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Among all types of cancer, gynecological malignancies belong to the 4th mostfrequent type of cancer among women. Besides chemotherapy and external beamradiation, brachytherapy is the standard procedure for the treatment of thesemalignancies. In the progress of treatment planning, localization of the tumoras the target volume and adjacent organs of risks by segmentation is crucial toaccomplish an optimal radiation distribution to the tumor while simultaneouslypreserving healthy tissue. Segmentation is performed manually and represents atime-consuming task in clinical daily routine. This study focuses on thesegmentation of the rectum/sigmoid colon as an Organ-At-Risk in gynecologicalbrachytherapy. The proposed segmentation method uses an interactive,graph-based segmentation scheme with a user-defined template. The schemecreates a directed two dimensional graph, followed by the minimal cost closedset computation on the graph, resulting in an outlining of the rectum. Thegraphs outline is dynamically adapted to the last calculated cut. Evaluationwas performed by comparing manual segmentations of the rectum/sigmoid colon toresults achieved with the proposed method. The comparison of the algorithmic tomanual results yielded to a Dice Similarity Coefficient value of 83.85+/-4.08%,in comparison to 83.97+/-8.08% for the comparison of two manual segmentationsof the same physician. Utilizing the proposed methodology resulted in a mediantime of 128 seconds per dataset, compared to 300 seconds needed for pure manualsegmentation.

Interactive and Scale Invariant Segmentation of the Rectum/Sigmoid via User-Defined Templates