Patent Description:
A technology of performing contrast imaging of capturing a low-energy image and a high-energy image by irradiating a subject into which a contrast medium has been injected with radiation having different energies and generating a difference image showing a difference between the high-energy image and the low-energy image to generate a radiation image in which the contrast medium is enhanced is known. It is desired to perform the contrast imaging in a state in which the contrast medium has sufficiently permeated the subject, and it is desired to capture at least the high-energy image at an appropriate timing. Therefore, a technology of controlling a timing of performing the contrast imaging is known. For example, <CIT> discloses a technology of starting an examination scan of an examinee based on a change in a computed tomography (CT) value of a region of interest in a pre-scan after injecting a contrast medium. The present invention is characterised over <CIT>, which discloses an apparatus for use in a radiation procedure that can generate volumetric composite images for different elapsed times after injection of a contrast agent, where for each time a volumetric composite image can be constructed from volumetric images associated with first and second radiation energy levels. <CIT> discloses a contrast imaging system.

By the way, the ease of permeation of the contrast medium, that is, a speed at which the contrast medium permeates, or the like may differ according to the subject or the like. Therefore, it is difficult to specify an appropriate imaging timing, and even the technology disclosed in <CIT> may not be sufficient in some cases.

The present disclosure is made in view of the above circumstances, and provides a control apparatus, a control method, and a non-transitory storage medium storing a control program capable of capturing a high-energy image at an appropriate timing in contrast imaging.

A first aspect of the present disclosure relates to a control apparatus comprising at least one processor, in which the processor acquires an elapsed time from injection of a contrast medium into a subject for which a radiation image is captured by a radiography apparatus, acquires a low-energy image captured by the radiography apparatus by emitting radiation having first energy to the subject into which the contrast medium has been injected, and a high-energy image captured by the radiography apparatus by emitting radiation having second energy higher than the first energy to the subject into which the contrast medium has been injected, generates a difference image showing a difference between the low-energy image and the high-energy image, and identifies whether or not to perform re-capturing of the high-energy image of the subject into which the contrast medium has been injected, based on an analysis result about a contrast amount, which is performed on the difference image, and the elapsed time.

A second aspect of the present disclosure relates to the control apparatus according to the first aspect, in which, in a case in which the processor identifies that the re-capturing is to be performed, the processor derives a timing for performing the re-capturing based on the analysis result and the elapsed time.

A third aspect of the present disclosure relates to the control apparatus according to the second aspect, in which the processor performs control of causing the radiography apparatus to re-capture the high-energy image at the derived timing for performing the re-capturing.

A fourth aspect of the present disclosure relates to the control apparatus according to any one of the first to third aspects, in which, in a case in which a contrast of a region of interest in the difference image is equal to or greater than a predetermined threshold value, the processor identifies that the re-capturing is not to be performed regardless of the elapsed time.

A fifth aspect of the present disclosure relates to the control apparatus according to any one of the first to fourth aspects, in which, in a case in which a contrast of a region of interest in the difference image is smaller than a predetermined threshold value and the elapsed time is equal to or longer than a threshold value time, the processor identifies that the re-capturing is not to be performed.

A sixth aspect of the present disclosure relates to the control apparatus according to any one of the first to fourth aspects, in which, in a case in which a contrast of a region of interest in the difference image is smaller than a predetermined threshold value and the elapsed time is shorter than a threshold value time, the processor identifies that the re-capturing is to be performed.

A seventh aspect of the present disclosure relates to the control apparatus according to the fifth or sixth aspect, in which the threshold value time is a time according to at least one of a type of the contrast medium, a blood flow of the subject, a height of the subject, a weight of the subject, or a type of an object of interest.

An eighth aspect of the present disclosure relates to the control apparatus according to the fifth or sixth aspect, in which the subject is a breast, and the threshold value time is a time according to a mammary gland mass of the breast.

A ninth aspect of the present disclosure relates to the control apparatus according to any one of the first to eighth aspects, in which, in a case in which the processor identifies that the re-capturing is to be performed, the processor acquires the high-energy image re-captured by the radiography apparatus, and generates a re-captured difference image showing a difference between the low-energy image and the re-captured high-energy image.

A tenth aspect of the present disclosure relates to the control apparatus according to any one of the first to eighth aspects, in which, in a case in which the processor identifies that the re-capturing is to be performed, the processor also specifies that re-capturing of the low-energy image is to be performed, and generates a re-captured difference image showing a difference between the re-captured low-energy image and the re-captured high-energy image.

An eleventh aspect of the present disclosure relates to the control apparatus according to the ninth or tenth aspect, in which the processor performs the same image processing of enhancing a region of interest on the difference image and the re-captured difference image, and displays the difference image and the re-captured difference image which have been subjected to the image processing.

A twelfth aspect of the present disclosure relates to the control apparatus according to any one of the ninth to eleventh aspects, in which the processor further displays contrast amount information about a contrast amount of the same region of each of the difference image and the re-captured difference image.

A thirteenth aspect of the present disclosure relates to the control apparatus according to any one of the first to twelfth aspects, in which the subject is a breast, and the radiography apparatus is a mammography apparatus.

In addition, a fourteenth aspect of the present disclosure relates to a control method executed by a computer, the method comprising acquiring an elapsed time from injection of a contrast medium into a subject for which a radiation image is captured by a radiography apparatus, acquiring a low-energy image captured by the radiography apparatus by emitting radiation having first energy to the subject into which the contrast medium has been injected, and a high-energy image captured by the radiography apparatus by emitting radiation having second energy higher than the first energy to the subject into which the contrast medium has been injected, generating a difference image showing a difference between the low-energy image and the high-energy image, and identifying whether or not to perform re-capturing of the high-energy image of the subject into which the contrast medium has been injected, based on an analysis result about a contrast amount, which is performed on the difference image, and the elapsed time.

In addition, a fifteenth aspect of the present disclosure relates to a non-transitory storage medium storing a program causing a computer to execute a control processing, the control processing comprising: acquiring an elapsed time from injection of a contrast medium into a subject for which a radiation image is captured by a radiography apparatus, acquiring a low-energy image captured by the radiography apparatus by emitting radiation having first energy to the subject into which the contrast medium has been injected, and a high-energy image captured by the radiography apparatus by emitting radiation having second energy higher than the first energy to the subject into which the contrast medium has been injected, generating a difference image showing a difference between the low-energy image and the high-energy image, and identifying whether or not to perform re-capturing of the high-energy image of the subject into which the contrast medium has been injected, based on an analysis result about a contrast amount, which is performed on the difference image, and the elapsed time.

According to the present disclosure, it is possible to capture the high-energy image at an appropriate timing in the contrast imaging.

In the following, an embodiment of the present invention will be described in detail with reference to the drawings. It should be noted that the present embodiment does not limit the present invention.

First, an example of an overall configuration of a radiography system according to the present embodiment will be described. <FIG> shows a configuration diagram showing an example of an overall configuration of a radiography system <NUM> according to the present embodiment. As shown in <FIG>, the radiography system <NUM> according to the present embodiment comprises a mammography apparatus <NUM> and a console <NUM>. The mammography apparatus <NUM> according to the present embodiment is an example of a radiography apparatus according to the present disclosure. In addition, the console <NUM> according to the present embodiment is an example of a control apparatus according to the present disclosure.

First, the mammography apparatus <NUM> according to the present embodiment will be described. <FIG> shows a side view showing an example of an appearance of the mammography apparatus <NUM> according to the present embodiment. It should be noted that <FIG> shows the example of the appearance of the mammography apparatus <NUM> as viewed from a right side of an examinee.

The mammography apparatus <NUM> according to the present embodiment is an apparatus that uses a breast of the examinee as a subject and captures a radiation image of the breast by irradiating the breast with radiation R (for example, X-rays). It should be noted that the mammography apparatus <NUM> may be an apparatus that images the breast of the examinee in a state in which the examinee is sitting on a chair (including a wheelchair) or the like (sitting state) in addition to a state in which the examinee is standing (standing state).

In addition, the mammography apparatus <NUM> according to the present embodiment has a function of performing two types of imaging of so-called contrast imaging in which the imaging is performed in a state in which a contrast medium has been injected into the breast of the examinee and general imaging. It should be noted that, in the present embodiment, the imaging to be performed in a state in which the contrast medium has been injected into the breast of the examinee refers to the "contrast imaging", and the imaging that is not the contrast imaging refers to the "general imaging".

As shown in <FIG>, the mammography apparatus <NUM> according to the present embodiment comprises a control unit <NUM>, a storage unit <NUM>, an interface (I/F) unit <NUM>, and an operation unit <NUM> inside the imaging table <NUM>. The control unit <NUM> controls an overall operation of the mammography apparatus <NUM> under the control of the console <NUM>. The control unit <NUM> comprises a central processing unit (CPU), a read only memory (ROM), and a random access memory (RAM) (all not shown). The ROM stores, in advance, various programs, including an imaging processing program for performing control related to radiation image capturing, which is executed by the CPU. The RAM transitorily stores various data.

The storage unit <NUM> stores the image data of the radiation image captured by the radiation detector <NUM> or various types of other information. Specific examples of the storage unit <NUM> include a hard disk drive (HDD) and a solid state drive (SSD). The I/F unit <NUM> performs communication of various types of information with the console <NUM> by wireless communication or wired communication. The image data of the radiation image captured by the radiation detector <NUM> in the mammography apparatus <NUM> is transmitted to the console <NUM> via the I/F unit <NUM> by wireless communication or wired communication.

In addition, an operation unit <NUM> is provided as a plurality of switches on an imaging table <NUM> of the mammography apparatus <NUM>, for example. It should be noted that the operation unit <NUM> may be provided as a touch panel type switch, or may be provided as a foot switch operated by a user, such as a doctor or an engineer with a foot.

The radiation detector <NUM> detects the radiation R that has passed through the breast which is the subject. In addition, as shown in <FIG>, the radiation detector <NUM> is disposed inside the imaging table <NUM>. In the mammography apparatus <NUM> according to the present embodiment, the user positions the breast of the examinee on an imaging surface 30A of the imaging table <NUM> in a case of performing the imaging.

The radiation detector <NUM> detects the radiation R transmitted through the breast of the examinee and the imaging table <NUM>, generates a radiation image based on the detected radiation R, and outputs image data representing the generated radiation image. A type of the radiation detector <NUM> according to the present embodiment is not particularly limited. For example, a radiation detector of an indirect conversion method that converts the radiation R into light and converts the converted light into a charge may be used, and a radiation detector of a direct conversion method that directly converts the radiation R into a charge may be used.

A radiation emitting unit <NUM> comprises the radiation source 37R. As shown in <FIG>, the radiation emitting unit <NUM> is provided in an arm part <NUM> together with the imaging table <NUM> and the compression unit <NUM>. As shown in <FIG>, a face guard <NUM> is attachably and detachably provided at a position near the examinee on the arm part <NUM> below the radiation emitting unit <NUM>. The face guard <NUM> is a protective member for protecting the examinee from the radiation R emitted from the radiation source 37R.

It should be noted that, as shown in <FIG>, the mammography apparatus <NUM> according to the present embodiment comprises the arm part <NUM>, a base <NUM>, and a shaft part <NUM>. The arm part <NUM> is held by the base <NUM> to be movable in a vertical direction (Z-axis direction). The shaft part <NUM> connects the arm part <NUM> to the base <NUM>. In addition, the arm part <NUM> is rotatable relative to the base <NUM> with the shaft part <NUM> as a rotation axis.

The arm part <NUM>, the imaging table <NUM>, and the compression unit <NUM> can be separately rotated relative to the base <NUM> with the shaft part <NUM> as a rotation axis. In the present embodiment, the base <NUM>, the arm part <NUM>, the imaging table <NUM>, and the compression unit <NUM> are each provided with an engaging part (not shown), and each of the arm part <NUM>, the imaging table <NUM>, and the compression unit <NUM> is connected to the base <NUM> by switching a state of the engaging part. One or two of the arm part <NUM>, the imaging table <NUM>, or the compression unit <NUM>, which are connected to the shaft part <NUM>, are integrally rotated around the shaft part <NUM>.

The compression unit <NUM> is provided with a compression plate driving unit (not shown) that moves the compression plate <NUM> in the vertical direction (Z-axis direction). The compression plate <NUM> according to the present embodiment has a function of compressing the breast of the examinee. A support part <NUM> of the compression plate <NUM> is attachably and detachably attached to the compression plate driving unit, is moved in the vertical direction (Z-axis direction) by the compression plate driving unit, and compresses the breast of the examinee with the imaging table <NUM>.

On the other hand, the console <NUM> according to the present embodiment has a function of controlling the mammography apparatus <NUM> by using an imaging order and various types of information acquired from a radiology information system (RIS) <NUM> via a wireless communication local area network (LAN) and the like, and an instruction performed by the user by an operation unit <NUM> and the like.

The console <NUM> according to the present embodiment is, for example, a server computer. As shown in <FIG>, the console <NUM> comprises a control unit <NUM>, a storage unit <NUM>, an I/F unit <NUM>, the operation unit <NUM>, a timer <NUM>, and a display unit <NUM>. The control unit <NUM>, the storage unit <NUM>, the I/F unit <NUM>, the operation unit <NUM>, the timer <NUM>, and the display unit <NUM> are connected to each other via a bus <NUM>, such as a system bus or a control bus, such that various types of information can be exchanged.

The control unit <NUM> according to the present embodiment controls an overall operation of the console <NUM>. The control unit <NUM> comprises a CPU 50A, a ROM 50B, and a RAM 50C. The ROM 50B stores, in advance, various programs including a contrast imaging control processing program 51A and a difference image display program 51B, which are executed by the CPU 50A and will be described below. The RAM 50C transitorily stores various data. The CPU 50A according to the present embodiment is an example of a processor according to the present disclosure. The contrast imaging control processing program 51A according to the present embodiment is an example of a control program according to the present disclosure.

The storage unit <NUM> stores the image data of the radiation image captured by the mammography apparatus <NUM> or various types of other information. Specific examples of the storage unit <NUM> include an HDD and an SSD.

The operation unit <NUM> is used by the user to input the instruction, various types of information, and the like related to the radiation image capturing and the like, including an irradiation instruction of the radiation R. The operation unit <NUM> is not particularly limited, and examples thereof include various switches, a touch panel, a touch pen, and a mouse. The display unit <NUM> displays various types of information. It should be noted that the operation unit <NUM> and the display unit <NUM> may be integrated to form a touch panel display.

The I/F unit <NUM> performs communication of various types of information between the mammography apparatus <NUM> and the RIS <NUM> by wireless communication or wired communication. The console <NUM> according to the present embodiment receives the image data of the radiation image captured by the mammography apparatus <NUM> from the mammography apparatus <NUM> via the I/F unit <NUM> by wireless communication or wired communication.

The timer <NUM> starts counting in a case in which a start instruction is received from the user via the operation unit <NUM>, and stops counting in a case in which a stop instruction is received from the user via the operation unit <NUM>. Stated another way, the timer <NUM> counts the time from the reception of the start instruction by the user to the reception of the stop instruction.

Further, <FIG> shows a functional block diagram of an example of the configuration of the console <NUM> according to the present embodiment. As shown in <FIG>, the console <NUM> comprises a control unit <NUM>, a first acquisition unit <NUM>, a second acquisition unit <NUM>, a generation unit <NUM>, and a specifying unit <NUM>. As an example, in the console <NUM> according to the present embodiment, the CPU 50A of the control unit <NUM> also functions as the control unit <NUM>, the first acquisition unit <NUM>, the second acquisition unit <NUM>, the generation unit <NUM>, and the specifying unit <NUM> by the CPU 50A executing the contrast imaging control processing program 51A stored in the ROM 50B.

The control unit <NUM> has a function of performing control related to the irradiation with the radiation R in the mammography apparatus <NUM> in the contrast imaging. In the present embodiment, in a case of performing the contrast imaging, the radiation image is captured by emitting the radiation R having the first energy from the radiation source 37R to the breast in a state in which the contrast medium has been injected. In addition, the radiation image is captured by emitting the radiation R having the second energy higher than the first energy from the radiation source 37R to the breast in a state in which the contrast medium has been injected. It should be noted that, in the present embodiment, the radiation image captured by emitting the radiation R having the first energy is referred to as a "low-energy image", and the radiation image captured by emitting the radiation R having the second energy is referred to as a "high-energy image". In addition, in a case in which the images captured by the mammography apparatus <NUM> are collectively referred to without distinction between types, such as the low-energy image and the high-energy image, the images are simply referred to as the "radiation image".

For example, an iodine contrast medium with a k-absorption edge of <NUM> keV is generally used as the contrast medium for the contrast imaging. In the contrast imaging in this case, the low-energy image is captured by emitting the radiation R having the first energy lower than the k-absorption edge of the iodine contrast medium. In addition, the high-energy image is captured by emitting the radiation R having the second energy higher than the k-absorption edge of the iodine contrast medium.

Therefore, in the contrast imaging, the control unit <NUM> according to the present embodiment performs control of emitting the radiation R having the first energy from the radiation source 37R and control of emitting the radiation R having the second energy. In other words, the control unit <NUM> performs control of causing the mammography apparatus <NUM> to capture the low-energy image and control of causing the mammography apparatus <NUM> to capture the high-energy image.

A body tissue, such as a mammary gland, and the contrast medium have different absorption characteristics of the radiation. Therefore, in the high-energy image captured as described above, the body tissue, such as the mammary gland or fat, is reflected, and the contrast medium is clearly reflected. In addition, in the low-energy image, almost no contrast medium is reflected, and the body tissue, such as the mammary gland, is clearly reflected. Therefore, the difference image showing a difference between the low-energy image and the high-energy image can be made to be an image in which a mammary gland structure is removed and the contrast medium is clearly reflected.

In addition, the control unit <NUM> according to the present embodiment has a function of performing control of causing the mammography apparatus <NUM> to re-capture each of the low-energy image and the high-energy image in a case in which the specifying unit <NUM>, which will be described in detail below, specifies that the re-capturing is to be performed.

The first acquisition unit <NUM> has a function of acquiring an elapsed time from the injection of the contrast medium into the breast. In the present embodiment, in a case in which the contrast medium is injected into the breast, the user operates the operation unit <NUM> to instruct the start of counting. According to the present instruction, the timer <NUM> starts counting, as described above. The first acquisition unit <NUM> acquires the time counted by the timer <NUM> as the elapsed time from the injection of the contrast medium into the breast (hereinafter, simply referred to as "elapsed time"). The first acquisition unit <NUM> outputs the acquired elapsed time to the generation unit <NUM>.

The second acquisition unit <NUM> has a function of acquiring the low-energy image and the high-energy image captured by the mammography apparatus <NUM>. Specifically, the acquisition unit <NUM> acquires image data representing the low-energy image and image data representing the high-energy image captured by the radiation detector <NUM> of the mammography apparatus <NUM> via the I/F unit <NUM> and the I/F unit <NUM>. The second acquisition unit <NUM> outputs the acquired low-energy image and high-energy image to the generation unit <NUM>.

The generation unit <NUM> has a function of generating a difference image showing a difference between the low-energy image and the high-energy image. As an example, the generation unit <NUM> according to the present embodiment generates the difference image data representing the difference image in which the mammary gland tissue is removed and the contrast medium is enhanced, by subtracting image data obtained by multiplying the low-energy image by a predetermined coefficient from image data obtained by multiplying the high-energy image by a predetermined coefficient for each corresponding pixel. It should be noted that, in a case in which the high-energy image is re-captured, the difference image based on the re-captured high-energy image is also generated. The difference image in this case is an example of the re-captured difference image according to the present disclosure. The generation unit <NUM> outputs the generated difference image and the elapsed time acquired from the first acquisition unit <NUM> in association with each other to each of the specifying unit <NUM> and the display control unit <NUM>.

The specifying unit <NUM> has a function of performing an image analysis on the difference image as an analysis about a contrast amount, and specifying whether or not to perform the re-capturing of the low-energy image and the high-energy image of the breast into which the contrast medium has been injected, based on the analysis result and the elapsed time.

The specifying unit <NUM> determines whether or not the contrast medium permeates sufficiently, particularly, whether or not the contrast medium permeates sufficiently a region of interest, by performing the image analysis about the contrast amount on the difference image. As an example, in the present embodiment, in a case in which a brightness value of the region of interest is higher than that of the surroundings in the difference image, specifically, in a case in which a contrast of the region of interest is equal to or greater than a threshold value, it is assumed that the contrast medium has sufficiently permeated the region of interest. In the present embodiment, as long as the high-energy image is captured in a state in which the contrast medium has sufficiently permeated the region of interest, the re-capturing may not be performed. Therefore, in a case in which the contrast of the region of interest in the difference image is equal to or greater than the threshold value, the specifying unit <NUM> specifies that the re-capturing is not to be performed. It should be noted that, the threshold value for determining whether or not the contrast medium has sufficiently permeated the region of interest may be determined in advance according to a type of the contrast medium, a mammary gland mass of the breast, a type of an object of interest, and the like. In addition, the threshold value may be able to be set by the user.

On the other hand, the ease of permeation of the contrast medium tends to differ according to the type of the contrast medium, a blood flow of the breast, the mammary gland mass of the breast, a height of the examinee, a weight of the examinee, the type of the object of interest, and the like. It can be said that as the speed at which the contrast medium permeates is faster, the contrast medium more easily permeates.

For example, even in a contrast medium using iodine, the speed at which the contrast medium permeates the region of interest tends to differ according to an iodine content in the contrast medium. As described above, the ease of permeation of the contrast medium tends to differ according to the type of the contrast medium. It should be noted that, regarding the "type of the contrast medium", it is said that the type of the contrast medium differs in a case in which at least one of a contrast component, such as iodine contained in the contrast medium, or a content of the contrast component in the contrast medium differs.

In addition, for example, since the contrast medium flows through a blood vessel while being mixed with blood, a permeation speed of the contrast medium tends to increase as the blood flow rate is increased. As described above, the ease of permeation of the contrast medium tends to differ according to the blood flow of the breast. It should be noted that the blood flow of the examinee may be applied instead of the blood flow of the breast itself.

In addition, for example, as the mammary gland mass of the breast is larger, the contrast medium tends to more easily permeate. Therefore, the contrast medium tends to more easily permeate in a case in which the breast is a so-called dense breast. On the other hand, since a probability of hiding in the background mammary gland is higher as the mammary gland mass is larger, it may be preferable to perform imaging early, regardless of whether or not the contrast medium has sufficiently permeated. In addition, for example, as the subject tends to be more obese, the contrast medium tends to be more hard to permeate.

In addition, for example, the contrast medium tends to more easily permeate in a lesion, such as a tumor, than the mammary gland. Also, as the lesion is more malignant, the contrast medium tends to permeate faster and the contrast medium tends to be washed out faster. However, in some cancers, such as mucous cancer, the speed at which the contrast medium permeates tends to be relatively slow. Therefore, the ease of permeation of the contrast medium tends to differ according to the type of the region of interest or whether or not the lesion is malignant.

In a case in which the contrast of the region of interest in the difference image is smaller than the threshold value, there are a case in which the contrast medium has not yet sufficiently permeated, a case in which washing out of the contrast medium that has permeated is started, and a case in which a permeation amount of the contrast medium is small for some reason. Therefore, the specifying unit <NUM> according to the present embodiment specifies that the re-capturing of the high-energy image is to be performed in a case in which the contrast of the region of interest in the difference image is smaller than the threshold value and the elapsed time is smaller than the threshold value. That is, the specifying unit <NUM> specifies that the re-capturing of the high-energy image is to be performed in a case in which the contrast medium has not yet sufficiently permeated the region of interest. On the other hand, the specifying unit <NUM> according to the present embodiment specifies that the re-capturing of the high-energy image is not to be performed in a case in which the contrast of the region of interest in the difference image is smaller than the threshold value and the elapsed time is equal to or longer than the threshold value. That is, the specifying unit <NUM> specifies that the re-capturing of the high-energy image is not to be performed in a case in which washing out of the contrast medium that has permeated the region of interest is started, or in a case in which the permeation amount of the contrast medium is small for some reason.

It should be noted that, as described above, since the permeation speed of the contrast medium differs according to the type of the contrast medium, the blood flow of the breast, the mammary gland mass of the breast, the height of the examinee, the weight of the examinee (weight of the subject), and the type of the object of interest, it is preferable that the threshold value time is determined according to at least one of the type of the contrast medium, the blood flow of the breast, the mammary gland mass of the breast, the height of the examinee, the weight of the examinee (weight of the subject), or the type of the object of interest.

In addition, in a case in which the re-capturing of the high-energy image is performed, the specifying unit <NUM> derives a timing for performing the re-capturing. As an example, in the present embodiment, a timing at which the elapsed time reaches a threshold value time is used as the timing performing the re-capturing of the high-energy image. Therefore, the specifying unit <NUM> derives the timing performing the re-capturing of the high-energy image based on the threshold value time and the elapsed time. In a case in which the re-capturing of the high-energy image is performed, the specifying unit <NUM> outputs information indicating the timing performing the re-capturing to the control unit <NUM>.

In addition, the console <NUM> according to the present embodiment comprises a display control unit <NUM>. As an example, in the console <NUM> according to the present embodiment, the CPU 50A of the control unit <NUM> functions as the display control unit <NUM> by the CPU 50A executing the difference image display program 51B stored in the ROM 50B.

The display control unit <NUM> has a function of displaying the difference image generated by the generation unit <NUM> on the display unit <NUM>. In addition, the display control unit <NUM> according to the present embodiment derives the contrast amount information about the contrast amount from the difference image. Examples of the contrast amount information include a numerical value indicating the contrast amount. For example, in a case of the numerical value indicating the contrast amount of the region of interest, the display control unit <NUM> first specifies the region of interest from the difference image. It should be noted that a method by which the display control unit <NUM> specifies the region of interest from the difference image is not particularly limited. For example, the region of interest may be specified from the difference image by receiving information about the region of interest input by the user. Specifically, at least one image of the difference image, the low-energy image, or the high-energy image may be displayed on the display unit <NUM>, and a region designated by the user operating the operation unit <NUM> on the display image may be received as the information about the region of interest. In addition, for example, the display control unit <NUM> may specify the region of interest by applying computer aided diagnosis (CAD) to the difference image.

A pixel value of a pixel in the difference image corresponds to the contrast amount. Therefore, it is possible to derive the contrast amount from the pixel value of the difference image. The display control unit <NUM> derives the contrast amount based on the pixel value of the pixel of the image corresponding to the specified region of interest. It should be noted that the display control unit <NUM> may derive any of a total value, an average value, a median value, a maximum value, and the like of the contrast amount of the entire region of interest, and which value to derive may be determined in advance, or may be able to be designated by the user. In addition, the display control unit <NUM> may derive the numerical value indicating the contrast amount regardless of the region of interest. For example, the display control unit <NUM> may derive the numerical value indicating the contrast amount of the position or the region indicated by the user for the difference image or the like. In addition, for example, the display control unit <NUM> may derive the numerical value indicating the contrast amount of the region outside the specified region of interest.

Next, an action of the console <NUM> in the contrast imaging by the radiography system <NUM> according to the present embodiment will be described with reference to the drawings.

<FIG> shows a flowchart showing an example of a flow of the contrast imaging by the radiography system <NUM> according to the present embodiment. In addition, <FIG> shows an example of a time chart of the contrast imaging in a case in which the re-capturing is performed. In addition, <FIG> shows an example of a time chart of the contrast imaging in a case in which the re-capturing is not performed. It should be noted that, in the present embodiment, in a case in which a captured low-energy image <NUM><NUM> and a re-captured low-energy image <NUM><NUM> are collectively referred to without distinction, the captured low-energy image <NUM><NUM> and the re-captured low-energy image <NUM><NUM> may be referred to as a low-energy image <NUM>. Similarly, in the present embodiment, in a case in which a first captured high-energy image <NUM><NUM> and a re-captured high-energy image <NUM><NUM> are collectively referred to without distinction, the first captured high-energy image <NUM><NUM> and the re-captured high-energy image <NUM><NUM> may be referred to as a high-energy image <NUM>. In addition, in the present embodiment, in a case in which a difference image <NUM><NUM> showing a difference between the low-energy image <NUM><NUM> and the high-energy image <NUM><NUM>, which are first captured, and a difference image <NUM><NUM> showing a difference between the low-energy image <NUM><NUM> and the high-energy image <NUM><NUM>, which are re-captured, are collectively referred to without distinction, the difference image <NUM><NUM> and the difference image <NUM><NUM> may be referred to as a difference image <NUM>.

In a case in which the contrast imaging is performed, first, the user injects the contrast medium into the breast, which is the subject, as shown in step S10 of <FIG>. As shown in next step S12, the user operates the operation unit <NUM> to start counting by the timer <NUM>. Next, as shown in step S14, the user positions the breast of the examinee on the imaging table <NUM> of the mammography apparatus <NUM> and compresses the breast with the compression plate <NUM>.

Next, in step S16, the contrast imaging control processing shown in <FIG> of capturing the low-energy image <NUM> and the high-energy image <NUM> by the mammography apparatus <NUM> is performed by the console <NUM>. In the console <NUM> according to the present embodiment, as an example, the CPU 50A of the control unit <NUM> executes the contrast imaging control processing program 51A stored in the ROM 50B, thereby executing the contrast imaging control processing shown in <FIG> as an example. <FIG> shows a flowchart showing an example of a flow of the contrast imaging control processing executed in the console <NUM> according to the present embodiment.

In step S100 of <FIG>, the control unit <NUM> determines whether or not the irradiation instruction of the radiation R is received. A negative determination is made in the determination in step S100 until the irradiation instruction is received. On the other hand, in a case in which the irradiation instruction is received, a positive determination is made in the determination in step S100, and the processing proceeds to step S102.

In step S102, the control unit <NUM> outputs the instruction to perform the irradiation with the radiation R having the first energy to the mammography apparatus <NUM>. In the mammography apparatus <NUM>, the control unit <NUM> emits the radiation R having the first energy from the radiation source 37R toward the breast based on the instruction input from the console <NUM>, and the low-energy image <NUM> is captured by the radiation detector <NUM>.

In step S104, the control unit <NUM> outputs an instruction to perform the irradiation with the radiation R having the second energy to the mammography apparatus <NUM>, and then proceeds to step S106. In the mammography apparatus <NUM>, the control unit <NUM> emits the radiation R having the second energy from the radiation source 37R toward the breast based on the instruction input from the console <NUM>, and the high-energy image <NUM> is captured by the radiation detector <NUM>.

It should be noted that the order in which the low-energy image <NUM> and the high-energy image <NUM> are captured is not limited to the present embodiment, and the high-energy image <NUM> may be captured before the low-energy image <NUM>. That is, the order of the processing of step S102 and the processing of step S104 may be switched.

In next step S106, the first acquisition unit <NUM> acquires the elapsed time, as described above. In addition, the second acquisition unit <NUM> acquires the low-energy image <NUM> and the high-energy image <NUM>, as described above.

In next step S108, as described above, the generation unit <NUM> generates the difference image <NUM> from the low-energy image <NUM> and the high-energy image <NUM> acquired in step S106. In the examples shown in <FIG>, the generation unit <NUM> generates the difference image <NUM><NUM> showing the difference between the low-energy image <NUM><NUM> and the high-energy image <NUM><NUM>.

In next step S110, the specifying unit <NUM> specifies the region of interest in the difference image <NUM>. As an example, the specifying unit <NUM> according to the present embodiment specifies the region of interest by applying the CAD to the difference image <NUM> generated in step S108.

In next step S112, the specifying unit <NUM> acquires prior information. The prior information is information for specifying the threshold value time, and is information obtained before the current contrast imaging. As described above, as an example, the threshold value time according to the present embodiment is determined according to at least one of the type of the contrast medium, the blood flow of the breast, the mammary gland mass of the breast, the height of the examinee, the weight of the examinee, or the type of the object of interest. A method by which the specifying unit <NUM> acquires the prior information is not particularly limited.

For example, in a case in which an image captured in advance for the breast that is currently undergoing the contrast imaging is present, the specifying unit <NUM> may acquire the prior information from the image captured in advance. Examples of the image captured in advance include a radiation image, an ultrasound image, a computed tomography (CT) image, and a magnetic resonance imaging (MRI) image obtained by performing the general imaging on the breast that is currently undergoing the contrast imaging. The specifying unit <NUM> applies the CAD to at least one of these images to acquire the mammary gland mass of the breast, the presence or absence of the region of interest, the degree of malignancy of the lesion, and the like as the type of the object of interest. Alternatively, in a case in which an interpretation result of a doctor or the like is added to these images, the specifying unit <NUM> acquires the interpretation result as the prior information.

In addition, for example, the specifying unit <NUM> may acquire the prior information, such as the type of the contrast medium, the blood flow of the breast, the height of the examinee, the weight of the examinee, and the type of the object of interest, from an imaging menu, an imaging order, an electronic medical record, and the like. In addition, for example, the specifying unit <NUM> may acquire the prior information input by the user using the operation unit <NUM>.

It should be noted that since there is a case in which the specifying unit <NUM> acquires a plurality of types of prior information, priorities may be set in advance for the plurality of types of prior information described above, or priorities may be able to be set by the user. For example, the specifying unit <NUM> may adopt the latest prior information at the present time. In addition, for example, in a case in which a malignant lesion is specified as the object of interest, the specifying unit <NUM> may adopt the prior information about the specified malignant lesion regardless of a point in time of the prior information in which the malignant lesion is specified.

It should be noted that, in a case in which the prior information that can be acquired by the specifying unit <NUM> is not present, the specifying unit <NUM> specifies that the prior information cannot be acquired.

In next step S114, as described above, the specifying unit <NUM> performs the image analysis about the contrast amount on the difference image <NUM>. In the present embodiment, the contrast of the region of interest in the difference image <NUM> is derived as the analysis result, as described above.

In next step S116, as described above, the specifying unit <NUM> determines whether or not the contrast derived in step S114 is equal to or greater than the threshold value (contrast ≥ threshold value). In a case in which the contrast is not equal to or greater than the threshold value, in other words, in a case in which the contrast is smaller than the threshold value, a negative determination is made in the determination in step S116, and the processing proceeds to step S118.

In step S118, the specifying unit <NUM> determines whether or not the elapsed time is equal to or longer than the threshold value time (elapsed time ≥ threshold value time), as described above. The threshold value time used in the present processing is specified according to the prior information acquired in step S112. As an example, in the present embodiment, correspondence relationship information indicating a correspondence relationship between the prior information and the threshold value time is stored in advance in the storage unit <NUM>. The specifying unit <NUM> specifies the threshold value time corresponding to the prior information acquired in step S112 with reference to the correspondence relationship information stored in the storage unit <NUM>. In a case in which the elapsed time is not equal to or longer than the threshold value time, in other words, in a case in which the elapsed time is shorter than the threshold value time, it can be assumed that the contrast medium has not yet sufficiently permeated, as described above. Therefore, a negative determination is made in the determination in step S118, and the specifying unit <NUM> specifies that the re-capturing of the high-energy image <NUM> is to be performed, returns to step S102, and repeats the processing of steps S102 to S116. As a result, for example, the re-capturing is performed as shown in <FIG>.

On the other hand, in a case in which the elapsed time is equal to or longer than the threshold value time, as described above, washing out of the contrast medium is started or the permeation amount of the contrast medium is small for some reason, so that the specifying unit <NUM> specifies that the re-capturing of the high-energy image <NUM> is not to be performed, and the contrast imaging control processing shown in <FIG> ends.

In addition, in a case in which the contrast is equal to or greater than the threshold value in step S116, it can be assumed that the contrast medium has sufficiently permeated the contrast medium, as described above. Therefore, a positive determination is made in the determination in step S116, and the contrast imaging control processing shown in <FIG> ends.

In this way, in a case in which the contrast imaging control processing shown in <FIG> ends, the processing of step S16 shown in <FIG> ends. In a case in which the processing of step S16 ends, the contrast imaging ends. It should be noted that the control unit <NUM> may notify the user that the contrast imaging ends.

Therefore, in next step S18, the compression of the breast is released. Specifically, the control unit <NUM> outputs an instruction to the mammography apparatus <NUM> to move the compression plate <NUM> in a direction away from the imaging table <NUM>. In the mammography apparatus <NUM>, the control unit <NUM> moves the compression plate <NUM> in the direction away from the imaging table <NUM> based on the input instruction. As a result, the compression of the breast is released. It should be noted that the release of the breast compression may be performed according to the instruction of the user, or may be performed automatically according to the end of the contrast imaging.

In next step S20, the difference image display processing shown in <FIG> is performed by the console <NUM>. In the console <NUM> according to the present embodiment, as an example, the CPU 50A of the control unit <NUM> executes the difference image display program 51B stored in the ROM 50B, thereby executing the difference image display processing shown in <FIG> as an example. <FIG> shows a flowchart showing an example of a flow of the difference image display processing executed in the console <NUM> according to the present embodiment.

In step S200, the display control unit <NUM> derives the contrast amount information, as described above. Specifically, the contrast amount information is derived from the difference image <NUM> generated in step S108 of the contrast imaging control processing shown in <FIG> executed in step S16.

In next step S202, the display control unit <NUM> performs the image processing of enhancing the difference image <NUM>. Examples of the image processing performed by the display control unit <NUM> include gradation enhancement processing and frequency enhancement processing. The display control unit <NUM> according to the present embodiment performs an analysis, such as a histogram analysis, on the difference image <NUM> generated by the generation unit <NUM>, specifies which image processing, the gradation enhancement processing or the frequency enhancement processing, to perform, and specifies a degree of enhancement. The display control unit <NUM> performs the image processing on the difference image <NUM> according to the specified image processing and degree of enhancement, and generates a difference image <NUM> after the image processing (hereinafter, simply referred to as a "difference image <NUM>").

It should be noted that, in order to facilitate the comparison between the difference image <NUM><NUM> and the difference image <NUM><NUM>, it is preferable that the display control unit <NUM> performs the same processing as the image processing performed on the difference image <NUM><NUM> and the image processing performed on the difference image <NUM><NUM>. In addition, it is preferable that the degree of enhancement in the image processing performed on the difference image <NUM><NUM> by the display control unit <NUM> and the degree of enhancement in the image processing performed on the difference image <NUM><NUM> by the display control unit <NUM> are the same.

In next step S204, the display control unit <NUM> performs control of displaying, on the display unit <NUM>, the contrast amount information derived in step S200 and the difference image <NUM> after the image processing in step S202. In a case in which the processing of step S204 ends, the difference image generation processing shown in <FIG> ends.

<FIG> shows an example of a state in which the difference image <NUM> and the contrast amount information <NUM> are displayed on the display unit <NUM>. As shown in <FIG>, the display control unit <NUM> according to the present embodiment displays a difference image <NUM><NUM> obtained by performing the image processing on the difference image <NUM><NUM> and a difference image <NUM><NUM> obtained by performing the image processing on the difference image <NUM><NUM> obtained by re-capturing side by side on the display unit <NUM>. In addition, in the example shown in <FIG>, the display control unit <NUM> displays contrast amount information <NUM><NUM> of the region of interest and elapsed time information <NUM><NUM> indicating the elapsed time corresponding to the difference image <NUM><NUM> in a manner being superimposed on the difference image <NUM><NUM>. In addition, the display control unit <NUM> displays contrast amount information <NUM><NUM> of the region of interest and elapsed time information <NUM><NUM> indicating the elapsed time corresponding to the difference image <NUM><NUM> in a manner being superimposed on the difference image <NUM><NUM>.

In addition, as shown in <FIG>, the display control unit <NUM> also displays a radiation image <NUM> on the display unit <NUM> as a comparative example in a case in which there is the radiation image <NUM> captured by the general imaging for the breast which is the subject, in other words, the radiation image <NUM> captured in a state in which the contrast medium has not been injected. It should be noted that, as described above, since almost no contrast medium is reflected and the body tissue, such as the mammary gland, is clearly reflected in the low-energy image, the low-energy image <NUM> may be displayed on the display unit <NUM> instead of the radiation image <NUM>.

In addition, in the example shown in <FIG>, the form has been described in which the difference image <NUM><NUM> and the difference image <NUM><NUM> are displayed side by side. However, a form may be adopted in which any one of the difference image <NUM><NUM> or the difference image <NUM><NUM> is displayed and the difference image to be displayed is switched according to the instruction of the user.

In this way, in a case in which the difference image display processing shown in <FIG> ends, the difference image display processing in step S20 shown in <FIG> ends. As a result, the series of processing related to the contrast imaging in the radiography system <NUM> according to the present embodiment ends. It should be noted that a form may be adopted in which the low-energy image <NUM> and the plurality of high-energy images <NUM>, which are captured by the mammography apparatus <NUM> according to the present embodiment, the elapsed time information <NUM>, the plurality of difference images <NUM>, the difference image <NUM> after the image processing, and the contrast amount information <NUM>, which are generated by the console <NUM>, and the like are stored in the storage unit <NUM> of the console <NUM>, picture archiving and communication systems (PACS), or the like.

In addition, in the form described above, the form has been described in which the difference image display processing is continuously performed after the processing of S18 of <FIG> ends. However, the timing for performing the difference image display processing, that is, the timing for displaying the difference image <NUM> is not limited to the present form. For example, a form may be adopted in which the timing for displaying the difference image <NUM> is a timing according to the user's desire after the contrast imaging.

As described above, the console <NUM> according to the form described above comprises the CPU 50A as at least one processor. The CPU 50A acquires the elapsed time from the injection of the contrast medium into the breast for which the radiation image is captured by the mammography apparatus <NUM>. In addition, the CPU 50A acquires the low-energy image captured by the mammography apparatus <NUM> by emitting the radiation R having the first energy to the breast into which the contrast medium has been injected, and the high-energy image captured by the mammography apparatus <NUM> by emitting the radiation R having the second energy higher than the first energy to the breast into which the contrast medium has been injected. In addition, the CPU 50A generates the difference image showing the difference between the low-energy image and the high-energy image. In addition, the CPU 50A specifies whether or not the re-capturing of the high-energy image of the breast into which the contrast medium has been injected is to be performed, based on the analysis result about the contrast amount, which is performed on the difference image, and the elapsed time.

The degree of permeation of the contrast medium into the breast is changed depending on various conditions, such as the mammary gland mass of the breast or the type of the object of interest. Therefore, it may be difficult to understand the imaging timing. In addition, it may be difficult to determine whether or not it can be assumed that the contrast medium has sufficiently permeated even with reference to the captured difference image. In response to such a case, in the present embodiment, it is specified whether or not the re-capturing of the high-energy image is to be performed, based on the analysis result about the contrast amount, which is performed on the difference image showing the difference between the low-energy image and the high-energy image, and the elapsed time. Therefore, according to the present embodiment, it is possible to capture the high-energy image at an appropriate timing in the contrast imaging.

In addition, according to the present embodiment, since the number of times of re-capturing can be set to an appropriate number of times, an exposure dose of the subject can be suppressed.

It should be noted that, in the form described above, for the re-capturing, the form has been described in which both the low-energy image and the high-energy image are re-captured, but the re-capturing is not limited to the present form, and a form need only be adopted in which the re-capturing of at least the high-energy image is performed. That is, the low-energy image may not be re-captured. As described above, in the low-energy image, the mammary gland structure is clearly reflected, but almost no contrast medium is reflected. Therefore, the low-energy image tends to be the same image regardless of the permeation of the contrast medium due to the lapse of time. Therefore, the low-energy image may not be re-captured more frequently than the high-energy image.

<FIG> shows an example of a time chart in a case in which the re-capturing of only the high-energy image is performed. In the example shown in <FIG>, after the compression of the breast, the low-energy image <NUM><NUM> and the high-energy image <NUM><NUM> are first captured, and the generation unit <NUM> generates the difference image <NUM><NUM>. In a case in which the specifying unit <NUM> specifies that the re-capturing is to be performed based on the analysis result of the image analysis of the difference image <NUM>, the control unit <NUM> re-captures only the high-energy image <NUM><NUM>. Then, the generation unit <NUM> generates the difference image <NUM><NUM> between the low-energy image <NUM><NUM> and the high-energy image <NUM><NUM>.

By reducing the number of times of capturing of the low-energy image by re-capturing only the high-energy image in this way, it is possible to reduce the exposure dose of the examinee. On the other hand, since there is a case in which the body movement, such as the movement of the mammary gland structure, occurs in the breast, it is preferable to re-capture the low-energy image in consideration of the body movement.

It should be noted that, in the form described above, the form has been described in which the re-capturing is performed until a positive determination is made in step S116 of the contrast imaging control processing (see <FIG>) or a positive determination is made in step S118. That is, the form has been described in which the re-capturing is performed a plurality of times until the condition described above is satisfied. However, the number of times of re-capturing is not limited, and for example, an upper limit number of times may be set, or the re-capturing may be performed only once.

It should be noted that, in the form described above, the form has been described in which the re-capturing of the high-energy image and the low-energy image is automatically performed, but a form may be adopted in which the re-capturing may be performed according to the instruction of the user. For example, a form may be adopted in which, in a case in which the specifying unit <NUM> specifies that the re-capturing is to be performed, the timing for performing the re-capturing is notified to the user, and the control unit <NUM> performs the re-capturing according to the instruction for the re-capturing by the user in response to the notification.

In addition, in the present embodiment, the form has been described in which the console <NUM> comprises the timer <NUM> and the console <NUM> itself counts the elapsed time, but a form may be adopted in which the console <NUM> does not comprise the timer <NUM> and counts the elapsed time by an external apparatus. For example, a form may be adopted in which the user measures the elapsed time by a measuring instrument, such as a stopwatch and inputs the elapsed time to the console <NUM> using the operation unit <NUM>, and the first acquisition unit <NUM> acquires the input elapsed time.

In addition, in the form described above, the form has been described in which the timing for the threshold value time or performing the re-capturing is specified based on the prior information, but the timing for first capturing the low-energy image and the high-energy image after the injection of the contrast medium may be derived based on the prior information. It should be noted that, in this case, the timing for first capturing the low-energy image and the high-energy image and the timings for the threshold value time and performing the re-capturing are set as different timings.

In addition, in the form described above, the form has been described in which the breast is applied as an example of the subject according to the present disclosure, and the mammography apparatus <NUM> is applied as an example of the radiography apparatus according to the present disclosure, but the subject is not limited to the breast, and the radiography apparatus is not limited to the mammography apparatus. For example, the subject may be a chest, an abdomen, or the like, and a form may be adopted in which a radiography apparatus other than the mammography apparatus is applied as the radiography apparatus.

In addition, in the form described above, the form has been described in which the console <NUM> is an example of the control apparatus according to the present disclosure, but an apparatus other than the console <NUM> may have the function of the control apparatus according to the present disclosure. In other words, some or all of the functions of the control unit <NUM>, the first acquisition unit <NUM>, the second acquisition unit <NUM>, the generation unit <NUM>, the specifying unit <NUM>, and the display control unit <NUM> may be provided in an apparatus other than the console <NUM>, for example, the mammography apparatus <NUM> or an external apparatus.

In addition, in the form described above, various processors shown below can be used as the hardware structure of processing units that execute various pieces of processing, such as the control unit <NUM>, the first acquisition unit <NUM>, the second acquisition unit <NUM>, the generation unit <NUM>, the specifying unit <NUM>, and the display control unit <NUM>. As described above, the various processors include, in addition to the CPU which is a general-purpose processor which executes software (program) and functions as various processing units, a programmable logic device (PLD) which is a processor of which a circuit configuration can be changed after manufacture, such as a field programmable gate array (FPGA), and a dedicated electric circuit which is a processor having a circuit configuration which is designed for exclusive use in order to execute specific processing, such as an application specific integrated circuit (ASIC).

One processing unit may be composed of one of the various processors or may be composed of a combination of two or more processors of the same type or different types (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 composed of one processor.

A first example of the configuration in which the plurality of processing units are composed of one processor is a form in which one processor is composed of a combination of one or more CPUs and software and the processor functions as the plurality of processing units, as represented by the computer, such as a client and a server. Second, as represented by a system on chip (SoC) or the like, there is a form of using a processor that realizes the function of the entire system including the plurality of processing units by one integrated circuit (IC) chip. As described above, various processing units are composed of one or more of the various processors as the hardware structure.

Further, more specifically, an electric circuit (circuitry) obtained by combining circuit elements, such as semiconductor elements, can be used as the hardware structure of the various processors.

Claim 1:
A control apparatus (<NUM>) comprising:
at least one processor (50A) that is configured to:
acquire an elapsed time from injection of a contrast medium into a subject for which a radiation image (<NUM>) is captured by a radiography apparatus (<NUM>),
acquire a low-energy image (<NUM><NUM>) captured by the radiography apparatus (<NUM>) by emitting radiation having first energy to the subject into which the contrast medium has been injected, and a high-energy image (<NUM><NUM>) captured by the radiography apparatus (<NUM>) by emitting radiation having second energy higher than the first energy to the subject into which the contrast medium has been injected,
generate a difference image (<NUM><NUM>) showing a difference between the low-energy image (<NUM><NUM>) and the high-energy image (<NUM><NUM>), and
the control apparatus (<NUM>) characterised in that the at least one processor (50A) is configured to:
identify whether or not to perform re-capturing of the high-energy image (<NUM><NUM>) of the subject into which the contrast medium has been injected, based on an analysis result about a contrast amount, which is performed on the difference image (<NUM><NUM>), and the elapsed time.