IMAGE DIAGNOSIS SUPPORT DEVICE, OPERATION METHOD FOR IMAGE DIAGNOSIS SUPPORT DEVICE, AND PROGRAM

Information

  • Patent Application
  • 20230326579
  • Publication Number
    20230326579
  • Date Filed
    June 16, 2023
    a year ago
  • Date Published
    October 12, 2023
    a year ago
Abstract
An image diagnosis support device is an image diagnosis support device that includes a processor and a memory and is portable by a user. The processor is configured to execute: computer-aided diagnostic processing for a medical image; communication processing of receiving an image file including the medical image and accessory information from an external device and of transmitting information including a result of the computer-aided diagnostic processing to the external device; and prohibition instruction transmission processing of transmitting, to the external device, an instruction to prohibit transmission of the image file in which the accessory information includes personal information unnecessary for the computer-aided diagnostic processing.
Description
BACKGROUND
1. Technical Field

The technology of the present disclosure relates to an image diagnosis support device, an operation method for an image diagnosis support device, and a program.


2. Description of the Related Art

An image diagnosis support device that executes image analysis processing of analyzing a medical image, such as a radiation image, through a computer to provide useful information for diagnosis, such as detection of a lesion in the medical image, is known. This image diagnosis support device is also called a computer-aided diagnosis (CAD) device.


The image diagnosis support device is configured as a stationary server and is connected to an image storage device, such as picture archiving and communication systems (PACS), in a medical facility via a network. A medical image captured by a modality, such as a radiography device, is stored in the PACS. For example, an image diagnosis device executes CAD processing on a medical image on the basis of a request from a terminal device operated by a doctor performing diagnosis in a medical facility and transmits the execution result of the CAD processing to the terminal device as a request source (JP2003-150714A).


In addition, JP2003-150714A discloses that, for example, an image diagnosis device installed in a medical facility, such as a base hospital, and a terminal device of a regional hospital in a remote location are connected via a network so that an image diagnosis support device existing in the base hospital is used from the regional hospital in which the image diagnosis support device is not provided.


SUMMARY

In recent years, the need for a medical diagnosis outside of hospitals, such as disaster medical care and home medical care, has been increasing. In response to this, a portable modality, such as a portable radiography device, has been developed. Even in such a field, there is a demand for the use of the image diagnosis support device in order to promptly perform a medical diagnosis in the field.


However, in some fields such as disaster medical care or home medical care, a network, such as the Internet, may not be available for use, and it may be difficult to use the image diagnosis support device installed in a facility as described in JP2003-150714A from a remote location. Therefore, there is a demand for an image diagnosis support device that can be used in the field such as disaster medical care or home medical care.


However, in some fields such as disaster medical care or home medical care, a network, such as the Internet, may not be available for use in many cases, and it may be difficult to use the image diagnosis support device installed in a facility as described in JP2003-150714A from a remote location. Therefore, there is a demand for an image diagnosis support device that can be used in the field such as disaster medical care or home medical care.


In that respect, it is conceivable to make the image diagnosis support device portable such that the image diagnosis support device can be used in the field such as disaster medical care or home medical care. However, in a case in which the image diagnosis support device is portable, there is a risk of theft. Since the image diagnosis support device stores the medical image and the accessory information of the medical image includes the personal information of the patient, the personal information may be leaked.


An object of the technology of the present disclosure is to provide an image diagnosis support device, an operation method for an image diagnosis support device, and a program capable of being used in a field such as disaster medical care or home medical care and preventing leakage of personal information.


In order to achieve the above object, according to the present disclosure, there is provided an image diagnosis support device that is portable by a user, the image diagnosis support device comprising: a processor; and a memory, in which the processor is configured to execute: computer-aided diagnostic processing for a medical image; communication processing of receiving an image file including the medical image and accessory information from an external device and of transmitting information including a result of the computer-aided diagnostic processing to the external device; and prohibition instruction transmission processing of transmitting, to the external device, an instruction to prohibit transmission of the image file in which the accessory information includes personal information unnecessary for the computer-aided diagnostic processing.


It is preferable that the processor is configured to execute the prohibition instruction transmission processing before receiving the image file from the external device.


It is preferable that the processor is configured to, in a case in which the image file received from the external device includes the personal information unnecessary for the computer-aided diagnostic processing after executing the prohibition instruction transmission processing, discard the image file.


It is preferable that the processor is configured to reject reception of data from the external device after discarding the image file.


It is preferable that the processor is configured to execute the prohibition instruction transmission processing after receiving the image file from the external device.


It is preferable that the processor is configured to, in a case in which the accessory information of the image file from the external device includes the personal information unnecessary for the computer-aided diagnostic processing, discard the image file and execute the prohibition instruction transmission processing.


It is preferable that the processor is configured to, in a case in which the accessory information of the image file received from the external device includes the personal information unnecessary for the computer-aided diagnostic processing after executing the prohibition instruction transmission processing, reject reception of data from the external device.


It is preferable that the processor is configured to, in a case in which the accessory information of the image file received from the external device includes the personal information unnecessary for the computer-aided diagnostic processing after executing the prohibition instruction transmission processing, discard the image file after performing the computer-aided diagnostic processing.


According to the present disclosure, there is provided an operation method for an image diagnosis support device that is portable by a user, the operation method comprising: executing computer-aided diagnostic processing for a medical image; executing communication processing of receiving an image file including the medical image and accessory information from an external device and of transmitting information including a result of the computer-aided diagnostic processing to the external device; and executing prohibition instruction transmission processing of transmitting, to the external device, an instruction to prohibit transmission of the image file in which the accessory information includes personal information unnecessary for the computer-aided diagnostic processing.


According to the present disclosure, there is provided a program causing a processor to execute processing in an image diagnosis support device that includes the processor and a memory and is portable by a user, the program causing the processor to execute: computer-aided diagnostic processing for a medical image; communication processing of receiving an image file including the medical image and accessory information from an external device and of transmitting information including a result of the computer-aided diagnostic processing to the external device; and prohibition instruction transmission processing of transmitting, to the external device, an instruction to prohibit transmission of the image file in which the accessory information includes personal information unnecessary for the computer-aided diagnostic processing.


According to the technology of the present disclosure, it is possible to provide an image diagnosis support device, an operation method for an image diagnosis support device, and a program capable of being used in a field such as disaster medical care or home medical care and preventing leakage of personal information.





BRIEF DESCRIPTION OF THE DRAWINGS

Exemplary embodiments according to the technique of the present disclosure will be described in detail based on the following figures, wherein:



FIG. 1 is a diagram showing an example of a configuration of an X-ray imaging system according to a first embodiment,



FIG. 2 is a block diagram showing an example of a hardware configuration of the X-ray imaging system according to the first embodiment,



FIG. 3 is a diagram showing an example of a console screen,



FIG. 4 is a diagram showing an example of a file format of an image file,



FIG. 5 is a diagram showing an example of personal information deletion processing,



FIG. 6 is a diagram conceptually showing an example of the personal information deletion processing and CAD processing,



FIG. 7 is a diagram illustrating an example of a learning phase in which a detection model is trained by machine learning,



FIG. 8 is a flowchart showing an example of a flow of processing of an X-ray source and an electronic cassette,



FIG. 9 is a flowchart showing an example of a flow of processing of a console and an image diagnosis support device,



FIG. 10 is a flowchart showing an example of processing of an image diagnosis support device according to a modification example of the first embodiment,



FIG. 11 is a flowchart showing an example of processing of a console and an image diagnosis support device according to a second embodiment,



FIG. 12 is a flowchart showing an example of processing of an image diagnosis support device according to a first modification example of the second embodiment,



FIG. 13 is a flowchart showing an example of processing of an image diagnosis support device according to a second modification example of the second embodiment, and



FIG. 14 is a diagram showing an example in which some of personal information is deleted from accessory information of the image file.





DETAILED DESCRIPTION
First Embodiment


FIG. 1 shows an example of a configuration of an X-ray imaging system 2 that uses an X-ray as radiation. The X-ray imaging system 2 that uses an X-ray as radiation comprises an X-ray source 10, an electronic cassette 20, a console 30, an image diagnosis support device 40, and a repeater 50. The console 30 communicates with the electronic cassette 20 and the image diagnosis support device 40 via the repeater 50. The repeater 50 functions as, for example, an access point.


The X-ray source 10 is an example of a radiation source that generates radiation. The electronic cassette 20 is an example of a radiation image detector that detects radiation and that generates a radiation image. The image diagnosis support device 40 performs CAD processing of detecting a region including an abnormal shadow from a radiation image.


The X-ray source 10, the electronic cassette 20, the console 30, and the image diagnosis support device 40 of the present embodiment are all compact and portable devices that can be carried. In the X-ray imaging system 2, these can be carried to a field where emergency medical response such as an accident or a disaster is required or a home of a patient who receives home medical care to perform X-ray imaging. With such a portable X-ray imaging system 2, the captured X-ray image can be immediately confirmed on the field, and re-imaging accompanied by a revisit at a later date can be prevented. The X-ray image is an example of a “medical image” according to the technology of the present disclosure.


In the X-ray imaging system 2, the electronic cassette 20 is disposed at a position facing the X-ray source 10. By disposing a subject H between the X-ray source 10 and the electronic cassette 20, it is possible to perform X-ray imaging of an examination site (for example, the chest part) of the subject H.


The X-ray source 10 is held by, for example, a holding device 60. The holding device 60 is, for example, a quadruped having four support legs 61 and a horizontal bar 62. The upper ends of the support legs 61 and both ends of the horizontal bar 62 are each connected to a three-pronged joint 63, whereby the holding device 60 is assembled. The horizontal bar 62 is provided with an attachment bracket 64 for mechanically attaching the X-ray source 10. The X-ray source 10 is suspended by the attachment bracket 64 such that the irradiation direction of an X-ray 4 is directed downward.


An irradiation switch 11 is connected to the X-ray source 10 via a cable 11A. A user, such as a radiologist or a doctor, who uses the X-ray imaging system 2 can operate the irradiation switch 11 to cause the X-ray source 10 to start irradiation of the X-ray 4.


The electronic cassette 20 has an automatic X-ray detection function of detecting the start of irradiation of the X-ray 4 emitted from the X-ray source 10. Therefore, the electronic cassette 20 does not need to be connected to the X-ray source 10. Further, since the electronic cassette 20 includes a built-in battery and has a wireless communication function, it is not necessary to connect the electronic cassette 20 to the power source or the console 30 via a cable. The electronic cassette 20 is wirelessly connected to the repeater 50 and communicates with the console 30 via the repeater 50.


The console 30 is composed of, for example, a personal computer and includes a display unit 31 and an input operation unit 32. The console 30 is connected to the repeater 50 via, for example, a communication cable 51. The display unit 31 is a display device such as a liquid crystal display or an organic electro luminescence (EL) display. The input operation unit 32 is an input device including a keyboard, a mouse, a touch pad, or the like.


The user can input patient information, imaging conditions, and the like by operating the input operation unit 32. The display unit 31 displays an X-ray image received by the console 30 from the X-ray source 10. In a case in which the user observes the X-ray image and determines that the CAD processing is necessary, the user can input an execution request of the CAD processing using the input operation unit 32.


The console 30 communicates with the image diagnosis support device 40 via the repeater 50. The console 30 transmits a CAD processing request to the image diagnosis support device 40 in response to an operation signal input by the user via the input operation unit 32. At this time, the console 30 transmits the X-ray image to the image diagnosis support device 40 together with the CAD processing request. In a case in which the console 30 receives the CAD processing result from the image diagnosis support device 40, the console 30 causes the display unit 31 to display an X-ray image in which the CAD processing result is reflected.


The image diagnosis support device 40 includes a housing 41 having a size portable by the user. The housing 41 is, for example, a box-shaped case having a length, a width, and a height each of which is 20 cm or less. The housing 41 is provided with a power switch 42, a first connector 43A, a second connector 43B, and a third connector 43C. For example, the first connector 43A is a terminal having a universal serial bus (USB) type A interface (hereinafter, referred to as a USB-A I/F). The second connector 43B is a terminal having a local area network (LAN) interface (hereinafter, referred to as a LAN I/F). The third connector 43C is a terminal having a USB type C interface (hereinafter, referred to as a USB-C I/F).


The housing 41 does not comprise a display that displays an X-ray image. In addition, the housing 41 does not comprise a user interface operated by the user to input information. The user interface is, for example, a physical operation button or a touch panel. As described above, since the housing 41 does not comprise the display and the user interface, miniaturization is possible as described above. The housing 41 may include a connector for connecting a display as an external device (for example, an High-Definition Multimedia Interface (HDMI (registered trademark)) terminal and a connector for connecting a keyboard or the like as an external device (for example, a USB terminal).


The image diagnosis support device 40 is connected to the repeater 50 in a wireless or wired manner. For example, by connecting a wireless dongle 70 to the first connector 43A, the image diagnosis support device 40 is wirelessly connected to the repeater 50. The wireless dongle 70 is, for example, a WiFi_USB adapter that enables communication by WiFi. In a case in which the wireless dongle 70 is connected to the first connector 43A, the image diagnosis support device 40 communicates with the console 30 via the repeater 50. The console 30 is an example of an “external device” according to the technology of the present disclosure.


In addition, the second connector 43B is used in a case in which the image diagnosis support device 40 and the repeater 50 are connected in a wired manner via a LAN cable (not shown). In a case in which the LAN cable is connected between the second connector 43B and the repeater 50, the image diagnosis support device 40 communicates with the console 30 via the repeater 50.


The third connector 43C corresponds to a power supply standard of USB_PD (power delivery). A mobile battery 80 can be connected to the third connector 43C via a USB cable 81 corresponding to USB_PD. The mobile battery 80 can supply power to the inside of the image diagnosis support device 40 and the built-in battery built in the image diagnosis support device 40. The mobile battery 80 supplies DC power to the image diagnosis support device 40.


In addition, the third connector 43C can also be connected to an alternating current (AC) adapter (not shown) instead of the mobile battery 80. The third connector 43C can be connected to the AC adapter via the USB cable 81, and the AC adapter can also be connected to a commercial AC power source of a general household or the like. As a result, the image diagnosis support device 40 can receive the supply of power converted into DC by the AC adapter from the commercial AC power source.



FIG. 2 shows an example of a hardware configuration of the X-ray imaging system 2. The X-ray source 10 comprises a processor 12, an input operation unit 13, a built-in battery 14, a high-voltage generator 15, an X-ray tube 16, and an irradiation field limiter 17. The processor 12 functions as a control unit that controls the operations of the high-voltage generator 15 and the irradiation field limiter 17. The irradiation switch 11 described above is connected to the processor 12. In addition, the input operation unit 13 is connected. The input operation unit 13 includes an imaging condition adjustment button for setting a tube voltage and a tube current of the X-ray tube 16, an irradiation field button for adjusting the size of the irradiation field of the irradiation field limiter 17, a power button, and the like.


The processor 12 controls the high-voltage generator 15 and the irradiation field limiter 17 on the basis of the setting conditions set via the input operation unit 13. The processor 12 causes the high-voltage generator 15 to generate a high voltage in response to the operation of the irradiation switch 11. The built-in battery 14 is a secondary battery such as a lithium polymer battery and can be charged via a connector (not shown).


The X-ray tube 16 is a fixed anode type X-ray tube that does not include a rotation mechanism of a target. The X-ray tube 16 is composed of a cold cathode electron source that emits electrons, an electron accelerator, a target that generates the X-ray 4 by colliding electrons, and an exterior tube that accommodates these. The cold cathode electron source does not require a filament and a heater for heating the filament, as in a case of a hot cathode. The X-ray tube 16 is compact and lightweight because the X-ray tube 16 does not include a rotation mechanism of the target and also does not include the filament and the heater. In addition, since the X-ray tube 16 does not require residual heat of the filament, it is possible to immediately generate the X-ray 4 in response to the irradiation start instruction.


The irradiation field limiter 17 limits the irradiation field of the X-ray 4 generated by the X-ray tube 16. In the X-ray 4 generated by the X-ray tube 16, the irradiation field is limited by the irradiation field limiter 17, and the examination site of the subject H is irradiated with the X-ray 4. The X-ray 4 transmitted through the examination site of the subject H is incident on the electronic cassette 20.


The electronic cassette 20 comprises a processor 21, an X-ray detection panel 22, a memory 23, a communication I/F 24, and a built-in battery 25. The processor 21 functions as a control unit that controls each unit in the electronic cassette 20. The X-ray detection panel 22 is, for example, a flat panel detector having a matrix substrate in which a plurality of pixels consisting of a thin film transistor (TFT) and an X-ray detection element are two-dimensionally arranged.


The X-ray detection panel 22 converts incident X-rays in a charge accumulation state in which the TFT is turned off into a charge by the X-ray detection element and accumulates the charge. Then, in the X-ray detection panel 22, the charge accumulated in the X-ray detection element is read out to the signal processing circuit in a charge read-out state in which the TFT is turned on. In the signal processing circuit, the read-out charge is converted into a voltage signal by an integrating amplifier, and the converted voltage signal is subjected to A/D conversion by an A/D converter, so that digital image data is generated. Hereinafter, this image data will be referred to as an X-ray image XP.


The memory 23 is a non-volatile memory such as a flash memory and stores the X-ray image XP generated by the X-ray detection panel 22. The communication I/F 24 is wirelessly connected to the repeater 50. The processor 21 transmits the X-ray image XP stored in the memory 23 to the console 30 via the repeater 50. The electronic cassette 20 can also be connected to the repeater 50 in a wired manner via a communication cable.


The built-in battery 25 is a secondary battery such as a lithium polymer battery and can be charged via a connector (not shown).


The console 30 comprises the display unit 31, the input operation unit 32, a processor 33, a random access memory (RAM) 34, a non-volatile memory (NVM) 35, and a communication I/F 36. The processor 33 is, for example, a central processing unit (CPU). The RAM 34 is a work memory for the processor 33 to execute processing. The NVM 35 is a storage device such as a flash memory and stores a program 37.


The processor 33 loads the program 37 stored in the NVM 35 into the RAM 34 and executes processing in accordance with the program 37, thereby functioning as a console control unit 38 that collectively controls each unit of the console 30. The console control unit 38 displays a graphical user interface (GUI) screen on the display unit 31 thereby enabling the input of patient information, imaging conditions, and the like using the input operation unit 32. In addition, the console control unit 38 causes the display unit 31 to display the X-ray image XP received from the electronic cassette 20. The doctor can perform a diagnosis on the basis of the X-ray image XP displayed on the display unit 31, but it is possible to input an execution request of the CAD processing by using the input operation unit 32 in order to narrow down candidates for abnormal shadows including lesions and the like from the X-ray image XP.


In addition, the console control unit 38 creates an image file PF by adding accessory information including patient information, imaging conditions, and the like to the X-ray image XP. In addition, the console control unit 38 performs personal information deletion processing of deleting personal information from the image file PF on the basis of an instruction transmitted from the image diagnosis support device 40.


The communication I/F 36 is connected to the repeater 50 in a wired manner via the communication cable 51 (see FIG. 1). The console control unit 38 transmits the CAD processing request and the image file PF including the X-ray image XP to the image diagnosis support device 40 via the communication I/F 36. It is also possible to wirelessly connect the console 30 to the repeater 50. Further, the console 30 may be, for example, a mobile terminal such as a tablet terminal or a smartphone, in addition to a laptop computer equipped with a battery.


The image diagnosis support device 40 comprises, in addition to the power switch 42, the first connector 43A, the second connector 43B, and the third connector 43C described above, a processor 44, a RAM 45, an NVM 46, a power supply unit 47, and a built-in battery 48 inside the housing 41. The processor 44 is composed of, for example, a CPU and a graphics processing unit (GPU). The RAM 45 is a work memory for the processor 44 to execute processing. The NVM 46 is a storage device such as a flash memory and stores a program 90 and a detection model 91. The NVM 46 also stores data such as the image file PF transmitted from the console 30. The NVM 46 is an example of a “memory” according to the technology of the present disclosure.


The processor 44 loads the program 90 stored in the NVM 46 into the RAM 45 and executes processing in accordance with the program 90, thereby functioning as a communication processing unit 92, a prohibition instruction transmission processing unit 93, and a CAD processing unit 94.


The communication processing unit 92 controls communication performed with the console 30 via the first connector 43A or the second connector 43B. Specifically, the communication processing unit 92 performs communication processing of receiving the image file PF from the console 30 and transmitting information including the CAD processing result to the console 30. The prohibition instruction transmission processing unit 93 performs prohibition instruction transmission processing of transmitting, to the console 30, an instruction (hereinafter referred to as transmission prohibition instruction) to prohibit the transmission of the image file PF in which the accessory information includes the personal information unnecessary for the CAD processing.


The CAD processing unit 94 performs the CAD processing on the X-ray image XP included in the image file PF using the detection model 91 stored in the NVM 46. The detection model 91 is a trained model that has been trained by machine learning.


The detection model 91 is configured using a neural network. The detection model 91 is configured using, for example, a deep neural network (DNN), which is a multi-layer neural network that is a target of deep learning. As the DNN, for example, a convolutional neural network (CNN) targeting images is used.


The power supply unit 47 supplies power supplied from the mobile battery 80 to the processor 44 and the like via the third connector 43C. The power supply unit 47 includes, for example, a power circuit and a charge control circuit. The power circuit regulates the power supplied from the mobile battery 80 and supplies the power to the processor 44 and the like. The charge control circuit controls charging of the built-in battery 48 with the power supplied from the mobile battery 80. The built-in battery 48 is a secondary battery such as a lithium polymer battery.



FIG. 3 shows an example of a console screen displayed on the display unit 31 of the console 30 by the console control unit 38. After X-ray imaging is performed by the X-ray source 10 and the electronic cassette 20 and the console 30 receives the X-ray image from the electronic cassette 20, a console screen 100 shown in FIG. 3 is displayed on the display unit 31. The console screen 100 is provided with an image display region 101 for displaying the X-ray image XP.


Further, an imaging end button 102 for completing imaging, a next imaging button 103 for performing the next imaging, and a CAD processing button 104 for making a CAD processing request are displayed on the console screen 100. In a case of making the CAD processing request, the doctor or the like presses the CAD processing button 104 by operating, for example, a mouse as the input operation unit 32.


In addition, the console control unit 38 stores the X-ray image XP, for example, as the image file PF in a format conforming to a digital imaging and communication in medicine (DICOM) standard as shown in FIG. 4 in the NVM 46. The image file PF is a file in which the X-ray image XP and accessory information AD are associated with one image ID. The accessory information AD includes patient information, a reception number, an examination site, imaging conditions, and the like. In the accessory information AD of the image file PF shown in FIG. 4, items 3 to 9 (patient name, patient ID, sex, date of birth, age, height, and weight) are the personal information of the patient. The personal information refers to information unique to a diagnosis target person for which the medical image has been acquired. The personal information is not limited to the information indicated by the items 3 to 9.



FIG. 5 shows an example of the personal information deletion processing executed by the console control unit 38. In the present embodiment, in a case in which the console control unit 38 executes the personal information deletion processing in response to an instruction from the console 30, the console control unit 38 deletes all the personal information included in the accessory information AD of the image file PF to generate the image file PF in which the personal information has been deleted.


In FIG. 5, the console control unit 38 deletes the data of the items 3 to 9 corresponding to the personal information. The console control unit 38 may add dummy data to the items 3 to 9 from which personal information has been deleted. That is, the personal information may be deleted by being replaced with the dummy data. For example, the image file PF in which the personal information has been deleted is the same DICOM format file as that of the image file PF before the personal information is deleted.



FIG. 6 conceptually shows an example of processing executed by the image diagnosis support device 40. In the present embodiment, first, the “CAD processing request” is transmitted from the console 30 to the image diagnosis support device 40. In a case in which the CAD processing request is received from the console 30, the communication processing unit 92 inputs the received CAD processing request to the prohibition instruction transmission processing unit 93. The prohibition instruction transmission processing unit 93 generates “personal information transmission permission/non-permission information” indicating whether or not to permit the transmission of the personal information on the basis of setting information S and transmits the generated personal information transmission permission/non-permission information to the console 30 via the communication processing unit 92.


The setting information S is data indicating whether or not to permit the transmission of the image file PF including the personal information for the console 30 and is stored in, for example, the NVM 46 (see FIG. 2). The setting information S is set in advance by an administrator or the like of the X-ray imaging system 2. In a case in which the setting information S indicates that the transmission of the personal information is not permitted, the prohibition instruction transmission processing unit 93 transmits the transmission prohibition instruction to the console 30 as the personal information transmission permission/non-permission information.


In a case in which the received personal information transmission permission/non-permission information includes the transmission prohibition instruction, the console control unit 38 of the console 30 transmits the image file PF in which the personal information has been deleted to the image diagnosis support device 40. On the other hand, in a case in which the received personal information transmission permission/non-permission information does not include the transmission prohibition instruction, the console control unit 38 transmits the image file PF in which the personal information is not deleted to the image diagnosis support device 40.


In a case in which the communication processing unit 92 receives the image file PF from the console 30, the image file PF is input to the CAD processing unit 94 via the prohibition instruction transmission processing unit 93.


The CAD processing unit 94 inputs the X-ray image XP included in the image file PF into the detection model 91. The detection model 91 detects a region including an abnormal shadow from the input X-ray image XP and outputs a detection result R. The detection result R includes position information of the region including the abnormal shadow in the X-ray image XP.


The CAD processing unit 94 generates a processed X-ray image XPC by performing image processing on the X-ray image XP on the basis of the detection result R. For example, the CAD processing unit 94 generates the processed X-ray image XPC by superimposing a circular mark M surrounding the abnormal shadow on the X-ray image XP, on the basis of the detection result R. The CAD processing unit 94 transmits the processed X-ray image XPC as the CAD processing result to the console 30 via the communication processing unit 92.


The CAD processing unit 94 may transmit only the information representing the detection result R as the CAD processing result to the console 30. In this case, image processing need only be performed on the X-ray image XP in the console 30 on the basis of the detection result R.



FIG. 7 illustrates an example of a learning phase in which the detection model 91 is trained by machine learning. The detection model 91 is trained using training data TD. The training data TD includes the X-ray images XP as a plurality of training images labeled with ground truth labels L. The X-ray images XP included in the training data TD are sample images including various abnormal shadows. The ground truth label L is, for example, position information of an abnormal shadow in the X-ray image XP.


In the learning phase, the X-ray image XP as the training image is input to the detection model 91. The detection model 91 outputs the detection result R based on the input X-ray image XP. A loss arithmetic operation using a loss function is performed on the basis of the detection result R and the ground truth label L. Then, update settings for various coefficients (weight coefficients, biases, and the like) of the detection model 91 are performed on the basis of the result of the loss arithmetic operation, and the detection model 91 is updated in accordance with the update settings.


In the learning phase, a series of processing of inputting the training image to the detection model 91, outputting the detection result R from the detection model 91, performing the loss arithmetic operation, performing the update settings, and updating the detection model 91 are repeatedly performed. The repetition of this series of processing ends in a case in which the detection accuracy has reached a predetermined setting level. The detection model 91 in which the detection accuracy has reached the setting level in this way is stored in the NVM 46 and then used by the CAD processing unit 94 in the CAD processing which is an operation phase (also referred to as an inference phase).


The learning phase is executed, for example, in another computer different from the image diagnosis support device 40. The detection model 91 generated by the other computer is transmitted to the image diagnosis support device 40 and stored in the NVM 46. The learning phase may be executed in the image diagnosis support device 40.


In addition, in the learning phase, the detection model 91 may be generated for each examination site (the chest part, the abdominal part, or the like). That is, the NVM 46 may store a plurality of the detection models 91 generated for each examination site. In this case, the CAD processing unit 94 need only select the detection model 91 corresponding to the examination site by referring to the examination site included in the accessory information AD (see FIG. 5) of the image file PF as a CAD processing target.


Next, the operation of the X-ray imaging system 2 having the above-described configuration will be described with reference to the flowcharts shown in FIGS. 8 and 9. FIG. 8 shows an example of a flow of processing of the X-ray source 10 and the electronic cassette 20. FIG. 9 shows an example of a flow of processing of the console 30 and the image diagnosis support device 40.


Prior to imaging, the user, such as the doctor, performs an operation to input imaging conditions, patient information, and the like to the X-ray source 10 and the console 30. Next, the subject H is disposed between the X-ray source 10 and the electronic cassette 20. When the imaging preparation is completed, the user operates the irradiation switch 11 to cause the X-ray source 10 to start the irradiation of the X-ray 4.


The processor 12 of the X-ray source 10 determines whether or not the irradiation switch 11 has been pressed by the user (step S10). In a case in which the processor 12 determines that the irradiation switch 11 has been pressed (step S10: YES), the processor 12 causes the high-voltage generator 15 to generate a high voltage to generate the X-ray 4 in the X-ray tube 16 (step S11). With this, the X-ray 4 is emitted from the X-ray source 10 to the electronic cassette 20 via the subject H.


The processor 21 of the electronic cassette 20 determines whether or not the X-ray irradiation has been detected by the automatic X-ray detection function (step S20). In a case in which the processor 21 determines that the X-ray irradiation has been detected (step S20: YES), the processor 21 causes the X-ray detection panel 22 to generate the X-ray image XP (step S21). Then, the processor 21 transmits the X-ray image XP to the console 30 via the communication I/F 24 (step S22).


As shown in FIG. 9, in the console 30, the console control unit 38 determines whether or not the X-ray image XP has been received from the electronic cassette 20 (step S30). In a case in which the console control unit 38 determines that the X-ray image XP has been received (step S30: YES), the console control unit 38 displays the X-ray image XP on the console screen 100 (see FIG. 3) (step S31). Next, the console control unit 38 determines whether or not the CAD processing button 104 has been pressed by the user (step S32). In a case in which the console control unit 38 determines that the CAD processing button 104 is not pressed (step S32: NO), the console control unit 38 ends the processing.


On the other hand, in a case in which the console control unit 38 determines that the CAD processing button 104 has been pressed (step S32: YES), the console control unit 38 transmits the CAD processing request to the image diagnosis support device 40 (step S33). Then, the console control unit 38 receives the personal information transmission permission/non-permission information from the image diagnosis support device 40 (step S34). The console control unit 38 determines whether or not the received personal information transmission permission/non-permission information includes the transmission prohibition instruction (step S35).


In a case in which the console control unit 38 determines that the personal information transmission permission/non-permission information includes the transmission prohibition instruction (step S35: YES), as shown in FIG. 5, the console control unit 38 deletes the personal information from the accessory information AD (step S36) and transmits the image file PF in which the personal information has been deleted to the image diagnosis support device 40 (step S37). On the other hand, in a case in which the console control unit 38 determines that the personal information transmission permission/non-permission information does not include the transmission prohibition instruction (step S35: NO), the console control unit 38 transmits the image file PF (see FIG. 4) in which the personal information is not deleted to the image diagnosis support device 40 (step S37).


After that, the console control unit 38 receives the processed X-ray image XPC (see FIG. 6) as the CAD processing result from the image diagnosis support device 40 (step S38) and displays the received processed X-ray image XPC on the console screen 100 (step S39).


In the image diagnosis support device 40, the communication processing unit 92 determines whether or not the CAD processing request has been received from the console 30 (step S40). In a case in which the communication processing unit 92 determines that the CAD processing request has been received (step S40: YES), the prohibition instruction transmission processing unit 93 transmits the personal information transmission permission/non-permission information to the console 30 (step S41). After that, the communication processing unit 92 receives the image file PF transmitted from the console 30 in step S37 described above (step S42).


Then, the CAD processing unit 94 executes the CAD processing on the X-ray image XP included in the image file PF (step S43). Here, the CAD processing unit 94 generates the processed X-ray image XPC by executing the CAD processing using the detection model 91 (see FIG. 6). Then, the communication processing unit 92 transmits the processed X-ray image XPC as the CAD processing result to the console 30 (step S44).


As described above, since the X-ray imaging system 2 comprises the image diagnosis support device 40, which is portable by the user and to which power can be supplied from the mobile battery 80, it is possible to provide an image diagnosis support device that can be used in the field such as disaster medical care or home medical care.


Meanwhile, since the image diagnosis support device 40 is portable, there is a risk of theft. However, since the image diagnosis support device 40 is configured to transmit, to the console 30, an instruction to prohibit the transmission of the image file PF in which the accessory information includes the personal information unnecessary for the CAD processing, it is possible to prevent the leakage of the personal information.


Modification Example

Next, a modification example of the first embodiment will be described. In the present modification example, the processing executed by the image diagnosis support device 40 is different from that of the first embodiment. In the present modification example, the prohibition instruction transmission processing unit 93 of the image diagnosis support device 40 performs processing of verifying whether or not the image file PF includes the personal information unnecessary for the CAD processing in a case in which the image file PF is received from the console 30.



FIG. 10 is a flowchart showing an example of processing executed by the image diagnosis support device 40 according to the modification example of the first embodiment. In the flowchart shown in FIG. 10, steps S50 to S52 are added between step S42 and step S43 of the flowchart shown in FIG. 9. Hereinafter, only the part of the difference from the first embodiment will be described.


Similar to the first embodiment, the communication processing unit 92 receives the image file PF transmitted from the console 30 (step S42). After that, in the present modification example, the prohibition instruction transmission processing unit 93 determines whether or not the image file PF received by the communication processing unit 92 includes the personal information unnecessary for the CAD processing (step S50). This personal information is information that is set as a transmission prohibition target by the transmission prohibition instruction included in the personal information transmission permission/non-permission information transmitted by the prohibition instruction transmission processing unit 93 in step S41.


In a case in which the prohibition instruction transmission processing unit 93 determines that the image file PF does not include the personal information unnecessary for the CAD processing (step S50: NO), the prohibition instruction transmission processing unit 93 causes the CAD processing unit 94 to execute the CAD processing (step S43). On the other hand, in a case in which the prohibition instruction transmission processing unit 93 determines that the image file PF includes the personal information unnecessary for the CAD processing (step S50: YES), the prohibition instruction transmission processing unit 93 discards the image file PF (step S51). After that, the communication processing unit 92 rejects the reception of the data (that is, interrupts the communication) from the console 30 (step S52). With that, the processing ends.


As described above, in the present modification example, in a case in which the image file PF transmitted from the console 30 includes the personal information unnecessary for the CAD processing, the image file PF is discarded and the reception of the data from the console 30 is rejected, so that it is possible to more reliably prevent the leakage of the personal information.


Second Embodiment

Next, a second embodiment will be described. In the second embodiment, the processing executed by the console 30 and the image diagnosis support device 40 is different from that of the first embodiment.


In the first embodiment, the image diagnosis support device 40 transmits the personal information transmission permission/non-permission information to the console 30 before receiving the image file PF from the console 30. On the other hand, in the present embodiment, the image diagnosis support device 40 transmits the personal information transmission permission/non-permission information to the console 30 after receiving the image file PF from the console 30.



FIG. 11 is a flowchart showing an example of processing executed by the console 30 and the image diagnosis support device 40 according to the second embodiment. Steps S60 to S63 are the same processing as that of steps S30 to S33 in the flowchart shown in FIG. 9. In the present embodiment, the console control unit 38 of the console 30 transmits the CAD processing request to the image diagnosis support device 40 in step S63 and then transmits the image file PF to the image diagnosis support device 40 (step S64).


In the image diagnosis support device 40, the communication processing unit 92 determines that the CAD processing request has been received (step S70: YES) and then receives the image file PF transmitted from the console 30 (step S71). The prohibition instruction transmission processing unit 93 determines whether or not the image file PF received by the communication processing unit 92 includes the personal information unnecessary for the CAD processing (step S72). In a case in which the prohibition instruction transmission processing unit 93 determines that the image file PF does not include the personal information unnecessary for the CAD processing (step S72: NO), the prohibition instruction transmission processing unit 93 causes the CAD processing unit 94 to execute the CAD processing (step S76).


On the other hand, in a case in which the prohibition instruction transmission processing unit 93 determines that the image file PF includes the personal information unnecessary for the CAD processing (step S72: YES), the prohibition instruction transmission processing unit 93 discards the image file PF (step S73). After that, the prohibition instruction transmission processing unit 93 transmits the personal information transmission permission/non-permission information including the transmission prohibition instruction to the console 30 via the communication processing unit 92 (step S74).


In the console 30, the console control unit 38 determines whether or not the personal information transmission permission/non-permission information has been received from the image diagnosis support device 40 (step S65). In a case in which the console control unit 38 determines that the personal information transmission permission/non-permission information is not received (step S65: NO), the process proceeds to step S68. On the other hand, in a case in which the console control unit 38 determines that the personal information transmission permission/non-permission information has been received (step S65: YES), the console control unit 38 deletes the personal information from the accessory information AD of the image file PF (step S66) and transmits the image file PF in which the personal information has been deleted to the image diagnosis support device 40 (step S67).


In the image diagnosis support device 40, the communication processing unit 92 receives the image file PF transmitted from the console 30 (step S75). After that, the CAD processing unit 94 executes the CAD processing on the X-ray image XP included in the image file PF (step S76). Then, the communication processing unit 92 transmits the processed X-ray image XPC as the CAD processing result to the console 30 (step S77).


In the console 30, the console control unit 38 receives the processed X-ray image XPC (see FIG. 6) as the CAD processing result from the image diagnosis support device 40 (step S68) and displays the received processed X-ray image XPC on the console screen 100 (step S69).


First Modification Example

Next, a first modification example of the second embodiment will be described. In the present modification example, the processing executed by the image diagnosis support device 40 is different from that of the second embodiment. In the present modification example, similar to the modification example of the first embodiment, the prohibition instruction transmission processing unit 93 of the image diagnosis support device 40 performs processing of verifying whether or not the image file PF includes the personal information unnecessary for the CAD processing in a case in which the image file PF is received from the console 30 in step S75.



FIG. 12 is a flowchart showing an example of processing executed by the image diagnosis support device 40 according to the first modification example of the second embodiment. In the flowchart shown in FIG. 12, steps S80 to S82 are added between step S75 and step S76 of the flowchart shown in FIG. 11. Hereinafter, only the part of the difference from the second embodiment will be described.


Similar to the second embodiment, the communication processing unit 92 receives the image file PF transmitted from the console 30 (step S75). After that, in the present modification example, the prohibition instruction transmission processing unit 93 determines whether or not the image file PF received by the communication processing unit 92 includes the personal information unnecessary for the CAD processing (step S80). This personal information is information that is set as the transmission prohibition target by the transmission prohibition instruction included in the personal information transmission permission/non-permission information transmitted by the prohibition instruction transmission processing unit 93 in step S74.


In a case in which the prohibition instruction transmission processing unit 93 determines that the image file PF does not include the personal information unnecessary for the CAD processing (step S80: NO), the prohibition instruction transmission processing unit 93 causes the CAD processing unit 94 to execute the CAD processing (step S76). On the other hand, in a case in which the prohibition instruction transmission processing unit 93 determines that the image file PF includes the personal information unnecessary for the CAD processing (step S80: YES), the prohibition instruction transmission processing unit 93 discards the image file PF (step S81). After that, the communication processing unit 92 rejects the reception of the data (that is, interrupts the communication) from the console 30 (step S82). With that, the processing ends.


As described above, in the present modification example, in a case in which the image file PF transmitted from the console 30 includes the personal information unnecessary for the CAD processing, the image file PF is discarded and the reception of the data from the console 30 is rejected, so that it is possible to more reliably prevent the leakage of the personal information.


Second Modification Example

Next, a second modification example of the second embodiment will be described. In the present modification example, the processing executed by the image diagnosis support device 40 is different from that of the second embodiment. In the present modification example, the prohibition instruction transmission processing unit 93 of the image diagnosis support device 40 performs processing of verifying whether or not the image file PF includes the personal information after the CAD processing unit 94 executes the CAD processing.



FIG. 13 is a flowchart showing an example of the processing executed by the image diagnosis support device 40 according to the second modification example of the second embodiment. In the flowchart shown in FIG. 13, steps S90 and S91 are added between step S76 and step S77 of the flowchart shown in FIG. 11. Hereinafter, only the part of the difference from the second embodiment will be described.


Similar to the second embodiment, the communication processing unit 92 receives the image file PF transmitted from the console 30 (step S75). The CAD processing unit 94 executes the CAD processing on the X-ray image XP included in the image file PF (step S76). After that, in the present modification example, the prohibition instruction transmission processing unit 93 determines whether or not the image file PF received by the communication processing unit 92 includes the personal information (step S90). This personal information is information that is set as the transmission prohibition target by the transmission prohibition instruction included in the personal information transmission permission/non-permission information transmitted by the prohibition instruction transmission processing unit 93 in step S74.


In a case in which the prohibition instruction transmission processing unit 93 determines that the image file PF does not include the personal information (step S90: NO), the process proceeds to step S77. On the other hand, in a case in which the prohibition instruction transmission processing unit 93 determines that the image file PF includes the personal information (step S90: YES), the prohibition instruction transmission processing unit 93 discards the image file PF (step S91). After that, the communication processing unit 92 transmits the processed X-ray image XPC as the CAD processing result to the console 30 (step S77).


As described above, in the present modification example, in a case in which the image file PF includes the personal information unnecessary for the CAD processing, the image file PF is discarded after the CAD processing is performed, so that it is possible to more reliably prevent the leakage of the personal information.


Other Modification Examples

In each of the above-described embodiments, the console control unit 38 deletes all the personal information from the accessory information AD of the image file PF, but in the personal information included in the accessory information AD, at least the personal information unnecessary for the CAD processing need only be deleted. The “personal information unnecessary for the CAD processing” is personal information except for information that may be used for the CAD processing. For example, in the console control unit 38, in the personal information unique to the diagnosis target person, information that specifies the diagnosis target person, such as the patient name and the patient ID, is the personal information unnecessary for the CAD processing.



FIG. 14 shows an example in which some of the personal information is deleted from the accessory information AD of the image file PF. In the example shown in FIG. 14, the data of items except for the “date of birth” and the “age” in the personal information is deleted. That is, the data of items except for the “date of birth” and the “age” are the personal information unnecessary for the CAD processing.


For example, it is assumed that the NVM 46 stores a detection model that supports a pediatric diagnosis and a detection model that does not support the pediatric diagnosis. The CAD processing unit 94 can determine whether or not to use the detection model that supports the pediatric diagnosis by referring to the “age” included in the accessory information AD of the image file PF in which the personal information has been deleted. The CAD processing unit 94 uses the detection model that supports the pediatric diagnosis, for example, in a case in which the age is less than 15 years.


The prohibition instruction transmission processing unit 93 may decide the personal information as the transmission prohibition target from the accessory information AD of the image file PF by referring to a table in which the personal information as the transmission prohibition target is recorded. This table is stored in, for example, the NVM 46.


Further, in each of the above-described embodiments, in the learning phase (see FIG. 7) in which the detection model 91 is trained by machine learning, the detection model 91 is trained using the training data TD including the X-ray image XP and the ground truth label L. Further, the detection model 91 may be trained using the training data TD including some of the personal information (for example, sex, age, height, and weight). In this case, in the CAD processing, the CAD processing unit 94 inputs some of the personal information to the detection model 91 in addition to the X-ray image XP.


In each of the above-described embodiments, the X-ray source 10 is a portable type, but the X-ray source 10 may be an X-ray source used in a general X-ray imaging system. In this case, the X-ray source 10 is movably held by, for example, a ceiling-type holding device. In addition, in the general X-ray imaging system, the electronic cassette 20 is used by being attached to an imaging table.


In addition, the X-ray imaging system 2 may be used with a so-called mobile medical vehicle. Further, the X-ray imaging system 2 may be a mammography device, computed tomography (CT), or the like.


In addition, the technology of the present disclosure is not limited to X-rays and can be applied to a system that images a subject using other radiation such as γ-rays.


Furthermore, the image diagnosis support device 40 can also be applied to an ultrasound imaging system that generates an image with ultrasound waves. That is, the image diagnosis support device 40 may perform CAD processing on an ultrasound image as a medical image.


Further, in each of the above-described embodiments, the CAD processing unit 94 performs the CAD processing using the detection model 91 which is a trained model generated by machine learning, but the technology of the present disclosure is not limited to the method using machine learning, and software for performing CAD processing through image analysis may be used. In addition, in each of the above-described embodiments, the CAD processing unit 94 detects the abnormal shadow through the CAD processing, but the CAD processing unit 94 may detect a site other than the abnormal shadow. For example, the CAD processing unit 94 may detect blood vessels from the ultrasound image in a case in which the CAD processing is performed on the ultrasound image.


Further, in each of the above-described embodiments, the X-ray imaging system 2 comprises the repeater 50, but the repeater 50 is not essential, and the console 30 may have the function of the repeater.


In each of the above-described embodiments, for example, as a hardware structure of a processing unit that executes various types of processing, such as the communication processing unit 92, the prohibition instruction transmission processing unit 93, and the CAD processing unit 94, various processors as described below are used.


Various processors include a CPU, a programmable logic device (PLD), a dedicated electrical circuit, and the like. As is well known, the CPU is a general-purpose processor that executes software (programs) and functions as various processing units. The PLD is a processor of which the circuit configuration can be changed after manufacturing, such as a field programmable gate array (FPGA). The dedicated electrical circuit is a processor having a dedicated circuit configuration designed to execute specific processing, such as an application specific integrated circuit (ASIC).


One processing unit may be composed of one of these various processors or a combination of two or more of the processors of the same type or different types (for example, a plurality of FPGAs or a combination of a CPU and an FPGA). Alternatively, a plurality of processing units may be composed of one processor. A first example in which a plurality of processing units are composed of one processor is an aspect in which one or more CPUs and software are combined to constitute one processor and the processor functions as the plurality of processing units. A second example is an aspect in which a processor that realizes functions of an entire system including a plurality of processing units with one IC chip is used, as typified by a system on chip (SoC) or the like. As described above, various processing units are composed of one or more of the above various processors, as the hardware structure.


Further, as the hardware structure of these various processors, more specifically, an electric circuit (circuitry) in which circuit elements, such as semiconductor elements, are combined is used.


The present disclosure is not limited to each of the above embodiments and various configurations may be employed without departing from the gist of the present disclosure, of course. Further, the present disclosure extends to a computer-readable storage medium that stores the program non-temporarily, in addition to the program.

Claims
  • 1. An image diagnosis support device that is portable by a user, the image diagnosis support device comprising: a processor; anda memory,wherein the processor is configured to execute:computer-aided diagnostic processing for a medical image;communication processing of receiving an image file including the medical image and accessory information from an external device and of transmitting information including a result of the computer-aided diagnostic processing to the external device; andprohibition instruction transmission processing of transmitting, to the external device, an instruction to prohibit transmission of the image file in which the accessory information includes personal information unnecessary for the computer-aided diagnostic processing.
  • 2. The image diagnosis support device according to claim 1, wherein the processor is configured to execute the prohibition instruction transmission processing before receiving the image file from the external device.
  • 3. The image diagnosis support device according to claim 2, wherein the processor is configured to, in a case in which the image file received from the external device includes the personal information unnecessary for the computer-aided diagnostic processing after executing the prohibition instruction transmission processing, discard the image file.
  • 4. The image diagnosis support device according to claim 3, wherein the processor is configured to reject reception of data from the external device after discarding the image file.
  • 5. The image diagnosis support device according to claim 1, wherein the processor is configured to execute the prohibition instruction transmission processing after receiving the image file from the external device.
  • 6. The image diagnosis support device according to claim 5, wherein the processor is configured to, in a case in which the accessory information of the image file from the external device includes the personal information unnecessary for the computer-aided diagnostic processing, discard the image file and execute the prohibition instruction transmission processing.
  • 7. The image diagnosis support device according to claim 6, wherein the processor is configured to, in a case in which the accessory information of the image file received from the external device includes the personal information unnecessary for the computer-aided diagnostic processing after executing the prohibition instruction transmission processing, reject reception of data from the external device.
  • 8. The image diagnosis support device according to claim 6, wherein the processor is configured to, in a case in which the accessory information of the image file received from the external device includes the personal information unnecessary for the computer-aided diagnostic processing after executing the prohibition instruction transmission processing, discard the image file after performing the computer-aided diagnostic processing.
  • 9. An operation method for an image diagnosis support device that is portable by a user, the operation method comprising: executing computer-aided diagnostic processing for a medical image;executing communication processing of receiving an image file including the medical image and accessory information from an external device and of transmitting information including a result of the computer-aided diagnostic processing to the external device; andexecuting prohibition instruction transmission processing of transmitting, to the external device, an instruction to prohibit transmission of the image file in which the accessory information includes personal information unnecessary for the computer-aided diagnostic processing.
  • 10. A non-transitory computer-readable storage medium storing a program causing a processor to execute processing in an image diagnosis support device that includes the processor and a memory and is portable by a user, the program causing the processor to execute: computer-aided diagnostic processing for a medical image;communication processing of receiving an image file including the medical image and accessory information from an external device and of transmitting information including a result of the computer-aided diagnostic processing to the external device; andprohibition instruction transmission processing of transmitting, to the external device, an instruction to prohibit transmission of the image file in which the accessory information includes personal information unnecessary for the computer-aided diagnostic processing.
Priority Claims (1)
Number Date Country Kind
2020-215535 Dec 2020 JP national
CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation application of International Application No. PCT/JP2021/048047, filed Dec. 23, 2021, the disclosure of which is incorporated herein by reference in its entirety. Further, this application claims priority from Japanese Patent Application No. 2020-215535, filed on Dec. 24, 2020, the disclosure of which is incorporated herein by reference in its entirety.

Continuations (1)
Number Date Country
Parent PCT/JP2021/048047 Dec 2021 US
Child 18336020 US