title: Automatic segmentation of the nasal cavity and paranasal sinuses from cone-beam CT images.
abstract: OBJECTIVE
  A patient-specific upper airway model is important for clinical, education, and research applications. Cone-beam computed tomography (CBCT) is used for imaging the upper airway but automatic segmentation is limited by noise and the complex anatomy. A multi-step level set segmentation scheme was developed for CBCT volumetric head scans to create a 3D model of the nasal cavity and paranasal sinuses.
  
  
  METHODS
  Gaussian mixture model thresholding and morphological operators are first employed to automatically locate the region of interest and to initialize the active contour. Second, the active contour driven by the Kullback-Leibler (K-L) divergence energy in a level set framework to segment the upper airway. The K-L divergence asymmetry is used to directly minimize the K-L divergence energy on the probability density function of the image intensity. Finally, to refine the segmentation result, an anisotropic localized active contour is employed which defines the local area based on shape prior information. The method was tested on ten CBCT data sets. The results were evaluated by the Dice coefficient, the volumetric overlap error (VOE), precision, recall, and F-score and compared with expert manual segmentation and existing methods.
  
  
  RESULTS
  The nasal cavity and paranasal sinuses were segmented in CBCT images with a median accuracy of 95.72 % [93.82-96.72 interquartile range] by Dice, 8.73 % [6.79-12.20] by VOE, 94.69 % [93.80-94.97] by precision, 97.73 % [92.70-98.79] by recall, and 95.72 % [93.82-96.69] by F-score.
  
  
  CONCLUSIONS
  Automated CBCT segmentation of the airway and paranasal sinuses was highly accurate in a test sample of clinical scans. The method may be useful in a variety of clinical, education, and research applications.
authors.affiliation: Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore, g0800578@nus.edu.sg.
authors.forename: Nhat Linh
authors.initials: NL
authors.lastname: Bui
authors.forename: Sim Heng
authors.initials: SH
authors.lastname: Ong
authors.forename: Kelvin Weng Chiong
authors.initials: KW
authors.lastname: Foong
mesh_terms: D054893:Cone-Beam Computed Tomography / Q000379:methods*; D006801:Humans; D009296:Nasal Cavity / Q000000981:diagnostic imaging*; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging*; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results