Interactive AI annotation of medical images in a virtual reality environment

Purpose: Artificial intelligence (AI) achieves high-quality annotations of radiological images, yet often lacks the robustness required in clinical practice. Interactive annotation starts with an AI-generated delineation, allowing radiologists to refine it with feedback, potentially improving precision and reliability. These techniques have been explored in two-dimensional desktop environments, but are not validated by radiologists or integrated with immersive visualization technologies. We used a Virtual Reality (VR) system to determine whether (1) the annotation quality improves when radiologists can edit the AI annotation and (2) whether the extra work done by editing is worthwhile. Methods: We evaluated the clinical feasibility of an interactive VR approach to annotate mandibular and mental foramina on segmented 3D mandibular models. Three experienced dentomaxillofacial radiologists reviewed AI-generated annotations and, when needed, refined them at the voxel level in 3D space through click-based interactions until clinical standards were met. Results: Our results indicate that integrating expert feedback within an immersive VR environment enhances annotation accuracy, improves clinical usability, and offers valuable insights for developing medical image analysis systems incorporating radiologist input. Conclusion: This study is the first to compare the quality of original and interactive AI annotation and to use radiologists’ opinions as the measure. More research is needed for generalization.