This paper evaluates the effectiveness of an interactive, three-dimensional image segmentation technique that relies on watersheds. This paper presents two user-based case studies, which include two different groups of domain experts. Subjects manipulate a graphics-based front end to a hierarchy of segmented regions generated from a watershed segmentation algorithm, which is implemented in the Insight Toolkit. In the first study, medical students segment several different anatomical structures from the Visible Human Female head and neck color cryosection data. In the second study, radiologists use the interactive tool to produce models of brain tumors from MRI data. This paper presents a quantitative and qualitative comparison against hand contouring. To quantify accuracy, we estimate ground truth from the hand-contouring data using the Simultaneous Truth and Performance Estimation algorithm. We also apply metrics from the literature to estimate precision and efficiency. The watershed segmentation technique showed improved subject interaction times and increased inter-subject precision over hand contouring, with quality that is visually and statistically comparable. The analysis also identifies some failures in the watershed technique, where edges were poorly defined in the data, and note a trend in the hand-contouring results toward systematically larger segmentations, which raises questions about the wisdom of using expert segmentations to define ground truth.