Fully automated segmentation of computed tomography (CT) images remains a challenge for musculoskeletal researchers. The surfaces generated from image segmentations are valuable for surgical evaluation and planning. Previously, we demonstrated the expectation maximization (EM) algorithm as a semi-automated method of bone segmentation from CT images. In this work, we improve upon the methodology of probability map generation and demonstrate extended applicability of EM-based segmentation to the distal femur and proximal tibia using 72 CT image sets. We also compare the resulting EM segmentations to manual tracings using overlap metrics and time. In the case of the distal femur, the resulting quality metrics had mean values of 0.91 and 0.95 for the Jaccard and Dice metrics, respectively. For the proximal tibia, the Jaccard and Dice metrics were 0.90 and 0.95, respectively. The EM segmentation method was 8 times faster than the average manual segmentation and required less than 4% of the human rater time. Overall, the EM algorithm offers reliable image segmentations with an increased efficiency in comparison to manual segmentation techniques.

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Finite element (FE) analysis is a cornerstone of orthopaedic biomechanics research. Three-dimensional medical imaging provides sufficient resolution for the subject-specific FE models to be generated from these data-sets. FE model development requires discretisation of a three-dimensional domain, which can be the most time-consuming component of a FE study. Hexahedral meshing tools based on the multiblock method currently rely on the manual placement of building blocks for mesh generation. We hypothesise that angular analysis of the geometric centreline for a three-dimensional surface could be used to automatically generate building block structures for the multiblock hexahedral mesh generation. Our algorithm uses a set of user-defined points and parameters to automatically generate a multiblock structure based on a surface's geometric centreline. This significantly reduces the time required for model development. We have applied this algorithm to 47 bones of varying geometries and successfully generated a FE mesh in all cases. This work represents significant advancement in automatically generating multiblock structures for a wide range of geometries.