Patent Publication Number: US-2020279651-A1

Title: Medical examination support apparatus, and operation method and operation program thereof

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a Continuation of PCT International Application No. PCT/JP2018/042565 filed on 16 Nov. 2018, which claims priority under 35 U.S.C § 119(a) to Japanese Patent Application No. 2017-223841 filed on 21 Nov. 2017. The above application is hereby expressly incorporated by reference, in its entirety, into the present application. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates to a medical examination support apparatus, and an operation method and an operation program thereof. 
     2. Description of the Related Art 
     A doctor performs various medical examinations on a patient and views and analyzes the obtained examination data by himself/herself. For example, in a case where the medical examination is an image examination such as a computed tomography (CT) examination or a magnetic resonance imaging (MRI) examination, and the examination data is a medical image, a doctor views the medical image to extract a lesion shown in the medical image, identifies the type of the extracted lesion, and measures the size. In order to assist a doctor in performing diagnosis, recently, a diagnosis support algorithm which automatically performs analysis processing on the examination data and outputs a result of the analysis processing as diagnosis support information for supporting diagnosis of the doctor has been developed. 
     JP2012-101088A discloses a diagnosis support algorithm which outputs the size of a lesion in a medical image as diagnosis support information. The diagnosis support information is displayed together with the medical image. Further, in JP2012-101088A, a manual operation log (described as history of work in JP2012-101088A) which is a history of a manual operation by a doctor on the medical image, such as enlargement of the medical image by the doctor or measurement of the size of the lesion in the medical image by the doctor, is stored. 
     In JP2017-134629A (corresponding to US2017/0220748A1), a medical examination support apparatus which displays a manual operation log (described as history of work in JP2017-134629A), such as enlargement of the medical image by the doctor or designation of a region of a lesion in the medical image and measurement of the size of the lesion by the doctor, in time series is disclosed. 
     SUMMARY OF THE INVENTION 
     In JP2012-101088A, the diagnosis support information is displayed, and in JP2017-134629A, the manual operation log is displayed. However, in JP2012-101088A and JP2017-134629A, the relationship between an output timing of the diagnosis support information and a generation timing of the manual operation log (execution timing of the manual operation) is not particularly considered. That is, in JP2012-101088A and JP2017-134629A, it is not possible to know whether a certain manual operation is executed before the output of the diagnosis support information or is executed after the output of the diagnosis support information. Accordingly, in JP2012-101088A and JP2017-134629A, it was not possible to easily grasp what kind of thinking process the doctor proceeded with, that is, the history of diagnosis at a glance. 
     An object of the invention is to provide a medical examination support apparatus in which the history of diagnosis can be easily grasped at a glance, and an operation method and an operation program thereof. 
     In order to achieve the object, a medical examination support apparatus according to an aspect of the invention comprises a first acquisition unit that acquires an automatic processing log which is a history of automatically performing analysis processing on examination data obtained in a medical examination performed on a patient by a diagnosis support algorithm to output a result of the analysis processing as diagnosis support information for supporting diagnosis of a doctor; a second acquisition unit that acquires a manual operation log which is a history of a manual operation of the doctor with respect to the examination data; an information management unit that stores the examination data in association with the automatic processing log and the manual operation log in a storage unit; and a screen output control unit that controls an output of a log display screen which has a collective display region in which the automatic processing log and the manual operation log are collectively displayed in a time series in a distinguishable manner. 
     It is preferable that the manual operation log includes an analysis result for the examination data, which is input by the doctor. 
     It is preferable that the screen output control unit causes a quotation log to be displayed in the collective display region to correspond to the automatic processing log or the manual operation log, the quotation log being a history of quoting the diagnosis support information included in the automatic processing log or the analysis result included in the manual operation log in a medical report or a medical conference. 
     It is preferable that the information management unit stores the number of times of quotation of the diagnosis support information included in the automatic processing log or the analysis result included in the manual operation log, in the medical report or the medical conference in association with the automatic processing log or the manual operation log in the storage unit. 
     It is preferable that the screen output control unit varies a display aspect of the automatic processing log or the manual operation log depending on the number of times of quotation. 
     It is preferable that the medical examination is an image examination, the examination data is a medical image, and the medical examination support apparatus further includes an extraction unit that extracts the medical image of which the number of times of quotation is equal to or greater than a threshold value, as a candidate image for a similar case image similar to a medical image of a target patient. 
     It is preferable that the medical examination support apparatus further comprises a search unit that searches for a similar case image similar to a medical image of a target patient using an equation with the number of times of quotation as a parameter. 
     It is preferable a selection instruction of the automatic processing log is received in the collective display region, and the screen output control unit displays detailed information, which includes the diagnosis support information, of the automatic processing log of which the selection instruction is received, and varies a display aspect between the automatic processing log of which the selection instruction has been received and the detailed information has been displayed, and the automatic processing log of which the selection instruction has not been received and the detailed information has not been displayed. 
     It is preferable that a selection instruction of the manual operation log is received in the collective display region, the information management unit stores display state information representing a display state of the examination data that the doctor was viewing at a time of acquisition of the manual operation log, in association with the manual operation log in the storage unit, and the screen output control unit reproduces the display state of the examination data of the manual operation log of which the selection instruction is received, on the basis of the display state information. 
     An operation method of a medical examination support apparatus according to an aspect of the invention comprises a first acquisition step of acquiring an automatic processing log which is a history of automatically performing analysis processing on examination data obtained in a medical examination performed on a patient by a diagnosis support algorithm to output a result of the analysis processing as diagnosis support information for supporting diagnosis of a doctor; a second acquisition step of acquiring a manual operation log which is a history of a manual operation of the doctor with respect to the examination data; an information management step of storing the examination data in association with the automatic processing log and the manual operation log in a storage unit; and a screen output control step of controlling an output of a log display screen which has a collective display region in which the automatic processing log and the manual operation log are collectively displayed in a time series in a distinguishable manner. 
     An operation program of a medical examination support apparatus according to an aspect of the invention causes a computer to execute a first acquisition function of acquiring an automatic processing log which is a history of automatically performing analysis processing on examination data obtained in a medical examination performed on a patient by a diagnosis support algorithm to output a result of the analysis processing as diagnosis support information for supporting diagnosis of a doctor; a second acquisition function of acquiring a manual operation log which is a history of a manual operation of the doctor with respect to the examination data; an information management function of storing the examination data in association with the automatic processing log and the manual operation log in a storage unit; and a screen output control function of controlling an output of a log display screen which has a collective display region in which the automatic processing log and the manual operation log are collectively displayed in a time series in a distinguishable manner. 
     According to the invention, it is possible to provide a medical examination support apparatus which collectively displays an automatic processing log which is a history of automatically performing analysis processing on examination data obtained in a medical examination performed on a patient by a diagnosis support algorithm to output a result of the analysis processing as diagnosis support information for supporting diagnosis of a doctor, and a manual operation log which is a history of a manual operation of the doctor with respect to the examination data in a time series in a distinguishable manner, and in which the history of diagnosis can be easily grasped at a glance, and an operation method and an operation program thereof. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a diagram illustrating a medical examination system. 
         FIG. 2  is a diagram illustrating a manual operation and a manual operation log which is a history of the manual operation. 
         FIG. 3  is a diagram illustrating automatic processing and an automatic processing log which is a history of the automatic processing. 
         FIG. 4  is a diagram illustrating various kinds of information transmitted and received between a client terminal and a medical examination support server. 
         FIG. 5  is a diagram illustrating contents of electronic medical records stored in a medical record DB. 
         FIG. 6  is a diagram illustrating contents of medical images stored in an image DB. 
         FIG. 7  is a diagram illustrating contents of medical reports stored in a report DB. 
         FIG. 8  is a diagram illustrating contents of conference information stored in a conference DB. 
         FIG. 9  is a block diagram illustrating a computer constituting the client terminal and the medical examination support server. 
         FIG. 10  is a block diagram illustrating various processing units of a CPU of the client terminal. 
         FIG. 11  is a block diagram illustrating various processing units of a CPU of the medical examination support server. 
         FIG. 12  is a diagram illustrating contents of log data tables. 
         FIG. 13  is a diagram illustrating more detailed contents of the log data table. 
         FIG. 14  is a diagram illustrating an integrated display screen. 
         FIG. 15  is a diagram illustrating a viewer screen. 
         FIG. 16  is a diagram illustrating a log display screen. 
         FIG. 17  is a diagram illustrating a method of quoting diagnosis support information or a doctor&#39;s analysis result in a medical report or a medical conference. 
         FIG. 18  is a diagram illustrating an aspect in which detailed information of an automatic processing log of which a selection instruction is received is displayed, and a display aspect is varied between an automatic processing log of which the selection instruction has been received and the detailed information has been displayed, and an automatic processing log of which the selection instruction has not been received and the detailed information has not been displayed,  FIG. 18A  illustrates a display block of an automatic processing log before a selection instruction,  FIG. 18B  illustrates a detailed information display screen, and  FIG. 18C  illustrates a display block of an automatic processing log after a selection instruction. 
         FIG. 19  is a diagram illustrating an aspect of reproducing a display state of examination data of a manual operation log of which a selection instruction is received, on the basis of display state information representing the display state of the examination data that the doctor was viewing at the time of acquisition of the manual operation log,  FIG. 19A  illustrates a display block of the manual operation log, and  FIG. 19B  illustrates a reproduction screen of the display state. 
         FIG. 20  is a flowchart illustrating a processing procedure of a medical examination support server. 
         FIG. 21  is a flowchart illustrating a processing procedure of a medical examination support server. 
         FIG. 22  is a diagram illustrating a second embodiment in which a display aspect of an automatic processing log or a manual operation log is varied depending on the number of times of quotation. 
         FIG. 23  is a table illustrating a change example of a display aspect of an automatic processing log or a manual operation log depending on the number of times of quotation. 
         FIG. 24  is a diagram illustrating a third embodiment in which a medical image of which the number of times of quotation is equal to or greater than a threshold value is extracted as a candidate image for a similar case image similar to a medical image of a target patient, and illustrates a case in which the number of times of quotation is equal to or greater than a threshold value. 
         FIG. 25  is a diagram illustrating the third embodiment in which a medical image of which the number of times of quotation is equal to or greater than a threshold value is extracted as a candidate image for a similar case image similar to a medical image of a target patient, and illustrates a case in which the number of times of quotation is less than a threshold value. 
         FIG. 26  is a diagram illustrating a fourth embodiment in which a similar case image similar to a medical image of a target patient is searched for using an equation with the number of times of quotation as a parameter. 
         FIG. 27  is a diagram illustrating another example of a log display screen. 
         FIG. 28  is a diagram illustrating a log display screen that displays a balloon in which examination data associated with a display block of a manual operation log where the cursor is placed is collectively displayed. 
         FIG. 29  is a diagram illustrating a log display screen that displays a frame in examination data associated with a display block of a manual operation log where the cursor is placed. 
     
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     First Embodiment 
     In  FIG. 1 , a medical examination system  10  is constructed in a medical facility, and includes a client terminal  11 , a medical examination support server  12  corresponding to a medical examination support apparatus, and the like. The client terminal  11  and the medical examination support server  12  are connected to each other communicably through a network  13 , such as a local area network (LAN) provided in the medical facility. 
     A server group  14  is also connected to the network  13 . The server group  14  includes an electronic medical record server  15 , an image server  16 , a report server  17 , and a conference server  18 . The electronic medical record server  15  has a medical record database (hereinafter, referred to as DB)  15 A, and electronic medical records  19  are stored in the medical record DB  15 A in a searchable manner. The image server  16  has an image DB  16 A, and medical images  20  obtained by various image examinations are stored in the image DB  16 A in a searchable manner. 
     The image examination is a kind of medical examination, and the medical image  20  is a kind of examination data. The image examination includes a computed radiography (CR) examination, a CT examination, an MRI examination, an electro cardiogram (ECG) examination, a coronary angiography (CAG) examination, an ultrasonography (US) examination, an endoscopic examination, and the like. The medical image  20  of the CR examination, the CT examination, the MRI examination, or the like is created in a data file format of a digital imaging and communications in medicine (DICOM) standard, for example. 
     The report server  17  has a report DB  17 A, and medical reports  21  in which findings resulting from the interpretation of the medical images  20  by a radiologist are summarized are stored in the report DB  17 A in a searchable manner. The conference server  18  has a conference DB  18 A, and conference information  22  in which contents of medical conferences are recorded is stored in the conference DB  18 A in a searchable manner. 
     The medical conference is performed in case of deciding a future treatment plan for a patient to be treated (hereinafter, referred to as target patient) or in case of reviewing improvements in capturing of the medical image  20 . The medical conference for deciding a treatment plan is performed by a plurality of medical staffs (doctors, nurses, examination technicians, and the like) in charge of treatment of the target patient while viewing the medical image  20  of the target patient. The medical conference for reviewing improvements in imaging is performed by a plurality of medical staffs (radiation technicians and the like) in charge of capturing the medical image  20  while viewing the medical image (failure image)  20  for which imaging has failed. 
     The client terminal  11 , the medical examination support server  12 , and the server group  14  are configured by installing a control program such as an operating system and various application programs based on a computer such as a personal computer, a server computer, and a workstation. 
     The client terminal  11  includes a display  23  for displaying various display screens, and an input device  24  such as a keyboard and a mouse, and is operated by a medical staff. In  FIG. 1 , only one client terminal  11  is illustrated, but a plurality of client terminals  11  are provided in practice for each medical department, such as internal medicine, surgery, examination department, and rehabilitation department, or each medical staff. The client terminal  11  is used to perform a medical examination for a patient by using various functions of the medical examination support server  12  and the server group  14 . 
     As illustrated in  FIG. 2 , in the client terminal  11 , examination data is displayed on the display  23 . The doctor can perform any input operation for the examination data displayed on the display  23  via the input device  24 . The input operation of the doctor for the examination data via the input device  24  is a manual operation, and a history thereof is a manual operation log MOL. In some cases, a doctor&#39;s analysis result of the examination data is included in the manual operation log MOL. 
     The manual operation is, for example, enlarging the medical image  20  (enlarged display operation), instructing to display two or more medical images  20  in parallel (comparison display operation), measuring the size (long diameter, short diameter, volume, and the like) of a lesion in the medical image  20  (lesion measurement operation), inputting an annotation to the electronic medical record  19  or the medical image  20  (annotation input operation), or inputting a diagnosis name to the electronic medical record  19  (diagnosis name input operation). The doctor&#39;s analysis result is, for example, an identification result of the type of a lesion in the medical image  20 , a measurement result of the size of a lesion, an annotation, a diagnosis name, or the like. Since the enlarged display operation, the comparison display operation, or the like is an operation that does not involve a doctor&#39;s analysis result, the manual operation log MOL of the enlarged display operation, the comparison display operation, or the like does not include a doctor&#39;s analysis result. 
     Since the medical examination support server  12  supports medical examination of the medical staff, particularly, the doctor, the medical examination support server  12  processes various kinds of medical data obtained during the medical examination for the patient and provides the results to the doctor. The medical data includes the examination data. 
     As illustrated in  FIG. 3 , the medical examination support server  12  uses a diagnosis support algorithm  30  as a part of the medical examination support. More specifically, the medical examination support server  12  inputs the examination data to the diagnosis support algorithm  30  and causes the diagnosis support algorithm  30  to automatically perform analysis processing on the examination data and output the result of the analysis processing as diagnosis support information for supporting the diagnosis of the doctor. A series of processing of causing the diagnosis support algorithm  30  to automatically output diagnosis support information is automatic processing, and a history thereof is an automatic processing log APL. The automatic processing log APL includes the diagnosis support information. 
     There are a plurality of diagnosis support algorithms  30 . The plurality of diagnosis support algorithms  30  include, for example, one that extracts a lesion shown in a CT image, identifies the type of the extracted lesion, and measures the size of the extracted lesion. The diagnosis support information in this case is the position of the extracted lesion in the CT image, and the type and size of the extracted lesion. 
     In  FIG. 4 , the medical examination support server  12  receives various requests from the client terminal  11 . The various requests include a distribution request for an integrated display screen  35  (refer to also  FIG. 14 ), a registration request for the manual operation log MOL illustrated in  FIG. 2 , and the like. 
     The integrated display screen  35  is a display screen in which various kinds of medical data of the target patient are combined into one for the doctor to easily perform analysis. The medical examination support server  12  acquires various kinds of medical data of the target patient according to the distribution request for the integrated display screen  35 , from the server group  14 , and generates the integrated display screen  35  on the basis of the acquired various kinds of medical data. The medical examination support server  12  transmits the generated integrated display screen  35  to the client terminal  11  that is a request source of the distribution request. The client terminal  11  outputs the integrated display screen  35  from the medical examination support server  12  to the display  23 . 
     The medical examination support server  12  generates the integrated display screen  35  that can be viewed on a web browser, and transmits the integrated display screen  35  to the client terminal  11 . The medical examination support server  12  issues an authentication key to the client terminal  11  to give a right for accessing the medical examination support server  12 . After the client terminal  11  accesses the medical examination support server  12  and performs authentication, the integrated display screen  35  is transmitted from the medical examination support server  12  to the client terminal  11 , and is displayed on the display  23 . 
     The medical examination support server  12  outputs various display screens including the integrated display screen  35  in a format of web distribution screen data created in a markup language such as Extensible Markup Language (XML), for example. The client terminal  11  reproduces and displays various display screens on the web browser on the basis of the screen data. Instead of the XML, other data description languages, such as JavaScript (registered trademark) Object Notation (JSON), may be used. 
     In  FIG. 5 , the electronic medical record  19  of the medical record DB  15 A is managed for each patient in association with a patient identification data (ID) which is a symbol and a number for identifying each patient such as P001. The electronic medical record server  15  can search for the electronic medical record  19  from the medical record DB  15 A using the patient ID as a search key. 
     The electronic medical record  19  has a plurality of pieces of measurement data and a plurality of pieces of medication data, as medical data. The measurement data is a kind of examination data as in case of the medical image  20 . The measurement data is organized by type of medical examination such as vital signs, blood tests, or urine tests, and is stored in association with the measurement date and time, measurement items, and measurement values. The measurement items include, for example, in case of vital signs, the body temperature, pulse, blood pressure (high and low), and the like, and include, in case of a blood test, the white blood cell count, platelets, casual blood sugar, and the like. The medication data is organized by type of medicines such as a medicine A and a medicine B, and is stored in association with an administration period and a dosage. 
     In the electronic medical record  19 , in addition to the patient ID, patient information such as the name, gender, age, date of birth, preference (smoking, drinking), past illness, and allergies of the patient is recorded. Further, in the electronic medical record  19 , medical examination, creation of the medical report  21 , orders with instructions of surgery, medication, and the like, events that occurred during the medical examination for the patient such as initial consultation, re-examination, and hospitalization, or a consultation record including patient&#39;s chief complaint and diagnosis name, a nursing record, and information from the patient&#39;s family are also recorded in time series. 
     In  FIG. 6 , the medical image  20  of the image DB  16 A is managed for each patient in association with the patient ID as in case of the electronic medical record  19 . As in case of the electronic medical record server  15 , the image server  16  can search for the medical image  20  from the image DB  16 A using the patient ID as a search key. 
     A file of the medical images  20  for one case includes the main body of the medical image  20 , and various kinds of additional information such as imaging date and time, an image ID, an order ID, and attributes (type of image examination, imaging part, direction). The image server  16  transmits the medical image  20  together with the additional information as the medical data to the medical examination support server  12 . 
     The image ID is a symbol and a number for identifying each medical image  20 , and the order ID is a symbol and a number for identifying an order of instructing various kinds of image examinations. In case of an image examination in which a plurality of medical images  20  are captured at one time, such as CT examination or CAG examination, in order to indicate that a plurality of medical images  20  are obtained at one image examination, the medical images  20  are assigned a common order ID, and are collectively managed as the medical image  20 . 
     In  FIG. 7 , the medical report  21  of the report DB  17 A is managed for each patient in association with the patient ID as in case of the electronic medical record  19  and the medical image  20 . As in case of the electronic medical record server  15  and the image server  16 , the report server  17  can search for the medical report  21  from the report DB  17 A using the patient ID as a search key. 
     In the medical report  21 , in addition to the patient ID, creation date and time of the medical report  21 , a report ID for identifying each medical report  21 , an image ID of the medical image  20  quoted in the medical report  21 , and attributes similar to the medical image  20  are associated as additional information. The report server  17  transmits the medical report  21  together with the additional information as the medical data to the medical examination support server  12 . 
     In  FIG. 8 , in the conference information  22  of the conference DB  18 A, date and time of a medical conference, a conference ID for identifying each medical conference, a purpose of a medical conference, a patient ID of the target patient (patient of which the medical image  20  quoted in the medical conference is captured) of the medical conference, an image ID of the medical image  20  quoted in the medical conference, a staff ID for identifying a medical staff attending the medical conference, and proceedings are associated as additional information. In the proceedings, remark contents of the medical staff attending the medical conference, the summary of the medical conference, and the like are recorded. In  FIGS. 5 to 8 , among various kinds of date and time, only the date is illustrated. 
     In  FIG. 9 , the computers constituting the client terminal  11  and the medical examination support server  12  have basically the same configuration, and each of the computers includes a storage device  40 , a memory  41 , a central processing unit (CPU)  42 , and a communication unit  43 . The client terminal  11  includes the display  23  and the input device  24  as described above, and similarly, the medical examination support server  12  includes a display  44  and an input device  45 . These are connected to each other through a data bus  46 . 
     The storage device  40  is a hard disk drive, which is built into a computer that constitutes the client terminal  11  or the like or which is connected to the computer through a cable or a network, or a disk array formed by connecting a plurality of hard disk drives. Control programs such as an operating system, various application programs, and display data of various display screens associated with these programs are stored in the storage device  40 . 
     The memory  41  is a work memory required for the CPU  42  to execute processing. The CPU  42  performs overall control of each unit of the computer by loading a program stored in the storage device  40  to the memory  41  and executing processing according to the program. 
     The communication unit  43  is a network interface to perform transmission control of various kinds of information through the network  13 . The displays  23  and  44  display various display screens according to the operations of the input devices  24  and  45 . The display screen has an operation function based on the graphical user interface (GUI). The computer constituting the client terminal  11  or the like receives an input of an operation instruction from the input devices  24  and  45  through the display screen. 
     In the following description, for the sake of distinction, a suffix “A” is attached to the reference numeral of each unit of the computer constituting the client terminal  11  except for the display  23  and the input device  24 , and a suffix “B” is attached to the reference numeral of each unit of the computer constituting the medical examination support server  12  except for the display  44  and the input device  45 . 
     In  FIG. 10 , in a case where a web browser is started, the CPU  42 A of the client terminal  11  cooperates with the memory  41  or the like to function as a GUI control unit  50  and a browser control unit  51 . 
     The GUI control unit  50  displays various display screens on the display  23 , and receives various operation instructions which are input from the input device  24  through various display screens by the medical staff. The operation instructions include a distribution instruction of the integrated display screen  35  to the medical examination support server  12 , a registration instruction of the manual operation log MOL, and the like. The GUI control unit  50  outputs the received operation instruction to the browser control unit  51 . 
     The browser control unit  51  controls the operation of the web browser. The browser control unit  51  issues a request according to the operation instruction from the GUI control unit  50 , specifically a distribution request for the integrated display screen  35  according to the distribution instruction of the integrated display screen  35 , a registration request for the manual operation log MOL according to the registration instruction of the manual operation log MOL to the medical examination support server  12 . 
     The browser control unit  51  receives screen data of each of various display screens from the medical examination support server  12 . The browser control unit  51  reproduces the display screen to be displayed on the web browser based on the screen data, and outputs the display screen to the GUI control unit  50 . The GUI control unit  50  displays the display screen on the display  23 . 
     In  FIG. 11 , the storage device  40 B of the medical examination support server  12  stores an operation program  55  in addition to the diagnosis support algorithm  30 . The operation program  55  is an application program for causing a computer constituting the medical examination support server  12  to function as a medical examination support apparatus. 
     A log data table  56  (refer to  FIGS. 12 and 13 ) is also stored in the storage device  40 B. The log data table  56  stores examination data in association with the automatic processing log APL and the manual operation log MOL. That is, the storage device  40 B corresponds to a storage unit that stores the examination data in association with the automatic processing log APL and the manual operation log MOL. 
     Although the details are described below, in addition to the automatic processing log APL and the manual operation log MOL, a quotation log QL is also stored in the log data table  56 . The quotation log QL is a history in which the diagnosis support information included in the automatic processing log APL or the doctor&#39;s analysis result included in the manual operation log MOL is quoted in the medical report  21  or the medical conference. 
     In a case where the operation program  55  is activated, the CPU  42 B of the medical examination support server  12  functions as a request receiving unit  60 , a medical data acquisition unit  61 , an analysis processing unit  62 , a first acquisition unit  63 , a second acquisition unit  64 , an information management unit  65 , and a screen output control unit  66 , in cooperation with the memory  41  or the like. 
     The request receiving unit  60  receives various requests from the client terminal  11 . The request receiving unit  60  outputs the distribution request for the integrated display screen  35  to the medical data acquisition unit  61 , the information management unit  65 , and the screen output control unit  66 , and outputs the registration request for the manual operation log MOL to the second acquisition unit  64 , among the various requests. The patient ID of the target patient is included in the distribution request for the integrated display screen  35 , and the manual operation log MOL is included in the registration request for the manual operation log MOL. 
     The medical data acquisition unit  61  issues an acquisition request for the medical data of the target patient to the server group  14 . In the acquisition request, the patient ID of the target patient included in the distribution request for the integrated display screen  35  from the request receiving unit  60  is the search key. The medical data acquisition unit  61  acquires the medical data of the target patient transmitted from the server group  14  in response to the acquisition request. The medical data acquisition unit  61  outputs the acquired medical data to the analysis processing unit  62  and the screen output control unit  66 . 
     The analysis processing unit  62  executes analysis processing by the diagnosis support algorithm  30 . Prior to the execution of the analysis processing, the analysis processing unit  62  selects examination data to be input to the diagnosis support algorithm  30 , from the examination data included in the medical data which is from the medical data acquisition unit  61 . 
     More specifically, the analysis processing unit  62  selects examination data which is to be subjected to the analysis processing by the diagnosis support algorithm  30  and for which the diagnosis support information has not been output yet, as examination data to be input to the diagnosis support algorithm  30 . The analysis processing unit  62  determines whether the examination data is examination data for which the diagnosis support information has not been output or examination data for which the diagnosis support information has been output, by referring to the automatic processing log APL transferred from the information management unit  65 . In a case where, for examination data which is to be subjected to the analysis processing by the diagnosis support algorithm  30 , there is an automatic processing log APL associated with the examination data, the analysis processing unit  62  determines that the diagnosis support information has been output, and excludes the examination data from examination data to be input to the diagnosis support algorithm  30 . 
     The analysis processing unit  62  inputs the selected examination data to the diagnosis support algorithm  30 , and causes the diagnosis support algorithm  30  to execute analysis processing. In this manner, the analysis processing by the diagnosis support algorithm  30  is automatically executed when the request receiving unit  60  receives a distribution request for the integrated display screen  35 . Therefore, it can be said that the distribution request for the integrated display screen  35  is an analysis processing request for the diagnosis support algorithm  30 . 
     The analysis processing unit  62  outputs an automatic processing log APL including the diagnosis support information as the result of the analysis processing to the first acquisition unit  63 . In a case where there is no examination data to be input to the diagnosis support algorithm  30 , the analysis processing unit  62  does not execute the analysis processing, and also does not output the automatic processing log APL. 
     The first acquisition unit  63  has a first acquisition function of acquiring an automatic processing log APL from the analysis processing unit  62 . The first acquisition unit  63  transfers the acquired automatic processing log APL to the information management unit  65 . 
     The second acquisition unit  64  has a second acquisition function of acquiring a manual operation log MOL included in the registration request for the manual operation log MOL from the request receiving unit  60 . The second acquisition unit  64  transfers the acquired manual operation log MOL to the information management unit  65 . 
     The information management unit  65  has an information management function of writing various kinds of information to the storage device  40 B and reading various kinds of information from the storage device  40 B. The information management unit  65  registers the automatic processing log APL from the first acquisition unit  63  and the manual operation log MOL from the second acquisition unit  64  in the log data table  56 . Further, in a case where the diagnosis support information included in the automatic processing log APL or the doctor&#39;s analysis result included in the manual operation log MOL is quoted in the medical report  21  or the medical conference, the information management unit  65  registers the quotation log QL in the log data table  56 . 
     The information management unit  65  outputs the automatic processing log APL of the target patient to the analysis processing unit  62  for reference at the time of selecting examination data to be input to the diagnosis support algorithm  30 . Further, the information management unit  65  outputs the automatic processing log APL, the manual operation log MOL, and the quotation log QL of the target patient to the screen output control unit  66  in response to the distribution request for the integrated display screen  35  from the request receiving unit  60 . 
     The screen output control unit  66  generates the integrated display screen  35  on the basis of the medical data of the target patient from the medical data acquisition unit  61 , and transmits the integrated display screen  35  to the client terminal  11  which is a request source of the distribution request for the integrated display screen  35 . Further, the screen output control unit  66  generates a log display screen  95  (refer to  FIG. 16 ) on the basis of the automatic processing log APL, the manual operation log MOL, and the quotation log QL of the target patient from the information management unit  65 , and transmits the log display screen  95  to the client terminal  11  which is a request source of the distribution request for the integrated display screen  35 . That is, the screen output control unit  66  has a screen output control function of controlling the output of the log display screen  95 . Further, since the log display screen  95  is also transmitted in response to the distribution request for the integrated display screen  35 , the distribution request for the integrated display screen  35  is a distribution request for the log display screen  95 . 
     In  FIG. 12 , the log data table  56  is managed for each patient as in case of the electronic medical record  19 , the medical image  20 , and the like. The log data table  56  is prepared for each medical image  20  such as a CT image, a CR image, and an MRI image. 
       FIG. 13  illustrates the log data table  56  relating to CT images of a patient having a patient ID of P001. The log data table  56  has items of a log ID, registration date and time, an algorithm ID, a staff ID, an image ID, a quotation source and a quotation destination, contents, diagnosis support information, a doctor&#39;s analysis result, display state information, presence/absence of detailed information display, and the number of times of quotation. 
     The log ID is a symbol and a number for identifying each log. The log ID is automatically assigned by the information management unit  65  at the time of registering each log in the log data table  56 . APL, MOL, and QL are respectively assigned as symbols to the log ID of the automatic processing log APL, the log ID of the manual operation log MOL, and the log ID of the quotation log QL, and numbers are assigned thereafter in order. 
     In the item of the registration date and time, date and time at which the information management unit  65  registers each log in the log data table  56  is recorded. In the item of the algorithm ID, an algorithm ID of the diagnosis support algorithm  30  which executes the analysis processing relating to the automatic processing log APL is recorded. Therefore, the algorithm ID is recorded only in the automatic processing log APL, and is not recorded in the manual operation log MOL and the quotation log QL. 
     In the item of the staff ID, a staff ID of the medical staff who performed the manual operation relating to the manual operation log MOL or the quotation act relating to the quotation log QL is registered. Therefore, the staff ID is not recorded in the automatic processing log APL. 
     In the item of the image ID, an image ID of the CT image as the target of each log is recorded. In the item of the quotation source and the quotation destination, a log ID of the automatic processing log APL or the manual operation log MOL which is a quotation source relating to the quotation log QL, and a report ID of the medical report  21  or a conference ID of the medical conference which is a quotation destination are recorded. Therefore, the quotation source and the quotation destination are recorded only in the quotation log QL, and are not recorded in the automatic processing log APL and the manual operation log MOL. 
     In the item of the contents, specific contents of each log are recorded. For example, in the automatic processing log APL having a log ID of APL001, extraction of a lesion, identification of the type of a lesion, and measurement of the size of a lesion are recorded. In the manual operation log MOL having a log ID of MOL001, an enlarged display operation is recorded. Further, in the manual operation log MOL having a log ID of MOL002, a lesion measurement operation is recorded. 
     The diagnosis support information is recorded in the item of the diagnosis support information, and the doctor&#39;s analysis result is recorded in the item of the doctor&#39;s analysis result. The diagnosis support information is recorded only in the automatic processing log APL, and the doctor&#39;s analysis result is recorded in the manual operation log MOL accompanying the doctor&#39;s analysis result such as a lesion measurement operation. 
     The display state information is recorded in the item of the display state information. The display state information is information representing a display state of the examination data that the doctor was viewing at the time of acquisition of the manual operation log MOL. The display state information is, in short, a screenshot of the display  23  at the time of acquisition of the manual operation log MOL. The display state information is recorded only in the manual operation log MOL. 
     In the item of the presence/absence of detailed information display, whether to display detailed information of the automatic processing log APL is recorded. That is, in case of displaying the detailed information, “displayed” is recorded, and in case of not displaying the detailed information, “not displayed” is recorded as illustrated in the drawing. The presence/absence of detailed information display is registered for each medical staff. The detailed information is the name of the diagnosis support algorithm  30  executing the analysis processing, the diagnosis support information, and the like. 
     In the item of the number of times of quotation, the number of times of quotation of the diagnosis support information included in the automatic processing log APL or the doctor&#39;s analysis result included in the manual operation log MOL in the medical report  21  or the medical conference is recorded. More specifically, the number of quotation logs QL in which the log ID is recorded as the quotation source is totalized for each of the automatic processing log APL and the manual operation log MOL, and the totalized number is registered as the number of times of quotation. 
     The followings can be known from the log data table  56  illustrated in  FIG. 13 . First, from the automatic processing log APL having a log ID of APL001, it can be known that analysis processing of extraction of a lesion, identification of the type of a lesion, and measurement of the size of a lesion is executed on a CT image having an image ID of CT050-5 by the diagnosis support algorithm  30  having an algorithm ID of AL050, and diagnosis support information indicating the lesion position (X, Y), the type A, and the size of 10×5 mm and 300 mm 3  is output. Further, it can be known that the detailed information of the automatic processing log APL is not displayed yet, and the diagnosis support information is not quoted in the medical report  21  or the medical conference. 
     Next, from the manual operation logs MOL having log IDs of MOL001 and MOL002, it can be known that an enlarged display operation and a lesion measurement operation are performed on a CT image having an image ID of CT050-5 by a doctor having a staff ID of SF050, and the lesion measurement result of the lesion position (XX, YY), the type A, and the size of 11×6 mm and 330 mm 3  is output. 
     Then, from the quotation log QL having a log ID of QL001, it can be known that the doctor&#39;s analysis result included in the manual operation log MOL having a log ID of MOL002 is quoted in the medical report  21  having a report ID of RE050 by a doctor having a staff ID of SF060. 
     The medical staff accesses the medical examination support server  12  via the client terminal  11 , and performs authentication by inputting his/her own staff ID and an authentication key. The staff ID input at this time is recorded in the item of the staff ID of the log data table  56 . 
     After authentication, an input screen for the patient ID is displayed on the web browser of the display  23  of the client terminal  11 . In the input screen for the patient ID, for example, an input box for the patient ID, and a transmission button for performing a distribution instruction of the integrated display screen  35  are prepared. In a case where a patient ID of the target patient is input to the input box and the transmission button is selected, a distribution request for the integrated display screen  35  including a patient ID of the target patient is issued from the browser control unit  51  of the client terminal  11  to the request receiving unit  60  of the medical examination support server  12 . 
     The distribution request for the integrated display screen  35  is received, and the acquisition request is issued from the medical data acquisition unit  61  to the server group  14 . The server group  14  transmits the medical data such as the electronic medical record  19  and the medical image  20  to which the patient ID of the target patient is assigned, to the medical data acquisition unit  61 . The screen output control unit  66  generates the integrated display screen  35  illustrated in  FIG. 14  on the basis of the medical data of the target patient from the server group  14 . 
     In  FIG. 14 , the integrated display screen  35  is divided into roughly four display regions of a first display region  70 , a second display region  71 , a third display region  72 , and a fourth display region  73 . In the first display region  70 , a graph indicating a time-series change of a measurement value of each measurement item such as the body temperature, pulse, and blood pressure (high and low) of vital signs, a bar indicating a dosage and an administration period of the medicine, and the like are displayed. 
     In the second display region  71 , a plurality of windows displaying the medical data are displayed side by side. For example, measurement values of a plurality of measurement items of the blood test are displayed in a list in a certain window, and measurement values of a plurality of measurement items of the urine test are displayed in a list in a certain window. Further, there is a window in which the type and the dosage of the medicine are displayed in a list. There are windows in which a thumbnail  75  of each of various medical images  20  is displayed, as three windows arranged on a right end of the second display region  71 . The latest medical data is displayed in each window of the second display region  71 . 
     In the second display region  71 , a window of a creation application program of the medical report  21  (hereinafter, referred to as report window)  76 , a window of a creation application program of the conference information  22  (hereinafter, referred to as conference window)  77 , and a window of various application programs are displayed. 
     In the third display region  72 , patient information of the target patient, such as the patient ID, the name, gender, age, date of birth, preference, past illness, and allergies, and the affiliation medical department and the name of the attending physician of the target patient are displayed. In the fourth display region  73 , windows displaying the patient&#39;s chief complaint, the consultation record, the nursing record, and the information from the patient&#39;s family included in the electronic medical record  19  are displayed side by side. In the window displayed in the fourth display region  73 , the annotation input operation and the diagnosis name input operation can be performed. The annotation is the doctor&#39;s impression for the patient&#39;s chief complaint, for example. 
     The thumbnail  75  of the medical image  20  in the second display region  71  can be selected by a cursor  80 . In a case where the thumbnail  75  is selected by the cursor  80 , the screen output control unit  66  causes a viewer screen  85  illustrated in  FIG. 15  to be displayed in a pop-up on the integrated display screen  35 . 
     In  FIG. 15 , the viewer screen  85  includes an image display region  86  in which a full-size medical image  20  is displayed, an information display region  87  in which the patient information such as the patient ID and the additional information such as the patient&#39;s name, the imaging date and time, the imaging part, and the direction are displayed, and a measurement result input region  88  in which the lesion measurement result such as the type of a lesion and the size of a lesion is input. 
     In the viewer screen  85 , a full-size medical image  20  is displayed instead of the thumbnail  75  in the integrated display screen  35 . Accordingly, the operation of selecting the thumbnail  75  in the integrated display screen  35  by the cursor  80  corresponds to the enlarged display operation of the medical image  20 . Therefore, in a case where the thumbnail  75  is selected in the integrated display screen  35 , the browser control unit  51  issues the registration request for the manual operation log MOL including the image ID or the like, to the request receiving unit  60 . That is, the selection of the thumbnail  75  corresponds to the registration instruction of the manual operation log MOL. In this case, the information management unit  65  registers the enlarged display operation in the item of contents of the manual operation log MOL. 
     In the viewer screen  85 , a lesion in the medical image  20  can be designated. The designation of a lesion is performed by inputting a plurality of control points to surround the periphery of a region seemed to be a lesion in the medical image  20  in the image display region  86  by the cursor  80 . A frame  89  indicated by a dashed line that draws a smooth curve passing through the plurality of control points and an inside of the frame  89  are designated as a lesion. 
     The doctor designates a lesion, inputs the type and size of the lesion to the measurement result input region  88 , and then selects a registration button  90  by the cursor  80 . The operation of selecting the registration button  90  corresponds to the lesion measurement operation. Therefore, in a case where the registration button  90  is selected, the browser control unit  51  issues the registration request for the manual operation log MOL including the lesion measurement result, the image ID, or the like, to the request receiving unit  60 . That is, the selection of the registration button  90  also corresponds to the registration instruction of the manual operation log MOL. In this case, the information management unit  65  registers the lesion measurement operation in the item of contents of the manual operation log MOL, and registers the lesion measurement result in the item of the doctor&#39;s analysis result. 
     In a case where a plurality of lesions are present in the medical image  20 , designating the frame  89  and inputting the type and size are performed for each lesion. The browser control unit  51  issues the registration request for the manual operation log MOL to the request receiving unit  60  each time the registration button  90  is selected for each lesion. Therefore, in a case where a plurality of lesions are present in the medical image  20 , the second acquisition unit  64  acquires the manual operation log MOL relating to the lesion measurement operation of each of the plurality of lesions. 
     In the viewer screen  85 , in addition to the enlarged display operation and the lesion measurement operation described above, the comparison display operation and the annotation input operation can be performed. The comparison display operation is specifically an instruction of displaying the medical image  20  obtained in the previous image examination and the medical image  20  obtained in the current image examination in parallel, or the like. Further, the annotation in this case is doctor&#39;s impression for the lesion. 
     The registration request for the manual operation log MOL may be issued by one action such as selecting a registration instruction button on the integrated display screen  35  by the cursor  80  or pressing a print screen button of the keyboard. For example, in a case where the registration instruction button or the print screen button is selected in a state where the viewer screen  85  of the CT image, the MRI image, and the ECG image is displayed, the registration request for the manual operation log MOL collectively including the enlarged display operations of the respective images is issued. In this manner, the medical staff can register the manual operation log MOL at his/her preferred timing. 
     The screen output control unit  66  causes the log display screen  95  illustrated in  FIG. 16  to be displayed on a lower portion of the integrated display screen  35  or the like. 
     In  FIG. 16 , the log display screen  95  has a display selection region  96  and a collective display region  97 . The display selection region  96  is provided with two pull-down menus  98 A and  98 B. The pull-down menu  98 A is for selecting the type of logs to be displayed in the collective display region  97 . In the pull-down menu  98 A, options for displaying only the automatic processing log APL, only the manual operation log MOL, or only the quotation log QL are prepared in addition to an option of “all” for displaying all types of logs, which is illustrated in the drawing. The pull-down menu  98 B is for narrowing down the logs to be displayed in the collective display region  97  using the examination data. In the pull-down menu  98 B, an option of “all” for displaying logs relating to all of the examination data, and options for displaying only the log relating to the CR image or only the log relating to the Mill image are prepared in addition to an option of “CT image” for displaying only the log relating to the CT image, which is illustrated in the drawing. In a case where the log display screen  95  is displayed, the option of “all” is selected in each of the pull-down menus  98 A and  98 B. In addition to this, a pull-down menu for narrowing down the logs to be displayed in the collective display region  97  using the date, the imaging part, the direction, or the like may be provided. 
     In the collective display region  97 , display based on the registration contents of the log data table  56  is performed. That is, in the collective display region  97 , a display block of the automatic processing log APL (hereinafter, referred to as APL block)  99 , and a display block of the manual operation log MOL (hereinafter, referred to as MOL block)  100  are collectively displayed. Further, in the collective display region  97 , a display block of the quotation log QL (hereinafter, referred to as QL block)  101  is also displayed. In the APL block  99  and the MOL block  100 , the thumbnail  75  of the medical image  20  is displayed as in case of the windows in the second display region  71  of the integrated display screen  35 . In  FIG. 16 , the log display screen  95  in which the display based on the registration contents of the log data table  56  relating to the CT image of the patient having a patient ID of P001 illustrated in  FIG. 13  is performed is illustrated. 
     The APL block  99  and the MOL block  100  are displayed in time series. In  FIG. 16 , from the top to the bottom, the APL block  99  and the MOL block  100  are arranged in an ascending order of registration date and time. That is, when the APL block  99  and the MOL block  100  in the collective display region  97  are viewed in order from the top, it can be known that in what order the automatic processing and the manual operation were performed. 
     In  FIG. 16 , the APL block  99  and the MOL block  100  for one day of “2016.01.14” are displayed, but in a case where there are a plurality of consultation dates of the target patient, the APL block  99  and the MOL block  100  for a plurality of days are displayed. In this case, the collective display region  97  is divided into small regions for each day. 
     In the APL block  99 , as indicated by a frame with a broken line and reference numeral  105 , characters (AUTO) indicating deriving from the automatic processing of the diagnosis support algorithm  30  are written. On the other hand, in the MOL block  100 , as indicated by frames with broken lines and reference numerals  106  and  107 , characters (enlarged display operation in MOL block  100 A, lesion measurement operation in MOL block  100 B) indicating specific contents of the manual operation, and characters (A doctor (SF050)) indicating the medical staff who performed the manual operation and the staff ID thereof are written. The APL block  99  and the MOL block  100  can be distinguishable from each other by such character notations  105  to  107 . 
     As a method of displaying the APL block  99  and the MOL block  100  in a distinguishable manner, instead of or in addition to the method of varying the character notations, a method of changing the character style (bold, italic, underline, font, and the like) between the APL block  99  and the MOL block  100 , changing the background color between the APL block  99  and the MOL block  100  (gray in the APL block  99 , light blue in the MOL block  100 ), surrounding any of the APL block  99  and the MOL block  100  with a frame, or graying out any of the APL block  99  and the MOL block  100  may be adopted. 
     In the APL block  99 , as indicated by a frame with a broken line and reference numeral  108 , characters indicating a part of the diagnosis support information is written. Further, in the APL block  99 , as indicated by a frame with a broken line and reference numeral  109 , characters indicating whether the detailed information has been displayed or has not been displayed are written. In case of  FIG. 16 , characters (not displayed) indicating that the detailed information has not been displayed are written. 
     In the MOL block  100 B of the lesion measurement operation, as indicated by a frame with a broken line and reference numeral  110 , characters indicating a part of the lesion measurement result are written. 
     The screen output control unit  66  causes the QL block  101  to be displayed to correspond to the APL block  99  of the automatic processing log APL as the quotation source or the MOL block  100  of the manual operation log MOL as the quotation source, in the collective display region  97 . More specifically, the QL block  101  is displayed to be hung down right below the APL block  99  of the automatic processing log APL as the quotation source or the MOL block  100  of the manual operation log MOL as the quotation source.  FIG. 16  illustrates an example in which the manual operation log MOL of the MOL block  100 B is the quotation source and the QL block  101  is displayed right below the MOL block  100 B. 
     In the QL block  101 , as indicated by a frame with a broken line and reference numeral  111 , characters (@Report) indicating the quotation destination of the diagnosis support information included in the automatic processing log APL or the doctor&#39;s analysis result included in the manual operation log MOL are written. The characters “@Report” exemplified here indicate that the quotation destination of the diagnosis support information or the doctor&#39;s analysis result is the medical report  21 . In a case where the medical conference is the quotation destination, instead of @Report, characters of @Conference (refer to reference numeral  157  of  FIG. 27  or the like) are written. 
     In the QL block  101 , similar to the MOL block  100 , as indicated by a frame with a broken line and reference numeral  112 , characters (B doctor (SF060)) indicating the medical staff who performed the quotation act and the staff ID thereof are written. Further, in the QL block  101 , as indicated by a frame with a broken line and reference numeral  113 , characters indicating a part of the contents of the medical report  21  or the medical conference which is the quotation destination are written. 
     In a case where the number of APL blocks  99 , MOL blocks  100 , and QL blocks  101  reach a number that cannot be displayed at one time, a vertical scroll bar is displayed in the collective display region  97 . 
     As a method of quoting the diagnosis support information or the doctor&#39;s analysis result in the medical report  21  or the medical conference, an aspect illustrated in  FIG. 17  is adopted, for example. That is, the APL block  99  or the MOL block  100  in the collective display region  97  is dragged and dropped into the report window  76  or the conference window  77 . The screen output control unit  66  causes the QL block  101  to be displayed right below the APL block  99  or the MOL block  100  which has been dragged and dropped.  FIG. 17  illustrates an aspect in which the MOL block  100 B of the lesion measurement operation illustrated in  FIG. 16  is dragged and dropped into the report window  76  and the QL block  101  is displayed right below the MOL block  100 B. 
     As illustrated in  FIG. 18A , in the collective display region  97 , the APL block  99  receives a selection instruction by the cursor  80 . In a case where there is a selection instruction of the APL block  99  by the cursor  80 , the screen output control unit  66  causes a detailed information display screen  120  illustrated in  FIG. 18B  to be displayed in a pop-up on the log display screen  95 . 
     The detailed information display screen  120  has an algorithm display region  121  in which the name of the diagnosis support algorithm  30  executing the automatic processing or the like is displayed, an image display region  122  in which the medical image  20  is displayed, and a diagnosis support information display region  123  in which the diagnosis support information is displayed. In the medical image  20  in the image display region  122 , a frame and an arrow indicating the position of a lesion extracted in the diagnosis support algorithm  30  are displayed. The display of the detailed information display screen  120  disappears by clicking a right button of the mouse or pressing an escape key on the keyboard. 
     The screen output control unit  66  causes “not displayed” to be displayed in the character notation  109  in the APL block  99  before the selection instruction illustrated in  FIG. 18A  since the detailed information has not been displayed. In contrast, in the APL block  99  illustrated in  FIG. 18C  after the selection instruction is performed and the detailed information display screen  120  is displayed, “displayed” indicating that the detailed information has been displayed is displayed in the character notation  109 . The screen output control unit  66  varies the display aspect between the automatic processing log APL of which the selection instruction has been received and the detailed information has been displayed, and the automatic processing log APL of which the selection instruction has not been received and the detailed information has not been displayed, by switching the display of the character notation  109 . 
     As illustrated in  FIG. 19A , in the collective display region  97 , the MOL block  100  also receives a selection instruction by the cursor  80 . In a case where there is a selection instruction of the MOL block  100  by the cursor  80 , the screen output control unit  66  causes a reproduction screen  130 , in which the display state of the examination data of the manual operation log MOL relating to the MOL block  100  which has received the selection instruction is reproduced on the basis of the display state information of the log data table  56 , to be displayed in a pop-up on the log display screen  95  as illustrated in  FIG. 19B . 
       FIG. 19  illustrates a case in which the selection instruction of the MOL block  100 B of the lesion measurement operation illustrated in  FIG. 16  is received. In this case, the screen output control unit  66  causes the viewer screen  85  to be displayed in a pop-up on the integrated display screen  35  as illustrated in  FIG. 19B , and the reproduction screen  130  of a state in which the lesion measurement result is input to the measurement result input region  88  in the viewer screen  85  is displayed. Similar to the detailed information display screen  120 , the display of the reproduction screen  130  disappears by clicking a right button of the mouse or pressing an escape key on the keyboard. 
     Hereinafter, the operation of the above configuration will be described with reference to the flowcharts in  FIGS. 20 and 21 . First, the medical staff such as a doctor accesses the medical examination support server  12  via the client terminal  11 , and performs authentication. In this case, the medical staff inputs his/her own staff ID and an authentication key. After authentication, in the medical examination support server  12 , the request receiving unit  60  receives various requests from the client terminal  11 . 
     In  FIG. 20 , in a case where the distribution request for the integrated display screen  35  is received by the request receiving unit  60  (YES in step ST 100 ), an acquisition request for the medical data of the target patient is issued from the medical data acquisition unit  61  to the server group  14 . The medical data of the target patient transmitted from the server group  14  in response to the acquisition request is acquired by the medical data acquisition unit  61  (step ST 110 ). 
     The analysis processing unit  62  determines whether there is examination data for which the diagnosis support information has not been output, among the medical data of the target patient. In a case where there is examination data for which the diagnosis support information has not been output (YES in step ST 120 ), the corresponding examination data is input to the diagnosis support algorithm  30  by the analysis processing unit  62 , and the analysis processing is executed (step ST 130 ). An automatic processing log APL including the diagnosis support information as the result of the analysis processing is output from the analysis processing unit  62  to the first acquisition unit  63 . In this manner, the automatic processing log APL is acquired by the first acquisition unit  63  (step ST 140 , first acquisition step). The automatic processing log APL is transferred from the first acquisition unit  63  to the information management unit  65 , and is registered in the log data table  56  by the information management unit  65  (step ST 150 , information management step). In a case where there is no examination data for which the diagnosis support information has not been output (NO in step ST 120 ), processing of steps ST 130  to ST 150  is not performed. 
     In a case where a registration request for a manual operation log MOL is received by the request receiving unit  60  (YES in step ST 160 ), the manual operation log MOL included in the registration request is acquired by the second acquisition unit  64  (step ST 170 , second acquisition step). The manual operation log MOL is transferred from the second acquisition unit  64  to the information management unit  65 , and is registered in the log data table  56  by the information management unit  65  (step ST 180 , information management step). 
       FIG. 20  illustrates a flowchart following a processing procedure of the medical examination support server  12  mainly from the viewpoint of the first acquisition unit  63  and the second acquisition unit  64 , and  FIG. 21  illustrates a flowchart following a processing procedure of the medical examination support server  12  mainly from the viewpoint of the screen output control unit  66 . 
     The distribution request for the integrated display screen  35  is received by the request receiving unit  60  (YES in step ST 100 ), and the medical data which is acquired by the medical data acquisition unit  61  in step ST 110  in response to the reception of the distribution request is output to the screen output control unit  66 . Further, each log of the target patient is read from the log data table  56  by the information management unit  65 , and is output to the screen output control unit  66  (step ST 200 ). 
     In the screen output control unit  66 , the integrated display screen  35  is generated on the basis of the medical data of the target patient from the medical data acquisition unit  61 . The log display screen  95  is generated on the basis of each log of the target patient from the information management unit  65 . The generated integrated display screen  35  and log display screen  95  are transmitted to the client terminal  11  which is a request source of the distribution request (step ST 210 , screen output control step). 
     In the client terminal  11  which is a request source of the distribution request for the integrated display screen  35 , the integrated display screen  35  and the log display screen  95  from the medical examination support server  12  are displayed on the display  23 . 
     In a case where a thumbnail  75  of the medical image  20  in the integrated display screen  35  is selected, the viewer screen  85  is displayed in a pop-up on the integrated display screen  35  by the screen output control unit  66 . Further, in this case, the registration request for the manual operation log MOL (enlarged display operation) is issued from the browser control unit  51 , and is received by the request receiving unit  60 . 
     Even in a case where the lesion measurement result is input to the measurement result input region  88  in the viewer screen  85  and the registration button  90  is selected, the registration request for the manual operation log MOL (lesion measurement operation) is issued from the browser control unit  51 , and is received by the request receiving unit  60 . 
     In this manner, the manual operation log MOL is registered frequently even after the transmission of the integrated display screen  35  and the log display screen  95  in step ST 210  of  FIG. 21 . In a case where a timing at which the analysis processing (step ST 130  of  FIG. 20 ) of the diagnosis support algorithm  30  is ended is after the transmission of the integrated display screen  35  and the log display screen  95  in step ST 210  of  FIG. 21 , the automatic processing log APL is also registered after the transmission of the integrated display screen  35  and the log display screen  95  in step ST 210  of  FIG. 21 . The screen output control unit  66  updates the display of the log display screen  95  each time the automatic processing log APL and the manual operation log MOL are newly registered. 
     In the collective display region  97  in the log display screen  95 , the APL block  99  and the MOL block  100  are collectively displayed in a time series in a distinguishable manner. Therefore, it can be clearly known whether a certain manual operation is executed before the output of the diagnosis support information or is executed after the output of the diagnosis support information. Accordingly, it is possible to easily grasp the history of doctor&#39;s diagnosis at a glance. 
     For example, in a case where a manual operation accompanying the doctor&#39;s analysis result is executed before the output of the diagnosis support information, the possibility that the doctor has derived the analysis result without referring to the diagnosis support information much is high. In contrast, in a case where a manual operation accompanying the doctor&#39;s analysis result is executed after the output of the diagnosis support information, the possibility that the doctor has derived the analysis result based on the diagnosis support information is high. In a case where the history of the diagnosis can be easily grasped in this manner, for example, the time required when the doctor reviews the history of his/her own diagnosis or when the supervisor reviews the history of the doctor&#39;s diagnosis becomes short, which is efficient. 
     Further, it can be known that what kind of manual operations or quotation acts is executed by which medical staff, by the MOL block  100  and the QL block  101  at a glance. Therefore, it is possible for a manager who is in charge of the entire medical facility to grasp the approximate work status of each medical staff by viewing the collective display region  97 . 
     In the collective display region  97 , in addition to the APL block  99  and the MOL block  100 , the QL block  101  is also displayed. Further, the QL block  101  is displayed to correspond to the APL block  99  of the automatic processing log APL as the quotation source or the MOL block  100  of the manual operation log MOL as the quotation source. Therefore, it can be known that what kind of diagnosis support information or doctor&#39;s analysis result is quoted in which medical report  21  or medical conference at a glance. 
     As illustrated in  FIG. 18 , the display aspect is varied between the APL block  99  of the automatic processing log APL of which the detailed information including the diagnosis support information has been displayed, and the APL block  99  of the automatic processing log APL of which the detailed information has not been displayed, and thus it can be known that whether the medical staff has checked the diagnosis support information by the display of the detailed information at a glance. Therefore, even in a case where a manual operation accompanying the doctor&#39;s analysis result is executed after the output of the diagnosis support information, when the detailed information is not displayed and the diagnosis support information is not checked, it can be determined that the doctor has derived the analysis result without referring to the diagnosis support information. 
     It is considered that the automatic processing log APL of which the detailed information is not displayed even when some time has passed from the initial display is information which is less important for the doctor. Thus, for the automatic processing log APL of which the detailed information is not displayed even when a preset display period has passed, the APL block  99  may be automatically grayed out or may not be automatically displayed. Similarly, for the automatic processing log APL of which the number of times of quotation is zero even when a preset display period has passed, the APL block  99  may be automatically grayed out or may not be automatically displayed. 
     As illustrated in  FIG. 19 , by reproducing the display state of the examination data of the manual operation log MOL of which the selection instruction has been received, on the basis of the display state information representing the display state of the examination data that the doctor was viewing at the time of acquisition of the manual operation log MOL, it is possible to easily grasp in what display state the doctor has performed the manual operation. 
     Second Embodiment 
     In the second embodiment illustrated in  FIGS. 22 and 23 , the display aspect of the automatic processing log APL or the manual operation log MOL is varied depending on the number of times of quotation. 
       FIG. 22  illustrates a method of quoting the diagnosis support information or the doctor&#39;s analysis result in the medical report  21  or the medical conference, as in  FIG. 17 . However, in  FIG. 22 , the display aspect of the automatic processing log APL or the manual operation log MOL is varied before and after the diagnosis support information or the doctor&#39;s analysis result is quoted, that is, between a case where the number of times of quotation is zero and a case where the number of times of quotation is one. More specifically, after the diagnosis support information or the doctor&#39;s analysis result is quoted, as indicated by hatching, the background color of the APL block  99  or the MOL block  100  (MOL block  100 B in  FIG. 22 ) is changed from the background color before the diagnosis support information or the doctor&#39;s analysis result is quoted. 
       FIG. 23  illustrates a change example of the background color of the APL block  99  or the MOL block  100  according to the number of times of quotation. That is, the background color of the APL block  99  or the MOL block  100  is white in a case where the number of times of quotation is zero, is yellow in a case where the number of times of quotation is one, is yellow-green in a case where the number of times of quotation is two, and is green in a case where the number of times of quotation is three or more. The screen output control unit  66  changes the background color of the APL block  99  or the MOL block  100  according to such a table, for example. In this manner, it is possible to immediately determine how many times the diagnosis support information or the doctor&#39;s analysis result is quoted. 
     The number of times of quotation can be known by counting the number of QL blocks  101 . However, it takes time to count the number, and it is difficult to intuitively understand. Thus, by varying the display aspect of the automatic processing log APL or the manual operation log MOL depending on the number of times of quotation as described above, it is possible to more intuitively grasp the number of times of quotation. 
     It is considered that the automatic processing log APL or the manual operation log MOL of which the number of times of quotation of the diagnosis support information or the doctor&#39;s analysis result is large has higher doctor&#39;s attention degree and is more important than the one of which the number of times of quotation is small. Therefore, in a case where a display aspect in which the difference in the number of times of quotation can be quickly grasped is used, it is possible to quickly distinguish the important automatic processing log APL or manual operation log MOL and unimportant automatic processing log APL or manual operation log MOL. 
     As a method of varying the display aspect of the automatic processing log APL or the manual operation log MOL depending on the number of times of quotation, instead of or in addition to the method of changing the background color of the APL block  99  or the MOL block  100 , a method of displaying a number indicating the number of times of quotation or a figure (for example, a circle) indicating the number of times of quotation by the number in the APL block  99  or the MOL block  100  may be adopted. 
     The display of the APL block  99  or the MOL block  100  may become less noticeable as the number of times of quotation is increased, for example, by graying out the APL block  99  or the MOL block  100  when the number of times of quotation becomes one. 
     Third Embodiment 
     In the third embodiment illustrated in  FIGS. 24 and 25 , a medical image  20  of which the number of times of quotation is equal to or greater than a threshold value is extracted as a candidate image for a similar case image similar to the medical image of the target patient. 
     In  FIGS. 24 and 25 , the CPU  42 B of the medical examination support server  12  functions as an extraction unit  135  in addition to the processing units  60  to  66  in the first embodiment. The extraction unit  135  extracts a candidate image on the basis of the number of times of quotation. 
     More specifically, the extraction unit  135  reads the number of times of quotation of, for example, the doctor&#39;s analysis result (the number of times of quotation of the diagnosis support information, and a total of the number of times of quotation of the diagnosis support information and the number of times of quotation of the doctor&#39;s analysis result are also possible) for the medical image  20  having a certain image ID, from the log data table  56 . Next, the extraction unit  135  collates the read number of times of quotation with an extraction condition  136  relating to the preset number of times of quotation. In  FIGS. 24 and 25 , the number of times of quotation of one or more is set in the extraction condition  136 . The number of times of quotation of one corresponds to the threshold value. 
     In the embodiment, in a file of the medical images  20  for one case, an item of a candidate image flag is provided in addition to the items illustrated in  FIG. 6  in the first embodiment. In the item of the candidate image flag, “1” is registered in a case where the corresponding medical image  20  is the candidate image, and “0” is registered in a case where the corresponding medical image  20  is not the candidate image. 
     The extraction unit  135  transmits a registration request for the candidate image flag according to the collation result to the image server  16 .  FIG. 24  illustrates a case in which the number of times of quotation for the medical image  20  read from the log data table  56  satisfies the extraction condition  136  (the number of times of quotation is equal to or greater than the threshold value). In this case, the extraction unit  135  transmits the registration request indicating that “1” is registered in the candidate image flag to the image server  16 . In contrast,  FIG. 25  illustrates a case in which the number of times of quotation for the medical image  20  read from the log data table  56  does not satisfy the extraction condition  136  (the number of times of quotation is less than the threshold value). In this case, the extraction unit  135  transmits the registration request indicating that “0” is registered in the candidate image flag to the image server  16 . 
     At the time of searching for the similar case image, the medical image  20  for which “0” is registered in the candidate image flag is excluded from the candidate image. The similar case image is searched for from the medical images  20  for which “1” is registered in the candidate image flag. 
     In this manner, since the medical image  20  of which the number of times of quotation is equal to or greater than the threshold value becomes the candidate image for the similar case image, it is possible to search for the medical image  20 , which is considered to have high doctor&#39;s attention degree and to be important, as the similar case image. In other words, it is possible to prevent the medical image  20 , which is considered to be less important, from being searched for as the similar case image. 
     Fourth Embodiment 
     In the fourth embodiment illustrated in  FIG. 26 , the similar case image similar to the medical image of the target patient is searched for by using an equation with the number of times of quotation as a parameter. 
     In  FIG. 26 , the CPU  42 B of the medical examination support server  12  functions as a feature quantity calculation unit  140  and a search unit  141  in addition to the processing units  60  to  66  in the first embodiment. The feature quantity calculation unit  140  calculates a feature quantity Z of the medical image  20 . The search unit  141  searches for the similar case image similar to the medical image  20  of the target patient from a plurality of medical images  20  of the image DB  16 A. 
     The feature quantity Z includes the size of a lesion exemplified as the diagnosis support information in the first embodiment, a numerical value relating to a pixel value such as an average value or the standard deviation of pixel values of a lesion, a numerical value relating to the position of a lesion such as a distance to another lesion, a distance to the chest wall, and belonging lobes of the lungs such as an upper lobe, a middle lobe, a lower lobe, S 1 , and S 2 . In addition to the above description, the feature quantity Z also includes a degree of irregularity of the lesion margin, a concentration gradient at the boundary between a lesion and a normal portion, a spiculation degree such as the number and length of the spiculation, and a cavity size. In this manner, there are a plurality of types of the feature quantity Z. 
     The feature quantity calculation unit  140  calculates a feature quantity ZTi (i=1, 2, 3, 4, . . . ) of the medical image  20  of the target patient, and a feature quantity ZCi of the medical image  20  of the image DB  16 A. The feature quantity calculation unit  140  outputs the calculated feature quantities ZTi and ZCi to the search unit  141 . A multidimensional vector with a plurality of types of feature quantity Z such as feature quantities ZTi and ZCi as elements is called a feature vector. 
     The search unit  141  calculates a similarity degree S between the medical image  20  of the target patient and the medical image  20  of the image DB  16 A using Equation (1) described below. 
         S =[{Σ( ZTi−ZCi ) 2 } 1/2 ]/ N   (1)
 
     Here, N is the number of times of quotation of, for example, the doctor&#39;s analysis result (the number of times of quotation of the diagnosis support information, and a total of the number of times of quotation of the diagnosis support information and the number of times of quotation of the doctor&#39;s analysis result are also possible) relating to the medical image  20  of the image DB  16 A. That is, Equation (1) is an equation with the number of times of quotation as a parameter. 
     In Equation (1), the right side numerator is a square root of the sum of squares of the difference (ZTi−ZCi) between a plurality of types of feature quantity ZTi of the medical image  20  of the target patient and a plurality of types of feature quantity ZCi of the medical image  20  of the image DB  16 A, that is, the distance between a feature vector having the feature quantity ZTi as an element and a feature vector having the feature quantity ZCi as an element. Therefore, since the distance between a feature vector having the feature quantity ZTi as an element and a feature vector having the feature quantity ZCi as an element becomes short as the similarity between the medical image  20  of the target patient and the medical image  20  of the image DB  16 A is increased, the value of the right side numerator in Equation (1) becomes smaller. Since the similarity degree S is obtained by dividing the distance between the feature vectors by the number of times of quotation N, the similarity degree S is decreased as the number of times of quotation N is increased. 
     The search unit  141  searches for the medical image  20  of the image DB  16 A having a similarity degree S equal to or less than a threshold value, as the similar case image. In a case where there are a plurality of medical images  20  of the image DB  16 A with almost the same value of the right side numerator in Equation (1), the medical image  20  of which the number of times of quotation N is higher has a smaller similarity degree S (higher similarity), and thus is more easily searched for as the similar case image. 
     In this manner, since the similar case image is searched for by using an equation with the number of times of quotation as a parameter, it is possible to search for the medical image  20 , which is considered to have high doctor&#39;s attention degree and to be important, as the similar case image. 
     As the feature quantity, instead of the feature quantity calculated by the feature quantity calculation unit  140 , the doctor&#39;s analysis result may be used. In this case, whether to use the feature quantity calculated by the feature quantity calculation unit  140  or to use the doctor&#39;s analysis result may be selected depending on the number of times of quotation, such as a case in which the doctor&#39;s analysis result is used as the feature quantity in a case where the number of times of quotation of the doctor&#39;s analysis result is greater than the number of times of quotation of the diagnosis support information for a certain medical image  20 . 
     Fifth Embodiment 
     The fifth embodiment illustrated in  FIGS. 27 to 29  is modification examples of the log display screen. 
     In  FIG. 27 , a log display screen  150  of the embodiment has a partial function of the integrated display screen  35  in a collective display region  151 . That is, in the collective display region  151 , the thumbnail  75  of the medical image  20  is displayed. The thumbnail  75  in the collective display region  151  can also be selected by the cursor  80 , and in a case where the thumbnail  75  is selected by the cursor  80 , the viewer screen  85  is displayed. 
     The collective display region  151  is divided into small regions for each day. In each small region, the thumbnails  75  of the medical images  20  acquired in the image examination performed on the day are displayed by being arranged from left to right and from top to bottom in order of imaging date and time. 
     In each small region of the collective display region  151 , APL blocks  152  and MOL blocks  153  which have the same size as the thumbnail  75  are displayed by being arranged from left to right and from top to bottom in order of registration date and time, similar to the thumbnail  75 . As in the APL block  99  in the first embodiment, in the APL block  152 , a character notation (AUTO)  154  indicating deriving from the automatic processing of the diagnosis support algorithm  30  is written. Further, in the APL block  152 , a character notation (not illustrated) indicating a part of the diagnosis support information with a small size is written. 
     Further, in the APL block  152 , a checkbox  155  is provided instead of the character notation  109 , which indicates whether the detailed information has been displayed or has not been displayed, of the APL block  99  in the first embodiment. In a case where the detailed information has been displayed, a check mark is displayed in the checkbox  155 . 
     The MOL block  153  includes display state information, that is, a thumbnail of a screenshot of the display  23  at the time of acquisition of the manual operation log MOL. In the MOL block  153 , a camera mark  156  indicating being a screenshot is displayed. The MOL block  153  is distinguishable from the APL block  152  by the camera mark  156 . 
     As indicated by a frame with a broken line and reference numeral  157 , a character notation is written in the APL block  152  of the automatic processing log APL of which the diagnosis support information is quoted in the medical report  21  or the medical conference, or in the MOL block  153  of the manual operation log MOL of which the doctor&#39;s analysis result is quoted in the medical report  21  or the medical conference.  FIG. 27  illustrates an example in which characters (@Conference) indicating that the doctor&#39;s analysis result is quoted in the medical conference are written. 
     In the log display screen  150 , the display indicating that the diagnosis support information or the doctor&#39;s analysis result is quoted in the medical report  21  or the medical conference is completed by the character notation  157 . That is, the QL block  101  in the first embodiment is not displayed. In this manner, the QL block  101  may not be necessarily displayed in the invention. 
     As illustrated in  FIG. 28 , in the log display screen  150 , in a case where a state where the cursor  80  is placed on the MOL block  153  is continued for a predetermined time (for example, 3 seconds), a balloon  160  is displayed near the MOL block  153 . In the balloon  160 , the examination data associated with the manual operation log MOL of the MOL block  153  where the cursor  80  is placed is collectively displayed.  FIG. 28  illustrates a state in which the manual operation log MOL of the MOL block  153  where the cursor  80  is placed relates to the enlarged display operation of the CT image, the CR image, and the CAG image, and the thumbnail  75  of each image thereof is displayed in the balloon  160 . 
     In the log display screen  150 , the MOL block  153  has the same size as the thumbnail  75 . Therefore, it is not clear what kind of examination data the manual operation log MOL is associated with, only by the display of the MOL block  153 . Thus, the examination data associated with the manual operation log MOL of the MOL block  153  is specified in the balloon  160 . In this manner, the examination data associated with the manual operation log MOL of the MOL block  153  can be easily confirmed. 
       FIG. 29  illustrates another method of specifying the examination data associated with the manual operation log MOL of the MOL block  153 . In this case, in a case where a state where the cursor  80  is placed on the MOL block  153  is continued for a predetermined time (for example, 3 seconds) as in  FIG. 28 , a frame  161  is displayed in the examination data associated with the manual operation log MOL of the MOL block  153  where the cursor  80  is placed.  FIG. 29  illustrates a state in which the manual operation log MOL of the MOL block  153  where the cursor  80  is placed relates to the comparison display operation between the CT image captured on “2016.01.14” and the CT image captured on “2016.01.18”, and the frame  161  is displayed on the thumbnail  75  of each image thereof. The examination data associated with the manual operation log MOL of the MOL block  153  can be easily confirmed even by the display of the frame  161 . 
     Both the balloon  160  and the frame  161  may be displayed. Further, instead of or in addition to the balloon  160  or the frame  161 , the reproduction screen  130  illustrated in  FIG. 19B  may be displayed. 
     The character notations  111  and  157  indicating that the diagnosis support information or the doctor&#39;s analysis result is quoted in the medical report  21  or the medical conference may have a function of a hyperlink to the medical report  21  or the conference information  22 . In this manner, it is possible to quickly refer to the medical report  21  or the conference information  22 . 
     In the medical report  21  or the medical conference, a medical image  20  other than that of the target patient is also quoted. Such a medical image  20  is often useful as information for grasping the medical state of the target patient, such as a similar case image. Therefore, in a case where it is possible to quickly refer to the medical report  21  or the conference information  22 , it is possible to quickly grasp the medical state of the target patient, which is efficient. 
     In each embodiment described above, as the examination data of which the APL blocks  99  and  152  and the MOL blocks  100  and  153  are displayed, the medical image  20  is exemplified, but the invention is not limited thereto. The APL blocks  99  and  152  and the MOL blocks  100  and  153  of the measurement data such as vital signs, blood tests, urine tests may be displayed. 
     The log display screens  95  and  150  may not always be displayed together with the integrated display screen  35 . When a new log is added to the log data table  56 , the log display screens  95  and  150  may be displayed in a pop-up on the integrated display screen  35 . 
     An item of a disease may be provided to the log data table  56 , and the disease may be associated with each log. In this manner, in case of a target patient with a plurality of diseases, it is possible to narrow down logs using the disease. 
     The hardware configuration of a computer which constitutes the medical examination support server  12  corresponding to the medical examination support apparatus of the invention can be modified in various ways. For example, in order to improve the processing capacity and reliability, the medical examination support server  12  may be constituted by a plurality of server computers that are separated from each other as hardware. For example, the functions of the request receiving unit  60  and the second acquisition unit  64 , the functions of the medical data acquisition unit  61 , the analysis processing unit  62 , and the first acquisition unit  63 , and the functions of the information management unit  65  and the screen output control unit  66  are distributed to three server computers. In this case, the three server computers constitute the medical examination support apparatus. 
     In each embodiment described above, an aspect in which the medical examination support server  12  generates various display screens and the various display screens are reproduced by the client terminal  11  and displayed on the display  23  on the basis of the screen data of the various display screens from the medical examination support server  12  is exemplified. However, data which is a source for generating various display screens may be transmitted from the medical examination support server  12  to the client terminal  11  and the client terminal  11  may generate the various display screens. In this case, the screen output control unit  66  is constructed in the CPU  42 A of the client terminal  11 . 
     Further, each processing unit constructed in the CPU  42 B of the medical examination support server  12  may be constructed in the CPU  42 A of the client terminal  11 , and the client terminal  11  may be operated as the medical examination support apparatus. In this case, the request receiving unit  60  directly receives instructions from the GUI control unit  50  instead of the distribution request or the like. In addition, the screen output control unit  66  outputs the generated various display screens to the GUI control unit  50 . Further, the electronic medical record server  15  or the image server  16  may be operated as the medical examination support apparatus. 
     In this manner, the hardware configuration of a computer can be appropriately changed according to the required performance, such as processing capacity, safety, or reliability. Further, in order to ensure the safety and the reliability, without being limited to hardware, an application program such as the operation program  55  may be duplicated or may be distributed and stored in a plurality of storage devices. 
     In each embodiment described above, an aspect in which the medical examination support server  12  is used in one medical facility is described, but an aspect in which the medical examination support server  12  is used by a plurality of medical facilities may be adopted. 
     In each embodiment described above, the medical examination support server  12  is communicably connected to the client terminal  11 , which is installed in one medical facility, through the network  13  such as a LAN, and provides various display screens in response to the distribution request from the client terminal  11 . In order for the medical examination support server  12  to be used by a plurality of medical facilities, the medical examination support server  12  is communicably connected to each of the client terminals  11  installed in the plurality of medical facilities, for example, through a wide area network (WAN) such as the Internet or a public communication network. Then, the medical examination support server  12  receives the distribution request from each client terminal  11  of the plurality of medical facilities through the WAN, and provides various display screens to each client terminal  11 . In case of using the WAN, it is preferable to construct a virtual private network (VPN) or to use a communication protocol with a high security level, such as hypertext transfer protocol secure (HTTPS), in consideration of information security. 
     In this case, the electronic medical record  19 , the medical image  20 , the medical report  21 , the conference information  22 , and the log data table  56  are managed for each medical facility. Further, the installation location and operating entity of the medical examination support server  12  in this case may be a data center operated by a company that is different from the medical facilities, or may be one of the plurality of medical facilities, for example. 
     It is sufficient that the medical examination support apparatus of the invention has at least the function of controlling the output of the log display screen  95 , and thus the medical examination support apparatus of the invention may not necessarily have the function of controlling the output of the integrated display screen  35  as in the screen output control unit  66  in each embodiment described above. 
     In each embodiment described above, the hardware structure of the processing units executing various kinds of processing, such as the request receiving unit  60 , the medical data acquisition unit  61 , the analysis processing unit  62 , the first acquisition unit  63 , the second acquisition unit  64 , the information management unit  65 , the screen output control unit  66 , the extraction unit  135 , the feature quantity calculation unit  140 , and the search unit  141  is various processors as follows. 
     The various processors include a CPU, a programmable logic device (PLD), dedicated electrical circuitry, and the like. The CPU is a general-purpose processor functioning as various processing units by executing software (program) as being well known. The PLD is a processor of which the circuit configuration can be changed after manufacture, such as a field programmable gate array (FPGA). The dedicated electrical circuitry is a processor having a circuit configuration designed exclusively to execute specific processing, such as an application specific integrated circuit (ASIC). 
     One processing unit may be configured by one of the various processors or a combination of the same or different kinds of two or more processors (for example, a combination of a plurality of FPGAs or a combination of a CPU and an FPGA). In addition, a plurality of processing units may be configured by one processor. As an example where a plurality of processing units are configured by one processor, first, there is an aspect where one processor is configured by a combination of one or more CPUs and software, and this processor functions as a plurality of processing units. Second, there is an aspect where a processor fulfilling the functions of the entire system including a plurality of processing units by one IC chip as typified by a system on chip (SoC) or the like is used. In this manner, various processing units are configured by using one or more of the above-described various processors as hardware structures. 
     Furthermore, the hardware structures of these various processors are more specifically electrical circuitry where circuit elements, such as semiconductor elements, are combined. 
     From the above description, the medical examination support apparatus described in Additional remark 1 described below can be grasped. 
     [Additional remark 1] A medical examination support apparatus comprising: 
     a first acquisition processor that acquires an automatic processing log which is a history of automatically performing analysis processing on examination data obtained in a medical examination performed on a patient by a diagnosis support algorithm to output a result of the analysis processing as diagnosis support information for supporting diagnosis of a doctor; 
     a second acquisition processor that acquires a manual operation log which is a history of a manual operation of the doctor with respect to the examination data; 
     an information management processor that stores the examination data in association with the automatic processing log and the manual operation log in a storage unit; and 
     a screen output control processor that controls an output of a log display screen which has a collective display region in which the automatic processing log and the manual operation log are collectively displayed in a time series in a distinguishable manner. 
     In the invention, it is also possible to appropriately combine the above-described various embodiments or various modification examples. Further, without being limited to the embodiments described above, various configurations can be adopted as long as the configurations do not depart from the scope of the invention. In addition to the program, the invention also extends to a storage medium that stores the program. 
     EXPLANATION OF REFERENCES 
     
         
         
           
               10 : medical examination system 
               11 : client terminal 
               12 : medical examination support server (medical examination support apparatus) 
               13 : network 
               14 : server group 
               15 : electronic medical record server 
               15 A: medical record database (DB) 
               16 : image server 
               16 A: image database (DB) 
               17 : report server 
               17 A: report database (DB) 
               18 : conference server 
               18 A: conference database (DB) 
               19 : electronic medical record 
               20 : medical image 
               21 : medical report 
               22 : conference information 
               23 ,  44 : display 
               24 ,  45 : input device 
               30 : diagnosis support algorithm 
               35 : integrated display screen 
               40 ,  40 B: storage device (storage unit) 
               41 : memory 
               42 ,  42 A,  42 B: CPU 
               43 : communication unit 
               46 : data bus 
               50 : GUI control unit 
               51 : browser control unit 
               55 : operation program 
               56 : log data table 
               60 : request receiving unit 
               61 : medical data acquisition unit 
               62 : analysis processing unit 
               63 : first acquisition unit 
               64 : second acquisition unit 
               65 : information management unit 
               66 : screen output control unit 
               70 : first display region 
               71 : second display region 
               72 : third display region 
               73 : fourth display region 
               75 : thumbnail 
               76 : report window 
               77 : conference window 
               80 : cursor 
               85 : viewer screen 
               86 ,  122 : image display region 
               87 : information display region 
               88 : measurement result input region 
               89 : frame 
               90 : registration button 
               95 ,  150 : log display screen 
               96 : display selection region 
               97 ,  151 : collective display region 
               98 A,  98 B: pull-down menu 
               99 ,  152 : display block of automatic processing log (APL block) 
               100 ,  100 A,  100 B,  153 : display block of manual operation log (MOL block) 
               101 : display block of quotation log (QL block) 
               105  to  113 ,  154 ,  157 : character notation 
               120 : detailed information display screen 
               121 : algorithm display region 
               123 : diagnosis support information display region 
               130 : reproduction screen 
               135 : extraction unit 
               136 : extraction condition 
               140 : feature quantity calculation unit 
               141 : search unit 
               155 : checkbox 
               156 : camera mark 
               160 : balloon 
               161 : frame 
             APL: automatic processing log 
             MOL: manual operation log 
             QL: quotation log 
             ST 100  to ST 180 , ST 200 , ST 210 : step 
             Z, ZTi, ZCi: feature quantity 
             S: similarity degree 
             N: number of times of quotation