Detection of Bronchopulmonary Segments on High-Resolution CT Preliminary Results

Sata Busayarat1 and Tatjana Zrimec1,2 School of Computer Science and Engineering, University of New South Wale
2

Centre for Health Informatics, University of New South Wale {satab, tatjana}@cse.unsw.edu.au Abstract

Bronchopulmonary segments are subdivisions of lung lobes and provide detailed description of lung anatomy. They are used in surgical resection planning and airway disease quantification. In this paper, we present a method for determining lung segments in volumetric high-resolution CT (HRCT) using segmental bronchi. The bronchial tree is automatically segmented and manually corrected to ensure optimum accuracy. The bronchopulmonary segments are determined by a 3D volume growing with a novel surface smoothing algorithm. Using the detected bronchoplumonary segments of three normal subjects, we measure the inter-patient variation of position of the segments in three subjects.

1. Introduction
Radiologists frequently use regional information about disease appearance to help distinguish between similar disease patterns. This information also helps them to determine the distribution of the patterns, which facilitates diagnosis and treatment. In lung images, detecting lung regions is relatively difficult because of the lack of stable landmarks inside the lungs. Modern imaging modalities, such as High-resolution CT (HRCT), make possible detection of regions since many small lung structures like fissures, secondary lobules and subsegmental bronchi are visible. A computer-aided disease detection system can benefit from the region detection. Several automated and semi-automated lung region detection methods have been reported. Most of them utilize the visible pulmonary fissures to divide lungs into lobes [1, 2]. However, in some clinical applications, more detailed information about the lung structure is required. Krass et al. [3], and Kitaoka et al. [4] divide lung into bronchopulmonary segments, which is a further division of the lobes. There are twenty bronchopulmonary segments (ten for each lung), which are named after the segmental bronchi that supply them as shown in Figure 1. Anatomically, adjacent bronchopulmonary segments are physically separated by connective tissue septa [6], which are not recognizable on HRCT. We use segmental bronchi to determine the bronchopulmonary segments. In this paper, we present a new method for bronchopulmonary segments detection based on a labeled bronchial tree. A three-dimensional volume growing with a novel surface-smoothing algorithm is used to determine the segments. We compare the results of three normal subjects and measure the inter-patient variation of the bronchopulmonary segments. In section 2 and 3, the segmental bronchi detection and the surface-smoothing volume growing are described. In section 4, a discussion of the interpatient variation of the bronchopulmonary segments is presented.

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Figure. 1. Bronchopulmonary segments

2. Segmental Bronchi Detection

To segment the bronchial tree from a volumetric HRCT scan, a two-dimensional seeded region growing and three-dimension stacking, similar to [6], is used. A leaking prevention mechanism was added to the region-growing algorithm to stop the region to leak into lung parenchyma when the bronchial wall is not well defined. The leaking prevention is implemented as additional region growings stopping criteria. The region growing stopping criteria, which usually defined as an intensity range, are extended by maximum intensity gradient and maximum region size. The seed point for the region growing is automatically determined by detecting the trachea in the first image in the scan (circular black object near the middle of the image). In HRCT data with 1mm slice thickness, walls of small bronchi (after the 4 th generation) sometimes appear blurry because of volume averaging effect. Often, bronchi have poor appearances on one 2D image but their appearances improve on the following image. We have improved the region-growing algorithm by enabling tracing to continue in the next two neighboring images, even though it fails to detect a bronchus in the current image. Even with the improvement, the sensitivity of the automatic bronchial tree detection algorithm is around 80%. The sensitivity of the detection algorithm drops when the size of the bronchi is less than two millimeters, or four pixels, in diameters (approximately after 5th generation of bronchi). With such small size, the effect of the volume

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averaging is much greater. It often increases the intensity of the entire lumen and, thus, fails the region growing threshold test. Human intervention can improve the performance of the automatic detection. An interactive tool was developed to enable an expert user to manually mark a 2D bronchus that the algorithm missed. The algorithm then proceeds with the tracing from marked locations. The user can also remove false-positive branches produced by the algorithm. Figure 2 shows an example of a bronchial tree before (left) and after (middle) manual intervention. The same tool also allows the expert to divide the whole bronchial tree into segmental branches. The expert only needs to mark the root of each segmental branch by clicking on it on a 2D image. The name of the branch is selected from a drop-down list. During the marking, the user can see the 3D visualization of the current labeling position, which is provided to ease the marking process. Figure 2 (right) shows a fully labeled bronchial tree. Figure 3 shows a screenshot of the tool.

Figure. 2. Segmental bronchi detection. From left to right, result of the automatic 3D region growing before, after human intervention and after segmental branch labeling.

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Figure. 3. The segmental branch labeling tool screenshot. An expert labels a root of a branch on 2D image (1), the marking is displayed on 3D (2) and the expert choose the name of the branch (3).

3. Bronchopulmonary Segments Determination

Since the physical boundaries of the bronchopulmonary segments, the connective tissue septa, are not recognizable on HRCT, the segmental branches are used to determine the bronchopulmonary segments. A three-dimensional region growing with multiple seeds is used to divide the entire lung into segments. A particular region grows from a segmental branch in all 3D directions. All regions grow simultaneously and stop when reaching the lung surface or other regions (See Figure 4). Each fully grown region will represent a bronchopulmonary segment. Surface-smoothing is added to the volume growing algorithm. This is used to prevent the growing algorithm from producing a small island of a region inside another region. A region stops growing if the surrounding area is dominated by another region. When two regions are close together, the further growing of each region is controlled by inspecting the surrounding area (in a 20 3-voxel cube). The region will grow only if the majority of the voxels inside the cube is of the same class as the current voxels. This virtually creates an elastic effect to the growing regions as a region will constantly inflate but not leak into small space. Figure 5 shows a comparison between results of the normal volume growing and that with the surface-smoothing algorithm.

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Figure 4. Step-by-step volume growing of bronchopulmonary segments

Figure 5. 2D projected result of the 3D volume growing without (left) and with (right) surface smoothing. The differences are highlighted by arrows.

4. Bronchopulmonary Segments Variation Analysis

It is interesting to analyze the variation of the bronchopulmonary segments detected from difference subjects. The variation can indicate how uniform the segments are in terms of spatial positions. This will suggest how suitable bronchopulmonary segments are for being used as lung regions. To measure the variation, we use three volumetric HRCT scans of three relatively normal subjects. The scans were taken using a SIEMENS scanner, with 512x512 spatial resolution, 1.0mm slice thickness and 1.0mm slice gap. We used the proposed method to detect the bronchopulmonary segments in each scan and compare against each other. To compare two lungs from different subjects, we use a lung registration technique developed to deform one lung to fit another so that they can be directly compared [7]. The variation between two lungs is measured using volume similarity and average distance from correct class. The volume similarity compares the two lungs directly and measures the percentage of the lung volume that has the same bronchopulmonary-segment class. The average distance from correct class measures the distance of between a voxel in the first lung and the closest voxel in the second lung that belongs to the same class. The value of the average distance from correct class is normalized to be between zero and one. To calculate the variation among the three subjects (e.g. A,B and C) we measure the variation factors between every parings (A-B, A-C and B-C) and calculate the average.

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The result in Table 1. suggests a low average volume similarity of 57.3%. This is caused by substantial differences found in the bronchial trees in terms of branch point locations and branch orientations. However, the very low average distance from correct class of 0.18 indicates a high correlation between bronchopulmonary segments of the three subjects in terms of 3D spatial relationship. This implies that, even though the locations of the bronchopulmonary segments are not exactly the same among different subjects, the misplacing is small. Table 1. Two variation measures of the bronchopulmonary segments among three subjects, A, B and C.
Volume similarity (%)
A-B 60.8% A-C 54.2% B-C 57.0% Average 57.3%

Average distance from correct class (0-1)

A-B 0.14 A-C 0.21 B-C 0.19 Average 0.18

5. Conclusions
We have presented a method to detect bronchopulmonary segments on volumetric HRCT scans. We also measure the variation of the detected segments. The bronchial tree is segmented using 2D region growing and 3D stacking. Segmental branches are manually labeled using the specially developed tool. A three-dimensional volume growing with a novel surface-smoothing algorithm is used to determine the bronchopulmonary segments using the labeled bronchial tree. The algorithm prevents a volume from leaking into a narrow path surrounded by other objects, which mimics elastic effect. The preliminary result of comparing the bronchopulmonary segments of three different subjects shows average agreement (57.3%). The differences are mainly contributed to the anatomical variation of the human bronchi tree. However, the very low average distance from the correct class (0.18) indicates the bronchopulmonary segments have a very similar spatial arrangement. Conclusively, the bronchopulmonary segments can be reliably detected on HRCT images. The anatomical significance and the stable spatial position of bronchopulmonary segments enable the usage in disease detection and quantification. Future work includes evaluating on a larger number of cases and measuring per-segment variations.

6. References
[1] L. Zhang, Atlas-driven lung lobe segmentation in volumetric X-ray CT images, PhD Thesis, University of Iowa, 2002. [2] J. Wang, M. Betke and J.P. Ko, Shape-based curve growing model and adaptive regularization for pulmonary fissure segmentation in CT, MICCAI, 1, 2004, pp. 541-548. [3] S. Krass, D. Selle, D. Boehm, H.H Jend, A. Kriete and H.O. Peitgen, Determination of bronchopulmonary segments based on HRCT data, CARS, 2000, 584-589. [4] H. Kitaoka, Y. Park, J. Tshirren, J.M. Reinhardt, M. Sonka, G. McLennan and E.A. Hoffman, Automated nomenclature labeling of the bronchial tree in 3D-CT lung images, MICCAI, 2, 2002, pp. 1-11. [5] K.L. Moore and A.F. Dalley, Clinically Oriented Anatomy, Lippincott Williams and Wilkins, 1999. [6] C. Fetita and F. Preteux, Three-dimensional reconstruction of human bronchial tree in HRCT, SPIE, 3646, 1999, pp. 281-295. [7] S. Busayarat and T. Zrimec, Ray-tracing based registration for HRCT images of the lungs, MICCAI, 2, 2006, pp. 670-677.

Twentieth IEEE International Symposium on Computer-Based Medical Systems (CBMS'07) 0-7695-2905-4/07 $20.00 2007