The Federated Tumor Segmentation and Classification (FeTS++) Challenge

Federated learning (FL) offers a privacy-preserving paradigm for collaborative medical image analysis without sharing raw data. However, the absence of standardized benchmarks for medical image segmentation hinders fair and comprehensive evaluation of FL methods. To address this gap, we introduce FL-MedSegBench, the first comprehensive benchmark for federated learning on medical image segmentation. Our benchmark encompasses nine segmentation tasks across ten imaging modalities, covering both 2D and 3D formats with realistic clinical heterogeneity. We systematically evaluate eight generic FL (gFL) and five personalized FL (pFL) methods across multiple dimensions: segmentation accuracy, fairness, communication efficiency, convergence behavior, and generalization to unseen domains. Extensive experiments reveal several key insights: (i) pFL methods, particularly those with client-specific batch normalization (e.g., FedBN), consistently outperform generic approaches; (ii) No single method universally dominates, with performance being dataset-dependent; (iii) Communication frequency analysis shows normalization-based personalization methods exhibit remarkable robustness to reduced communication frequency; (iv) Fairness evaluation identifies methods like Ditto and FedRDN that protect underperforming clients; (v) A method's generalization to unseen domains is strongly tied to its ability to perform well across participating clients. We will release an open-source toolkit to foster reproducible research and accelerate clinically applicable FL solutions, providing empirically grounded guidelines for real-world clinical deployment. The source code is available at https://github.com/meiluzhu/FL-MedSegBench.

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.

Most existing federated learning (FL) methods for medical image analysis only considered intramodal heterogeneity, limiting their applicability to multimodal imaging applications. In practice, some FL participants may possess only a subset of the complete imaging modalities, posing intermodal heterogeneity as a challenge to effectively training a global model on all participants' data. Meanwhile, each participant expects a personalized model tailored to its local data characteristics in FL. This work proposes a new FL framework with federated modality-specific encoders and partially personalized multimodal fusion decoders (FedMEPD) to address the two concurrent issues. Specifically, FedMEPD employs an exclusive encoder for each modality to account for the intermodal heterogeneity. While these encoders are fully federated, the decoders are partially personalized to meet individual needs -- using the discrepancy between global and local parameter updates to dynamically determine which decoder filters are personalized. Implementation-wise, a server with full-modal data employs a fusion decoder to fuse representations from all modality-specific encoders, thus bridging the modalities to optimize the encoders via backpropagation. Moreover, multiple anchors are extracted from the fused multimodal representations and distributed to the clients in addition to the model parameters. Conversely, the clients with incomplete modalities calibrate their missing-modal representations toward the global full-modal anchors via scaled dot-product cross-attention, making up for the information loss due to absent modalities. FedMEPD is validated on the BraTS 2018 and 2020 multimodal brain tumor segmentation benchmarks. Results show that it outperforms various up-to-date methods for multimodal and personalized FL, and its novel designs are effective.