Benchmark Evaluation of Feredated Learning on Multi-organ Images

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.

Simultaneous assessment of medical imaging and patient records is often required in clinical diagnosis. However, standard machine learning algorithms cannot analyze these data types together. Meanwhile, compliance with HIPAA and GDPR can constrain centralized aggregation of sensitive patient data. This leaves a crucial void of secure fusion of visual and textual context across distant networks. Thus, we present OmniMed-FL, a controlled systems study of multimodal federated learning for five-class clinical condition classification (Normal, Pneumonia, COVID-19, Pleural Effusion, Cardiomegaly). Our proxy corpus pairs 3,000 public chest radiographs with 3,000 class-conditioned synthetic notes, matched by class, not by patient. The framework benchmarks eight fusion strategies, three initializations, four missing-text imputation rules, and matched federated baselines under non-IID Dirichlet partitioning across 3 to 20 hospital clients. As all notes are synthetic and pairing is not patient-level, these are descriptive proxy comparisons, not estimates of diagnostic performance or deployment readiness. Within those limits with clients ($K=5$) and severe skew ($α=0.1$), local-only training achieves a macro-F1 score of 0.297, FedAvg achieves $0.662\pm0.074$, FedProx $0.737\pm0.085$, a matched FedMME-style one-shot ensemble $0.647\pm0.080$, and our SCAFFOLD-AdamW adaptation $0.070\pm0.015$, the 0.075 FedProx-FedAvg gap falling inside the wider of the two two-seed standard deviations. Over a $4\times3$ grid, label skew costs up to 0.27 F1 whereas a near-sevenfold client increase costs at most 0.10, while bidirectional volume grows linearly to 183.5 GiB at $K=20$. Multimodal fusion leads on both corpora, scoring 0.956 against 0.934 for text and 0.664 for images on the synthetic corpus and 0.906 against 0.880 and 0.737 on the radiograph corpus, for $2.3\times$ the model state of text alone.

While federated learning (FL) enables collaborative medical image segmentation without centralizing sensitive data, real-world deployment is frequently complicated by cross-site label imperfections such as contour disagreement, missing or additional structures, and confused labels. Federated noisy label learning (FNLL) aims to mitigate these effects, yet remains underused in practice as existing evidence is largely based on synthetic noise, simplified settings, and limited real-world noisy evaluation. We address this gap by introducing a benchmark suite that combines diverse real-world noisy datasets, deployment-relevant client-noise scenarios, and label-noise-targeted evaluation to support systematic FNLL assessment and informed method selection. The suite combines curated real-world noisy medical image segmentation datasets from diverse sources with a comprehensive federated segmentation framework including various client-noise scenarios and noise-targeted evaluation. The presented suite provides a realistic and discriminative basis for FNLL evaluation in medical image segmentation and establishes a reusable foundation for fair benchmarking, dataset-specific label-noise characterization, and future method development under realistic federated settings. Code is available at https://github.com/MIC-DKFZ/FedSegNoiseBench.