the above-described diameter of 6000 μm), information that defines a partial region within the inspection region, and the like. Information defining the partial area includes information defining the diameter of the partial area (for example, 1000 μm, 3000 μm, etc.), information defining the direction (for example, superior (upper), informer (lower), nosal (nose side), temporal) (Ear side)).

  The storage unit 132 includes a nonvolatile storage device 202 (particularly a hard disk drive). The storage unit 132 is an example of the “storage unit” in the present invention.

(Inspection area determination unit)
The examination area determination unit 133 determines an examination area in the fundus image based on information (particularly eyeball information) stored in the storage unit 132. This process will be described more specifically.

  Information such as shooting magnification (shooting angle of view) is attached to the fundus image. The storage unit 132 stores eyeball information. The examination region determination unit 133 refers to these pieces of information to determine a unit distance in the fundus image.

  This unit distance may be, for example, a unit distance (such as 10 μm) on the fundus image, or may be a distance between adjacent pixels of the fundus image. By determining such a unit distance, it is possible to define the distance on the fundus image.

  Note that the unit distance is calculated by, for example, obtaining an approximate value of the unit distance based on the imaging magnification (magnification by the optical system of the fundus imaging apparatus 300) and taking into account the influence of the eyeball optical system based on the eyeball information. This is done by correcting the value. Here, the influence of the eyeball optical system can be obtained by any conventional method such as the method described in Japanese Patent Application No. 2007-45831.

  When the unit distance on the fundus image is determined in this way, the examination region determination unit 133 determines the reference position determined separately and information defining the size of the examination region (stored in the storage unit 132). Based on this, an examination region is set in the fundus image.

  Note that the inspection region determination unit 133 may determine only the size of the inspection region. In this case, the position of the inspection region is manually determined by an operator observing the fundus image. Further, instead of determining the size of the examination area according to the fundus image, the size of the fundus image may be adjusted according to the size of the examination area.

  In this embodiment, an image position (fovea position) corresponding to the fovea fovea is used as the reference position. The foveal position may be automatically detected by the examination region determination unit 133 or may be manually designated by the operator.

  A case where the fovea position is automatically detected will be described. First, the examination region determination unit 133 analyzes the pixel value of the fundus image and specifies an image region (macular region) corresponding to the macular portion of the fundus. In general, the macular region is a low luminance region in the fundus image, and an approximate shape (substantially circular or elliptical) is also known. Therefore, the macular region can be identified by searching for a region having a small pixel value in the fundus image. When the macular region is specified, the examination region determination unit 133 obtains a position (center position, center of gravity position, etc.) that can be regarded as the center. This process can be easily executed by considering the coordinates of the pixels included in the macular region.

  A case where the fovea position is designated manually will be described. For this purpose, the fundus image is displayed on the display unit 141. The operator identifies the foveal position by observing the fundus image. Then, the operator designates the foveal position by designating the specific position by clicking the mouse 205, for example.

  For example, when the operator designates a macular region by clicking or dragging the mouse 205, the examination region determining unit 133 can be configured to automatically detect the foveal position in the macular region. is there.

  When the unit distance and the foveal position on the fundus image are determined as described above, the examination area determination unit 133 determines the examination area on the fundus image based on the information defining the size of the examination area and the unit distance. Determine the size of the. Further, the examination area determination unit 133 determines the examination area on the fundus image by arranging the center of the examination area at the foveal position. In this embodiment, an area having a diameter of 6000 μm centered on the fovea position is set as the examination area of the fundus image.

  The inspection area determination unit 133 is an example of the “determination unit” according to the present invention.

(Designated processing part)
The designation processing unit 134 performs a process of designating a lesion area on the fundus image. There are two types of lesion areas, one designated manually by the operator and one designated automatically by the fundus examination apparatus 1.

  A case where the lesion area is designated manually will be described. For this purpose, the fundus image is displayed on the display unit 141. The operator observes the fundus image and identifies it as a lesion area, and designates the particular area as a lesion area by, for example, clicking or dragging the mouse 205. At this time, the operator selects a class (C0 to C4) according to the size of the specific area and designates the lesion area. The class is selected by, for example, rotating the mouse wheel of the mouse 205 or right-clicking. The designation processing unit 134 designates the lesion area designated on the display image in this way for the image data. That is, the designation processing unit 134 records the designated lesion area range (pixel coordinate values).

  A case where a lesion area is automatically designated will be described. A (visible) lesion area is depicted with a brightness or color different from other image areas. Therefore, the lesion area can be extracted by executing image analysis such as threshold processing based on the pixel value of the pixel in the examination area. The designation processing unit 134 extracts and designates the lesion area in this way. When the lesion area is automatically designated as described above, the designation processing unit 134 functions as an example of the “extraction means” of the present invention.

  In addition, the designation | designated aspect of a lesion area is not limited to the above. For example, when an arbitrary position in a lesion area is manually designated (clicked, etc.), the pixel values of pixels around the designated position are analyzed (threshold processing, etc.), and the boundary (outer circumference) of the lesion area is analyzed. It is possible to automatically specify the range of the lesion area.

  When an image area including at least a part of a lesion area is manually designated, the pixel value of the pixel in the designated area (and its surroundings) is analyzed to automatically specify the range of the lesion area. It is also possible to configure as described above.

(Distribution information generator)
The distribution information generation unit 135 generates information (distribution information) indicating the distribution state of the lesion area in the examination area based on the lesion area designation result by the lesion area designation unit 131.

  The distribution information is information indicating the number of lesion areas in the examination area. In particular, when classifying a lesion area into a plurality of classes, the distribution information represents the distribution of the number of lesion areas in the plurality of classes (that is, the number of lesion areas classified into the classes C0 to C4). The distribution information is displayed in, for example, a table format or a map format. Specific examples of the distribution information will be described later.

  The distribution information generation unit 135 is an example of the “generation unit” in the present invention.

(User interface)
The user interface 14 is a user interface (User Interface) of the fundus examination apparatus 1. The user interface 14 is provided with the display unit 141 and the operation unit 142 described above.

  In this embodiment, the display means and the operation means are configured separately, but a user interface such as a touch panel display in which these are integrated can also be applied.

(Data output part)
The data output unit 15 outputs distribution information. The data output unit 15 includes, for example, a communication interface 206 and transmits distribution information to an external device (not shown) connected via a communication line such as a LAN. Examples of the external device include an electronic medical record database and a doctor terminal.

  The data output unit 15 may include a printing device (not shown) that prints out the distribution information.

  The data output unit 15 may include a drive device (not shown) that records the distribution information on a recording medium. Examples of the recording medium include an optical disk, a magneto-optical disk (CD-ROM, DVD-RAM, DVD-ROM, MO, etc.), a magnetic storage medium (floppy (registered trademark) disk, ZIP, etc.), and the like.

  The data output unit 15 is an example of the “output unit” in the present invention. In addition, when displaying the distribution information on the display unit 141, the display unit 141 is also an example of the “output unit”.

[Usage form]
A usage pattern of the fundus examination apparatus 1 will be described. The flowchart shown in FIG. 3 represents an example of a usage pattern of the fundus examination apparatus 1. 4 to 11 show examples of display screens in this usage pattern. These display screens are displayed when the control unit 10 controls the display unit 141.

(Step 1: Patient selection)
First, when the operator performs a predetermined operation, the image receiving unit 11 requests the ophthalmic image database 400 to transmit patient information under the control of the control unit 10. Upon receiving this request, the ophthalmologic image database 400 transmits patient information of a patient in which an image (particularly a fundus image) is stored to the fundus examination apparatus 1. The image receiving unit 11 receives this patient information and inputs it to the control unit 10. Based on this patient information, the control unit 10 causes the display unit 141 to display a patient selection screen 1000 shown in FIG.

  A patient list display unit 1002 on the patient selection screen 1000 displays a list of patient information of each patient. In the patient list display unit 1002 shown in FIG. 4, patient ID, patient name, sex, date of birth, date of registration, and date of last visit are presented as patient information.

  The patient selection unit 1001 of the patient selection screen 1000 is provided with an input space for inputting a patient ID, a patient name, and a furigana. The operator of the fundus examination apparatus 1 inputs information on the patient to be examined (selected patient information) into at least one of these input spaces. The input operation of the selected patient information is performed by operating the operation unit 142 (keyboard 204 or the like). When the input of the selected patient information is completed, the operator operates the mouse 205 and clicks an OK button 1003.

(Step 2: Selection of fundus image)
When the OK button 1003 is clicked, the control unit 10 causes the display unit 141 to display the image selection screen 1100 shown in FIG. The patient information display unit 1101 of the image selection screen 1100 displays the patient information of the patient selected in step 1 (patient ID, patient name, date of birth and sex in FIG. 5).

  The image list display unit 1102 displays a list of images taken in the past for this patient. In the image list shown in FIG. 5, the disk ID, the shooting date, the procedure (shooting mode), the image label, the type (type of image), the file name, and the like in which the image is stored are presented. In addition, the imaging | photography log | history of the image for every patient is stored in the ophthalmic image database 400 as patient information, for example.

  The operator selects desired information from the image information listed in the image list. This selection operation is performed, for example, by clicking the desired image information with the mouse 205. After selecting the desired image information, the operator clicks an OK button 1103 with the mouse 205 to confirm the selection result. In addition, what is necessary is just to reselect the information of another image, when changing selection contents.

  The control unit 10 sends a selection result of image information (for example, together with selected patient information) to the image receiving unit 11. The image receiving unit 11 transmits the selected image transmission request (particularly, the patient ID and the file name of the image) to the ophthalmic image database 400. The ophthalmologic image database 400 searches for an image based on this transmission request and transmits it to the fundus examination apparatus 1.

(Step 3: Display of fundus image)
The image receiving unit 11 receives an image from the ophthalmic image database 400 and inputs it to the control unit 10. The control unit 10 causes the display unit 141 to display this image. FIG. 6 shows an image display screen 1200 that displays the fundus oculi image G.

  The operator confirms the display image, image information, and the like, and determines whether this image is appropriate as an inspection target. If it is not appropriate, repeat step 1 and step 2 above.

(Step 4: Start inspection)
If it is appropriate, a predetermined operation is performed by the operation unit 142 to start a fundus examination program (included in the program P). The control unit 10 causes the display unit 141 to display the inspection screen 1300 shown in FIG. 7 according to this program.

  On the examination screen 1300, a fundus image G (an enlarged image thereof) is displayed. Further, the image processing area Ga and the examination area R are displayed so as to be superimposed on the fundus image G.

  The image processing area Ga defines an area to which various image processing (color enhancement, color adjustment, contrast, sharpening, etc., which will be described later) for improving visibility of a lesioned part is applied. That is, only the image area located in the image processing area Ga in the fundus image G is subjected to image processing. As a result, the processing can be executed in a shorter time than when the entire fundus image G is processed.

  The inspection region R defines, for example, the aforementioned circular region having a diameter of 6000 μm. At this time, the examination region R is determined by the examination region determination unit 133 based on the above-described eyeball information and classification information. In FIG. 7, the center position of the inspection region R is represented by the symbol C. Here, 6000 μm means the actual size on the fundus of the examination object as described above.

  The inspection area R is always located inside the image processing area Ga. Further, the image processing area Ga is set larger than the inspection area R. This is because a lesioned part of which only a part is included in the examination region R is handled as an examination target.

  On the inspection screen 1300, a circular mark M indicating the center position of the screen is displayed. The operator observes the fundus oculi image G and specifies the fovea position (macular region). Further, the operator changes the display position of the fundus oculi image G on the examination screen 1300 so that the fovea position is located in the mark M. This change operation is performed by, for example, a drag operation with the mouse 205 or a cursor key operation on the keyboard 204.

  The operator operates the operation unit 142 to move the inspection region R so that the center position C is located at the foveal position (at least in the vicinity thereof). At this time, the operator moves the inspection region R so that the center position C is arranged in the mark M, for example. This moving operation is performed by, for example, a drag operation of the mouse 205. It is also possible to automatically move the inspection area R and the image processing area Ga so that the center position C is arranged in the mark M. This process is executed by the inspection area determination unit 133.

  When the position of the examination region R on the fundus image G is determined, the designation processing unit 134 acquires the range of the partial region of the fundus image G corresponding to the examination region R (this range is also called the examination region R). Remember. A two-dimensional coordinate system is set in advance for the fundus image G. The inspection region R is obtained as a coordinate value of the coordinate system, for example.

  As described above, instead of displaying the inspection region R and the image processing region Ga from the beginning, the inspection region R and the like may be set as follows. First, only the fundus oculi image G is displayed on the examination screen 1300. The operator observes the fundus oculi image G, specifies the foveal position, and clicks with the mouse 205. The inspection region determination unit 133 determines the inspection region R based on the click position, eyeball information, and classification information. Further, the inspection area determination unit 133 determines the image processing area Ga so as to include the inspection area R. At this time, the size of the image processing area Ga is set in advance. The image processing area G may be set manually.

  The examination screen 1300 further includes a lesion size button 1301, a map button 1302, an image processing button 1303, a scale button 1304, a cancel button 1305, and an end button 1306. As the lesion size button 1301, five buttons corresponding to the above-described classifications C0 to C4 are provided so as to be selectable. When the designation of the lesion area is started, a save button 1309 is displayed instead of the end button 1306 (see FIG. 9).

  When the lesion size button 1301 is operated (clicked), as illustrated in FIG. 8, the control unit 10 displays a lesion on the lesion information display unit 1307 in the edge region (a position that does not overlap the image processing region Ga) of the examination screen 1300. Display size information. As the lesion size information, the name of each class (C0 to C4) and an image representing the size of each class (circular image) are displayed.

  When one of the lesion size buttons 1301 is selected, a selection mark indicating that this button (size) is selected is displayed. In FIG. 8, an asterisk “*” is displayed above the name “C0” in the lesion information display unit 1307 in a state where the C0 button is selected.

  Note that the selection of the five classes C0 to C4 can be performed by rotating the mouse wheel of the mouse 205, for example.

  When the map button 1302 is operated (clicked), the control unit 10 displays a distribution information display screen 1400 shown in FIG. The distribution information display screen 1400 will be described later.

  The image processing button 1303 is provided with buttons corresponding to various image processing. When the color enhancement button is operated, the data processing unit 13 performs color enhancement processing on the fundus image G (only in the examination region R; the same applies hereinafter). When the color adjustment button is operated, the data processing unit 13 performs color adjustment processing on the fundus image G. When the contrast button is operated, the data processing unit 13 performs contrast processing on the fundus image G. When the sharpening button is operated, the data processing unit 13 performs a sharpening process on the fundus image G.

  Specific examples of these image processes will be described. When any one of the image processing buttons 1303 is operated, the control unit 10 displays a setting screen (dialog or the like) corresponding to the operated button. The operator uses the setting screen and the operation unit 142 to set the processing content of the image processing. The data processing unit 13 performs image processing on the fundus image G based on the set processing content. The control unit 10 causes the display unit 141 to display the fundus image G that has been subjected to image processing.

  The control unit 10 causes the display unit 141 to display an image in the inspection region R on which the above image processing has been performed. At this time, for image regions other than the inspection region R, an image that has not been subjected to image processing is displayed as it is. The operator can appropriately perform these image processing on the fundus image G by operating the image processing button 1303.

  When the scale button 1304 is operated, the control unit 10 displays a scale image that divides the inspection region R into a plurality of partial regions. When the scale button 1304 is operated again, the control unit 10 hides the scale image. That is, the scale button 1304 is a button for the operator to appropriately switch between display / non-display of the scale image.

  Since the scale image is superimposed on the fundus image G, it may be desirable to specify the lesion area in a non-display state (step 5). However, it is desirable to display the scale image with high transparency. It is also possible to elaborate.

  As the scale image, for example, as shown in FIG. 8, there are a circular region Ra having a diameter of 3000 μm and a circular region Rb having a diameter of 1000 μm centered on the center position C. These circular regions Ra and Rb divide the inspection region R into its internal region and external region.

  Further, as shown in FIG. 8, line images L1 to L4 for dividing the inspection region R according to the direction are displayed as scale images. The line images L1 to L4 are arranged radially about the center position C. A fan-shaped image region sandwiched between the line images L1 and L2 defines an upper partial region. A fan-shaped image region sandwiched between the line images L1 and L3 defines a partial region on the ear side (temporal). The fan-shaped image region sandwiched between the line images L2 and L4 defines a partial region on the nose side. A fan-shaped image region sandwiched between the line images L3 and L4 defines an inferior partial region.

  A cancel button 1305 is operated to reset a lesion area designation result in step 5 described later.

  An end button 1306 is operated to end the inspection using the inspection screen 1300.

  A save button 1309 is operated to save the inspection result. The inspection result storing process will be described later.

  The inspection screen 1300 is provided with an information display unit 1308 that displays various types of information. The information display unit 1308 displays patient information such as the patient's sex and age, and eyeball information such as the refractive index, average corneal curvature (radius), and axial length.

(Step 5: Designation of lesion area)
The operator observes the examination region R and specifies a lesion region such as a vitiligo. The operator clicks a button corresponding to the size of the lesion area among the five buttons (C0 button to C4 button) arranged on the lesion size button 1301. At this time, the button corresponding to the minimum size surrounding this lesion area is selected.

  The control unit 10 displays a circular cursor image having a size corresponding to the clicked button on the fundus image G. The operator moves the cursor image onto the lesion area by dragging the mouse 205 or the like. At this time, the position of the cursor image is changed so as to surround the lesion area. Furthermore, the operator designates a lesion area by performing a click operation or the like. Accordingly, the control unit 10 displays an image having the same size and shape as the cursor image so as to surround the lesion area.

  Thus, the cursor image is circular and is an image having a size corresponding to each class C0 to C4. The cursor image is an example of the “cursor” of the present invention. Note that a cursor is generally a mark indicating at which position on the screen an operation is executed. The cursor according to this embodiment represents which position on the fundus image G is designated as a lesion area.

  Furthermore, the designation processing unit 134 acquires and stores the position of the designated lesion area (the coordinate value in the coordinate system described above). This coordinate value is a coordinate value of an arbitrary position that can specify the position of the image (that is, the position of the lesion area) such as the center position of the image surrounding the lesion area.

  An example of the designated mode of the lesion area is shown in FIG. In the examination area R shown in FIG. 9, a lesion area group B1 including a lesion area of class C0, a lesion area group B2 including lesion areas of classes C2 and C3, and a lesion area group B3 including a lesion area of class C1 are included. And a lesion area group B4 including lesion areas of classes C1 and C4 are designated. Each lesion area group B1 to B4 includes a plurality of lesion areas. The operator designates each of these lesion areas as described above.

  Each of the lesion areas B5 and B6 belongs to the inside of the examination area R. In this way, it is also assumed that only a part of the lesion area belonging to the examination area R is specified.

  The designation processing unit 134 counts the designated number for each class Ci every time the lesion area of each class Ci (i = 0 to 4) is designated. Therefore, the designation processing unit 134 includes a counter for each class Ci, and increments the class Ci counter by “+1” every time one lesion area of each class Ci is designated.

  On the other hand, when the designation of the lesion area is canceled, the counter of the class Ci of the lesion area is set to “−1”. The designation of the lesion area can be canceled by selecting, for example, by clicking on an image surrounding the lesion area and pressing the backspace key or delete key on the keyboard 204. Alternatively, the operation menu can be displayed by right-clicking the mouse 205 to request cancellation.

  The control unit 10 causes the lesion information display unit 1307 to display the designated number (counter value) of each class Ci by the designation processing unit 134. This display is sequentially updated every time a lesion area is designated.

  In the state shown in FIG. 9, the designated number of class C0 is 33, the designated number of class C1 is 8, the designated number of class C2 is 2, the designated number of class C3 is 5, and the designated number of class C4 is 2. Thereby, the operator can easily grasp the designated number of lesion areas of each class Ci so far.

(Step 6: Generation of distribution information)
When the lesion area designation operation is completed, the operator clicks the map button 1302. The distribution information generation unit 135 acquires the size (class Ci) and position (coordinate value) of the designated lesion area from the lesion area designation unit 131 (designation processing unit 134). Then, the distribution information generating unit 135 generates lesion area distribution information in the examination area R based on these pieces of information.

  Examples of the distribution information include the following: (1) Table information and map information indicating the designated number of lesion areas for each class Ci; (2) The lesion area for each partial area of the examination area R Table information and map information indicating the specified number; (3) Table information and map information indicating the specified number for each class Ci and for each partial area. Specific examples of distribution information will be described below.

(Step 7: Display distribution information)
The control unit 10 causes the display unit 141 to display the generated distribution information. An example of the display mode of the distribution information is shown in FIG. A distribution information display screen 1400 in FIG. 10 is provided with a table information display unit 1401 and a map information display unit 1402.

  The table information display unit 1401 displays table information that displays a list of designated numbers of lesion areas for each class Ci and for each partial area. In the vertical direction of the table information shown in FIG. 10, the designated number of lesion areas of each class C0 to C4 is listed. Further, the total number of lesion areas of all classes C0 to C4 is also displayed in this table information.

  Further, the partial areas of the inspection area R are listed in the horizontal direction of the table information. The partial area “central” represents the inner area of the circular area Rb, the partial area “middle” represents the area inside the circular area Ra and outside the circular area Rb, and the partial area “outer” represents the inner area of the inspection area R. In addition, a region outside the circular region Ra is represented, and a partial region “other” represents a region outside the inspection region R.

  The map information display unit 1402 displays map information indicating the distribution state of the lesion area in the examination area R. In this map information, the designated number of lesion areas in each partial area of the examination area R based on the scale image is displayed. In addition, map information is not limited to what designated number was expressed numerically like FIG. For example, the position of the designated partial region can be presented on the map, or the designated partial region classes C0 to C4 can be presented.

  The information display unit 1403 displays patient information and eyeball information. When the end button 1404 is clicked, the control unit 10 ends the display of the distribution information display screen 1400 and displays the inspection screen 1300 again.

  The operator can grasp the distribution state of the lesion area in the examination area R by using such a distribution information display screen 1400.

(Step 8: Saving / outputting distribution information)
The operator clicks a save button 1309 on the inspection screen 1300 (see FIG. 9). In response to this, the control unit 10 causes the display unit 141 to display a designation result screen 1500 shown in FIG.

  On the designation result screen 1500, information (designation result information) D regarding each lesion area designated on the examination screen 1300 is presented. The designation result information D includes the patient name, the photographing date, the left and right distinction of the eye to be examined, eyeball information, the designated number (distribution information) of each class C0 to C4, and the like.

  Further, the control unit 10 saves the designation result information D in response to the save button 1309 being clicked. The storage destination includes an ophthalmologic image database 400, an electronic medical record database (not shown), and the fundus examination apparatus 1 itself.

  The designation result information D is stored so as to be searchable in association with the patient ID or the like. The designation result information D is stored in association with the fundus image G. Thereby, it is possible to appropriately call and display the designation result information D when observing the fundus image G. At this time, the table information and map information shown in FIG. 10 can also be displayed. It is also possible to call and display the fundus image G as appropriate when referring to the designation result information D.

  Note that the data output unit 15 may output the designation result information D in response to the save button 1309 being clicked.

[Action / Effect]
The operation and effect of the fundus examination apparatus 1 will be described.

  When the operator designates a lesion area in the examination area R in the fundus image G, the fundus examination apparatus 1 generates distribution information of the lesion area in the examination area R based on the designation result of the lesion area, and outputs this distribution information. .

  According to the fundus examination apparatus 1 acting in this way, it is not necessary to perform a complicated manual operation as in the prior art, and it is possible to improve the efficiency of examination of the fundus. In particular, even when a large number of patients are inspected as in a mass screening, it is possible to perform the inspection smoothly.

  Further, according to the fundus examination apparatus 1, it is possible to prevent an artificial mistake such as counting the number of lesion areas and making a mistake.

  Further, according to the fundus examination apparatus 1, not only examination of patients who have already suffered from visual impairment, but also early stage patients who have not yet developed visual impairment, early detection and early treatment of fundus lesions can be performed. Can be done.

  Further, according to the fundus examination apparatus 1, it is possible to store the eyeball information of the eye to be examined and determine the size of the examination region R in the fundus image G based on the eyeball information. Therefore, a highly reliable test can be performed for each eye to be examined.

  Further, according to the fundus examination apparatus 1, classification information representing a plurality of classes for classifying a lesion area can be stored, and a lesion area can be designated for each class of the classification information. Here, the classification information classifies the lesion area according to the size (C0 to C4) of the lesion area and the position in the examination area R. Furthermore, the fundus examination apparatus 1 can generate distribution information representing the distribution of the designated number of lesion areas in a plurality of classes based on the designation result of the lesion areas. Thereby, in the examination of fundus diseases such as age-related macular degeneration, it is possible to appropriately grasp the distribution state of the lesion area.

  The distribution information is table information or image information (map information) representing the distribution state of the lesion area. According to such distribution information, it is possible to easily and accurately grasp the distribution state of the lesion area.

[Modification]
A modification of the fundus examination apparatus 1 will be described.

  In the above-described embodiment, the case where the lesion area is manually specified has been described in detail. However, as described above, the distribution information generation process and the output process are similarly performed even when the lesion area is automatically specified. Is possible. By automatically specifying the lesion area in this way, it is possible to improve the efficiency of the examination.

  In particular, when a large number of patients are examined like a mass examination, automatic designation of a lesion area is effective.

  When the lesion area is automatically designated, it is desirable that the designation result can be corrected manually. This correction operation can be performed in the same manner as in the above embodiment, for example, by displaying the fundus image and the lesion area designation result. In order to make it easier to visually recognize the fundus image, it is desirable to indicate the lesion area by a point image or the like instead of the circular image.

  In addition, when a boundary of a lesion area is designated manually or automatically, it is possible to automatically select a class C0 to C4 having a size suitable for the lesion area. For this purpose, the designation processing unit 134 functions to obtain the maximum diameter of the lesion area, for example, and select the smallest class among classes C0 to C4 having a diameter longer than the maximum diameter. Note that the maximum diameter of the lesion area can be obtained by image processing such as Greatest Linear Dimension.

  In addition, when one or more lesion areas are manually specified, other lesion areas are extracted based on the pixel values of the pixels of the lesion area, and the lesion areas automatically extracted from the manually specified lesion area. It is possible to generate distribution information representing the distribution of the region. The reason why the lesion area is first manually specified is that the hue and brightness differ depending on the image, and therefore the hue of the lesion area differs depending on the image. That is, it is possible to set a threshold value of the pixel value based on the pixel value of the pixel of the lesion area designated manually first, and extract another lesion area based on this threshold value.

  In addition, there are cases where it is difficult to specify individual lesion areas, for example, when small lesion areas are dense as in the lesion area group B1 of FIG. In such a case, it is difficult to select the size classes C0 to C4. In order to cope with such a case, the following processing can be executed.

  Consider a case where there are two lesion regions (first lesion region and second lesion region) close to each other. It is assumed that the first lesion area and the second lesion area are very close to each other and cannot be separated by threshold processing (using a default threshold) for extracting the lesion area.

  When the position (or region) in the first lesion area is designated, the designation processing unit 134 performs threshold processing using a default threshold value and extracts the lesion area. According to this process, both the first and second lesion areas are extracted as one lesion area (entire area).

  Subsequently, when the operator designates a position (or region) in the second lesion area, the designation processing unit 134 sets the pixel values of the pixels in the entire area to the first, The boundary of the second lesion area is specified. At this time, the boundary is specified by performing threshold processing while gradually tightening the threshold. Thereby, the first and second lesion areas can be designated. The same processing can be performed when three or more lesion areas are close to each other.

  The embodiment described above is merely a specific example of the present invention. Therefore, arbitrary modifications within the scope of the present invention can be made as appropriate. Note that the modification described above can also be applied to the second embodiment described below.

<Second Embodiment>
A second embodiment of the present invention will be described. This embodiment is used for an examination that refers to the area ratio of the lesion area to the examination area of the fundus image.

  An example of the fundus examination apparatus according to this embodiment is shown in FIG. This fundus examination apparatus 100 has substantially the same configuration as the fundus examination apparatus 1 of the first embodiment. The same components as those in the first embodiment are denoted by the same reference numerals.

  As in the first embodiment, the data processing unit 13 of the fundus examination apparatus 100 includes a lesion area designation unit 131 and a distribution information generation unit 135. The distribution information generation unit 135 is provided with an area ratio calculation unit 136.

  The area ratio calculation unit 136 calculates the area ratio of the lesion area to the examination area of the fundus image G based on the result of specifying the lesion area that is manually or automatically specified. The area ratio calculation unit 136 is an example of the “calculation unit” of the present invention.

  In order to calculate the area ratio, the area ratio calculation unit 136 first calculates the area of the designated lesion area. Note that the size of the inspection region is set in advance, and its area is known.

  The area of the lesion area can be obtained by the following method, for example. The first calculation method is based on the number of pixels included in the lesion area. The unit distance as described above can be set in the fundus image G. Therefore, a unit area on the fundus image G can also be set. In the first calculation method, the number of pixels (number of unit pixels) included in the unit area is obtained, and the area of the lesion area is obtained by dividing the number of pixels in the lesion area by the number of unit pixels.

  As the second calculation method, it is possible to use Green's theorem. Green's theorem is a widely used formula for determining the area of a region surrounded by a closed curve.

  Note that the method of calculating the area of the lesion area is not limited to these, and any calculation method capable of obtaining the area of the area on the image can be applied.

  A usage pattern of the fundus examination apparatus 100 will be described. The flowchart shown in FIG. 13 represents an example of a usage pattern of the fundus examination apparatus 100. 14 to 16 show examples of display screens in this usage pattern.

  First, as in the first embodiment, a patient is selected (S11), a fundus image G is selected (S12), the fundus image G is displayed (S13), and an examination is started (S14). At this time, display screens 1000, 1100, 1200, and 1300 similar to those in the first embodiment are displayed (see FIGS. 4 to 7).

  An inspection screen 1300 similar to that of the first embodiment is displayed on the display unit 141 (see FIG. 14). A fundus image G is displayed on the examination screen 1300. An image processing area Ga and an examination area R are superimposed on the fundus image G.

  The inspection region R is a circular region having a diameter of 6000 μm, for example, as in the first embodiment. In this case, the area S (R) of the inspection region R is π × (6000/2) ^ 2 (μm ^ 2).

  Similar to the first embodiment, the inspection screen 1300 is provided with an image processing button 1303, a scale button 1304, a cancel button 1305, and an end button 1306.

  The examination screen 1300 shown in FIG. 14 is provided with the lesion size button 1301 and the map button 1302 in the first embodiment, but when applying a configuration capable of executing only the processing according to this embodiment, There is no need to provide the lesion size button 1301 and the map button 1302. Conversely, when applying a configuration capable of executing only the processing according to the first embodiment, it is not necessary to provide the following lesion designation button 1310 and measurement button 1311.

  The examination screen 1300 is provided with a lesion designation button 1310. The lesion designation button 1310 includes a plurality of buttons corresponding to the area ratio of the lesion area to the examination area R. The lesion designation button 1310 shown in FIG. 14 includes three buttons corresponding to an area ratio of less than 10%, less than 25%, and less than 50%. Note that the size (area ratio) of the lesion area can be selected not only by the lesion designation button 1310 but also by rotating the mouse wheel.

  In addition, a measurement button 1311 is provided on the inspection screen 1300. When the measurement button 1311 is clicked, the area ratio calculation unit 136 calculates the area of the designated lesion area or the area ratio of the lesion area with respect to the examination area R.

  The designation of the lesion area (S15) will be described. When any one of the lesion designation buttons 1310 is clicked, the control unit 10 causes the cursor images R1, R2, and R3 to be superimposed on the fundus image G as shown in FIG.

  The cursor images R1 to R3 are displayed concentrically around the center position K. The cursor image R1 is an image representing the circumference of a circular region having an area ratio with respect to the inspection region R of 10% (that is, an area of 1/10 of the inspection region R). The cursor image R2 is an image representing the circumference of a circular region whose area ratio to the inspection region R is 25% (that is, an area of 1/4 of the inspection region R). The cursor image R3 is an image representing the circumference of a circular region having an area ratio with respect to the inspection region R of 50% (that is, half the area of the inspection region R).

  The control unit 10 displays the cursor image Ri (i = 1 to 3) corresponding to the clicked button of the lesion designation button 1310 in a display mode different from the other cursor images Rj (j = 1 to 3, j ≠ i). Display. For example, the cursor image Ri can be displayed with a thicker line than the other cursor image Rj, or the cursor image Ri can be displayed with a color different from the other cursor image Rj. Thereby, the operator can easily grasp which size of the cursor image is selected. Only the cursor image selected by the operator may be displayed.

  The cursor images R <b> 1 to R <b> 3 can be moved on the fundus image G by, for example, dragging the mouse 205 or operating cursor keys on the keyboard 204. The operator observes the fundus oculi image G, identifies a lesion area such as drusen, and moves the cursor images R1 to R3 over the lesion area. Thereby, the approximate size (area ratio) of the lesion area can be grasped.

  Further, the operator designates a lesion area by, for example, clicking the mouse 205. The control unit 10 displays a circular image (lesion designated image) having the same size as the cursor image Ri corresponding to the area ratio selected in advance at the designated position.

  The lesion designation image is a deformable closed curve image formed of a spline curve, a Bezier curve, or the like (see FIG. 16). A lesion designation image is also an example of a “cursor”. Several moving points are provided on the lesion designation image T in FIG.

  The operator appropriately moves the moving point by, for example, a drag operation of the mouse 205, and changes the shape and size of the lesion designation image T so as to follow the boundary (outer periphery) of the visually recognized lesion area. The lesion area designation unit 131 obtains a spline curve or the like corresponding to the position of the moving point. The control unit 10 displays this new spline curve as a lesion designation image.

  The operator can add / delete a moving point as appropriate by using a right click menu of the mouse 205, for example.

  When the lesion area is designated, the lesion area designating unit 131 acquires the range (coordinate values) of the lesion area in the examination region R. The range of the lesion area is a closed area surrounded by the lesion designation image T.

  When only a part of the lesion area is located in the examination area R, only the part of the lesion area belonging to the examination area R is designated. That is, the lesion designation image T is deformed so as to be along the boundary of the part (a part thereof is the outer periphery of the examination region R).

  Instead of manually specifying a lesion area as described above, it is also possible to specify a lesion area fully automatically or partially automatically as in the first embodiment. In that case, the lesion area designating unit 131 extracts a lesion area in the examination area R as the “extraction means” of the present invention.

  When the designation of the lesion area is completed, the operator operates the mouse 205 and clicks the measurement button 1311. The area ratio calculation unit 136 calculates the area of the designated lesion area (S16). The calculation method has been described above. When two or more lesion areas are designated, the area of each lesion area is calculated.

  Further, the area ratio calculation unit 136 divides the area of the lesion area by the area of the examination area R, and calculates the area of the lesion area with respect to the examination area R (S17). When two or more lesion areas are designated, the area ratio with respect to the examination area R can be calculated for each lesion area. It is also possible to calculate the total area of these lesion areas by adding the areas of two or more lesion areas and divide this total area by the area of the examination area R to obtain the area ratio.

  Such an area ratio of the lesion area represents how much the lesion area is distributed in the examination area R. This area ratio is an example of “distribution information” of the present invention.

  The control unit 10 causes the display unit 141 to display the calculation result of the area ratio of the lesion area to the examination area R (S18). An example of the display mode will be described. The calculation result of the area ratio is displayed on the inspection result display unit 1312 of the inspection image 1300 as shown in FIG. In this example, the area ratio “27.64%” of the lesion area surrounded by the lesion designation image T to the examination area R is displayed.

  In addition to the area ratio, the examination result display unit 1312 displays the area of the lesion area and the classification result based on the area ratio of the lesion area. The area and the classification result may also be included in the distribution information. The area of the lesion area is the value calculated in step 16.

  The classification by area ratio includes the first class “less than 10%”, the second class “10% or more, less than 25%”, the third class “25% or more, less than 50%”, and the fourth class “50% or more”. The lesion area is classified into four classes.

  The inspection result display unit 1312 displays information “less than 50%” indicating the third type to which the lesion area belongs in this classification method. In this display mode, the second class is shortened to “less than 25%” and the third class is shortened to “less than 50%”.

  The classification method based on the area ratio and the range of each class are not limited to those described above, and can be set as appropriate.

  When the save button (see FIG. 9) on the examination screen 1300 is clicked, the data output unit 15 saves and outputs the distribution information (S19).

  The operation and effect of the fundus examination apparatus 100 will be described.

  When the operator designates a lesion area in the examination area R in the fundus image G, the fundus examination apparatus 100 generates distribution information (area ratio or the like) of the lesion area in the examination area R based on the designation result of the lesion area. Output distribution information.

  According to the fundus examination apparatus 100 acting in this way, there is no need to perform complicated manual work for acquiring the area and area ratio of the lesion area. Therefore, it is possible to improve the efficiency of the examination of the fundus. In particular, even when a large number of patients are inspected as in a mass screening, it is possible to perform the inspection smoothly.

  Further, according to the fundus examination apparatus 100, it is possible to prevent a calculation error of the area and the area ratio.

  Further, according to the fundus examination apparatus 100, not only examination of patients who have already suffered from visual impairment, but also examination of early patients who have not yet developed visual impairment, early detection and early treatment of fundus lesions can be performed. Can be done.

  Further, according to the fundus examination apparatus 100, it is possible to store the eyeball information of the eye to be examined and determine the size of the examination region R in the fundus image G based on the eyeball information. Therefore, a highly reliable test can be performed for each eye to be examined.

  A modification of the fundus examination apparatus 100 according to this embodiment will be described.

  A modification of the lesion area designation mode will be described. In the above embodiment, the case where the operator manually designates the lesion area has been described. The automatic designation of a lesion area can be realized by applying threshold processing of pixel values, for example, as in the first embodiment.

<Third Embodiment>
The fundus examination apparatus according to this embodiment is configured to be able to switch examination contents according to the type of lesion.

  The fundus examination apparatus according to this embodiment has the same configuration as that of the first and second embodiments (see FIGS. 1, 2, and 12). The same reference numerals are used for the same components as those in the first and second embodiments.

  This fundus examination apparatus displays an examination screen 1320 shown in FIG. The inspection screen 1320 has substantially the same configuration as the inspection screen 1300 shown in FIG.

  Various buttons such as a lesion selection button 1321, a lesion size button 1322, a summary button 1323, a lesion size button 1324, and a measurement button 1325 are displayed on the examination screen 1320 (for the image processing buttons and the like, the examination described above is performed). Since it is the same as the screen 1300, the description is omitted).

  The lesion size button 1322 is the same as the lesion size button 1301 of the first embodiment. When the summary button 1323 is clicked, a distribution information display screen 1410 (details will be described later) shown in FIGS. 20 and 21 is displayed.

  The lesion size button 1324 is a button used to classify lesions having a size not corresponding to the classification (C0 to C4) by the lesion size button 1321. The button presented in the lesion size button 1324 is changed according to the type of lesion to be examined (described later).

  The measurement button 1325 is the same as the measurement button 1311 shown in FIG. That is, when the measurement button 1325 is clicked, the distribution information generation unit 135 (area ratio calculation unit 136) calculates the area of the lesion area designated using the lesion size button 1324 or the area of the lesion area with respect to the examination area. Perform the ratio calculation.

  The selection of the type of lesion to be examined will be described. Selection of the type of lesion is performed by operating the lesion selection button 1321. When the lesion selection button 1321 is clicked, for example, the type of lesion is cyclically changed in the order of “drusen” → “dye abnormal” → “map-like atrophy” → “AMD (age-related macular degeneration)”. . The type of the selected lesion is displayed on the lesion selection button 1321 as a character string or the like. The control unit 10 performs switching display of the lesion type.

  Further, the control unit 10 causes the lesion type display unit 1331 to display information indicating the type of the selected lesion. The lesion type display unit 1331 also displays information indicating the examination implementation status for the selected lesion. In FIG. 17, information “drusen” indicating the type of the selected lesion and information “no measurement” indicating the state of execution of the examination (indicating that the examination has not yet been carried out) are included in the lesion type display section. 1331 is displayed.

  Further, the control unit 10 changes the display mode of the lesion size buttons 1322 and 1324 according to the type of the selected lesion. For the lesion size button 1322, for example, the validity / invalidity of the operation for each button is determined according to the type of lesion. As a specific example, when drusen is selected, all buttons C0 to C4 are enabled (operable). When the pigment abnormality is selected, only the buttons C0 and C1 are valid, and the other buttons are invalid.

  For the lesion size button 1324, for example, different buttons are switched and displayed depending on the type of lesion. As a specific example, when drusen is selected, a lesion designation button similar to that in the second embodiment is displayed as a lesion size button 1324 (see FIG. 18).

  When pigment abnormality is selected, three buttons of “center circle”, “inner circle”, and “outer circle” are displayed as a lesion size button 1324 (see FIG. 19). When the center circle button is clicked, the control unit 10 displays a circular cursor image having a diameter of 1000 μm on the inspection screen 1320. When the inner circle button is clicked, the control unit 10 displays a circular cursor image having a diameter of 3000 μm. When the outer circle button is clicked, the control unit 10 displays a circular cursor image having a diameter of 6000 μm. These cursor images are also used to classify the lesion area based on the size as in the above-described embodiment.

  Similar to the lesion information display unit 1307 (see FIG. 8 and the like) of the first embodiment, lesion size information is displayed on the lesion information display unit 1332. The control unit 10 may selectively display only the lesion size information regarding the buttons effective for the selected lesion type.

  The distribution information display screen 1410 will be described with reference to FIGS. The distribution information display screen 1410 is displayed when the summary button 1323 is clicked as described above.

  Similar to the first embodiment, the distribution information display screen 1410 is provided with a map information display unit 1412, an information display unit 1413, and an end button 1416.

  When the summary button 1414 on the distribution information display screen 1410 is clicked, the control unit 10 causes the summary display unit 1411 to display summary information. The summary information includes a summary of test results of various lesion areas designated using the test screen 1320. The summary information is generated by the distribution information generation unit 135 based on the size and position of the designated lesion area.

  When a detail button 1415 is clicked, the control unit 10 displays a selection button 1422 shown in FIG. 21 on the distribution information display screen 1410. The selection button 1422 is provided with buttons corresponding to lesions that can be selected by the lesion selection button 1321. At this time, it is desirable to display buttons other than the lesion for which the examination has been performed in an invalid operation state.

  When any one of the selection buttons 1422 is clicked, the control unit 10 displays the examination result of the lesion corresponding to the button. Specifically, the control unit 10 causes the map information display unit 1412 to display map information representing the distribution of the lesion. Further, the control unit 10 causes the table information display unit 1421 to display table information representing the distribution of the lesion. Map information and table information are generated in the same manner as in the first embodiment. It is also possible to generate and display map information and table information that simultaneously express the distribution of two or more types of lesions.

  According to this fundus examination apparatus, distribution states of a plurality of types of lesions can be individually grasped. Also, the operability for that is good.

<About the program>
The program according to the present invention is a computer program for controlling a computer that processes a fundus image. More specifically, this program causes the computer to function as (1) designation means for designating a lesion area in the examination area including the foveal position in the fundus image, and (2) in the lesion area designation result. Based on this, it functions as a generation unit that generates distribution information of a lesion area in an examination region, and (3) functions as an output unit that outputs distribution information.

  According to such a program, the computer can generate the distribution information of the lesion area in the examination area based on the designation result of the lesion area in the examination area and output the distribution information. Accordingly, in the examination of the fundus, there is no need to perform a complicated manual operation as in the prior art, and the efficiency of the examination of the fundus can be improved.

  The program according to the present invention can be recorded on any recording medium that can be read by a drive device of a computer. For example, a recording medium such as an optical disk, a magneto-optical disk (CD-ROM / DVD-RAM / DVD-ROM / MO, etc.), a magnetic storage medium (hard disk / floppy (registered trademark) disk / ZIP, etc.) can be used. is there. It can also be stored in a storage device such as a hard disk drive or memory. Further, this program can be transmitted through a network such as the Internet or a LAN.

It is a schematic block diagram showing an example of composition of a 1st embodiment of a fundus examination device concerning this invention. It is a schematic block diagram showing an example of composition of a 1st embodiment of a fundus examination device concerning this invention. It is a flowchart showing an example of the usage pattern of 1st Embodiment of the fundus examination apparatus concerning this invention. It is the schematic showing an example of the display screen displayed by 1st Embodiment of the fundus examination apparatus concerning this invention. It is the schematic showing an example of the display screen displayed by 1st Embodiment of the fundus examination apparatus concerning this invention. It is the schematic showing an example of the display screen displayed by 1st Embodiment of the fundus examination apparatus concerning this invention. It is the schematic showing an example of the display screen displayed by 1st Embodiment of the fundus examination apparatus concerning this invention. It is the schematic showing an example of the display screen displayed by 1st Embodiment of the fundus examination apparatus concerning this invention. It is the schematic showing an example of the display screen displayed by 1st Embodiment of the fundus examination apparatus concerning this invention. It is the schematic showing an example of the display screen displayed by 1st Embodiment of the fundus examination apparatus concerning this invention. It is the schematic showing an example of the display screen displayed by 1st Embodiment of the fundus examination apparatus concerning this invention. It is a schematic block diagram showing an example of composition of a 2nd embodiment of a fundus examination device concerning this invention. It is a flowchart showing an example of the usage pattern of 2nd Embodiment of the fundus examination apparatus concerning this invention. It is the schematic showing an example of the display screen displayed by 2nd Embodiment of the fundus examination apparatus concerning this invention. It is the schematic showing an example of the display screen displayed by 2nd Embodiment of the fundus examination apparatus concerning this invention. It is the schematic showing an example of the display screen displayed by 2nd Embodiment of the fundus examination apparatus concerning this invention. It is the schematic showing an example of the display screen displayed by 3rd Embodiment of the fundus examination apparatus concerning this invention. It is the schematic showing an example of the display screen displayed by 3rd Embodiment of the fundus examination apparatus concerning this invention. It is the schematic showing an example of the display screen displayed by 3rd Embodiment of the fundus examination apparatus concerning this invention. It is the schematic showing an example of the display screen displayed by 3rd Embodiment of the fundus examination apparatus concerning this invention. It is the schematic showing an example of the display screen displayed by 3rd Embodiment of the fundus examination apparatus concerning this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1,100 Fundus examination apparatus 10 Control part 12 Image storage part 13 Data processing part 131 Lesion area designation part 132 Storage part 133 Examination area determination part 134 Specification processing part 135 Distribution information generation part 136 Area ratio calculation part 14 User interface 141 Display part 142 Operation unit 15 Data output unit 200 Microprocessor 201 RAM
202 Nonvolatile storage device 203 Display 204 Keyboard 205 Mouse 206 Communication interface 300 Fundus imaging device 400 Ophthalmologic image database 1300 Examination screen 1301 Lesion size button 1302 Map button 1303 Image processing button 1304 Scale button 1307 Lesion information display unit 1309 Save button 1310 Lesion designation Button 1311 Measurement button 1400 Distribution information display screen 1401 Table information display section 1402 Map information display section

Claims (18)

A designation means for designating a lesion area in an examination area including a fovea position in a fundus image;
Generating means for generating distribution information of the lesion area in the examination area;
Output means for outputting the distribution information;
A fundus examination apparatus comprising: The designation means includes storage means for storing eyeball information including information on the eyeball optical system of the eye to be examined, and determination means for determining the size of the examination region in the fundus image based on the eyeball information.
The fundus examination apparatus according to claim 1. The designation means stores in advance classification information for classifying a lesion area into a plurality of classes, and can designate a lesion area for each class of the classification information;
The generation unit generates the distribution information representing the number of lesion areas classified into the classes based on a lesion area designation result by the designation unit.
The fundus examination apparatus according to claim 1, wherein the fundus examination apparatus is provided. The classification information is information for classifying a lesion area according to size,
The designation means is capable of selecting and specifying a class according to the size of a lesion area from the plurality of classes,
The fundus examination apparatus according to claim 3. The designation means is capable of designating a class of the minimum size among classes of sizes equal to or greater than a lesion area based on the classification information.
The fundus examination apparatus according to claim 4. The designation means includes a display means for displaying a fundus image and a cursor having a predetermined shape and a predetermined size, and an operation means for operating the cursor on an examination area in the displayed fundus image to designate a lesion area. including,
The fundus examination apparatus according to claim 4 or 5, wherein The generation means generates table information that displays a list of the number of lesion areas classified into each of the plurality of classes as the distribution information.
The fundus examination apparatus according to any one of claims 4 to 6, wherein the fundus examination apparatus is characterized. The classification information is information for dividing an examination area of a fundus image into a plurality of partial areas as the plurality of classes,
The generation unit generates the distribution information indicating the number of lesion areas classified into the partial areas based on a lesion area designation result by the designation unit.
The fundus examination apparatus according to claim 3. The designation means includes a display means for displaying a fundus image, a cursor having a predetermined shape and a predetermined size, and an operation means for operating the cursor on an examination area in the displayed fundus image to designate a lesion area. Including,
The fundus examination apparatus according to claim 8. The generation means generates table information that displays a list of the number of lesion areas classified into each of the plurality of partial areas as the distribution information.
The fundus examination apparatus according to claim 8 or 9, wherein The generation means generates image information representing the number of lesion areas classified into each of the plurality of partial areas as the distribution information.
The fundus examination apparatus according to claim 8 or 9, wherein The classification information is information for classifying a lesion area into the plurality of classes according to both the position and size in the examination area,
The designation means includes a display means for displaying a fundus image and a cursor having a predetermined shape and a predetermined size, and an operation means for operating the cursor on an examination area in the displayed fundus image to designate a lesion area. Including
The generation means generates table information and / or image information representing the number of lesion areas according to both the position and size as the distribution information based on a lesion area designation result by the operation means.
The fundus examination apparatus according to claim 3. The generation means includes calculation means for calculating an area ratio of the lesion area to the examination area of the fundus image based on a lesion area designation result by the designation means, and generates the distribution information representing the calculation result of the area ratio. ,
The fundus examination apparatus according to claim 1, wherein the fundus examination apparatus is provided. The designation means includes a display means for displaying a fundus image and a cursor having a predetermined shape and a predetermined size, and an operation means for operating the cursor on an examination area in the displayed fundus image to designate a lesion area. including,
The fundus examination apparatus according to claim 13. The shape and size of the cursor can be changed by the operation means.
The fundus examination apparatus according to claim 14. The designation means includes an extraction means for extracting a lesion area in the examination area based on a pixel value of a pixel of the fundus image,
The generating means generates the distribution information based on the extracted lesion area;
The fundus examination apparatus according to claim 1, wherein the fundus examination apparatus is provided. The designation means includes a display means for displaying a fundus image and a cursor having a predetermined shape and a predetermined size, and an operation means for operating the cursor on an examination area in the displayed fundus image to designate a lesion area. An extraction means for extracting another lesion area based on a pixel value of a pixel of the one or more lesion areas when one or more lesion areas are designated by the operation means;
The generating means generates the distribution information representing a distribution of the one or more lesion areas and the other lesion areas;
The fundus examination apparatus according to claim 1, wherein the fundus examination apparatus is provided. A program for controlling a computer that processes a fundus image,
The computer,
Function as a designation means for designating the lesion area in the examination area including the fovea position in the fundus image,
Function as generation means for generating distribution information of the lesion area in the examination area;
Function as output means for outputting the distribution information;
A program characterized by that.

Images