For each of a number of landmarks in an image an initial position of the landmark is defined. Next a neighborhood around the initial position, comprising a number of candidate locations of the landmark is sampled and a cost is associated with each of the candidate locations. A cost function expressing a weighted sum of overall gray level cost and overall shape cost for all candidate locations is optimized. A segmented anatomic entity is defined as a path through a selected combination of candidate locations for which combination the cost function is optimized.