Accurate and automatic quantitative cephalometry analysis is of great importance in orthodontics. The fundamental step for cephalometry analysis is to annotate anatomic-interested landmarks on X-ray images. Computer-aided automatic method remains to be an open topic nowadays. In this paper, we propose an efficient deep learning-based coarse-to-fine approach to realize accurate landmark detection. In the coarse detection step, we train a deep learning-based deformable transformation model by using training samples. We register test images to the reference image (one training image) using the trained model to predict coarse landmarks' locations on test images. Thus, regions of interest (ROIs) which include landmarks can be located. In the fine detection step, we utilize trained deep convolutional neural networks (CNNs), to detect landmarks in ROI patches. For each landmark, there is one corresponding neural network, which directly does regression to the landmark's coordinates. The fine step can be considered as a refinement or fine-tuning step based on the coarse detection step. We validated the proposed method on public dataset from 2015 International Symposium on Biomedical Imaging (ISBI) grand challenge. Compared with the state-of-the-art method, we not only achieved the comparable detection accuracy (the mean radial error is about 1.0-1.6mm), but also largely shortened the computation time (4 seconds per image).

Convolutional neural networks (CNNs) have become popular in medical image segmentation. The widely used deep CNNs are customized to extract multiple representative features for two-dimensional (2D) data, generally called 2D networks. However, 2D networks are inefficient in extracting three-dimensional (3D) spatial features from volumetric images. Although most 2D segmentation networks can be extended to 3D networks, the naively extended 3D methods are resource-intensive. In this paper, we propose an efficient and accurate network for fully automatic 3D segmentation. Specifically, we designed a 3D multiple-contextual extractor to capture rich global contextual dependencies from different feature levels. Then we leveraged an ROI-estimation strategy to crop the ROI bounding box. Meanwhile, we used a 3D ROI-attention module to improve the accuracy of in-region segmentation in the decoder path. Moreover, we used a hybrid Dice loss function to address the issues of class imbalance and blurry contour in medical images. By incorporating the above strategies, we realized a practical end-to-end 3D medical image segmentation with high efficiency and accuracy. To validate the 3D segmentation performance of our proposed method, we conducted extensive experiments on two datasets and demonstrated favorable results over the state-of-the-art methods.