Automatic Segmentation of Mandible from Conventional Methods to Deep Learning-A Review

Medical imaging techniques, such as (cone beam) computed tomography and magnetic resonance imaging, have proven to be a valuable component for oral and maxillofacial surgery (OMFS). Accurate segmentation of the mandible from head and neck (H&N) scans is an important step in order to build a personalized 3D digital mandible model for 3D printing and treatment planning of OMFS. Segmented mandible structures are used to effectively visualize the mandible volumes and to evaluate particular mandible properties quantitatively. However, mandible segmentation is always challenging for both clinicians and researchers, due to complex structures and higher attenuation materials, such as teeth (filling) or metal implants that easily lead to high noise and strong artifacts during scanning. Moreover, the size and shape of the mandible vary to a large extent between individuals. Therefore, mandible segmentation is a tedious and time-consuming task and requires adequate training to be performed properly. With the advancement of computer vision approaches, researchers have developed several algorithms to automatically segment the mandible during the last two decades. The objective of this review was to present the available fully (semi)automatic segmentation methods of the mandible published in different scientific articles. This review provides a vivid description of the scientific advancements to clinicians and researchers in this field to help develop novel automatic methods for clinical applications

FocusNet: Imbalanced Large and Small Organ Segmentation with an End-to-End Deep Neural Network for Head and Neck CT Images

In this paper, we propose an end-to-end deep neural network for solving the problem of imbalanced large and small organ segmentation in head and neck (HaN) CT images. To conduct radiotherapy planning for nasopharyngeal cancer, more than 10 organs-at-risk (normal organs) need to be precisely segmented in advance. However, the size ratio between large and small organs in the head could reach hundreds. Directly using such imbalanced organ annotations to train deep neural networks generally leads to inaccurate small-organ label maps. We propose a novel end-to-end deep neural network to solve this challenging problem by automatically locating, ROI-pooling, and segmenting small organs with specifically designed small-organ sub-networks while maintaining the accuracy of large organ segmentation. A strong main network with densely connected atrous spatial pyramid pooling and squeeze-and-excitation modules is used for segmenting large organs, where large organs' label maps are directly output. For small organs, their probabilistic locations instead of label maps are estimated by the main network. High-resolution and multi-scale feature volumes for each small organ are ROI-pooled according to their locations and are fed into small-organ networks for accurate segmenting small organs. Our proposed network is extensively tested on both collected real data and the \emph{MICCAI Head and Neck Auto Segmentation Challenge 2015} dataset, and shows superior performance compared with state-of-the-art segmentation methods.Comment: MICCAI 201

Automatic Segmentation of the Mandible for Three-Dimensional Virtual Surgical Planning

Three-dimensional (3D) medical imaging techniques have a fundamental role in the field of oral and maxillofacial surgery (OMFS). 3D images are used to guide diagnosis, assess the severity of disease, for pre-operative planning, per-operative guidance and virtual surgical planning (VSP). In the field of oral cancer, where surgical resection requiring the partial removal of the mandible is a common treatment, resection surgery is often based on 3D VSP to accurately design a resection plan around tumor margins. In orthognathic surgery and dental implant surgery, 3D VSP is also extensively used to precisely guide mandibular surgery. Image segmentation from the radiography images of the head and neck, which is a process to create a 3D volume of the target tissue, is a useful tool to visualize the mandible and quantify geometric parameters. Studies have shown that 3D VSP requires accurate segmentation of the mandible, which is currently performed by medical technicians. Mandible segmentation was usually done manually, which is a time-consuming and poorly reproducible process. This thesis presents four algorithms for mandible segmentation from CT and CBCT and contributes to some novel ideas for the development of automatic mandible segmentation for 3D VSP. We implement the segmentation approaches on head and neck CT/CBCT datasets and then evaluate the performance. Experimental results show that our proposed approaches for mandible segmentation in CT/CBCT datasets exhibit high accuracy

Clinically Applicable Segmentation of Head and Neck Anatomy for Radiotherapy: Deep Learning Algorithm Development and Validation Study

BACKGROUND: Over half a million individuals are diagnosed with head and neck cancer each year globally. Radiotherapy is an important curative treatment for this disease, but it requires manual time to delineate radiosensitive organs at risk. This planning process can delay treatment while also introducing interoperator variability, resulting in downstream radiation dose differences. Although auto-segmentation algorithms offer a potentially time-saving solution, the challenges in defining, quantifying, and achieving expert performance remain. OBJECTIVE: Adopting a deep learning approach, we aim to demonstrate a 3D U-Net architecture that achieves expert-level performance in delineating 21 distinct head and neck organs at risk commonly segmented in clinical practice. METHODS: The model was trained on a data set of 663 deidentified computed tomography scans acquired in routine clinical practice and with both segmentations taken from clinical practice and segmentations created by experienced radiographers as part of this research, all in accordance with consensus organ at risk definitions. RESULTS: We demonstrated the model's clinical applicability by assessing its performance on a test set of 21 computed tomography scans from clinical practice, each with 21 organs at risk segmented by 2 independent experts. We also introduced surface Dice similarity coefficient, a new metric for the comparison of organ delineation, to quantify the deviation between organ at risk surface contours rather than volumes, better reflecting the clinical task of correcting errors in automated organ segmentations. The model's generalizability was then demonstrated on 2 distinct open-source data sets, reflecting different centers and countries to model training. CONCLUSIONS: Deep learning is an effective and clinically applicable technique for the segmentation of the head and neck anatomy for radiotherapy. With appropriate validation studies and regulatory approvals, this system could improve the efficiency, consistency, and safety of radiotherapy pathways