European Radiology

, Volume 28, Issue 11, pp 4586–4597 | Cite as

Stylus/tablet user input device for MRI heart wall segmentation: efficiency and ease of use

  • Bedros Taslakian
  • Antonio Pires
  • Dan Halpern
  • James S. Babb
  • Leon AxelEmail author



To determine whether use of a stylus user input device (UID) would be superior to a mouse for CMR segmentation.


Twenty-five consecutive clinical cardiac magnetic resonance (CMR) examinations were selected. Image analysis was independently performed by four observers. Manual tracing of left (LV) and right (RV) ventricular endocardial contours was performed twice in 10 randomly assigned sessions, each session using only one UID. Segmentation time and the ventricular function variables were recorded. The mean segmentation time and time reduction were calculated for each method. Intraclass correlation coefficients (ICC) and Bland-Altman plots of function variables were used to assess intra- and interobserver variability and agreement between methods. Observers completed a Likert-type questionnaire.


The mean segmentation time (in seconds) was significantly less with the stylus compared to the mouse, averaging 206±108 versus 308±125 (p<0.001) and 225±140 versus 353±162 (p<0.001) for LV and RV segmentation, respectively. The intra- and interobserver agreement rates were excellent (ICC≥0.75) regardless of the UID. There was an excellent agreement between measurements derived from manual segmentation using different UIDs (ICC≥0.75), with few exceptions. Observers preferred the stylus.


The study shows a significant reduction in segmentation time using the stylus, a subjective preference, and excellent agreement between the methods.

Key Points

• Using a stylus for MRI ventricular segmentation is faster compared to mouse

• A stylus is easier to use and results in less fatigue

• There is excellent agreement between stylus and mouse UIDs


Magnetic resonance imaging Radiology Heart Cardiac imaging techniques Image processing, computer-assisted 



Analysis of variance


Cardiac magnetic resonance


Coefficient of variation




End-diastolic volume


Ejection fraction




End-systolic volume


Intra-class correlation coefficient


Limits of agreement


Left ventricle


Right ventricle






Steady-state free precession


Stroke volume


User input device



The work has been submitted for consideration as a scientific presentation to the RSNA 2017 annual meeting.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Dr. Leon Axel.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• Retrospective performed at one institution

Supplementary material

330_2018_5435_MOESM1_ESM.docx (15 kb)
Supplemental material 1 Subject Characteristics (DOCX 14.9 kb)
330_2018_5435_Fig7_ESM.jpg (97 kb)
Supplemental material 2

Boxplot of the ordinal scores for subjective level of comfort, ease of use, and level of confidence provided by all observers for each method. In each plot, the box represents the inter-quartile range, extending from the first quartile (Q1) to the third quartile (Q3). The line segment containing a diamond at the edge of the box is drawn at the median. The whiskers extend down to the lowest observed value > Q1 – 1.5*(Q3 – Q1) and up to the highest observed value < Q3 + 1.5*(Q3 – Q1). Outliers, representing observed values beyond the whiskers, are denoted by a solid circle. (JPEG 97.3 kb)

330_2018_5435_MOESM2_ESM.tif (28.7 mb)
High resolution image (TIFF 28.7 MB)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologyNYU Langone Medical CenterNew YorkUSA
  2. 2.Department of Internal MedicineNYU Langone Medical CenterNew YorkUSA

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