Training a model that effectively handles both common and rare data-i.e., achieving performance fairness-is crucial in federated learning (FL). While existing fair FL methods have shown effectiveness, they remain vulnerable to mislabeled data. Ensuring robustness in fair FL is therefore essential. However, fairness and robustness inherently compete, which causes robust strategies to hinder fairness. In this paper, we attribute this competition to the homogeneity in loss patterns exhibited by rare and mislabeled data clients, preventing existing loss-based fair and robust FL methods from effectively distinguishing and handling these two distinct client types. To address this, we propose performance-capacity analysis, which jointly considers model performance on each client and its capacity to handle the dataset, measured by loss and a newly introduced feature dispersion score. This allows mislabeled clients to be identified by their significantly deviated performance relative to capacity while preserving rare data clients. Building on this, we introduce FedPCA, an FL method that robustly achieves fairness. FedPCA first identifies mislabeled clients via a Gaussian Mixture Model on loss-dispersion pairs, then applies fairness and robustness strategies in global aggregation and local training by adjusting client weights and selectively using reliable data. Extensive experiments on three datasets demonstrate FedPCA's effectiveness in tackling this complex challenge. Code will be publicly available upon acceptance.

Despite the potential of federated learning in medical applications, inconsistent imaging quality across institutions-stemming from lower-quality data from a minority of clients-biases federated models toward more common high-quality images. This raises significant fairness concerns. Existing fair federated learning methods have demonstrated some effectiveness in solving this problem by aligning a single 0th- or 1st-order state of convergence (e.g., training loss or sharpness). However, we argue in this work that fairness based on such a single state is still not an adequate surrogate for fairness during testing, as these single metrics fail to fully capture the convergence characteristics, making them suboptimal for guiding fair learning. To address this limitation, we develop a generalized framework. Specifically, we propose assessing convergence using multiple states, defined as sharpness or perturbed loss computed at varying search distances. Building on this comprehensive assessment, we propose promoting fairness for these states across clients to achieve our ultimate fairness objective. This is accomplished through the proposed method, FedISM+. In FedISM+, the search distance evolves over time, progressively focusing on different states. We then incorporate two components in local training and global aggregation to ensure cross-client fairness for each state. This gradually makes convergence equitable for all states, thereby improving fairness during testing. Our empirical evaluations, performed on the well-known RSNA ICH and ISIC 2019 datasets, demonstrate the superiority of FedISM+ over existing state-of-the-art methods for fair federated learning. The code is available at https://github.com/wnn2000/FFL4MIA.

Federated learning has emerged as a compelling paradigm for medical image segmentation, particularly in light of increasing privacy concerns. However, most of the existing research relies on relatively stringent assumptions regarding the uniformity and completeness of annotations across clients. Contrary to this, this paper highlights a prevalent challenge in medical practice: incomplete annotations. Such annotations can introduce incorrectly labeled pixels, potentially undermining the performance of neural networks in supervised learning. To tackle this issue, we introduce a novel solution, named FedIA. Our insight is to conceptualize incomplete annotations as noisy data (i.e., low-quality data), with a focus on mitigating their adverse effects. We begin by evaluating the completeness of annotations at the client level using a designed indicator. Subsequently, we enhance the influence of clients with more comprehensive annotations and implement corrections for incomplete ones, thereby ensuring that models are trained on accurate data. Our method's effectiveness is validated through its superior performance on two extensively used medical image segmentation datasets, outperforming existing solutions. The code is available at https://github.com/HUSTxyy/FedIA.

Cross-silo federated learning (FL) enables decentralized organizations to collaboratively train models while preserving data privacy and has made significant progress in medical image classification. One common assumption is task homogeneity where each client has access to all classes during training. However, in clinical practice, given a multi-label classification task, constrained by the level of medical knowledge and the prevalence of diseases, each institution may diagnose only partial categories, resulting in task heterogeneity. How to pursue effective multi-label medical image classification under task heterogeneity is under-explored. In this paper, we first formulate such a realistic label missing setting in the multi-label FL domain and propose a two-stage method FedMLP to combat class missing from two aspects: pseudo label tagging and global knowledge learning. The former utilizes a warmed-up model to generate class prototypes and select samples with high confidence to supplement missing labels, while the latter uses a global model as a teacher for consistency regularization to prevent forgetting missing class knowledge. Experiments on two publicly-available medical datasets validate the superiority of FedMLP against the state-of-the-art both federated semi-supervised and noisy label learning approaches under task heterogeneity. Code is available at https://github.com/szbonaldo/FedMLP.

Due to escalating privacy concerns, federated learning has been recognized as a vital approach for training deep neural networks with decentralized medical data. In practice, it is challenging to ensure consistent imaging quality across various institutions, often attributed to equipment malfunctions affecting a minority of clients. This imbalance in image quality can cause the federated model to develop an inherent bias towards higher-quality images, thus posing a severe fairness issue. In this study, we pioneer the identification and formulation of this new fairness challenge within the context of the imaging quality shift. Traditional methods for promoting fairness in federated learning predominantly focus on balancing empirical risks across diverse client distributions. This strategy primarily facilitates fair optimization across different training data distributions, yet neglects the crucial aspect of generalization. To address this, we introduce a solution termed Federated learning with Inter-client Sharpness Matching (FedISM). FedISM enhances both local training and global aggregation by incorporating sharpness-awareness, aiming to harmonize the sharpness levels across clients for fair generalization. Our empirical evaluations, conducted using the widely-used ICH and ISIC 2019 datasets, establish FedISM's superiority over current state-of-the-art federated learning methods in promoting fairness. Code is available at https://github.com/wnn2000/FFL4MIA.

Federated learning (FL) has emerged as a promising paradigm for training segmentation models on decentralized medical data, owing to its privacy-preserving property. However, existing research overlooks the prevalent annotation noise encountered in real-world medical datasets, which limits the performance ceilings of FL. In this paper, we, for the first time, identify and tackle this problem. For problem formulation, we propose a contour evolution for modeling non-independent and identically distributed (Non-IID) noise across pixels within each client and then extend it to the case of multi-source data to form a heterogeneous noise model (i.e., Non-IID annotation noise across clients). For robust learning from annotations with such two-level Non-IID noise, we emphasize the importance of data quality in model aggregation, allowing high-quality clients to have a greater impact on FL. To achieve this, we propose Federated learning with Annotation quAlity-aware AggregatIon, named FedA3I, by introducing a quality factor based on client-wise noise estimation. Specifically, noise estimation at each client is accomplished through the Gaussian mixture model and then incorporated into model aggregation in a layer-wise manner to up-weight high-quality clients. Extensive experiments on two real-world medical image segmentation datasets demonstrate the superior performance of FedA$^3$I against the state-of-the-art approaches in dealing with cross-client annotation noise. The code is available at https://github.com/wnn2000/FedAAAI.

Federated noisy label learning (FNLL) is emerging as a promising tool for privacy-preserving multi-source decentralized learning. Existing research, relying on the assumption of class-balanced global data, might be incapable to model complicated label noise, especially in medical scenarios. In this paper, we first formulate a new and more realistic federated label noise problem where global data is class-imbalanced and label noise is heterogeneous, and then propose a two-stage framework named FedNoRo for noise-robust federated learning. Specifically, in the first stage of FedNoRo, per-class loss indicators followed by Gaussian Mixture Model are deployed for noisy client identification. In the second stage, knowledge distillation and a distance-aware aggregation function are jointly adopted for noise-robust federated model updating. Experimental results on the widely-used ICH and ISIC2019 datasets demonstrate the superiority of FedNoRo against the state-of-the-art FNLL methods for addressing class imbalance and label noise heterogeneity in real-world FL scenarios.

Federated learning (FL), training deep models from decentralized data without privacy leakage, has shown great potential in medical image computing recently. However, considering the ubiquitous class imbalance in medical data, FL can exhibit performance degradation, especially for minority classes (e.g. rare diseases). Existing methods towards this problem mainly focus on training a balanced classifier to eliminate class prior bias among classes, but neglect to explore better representation to facilitate classification performance. In this paper, we present a privacy-preserving FL method named FedIIC to combat class imbalance from two perspectives: feature learning and classifier learning. In feature learning, two levels of contrastive learning are designed to extract better class-specific features with imbalanced data in FL. In classifier learning, per-class margins are dynamically set according to real-time difficulty and class priors, which helps the model learn classes equally. Experimental results on publicly-available datasets demonstrate the superior performance of FedIIC in dealing with both real-world and simulated multi-source medical imaging data under class imbalance. Code is available at https://github.com/wnn2000/FedIIC.

Objective: Transformers, born to remedy the inadequate receptive fields of CNNs, have drawn explosive attention recently. However, the daunting computational complexity of global representation learning, together with rigid window partitioning, hinders their deployment in medical image segmentation. This work aims to address the above two issues in transformers for better medical image segmentation. Methods: We propose a boundary-aware lightweight transformer (BATFormer) that can build cross-scale global interaction with lower computational complexity and generate windows flexibly under the guidance of entropy. Specifically, to fully explore the benefits of transformers in long-range dependency establishment, a cross-scale global transformer (CGT) module is introduced to jointly utilize multiple small-scale feature maps for richer global features with lower computational complexity. Given the importance of shape modeling in medical image segmentation, a boundary-aware local transformer (BLT) module is constructed. Different from rigid window partitioning in vanilla transformers which would produce boundary distortion, BLT adopts an adaptive window partitioning scheme under the guidance of entropy for both computational complexity reduction and shape preservation. Results: BATFormer achieves the best performance in Dice of 92.84%, 91.97%, 90.26%, and 96.30% for the average, right ventricle, myocardium, and left ventricle respectively on the ACDC dataset and the best performance in Dice, IoU, and ACC of 90.76%, 84.64%, and 96.76% respectively on the ISIC 2018 dataset. More importantly, BATFormer requires the least amount of model parameters and the lowest computational complexity compared to the state-of-the-art approaches. Conclusion and Significance: Our results demonstrate the necessity of developing customized transformers for efficient and better medical image segmentation.