*Article* **Novel Biased Normalized Cuts Approach for the Automatic Segmentation of the Conjunctiva**

**Giovanni Dimauro 1,***∗* **and Lorenzo Simone 2**


Received: 18 May 2020; Accepted: 9 June 2020; Published: 14 June 2020

**Abstract:** Anemia is a common public health disease diffused worldwide. In many cases it affects the daily lives of patients needing medical assistance and continuous monitoring. Medical literature states empirical evidence of a correlation between conjunctival pallor on physical examinations and its association with anemia diagnosis. Although humans exhibit a natural expertise in pattern recognition and associative skills based on hue properties, the variance of estimates is high, requiring blood sampling even for monitoring. To design automatic systems for the objective evaluation of pallor utilizing digital images of the conjunctiva, it is necessary to obtain reliable automatic segmentation of the eyelid conjunctiva. In this study, we propose a graph partitioning segmentation approach. The semantic segmentation procedure of a diagnostically meaningful region of interest has been proposed for exploiting normalized cuts for perceptual grouping, thereby introducing a bias towards spectrophotometry features of hemoglobin. The reliability of the identification of the region of interest is demonstrated both with standard metrics and by measuring the correlation between the color of the ROI and the hemoglobin level based on 94 samples distributed in relation to age, sex and hemoglobin concentration. The region of interest automatically segmented is suitable for diagnostic procedures based on quantitative hemoglobin estimation of exposed tissues of the conjunctiva.

**Keywords:** semantic segmentation; pattern recognition; hemoglobin; anemia; human tissues; conjunctiva; non-invasive medical device
