Federated learning allows distributed medical institutions to collaboratively learn a shared prediction model with privacy protection. While at clinical deployment, the models trained in federated learning can still suffer from performance drop when applied to completely unseen hospitals outside the federation. In this paper, we point out and solve a novel problem setting of federated domain generalization (FedDG), which aims to learn a federated model from multiple distributed source domains such that it can directly generalize to unseen target domains. We present a novel approach, named as Episodic Learning in Continuous Frequency Space (ELCFS), for this problem by enabling each client to exploit multi-source data distributions under the challenging constraint of data decentralization. Our approach transmits the distribution information across clients in a privacy-protecting way through an effective continuous frequency space interpolation mechanism. With the transferred multi-source distributions, we further carefully design a boundary-oriented episodic learning paradigm to expose the local learning to domain distribution shifts and particularly meet the challenges of model generalization in medical image segmentation scenario. The effectiveness of our method is demonstrated with superior performance over state-of-the-arts and in-depth ablation experiments on two medical image segmentation tasks. The code is available at https://github.com/liuquande/FedDG-ELCFS.

/pdf/feddg-federated-domain-generalization-on-medical-image-z6zo227nrx.pdf

FedDG: Federated Domain Generalization on Medical Image Segmentation via Episodic Learning in Continuous Frequency Space

Federated learning (FL) is a method used for training artificial intelligence models with data from multiple sources while maintaining data anonymity, thus removing many barriers to data sharing. Here we used data from 20 institutes across the globe to train a FL model, called EXAM (electronic medical record (EMR) chest X-ray AI model), that predicts the future oxygen requirements of symptomatic patients with COVID-19 using inputs of vital signs, laboratory data and chest X-rays. EXAM achieved an average area under the curve (AUC) >0.92 for predicting outcomes at 24 and 72 h from the time of initial presentation to the emergency room, and it provided 16% improvement in average AUC measured across all participating sites and an average increase in generalizability of 38% when compared with models trained at a single site using that site’s data. For prediction of mechanical ventilation treatment or death at 24 h at the largest independent test site, EXAM achieved a sensitivity of 0.950 and specificity of 0.882. In this study, FL facilitated rapid data science collaboration without data exchange and generated a model that generalized across heterogeneous, unharmonized datasets for prediction of clinical outcomes in patients with COVID-19, setting the stage for the broader use of FL in healthcare. Federated learning, a method for training artificial intelligence algorithms that protects data privacy, was used to predict future oxygen requirements of symptomatic patients with COVID-19 using data from 20 different institutes across the globe.

/pdf/federated-learning-for-predicting-clinical-outcomes-in-y2vgymhawm.pdf

Federated learning for predicting clinical outcomes in patients with COVID-19.

Using large, multi-national datasets for high-performance medical imaging AI systems requires innovation in privacy-preserving machine learning so models can train on sensitive data without requiring data transfer. Here we present PriMIA (Privacy-preserving Medical Image Analysis), a free, open-source software framework for differentially private, securely aggregated federated learning and encrypted inference on medical imaging data. We test PriMIA using a real-life case study in which an expert-level deep convolutional neural network classifies paediatric chest X-rays; the resulting model’s classification performance is on par with locally, non-securely trained models. We theoretically and empirically evaluate our framework’s performance and privacy guarantees, and demonstrate that the protections provided prevent the reconstruction of usable data by a gradient-based model inversion attack. Finally, we successfully employ the trained model in an end-to-end encrypted remote inference scenario using secure multi-party computation to prevent the disclosure of the data and the model. Gaining access to medical data to train AI applications can present problems due to patient privacy or proprietary interests. A way forward can be privacy-preserving federated learning schemes. Kaissis, Ziller and colleagues demonstrate here their open source framework for privacy-preserving medical image analysis in a remote inference scenario.

/pdf/end-to-end-privacy-preserving-deep-learning-on-multi-qat6j8x5uq.pdf

End-to-end privacy preserving deep learning on multi-institutional medical imaging

Recent advances in communication technologies and the Internet-of-Medical-Things (IOMT) have transformed smart healthcare enabled by artificial intelligence (AI). Traditionally, AI techniques require centralized data collection and processing that may be infeasible in realistic healthcare scenarios due to the high scalability of modern healthcare networks and growing data privacy concerns. Federated Learning (FL), as an emerging distributed collaborative AI paradigm, is particularly attractive for smart healthcare, by coordinating multiple clients (e.g., hospitals) to perform AI training without sharing raw data. Accordingly, we provide a comprehensive survey on the use of FL in smart healthcare. First, we present the recent advances in FL, the motivations, and the requirements of using FL in smart healthcare. The recent FL designs for smart healthcare are then discussed, ranging from resource-aware FL, secure and privacy-aware FL to incentive FL and personalized FL. Subsequently, we provide a state-of-the-art review on the emerging applications of FL in key healthcare domains, including health data management, remote health monitoring, medical imaging, and COVID-19 detection. Several recent FL-based smart healthcare projects are analyzed, and the key lessons learned from the survey are also highlighted. Finally, we discuss interesting research challenges and possible directions for future FL research in smart healthcare. 

/pdf/federated-learning-for-smart-healthcare-a-survey-2kuzq1dr.pdf

Federated Learning for Smart Healthcare: A Survey

Abstract Although machine learning (ML) has shown promise across disciplines, out-of-sample generalizability is concerning. This is currently addressed by sharing multi-site data, but such centralization is challenging/infeasible to scale due to various limitations. Federated ML (FL) provides an alternative paradigm for accurate and generalizable ML, by only sharing numerical model updates. Here we present the largest FL study to-date, involving data from 71 sites across 6 continents, to generate an automatic tumor boundary detector for the rare disease of glioblastoma, reporting the largest such dataset in the literature ( n = 6, 314). We demonstrate a 33% delineation improvement for the surgically targetable tumor, and 23% for the complete tumor extent, over a publicly trained model. We anticipate our study to: 1) enable more healthcare studies informed by large diverse data, ensuring meaningful results for rare diseases and underrepresented populations, 2) facilitate further analyses for glioblastoma by releasing our consensus model, and 3) demonstrate the FL effectiveness at such scale and task-complexity as a paradigm shift for multi-site collaborations, alleviating the need for data-sharing. 

/pdf/federated-learning-enables-big-data-for-rare-cancer-boundary-1fws2mel.pdf

Federated learning enables big data for rare cancer boundary detection

Building robust deep learning-based models requires large quantities of diverse training data. In this study, we investigate the use of federated learning (FL) to build medical imaging classification models in a real-world collaborative setting. Seven clinical institutions from across the world joined this FL effort to train a model for breast density classification based on Breast Imaging, Reporting & Data System (BI-RADS). We show that despite substantial differences among the datasets from all sites (mammography system, class distribution, and data set size) and without centralizing data, we can successfully train AI models in federation. The results show that models trained using FL perform 6.3% on average better than their counterparts trained on an institute’s local data alone. Furthermore, we show a 45.8% relative improvement in the models’ generalizability when evaluated on the other participating sites’ testing data.

pdf/federated-learning-for-breast-density-classification-a-real-4m0j23fzf7.pdf

Federated Learning for Breast Density Classification: A Real-World Implementation.

Building robust deep learning-based models requires large quantities of diverse training data. In this study, we investigate the use of federated learning (FL) to build medical imaging classification models in a real-world collaborative setting. Seven clinical institutions from across the world joined this FL effort to train a model for breast density classification based on Breast Imaging, Reporting & Data System (BI-RADS). We show that despite substantial differences among the datasets from all sites (mammography system, class distribution, and data set size) and without centralizing data, we can successfully train AI models in federation. The results show that models trained using FL perform 6.3% on average better than their counterparts trained on an institute's local data alone. Furthermore, we show a 45.8% relative improvement in the models' generalizability when evaluated on the other participating sites' testing data.

Federated Learning for Breast Density Classification: A Real-World Implementation

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Federated Learning for Breast Density Classification: A Real-World Implementation.

Federated Learning for Breast Density Classification: A Real-World Implementation