Patent Publication Number: US-2021174115-A1

Title: Medical image processing apparatus, medical image processing method, program, and endoscope system

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     The present application is a Continuation of PCT International Application No. PCT/JP2019/034790 filed on Sep. 4, 2019 claiming priority under 35 U.S.C § 119(a) to Japanese Patent Application No. 2018-169399 filed on Sep. 11, 2018. Each of the above applications is hereby expressly incorporated by reference, in its entirety, into the present application. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates to a medical image processing apparatus, a medical image processing method, a program, and an endoscope system, and particularly to a technique for reporting a region of interest in a time-series image. 
     2. Description of the Related Art 
     In the medical field, inspections are performed by using an endoscope system. In recent years, a technique for automatically detecting a region of interest such as a lesion from an endoscopic image captured by an endoscope-scope is expected to lead to prevention of missing of a lesion. 
     As a method for reporting the automatically detected result to a surgeon, for example, there is emphasis display by superposing a figure on the region of interest in the image. 
     JP2011-160848A discloses an image processing apparatus that, when performing display manner setting processing of a display image generated based on a normal light image having information within a wavelength band of white light, detects a region of interest based on a feature quantity of a pixel within a specific wavelength band light image, performs processing for setting an elapsed time based on a detection result of the region of interest, and, until the elapsed time elapses, displays a display image for which alert information for the region of interest is set. A movement amount in the normal light image is detected, and, as the detected movement amount is larger, a shorter overtime is set. 
     In addition, WO2017/203560A discloses an endoscopic image processing apparatus that detects a region of interest from sequentially input observation images of a subject, and, if the region of interest is continuously detected, performs emphasis processing of a position corresponding to the region of interest, on the observation images of the subject that are input after a first period elapses from a time point of a start of detection of the region of interest. The first period is set based on at least one of position information or size information of the region of interest in the observation images. 
     SUMMARY OF THE INVENTION 
     Since the image processing apparatus according to JP2011-160848A displays the display image for which alert information is set until the set elapsed time elapses, even if the region of interest disappears from a screen, the alert information may be continuously displayed. Such alert information may unfortunately interrupt image observation. In addition, even if the shorter overtime is set as the movement amount is larger, unfortunately, it is not possible to emphasize the region of interest that tends to be missed. 
     Furthermore, in the endoscopic image processing apparatus according to WO2017/203560A, the emphasis processing is not performed immediately after detection of the region of interest, and thus, unfortunately, it is not possible to prevent the region of interest from being missed. In addition, it is likely that the emphasis processing is performed after a surgeon has found the region of interest, and unfortunately, it may interrupt image observation. 
     The present invention has been made in view of such circumstances, and an object is to provide a medical image processing apparatus, a medical image processing method, a program, and an endoscope system that report a region of interest without interrupting observation of a medical image. 
     In order to achieve the above object, a medical image processing apparatus according to an aspect is a medical image processing apparatus including: an emphasis processing unit that emphasizes a position of a region of interest included in a plurality of medical images sequentially displayed on a display unit; and a transition time setting unit that sets a transition time in accordance with a feature quantity of the region of interest, in which the emphasis processing unit emphasizes the position of the region of interest at a first emphasis level and, after the transition time has elapsed from emphasis at the first emphasis level, emphasizes the position of the region of interest at a second emphasis level relatively lower than the first emphasis level. 
     According to this aspect, the position of the region of interest is emphasized at the first emphasis level and, after the transition time has elapsed, is emphasized at the second emphasis level relatively lower than the first emphasis level. Thus, the region of interest can be reported without interrupting observation of the medical images. 
     According to the present invention, the region of interest can be reported without interrupting observation of the medical images. 
     The medical image processing apparatus preferably further includes: an image acquiring unit that acquires the plurality of medical images; a region-of-interest detecting unit that detects the region of interest from the medical images; and a feature quantity calculating unit that calculates the feature quantity of the region of interest. Thus, the plurality of medical images, the region of interest, and the feature quantity can be acquired appropriately. 
     The medical image processing apparatus preferably further includes: a display control unit that causes the display unit to sequentially display the plurality of medical images. Thus, the plurality of medical images in which the region of interest is emphasized can be sequentially displayed on the display unit. 
     The feature quantity is preferably calculated based on visibility of the region of interest. Thus, the transition time can be set appropriately. 
     The transition time setting unit preferably sets the transition time to a longer time as the visibility of the region of interest is relatively lower. Thus, the transition time can be set appropriately. 
     The feature quantity is preferably calculated based on a size of the region of interest in the medical images. Thus, the transition time can be set appropriately. 
     The transition time setting unit preferably sets the transition time to a longer time as the size of the region of interest in the medical images is relatively smaller. Thus, the transition time can be set appropriately. 
     The feature quantity is preferably calculated based on a position of the region of interest in the medical images. Thus, the transition time can be set appropriately. 
     The transition time setting unit preferably sets the transition time to a longer time as the position of the region of interest in the medical images is relatively closer to a periphery. Thus, the transition time can be set appropriately. 
     The feature quantity is preferably calculated based on luminance of the region of interest or a difference between the luminance of the region of interest and luminance of an outside region of the region of interest. Thus, the transition time can be set appropriately. 
     The transition time setting unit preferably sets the transition time to a longer time as the luminance of the region of interest is lower, or the difference between the luminance of the region of interest and the luminance of the outside region of the region of interest is smaller. Thus, the transition time can be set appropriately. 
     The feature quantity is preferably calculated based on color information of the region of interest or a difference between the color information of the region of interest and color information of an outside region of the region of interest. Thus, the transition time can be set appropriately. 
     The transition time setting unit preferably sets the transition time to a longer time as a difference between a color space of the region of interest and a color space of the outside region of the region of interest is smaller. Thus, the transition time can be set appropriately. 
     The feature quantity is preferably calculated based on a movement amount of the region of interest or a movement direction of the region of interest. Thus, the transition time can be set appropriately. 
     The transition time setting unit preferably sets the transition time to a longer time as the movement amount of the region of interest is larger. 
     Thus, the transition time can be set appropriately. 
     The transition time setting unit preferably resets the transition time in accordance with the feature quantity of the region of interest from emphasis at the first emphasis level until the transition time elapses. Thus, the transition time can be set appropriately. 
     The emphasis processing unit preferably places emphasis at the first emphasis level from emphasis at the first emphasis level until the transition time elapses. Thus, the position of the region of interest can be emphasized appropriately. 
     The emphasis processing unit preferably places emphasis while relatively, gradually decreasing an emphasis level from emphasis at the first emphasis level until the transition time elapses. Thus, the position of the region of interest can be emphasized appropriately. 
     The emphasis processing unit preferably ends emphasis when a fixed time elapses from emphasis at the second emphasis level. Thus, the region of interest can be emphasized without interrupting observation of the medical images. 
     The emphasis processing unit preferably places emphasis at the second emphasis level from emphasis at the second emphasis level until the fixed time elapses. Thus, the position of the region of interest can be emphasized appropriately. 
     The emphasis processing unit preferably places emphasis while relatively, gradually decreasing an emphasis level from emphasis at the second emphasis level until the fixed time elapses. Thus, the position of the region of interest can be emphasized appropriately. 
     In order to achieve the above object, an endoscope system according to an aspect is an endoscope system including: the above medical image processing apparatus; an endoscope that captures the plurality of medical images; and the display unit. 
     According to this aspect, the region of interest can be reported without interrupting observation of the medical images. 
     In order to achieve the above object, a medical image processing method according to an aspect is a medical image processing method including: an emphasis processing step for enhancing a position of a region of interest included in a plurality of medical images sequentially displayed on a display unit; and a transition time setting step for setting a transition time in accordance with a feature quantity of the region of interest, in which, in the emphasis processing step, the position of the region of interest is emphasized at a first emphasis level and, after the transition time has elapsed from emphasis at the first emphasis level, the position of the region of interest is emphasized at a second emphasis level relatively lower than the first emphasis level. 
     According to this aspect, the region of interest can be reported without interrupting observation of the medical images. A program causing a computer to execute the above medical image processing method is also included in this aspect. 
     According to the present invention, the region of interest can be reported without interrupting observation of the medical images. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  illustrates an overview of an overall configuration of an endoscope system; 
         FIG. 2  is a block diagram illustrating an electric configuration of a medical image processing apparatus; 
         FIG. 3  is a diagram for describing a coordinates calculating unit and a reporting information display control unit; 
         FIG. 4  is a flowchart illustrating details of an emphasis processing step; 
         FIG. 5  illustrates transition of an emphasis level of a region of interest; 
         FIG. 6  illustrates an example of transition of emphasis display of a region of interest; 
         FIG. 7  illustrates an example of a manner for changing an emphasis level of a region of interest by changing the color of a figure; 
         FIG. 8  illustrates an example of a manner for changing an emphasis level of a region of interest by changing the line thickness of a figure; 
         FIG. 9  illustrates an example of a manner for changing an emphasis level of a region of interest by changing the shape of a figure; 
         FIG. 10  illustrates an example of a manner for changing an emphasis level of a region of interest by changing the concentration of a figure; 
         FIG. 11  illustrates continuous transition of an emphasis level of a region of interest; 
         FIG. 12  is a flowchart illustrating each process of a medical image processing method; 
         FIG. 13  is a flowchart illustrating details of a transition time resetting step; and 
         FIG. 14  illustrates an example of transition of an emphasis level of a region of interest. 
     
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Hereinafter, preferred embodiments will be described in detail with reference to the accompanying drawings. 
     Overall Configuration of Endoscope System 
       FIG. 1  illustrates an overview of an overall configuration of an endoscope system  9  including a medical image processing apparatus according to an embodiment. As illustrated in  FIG. 1 , the endoscope system  9  includes an endoscope  10 , which is an electronic endoscope, a light source apparatus  11 , an endoscope processor apparatus  12 , a display apparatus  13 , a medical image processing apparatus  14 , an operating unit  15 , and a display  16 . 
     The endoscope  10  corresponds to a time-series image acquiring unit that acquires a time-series image including a photographic subject image and is a flexible endoscope, for example. The endoscope  10  has an insertion part  20 , a handheld operating unit  21 , and a universal cord  22 . The insertion part  20  is inserted into a subject and has a distal end and a base end. The handheld operating unit  21  is disposed continuously with the base end side of the insertion part  20  and held by a surgeon to perform various operations. The universal cord  22  is disposed continuously with the handheld operating unit  21 . 
     The entire insertion part  20  is formed to have a small diameter and an elongated shape. The insertion part  20  is constituted by a soft part  25 , a bending part  26 , and a distal end part  27 , which are disposed continuously with each other in this order from the base end side to the distal end side. The soft part  25  has flexibility. The bending part  26  is bendable by an operation of the handheld operating unit  21 . An imaging optical system (objective lens), an imaging element  28 , and the like, which are not illustrated, are incorporated in the distal end part  27 . 
     The imaging element  28  is an imaging element of a complementary metal oxide semiconductor (CMOS) type or a charge coupled device (CCD) type. Image light of a part to be observed is incident on an imaging surface of the imaging element  28  through an observation window and the objective lens. The observation window, which is not illustrated, is open on a distal end surface of the distal end part  27 , and the objective lens, which is not illustrated, is disposed behind the observation window. The imaging element  28  captures the image light of the part to be observed, which is incident on the imaging surface (converts the image light into an electric signal) and outputs an image signal. 
     The handheld operating unit  21  is provided with various operating members to be operated by a surgeon. Specifically, the handheld operating unit  21  is provided with two types of bending operation knobs  29  to be used for a bending operation of the bending part  26 , an air/water supply button  30  for air supply/water supply operations, and a suction button  31  for a suction operation. The handheld operating unit  21  is further provided with a still image pick-up command unit  32  for issuing a command for capturing a still image  39  of the part to be observed and a treatment tool introduction port  33  for inserting a treatment tool (not illustrated) into a treatment tool insertion path (not illustrated) that penetrates through the insertion part  20 . 
     The universal cord  22  is a connection cord for connecting the endoscope  10  to the light source apparatus  11 . The universal cord  22  contains a light guide  35  that penetrates through the insertion part  20 , a signal cable  36 , and a fluid tube (not illustrated). In addition, an end portion of the universal cord  22  is provided with a connector  37   a  that is connected to the light source apparatus  11  and a connector  37   b  that branches off from the connector  37   a  and is connected to the endoscope processor apparatus  12 . 
     Since the connector  37   a  is connected to the light source apparatus  11 , the light guide  35  and the fluid tube (not illustrated) are inserted into the light source apparatus  11 . Thus, through the light guide  35  and the fluid tube (not illustrated), necessary illumination light, water, and gas are supplied from the light source apparatus  11  to the endoscope  10 . As a result, the part to be observed is irradiated with the illumination light from an illumination window (not illustrated) on the distal end surface of the distal end part  27 . In accordance with a pressing operation on the above-described air/water supply button  30 , the gas or water is injected from an air/water supply nozzle (not illustrated) on the distal end surface of the distal end part  27  to the observation window (not illustrated) on the distal end surface. 
     Since the connector  37   b  is connected to the endoscope processor apparatus  12 , the signal cable  36  is electrically connected to the endoscope processor apparatus  12 . Thus, through the signal cable  36 , an image signal of the part to be observed is output from the imaging element  28  of the endoscope  10  to the endoscope processor apparatus  12 , and also, a control signal is output from the endoscope processor apparatus  12  to the endoscope  10 . 
     The light source apparatus  11  supplies the illumination light through the connector  37   a  to the light guide  35  of the endoscope  10 . As the illumination light, light in various wavelength ranges in accordance with an observation purpose, such as white light (light in a white wavelength range or light in a plurality of wavelength ranges), light in one or more specific wavelength ranges, or a combination thereof is selected. Note that the specific wavelength range is narrower than the white wavelength range. 
     A first example of the specific wavelength range is, for example, a blue range or a green range in a visible range. The wavelength range of the first example includes a wavelength range of greater than or equal to 390 nm and less than or equal to 450 nm or greater than or equal to 530 nm and less than or equal to 550 nm, and light of the first example has a peak wavelength in the wavelength range of greater than or equal to 390 nm and less than or equal to 450 nm or greater than or equal to 530 nm and less than or equal to 550 nm. 
     A second example of the specific wavelength range is, for example, a red range in a visible range. The wavelength range of the second example includes a wavelength range of greater than or equal to 585 nm and less than or equal to 615 nm or greater than or equal to 610 nm and less than or equal to 730 nm, and light of the second example has a peak wavelength in the wavelength range of greater than or equal to 585 nm and less than or equal to 615 nm or greater than or equal to 610 nm and less than or equal to 730 nm. 
     A third example of the specific wavelength range includes a wavelength range in which oxidized hemoglobin and reduced hemoglobin have different absorption coefficients, and light of the third example has a peak wavelength in the wavelength range in which oxidized hemoglobin and reduced hemoglobin have different absorption coefficients. The wavelength range of the third example includes a wavelength range of 400±10 nm, 440±10 nm, 470±10 nm, or greater than or equal to 600 nm and less than or equal to 750 nm, and light of the third example has a peak wavelength in the wavelength range of 400±10 nm, 440±10 nm, 470±10 nm, or greater than or equal to 600 nm and less than or equal to 750 nm. 
     A fourth example of the specific wavelength range is the wavelength range (from 390 nm to 470 nm) of excitation light that is used for observing fluorescence (fluorescence observation) emitted by a fluorescent material in a living body and that excites the fluorescent material. 
     A fifth example of the specific wavelength range is the wavelength range of infrared light. The wavelength range of the fifth example includes a wavelength range of greater than or equal to 790 nm and less than or equal to 820 nm or greater than or equal to 905 nm and less than or equal to 970 nm, and light of the fifth example has a peak wavelength in the wavelength range of greater than or equal to 790 nm and less than or equal to 820 nm or greater than or equal to 905 nm and less than or equal to 970 nm. 
     The endoscope processor apparatus  12  controls operations of the endoscope  10  through the connector  37   b  and the signal cable  36 . In addition, based on the image signal acquired from the imaging element  28  of the endoscope  10  through the connector  37   b  and the signal cable  36 , the endoscope processor apparatus  12  generates a moving image  38  that is a time-series image (example of a plurality of medical images) formed of time-series frame images  38   a  (see  FIG. 2 ) including the photographic subject image. The frame rate of the moving image  38  is, for example, 30 fps (frame per second). 
     Furthermore, if the still image pick-up command unit  32  is operated in the handheld operating unit  21  of the endoscope  10 , concurrently with the generation of the moving image  38 , the endoscope processor apparatus  12  acquires one frame image  38   a  in the moving image  38  as the still image  39  in accordance with the timing of an imaging command. 
     The moving image  38  and the still image  39  are medical images obtained by capturing images of the inside of the subject, that is, a living body. In addition, if the moving image  38  and the still image  39  are images obtained with the above-described light in the specific wavelength range (special light), both are special light images. In addition, the endoscope processor apparatus  12  outputs the generated moving image  38  and the still image  39  to each of the display apparatus  13  and the medical image processing apparatus  14 . 
     Note that the endoscope processor apparatus  12  may generate (acquire) the special light image having information on the above-described specific wavelength range, based on a usual light image obtained with the above-described white light. In this case, the endoscope processor apparatus  12  functions as a special light image acquiring unit. Then, the endoscope processor apparatus  12  obtains a signal in the specific wavelength range by performing calculation based on RGB color information of red, green, and blue or CMY color information of cyan, magenta, and yellow included in the usual light image. 
     Based on, for example, at least one of the usual light image obtained with the above-described white light or the special light image obtained with the above-described light in the specific wavelength range (special light), the endoscope processor apparatus  12  may generate a feature quantity image such as a known oxygen saturation image. In this case, the endoscope processor apparatus  12  functions as a feature quantity image generating unit. Note that each of the moving image  38  and the still image  39  including the above-described in-living-body image, the usual light image, the special light image, and the feature quantity image is a medical image obtained by converting results of imaging or measuring of a human body into an image for the purpose of image diagnosis or inspection. 
     The display apparatus  13  is connected to the endoscope processor apparatus  12  and displays the moving image  38  and the still image  39  input from the endoscope processor apparatus  12 . A surgeon (physician) operates the insertion part  20  back and forth, for example, while viewing the moving image  38  displayed on the display apparatus  13 , and, if a lesion or the like is found at the part to be observed, the surgeon (physician) operates the still image pick-up command unit  32  to capture a still image of the part to be observed for diagnosis, biopsy, or the like. 
     Configuration of Medical Image Processing Apparatus 
     The medical image processing apparatus  14  mainly reports a region of interest included in a time-series image to a surgeon, and, for example, a personal computer is used as the medical image processing apparatus  14  in this embodiment. In addition, a keyboard, a mouse, or the like connected to the personal computer via wired or wireless connection is used as the operating unit  15 , and any monitor, such as a liquid crystal monitor that can be connected to the personal computer, is used as the display  16  (example of a display unit). 
       FIG. 2  is a block diagram illustrating an electric configuration of the medical image processing apparatus  14 . The medical image processing apparatus  14  illustrated in  FIG. 2  is mainly constituted by a time-series image acquiring unit  40 , a region-of-interest detecting unit  41 , a region-of-interest information acquiring unit  42 , a coordinates calculating unit  43 , a control unit  44 , a display control unit  45 , a transition time setting unit  46 , and a storage unit  47 . 
     Based on a program (medical image processing program)  51  stored in the storage unit  47 , the control unit  44  generally controls the time-series image acquiring unit  40 , the region-of-interest detecting unit  41 , the region-of-interest information acquiring unit  42 , the coordinates calculating unit  43 , the display control unit  45 , and the transition time setting unit  46  and functions as part of these units. 
     The storage unit  47  is a part that stores detection results obtained by the region-of-interest detecting unit  41  and stores a captured still image  39 , and also stores information or the like related to various controls of a figure storage unit  50  that stores figures constituting the reporting information, a program  51 , and the medical image processing apparatus  14 . 
     The time-series image acquiring unit  40  acquires, from the endoscope processor apparatus  12  ( FIG. 1 ), the moving image  38  (moving image  38  captured by the endoscope  10  in this example), formed of the time-series frame images  38   a  including a photographic subject image, by using an image input/output interface, which is not illustrated, connected to the endoscope processor apparatus  12  via wired or wireless connection. In addition, if the above-described still image  39  is captured while the moving image  38  is being captured by the endoscope  10 , the time-series image acquiring unit  40  acquires the moving image  38  and the still image  39  from the endoscope processor apparatus  12 . 
     Note that, instead of directly acquiring the moving image  38  from the endoscope processor apparatus  12 , the time-series image acquiring unit  40  may acquire the moving image  38  via any information storage medium, such as a memory card or a hard disk apparatus. In addition, the time-series image acquiring unit  40  may acquire, via the Internet, the moving image  38  uploaded on a server, database, or the like on the Internet. 
     The region-of-interest detecting unit  41  is a part that detects a region of interest from the moving image  38  captured during observation of a body cavity. The region-of-interest detecting unit  41  calculates a feature quantity (an example of an image feature quantity) of the frame images  38   a  (or the frame images  38   a  decimated at certain intervals) of the moving image  38 , includes a convolutional neural network (CNN) that performs recognition processing of the region of interest within an image, and calculates a feature quantity from color information, a pixel value gradient, or the like within the image. By using the calculated feature quantity, the region-of-interest detecting unit  41  detects the region of interest such as a lesion in the image. 
     As examples of the region of interest, there are a polyp, cancer, a colon diverticulum, inflammation, an endoscopic mucosal resection (EMR) scar, an endoscopic submucosal dissection (ESD) scar, a clipped part, a bleeding point, perforation, an atypical vessel, a treatment tool, and the like. 
     The region-of-interest detecting unit  41  can further acquire a recognition result of, for example, category classification as to whether the detected region of interest belongs to which of a plurality of categories about the lesion, such as “tumorous”, “non-tumorous”, and “others”. 
     Note that the region-of-interest detecting unit  41  is not limited to the one that detects the region of interest by the CNN, but may detect the region of interest by analyzing a feature quantity such as the color, pixel value gradient, shape, or size the image through image processing. 
     If the region-of-interest detecting unit  41  detects the region of interest, the region-of-interest information acquiring unit  42  acquires region-of-interest information indicating the region of interest from the region-of-interest detecting unit  41 . The region-of-interest information can be, for example, information of coordinates of a contour of the region of interest in the image. 
     The coordinates calculating unit  43  acquires the region-of-interest information from the region-of-interest information acquiring unit  42  and, based on the acquired region-of-interest information, calculates one or more sets of coordinates of interest indicating the position of the region of interest in the moving image  38 . The coordinates calculating unit  43  calculates, for example, one or more sets of coordinates of interest on the contour of a polygon or a circle that surrounds a region of interest. As the one or more sets of coordinates of interest, sets of coordinates of vertexes of the polygon or sets of coordinates of midpoints of sides of the polygon may be calculated, or sets coordinates of points at which a circumference of the circle is equally divided into a plurality of parts may be calculated. 
     The transition time setting unit  46  acquires a feature quantity of the region of interest from the region-of-interest information acquiring unit  42  and sets a transition time for emphasis processing in accordance with the acquired feature quantity. 
     The display control unit  45  includes an image display control unit  45 A and a reporting information display control unit  45 B. The image display control unit  45 A outputs the moving image  38  acquired by the time-series image acquiring unit  40  to the display  16  and causes the display  16  to display the moving image  38 . That is, the display  16  sequentially displays a plurality of frame images  38   a.    
     Based on a set of coordinates of interest calculated by the coordinates calculating unit  43 , and based on the transition time set by the transition time setting unit  46 , the reporting information display control unit  45 B outputs reporting information constituted by a figure for reporting the region of interest to the display  16 . Thus, in accordance with the transition time, the reporting information is superposed on the moving image  38  displayed on the display  16 , and the position of the region of interest is emphasized by the reporting information. The reporting information display control unit  45 B may superpose a plurality of figures, the number of which equals to the number of a plurality of sets of coordinates of interest or may superpose a circular figure or a rectangular figure obtained by connecting the plurality of sets of coordinates of interest with a straight line. 
     Medical Image Processing Method: First Embodiment 
     A medical image processing method using the endoscope system  9  is described.  FIG. 3  is a flowchart illustrating each process of the medical image processing method according to a first embodiment. The medical image processing method includes an image acquisition step (step S 1 ), a region-of-interest detection step (step S 2 ), a feature quantity calculation step (step S 4 ), a transition time setting step (step S 5 ), and an emphasis processing step (step S 6 ). 
     In step S 1 , the time-series image acquiring unit  40  acquires a frame image  38   a  from the moving image  38  captured by the endoscope  10 . 
     In step S 2 , the region-of-interest detecting unit  41  detects a region of interest from the frame image  38   a  acquired in step S 1 . 
     In step S 3 , the region-of-interest information acquiring unit  42  determines whether a new region of interest is detected in step S 2 . That is, the region-of-interest information acquiring unit  42  determines whether the region of interest detected in step S 2  is a region of interest that is detected in a last-time frame image  38   a  and that is successively detected in the current frame image  38   a  or a new region of interest that is not detected in the last-time frame image  38   a . If a new region of interest is detected in step S 2 , the process proceeds to step S 4 . If the region of interest detected in step S 2  is not a new region of interest, or if a region of interest is not detected, the process proceeds to step S 6 . 
     In step S 4 , the region-of-interest information acquiring unit  42  (example of a feature quantity calculating unit) calculates a feature quantity of the new region of interest detected by the region-of-interest detecting unit  41 . The feature quantity is calculated based on the visibility of the region of interest. 
     In step S 5 , the transition time setting unit  46  sets a transition time Ta of the new region of interest in accordance with the feature quantity calculated in step S 4 . The transition time Ta is set to a longer time as the visibility of the region of interest is relatively lower. 
     The transition time setting unit  46  stores, in association with the new region of interest, the set transition time Ta in a memory that is not illustrated. In addition, the transition time setting unit  46  acquires a time tf at which a time measuring unit that is not illustrated initially detects the new region of interest and stores, in association with the new region of interest, the acquired time tf in the memory that is not illustrated. 
     In step S 6 , the medical image processing apparatus  14  emphasizes the position of the region of interest included in the time-series image. That is, the image display control unit  45 A causes the display  16  to display the frame image  38   a . In addition, the reporting information display control unit  45 B superposes reporting information constituted by a figure at the position of the region of interest detected in step S 2  in the frame image  38   a  displayed on the display  16 . 
     Herein, the image display control unit  45 A causes the display  16  to display the frame image  38   a  in which the region of interest is detected in step S 2 . If the processing time from step S 3  to step S 6  is long, the image display control unit  45 A may superpose the reporting information on frame images  38   a  after the frame image  38   a  in which the region of interest is detected in step S 2 . 
     Immediately after a lesion is detected, movement on a screen is large in many cases. Thus, in order to prevent missing, higher-level emphasis display is needed. On the other hand, after a specific time elapses from the detection and a user finds a region of interest, emphasis display may interrupt observation and is not preferable. Thus, in step S 6 , the reporting information display control unit  45 B (example of an emphasis processing unit) emphasizes the position of the region of interest at a first emphasis level and, after the transition time has elapsed from emphasis at the first emphasis level, emphasizes the position of the region of interest at a second emphasis level relatively lower than the first emphasis level. Details of the emphasis processing will be described later. 
     In subsequent step S 7 , the control unit  44  determines if an endoscope inspection ends. If the inspection ends, the process in this flowchart ends. If the inspection does not end, substantially the same process from step S 1  is repeated. 
     Emphasis Processing Step 
       FIG. 4  is a flowchart illustrating details of the emphasis processing step (step S 6 ). 
     In step S 11 , the reporting information display control unit  45 B selects one region of interest from among regions of interest detected in step S 2 . 
     In step S 12 , the reporting information display control unit  45 B determines whether the transition time Ta has elapsed from the initial detection of the region of interest selected in step S 11 . 
     That is, the reporting information display control unit  45 B reads, from the memory that is not illustrated, the transition time Ta associated with the region of interest selected in step S 11  and the time tf at which the region of interest selected in S 11  is initially detected. The reporting information display control unit  45 B further reads a current time tc from the time measuring unit that is not illustrated. Then, the reporting information display control unit  45 B calculates an elapsed time Tp=tc−tf from the initial detection of the region of interest selected in step S 11  and compares the elapsed time Tp with the transition time Ta. 
     If the time from the initial detection of the region of interest is shorter than the transition time Ta, the process proceeds to step S 13 . In step S 13 , the reporting information display control unit  45 B emphasizes the region of interest selected in step S 11  at a first emphasis level LV1. In this manner, immediately after the detection, emphasis is placed at the first emphasis level LV1, which is a relatively high emphasis level, and thus, a surgeon can be prevented from missing the region of interest. 
     If the time from the initial detection of the region of interest is longer than or equal to the transition time Ta, the process proceeds to step S 14 . In step S 14 , the reporting information display control unit  45 B determines whether an end time Te has elapsed from the initial detection of the region of interest selected in step S 11 . Herein, the end time Te=transition time Ta+fixed time Tb, and the reporting information display control unit  45 B compares the elapsed time Tp with the end time Te. The fixed time Tb is stored in advance in the memory that is not illustrated. The fixed time Tb may be set to the same time as the transition time Ta. 
     If the time from the initial detection of the region of interest is shorter than the end time Te, the process proceeds to step S 15 . In step S 15 , the reporting information display control unit  45 B emphasizes the region of interest selected in step S 11  at a second emphasis level LV2. The second emphasis level LV2 is an emphasis level relatively lower than the first emphasis level LV1. 
     In this manner, after the transition time Ta has elapsed, emphasis is placed at the second emphasis level LV2, which is a relatively low emphasis level, and thus, appropriate emphasis display can be performed. 
     If the time from the initial detection of the region of interest is longer than or equal to the end time Te, the process proceeds to step S 16 . In step S 16 , the reporting information display control unit  45 B ends emphasis of the region of interest selected in step S 11 . That is, after the end time Te has elapsed, the reporting information display control unit  45 B does not emphasize the region of interest selected in step S 11 . 
     In this manner, since the emphasis processing is not performed after the end time Te has elapsed, observation of the region of interest found by a surgeon is not interrupted. 
     In subsequent step S 17 , the reporting information display control unit  45 B determines whether the emphasis processing for all regions of interest detected in step S 2  has ended. If the emphasis processing for all regions of interest has ended, the process in this flowchart ends. If the emphasis processing for all regions of interest has not ended, the process returns to step S 1  to select a different region of interest, and substantially the same process is repeated. 
     Note that even a detected region that is detected once and for which the transition time Ta is set, a region of interest not detected in step S 2  is not selected in step S 11 . That is, a region of interest not detected in step S 2  is not subjected to emphasis processing regardless of the set transition time Ta. Thus, the region of interest that disappears from the screen is not subjected to emphasis processing, and observation of the moving image by a surgeon is not interrupted by unnecessary emphasis processing. In addition, the region of interest that is likely to be missed can be emphasized. 
     Display Examples of Emphasis Processing 
       FIG. 5  illustrates an example of transition of an emphasis level of a region of interest. In the example illustrated in  FIG. 5 , a time t1 is a time at which the region of interest is detected. In addition, a time t2 is a time at which the transition time Ta has elapsed from the time t1. Furthermore, a time t3 is a time at which the end time Te (=Ta+Tb) has elapsed from the time t1. 
       FIG. 6  illustrates an example of transition of emphasis display of a region of interest. F 6 A in  FIG. 6  illustrates an example of an image displayed on the display  16  from the time t1 until the time t2. As illustrated in F 6 A, from the time t1 until the time t2, a region of interest R 1  that is newly detected at the time t1 is emphasized by being surrounded by a rectangular  figure F1 . In this example, the  figure F1  has a color at the first emphasis level LV1, and the position of the region of interest R 1  is emphasized by the  figure F1  at the first emphasis level LV1. In this manner, the newly detected region of interest R 1  is emphasized at the first emphasis level LV1, and thus, a surgeon can be prevented from missing the region of interest. 
     F 6 B in  FIG. 6  illustrates an example of an image displayed on the display  16  from the time t2 until the time t3. As illustrated in F 6 B, from the time t2 until the time t3, a region of interest R 1  that is successively detected from the time t1 is emphasized by being surrounded by a rectangular  figure F2 . The  figure F2  has a color at the second emphasis level LV2, and the position of the region of interest R 1  is emphasized by the  figure F2  at the second emphasis level LV2. 
     After the transition time Ta has elapsed, necessity for reporting (enhancing) the region of interest R 1  is decreased. Thus, after the transition time Ta has elapsed, the region of interest R 1  is emphasized at the second emphasis level LV2, which is the emphasis level lower than the first emphasis level LV1. This enables emphasis display appropriate for each occasion. 
     By setting the transition time Ta in accordance with features of the region of interest, emphasis display can be switched at an optimal time for each region of interest. Herein, a longer transition time is set as the evaluated visibility of the region of interest is lower. As the visibility is lower, it is more likely that a surgeon is delayed in finding the region of interest. Thus, display at the first emphasis level LV1 for a longer time can contribute to prevention of missing. In contrast, a lesion with high visibility can be found by a surgeon with ease, by switching display at the first emphasis level LV1 to emphasis at the second emphasis level LV2 in a short time, observation by a surgeon can be less adversely affected. 
     F 6 C in  FIG. 6  illustrates an example of an image displayed on the display  16  at and after the time t3. As illustrated in F 6 C, the region of interest R 1  is not emphasized at and after the time t3. After the end time Te has elapsed, it may be unnecessary to report the region of interest R 1 . Thus, since the region of interest R 1  is not emphasized, observation of the moving image by a surgeon can be prevented from being interrupted. 
     Variations of Changes in Emphasis Levels 
     In the example illustrated in  FIG. 6 , emphasis at the first emphasis level LV1 and emphasis at the second emphasis level LV2 are implemented by changing the color of a figure that is superposed and displayed, the emphasis level can be changed in the following manners. 
       FIG. 7  illustrates an example of a manner for changing an emphasis level of a region of interest by changing the color of a figure. In F 7 A in  FIG. 7 , a region of interest R 2  is emphasized by being surrounded by a rectangular  figure F11 . The  figure F11  has a concentration at the first emphasis level LV1, and the position of the region of interest R 2  is emphasized at the first emphasis level LV1 by the  figure F11 . In F 7 B in  FIG. 7 , the region of interest R 2  is emphasized by being surrounded by a rectangular  figure F12 . The  figure F12  has a concentration at the second emphasis level LV2, and the position of the region of interest R 2  is emphasized at the second emphasis level LV2 by the  figure F12 . In this manner, by placing emphasis by using the  figure F11  and the  figure F12 , the emphasis level can be changed. 
       FIG. 8  illustrates an example of a manner for changing an emphasis level of a region of interest by changing the line thickness of a figure. In F 8 A in  FIG. 8 , a region of interest R 3  is emphasized by being surrounded by a rectangular  figure F21 . The  figure F21  has a line thickness at the first emphasis level LV1, and the position of the region of interest R 3  is emphasized at the first emphasis level LV1 by the  figure F21 . In F 8 B in  FIG. 8 , the region of interest R 3  is emphasized by being surrounded by a rectangular  figure F22 . The  figure F22  has a line thickness at the second emphasis level LV2, and the position of the region of interest R 3  is emphasized at the second emphasis level LV2 by the  figure F22 . In this manner, by placing emphasis by using the  figure F21  and the  figure F22 , the emphasis level can be changed. 
       FIG. 9  illustrates an example of a manner for changing an emphasis level of a region of interest by changing the shape of a figure. In F 9 A in  FIG. 9 , a region of interest R 4  is emphasized by being surrounded by a solid-line rectangular  figure F31 . The  figure F31  has a shape at the first emphasis level LV1, and the position of the region of interest R 4  is emphasized at the first emphasis level LV1 by the  figure F31 . In F 9 B 1  in  FIG. 9 , the region of interest R 4  is emphasized by being surrounded by a broken-line rectangular  figure F32 . The  figure F32  has a shape at the second emphasis level LV2, and the position of the region of interest R 4  is emphasized at the second emphasis level LV2 by the  figure F32 . In this manner, by placing emphasis by using the  figure F31  and the  figure F32 , the emphasis level can be changed. 
     In F 9 B 2  in  FIG. 9 , the region of interest R 4  is emphasized by being indicated by an arrow-like  figure F33 . The  figure F33  has a shape at the second emphasis level LV2, and the position of the region of interest R 4  is emphasized at the second emphasis level LV2 by the  figure F33 . Thus, by placing emphasis by using the  figure F31  and the  figure F33 , the emphasis level can be changed. 
       FIG. 10  illustrates an example of a manner for changing an emphasis level of a region of interest by changing the concentration of a figure. Herein, the figure is superposed on the region of interest. In F 10 A in  FIG. 10 , a region of interest R 5  is emphasized by a  figure F41  superposed thereon. The  figure F41  has a concentration at the first emphasis level LV1, and the position of the region of interest R 5  is emphasized at the first emphasis level LV1 by the  figure F41 . In F 10 B in  FIG. 10 , the region of interest R 5  is emphasized by a  figure F42  superposed thereon. The  figure F42  has a concentration at the second emphasis level LV2, and the position of the region of interest R 5  is emphasized at the second emphasis level LV2 by the  figure F42 . In this manner, by placing emphasis by using the  figure F41  and the  figure F42 , the emphasis level can be changed. 
     A plurality of parameters among the color, concentration, line thickness, and shape can be changed, and the figures at the first emphasis level LV1 and the figures at the second emphasis level LV2 illustrated in  FIGS. 6 to 10  can be used in combination as appropriate. 
     Although the emphasis level is changed in a stepwise manner in the example illustrated in  FIG. 5 , the emphasis level may also be changed continuously.  FIG. 11  illustrates continuous transition of an emphasis level of a region of interest. The times t1, t2, and t3 are substantially the same as those in  FIG. 5 . 
     In the example illustrated in  FIG. 11 , from emphasis at the first emphasis level until the transition time Ta elapses (from the time t1 until the time t2), emphasis is placed while the emphasis level is relatively, gradually decreased, and from emphasis at the second emphasis level LV2 until the fixed time Tb elapses (from the time t2 until the time t3), emphasis is implemented while the emphasis level is relatively, gradually decreased. The emphasis level may be changed in this manner. 
     Note that emphasis may be placed while the emphasis level is relatively, gradually decreased from the time t1 until the time t2, and emphasis may be placed at the second emphasis level LV2 from the time t2 until the time t3. Alternatively, emphasis may be placed at the first emphasis level LV1 from the time t1 until the time t2, and emphasis may be placed while the emphasis level is relatively, gradually decreased from the time t2 until the time t3. 
     Feature Quantity and Transition Time 
     In this embodiment, the region-of-interest information acquiring unit  42  calculates the feature quantity based on the visibility of the region of interest, and the transition time setting unit  46  sets the longer transition time Ta as the visibility is relatively lower. However, the feature quantity may be calculated based on other features of the region of interest, and the transition time may be set. 
     For example, the feature quantity may be calculated based on the size of the region of interest in an image. In this case, the transition time is set based on the size of the region of interest in the image. As the region of interest is smaller, it is more likely that a surgeon is delayed in finding the region of interest. Thus, as the region of interest is relatively smaller, the transition time Ta is preferably set to a longer time. 
     The feature quantity may also be calculated based on the position of the region of interest in an image. In this case, the transition time is set based on the position of the region of interest in the image. As the position of the region of interest is closer to an edge (periphery) of the image, it is more likely that a surgeon pays low attention, that the region of interest tends to be outside the image, and that the surgeon is delayed in finding the region of interest. Thus, as the position of the region of interest is relatively closer to the periphery of the image, the transition time Ta is preferably set to a longer time. 
     The feature quantity may also be calculated based on the luminance of the region of interest or a difference between the luminance of the region of interest and the luminance of an outside region of the region of interest. In this case, the transition time is set based on the luminance of the region of interest or a difference between the luminance of the region of interest and the luminance of an outside region of the region of interest. As the region of interest is darker, or the difference in luminance from the periphery is smaller, it is more likely that a surgeon is delayed in finding the region of interest. Thus, as the luminance of the region of interest is relatively smaller, or the difference between the luminance of the region of interest and the luminance of an outside region of the region of interest is relatively smaller, the transition time Ta is preferably set to a longer time. The luminance of the region of interest and the luminance of an outside region of the region of interest can be calculated based on a statistical index such as an average or a median of the luminance. 
     The feature quantity may also be calculated based on the color information of the region of interest or a difference (distance in a color space) between the color information of the region of interest and the color information of an outside region of the region of interest. In this case, the transition time is set based on the color information of the region of interest or a difference (distance in a color space) between the color information of the region of interest and the color information of an outside region of the region of interest. As the saturation (example of the color information) of the region of interest is lower, or the color difference from the periphery is smaller, it is more likely that a surgeon is delayed in finding the region of interest. Thus, as the saturation of the region of interest is relatively lower, or the difference between the saturation of the region of interest and the saturation of an outside region of the region of interest is relatively smaller, the transition time Ta is preferably set to a longer time. 
     Furthermore, the feature quantity may also be calculated based on the movement amount of the region of interest or the movement direction of the region of interest. In this case, the transition time is set based on the movement amount of the region of interest or the movement direction of the region of interest. As the movement amount of the region of interest is larger, it is more likely that a surgeon is delayed in finding the region of interest. Thus, as the movement amount of the region of interest is larger, the transition time Ta is preferably set to a longer time. In addition, if the movement direction of the region of interest is toward the edge of the screen, it is likely that a surgeon is delayed in finding the region of interest. Thus, if the movement direction of the region of interest is toward the edge of the screen, the transition time Ta is preferably set to a longer time than that set if the movement direction of the region of interest is toward the center of the screen. 
     Second Embodiment 
     In the first embodiment, upon detection of a new region of interest, the feature quantity of the region of interest is calculated, and, in accordance with the calculated feature quantity, the transition time Ta of the region of interest is set. Thus, the transition time Ta is determined at the time point of detection, and future change in the region of interest caused by, for example, movement of the endoscope  10 , is not supported. In contrast, the transition time is reset in accordance with the feature quantity of the region of interest in a second embodiment. 
     A medical image processing method according to the second embodiment is described.  FIG. 12  is a flowchart illustrating each process of the medical image processing method according to the second embodiment. Note that parts common to the flowchart illustrated in  FIG. 3  are dented by the same reference numerals, and detailed description thereof is omitted. 
     The medical image processing method according to the second embodiment includes a transition time resetting step (step S 21 ) between the transition time setting step (step S 5 ) and the emphasis processing step (step S 6 ). 
     Transition Time Resetting Step 
       FIG. 13  is a flowchart illustrating details of the transition time resetting step (step S 21 ). 
     In step S 31 , the transition time setting unit  46  selects one region of interest from among regions of interest detected in step S 2 . 
     In step S 32 , the transition time setting unit  46  determines whether a re-evaluation time Tr has elapsed from the initial detection of the region of interest selected in step S 31 . 
     That is, the transition time setting unit  46  reads, from the memory that is not illustrated, the preset re-evaluation time Tr and the time tf at which the region of interest selected in S 31  is initially detected. The transition time setting unit  46  further reads a current time tc from the time measuring unit that is not illustrated. Then, the transition time setting unit  46  calculates an elapsed time Tp=tc−tf from the initial detection of the region of interest selected in step S 31  and compares the elapsed time Tp with the re-evaluation time Tr. 
     If the re-evaluation time Tr has not elapsed, the process proceeds to step S 35 . On the other hand, if the re-evaluation time Tr has elapsed, the process proceeds to step S 33 . In step S 33 , the region-of-interest information acquiring unit  42  calculates again the feature quantity of the region of interest selected in step S 31 . The feature quantity is calculated based on, for example, the visibility of the region of interest. Note that the feature quantity may also be calculated based on other features of the region of interest. 
     In subsequent step S 34 , the transition time setting unit  46  resets the transition time of the region of interest selected in step S 31  in accordance with the feature quantity that is calculated again in step S 33 . The reset transition time is Tar. The transition time Tar is set to a longer time, for example, as the visibility of the region of interest is relatively lower. 
     The transition time setting unit  46  stores the reset transition time Tar in the memory that is not illustrated in association with the region of interest selected in step S 31 . 
     In step S 35 , the transition time setting unit  46  determines whether the emphasis processing for all regions of interest detected in step S 2  has ended. If the emphasis processing for all regions of interest has ended, the process in this flowchart ends. If the emphasis processing for all regions of interest has not ended, the process returns to step S 31  to select a different region of interest, and substantially the same process is repeated. 
     In the above manner, the transition time is reset. In the emphasis processing step in step S 6 , the emphasis processing is performed based on the reset transition time Tar. 
       FIG. 14  illustrates an example of transition of an emphasis level of a region of interest in this embodiment. A time t1 is a time at which the region of interest is detected. In addition, a time t2 is a time at which the initially set transition time Ta has elapsed from the time t1. 
     A time t4 is a time at which the re-evaluation time Tr has elapsed from the time t1. Herein, the transition time Tar is reset at the time t4. A time t5 is a time at which the reset transition time Tar has elapsed from the time t1. 
     In this manner, in the example illustrated in  FIG. 14 , the reset transition time Tar is a shorter time than the initial transition time Ta. Depending on the feature quantity of the region of interest at the time t4, the reset transition time Tar may be a longer time than the initial transition time Ta. 
     According to this embodiment, even if the feature quantity of the region of interest varies over time, the transition time can be set appropriately. For example, if the size of the region of interest in an image is small at the time point of detection of the region of interest, in many cases, the size of the region of interest in the image may be later increased by a surgeon&#39;s operation of the endoscope  10 . In such a case, there is a problem that a comparatively long transition time that is set at the time point of detection may become inappropriate. 
     According to this embodiment, since the transition time is reset to a short time through re-evaluation of the feature quantity of the region of interest, such a problem can be solved. In contrast, in a case where the visibility is high at the time point of detection of the region of interest and is decreased for some reason, the transition time can be reset to a longer time. The re-evaluation of the feature quantity is not necessarily once and may be performed a number of times at fixed time intervals or at every frame. 
     Note that the transition time setting unit  46  may reset the fixed time Tb based on the feature quantity of the region of interest during the transition time resetting step. 
     Miscellaneous 
     The above medical image processing method can be configured as a program causing a computer to execute each step, and a non-transitory recording medium such as a compact disk-read only memory (CD-ROM) storing this program may also be configured. 
     Although the endoscope processor apparatus  12  and the medical image processing apparatus  14  are different apparatuses in the above embodiments, the endoscope processor apparatus  12  and the medical image processing apparatus  14  may also be constituted as an integrated apparatus, and the functions of the medical image processing apparatus  14  may be provided in the endoscope processor apparatus  12 . 
     In addition, a hardware structure of a processing unit that performs various processes of the endoscope processor apparatus  12  and the medical image processing apparatus  14  is any of the following various processors. Various processors include a central processing unit (CPU) that is a general-purpose processor functioning as various processing units by executing software (programs), a graphics processing unit (GPU) that is a processor specialized in image processing, a programmable logic device (PLD) that is a processor in which the circuit configuration is changeable after manufacture, such as field programmable gate array (FPGA), a dedicated electric circuit that is a processor having a circuit configuration that is specially designed to execute specific processing, such as an application specific integrated circuit (ASIC), and the like. 
     One processing unit may be constituted by one of these various processors, or may be constituted by two or more processors of the same type or different types (e.g., a combination of a plurality of FPGAs, a combination of a CPU and an FPGA, or a combination of a CPU and a GPU). In addition, a plurality of processing units may be configured as one processor. As a first example for configuring a plurality of processing units as one processor, one or more CPUs and software may be combined to configure one processor, and this processor may function as a plurality of processing units, as typified by a computer such as a client or a server. As a second example, a processor may be used that implements the functions of the entire system including a plurality of processing units as one integrated circuit (IC) chip, as typified by a system on chip (SoC) or the like. In this manner, various processing units are constituted by one or more of various processors as a hardware structure. 
     Furthermore, the hardware structure of these various processors is more specifically is electric circuitry obtained by combining circuit elements such as semiconductor elements. 
     The technical scope of the present invention is not limited to the scope described in the above embodiments, and configurations or the like in each embodiment may be combined as appropriate between the embodiments without departing from the spirit of the present invention. 
     REFERENCE SIGNS LIST 
     
         
         
           
               9  endoscope system 
               10  endoscope 
               11  light source apparatus 
               12  endoscope processor apparatus 
               13  display apparatus 
               14  medical image processing apparatus 
               15  operating unit 
               16  display 
               20  insertion part 
               21  handheld operating unit 
               22  universal cord 
               25  soft part 
               26  bending part 
               27  distal end part 
               28  imaging element 
               29  bending operation knob 
               30  air/water supply button 
               31  suction button 
               32  still image pick-up command unit 
               33  treatment tool introduction port 
               35  light guide 
               36  signal cable 
               37   a  connector 
               37   b  connector 
               38  moving image 
               38   a  frame image 
               39  still image 
               40  time-series image acquiring unit 
               41  region-of-interest detecting unit 
               42  region-of-interest information acquiring unit 
               43  coordinates calculating unit 
               44  control unit 
               45  display control unit 
               45 A image display control unit 
               45 B reporting information display control unit 
               46  transition time setting unit 
               47  storage unit 
               50  figure storage unit 
               51  program 
             F 1  to F 42  figure 
             R 1  to R 5  region of interest 
             S 1  to S 35  step of medical image processing method