Abstract:
An echocardiogram report generation method and system are disclosed for creating a complete medical report describing an echocardiogram without dictation, transcription or typing. The report is tailored to describe an individual patient and generated in complete grammatically complex sentences in response to the user&#39;s input with a text report that is complete and understandable for a primary care physician. The method and system provides the user the parallel options of an anatomical structure approach and a disease-specific approach in order to amplify the description of the echocardiogram in specific areas and give a more meaningful report. The echo report generated by the method and system creates a table of measurements and calculations in compact form, omitting any data fields not used. The method and system guides the user through the various areas of the heart which merit comment on the report and provides clear color coded segments of the heart muscle and provides several heart segment classifications so that the user can use his favored classification scheme. Diagnostic possibilities are provided for inclusion in the report conclusions.

Description:
FIELD OF THE INVENTION 
     The present invention relates to a computer software product for generation of a medical report. More particularly, the present invention is related to the generation of a medical report describing an echocardiogram. 
     BACKGROUND OF THE INVENTION 
     The echocardiogram is a well-known diagnostic procedure that uses ultrasound to take moving pictures of the heart. It is estimated that there are over ten million echocardiograms performed annually in the United States. Among other things, the echocardiogram allows measurements of the chambers of the heart and the appearance and motion of the heart. A large amount of detailed information must be reviewed and evaluated by the interpreting physician, sometimes called an echocardiographer. Echocardiogram reports (hereinafter “echo reports”) are typically arranged by the different anatomical structures in the heart such as chambers or valves. On the basis of this anatomical structure approach, the echocardiographer may identify a particular condition. The echo report is then dictated or hand-written before being typed and returned to the interpreting physician for review and signature. Only then is the echo report, which must be complete and understandable, sent to the primary care physician who ordered the report. Aside from the loss of time and money in this process, the echocardiographer must review and approve a report without the benefit of the echocardiogram images in front of him for review. 
     In addition to the large amount of information that must be reviewed and evaluated by the echocardiographer, there are differences in opinion among echocardiographers as to the number of segments appropriate for classification of the heart muscle. For example, some use a sixteen-segment classification and others use a fifteen-segment classification. 
     Aside from differences in preferred classification of the heart muscle segments, the number of measurements actually taken on a particular patient is usually less than the possible number of measurements. It is also true that some areas of the heart cannot be visualized well in every patient. What this means is that many data fields may be empty and make a report longer than necessary and require additional time on the part of the evaluation physician to dictate an explanation for the missing items. 
     Although there have been attempts to generate echo reports by computer software, there is a need for a method or system that allows the user, having identified a specific condition by an anatomical based approach to cross reference and compare other options by a condition or disease based approach. Likewise, there is a need for a method or system which gives the user the ability to create an echo report with minimal interaction and to edit the elements of the report as selections are made or to generate a report in grammatically correct sentences that is complete and understandable for the primary care physician. 
     What is also needed is a method or system that can quickly and easily guide the user through the various areas of the heart with color-coded diagrams of the various segments of the heart which merit comment on the report. Likewise, what is needed is a method or system that can be easily installed in a doctor&#39;s personal computer (“PC”) or laptop and is suitable for both general cardiologists and echocardiographers. 
     SUMMARY OF THE INVENTION 
     The present invention is directed to a computer readable storage method and system allowing a physician to create a complete and well-organized medical report describing an echocardiogram (an echo report) without dictation, transcription or typing. The inventive method and system quickly and easily guides the doctor through the various areas of the heart which merit comment on the echo report. The inventive method and system allows the physician to create an echo report with minimal interaction and without the need to enter any measurements. However, any measurements entered by the technician can be corrected by the physician if needed. 
     The inventive method and system provides clear color-coded diagrams of the various named segments of the heart muscle. As there is a lack of unanimity among echocardiographers as to whether a fifteen-segment classification or a sixteen-segment classification is preferable, this invention provides each, as well as a third classification so the user can choose whichever classification scheme is desired. 
     In addition to the standard anatomical-based approach by which traditional echo reports are structured, the inventive method and system provides a parallel disease or condition specific section with a separate set of tabbed pages or interfaces each devoted to a specific disease entity. Thus the user, having identified the presence of a certain condition by a standard anatomical-based approach, may, if desired, shift to a specific disease-oriented page and be presented with a set of options reminding the user of all of the various possible echo findings in that disease. This gives the user the option to amplify the description of the echo in certain specific areas and give a more meaningful echo report 
     The inventive method and system provides a list of normal values for certain measurements of artificial heart valve functions, important to the interpretation of artificial heart valve echo studies, and also provides diagrammatic prompts to aid in the interpretation of certain Doppler echo measurements that are infrequently made but important in certain cases. 
     The inventive method and system collects diagnostic possibilities based on the descriptive choices made by the user and presents a list of these diagnoses, which list can be amended from a predetermined list of common cardiac conditions or with free text additions. ICD-9 codes for each diagnosis are added automatically, eliminating the time consuming and expensive stage of coding the diagnosis. 
     The invention is compatible with a Windows® based operating system and can be installed and used on a PC in a physician&#39;s office or in a hospital. The invention operates by controlling Microsoft Word® as its word processing output and uses Microsoft Access® as a database. The invention will also operate with Windows® 98SE and Windows® XP. It can utilize Word® 2000 or later and likewise can utilize Access® 2000 or later. 
     Although mainly intended for use in a PC, the invention is easily adaptable to a larger echocardiogram-processing package or can be built into an echocardiogram machine. 
     The invention provides graphic user interfaces (herein referred to as “screen pages” or “screens”) for use with any mouse-type pointing device or equally effective in a touch-screen computer, totally eliminating any mouse motion. The various sections of the echo report are shown “live” on the graphic user interface in the form of text in text boxes as the user&#39;s input occurs. This input is editable by the user at any stage if there are any nuances that need to be recorded. At the end of the user interface is another blank text box for additional free-text comments. In addition, a user can customize a number of check boxes with statements unique to that user which will be displayed each time the user initiates or logs in to the inventive system. 
     It is an object of this invention that the echo report includes a table of measurements and calculations on an individual patient, which table shall be compact and only include those measurements taken on that patient and omitting any unused data fields. In practice each patient will normally have only five to ten measurements out of a possible fifty. 
     It is an object of this invention that an echo report to describe an individual patient is created in complete sentences including complex sentences grammatically tailored by the software in response to the user&#39;s input. 
     The invention will create a final echo report instantly, allow its review immediately on the computer screen, and allow the immediate finalization of the echo report either with an electronic signature or an on-the-spot hard copy. The final product will be an ordinary Word® document, which can be sent electronically to a patient&#39;s chart or referring doctor&#39;s office. 
     It is therefore an object of this invention to provide a computer-implemented method of generating a medical report from an echocardiogram for a patient, comprising the steps of: creating at least one database comprising echocardiogram measurements for at least one patient; providing a user with a prompting graphical user interface to log in and gain access to said database and the echocardiogram measurements for a patient; providing the user with a start-up graphical user interface for display of echocardiogram measurements for the patient, said start-up graphical user interface having a plurality of tabbed anatomical-based graphical user interfaces pertaining to specific anatomical parts of a human heart for entry of a diagnosis by the user pertaining to any of said anatomical parts of the human heart based upon the echocardiogram measurements for the patient available in said data base; providing the user with a plurality of disease-based graphical user interfaces pertaining to disease states of the human heart accessible from the anatomical-based graphical user interfaces to assist the user in the entry of a diagnosis by the user pertaining to any of the specific anatomical parts of the human heart based upon the echocardiogram measurements for the patient available in said data base; generating complete grammatically correct sentences in response to the entry of diagnosis by the user pertaining to any of the specific anatomical parts of the human heart based upon the echocardiogram measurements for the patient available in said data base; generating complete grammatically correct sentences in response to the entry of diagnosis by the user pertaining to any of the disease states of the human heart based upon the echocardiogram measurements for the patient available in said data base; providing the user with a graphical user interface to create a medical report in complete grammatically correct sentences based on the entry of diagnoses by the user; and generating a medical report in complete grammatically correct sentences based on the entry of diagnoses by the user. 
     It is a further object of this invention to provide a computer-readable storage medium for use with a graphics display device bearing program code for instructing a computer to perform a method of generating a medical report from an echocardiogram for a patient, said method comprising the steps of: comprising the steps of: creating at least one database comprising echocardiogram measurements for at least one patient; providing a user with a prompting graphical user interface to log in and gain access to said database and the echocardiogram measurements for a patient; providing the user with a start-up graphical user interface for display of echocardiogram measurements for the patient, said start-up graphical user interface having a plurality of tabbed anatomical-based graphical user interfaces pertaining to specific anatomical parts of a human heart for entry of a diagnosis by the user pertaining to any of said anatomical parts of the human heart based upon the echocardiogram measurements for the patient available in said data base; providing the user with a plurality of disease-based graphical user interfaces pertaining to disease states of the human heart accessible from the anatomical-based graphical user interfaces to assist the user in the entry of a diagnosis by the user pertaining to any of the specific anatomical parts of the human heart based upon the echocardiogram measurements for the patient available in said data base; generating complete grammatically correct sentences in response to the entry of diagnosis by the user pertaining to any of the specific anatomical parts of the human heart based upon the echocardiogram measurements for the patient available in said data base; generating complete grammatically correct sentences in response to the entry of diagnosis by the user pertaining to-any of the disease states of the human heart based upon the echocardiogram measurements for the patient available in said data base; providing the user with a graphical user interface to create a medical report in complete grammatically correct sentences based on the entry of diagnoses by the user; and generating a medical report in complete grammatically correct sentences based on the entry of diagnoses by the user. 
     It is a further object of this invention that the user be provided with graphical user interfaces pertaining to specific anatomical parts of a human heart, comprising a graphical user interface for the aortic valve, a graphical user interface for the left ventricle and left atrium, a graphical user interface for the right ventricle and right atrium, a graphical user interface for the mitral valve, a graphical user interface for the tricuspid valve, the pulmonic valve and the inferior vena cava, a graphical user interface for the pericardium, a graphical user interface for the aorta, thrombus and foreign bodies, a graphical user interface for vegetations, a graphical user interface for atrial septal defect, patent foramen ovale and ventricular septal defect, a graphical user interface for M-mode and Doppler left ventricular signs; a graphical user interface for abnormal septal motion, a graphical user interface for prosthetic valves, and a graphical user interface for segmental wall motion. It is not intended that this invention be limited to this listing of anatomical parts of the human heart. 
     It is a further object of this invention that the user be provided with graphical user interfaces pertaining to disease states of the human heart comprising a graphical user interface for cardiac source of emboli, a graphical user interface for diastolic analysis, a graphical user interface for myxoma, a graphical user interface for restrictive cardiomyopathy, a graphical user interface for aortic dissection, a graphical user interface for infective endocarditis, a graphical user interface for dilated cardiomyopathy, a graphical user interface for hypertropic cardiomyopathy, and a graphical user interface for myocardial infarction. It is not intended that this invention be limited to these disease states. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a splash screen introductory page. 
         FIG. 2  is a log-in form screen page. 
         FIG. 3  is the start-up page of the report form screen page. 
         FIG. 4  is a search form screen page. 
         FIG. 5  is a new patient database form. 
         FIG. 6  is a technician&#39;s form screen page for display of data. 
         FIGS. 7   a  through  7   c  are maintenance form screen pages. 
         FIG. 8  is an “Omit Any Uninterpretable Data” box displayed on the start-up screen page. 
         FIGS. 9   a  through  9   e  are tabbed screen pages of selected indications for echocardiography. 
         FIGS. 10   a  through  10   z  are the tabbed anatomical-based screen pages opened from the start-up page. 
         FIGS. 10   aa  through  10   ab  are the conclusion screen pages opened from the start-up page. 
         FIGS. 11   a  through  11   k  are the tabbed individual condition screen pages opened from the start-up page. 
         FIG. 12  is a completed exemplary echo report generated by the inventive computer-implemented method and computer-readable storage medium. 
         FIG. 13  is a flow diagram of the inventive computer-implemented method and computer-readable Storage medium for generating a medical report for a patient from an echocardiogram. 
         FIGS. 14   a ,  14   b ,  15   a ,  15   b ,  15   c ,  15   d ,  15   e ,  16 ,  17   a ,  17   b ,  17   c ,  17   d ,  18   a ,  18   b ,  18   c ,  18   d ,  18   e ,  18   f , and  19  are tabbed anatomical-based screen pages showing the generation of complete grammatically complex sentences in response to the user&#39;s input with illustration of different inputs and the resulting sentences. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       FIG. 1  is a splash screen introductory page  101  with a graphic color representation  102  of sixteen segment classification of the heart muscle and a graphic representation  103  of a mitral diastolic Doppler. 
       FIG. 2  is a log-in form screen page  201  for the using physician to enter a name into the User Name box  202  and a password into Password box  203  and engage an Enter button  204  to continue the inventive computer-implemented method and computer-readable storage medium for generating a medical report for a patient from an echocardiogram. 
       FIG. 3  is the start-up screen page  301  for opening the inventive computer-implemented method and computer-readable storage medium. There are command buttons  302  at the bottom of start-up screen page  301  for performing various functions and there are tabs  303  at the top of the start-up screen page  301  which allows the user to select different areas of the heart for comment. These buttons and tabs are illustrative examples and it is not intended that the present invention be limited to these examples nor to the location of these examples on the start-up screen page  301 . 
     Start-up screen page  301  also contains boxes  304  for entry of patient name and data, as well as boxes  305  for entry of all measurements taken in an echocardiogram test for that patient. As shown in  FIG. 3 , start-up screen  301  allows the user to access a database and find an existing patient through a drop-down box  306 , or by a Show Search Form button  307  which opens a search form screen page  401  as shown in  FIG. 4 . Search form screen page  401  has a box  402  for the patient&#39;s name and a button  403  for entry of the patient&#39;s data from the database. By use of the drop-down box  306  or the search form screen page  401 , the data for an existing patient can be accessed and automatically entered into boxes  304  and  305 . For a new patient, the user can depress the New Patient button  308  which will open a new patient database form  501  illustrated in  FIG. 5 , which contains boxes  502  for entry of patient name and data, as well as boxes  503  for entry of all measurements taken in an echocardiogram test for that patient. Also included on new patient database form  501  are command buttons  504  to perform various functions with the patient data. As indicated on form  501 , the form may be used to add new patient data to the. database, update that data or delete an existing patient from the database. 
       FIG. 6  is a technician&#39;s form screen page  601  used by an echocardiogram technician to enter data and measurements from an echocardiogram for a patient. This form screen page  601  is identical to the new patient database form screen page  501  and the information on screen page  601  is the source of information which may be ultimately entered for a new patient by using form screen page  501 . 
     All measurements visible in boxes  305  on the start-up screen page  301  are brought forward to each screen page as needed. 
       FIG. 7   a  is a maintenance form screen page  701  which is opened by the Maintenance button  309  on start-up screen page  301 , as shown in  FIG. 3 . Maintenance form screen page  701  is used to register a new reading doctor on boxes  702 , add headings in box  703  and add user-specific controls and favorite diagnosis under tabs  704  and boxes  705 .  FIG. 7   a  depicts the maintenance form screen page with a “user checkboxes—general” tab  706 .  FIG. 7   b  depicts the maintenance form screen page with a “user checkboxes—LV” tab  707  which provides boxes  708  for entry of specific information related to the Left Ventricle.  FIG. 7   c  depicts the maintenance form screen page with a “user checkboxes—AV and MV” tab  709  which provides boxes  710  for entry of specific information related to the Aortic Valve and the Mitral Valve. 
       FIG. 8  is an “Omit Any Uninterpretable Data” box  801  displayed on the start-up screen page  301  when the Image Quality box  311  on start-up screen page  301  is checked with a “Poor” image quality selection  312 . Box  801  affords the reading doctor several enumerated options relating to specific anatomical structure. For example, if the statement  802  “No images of the aorta are sufficient for diagnostic comment”, is selected, then that statement is made in the report and all controls in the inventive method and system related to that anatomical structure are disabled and appear pale grey and do not respond to clicks. However, comments still can be made by clicking the “Enable All Controls” button  313  on the start-up screen page  301  with a warning box that the user must carefully avoid contradictory statements. 
       FIGS. 9   a  through  9   e  are tabbed screen pages opened by clicking on the “Indications” button  314  on the start-up screen page  301 . These pages are for ready reference and contain Medicare approved indications for echocardiograms and the ICD-9 codes for each. 
       FIGS. 10   a  through  10   z , are the tabbed anatomical-based screen pages opened by clicking on the tabs  303  on the start-up screen page  301  shown in  FIG. 3 . 
       FIG. 10   a  is a screen page  1001  opened by clicking on the “Left Ventricle and Atrium” tab  315  on the start-up screen page  301 . This screen page  1001  has option boxes  1002  for entry of comments specific to the left ventricle (LV) and left atrium (LA), and box  1003  for entry of free text comments about the left ventricle and left atrium. 
       FIG. 10   b  is a screen page  1004  opened by clicking on the “Right Ventricle and Atrium” tab  316  on the start-up screen page  301 . This screen page  1004  has option box  1005  for entry of 
     This screen page  1004  has option box  1005  for entry of comments specific to the right ventricle (RV) and option box  1006  for entry of comments specific to the right atrium (RV). 
       FIG. 10   c  is a screen page  1007  opened by clicking on the “Mitral Valve” tab  317  on the start-up screen page  301 . This screen page  1007  for the mitral valve has been divided into five sections, each with its own tab and screen page beginning with the “Mitral. Structure” (MS) tab  1008  and screen page  1007  shown in  FIG. 10   c . On the MS screen page  1007  are provided option boxes  1009  for various comments appropriate to the MS, with a text box  1010  to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1009 . The sentences are constructed in the text box  1010  as the selections are made in the option boxes  1009  and are intended to appear in the final report with minor editing if needed. 
     Another tabbed section under the “Mitral Valve” tab  317  on the start-up screen page  301  is shown in  FIG. 10   d .  FIG. 10   d  shows a “Mitral Valve Prolapse” (MVP) tab  1011  and screen page  1012  with option boxes  1013  for various comments appropriate to MVP, with text boxes  1014  to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1013 . The sentences are constructed in the text boxes  1014  as the selections are made in the option boxes  1013  and are intended to appear in the final report with minor editing if needed. 
     Another tabbed section under the “Mitral Valve” tab  317  on the start-up screen page  301  is shown in  FIG. 10   e .  FIG. 10   e  shows a “Mitral Regurgitation” (MR) tab  1015  and screen page  1016  with option boxes  1017  for various comments appropriate to MR, with text boxes  1018  to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1017 . The sentences are constructed in the text boxes  1018  as the selections are made in the option boxes  1017  and are intended to appear in the final report with minor editing if needed. 
     Another tabbed section under the “Mitral Valve” tab  317  on the start-up screen page  301  is shown in  FIG. 10   f .  FIG. 10   f  shows a “Mitral Stenosis” (MS) tab  1019  and screen page  1020  with option boxes  1021  for various comments appropriate to MS, with text boxes  1022  to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1021 . The sentences are constructed in the text boxes  1022  as-the selections are made in the option boxes  1021  and are intended to appear in the final report with minor editing if needed. 
     The last tabbed section under the “Mitral Valve” tab  317  on the start-up screen page  301  is shown in  FIG. 10   g .  FIG. 10   g  shows an “Other Mitral Motion” tab  1023  and screen page  1024  with option boxes  1025  for various comments appropriate to Other Mitral Motion, with text boxes  1026  to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1025 . The sentences are constructed in the text boxes  1026  as the selections are made in the option boxes  1025  and are intended to appear in the final report with minor editing if needed. 
       FIG. 10   h  is a screen page  1027  opened by clicking on the “Vegetations” tab  318  on the start-up screen page  301 . This screen page  1027  has option boxes  1028  for entry of comments specific to vegetation location and size, and text box  1029  to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1028 . The sentences are constructed in the text boxes  1029  as the selections are made in the option boxes  1028  and are intended to appear in the final report with minor editing if needed. 
       FIG. 10   i  is a screen page  1030  opened by clicking on the “Aorta, Thrombus, Mass, FB” tab  319  on the start-up screen page  301 . This screen page  1030  has option boxes  1031  for entry of comments specific to the ascending aorta, the descending aorta, thrombi, masses and foreign bodies, a free text box  1032  for entry of free text comments about the ascending aorta, the descending aorta, thrombi, masses and foreign bodies, and text box  1033  to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1031 . The sentences are constructed in the text box  1033  as the selections are made in the option boxes  1031  and are intended to appear in the final report with minor editing if needed. 
       FIG. 10   j  is a screen page  1034  opened by clicking on the “Pericardium” tab  320  on the start-up screen page  301 . This screen page  1034  has option boxes  1035  for entry of comments specific to the pericardium, and text boxes  1037  to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1035 . The sentences are constructed in the text boxes  1037  as the selections are made in the option boxes  1035  and are intended to appear in the final report with minor editing if needed. 
       FIG. 10   k  is a screen page  1038  opened by clicking on the “Tricuspid, Pulmonic, IVC” tab  321  on the start-up screen page  301 . This screen page  1038  has option boxes  1039  for entry of comments specific to the tricuspid valve, pulmonic valve and inferior vena cava, and text boxes  1040  to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1039 . The sentences are constructed in the text boxes  1040  as the selections are made in the option boxes  1039  and are intended to appear in the final report with minor editing if needed. 
       FIG. 10   l  is a screen page  1041  opened by clicking on the “Aortic Valve” tab  322  on the start-up screen page  301 . This screen page  1041  has option boxes  1042  for entry of comments specific to aortic valve structure, aortic stenosis data and aortic regurgitation data, and text boxes  1043  to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1042 . The sentences are constructed in the text boxes  1043  as the selections are made in the option boxes  1042  and are intended to appear in the final report with minor editing if needed. 
       FIG. 10   m  is a screen page  1044  opened by clicking on the “ASD, PFD, VSD” tab  323  on the start-up screen page  301 . This screen page  1044  has option boxes  1045  for entry of comments specific to atrial septal defect (ASD), patent foramen ovale (PFO), and ventricular septal defect (VSD). The selection of any of the option boxes  1045  will generate a grammatically correct sentence reflecting the user&#39;s selections from the option boxes  1045  and are intended to appear in the final report with minor editing if needed. 
       FIG. 10   n  is a screen page  1046  opened by clicking on the “M-Mode and Doppler LV signs” tab  324  on the start-up screen page  301 . This screen page  1046  has option boxes  1047  for entry of comments specific to mitral valve signs of left ventricular systolic dysfunction, aortic and aortic valve signs of left ventricular systolic dysfunction, mitral Doppler signs of left ventricular diastolic dysfunction and other Doppler signs, and text boxes  1048  to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1047 . The sentences are constructed in the text boxes  1048  as the selections are made in the option boxes  1047  and are intended to appear in the final report with minor editing if needed. 
       FIG. 10   o  is a screen page  1049  opened from screen page  1046  by clicking on the “Show Doppler Guide” command button  325  on the start-up screen  301  which is shown on the various tabbed screen pages accessed from the start-up screen  301 , such as screen page  1046  shown on  FIG. 10   n . The “Show Doppler Guide” command button  325  may also be used when the “Pericardium” screen page  1034  is open. As shown in  FIG. 10   o , there are three sections under the “Show Doppler Guide” command button  325 . One of these three is shown as screen page  1049  under the “Restriction” tab  1050 . A second is shown as screen page  1051  in  FIG. 10   p  under the “Diastolic Doppler” tab  1052 . A third is shown as screen page  1053  in  FIG. 10   q  under the “Constriction” tab  1054 . The three diagrams shown on screen pages  1049 ,  1051  and  1053  are intended to help the user in his analysis. 
       FIG. 10   r  is a screen page  1055  opened from the “Pericardium” screen page  1034  by clicking on the “Show Doppler Guide” command button  325  and illustrates one of the three sections under this command button, namely the screen page  1055  under the “Restriction” tab  1056 . A second is shown as screen page  1057  in  FIG. 10   s  under the “Diastolic Doppler” tab  1058 . A third is shown as screen page  1059  in  FIG. 10   t  under the “Constriction” tab  1060 . The three diagrams shown on screen pages  1055 ,  1057  and  1059  are intended to help the user in his analysis. 
       FIG. 10   u  is a screen page  1061  opened by clicking on the “Abnormal Septal Motion” tab  326  on the start-up screen page  301 . This screen page  1061  has option boxes  1062  for entry of comments specific to abnormal septal motion and text boxes  1063  to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1062 . The sentences are constructed in the text boxes  1063  as the selections are made in the option boxes  1062  and are intended to appear in the final report with minor editing if needed. 
       FIG. 10   v  is a screen page  1064  opened by clicking on the “Prosthetic Valves” tab  327  on the start-up screen page  301 . This screen page  1064  has option boxes  1065  for entry of comments specific to prosthetic valves. Grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1065  are accessed by clicking on the “View Prosthetic Valve Text Boxes” command button  1066  and closed by clicking on the “Hide Text Boxes” command button  1067 . The sentences are constructed as the selections are made in the option boxes  1065  and can be edited directly by the user and are intended to appear in the final report. 
       FIG. 10   w  is a screen page  1068  opened by clicking on the “View Normal Doppler Values” command button  1069  on the “Prosthetic Valves” screen page  1064 . This screen page  1068  provides the user with a table of normal values for common prosthetic aortic and mitral valves. Screen page  1068  is closed by clicking on command button  1069 , which reverts to “Close Down Values” when the “View Normal Doppler Values” command button is clicked. 
       FIG. 10   x  is a screen page  1070  opened by clicking on the “Segmental Wall Motion” tab  328  on the start-up screen page  301  and illustrates one of the sections available under this command button, namely the screen page  1070  under the “Basic” tab  1071  which has option boxes  1072  and a text box  1073 . The selection of any of the option boxes  1072  will generate a grammatically correct sentence in the text box  1073  reflecting the user&#39;s selections from the option boxes  1072  and are intended to appear in the final report with minor editing if needed. The “Segmental Wall Motion” tab  328  allows the user to select one of three different schemes to describe segmental wall motion abnormalities. The screen page  1070  under the “Basic” tab  1071  allows selection of the regions of the heart by more colloquial terms such as “Inferior Wall” or “Anterior Wall”. The segments of the heart are represented by graphic color coded segment images  1074 . The other two schemes are available under the “15 Segment” tab  1076  shown as screen page  1075  in  FIG. 10   y  with graphic color coded segment images  1077 , keyed to segment name option boxes  1078 , or the “16 Segment” tab  1080  shown as screen page  1079  in  FIG. 10   z  with graphic color coded segment images  1081 , keyed to segment name option boxes  1082 , and allow the selection of either a formal 15-segment or 16-segment classification. Screen page  1075  for the 15-segment selection or screen page  1079  for the 16-segment selection are further enhanced by clicking on any segment in the graphic color coded segment images  1077  or any segment in the graphic color coded segment images  1081  will show a line  1083  connecting the segment to its name in the segment name option boxes  1078  or  1082  respectively and will also show a line  1084  from the respective segment name option box to the corresponding segment representation in the other axis. The final tabbed section under “Segmental Wall Motion” tab  328  is the “Text” tab  1085  is a text page which will display grammatically correct sentences reflecting the user&#39;s selections from the-various option boxes as the selections are made and are intended to appear in the final report with minor editing if needed. This text page is not shown but is available to the user at any time. 
       FIG. 10   aa  is a screen page  1086  opened by clicking on the “Conclusions” tab  329  on the start-up screen page  301 . This screen page  1086  has been divided into two sections, each with its own tab and screen page, beginning with the “CONCLUSIONS” tab  1087  shown on screen page  1086  shown in  FIG. 10   aa . On this screen page  1086  is text box  1088  labeled as “extra suggestions for favorite diagnoses” which the user entered on the maintenance form screen page  701  in text box  705 . A text box  1089  for additional conclusions is provided. Text box  1090  displays all diagnoses (with ICD-9 codes) as suggested by the user&#39;s selections throughout the inventive computer-implemented method and system. A control button  1091  is provided to add the additional conclusions from text box  1089  to the text box  1090 , and a control button  1092  is provided to add a selection from text box  1088  to the text box  1090 . A text box  1093  is provided for discarding or reinserting diagnoses in text box  1090  by control buttons  1094  and  1095 . Once the user is satisfied with the list in text box  1090 , the list can be copied into a final conclusion text box  1096  by the control button  1097 . The list in text box  1096  can be edited if desired. The “Write Report” button  1098  writes a final report in a computer software system such as Microsoft Word®. The “Write Print Save” button  1099  can be used in place of “Write Report” button  1098 , and this button  1099  writes the report, prints it to a default printer and saves it. These functions can also be performed with the “Print” bottom  331  and the “Save” button  332 . The user can view the report by clicking on the “Look at Report” button  1990 . A “Sign Report” button  1991  is provided for electronic signature. The “Exit” button  333  closes the program. 
     The second section under the “Conclusions” tab  329  on the start-up screen page  301  is opened by clicking on the “User Controls and Free Text” tab  1992  and is shown in  FIG. 10   ab  as screen page  1993 . This screen page  1993  contains any entries from boxes  706  on the maintenance form screen page  701  and also allows the entry of any free text that the user may desire. 
       FIGS. 11   a  through  11   k  are the individual conditions screens opened by clicking on the “Show Individual Conditions Pages” control button  330  on the start-up screen page  301 . These individual condition screen pages are devoted to a specific disease entity and allow the user, having identified the presence of a certain condition by a standard anatomical-based approach through the use of anatomical-based screen pages illustrated in  FIGS. 10   a  through  10   z , to shift to a disease-oriented screen page and be presented with options reminding the user of all the various possible echo findings in that disease. This allows the user to amplify the description of the echo in specific areas and give a more meaningful echo report. 
       FIG. 11   a  is a screen page  1101  opened by clicking on the “CARDIAC SOURCE OF EMBOLI” tab  1102 . This screen  1101  has an option box  1103  with an extensive list for entry of comments related to sources already identified elsewhere in program, and an option box  1104  for entry of additional items identified. The listings in these option boxes  1103  and  1104  serve as a tutorial for the user to consider many details. A text box  1105  is provided to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1103  and  1104 . The sentences are constructed in the text box  1105  as the selections are made in the option boxes  1103  and  1104  and are intended to appear in the final report with minor editing if needed. 
       FIG. 11   b  is a screen page  1106  opened by clicking on the “AORTIC DISSECTION” tab  1107 . This screen  1106  has an option box  1108  for entry of comments related to Underlying Pathology, Anatomic Features, Functional Features and Complications and an option box  1109  for entry of comments related to Debakey Classification. A text box  1110  is provided to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1108  and  1109 . The sentences are constructed in the text box  1110  as the selections are made in the option boxes  1108  and  1109  and are intended to appear in the final report with minor editing if needed. 
       FIG. 11   c  is a screen page  1111  opened by clicking on the “INFECTIVE ENDOCARDITIS” tab  1112 . This screen  1111  has an option box  1113  for entry of comments related to Anatomic Features, an option box  1114  for entry of comments related to Functional Changes, and an option box  1115  for entry of comments related to Complications. A text box  1116  is provided to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1113 ,  1114  and  1115 . The sentences are constructed in the text box  1116  as the selections are made in the option boxes  1113 ,  1114  and  1115  and are intended to appear in the final report with minor editing if needed. 
       FIG. 11   d  is a screen page  1117  opened by clicking on the “MYOCARDIAL INFARCTION” tab  1118 . This screen  1117  has an option box  1119  for entry of comments related to Segmental Motion Abnormality, Aneurysm Formation, Thrombus, Pseudoaneurysm, Right Ventricular Infarct, Papillary Muscles, Cardiogenic Shock, Myocardial Rupture and Pericardium. A text box  1120  is provided to display grammatically correct sentences reflecting the user&#39;s selections from the option box  1119 . The sentences are constructed in the text box  1120  as the selections are made in the option box  1119  and are intended to appear in the final report with minor editing if needed. 
       FIG. 11   e  is a screen page  1121  opened by clicking on the “COMPARISON TO PRIOR ECHO” tab  1122 . The screen page  1121  lists core aspects of the heart and provides comparison selection boxes  1123  for each. For each, the user can indicate whether a certain feature is new, has gone away, is unchanged, or slightly or greatly changed for either the better or the worse. A text box  1124  is provided to display grammatically correct sentences reflecting the user&#39;s selections from the comparison selection boxes  1123 . The sentences are constructed in the text box  1124  as the selections are made in the comparison selection boxes  1123  and are intended to appear in the final report with minor editing if needed. 
       FIG. 11   f  is a screen page  1125  opened by clicking on the “RESTRICTIVE CARDIOMYOPATHY” tab  1126 . This screen page  1125  provides a reference Doppler graphic and comments  1127  specific to restrictive cardiomyopathy. This screen page  1125  provides option boxes  1128  for entry of comments related to General Features of Restriction, Sarcoid Heart Disease and Amyloid Heart, and an option box  1129  for comments specific to Restrictive Cardiomyopathy. A text box  1130  is provided to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1128  and  1129 . The sentences are constructed in the text box  1130  as the selections are made in the comparison selection boxes  1128  and  1129  and are intended to appear in the final report with minor editing if needed. 
       FIG. 11   g  is a screen page  1131  opened by clicking on the “MYXOMA” tab  1132 . This screen  1131  has an option box  1133  for entry of comments related to Left Atrium, Bilateral Atrial Myxomas, Right Atrium, Left Ventricle and Right Ventricle. A text box  1134  is provided to display grammatically correct sentences reflecting the user&#39;s selections from the option box  1133 . The sentences are constructed in the text box  1134  as the selections are made in the option box  1133  and are intended to appear in the final report with minor editing if needed. 
       FIG. 11   h  is a screen page  1135  opened by clicking on the “HYPERTROPIC CARDIOMYOPATHY” tab  1136 . This screen  1135  has an option box  1137  for entry of comments related to Anatomic, Functional and IHSS categories. A text box  1138  is provided to display grammatically correct sentences reflecting the user&#39;s selections from the option box  1137 . The sentences are constructed in the text box  1138  as the selections are made in the option box  1137  and are intended to appear in the final report with minor editing if needed. 
       FIG. 11   i  is a screen page  1139  opened by clicking on the “DILATED CARDIOMYOPATHY” tab  1140 . This screen  1139  has an option box  1141  for entry of comments related to Anatomic, Functional and Other Feature categories. A text box  1142  is provided to display grammatically correct sentences reflecting the user&#39;s selections from the option box  1141 . The sentences are constructed in the text box  1142  as the selections are made in the option box  1141  and are intended to appear in the final report with minor editing if needed. 
       FIG. 11   j  is a screen page  1143  opened by clicking on the “DIASTOLIC ANALYSIS” tab  1144 . This screen page  1143  provides the user with a column  1145  of patient specific data taken from the new patient database form  501  and/or the technician&#39;s form screen page  601 . In order to assist the user in making a meaningful analysis of the patient specific data, graphic Doppler illustrations  1146  and a corresponding table  1147  of data parameters are provided for various degrees of disease state beginning with Normal, and continuing with Stage 1A (impaired relaxation), Stage 1B (impaired relaxation), Stage 2 (pseudonormal), Stage 3 (reversible restriction), Stage 4 (irreversible restriction) and Constriction (pericardial constriction). Where the patient specific data illustrated in column  1145  exceeds or surpasses the data parameters shown in the table  1147 , that data point is highlighted with a marker  1148  to assist the user. There is also a “Show Diastole Form” control button  1149  on screen page  1143  which opens a “Diastole” screen page  1150  as shown in  FIG. 11   k . On “Diastole” screen page  1150  is an option box  1151  titled “Mitral Doppler Signs of Left Ventricular Diastolic Dysfunction” and an option box  1152  for Other Doppler Signs. A text box  1153  is also provided to display grammatically correct sentences reflecting the user&#39;s selections from the option boxes  1151  and  1152 . The sentences are constructed in the text box  1153  as the selections are made in the option boxes  1151  and  1152  and are intended to appear in the final report with minor editing if needed. 
       FIG. 12  illustrates an Echocardiogram Report  1201  generated by the inventive computer-implemented method and computer-readable storage medium by clicking the “Write Print Save” button  1099  on the “Conclusions” screen page  1086  shown in  FIG. 10   aa . The report is in final form with grammatically correct sentences and the report also contains a table of measurements and calculations in compact form, omitting any data fields not used. 
       FIG. 13 , a flow diagram of the inventive computer-implemented method and computer-readable storage medium for generating a medical report for a patient from an echocardiogram, illustrates the various steps and possibilities available to a user of the inventive computer-readable storage medium and the method performed by a computer under the instructions provided by the inventive computable readable storage medium. 
     As defined herein, a computer-readable storage medium is any article of manufacture that contains data that can be read by a computer or a carrier wave signal carrying data that can be read by a computer. For example, the inventive computer-readable storage medium for generating a medical report for a patient from an echocardiogram may be distributed on magnetic media, such as a floppy disk, flexible disk, hard disk, reel-to-reel tape, cartridge tape and cassette tape; optical media, such as a CD-ROM and writable compact disk; and paper media, such as punched cards and paper tape; or on a carrier wave signal received through a network, wireless network, or modem, including radio-frequency signals and infrared signals. 
       FIGS. 14   a  and  14   b  are both screen pages  1041  opened by clicking on the “Aortic Valve” tab  322  on the start-up screen page  301 , and as also shown in  FIG. 10   l . In  FIG. 14   a , several option boxes  1042  have been selected and the text box  1043  shows the generation of complete grammatically complex sentences in response to the option boxes selected. In this example, the text box  1043  reads, “Aortic valve images show mild calcific changes, severely reduced opening and degenerative nodule formation in the left and noncoronary cusps.” In  FIG. 14   b , alternative option boxes  1042  have been selected and the text box  1043  reads, “Aortic valve images show bicuspid structure, moderate aortic root dilatation and severely reduced opening.” 
       FIGS. 15   a  through  15   e  are all screen pages  1501  opened by clicking on the “Mitral Stenosis” tab  1502  after clicking on the “Mitral Valve” tab  317  and making selections on the option boxes  1503 . The text box  1504  shows the generation of complete grammatically complex sentences in response to the option boxes selected. In  FIG. 15   a , no option boxes  1503  were selected and the text box  1504  reads simply, “The mitral valve is not stenotic.” However, on  FIG. 15   b , several option boxes  1503  were selected and the text box  1504  now reads, “There is mild to moderate mitral stenosis.” Going further, on  FIG. 15   c , additional option boxes  1503  were selected and the text box  1504 , now reads, “There is mild to moderate mitral stenosis with minimal leaflet mobility.” Additional option box  1503  selections shown on  FIG. 15   d  causes the text box  1504  to read, “There is mild to moderate mitral stenosis with minimal leaflet mobility and marked leaflet thickening.” An alternative option box  1503  selection shown on  FIG. 15   e , automatically changes the text box  1504  to read, There is mild to moderate mitral stenosis with minimal leaflet mobility and marked leaflet thickening and minimal subvalvular chordal fusion.” 
       FIG. 16  is a screen page  1601  opened by clicking on the “Mitral Structure” tab  1602  after clicking on the “Mitral Valve” tab  317  and making selections on the option boxes  1603 . The text box  1604  shows the generation of a complete grammatically complex sentence in response to the option boxes selected. 
       FIGS. 17   a  through  17   d  are all screen pages  1034  opened by clicking on the “Pericardium” tab  320  on the start-up screen page  301 , and as also shown in  FIG. 10   j . In  FIG. 17   a , no option boxes  1035  were selected and the text box  1037  says simply, “There is no pericardial effusion.” As illustrated further in  FIGS. 17   b  through  17   d , the selection of various option boxes  1035  automatically changes the text box  1037  with the generation of a complete grammatically complex sentence in response to the option boxes selected. 
       FIGS. 18   a  through  18   f  are all screen pages  1801  opened by clicking on the “Segmental Wall Motion” tab  328  on the start-up screen page  301 .  FIGS. 18   a ,  18   c , and  18   e  are opened by clicking on the “Segments” tab  1802 , and  FIGS. 18   b ,  18   d  and  18   e  are opened by clicking on the “Text” tab  1803 . Selection of the option boxes  1804  on  FIGS. 18   a ,  18   c , and  18   e , generates complete grammatically complex sentences in the text boxes  1805  on  FIGS. 18   b ,  18   d  and  18   f  in response to the option boxes selected. 
       FIG. 19  is a screen page  1027  opened by clicking on the “Vegetations” tab  318  on the start-up screen  301 . Selection of several option boxes  1028  automatically generates complete grammatically complex sentences in the text box  1029 . In this case, the text box reads, “There is a large mobile and pedunculated vegetation of the aortic valve. There is a medium-sized non-mobile vegetation of the anterior leaflet of the mitral valve, visible in diastole.”