Abstract. Radiotherapy planning needs accurate delineations of the critical structures. Atlas-based segmentation has been shown to be very e cient to delineate brain structures [1]. However, the construction of an atlas from a dataset of images [2], particularly for the head and neck region, is very di cult due to the high variability of the images and can generate over-segmented structures in the atlas. To overcome this drawback, we present in this paper an alternative method to select as a template the image in a database that is the most similar to the patient to be segmented. This similarity is based on a distance between transformations. A major contribution is that we do not compute every patient-to-sample registration to nd the most similar template, but only the registration of the patient towards an average image. This method has therefore the advantage of being computationally very e cient. We present a qualitative and quantitative comparison between the proposed method and a classical atlas-based segmentation method. This evaluation is performed on a subset of 45 patients using a Leave-One-Out method and shows a great improvement of the speci city of the results.