Deep Learning-based Assessment of the Relation Between the Third Molar and Mandibular Canal on Panoramic Radiographs using Local, Centralized, and Federated Learning

Deep learning-based organs/structures-at-risk(OARs) auto-contouring models can improve radiotherapy workflows, but models trained on adult data often underperform in pediatric patients. Developing robust pediatric-specific models is hindered by data scarcity and fragmentation across centers. Federated learning (FL) enables privacy-preserving collaborative training without the need for data sharing. We evaluated the feasibility and performance of FL for developing pediatric-specific OAR segmentation models across two European medical centers. Computed tomography (CT) images from pediatric patients from Utrecht and Heidelberg with a renal tumor or abdominal neuroblastoma were retrospectively collected and locally processed. An nnU-Net-based framework segmented 19 OARs using local and FL schemes. FL was implemented with secure weight exchange on a cloud storage across institutional firewalls. Performance was assessed using the Dice similarity coefficient (DSC), 95th percentile Hausdorff distance, and mean surface distance. Robustness to patient orientation, false-positive segmentation of surgically removed kidneys, and failure cases were identified. A total of 310 postoperative CTs from 272 patients (105 renal tumors, 167 neuroblastomas) were included. Local models performed well on their respective center data but showed significantly reduced cross-center performance for four to seven of the nine evaluated OARs (DSC). In contrast, the FL model matched local performance for at least seven of nine OARs and achieved the best cross-center results across three metrics, with DSC gains of 0.003-0.007 over local models. FL also maintained stable performance across patient orientations and reduced false-positive kidney segmentations. Real-world FL improves cross-center robustness of CT-based OAR segmentation models in pediatric upper abdominal tumors.

Dental caries and endodontic disease are among the most common health conditions worldwide, and intraoral periapical radiographs are central to their detection, treatment planning, and follow-up. Automated tooth-level classification of these images, however, lacks reproducible benchmarks, is often evaluated with image-level splits that leak patients between training and test, and is rarely validated across clinics. This paper presents the first patient-level, leakage-aware classification benchmark for single-tooth intraoral periapical radiographs on the DentIRO dataset, which comprises 5,300 images from 3,243 patients across two clinics and four classes: Healthy, Caries, Crowned, and Root Canal. Five transfer-learning models are compared with patient-grouped stratified cross-validation, so that every patient remains within a single fold. DenseNet121 gave the strongest and most stable result at a mean macro-F1 of 0.9787, while the four ImageNet-initialized backbones performed comparably. A controlled comparison on a fixed architecture showed that chest-radiograph pretraining transferred less effectively than ImageNet initialization. Bidirectional cross-center validation produced a small average generalization gap of 0.0077, and Grad-CAM confirmed that predictions rely on clinically meaningful tooth regions rather than acquisition artifacts. The benchmark offers a rigorous and reproducible baseline for intraoral radiograph classification.

Artificial intelligence models are promising for medical diagnosis, but they require large numbers of unbiased data, which in medicine are distributed across hospitals and cannot be centralized to protect patient privacy. Federated Learning (FL) addresses this, since hospitals train one shared diagnostic model while patient data remain local. Training proceeds in communication rounds, in which each hospital trains the shared model locally and returns it to the server for merging by weighted average. This aggregation weight determines whose institutional knowledge shapes the result. Federated averaging (FedAvg) sets it in proportion to local sample count, so a small but informative hospital is permanently assigned a small influence, andl argest clients could dominate the global model even when they are less informative. We propose Federated Dual Reputation Annealing Weighting (FedDRAW), a server-side aggregation method that combines a data-size prior with the cosine similarity between client and global parameters under two coupled annealing schedules. An inner schedule shifts client reputation from the size prior towards similarity. An outer, deferred annealing schedule on the softmax inverse temperature keeps the weighting selective in the early and middle rounds and relaxes it to uniformity at convergence. We evaluate FedDRAW on 12 simulated client-partition scenarios of two chest radiograph datasets (CheXpert and ChestMNIST), against seven federated baselines under identical local training settings. FedDRAW achieved the highest average rank among all eight methods under both AUC and the geometric mean (GM) of sensitivity and specificity, which a Friedman test with Nemenyi post-hoc analysis confirmed to be a statistically significant difference between the methods. Scheduling two signals, rather than fixing the weights by sample count alone, could enable less biased diagnostic models.