FedAgain: A Trust-Based and Robust Federated Learning Strategy for an Automated Kidney Stone Identification in Ureteroscopy

Recent innovations in deep learning have significantly enhanced the diagnosis of medical images, although they are based on the use of centralized data storage that pose severe threats to patient privacy and medical data security. To address this issue, this research proposes a Federated Learning (FL) model that is coupled with an optimized YOLOv8 network to detect the kidney stones on a computed tomography (CT) image and at the same time, protect privacy of the patients. The suggested system can help various medical organizations to jointly train a common model without exchanging the information about the patients. This is to ensure that data protection laws like GDPR and HIPAA are adhered to. The residual feature fusion and DropBlock regularization among other architectural improvements are also included in YOLOv8 to enhance detection robustness and minimize overfitting. Experimental analysis carried out on a distributed CT dataset demonstrated that the federated YOLOv8 model has a mAP at 50 of 0.733 and is able to keep the data confidential. Moreover, its lean design facilitates fast edge deployment and real-time inference across a clinical setting. Altogether, these findings indicate that Federated Learning is a safe and efficient solution to AI-assisted diagnosis in contemporary healthcare when combined with the use of sophisticated object detection models.

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 (FL) enables collaborative model training without sharing raw patient data, but standard approaches such as FedAvg treat each client as a black box and provide no mechanism for isolating an adversarial contributor, auditing per-client influence, or honoring a departed participant's right to be forgotten. We present Fed-FBD (Federated Functional Block Diversification), a modular federated architecture that decomposes a ResNet backbone into six functional blocks (the stem, four residual groups, and the classification head) and maintains a warehouse of N color variants, each assembled from independently tracked and contributor-stamped blocks. Fed-FBD provides three capabilities absent in FedAvg: (i) architecturally guaranteed block-level isolation, so that an adversarial or mislabelled client cannot contaminate the clean colous; (ii) privacy-by-design, where membership inference advantage is already indistinguishable from chance before any privacy mechanism is applied; and (iii) surgical machine unlearning of a departed participant's contribution at sub-second cost and without retraining. Experiments on six MedMNIST-2D datasets, PathMNIST at 224x224, and CIFAR-10 show that Fed-FBD trades a modest 0.3%-3.1% IID accuracy gap on the adequately sized datasets for these guarantees, remains within 0.8%-4.0% of FedAvg at Dirichlet alpha=1.0 on three of four datasets, and confines all six adversarial attacks we study to the poisoned client's own blocks with at most +/-0.01 AUC drift on the clean colors.