Craniomaxillofacial Bone Segmentation and Landmark Detection Using Semantic Segmentation Networks and an Unbiased...

Craniomaxillofacial (CMF) surgery always relies on accurate preoperative planning to assist surgeons, and automatically generating bone structures and digitizing landmarks for CMF preoperative planning is crucial. Since the soft and hard tissues of the CMF regions possess complicated attachment, segmenting the CMF bones and detecting the CMF landmarks are challenging problems. In this study, we proposed a semantic segmentation network to segment the maxilla, mandible, zygoma, zygomatic arch, and frontal bones. Then, we obtained the minimum bounding box around the CMF bones. After cropping, we used the top-down heatmap landmark detection network, similar to the segmentation module, to identify 18 CMF landmarks from the cropping patch. In addition, an unbiased heatmap encoding method was proposed to generate actual landmark coordinates in the heatmap. To overcome quantization effects in the heatmap-based landmark detection networks, the distribution-prior coordinate representation of medical landmarks (DCRML) was proposed to utilize the prior distribution of the encoding heatmap, approximating the accurate landmark coordinates in heatmap decoding by Taylor's theorem. The encoding and decoding method can easily contribute to other existing landmark detection frameworks based on heatmaps; consequently, these approaches can readily benefit without changing model structure. We used prior segmentation knowledge to enhance the semantic information around the landmarks, increasing landmark detection accuracy. The proposed framework was evaluated by 100 healthy persons and 86 patients from multicenter cooperation. The mean Dice score of our proposed segmentation network achieved over 88 %; in particular, the mandible accuracy was approximately 95%. The mean error of landmarks was 1.84 ±1.32 mm.