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Indeed, existing approaches may easily fail in the presence of some abnormalities caused by a disease, trauma, or previous surgery. For robustness, we present ALTIS (implementation is available at <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/lids.ic.unicamp.br\/downloads\">http:\/\/lids.ic.unicamp.br\/downloads<\/jats:ext-link>) \u2014 a fast automatic lung and trachea CT\u2010image segmentation method that relies on image features and relative shape\u2010 and intensity\u2010based characteristics less affected by most appearance variations of abnormal lungs and trachea.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>ALTIS consists of a sequence of image foresting transforms (IFTs) organized in three main steps: (a) lung\u2010and\u2010trachea extraction, (b) seed estimation inside background, trachea, left lung, and right lung, and (c) their delineation such that each object is defined by an optimum\u2010path forest rooted at its internal seeds. We compare ALTIS with two methods based on shape models (SOSM\u2010S and MALF), and one algorithm based on seeded region growing (PTK).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The experiments involve the highest number of scans found in literature \u2014 1255 scans, from multiple public data sets containing many anomalous cases, being only 50 normal scans used for training and 1205 scans used for testing the methods. Quantitative experiments are based on two metrics, DICE and ASSD. Furthermore, we also demonstrate the robustness of ALTIS in seed estimation. Considering the test set, the proposed method achieves an average DICE of 0.987 for both lungs and 0.898 for the trachea, whereas an average ASSD of 0.938 for the right lung, 0.856 for the left lung, and 1.316 for the trachea. These results indicate that ALTIS is statistically more accurate and considerably faster than the compared methods, being able to complete segmentation in a few seconds on modern PCs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ALTIS is the most effective and efficient choice among the compared methods to segment left lung, right lung, and trachea in anomalous CT scans for subsequent detection, segmentation, and quantitative analysis of abnormal structures in the lung parenchyma and pleural space.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.13773","type":"journal-article","created":{"date-parts":[[2019,8,22]],"date-time":"2019-08-22T03:53:39Z","timestamp":1566446019000},"page":"4970-4982","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["ALTIS: A fast and automatic lung and trachea CT\u2010image segmentation method"],"prefix":"10.1002","volume":"46","author":[{"given":"Azael M.","family":"Sousa","sequence":"first","affiliation":[{"name":"Laboratory of Image Data Science Institute of Computing University of Campinas Campinas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel B.","family":"Martins","sequence":"additional","affiliation":[{"name":"Laboratory of Image Data Science Institute of Computing University of Campinas Campinas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre X.","family":"Falc\u00e3o","sequence":"additional","affiliation":[{"name":"Laboratory of Image Data Science Institute of Computing University of Campinas Campinas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiano","family":"Reis","sequence":"additional","affiliation":[{"name":"School of Medical Sciences University of Campinas Campinas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ericson","family":"Bagatin","sequence":"additional","affiliation":[{"name":"School of Medical Sciences University of Campinas Campinas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Irion","sequence":"additional","affiliation":[{"name":"Department of Radiology Manchester University NHS Campinas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,9,11]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1109\/42.929615"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1109\/TITB.2007.899504"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2008.929101"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2014.2337057"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2005.857654"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.156.1.9606093"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.174.5.1741315"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2015140232"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acra.2004.06.005"},{"key":"e_1_2_7_11_1","doi-asserted-by":"crossref","unstructured":"ShojaiiR AlirezaieJ BabynP.Automatic lung segmentation in CT images using watershed transform. 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