title: Comparison and assessment of semi-automatic image segmentation in computed tomography scans for image-guided kidney surgery.
abstract: OBJECTIVE
  Image segmentation is integral to implementing intraoperative guidance for kidney tumor resection. Results seen in computed tomography (CT) data are affected by target organ physiology as well as by the segmentation algorithm used. This work studies variables involved in using level set methods found in the Insight Toolkit to segment kidneys from CT scans and applies the results to an image guidance setting.
  
  
  METHODS
  A composite algorithm drawing on the strengths of multiple level set approaches was built using the Insight Toolkit. This algorithm requires image contrast state and seed points to be identified as input, and functions independently thereafter, selecting and altering method and variable choice as needed.
  
  
  RESULTS
  Semi-automatic results were compared to expert hand segmentation results directly and by the use of the resultant surfaces for registration of intraoperative data. Direct comparison using the Dice metric showed average agreement of 0.93 between semi-automatic and hand segmentation results. Use of the segmented surfaces in closest point registration of intraoperative laser range scan data yielded average closest point distances of approximately 1 mm. Application of both inverse registration transforms from the previous step to all hand segmented image space points revealed that the distance variability introduced by registering to the semi-automatically segmented surface versus the hand segmented surface was typically less than 3 mm both near the tumor target and at distal points, including subsurface points.
  
  
  CONCLUSIONS
  Use of the algorithm shortened user interaction time and provided results which were comparable to the gold standard of hand segmentation. Further, the use of the algorithm's resultant surfaces in image registration provided comparable transformations to surfaces produced by hand segmentation. These data support the applicability and utility of such an algorithm as part of an image guidance workflow.
authors: Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37232, USA. c.glisson@vanderbilt.edu
authors: Courtenay L
authors: CL
authors: Glisson
authors: Hernan O
authors: HO
authors: Altamar
authors: S Duke
authors: SD
authors: Herrell
authors: Peter
authors: P
authors: Clark
authors: Robert L
authors: RL
authors: Galloway
mesh_terms: D000465:Algorithms; D001331:Automation; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D007668:Kidney / Q000000981:diagnostic imaging* / Q000601:surgery*; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*