Patent Description:
Minimally invasive medical techniques are intended to reduce the amount of tissue that is damaged during medical procedures, thereby reducing patient recovery time, discomfort, and harmful side effects. Such minimally invasive techniques may be performed through natural orifices in a patient anatomy or through one or more surgical incisions. Through these natural orifices or incisions, an operator may insert minimally invasive medical tools to reach a target tissue location. Minimally invasive medical tools include instruments such as therapeutic, diagnostic, biopsy, and surgical instruments. Medical tools may be inserted into anatomic passageways and navigated toward a region of interest within a patient anatomy. Navigation may be assisted using images of the anatomic passageways. Improved systems and methods are needed to accurately perform image segmentation and generate anatomical tree structures that correspond to the patient's anatomy.

<NPL> discloses a method for segmentation of the airway tree from a <NUM>-D multidetector computed tomography chest scan. The method begins with a conservative segmentation of the major airways. Follow-on stages then exhaustively search for additional candidate airway locations. Finally, a graph-based optimization method counterbalances both the benefit and cost of retaining candidate airway locations for the final segmentation.

<CIT> discloses a method and a system for segmentation of vascular structure in a volumetric image dataset. The method comprises initial segmentation of an input volumetric image dataset to obtain a main vessel structure and a plurality of broken segments. A weighted path is computed between the main vessel structure and a broken segment of the plurality of broken segments. The computation of the weighted path is based on at least one or more parameters associated with a first voxel of the broken segment and a second voxel of the main vessel structure. A valid, weighted path is determined between the main vessel structure and a broken segment of the plurality of broken segments, based on the computed weighted path and one or more pre-specified conditions. Based on the determined valid, weighted path, an output volumetric image dataset is generated by performance of a final segmentation on a gradient field.

<CIT> discloses a method for repairing coronary artery segmentation fracture and a device for repairing coronary artery segmentation fracture. The method comprises the following steps: obtaining a prediction output image of a coronary artery segmentation body; performing segmentation and selection of the predicted output image to obtain an effective connector and a candidate connector; performing connectivity analysis on the effective connector and the candidate connector; if it is determined by analysis that the effective connector and the candidate connector are connectable, a corresponding connecting operation is performed to realize segmentation and fracture repair of the predicted output image.

<CIT> discloses a method and system for reconstructing a model path through a branched tubular organ. Disclosed methodologies and systems segment and define accurate endoluminal surfaces in airway trees, including small peripheral bronchi. An automatic algorithm is described that searches the entire lung volume for airway branches and poses airway-tree segmentation as a global graph-theoretic optimization problem. A suite of interactive segmentation tools for cleaning and extending critical areas of the automatically segmented result is disclosed. A model path is reconstructed through the airway tree.

Any "aspect", "example" and "embodiment" of the description not falling within the scope of the claims does not form part of the invention and is provided for illustrative purposes only.

In the following description, specific details are set forth describing some embodiments consistent with the present disclosure. Numerous specific details are set forth in order to provide a thorough understanding of the embodiments. It will be apparent, however, to one skilled in the art that some embodiments may be practiced without some or all of these specific details. The specific embodiments disclosed herein are meant to be illustrative but not limiting. In addition, to avoid unnecessary repetition, one or more features shown and described in association with one embodiment may be incorporated into other embodiments unless specifically described otherwise or if the one or more features would make an embodiment non-functional.

Various imaging techniques may be used to acquire anatomical image data of a patient anatomy for use in a variety of medical procedures including surgical, diagnostic, therapeutic procedures. For example, anatomical image data may be acquired using imaging technology such as computerized tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermography, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, nanotube X-ray imaging, and/or the like. Anatomical image data may be acquired preoperatively or intraoperatively. In some embodiments, anatomical image data may be used with a virtual visualization system to provide navigation assistance to an operator controlling a medical instrument during an image-guided surgical procedure.

Anatomical image data may be segmented to produce graphical units (e.g. pixels or voxels). Model-based or machine learning techniques may be used to associate a probability value with each graphical unit. The probability value may correspond to a type of anatomical tissue and thus may be used to differentiate tissues and generate segmented models of the anatomical tissue. If, for example, the anatomic structure is a lung, the probability value may correspond to soft tissue or to airways. Often, probability values alone provide only rudimentary information that may not be sufficient to generate an accurately segmented model of branched anatomical passageways, particularly when the anatomical image data set is noisy (e.g., inherent electronic noise, artifacts, or physical anomalies) or the passageways are very small. Thus, image data segmentation based on probability values alone may be insufficient to generate anatomical tree models that can be used in clinical applications. In the example of the lung, probability values may provide a false positive probability value for a graphical unit which may cause the graphical unit to be misclassified as an airway. Alternatively, the probability values may provide a false negative probability value for a graphical unit which may cause the graphical unit to be misclassified as not part of an airway. The systems and methods described below may be used to generate more accurate anatomical tree models (also referred to as anatomical branch models).

In some embodiments, an initial segmentation of anatomical image data of branched anatomical structures based on probability values may generate a tree model in which some branches (e.g., smaller or more distal branches) are separated or disconnected from the central structures or trunk of the model. The unconnected segmented structures may result from stenosis or passageway blockages that cause portions of passageways to be misclassified. <FIG> illustrates a display <NUM> of a tree model <NUM> including a segmented trunk structure <NUM> and segmented branched structures <NUM>, <NUM>, <NUM>, <NUM>, <NUM> unconnected to the trunk structure <NUM>. The segmented trunk structure <NUM> and the segmented branched structures <NUM>-<NUM> are formed of segmented graphical units. In some embodiments, the segmented trunk structure <NUM> may include bifurcations resulting in branched structures, and in other embodiments the trunk structure may have no bifurcations and present as a generally elongated unidirectional structure. In some embodiments the unconnected branched structures <NUM>-<NUM> may include at least one bifurcation and at least two branched members. In alternative embodiments, the branched structures may include a single elongated branch member with no bifurcations.

<FIG> illustrates a method <NUM> for connecting one or more of the branched structures <NUM>-<NUM> to the trunk structure <NUM>. The method <NUM> is illustrated as a set of operations or processes <NUM> through <NUM> and is described with continuing reference to <FIG> and <FIG>. Not all of the illustrated processes <NUM> through <NUM> may be performed in all embodiments of method <NUM>. Additionally, one or more processes that are not expressly illustrated in <FIG> may be included before, after, in between, or as part of the processes <NUM> through <NUM>. In some embodiments, one or more of the processes <NUM> through <NUM> may be implemented, at least in part, in the form of executable code stored on non-transitory, tangible, machine-readable media that when run by one or more processors (e.g., the processors of control system) may cause the one or more processors to perform one or more of the processes. In one or more embodiments, the processes <NUM> through <NUM> may be performed by a control system.

At a process <NUM>, anatomical image data for an anatomic tree structure is received. The anatomic tree structure may be any set of natural or surgically created connected passageways, in any of a variety of anatomic systems, including the colon, the intestines, the kidneys and kidney calices, the brain, the heart, the lungs, the circulatory system including vasculature, and/or the like. At a process <NUM>, an initial segmentation of the anatomical image data is performed, resulting in the trunk structure <NUM> and the disconnected branched structures <NUM>-<NUM>.

At a process <NUM>, one of the branched structure <NUM>-<NUM> is evaluated to determine whether to connect the branched structure to the trunk structure <NUM>. Determining whether a disconnected branched structure is a true structure of the tree model is based on an assessment of one or more parameters including the shape of the branched structure and the relationship between the trunk structure and the branched structure. The assessment considers the parameters relative to threshold values. The branched structure is required to have a shape with a threshold number of bifurcations or branched members. In one embodiment the shape of the branched structure must include a threshold value of one bifurcation and a threshold value of at least two branched members. The assessment may also consider the location and distance of the branched structure in relationship to the trunk structure. The assessment may also consider the size of the unconnected branched structure relative to a threshold value or relative to the trunk structure. The assessment may also consider the size of the unconnected branched structure in terms of the number to graphical units forming the branched structure. The assessment may also consider an orientation of the unconnected branched structure and/or the angle of the portion of the branched structure closest to the trunk structure. Matched angles of a connection portion of the trunk structure and at least one of the branched members of the branched structure may determine whether to select the branched structure for connection to the trunk structure. Any branched structure that meets or exceeds a threshold value for the selection parameter used may be connected to the trunk structure. Any branched structure that does not meet the threshold value for the selection parameter may be discarded and removed from display.

If, for example, the disconnected branched structure <NUM> is determined to be a branched structure that should be connected to the trunk structure <NUM> based on one or more of the assessed parameters, a control system may generate a plurality of graphical units forming a connector structure <NUM> (<FIG>) between the trunk and the branched structure <NUM>. At optional process <NUM>, a connector structure <NUM> is a tubular member generated between the branched structure <NUM> and the trunk structure <NUM>. The size, shape, and orientation of the connector structure and the connection location on the trunk structure may be based on reference to the original anatomic image data and/or on the location and angle of the connection points on each of the connected structures. The connector structure <NUM> and the connected branched structure <NUM> may be displayed with a color, texture, transparency, outline or another visual characteristic distinguishable from the trunk structure.

In some embodiments, user interface components allow a user to undo system-generated connections between structures or alter the size, shape or connection points for the connector structures. At an optional process <NUM>, a user command to change the connector structure <NUM> may be received via a user interface component such as menu <NUM>. The menu <NUM> allows a user to, for example, select whether to remove the system generated connector structure <NUM> or edit some aspect of the connector structure <NUM> such as the location of the connector points or the thickness of the tube. In various embodiments, the user interface may be responsive to user input devices such as joysticks, trackballs, touchscreens, data gloves, trigger-guns, hand-operated controllers, voice recognition devices, eye-tracking devices, body motion or presence sensors, and/or the like. In various embodiments, all or fewer than all of the branched structures <NUM>-<NUM> may be evaluated for connection to the trunk structure. For example, if an anatomical target, such as a lesion or biopsy location, is located in a particular anatomic region, the unconnected branched structures near the target may be evaluated for connection but other unconnected branched structures in other areas may not be evaluated.

In another embodiment, unconnected branched structures may be connected to the trunk structure based on a determination made by a user. <FIG> illustrates the display <NUM> with a tree model <NUM> including the segmented trunk structure <NUM> and the segmented branched structures <NUM>, <NUM>, <NUM>, <NUM>, <NUM> unconnected to the trunk structure <NUM>. <FIG> illustrates a method <NUM> for connecting one or more of the branched structures <NUM>-<NUM> to the trunk structure <NUM>. The method <NUM> is illustrated as a set of operations or processes and is described with continuing reference to <FIG> and <FIG>. Not all of the illustrated processes may be performed in all embodiments of method <NUM>. Additionally, one or more processes that are not expressly illustrated in <FIG> may be included before, after, in between, or as part of the processes described. In some embodiments, one or more of the processes may be implemented, at least in part, in the form of executable code stored on non-transitory, tangible, machine-readable media that when run by one or more processors (e.g., the processors of control system) may cause the one or more processors to perform one or more of the processes. In one or more embodiments, the processes may be performed by a control system.

At a process <NUM>, anatomical image data for an anatomic tree structure is received. The process <NUM> may be substantially the same as process <NUM>. At a process <NUM>, an initial segmentation of the anatomical image data is performed, resulting in the trunk structure <NUM> and the disconnected branched structures <NUM>-<NUM>. The process <NUM> may be substantially the same as process <NUM>.

At a process <NUM>, the unconnected branched structures <NUM>-<NUM> and the trunk structure <NUM> may be displayed on the display <NUM>. In some embodiments, the unconnected branched structures <NUM>-<NUM> may be displayed with a color, texture, transparency, outline or another visual characteristic distinguishable from the trunk structure. One or more of the branched structures <NUM>-<NUM> may be evaluated by a user to determine whether the branched structure should be selected for connection to the trunk structure <NUM>.

During the user evaluation, a selected branched structure under evaluation, e.g., structure <NUM> may be identified with a color, texture, transparency, outline or another visual characteristic distinguishable from the other branched structures <NUM>-<NUM>. A user interface component, such as a menu <NUM> may be displayed for the selected structure <NUM> to allow the user to choose a disposition for the structure <NUM>. For example, the user may select from menu options including a user-involved connector generation tool, an automatic connector generation tool, or a discard tool. At a process <NUM>, an indication to add or discard the selected structure <NUM> is received from the user. For example, the user may choose an option from the menu <NUM>.

If, for example, the user indicates that the disconnected branched structure <NUM> should be automatically connected to the trunk structure <NUM>, a control system may generate a plurality of graphical units forming a connector structure <NUM> (<FIG>) between the trunk structure <NUM> and the branched structure <NUM>. The connector structure <NUM> may be a tubular member generated between the branched structure <NUM> and the trunk structure <NUM>. The size, shape, and orientation of the connector structure may be based on reference to the original anatomic image data and/or the location and angle of the connection points on each of the connected structures. If, for example, the user indicates that a manual process should be used (i.e., the user-involved connector generation tool) to connect the branched structure <NUM> to the trunk structure <NUM>, the user may use a manual grow process to choose the size, shape, or other characteristics of the connector structure <NUM>. The connector structure <NUM> and the connected branched structure <NUM> may be displayed with a color, texture, transparency, outline or another visual characteristic distinguishable from the trunk structure. If, for example the user indicates by menu selection that the disconnected branched structure <NUM> should be discarded, the branched structure <NUM> may be removed from the display.

In another embodiment, a user-driven segmentation growth process may reveal a disconnected branched structure for display when the user begins to grow the segmentation of the trunk structure (e.g., select graphical units to add to the trunk structure) into an area where the disconnected branched structures are located. <FIG> illustrates the display <NUM> with a tree model <NUM> including the segmented trunk structure <NUM>. In this embodiment, display of the unconnected segmented branched structures <NUM>, <NUM>, <NUM>, <NUM>, <NUM> is suppressed and the unconnected branched structures are not visible on the display <NUM>. <FIG> illustrates a method <NUM> for connecting one or more of the branched structures <NUM>-<NUM> to the trunk structure <NUM>.

At a process <NUM>, the trunk structure <NUM> is displayed on the display system <NUM> as shown in <FIG>. The unconnected branched structures <NUM>-<NUM> are not displayed. To extend the trunk structure <NUM>, the user may initiate a grow process to add graphical units to the trunk structure. At a process <NUM>, an indication is received from the user selecting an area or region proximate to the trunk structure into which the user would like to grow the segmentation. As shown in <FIG>, an indication is received that the user intends to grow the segmentation of the trunk structure <NUM> in the direction of an area proximate to the trunk structure indicated by the arrow <NUM>. At a process <NUM>, the branched structure <NUM> located in the area indicated by the arrow <NUM> proximate to the trunk structure <NUM> is displayed. The remaining branched structures <NUM>, <NUM>, <NUM>, <NUM> that are not in the indicated area proximate to the trunk structure <NUM> continue to not be displayed. At a process <NUM>. a connector structure <NUM> is generated between the trunk structure <NUM> and the branched structure <NUM>. Optionally, the processes <NUM> and <NUM> may be combined so that the uncovered branch structure <NUM> and the graphical units connecting the branched structure <NUM> to the trunk structure104 may be displayed simultaneously when the area proximate to the trunk structure is indicated. In some embodiments, the connector structure <NUM> and the connected branched structure <NUM> may be displayed with a color, texture, transparency, outline or another visual characteristic distinguishable from the trunk structure. In some embodiments, the branched structures that are outside of areas selected by the user for growth of the segmentation are discarded and not included in the final segmented tree structure.

In some embodiments, segmented tree structures may be used in an image-guided medical procedure performed with a teleoperated medical system as described in further detail below. While some embodiments are provided herein with respect to such procedures, any reference to medical or surgical instruments and medical or surgical methods is non-limiting. In some embodiments, the segmented tree structures may be used for non-teleoperational procedures involving guidance of traditional manually operated medical instruments. The systems, instruments, and methods described herein may be used for animals, human cadavers, animal cadavers, portions of human or animal anatomy, non-surgical diagnosis, as well as for industrial systems and general robotic, general teleoperational, or robotic medical systems. As shown in <FIG>, medical system <NUM> generally includes a manipulator assembly <NUM> for operating a medical instrument <NUM> in performing various procedures on a patient P positioned on a table T. The manipulator assembly <NUM> may be teleoperated, non-teleoperated, or a hybrid teleoperated and non-teleoperated assembly with select degrees of freedom of motion that may be motorized and/or teleoperated and select degrees of freedom of motion that may be non-motorized and/or non-teleoperated. Master assembly <NUM> generally includes one or more control devices for controlling manipulator assembly <NUM>. Manipulator assembly <NUM> supports medical instrument <NUM> and may optionally include a plurality of actuators or motors that drive inputs on medical instrument <NUM> in response to commands from a control system <NUM>. The actuators may optionally include drive systems that when coupled to medical instrument <NUM> may advance medical instrument <NUM> into a naturally or surgically created anatomic orifice. Other drive systems may move the distal end of medical instrument <NUM> in multiple degrees of freedom, which may include three degrees of linear motion (e.g., linear motion along the X, Y, Z Cartesian axes) and in three degrees of rotational motion (e.g., rotation about the X, Y, Z Cartesian axes). Additionally, the actuators can be used to actuate an articulable end effector of medical instrument <NUM> for grasping tissue in the jaws of a biopsy device and/or the like.

Teleoperated medical system <NUM> also includes a display system <NUM> for displaying an image or representation of the surgical site and medical instrument <NUM> generated by sub-systems of sensor system <NUM>. Display system <NUM> may include the display <NUM>. Display system <NUM> and master assembly <NUM> may be oriented so operator O can control medical instrument <NUM> and master assembly <NUM> with the perception of telepresence.

In some embodiments, medical instrument <NUM> may include components of an imaging system, which may include an imaging scope assembly or imaging instrument that records a concurrent or real-time image of a surgical site and provides the image to the operator or operator O through one or more displays of medical system <NUM>, such as one or more displays of display system <NUM>. The concurrent image may be, for example, a two or three-dimensional image captured by an imaging instrument positioned within the surgical site. In some embodiments, the imaging system includes endoscopic imaging instrument components that may be integrally or removably coupled to medical instrument <NUM>. However, in some embodiments, a separate endoscope, attached to a separate manipulator assembly may be used with medical instrument <NUM> to image the surgical site. The imaging system may be implemented as hardware, firmware, software or a combination thereof which interact with or are otherwise executed by one or more computer processors, which may include the processors of the control system <NUM>.

Teleoperated medical system <NUM> may also include control system <NUM>. Control system <NUM> includes at least one memory and at least one computer processor (not shown) for effecting control between medical instrument <NUM>, master assembly <NUM>, sensor system <NUM>, and display system <NUM>. Control system <NUM> also includes programmed instructions (e.g., a non-transitory machine-readable medium storing the instructions) to implement some or all of the methods described in accordance with aspects disclosed herein, including instructions for providing information to display system <NUM>.

Control system <NUM> may optionally further include a virtual visualization system to provide navigation assistance to operator O when controlling medical instrument <NUM> during an image-guided surgical procedure. Virtual navigation using the virtual visualization system may be based upon reference to an acquired preoperative or intraoperative dataset of anatomic passageways. The virtual visualization system processes images of the surgical site imaged using imaging technology such as computerized tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermography, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, nanotube X-ray imaging, and/or the like.

<FIG> is a simplified diagram of a medical instrument system <NUM> according to some embodiments. Medical instrument system <NUM> includes elongate device <NUM>, such as a flexible catheter, coupled to a drive unit <NUM>. Elongate device <NUM> includes a flexible body <NUM> having proximal end <NUM> and distal end or tip portion <NUM>. Medical instrument system <NUM> further includes a tracking system <NUM> for determining the position, orientation, speed, velocity, pose, and/or shape of distal end <NUM> and/or of one or more segments <NUM> along flexible body <NUM> using one or more sensors and/or imaging devices as described in further detail below.

Tracking system <NUM> may optionally track distal end <NUM> and/or one or more of the segments <NUM> using a shape sensor <NUM>. Shape sensor <NUM> may optionally include an optical fiber aligned with flexible body <NUM> (e.g., provided within an interior channel (not shown) or mounted externally). The optical fiber of shape sensor <NUM> forms a fiber optic bend sensor for determining the shape of flexible body <NUM>. In one alternative, optical fibers including Fiber Bragg Gratings (FBGs) are used to provide strain measurements in structures in one or more dimensions. In some embodiments, tracking system <NUM> may optionally and/or additionally track distal end <NUM> using a position sensor system <NUM>. Position sensor system <NUM> may be a component of an EM sensor system with position sensor system <NUM> including one or more conductive coils that may be subjected to an externally generated electromagnetic field.

Flexible body <NUM> includes a channel <NUM> sized and shaped to receive a medical instrument <NUM>. <FIG> is a simplified diagram of flexible body <NUM> with medical instrument <NUM> extended according to some embodiments. In some embodiments, medical instrument <NUM> may be used for procedures such as surgery, biopsy, ablation, illumination, irrigation, or suction. Medical instrument <NUM> can be deployed through channel <NUM> of flexible body <NUM> and used at a target location within the anatomy. Medical instrument <NUM> may include, for example, image capture probes, biopsy instruments, laser ablation fibers, and/or other surgical, diagnostic, or therapeutic tools. Medical instrument <NUM> may be used with an imaging instrument (e.g., an image capture probe) also within flexible body <NUM>. Medical instrument <NUM> may be advanced from the opening of channel <NUM> to perform the procedure and then retracted back into the channel when the procedure is complete. Medical instrument <NUM> may be removed from proximal end <NUM> of flexible body <NUM> or from another optional instrument port (not shown) along flexible body <NUM>.

Flexible body <NUM> may also house cables, linkages, or other steering controls (not shown) that extend between drive unit <NUM> and distal end <NUM> to controllably bend distal end <NUM> as shown, for example, by broken dashed line depictions <NUM> of distal end <NUM>. In some examples, at least four cables are used to provide independent "up-down" steering to control a pitch of distal end <NUM> and "left-right" steering to control a yaw of distal end <NUM>.

The information from tracking system <NUM> may be sent to a navigation system <NUM> where it is combined with information from image processing system <NUM> and/or the preoperatively obtained models to provide the operator with real-time position information. In some examples, the real-time position information may be displayed on display system <NUM> of <FIG> for use in the control of medical instrument system <NUM>. In some examples, control system <NUM> of <FIG> may utilize the position information as feedback for positioning medical instrument system <NUM>.

In some examples, medical instrument system <NUM> may be teleoperated within medical system <NUM> of <FIG>. In some embodiments, manipulator assembly <NUM> of <FIG> may be replaced by direct operator control. In some examples, the direct operator control may include various handles and operator interfaces for hand-held operation of the instrument.

One or more elements in embodiments of this disclosure may be implemented in software to execute on a processor of a computer system such as control processing system. When implemented in software, the elements of the embodiments of the invention are essentially the code segments to perform the necessary tasks. The program or code segments can be stored in a processor readable storage medium or device that may have been downloaded by way of a computer data signal embodied in a carrier wave over a transmission medium or a communication link. The processor readable storage device may include any medium that can store information including an optical medium, semiconductor medium, and magnetic medium. Processor readable storage device examples include an electronic circuit; a semiconductor device, a semiconductor memory device, a read only memory (ROM), a flash memory, an erasable programmable read only memory (EPROM); a floppy diskette, a CD-ROM, an optical disk, a hard disk, or other storage device. The code segments may be downloaded via computer networks such as the Internet, Intranet, etc. Any of a wide variety of centralized or distributed data processing architectures may be employed. Programmed instructions may be implemented as a number of separate programs or subroutines, or they may be integrated into a number of other aspects of the systems described herein. In one embodiment, the control system supports wireless communication protocols such as Bluetooth, IrDA, HomeRF, IEEE <NUM>, DECT, and Wireless Telemetry.

In some instances well known methods, procedures, components, and circuits have not been described in detail so as not to unnecessarily obscure aspects of the embodiments. This disclosure describes various instruments, portions of instruments, and anatomic structures in terms of their state in three-dimensional space. As used herein, the term "position" refers to the location of an object or a portion of an object in a three-dimensional space (e.g., three degrees of translational freedom along Cartesian x-, y-, and z-coordinates). As used herein, the term "orientation" refers to the rotational placement of an object or a portion of an object (three degrees of rotational freedom - e.g., roll, pitch, and yaw). As used herein, the term "pose" refers to the position of an object or a portion of an object in at least one degree of translational freedom and to the orientation of that object or portion of the object in at least one degree of rotational freedom (up to six total degrees of freedom). As used herein, the term "shape" refers to a set of poses, positions, or orientations measured along an object.

Claim 1:
A system comprising:
a display system (<NUM>); and
a control system (<NUM>) communicatively coupled to the display system (<NUM>), the control system (<NUM>) configured to:
receive anatomic image data for an anatomic tree structure;
generate an initial segmentation of the anatomic image data, the initial segmentation including a trunk structure and a branched structure unconnected to the trunk structure; and
determine whether to connect the branched structure to the trunk structure based on an assessment of a shape of the branched structure and an assessment of a relationship between the trunk structure and the branched structure, wherein the assessment of the shape of the branched structure is based on a number of bifurcations or branched members of the branched structure.