Oral-Anatomical Knowledge-Informed Semi-Supervised Learning for 3D Dental CBCT Segmentation and Lesion Detection

Cone beam computed tomography (CBCT) is a widely-used imaging modality in dental healthcare. It is an important task to segment each 3D CBCT image, which involves labeling lesions, bones, teeth, and restorative materials on a voxel-by-voxel basis, as it aids in lesion detection, diagnosis, and treatment planning. The current clinical practice relies on manual segmentation, which is labor-intensive and demands considerable expertise. Leveraging Artificial Intelligence (AI) to fully automate the segmentation process could tremendously improve the quality and efficiency of dental healthcare. The main hurdle in this advancement is reducing AI’s reliance on a large quantity of manually labeled images to train robust, accurate, and generalizable algorithms. To tackle this challenge, we propose a novel Oral-Anatomical Knowledge-informed Semi-Supervised Learning (OAK-SSL) model for 3D CBCT image segmentation and lesion detection. The uniqueness of OAK-SSL is its capability of integrating qualitative oral-anatomical knowledge of plausible lesion locations into the deep learning design. Specifically, the unique design of OAK-SSL includes three key elements, including transformation of qualitative knowledge into quantitative representation, knowledge-informed dual-task learning architecture, and knowledge-informed semi-supervised loss function. We apply OAK-SSL to a real-world dataset, focusing on segmenting CBCT images that contain small lesions. This task is inherently challenging yet holds significant clinical value as treating lesions at their early stages lead to excellent prognosis. OAK-SSL demonstrated significantly better performance than a range of existing methods. Note to Practitioners—This study tackles the challenges arising from a limited amount of labeled data due to the time-consuming manual segmentation of 3D dental cone beam computed tomography (CBCT) images. The scarcity of labeled data often impedes AI models from accurately segmenting periapical lesions. To overcome this, we introduce a novel semi-supervised learning algorithm that integrates the oral-anatomical knowledge about lesion location for 3D CBCT image segmentation. Our method effectively segments periapical lesions, including even small-sized periapical lesions, without solely relying on labeled data. The proposed method offers two significant benefits to clinicians. First, it reduces the necessity for large amounts of labeled data, particularly easing the burden of manually segmenting early-stage periapical lesions. Second, it helps reduce intra- and inter-observer disagreements and human errors by providing consistent and automated segmentation maps. These benefits not only simplify the segmentation process in dental imaging but also improve its reliability. As a result, our automated algorithm makes it easier and more trustworthy for practitioners. However, practitioners should be aware that the effectiveness of our method relies on the assumption of consistency between labeled and unlabeled data. When applying this method, it is crucial to carefully consider the characteristics of the unlabeled dataset. Significant differences in image quality, patient demographics, or acquisition parameters between labeled and unlabeled data might affect model performance.