Patent Publication Number: US-2021177248-A1

Title: Endoscope system

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a Continuation of PCT International Application No. PCT/JP2019/032166 filed on 16 Aug. 2019, which claims priority under 35 U.S.C § 119(a) to Japanese Patent Application No. 2018-153733 filed on 17 Aug. 2018. The above application is hereby expressly incorporated by reference, in its entirety, into the present application. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates to an endoscope system that performs a recognition process for a photographic subject using an image captured by using an endoscope. 
     2. Description of the Related Art 
     In the medical field, endoscope systems that include a light source device, an endoscope, and a processor device are in widespread use. The light source device generates illumination light. The endoscope captures an image of a photographic subject by using an image sensor. The processor device generates an image and performs other image processing and so on. 
     Endoscope systems may not only capture an image of a photographic subject for observation but also have additional functions. For example, an endoscope system that has an “input mode” in which the position and orientation of a treatment tool are controlled by using a touch panel is known (JP2008-245840A (corresponding to US2010/0004505A1)). In the endoscope system described in JP2008-245840A, the state of the input mode is displayed on a screen. An endoscope system that has a function of displaying on a screen an image representing the bending state of a tip part of an endoscope and a character string for notification of, for example, completion of calibration to thereby give a notification of, for example, a system error is known (JP2007-330405A). In addition, an endoscope system that displays on a screen the ON state or the OFF state of a foot switch (JP2005-073799A (corresponding to US2005/0049458A1)), an endoscope system that displays on a screen a mark indicating that air supply is ongoing (JP991-277340A (JP-H03-277340A)), and an endoscope system that displays on a screen the ON state or the OFF state of image recording (JP1988-259614A (JP-S63-259614A)) are known. 
     Further, endoscope systems that detect a treatment tool and use the result of detection are known. For example, an endoscope system that uses the result of detecting a treatment tool to determine the correction intensity of an image is known (JP2015-96237A). An endoscope system that inactivates an autofocus function in a case where a treatment tool is detected is known (JP2013-150658A (corresponding to US2013/0188029A1)). 
     In addition, currently, an endoscope system that supports diagnoses by, for example, calculating biological function information using a captured image of a photographic subject is known (JP2018-51364A). 
     SUMMARY OF THE INVENTION 
     In a case where a medical image, such as an image captured by using an endoscope (hereinafter referred to as an endoscopic image), is used to recognize a photographic subject having specific characteristics or part of the photographic subject, thereby obtaining information for supporting a diagnosis (hereinafter referred to as diagnosis support information), it is necessary to use a medical image that is captured under specific conditions such that a recognition process can function for the medical image. When a medical image for which a recognition process does not function is used, even when the result of the recognition process is obtained, the result of the recognition process may be inaccurate. 
     It is not necessarily the case that a medical image for which a recognition process can function is always obtained. Accordingly, an inaccurate result of the recognition process or diagnosis support information obtained by, for example, calculation using an inaccurate result of the recognition process may hinder observation or a diagnosis of the photographic subject. For example, in endoscope systems, the accuracy of a recognition process may decrease in a case where a treatment tool is present in an endoscopic image. 
     In order not to provide, for example, an inaccurate result of a recognition process as described above, the recognition process can be prevented from being performed unless a medical image for which the recognition process can function is obtained. However, when the recognition process is simply prohibited from being performed, a doctor or the like, who is a user, may incorrectly recognize the result of performing the recognition process or the result of not performing the recognition process. For example, in a case of using, for example, an apparatus that performs a recognition process for detecting a potential lesion, when the recognition process is simply prohibited from being performed, a doctor or the like who is using the apparatus may incorrectly recognize that the recognition process is performed and a potential lesion is not detected as a result of the recognition process. That is, a doctor or the like may unable to determine whether the result of the recognition process is not displayed because the recognition process is not performed or the result of the recognition process is not displayed because the recognition process is performed and a recognition target is not detected as a result of the recognition process. 
     For example, in a case where a doctor or the like starts, for example, a surgical operation on a photographic subject or in a case where a doctor or the like sprays a coloring agent and starts close observation, a recognition process or display of the result of the recognition process may be automatically disabled in order not to hinder an operation of the doctor or the like. Also in this case, the doctor or the like may incorrectly recognize the result of performing the recognition process or the result of not performing the recognition process as in the above-described case. In addition, in a case where a recognition function is automatically disabled although a doctor or the like does not explicitly disable the recognition function, the doctor or the like may lose concentration, which is a problem. 
     An object of the present invention is to provide an endoscope system that at least prevents incorrect recognition of the result of performing a recognition process and the result of not performing the recognition process. 
     An endoscope system according to the present invention includes: an image obtaining unit that obtains an image obtained by image capturing of a photographic subject; a recognition unit that performs a recognition process of recognizing the photographic subject by using the image; an identification unit that identifies an operation performed on the photographic subject; a setting unit that enables or disables the recognition unit in accordance with a result of identification by the identification unit; and a notification unit that gives a notification of whether the recognition unit is enabled or disabled. 
     Preferably, the identification unit determines whether or not an operation is performed on the photographic subject. 
     Preferably, the identification unit identifies a type of the operation performed on the photographic subject. 
     Preferably, the operation identified by the identification unit is use of a treatment tool. 
     Preferably, the operation identified by the identification unit is spraying of a liquid on the photographic subject. 
     Preferably, the setting unit disables the recognition unit in a case where an operation is performed on the photographic subject, and enables the recognition unit in a case where no operation is performed on the photographic subject. 
     Preferably, the setting unit disables the recognition unit in a case where a specific operation is performed on the photographic subject. 
     Preferably, the setting unit enables or disables the recognition process that is performed by the recognition unit. 
     Preferably, the setting unit enables or disables giving of a notification of a result of the recognition process. 
     Preferably, the notification unit gives a notification of the result of identification by the identification unit in addition to whether the recognition unit is enabled or disabled. 
     Preferably, the recognition unit recognizes presence or absence of a lesion or a potential lesion of the photographic subject or recognizes a type or a degree of progression of a lesion or a potential lesion of the photographic subject. 
     Preferably, in a case where the recognition unit performs a plurality of types of recognition processes, the setting unit enables or disables each of the recognition processes. 
     According to the present invention, it is possible to provide an endoscope system that prevents incorrect recognition of the result of performing a recognition process and the result of not performing the recognition process. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is an external view of an endoscope system; 
         FIG. 2  is a block diagram of the endoscope system; 
         FIG. 3  is a block diagram of an image processing unit; 
         FIG. 4  is a flowchart illustrating an operation form of the endoscope system; 
         FIG. 5  illustrates an example of display in a case where a recognition unit is enabled; 
         FIG. 6  illustrates an example of display in a case where the recognition unit is disabled; 
         FIG. 7  illustrates an example of display of a second embodiment; 
         FIG. 8  is a table indicating operation states of detection and determination; 
         FIG. 9  is an example of display of a third embodiment; 
         FIG. 10  is an example of display of the details of an operation; 
         FIG. 11  is an example of display of the details of an operation; 
         FIG. 12  is an example of display of the details of an operation; 
         FIG. 13  is a block diagram of a processor device in a case where a notification of whether the recognition unit is enabled or disabled is given with a method other than display on a monitor; 
         FIG. 14  is an explanatory diagram illustrating a medical image processing apparatus; 
         FIG. 15  is an explanatory diagram illustrating a diagnosis support apparatus; and 
         FIG. 16  is an explanatory diagram illustrating a medical service support apparatus. 
     
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     First Embodiment 
     As illustrated in  FIG. 1 , an endoscope system  10  (endoscope apparatus) includes an endoscope  12 , a light source device  14 , a processor device  16 , a monitor  18 , and a console  19 . The endoscope  12  captures an image of a photographic subject. The light source device  14  generates illumination light. The processor device  16  performs, for example, system control and image processing of the endoscope system  10 . The monitor  18  is a display unit that displays, for example, an image captured by the endoscope  12 . The console  19  is an input device for, for example, inputting settings to, for example, the processor device  16 . 
     The endoscope  12  has an insertion part  12   a  that is inserted into a subject, an operation part  12   b  that is provided on the proximal end part of the insertion part  12   a , a bending part  12   c  that is provided on the distal end side of the insertion part  12   a , and a tip part  12   d . When an angle knob  12   e  of the operation part  12   b  is operated, the bending part  12   c  bends. As a result, the tip part  12   d  turns in a desired direction. In addition to the angle knob  12   e , the operation part  12   b  is provided with a treatment tool insertion port  12   f , a zoom operation part  13   a , and a water supply button  13   b . The treatment tool insertion port  12   f  is a port through which a treatment tool, such as biopsy forceps, a snare, or an electric scalpel, is inserted. A treatment tool inserted through the treatment tool insertion port  12   f  protrudes from the tip part  12   d . When the zoom operation part  13   a  is operated, an enlarged or reduced image of a photographic subject is captured. When the water supply button  13   b  is operated, a liquid, such as water, stored in a water supply tank  17  gushes out of the tip part  12   d.    
     As illustrated in  FIG. 2 , the light source device  14  includes a light source unit  20  that emits illumination light and a light source control unit  22  that controls operations of the light source unit  20 . 
     The light source unit  20  emits illumination light that illuminates a photographic subject. Emission of illumination light includes emission of, for example, excitation light that is used to emit illumination light. The light source unit  20  includes a light source formed of, for example, a laser diode (hereinafter referred to as an LD), an LED (light emitting diode), a xenon lamp, or a halogen lamp and emits at least illumination light in a white color or excitation light that is used to emit illumination light in the white color. The white color includes a pseudo white color that is substantially equivalent to a white color in image capturing of a photographic subject using the endoscope  12 . The light source unit  20  includes, for example, a fluorescent body that emits light when irradiated with excitation light or an optical filter for adjusting, for example, the wavelength range, spectrum, or amount of light of the illumination light or excitation light as necessary. In addition, the light source unit  20  can emit light having a specific wavelength range necessary for capturing an image that is used to calculate biological information, such as the oxygen saturation of hemoglobin contained in the photographic subject. 
     In this embodiment, the light source unit  20  has LEDs in four colors, namely, a V-LED  20   a , a B-LED  20   b , a G-LED  20   c , and an R-LED  20   d . The V-LED  20   a  emits violet light VL having a center wavelength of 405 nm and a wavelength range of 380 to 420 nm. The B-LED  20   b  emits blue light BL having a center wavelength of 460 nm and a wavelength range of 420 to 500 nm. The G-LED  20   c  emits green light GL having a wavelength range of 480 to 600 nm. The R-LED  20   d  emits red light RL having a center wavelength of 620 to 630 nm and a wavelength range of 600 to 650 nm. The center wavelengths of the V-LED  20   a  and the B-LED  20   b  have a width of about 20 nm, and preferably, about 5 nm to about 10 nm. 
     The light source control unit  22  controls, for example, the timing at which each light source that constitutes the light source unit  20  is turned on, turned off, or blocked and the amount of light emission of each light source. As a result, the light source unit  20  can emit a plurality of types of illumination light having different spectra. In this embodiment, the light source control unit  22  controls, for example, turning-on and turning-off of each of the LEDs  20   a  to  20   d , the amounts of light emission during turning-on, and insertion and removal of the optical filter by inputting independent control signals to the LEDs  20   a  to  20   d  to thereby adjust the spectrum of illumination light. Accordingly, the light source unit  20  emits white light. The light source unit  20  can at least emit illumination light formed of violet light in a narrow band. The “narrow band” means a substantially single wavelength range in relation to the characteristics of the photographic subject and/or the spectral characteristics of color filters of an image sensor  48 . For example, in a case where light has a wavelength range of, for example, about ±20 nm or less (preferably, about ±10 nm or less) with reference to the center wavelength, the light is in a narrow band. 
     In the tip part  12   d  of the endoscope  12 , an illumination optical system  30   a  and an imaging optical system  30   b  are provided. Illumination light from the light source unit  20  is propagated to the illumination optical system  30   a  through a light guide  41 . The illumination optical system  30   a  has an illumination lens  45 , and illumination light is emitted toward a photographic subject via the illumination lens  45 . 
     The imaging optical system  30   b  has an object lens  46 , a zoom lens  47 , and the image sensor  48 . The image sensor  48  captures an image of a photographic subject by using, for example, reflected light (in addition to the reflected light, scattered light, fluorescent light emitted from the photographic subject, or fluorescent light caused by a drug administered to the photographic subject is included) resulting from illumination light and returning from the photographic subject via the object lens  46  and the zoom lens  47 . The zoom lens  47  moves in response to an operation of the zoom operation part  13   a  to enlarge or reduce an image of the photographic subject. 
     The image sensor  48  has, for each pixel, a color filter in one color among color filters in a plurality of colors. In this embodiment, the image sensor  48  is a color sensor having color filters in primary colors. Specifically, the image sensor  48  has R pixels each having a red filter (R filter), G pixels each having a green filter (G filter), and B pixels each having a blue filter (B filter). 
     Note that as the image sensor  48 , a CCD (charge-coupled device) sensor or a CMOS (complementary metal-oxide semiconductor) sensor can be used. Although the image sensor  48  of this embodiment is a primary color sensor, a complementary color sensor can also be used. A complementary color sensor has, for example, cyan pixels each of which is provided with a cyan filter, magenta pixels each of which is provided with a magenta filter, yellow pixels each of which is provided with a yellow filter, and green pixels each of which is provided with a green filter. In a case where a complementary color sensor is used, an image obtained from the above-described pixels in the respective colors can be converted to an image similar to an image obtained by using a primary color sensor by performing conversion from complementary colors to primary colors. The same applies to a primary color sensor or a complementary color sensor having one or more types of pixels, such as W pixels (white pixels that receive light in substantially all wavelength ranges), having characteristics other than the above. Although the image sensor  48  of this embodiment is a color sensor, a monochrome sensor having no color filters may be used. 
     The processor device  16  has a control unit  52 , an image obtaining unit  54 , an image processing unit  61 , a notification unit  65 , and a display control unit  66  (see  FIG. 2 ). 
     The control unit  52  centrally controls the endoscope system  10  and controls, for example, synchronization between the timing of irradiation with illumination light and the timing of image capturing. In a case where, for example, various settings are input by using, for example, the console  19 , the control unit  52  inputs the settings to the respective units of the endoscope system  10 , such as the light source control unit  22 , the image sensor  48 , and the image processing unit  61 . 
     The image obtaining unit  54  obtains a captured image of a photographic subject. 
     More specifically, the image obtaining unit  54  obtains from the image sensor  48  an image obtained by image capturing of a photographic subject using the pixels in the respective colors, that is, a raw image. The raw image is an image that is not yet subjected to demosaicing. An image obtained from the image sensor  48  and subjected to a process, such as a noise reducing process, is also a raw image as long as the image is not yet subjected to demosaicing. 
     The image obtaining unit  54  includes a DSP (digital signal processor)  56 , a noise reduction unit  58 , and a conversion unit  59  that perform various processes for the obtained raw image as necessary to generate an endoscopic image. 
     The DSP  56  includes, for example, an offset processing unit, a defect correction processing unit, a demosaicing processing unit, an interpolation processing unit, a linear matrix processing unit, and a YC conversion processing unit (none of which are illustrated). The DSP  56  uses these units to perform various processes for a raw image or an image generated by using a raw image. 
     The offset processing unit performs an offset process for a raw image. The offset process is a process for reducing dark current components in a raw image to set an accurate zero level. The offset process may be called a clamping process. The defect correction processing unit performs a defect correction process for a raw image. The defect correction process is a process for, in a case where the image sensor  48  includes a pixel (defective pixel) having a defect caused by a manufacturing process or by aging, correcting or generating the pixel value of a raw pixel corresponding to the defective pixel of the image sensor  48 . The demosaicing processing unit performs a demosaicing process for raw images in the respective colors corresponding to the respective color filters. The demosaicing process is a process for generating a pixel value, of a raw image, that is missing due to the arrangement of the color filters, by interpolation. The linear matrix processing unit performs a linear matrix process for an endoscopic image generated by allocating one or more raw images to R, G, and B channels. The linear matrix process is a process for increasing the color reproducibility of the endoscopic image. The YC conversion processing unit performs a process for converting the endoscopic image generated by allocating one or more raw images to the R, G, and B channels to an endoscopic image having a luminance channel Y, a color difference channel Cb, and a color difference channel Cr. 
     The noise reduction unit  58  performs a noise reduction process for the endoscopic image having the luminance channel Y, the color difference channel Cb, and the color difference channel Cr by using, for example, a moving average method or a median filtering method. The conversion unit  59  reconverts the endoscopic image having the luminance channel Y, the color difference channel Cb, and the color difference channel Cr and subjected to the noise reduction process to an endoscopic image having the channels of the respective colors of R, G, and B. 
     The image processing unit  61  performs for an endoscopic image output by the image obtaining unit  54 , necessary image processing. The image processing unit  61  uses the endoscopic image to perform a recognition process of recognizing a photographic subject having specific characteristics or part of the photographic subject. Specifically, as illustrated in  FIG. 3 , the image processing unit  61  includes, for example, an image generation unit  71 , a recognition unit  72 , an identification unit  73 , and a setting unit  74 . 
     The image generation unit  71  obtains an endoscopic image from the image obtaining unit  54  and generates an endoscopic image that is used in, for example, display on the monitor  18 . For example, the image generation unit  71  obtains from the image obtaining unit  54  a B image obtained by image capturing of a photographic subject using the B pixels, a G image obtained by image capturing of the photographic subject using the G pixels, and an R image obtained by image capturing of the photographic subject using the R pixels and uses all or some of the images to generate an endoscopic image for display. 
     When generating an endoscopic image for display, the image generation unit  71  performs for an endoscopic image obtained from the image obtaining unit  54  or for an image generated by using an endoscopic image obtained from the image obtaining unit  54 , necessary image processing. The image processing performed by the image generation unit  71  is, for example, a highlighting process of highlighting a photographic subject or part of the photographic subject. Highlighting means to distinguish a specific part from, for example, the other tissue or structures to allow obtaining of information about the specific part. For example, a process for outlining a part having specific characteristics with a frame to display the outline or a process for, for example, changing the color or brightness of the part having specific characteristics relative to the other parts (for example, a normal mucous membrane) is the highlighting process. “Allowing obtaining of information about the specific part” includes allowing recognition of, for example, the position, shape, color or brightness, and/or size (area) of the specific part and also includes allowing knowing or obtaining of biological function information (for example, the oxygen saturation or the blood vessel concentration) about the specific part. 
     The recognition unit  72  performs the recognition process of recognizing a photographic subject by using an image obtained by image capturing of the photographic subject. “Recognizing a photographic subject” means to detect the presence or absence of a part of a photographic subject having specific characteristics (including a case of detecting the entire photographic subject), determine the type or the degree of progression of a part of a photographic subject having specific characteristics (including determination of the entire photographic subject), and/or obtain (for example, calculate) biological function information about a photographic subject in part or in whole. A part of a photographic subject having specific characteristics is, for example, a lesion, a potential lesion, or a treatment scar, which is a scar from a treatment (hereinafter referred to as a lesion or the like). That is, the recognition unit  72  can recognize the presence or absence of a lesion or the like by the recognition process. Further, the recognition unit  72  can recognize the type or the degree of progression of a lesion or the like by the recognition process. Recognition of the type of a lesion or the like means, for example, in a case where the lesion or the like is a polyp, to determine the type, such as adenoma, hypertrophic polyp, or cancer. Recognition of the degree of progression of a lesion or the like means, for example, in a case where the lesion or the like is cancer, to determine the stage of the cancer or determine, for example, the NICE (NB (Narrow-Band Imaging) International Colorectal Endoscopic) classification or the JNET (The Japan NBI Expert Team) classification. In this embodiment, an image obtained by image capturing of a photographic subject is an endoscopic image obtained from the image obtaining unit  54  or an endoscopic image generated by the image generation unit  71 . Further, in this embodiment, the recognition unit  72  detects a lesion or the like by the recognition process. 
     The recognition unit  72  is, for example, an artificial intelligence (AI) having a learning function. Specifically, the recognition unit  72  is an AI trained by using a machine learning algorithm, such as a neural network (NN), a convolutional neural network (CNN), AdaBoost, or a random forest. Further, the recognition unit  72  is trained using specific images in order to perform the recognition process, and therefore, even if the recognition unit  72  can perform the recognition process using the other images, the accuracy of the result of the recognition process may be low. In this embodiment, the recognition unit  72  is an AI trained to detect lesions or the like using endoscopic images. “Having a learning function” means to have an ability to learn and includes a trained state. Note that the recognition unit  72  might not be configured as an AI and can be configured to calculate a feature value from an image and to, for example, perform detection by using the calculated feature value. 
     In this embodiment, the recognition unit  72  includes a detection unit  76  and a determination unit  77 . The detection unit  76  is an AI trained to detect lesions or the like using endoscopic images. The determination unit  77  is an AI trained to determine the degrees of progression of lesions or the like using endoscopic images. 
     The recognition unit  72  inputs the result of the recognition process to the image generation unit  71  or to the display control unit  66  in accordance with the details of the recognition process. When the recognition unit  72  inputs the result of the recognition process to the image generation unit  71 , the image generation unit  71  generates an endoscopic image for display that reflects the result of the recognition process. When the recognition unit  72  inputs the result of the recognition process to the display control unit  66 , the display control unit  66  displays the result of the recognition process on the screen of the monitor  18  together with the endoscopic image obtained from the image generation unit  71 . The recognition unit  72  inputs the result of the recognition process to the image generation unit  71  in a case where, for example, the color of the endoscopic image for display is changed in accordance with a value of biological function information, which is the result of the recognition process. The recognition unit  72  inputs the result of the recognition process to the display control unit  66  in a case where, for example, the position of a lesion or the like, which is the result of the recognition process, is to be indicated by, for example, displaying a frame that is superimposed on the endoscopic image. In this embodiment, the recognition unit  72  inputs information about, for example, the position of a detected lesion or the like, which is the result of the recognition process, to the image generation unit  71 . The image generation unit  71  generates an endoscopic image for display for which the highlighting process is performed for a part in which the lesion or the like is present. 
     The identification unit  73  identifies an operation performed on a photographic subject. An operation performed on a photographic subject means an act that exerts some (desired) effects on a photographic subject. Examples of an operation performed on a photographic subject include surgical operations or treatments related to therapies, such as removal of tissue from a living body for use in a biopsy or endoscopic mucosal resection (EMR), spraying of a liquid on a photographic subject, and cleaning of a photographic subject. Spraying of a liquid on a photographic subject means to administer a liquid drug to a photographic subject or spray water. Spraying of water means to pour water over a photographic subject in part or in whole. Administration of a drug includes spraying of, for example, a coloring agent, such as indigo carmine, on a photographic subject and also includes intravenous injection of a fluorescent drug, such as indocyanine green (ICG), into a photographic subject. Cleaning of a photographic subject means to remove, for example, substances, such as a residual substance, a residual liquid, or blood, which are adhered to the photographic subject and hinder observation, by, for example, water or air so as to make the photographic subject that is to be observed visible to the endoscope  12 . An act that can exert an effect on a photographic subject is included in an “operation performed on a photographic subject” even if no effect is exerted on the photographic subject as a result of the act. For example, an act of jetting air in order to clean a photographic subject is an operation performed on the photographic subject even if the photographic subject does not become clean as a result of the act. An “operation performed on a photographic subject” includes a series of related acts before and after an effect is exerted on the photographic subject. For example, an act of making forceps protrude from the endoscope  12  in a case of a biopsy is included in a series of acts related to the biopsy even if the act is performed before removal of tissue, and is included in an operation performed on the photographic subject. 
     Identification of an operation performed on a photographic subject means to detect an operation to be performed on a photographic subject or to detect an operation that has been performed on a photographic subject. An operation is identified by, for example, detecting use of a treatment tool, detecting a treatment scar (in addition to detection of a scar from a surgical operation, for example, detection of bleeding caused by a treatment and detection of tissue or a structure for which, for example, the color has changed as a result of, for example, spraying of a coloring agent are included), or detecting an operation of, for example, the water supply button  13   b . Regarding use of a treatment tool, the identification unit  73  can detect the presence or absence of a treatment tool or the type (for example, the shape) of a treatment tool by using, for example, an endoscopic image or setting information. The identification unit  73  can detect, for example, a treatment tool (including spraying of water) as described above by analyzing an endoscopic image. Further, the identification unit  73  can detect an operation of, for example, the water supply button  13   b  by obtaining a signal or setting information from the control unit  52 . 
     Identification of an operation performed on a photographic subject includes determination of whether or not an operation is performed on a photographic subject and identification of the type of an operation performed on a photographic subject. Determination of whether or not an operation is performed includes detection of an “operation performed on a photographic subject”, which is a detection target, regardless of the type of operation. Identification of the type of operation performed on a photographic subject means to identify an operation performed on a photographic subject by identifying the details of the operation in a distinguished manner (for example, whether the operation is a biopsy or administration of a drug). In this embodiment, the identification unit  73  determines whether or not an operation is performed on a photographic subject. 
     The setting unit  74  enables or disables the recognition unit  72  in accordance with the result of identification by the identification unit  73 . The result of identification by the identification unit  73  is whether or not an operation is performed on the photographic subject and/or the type of operation performed on the photographic subject. “Enabling the recognition unit  72 ” means to enable the recognition process that is performed by the recognition unit  72 , thereby performing setting so as to allow the recognition unit  72  to perform the recognition process, to allow a notification of the result of the recognition process to be given, or to allow the recognition unit  72  to output the result of the recognition process. “Disabling the recognition unit  72 ” means to disable the recognition process that is performed by the recognition unit  72 , thereby performing setting so as not to allow the recognition unit  72  to perform the recognition process, not to allow a notification of the result of the recognition process to be given, or not to allow the recognition unit  72  to output the result of the recognition process. That is, “enabling or disabling the recognition unit  72 ” means to enable or disable the recognition process that is performed by the recognition unit  72  or enable or disable giving of a notification of the result of the recognition process (or output of the result of the recognition process). “Giving of a notification of the result of the recognition process” means to make the result of the recognition process recognizable by a doctor or the like. “Output of the result of the recognition process” means to pass, by the recognition unit  72 , the result of the recognition process to, for example, the other processing units, such as the image generation unit  71  and so on. In this embodiment, the setting unit  74  enables or disables the recognition process itself that is performed by the recognition unit  72 . 
     When the identification unit  73  determines whether or not an operation is performed on a photographic subject, the setting unit  74  disables the recognition unit  72  in a case where an operation is performed on the photographic subject, and enables the recognition unit  72  in a case where no operation is performed on the photographic subject. This is because the case where an operation is performed on the photographic subject is a situation where the accuracy of the recognition process may decrease or the doctor or the like needs to concentrate on their operation. 
     When the identification unit  73  identifies the type of operation performed on a photographic subject, the setting unit  74  disables the recognition unit  72  in a case where a specific operation is performed on the photographic subject. The specific operation means an operation that decreases the accuracy of the recognition process that is performed by the recognition unit  72  or an operation on which the doctor or the like needs to concentrate. Therefore, when the identification unit  73  identifies the type of operation performed on the photographic subject, the setting unit  74  can enable the recognition unit  72  depending on the type of operation. Accordingly, appropriate diagnosis support can be continuously provided in accordance with the situation. 
     In a case where the recognition unit  72  performs a plurality of types of recognition processes, the setting unit  74  can enable or disable each of the recognition processes. For example, in a case where the setting unit  74  enables or disables the recognition unit  72 , the setting unit  74  can enable or disable the detection unit  76  and enable or disable the determination unit  77  regardless of whether the detection unit  76  is enabled or disabled. As a matter of course, the setting unit  74  can enable or disable the recognition unit  72  as a whole including both the detection unit  76  and the determination unit  77 . In this embodiment, the setting unit  74  enables or disables the recognition unit  72  as a whole, namely, including both the detection unit  76  and the determination unit  77 . 
     The notification unit  65  obtains, for example, the result of identification from the identification unit  73  (or obtains information about setting of the recognition unit  72  from the setting unit  74 ) and gives a notification of whether the recognition unit  72  is enabled or disabled. “Giving a notification” of whether the recognition unit  72  is enabled or disabled means to allow the doctor or the like, who is a user, to know whether the recognition unit  72  is enabled or disabled. For example, the notification unit  65  can give a notification of whether the recognition unit  72  is enabled or disabled by displaying or not displaying on the screen of the monitor  18 , for example, a message (character string), a letter, a geometric shape, and/or a symbol (including display of, for example, a mark, an icon, or an indicator) or by changing the display. In addition, the notification unit  65  can give a notification of whether the recognition unit  72  is enabled or disabled by, for example, lighting, extinguishing, or blinking a lamp, a sound (including voice), or vibrating a member having a vibration function, or by changing these. As a matter of course, the notification unit  65  can give a notification of whether the recognition unit  72  is enabled or disabled by combining, for example, a character string and lighting of a lamp. In this embodiment, the notification unit  65  performs display on the screen of the monitor  18  indicating whether the recognition unit  72  is enabled or disabled. 
     The display control unit  66  converts an endoscopic image output by the image processing unit  61  to an endoscopic image in a form suitable for display and outputs the endoscopic image to the monitor  18 . Then, the monitor  18  displays the endoscopic image. In this embodiment, the notification unit  65  inputs information indicating whether the recognition unit  72  is enabled or disabled to the display control unit  66 . Then, the display control unit  66  displays the information on the screen of the monitor  18 . 
     The endoscope system  10  configured as described above operates as follows to give a notification of whether the recognition unit  72  is enabled or disabled. As illustrated in  FIG. 4 , when a doctor or the like performs image capturing of a photographic subject by using the endoscope  12  (step S 111 ), the image obtaining unit  54  obtains an endoscopic image. The image generation unit  71  performs necessary image processing and generates an endoscopic image for display (step S 112 ). 
     Thereafter or concurrently with generation of an endoscopic image for display, the identification unit  73  identifies an operation performed on the photographic subject by using, for example, the endoscopic image for display (step S 113 ). In a case where no operation is performed on the photographic subject (NO in step S 113 ), the setting unit  74  enables the recognition unit  72  (step S 114 ). Then, the recognition unit  72  performs the recognition process for, for example, the endoscopic image for display (step S 115 ). In this embodiment, the recognition unit  72  includes the detection unit  76  and the determination unit  77 , and the setting unit  74  enables or disables these units as a whole, and therefore, in the case where no operation is performed on the photographic subject, the recognition unit  72  performs recognition processes for both detection and determination of a lesion or the like. Thereafter, the recognition unit  72  outputs the results of recognition to the image generation unit  71 , and the image generation unit  71  uses the results of recognition to generate an endoscopic image for display in which, for example, a lesion or the like is highlighted and outputs the endoscopic image to the display control unit  66 . Then, the monitor  18  displays the endoscopic image on the screen. The notification unit  65  gives a notification that the recognition unit  72  is enabled (step S 116 ). Here, the setting unit  74  enables the recognition unit  72 , and therefore, the notification unit  65  displays on the screen of the monitor  18 , for example, a character string indicating that the recognition unit  72  is enabled. For example, as illustrated in  FIG. 5 , the notification unit  65  displays display  122  “AI: ON” on the screen of the monitor  18  on which an endoscopic image  121  is displayed. Accordingly, the notification unit  65  gives a notification that the recognition unit  72  is enabled. Note that the endoscopic image  121  is an image representing that no operation is performed on the photographic subject and that no lesion or the like is present 
     On the other hand, in a case where the identification unit  73  detects an operation performed on the photographic subject (YES in step S 113 ), the setting unit  74  disables the recognition unit  72  (step S 117 ). Then, the recognition unit  72  does not perform detection or determination, and the image generation unit  71  outputs the generated endoscopic image for display to the display control unit  66 . Then, the monitor  18  displays the endoscopic image on the screen. The notification unit  65  gives a notification that the recognition unit  72  is disabled (step S 118 ). For example, as illustrated in  FIG. 6 , the notification unit  65  displays display  127  “AI: OFF” on the screen of the monitor  18  on which an endoscopic image  126  is displayed. Accordingly, the notification unit  65  gives a notification that the recognition unit  72  is disabled. Note that in the endoscopic image  126 , biopsy forceps  128  are present. Therefore, the recognition unit  72  is disabled. 
     As described above, in the endoscope system  10 , the identification unit  73  identifies an operation performed on the photographic subject, and the setting unit  74  enables or disables the recognition unit  72  in accordance with the result of identification by the identification unit  73 . Accordingly, the endoscope system  10  enables or disables the recognition unit  72  in accordance with the situation of observation, and therefore, the doctor or the like, who is a user, need not manually enable or disable the recognition unit  72  by themselves during the observation, which is convenient therefor. However, when the recognition unit  72  is only automatically enabled or disabled, a doctor or the like may incorrectly recognize the result of performing the recognition process or the result of not performing the recognition process. For example, in a case where a doctor or the like has a preconception that the recognition unit  72  is enabled, when the recognition unit  72  is automatically disabled and the result of the recognition process is not displayed any more, even if a lesion or the like is present, the doctor or the like may incorrectly recognize that no lesion or the like is present as a result of the recognition unit  72  performing the recognition process. Therefore, in the endoscope system  10 , the notification unit  65  gives a notification of whether the recognition unit  72  is enabled or disabled. Accordingly, when the doctor or the like sees the display  122  “AI: ON” or the display  127  “AI: OFF”, it is obvious to the doctor or the like that the recognition unit  72  is performing the recognition process or not performing the recognition process, which can prevent incorrect recognition as described above. As a consequence, it is possible to prevent wrong diagnoses. 
     Second Embodiment 
     In a case where the setting unit  74  enables or disables each of the recognition processes, the notification unit  65  can give a notification, for each recognition process, of whether the recognition process is enabled or disabled. For example, in a case where the recognition unit  72  has the detection unit  76  and the determination unit  77  and where the setting unit  74  enables or disables the detection unit  76  and the determination unit  77  independently of each other, as illustrated in  FIG. 7 , the notification unit  65  can display in a display field  222  showing whether the recognition unit  72  is enabled or disabled, display  223  indicating whether the detection unit  76  is enabled or disabled and display  224  indicating whether the determination unit  77  is enabled or disabled to thereby give a notification of the states of these units. For example, the display  223  “Detection: ON” indicates that the detection unit  76  is enabled, and display “Detection: OFF” (not illustrated) indicates that the detection unit  76  is disabled. Similarly, the display  224  “Determination: ON” indicates that the determination unit  77  is enabled, and display “Determination: OFF” (not illustrated) indicates that the determination unit  77  is disabled. 
     As described above, in a case where the setting unit  74  enables or disables each of the recognition processes, the setting unit  74  can enable a recognition process that is appropriate to the situation of observation and disable the other recognition process. Accordingly, the endoscope system  10  can provide optimum diagnosis support. Then, the notification unit  65  gives a notification, for each recognition process, whether the recognition process is enabled or disabled, and therefore, the doctor or the like can accurately grasp whether each recognition process is enabled or disabled. Accordingly, it is possible to prevent incorrect recognition of the result of performing the recognition process and the result of not performing the recognition process. As a consequence, it is possible to prevent wrong diagnoses. 
     In the second embodiment described above, an example where both the detection unit  76  and the determination unit  77  are enabled is illustrated. As illustrated in  FIG. 8 , depending on the identification state of the identification unit  73 , it may be appropriate to enable only the detection unit  76 , it may be appropriate to enable only the determination unit  77 , or it may be appropriate to disable both the detection unit  76  and the determination unit  77 . 
     “Identification state  1 ” is a state where it is appropriate to enable both the detection unit  76  and the determination unit  77  and corresponds to, for example, a case where no operation is performed on the photographic subject or a case where the photographic subject is cleaned by using, for example, water. In these cases, it is highly likely that detection and determination of a lesion or the like are required. 
     “Identification state  2 ” is a state where it is appropriate to enable the detection unit  76  and disable the determination unit  77 . For example, this state corresponds to a case where, when a doctor or the like performs, for example, a biopsy or a surgical operation, bleeding from the photographic subject is an identification target (detection target) of the identification unit  73 , that is, corresponds to a situation where detection of bleeding is necessary in order to, for example, confirm stopping of bleeding but determination is not necessary because, for example, a surgical operation is already ongoing. The identification unit  73  can determine the above-described state in accordance with, for example, the type of operation performed on the photographic subject. 
     “Identification state  3 ” is a state where it is appropriate to disable the detection unit  76  and enable the determination unit  77 . This state corresponds to, for example, a case where, for example, a lesion or the like has already been detected, redetection of the lesion or the like is not necessary, and the doctor or the like wants to receive more detailed diagnosis support from the endoscope system  10  in a diagnosis regarding the detected lesion or the like. Specifically, this state corresponds to a case where a coloring agent is sprayed on the photographic subject to determine the degree of progression of the lesion or the like. The identification unit  73  can determine the above-described state in accordance with, for example, the type of operation performed on the photographic subject. 
     “Identification state  4 ” is a state where it is appropriate to disable both the detection unit  76  and the determination unit  77 . This state corresponds to, for example, a case where, for example, detection and determination of a lesion or the like are completed and the doctor or the like performs, for example, a biopsy or a surgical operation in which the doctor or the like needs to concentrate on their operation. The identification unit  73  can determine the above-described state in accordance with, for example, the type of operation. In a case where the identification unit  73  detects bleeding from the photographic subject, for example, the identification state of the identification unit  73  becomes identification state  2 . 
     Note that in the second embodiment described above, whether the detection unit  76  and the determination unit  77  are enabled or disabled is indicated by “ON” or “OFF”; however, whether the detection unit  76  and the determination unit  77  are enabled or disabled can be indicated by the other display. For example, instead of the display “OFF”, display such as “Unsupported” may be used. In a case where the detection unit  76  or the determination unit  77  is enabled but the accuracy (correctness or reliability) of the recognition process is low, display such as “Unsupported” can be displayed instead of the display “ON”. For example, in identification state  3 , in a case where the determination unit  77  does not support determination of a photographic subject on which a coloring agent is sprayed, the accuracy of determination decreases, and therefore, “Detection: OFF” and “Determination: Unsupported” can be displayed. Such changes and so on in the display form can be similarly made in the first embodiment. 
     Third Embodiment 
     In the first embodiment and the second embodiment described above, the notification unit  65  gives a notification of whether the recognition unit  72  is enabled or disabled; however, the notification unit  65  can further give a notification of whether or not an operation is performed or the type of operation identified by the identification unit  73 . That is, in addition to whether the recognition unit  72  is enabled or disabled, the notification unit  65  can give a notification of the result of identification by the identification unit  73 . 
     For example, in a case where the identification unit  73  detects an operation performed on a photographic subject, the notification unit  65  can give a notification that an operation performed on the photographic subject is detected, by, for example, display  301  “Actions” (“Operation”) in addition to a notification of whether the recognition unit  72  is enabled or disabled, such as the display  127  “AI: OFF”, as illustrated in  FIG. 9 . Note that an endoscopic image  310  is an endoscopic image representing that a coloring agent  311  is sprayed on the photographic subject. 
     As described above, when the notification unit  65  gives a notification of whether or not an operation is performed on the photographic subject, the doctor or the like can recognize what causes the recognition unit  72  to be enabled or disabled. As a consequence, it is possible to prevent incorrect recognition of the result of performing the recognition process and the result of not performing the recognition process with more certainty and to prevent wrong diagnoses. 
     The notification unit  65  can give a notification of the type of operation identified by the identification unit  73 . For example, as illustrated in  FIG. 10 , the notification unit  65  can display “Biopsy” indicating a biopsy, “Chromo” indicating spraying of a coloring agent, and “Resection” indicating endoscopic mucosal resection in an operation type display field  313  in a list form and, for example, check the type of operation (in  FIG. 10 , “Chromo”) identified by the identification unit  73  to thereby give a notification of the type of operation identified by the identification unit  73 . 
     As described above, when the identification unit  73  identifies the type of operation and the notification unit  65  gives a notification of the type of operation identified by the identification unit  73 , the doctor or the like can recognize in detail what causes the recognition unit  72  to be enabled or disabled. As a consequence, it is possible to prevent incorrect recognition of the result of performing the recognition process and the result of not performing the recognition process with more certainty and to prevent wrong diagnoses. 
     Note that a notification of whether or not an operation is performed on the photographic subject and the type of operation in the third embodiment described above is applicable to the case where, for each recognition process, a notification of whether the recognition process is enabled or disabled is given as in the second embodiment. In this case, the display field  222  showing whether the recognition unit  72  is enabled or disabled (see  FIG. 7 ), and the display  301  “Actions” or the operation type display field  313  need to be displayed on the monitor  18 . 
     In the third embodiment described above, the notification unit  65  can give a notification of whether or not an operation is performed on the photographic subject or the type of operation, by display other than display of a letter or a character string. For example, as illustrated in  FIG. 11 , an icon  331  indicating a biopsy, an icon  332  indicating spraying of a coloring agent, and an icon  333  indicating endoscopic mucosal resection can be displayed in the operation type display field  313  in a list form, and an icon corresponding to the type of operation identified by the identification unit  73  can be colored to thereby give a notification of the type of operation identified by the identification unit  73 . Note that in  FIG. 11 , biopsy forceps  128  are present in an endoscopic image  321 , and therefore, the icon  331  indicating a biopsy is colored. 
     As described above, in a case where the types of operations are indicated by icons, only an icon that corresponds to the type of operation identified by the identification unit  73  can be displayed in the operation type display field  313  as illustrated in  FIG. 12 . The same applies to a case where the types of operations performed on the photographic subject are indicated in the operation type display field  313  by character strings (see  FIG. 10 ) and, for example, only a character string that indicates the type of operation identified by the identification unit  73  can be displayed in the operation type display field  313 . 
     In the first embodiment, the second embodiment, and the third embodiment, the setting unit  74  enables or disables the recognition process that is performed by the recognition unit  72 ; however, the setting unit  74  can enable or disable giving of a notification of the result of the recognition process to thereby enable or disable the recognition unit  72 . In this case, when disabling giving of a notification of the result of the recognition process, the setting unit  74  can, for example, stop output of the result of the recognition process to, for example, the image generation unit  71  while keeping the detection unit  76  and the determination unit  77  enabled to make the doctor or the like be unable to know the result of the recognition process. As a result, the setting unit  74  can enable or disable the recognition unit  72  more simply and quickly than in a case where the setting unit  74  enables or disables the recognition process itself. 
     In the first embodiment, the second embodiment, and the third embodiment, the notification unit  65  gives the notification of whether the recognition unit  72  is enabled or disabled by display on the screen of the monitor  18 ; however, in a case where the notification unit  65  gives the notification of whether the recognition unit  72  is enabled or disabled in a form other than display on the screen of the monitor  18 , the processor device  16  can include a notification device  171  as illustrated in  FIG. 13 . The notification device  171  is, for example, a speaker that generates a sound or voice, an indicator formed of a light-emitting device, such as an LED, or a vibrating device, such as a motor or a piezoelectric element. In addition, the notification unit  65  can use, for example, a device included in the endoscope system  10  as the notification device  171 . Further, the notification device  171  may be provided not in the processor device  16  but in the endoscope  12  or in the light source device  14 . 
     As illustrated in  FIG. 14 , the recognition unit  72 , the identification unit  73 , the setting unit  74 , and/or the notification unit  65  can be provided in, for example, a medical image processing apparatus  901  that communicates with the processor device  16  to cooperate with the endoscope system  10 . As illustrated in  FIG. 15 , the recognition unit  72 , the identification unit  73 , the setting unit  74 , and/or the notification unit  65  can be provided in, for example, a diagnosis support apparatus  911  that obtains directly from the endoscope system  10  (including one that does not have the notification unit  65  and so on) or indirectly from a PACS (Picture Archiving and Communication Systems)  910 , raw images captured by the endoscope  12 . Further, as illustrated in  FIG. 16 , the recognition unit  72 , the identification unit  73 , the setting unit  74 , and/or the notification unit  65  can be provided in a medical service support apparatus  930  that is connected, via a network  926 , to various examination apparatuses, such as a first examination apparatus  921 , a second examination apparatus  922 , . . . , a K-th examination apparatus  923 , that include the endoscope system  10 . 
     That is, the present invention includes a medical image processing apparatus including an image obtaining unit that obtains an image obtained by image capturing of a photographic subject, a recognition unit that performs a recognition process of recognizing the photographic subject by using the image, an identification unit that identifies an operation performed on the photographic subject, a setting unit that enables or disables the recognition unit in accordance with the result of identification by the identification unit, and a notification unit that gives a notification of whether the recognition unit is enabled or disabled, and an operation method for the medical image processing apparatus. Further, the present invention includes a diagnosis support apparatus including an image obtaining unit that obtains an image obtained by image capturing of a photographic subject, a recognition unit that performs a recognition process of recognizing the photographic subject by using the image, an identification unit that identifies an operation performed on the photographic subject, a setting unit that enables or disables the recognition unit in accordance with the result of identification by the identification unit, and a notification unit that gives a notification of whether the recognition unit is enabled or disabled, and an operation method for the diagnosis support apparatus. Similarly, the present invention includes a medical service support apparatus including an image obtaining unit that obtains an image obtained by image capturing of a photographic subject, a recognition unit that performs a recognition process of recognizing the photographic subject by using the image, an identification unit that identifies an operation performed on the photographic subject, a setting unit that enables or disables the recognition unit in accordance with the result of identification by the identification unit, and a notification unit that gives a notification of whether the recognition unit is enabled or disabled, and an operation method for the medical service support apparatus. 
     The present invention includes an operation method for an endoscope system, the operation method including a step of obtaining, by an image obtaining unit, an image obtained by image capturing of a photographic subject, a step of performing, by a recognition unit, a recognition process of recognizing the photographic subject by using the image, a step of identifying, by an identification unit, an operation performed on the photographic subject, a step of enabling or disabling, by a setting unit, the recognition unit in accordance with the result of identification by the identification unit, and a step of giving, by a notification unit, a notification of whether the recognition unit is enabled or disabled. Further, the present invention includes a processor device including an image obtaining unit that obtains an image obtained by image capturing of a photographic subject, a recognition unit that performs a recognition process of recognizing the photographic subject by using the image, an identification unit that identifies an operation performed on the photographic subject, a setting unit that enables or disables the recognition unit in accordance with the result of identification by the identification unit, and a notification unit that gives a notification of whether the recognition unit is enabled or disabled, and an operation method for the processor device. 
     Note that as the endoscope  12 , a capsule endoscope can be used. In this case, the light source device  14  and part of the processor device  16  can be mounted in the capsule endoscope. 
     In the above embodiments, the hardware configuration of the processing units that perform various types of processing of, for example, the recognition unit  72 , the identification unit  73 , the setting unit  74 , and the notification unit  65  is implemented as various processors as described below. The various processors include a CPU (central processing unit), which is a general-purpose processor executing software (program) to function as various processing units, a GPU (graphical processing unit), a programmable logic device (PLD), such as an FPGA (field-programmable gate array), which is a processor having a circuit configuration that is changeable after manufacture, and a dedicated electric circuit, which is a processor having a circuit configuration specifically designed to perform various types of processing. 
     One processing unit may be configured as one of the various processors or a combination of two or more processors of the same type or different types (for example, a plurality of FPGAs, a combination of a CPU and an FPGA, or a combination of a CPU and a GPU). Further, a plurality of processing units may be configured as one processor. As the first example of configuring a plurality of processing units as one processor, a form is possible where one or more CPUs and software are combined to configure one processor, and the processor functions as the plurality of processing units, a representative example of which is a computer, such as a client or a server. As the second example thereof, a form is possible where a processor is used in which the functions of the entire system including the plurality of processing units are implemented as one IC (integrated circuit) chip, a representative example of which is a system on chip (SoC). As described above, regarding the hardware configuration, the various processing units are configured by using one or more of the various processors described above. 
     Further, the hardware configuration of the various processors is more specifically an electric circuit (circuitry) in a form in which circuit elements, such as semiconductor elements, are combined. 
     Note that the present invention can be used in, for example, a system or an apparatus that obtains medical images (including moving images) other than endoscopic images as well as an endoscope system that, for example, obtains endoscopic images, a processor device, and other related apparatuses. For example, the present invention is applicable to ultrasonic examination apparatuses, X-ray imaging apparatuses (including CT (computed tomography) examination apparatuses and mammography apparatuses), and MRI (magnetic resonance imaging) apparatuses. 
     REFERENCE SIGNS LIST 
     
         
         
           
               10  endoscope system 
               12  endoscope 
               12   a  insertion part 
               12   b  operation part 
               12   c  bending part 
               12   d  tip part 
               12   e  angle knob 
               12   f  treatment tool insertion port 
               13   a  zoom operation part 
               13   b  water supply button 
               14  light source device 
               16  processor device 
               17  water supply tank 
               18  monitor 
               19  console 
               20  light source unit 
               22  light source control unit 
               30   a  illumination optical system 
               30   b  imaging optical system 
               45  illumination lens 
               46  object lens 
               47  zoom lens 
               48  image sensor 
               52  control unit 
               54  image obtaining unit 
               56  DSP 
               58  noise reduction unit 
               59  conversion unit 
               61  image processing unit 
               65  notification unit 
               66  display control unit 
               71  image generation unit 
               72  recognition unit 
               73  identification unit 
               74  setting unit 
               76  detection unit 
               77  determination unit 
               121 ,  126 ,  310 ,  321  endoscopic image 
               122 ,  127 ,  223 ,  224 ,  301  display 
               128  forceps 
               171  notification device 
               222  display field 
               311  coloring agent 
               313  type display field 
               331 ,  332 ,  333  icon 
               901  medical image processing apparatus 
               910  PACS 
               911  diagnosis support apparatus 
               921  first examination apparatus 
               922  second examination apparatus 
               923  K-th examination apparatus 
               926  network 
               930  medical service support apparatus 
             S 111  to S 118  operation steps