Overcoming data scarcity through multi-center federated learning for organs-at-risk segmentation in pediatric upper abdominal radiotherapy
Authors: Mianyong Ding, Maximilian Knoll, Semi Harrabi, Martine van Grotel, Annemieke S. Littooij, Max van Noesel, Jens-Peter Schenk, Marry M. van den Heuvel-Eibrink, +2 more
Organizations: Department of Radiation Oncology, Imaging and Cancer Division, University Medical Centre Utrecht, Utrecht, The Netherlands · University Hospital Heidelberg, Heidelberg Ion Beam Therapy Centre (HIT), Department of Radiation Oncology, Heidelberg, Germany · Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands · Division Imaging & Cancer, University Medical Center Utrecht, Utrecht, The Netherlands · Wilhelmina Children’s Hospital-Division of CHILD HEALTH, University Medical Centre Utrecht, University of Utrecht, Utrecht, the Netherlands · Computational Imaging Group for MR Diagnostics & Therapy, Centre for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
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.
Multi-organ segmentation using deep learning requires large amounts of annotated patient data; however, institutions often lack sufficiently large and diverse annotated datasets. Privacy constraints further prevent institutions from sharing patient data to overcome this limitation. Moreover, due to the labor-intensive nature of annotation and the scarcity of diverse expertise, institutions typically have labels for only a small portion of their local data, leaving the larger unlabeled portion unused. In this work, we propose a flexible semi-supervised federated multi-task student-teacher framework that leverages federated learning (FL) to improve multi-organ segmentation using both labeled and unlabeled data across participating sites. At each communication round, the proposed framework initiates local training, where clients with labels for the same task form a federation to produce an aggregated teacher model. The resulting teachers generate task-specific features for all data at each client. Subsequently, all clients form a second federation to train a multi-task student model with a shared encoder and task-specific decoders that replicate the teacher-generated features across all segmentation tasks. The aggregated student model is then used to update the local teachers and initiate the next training round. Extensive experiments demonstrated the effectiveness of the proposed method compared with local and federated single-organ models, yielding an average performance gain of 13 percent across clients. The experiments also demonstrated the impact of multi-task learning and unlabeled data and the applicability of the framework in relaxing labeled-data requirements for client participation. The code is available at https://github.com/AshknMrd/FedMust.
Purpose: Developing generalizable medical image segmentation models is challenging because imaging data are distributed across institutions and differ in modality and acquisition protocol. Federated learning (FL) enables collaborative training without centralizing raw medical images, but cross-modality domain shifts between computed tomography (CT) and magnetic resonance imaging (MRI) can substantially reduce model performance. This study investigates augmentation-driven cross-modality FL for abdominal organ and whole-heart segmentation. Methods: We evaluate convolution-based spatial augmentation, frequency-domain argumentation, domain-specific normalization, and global intensity nonlinear (GIN) augmentation for multimodal segmentation. Abdominal organ segmentation and whole-heart segmentation are first evaluated using a 2D U-Net framework. For whole-heart segmentation, we additionally perform native 3D experiments using a self-configuring nnU-Net architecture on the CARE-WHS 2026 dataset, enabling evaluation of whether the observed cross-modality FL behavior persists when moving from slice-based 2D segmentation to volumetric 3D segmentation. Results: GIN provides the most consistent cross-modality performance among the evaluated approaches in the original 2D experiments. For pancreas segmentation, the Dice similarity coefficient (DSC) improved from 0.073 to 0.437 when CT data were incorporated through federated cross-modality training. In 3D whole-heart segmentation, FedGIN improved mean DSC over FedAvg from 0.8696 to 0.8901 on the unseen CT center and from 0.7160 to 0.7956 on the unseen MRI center. Relative to centralized GIN training, FedGIN retained 92.4% of performance on unseen CT data and achieved comparable performance on unseen MRI data (0.7956 versus 0.7937).
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.