J. Festas, L.C. Sousa, S.S. Siusa, S.I.S. PintoCardiovascular diseases (CVDs) are the leading cause of death globally, accounting for approximately 17.9 million deaths annually, with coronary artery disease (CAD) as a major contributor. CAD results from the build-up of atherosclerotic plaques, reducing myocardial perfusion and leading to conditions like angina and myocardial infarctions, severely affecting the left ventricles function. Advanced diagnostic tools are being developed to enhance the segmentation of cardiovascular structures, improving diagnostic accuracy and treatment outcomes.Accurate segmentation is crucial for analyzing coronary behavior via Computed Tomography Angiography (CTA), a non-invasive alternative to coronary angiography, and for planning surgical interventions. Furthermore, the models retrieved after segmentation can be enlarged simulating hyperemia for further hemodynamic simulations. Similarly, segmenting the left ventricle in dynamic CT scans is vital for assessing cardiac health through measurements like ventricular volume and ejection fraction.However, manual segmentation is time-consuming and suffers from variability, which can lead to significant diagnostic errors [1]. As such, there is a pressing need for more automated tools that enhance accuracy while reducing manual labor.Most common advancements are in the realms of deep learning. These have propelled automated medical image segmentation, achieving results with high efficiency and reliability [2]; however, these require extensive data sets and high variability. In scenarios where such datasets are limited or exhibit low variance, these models risk developing biases or failing to achieve accurate results in cases that are very different then the norm of the training dataset.To mitigate these risks, we are developing a Python-based semi-automatic algorithm that relies on existing open-source libraries, enhancing them with custom developments tailored to our specific needs, while relying on technician input to enhance classical image processing, ensuring adaptability to varied clinical conditions. We are testing this tool with patient data, with results that are very promising: segmentation similarity results of around 85%. We plan to release it as open-source software, encouraging a community-driven approach for continuous improvement and adaptation to clinical needs.The initial tests allows to believe this tool can be a robust and accurate software that can be used in hospital or for investigation purposes. The semi-automatic nature allows for user input and post processing tailoring of the segmentation.[1] Tavakoli, V. et al. (2013) A survey of shaped-based registration and segmentation techniques for cardiac images. Computer Vision and Image Understanding 117, no. 9: 966-989.[2] Litjens, G. et al. (2017) A survey on deep learning in medical image analysis. Medical Image Analysis 42: 60-88.
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