Segmentation of medical images is a challenging task that aims to identify a particular structure present on the image. Among the existing methods involving the user at different levels, from a fully-manual to a fully-automated task, interactive segmentation methods provide assistance to the user during the task to reduce the variability in the results and allow occasional corrections of segmentation failures. Therefore, they offer a compromise between the segmentation efficiency and the accuracy of the results. It is the user who judges whether the results are satisfactory and how to correct them during the segmentation, making the process subject to human factors. Despite the strong influence of the user on the outcomes of a segmentation task, the impact of such factors has received little attention, with the literature focusing the assessment of segmentation processes on computational performance. Yet, involving the user performance in the analysis is more representative of a realistic scenario. Our goal is to explore the user behaviour in order to improve the efficiency of interactive image segmentation processes. This is achieved through three contributions. First, we developed a method which is based on a new user interaction mechanism to provide hints as to where to concentrate the computations. This significantly improves the computation efficiency without sacrificing the quality of the segmentation. The benefits of using such hints are twofold: (i) because our contribution is based on user interaction, it generalizes to a wide range of segmentation methods, and (ii) it gives comprehensive indications about where to focus the segmentation search. The latter advantage is used to achieve the second contribution. We developed an automated method based on a multi-scale strategy to: (i) reduce the user’s workload and, (ii) improve the computational time up to tenfold, allowing real-time segmentation feedback. Third, we have investigated the effects of such improvements in computations on the user’s performance. We report an experiment that manipulates the delay induced by the computation time while performing an interactive segmentation task. Results reveal that the influence of this delay can be significantly reduced with an appropriate interaction mechanism design. In conclusion, this project provides an effective image segmentation solution that has been developed in compliance with user performance requirements. We validated our approach through multiple user studies that provided a step forward into understanding the user behaviour during interactive image segmentation
