TY - CHAP A1 - Kainmüller, Dagmar A1 - Lamecker, Hans A1 - Seim, Heiko A1 - Zinser, Max A1 - Zachow, Stefan ED - Yang, Guang-Zhong ED - J. Hawkes, David ED - Rueckert, Daniel ED - Noble, J. Alison ED - J. Taylor, Chris T1 - Automatic Extraction of Mandibular Nerve and Bone from Cone-Beam CT Data T2 - Proceedings of Medical Image Computing and Computer Assisted Intervention (MICCAI) Y1 - 2009 SP - 76 EP - 83 CY - London, UK ER - TY - JOUR A1 - Zachow, Stefan A1 - Lamecker, Hans A1 - Zöckler, Maja A1 - Haberl, Ernst T1 - Computergestützte Planung zur chirurgischen Korrektur von frühkindlichen Schädelfehlbildungen (Craniosynostosen) JF - Face 02/09, Int. Mag. of Orofacial Esthetics, Oemus Journale Leipzig Y1 - 2009 SP - 48 EP - 53 ER - TY - CHAP A1 - Heimann, Tobias A1 - Chung, François A1 - Lamecker, Hans A1 - Delingette, Hervé T1 - Subject-Specific Ligament Models: Towards Real-Time Simulation of the Knee Joint T2 - Proc. Computational Biomechanics for Medicine IV Workshop Y1 - 2009 U6 - https://doi.org/10.1007/978-1-4419-5874-7 SP - 107 EP - 119 PB - Springer New York ER - TY - JOUR A1 - Kainmüller, Dagmar A1 - Lamecker, Hans A1 - Zachow, Stefan T1 - Multi-object Segmentation with Coupled Deformable Models JF - Annals of the British Machine Vision Association (BMVA) Y1 - 2009 VL - 5 SP - 1 EP - 10 ER - TY - CHAP A1 - Seim, Heiko A1 - Kainmüller, Dagmar A1 - Kuss, Anja A1 - Lamecker, Hans A1 - Zachow, Stefan A1 - Menzel, Randolf A1 - Rybak, Juergen T1 - Model-based autosegmentation of the central brain of the honeybee, Apis mellifera, using active statistical shape models T2 - Proc. 1st INCF Congress of Neuroinformatics: Databasing and Modeling the Brain Y1 - 2008 U6 - https://doi.org/10.3389/conf.neuro.11.2008.01.064 ER - TY - JOUR A1 - Sahner, Jan A1 - Weber, Britta A1 - Lamecker, Hans A1 - Prohaska, Steffen T1 - Extraction of feature Lines on surface meshes based on discrete Morse theory JF - Computer Graphics Forum Y1 - 2008 U6 - https://doi.org/10.1111/j.1467-8659.2008.01202.x VL - 27 IS - 3 SP - 735 EP - 742 CY - Eindhoven, Netherlands ER - TY - CHAP A1 - Zilske, Michael A1 - Lamecker, Hans A1 - Zachow, Stefan T1 - Adaptive Remeshing of Non-Manifold Surfaces T2 - Eurographics 2008 Annex to the Conf. Proc. Y1 - 2008 SP - 207 EP - 211 ER - TY - CHAP A1 - Seim, Heiko A1 - Lamecker, Hans A1 - Zachow, Stefan T1 - Segmentation of Bony Structures with Ligament Attachment Sites T2 - Bildverarbeitung für die Medizin 2008 Y1 - 2008 U6 - https://doi.org/10.1007/978-3-540-78640-5_42 SP - 207 EP - 211 PB - Springer ER - TY - JOUR A1 - Lamecker, Hans A1 - Kamer, Lukas A1 - Wittmers, Antonia A1 - Zachow, Stefan A1 - Kaup, Thomas A1 - Schramm, Alexander A1 - Noser, Hansrudi A1 - Hammer, Beat T1 - A method for the three-dimensional statistical shape analysis of the bony orbit JF - Proc. Computer Aided Surgery around the Head Y1 - 2007 SP - 94 EP - 97 ER - TY - CHAP A1 - Lange, Thomas A1 - Lamecker, Hans A1 - Hünerbein, Michael A1 - Eulenstein, Sebastian A1 - Beller, Sigfried A1 - Schlag, Peter ED - Horsch, A. T1 - A new class of distance measures for registration of tubular models to image data T2 - Proc. Bildverarbeitung für die Medizin (BVM) Y1 - 2007 U6 - https://doi.org/10.1007/978-3-540-71091-2_21 SP - 101 EP - 105 PB - Springer ER - TY - JOUR A1 - Kainmüller, Dagmar A1 - Lamecker, Hans A1 - Seim, Heiko A1 - Zachow, Stefan T1 - Multi-object segmentation of head bones JF - MIDAS Journal Y1 - 2009 ER - TY - CHAP A1 - Seim, Heiko A1 - Kainmüller, Dagmar A1 - Lamecker, Hans A1 - Zachow, Stefan T1 - A System for Unsupervised Extraction of Orthopaedic Parameters from CT Data T2 - GI Workshop Softwareassistenten - Computerunterstützung für die medizinische Diagnose und Therapieplanung Y1 - 2009 SP - 1328 EP - 1337 CY - Lübeck, Germany ER - TY - CHAP A1 - Lamecker, Hans A1 - Mansi, Tomaso A1 - Relan, Jatin A1 - Billet, Florence A1 - Sermesant, Maxime A1 - Ayache, Nicholas A1 - Delingette, Hervé T1 - Adaptive Tetrahedral Meshing for Personalized Cardiac Simulations T2 - Proc. MICCAI Workshop on Cardiovascular Interventional Imaging and Biophysical Modelling (CI2BM) Y1 - 2009 SP - 149 EP - 158 ER - TY - JOUR A1 - Lange, Thomas A1 - Hünerbein, Michael A1 - Eulenstein, Sebastian A1 - Beller, Sigfried A1 - Schlag, Peter A1 - Lamecker, Hans T1 - A Distance Measure for Non-Rigid Registration of Geometrical Models to Intensity Data JF - Int. J. Computer Assisted Radiology and Surgery Y1 - 2007 VL - 2, Suppl. 1 SP - 204 EP - 206 PB - Springer ER - TY - JOUR A1 - Kainmüller, Dagmar A1 - Lange, Thomas A1 - Lamecker, Hans T1 - Shape constrained automatic segmentation of the liver based on a heuristic intensity model JF - Proc. MICCAI Workshop 3D Segmentation in the Clinic Y1 - 2007 SP - 109 EP - 116 ER - TY - CHAP A1 - Lange, Thomas A1 - Wenckebach, Thomas A1 - Lamecker, Hans A1 - Seebaß, Martin A1 - Hünerbein, Michael A1 - Eulenstein, Sebastian A1 - Schlag, Peter-Michael T1 - Registration of different phases of contrast-enhanced CT/MRI data for computer-assisted liver surgery planning T2 - Int. J. Medical Robotics and Computer Assisted Surgery Y1 - 2005 U6 - https://doi.org/10.1002/rcs.23 VL - 1 (3) SP - 6 EP - 20 PB - Wiley ER - TY - GEN A1 - Kamer, Lukas A1 - Noser, Hansrudi A1 - Lamecker, Hans A1 - Zachow, Stefan A1 - Wittmers, Antonia A1 - Kaup, Thomas A1 - Schramm, Alexander A1 - Hammer, Beat T1 - Three-dimensional statistical shape analysis - A useful tool for developing a new type of orbital implant? Y1 - 2006 SP - 20 EP - 21 PB - AO Development Institute, New Products Brochure 2/06 ER - TY - JOUR A1 - Haberl, Hannes A1 - Hell, Bertold A1 - Zöckler, Maja A1 - Zachow, Stefan A1 - Lamecker, Hans A1 - Sarrafzadeh, Asita A1 - Riecke, B. A1 - Langsch, Wolfgang A1 - Deuflhard, Peter A1 - Bier, Jürgen A1 - Brock, Mario T1 - Technical aspects and results of surgery for craniosynostosis JF - Zentralblatt für Neurochirurgie Y1 - 2004 VL - 65 IS - 2 SP - 65 EP - 74 ER - TY - CHAP A1 - Lange, Thomas A1 - Wenckebach, Thomas A1 - Seebaß, Martin A1 - Lamecker, Hans A1 - Hünerbein, Michael T1 - Registration of different phases of contrast-enhanced MR data for liver surgery T2 - 3. Jahrestagung der Deutschen Gesellschaft für Computer-Roboterassistierte Chirurgie CURAC Y1 - 2004 ER - TY - CHAP A1 - Lange, Thomas A1 - Eulenstein, Sebastian A1 - Hünerbein, Michael A1 - Lamecker, Hans A1 - Schlag, Peter-Michael ED - Barrilot, Christian T1 - Augmenting intraoperative 3D ultrasound with preoperative models for navigation in liver surgery T2 - Proceedings MICCAI Y1 - 2004 SP - 543 EP - 541 PB - Springer ER - TY - JOUR A1 - Lamecker, Hans A1 - Zachow, Stefan A1 - Haberl, Hannes A1 - Stiller, Michael T1 - Medical applications for statistical shape models JF - Computer Aided Surgery around the Head, Fortschritt-Berichte VDI - Biotechnik/Medizintechnik Y1 - 2005 VL - 17 (258) SP - 61 ER - TY - CHAP A1 - Zachow, Stefan A1 - Lamecker, Hans A1 - Elsholtz, Barbara A1 - Stiller, Michael T1 - Reconstruction of mandibular dysplasia using a statistical 3D shape model T2 - Proc. Computer Assisted Radiology and Surgery (CARS) Y1 - 2005 U6 - https://doi.org/10.1016/j.ics.2005.03.339 SP - 1238 EP - 1243 CY - Berlin, Germany ER - TY - JOUR A1 - Todt, Ingo A1 - Lamecker, Hans A1 - Ramm, Heiko A1 - Frenzel, Henning A1 - Wollenberg, Barbara A1 - Beleites, Thomas A1 - Zahnert, Thomas A1 - Thomas, Jan Peter A1 - Dazert, Stefan A1 - Ernst, Arneborg T1 - Entwicklung eines CT-Daten-basierten Vibrant-Bonebridge-Viewers JF - HNO N2 - Die Positionierung des B-FMT der Vibrant Bonebridge kann aufgrund der anatomischen Verhältnisse des Mastoids und der Größe des Aktuators ohne eine vorherige Beurteilung der individuellen Computertomographie (CT) des Felsenbeins problematisch sein. Die Entwicklung eines einfach zu bedienenden Viewers, welcher eine Positionierung des B-FMT im Felsenbeinmodell ermöglicht und hier auf individuelle potenzielle anatomische Konflikte hinweist sowie Lösungsmöglichkeiten anbietet, kann ein hilfreiches Werkzeug zur präoperativen Positionierung sein. Ziel der Arbeit war die Definition von Anforderungen und die Anfertigung eines Prototyps eines Vibrant-Bonebridge-Viewers. Auf der Basis einer ZIBAmira-Software-Version und der Inklusion eines B-FMT-Modells unter Erstellung eines Felsenbeinmodells, welches die intuitive Beurteilung von Konflikten ermöglicht, erfolgte die Erstellung des Prototyps eines Vibrant-Bonebridge-Viewers.Ergebnisse. Die Segmentierungszeit der individuellen DICOM-Daten („digital imaging and communications in medicine“) beträgt etwa 5 min. Eine Positionierung im individuellen 3-D-Felsenbeinmodell ermöglicht die quantitative und qualitative Beurteilung von Konflikten (Sinus sigmoideus, mittlere Schädelgrube) und das Aufsuchen einer bevorzugten Position. Das Anheben des B-FMT mittels virtueller Unterlegscheiben kann simuliert werden. Der erstellte Vibrant-Bonebridge-Viewer ermöglicht verlässlich eine Simulation der B-FMT-Positionierung. Die klinische Anwendbarkeit muss evaluiert werden. Y1 - 2014 U6 - https://doi.org/10.1007/s00106-014-2851-3 VL - 62 SP - 439 EP - 442 PB - Springer ER - TY - JOUR A1 - Todt, Ingo A1 - Lamecker, Hans A1 - Ramm, Heiko A1 - Ernst, Arneborg T1 - A computed tomographic data-based vibrant bonebridge visualization tool JF - Cochlear Implants International N2 - Information about the temporal bone size and variations of anatomical structures are crucial for a safe positioning of the Vibrant Bonebridge B-FMT. A radiological based preoperative planning of the surgical procedure decreases the surgical time and minimizes the risk of complications. We developed a software tool, which allows a catch up of foreign DICOM data based CT temporal bone scans. The individual CT scan is transmitted into a 3D reconstructed pattern of the temporal bone. In this 3D reconstruction the individually favored position of the B- FMT should be found. The software allows a determination of a safe B-FMT position by identifying the individual relation of middle fossa, jugular bulb and external auditory canal. Skull thickness and screw length are contained parameters for the surgical planning. An easy to handle software tool allows a radiologically data based safe and fast surgical positioning of the B-FMT. Y1 - 2014 U6 - https://doi.org/10.1179/1467010014Z.000000000155 VL - 15 IS - S1 SP - 72 EP - 74 ER - TY - JOUR A1 - Hochfeld, Mascha A1 - Lamecker, Hans A1 - Thomale, Ulrich W. A1 - Schulz, Matthias A1 - Zachow, Stefan A1 - Haberl, Hannes T1 - Frame-based cranial reconstruction JF - Journal of Neurosurgery: Pediatrics N2 - The authors report on the first experiences with the prototype of a surgical tool for cranial remodeling. The device enables the surgeon to transfer statistical information, represented in a model, into the disfigured bone. The model is derived from a currently evolving databank of normal head shapes. Ultimately, the databank will provide a set of standard models covering the statistical range of normal head shapes, thus providing the required template for any standard remodeling procedure as well as customized models for intended overcorrection. To date, this technique has been used in the surgical treatment of 14 infants (age range 6-12 months) with craniosynostosis. In all 14 cases, the designated esthetic result, embodied by the selected model, has been achieved, without morbidity or mortality. Frame-based reconstruction provides the required tools to precisely realize the surgical reproduction of the model shape. It enables the establishment of a self-referring system, feeding back postoperative growth patterns, recorded by 3D follow-up, into the model design. Y1 - 2014 U6 - https://doi.org/10.3171/2013.11.PEDS1369 VL - 13 IS - 3 SP - 319 EP - 323 ER - TY - CHAP A1 - Mukhopadhyay, Anirban A1 - Morillo, Oscar A1 - Zachow, Stefan A1 - Lamecker, Hans T1 - Robust and Accurate Appearance Models Based on Joint Dictionary Learning Data from the Osteoarthritis Initiative T2 - Lecture Notes in Computer Science, Patch-Based Techniques in Medical Imaging. Patch-MI 2016 N2 - Deformable model-based approaches to 3D image segmentation have been shown to be highly successful. Such methodology requires an appearance model that drives the deformation of a geometric model to the image data. Appearance models are usually either created heuristically or through supervised learning. Heuristic methods have been shown to work effectively in many applications but are hard to transfer from one application (imaging modality/anatomical structure) to another. On the contrary, supervised learning approaches can learn patterns from a collection of annotated training data. In this work, we show that the supervised joint dictionary learning technique is capable of overcoming the traditional drawbacks of the heuristic approaches. Our evaluation based on two different applications (liver/CT and knee/MR) reveals that our approach generates appearance models, which can be used effectively and efficiently in a deformable model-based segmentation framework. Y1 - 2016 U6 - https://doi.org/10.1007/978-3-319-47118-1_4 VL - 9993 SP - 25 EP - 33 ER - TY - JOUR A1 - Wilson, David A1 - Anglin, Carolyn A1 - Ambellan, Felix A1 - Grewe, Carl Martin A1 - Tack, Alexander A1 - Lamecker, Hans A1 - Dunbar, Michael A1 - Zachow, Stefan T1 - Validation of three-dimensional models of the distal femur created from surgical navigation point cloud data for intraoperative and postoperative analysis of total knee arthroplasty JF - International Journal of Computer Assisted Radiology and Surgery N2 - Purpose: Despite the success of total knee arthroplasty there continues to be a significant proportion of patients who are dissatisfied. One explanation may be a shape mismatch between pre and post-operative distal femurs. The purpose of this study was to investigate a method to match a statistical shape model (SSM) to intra-operatively acquired point cloud data from a surgical navigation system, and to validate it against the pre-operative magnetic resonance imaging (MRI) data from the same patients. Methods: A total of 10 patients who underwent navigated total knee arthroplasty also had an MRI scan less than 2 months pre-operatively. The standard surgical protocol was followed which included partial digitization of the distal femur. Two different methods were employed to fit the SSM to the digitized point cloud data, based on (1) Iterative Closest Points (ICP) and (2) Gaussian Mixture Models (GMM). The available MRI data were manually segmented and the reconstructed three-dimensional surfaces used as ground truth against which the statistical shape model fit was compared. Results: For both approaches, the difference between the statistical shape model-generated femur and the surface generated from MRI segmentation averaged less than 1.7 mm, with maximum errors occurring in less clinically important areas. Conclusion: The results demonstrated good correspondence with the distal femoral morphology even in cases of sparse data sets. Application of this technique will allow for measurement of mismatch between pre and post-operative femurs retrospectively on any case done using the surgical navigation system and could be integrated into the surgical navigation unit to provide real-time feedback. Y1 - 2017 UR - https://link.springer.com/content/pdf/10.1007%2Fs11548-017-1630-5.pdf U6 - https://doi.org/10.1007/s11548-017-1630-5 VL - 12 IS - 12 SP - 2097 EP - 2105 PB - Springer ER - TY - GEN A1 - Ehlke, Moritz A1 - Frenzel, Thomas A1 - Ramm, Heiko A1 - Lamecker, Hans A1 - Akbari Shandiz, Mohsen A1 - Anglin, Carolyn A1 - Zachow, Stefan T1 - Robust Measurement of Natural Acetabular Orientation from AP Radiographs using Articulated 3D Shape and Intensity Models T3 - ZIB-Report - 14-12 KW - articulated shape and intensity models KW - 3D reconstruction KW - acetabular orientation KW - image registration Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:0297-zib-49824 SN - 1438-0064 ER - TY - CHAP A1 - Lamecker, Hans A1 - Zachow, Stefan T1 - Statistical Shape Modeling of Musculoskeletal Structures and Its Applications T2 - Computational Radiology for Orthopaedic Interventions N2 - Statistical shape models (SSM) describe the shape variability contained in a given population. They are able to describe large populations of complex shapes with few degrees of freedom. This makes them a useful tool for a variety of tasks that arise in computer-aided madicine. In this chapter we are going to explain the basic methodology of SSMs and present a variety of examples, where SSMs have been successfully applied. Y1 - 2016 SN - 978-3-319-23481-6 U6 - https://doi.org/10.1007/978-3-319-23482-3 VL - 23 SP - 1 EP - 23 PB - Springer ER - TY - JOUR A1 - Günther, Andreas A1 - Lamecker, Hans A1 - Weiser, Martin T1 - Flexible Shape Matching with Finite Element Based LDDMM JF - International Journal of Computer Vision N2 - We consider Large Deformation Diffeomorphic Metric Mapping of general $m$-currents. After stating an optimization algorithm in the function space of admissable morph generating velocity fields, two innovative aspects in this framework are presented and numerically investigated: First, we spatially discretize the velocity field with conforming adaptive finite elements and discuss advantages of this new approach. Second, we directly compute the temporal evolution of discrete $m$-current attributes. Y1 - 2013 U6 - https://doi.org/10.1007/s11263-012-0599-3 VL - 105 IS - 2 SP - 128 EP - 143 ER - TY - GEN A1 - Günther, Andreas A1 - Lamecker, Hans A1 - Weiser, Martin ED - Pennec, X. ED - Joshi, S. ED - Nielsen, M. T1 - Direct LDDMM of Discrete Currents with Adaptive Finite Elements T2 - Proceedings of the Third International Workshop on Mathematical Foundations of Computational Anatomy - Geometrical and Statistical Methods for Modelling Biological Shape Variability N2 - We consider Large Deformation Diffeomorphic Metric Mapping of general $m$-currents. After stating an optimization algorithm in the function space of admissable morph generating velocity fields, two innovative aspects in this framework are presented and numerically investigated: First, we spatially discretize the velocity field with conforming adaptive finite elements and discuss advantages of this new approach. Second, we directly compute the temporal evolution of discrete $m$-current attributes. Y1 - 2011 SP - 1 EP - 14 ER - TY - JOUR A1 - Li, Jianning A1 - Pimentel, Pedro A1 - Szengel, Angelika A1 - Ehlke, Moritz A1 - Lamecker, Hans A1 - Zachow, Stefan A1 - Estacio, Laura A1 - Doenitz, Christian A1 - Ramm, Heiko A1 - Shi, Haochen A1 - Chen, Xiaojun A1 - Matzkin, Franco A1 - Newcombe, Virginia A1 - Ferrante, Enzo A1 - Jin, Yuan A1 - Ellis, David G. A1 - Aizenberg, Michele R. A1 - Kodym, Oldrich A1 - Spanel, Michal A1 - Herout, Adam A1 - Mainprize, James G. A1 - Fishman, Zachary A1 - Hardisty, Michael R. A1 - Bayat, Amirhossein A1 - Shit, Suprosanna A1 - Wang, Bomin A1 - Liu, Zhi A1 - Eder, Matthias A1 - Pepe, Antonio A1 - Gsaxner, Christina A1 - Alves, Victor A1 - Zefferer, Ulrike A1 - von Campe, Cord A1 - Pistracher, Karin A1 - Schäfer, Ute A1 - Schmalstieg, Dieter A1 - Menze, Bjoern H. A1 - Glocker, Ben A1 - Egger, Jan T1 - AutoImplant 2020 - First MICCAI Challenge on Automatic Cranial Implant Design JF - IEEE Transactions on Medical Imaging N2 - The aim of this paper is to provide a comprehensive overview of the MICCAI 2020 AutoImplant Challenge. The approaches and publications submitted and accepted within the challenge will be summarized and reported, highlighting common algorithmic trends and algorithmic diversity. Furthermore, the evaluation results will be presented, compared and discussed in regard to the challenge aim: seeking for low cost, fast and fully automated solutions for cranial implant design. Based on feedback from collaborating neurosurgeons, this paper concludes by stating open issues and post-challenge requirements for intra-operative use. Y1 - 2021 U6 - https://doi.org/10.1109/TMI.2021.3077047 SN - 0278-0062 VL - 40 IS - 9 SP - 2329 EP - 2342 ER - TY - JOUR A1 - Xie, Kunpeng A1 - Gruber, Lennart Johannes A1 - Crampen, Martin A1 - Li, Yao A1 - Ferreira, André A1 - Tappeiner, Elias A1 - Gillot, Maxime A1 - Schepers, Jan A1 - Xu, Jiangchang A1 - Pankert, Tobias A1 - Beyer, Michel A1 - Shahamiri, Negar A1 - ten Brink, Reinier A1 - Dot, Gauthier A1 - Weschke, Charlotte A1 - van Nistelrooij, Niels A1 - Verhelst, Pieter-Jan A1 - Guo, Yan A1 - Xu, Zhibin A1 - Bienzeisler, Jonas A1 - Rashad, Ashkan A1 - Flügge, Tabea A1 - Cotton, Ross A1 - Vinayahalingam, Shankeeth A1 - Ilesan, Robert A1 - Raith, Stefan A1 - Madsen, Dennis A1 - Seibold, Constantin A1 - Xi, Tong A1 - Bergé, Stefaan A1 - Nebelung, Sven A1 - Kodym, Oldřich A1 - Sundqvist, Osku A1 - Thieringer, Florian A1 - Lamecker, Hans A1 - Coppens, Antoine A1 - Potrusil, Thomas A1 - Kraeima, Joep A1 - Witjes, Max A1 - Wu, Guomin A1 - Chen, Xiaojun A1 - Lambrechts, Adriaan A1 - Cevidanes, Lucia H Soares A1 - Zachow, Stefan A1 - Hermans, Alexander A1 - Truhn, Daniel A1 - Alves, Victor A1 - Egger, Jan A1 - Röhrig, Rainer A1 - Hölzle, Frank A1 - Puladi, Behrus T1 - Beyond Benchmarks: Towards Robust Artificial Intelligence Bone Segmentation in Socio-Technical Systems JF - Expert Systems With Applications N2 - Despite the advances in automated medical image segmentation, AI models still underperform in various clinical settings, challenging real-world integration. In this multicenter evaluation, we analyzed 20 state-of-the-art mandibular segmentation models across 19,218 segmentations of 1,000 clinically resampled CT/CBCT scans. We show that segmentation accuracy varies by up to 25% depending on socio-technical factors such as voxel size, bone orientation, and patient conditions such as osteosynthesis or pathology. Higher sharpness, isotropic smaller voxels, and neutral orientation significantly improved results, while metallic osteosynthesis and anatomical complexity led to significant degradation. Our findings challenge the common view of AI models as “plug-and-play” tools and suggest evidence-based optimization recommendations for both clinicians and developers. This will in turn boost the integration of AI segmentation tools in routine healthcare. Y1 - 2025 UR - https://www.medrxiv.org/content/10.1101/2025.06.11.25329022v1 U6 - https://doi.org/10.1016/j.eswa.2025.130031 VL - 299 IS - Part D ER -