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From the The ITK Software Guide: "The criterion used by the Confidence Connected method is based on simple statistics of the current region. First, the algorithm computes the mean and standard deviation of intensity values for all the pixels currently included in the region. A user-provided factor (Multiplier)is used to multiply the standard deviation and define a range around the mean. Neighbor pixels whose intensity values fall inside the range are accepted and included in the region. When no more neighbor pixels are found that satisfy the criterion, the algorithm is considered to have finished its first iteration. At that point, the mean and standard deviation of the intensity levels are recomputed using all the pixels currently included in the region. This mean and standard deviation defines a new intensity range that is used to visit current region neighbors and evaluate whether their intensity falls inside the range. This iterative process is repeated until no more pixels are added or the maximum number of iterations is reached.

The number of Iterations is specified based on the homogeneity of the intensities of the anatomical structure to be segmented. Highly homogeneous regions may only require a couple of iterations. Regions with ramp effects, like MRI images with inhomogeneous fields, may require more iterations. In practice, it seems to be more important to carefully select the multiplier factor than the number of iterations. However, keep in mind that there is no reason to assume that this algorithm should converge to a stable region. It is possible that by letting the algorithm run for more iterations the region will end up engulfing the entire image."

The initialization of the algorithm requires the user to provide a seed point. It is convenient to select this point to be placed in a typical region of the anatomical structure to be segmented. A small initial neighborhood Radius around the seed point will be used to compute the initial mean and standard deviation for the inclusion criterion.