Abstract
Manual segmentation, which is tedious, time-consuming, and operator-dependent, is currently used as the gold standard to validate automatic and semiautomatic methods that quantify geometries from 2D and 3D MR images. This study examines the accuracy of manual segmentation and generalizes a strategy to eliminate its use. Trained individuals manually measured MR lateral ventricles images of normal and hydrocephalus infants from 1 month to 9.5 years of age. We created 3D-printed models of the lateral ventricles from the MRI studies and accurately estimated their volume by water displacement. MRI phantoms were made from the 3D models and images obtained. Using a previously developed artificial intelligence (AI) algorithm that employs four features extracted from the images, we estimated the ventricular volume of the phantom images. The algorithm was certified when discrepancies between the volumes-gold standards-yielded by the water displacement device and those measured by the automation were smaller than 2%. Then, we compared volumes after manual segmentation with those obtained with the certified automation. As determined by manual segmentation, lateral ventricular volume yielded an inter and intra-operator variation up to 50% and 48%, respectively, while manually segmenting saggital images generated errors up to 71%. These errors were determined by direct comparisons with the volumes yielded by the certified automation. The errors induced by manual segmentation are large enough to adversely affect decisions that may lead to less-than-optimal treatment; therefore, we suggest avoiding manual segmentation whenever possible.