Probabilistic Feature Imputation and Uncertainty-Aware Multimodal Federated Aggregation

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.

In this paper, we address the problem of multimodal federated learning with missing modality. Existing methods utilize an additional public dataset or perform naive feature synthesis that is based solely on the available modality. To address these limitations, we propose ProMoE-FL, a Prototype-conditioned Mixture-of-Experts framework for robust missing-modality feature synthesis in multimodal federated learning. ProMoE-FL builds a global client-aware prototype bank that captures clinically meaningful modality priors across institutions. Our Mixture of Experts is conditioned on these prototypes and modality indices to enable direction-aware expert routing for dynamically synthesizing missing features. We perform extensive quantitative and qualitative evaluations on four public chest X-ray datasets (MIMIC-CXR, NIH Open-I, PadChest, and CheXpert) and demonstrate that ProMoE-FL consistently outperforms state-of-the-art methods in both homogeneous as well as the more challenging heterogeneous settings.

Multimodal Federated Learning (MMFL) enables privacy-preserving collaborative training, but real-world clinical applications often suffer from within-modality missingness caused by sensor intermittency or irregular sampling. Existing methods implicitly represent unobserved data via architectural alignment or missing embeddings, often failing to recover the true distribution and yielding sub-optimal performance. We propose CondI, a federated framework explicitly addressing this missingness using conditional diffusion models. CondI employs a two-phase training pipeline: first, imputing unobserved temporal components using available multimodal context and conditional embeddings; second, optimizing modality-specific extractors and joint embedding spaces. During inference, imputed raw data pass through trained extractors to generate robust features, providing a holistic representation for downstream tasks. Explicit data imputation ensures models operate on complete semantic structures, significantly enhancing resilience against severe data incompleteness. Experiments on three clinical datasets (PTB-XL, SLEEP-EDF, MIMIC-IV) demonstrate CondI achieves comparable results to state-of-the-art baselines. Code: https://github.com/ZhengWugeng/CondI