Benchmark of Segmentation Techniques for Pelvic Fracture in CT and X-ray: Summary of the PENGWIN 2024 Challenge

The segmentation of pelvic fracture fragments in CT and X-ray images is crucial for trauma diagnosis, surgical planning, and intraoperative guidance. However, accurately and efficiently delineating the bone fragments remains a significant challenge due to complex anatomy and imaging limitations. The PENGWIN challenge, organized as a MICCAI 2024 satellite event, aimed to advance automated fracture segmentation by benchmarking state-of-the-art algorithms on these complex tasks. A diverse dataset of 150 CT scans was collected from multiple clinical centers, and a large set of simulated X-ray images was generated using the DeepDRR method. Final submissions from 16 teams worldwide were evaluated under a rigorous multi-metric testing scheme. The top-performing CT algorithm achieved an average fragment-wise intersection over union (IoU) of 0.930, demonstrating satisfactory accuracy. However, in the X-ray task, the best algorithm attained an IoU of 0.774, highlighting the greater challenges posed by overlapping anatomical structures. Beyond the quantitative evaluation, the challenge revealed methodological diversity in algorithm design. Variations in instance representation, such as primary-secondary classification versus boundary-core separation, led to differing segmentation strategies. Despite promising results, the challenge also exposed inherent uncertainties in fragment definition, particularly in cases of incomplete fractures. These findings suggest that interactive segmentation approaches, integrating human decision-making with task-relevant information, may be essential for improving model reliability and clinical applicability.

@article{sang2025_2504.02382,
  title={ Benchmark of Segmentation Techniques for Pelvic Fracture in CT and X-ray: Summary of the PENGWIN 2024 Challenge },
  author={ Yudi Sang and Yanzhen Liu and Sutuke Yibulayimu and Yunning Wang and Benjamin D. Killeen and Mingxu Liu and Ping-Cheng Ku and Ole Johannsen and Karol Gotkowski and Maximilian Zenk and Klaus Maier-Hein and Fabian Isensee and Peiyan Yue and Yi Wang and Haidong Yu and Zhaohong Pan and Yutong He and Xiaokun Liang and Daiqi Liu and Fuxin Fan and Artur Jurgas and Andrzej Skalski and Yuxi Ma and Jing Yang and Szymon Płotka and Rafał Litka and Gang Zhu and Yingchun Song and Mathias Unberath and Mehran Armand and Dan Ruan and S. Kevin Zhou and Qiyong Cao and Chunpeng Zhao and Xinbao Wu and Yu Wang },
  journal={arXiv preprint arXiv:2504.02382},
  year={ 2025 }
}