A new accurate and precise 3-D segmentation method for skeletal structures in volumetric CT data.

We developed a highly automated three-dimensionally based method for the segmentation of bone in volumetric computed tomography (CT) datasets. The multistep approach starts with three-dimensional (3-D) region-growing using local adaptive thresholds followed by procedures to correct for remaining boundary discontinuities and a subsequent anatomically oriented boundary adjustment using local values of cortical bone density. We describe the details of our approach and show applications in the proximal femur, the knee, and the skull. The accuracy of the determination of geometrical parameters was analyzed using CT scans of the semi-anthropomorphic European spine phantom. Depending on the settings of the segmentation parameters cortical thickness could be determined with an accuracy corresponding to the side length of 1 to 2.5 voxels. The impact of noise on the segmentation was investigated by artificially adding noise to the CT data. An increase in noise by factors of two and five changed cortical thickness corresponding to the side length of one voxel. Intraoperator and interoperator precision was analyzed by repeated analysis of nine pelvic CT scans. Precision errors were smaller than 1% for trabecular and total volumes and smaller than 2% for cortical thickness. Intraoperator and interoperator precision errors were not significantly different. Our segmentation approach shows: 1) high accuracy and precision and is 2) robust to noise, 3) insensitive to user-defined thresholds, 4) highly automated and fast, and 5) easy to initialize.