This study presents an automatic method to trace the boundary of the tumour in positron emission tomography (PET) images. It has been discovered that Otsu's threshold value is biased when the within-class variances between the object and the background are significantly different. To solve the problem, a double-stage threshold search that minimizes the energy between the first Otsu's threshold and the maximum intensity value is introduced. Such shifted-optimal thresholding is embedded into a region-based active contour so that both algorithms are performed consecutively. The efficiency of the method is validated using six sphere inserts (0.52-26.53 cc volume) of the IEC/2001 torso phantom. Both spheres and phantom were filled with (18)F solution with four source-to-background ratio (SBR) measurements of PET images. The results illustrate that the tumour volumes segmented by combined algorithm are of higher accuracy than the traditional active contour. The method had been clinically implemented in ten oesophageal cancer patients. The results are evaluated and compared with the manual tracing by an experienced radiation oncologist. The advantage of the algorithm is the reduced erroneous delineation that improves the precision and accuracy of PET tumour contouring. Moreover, the combined method is robust, independent of the SBR threshold-volume curves, and it does not require prior lesion size measurement.