Unlocking Multi-Site Clinical Data: A Federated Approach to Privacy-First Child Autism Behavior Analysis

The growing availability of clinical data has increased the use of machine learning, yet centralized data aggregation is often infeasible for sensitive health information. Federated Learning (FL) offers a distributed alternative, but its adoption is limited by substantial heterogeneity across institutional datasets, making harmonization a critical but frequently overlooked prerequisite for multi-site analytics. We introduce PrivFusion, a privacy-preserving multi-agent framework that automates the harmonization of structured datasets prior to federated training. PrivFusion uses agents to analyze local data, cluster semantically similar features across sites, and provide iterative transformation recommendations until alignment is achieved. Evaluation across four heterogeneous COVID-19 datasets demonstrates that PrivFusion effectively and efficiently harmonizes multi-site data while substantially reducing manual effort.

Infant movement analysis provides valuable biomarkers for the early identification of neurodevelopmental disorders. Recent advances in deep learning have enabled automated analysis of infant movements from video-derived skeletal representations, achieving performance comparable to expert assessment for tasks such as General Movement Assessment (GMA). However, most existing approaches rely on centralized training, requiring data from multiple institutions to be collected and stored at a single site. Such assumptions are often impractical in clinical settings due to privacy, governance, and data-sharing constraints. To address these challenges, we present, to the best of our knowledge, the first federated learning framework for automated infant movement analysis and General Movement Assessment using skeletal motion data. As a clinically relevant use case, the proposed framework is evaluated on fidgety movement classification. To quantify model confidence, Monte Carlo (MC) Dropout is employed to estimate predictive uncertainty during inference. Building upon this, we propose an Uncertainty-Aware Federated Averaging (UA-FedAvg) strategy that incorporates predictive entropy derived from MC-Dropout into the federated aggregation process, enabling client contributions to be adjusted according to their predictive uncertainty. Experiments were conducted using a cross-subject evaluation protocol under a three-client federated learning setting. Results demonstrate that federated learning substantially improves classification performance compared with independently trained local models while achieving performance approaching that of centralized training. Furthermore, UA-FedAvg and its variant incorporating validation loss generally outperform conventional FedAvg across the evaluated data-split configurations.

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.