Patent Publication Number: US-2019189270-A1

Title: Hospital information apparatus, hospital information system, and hospital information processing method

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is based upon and claims the benefit of priority from Japanese Patent Application No. 2017-239674, filed on Dec. 14, 2017; the entire contents of which are incorporated herein by reference. 
     FIELD 
     Embodiments described herein relate generally to a hospital information apparatus, a hospital information system, and a hospital information processing method. 
     BACKGROUND 
     Generally speaking, medical doctors (hereinafter, “doctor”) order medical examinations (hereinafter, “examinations”) to be performed on patients by using an X-ray Computed Tomography (CT) apparatus or the like, while designating a site (e.g., the heart) suspected to have a lesion. According to the orders for the examinations (hereinafter, “examination orders”), an image taking process and a reconstruction process are performed on a region (a region of interest) that covers the designated site (e.g., the heart), so as to check the state of the lesion in the acquired image. However, it is often the case that a lesion is present in another site (e.g., a lung) in a region (a non region of interest) that is different from the region of interest indicated in the designation by the doctor. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a diagram illustrating an exemplary configuration of a hospital information apparatus and a hospital information system according to a first embodiment; 
         FIG. 2  is a diagram illustrating an exemplary configuration in which a radiation department information server apparatus is provided with an additional process proposing function; 
         FIG. 3  is a sequence chart illustrating an example of a process performed when a proposed order suggesting expanding an examination area and an image taking area is presented to a doctor; 
         FIG. 4A  is a drawing illustrating an example of an examination order; 
         FIG. 4B  is a drawing illustrating an example of past information; 
         FIG. 4C  is a drawing illustrating an example of a metastasis possibility judgment table; 
         FIG. 4D  is a drawing illustrating examples of lesion candidates; 
         FIG. 4E  is a drawing illustrating examples of examination area candidates; 
         FIG. 4F  is a drawing illustrating examples of additional examination orders (candidates); 
         FIG. 4G  is a drawing illustrating an example of a site map; 
         FIG. 4H  is a drawing illustrating an example of a proposed order; 
         FIG. 5  is a sequence chart illustrating an example of a process performed when a proposed order suggesting a reconstruction process is presented to a medical technologist; 
         FIG. 6A  is a drawing illustrating an example of past information; 
         FIG. 6B  is a drawing illustrating examples of additional examination orders (candidates); 
         FIG. 6C  is a drawing illustrating an example of a proposed order; 
         FIG. 7  is a sequence chart illustrating an example of a process performed when a reconstruction process is automatically performed; 
         FIG. 8  is a diagram illustrating an exemplary configuration in which a radiation department information server apparatus is provided with an additional process proposing function according to a second embodiment; and 
         FIG. 9  is a drawing illustrating examples of additional examination orders (candidates). 
     
    
    
     DETAILED DESCRIPTION 
     A hospital information apparatus according to an embodiment includes a processing circuit. The processing circuit is configured to obtain past information related to an examined subject (hereinafter, “patient”) for whom an examination order is issued. The processing circuit is configured to set one or more additional examination orders on the basis of an analysis performed on the past information. The processing circuit is configured to determine a proposed order from among the additional examination orders on the basis of a relationship between the examination order and the additional examination orders. 
     Exemplary embodiments of a hospital information apparatus, a hospital information system, and a hospital information processing method will be explained below, with reference to the accompanying drawings. Possible embodiments are not limited to the embodiments described below. Further, it is possible, in principle, to similarly apply each of the embodiments and the modification examples to any other embodiment or any other modification example. 
     First Embodiment 
       FIG. 1  is a diagram illustrating an exemplary configuration of a hospital information apparatus and a hospital information system according to a first embodiment.  FIG. 1  illustrates an electronic medical record system  1 , an integrated database system  2 , a medical image management system  3 , a radiation department information system  4 , an X-ray CT examination room  5 , and a Magnetic Resonance (MR) examination room  6 . The electronic medical record system  1  is an information system configured to manage electronic medical records used for recording details of diagnoses and treatments and includes an electronic medical record server apparatus  11  and at least one electronic medical record terminal device  12 . The electronic medical record server apparatus  11  is a computer apparatus configured to perform processes related to the management of the electronic medical records. The electronic medical record server apparatus  11  may be configured by using one or more computer apparatuses depending on the scale of the system. The electronic medical record terminal device  12  is used by doctors, nurses, and the like who input and/or refer to the electronic medical records. One or more electronic medical record terminal devices  12  may be provided depending on the scale of the system. The electronic medical record server apparatus  11  and the electronic medical record terminal device  12  are connected to an intra-hospital network  7  that is either wired or wireless. 
     The integrated database system  2  is a database system that is not dependent on vendors (suppliers of computer software or hardware) and is configured to store therein data for the electronic medical record system  1 , the medical image management system  3 , the radiation department information system  4 , and the like. The integrated database system  2  includes an integrated database server apparatus  21 . The integrated database server apparatus  21  is a computer apparatus configured to perform processes related to managing databases. The integrated database server apparatus  21  is configured by using one or more computer apparatuses depending on the scale of the system. The integrated database server apparatus  21  is connected to the intra-hospital network  7 . It is also possible to omit the integrated database system  2 . In that situation, the data for the electronic medical record system  1 , the medical image management system  3 , the radiation department information system  4 , and the like is stored in each of the systems. 
     The medical image management system  3  is an information system configured to manage medical images such as X-ray CT images, MR images, and the like. The medical image management system  3  may be configured to manage not only image data after reconstruction processes hut also data (raw data) before reconstruction processes. The medical image management system  3  includes a medical image management server apparatus  31 . The medical image management server apparatus  31  is a computer apparatus configured to perform processes related to the management of the medical images. The medical image management server apparatus  31  may be configured by using one or more computer apparatuses depending on the scale of the system. The medical image management server apparatus  31  is connected to the intra-hospital network  7 . 
     The radiation department information system  4  is an information system configured to manage information in the radiation department of a hospital and includes a radiation department information server apparatus  41  and at least one radiation department information terminal device  42 . The radiation department information server apparatus  41  is a computer apparatus configured to perform a process related to the management of the information in the radiation department. The radiation department information server apparatus  41  may be configured by using one or more computer apparatuses depending on the scale of the system. The radiation department information terminal device  42  is used by medical technologists in the radiation department or the like. One or more radiation department information terminal devices  42  may be provided depending on the scale of the system. The radiation department information server apparatus  41  and the radiation department information terminal device  42  are connected to the intra-hospital network  7 . 
     In the X-ray CT examination room  5 , an X-ray CT apparatus main body  51 , a console device main body  52 , and an input/output device  53  are provided. The X-ray CT apparatus main body  51  includes: a gantry device provided with an X-ray tube, an X-ray detector, a rotating frame, and the like; and a couch device on which an examined subject (a patient) is placed. The console device main body  52  is a computer apparatus configured to control operations of the X-ray CT apparatus main body  51  and has connected thereto the input/output device  53  including a monitor and a keyboard, or the like. The console device main body  52  is connected to the intra-hospital network  7 . 
     In the MR examination room  6 , an MR apparatus main body  61 , a console device main body  62 , and an input/output device  63  are provided. The MR apparatus main body  61  includes: a gantry device provided with a magnet, an RF coil, a radio frequency circuit system, a gradient magnetic field system, and the like; and a couch device on which the examined patient (the patient) is placed. The console device main body  62  is a computer apparatus configured to control operations of the MR apparatus main body  61  and has connected thereto the input/output device  63  including a monitor and a keyboard, or the like. The console device main body  62  is connected to the intra-hospital network  7 . 
     In the present example, the X-ray CT apparatus and the MR apparatus are used as examination apparatuses. For each of these types of apparatuses, two or more apparatuses may be provided. Further, one or more apparatuses in any other modality (e.g., ultrasound diagnosis apparatuses) may be provided. 
       FIG. 2  is a diagram illustrating an exemplary configuration in which the radiation department information server apparatus  41  is provided with an additional process proposing function  8 . The additional process proposing function  8  has a function configured either to propose or to automatically execute an additional process, with respect to an examination order issued by a doctor. Instead of being provided for the radiation department information server apparatus  41 , the additional process proposing function  8  may be provided for the integrated database server apparatus  21 , for the electronic medical record server apparatus  11 , or for the medical image management server apparatus  31 . Further, the additional process proposing function  8  may be provided for a dedicated server apparatus. 
     The computer apparatus such as the radiation department information server apparatus  41  provided with the additional process proposing function  8  is an example of the hospital information apparatus. An information system including: the computer apparatus such as the radiation department information server apparatus  41  provided with the additional process proposing function  8 ; and another computer apparatus configured to exchange information with the computer apparatus through communication is an example of the hospital information system. 
     In  FIG. 2 , the radiation department information server apparatus  41  includes a processing circuit  411 , an input/output interface  413 , and a storage circuit  414 . The processing circuit  411 , the input/output interface  413 , and the storage circuit  414  are connected together via a bus. 
     The processing circuit  411  is configured to control operations of the entirety of the radiation department information server apparatus  41 . For example, the processing circuit  411  is realized by using a processor. For example, in addition to an existing function  412  of the radiation department information server apparatus  41 , the processing circuit  411  includes the additional process proposing function  8 . The existing function  412  is configured, for example, to input, store, process, and output information within the radiation department. As explained above, the additional process proposing function  8  is configured either to propose or to automatically execute the additional process, with respect to the examination order issued by a doctor. The additional process proposing function  8  includes an examination order recognizing function  81 , a past information obtaining function  82 , an additional examination order setting function  83 , a proposed order determining function  84 , and an additional examination order proposing/executing function  85 . The additional examination order setting function  83  includes a past information analyzing function  831 , a lesion risk analyzing function  832 , an examination area obtaining function  833 , and an additional examination order extracting/setting function  834 . 
     For example, the processing circuit  411  is configured to perform a process as the radiation department information server apparatus  41  by controlling the radiation department information server apparatus  41 , as a result of reading and executing a computer program (hereinafter, “program”) corresponding to the existing function  412  from the storage circuit  414 . 
     Further, for example, the processing circuit  411  is configured either to propose or to automatically execute the additional process with respect to the examination order issued by a doctor, by controlling the radiation department information server apparatus  41 , as a result of reading and executing a program orresponding to the additional process proposing function  8  from the storage circuit  414 . 
     The examination order recognizing function  81  included in the additional process proposing function  8  is configured to recognize the examination order issued by the doctor in the electronic medical record system  1 . The past information obtaining function  82  is configured to obtain past information related to the patient (the examined subject) for whom the examination order is issued, on the basis of information included in the examination order recognized by the examination order recognizing function  81 , such as a patient ID identifying the patient, for example. The past information includes not only general attributes such as the age, the gender, and the like of the patient, but also non-image or image information such as a medical history of the patient (the patient&#39;s medical history), medical histories of one or more family members (family medical histories), an imaging history using X-ray CT and the like, a blood test history, and the like. 
     The additional examination order setting function  83  is configured to set one or more additional examination orders (candidates) for examining the patient for a lesion suspected to occur in the patient, by analyzing the past information obtained by the past information obtaining function  82 . Each of the one or more additional examination orders is an order for examining the patient for a lesion that is different from the lesion for which an examination is performed under the examination order. The examination order and the additional examination orders each instruct either that an image of the patient be taken by using a medical image diagnosis apparatus or that a specimen acquired from the patient be analyzed. As a more detailed function, the past information analyzing function  831  included in the additional examination order setting function  83  is configured to analyze the past information obtained by the past information obtaining function  82 . For example, the past information analyzing function  831  recognizes items in individual pieces of information included in the past information and extracts information that can be used for speculating lesions (e.g., the patient&#39;s medical history, the family medical histories, and the like) and information that can be used for judging about reconstruction processes (e.g., the imaging history or the like). 
     The lesion risk analyzing function  832  is configured to speculate a lesion having a possibility of occurring in the patient, as a lesion risk analysis, on the basis of the past information analyzed by the past information analyzing function  831 . For example, when the patient&#39;s medical history indicates that he/she had “cancer” at a site, the lesion risk analyzing function  832  speculates the lesion having a possibility of occurring in the patient, on the basis of a possibility of the cancer metastasizing to another site, a possibility of recurrence, or the like. The examination area obtaining function  833  is configured to obtain an examination area corresponding to the lesion speculated by the lesion risk analyzing function  832 . In this situation, the examination area denotes an area of which a diagnosis-purpose image is to be obtained for the purpose of checking for the lesion. When an image is to be newly taken, the examination area denotes an area to be reconstructed reconstruction area) within an area to be imaged (an image taking area). Alternatively, when raw data that has already been taken is subject to the process, the examination area denotes an area to be reconstructed within the area of the raw data. The additional examination order extracting/setting function  834  is configured to set the additional examination orders (candidates), from among candidates obtained by the examination area obtaining function  833  as the examination areas. Further, the additional examination order extracting/setting function  834  is configured to judge whether or not it is possible to substitute all or a part of the examination areas with a reconstructed image of either a part within an image taking area used in the past indicated in the image taking history or a part that is within a new image taking area but is not subject to an examination. When the substitution is possible, the additional examination order extracting/setting function  834  sets an additional examination order (a candidate) indicating the reconstruction process. 
     The proposed order determining function  84  is configured to determine a proposed order that is either to be presented to a user (e.g., a , a medical technologist, or the like) or to be automatically executed, from among the additional examination orders, on the basis of a relationship between the examination order recognized by the examination order recognizing function  81  and the additional examination orders set by the additional examination order setting function  83 . The additional examination order proposing/executing function  85  is configured either to present the proposed order determined by the proposed order determining function  84  to the user (e.g., a doctor, a medical technologist, or the like) or to automatically execute the proposed order. 
     The processing circuit  411  realizing the past information obtaining function  82  is an example of the obtaining circuit. The processing circuit  411  realizing the additional examination order setting function  83  is an example of the setting circuit. The processing circuit  411  realizing the proposed order determining function  84  is an example of the determining circuit. 
     The input/output interface  413  is configured to establish a connection with the intra-hospital network  7  and a connection with an input device such as a mouse and/or a keyboard and with an output device such as a display device. The input device is configured to receive various types of input operations from an operator and to convert the received input operations into electrical signals. Examples of the input device include a mouse and a keyboard, as well as a trackball, a switch, a button, a joystick, a touch panel, and the like. The display device is configured to display various types of information. For example, the display device outputs a Graphical User Interface (GUI) or the like used for receiving various types of operations from the operator. The display device may be a liquid crystal display device or a Cathode Ray Tube (CRT) display device. 
     The storage circuit  414  is realized by using a semiconductor memory element such as a Random Access Memory (RAM) or a flash memory, or a hard disk, an optical disk, or the like. For example, the storage circuit  414  is configured to store therein data used by the radiation department information server apparatus  41  and one or more programs executed by the radiation department information server apparatus  41 . The storage circuit  414  may also be used as a non-transient storage medium realized with hardware. 
     The term “processor” used in the explanations above denotes, for example, a Central Processing Unit (CPU), a Graphics Processing Unit (GPU), or a circuit such as an Application Specific integrated Circuit (ASIC) or a programmable logic device (e.g., a Simple Programmable Logic Device [SPLD], a Complex Programmable Logic Device [CPLD], or a Field Programmable Gate Array [FPGA]). The one or more processors realize the functions thereof by reading and executing corresponding programs stored in the storage circuit  414 . in this situation, instead saving the programs in the storage circuit  414 , it is also acceptable to directly incorporate the programs in the circuits of the processors. In that situation, the processors realize the functions thereof by reading and executing the programs incorporated in the circuits thereof. Further, the processors in the present embodiments do not each necessarily have to be structured as a single circuit. It is also acceptable to structure one processor by combining together a plurality of independent circuits so as to realize the functions thereof. 
       FIG. 3  is a sequence chart illustrating an example of a process performed when a proposed order suggesting expanding an examination area and an image taking area is presented to a doctor. In  FIG. 3 , let us assume that the doctor issued an examination order from the electronic medical record terminal device  12  to the electronic medical record server apparatus  11  (step S 101 ).  FIG. 4A  is a drawing illustrating an example of the examination order. In  FIG. 4 , the examination order includes a doctor ID identifying the doctor, a patient ID identifying the patient, a site on which the examination is to be performed, and a modality to be used in the examination. In the present example, it is assumed that the site is the heart, whereas the modality is CT. 
     Returning to the description of  FIG. 3 , the electronic medical record server apparatus  11  informs the additional process proposing function  8  of details of the examination order (step S 102 ). In this situation, instead of the details of the examination order being provided from the electronic medical record server apparatus  11  side for the additional process proposing function  8  side, another arrangement is also acceptable in which, from the additional process proposing function  8  side, it is checked to see whether a new examination order is present in the electronic medical record server apparatus  11 , so as obtain details of the examination order when a new examination order is present. Further, while the electronic medical record system  1  is in an environment where direct communication with another system is not possible, the details of the examination order may be given to the additional process proposing function  8  through a human means. 
     When the examination order recognizing function  81  included in the additional process proposing function  8  recognizes the examination order (step S 102 ), the past information obtaining function  82  requests past information from the integrated database server apparatus  21  by designating, for example, the patient ID included in the examination order (step S 103 ). The integrated database server apparatus  21  checks to see whether or not the requested past information is present, and when the requested past information is present, responds with the past information (step S 104 ). Examples of the obtained past information include non-image information such as a report related to a diagnosis made on the patient, as well as image information obtained through an examination performed on the patient or the like. Examples of the non-image information include a report or the like created by a doctor or a person in charge of an examination, as well as a result extracted by applying a segmentation process or a Computer-Aided Diagnosis (CAD) process to an image indicating a result of an examination. At the point in time when the past information is requested, it is possible to obtain, from the image serving as the past information, information appended to the image, as well as information extracted as a result of applying the segmentation process and/or the CAD process thereto in a real-time manner. 
     If the integrated database server apparatus  21  were not provided, the past information obtaining function  82  would request the past information from the electronic medical record server apparatus  11 , the medical image management server apparatus  31 , and the radiation department information server apparatus  41 . When the past information is present in any other apparatus, the past information obtaining function  82  requests the past information from the apparatus.  FIG. 4B  is a drawing illustrating an example of the past information. In  FIG. 4B , the past information includes the patient&#39;s ID, age, gender, and so on, as well as the patient&#39;s medical history, family medical histories, an imaging history, a blood test history, and the like. In the present example, it is assumed that the patient&#39;s medical history indicates liver cancer. 
     Returning to the description of  FIG. 3 , the past information analyzing function  831  included in the additional examination order setting function  83  analyzes the past information obtained by the past information obtaining function  82  (step S 105 ). The past information analyzing function  831  extracts “liver cancer” in the patient&#39;s medical history, from the example of the past information in  FIG. 4B . 
     Returning to the description of  FIG. 3 , on the basis of the past information analyzed by the past information analyzing function  831 , the lesion risk analyzing function  832  speculates one or more lesions each having a possibility of occurring in the patient, as a lesion risk analysis (step S 106 ). Next, an example of the lesion speculating process will be explained with reference to  FIG. 4C .  FIG. 4C  is a drawing illustrating an example of a metastasis possibility judgment table. The metastasis possibility judgment table stores therein pieces of information about various types of tumors with which people can have previously been diagnosed and pieces of information of primary sites each having a possibility of metastasis, so as to be kept in correspondence with each other. For example, on the basis of “liver cancer” in the patient&#39;s medical history included in the past information in  FIG. 4B , the lesion risk analyzing function  832  obtains “lungs” listed as the first item for “liver cancer” in the metastasis possibility judgment table illustrated in  FIG. 4C  and speculates a lesion of “lung cancer”. Further, on the basis of “liver cancer” in the patient&#39;s medical history, the lesion risk analyzing function  832  speculates a lesion of “liver cancer” that may be recurring.  FIG. 4D  is a drawing illustrating examples of lesion candidates.  FIG. 4D  illustrates the speculated lesion candidates “lung cancer” and “liver cancer”. In the present example, the lesion candidates are displayed together with reasons for the speculation; however, it is also acceptable to display the lesion candidates together with probability values or ranking indicating the possibility of occurrence for each of the lesions. The probability values and the raking may be configured, in advance, into the metastasis probability judgment table illustrated in  FIG. 4C  or may be set in advance for each of the lesions. 
     Returning to the description of  FIG. 3 , the examination area obtaining function  833  obtains examination areas corresponding to the lesions speculated by the lesion risk analyzing function  832  (step S 107 ). For example, the examination area obtaining function  833  refers to a table or the like storing therein names of lesions and examination areas so as to be kept in correspondence with each other and obtains an examination area as a candidate, on the basis of the name of each of the lesions. For example, as the candidates for the examination areas, the examination area obtaining function  833  obtains “entire lung field region” on the basis of “lung cancer” and obtains “liver” on the basis of “liver cancer”.  FIG. 4E  is a drawing illustrating examples of the examination area candidates.  FIG. 4E  illustrates the obtained examination area candidates “site: entire lung field region” and “site: liver”. 
     Returning to the description of  FIG. 3 , the additional examination order extracting/setting function  834  sets one or more additional examination orders (candidates) from among the candidates obtained as the examination areas by the examination area obtaining function  833  (step S 108 ). For example, while using the examination areas, the additional examination order extracting/setting function  834  sets the additional examination orders (candidates) in descending order of the possibility of occurrence of the lesions, on the basis of the reasons for the speculation or the like.  FIG. 4F  is a drawing illustrating examples of the additional examination orders (candidates).  FIG. 4F  illustrates “site: entire lung field region” and “site: liver” as the examples of the additional examination orders (candidates). 
     Returning to the description of  FIG. 3 , from among the additional examination orders, the proposed order determining function  84  determines a proposed order that is either to be presented to the user (e.g., a doctor, a medical technologist, or the like) or to be automatically executed, on the basis of a relationship between the examination order recognized by the examination order recognizing function  81  and the additional examination orders set by the additional examination order setting function  83  (step S 109 ). To perform the process, the proposed order determining function  84  refers to a site map (a human body map) indicating inclusion relationships among examination areas.  FIG. 4G  is a drawing illustrating an example of the site map. For example, the proposed order determining function  84  compares “site: heart” in the examination order illustrated in  FIG. 4A  with “site: entire lung field region” and “site: liver” in the additional examination orders (candidates) illustrated in  FIG. 4F  and judges whether or not it is necessary to expand the examination area and the image taking area by referring to a site map such as that illustrated in  FIG. 4G . The site map illustrated in  FIG. 4G  indicates only the inclusion relationships in the body axis direction in correspondence with an X-ray CT apparatus. In comparison to “site: heart” in the examination order, “site: entire lung field region” and “site: liver” in the additional examination orders (candidates) both require expansion of the examination area and the image taking area. Accordingly, because the radiation exposure amount increases, it is necessary to have a doctor make a judgment.  FIG. 4H  is a drawing illustrating an example of a proposed order. In  FIG. 4H , “site: entire lung field region” and “site: heart+liver” to be presented to a doctor are determined. Alternatively, the proposed order determining function  84  may determine, as a proposed order, “site: entire lung field region+liver” by combining together “site: entire lung field region” and “site: heart+liver”. 
     Returning to the description of  FIG. 3 , the additional examination order proposing/executing function  85  notifies the electronic medical record server apparatus  11  of the proposed order suggesting expanding the examination area and the image taking area and having been determined by the proposed order determining function  84 , so that the proposed order can be presented to the user (i.e., a doctor) (step S 110 ). Further, while the electronic medical record system  1  is in an environment where direct communication with another system is not possible, the details of the proposed order may be given to the electronic medical record server apparatus  11  through a human means. 
     Subsequently, the electronic medical record server apparatus  11  notifies the electronic medical record terminal device  12  used by the doctor who issued the original examination order, of the proposed order suggesting expanding the examination area and the image taking area and having been provided in the notification from the additional process proposing function  8  (step S 111 ). It is also acceptable to arrange a portable terminal device (e.g., a smartphone) carried by the doctor to be notified of the proposed order, separately from the electronic medical record terminal device  12 . 
     The doctor checks the proposed order on the electronic medical record terminal device  12 . When the doctor is to adopt the proposed order suggesting expanding the examination area and the image taking area, the doctor performs an examination order changing process on the electronic medical record server apparatus  11  (step S 112 ). The electronic medical record server apparatus  11  notifies the radiation department information server apparatus  41  of the examination order after the change (step S 113 ). The radiation department information server apparatus  41  notifies the console device main body  52  or  62  in the corresponding modality, of the examination order after the change (step S 114 ). A medical technologist performs an examination according to the examination order of which the console device main body  52  or  62  was notified. 
     In the proposed order suggesting the expansion of the examination area and the image taking area, it is assumed that each of the areas is expanded while being centered on the original area, within the range of the modality (e.g., CT) designated in the original examination order. However, the proposed order may suggest expansion (addition) of an area that is noncontiguous or may further suggest that the modality should be changed. 
     Step S 102  illustrated in  FIG. 3  is a step corresponding to the examination order recognizing function  81 . Step S 102  is a step at which the examination order recognizing function  81  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the examination order recognizing function  81  from the storage circuit  414 . 
     Steps S 103  and S 104  illustrated in  FIG. 3  are steps corresponding to the past information obtaining function  82 . Steps S 103  and S 104  are steps at which the past information obtaining function  82  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the past information obtaining function  82  from the storage circuit  414 . 
     Step S 105  illustrated in  FIG. 3  is a step corresponding to the past information analyzing function  831  included in the additional examination order setting function  83 . Step S 105  is a step at which the past information analyzing function  831  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the past information analyzing function  831  from the storage circuit  414 . 
     Step S 106  illustrated in  FIG. 3  is a step corresponding to the lesion risk analyzing function  832  included in the additional examination order setting function  83 . Step S 106  is a step at which the lesion risk analyzing function  832  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the lesion risk analyzing function  832  from the storage circuit  414 . 
     Step S 107  illustrated in  FIG. 3  is a step corresponding to the examination area obtaining function  833  included in the additional examination order setting function  83 . Step S 107  is a step at which the examination area obtaining function  833  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the examination area obtaining function  833  from the storage circuit  414 . 
     Step S 108  illustrated in  FIG. 3  is a step corresponding to the additional examination order extracting/setting function  834  included in the additional examination order setting function  83 . Step S 108  is a step at which the additional examination order extracting/setting function  834  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the additional examination order extracting/setting function  834  from the storage circuit  414 . 
     Step S 109  illustrated in  FIG. 3  is a step corresponding to the proposed order determining function  84 . Step S 109  is a step at which the proposed order determining function  84  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the proposed order determining function  84  from the storage circuit  414 . 
     Step S 110  illustrated in  FIG. 3  is a step corresponding to the additional examination order proposing/executing function  85 . Step S 110  is a step at which the additional examination order proposing/executing function  85  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the additional examination order proposing/executing function  85  from the storage circuit  414 . 
       FIG. 5  is a sequence chart illustrating an example of a process performed when a proposed order suggesting a reconstruction process is presented to a medical technologist. In  FIG. 5 , it is assumed that a medical order issued an examination order from the electronic medical record terminal device  12  to the electronic medical record server apparatus  11  (step S 121 ). An example of the examination order is the same as the one illustrated in  FIG. 4A . In other words, the site is the heart, while the modality is CT. 
     Returning to the description of  FIG. 5 , the electronic medical record server apparatus  11  notifies the additional process proposing function  8  of details of the examination order (step S 122 ). As explained above, the other arrangements are also similarly acceptable in which, from the additional process proposing function  8  side, it is checked to see whether a new examination order is present in the electronic medical record server apparatus  11  and in which the details of the examination order are given to the additional process proposing function  8  through a human means. 
     When the examination order recognizing function  81  included in the additional process proposing function  8  recognizes the examination order (step S 122 ), the past information obtaining function  82  requests past information from the integrated database server apparatus  21  by designating, for example, the patient ID (step S 123 ). The integrated database server apparatus  21  checks to see whether or not the requested past information is present, and when the requested past information is present, responds with the past information (step S 124 ). If the integrated database server apparatus  21  were not provided, the past information obtaining function  82  would request the past information from the electronic medical record server apparatus  11 , the medical image management server apparatus  31 , and the radiation department information server apparatus  41 . When the past information is present in any other apparatus, the past information obtaining function  82  requests the past information from the apparatus.  FIG. 6A  is a drawing illustrating an example of the past information. In  FIG. 6A , the past information includes the patient&#39;s ID, age, gender, and so on, as well as the patient&#39;s medical history, family medical histories, an imaging history, a blood test history, and the like. In the present example, it is assumed that the patient&#39;s medical history indicates liver cancer and that the imaging history indicates “heart (CT)” (the heart was imaged by using an X-ray CT apparatus). 
     Returning to the description of  FIG. 5 , the past information analyzing function  831  included in the additional examination order setting function  83  analyzes the past information obtained by the past information obtaining function  82  (step S 125 ). The past information analyzing function  831  extracts “liver cancer” in the patient&#39;s medical history and “heart (CT)” in the imaging history, from the example of the past information in  FIG. 6A . 
     Returning to the description of  FIG. 5 , on the basis of the past information analyzed by the past information analyzing function  831 , the lesion risk analyzing function  832  speculates one or more lesions each having a possibility of occurring in the patient, as a lesion risk analysis (step S 126 ). For example, on the basis of “liver cancer” in the patient&#39;s medical history, the lesion risk analyzing function  832  speculates “lungs”, i.e., a lesion of “lung cancer”, from a metastasis possibility judgment table such as that illustrated in  FIG. 4C . Further, on the basis of “liver cancer” in the patient&#39;s medical history, the lesion risk analyzing function  832  speculates a lesion of “liver cancer” that may be recurring. The speculated lesion candidates are the same as those illustrated in  FIG. 4D . In the present example, the lesion candidates are displayed together with the reasons for the speculation; however, it is also acceptable to display the lesion candidates together with probability values or ranking indicating the possibility of occurrence for each of the lesions. 
     Returning to the description of  FIG. 5 , the examination area obtaining function  833  obtains examination areas corresponding to the lesions speculated by the lesion risk analyzing function  832  (step S 127 ). For example, the examination area obtaining function  833  obtains “entire lung field region” from “lung cancer” and obtains “liver” from “liver cancer”, as candidates for the examination areas. Examples of the obtained examination area candidates are the same as those illustrated in  FIG. 4E . 
     Returning to the description of  FIG. 5 , the additional examination order extracting/setting function  834  sets one or more additional examination orders (candidates) from among the candidates obtained as the examination areas by the examination area obtaining function  833  (step S 128 ). In this situation, while using the examination areas, the additional examination order extracting/setting function  834  sets the additional examination orders (candidates) in descending order of the possibility of occurrence, on the basis of the reasons for the speculation or the like, and further judges whether or not it is possible to substitute all or a part of the examination areas with a reconstructed image of either a part within an image taking area used in the past indicated in the image taking history or a part that is within a new image taking area but is not subject to an examination. When the substitution is possible, the additional examination order extracting/setting function  834  sets an additional examination order (candidate) indicating the reconstruction process. For example, with respect to each of the items such as “site: entire lung field region” and “site: liver” illustrated as the examination area candidates in  FIG. 4E , the additional examination order extracting/setting function  834  compares the relationship thereof with “imaging history: heart (CT)” in the past information by referring to the site map in  FIG. 4G  and determines that it is possible to reconstruct a part of the “lung field region” from raw data of “heart (CT)” performed in the past. The additional examination order extracting/setting function  834  thus sets the reconstruction process in an additional examination order (a candidate). In other words, in the imaging process performed on the “heart (CT)” in the past, the imaging process must have been performed also on the lung field region which overlaps the heart in the body axis direction, and the raw data must be present. However, because no reconstruction process was performed on the lung field region, the raw data of the lung field region was not used for the diagnosis. Accordingly, it is possible to substitute a part of the examination areas by performing a reconstruction process on the raw data with respect to the lung field region. The reconstruction process in this situation is not an examination of the entire “lungs”, but is able to provide useful information for checking the state of the “lungs” without increasing the radiation exposure amount.  FIG. 6B  is a drawing illustrating examples of the additional examination orders (candidates). In  FIG. 6B , as the examples of the additional examination orders (candidates), “process: reconstruction of lung field region” is added to “site: entire lung field region” and “site: liver”. 
     Returning to the description of  FIG. 5 , from among the additional examination orders, the proposed order determining function  84  determines a proposed order that is either to be presented to the user (e.g., a doctor, a medical technologist, or the like) or to be automatically executed, on the basis of a relationship between the examination order recognized by the examination order recognizing function  81  and the additional examination orders set by the additional examination order setting function  83  (step  129 ). For example, the proposed order determining function  84  compares “site: heart” in the examination order illustrated in  FIG. 4A  with “site: entire lung field region” and “site: liver” in the additional examination orders (candidates) illustrated in  FIG. 6B  and judges whether or not it is necessary to expand the examination area and the image taking area by referring to a site map (a human body map) indicating inclusion relationships among examination areas such as that illustrated in  FIG. 4G . In comparison to “site: heart” in the examination order, “site: entire lung field region” and “site: liver” in the additional examination orders (candidates) both require expansion of the examination area and the image taking area. Accordingly, because the radiation exposure amount increases, it is necessary to have a doctor make a judgment. Thus, “site: entire lung field region” and “site: heart+liver” to be presented to a doctor are determined. 
     Further, as for “process: reconstruction of lung field region” in one of the additional examination orders (candidates), it is not necessary to perform a new imaging process, and it is sufficient to only perform the process on the existing raw data. Accordingly, because it is not requisite to check with doctors, this additional examination order will be presented to a medical technologist. However, because the result of the reconstruction process shall be used for diagnosis purposes, it is meaningful to provide the doctor who issued the original examination order with the information. Further, in some hospitals, doctors also serve as medical technologists, and it may not be necessary to distinguish doctors from medical technologists. Further, it is also acceptable to limit the situations where a proposed order contains details of a reconstruction process to only when the additional process proposing function  8  is unable to automatically execute the reconstruction process (for example, being unable to request the reconstruction process due to an issue related to access right to the raw data or processing software). Further, the additional process proposing function  8  may be configured not to automatically control the execution of the reconstruction process so that the proposed order is always presented to a medical technologist. 
       FIG. 6C  is a drawing illustrating an example of the proposed order.  FIG. 6C  illustrates the example of the proposed order includin “process: reconstruction of lung field region from heart projection data” to be presented to a medical technologist and “site: entire lung field region” and “site: heart+liver” to be presented to a doctor. Alternatively, the proposed order may include “site: entire lung field region+liver” in which “site: entire lung field region” and “site: heart+liver” are combined together. Further, when proposed orders include a proposed order concerning a site or a region that is duplicate between a doctor and a medical technologist, it is desirable to issue an alert when the proposed orders are presented, because when one of the duplicate proposed orders is adopted, the other proposed order may no longer be necessary. 
     The example is explained above in which the reconstruction process from the past raw data is proposed on the basis of the imaging history of the patient in the past information; however, another arrangement is also acceptable in which a reconstruction process is proposed from within an image taking area on which an examination is going to be performed on the basis of the examination order issued by the doctor. For example, when “site: heart” and “modality: CT” were designated in the original examination order, and a metastasis to “lung cancer” from “liver cancer” in the patient&#39;s medical history is speculated, it is possible to propose a reconstruction process of a “lungs” section that is to be imaged at the same time by implementing an X-ray CT procedure, while keeping the “heart” as the examined site, instead of expanding the examination area to the “entire lung field region”. 
     When the proposed order determined by the proposed order determining function  84  contains only one or more reconstruction processes, the processes at steps S 130  through S 135  in  FIG. 5  shall be performed. When the proposed order determined by the proposed order determining function  84  contains both expansion of the examination area and the image taking area and one or more reconstruction processes, a process obtained by combining together the processes at steps S 110  through S 114  in  FIG. 3  and the processes at steps S 130  through S 135  in  FIG. 5  shall be performed. 
     In  FIG. 5 , the additional examination order proposing/executing function  85  notifies the electronic medical record server apparatus  11  of the proposed order suggesting the reconstruction process, so that the proposed order can be presented to the user (i.e., a medical technologist) (step S 130 ). While the electronic medical record system  1  is in an environment where direct communication with another system is not possible, the details of the proposed order may be given to the electronic medical record server apparatus  11  through a human means. 
     Subsequently, although the procedure is not requisite, the electronic medical record server apparatus  11  notifies the electroni medical record terminal device  12  used by the doctor or the like who issued the original examination order of the proposed order provided in the notification from the additional process proposing function  8 , as reference information (step S 131 ). 
     Further, the electronic medical record server apparatus  11  notifies the radiation department information server apparatus  41  of the original examination order issued by the doctor (step S 132 ). The radiation department information server apparatus  41  notifies the console device main body  52  (or  62 ) in the corresponding modality, of the examination order provided in the notification (step S 133 ). 
     Further, the additional examination order proposing/executing function  85  included in the additional process proposing function  8  notifies the radiation department information server apparatus  41  of the proposed order suggesting the reconstruction process to be presented to a medical technologist (step S 134 ). The radiation department information server apparatus  41  notifies the console device main body  52  (or  62 ) in the corresponding modality, of the proposed order indicating the reconstruction process and having been provided in the notification (step S 135 ). The medical technologist who has checked the examination order and the proposed order performs the examination according to the examination order, and further, when adopting the proposed order, the medical technologist performs the reconstruction process according to the proposed order. It is also acceptable to arrange a portable terminal device (e.g., a smartphone) carried by the medical technologist to be notified of the examination order and the proposed order, separately from the console device main body  52  (or  62 ). 
     In the above example, the proposed order suggesting the reconstruction process is assumed to be in the same modality as the modality (e.g., CT) designated in the original examination order. However, it is also acceptable when the proposed order suggests a modality different from that in the original examination order. 
     When the proposed order contains both expansion of the image taking area and one or more reconstruction processes, the process at step S 114  in  FIG. 3  shall be followed by the processes at steps S 130 , S 131 , S 134 , and S 135  illustrated in  FIG. 5 . 
     Step S 122  illustrated in  FIG. 5  is a step corresponding to the examination order recognizing function  81 . Step S 122  is a step at which the examination order recognizing function  81  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the examination order recognizing function  81  from the storage circuit  414 . 
     Steps S 123  and S 124  illustrated in  FIG. 5  are steps corresponding to the past information obtaining function  82 . Steps S 123  and S 124  are steps at which the past information obtaining function  82  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the past information obtaining function  82  from the storage circuit  414 . 
     Step S 125  illustrated in  FIG. 5  is a step corresponding to the past information analyzing function  831  included in the additional examination order setting function  83 . Step S 125  is a step at which the past information analyzing function  831  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the past information analyzing function  831  from the storage circuit  414 . 
     Step S 126  illustrated in  FIG. 5  is a step corresponding to the lesion risk analyzing function  832  included in the additional examination order setting function  83 . Step S 126  is a step at which the lesion risk analyzing function  832  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the lesion risk analyzing function  832  from the storage circuit  414 . 
     Step S 127  illustrated in  FIG. 5  is a step corresponding to the examination area obtaining function  833  included in the additional examination order setting function  83 . Step S 127  is a step at which the examination area obtaining function  833  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the examination area obtaining function  833  from the storage circuit  414 . 
     Step S 128  illustrated in  FIG. 5  is a step corresponding to the additional examination order extracting/setting function  834  included in the additional examination order setting function  83 . Step S 123  is a step at which the additional examination order extracting/setting function  834  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the additional examination order extracting/setting function  834  from the storage circuit  414 . Step S 129  illustrated in  FIG. 5  is a step corresponding to the proposed order determining function  84 . Step S 129  is a step at which the proposed order determining function  84  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the proposed order determining function  84  from the storage circuit  414 . 
     Steps S 130  and S 134  illustrated in  FIG. 5  are steps corresponding to the additional examination order proposing/executing function  85 . Steps S 130  and S 134  are steps at which the additional examination order proposing/executing function  85  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the additional examination order proposing executing function  85  from the storage circuit  414 . 
     Next,  FIG. 7  is a sequence chart illustrating an example of a process performed when the reconstruction process is automatically performed. In  FIG. 7 , the processes at steps S 141  through S 148  are the same as the processes at step S 121  through S 128  illustrated in  FIG. 5 . 
     In the example in  FIG. 7 , when determining, from among the additional examination orders, the proposed order that is either to be presented to a user (e.g., a doctor, a medical technologist, or the like) or to be automatically executed, (step S 149 ), the proposed order determining function  84  determines that the proposed order suggesting a reconstruction process is to be automatically executed. For example, when there is no issue related to access right to the raw data or processing software or the like, so that it is possible to automatically control the execution of the reconstruction process, the additional process proposing function  8  determines that the proposal order suggesting the reconstruction process is to be executed automatically. 
     As a subsequent process, when the proposed order determined by the proposed order determining function  84  contains only one or more reconstruction processes, the processes at steps S 150  through S 160  in  FIG. 7  shall be performed. When the proposed order determined by the proposed order determining function  84  contains both expansion of the examination area and the image taking area and one or more reconstruction processes, a process obtained by combining together the processes at steps S 110  through S 114  illustrated in  FIG. 3  and the processes at steps S 150  through S 160  illustrated in  FIG. 7  shall be performed. 
     In  FIG. 7 , the additional examination order proposing/executing function  85  notifies the electronic medical record server apparatus  11  that the proposed order suggesting the reconstruction process will automatically be executed (step S 150 ). In this situation, while the electronic medical record system  1  is in an environment where direct communication with another system is not possible, the details of the proposed order may be given to the electronic medical record server apparatus  11  through a human means. 
     Subsequently, although the procedure is not requisite, the electronic medical record server apparatus  11  notifies the electronic medical record terminal device  12  used by the doctor or the like who issued the original examination order of the proposed order provided in the notification from the additional process proposing function  8 , as reference information (step S 151 ). 
     Further, the electronic medical record server apparatus  11  notifies the radiation department information server apparatus  41  of the original examination order issued by the doctor (step S 152 ). The radiation department information server apparatus  41  notifies the console device main body  52  (or  62 ) in the corresponding modality, of the examination order provided in the notification (step S 153 ). 
     Further, the additional examination order proposing/executing function  85  included in the additional process proposing function  8  notifies the radiation department information server apparatus  41  of the request to execute the reconstruction process based on the proposed order suggesting the reconstruction process (step S 154 ). The radiation department information server apparatus  41  notifies the console device main body  52  (or  62 ) in the corresponding modality, of the reconstruction execution request provided in the notification (step S 155 ). The reconstruction execution request includes information used for identifying the raw data from the imaging process performed in the past. When the software (a computer program) used for the reconstruction process is present in a device other than the console device main body  52  (or  62 ), it is also acceptable to request the device to execute the reconstruction process. 
     When having received the execution request, the console device main body  52  (or  62 ) executes the reconstruction process, and when the reconstruction process has been executed successfully, the console device main body  52  (or  62 ) stores an image resulting from the reconstruction process into the integrated database server apparatus  21  (step S 156 ). When the reconstruction process has been performed successfully, it is desirable to further arrange a segmentation process and/or a CAD process to also be automatically performed on the resulting image, so that results thereof can be stored into the integrated database server apparatus  21 . The results of the segmentation process and/or the CAD process serve as information useful for diagnosis processes performed by doctors, and the like. 
     Although the procedure is not requisite, the console device main body  52  (or  62 ) notifies the radiation department information server apparatus  41  that the reconstruction process has been performed (step S 157 ). The radiation department information server apparatus  41  notifies the additional process proposing function B of the same (step S 158 ). The additional examination order proposing/executing function  85  included in the additional process proposing function  8  notifies the electronic medical record server apparatus  11  that the reconstruction process has been performed (step S 159 ). The electronic medical record server apparatus  11  notifies the electronic medical record terminal device  12  used by the doctor of the same (step S 160 ). The doctor refers to the result of the reconstruction process as necessary and uses the information for diagnoses and treatments for the patient. 
     Step S 142  illustrated in  FIG. 7  is a step corresponding to the examination order recognizing function  81 . Step S 142  is a step at which the examination order recognizing function  81  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the examination order recognizing function  81  from the storage circuit  414 . 
     Steps S 143  and S 144  illustrated in  FIG. 7  are steps corresponding to the past information obtaining function  82 . Steps S 143  and S 144  are steps at which the past information obtaining function  82  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the past information obtaining function  82  from the storage circuit  414 . 
     Step S 145  illustrated in  FIG. 7  is a step corresponding to the past information analyzing function  831  included in the additional examination order setting function  83 . Step S 145  is a step at which the past information analyzing function  831  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the past information analyzing function  831  from the storage circuit  414 . 
     Step S 146  illustrated in  FIG. 7  is a step corresponding to the lesion risk analyzing function  832  included in the additional examination order setting function  83 . Step S 146  is a step at which the lesion risk analyzing function  832  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the lesion risk analyzing function  832  from the storage circuit  414 . 
     Step S 147  illustrated in  FIG. 7  is a step corresponding to the examination area obtaining function  833  included in the additional examination order setting function  83 . Step S 147  is a step at which the examination area obtaining function  833  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the examination area obtaining function  833  from the storage circuit  414 . 
     Step S 148  illustrated in  FIG. 7  is a step corresponding to the additional examination order extracting/setting function  834  included in the additional examination order setting function  83 . Step S 148  is a step at which the additional examination order extracting/setting function  834  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the additional examination order extracting/setting function  834  from the storage circuit  414 . 
     Step S 149  illustrated in  FIG. 7  is a step corresponding to the proposed order determining function  84 . Step S 149  is a step at which the proposed order determining function  84  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the proposed order determining function  84  from the storage circuit  414 . 
     Steps S 150 , S 154 , and S 159  illustrated in  FIG. 7  are steps corresponding to the additional examination order proposing/executing function  85 . Steps S 150 , S 154 , and S 159  are steps at which the additional examination order proposing/executing function  85  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the additional examination order proposing/executing function  85  from the storage circuit  414 . 
     As explained above, according to the first embodiment, with respect to the examination order issued by the doctor, the proposal is made to suggest the expansion of the examination area and the image taking area or the reconstruction process, on the basis of the past information related to the patient. In addition, the reconstruction process is executed automatically when possible. Accordingly, it is possible to assist the user in discovering a lesion in a non region of interest. Further, the first embodiment is also expected to be utilized as supplementary data when development is observed (as a follow-up) after a treatment applied to the patient in the past. 
     Second Embodiment 
     In a second embodiment, additional costs are evaluated with respect to additional examination orders or a proposed order, so as to append the evaluated additional costs as reference information to a presented proposed order or so as to use the evaluated additional costs as an index for determining a proposed order from among the additional examination orders. Examples of the additional costs include an increase in the radiation exposure amount due to expansion of the image taking area, an increase in the acquisition time period due to an enlargement of the image taking area, an increase in the processing time period required by the reconstruction process, and the like. Because the proposed order will be presented together with the additional costs, it becomes easier for the doctor or the medical technologist to determine whether or not the proposed order should be adopted. In other words, regarding the adoption of the proposed order, it becomes easier for the doctor or the medical technologist to determine whether or not the proposed order should be adopted, by considering whether or not it is worth bearing the presented additional costs. Further, because a proposed order may automatically be determined from among the additional examination orders on the basis of the additional costs, the classification among the destinations to whom the proposed order is to be presented becomes clearer. For example, when there is an increase in the radiation exposure amount, it is understood there is a high possibility that the image taking area may be enlarged. It is therefore more clearly indicated that the proposed order should be presented to a doctor. An increase in the acquisition time period can also be handled in the same manner as an increase in the radiation exposure amount. Further, even when there is an increase in the processing time period required by a construction process, unless there is an increase in the radiation exposure amount, there is no need to present the proposed order to a doctor. It is therefore more clearly indicated that it is possible to present the proposed order to a medical technologist or to have the proposed order executed automatically. 
       FIG. 8  is a diagram illustrating an exemplary configuration in which the radiation department information server apparatus  41  is provided with the additional process proposing function  8  according to the second embodiment. The configuration illustrated in  FIG. 8  is almost the same as the configuration illustrated in  FIG. 2 , except that the additional process proposing function  8  is further provided with a cost evaluating function  86 . The cost evaluating function  86  is configured to evaluate additional costs of the additional examination orders (candidates) set by the additional examination order setting function  83  and to append the evaluated additional costs to the additional examination orders (candidates) as reference information. 
     As for the details of the process, the descriptions of the process explained with reference to  FIGS. 3, 5, and 7  are slightly changed. More specifically, a processing step of evaluating the additional costs performed by the cost evaluating function  86  are added immediately after step S 108  in  FIG. 3 , step S 128  in  FIG. 5 , and step S 148  in  FIG. 7 . At the processing step of evaluating the additional costs performed by the cost evaluating function  86 , calculations are performed to obtain an increase in the radiation exposure amount due to the expansion of the image taking area, an increase in the acquisition time period due to an enlargement of the image taking area, an increase in the processing time period required by the reconstruction process, and/or the like in accordance with details of the additional examination orders (candidates), so that information about the additional costs can be appended to the additional examination orders (candidates).  FIG. 9  is a drawing illustrating examples of additional examination orders (candidates). In  FIG. 9 , for each of the items such as “site: entire lung field region” and “site: liver” indicated in the additional examination orders (candidates), a radiation exposure amount, an acquisition time period, and a reconstruction time period are calculated and appended thereto. 
     Further, in the proposed order determining process performed by the proposed order determining function  84  at step S 109  in  FIG. 3 , step S 129  in  FIG. 5 , and step S 149  in  FIG. 7 , any of the proposed order having an additional cost with an increase in the radiation exposure amount is classified a a proposed order to be presented to a doctor, whereas any of the proposed orders having an additional cost with no increase in the radiation exposure amount is classified as a proposed order to be presented to a medical technologist. In other words, it is possible to classify the proposed orders according to the radiation exposure amounts calculated as the additional costs and to indicate the processes clearer, without the need to distinguish whether or not each of the proposed orders involves a reconstruction process or not. 
     Further, when the proposed order is presented to a doctor or a medical technologist at steps S 110  and S 111  in  FIG. 3 , at steps S 130 , S 131 , S 134 , and S 135  in  FIG. 5 , and at steps S 150  and S 151  in  FIG. 7 , the additional costs evaluated by the cost evaluating function  86  are additionally presented. In this situation, an arbitrary format may be used for presenting the additional costs. For example, the details of the additional costs may be presented together with the proposed order displayed as a list. 
     When the proposed order is presented to the doctor or the medical technologist by the additional examination order proposing/executing function  85  as described above, it is also acceptable to present diagnosis resource materials (e.g., examination results, acquired images, and the like) of the examined subject (the patient) from the past together therewith. In that situation, the past information obtaining function  82  included in the additional process proposing function  8  obtains non-image and/or image relevant information as the past information, on the basis of the patient ID or the like and forwards the obtained information to the additional examination order proposing/executing function  85 . Examples of the images obtained in this situation include, not only the images stored in the integrated database server apparatus  21  or the like, but also images that are, separately from the proposed order explained above, reconstructed from raw data that was acquired in a past examination and stored in the integrated database server apparatus  21  or the like. The reconstruction process realized by using the raw data may be performed in a real-time manner or may be performed in the background at an appropriate time. 
     To obtain the relevant information, a machine learning scheme may be used. For example, it is acceptable to implement a machine learning process by using a relationship between the state of patients and pieces of information referenced to make diagnoses as a corpus, on the basis of a large number of diagnosis examples from the past. Accordingly, the past information obtaining function  82  is able to obtain, with a higher priority, certain types of information and details thereof speculated by the machine learning process on the basis of a current state of a patient. When presenting the proposed order to the doctor or the medical technologist, the additional examination order proposing/executing function  85  presents the non-image and/or image relevant information together therewith. In that situation, an arbitrary format may be used for presenting the relevant information. For example, details of the relevant information may directly be incorporated in the notification. Alternatively, a link to a reference address may be attached thereto. 
     The processing step of evaluating the additional costs described above is a step corresponding to the cost evaluating function  86 . The processing step of evaluating the additional costs is a step at which the cost evaluating function  86  is realized as a result of the processing circuit  411  reading and executing a program corresponding to the cost evaluating function  86  from the storage circuit  414 . 
     According to at least one aspect of the embodiments described above, it is possible to assist the user in discovering a lesion in the non region of interest. 
     While certain embodiments have been described, these embodiments have been presented by way of example only, and are not intended to limit the scope of the inventions. Indeed, the novel embodiments described herein may be embodied in a variety of other forms; furthermore, various omissions, substitutions and changes in the form of the embodiments described herein may be made without departing from the spirit of the inventions. The accompanying claims and their equivalents are intended to cover such forms or modifications as would fall within the scope and spirit of the inventions.