Development of an open-source algorithm for automated segmentation in clinician-led paranasal sinus radiologic research

Objective: Artificial Intelligence (AI) research needs to be clinician led; however, expertise typically lies outside their skill set. Collaborations exist but are often commercially driven. Free and open-source computational algorithms and software expertise are required for meaningful clinically driven AI medical research. Deep learning algorithms automate segmenting regions of interest for analysis and clinical translation. Numerous studies have automatically segmented paranasal sinus computed tomography (CT) scans; however, openly accessible algorithms capturing the sinonasal cavity remain scarce. The purpose of this study was to validate and provide an open-source segmentation algorithm for paranasal sinus CTs for the otolaryngology research community. Methods: A cross-sectional comparative study was conducted with a deep learning algorithm, UNet++, modified for automatic segmentation of paranasal sinuses CTs and “ground-truth” manual segmentations. A dataset of 100 paranasal sinuses scans was manually segmented, with an 80/20 training/testing split. The algorithm is available at https://github.com/rheadkaul/SinusSegment. Primary outcomes included the Dice similarity coefficient (DSC) score, Intersection over Union (IoU), Hausdorff distance (HD), sensitivity, specificity, and visual similarity grading. Results: Twenty scans representing 7300 slices were assessed. The mean DSC was 0.87 and IoU 0.80, with HD 33.61 mm. The mean sensitivity was 83.98% and specificity 99.81%. The median visual similarity grading score was 3 (good). There were no statistically significant differences in outcomes with normal or diseased paranasal sinus CTs. Conclusion: Automatic segmentation of CT paranasal sinuses yields good results when compared with manual segmentation. This study provides an open-source segmentation algorithm as a foundation and gateway for more complex AI-based analysis of large datasets. Level of Evidence: 3.