JP7533050B2 - Fundus image observation program - Google Patents

Description

This disclosure relates to a fundus image observation program.

In image diagnosis in the field of ophthalmology, fundus images taken with fundus photography devices are widely used.

When diagnosing and observing a subject's eye from multiple angles, it is useful to interpret multiple fundus images taken using various imaging methods. For example, Patent Document 1 discloses a device that can take color images, infrared images, fluorescein contrast images, indocyanine green contrast images, and autofluorescence images of the fundus with a single device.

In addition, during follow-up observation, fundus images taken on different examination dates are often compared.

JP 2016-59399 A

For example, the device disclosed in Patent Document 1 obtains multiple fundus images taken using various imaging methods on each examination day, and the task of selecting images can become cumbersome in order to compare and interpret two or more images from among them.

In addition, there are various cases where two or more fundus images taken using various imaging methods on each examination date are compared, depending on the purpose of the interpretation, such as when you want to understand changes over time or when you want to compare different modalities, and the combination of images to be compared varies depending on the case. In addition, the combination of images to be compared is likely to differ depending on the workflow of each examination facility.

The present disclosure has been made in consideration of the above circumstances, and has as its technical objective the provision of a fundus image observation program that allows the examiner to easily select a fundus image to be used for comparison from multiple fundus images that have been captured in advance.

A fundus image observation program according to a first aspect of the present disclosure is a fundus image observation program executed by a processor of a computer, the fundus image observation program including: an acquisition step of acquiring a plurality of fundus images photographed by a plurality of photographing methods on different examination dates and times for a subject; a display output step of setting one of the plurality of fundus images as a reference image, setting another image of the plurality of fundus images to be compared with the reference image as a comparison image, and displaying the reference image and the comparison image as interpretation images in adjacent display areas that are determined in advance; and an ophthalmological image processing step of processing the fundus images associated with the examination dates and times and the photographing methods and corresponding to each examination date and time and each photographing method. The computer executes a GUI display step of displaying a GUI including an examination data list based on a two-axis table indicating whether or not an image is present, and a condition input section arranged near the examination data list and enabling the examination date and time and the shooting method to be input as narrowing down conditions, together with the interpretation image; a narrowing down step of reflecting the narrowing down results in the examination data list when the narrowing down conditions are input via the condition input section ; and a comparison image selection step of displaying the selected ophthalmic image in the display area as a new comparison image when any ophthalmic image is selected via the examination data list .

According to the present disclosure, the examiner can easily select a fundus image to be used for comparison from multiple fundus images that have been captured in advance.

1 is a block diagram showing an overview of a fundus image observation system according to an embodiment. FIG. 1 is a diagram showing a flow of a series of fluorescence angiography. FIG. 2 is a diagram showing an example of a main screen in a first display state. FIG. 13 is a diagram showing an example of a main screen in a second display state. FIG. 13 is a diagram showing an example of a second viewer screen with a layout in which two images are arranged side by side. FIG. 13 is a diagram showing an example of a second viewer screen with a layout in which three images are arranged.

One embodiment of the present disclosure will be described below. First, a fundus image observation system according to an embodiment will be described with reference to FIG. 1. The fundus image observation system captures fundus images using multiple imaging methods and displays the captured fundus images. By capturing multiple fundus images of a subject using multiple imaging methods on different days, it is possible to display any image from among the captured images. For ease of explanation, unless otherwise specified, in the description of the embodiment, a fundus image refers to a front image of the fundus.

The difference between the different imaging methods may be the wavelength range of the light irradiated to the subject's eye, or between fluorescent imaging and reflectance imaging, or between frontal imaging and tomographic (cross-sectional) imaging, or there may be other differences.

The fundus image observation system includes a computer 1 and a fundus imaging device 100. The computer 1 and the fundus imaging device 100 are connected by wire or wirelessly. This allows the computer 1 and the fundus imaging device 100 to communicate with each other. The fundus image observation program according to the embodiment is stored in a non-volatile memory that can be read by the processor of the computer 1. In the embodiment described below, the fundus imaging device 100 and the computer 1 are separate entities. However, the two devices may be integrated.

<Fundus Photography Device>
The fundus imaging device 100 has at least an imaging optical system (not shown). In this imaging optical system, the fundus of the subject's eye is irradiated with light, and then the light returning from the fundus is received by a light receiving element. In this embodiment, a fundus image is formed based on a light receiving signal from the light receiving element. The fundus image is formed by an image processing circuit (e.g., an IC and a processor, etc.) of the fundus imaging device 100. It is not necessary for the image processing circuit to be provided in the fundus imaging device 100. For example, the image processing circuit of the computer 1 may also serve as the image processing circuit of the fundus imaging device 100.

In this embodiment, the fundus imaging device 100 captures fundus images using a number of different imaging methods. It may be possible to capture a fluorescent contrast image as one type of fundus image. It may also be possible to capture a reflected image as another type of fundus image. A fluorescent contrast image is an image captured using the fluorescent emission of a fluorescent contrast agent administered to the fundus blood vessels. A reflected image is an image captured using fundus reflected light of the illumination light used to irradiate the fundus.

The imaging optical system of the fundus imaging device 100 may be capable of capturing a fluorescent contrast image and a reflection image simultaneously. Simultaneous here does not necessarily mean completely simultaneous. A slight time difference is permissible. The time difference may be set, for example, within a range in which no significant eye movement occurs between the time when the two types of fundus images are captured.

The fundus imaging device 100 may capture fluorescent contrast images using, for example, either indocyanine green angiography (ICGA) or fluorescein angiography (FA). Two types of fluorescent contrast images may be captured simultaneously by simultaneously injecting two types of contrast agents intravenously. The fundus imaging device 100 may also be capable of capturing infrared light reflection images (hereinafter referred to as IR images) and color images. Furthermore, it may also be capable of capturing spontaneous fluorescence images.

The fundus imaging device 100 according to the embodiment may be a scanning laser ophthalmoscope (SLO). However, this is not necessarily limited to this, and the fundus imaging device 100 may be another fundus imaging device such as a fundus camera. For a detailed configuration of an SLO capable of simultaneously capturing a fluorescent contrast image and a reflected image, please refer to, for example, Japanese Patent Application Laid-Open No. 2016-59399 filed by the present applicant.

<Computer>
The computer 1 at least acquires various fundus images captured by the fundus imaging device 100 and displays them on the monitor 80. The computer 1 includes at least an arithmetic and control unit 70. The arithmetic and control unit 70 is a processor of the computer 1. As shown in Fig. 1, the arithmetic and control unit 70 may be configured with a CPU, a RAM, a ROM, etc. The arithmetic and control unit 70 controls the display of the fundus images and also executes various processes related to the fundus images based on a fundus image observation program.

As shown in FIG. 1, the calculation control unit 70 of the computer 1 is connected to a memory 71, an operation unit 75, a monitor 80, and a fundus imaging device 100, etc., via a data bus or the like.

In this embodiment, the memory 71 is a non-volatile storage device. For example, a hard disk or a flash memory can be used as the memory 71. In this embodiment, the fundus image observation program is pre-stored in the memory 71. The memory 71 may be rewritable. In this case, as described in the following examples, the memory 71 may store various fundus images acquired from the fundus imaging device 100. However, the fundus images may be stored in a memory (not shown) separate from the memory in which the fundus image observation program is stored.

The operation unit 75 is an input interface of the computer 1. The calculation control unit 70 receives a signal corresponding to an operation input to the operation unit 75. Various devices are conceivable as the operation unit 75. For example, at least one of a touch pad, a mouse, and a keyboard may be used as the operation unit 75. The operation unit 75 may also be used as an input interface for the fundus imaging device 100. A joystick and switches, etc., provided on the fundus imaging device 100 may be provided on the fundus imaging device 100 as an input interface (operation unit) for the fundus imaging device 100.

In this embodiment, the monitor 80 is used as a display unit (display device) for images captured by the fundus imaging device 100. The monitor 80 may be, for example, a general-purpose monitor or a monitor built into the device. Instead of the monitor 80, other display devices such as a head-mounted display may be used as the display unit.

<Operation description>
The operation of the fundus image observation system having the above configuration will be described below.

During an examination on the same day, the subject's eye E may be photographed using multiple imaging methods. The fundus imaging device 100 switches between imaging methods as appropriate in response to the examiner's operation, and captures IR images, color images, spontaneous fluorescence images, fluorescent contrast images, etc. The captured fundus images are stored in the device's memory in association with identification information indicating the imaging method.

<Fluorescence angiography>
Here, the flow of imaging will be described in detail, taking fluorescent contrast imaging as an example. When a contrast agent is intravenously injected into a subject, the amount of contrast agent flowing into the blood vessels at the fundus increases rapidly after a certain time has passed since the intravenous injection, and then gradually decreases. In the early stage of imaging immediately after the intravenous injection, the contrast agent flows into thick blood vessels followed by thin blood vessels. At this time, the change in the state of fluorescence emission at the fundus is large and rapid. On the other hand, in the middle and late stages of imaging, when more time has passed since the contrast agent was injected, the contrast agent has sufficiently spread within the blood vessels, and so the change in the state of fluorescence emission at the fundus becomes smaller.

Therefore, in a series of fluorescent contrast imaging from the early contrast imaging stage to the late contrast imaging stage, in the early contrast imaging stage, continuous imaging of fluorescent contrast images may be started based on an imaging trigger signal (first trigger signal in this embodiment). In continuous imaging, fluorescent contrast images are continuously captured for a period of at least 10 seconds to several minutes, or several tens of minutes, after the imaging trigger signal is output. In other words, during this period, light is projected onto the fundus and the returning light is received by the light receiving element. As a result of the continuous imaging, a group of captured images is acquired by the fundus imaging device 100.

The captured image group includes multiple consecutive frames of fluorescent angiograms (fluorescent fundus images) captured at a fixed cycle after the output timing of the capture trigger signal (first trigger signal in this embodiment). In SLO, a predetermined range of the fundus is periodically scanned, so that one frame of captured image can be obtained each time the predetermined range is scanned once (i.e., one cycle). The captured image group may be composed of fluorescent angiograms obtained by fundus scanning at each cycle during the capture period. Alternatively, the captured image group may be composed of fluorescent angiograms obtained by fundus scanning with one cycle skipped (or two cycles skipped, three cycles skipped, ... n cycles skipped). The fundus imaging device 100 captures at least several frames of captured images per second.

In the following, for convenience, each fluorescent contrast image included in the captured image group may be referred to as a frame image.

In addition, in a series of fluorescent contrast imaging, in the middle and late contrast imaging periods, a fluorescent contrast image may be captured in a single shot based on the output of an imaging trigger signal (the second trigger signal in this embodiment). In this case, a still image of the fluorescent contrast image is captured in a single shot immediately after the output of the imaging trigger signal. The single shot imaging means that at least one predetermined number of fluorescent contrast images are obtained in response to the output of the imaging trigger signal. In addition, in a single shot imaging, imaging is performed in a shorter time than in continuous imaging. The number of fluorescent contrast images obtained per one imaging trigger signal is preferably limited to about ten at most. Hereinafter, the fluorescent contrast image obtained as a result of the single shot imaging is referred to as a contrast still image for convenience. The contrast still image may be an image having a larger number of pixels (for example, a higher resolution) than the frame images obtained in continuous contrast imaging.

Note that the fluorescent contrast imaging is not necessarily limited to the techniques described above. Still contrast images may be taken in the early stage of contrast imaging, and continuous contrast imaging may be performed in the later stage of contrast imaging.

Some or all of the multiple fluorescent angiograms obtained as a result of a series of fluorescent angiograms may be additive images. In both FA and ICGA, the fluorescence from the fundus is weak, and this is particularly noticeable in the early and late stages of contrast imaging. For this reason, for example, multiple consecutive frames of fluorescent angiograms may be obtained and then added together (this may be an additive average or a weighted average, etc.) to obtain a good fluorescent angiogram.

The fundus imaging device 100 captures a reflected image at the same time as each fluorescent angiogram. The reflected image can be used to correlate the positional relationship of each fluorescent angiogram. Details of the reflected image will be described later.

Next, referring to Figure 2, we will explain a specific example of device operation during fluorescence angiography.

[t0: Setting of alignment and imaging conditions]
First, the examiner aligns the device with the subject's eye and sets the imaging conditions. The imaging conditions set in this case include at least a condition for the wavelength of the light irradiating the fundus as the excitation light. For example, in the case of FA, blue or green light is set as the excitation light. In the case of ICGA, light in the infrared region is set as the excitation light. When FA and ICGA are performed simultaneously, two types of wavelength regions corresponding to each are set as the excitation light. Furthermore, in this embodiment, a second infrared light is further set as the light irradiated to the fundus. The second infrared light is used both as the light for fundus observation and the light for obtaining a reflection image. The second infrared light and the infrared light for ICG excitation belong to different wavelength regions.

[t1: Start of fluorescence angiography]
After completing the alignment and the setting of the imaging conditions, the examiner intravenously injects a contrast agent into the subject. At the same time (or immediately afterwards), the examiner performs an operation input to the input interface of the fundus imaging device 100 to start a series of fluorescent contrast imaging. As a result, the fundus imaging device 100 starts fluorescent contrast imaging.

In conjunction with the fluorescent angiography, an angiography timer is operated in the fundus imaging device 100. The angiography timer is a time measurement means for measuring the time elapsed from the start of angiography. In other words, the contrast period (also called the time phase) is managed by the angiography timer. The angiography timer may be displayed on the monitor 80. In this embodiment, the measurement time of the contrast timer at the time of shooting is associated with each fundus image (fluorescent angiography image and reflection image) captured in a series of fluorescent angiography images and stored in memory.

During the series of fluorescence contrast imaging, the fundus is continuously irradiated with excitation light (and further scanned in SLO), and fundus images of fluorescence from the fundus caused by irradiation with excitation light may be sequentially acquired by the fundus imaging device 100. The sequentially acquired images may be displayed on the monitor 80 as observation images (real-time moving images). This allows the imaging range and fixation deviation to be confirmed from the reflected images. Also, by checking the observation images of fluorescence, the examiner can perform a trigger operation at the appropriate timing.

[t1-t2: Early contrast imaging]
In this embodiment, the continuous contrast imaging starts from the start timing of a series of fluorescent contrast imaging. That is, an imaging trigger signal for the continuous contrast imaging is output based on a start operation of the continuous contrast imaging. As a result, a captured image group including a plurality of frames of fluorescent contrast images is stored in the memory. In addition, in this embodiment, a reflection image captured simultaneously with each of the fluorescent contrast images is also stored in the memory. The continuous contrast imaging may be automatically terminated after a certain time has elapsed since the start of the imaging, or may be terminated manually based on a predetermined operation on the input interface of the fundus imaging apparatus 100, or may be terminated in other ways. It may end when a condition is met.

In this embodiment, the frame images (fluorescence contrast images) that are acquired sequentially are displayed as a real-time video on the monitor 80. In addition, the reflected images that are captured together with each frame image may also be displayed as a video. The examiner can check the imaging range and fixation deviation from the reflected images.

Of the group of captured images obtained as a result of continuous contrast imaging, only a portion of the images may be used for interpretation, etc. For this reason, a portion of the frame images in one captured image group may be registered as a key frame. A "key frame" here is an image that shows the desired contrast state among the multiple frame images obtained as a result of continuous contrast imaging.

For example, a frame image formed during the few seconds that contrast medium flows into CNV (choroidal neovascularization), which is useful in diagnosis, may be selected as one of the key frames. Multiple key frames can be selected for one continuous contrast imaging session. For example, the frame image may be acquired at a predetermined timing, or may be acquired when a predetermined trigger operation is performed during continuous contrast imaging. In addition, it may be possible to select a key frame after imaging.

In this embodiment, key frames are preferentially displayed on a viewer screen, which will be described later, compared to other frame images in the group of captured images. For example, other frame images may require more operational inputs than key frames from when the viewer screen is launched until they are displayed, or other frame images may be hidden on the viewer screen.

[t2-t3: mid- and late-stage imaging]
Next, after an appropriate time of several minutes to several tens of minutes, a contrast still image is captured. During this capture, the fundus imaging device 100 captures an observation image and displays the captured image on the monitor 80. At any timing during the middle and late stages of contrast imaging, a capture operation is performed while checking the contrast state or the capture range using the observation image (for example, pressing the release button). Based on the capture operation, a capture trigger signal (second trigger signal) is input to the fundus imaging device 100. This causes the fundus imaging device 100 to capture a contrast still image. At this time, a reflection image is obtained simultaneously with the contrast still image by projecting light for capturing a reflection image onto the fundus together with the excitation light. In this way, during the middle and late stages of imaging, a contrast still image and a reflection image are simultaneously captured and stored in a memory for each capture operation.

The number of contrast still images captured during the middle and late contrast stages is smaller than the number of frame images that make up the group of captured images captured during the early contrast stage. For this reason, in this embodiment, each contrast still image is displayed with the same priority as a key frame on the viewer screen, which will be described later.

<Acquisition of shooting results>
The fluorescence contrast images and reflection images captured by the fundus imaging device 100 in the above manner are stored in a memory (here, memory 71) accessible from the processor of the computer 1. In this manner, in this embodiment, fundus images captured by a plurality of different imaging methods are acquired by the computer 1. In detail, a plurality of frames of fluorescence contrast images obtained by a series of fluorescence contrast imaging are acquired. A reflection image may also be acquired.

As described above, in this embodiment, information indicating the measurement time of the contrast timer when each fluorescent contrast image and reflection image was captured is also stored in memory 71.

By performing such imaging on multiple days, multiple fundus images are obtained for the subject, taken using multiple imaging methods on different examination days.

<Viewer screen display>
The arithmetic and control unit 70 of the computer 1 displays a viewer screen on the monitor 80. A fundus image is displayed on the viewer screen. This viewer screen is used for selecting a fundus image to be output as a report or the like, or for editing (processing an image), etc.

The viewer screen in this embodiment will be described with reference to Figures 3 to 6. The viewer screen in this embodiment is broadly divided into a main screen (first viewer screen) shown in Figures 3 and 4, and a second viewer screen shown in Figures 5 and 6.

The main screen (first viewer screen) shown in Figures 3 and 4 is used to display at least fundus images taken on an examination date specified by the examiner. In this embodiment, a first display area 201 (see Figure 3) and a second display area 202 (see Figure 4) are alternatively displayed on the main screen. In this embodiment, various widgets are arranged on the main screen. The widget here is a general term for GUI interface components (UI parts), and is also called a control. Specific examples of widgets that are well known include buttons, sliders, check boxes, text boxes, and other commonly used items.

The widgets displayed on the main screen include at least those that are operated to switch the display area on the main screen. On the main screen, a first display area 201 (see FIG. 3) and a second display area 202 (see FIG. 4) are displayed in a switched manner based on the operation input for the widget.

<Various widgets on the main screen>
3 and 4, a plurality of tabs 211 to 216 are arranged above the display areas 201 and 202 as an example of a widget used for switching the display areas. The display areas 201 and 202 are switched by selecting any one of the plurality of tabs 211 to 216 via a pointing device. In addition, the fundus images displayed in the respective display areas 201 and 202 can be enlarged as appropriate in response to a predetermined operation. By selecting a fundus image based on a predetermined operation, it may be possible to perform enlarged observation on another screen (e.g., a second viewer screen).

In the first display area 201, a fundus image captured by one of a plurality of fundus images captured by mutually different capturing methods is selectively displayed. In other words, the first display area 201 is capable of displaying fundus images captured by a single capturing method. Tabs 212 to 216 corresponding to each capturing method (for example, ICGA tab 212, FA tab 213, Color tab 214, FAF tab 215, and IR tab 216) correspond to the first display area 201. When any of these is selected, the first display area 201 is displayed on the main screen. In the first display area 201, a fundus image captured by the capturing method corresponding to the selected tab is selectively displayed.

In addition, in this embodiment, when a tab for comparative display (Comparison tab 211) is selected, a second display area 202 is displayed on the main screen. In the second display area 202, a plurality of fundus images captured by different imaging methods and registered in advance as registered images can be selectively displayed. The "registered image" may be used, for example, for comparison with other fundus images captured by different imaging methods.

Other widgets arranged on the main screen shown in Figures 3 and 4 include a left/right eye switching button 231, a data output button 233, and an image editing button 234.

The left/right eye switching button 231 is operated to switch the fundus image displayed on the main screen between an image of the right eye and an image of the left eye.

The data output button 233 is operated to output the fundus image selected, edited, etc. on the main screen. For example, when button 233 is operated, the image may be output in a predetermined report format. The output may be a display output, a data output, or a print output.

The image editing button 234 is a fundus image displayed in the display area, and is operated when editing an image selected by the examiner. Various image processing operations, such as brightness, contrast correction, gamma correction, sharpening, and smoothing, may be performed via the image editing button 234.

<First display area>
As shown in FIG. 3, a first display area 201 displays a fundus image captured by a single imaging method.

For example, when either the FA tab 212 or the ICGA tab 213 is selected, a fundus image captured by fluorescence angiography is displayed in the first display area 201. In this case, from the multiple frames of fluorescence angiography images obtained for each imaging trigger signal, a fluorescence angiography image captured at any contrast time can be selected and registered as a registered image.

In this embodiment, the display area displays key frames and contrast still images from among the many fundus images obtained in a series of fluorescent contrast photographs. This allows for efficient registration of registered images.

In addition, in the first display area 201, an operation for registering a fundus image as a registered image can be accepted for each fundus image displayed in the first display area 201. As shown in FIG. 3, check boxes 237 (an example of a second widget) may be arranged around (at the top in the figure) each fundus image in the first display area 201. When the check box 237 is selected, the checked fundus image is registered as a registered image.

When fluorescent contrast images are displayed on the main screen, information indicating the contrast time is displayed in association with each fluorescent contrast image. The information indicating the contrast time may be the value of the contrast timer at the time of shooting, or may be the examination date and time. As an example, in the main screen shown in Figures 3 and 4, the contrast time is graphically displayed using a contrast bar 240. The ratio of the filled area to the blank space in the contrast bar 240 indicates the ratio of elapsed time to remaining time. This allows the examiner to intuitively grasp the contrast time for each fundus image.

For example, when the Color tab 214 is selected, a color image is displayed, when the FAF tab 215 is selected, an autofluorescence image is displayed, and when the IR tab 216 is selected, an infrared image is displayed. In this case, too, a registered image may be registered by the same operation as when the FA tab 212 or ICGA tab 213 is selected. Note that these tabs are merely examples, and other tabs may be provided as appropriate depending on the shooting method. For example, a tab corresponding to a wide-angle fundus image may be provided. Tabs corresponding to wide-angle fundus images may be further provided for each detailed shooting method (for example, FA, ICGA, Color shooting, FAF shooting, IR shooting, etc. at wide angles).

<Second Display Area>
As shown in Fig. 4, the second display area 202 can display registered images registered in advance for each photographing method side by side in the display area 201. At this time, a plurality of fundus images photographed by different photographing methods can be arranged in the second display area 202. Since each fundus image is picked up for each photographing method in the first display area 201, it is easy to view even if a plurality of fundus images photographed by different photographing methods are mixed in the second display area 202. Therefore, according to the main screen of this embodiment, an image selected by the examiner from a plurality of fundus images photographed by different photographing methods is suitably displayed.

Each fundus image on the main screen shown in Figures 3 and 4 is given identification information indicating the shooting method. As an example, a color corresponding to the shooting method is given to the frame portion (e.g., the header portion) of each fundus image. Furthermore, the tabs 212 to 216 are also given a color corresponding to the shooting method. This makes it easier for the examiner to intuitively understand the shooting method of each fundus image displayed in the second display area 202. Note that the identification information indicating the shooting method may be, for example, text indicating the shooting method, or may be something else.

In the main screen shown in Figures 3 and 4, the operation for switching the display area is sufficient to select tabs 211 to 216. In other words, a single action operation input is sufficient. Since the display state is switched with a single action, the examiner can select registered images in the first display area 201 and compare the selected images in the second display area 202 with each other with improved operability. Note that the single action operation referred to here is the only operation required to switch the display area. In other words, no confirmation is required after the operation is performed to switch the display area.

<Reuse of registration results>
The registration result of the registration work may be reused between the left and right eyes. More specifically, the control unit 70 may automatically register an ophthalmologic image registered as a registered image for one eye and a fundus image for the other eye photographed under the same conditions as the registered image for the other eye. For example, after the registration image for one eye is registered, the registered image for the other eye may be automatically set by operating the left/right eye switching button 231. The same conditions refer to the same conditions for one or both of the photographing method and the photographing timing (for example, the time of contrast injection). In this embodiment, since the left and right eyes cannot be photographed simultaneously, strict identity is not required for the photographing timing. For example, images of each eye photographed within a predetermined time may be treated as images photographed under the same conditions for the photographing timing. This allows the work of registering the registered images for both the left and right eyes to proceed efficiently.

In addition, without being limited to this, the registration results from a certain registration operation may be reused in a subsequent registration operation. In other words, a fundus image captured under the same conditions as each fundus image arranged in the second display area 202 at a certain time may be automatically set as a registered image during a new registration operation.

<Second viewer screen>
Next, the second viewer screen will be described with reference to Figures 5 and 6. When one or more fundus images are selected on the main screen, the button 250 is operated to transition to the second viewer screen. In this embodiment, unless otherwise specified, the description will be given assuming that two images are selected on the main screen, and then the button 250 is operated, resulting in transition to the screen in Figure 5.

Two or more predetermined display areas are set adjacent to each other on the second viewer screen. In each display area, a fundus image is displayed as a reading image. In FIG. 5, one of the images to be compared is displayed in the third display area 310 on the left. For convenience, this image is referred to as the reference image. In the fourth display area 320 on the right, a comparison image, which is a fundus image different from the reference image and is compared with the reference image, is displayed. Note that the terms reference image and comparison image are used for convenience in this embodiment. In this embodiment, the reference image and comparison image can be swapped by operating buttons 351 and 352, as described below.

Furthermore, in the second viewer screen, an examination date selection control 330 is set along with two display areas 310, 320. The examination date selection control 330 is an example of a GUI for narrowing down the images to be displayed as comparison images from among a plurality of fundus images. Narrowing down via the examination date selection control 330 limits the images that can be displayed in the display area 320. In this embodiment, both the examination date itself and the shooting method are used as the narrowing down conditions.

The examination date selection control 330 shown in FIG. 5 is broadly divided into a date input form 331 and an examination data list 335. The date input form 331 is a condition input section for inputting narrowing down conditions related to the examination date. The examination data list 335 is a narrowing down result display section in this embodiment. In addition, as described later, it has multiple check boxes 336 as a condition input section related to the imaging method.

The date input form 331 is used by the examiner to specify a period and narrow down the fundus images that can be displayed in the fourth display area 320 to the range obtained during the specified period. The date input form 331 shown in FIG. 5 has input fields for inputting the start and end of the period. The examiner's desired date is input by directly inputting the date into the input field, or via a calendar that is expanded by selecting a calendar icon adjacent to the input field. However, the date input form 331 is not necessarily limited to this, and various date and time pickers may be applied.

As shown in FIG. 5, the examination data list 335 is formed as a two-axis table associated with the examination date and the imaging method. In addition, the presence or absence of fundus images obtained with each imaging method is displayed as a list for each examination date. The list is arranged in order of examination date. This allows the examiner to easily grasp through the examination data list 335 whether or not fundus images were obtained with each imaging method for each imaging date, even if imaging was performed using a different combination of imaging methods for each examination date. When the examination dates are narrowed down using the date input form 331, the examination data list 335 displays a list for the narrowed down period.

It is also possible to narrow down the imaging methods via the examination data list 335. That is, in the first row of the examination data list 335, an indication of the imaging method (in FIG. 5, text such as FA, ICGA, Color, FAF, Retro, IR, etc.) is displayed in association with each imaging method, and a check box 336 is provided next to each indication. By checking the check box 336, a narrowing down condition for the imaging method is set. In the examination data list 335, examination dates on which fundus images exist using the checked imaging method (i.e., matching the narrowing down condition) are extracted and displayed as a list. In this embodiment, further narrowing down is possible by checking multiple check boxes 336. For example, if two check boxes 336 are checked, examination dates on which fundus images exist using both checked imaging methods are extracted.

In this way, the examination date itself and the imaging method are each used as the filtering conditions to narrow down the images that can be displayed as comparison images in the fourth display area 320. Even if examinations have been performed many times in the past and different combinations of imaging methods were used for each examination date, the examination date on which the desired fundus image was captured can be easily narrowed down via the examination date selection control 330. Furthermore, in the examination data list 335, the presence or absence of fundus images that match the filtering conditions is displayed in order of examination date and time. Furthermore, the examination data list 335 is configured as a two-axis table associated with the examination date and the imaging method. Therefore, it is easy to know whether the desired fundus image is present on each of the narrowed down examination dates.

When a row for any examination date is selected on the examination data list 335, the fundus image for the selected examination date is displayed in the fourth display area 320. In this embodiment, the contents of the examination data list 335 are maintained unless an operation to change the narrowing down conditions for the examination date and shooting method is input to the examination date selection control 330. In other words, the narrowed down state is maintained.

Here, there may be multiple fundus images for the selected examination date. Therefore, in this embodiment, a widget is further provided on the screen to allow the examiner to specify the desired image from among the multiple fundus images obtained on the selected examination date. Examples of such widgets include a left/right eye setting button 341, a scroll bar 342, and an imaging method designation section 343, as shown in FIG. 5.

The left/right eye setting button 341 is used to switch the test eye related to the comparison image to either the right eye, left eye, or both eyes (not limited to left or right). In this embodiment, the test eye related to the reference image and the test eye related to the comparison image can be set independently.

When there are multiple fundus images that can be displayed, the scroll bar 342 is operated to switch the image that is alternatively displayed in the fourth display area 320. By scrolling the scroll bar 342, the fundus images displayed in the fourth display area 320 are switched in a predetermined order.

The imaging method designation section 343 is operated to switch whether or not the fundus image displayed in the fourth display area 320 is an image obtained by a specific imaging method. The imaging method designation section 343 shown in FIG. 5 may be a drop-down list for selecting one of a plurality of imaging methods. When one of the imaging methods is designated in the imaging method designation section 343, the fundus images that can be displayed in the fourth display area 320 are limited to images obtained by the selected imaging method.

Check box 344 is used to indicate whether the fundus image displayed in fourth display area 320 is a registered image. If the image being displayed in fourth display area 320 is a registered image, check box 344 is checked, and if it is not a registered image, check box 344 is blank.

The second viewer screen may also include display position movement buttons 351, 352 and an image addition button 353. The display position movement buttons 351, 352 are selected to switch the display area of the fundus image. That is, in the example of FIG. 5, the images displayed between the third display area 310 and the fourth display area 320 are switched by operating the "→" button located under the third display area 310 or the "←" button located under the fourth display area 320. That is, the reference image and the comparison image in this embodiment are switched. Accordingly, based on the operation of the above-mentioned GUI (examination date selection control 330, left and right eye setting button 341, scroll bar 342, shooting method designation section 343, and check box 344), the image that was displayed in the third display area 310 can be changed to another fundus image with at least one of a different examination date and shooting method.

In this embodiment, the reference image displayed in the third display area 310 can be changed to another fundus image as long as the shooting date is not changed. For this purpose, a left/right eye setting button 315, a scroll bar 316, and a shooting method designation section 317 are arranged near the third display area 310. These widgets are operated in the same way as the widgets 341, 342, and 343 for switching the image displayed in the fourth display area 320, and the image displayed in the third display area 310 is changed in response to the operation.

The image addition button 353 is operated to add an image to be compared with the reference image and the comparative image shown in FIG. 5. When the image addition button 353 is operated, the screen layout transitions to the screen layout shown in FIG. 6 in which the display areas of three fundus images are set side by side. The image displayed in the third display area 310 in FIG. 5 is arranged in the left display area 410 in FIG. 6, and the image displayed in the fourth display area 320 in FIG. 5 is arranged in the central display area 420 in FIG. 6. The third fundus image is added to the right display area 430 in FIG. 6. The third fundus image can be selected and displayed by the same operation as the fundus image displayed in the fourth display area 320 in FIG. 5. In the second viewer screen of this embodiment, up to three fundus images are displayed side by side as shown in FIG. 6. However, this is not necessarily limited to this, and more fundus images may be displayed side by side.

Similar to the operation on the main screen, the fundus image selected on the second viewer screen is also output on the second viewer screen based on the operation of a data output button (not shown) or the like. At this time, multiple fundus images displayed on the second viewer screen may be output as a report with the same horizontal layout as the second viewer screen.

As described above, in this embodiment, even if a large number of images are acquired as a result of imaging a single subject using multiple imaging methods on different examination dates, the results can be narrowed down by examination date and imaging method via the examination date selection control 330. In addition, the results of narrowing down can be immediately grasped via the examination data list 335, which is a two-axis table associated with the examination date and imaging method.

When an examination date is selected from the narrowed down list, the fundus image obtained on that examination date is immediately displayed in the fourth display area 320. At this time, even if the type or time phase of the image initially displayed as the comparison image is different from what the examiner desires, the examiner can easily change the desired image to the comparison image via various widgets 341, 342, and 343.

If no suitable image is available for the selected examination date, a new image is selected. However, since the results of narrowing down the examination dates previously performed via the examination date selection control 330 are retained, for example, a different examination date can be selected in one action from among the examination dates previously narrowed down. In this case, the user can work while checking the reference image or the comparison image previously selected. This allows the user to efficiently arrange multiple images suitable for comparison.

Furthermore, in this embodiment, by narrowing down the search using the examination date selection control 330 ⇒ selecting the examination date ⇒ selecting images by operating the various widgets 341, 342, and 343, it becomes possible to display multiple images in parallel according to the purpose of the interpretation and the workflow of each examination facility. In other words, on a single viewer screen (second viewer screen), it is possible to compare images of one eye taken with different shooting methods, compare images of one eye taken with the same shooting method on different shooting dates, and compare images of both eyes. Therefore, a single viewer screen can flexibly respond to the purpose of the interpretation and the workflow of each examination facility.

"Example of transformation"
Although the present disclosure has been described based on the embodiments, the present disclosure is not limited to the above-described embodiments and may include various modifications of the above-described embodiments.

<Simultaneous Display of First Display Area 201 and Second Display Area 202>
In the above embodiment, the first display area 201 and the second display area 202 are alternatively displayed on the main screen based on the operation of the tabs 201 to 206. However, this is not necessarily limited to this, and the first display area 201 and the second display area 202 may be displayed simultaneously (in other words, in parallel) on the main screen. In this case, a registration operation may be performed in which a fundus image displayed in the first display area 201 is dragged and dropped into the second display area 202 to register the dragged and dropped fundus image as a registered image.

<Pre-setting the conditions to be registered in the registration image>
In the above embodiment, in order to register various fundus images acquired by the computer 1 as registered images, a registration operation on the main screen is required for each image.

In contrast, by setting conditions for registration as a registered image in advance, images that meet the conditions among fundus images acquired by computer 1 may be registered in advance as registered images. Such images may be displayed as registered images on the main screen without requiring a registration operation via the main screen.

The pre-set condition may be selectable from the following three conditions, for example: These conditions may be set for each imaging method.
First condition: All images captured using a specific shooting method are registered as registered images.
Second condition: A fluorescent contrast image obtained at a predetermined time is registered as a registered image.
Third condition: No pre-registration of the registration image is performed.

The first condition is suitable for color images, autofluorescence images, and IR images. The number of times these images are taken in a day is generally smaller than the number of times fluorescent contrast images are taken, so each fundus image is registered as a registered image in the default settings, reducing the burden on the examiner in setting up the registered images.

The second condition is useful when contrast examinations become routine work in a facility. Note that the elapsed time in the second condition may be set to any time, or multiple times may be set.

<Alignment>
For example, in the above embodiment, each fundus image displayed on the viewer screen may be displayed in a state where the images are aligned with each other (positional deviations are corrected). The alignment process at this time may utilize, for example, the technology disclosed in Japanese Patent Application Laid-Open No. 2016-59400 by the present applicant.

<Defective judgement>
For example, in the above embodiment, the computer 1 may determine whether the fundus image stored in the memory 71 is poorly photographed, and may exclude images determined to be poorly photographed from the display target on the viewer screen. If the fluorescence contrast image is poorly photographed, the reflection image photographed at the same time will also be poorly photographed. Therefore, the above determination may be made based on the reflection image. In particular, in the early stage of contrast enhancement, the change in the contrast state is large and rapid. Therefore, it may be difficult to determine poor photography from the fluorescence contrast image itself. However, since the photographing conditions of the reflection image are constant, poor photography can be easily determined.

<Application to other modalities>
In addition, the fundus image observation program of the embodiment is not limited to application to fluorescent contrast photography, but can also be applied to a case where a desired image is extracted from a large number of photographed images of a subject's eye obtained as a result of outputting a photographing trigger signal multiple times in a series of photographs (for example, photographs on the same day). For example, there are a wide variety of images of the subject's eye that can be applied. Specific examples include OCT images, functional OCT images (specific examples include motion contrast images), Enface images based on OCT images or functional OCT images, fundus images, and anterior segment images. In addition, the fundus image observation program of the embodiment may be used when administering a drug and evaluating the response of the subject's eye over time to the drug.

In addition, in the above embodiment, the multiple fundus images acquired by computer 1 and displayed on the viewer screen may be images captured by a single imaging optical system. The fundus images acquired by computer 1 and displayed on the viewer screen may additionally include fundus images captured by another imaging optical system. For example, computer 1 may further acquire an OCT image of the test eye acquired via an OCT optical system (not shown) and display it on the viewer screen together with the SLO image.

310 Third display area 320 Fourth display area 330 Examination date selection control

Claims (1)

A fundus image observation program executed by a processor of a computer,
An acquisition step of acquiring a plurality of fundus images of a subject taken by a plurality of imaging methods at different examination dates and times;
a display output step of setting one of the plurality of fundus images as a reference image, setting another image of the plurality of fundus images to be compared with the reference image as a comparison image, and displaying the reference image and the comparison image as interpretation images in adjacent display areas determined in advance;
a GUI display step of displaying, together with the image to be interpreted, a GUI including an examination data list in the form of a two-axis table that is associated with the examination date and time and the imaging method and indicates the presence or absence of an ophthalmic image corresponding to each examination date and each imaging method , and a condition input section that is arranged near the examination data list and allows the examination date and the imaging method to be input as narrowing conditions ;
a narrowing down step of reflecting a narrowing down result in the examination data list when the narrowing down condition is input via the condition input unit ;
A fundus image observation program that causes the computer to execute a comparison image selection step in which, when any ophthalmological image is selected via the examination data list, the selected ophthalmological image is displayed in the display area as a new comparison image.