Automatic and hierarchical segmentation of the human skeleton in CT images

Accurate segmentation of each bone of the human skeleton is useful in many medical disciplines. The results of bone segmentation could facilitate bone disease diagnosis and post-treatment assessment, and support planning and image guidance for many treatment modalities including surgery and radiation therapy. As a medium level medical image processing task, accurate bone segmentation can facilitate automatic internal organ segmentation by providing stable structural reference for inter- or intra-patient registration and internal organ localization. Even though bones in CT images can be visually observed with minimal difficulty due to the high image contrast between the bony structures and surrounding soft tissues, automatic and precise segmentation of individual bones is still challenging due to the many limitations of the CT images. The common limitations include low signal-to-noise ratio, insufficient spatial resolution, and indistinguishable image intensity between spongy bones and soft tissues. In this study, a novel and automatic method is proposed to segment all the major individual bones of the human skeleton above the upper legs in CT images based on an articulated skeleton atlas. The reported method is capable of automatically segmenting 62 major bones, including 24 vertebrae and 24 ribs, by traversing a hierarchical anatomical tree and by using both rigid and deformable image registration. The degrees of freedom of femora and humeri are modeled to support patients in different body and limb postures. The segmentation results are evaluated using the Dice coefficient and point-to-surface error (PSE) against manual segmentation results as the ground-truth. The results suggest that the reported method can automatically segment and label the human skeleton into detailed individual bones with high accuracy. The overall average Dice coefficient is 0.90. The average PSEs are 0.41 mm for the mandible, 0.62 mm for cervical vertebrae, 0.92 mm for thoracic vertebrae, and 1.45 mm for pelvis bones.