EM segmentation of the distal femur and proximal tibia: a high-throughput approach to anatomic surface generation.

Fully automated segmentation of computed tomography (CT) images remains a challenge for musculoskeletal researchers. The surfaces generated from image segmentations are valuable for surgical evaluation and planning. Previously, we demonstrated the expectation maximization (EM) algorithm as a semi-automated method of bone segmentation from CT images. In this work, we improve upon the methodology of probability map generation and demonstrate extended applicability of EM-based segmentation to the distal femur and proximal tibia using 72 CT image sets. We also compare the resulting EM segmentations to manual tracings using overlap metrics and time. In the case of the distal femur, the resulting quality metrics had mean values of 0.91 and 0.95 for the Jaccard and Dice metrics, respectively. For the proximal tibia, the Jaccard and Dice metrics were 0.90 and 0.95, respectively. The EM segmentation method was 8 times faster than the average manual segmentation and required less than 4% of the human rater time. Overall, the EM algorithm offers reliable image segmentations with an increased efficiency in comparison to manual segmentation techniques.