Patent Publication Number: US-2004044269-A1

Title: Endoscopic image filing system for recording and managing information on condition of patient in endoscopic examination so as to relate such information with endoscopic image information

Description:
[0001] This application claims benefit of Japanese Application No. 2001-83002 filed in Japan on Mar. 22, 2001, the contents of which are incorporated by this reference.  
       BACKGROUND OF THE INVENTION  
       [0002] 1. Field of the Invention  
       [0003] The present invention relates to an endoscopic image filing system for recording endoscopic images, patient information, and the like, and for recording patient biological information measured by means of a patient monitoring apparatus or similar in the course of an endoscopic examination.  
       [0004] 2. Description of the Related Art  
       [0005] An endoscope apparatus as used conventionally is constituted such that imaging means are provided in an endoscope which performs observation when a long and narrow insert portion thereof is inserted into an examination site such as a body cavity and constituted such that images of the examination site picked up by the imaging means, that is, endoscopic images, are displayed on a monitor.  
       [0006] In recent years, endoscopic image filing systems, for which an image filing apparatus for recording endoscopic images is connected with the endoscope apparatus, have been widely used.  
       [0007] An endoscopic image filing system is constituted such that upon pressing an endoscope switch, for example a release switch, with which the endoscope apparatus is provided, still images of endoscopic images displayed on the monitor are recorded by the image filing apparatus.  
       [0008] Further, the endoscopic image filing system is not only capable of recording endoscopic images but is also capable of recording a variety of information relating to an endoscopic examination including a physician&#39;s view with regard to recorded endoscopic images, patient information such as the age and gender of the patient, as well as the date and time when the endoscopic examination was conducted.  
       [0009] Meanwhile, when the patient&#39;s condition during an endoscopic examination is also monitored and an abnormality occurs in the patient, appropriate equipment must be chosen immediately. There are, for example, methods for measuring the patient&#39;s maximum blood pressure, minimum blood pressure and pulse using a non-invasive blood pressure manometer. Here it is possible to set the time interval for the blood pressure manometer and to repeat the measurement at fixed intervals. Methods also exist for measuring the arterial blood oxygen concentration and pulse using a pulse oximeter. There are also methods for measuring an electrocardiogram using an electrocardiogram monitor, and also methods for monitoring through integration of the above-mentioned biological information by means of a patient monitoring apparatus that integrates the functions of a blood pressure manometer, a pulse oximeter, and an electrocardiogram monitor.  
       [0010] Methods for displaying a plurality of biological information simultaneously and for recording biological information as digital data were disclosed in European Patent No. EP0676709A2 and Japanese Patent Application (Kokai) No. H3-258240 and so forth. Such methods could also be employed in an endoscopic examination or during a surgical operation and made it possible to record the condition of the patient undergoing surgery.  
       [0011] Such biological information is not only used to provide information on the condition of the patient in an examination but is also important data for reference at the time of making a diagnosis from examination results. However, although conventional endoscopic image filing systems have permitted the recording of endoscopic images in the course of an endoscopic examination, such systems have not enabled biological information on a patient in an examination to be recorded so as to be related with these endoscopic images.  
       SUMMARY OF THE INVENTION  
       [0012] It is accordingly an object of the present invention to provide an endoscopic image filing system that is capable of improving the accuracy of an endoscopy diagnosis by recording the condition of the patient in the endoscopic examination along with endoscopic images, referring to the patient&#39;s condition while playing back images, or recording the patient&#39;s condition in an examination report.  
       [0013] The endoscopic image filing system of the present invention is constituted comprising: a first communication section for capturing an endoscopic image signal from an endoscope apparatus that obtains an endoscopic image signal by observing an examined body by means of an endoscope; a second communication section for capturing biological information from a measuring apparatus that obtains the biological information by measuring the examined body being observed by the endoscope; a storage section for storing data; and a registration section for registering, in the storage section, the biological information and the endoscopic image signal thus captured as examination data on the examined body, such that the biological information and the endoscopic image signal are related on the basis of pre-registered information identifying the examined body.  
       [0014] Other characteristic features and benefits of the present invention will be made sufficiently apparent by means of the following description. 
     
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
     [0015] FIGS.  1  to  12  relate to an embodiment of the present invention.  
     [0016]FIG. 1 is a constitutional view of the constitution of the endoscopic image filing system;  
     [0017]FIG. 2 is a constitutional view of the constitution of the endoscope system in FIG. 1;  
     [0018]FIG. 3 is a constitutional view of the constitution of the image filing apparatus in FIG. 1;  
     [0019]FIG. 4 is a constitutional view of the constitution of the patient monitoring apparatus in FIG. 1;  
     [0020]FIG. 5 is an explanatory diagram that provides an overview of the configuration of the windows of the image filing apparatus in FIG. 3;  
     [0021]FIG. 6 is a flowchart to explain an example of the overall flow of the operation of the image filing apparatus in FIG. 3;  
     [0022]FIG. 7 is a first flowchart to explain the operation of setting various information related to patient biological information by means of the image filing apparatus in FIG. 3;  
     [0023]FIG. 8 is a second flowchart to explain the operation of setting various information related to patient biological information by means of the image filing apparatus in FIG. 3;  
     [0024]FIG. 9 shows a template which has been edited using the template editing window by means of the image filing apparatus in FIG. 3;  
     [0025]FIG. 10 is a flowchart to explain the operation of an endoscopic examination by means of the endoscopic image filing system in FIG. 1;  
     [0026]FIG. 11 shows an examination performance window that is developed in the process of FIG. 10; and  
     [0027]FIG. 12 shows a patient biological information window for referring to patient biological information by means of the image filing apparatus in FIG. 3. 
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS  
     [0028] As shown in FIG. 1, the endoscopic image filing system  1  of the present embodiment is principally constituted by an endoscope system  2  for performing an examination by means of endoscopic images; an image filing apparatus  3 , which is connected to the endoscope system  2  and is for recording desired endoscopic images; and a patient monitoring apparatus  4  for monitoring biological information such as the patient&#39;s blood pressure and pulse, and an electrocardiogram.  
     [0029] The endoscope system  2  is constituted by: an endoscope  5 , which is inserted into a body cavity to pick up images of an examination site; a video processor  6  for processing image pickup signals from the endoscope  5  to generate endoscopic images; a light source  7  for supplying illuminating light to the endoscope  5 ; and a monitor  8  for displaying endoscopic images that are generated by the video processor  6 .  
     [0030] A keyboard  9  for inputting data is connected to the video processor  6 . A monitor  10  for displaying endoscopic images and data, a keyboard  11  for inputting data, and a mouse  12  are connected to the image filing apparatus  8 .  
     [0031] Connected to the patient monitoring apparatus  4  are: a cuff  13  for measuring the patient&#39;s blood pressure; an electrode section  14  constituted by a plurality of electrodes and cables for measuring a patient electrocardiogram; and a probe  15 , which comprises a red light light-emitting portion and light-receiving portion and which is for measuring the patient&#39;s arterial blood oxygen concentration and pulse.  
     [0032] As shown in FIG. 2, the endoscope  5  comprises an insert portion  5   a , which is formed to be flexible and long and thin. The insert portion  5   a  is provided with a light guide  5   b  for transmitting illuminating light, which is for illuminating an examination site, from the base side of the endoscope  5  to the tip of the insert portion  5   a  thereof, the base side of the light guide  5   b  being connected to the light source  7 .  
     [0033] The tip of the insert portion  5   a  is provided with an imaging apparatus  5   c  for picking up images of an examination site and comprising a CCD or similar, which is a solid-state image sensor, for example. The endoscope  5  is connected by means of a connector  5   d  to the light source  7  and is also connected to the video processor  6  by means of a universal cable  5   e . The endoscope  5  further comprises, at the base side thereof, a release switch  5   f  for inputting an instruction to record an image.  
     [0034] Light emitting means  7   a , such as a lamp, for emitting illuminating light are provided in the light source  7 . The illuminating light emitted by the light emitting means  7   a  is condensed by a condensing optical system  7   b  and enters the light guide  5   b . A rotating plate, which is rotated by a motor  7   c  and has three optical filters  7   d  attached thereto which are red, green and blue in color respectively (written as R, G, B respectively in FIG. 2), is disposed at a midway point of the light path of the condensing optical system  7   b , whereby the color of the illuminating light illuminating the examination site can be switched using time division.  
     [0035] An image signal of the examination site which is picked up by imaging apparatus  5   c  is inputted to an image processing section  6   a  inside the video processor  6 , and image processing such as color highlighting for example is carried out, such images being temporarily stored in sequence in an image memory  6   b . Image data stored in the image memory  6   b  is inputted to a D/A conversion section  6   c  where this data is D/A converted, and the D/A conversion section  6   c  outputs an RGB format image signal. The image processing section  6   a , image memory  6   b , and the like, operate under the control of a controller  6 d which constitutes control means for controlling components in the video processor  6 . The image signal which is outputted from the D/A conversion section  6   c  is synthesized by a synthesis circuit  6   f  with an image signal outputted from a character generator  6   e  described hereinafter. The RGB format image signal which is output from the synthesis circuit  6   f  is inputted to the monitor  8  to cause an image of the examination site to be displayed on the monitor  8 . At such time, a sync signal (written as SYNC in FIG. 2),which is supplied to the monitor  8 , is generated by a sync signal generator  6   g  that is controlled by the controller  6   d.    
     [0036] Character information is inputted by the controller  6   d  to the character generator  6   e  such that the character generator  6   e  is then able to output the character information thus inputted following conversion thereof into an image signal. In other words, character information can then be synthesized and displayed as an image of the examination site in a window of the monitor  8 , and it is possible to transmit various messages to the user of the endoscope system  2 .  
     [0037] The image signal which is output from the synthesis circuit  6   f  is not only output to the monitor  8  but rather is also output to the image filing apparatus  3  so as to also be displayable by the image filing apparatus  3 .  
     [0038] Further, the controller  6   d  is also constituted so as to be capable of transmitting and receiving information to and from the image filing apparatus  3  via a communication interface  6   h  of the commonly known RS-232C system for example. In addition, the controller  6   d  is connected to the release switch  5   f  and is thus capable of detecting the state of the release switch  5   f.    
     [0039] A keyboard interface  6   i  is for detecting inputs from the keyboard  9 .  
     [0040] As shown in FIG. 3, the image filing apparatus  3  possesses the function of a storage section, a registration section, a report creation section, and a selecting section, and the like, and comprises: a CPU  3   a , which constitutes the principal control unit for controlling the components of the image filing apparatus  3 ; a ROM  3   b , in which programs which cause the CPU  3   a  to operate, or similar, are stored; a RAM  3   c , which is used as the work area of the CPU  3   a  and as a buffer for various data; a VRAM  3   d  for temporarily storing image data which is output to the monitor  10 ; a hard disk  3   e  for storing image data and various data; a hard disk controller  3   f  for reading and writing data to and from the hard disk  3   e ; a mouse interface  3   g  for detecting inputs via the mouse  12 ; a keyboard interface  3   h  for detecting inputs via the keyboard  11 ; a communication interface  3   i  which uses the commonly known RS-232C system for example and is a second communication section for transmitting and receiving various data to and from the video processor  6  and the patient monitoring apparatus  4 ; a video circuit  3   j , which is a first communication section constituting an interface circuit for inputting an image signal which is outputted from the video processor  6 ; an A/D conversion section  3   k  for A/D converting an image signal which is inputted by the video circuit  3   j ; and an image memory  31  for temporarily storing image data which is output from the A/D conversion section  3   k.    
     [0041] By means of the aforementioned components, the image filing apparatus  3  is capable of displaying image data obtained by the endoscope system  2  on the monitor  10 , storing this image data on the hard disk  3   e , and so forth.  
     [0042] Also, by obtaining the state of the release switch  5   f , the image filing apparatus  3  is also capable of dividing up processing by the CPU  3   a , to permit the recording of images for example.  
     [0043] In accordance with the various windows displayed on the monitor  10 , the image filing apparatus  3  executes processing such that the operator inputs data and instructions via the keyboard  11 , mouse  12 , and the like, and such that the CPU  3   a  controls each component in accordance with inputted data and/or instructions. That is, the image filing apparatus  3  is thus capable of executing various processing in accordance with the flow of the windows displayed on the monitor  10 .  
     [0044] As shown in FIG. 4, the patient monitoring apparatus  4  comprises: a CPU  4   a , which constitutes the principal control unit for controlling the components of the patient monitoring apparatus  4 ; a ROM  4   b , in which programs which cause the CPU  4   a  to operate, or similar, are stored; a RAM  4   c , which is used as the work area of the CPU  4   a  and as a buffer for various data; a pre-amp  4   d , which is electrically isolated from the power supply (not illustrated) of the patient monitoring apparatus  4  and is for amplifying weak electrical signals detected by the electrode section  14  attached to the patient; a main amp  4   e , which further amplifies electrical signals amplified by the pre-amp  4   d  to a magnitude permitting processing; an A/D conversion section  4   f  for A/D converting electrical signals amplified by the main amp  4   e ; a computing section  4   g  for computing electrical signals inputted from the A/D conversion section  4   f  to thereby calculate various forms of electrocardiogram, the patient&#39;s pulse, and the like; a pump unit  4   h  constituted by a pump (not illustrated) for supplying air to the cuff  13 , and an air valve (not illustrated); a pump control unit  4   i  for controlling the pump unit  4   h ; a pressure sensor unit  4   j  for measuring the pressure acting on the cuff  13  via the pump unit  4   h ; an A/D conversion section  4   k  for A/D converting numerical values inputted from the pressure sensor unit  4   j ; a computing section  4   l  for calculating values such as the maximum blood pressure and the minimum blood pressure from numerical values inputted from the A/D conversion section  4   k ; an amplifying section  4   m  for amplifying signals transmitted by the light-receiving section (not illustrated) causing the light-emitting section (not illustrated) of the probe  15  to emit light; an A/D conversion section  4   n  for A/D converting signals transmitted by the amplifying section  4   m ; a computing section  4   o  for computing signals transmitted by the A/D conversion section  4   n  to thereby calculate the arterial blood oxygen concentration, heart rate, and the like; a display  4   p  for displaying data for an electrocardiogram, the heart rate, or the like, calculated by the computing section  4   g ; data for the blood pressure and heart rate, and the like, calculated by the computing section  4   l ; and data for the arterial blood oxygen concentration, heart rate, and the like, calculated by the computing section  4   o ; a display interface  4   q  for transmitting data to the display  4   p ; an operation section  4   r  permitting the operator to issue instructions; and a communication interface  4   s  of the commonly known RS-232C system for example, for transmitting and receiving various data to and from the image filing apparatus  3 .  
     [0045] By means of the aforementioned components, the patient monitoring apparatus  4  is capable of measuring the patient&#39;s pulse, an electrocardiogram, and the like, as a result of the electrode section  14  detecting weak electrical signals generated in accordance with contractions of the myocardium and also by amplifying and computing detected electrical signals. The measurement data can be stored in the RAM  4   c  and displayed on the display  4   p  in real time in the format desired by the operator, and numerical value data for a pulse or the like can be transmitted to the image filing apparatus  3 .  
     [0046] Furthermore, the patient monitoring apparatus  4  is capable of detecting pulse waves and pressures thereof in accordance with pulsations produced by supplying air to the cuff  13  attached to the patient to thereby measure the patient&#39;s blood pressure (maximum blood pressure and minimum blood pressure), and of displaying the patient&#39;s blood pressure on the display  4   p  and transmitting numerical values for the patient&#39;s blood pressure to the image filing apparatus  3 . These blood pressure measurements cannot be measured as serial values but the user can, in accordance with requirements, make measurements with respect to optional timing by operating the operation section  4   r , or can also repeat the measurements periodically in accordance with a program. In the latter case, the measurement interval is set by the operator by operating the operation section  4   r . These measured values are stored in the RAM  4   c  until the next measurements are made in accordance with optional timing or a program.  
     [0047] The patient monitoring apparatus  4  is also capable of calculating the arterial blood oxygen concentration (SpO 2 ) and heart rate by calculating the difference in the transmittance of red light of two different wavelengths detected by the probe  15  attached to the patient. This measurement data can be stored in the RAM  4   c  and displayed on the display  4   p  in real time and numerical values of this data can be transmitted to the image filing apparatus  3 .  
     [0048] The patient monitoring apparatus  4  of this constitution possesses the functions of a boundary value setting section, a comparing section, and a notifying section, and the like, and is capable of setting boundary values for each measured value and of providing a warning by means of the display of the display  4   p , or the like, when measurement results exceed boundary values. For example, when a user uses the operation section  4   r  to input maximum and minimum heart rates, a minimum value for the minimum blood pressure, a maximum value for the maximum blood pressure, and a minimum value for the arterial blood oxygen concentration, and the like, a warning can be displayed on the display  4   p  and a warning sound can be emitted by a speaker (not illustrated) in cases where measured values exceed these set values.  
     [0049] The patient monitoring apparatus  4  is also capable of transmitting data for the patient&#39;s electrocardiogram, pulse, blood pressure, arterial blood oxygen concentration and the like, by means of a communication system determined by the manufacturer, via the communication interface  4   s  to an image filing apparatus or other external device.  
     [0050] An overview of the configuration of the windows of the image filing apparatus  3  will now be provided using FIG. 5.  
     [0051] First, upon startup of the image filing apparatus  3 , a login window  20  for user authentication is displayed on the monitor  10 . Following user authentication by means of the login window  20 , a schedule window  21 , which is for displaying a list of examination schedules or similar, is displayed on the monitor  10 .  
     [0052] A patient list window  22  for displaying a list of patient information can be called from the schedule window  21 . A patient information window  22   a  for newly registering patient information or editing patient information which has already been registered can be called from the patient list window  22 .  
     [0053] Further, an examination information window  23  for reserving an examination by newly registering examination information or editing examination information which has already been registered can be called from the schedule window  21 .  
     [0054] An examination performance window  24  for performing an examination by means of a connection with the endoscope system  2  and capturing images from the endoscope system  2  can also be called from the schedule window  21 .  
     [0055] A patient biological information window  25  for referring to and editing captured biological information in the course of an endoscopic examination can be also called from the schedule window  21 .  
     [0056] An image selection window  26  for selecting images to be attached to an examination report that is created, from among captured images, can also be called from the schedule window  21 .  
     [0057] A report creation window  27 , which constitutes one of the windows for creating an examination report, can be called from the schedule window  21 , and a transition can also be made from the report creation window  27  to report creation windows  27   a ,  27   b  which have different functions.  
     [0058] Further, a management window  28  for setting the various operations of the image filing apparatus  3  can be called from the schedule window  21 . A biological information management window  28   a  for setting operations related to biological information (described hereinafter), and a report management window  28   b  for setting operations related to report creation, for example, or the like, can be called from the management window  28 . In addition, a template editing window  28   ba  for editing report templates, and a set phrase editing window  28   bb  for editing set phrases used for report creation, for example, or similar, can be called from the report management window  28   b.    
     [0059] Next, the operation of the present embodiment having such a constitution will be described.  
     [0060] An example of the overall flow of the operation of the image filing apparatus  3  will be described using FIG. 6.  
     [0061] First, upon startup of the image filing apparatus  3 , the login window  20  is displayed in step S 1 , and operator authentication is performed here. When the operator logs in following authentication, the schedule window  21  is displayed in step S 2 , whereupon an examination schedule is confirmed.  
     [0062] Thereafter, when the patient to undergo the examination is a new patient, in step S 3 , patient information is registered after calling the patient list window  22  and the patient information window  22   a . Next, in step S 4 , a new examination reservation is inputted after calling the examination information window  23 .  
     [0063] Next, in step S 5 , the examination performance window  24  is called and an examination is performed using the endoscope system  2 , which is connected to the image filing apparatus  3 . Images obtained by the endoscope system  2  are stored in the image filing apparatus  3 . After the examination has ended, in step S 6 , the image selection window  26  is called and images to be used in an examination report that is created are selected from among images obtained while the examination was performed. In step S 7 , the report creation windows  27 ,  27   a ,  27   b  are called and an examination report is created. Further, according to requirements, the patient biological information window  25  can be called with respect to optional timing after the examination has ended, and patient biological information captured in the course of the examination can be referenced. The above description constitutes an example of the overall flow of operation.  
     [0064] Independently of the overall flow of operation, it is possible, according to requirements, to call the management window  28  with respect to optional timing to perform setting for the various operations of the image filing apparatus  3 .  
     [0065] Next, the operation for performing setting of the various operations of the image filing apparatus  3  in the management window  28  will be described. The management window  28  is used, for example, to register and edit information on patients and examiners which is inputted as examination information, to perform setting of required items of patient information and examination information, and so forth, setting for various information related to report creation, and setting for various information related to patient biological information.  
     [0066] Of the operations of the management window  28 , a description will first be provided for the operation of setting various information related to patient biological information, using FIGS. 7 and 8. The biological information management window  28   a  is called from the management window  28 .  
     [0067] First, the patient monitoring apparatus  4  is selected for use in step S 30 . Next, in step S 31 , a choice is made of whether or not to make a blood pressure recording. When a blood pressure recording is not made, step S 36  follows. When a blood pressure recording is made, step S 32  follows and a choice is made of whether or not to set maximum and minimum blood pressure values at which a warning is to be provided. When such values are to be set, step S 33  follows and a choice is made of whether or not to allocate default maximum and minimum blood pressure values as the set values. When default values are allocated, step S 34  follows and the default maximum and minimum blood pressure values are allocated as the set values, and processing proceeds to step S 36 . A minimum blood pressure of 40 mmHg and a maximum blood pressure of 180 mmHg, for example, can be set as default values. When default values are not allocated, step S 35  follows, and the maximum and minimum blood pressure values are set manually, and processing proceeds to step S 36 . When maximum and minimum blood pressure values at which a warning is to be provided are not set, processing proceeds to step S 36  without any setting being made.  
     [0068] Next, in step S 36 , a choice is made of whether or not to make a pulse rate recording. When a pulse rate recording is not made, step S 37  follows. When a pulse rate recording is made, step S 32  follows, whereupon a choice is made of whether or not to set maximum and minimum pulse rates at which a warning is to be provided. When such pulse rates are set, step S 33  follows and a choice is made of whether or not to allocate default maximum and minimum pulse rates as set values. When default values are allocated, step S 34  follows and default maximum and minimum pulse rates are allocated as set values, and processing proceeds to step S 37 . A minimum pulse rate of 40 beats per minute and a maximum pulse rate of 180 beats per minute, for example, can be set as default values. When default values are not allocated, step S 35  follows, and the maximum and minimum pulse rates are set manually, and processing proceeds to step S 37 . When maximum and minimum pulse rates at which a warning is to be provided are not set, processing proceeds to step S 37  without any setting being made.  
     [0069] Next, in step S 37 , a choice is made of whether or not to make an arterial blood oxygen concentration recording. When an arterial blood oxygen concentration recording is not made, step S 38  follows. When an arterial blood oxygen concentration recording is made, step S 32  follows, whereupon a choice is made of whether or not to set maximum and minimum an arterial blood oxygen concentrations at which a warning is to be provided. When such arterial blood oxygen concentrations are set, step S 33  follows and a choice is made of whether or not to allocate default maximum and minimum arterial blood oxygen concentrations as set values. When default values are allocated, step S 34  follows and default maximum and minimum arterial blood oxygen concentrations are allocated as set values, and processing proceeds to step S 38 . A minimum arterial blood oxygen concentration of 85 (%) and a maximum arterial blood oxygen concentration of 100 (%), for example, can be set as default values. When default values are not allocated, step S 35  follows, and the maximum and minimum arterial blood oxygen concentrations are set manually, and processing proceeds to step S 38 . When maximum and minimum arterial blood oxygen concentrations at which a warning is to be provided are not set, processing proceeds to step S 38  without any setting being made.  
     [0070] Next, an interval for recording biological information is set in step S 38 . Thereafter, in step S 39 , the serial port parameters are set. Here, for example, the port number to which the patient monitoring apparatus  4  is connected, the data bits, the stop bit, the parity, and the like, are set. When setting is complete, the setting of various information relating to patient biological information ends.  
     [0071] Next, among the operations of the management windows  28 , a description is provided for the operation of setting various information related to report creation. The report management window  28   b , which is called from the management window  28 , permits the setting of various conditions and so forth related to the editing of set phrases and medical terms or similar used for opinions appearing in reports, the editing of report templates, and the editing of reports.  
     [0072] Here, a description will be provided using FIG. 9 for the operation of editing a report template, which is performed using the template editing window  28   ba.    
     [0073] Patient information and examination information registered in steps S 3  and S 4  of FIG. 6 are registered in a database, and this data can be reflected in a report. The operator enters optional text in the template editing window  28   ba , and inserts information registered in the database, to thereby edit a template. An opinion and diagnostic information entered in the report creation window  27 , patient biological information registered during an examination by means of an operation described hereinafter, and images selected by means of the image selection window  26  can also be reflected in a report. FIG. 9 shows an example of a template which has been edited using the template editing window  28   ba . In FIG. 9, information registered in the database is allocated as half-tone dot meshed text.  
     [0074] Next, a description is provided for the operation of an actual endoscopic examination, using FIG. 10. First, in step S 51 , the schedule window  21  opens, and examinations which have been reserved for that day are confirmed, and, in step S 52 , the examination in question is selected, and the examination performance window  24  opens.  
     [0075] As shown in FIG. 11, the examination performance window  24  has disposed therein: a display area  24   a  for displaying in real time endoscopic images picked up by the video processor  6 ; a Start button  24   b  for starting the examination; an End button  24   c  for ending the examination; a Release button  24   d  for performing image recording; an examination information button  24   e  for displaying examination information of an examination being performed; a patient information button  24   f  for displaying patient information of a patient being examined; and a Close button  24   g  for closing the examination performance window  24 . Further disposed in the examination performance window  24  are: an index image area  24   h  for displaying recorded images in reduced form; a source field  24   i  for displaying a variety of connected video processors; a maximum blood pressure field  24   j  and a minimum blood pressure field  24   k  for displaying maximum and minimum blood pressures respectively recorded by means of an operation described hereinafter; a pulse field  24   l  for displaying the patient&#39;s pulse; and an arterial blood oxygen concentration (SpO 2 ) field  24   m  for displaying arterial blood oxygen concentration.  
     [0076] In step S 53 , the examination is started by pressing an examination start button (not illustrated) of the keyboard  9 , or the start button  24   b . The examination starts and, in step S 54 , if the time of the interval for recording biological information (set by means of the operation described earlier) elapses after biological information recording is performed at the start or end of the examination, biological information recording is performed in step S 55 . In this recording operation, the image filing apparatus  3  accesses the communication interface  4   s  of the patient monitoring apparatus  4  via the communication interface  3   i , and biological information held in the RAM  4   c  is read in accordance with the serial port parameters and recorded on the hard disk  3   e  along with the actual time. Each item of biological information is registered in the database so as to be related with registered examination information. Here, each type of measured biological information is displayed in the maximum blood pressure field  24   j , the minimum blood pressure field  24   k , the pulse field  24   l , and the arterial blood oxygen concentration field  24   m  respectively. When the time of the recording interval has not elapsed, processing proceeds to step S 56 .  
     [0077] When it is detected in step S 56  that the release switch  5   f  of the endoscope  5 , or the release button  24   d  is depressed, step S 57  follows and image recording is performed. An image signal inputted from the video processor  6  via the video circuit  3   j  is A/D converted by the A/D conversion section  3   k  and stored in the image memory  3   l . When the release switch  5   f  or the release button  24   d  is depressed, this A/D converted image signal is recorded on the hard disk  3   e . At such time, each image is registered in the database so as to be related with registered examination information. When image recording is complete, step S 58  follows, and, when it is not detected that the examination end button (not illustrated) of the keyboard  9 , or the end button  24   c  is depressed, processing returns to step S 54 . When neither the release switch  5   f  nor the release button  24   d  is depressed and it is detected in step S 58  that the examination end button or the end button  24   c  is depressed, processing proceeds to step S 59  and the examination ends.  
     [0078] That is, one item of examination information is constituted by examination information comprising patient information registered in an examination reservation, and image information and biological information recorded during the examination.  
     [0079] In cases where warning values are set, when measured values that exceed the warning values are recorded in step S 55 , these measured values are recorded with a warning flag attached thereto. This warning flag can be shown, for example, by changing the color of a measured value or by means of half-tone dot meshing processing, when displaying biological information recorded using the patient biological information window  25 .  
     [0080] Next, a description is provided for the operation of referencing patient biological information which has been recorded in this manner. An examination which has been performed is selected in the schedule window  21 , and when the patient biological information window  25  is called, the patient biological information window  25  opens as shown in FIG. 12. The patient biological information window  25  comprises: a patient information area  25   a  for displaying patient information entered in the patient information window  22   a ; an examination information area  25   b  for displaying examination information entered in the examination information window  23 ; a monitoring apparatus information area  25   c  for displaying information entered in the biological information management window  28   b ; a measured value area  25   d  for displaying patient biological information recorded in the examination performance operation described hereinabove; a graph button  25   e  for converting information in the measured value area  25   d  into a graph; and an OK button  25   f  for closing the patient biological information window  25 .  
     [0081] The monitoring apparatus information area  25   c  comprises: a blood pressure check box  25   ca ; blood pressure maximum value and minimum value display sections  25   cb ; a pulse check box  25   cc ; pulse maximum value and minimum value display sections  25   cd ; an arterial blood oxygen concentration check box  25   ce ; and arterial blood oxygen concentration maximum value and minimum value display sections  25   cf.    
     [0082] When, in the operation of setting various information related to patient biological information described earlier, setting is performed to make a blood pressure measurement, the blood pressure check box  25   ca  is checked automatically and set blood pressure maximum and minimum values are displayed in the blood pressure maximum and minimum value display sections  25   cb  respectively. When setting is performed to make a pulse measurement, the pulse check box  25   cc  is checked automatically and set pulse maximum and minimum values are displayed in the pulse maximum and minimum value display sections  25   cd  respectively.  
     [0083] When setting is performed to make an arterial blood oxygen concentration measurement, the arterial blood oxygen concentration check box  25   ce  is checked automatically and set arterial blood oxygen concentration maximum and minimum values are displayed in the arterial blood oxygen concentration maximum and minimum value display sections  25   cf  respectively. Patient biological information which is recorded while an examination is performed is displayed chronologically in the measured value area  25   d . Among the measured values, values recorded with an attached warning flag at the time of image recording, which are higher than a set maximum value or lower than a set minimum value are displayed in a color different from that used for normal values or are displayed with half-tone dot meshing as shown in FIG. 11.  
     [0084] Clicking on the graph button  25   e  causes the values displayed in the measured value area  25   d  to be displayed as a line graph or the like. Pushing the OK button  25   f  causes the patient biological information window  25  to close. Further, data displayed in the patient biological information window  25  is preset data or data recorded during an examination, and cannot be changed after the examination has ended.  
     [0085] A description follows for the operation of creating an examination report using image information and biological information thus recorded.  
     [0086] The schedule window  21  is used to select an examination which has been performed, and to then call the image selection window  26  where endoscopic images recorded during an examination are confirmed and images that are to be attached to a report are selected. If required, comments are appended to selected images.  
     [0087] Processing then moves to the report creation window  27  in which examination information that comprises patient information inputted at the time of a reservation, endoscopic images selected using the image selection window  26 , and biological information are already inputted. Here, opinions and supplementary information are entered by the examiner and, when an edited template is called in the template editing window  28   ba , the above-described patient information, examination information, endoscopic images, and biological information are respectively allocated to locations allocated for information registered in a template database, to thereby complete one report. In this report, with respect to biological information recorded while an examination is performed, values which are higher than a set maximum value or lower than a set minimum value are displayed in a color different from that used for normal values or are displayed with half-tone dot meshing, similarly to the patient biological information window  25 .  
     [0088] According to the present invention, it is obvious that, in a broad scope, different embodiments can be constituted based on the present invention without departing from the spirit and scope of the invention. Other than the restrictions placed by the attached claims, the present invention is not limited to or by specific embodiments.