A unifying framework for automatic and semi-automatic segmentation of vertebrae from radiographs using sample-driven active shape models

Segmentation of vertebral contours is an essential task in the design of imaging biomarkers for osteoporosis based on vertebra shape or texture. In this paper, we propose a novel automatic segmentation technique which can optionally be constrained by the user. The proposed technique solves the segmentation problem in a hierarchical manner. In the first phase, a coarse estimate of the overall spine alignment and the vertebra locations is computed using a sampling scheme. These samples are used to initialize a second phase of active shape model search, under a nonlinear model of vertebra appearance. The search is constrained by a conditional shape model, based on the variability of the coarse spine location estimates. In supplement, we describe an approach for manual initialization of the segmentation procedure as a simple set of constraints on the fully automatic technique. The technique is evaluated on a data base of 157 manually annotated lumbar radiographs, resulting in a final mean point-to-contour error of $0.81~\pm ~0.98$  mm for automatic segmentation. The results outperform the previous work in automatic vertebra segmentation in terms of both segmentation accuracy and failure rate, offering a both automatic and semi-automatic approach in one unifying framework.