Trust Aware Federated Learning for Secure Bone Healing Stage Interpretation in e-Health

Byzantine-robust federated learning seeks to protect distributed model training from malicious or corrupted clients without requiring access to their private data. FLTrust addresses this challenge by introducing a trusted server-side root dataset that assigns trust scores to client updates for more robust aggregation. In this work, we propose FOGGYTRUST, a hierarchical extension of FLTrust that localizes trust computation to fog nodes, allowing the framework to better handle globally heterogeneous data while preserving robustness within locally homogeneous client groups. We further show that this two-level architecture can simultaneously address distribution mismatch in trust estimation and client drift across groups by combining local trust-based aggregation with heterogeneity-aware global optimizers such as FedAdam and SCAFFOLD. Across benchmark datasets, FOGGYTRUST achieves its strongest gains on more challenging heterogeneous settings, particularly on CIFAR-10 under Krum and Trim attacks, where it achieves an over 50% improvement over FLTrust. We also test FOGGYTRUST in a real-world safari dataset to show the promise of hierarchical trust networks for robust federated learning in socially impactful, safety-critical settings such as distributed wildlife monitoring.

Protecting patient privacy remains a fundamental barrier to scaling machine learning across healthcare institutions, where centralizing sensitive data is often infeasible due to ethical, legal, and regulatory constraints. Federated learning offers a promising alternative by enabling privacy-preserving, multi-institutional training without sharing raw patient data; however, real-world deployments face severe challenges from data heterogeneity, site-specific biases, and class imbalance, which degrade predictive reliability and render existing uncertainty quantification methods ineffective. Here, we present TrustFed, a federated uncertainty quantification framework that provides distribution-free, finite-sample coverage guarantees under heterogeneous and imbalanced healthcare data, without requiring centralized access. TrustFed introduces a representation-aware client assignment mechanism that leverages internal model representations to enable effective calibration across institutions, along with a soft-nearest threshold aggregation strategy that mitigates assignment uncertainty while producing compact and reliable prediction sets. Using over 430,000 medical images across six clinically distinct imaging modalities, we conduct one of the most comprehensive evaluations of uncertainty-aware federated learning in medical imaging, demonstrating robust coverage guarantees across datasets with diverse class cardinalities and imbalance regimes. By validating TrustFed at this scale and breadth, our study advances uncertainty-aware federated learning from proof-of-concept toward clinically meaningful, modality-agnostic deployment, positioning statistically guaranteed uncertainty as a core requirement for next-generation healthcare AI systems.

Federated learning enables hospitals to collaboratively train segmentation models without sharing patient data. However, current evaluation protocols report only average performance across clients, masking failures at individual sites. In clinical deployment, a model that fails consistently at one hospital is a real safety risk that a good mean score can hide entirely. We introduce MedFL-Stress, a controlled stress-testing framework that exposes exactly this failure mode. Using 2D axial slices from BraTS 2020 distributed across four simulated hospital clients, we apply graded MRI appearance shifts (gamma contrast, scale-shift, and noise-plus-blur) reflecting scanner and acquisition variability in real multi-site deployments. Three federated baselines are evaluated: FedAvg, FedProx, and FedBN. Worst-hospital Dice and inter-hospital disparity are treated as primary metrics, not supplementary observations. FedAvg achieves the highest global mean Dice (0.8159) but conceals a 0.0850 gap between its best and worst-performing hospital. FedBN closes that gap by 41% (0.0850 to 0.0503) while sacrificing less than half a Dice point in mean accuracy (0.8159 to 0.8109), and the weakest hospital gains 3.5 Dice points outright (0.7309 to 0.7656). These findings demonstrate that robustness-oriented evaluation protocols are essential for reliable federated medical imaging deployment.