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Automatic bone segmentation of computed tomography (CT) images is an important step in image-guided surgery that requires both high accuracy and minimal user interaction. Previous attempts include global thresholding, region growing, region competition, watershed segmentation, and parametric active contour (AC) approaches, but none claim fully satisfactory performance. Recently, geometric or level-set-based AC models have been developed and appear to have characteristics suitable for automatic bone segmentation such as initialization insensitivity and topology adaptability. In this study, we have tested the feasibility of five level-set-based AC approaches for automatic CT bone segmentation with both synthetic and real CT images: namely, the geometric AC, geodesic AC, gradient vector flow fast geometric AC, Chan-Vese (CV) AC, and our proposed density distance augmented CV AC (Aug. CV AC). Qualitative and quantitative evaluations have been made in comparison with the segmentation results from standard commercial software and a medical expert. The first three models showed their robustness to various image contrasts, but their performances decreased much when noise level increased. On the contrary, the CV AC's performance was more robust to noise, yet dependent on image contrast. On the other hand, the Aug. CV AC demonstrated its robustness to both noise and contrast levels and yielded improved performances on a set of real CT data compared with the commercial software, proving its suitability for automatic bone segmentation from CT images.

A Study on the Feasibility of Active Contours on Automatic CT Bone Segmentation