Three-dimensional (3-D) visualization has become an essential part for imaging applications, including image-guided surgery, radiotherapy planning, and computer-aided diagnosis. In the visualization of dual-modality positron emission tomography and computed tomography (PET/CT), 3-D volume rendering is often limited to rendering of a single image volume and by high computational demand. Furthermore, incorporation of segmentation in volume rendering is usually restricted to visualizing the presegmented volumes of interest. In this paper, we investigated the integration of interactive segmentation into real-time volume rendering of dual-modality PET/CT images. We present and validate a fuzzy thresholding segmentation technique based on fuzzy cluster analysis, which allows interactive and real-time optimization of the segmentation results. This technique is then incorporated into a real-time multi-volume rendering of PET/CT images. Our method allows a real-time fusion and interchangeability of segmentation volume with PET or CT volumes, as well as the usual fusion of PET/CT volumes. Volume manipulations such as window level adjustments and lookup table can be applied to individual volumes, which are then fused together in real time as adjustments are made. We demonstrate the benefit of our method in integrating segmentation with volume rendering in its application to PET/CT images. Responsive frame rates are achieved by utilizing a texture-based volume rendering algorithm and the rapid transfer capability of the high-memory bandwidth available in low-cost graphic hardware.