Accurate segmentations in medical imaging form a crucial role in many applications from pa-
tient diagnosis to population studies. As the amount of data generated from medical images
increases, the ability to perform this task without human intervention becomes ever more de-
sirable. One approach, known broadly as atlas-based segmentation, is to propagate labels from
images which have already been manually labelled by clinical experts. Methods using this ap-
proach have been shown to be e ective in many applications, demonstrating great potential for
automatic labelling of large datasets. However, these methods usually require the use of image
registration and are dependent on the outcome of the registration. Any registrations errors
that occur are also propagated to the segmentation process and are likely to have an adverse
e ect on segmentation accuracy. Recently, patch-based methods have been shown to allow a
relaxation of the required image alignment, whilst achieving similar results. In general, these
methods label each voxel of a target image by comparing the image patch centred on the voxel
with neighbouring patches from an atlas library and assigning the most likely label according
to the closest matches. The main contributions of this thesis focuses around this approach
in providing accurate segmentation results whilst minimising the dependency on registration
quality. In particular, this thesis proposes a novel kNN patch-based segmentation framework,
which utilises both intensity and spatial information, and explore the use of spatial context in
a diverse range of applications. The proposed methods extend the potential for patch-based
segmentation to tolerate registration errors by rede ning the \locality" for patch selection and
comparison, whilst also allowing similar looking patches from di erent anatomical structures
to be di erentiated. The methods are evaluated on a wide variety of image datasets, ranging
from the brain to the knees, demonstrating its potential with results which are competitive to
state-of-the-art techniques.