Systems and methods are disclosed for manipulating image annotations. One method includes receiving an image of an individual's anatomy; automatically determining, using a processor, one or more annotations for anatomical features identified in the image of the individual's anatomy; determining a dependency or hierarchy between at least two of the one or more annotations for anatomical features identified in the image of the individual's anatomy; and generating, based on the dependency or hierarchy, a workflow prompting a user to manipulate the one or more annotations for anatomical features identified in the image of the individual's anatomy.