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Automatic segmentation method of pelvic floor levator hiatus in ultrasound using a self-normalizing neural network

Research output: Contribution to journalArticle

Ester Bonmati, Yipeng Hu, Nikhil Sindhwani, Hans Peter Dietz, Jan D'hooge, Dean Barratt, Jan Deprest, Tom Vercauteren

Original languageEnglish
Article number021206
Pages (from-to)021206
JournalJournal of Medical Imaging
Issue number2
Publication statusPublished - 1 Apr 2018

King's Authors


Segmentation of the levator hiatus in ultrasound allows the extraction of biometrics, which are of importance for pelvic floor disorder assessment. We present a fully automatic method using a convolutional neural network (CNN) to outline the levator hiatus in a two-dimensional image extracted from a three-dimensional ultrasound volume. In particular, our method uses a recently developed scaled exponential linear unit (SELU) as a nonlinear self-normalizing activation function, which for the first time has been applied in medical imaging with CNN. SELU has important advantages such as being parameter-free and mini-batch independent, which may help to overcome memory constraints during training. A dataset with 91 images from 35 patients during Valsalva, contraction, and rest, all labeled by three operators, is used for training and evaluation in a leave-one-patient-out cross validation. Results show a median Dice similarity coefficient of 0.90 with an interquartile range of 0.08, with equivalent performance to the three operators (with a Williams' index of 1.03), and outperforming a U-Net architecture without the need for batch normalization. We conclude that the proposed fully automatic method achieved equivalent accuracy in segmenting the pelvic floor levator hiatus compared to a previous semiautomatic approach.

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