Due to rapid advances in radiation therapy (RT), especially image guidance and treatment adaptation, a fast and accurate segmentation of medical images is a very important part of the treatment. Manual delineation of target volumes and organs at risk is still the standard routine for most clinics, even though it is time consuming and prone to intra-and interobserver variations. Automated segmentation methods seek to reduce delineation workload and unify the organ boundary definition. In this paper, the authors review the current autosegmentation methods particularly relevant for applications in RT. The authors outline the methods' strengths and limitations and propose strategies that could lead to wider acceptance of autosegmentation in routine clinical practice. The authors conclude that currently, autosegmentation technology in RT planning is an efficient tool for the clinicians to provide them with a good starting point for review and adjustment. Modern hardware platforms including GPUs allow most of the autosegmentation tasks to be done in a range of a few minutes. In the nearest future, improvements in CT-based autosegmentation tools will be achieved through standardization of imaging and contouring protocols. In the longer term, the authors expect a wider use of multimodality approaches and better understanding of correlation of imaging with biology and pathology.

Purpose: Automated delineation of structures and organs is a key step in medical imaging. However, due to the large number and diversity of structures and the large variety of segmentation algorithms, a consensus is lacking as to which automated segmentation method works best for certain applications. Segmentation challenges are a good approach for unbiased evaluation and comparison of segmentation algorithms. Methods: In this work, we describe and present the results of the Head and Neck Auto-Segmentation Challenge 2015, a satellite event at the Medical Image Computing and Computer Assisted Interventions (MICCAI) 2015 conference. Six teams participated in a challenge to segment nine structures in the head and neck region of CT images: brainstem, mandible, chiasm, bilateral optic nerves, bilateral parotid glands, and bilateral submandibular glands. Results: This paper presents the quantitative results of this challenge using multiple established error metrics and a well-defined ranking system. The strengths and weaknesses of the different auto-segmentation approaches are analyzed and discussed. Conclusions: The Head and Neck Auto-Segmentation Challenge 2015 was a good opportunity to assess the current state-of-the-art in segmentation of organs at risk for radiotherapy treatment. Participating teams had the possibility to compare their approaches to other methods under unbiased and standardized circumstances. The results demonstrate a clear tendency toward more general purpose and fewer structure-specific segmentation algorithms.

The presented framework provides accurate segmentation results for three important structures in the head neck area. Compared to a segmentation approach based on using multiple atlases in combination with label fusion, the proposed hybrid approach provided more accurate results within a clinically acceptable amount of time.

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The proposed software fills a gap in the multiatlas based segmentation field, since all currently available tools (both for commercial and for research purposes) are restricted to a well specified application. Furthermore, it can be adopted as a platform for exploring MABS parameters and as a reference implementation for comparing against other segmentation algorithms.

Objective Statistical models for medical images have been developed to increase robustness in the segmentation process. In this project, a fully automatic approach to build a statistical shape-intensity model and combine this model with level set segmentation was designed, implemented and tested by applying the algorithm to clinical image data. Methods By using a hierarchical registration approach based on mutual information and demons registration, 3D statistical shape-intensity models were created by applying Principal Component Analysis. Using these models in combination with level set segmentation results in a fully automatic modeling and segmentation pipeline. Results Examples for shape-intensity models were synthesized and these models were used to automatically segment 3D MRI and CT images. Quantitative evaluation of the framework was performed by comparing automatic segmentation results to segmentation results of medical experts. Conclusion Evaluation tests in which this method was used for the automatic segmentation of femora and cardiac MRI endocardial surfaces are very promising. The implementation of an additional cost function term and the addition of information about the surroundings of an organ in the model are currently under development.

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We propose new methods for automatic segmentation of images based on an atlas of manually labeled scans and contours in the image. First, we introduce a Bayesian framework for creating initial label maps from manually annotated training images. Within this framework, we model various registration- and patch-based segmentation techniques by changing the deformation field prior. Second, we perform contour-driven regression on the created label maps to refine the segmentation. Image contours and image parcellations give rise to non-stationary kernel functions that model the relationship between image locations. Setting the kernel to the covariance function in a Gaussian process establishes a distribution over label maps supported by image structures. Maximum a posteriori estimation of the distribution over label maps conditioned on the outcome of the atlas-based segmentation yields the refined segmentation. We evaluate the segmentation in two clinical applications: the segmentation of parotid glands in head and neck CT scans and the segmentation of the left atrium in cardiac MR angiography images.