Medical support system, endoscope system, and method of operating a medical support system

Abstract

A medical assistance system (100) comprising an examination status information acquisition unit (170), a sedative necessity determination unit (180), and an assistance information generation unit (150). The examination status acquisition unit acquires examination status information relating to a status of an endoscopic examination using an endoscope. The sedative necessity determination unit determines the necessity of a sedative on the basis of the examination status information. The assistance information generation unit generates assistance information for a user on the basis of the result of determination of the necessity of a sedative.

Description

Technical Field

[0001] The present invention relates to a medical support system, an endoscope system, and the like. Operation method of a medical support system and the like.

Background Art

[0002] As shown in Non-Patent Document 1, conventionally, in endoscopic examination, it is known that a doctor uses a sedative for a patient in consideration of the presence or absence of pain transmitted from the patient.

Prior Art Documents

Non-Patent Documents

[0003]

Non-Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0004] The above prior art is such that a doctor receives a transmission from a patient and decides whether to use a sedative. For this reason, there is a problem that when a patient endures pain and does not transmit it, or when a doctor does not notice the transmission of the patient's pain, a sedative may not be used.

Means for Solving the Problems

[0005] One aspect of the present disclosure relates to a medical support system including an examination situation information acquisition unit that acquires examination situation information regarding the situation of an endoscopic examination using an endoscope, a sedative necessity determination unit that determines the necessity of a sedative based on the examination situation information, and a support information generation unit that generates support information for a user based on the determination result of the necessity of the sedative.

[0006] Another aspect of the present disclosure relates to an endoscope system including an endoscope used for endoscopy, an examination situation information acquisition unit that acquires examination situation information regarding the situation of the endoscopy using the endoscope, a sedative necessity determination unit that determines the necessity of a sedative based on the examination situation information, and a support information generation unit that generates support information for a user based on the determination result of the necessity of the sedative.

[0007] Still another aspect of the present disclosure relates to a medical support method including acquiring examination situation information regarding the situation of endoscopy using an endoscope, determining the necessity of a sedative based on the examination situation information, and generating support information for a user based on the determination result of the necessity of the sedative.

Brief Description of the Drawings

[0008]

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Mode for Carrying Out the Invention

[0009] Hereinafter, this embodiment will be described. Note that the embodiment described below does not unduly limit the content described in the claims. Also, not all of the configurations described in this embodiment are essential constituent elements of the present disclosure.

[0010] 1. Configuration Example Here, a basic configuration example of the medical support system in this embodiment will be described. The detailed configuration examples of the medical support system and the correspondence between the detailed configuration examples and the basic configuration example will be described later.

[0011] FIG. 1 shows a first configuration example of the medical support system 100. The medical support system 100 includes an examination status information acquisition unit 170, a sedative necessity determination unit 180, and a support information generation unit 150.

[0012] The inspection status information acquisition unit 170 acquires inspection status information regarding the status of an endoscopic examination using an endoscope. The inspection status information may be any information from which the inspection status can be determined. For example, it is information that can determine the insertion status of the endoscope insertion unit. Further, the inspection status information may include information on the inspection environment or inspection conditions regarding the patient, or input pain information input from outside the medical support system 100 due to transmission from the patient or the like. The inspection status information acquisition unit 170 outputs the inspection status information DSI. The output inspection status information DSI may be the inspection status information itself acquired by the inspection status information acquisition unit 170 as described above, or may be information obtained by processing the acquired inspection status information, or may be a combination thereof.

[0013] The sedative necessity determination unit 180 determines the necessity of a sedative based on the inspection status information. A sedative is a drug that sedates excitement. For example, it is a drug that relieves the pain felt by a patient by sedation. When the sedative necessity determination unit 180 determines that the inspection status indicated by the inspection status information is an inspection status where a sedative is required, it determines that a sedative is required, and when it is not, it determines that a sedative is not required. The sedative necessity determination unit 180 outputs the sedative necessity determination result SYN. The necessity determination result SYN is not limited to information indicating the necessity of a sedative, and may be, for example, information indicating the degree of necessity of a sedative.

[0014] Based on the necessity determination result SYN of the sedative, the support information generation unit 150 generates support information for the user. Specifically, when it is determined in the necessity determination that a sedative is required, the support information generation unit 150 generates support information indicating that a sedative is required. Also, when it is determined in the necessity determination that a sedative is not required, the support information generation unit 150 does not generate support information, or generates support information when a sedative is not required. The support information when a sedative is not required is, for example, information indicating an operation, an action, or a situation. The operation is an endoscope operation according to the inspection situation or the insertion situation, and as an example, it is a pulling operation and a right torque operation in N-loop release. The action is an action taken by a medical staff or a patient according to the inspection situation or the insertion situation, and as an example, it is manual compression or position change. The situation is the inspection situation or the endoscope insertion situation, and as an example, it is the occurrence of an N-loop, the occurrence of deflection of the endoscope insertion part, or the occurrence of intestinal stretching.

[0015] The user is a medical staff operating the endoscope used in the inspection, or an assistant assisting the medical staff. Alternatively, the user may be an insertion / extraction device that automatically or semi-automatically inserts and extracts the endoscope insertion part. The support information is information indicating what operation or action should be taken next, and for example, it is information indicating the use or non-use of a sedative, information indicating the next endoscope operation, or information indicating the suspension or termination of the inspection. The support information generation unit 150 may, for example, display characters, symbols, images, etc. corresponding to the support information on the display device of the endoscope system, or output a control signal for causing the insertion / extraction device to perform the operation or process indicated by the support information.

[0016] According to this embodiment, the medical support system 100 can infer a situation where a sedative is required and generate support information indicating the use of a sedative based on the inference result. For example, even when the patient endured the pain without transmitting it, or when the doctor did not notice the patient's transmission of pain, the medical support system 100 can infer those situations and guide the use of a sedative.

[0017] The inspection status information is at least one of endoscopic image recognition information, insertion part shape information, operation recognition information, patient expression information, pain transmission information, endoscopic type information, or patient information. Note that "at least one of endoscopic image recognition information, insertion part shape information, operation recognition information, patient expression information, pain transmission information, endoscopic type information, or patient information" means endoscopic image recognition information, insertion part shape information, operation recognition information, patient expression information, pain transmission information, endoscopic type information, patient information, or a combination of any two or more of them.

[0018] The endoscopic image recognition information is information on the recognition result of the endoscopic image in the endoscopic examination. That is, the endoscopic image recognition information is information obtained by image recognition processing on the endoscopic image. The endoscopic image is an image taken by the endoscope. Specifically, the endoscopic image is each frame image of the video taken by the endoscope.

[0019] The insertion part shape information is information on the shape of the endoscopic insertion part, and is obtained, for example, by the insertion shape observation device described later. The endoscopic insertion part is the part of the endoscope that is inserted into the body, and in this embodiment, it is the insertion part of a flexible endoscope used for the digestive tract or the like.

[0020] The operation recognition information is information on at least one change in the shape or position of the endoscopic insertion part. That is, the operation recognition information is a temporal change in at least one of the shape or position of the endoscopic insertion part that occurs when the endoscope is operated. For example, by the insertion part shape observation device observing the insertion part shape at all times, the insertion part shape information is output in a time series, and the operation recognition information is obtained from the temporal change of the insertion part shape information output in this time series.

[0021] Patient expression information is information regarding the patient's expression during an endoscopic examination. Specifically, a camera captures the patient's expression, and an expression recognition unit recognizes whether the expression of the patient shown in the image is an expression of feeling pain, and outputs the result as pain transmission information. The pain transmission information is information from a transmission device operated by the patient or a medical staff member. Specifically, the transmission device is a device operable by the patient or a medical staff member according to the patient's pain situation, such as a switch or a touch panel. Note that each of the camera, the expression recognition unit, and the transmission device may be included in the medical support system 100 or may be provided outside the medical support system 100.

[0022] Endoscope type information is information regarding the type of the endoscope insertion part used in an endoscopic examination. The physical characteristics such as the thickness or firmness of the endoscope insertion part differ according to the type of the endoscope. For example, the endoscope stores an ID indicating its model, and the endoscope type information can be obtained by acquiring the ID. The ease of occurrence of the pain situation or the pain level etc. change according to the physical characteristics such as the thickness or firmness of the endoscope insertion part. By acquiring the endoscope type information, the sedative necessity determination unit 180 can appropriately determine the necessity of an analgesic according to the physical characteristics such as the thickness or firmness of the endoscope insertion part.

[0023] Patient information is information such as the patient's gender, physique, body type, or medical history. For example, as will be described later, the patient information can be obtained from the information stored in the electronic medical record. Alternatively, a medical staff member may input the patient information into the medical support system 100. The ease of occurrence of the pain situation or the pain level etc. change according to the patient's gender, physique, body type, or medical history. By acquiring the patient information, the sedative necessity determination unit 180 can appropriately determine the necessity of a sedative according to the patient's gender, physique, body type, or medical history.

[0024] According to this embodiment, it is possible to infer whether or not a situation requires a sedative from various acquired information, so that a situation requiring a sedative can be inferred more appropriately. That is, from various acquired information, various inspection situations regarding the insertion situation or inspection conditions are judged, and the necessity of a sedative can be appropriately guided based on the various inspection situations.

[0025] The inspection situation information acquisition unit 170 classifies the insertion situation of the endoscope based on at least one of the endoscope image recognition information, the insertion unit shape information, or the operation recognition information, and outputs inspection situation information including the classification result. The sedative necessity determination unit 180 determines the necessity of a sedative based on the insertion situation indicated by the classification result.

[0026] The insertion situation of the endoscope is a predetermined insertion situation that appears in the procedure of advancing the endoscope examination. For example, it is specified by a predetermined insertion unit position, a change in the predetermined insertion unit position, a predetermined insertion unit shape, a change in the predetermined insertion unit shape, a predetermined endoscope operation, or any combination of two or more of them. For example, in colonoscopy, there are insertion methods such as the loop method and the shaft-holding shortening method, and there are insertion situations such as the insertion unit shape or operation that appear when proceeding with the insertion procedure in each insertion method. The next operation to be performed is determined in each of these insertion situations, and pain is likely to occur in a specific insertion situation among these insertion situations.

[0027] The inspection situation information acquisition unit 170 determines which of the plurality of insertion situations is applicable based on at least one of the endoscope image recognition information, the insertion unit shape information, or the operation recognition information. The plurality of insertion situations includes insertion situations that require the use of a sedative. The sedative necessity determination unit 180 determines that a situation requires the use of a sedative when the determined insertion situation corresponds to an insertion situation that requires the use of a sedative.

[0028] According to the present embodiment, since the insertion situation of the endoscope is classified, the sedative necessity determination unit 180 can determine the necessity of a sedative by determining whether the insertion situation is an insertion situation in which the use of a sedative is necessary. Further, since the insertion situations in which pain is likely to occur in endoscopy are determined as described above, by setting such insertion situations as candidates for classification, it becomes possible to determine whether the insertion situation is an insertion situation in which the use of a sedative is necessary.

[0029] The above-described operation recognition information may include insertion part shape displacement information that is information on the shape displacement of the endoscope insertion part. In this case, the inspection situation information acquisition unit 170 performs the above classification based on the insertion part shape information and the insertion part shape displacement information. The shape displacement is the displacement between the shape before the change and the shape after the change in the shape change of the endoscope insertion part. The information on the shape displacement may include information on the displacement direction, information on the magnitude of the displacement, or both.

[0030] When the endoscope is operated, the shape of the endoscope insertion part changes, and pain may occur according to the shape displacement at this time. According to the present embodiment, by performing classification based on the insertion part shape displacement information, it is possible to recognize a situation in which a sedative is required, which has occurred according to the shape displacement of the endoscope insertion part.

[0031] As described above, the insertion part shape displacement information may include shape displacement amount information that is information on the magnitude of the shape displacement. The inspection situation information acquisition unit 170 performs the above classification based on the insertion part shape information and the shape displacement amount information.

[0032] In a certain insertion situation, pain may occur when the magnitude of the shape displacement exceeds a predetermined value. According to the present embodiment, by performing classification based on the shape displacement amount information, it is possible to recognize a situation in which a sedative is required, which has occurred in response to the magnitude of the shape displacement exceeding the predetermined value.

[0033] FIG. 2 shows a second configuration example of the medical support system 100. In FIG. 2, the medical support system 100 further includes a pain situation recognition unit 130. For components that are the same as those already described, the description thereof will be omitted as appropriate.

[0034] Based on the examination situation information, the pain situation recognition unit 130 recognizes a pain situation where pain is occurring in the patient and obtains pain situation information PSI. The sedative necessity determination unit 180 performs a determination on the necessity of a sedative based on the pain situation information. The pain situation information PSI is the recognition result of the pain situation, and is, for example, the presence or absence of the pain situation, the estimated level of pain, or a combination thereof. The "situation where pain is occurring in the patient" is not limited to the case where pain actually occurs, but may be a situation where the occurrence of pain is estimated. More specifically, a situation where pain is likely to occur is predetermined, and when the situation recognized based on the examination situation information DSI matches the predetermined situation, it is recognized as the "situation where pain is occurring in the patient". Alternatively, when the pain situation is recognized based on pain transmission information or patient expression information, when pain transmission information or patient expression information indicating the occurrence of pain is input, it is recognized as the "situation where pain is occurring in the patient".

[0035] According to the present embodiment, it is possible to provide guidance on the necessity of a sedative considering the situation where pain is occurring in the patient during an endoscopic examination. That is, by a medical staff member determining the use of a sedative or the like based on the support information of the present embodiment, when pain occurs in the patient or before pain is transmitted from the patient, the pain situation can be recognized, and the pain situation can be alleviated or avoided beforehand.

[0036] The above pain situation is not limited to only the presence or absence of pain. Specifically, the pain situation recognition unit 130 may recognize the pain situation by distinguishing situations with different pain levels, situations with different pain frequencies, or situations with different ease of avoiding pain.

[0037] The pain level is the level of pain felt by the patient in a pain situation when the situation where the patient is experiencing pain is recognized. For example, the pain level changes according to the displacement amount of the endoscope insertion portion in a certain insertion situation. In this case, the pain level is determined based on the displacement amount. Alternatively, when the pain level changes according to the insertion situation, a pain level is associated with each insertion situation, and when a certain insertion situation is detected, the pain level associated with that insertion situation is output.

[0038] The pain frequency is the frequency at which the situation where the patient is feeling pain is recognized, for example, the number of times the pain situation is recognized per unit time. This frequency may be either the frequency when the same insertion situation is repeated or the frequency when a plurality of insertion situations are mixed. For example, the medical support system 100 includes a memory (not shown), the pain situation recognition unit 130 stores the pain situation information PSI in the memory, and the pain frequency is detected by referring to the pain situation information PSI stored in the memory.

[0039] The ease of avoiding pain is determined according to whether there is an operation to relieve pain or an operation to avoid pain in each pain situation. For example, in a certain insertion situation, if there is no operation to relieve pain or an operation to avoid pain, the degree of ease of avoiding pain is low. Also, in a certain insertion situation, if there is an operation to avoid pain, the degree of ease of avoiding pain is high. Further, in a certain insertion situation, if there is an operation to relieve pain but no operation to avoid pain, the ease of avoiding pain is moderate. For example, information indicating the ease of avoiding pain corresponding to each pain situation is stored in a memory (not shown) or the like, and when the pain situation recognition unit 130 recognizes a certain pain situation, the ease of avoiding pain can be determined by referring to the information indicating the ease of avoiding pain corresponding to that pain situation.

[0040] FIG. 3 is a third configuration example of the medical support system 100. In FIG. 3, the medical support system 100 includes a past examination information acquisition unit 190. Note that the description of the same components as those already described will be omitted as appropriate.

[0041] The past examination information acquisition unit 190 acquires past examination information KJH, which is information regarding past endoscopic examinations. The sedative necessity determination unit 180 determines the necessity of a sedative based on the past examination information KJH. Specifically, when support information that prompts a predetermined pain avoidance operation is acquired as the past examination information KJH, the sedative necessity determination unit 180 determines that a sedative is necessary.

[0042] The past examination information KJH is past examination information regarding the same site as the site to be examined this time. The past examination information KJH is at least one of the necessity determination result of a sedative, the content of support information, endoscopic image recognition information, insertion part shape information, or operation recognition information in the past examination. The past examination information KJH may be examination information obtained in the past from the same patient as the patient to be examined this time, or may be examination information obtained in the past from a plurality of patients. For example, the examination situation information DSI, the necessity determination result SYN of an analgesic, and the support information are recorded in the storage device 191 as a log, and the past examination information KJH can be acquired by referring to the log recorded in the past. Although FIG. 3 shows an example in which the storage device 191 is provided outside the medical support system 100, the storage device 191 may be provided inside the medical support system 100.

[0043] Note that the second configuration example and the third configuration example may be combined. In that case, the pain situation recognition unit 130 may recognize the pain situation based on the examination situation information DSI and the past examination information KJH to acquire pain situation information PSI, and the sedative necessity determination unit 180 may determine the necessity of a sedative based on the acquired pain situation information PSI.

[0044] Note that the processing of the medical support system 100 described above may be implemented as a medical support method as follows. The entity implementing the medical support method is not limited to the medical support system 100, and may be various systems or devices such as an endoscope system described later. The medical support method includes acquiring inspection status information DSI regarding the status of an endoscope examination using an endoscope, determining the necessity of a sedative based on the inspection status information DSI, and generating support information for the user based on the determination result SYN of the necessity of the sedative.

[0045] In addition, part or all of the processing of the medical support system 100 described above may be realized by a program. In that case, the medical support system 100 may be configured as follows.

[0046] The medical support system 100 includes a memory for storing information and a processor that operates based on the information stored in the memory. The information is, for example, a program and various types of data. The program describes some or all of the functions of the inspection status information acquisition unit 170, the past inspection information acquisition unit 190, the pain status recognition unit 130, the sedative necessity determination unit 180, and the support information generation unit 150. By executing the program, the processor realizes some or all of the functions of the inspection status information acquisition unit 170, the past inspection information acquisition unit 190, the pain status recognition unit 130, the sedative necessity determination unit 180, and the support information generation unit 150.

[0047] The processor includes hardware, and the hardware can include at least one of a circuit for processing digital signals and a circuit for processing analog signals. For example, the processor can be composed of one or more circuit devices mounted on a circuit board or one or more circuit elements. The one or more circuit devices are, for example, ICs, etc. The one or more circuit elements are, for example, resistors, capacitors, etc. The processor can be, for example, a CPU (Central Processing Unit). However, the processor is not limited to the CPU, and various processors such as a GPU (Graphics Processing Unit) or a DSP (Digital Signal Processor) can be used. Also, the processor can be an integrated circuit device such as an ASIC (Application Specific Integrated Circuit) or an FPGA (Field Programmable Gate Array). Further, the processor may include an amplifier circuit, a filter circuit, etc. for processing analog signals. The memory can be a semiconductor memory such as SRAM or DRAM, a register, a magnetic storage device such as a hard disk drive, or an optical storage device such as an optical disk drive. For example, the memory stores instructions readable by a computer, and when the instructions are executed by the processor, the functions of each part of the medical support system 100 are realized as processing. The instructions here can be instructions in an instruction set constituting a program or instructions for instructing operations to the hardware circuit of the processor.

[0048] Also, the above program can be stored in a non-temporary information storage medium, which is, for example, a computer-readable medium. The information storage medium can be realized by, for example, an optical disk, a memory card, an HDD, or a semiconductor memory. The semiconductor memory is, for example, a ROM or a non-volatile memory.

[0049] 2. Endoscope System The following describes a detailed configuration example. FIG. 4 is a configuration example of an endoscope system 400 including a medical support system 100. The endoscope system 400 includes an endoscope device 300 and an insertion shape observation device 200.

[0050] The endoscope device 300 includes an endoscope 10, a light source device 330, a signal processing device 310, and a display device 320. The endoscope 10, also called a scope, is inserted into a patient's body and captures images of the patient's body. The light source device 330 generates and controls illumination light, and the illumination light is guided by a light guide to the tip of the endoscope 10 and emitted from the tip of the endoscope 10. The signal processing device 310 generates an endoscope image by processing the image signal output by the endoscope 10. The signal processing device 310 also acquires the ID of the endoscope 10, etc. as endoscope type information. The display device 320 displays the endoscope image generated by the signal processing device 310.

[0051] The insertion shape observation device 200 includes an endoscope shape acquisition sensor 20, a main body device 210, and a display device 220. The endoscope shape acquisition sensor 20 detects the magnetic field of a source coil provided in the endoscope insertion portion. The main body device 210 acquires the position and shape of the endoscope insertion portion based on the detection signal from the endoscope shape acquisition sensor 20, and outputs an image indicating the position and shape of the endoscope insertion portion to the display device 220. The display device 220 displays the image output by the main body device 210. The display device 220 and the display device 320 are also called monitors and are liquid crystal display devices, etc. Note that one display device may be provided in the endoscope system 400, and the endoscope device 300 and the insertion shape observation device 200 may share the one display device.

[0052] The medical support system 100 is provided in the main body device 210. The medical support system 100 receives the endoscope image and endoscope type information from the signal processing device 310, and information on the position and shape of the endoscope insertion portion acquired by the main body device 210, etc. Note that the medical support system 100 may be provided anywhere within the endoscope system 400.

[0053] FIG. 5 is a configuration example of the endoscope 10 and the endoscope shape acquisition sensor 20. As shown in FIG. 5, the endoscope 10 includes an operation unit 12, an endoscope insertion unit 14, and a source coil 18.

[0054] The endoscope insertion unit 14 has a flexible and elongated shape, and includes a rigid portion 16 provided at its tip and a bendable portion 15 capable of angle operation. The rigid portion 16 is provided with an imaging device, an illumination lens, a water supply port, an air supply port, a forceps port, and the like.

[0055] The operation unit 12 is a device for the user to operate the endoscope 10, and includes, for example, a grip portion, an angle operation dial, and an air / water supply button. FIG. 6 shows an explanatory diagram of endoscope operation. As shown in A1, when the user pushes the grip portion in the longitudinal direction of the endoscope insertion unit 14, the endoscope insertion unit 14 is inserted. This is called a push operation. Also, when the user pulls the grip portion in the longitudinal direction of the endoscope insertion unit 14, the endoscope insertion unit 14 is pulled out. This is called a pull operation. As shown in A2, when the user rotates the grip portion in the circumferential direction of the endoscope insertion unit 14, the endoscope insertion unit 14 rotates in the circumferential direction. This is called a torque operation. When viewed from the direction of the endoscope insertion unit 14 from the grip portion, the clockwise torque operation is called a right torque operation, and the counterclockwise torque operation is called a left torque operation. As shown in A3 and A4, when the user operates the angle operation dial, the bendable portion 15 of the endoscope insertion unit 14 bends up, down, left, and right. This is called an angle operation. The up / down angle operation and the left / right angle operation can be operated independently.

[0056] The source coil 18 generates a magnetic field. For example, a plurality of source coils 18 are provided in the endoscope insertion portion 14 at a predetermined interval. The endoscope shape acquisition sensor 20 detects the magnetic field from each source coil 18, and the main body device 210 of the insertion shape observation device 200 detects the position of each source coil 18 based on the detection signal, thereby detecting the position of each part of the endoscope insertion portion 14. Further, the main body device 210 detects the shape of the endoscope insertion portion 14 based on the detected positions of the plurality of source coils 18. Note that the sensing method for insertion shape observation is not limited to the method using a magnetic field, and for example, a method using electromagnetic waves, ultrasonic waves, light, or the like may be used.

[0057] 3. First detailed configuration example of the medical support system FIG. 7 shows a first detailed configuration example of the medical support system 100. The medical support system 100 includes an information acquisition unit 140, a situation recognition unit 120 a sedative necessity determination unit 180, and a support information generation unit 150. In this configuration example, for example, a part of the information acquisition unit 140 and the immediate situation determination unit 121 correspond to the inspection situation information acquisition unit 170 in FIGS. 1 to 3, and a part of the information acquisition unit 140 and the time-series situation determination unit 122 correspond to the past inspection information acquisition unit 190 in FIG. 3. Note that the description of the same components as those already described will be omitted as appropriate.

[0058] Hereinafter, an example in which the medical support system 100 includes a pain situation recognition unit 130 will be described. However, as shown in FIG. 1, the pain situation recognition unit 130 is not essential. That is, it is not necessarily required to recognize the pain situation, and it is sufficient to recognize a situation where a sedative is required. Hereinafter, the pain situation recognition unit 130 recognizes the pain situation based on the immediate situation information TYK and the time-series situation information JIK, and the sedative necessity determination unit 180 determines the necessity of a sedative based on the pain situation. However, the pain situation recognition unit 130 may be omitted, and the sedative necessity determination unit 180 may determine the necessity of a sedative based on the immediate situation information TYK and the time-series situation information JIK.

[0059] The information acquisition unit 140 acquires various pieces of information IFIN used for recognizing the pain situation. The information IFIN is, for example, an endoscopic image, insertion part shape information, input pain information, endoscope type information, patient information, past examination information, or any combination of two or more of them.

[0060] The situation recognition unit 120 recognizes the current situation, the time-series situation, and the pain situation from the information IFIN, and outputs the current situation information TYK, the time-series situation information JIK, and the pain situation information PSI. The situation recognition unit 120 includes a current situation determination unit 121, a time-series situation determination unit 122, and a pain situation recognition unit 130.

[0061] The current situation determination unit 121 recognizes the current insertion situation of the endoscope from information such as an endoscopic image or insertion part shape information, and outputs the result as the current situation information TYK. "Current" includes not only the current moment but also the recent time including the current time. The recent time may be, for example, a length that allows recognition of a series of movements of the insertion part when the operation or operation procedure currently being performed is specified by the series of movements of the insertion part.

[0062] The time-series situation determination unit 122 recognizes the insertion situation in a time series from information such as past examination information, including the past situation recognition results, and outputs the result as the time-series situation information JIK. "Past" is before the above "recent time" and may be either within the current endoscope examination or in a previous endoscope examination before the previous one.

[0063] The pain situation recognition unit 130 recognizes a situation where pain is likely to occur or a situation where pain has occurred from the current situation information TYK and the time-series situation information JIK, and outputs the result as the pain situation information PSI. The pain situation recognition unit 130 uses not only the current situation information TYK but also the time-series situation information JIK to determine the current pain situation based on the past recognition results.

[0064] The sedative necessity determination unit 180 determines the necessity of a sedative based on the pain situation recognized by the pain situation recognition unit 130. That is, when the pain situation requiring a sedative is recognized, the sedative necessity determination unit 180 outputs a necessity determination result SYN indicating that a sedative is necessary, and when the pain situation requiring a sedative is not recognized, the sedative necessity determination unit 180 outputs a necessity determination result SYN indicating that a sedative is not necessary.

[0065] The support information generation unit 150 generates support information corresponding to the necessity of a sedative based on the necessity determination result SYN of the sedative. By guiding the necessity of a sedative according to the pain situation, the guidance of alleviating the generated pain or avoiding the occurrence of pain is realized.

[0066] Situation recognition unit 120 and the sedative necessity determination unit 180 are realized by machine learning using, for example, a neural network or the like. Specifically, a memory (not shown) stores a program in which an inference algorithm is described and parameters used in the inference algorithm as information of a learned model. Then, the processor performs processing based on the information of the learned model. That is, the processor executes the program using the parameters stored in the memory, thereby executing the processing of the situation recognition unit 120 and the sedative necessity determination unit 180. Note that the situation recognition unit 120 and the sedative necessity determination unit 180 may be realized by one learned model, or each of the situation recognition unit 120 and the sedative necessity determination unit 180 may be realized by individual learned models. Only a part of the situation recognition unit 120 and the sedative necessity determination unit 180 may be realized by a learned model. Also, when the situation recognition unit 120 is realized by a learned model, the situation recognition unit 120The whole may be realized by a single learned model, or each of the recent situation determination unit 121, the time-series situation determination unit 122, and the pain situation recognition unit 130 may be realized by an individual learned model. Also, only a part of the recent situation determination unit 121, the time-series situation determination unit 122, and the pain situation recognition unit 130 may be realized by a learned model.

[0067] As an inference algorithm, for example, a neural network can be adopted. The weight coefficients of the node connections in the neural network are parameters. The neural network includes an input layer to which input data is input, an intermediate layer that performs arithmetic processing on the data input through the input layer, and an output layer that outputs a recognition result based on the arithmetic result output from the intermediate layer. The inference algorithm is not limited to a neural network, and various machine learning techniques used for recognition processing can be adopted. Situation recognition unit 120 Taking the case where the whole of the situation recognition unit is realized by a single learned model as an example, the learning process will be described. In this case, the input data is the information IFIN, and the recognition results are the recent situation information TYK, the time-series situation information JIK, and the pain situation information PSI. The learning device that executes the learning process is an information processing device such as a PC. The learning device inputs teacher data into the learning model and performs feedback on the learning model based on the recognition result thereof to generate a learned model. The teacher data includes a plurality of sets of data, and each set includes input data and correct answer data. The correct answer data is the recognition result to be obtained for the input data and is prepared in advance by medical staff or the like.

[0068] Hereinafter, an example of applying the medical support system 100 to a colon endoscope will be described, but the application target of the medical support system 100 is not limited to a colon endoscope. Also, hereinafter, using a sedative will also be referred to as sedation.

[0069] Examples (a) to (c) of the recent situation information TYK and an example (d) of the time-series situation information JIK are shown.

[0070] (a) The recent situation determination unit 121 acquires the following information by performing image recognition processing on the endoscopic image.

[0071] a1: The site where the endoscopic insertion portion is located. Fig. 8 is an explanatory diagram of the site of the large intestine. The site of the large intestine has an ascending colon, a hepatic flexure, a transverse colon, a splenic flexure, a descending colon, an SDJ, a sigmoid colon, and a rectum between the cecum and the anus. The vicinity of the hepatic flexure is also called the right colon portion, and the vicinity of the splenic flexure is also called the left colon portion. SDJ is the abbreviation of Sigmoid Descending colon Junction and is the boundary portion between the sigmoid colon and the descending colon. Utilizing the fact that the characteristics of the image differ according to the site, the site is recognized from the image. Note that the length of the portion of the endoscopic insertion portion inserted into the patient can be obtained from the insertion portion shape information, but the site can also be estimated from this insertion length.

[0072] a2: Optimal distance, soil tube shape, red ball, or residue. The optimal distance and the soil tube shape are the distances between the tip of the insertion portion and the intestinal wall in the axis holding shortening method. The optimal distance can be created by an inhalation, pushing operation, or pulling operation, and is the optimal distance between the insertion portion and the intestinal wall where the fold can be turned by an angle operation, a torque operation, or both. By realizing the optimal distance, the pushing operation becomes unnecessary when passing over the fold, and the occurrence of pain due to the pushing operation can be suppressed. The soil tube shape is a state where the optimal distance is not achieved and the tip of the insertion portion and the intestinal wall are far apart. The red ball is a state where the tip of the insertion portion is in contact with the intestinal wall mucosa, and the image has become red due to the contact. The residue is a state where water or the like remains on the intestinal wall.

[0073] a3: Movement of the intestine. The movement of the intestine is forward / backward movement, parallel movement, rotation, or peristaltic movement. Forward / backward movement is that the endoscopic insertion portion and the intestinal tube move relatively in the optical axis direction. Parallel movement is that the endoscopic insertion portion and the intestinal tube move relatively in a direction orthogonal to the optical axis direction. Rotation is that the endoscopic insertion portion and the intestinal tube rotate relatively around the optical axis direction as the central axis. Peristaltic movement is the movement performed by the large intestine to Transfer move the contents.

[0074] a4: Suction or air injection. Suction means sucking the gas in the large intestine. By suction, the intestinal wall is drawn towards the tip of the insertion portion. Air injection means sending gas into the large intestine. By air injection, the large intestine expands and the intestinal wall separates from the tip of the insertion portion.

[0075] (b) The recent situation determination unit 121 acquires the following information by performing recognition processing on the insertion portion shape information.

[0076] b1: The shape of the endoscope insertion portion. Here, the "shape" is the shape at a certain moment, such as the current moment.

[0077] b2: The type of loop in the loop method. Also, the shape transition of the endoscope insertion portion during, before, and after the implementation of the loop method. The type of loop is an N-loop, an α-loop, an inverse α-loop, or a γ-loop, and is identified by the loop shape formed by the endoscope insertion portion. FIG. 9 is an example of the shape transition of the endoscope insertion portion. Here, the shape transition at the time of releasing the N-loop will be described as an example. The loop method is used when passing the endoscope insertion portion through the sigmoid colon. When an N-loop is formed, the endoscope insertion portion is approximately in the shape of an N. By performing a pulling operation, the N-loop is gradually released, and when it is released, the endoscope insertion portion becomes approximately straight. During the release process, the endoscope insertion portion is in a shape intermediate between approximately N-shaped and approximately straight. By recognizing this shape transition, it can be recognized that the N-loop has been appropriately released.

[0078] b3: The shape transition of the endoscope insertion portion during, before, and after the implementation of the axis holding shortening method. The axis holding shortening method is used when passing the endoscope insertion portion through the sigmoid colon. The axis holding shortening method passes through the sigmoid colon by overcoming the wrinkles of the intestinal wall by an angle operation and folding the wrinkles by a torque operation and repeating them. The shape transition caused by these operations is detected.

[0079] b4: The shape transition of the endoscope insertion portion during the transverse colon operation. The transverse colon operation is the shortening of the transverse colon mitt trans. Similar to the loop method, etc., the shape transition caused by the operation of the transverse colon operation is detected.

[0080] b5: Deflection of the endoscope insertion portion or stretching of the intestinal wall by the endoscope insertion portion. The deflection of the endoscope insertion portion means that when a pushing operation is performed, the middle part of the insertion portion deflects while the tip of the insertion portion does not move. The stretching of the intestinal wall by the endoscope insertion portion means that when the endoscope insertion portion pushes the free colon of the large intestine, the intestinal wall between the pushed portion and the fixed colon of the large intestine stretches. In FIG. 8, the free colon is the sigmoid colon and the transverse colon, and the fixed colon is the rectum, the ascending colon, and the descending colon.

[0081] (c) The recent situation determination unit 121 acquires the following operation recognition information based on the shape displacement of the endoscope insertion portion.

[0082] c1: Whether a pushing operation, a pulling operation, a torque operation, or an angle operation can be performed during the implementation of the shaft holding shortening method, the loop method, or shortening. Based on the displacement direction, displacement amount, or both of the endoscope insertion portion, it is determined whether pain occurs when the operation is performed or continued.

[0083] (d) The time-series situation determination unit 122 acquires the following information based on the past examination information.

[0084] d1: Support information, image recognition results, shape recognition results, or operation recognition information generated in the past. These information are acquired by obtaining the past examination information stored in the storage device.

[0085] An example of the relationship between the above information and sedation will be described taking "a4: Suction or air supply" as an example.

[0086] Suction is related to the pain situation (1) or (3) described later. When it is observed that the intestinal wall moves closer to the endoscope tip due to suction, there is no need to approach the intestinal wall by an operation that may cause pain, such as a pushing operation or a pulling operation. Therefore, when there is a movement of the intestinal wall approaching the endoscope tip due to suction, the possibility of pain occurring is reduced. On the other hand, when such a movement is not observed, it is necessary to approach the intestinal wall by an operation that may cause pain, such as a pushing operation or a pulling operation. Therefore, in this case, the possibility of pain occurring in the operation to be performed next is increased.

[0087] Therefore, the inspection situation information acquisition unit 170 acquires inspection situation information DSI regarding whether the intestinal wall approaches the endoscope tip due to the suction of the endoscope. The sedative necessity determination unit 180 determines that a sedative is necessary in the case where the intestinal wall does not approach the endoscope tip even when the endoscope is suctioned.

[0088] According to the present embodiment, when it is recognized that suction is ineffective, that is, no movement of the intestinal wall approaching the endoscope tip is observed due to suction, it is determined that there is a high possibility that pain may occur, and the sedative necessity determination unit 180 can prompt early sedation.

[0089] Air supply is related to the inflation of the intestinal tract due to air supply in the pain situation (23) described later. When a large amount of air is sent into the large intestine by air supply and the intestinal tract is inflated, pain will occur. Therefore, when it is recognized that the intestinal tract has been inflated due to air supply, the pain situation recognition unit 130 determines that there is a high possibility that pain may occur, and the sedative necessity determination unit 180 prompts sedation.

[0090] Next, the pain situation recognized based on the above-mentioned most recent situation information TYK and time-series situation information JIK will be described.

[0091] Based on the inspection status information DSI, the sedative necessity determination unit 180 determines that a sedative is necessary when it recognizes a situation where pain occurs due to the stretching of the intestinal wall of the large intestine, a situation where pain occurs due to the pulling of the mesentery, a situation where pain occurs due to the endoscope insertion part pressing against the intestinal wall, or a situation where pain occurs due to the relationship between the fixed colon of the large intestine and the endoscope insertion part. The "relationship between the fixed colon of the large intestine and the endoscope insertion part" means that the endoscope insertion part presses or pulls the fixed colon due to the endoscope operation. Note that this relationship is estimated from the position, shape, positional displacement, or shape displacement of the endoscope insertion part, rather than an estimate of force.

[0092] The above four situations are the main insertion situations where pain occurs to the patient during a colonoscopy. By recognizing these insertion situations, the pain situation recognition unit 130 can recognize the pain situation where pain is occurring to the patient.

[0093] Specific examples (1) to (23) of the pain situation are shown.

[0094] (1) The situation where a pushing operation is performed when not in a loop. This pain situation is an insertion situation where the intestinal wall stretches due to a pushing operation when no loop is formed.

[0095] (2) The situation where a right torque operation is performed during a reverse α loop. The reverse α loop is released by a left torque operation, but if a right torque operation is performed instead, the loop is not released and pain may occur. This insertion situation where the reverse α loop is not released by this right torque operation is this pain situation.

[0096] (3) The situation where a pushing operation is performed during a loop. This pain situation is an insertion situation where the intestinal wall stretches due to a pushing operation when an N loop is formed.

[0097] (4) The situation where a pushing-up operation is performed toward the flank side or the cranial side near the SDJ by the angle operation of the endoscope. FIG. 10 shows an explanatory diagram of this pain situation. Since the SDJ is near the boundary between the sigmoid colon and the descending colon, when a pushing-up occurs near the SDJ, the descending colon, which is the fixed colon, is pushed, so pain may occur. The position of the source coil 18 provided in the endoscope insertion portion 14 is detected based on the position of the endoscope shape acquisition sensor 20. Therefore, based on the relative positional relationship between the patient and the endoscope shape acquisition sensor 20, the flank side direction and the cranial side direction in the detected insertion portion shape can be determined.

[0098] (5) The situation where a pushing-up operation is performed toward the cranial side near the SDJ by the torque operation and the angle operation of the endoscope. Similar to (4), since the descending colon, which is the fixed colon, is pushed, pain may occur.

[0099] (6) The situation where the operation is performed with the endoscope insertion portion bent near the SDJ. This pain situation is an insertion situation where the fixed colon is pushed because the operation is performed near the SDJ, which is near the fixed colon. For example, it is a situation where the operation is performed with an angle during the formation of an N-loop or the like.

[0100] (7) The situation where a pulling operation is performed during the looping of the endoscope. FIG. 11 shows an explanatory diagram of this pain situation. Here, the α-loop is taken as an example for explanation, but other loops may also be used. The α-loop is released by a right torque operation. When a pulling operation is performed during the formation of the α-loop, the loop is not released and pain may occur.

[0101] (8) The situation where a pulling operation is performed when it is not a loop. This pain situation is an insertion situation where too much pulling or pulling in the wrong direction occurs during the pulling operation when no loop is formed.

[0102] (9) The situation where an operation is performed when there is adhesion. This pain situation is an insertion situation where a part of the endoscope insertion portion is caught by the intestinal wall and cannot move during the pulling operation. Adhesion is suspected in the part of the intestinal wall that is caught. For example, the tip of the endoscope insertion portion is caught by the adhesion portion. At this time, the tip does not move during the pulling operation, and the shape of other parts changes. Or, the endoscope image does not change. By recognizing these, this pain situation can be recognized.

[0103] (10) The situation where a pushing-up operation is performed on the vicinity of the boundary between the fixed colon and the free colon by a pushing operation or a pulling operation. The boundary between the fixed colon and the free colon is the SDJ or the splenic flexure. Since the fixed colon is pushed as in (4), there is a possibility of pain.

[0104] (11) The situation where a pushing operation on the splenic flexure is performed. Since there is a diaphragm on the cephalic side of the splenic flexure, pain may occur when the splenic flexure is pressed against the diaphragm by the pushing operation.

[0105] (12) The situation where a pushing operation is performed when the tip of the endoscope insertion portion is present in any of the splenic flexure, the transverse colon, or the hepatic flexure, and a re-loop is formed in the sigmoid colon. FIG. 12 shows an explanatory diagram of this pain situation. Here, an example where the tip of the endoscope insertion portion is present in the splenic flexure is shown. When a pushing operation is performed to pass through the splenic flexure, the insertion portion near the sigmoid colon may bend in a state where the tip of the insertion portion is caught by the splenic flexure. The bent portion of the insertion portion near the sigmoid colon is called a re-loop. When a pushing operation of a certain level or more is performed in this situation, the re-loop swells, causing stretching of the intestinal wall. By recognizing that the tip of the endoscope insertion portion does not move and that the re-loop has displaced by a certain level or more, this pain situation can be recognized.

[0106] (13) The situation where the tip of the endoscope insertion part is present in either the splenic flexure, the transverse colon, or the hepatic flexure, and a pulling operation is performed during the re-loop handling in the sigmoid colon. Fig. 13 shows an explanatory diagram of this pain situation. Here, an example where the tip of the endoscope insertion part is present in the splenic flexure is shown. Although the re-loop is released by the pulling operation, pain may occur when the pulling operation is performed with the bending of the insertion part tip caught on the upper end of the descending colon. Similar to (12), this pain situation can be recognized by the difference between the movement of the insertion part tip and the movement of other parts.

[0107] (14) The situation where the left colon part is pushed up from the splenic flexure by the pushing operation of the endoscope. Fig. 14 shows an explanatory diagram of this pain situation. When the pushing operation is performed with the endoscope insertion part hitting the splenic flexure, the splenic flexure is pushed up. As a result, stretching of the left colon part or pressing against the diaphragm may occur.

[0108] (15) The situation where, due to the shortening operation, pulling down from the descending colon to the anal side of the splenic flexure or bouncing up of the right colon part to the cephalic side occurs. When a pulling operation is performed during the shortening of the mitt trans, the tip of the insertion part of the right colon part rises cephalically and the insertion part near the splenic flexure drops anal side. As a result, pain may occur because the ascending colon, which is the fixed colon, is pulled or the descending colon, which is the fixed colon, is pushed.

[0109] (16) The situation where the splenic flexure is pushed up cephalically by the pushing operation during the insertion of the mitt trans. When the endoscope insertion part is at the sagging part of the transverse colon, the insertion part near the splenic flexure may bend cephalically by the pushing operation, and the splenic flexure may be pushed up.

[0110] (17) The situation where the right colon part is pulled to the left hypochondrium side by the angle operation during the shortening operation.

[0111] (18) The situation where the hepatic flexure is pushed up by the angle operation.

[0112] (19) The situation where the hepatic flexure is pushed up by the pushing operation.

[0113] (20) When the tip of the endoscope insertion portion is at the hepatic flexure, the situation where the splenic flexure is pushed up by a pushing operation.

[0114] (21) After reaching the hepatic flexure, the situation where the splenic flexure is pulled toward the anus by a pulling operation.

[0115] (22) The situation where the splenic flexure is pulled toward the anus by a pulling operation at the splenic flexure.

[0116] (23) The situation where the intestinal tract expands due to air insufflation.

[0117] Note that the pain situation recognition unit 130 may recognize a pain situation when the displacement amount exceeds a predetermined value in each situation. As shown in FIG. 15, in the situation of (3) above, when an N-loop is detected and the displacement amount of the convex portion of the loop is equal to or greater than a predetermined value, it may be determined that it is a pain situation. Since the degree of stretching changes according to the displacement amount, a pain situation is recognized when the displacement amount causes stretching of a certain degree or more.

[0118] Also, the pain situation recognition unit 130 may determine a pain level based on the displacement amount in each situation. For example, in FIG. 15, when the displacement amount of the convex portion of the loop is equal to or greater than a first predetermined value, it is determined that it is a first pain level, and the displacement amount of the convex portion of the loop is a second predetermined value Above When it is, it may be determined that it is a second pain level. When the second predetermined value is greater than the first predetermined value, the second pain level indicates that the pain is stronger than the first pain level.

[0119] FIG. 16 is a flowchart of the processing performed by the medical support system 100 in the first detailed configuration example. Note that in this flowchart, steps S53 and S55 to S57 correspond to the determination of the necessity of a sedative explained in FIG. 1.

[0120] In step S51, the information acquisition unit 140 acquires the information IFIN. In step S52, the situation recognition unit 120determines the presence or absence of a pain situation based on the information IFIN. Also, the situation recognition unit 120 when determining that it is a pain situation, outputs information on the pain level, information on the pain frequency, information on the pain type, and support information presented in the past as pain situation information PSI. The information on the pain type is information indicating which of the above-described pain situations (1) to (23) it corresponds to.

[0121] In step S53, the sedative necessity determination unit 180 determines whether the pain level is stronger than a predetermined level.

[0122] In step S53, when the sedative necessity determination unit 180 determines that the pain level is stronger than a predetermined level, in step S54, the sedative necessity determination unit 180 determines that sedation is necessary, and the support information generation unit 150 generates support information presenting the use of sedation. That is, when severe pain that is difficult to endure is recognized, the use of sedation is presented.

[0123] Step S53 when the sedative necessity determination unit 180 determines that the pain level is weaker than a predetermined level, in step S55, the sedative necessity determination unit 180 determines the pain frequency. Specifically, the sedative necessity determination unit 180 determines whether the number of pain occurrences is plural or whether the pain duration is longer than a predetermined time.

[0124] In step S55, when the sedative necessity determination unit 180 determines that the number of pain occurrences is plural or the pain duration is longer than a predetermined time, in step S54, the sedative necessity determination unit 180 determines that sedation is necessary, and the support information generation unit 150 generates support information presenting the use of sedation. That is, even for pain with a weak pain level, when the pain frequency is high or the time during which pain occurs is long, the use of sedation is presented.

[0125] In step S55, when the sedative necessity determination unit 180 determines that the number of pain occurrences is single or the pain duration is shorter than a predetermined time, in step S56, the sedative necessity determination unit 180 determines the type of pain. Specifically, the sedative necessity determination unit 180 determines whether there is an avoidance operation to avoid pain in the pain situation recognized in step S52.

[0126] In step S56, when the sedative necessity determination unit 180 determines that there is no avoidance operation to avoid pain, in step S54, the sedative necessity determination unit 180 determines that sedation is necessary, and the support information generation unit 150 generates support information presenting the use of sedation.

[0127] In step S56, when the sedative necessity determination unit 180 determines that there is an avoidance operation to avoid pain, in step S57, the sedative necessity determination unit 180 determines whether the same avoidance operation has been presented in the past.

[0128] In step S57, when the sedative necessity determination unit 180 determines that the same avoidance operation has been presented in the past, in step S54, the sedative necessity determination unit 180 determines that sedation is necessary, and the support information generation unit 150 generates support information presenting the use of sedation.

[0129] In step S57, when the sedative necessity determination unit 180 determines that the same avoidance operation has not been presented in the past, in step S58, the sedative necessity determination unit 180 determines that sedation is not necessary, and the support information generation unit 150 generates support information presenting an avoidance operation corresponding to the pain situation recognized in step S52. That is, when the pain level is weak and the frequency of pain is low or the time when pain occurs is short, basically, avoidance operations such as the endoscopic operation of the operator, manual compression by the assistant, or the position conversion of the patient are performed.

[0130] However, depending on the type of pain, there is pain that cannot be avoided. For example, there is no avoidance operation for the pain situation (9) described above. In that case, the use of sedation is recommended. Also, the pain that is currently occurring has occurred in the past, and there may have been an avoidance operation presented at that time. In that case, since the currently recognized pain is pain that could not be completely prevented even with an avoidance operation or is difficult to prevent, the use of sedation is presented.

[0131] The content presented in step S54 is, for example, content that indicates that it is considered better to use sedation, such as "Pain is occurring frequently. It is recommended to use sedation."

[0132] When the use of sedation is presented in step S54, the information on the pain situation recognized in step S52 or the information on the pain determined in steps S53 and S55 to S57 may be recorded in the electronic medical record.

[0133] FIG. 17 is a flowchart showing a specific example of pain situation recognition and sedation necessity determination according to the recognition result. Here, the shaft holding shortening method will be described as an example, but a processing flow corresponding to each insertion method or each of the above-described pain situations (1) to (23) is set.

[0134] In step S61, the recent situation determination unit 121 determines whether it is the optimal distance based on the information IFIN.

[0135] In step S61, when the recent situation determination unit 121 determines that it is the optimal distance, in step S62, the pain situation recognition unit 130 determines whether it is a pain situation based on the insertion situation recognized by the recent situation determination unit 121 and the time-series situation determination unit 122. In step S62, when the pain situation recognition unit 130 determines that it is not a pain situation, in step S63, the sedative necessity determination unit 180 determines that sedation is not necessary. In step S62, when the pain situation recognition unit 130 determines that it is a pain situation, in step S70, the sedative necessity determination unit 180 performs the sedation necessity determination shown in S53 and S55 to S57 of FIG. 16.

[0136] In step S61, when the recent situation determination unit 121 determines that it is not the optimal distance, in step S65, the pain situation recognition unit 130 determines whether it is a pain situation based on the insertion situation recognized by the recent situation determination unit 121 and the time-series situation determination unit 122. In step S65, when the pain situation recognition unit 130 determines that it is not a pain situation, in step S66, the sedative necessity determination unit 180 determines that sedation is not necessary. In step S65 and S67 when the pain situation recognition unit 130 determines that it is a pain situation where a pulling operation has been performed when it is not a loop, in steps S68 and S69, the pain situation recognition unit 130 determines that the optimal distance cannot be achieved by the pulling operation and that the optimal distance can be achieved by the pushing operation but pain may occur during the pushing operation. In step S70, the sedative necessity determination unit 180 performs the sedation necessity determination shown in S53 and S55 to S57 of FIG. 16.

[0137] FIG. 18 is a flowchart showing a specific example of the recognition of a pain situation. Here, as shown in FIG. 24, a pain situation where stretching occurs in the sigmoid colon will be described as an example.

[0138] In step S31, the recent situation determination unit 121 determines the site where the endoscope insertion portion is located based on the endoscope image and the insertion portion shape information. Specifically, the recent situation determination unit 121 performs image recognition on the endoscope image and shape recognition on the insertion portion shape information, and determines the site where the endoscope insertion portion is located based on the image recognition result and the shape recognition result.

[0139] In step S31, when the recent situation determination unit 121 determines that the endoscope insertion portion exists outside the sigmoid colon, in step S32, the pain situation recognition unit 130 determines that it is the pain situation of other sites.

[0140] In step S31, when the recent situation determination unit 121 determines that the endoscope insertion portion exists in the sigmoid colon, in step S33, the recent situation determination unit 121 determines whether the endoscope insertion portion is in an extended shape. Here, the extended shape is a stick shape that is convex toward the head side and bent toward the left hypochondrium as shown in FIG. 24.

[0141] In step S33, when the recent situation determination unit 121 determines that it is not in the extended shape, in step S34, the pain situation recognition unit 130 determines that it is a different type of pain situation.

[0142] In step S33, when the recent situation determination unit 121 determines that it is in the extended shape, in step S35, the recent situation determination unit 121 determines whether extension has occurred. Specifically, the recent situation determination unit 121 determines extension based on the fact that the endoscope insertion portion has been displaced toward the head side while maintaining the extended shape, the endoscope image has stopped or retreated in the section where extension is recognized from the recent recognition information, or both of them.

[0143] In step S35, when the recent situation determination unit 121 determines that extension has not occurred, in step S36, the pain situation recognition unit 130 determines that the pain situation due to extension has not occurred, and the sedative necessity determination unit 180 determines that sedation is not required.

[0144] In step S35, when the recent situation determination unit 121 determines that stretching has occurred, in step S37, the pain situation recognition unit 130 determines whether the stretching has exceeded a threshold value. Specifically, as shown in FIG. 24, the pain situation recognition unit 130 determines whether the displacement amount of the convex portion of the endoscope insertion unit has exceeded the threshold value.

[0145] In step S37, when the pain situation recognition unit 130 determines that the stretching has not exceeded the threshold value, in step S36, the pain situation recognition unit 130 determines that no pain situation due to stretching has occurred, and the sedative necessity determination unit 180 determines that sedation is not required.

[0146] In step S37, when the pain situation recognition unit 130 determines that the stretching has exceeded the threshold value, in step S38, the pain situation recognition unit 130 determines that a pain situation due to stretching has occurred, and the sedative necessity determination unit 180 performs the sedation necessity determination shown in S53 and S55 to S57 of FIG. 16.

[0147] 4. Second detailed configuration example of the medical support system FIG. 19 shows a second detailed configuration example of the medical support system 100. The medical support system 100 includes an image acquisition unit 141, an endoscope shape acquisition unit 142, a situation recognition unit 120 and a sedative necessity determination unit 180 and a support information generation unit 150. In this configuration example, for example, the image acquisition unit 141, the endoscope shape acquisition unit 142, and the recent situation determination unit 121 correspond to the past examination information acquisition unit 190 in FIGS. 1 to 3, and the time-series situation determination unit 122 corresponds to the past examination information acquisition unit 190 in FIG. 3. Note that the description of the same components as those already described will be omitted as appropriate.

[0148] The pain information acquisition unit 500 is included in the endoscope system 400. For example, when the medical support system 100 is included in the insertion shape observation device 200, the pain information acquisition unit 500 may be included in the insertion shape observation device 200.

[0149] The pain information acquisition unit 500 includes a transmission device 510 that can be operated by a patient or a medical staff according to the pain condition of the patient. The transmission device 510 is, for example, a switch or a touch panel. Taking the case where the patient operates the switch as an example, the patient is provided with the switch, and when pain occurs, the patient is asked to press the switch. The pain condition recognition unit 130 recognizes the occurrence of pain based on the information from the switch, and based on the recognition result, the sedative necessity determination unit 180 determines whether a sedative is necessary. The switch may be a one-stage switch or a two-stage switch so that the intensity can be distinguished. The switch may be able to transmit only the presence or absence of pain, or may be able to transmit information other than the presence or absence of pain, such as intensity or pain duration. The switch may be held by an assistant such as a nurse, and when the patient complains of pain, the assistant may press the switch instead.

[0150] In addition, the pain information acquisition unit 500 may include a camera that photographs the patient's expression, and may recognize pain by recognizing that the photographed image is a pained expression. Further, the pain information acquisition unit 500 may include a microphone that acquires the voice emitted by the patient, and may recognize pain by recognizing from the voice that the patient has complained of pain. The output signal of the transmission device 510, the expression recognition result, or the voice recognition result is input as input pain information INPN to the situation recognition unit 120 is input.

[0151] The endoscopic image acquisition unit 141 acquires an endoscopic image by receiving the endoscopic image transmitted by the signal processing device 310 of the endoscopic device 300. The endoscopic shape acquisition unit 142 acquires the position and shape of the endoscopic insertion portion based on the detection signal from the endoscopic shape acquisition sensor 20. The endoscopic image and the information on the position and shape of the endoscopic insertion portion are input as information IFIN to the situation recognition unit 120 is input.

[0152] FIG. 20 is a flowchart of the processing performed by the medical support system 100 in the second detailed configuration example.

[0153] In step S11, the support information generation unit 150 determines whether the pain situation recognition unit 130 has detected the pain situation based on the internal information. The internal information is information other than the input pain information INPN transmitted by the patient or medical staff. In the example of FIG. 19, it is the endoscopic image acquired by the image acquisition unit 141, the insertion part shape information acquired by the endoscopic shape acquisition unit 142, the latest situation information TYK output by the latest situation determination unit 121, the time-series situation information JIK output by the time-series situation determination unit 122, or any combination of two or more of them.

[0154] In step S11, when the pain situation recognition unit 130 has detected the pain situation based on the internal information, in step S16, the support information generation unit 150 determines whether the pain situation recognition unit 130 has detected the pain situation based on the external information. The external information is the input pain information INPN transmitted by the patient or medical staff.

[0155] In step S16, when the pain situation recognition unit 130 has not detected the pain situation based on the external information, in step S17, the sedative necessity determination unit 180 determines that sedation is not required.

[0156] In step S16, when the pain situation recognition unit 130 has detected the pain situation based on the external information, in step S18, the pain situation recognition unit 130 records the detected pain situation in the memory as a log. In step S19, when the detected pain situation corresponds to any of the above-described predetermined pain situations (1) to (23), the pain situation recognition unit 130 updates the determination condition of the corresponding pain situation. For example, when the pain situation is detected by determining that the displacement amount is a threshold value, the threshold value is updated. In step S15, the sedative necessity determination unit 180 performs the sedation necessity determination shown in S53 and S55 to S57 of FIG. 16. When it is determined in step S15 that sedation is necessary, in step S14, the support information generation unit 150 causes the display device 220 to display support information indicating the use of sedation.

[0157] In step S11, when the pain situation recognition unit 130 does not detect the pain situation based on the internal information, in step S12, the support information generation unit 150 determines whether the pain situation recognition unit 130 detects the pain situation based on the external information.

[0158] In step S12, when the pain situation recognition unit 130 does not detect the pain situation based on the external information, in step S13, the sedative necessity determination unit 180 determines that sedation is not required.

[0159] In step S12, when the pain situation recognition unit 130 detects the pain situation based on the external information, the pain situation is recorded in step S20. For example, the pain situation is recorded in an electronic medical record or the like. When the pain situation recognition unit 130 recognizes a pain situation that does not fall under the above-described pain situations (1) to (23) based on the external information, by recording the pain situation as the patient-specific pain, when a similar pain situation occurs again in the current examination or in another examination after the next time, the patient-specific pain situation can be recognized. Next, when it is determined in step S15 that sedation is necessary, in step S14, the support information generation unit 150 causes the display device 220 to display support information indicating the use of sedation.

[0160] 5. Third Detailed Configuration Example and Fourth Detailed Configuration Example of the Medical Support System FIG. 21 is a third detailed configuration example of the medical support system 100. The medical support system 100 includes an image acquisition unit 141, an endoscope shape acquisition unit 142, a patient information acquisition unit 143, an endoscope information acquisition unit 144, and a situation recognition unit 120It includes a sedative necessity determination unit 180 and a support information generation unit 150. FIG. 22 is a fourth detailed configuration example of the medical support system 100. The fourth detailed configuration example is obtained by further adding a pain information acquisition unit 500 to the third detailed configuration example. In the third and fourth detailed configuration examples, for example, a part of the image acquisition unit 141, the endoscope shape acquisition unit 142, the recent situation determination unit 121, the patient information acquisition unit 143, and the endoscope information acquisition unit 144 correspond to the past examination information acquisition unit 190 in FIGS. 1 to 3, and a part of the patient information acquisition unit 143 and the time-series situation determination unit 122 correspond to the past examination information acquisition unit 190 in FIG. 3. For the components that are the same as the components already described, the description thereof will be omitted as appropriate.

[0161] The electronic medical record 600 stores patient information which is information regarding the attributes of the patient. The electronic medical record 600 is stored, for example, in a storage device provided outside the endoscope system 400, and the patient information acquisition unit 143 acquires the electronic medical record 600 from the storage device.

[0162] The patient information is, for example, the build, gender, age, past history, body fat percentage of the patient, or any combination of two or more of them. The build is the BMI, height, weight, or any combination of two or more of them. Depending on these attributes of the patient, the pain situation that is likely to occur or the pain threshold may be different. As an example, there are situations such as a thin female being prone to pain, or a male feeling pain when stretched 50 mm in the head direction in the N loop. By recognizing the pain situation based on the patient information, the pain situation specific to the patient is appropriately recognized, so that an appropriate determination of the necessity for sedation is realized.

[0163] In addition, the patient information may include past examination information. The past examination information is what insertion method was used, how many minutes it took until insertion, whether pain occurred, the insertion trajectory, which scope was used, whether a sedative was used, or any combination of two or more of them. By recognizing the pain situation based on these past examination information, the pain situation specific to the patient is appropriately recognized, so that an appropriate determination of the necessity for sedation is realized.

[0164] The endoscope information acquisition unit 144 acquires endoscope type information from the signal processing device 310 of the endoscope device 300. The thickness of the endoscope insertion part varies according to the type of endoscope. Therefore, the pain that is likely to occur may vary according to the type of endoscope. Thus, by recognizing the pain situation based on the endoscope type information, different pain situations according to the type of endoscope can be appropriately recognized, so that an appropriate determination of the necessity of sedation is realized.

[0165] 6. Fifth detailed configuration example of the medical support system FIG. 23 shows a fifth detailed configuration example of the medical support system 100. The medical support system 100 includes an image acquisition unit 141, an endoscope shape acquisition unit 142, a patient information acquisition unit 143, an endoscope information acquisition unit 144, and a situation recognition unit 120 and a sedative necessity determination unit 180 and a support information generation unit 150. For the components that have already been described, the description thereof will be omitted as appropriate.

[0166] The support information generation unit 150 may control the automatic insertion / extraction device 700 by outputting support information AST to the control device 710 of the automatic insertion / extraction device 700. The automatic insertion / extraction device 700 is a robot that automatically or semi-automatically inserts and extracts an endoscope, and the control device 710 is a device that controls the robot. The support information AST is output as a control signal to the control device 710. When the sedative necessity determination unit 180 determines that sedation is necessary, the support information generation unit 150 may output, for example, a control signal for stopping the operation of the automatic insertion / extraction device 700.

[0167] As described above, the present embodiment and its modifications have been explained. However, the present disclosure is not limited to each embodiment or its modifications as they are. At the implementation stage, the components can be modified and embodied within the scope of not departing from the gist. Also, a plurality of components disclosed in the above-described embodiments and modifications can be appropriately combined. For example, some components may be deleted from all the components described in each embodiment and modification. Furthermore, components described in different embodiments and modifications may be appropriately combined. Thus, various modifications and applications are possible within the scope of not departing from the gist of the present disclosure. Also, in the specification or drawings, a term that has been described at least once together with a broader or synonymous different term can be replaced with that different term at any location in the specification or drawings.

Explanation of Signs

[0168] 10…Endoscope, 12…Operation unit, 14…Endoscope insertion part, 15…Bending part, 16…Rigid part, 18…Source coil, 20…Endoscope shape acquisition sensor, 100…Medical support system, 120…Situation recognition part, 121…Latest situation determination part, 122…Time-series situation determination part, 130…Pain situation recognition part, 140…Information acquisition part, 141…Image acquisition part, 142…Endoscope shape acquisition part, 143…Patient information acquisition part, 144…Endoscope information acquisition part, 150…Support information generation part, 170…Examination situation information acquisition part, 180…Sedative necessity determination part, 190…Past examination information acquisition part, 191…Storage device, 200…Insertion shape observation device, 210…Main body device, 220…Display device, 300…Endoscope device, 310…Signal processing device, 320…Display device, 330…Light source device, 400…Endoscope system, 500…Information acquisition part, 510…Transmitting device, 600…Electronic medical record, 700…Automatic insertion / extraction device, 710…Control device, AST…Support information, DSI…Examination situation information, INPN…Input pain information, JIK…Time-series situation information, KJH…Past examination information, PSI…Pain situation information, SYN…Necessity determination result, TYK…Latest situation information

Claims

1. Comprising a processor, The processor: Obtains inspection status information regarding the status of an endoscopic examination using an endoscope, Based on the inspection status information, recognizes a pain status, which is a status where pain is likely to occur or is occurring in the patient during the endoscopic examination, When it is determined that the status is the pain status, outputs information on the pain level as pain status information, A medical support system, characterized in that when the pain level is stronger than a predetermined level, it is determined that a sedative is necessary.

2. In Claim 1, The processor: When it is determined that the pain level is weaker than the predetermined level, determines the frequency of pain, A medical support system, characterized in that when it is determined that the number of pain occurrences is plural in the frequency of pain or the duration of pain is longer than a predetermined time, it is determined that the sedative is necessary.

3. In Claim 2, The processor: When it is determined that the number of pain occurrences is single or the duration of pain is shorter than the predetermined time, determines whether there is an avoidance operation to avoid pain, A medical support system, characterized in that when it is determined that there is no such avoidance operation to avoid pain, it is determined that the sedative is necessary.

4. In Claim 3, The processor: When it is determined that there is the avoidance operation to avoid pain, determines whether the same avoidance operation has been presented in the past, A medical support system, characterized in that when it is determined that the same avoidance operation has been presented in the past, it is determined that the sedative is necessary.

5. In Claim 1, The processor: Obtains the shape displacement of the endoscope insertion portion as the inspection status information, When the displacement amount of the loop portion formed in the endoscope insertion portion is equal to or more than a first predetermined value, determines that the pain level is a first pain level, A medical support system, characterized in that when the displacement amount of the loop portion is equal to or more than a second predetermined value, which is larger than the first predetermined value, determines that the pain level is a second pain level, which is stronger than the first pain level.

6. In Claim 1, The medical support system is characterized in that the inspection status information includes at least one of endoscopic image recognition information which is information on the recognition result of an endoscopic image in the endoscopic examination, insertion part shape information which is information on the shape of the endoscopic insertion part, operation recognition information which is information on at least one change in the shape or position of the endoscopic insertion part, patient expression information which is information on the expression of the patient in the endoscopic examination, pain transmission information which is information from a transmission device operated by the patient or medical staff, endoscopic type information which is information on the type of the endoscopic insertion part used in the endoscopic examination, or patient information which is information on the attributes of the patient.

7. In claim 1, the processor classifies the insertion status of the endoscope based on at least one of endoscopic image recognition information which is information on the recognition result of an endoscopic image in the endoscopic examination, insertion part shape information which is the shape of the endoscopic insertion part, or operation recognition information which is information on at least one change in the shape or position of the endoscopic insertion part, and outputs the inspection status information including the classification result. The medical support system is characterized in that it determines the necessity of the sedative based on the insertion status indicated by the classification result.

8. In claim 7, the operation recognition information includes insertion part shape displacement information which is information on the shape displacement of the endoscopic insertion part. The medical support system is characterized in that the processor performs the classification based on the insertion part shape information and the insertion part shape displacement information.

9. In claim 8, the insertion part shape displacement information includes shape displacement amount information which is information on the magnitude of the shape displacement. The medical support system is characterized in that the processor performs the classification based on the insertion part shape information and the shape displacement amount information.

10. In claim 1, the medical support system is characterized in that when it is determined that the sedative is necessary, the processor generates support information indicating that the sedative is necessary.

11. In claim 1, When the processor determines that it is a pain situation when it recognizes, based on the inspection situation information, a situation where pain occurs due to the stretching of the intestinal wall of the large intestine, a situation where pain occurs due to the pulling of the mesentery, a situation where pain occurs due to the endoscopic insertion part pressing the intestinal wall, or a situation where pain occurs due to the relationship between the fixed part of the large intestine and the endoscopic insertion part. A medical support system characterized by this.

12. In claim 1, When the processor determines that it is a pain situation when it recognizes, based on the inspection situation information, a situation where a pushing-up operation is performed toward the flank side or the cephalic side in the vicinity of the SDJ by the angle operation of the endoscope. A medical support system characterized by this.

13. In claim 1, When the processor determines that it is a pain situation when it recognizes, based on the inspection situation information, a situation where a pushing-up operation is performed toward the cephalic side in the vicinity of the SDJ by the torque operation and the angle operation of the endoscope. A medical support system characterized by this.

14. In claim 1, When the processor determines that it is a pain situation when it recognizes, based on the inspection situation information, a situation where an operation is performed with the endoscopic insertion part bent in the vicinity of the SDJ. A medical support system characterized by this.

15. In claim 1, When the processor determines that it is a pain situation when it recognizes, based on the inspection situation information, a situation where a pulling operation is performed during the looping of the endoscope. A medical support system characterized by this.

16. In claim 1, When the processor determines that it is a pain situation when it recognizes, based on the inspection situation information, a situation where a pushing operation is performed when the tip of the endoscopic insertion part is present at any of the splenic flexure, transverse colon, or hepatic flexure and a re-loop is formed in the sigmoid colon. A medical support system characterized by this.

17. In claim 1, When the processor determines that it is a pain situation when it recognizes, based on the inspection situation information, a situation where a pulling operation is performed during the re-loop handling in the sigmoid colon when the tip of the endoscopic insertion part is present at any of the splenic flexure, transverse colon, or hepatic flexure. A medical support system characterized by this.

18. In claim 1, When the processor generates support information for the user based on the determination result of the necessity of the sedative. A medical support system characterized by this.

19. In claim 1, the processor acquires the inspection status information regarding whether the intestinal wall approaches the endoscope tip by suction of the endoscope, and determines that it is a pain situation when the intestinal wall does not approach the endoscope tip even when the endoscope is suctioned. A medical support system characterized by this.

20. In claim 1, the processor acquires past inspection information which is information regarding past endoscope inspections, and determines the necessity of the sedative based on the past inspection information. A medical support system characterized by this.

21. In claim 20, the processor acquires at least one of the necessity determination result of the sedative, the content of the support information, the endoscope image recognition information which is information regarding the recognition result for the endoscope image, the insertion part shape information which is information regarding the shape of the endoscope insertion part, or the operation recognition information which is information regarding at least one change in the shape or position of the endoscope insertion part, in the past inspection as the past inspection information. A medical support system characterized by this.

22. An endoscope used for endoscope inspection, a processor, and includes the processor acquires inspection status information regarding the status of the endoscope inspection using the endoscope, recognizes a pain situation which is a situation where pain is likely to occur or is occurring in the patient during the endoscope inspection based on the inspection status information, when it is determined that it is the pain situation, outputs information on the pain level as pain situation information, and determines that a sedative is necessary when the pain level is stronger than a predetermined level. An endoscope system characterized by this.

23. An operating method of a medical support system including a processor, comprising: the processor acquires inspection status information regarding the status of an endoscope inspection using an endoscope; the processor recognizes a pain situation which is a situation where pain is likely to occur or is occurring in the patient during the endoscope inspection based on the inspection status information; the processor outputs information on the pain level as pain situation information when it is determined that it is the pain situation; the processor determines the necessity of the sedative by determining that a sedative is necessary when the pain level is stronger than a predetermined level; the processor generates support information for the user based on the necessity determination result of the sedative; An operating method of a medical support system characterized by including this.

24. In claim 23, when the processor determines that the pain level is weaker than the predetermined level, determining the frequency of pain; when the processor determines that the number of pain occurrences is plural or the pain duration is longer than a predetermined time in the frequency of pain, determining that the sedative is necessary; A method for operating a medical support system, comprising the above.

25. In claim 24, when the processor determines that the number of pain occurrences is single or the pain duration is shorter than the predetermined time, determining whether there is an avoidance operation for avoiding pain; when the processor determines that there is no such avoidance operation for avoiding pain, determining that the sedative is necessary; A method for operating a medical support system, comprising the above.

26. In claim 25, when the processor determines that there is such an avoidance operation for avoiding pain, determining whether the same avoidance operation has been presented in the past; when the processor determines that the same avoidance operation has been presented in the past, determining that the sedative is necessary; A method for operating a medical support system, comprising the above.

27. In claim 23, the processor acquiring the shape displacement of the endoscope insertion portion as the inspection situation information; when the displacement amount of the loop portion formed in the endoscope insertion portion is equal to or greater than a first predetermined value, the processor determining that the pain level is a first pain level; when the displacement amount of the loop portion is equal to or greater than a second predetermined value greater than the first predetermined value, the processor determining that the pain level is a second pain level stronger than the first pain level; A method for operating a medical support system, comprising the above.

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