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In the past years sophisticated automatic segmentation algorithms for various medical image segmentation problems have been developed. However, there are always cases where automatic algorithms fail to provide an acceptable segmentation. In these cases the user needs efficient segmentation editing tools, a problem which has not received much attention in research. We give a comprehensive overview on segmentation editing for three-dimensional (3D) medical images. For segmentation editing in two-dimensional (2D) images, we discuss a sketch-based approach where the user modifies the segmentation in the contour domain. Based on this 2D interface, we present an image-based as well as an image-independent method for intuitive and efficient segmentation editing in 3D in the context of tumour segmentation in computed tomography (CT). Our editing tools have been evaluated on a database containing 1226 representative liver metastases, lung nodules and lymph nodes of different shape, size and image quality. In addition, we have performed a qualitative evaluation with radiologists and technical experts, proving the efficiency of our tools.

3D medical images are important components of modern medicine. Their usefulness for the physician depends on their quality, though. Only high-quality images allow accurate and reproducible diagnosis and appropriate support during treatment. We have analyzed 202 MRI images for brain tumor surgery in a retrospective study. Both an experienced neurosurgeon and an experienced neuroradiologist rated each available image with respect to its role in the clinical workflow, its suitability for this specific role, various image quality characteristics, and imaging artifacts. Our results show that MRI data acquired for brain tumor surgery does not always fulfill the required quality standards and that there is a significant disagreement between the surgeon and the radiologist, with the surgeon being more critical. Noise, resolution, as well as the coverage of anatomical structures were the most important criteria for the surgeon, while the radiologist was mainly disturbed by motion artifacts.

We present an interactive segmentation method for 3D medical images that reconstructs the surface of an object using energy-minimizing, smooth, implicit functions. This reconstruction problem is called variational interpolation. For an intuitive segmentation of medical images, variational interpolation can be based on a set of user-drawn, planar contours that can be arbitrarily oriented in 3D space. This also allows an easy integration of the algorithm into the common manual segmentation workflow, where objects are segmented by drawing contours around them on each slice of a 3D image. Because variational interpolation is computationally expensive, we show how to speed up the algorithm to achieve almost real-time calculation times while preserving the overall segmentation quality. Moreover, we show how to improve the robustness of the algorithm by transforming it from an interpolation to an approximation problem and we discuss a local interpolation scheme. A first evaluation of our algorithm by two experienced radiology technicians on 15 liver metastases and 1 liver has shown that the segmentation times can be reduced by a factor of about 2 compared to a slice-wise manual segmentation and only about one fourth of the contours are necessary compared to the number of contours necessary for a manual segmentation.

Efficient segmentation editing tools are important components in the segmentation process, as no automatic methods exist that always generate sufficient results. Evaluating segmentation editing algorithms is challenging, because their quality depends on the user’s subjective impression. So far, no established methods for an objective, comprehensive evaluation of such tools exist and, particularly, intermediate segmentation results are not taken into account. We discuss the evaluation of editing algorithms in the context of tumor segmentation in computed tomography. We propose a rating scheme to qualitatively measure the accuracy and efficiency of editing tools in user studies. In order to objectively summarize the overall quality, we propose two scores based on the subjective rating and the quantified segmentation quality over time. Finally, a simulation-based evaluation approach is discussed, which allows a more reproducible evaluation without the need for human input. This automated evaluation complements user studies, allowing a more convincing evaluation, particularly during development, where frequent user studies are not possible. The proposed methods have been used to evaluate two dedicated editing algorithms on 131 representative tumor segmentations. We show how the comparison of editing algorithms benefits from the proposed methods. Our results also show the correlation of the suggested quality score with the qualitative ratings.

In oncological chemotherapy monitoring, the change of a tumor's size is an important criterion for assessing cancer therapeutics. Measuring the volume of a tumor requires its delineation in 3-D. This is called segmentation, which is an intensively studied problem in medical image processing. However, simply counting the voxels within a binary segmentation result can lead to significant differences in the volume, if the lesion has been segmented slightly differently by various segmentation procedures or in different scans, for example due to the limited spatial resolution of computed tomography (CT) or partial volume effects. This variability limits the sensitivity of size measurements and thus of therapy response assessments and it can even lead to misclassifications. We present a fast, generic algorithm for measuring the volume of solid, compact tumors in CT that considers partial volume effects at the border of a given segmentation result. The algorithm is an extension of the segmentation-based partial volume analysis proposed by Kuhnigk for the volumetry of solid lung lesions , such that it can be applied to inhomogeneous lesions and lesions with inhomogeneous surroundings. Our generalized segmentation-based partial volume correction is based on a spatial subdivision of the segmentation result, from which the fraction of tumor for each voxel is computed. It has been evaluated on phantom data, 1516 lesion segmentation pairs (lung nodules, liver metastases and lymph nodes) as well as 1851 lung nodules from the LIDC-IDRI database. The evaluations of our algorithm show a more accurate estimation of the real volume and its ability to reduce inter- and intra-observer variability significantly for each entity. Overall, the variability (interquartile range) for phantom data is reduced by 49% ( p ≪ 0.001) and the variability between different readers is reduced by 28% ( p ≪ 0.001). The average computation time is 0.2 s.

Segmentation is one of the main tasks in medical image analysis. Measuring the quality of 3D segmentation algorithms is an essential requirement during development and for evaluation. Various methods exist to measure the quality of a segmentation with respect to a reference segmentation. Validating interactive 3D segmentation approaches or methods for 3D segmentation editing is more complex, however. Using interactive tools, the user plays a central role during the segmentation process as he or she needs to react on intermediate results, making established static validation approaches insufficient. In this paper we present a method to automatically generate plausible user inputs for 3D sketch-based segmentation editing algorithms, to allow an objective and reproducible validation and comparison of such tools. The user inputs are generated iteratively based on the intermediate and the reference segmentation, while static quality measurements are tracked over time. We present first results where we have compared two segmentation editing algorithms using our framework.

Manual delineations by experts are often used as reference standards for validating segmentation algorithms, although it is well known that they always show some degree of variability. Our goal is to estimate the effects of using a limited number of expert segmentations. Given ten manual delineations of 13 liver tumors, we analyzed the volume error made by randomly selecting subsets of the ten segmentations compared to the complete set. We found that when using just one segmentation the expected error was 17% with a maximum of 35%. This means that it is questionable whether a comparison with a single reference allows a reliable validation. When three segmentations are chosen, the error is halved, so this might be a reasonable compromise between accuracy and viability of evaluation studies.

In oncological therapy monitoring, the estimation of tumor growth from consecutive CT scans is an important aspect in deciding whether the given treatment is adequate for the patient. This can be done by measuring and comparing the volume of a lesion in the scans based on a segmentation. However, simply counting the voxels within the segmentation mask can lead to significant differences in the volume, if the lesion has been segmented slightly differently by various readers or in different scans, due to the limited spatial resolution of CT and due to partial volume effects. We present a novel algorithm for measuring the volume of liver metastases and lymph nodes which considers partial volume effects at the surface of a lesion. Our algorithm is based on a spatial subdivision of the segmentation. We have evaluated the algorithm on a phantom and a multi-reader study. Our evaluations have shown that our algorithm allows determining the volume more accurately even for larger slice thicknesses. Moreover, it reduces inter-observer variability of volume measurements significantly. The calculation of the volume takes 2 seconds for 50 3 voxels on a single 2.66GHz Intel Core2 CPU.

Segmentation is an essential task in medical image analysis. For example measuring tumor growth in consecutive CT scans based on the volume of the tumor requires a good segmentation. Since manual segmentation takes too much time in clinical routine automatic segmentation algorithms are typically used. However there are always cases where an automatic segmentation fails to provide an acceptable segmentation for example due to low contrast, noise or structures of the same density lying close to the lesion. These erroneous segmentation masks need to be manually corrected. We present a novel method for fast three-dimensional local manual correction of segmentation masks. The user needs to draw only one partial contour which describes the lesion's actual border. This two-dimensional interaction is then transferred into 3D using a live-wire based extrapolation of the contour that is given by the user in one slice. Seed points calculated from this contour are moved to adjacent slices by a block matching algorithm. The seed points are then connected by a live-wire algorithm which ensures a segmentation that passes along the border of the lesion. After this extrapolation a morphological postprocessing is performed to generate a coherent and smooth surface corresponding to the user drawn contour as well as to the initial segmentation. An evaluation on 108 lesions by six radiologists has shown that our method is both intuitive and fast. Using our method the radiologists were able to correct 96.3% of lesion segmentations rated as insufficient to acceptable ones in a median time of 44s.