Algorithms used in medical image segmentation for 3D printing and how to understand and quantify their performance.

BACKGROUND: 3D printing (3DP) has enabled medical professionals to create patient-specific medical devices to assist in surgical planning. Anatomical models can be generated from patient scans using a wide array of software, but there are limited studies on the geometric variance that is introduced during the digital conversion of images to models. The final accuracy of the 3D printed model is a function of manufacturing hardware quality control and the variability introduced during the multiple digital steps that convert patient scans to a printable format. This study provides a brief summary of common algorithms used for segmentation and refinement. Parameters for each that can introduce geometric variability are also identified. Several metrics for measuring variability between models and validating processes are explored and assessed. METHODS: Using a clinical maxillofacial CT scan of a patient with a tumor of the mandible, four segmentation and refinement workflows were processed using four software packages. Differences in segmentation were calculated using several techniques including volumetric, surface, linear, global, and local measurements. RESULTS: Visual inspection of print-ready models showed distinct differences in the thickness of the medial wall of the mandible adjacent to the tumor. Volumetric intersections and heatmaps provided useful local metrics of mismatch or variance between models made by different workflows. They also allowed calculations of aggregate percentage agreement and disagreement which provided a global benchmark metric. For the relevant regions of interest (ROIs), statistically significant differences were found in the volume and surface area comparisons for the final mandible and tumor models, as well as between measurements of the nerve central path. As with all clinical use cases, statistically significant results must be weighed against the clinical significance of any deviations found. CONCLUSIONS: Statistically significant geometric variations from differences in segmentation and refinement algorithms can be introduced into patient-specific models. No single metric was able to capture the true accuracy of the final models. However, a combination of global and local measurements provided an understanding of important geometric variations. The clinical implications of each geometric variation is different for each anatomical location and should be evaluated on a case-by-case basis by clinicians familiar with the process. Understanding the basic segmentation and refinement functions of software is essential for sites to create a baseline from which to evaluate their standard workflows, user training, and inter-user variability when using patient-specific models for clinical interventions or decisions.

A population based statistical model for daily geometric variations in the thorax.

PURPOSE: To develop a population based statistical model of the systematic interfraction geometric variations between the planning CT and first treatment week of lung cancer patients for inclusion as uncertainty term in future probabilistic planning. MATERIALS AND METHODS: Deformable image registrations between the planning CT and first week CBCTs of 235 lung cancer patients were used to generate deformation vector fields (DVFs) representing the geometric variations of lung cancer patients. Using a second deformable registration step, the average DVF per patient was mapped to an average patient CT. Subsequently, the dominant modes of systematic geometric variations were extracted using Principal Component Analysis (PCA). For evaluation a leave-one-out cross-validation was performed. RESULTS: The first three PCA components mainly described cranial-caudal, anterior-posterior, and left-right variations, respectively. Fifty and 112 components were needed to describe correspondingly 75% and 90% of the variance. An overall systematic variation of 3.6mm SD was observed and could be described with an accuracy of about 1.0mm with the PCA model. CONCLUSIONS: A PCA based model for systematic geometric variations in the thorax was developed, and its accuracy determined. Such a model can serve as a basis for probability based treatment planning in lung cancer patients.