Abstract:
A method and computer system for screening of medical cases in which the computer system has a user interface which enables pre-programming of a sequence of images to be reviewed for each of a group of medical cases. The pre-programming is conducted by means of symbols or icons which are selectable by a user. The pre-programming of the sequence of images is done in a configuration phase of the computer system. During the screening procedure, the user can go from one image to the next by performing a single action input operation, such as, making a mouse click or pressing a next-step button. This has the advantage that the user can fully concentrate on reviewing the medical images without distraction.

Description:
CROSS REFERENCES TO RELATED APPLICATION 
     This application is related to the following patent applications, filed on the same day as this application and assigned to the same assignee, MeVis Technology GmbH &amp; Co. KG
     (1) A Method And Computer System For Prefetching Of Images, Ser. No. 09/870,389; filed May 29, 2001,   (2) A Method And System For In-Service Monitoring And Training For A Radiologic Workstation, Ser. No. 09/870,388; filed May 29, 2001,
 
which are hereby incorporated by reference to be understood in connection with the present invention.
   

     FIELD OF THE INVENTION 
     The present invention relates to the field of screening of medical cases, and more specifically to a method, apparatus and computer system, which has a user interface to facilitate the screening. 
     BACKGROUND AND RELATED ART 
     In a medical screening procedure, such as radiologic screening mammography, a large number of medical images need to be reviewed. In order to allow a radiologist to fully concentrate on the review of the medical images an efficient and user friendly interface is required. 
     U.S. Pat. No. 5,917,929 shows a user interface for a computer aided diagnosis system. A touch sensitive display screen is provided to display status information and to receive instruction from an operator. The display screen displays miniature images of the films having colour-coded borders so that the operator monitors the processing of the radiologic films. The interface includes view selection buttons to allow the operator to select certain x-ray images. This interface requires that the user select the images and the view of the images during the ongoing screening procedure. 
     U.S. Pat. No. 5,987,345 shows a method and system for displaying of medical images and computer output from various computer aided diagnosis (CAD) schemes on the images. Images are loaded into the display system and displayed in a main viewing area. Individual abnormality from CAD schemes can be viewed by clicking buttons with minified (postage stamp size) images with CAD annotation rendered into them. The images and results are then shown on a high-speed monitor. Again this prior art system is deficient or has disadvantages as the complexity of the user interface requires a substantial amount of the radiologist&#39;s attention and concentration during the screening. 
     SUMMARY OF THE INVENTION 
     It is an object of the present invention to provide a novel method and system for screening of medical cases. 
     It is another object of the present invention to provide a method and a computer system for screening of medical cases with a user interface which allows the radiologist to focus his or her attention to the review of the medical cases without distraction of attention due to the complexity of the user interface. 
     These and other objects and advantages of the invention are achieved by a method and a system that utilizes a user interface enabling a user to pre-program a typical sequence of images to be reviewed in the workflow of the screening procedure of a number of medical cases. The pre-programming is advantageously achieved by means of symbols or icons being provided by a graphical user interface. 
     An individual icon can specify a certain view and/or a certain image processing algorithm to be performed, activate the marking of a region of interest (ROI) or the entering of a diagnosis/annotation, or activate the display of computer assisted diagnosis (CAD) markers. The user can select an icon by clicking on it and by moving the icon to a sequence bar by means of a drag-and-drop operation. This way a sequence of icons results that specifies the sequence of images to be rendered, including images for prompting a user action, images for inputting an annotation and/or another sequence of actions, and images resulting from an image processing operation to be performed for the screening of an individual medical case. In the following the term “image” is used for all kinds of images, including raw data mammograms, views of images, images resulting from image processing operations, image processing and other operations and user operations, prompts for user actions and other screens for the purposes of workflow management. 
     After the pre-programming of the sequence has been done by the user, the user can start the screening process. Typically a stack of medical cases is assigned to the user for review. As the sequence of images to be rendered for an individual medical case is pre-programmed the user can go from one image, such as a view or an operation, to the next by performing a single action input operation, such as a mouse click, pressing on a “next-step” button, touching an area of a touch-screen or by natural language, if speech recognition is available. 
     When the sequence of images of the first case to be reviewed has been completed the control goes to the consecutive medical case and restarts the same sequence. This way the user can go through all images to be reviewed by just performing single action input operations for going from one image to the next. This has the advantage that the user can focus his or her attention to the review of the medical cases without being distracted by a complex user interface requiring frequent decision making as regards the control of the display of the images. 
     Preferably the user has to do the pre-programming only once. The pre-programmed sequence can be stored in conjunction with the user&#39;s profile. When the user logs on, the pre-programmed sequence is retrieved and re-activated. Further, it is possible for the user to edit the pre-programmed sequence in order to modify the sequence. 
     Another advantageous aspect of the invention is that the throughput of a radiologic workstation can be optimised in two ways. First, this is due to the fact that the time required for the review of an individual medical case is minimised by the user interface of the invention. Second, the computer system can anticipate the next user interaction, thus shortening the system response time. In particular this enables prefetching of consecutive images into the image cache as it is disclosed in co-pending U.S. Patent Application (1) entitled “A Method And Computer System For Prefetching Of Images”, filed May 29, 2001, here incorporated by reference. 
     However if the radiologist needs to perform actions during the screening procedure, which are not contained in the pre-programmed sequence, this can be done by means of a keypad and/or keyboard. The specific action can be, for example, a particular image processing algorithm, a particular view, entering of an annotation or a diagnosis, marking of regions of interest or the like. After the radiologist has completed the special operations, which have not been pre-programmed, he or she can return to the pre-programmed sequence by simply resuming to perform the single action input operations. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       A more complete appreciation of the invention and many of the attendant advantages thereof will be readily apparent from the following detailed description of preferred embodiments of the invention when considered in connection with the accompanying drawings, wherein: 
         FIG. 1  is a block diagram of an embodiment of the computer system according to the invention; 
         FIG. 2  is a flow chart illustrating the pre-programming of the sequence of images to be reviewed for a medical case; 
         FIG. 3  is a flow chart illustrating the screening procedure relying on the pre-programmed sequence; 
         FIG. 4  shows an embodiment of a graphical user interface according to the invention; 
         FIG. 5  shows various tilings of a single monitor embodiment; 
         FIG. 6  shows various tilings of an embodiment with two monitors; 
         FIG. 7  is a further embodiment of the graphical user interface according to the invention; 
         FIG. 8  illustrates the embodiment of  FIG. 7  after the pre-programming of the sequence of images; and 
         FIG. 9  shows an embodiment of a keypad for the user interface having a next-step button. 
     
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Referring now to the drawings, in particular  FIG. 1 , a preferred embodiment of the invention will be described. 
       FIG. 1  shows a block diagram of the computer system according to the invention. The computer system has a computer  1  comprising a graphical user interface  2 . The graphical user interface  2  is coupled to a workflow memory  3 . The workflow memory  3  has a stack  4  for storing a stack of cases to be reviewed in the screening procedure. In the example considered here the cases case i, case i+1, . . . case n are contained in the stack  4  in this order. Each of the cases has a unique identifier (“case ID”). 
     The current case to be reviewed is identified by a pointer  5 . At the time considered in the example of  FIG. 1  the pointer  5  is directed to the first case i in the stack  4 . 
     The workflow memory  3  has a memory  6 . The memory  6  has a number of L data fields of which data fields  7 ,  8 ,  9 ,  10  and  11  are shown in  FIG. 1 . Each of the data fields stores a specification of an image reviewed of each of the cases. The current image in the sequence is identified by a pointer  12  which points to the current image, in the example considered here, image  1  of the sequence. 
     The workflow memory is coupled to an image processing (IP) module  13  and to retrieval module  14 . The IP module  13  is also coupled to the retrieval module  14  for retrieval of image data on which an image processing operation, such as a computer aided diagnosis (CAD) operation, is to be performed. Both the IP module  13  and the retrieval module  14  have an output which is coupled to display system  15 . 
     Further the computer system of  FIG. 1  has a database  16  that is coupled to the retrieval module  14 . The database  16  can be part of the computer  1  or it can be an external database as in the example depicted in  FIG. 1 . The database  16  contains an image memory and/or archive for a number of cases  1  to m. In the example considered here each of the medical cases comprises a number of 4 images: image a, image b, image c, and image d. 
     For example, in mammography each breast is usually imaged twice. The first image being a top view ordinarily called the craniocaudal view (“CC”) and the second image being a lateral view ordinarily called the mediolateral oblique view (“MLO”). Therefore, for applications of the computer system of  FIG. 1  for screening mammography, the images of a medical case of the database  16  can be a right MLO image (image a), a left MLO image (image b), a right CC image (image c), and a left CC image (image d). Ordinarily each of the individual cases forming part of the screening program is structured in the same way as explained above. 
     Further the computer system has a monitor  17  and a monitor  18 . The monitor  17  and the monitor  18  are coupled to the display system  15 . The icons  19  which belong to the graphical user interface  2  are displayed on the monitor  18  and/or  17 . Further a sequence bar  20  is displayed on the monitor  18  enabling the user to pre-program the sequence of images by drag-and-drop of icons  19  onto the sequence bar  20 . 
     Further, the user interface  2  is coupled to a keypad  21  having a next-step button  22 . By pressing the next-step button  22 , the user goes from the current image to a consecutive image. In other words, when the user operates the next-step button  22  the pointer  12  is shifted to the next consecutive data field of the memory  6 , such that the next consecutive image is retrieved and/or generated for display on one of the monitors  17  and/or  18 . 
     Further, the user interface  2  is coupled to a keyboard  23  and to a mouse  24 . 
     To prepare the screening of the cases, the computer system first needs to be initialised by loading the cases to be reviewed into the stack  4 . The pointer  5  is set to the first case—case i—of the stack  4 . For the pre-programming of the sequence of images the user sequentially selects a number of icons  19  and performs drag-and-drop operations to move selected icons to the sequence bar  20 . 
     An individual icon  19  can be selected on the monitor  18  by clicking on the icon  19  by means of the mouse  24  and moving the icon to the sequence bar  20  by making a corresponding move of the mouse  24 . Each of the icons  19  can be selected several times for the pre-programming. 
     When the sequence of icons in the sequence bar  20  is complete the user performs an enter operation by pressing the enter button of the keyboard  23  or clicking on an ok button or the like. This way the sequence of icons of the sequence bar  20  is transformed into data contained in the data fields  7  to  11  of the memory  6 . In other words, each of the icons  19  which have been selected by the user specifies a particular image in the sequence of images to be rendered for each individual case. The pointer  12  is set to the first element of the sequence of images contained in the data field  7 . 
     After the initialisation of the computer system the screening procedure can start. The first image  1  of the sequence of images of case i is displayed in accordance with the specification stored in the data field  7 . For example the data field  7  can specify a right craniocaudal image with a contrast limited adaptive histogram equalisation (CLAHE). To display the first image  1  a request is made to the retrieval module  14  in order to retrieve the left craniocaudal image of the case i. The retrieval is made with the case ID of case i as a key to perform the database access of database  16 . 
     When the corresponding image data is available the IP module  13  performs a CLAHE operation on the image data and outputs the result to the display system  15  for display on monitor  17  or  18 . 
     After the radiologist has reviewed image  1  he or she presses the next-step button in order to go to the next image in the sequence—which is the image  2 . When the radiologist presses the next-step button  22  the pointer  12  is shifted to the data field  8  containing the specification for the image  2 . 
     The image data corresponding to the specification contained in the data field  8  is retrieved and/or generated by the computer system and the image  2  is displayed on monitor  17  or  18  . By repeatedly pressing the next-step button  22  the user of the computer system can go through an entire medical case in accordance with the pre-programmed sequence stored in the memory  6 . When the pointer  12  is at the last data field  11  pressing the next-step button  22  will move the pointer  5  to the next case “case i+1” and the pointer  12  is reset to the initial position of data field  7 . This way the complete display sequence is repeated for the next case i+1 without a requirement for a user action other than pressing the next-step button  22 . 
       FIG. 2  shows the sequence of steps performed by a user in the configuration phase of the computer system for the pre-programming of the sequence of images to be reviewed for each individual case of the screening program. In step  20   c  the user selects an icon I 1  corresponding to a particular image specification. This icon is moved to the sequence bar by a drag- and-drop operation in step  21   c.    
     Corresponding steps  22   c  and  23   c  are performed with respect to the same or another icon I 2  until the last icon I n  is selected in step  24   c  and moved to the sequence bar in step  25   c . To complete the pre-programming of the sequence of images the user performs an enter operation in step  26   c.    
       FIG. 3  illustrates the operation of the computer system of  FIG. 1  after the configuration phase. In order to start the screening procedure the user presses a start button in step  30   c.    
     In step  31   c  the variable j is initialised to be equal to 1. In step  32   c  the first image of the sequence is retrieved and/or generated in accordance with the specification provided by the first icon I 1  of the sequence of icons of the sequence bar. After review of the first image, which is displayed for the current case, the user presses the next-step button in step  33   c  such that the consecutive image in the sequence is displayed in accordance with the specification provided by the consecutive icon I 2  of the sequence of icons of the sequence bar  20 . 
     After the display of this image in step  34   c  the procedure continues by repetitively pressing the next-step button (steps  35   c ,  36   c ) until the last image in the sequence of the current case j=1 is reached. 
     When the next-step button is pressed in step  37   c  after the display of the last image for the current case in step  36   c , the variable j is incremented and the control goes back to step  32   c  in order to repeat the steps  32   c  to  38   c  with respect to the consecutive case of the case stack  4 . By incrementing the variable j the corresponding pointer (cf. pointer  5  of  FIG. 1 ) is shifted to the consecutive case. 
     It is to be noted that other actions other than displaying of images (steps  32   c ,  34   c  . . .  36   c ) can be performed in the operation of the computer system such as making a diagnosis, marking of a region in the image, entering an annotation, performing an image processing operation and/or entering a diagnosis or other actions—depending on the particular pre-programmed sequence. Also the use or activity can always deviate from the pre-programmed sequence by directly inputting, requesting and/or performing an action by means of the key pad, key board, touch screen or by voice control. 
       FIG. 4  shows an example for the display and screen layout of the monitors  17  and  18  of the computer system of  FIG. 1 . The right monitor  17  shows a mammogram  25 ; the left monitor  18  shows a mammogram  26 . The display fields  27  and  28  show CAD status information for the mammograms  25  and  26 , respectively. The display fields  29  and  30  show image type information for the mammograms  25  and  26 , respectively, including image enhancement status information, if any. 
     Further, on the right monitor  17  there is a toolbar  31  having a number of buttons or icons. Each of the buttons or icons of the tool bar  31  corresponds to a particular selection of a tool, such as image magnification, CLAHE or wavelet enhancement. 
     A corresponding tool bar  32  is displayed on the left monitor  18  for specifying particular views of images. In the configuration phase of the computer system the user can pre-program the sequence of images to be displayed for each individual case by drag-and-drop of the icons of the toolbars  31  and  32  to the sequence bar  20 . 
     Alternatively the pre-programming can also be performed without a drag-and-drop operation, for example, by sequentially selecting the buttons of the tool bars  31  and/or  32 . As a further alternative, the tool bars  31  and  32  can also be implemented by means of pop-up or pull-down menus. During the screening operation the user can still directly use the icons or buttons to divert from the pre-programmed workflow sequence. 
     In the example considered here the user has utilised an ellipse contour tool provided by the tool bar  31  in order to highlight the regions  33  and  34  of the mammograms  25  and  26 , respectively. Likewise the user has utilised the freehand contour tool to highlight the regions  35  and  36  of the mammograms  25  and  26  respectively. 
       FIG. 5  shows three different tilings of the display in a single monitor mode. The display  37  shows a single tiling and the display  38  a half tiling with a look-up table window  39 . The look-up table window  39  can be used in order to change or adjust the brightness and/or the contrast of the image. 
     Further,  FIG. 5  shows a display  40  with a quarter tiling. The quarter tiling enables displaying four different views at the same time. 
       FIG. 6  shows corresponding display modes when using two monitors. The display mode  1  provides an overview for the radiologist. The tilings  41 ,  42 ,  43  and  44  can be used to display of prior images MLO right, MLO left, CC right, CC left. Likewise the tilings  45 ,  46 ,  47  and  48  of the lower row can be used to display the current images MLO right, MLO left, CC right and CC left, respectively of the current case. 
     In the display mode  2  there are tilings  49 ,  50 ,  51  and  52 , as apparent from  FIG. 6 . These tilings allow an overview of a set of current or prior images. 
     In the display mode  3  the full screen of each monitor is used to display an image. 
     In order to specify a required image arrangement, the icons as listed in table 1 can be utilised. In order to specify a tool, a separate icon can be provided for each of the available functions as defined in respective rows of the table 2. 
     
       
         
               
               
             
           
               
                 TABLE I 
               
               
                   
               
             
             
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
                 Overview image arrangement: 2 quarter tilings:maximum 8 images on two monitors. (upper rowprior images: MLO right, MLO left (left monitor)/CC right, CC left (right monitor)) (lower rowcurrent images: MLO right, MLO left (leftmonitor)/CC right. CC left (right monitor)) 
               
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
                 Overview current image arrangement: 2 doubletilings: maximum 4 images on two monitors.MLO right, MLO left (left monitor/CC right, CCleft (right monitor) 
               
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
                 Overview prior image arrangement: 2 doubletilings: maximum 4 images on two monitors.MLO right, MLO left (left monitor)/CC right, CCleft (right monitor) 
               
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
                 MLO current (2 single tilings): right (leftmonitor)/left (right monitor) 
               
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
                 MLO prior (2 single tilings): right (left monitor)/left (right monitor) 
               
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
                 CC current (2 single tilings): right (left monitor)/left (right monitor) 
               
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
                 CC prior (2 single tilings): right (left monitor)/left(right monitor) 
               
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
                 MLO right (2 single tilings): prior (left monitor)/current (right monitor) 
               
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
                 MLO left (2 single tilings): prior (left monitor)/current (right monitor) 
               
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
                 CC right (2 single tilings): prior (left monitor)/current (right monitor) 
               
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
                 CC left (2 single tilings); prior (left monitor)/current (right monitor) 
               
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
                 Current right (2 single tilings): MLO (leftmonitor)/CC (right monitor) 
               
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
                 Current left (2 single tilings): MLO (left monitor)/CC (right monitor) 
               
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
                 Prior right (2 single tilings): MLO (left monitor)/CC (right monitor) 
               
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
                 Prior left (2 single tilings): MLO (left monitor)/CC (right monitor) 
               
               
                   
               
             
          
         
       
     
     
       
         
               
               
             
           
               
                 TABLE II 
               
               
                   
               
             
             
               
                 CAD on 
                 turns display of CAD results for all images of the current 
               
               
                   
                 case on 
               
               
                 CAD off 
                 turns display of CAD results for all images of the current 
               
               
                   
                 case off 
               
               
                 ROAMING 
                 is only possible for single tilings 
               
               
                 on 
                 displays the 50 micron images of the currently displayed 
               
               
                   
                 images. The 50 micron images are larger than one monitor, 
               
               
                   
                 so moving is needed to see all parts of the image 
               
               
                 ROAMING 
                 is only possible for single tilings: 
               
               
                 off 
                 changes the roaming images back into the single tilings. 
               
               
                 CLAHE on 
                 changes the currently displayed images into CLAHE 
               
               
                   
                 images. 
               
               
                 CLAHE off 
                 changes the images of the current image arrangement 
               
               
                   
                 back to original. 
               
               
                 recycle 
                 deletes the step 
               
               
                   
               
             
          
         
       
     
       FIG. 7  shows an embodiment of the graphical user interface in accordance with the invention which functions based on the icons as explained with respect to the tables 1 and 2. The graphical user interface contains a region  53  in which is shown all the icons that can be selected by a user for pre-programming the sequence of images. This is done by selecting one of the icons at a time and moving the selected icon to the region  54  that corresponds to the sequence bar  20  of  FIG. 1 . When the pre-programming is complete the user clicks on the OK button  55 . 
       FIG. 8  shows the graphical user interface of  FIG. 7  after a pre-programming has been performed. The resulting sequence of icons  56  is depicted in  FIG. 8 . The user can correct the sequence  56  by selecting an icon from the sequence  56  and moving the icon to the trash symbol  57 . 
     The  FIG. 9  shows an example of a layout for the keypad  21 . The keypad  21  has a next-step button  22  (cf.  FIG. 1 ). 
     The menu button  58  serves to switch on and off the tool bars. The reset button  59  resets all tools and brings the computer system into the overview display mode. 
     The roaming left button  60  activates the roaming for the left monitor; the roaming right button  61  activates the roaming for the right monitor. 
     The MLO CC button  62  serves to select an overview current view in double tiling and the MLO button  63  serves to select a MLO current view. 
     The CC button  64  serves to select a CC current view. Pressing the CLAHE button  65  start a CLAHE enhancement for both monitors. The wavelet button  66  starts a wavelet enhancement for both monitors; the LUT button  67  serves to select the brightness/contrast mode as well as to deselect this mode. 
     The overview button  68  serves to select an overview of all images of a case with both monitors in quarter tiling. The CAD button  69  shows all CAD results for all images. The previous button  70  serves to go back to the preceding case; the annotation button  71  selects the annotation mode in order to highlight specific regions of interest in an image. 
     In response to pressing the diagnosis button  72 , the diagnosis window is displayed in order to input a diagnosis for the current case. In response to pressing the diagnosis button  72  the computer system automatically goes to the consecutive case. 
     It is important to note that the buttons  22  and  58  to  72  of the keypads  21  are arranged such that the most frequently used buttons are located in an upper portion of the keypad  21 . Lower buttons of the keypad  21  have decreasing degrees of importance in terms of their respective usage frequencies. 
     Although the present invention has been shown and described with respect to preferred embodiments, nevertheless, changes and modifications will be evident to those skilled in the art from the teachings of the invention. Such changes and modifications that embody the spirit, scope and teachings of the invention are deemed to fall within the purview of the invention as set forth in the appended claims. 
     List of Reference Numerals 
     
       
         
               
               
               
             
           
               
                   
                   
               
             
             
               
                   
                 computer 
                 01 
               
               
                   
                 graphical user interface 
                 02 
               
               
                   
                 work flow memory 
                 03 
               
               
                   
                 stack 
                 04 
               
               
                   
                 pointer 
                 05 
               
               
                   
                 memory 
                 06 
               
               
                   
                 data field 
                 07 
               
               
                   
                 data field 
                 08 
               
               
                   
                 data field 
                 09 
               
               
                   
                 data field 
                 10 
               
               
                   
                 data field 
                 11 
               
               
                   
                 pointer 
                 12 
               
               
                   
                 IP module 
                 13 
               
               
                   
                 retrieval module 
                 14 
               
               
                   
                 display system 
                 15 
               
               
                   
                 database 
                 16 
               
               
                   
                 monitor 
                 17 
               
               
                   
                 monitor 
                 18 
               
               
                   
                 icons 
                 19 
               
               
                   
                 sequence bar 
                 20 
               
               
                   
                 keypad 
                 21 
               
               
                   
                 next-step button 
                 22 
               
               
                   
                 keyboard 
                 23 
               
               
                   
                 mouse 
                 24 
               
               
                   
                 mammogram 
                 25 
               
               
                   
                 mammogram 
                 26 
               
               
                   
                 display field 
                 27 
               
               
                   
                 display field 
                 28 
               
               
                   
                 display field 
                 29 
               
               
                   
                 display field 
                 30 
               
               
                   
                 toolbar 
                 31 
               
               
                   
                 toolbar 
                 32 
               
               
                   
                 region 
                 33 
               
               
                   
                 region 
                 34 
               
               
                   
                 region 
                 35 
               
               
                   
                 region 
                 36 
               
               
                   
                 display 
                 37 
               
               
                   
                 display 
                 38 
               
               
                   
                 look-up table window 
                 39 
               
               
                   
                 display 
                 40 
               
               
                   
                 tiling 
                 41 
               
               
                   
                 tiling 
                 42 
               
               
                   
                 tiling 
                 43 
               
               
                   
                 tiling 
                 44 
               
               
                   
                 tiling 
                 45 
               
               
                   
                 tiling 
                 46 
               
               
                   
                 tiling 
                 47 
               
               
                   
                 tiling 
                 48 
               
               
                   
                 tiling 
                 49 
               
               
                   
                 tiling 
                 50 
               
               
                   
                 tiling 
                 51 
               
               
                   
                 tiling 
                 52 
               
               
                   
                 region 
                 53 
               
               
                   
                 region 
                 54 
               
               
                   
                 ok-button 
                 55 
               
               
                   
                 sequence 
                 56 
               
               
                   
                 trash symbol 
                 57 
               
               
                   
                 menu button 
                 58 
               
               
                   
                 reset button 
                 59 
               
               
                   
                 roaming left button 
                 60 
               
               
                   
                 roaming right button 
                 61 
               
               
                   
                 MLO space CC button 
                 62 
               
               
                   
                 MLO button 
                 63 
               
               
                   
                 CC button 
                 64 
               
               
                   
                 CLAHE button 
                 65 
               
               
                   
                 wavelet button 
                 66 
               
               
                   
                 LUT button 
                 67 
               
               
                   
                 overview button 
                 68 
               
               
                   
                 CAD button 
                 69 
               
               
                   
                 previous button 
                 70 
               
               
                   
                 annotation button 
                 71 
               
               
                   
                 diagnosis button 
                 72