1

The Segmentation of Maxillary Sinus by using 3D Level Set with Chan-Vase Method
Amornched Jinda-apiraksa, trainee student Ong Simheng, associate professor and Hiew Litt Teen, research fellow Department of Electrical and Computer Engineering National University of Singapore

AbstractIn this paper, we propose an improved model, called three-dimension (3-D) level set with Chan-Vase method, for active contours to detect maxillary sinuses in a cone beam computed tomography(CBCT) images. This method is based on the techniques of two-dimension(2-D) level set method and Chan-Vase method(or active contour without edges method). This model can detect the maxillary sinus correctly not only in normal case, but also in special cases such as low intensity regions, blurring regions, or multiple regions which are normally occur in the CBCT images. Also, the energy changing speed of 3-D level set with Chan-Vase method is faster than 2-D level set method. However, this method takes more computation time than 2-D level set method. The combination of the parameters also depends on the input images. Moreover, some of these parameters are quite sensitive to change. Finally, the examples of this method apply to both normal case and special cases and the comparison of energy changing graph of both methods are shown. Also, the discussions on adjustment of each parameters are presented. Index Termsthree-dimension (3-D) level set, two-dimension level set, Chan-Vase(active contour without edges), segmentation, Maxillary sinus, CBCT.

(a) Maxillary Sinus Anatomy

(b) CBCT

Fig. 1. (a)The anatomy of the maxillary sinus and (b)sample slice of CBCT contain maxillary sinus

I. I NTRODUCTION

HIS paper studies about the digital image segmentation technique, which is called three-dimension level set with Chan-Vase method, by using dental cone beam computed tomography (CBCT) as a resource. There are some technical terms used in this paper as described in the following sections. A. Technical Terms 1) Maxillary Sinuses: The maxillary sinuses are the air cavity inside the head. They are located beneath the cheeks, above the teeth and on either sides of the nose. The maxillary sinuses drain into the nose through a hole located about half way up the side of the sinus wall. If the maxillary sinuses become blocked they ll up with liquid that often gets infected (sinusitis). This could cause toothache or a dull aching pain under your cheeks. The anatomy of the maxillary sinus is shown in the Figure 1(a). 2) Cone Beam Computed Tomography: The cone beam computed tomography(CBCT) is a new introduced technique of computed tomography(CT). The scanner uses a cone shaped x-ray beam, as shown in Figure 2(a), rather than a conventional linear fan beam, as shown in Figure 2(b), to provide images of the bony structures of the skull. Conventional medical CT scanners use a single row or a series (4, 8, 12, 32 and now 64) of solid state detectors paired with a fan shaped beam to capture the attenuated x-ray. Cone beam CT scanners use a square 2 dimensional array of detectors to capture the cone

(a) Cone beam CT

(b) Fan Beam CT

Fig. 2. The illustration of the beam which is using by (a)cone beam CT and (b)fan beam CT.

shaped beam. As a result the medical CT scanner provides a set of consecutive slices of the patient while the cone beam CT scanner provides a volume of data. The compact size and relatively low radiation dosage of the Cone Beam CT scanner makes it ideally suited for imaging the craniofacial region, including dental structures. With the increasing accessibility of cone beam CT imaging, this modality is emerging as the imaging standard of care for the number of diagnostic assessments of the bony components of the face. The sample of the CBCT image is shown in Figure 1(b). B. The Specications of CBCT data As previously state, this paper studies about the segmentation of the maxillary sinus out from CBCT image. The specications of the CBCT raw image (one of them is shown in Figure 1(b)) are state in the following sections. 1) Format: The image format is .dcm, which is stand for Digital Imaging and Communications in Medicine (DICOM). The DICOM image format is created by the National Electrical Manufacturers Association (NEMA) as a standard for storing,

distributing and viewing medical images, such as MRIs, CT scans, and ultrasound images. A single DICOM le contains both a header (which stores information about the patients name, the type of scan, image dimensions, and so on), as well as all of the image data (which can contain information in three dimensions). The DICOM image data can be compressed (encapsulated) to reduce the image size using both lossy or lossless method. 2) Details: The CBCT images, which are used by this paper, have a resolution of 640 x 640 pixels. Each pixel contains a signed 16 bits integer and has pixel spacing in both direction of 0.25. All images have been captured by Imaging Sciences International on November 3, 2008. As usual of CT images, most of them are affected by Gaussian noise. II. M ETHODS A. Two-dimension Level Set Method Without Re-initialization Geometric active contours are introduced by M. Kass [1], and Chenyang Xu[2] respectively. Traditional level set method(with re-initialization process) depends on signed distance() function. The function has a positive value when the points locate outside the interested boundary. The function has a negative value when the points locate inside the interested boundary. The function has zero value when the points locate at the interested boundary. Therefore, the boundary or contour of the interested curve (C) can be expressed by the function as followed: C(t) = {(x, y)|(t, x, y) = 0}. The (t, x, y) function not only be a function of any particular point x and y , but also be a function of time because the interested contour evolves with time. The relationship between t and F can be expressed by the level set equation as follow: + F | | = 0 (1) t The notation F is called the speed function which is denoted by weighted normalize of gradient of phi, F = k and = n n . Clearly , F depends on the image information and level | | set () function. The level set () function may develop an error during the evolution, which is called shock. The shock, sharp and/or at shape, brings the result to very high errors. Typically, the reinitialization process is applied to the function to force or re-shape them back periodically. As state in Ma Tengfeis paper [3], the maxillary sinuses are segmented out from CBCT images by using two-dimension level set method without re-initialization. To avoid the reinitialize process, the level set method without re-initialization is introduced, as state in C. Lis paper [4]. The goal is to keep the evolving level set function as an approximate signed distance function during the evolution by following the criteria | | = 1. The penalizing equation is introduced in following term: P() =

the derivative of P() with respect to , P() . This term will tell the information about the direction of P() should be. Therefore, the next appropriate value of P() is P()+ P() . Then, the following variational or error formulation is introduced: E() = P() + Eg,,v () (3)

where > 0 is a parameter controlling the effect of penalizing the deviation of from a signed distance function, and Eg,,v () is an external energy for a function (x, y) The external energy function can be expressed in the following term: Eg,,v () = Lg () + vAg () (4)

where > 0 and v are constants, and the terms Lg () and Ag () are dened by Lg () =

g()| |dxdy

(5)

and Ag () =

gH()| |dxdy

(6)

The successful function can be accomplished by carefully adjust the appropriate values of both and v. B. Three-dimension Level Set With Chan-Vase Method The three-dimension(3-D) level set method is improved base on the previously state two-dimension(2-D) level set method. Some of 2-D methods and/or results may not fully describe the real 3-D objects. Since the object to be segment are isotropic spatial voxels, the 3-D gradients and curvature will provide the third dimensional ow for the surface evolution, unlike 2D where all ows are in 2-D, segmentation results should be more stable and robust. Therefore, the contour of interested curve (C) is C(t) = {(x, y, z)|(t, x, y, z) = 0}. Not only one more dimension is improved, but also another method called Chan-Vase method is added. As state in ChanVases paper [5] and N. Zhangs paper [6], the Chan-Vase method is basically base on the techniques of level set method or other active contour methods. The energy equation in ChanVase method can be written as E(c1 , c2 , C)= Length(C) + v Area(inside(C)) + 1
inside(C)

|u0 (x, y, z) c1 |2 dxdydz |u0 (x, y, z) c2 |2 dxdydz (7)

outside(C)

+ 2

The rst two terms length and area term are improved to 3D manner from previously state Equation(5) and (6) as follow. Lg () =

1 (| | 1)2 dxdy 2

(2)

g()| |dxdydz gH()| |dxdydz

(8) (9)

If the assigned function still not appropriate, the error will be large. To decrease the penalizing error, we will take

Ag () =

The other two terms are the newly introduced by ChanVase method. Normally, both of 1 and 2 are set to 1. The u0 (x, y, z) is the image pixel information for each particular position x, y, and z. The c1 and c2 are the mean of the intensity of the pixels inside and outside the boundary C. Therefore, 1 inside(C) |u0 (x, y, z) c1 |2 dxdydz and 2 outside(C) |u0 (x, y, z) c2 |2 dxdydz are the sum of the variance of all the pixels inside and outside of the boundary respectively. The Chan-Vase method is working on the region which has a difference in intensity between inside and outside the desired boundary. If the current boundary is exactly at the right region boundary, both of two variance terms will be minimum. Therefore, the task of the Chan-Vase method, as same as the other active contour models, is to minimize the overall energy. Onlt the Chan-Vase method does not depend on the gradient of the image, as in the classical active contour models, but is instead related to a particular segmentation of the image. The rest of the equations used in three-dimension level set with Chan-Vase method are as follow: The penalizing equation: 1 (| | 1)2 dxdydz (10) P() = 2 The variational or error formulation: E() = P() + Eg,,v,1 ,2 () The external energy function: Eg,,v,1 ,2 () = Lg () + vAg () + 1
inside(C)

(a) 2D Level Set

(b) 3-D Level Set with Chan-Vase

(11)

|u0 (x, y, z) c1 |2 dxdydz |u0 (x, y, z) c2 |2 dxdydz(12)

outside(C)

+ 2

III. E XPERIMENTAL R ESULTS AND C OMPARISONS Three-dimension level set with Chan-Vase method has been applied to all the CBCT image stacks. Some of the selected slices are shown. Basically, 1 and 2 are set to be equal to one value, which is called Chan-Vase weight, at each time of processing. The other parameters such as , v, number of iterations, and time step are vary depend on each set of image stacks. A. Normal Cases Most of the images are considered as a normal case, i.e. image clearly shows only 1 region of the maxillary sinus. The Figure 3 shown the result, and energy comparison between 2-D level set method and 3-D level set with Chan-Vase method by using the parameters according to the following table apply to the normal case (slice number 171). (Normal Case) v No. of Iterations Time Step Chan-Vase Weight 2-D Level Set 5 -1.5 700 50 None

(c) Energy Plot Fig. 3. The normal case(slice171) segmentation result by using (a)2-D level set method and (b)3-D level set with Chan-Vase method. Also, (c)its energy plot.

Figure 3(a) shows the segmentation result from 2-D level set method. Figure 3(b) shows the segmentation result from 3-D level set with Chan-Vase method. Figure 3(c) shows the comparison of its energy of both methods.

B. Special Cases

Some of the images are considered as special cases. There are three special cases from the experiments. 3-D with Chan-Vase 1) Low Intensity Region: The slice number 69 is the 6 sample of the low intensity problem at lower part of -1.5 maxillary sinus. The result from apply both methods with 700 the best parameters of this study, as shown in the following 70 table, is shown in the Figure 4. 0.05

(a) 2D Level Set

(a) 2D Level Set

(b) 3-D Level Set with Chan-Vase Fig. 4. The low intensity case(slice69) segmentation result by using (a)2-D level set method and (b)3-D level set with Chan-Vase method.

(b) 3-D Level Set with Chan-Vase Fig. 5. The blurring case(slice115) segmentation result by using (a)2-D level set method and (b)3-D level set with Chan-Vase method.

(Low Intensity) v No. of Iterations Time Step Chan-Vase Weight

2-D Level Set 5 -1.5 1000 2 None

3-D with Chan-Vase 5 -1.5 800 50 0.04

(Multiple Regions) v No. of Iterations Time Step Chan-Vase Weight

2-D Level Set 5 -1.5 1000 2 None

3-D with Chan-Vase 5 -1.5 1000 5 0

IV. D ISCUSSION

A. Processing time For the processing time, we roughly measure the processing 2) Blurring Region: The slice number 115 is the sample time of 20 slices of each methods. The processing time also of the blurring region problem at the top part of the maxillary depends on the number of iterations and time step. Therefore, sinus. The result from apply both methods with the best we set the same value of parameters for each methods, i.e. parameters of this study, as shown in the following table, is time step = 120, number of iterations = 340, = 5, v = shown in the Figure 5. 1.5 (Chan-Vase weight = 0 for 3-D level set with Chan-Vase method). 1) Two-dimension Level Set Method: The processing time (Blurring) 2-D Level Set 3-D with Chan-Vase is approximately 3.39 minutes. 5 6 2) Three-dimension Level Set With Chan-Vase Method: The v -1.5 -1.5 processing time is approximately 10.29 minutes. No. of Iterations 1000 700 Time Step 2 70 B. Effects of each parameters Chan-Vase Weight None 0.05 The effects of the parameters which appear in 2-D level set method are as same as state in Ma Tengfeis paper [3]. The effects of the additional parameters in 3-D level set with 3) Multiple Regions: The slice number 220 is the sample Chan-Vase method are as follow: of the multiple regions problem. The result from apply both 1) Weighted Length Term (): The signicantly determethods with the best parameters of this study, as shown in mines the shape (the length) in the curve evolution. The effect the following table, is shown in the Figure 6. of varying the value of are shown in Figure 7 by using = 6 and = 20 to demonstrate.

(a) v = -1.5

(b) v = -0.25

(a) 2D Level Set

Fig. 8. The comparison of slice number 212 by using (a)v = -1.5 and (b) v = -0.25. The other parameters are the same, which are = 6, Number of iterations = 600, Time step = 30, and Chan-Vase weight = 0.005

(a) time step = 15 (b) 3-D Level Set with Chan-Vase Fig. 6. The multiple regions case(slice220) segmentation result by using (a)2-D level set method and (b)3-D level set with Chan-Vase method.

(b) time step = 150

Fig. 9. The comparison of slice number 212 by using (a)time step = 15 and (b) time step = 150. The other parameters are the same, which are = 6, v = -1.5, Number of iterations = 600, and Chan-Vase weight = 0.005

very sensitive parameter. Basically, small amount of the value is used. False assigning of this parameter affects to the result become unstable. The effect of varying the value of Chan-Vase weight are shown in Figure 10 by using Chan-Vase weight 0.005 and 1 to demonstrate. C. The Robust Set of Parameters The robust set of parameters for 3-D level set with ChanVase method depends on each 3-D image stack of input slices. Therefore, we cannot show all of the possible sets of parameters. The following sections are the best parameter set of the particular image stacks. 1) Slice 65-90: The best parameters are = 5, v = -1.5, Number of iterations = 800, Time step = 50, and Chan-Vase weight = 0.04 . 2) Slice 91-97: The best parameters are = 5, v = -1.5, Number of iterations = 500, Time step = 50, and Chan-Vase weight = 0.05 .

(a) = 6

(b) = 20

Fig. 7. The comparison of slice number 212 by using (a) = 6 and (b) = 20. The other parameters are the same, which are v = -1.5, Number of iterations = 600, Time step = 30, and Chan-Vase weight = 0.005

2) Weighted Area Term (v): The larger the |v|, the faster it grows towards the actual shape. The negative value means the curve is expanding and positive value means the curve is shrinking. The effect of varying the value of |v| are shown in Figure 8 by using v = -1.5 and = -0.25 to demonstrate. 3) Number of Iterations: The number of iterations must be adjusted to the appropriate value. Too less number of iterations affect the shape of the segmentation. Too many number of iterations affect the processing time of the segmentation as well. 4) Time Step: The bigger time-step can make the evolution faster but may cause false contour of the segmentation. The effect of varying the value of time step are shown in Figure 9 by using time step = 15 and 150 respectively. 5) Chan-Vase Weight: The Chan-Vase weight are the newly introduced parameter by this method. The Chan-Vase weight helps to increase the energy decreasing rate, but it is also a

(a) CV weight = 0.005

(b) CV weight = 1

Fig. 10. The comparison of slice number 212 by using (a)Chan-Vase weight = 0.005 and (b) Chan-Vase weight = 1. The other parameters are the same, which are = 6, v = -1.5, Number of iterations = 600, and Time step = 30.

3) Slice 98-113: The best parameters are = 8, v = -1.5, Number of iterations = 500, Time step = 70, and Chan-Vase weight = 0.04 . 4) Slice 110-129: The best parameters are = 5, v = -1.5, Number of iterations = 900, Time step = 10, and Chan-Vase weight = 0 . 5) Slice 130-149: The best parameters are = 6, v = -1.5, Number of iterations = 800, Time step = 70, and Chan-Vase weight = 0.05 . 6) Slice 150-169: The best parameters are = 6, v = -1.5, Number of iterations = 800, Time step = 70, and Chan-Vase weight = 0.05 . 7) Slice 170-189: The best parameters are = 6, v = -1.5, Number of iterations = 700, Time step = 70, and Chan-Vase weight = 0.05 . 8) Slice 190-209: The best parameters are = 6, v = -1.5, Number of iterations = 800, Time step = 50, and Chan-Vase weight = 0.05 . 9) Slice 208-215: The best parameters are = 6, v = -1.5, Number of iterations = 600, Time step = 30, and Chan-Vase weight = 0.005 . 10) Slice 210-229: The best parameters are = 5, v = -1.5, Number of iterations = 1000, Time step = 5, and Chan-Vase weight = 0 . 11) Slice 230-255: The best parameters are = 5, v = -1.5, Number of iterations = 1000, Time step = 2, and Chan-Vase weight = 0 . V. C ONCLUSION Using three-dimension level set with Chan-Vase method is more accuracy than using two-dimension level set method, as it clearly shown from all the results above. Moreover, 3-D level set with Chan-Vase method has faster energy decreasing rate and lower nal energy than 2-D level set method, as shown in Figure 3(c). The 3-D level set with Chan-Vase method works well in many of input images problem, that is to say low intensity, blurring, and multiple regions problems, which are all the problems by using 2-d level set method. Also, 3-D method allow a smaller number of slice initializations. Comparing it to 2-D, initializations need to be made for every single slice. Since the object to be segment are isotropic spatial voxels, the 3-D gradients and curvature will provide the third dimensional ow for the surface evolution, unlike 2-D where all ows are in 2-D, segmentation results should be more stable and robust. Although 3-D level set with Chan-Vase method has many advantages over 2-D level set method, it requires more computation time. It also use the different combination of the parameters with different images input to achieve the best segmentation. ACKNOWLEDGMENT The author would like to thank to the author(s) of the website http://sinus-pro.com and http://www.conebeam.com for the information and gures of the maxillary sinus anatomy and CBCT.

R EFERENCES
[1] A. W. Michael Kass and D. Terzopoulos, Snakes: Active contour models, International Journal of Computer Vision, pp. 321331, 1988. [2] C. Xu and J. L. Prince, Snakes, shapes, and gradient vector ow, IEEE Transactions on Image Processing, vol. 7, pp. 359369, 1998. [3] M. Tengfei and O. Simheng, Relational and spatial 3d visualisation with dental cone beam ct images, pp. 19. [4] C. G. Chunming Li, Chenyang Xu and M. D. Fox, Level set evolution without re-initialization: A new variational formulation, IEEE Computer Society Conference on Computer Vision and Pattern Recognition, pp. 17, 2005. [5] T. F. Chan and L. A. Vese, Active contours without edges, IEEE Transactions on Image Processing, vol. 10, pp. 266277, 2001. [6] J. Z. Na Zhang and R. Shi, An improved chan-vese model for medical image segmentation, International Conference on Computer Science and Software Engineering, pp. 864867, 2008.

Amornched Jinda-apiraksa is currently(2009) a fourth-year student in Faculty of Engineering (Telecommunication Program) at Sirindhorn International Institute of Technology (SIIT), Thammasat University, Thailand. He will be received the bachelor degree in 2010. By doing this paper(AprilMay, 2009), he is a trainee student at Department of Electrical and Computer Engineering, Faculty of Engineering National University of Singapore.