SkullEngine: A Multi-Stage CNN Framework for Collaborative CBCT Image Segmentation and Landmark Detection.

Accurate bone segmentation and landmark detection are two essential preparation tasks in computer-aided surgical planning for patients with craniomaxillofacial (CMF) deformities. Surgeons typically have to complete the two tasks manually, spending ~12 hours for each set of CBCT or ~5 hours for CT. To tackle these problems, we propose a multi-stage coarse-to-fine CNN-based framework, called SkullEngine, for high-resolution segmentation and large-scale landmark detection through a collaborative, integrated, and scalable JSD model and three segmentation and landmark detection refinement models. We evaluated our framework on a clinical dataset consisting of 170 CBCT/CT images for the task of segmenting 2 bones (midface and mandible) and detecting 175 clinically common landmarks on bones, teeth, and soft tissues. Experimental results show that SkullEngine significantly improves segmentation quality, especially in regions where the bone is thin. In addition, SkullEngine also efficiently and accurately detect all of the 175 landmarks. Both tasks were completed simultaneously within 3 minutes regardless of CBCT or CT with high segmentation quality. Currently, SkullEngine has been integrated into a clinical workflow to further evaluate its clinical efficiency.