# Privacy-Aware Federated nnU-Net for ECG Page Digitization

arXiv: https://arxiv.org/abs/2510.22387 · HTML: https://mlsanity.com/paper/2510.22387/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 15 of its 36 references that are in the map.
- First posted on arXiv 25 Oct 2025.

## Builds on (most cited first, 15 of 15)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Communication-Efficient Learning of Deep Networks from Decentralized Data](https://mlsanity.com/paper/1602.05629/) (2016)
- [Federated Optimization in Heterogeneous Networks](https://mlsanity.com/paper/1812.06127/) (2018)
- [Deep Learning with Differential Privacy](https://mlsanity.com/paper/1607.00133/) (2016)
- [Adaptive Federated Optimization](https://mlsanity.com/paper/2003.00295/) (2020)
- [Contrastive Learning of Medical Visual Representations from Paired Images and Text](https://mlsanity.com/paper/2010.00747/) (2020)
- [Flower: A Friendly Federated Learning Research Framework](https://mlsanity.com/paper/2007.14390/) (2020)
- [Think Locally, Act Globally: Federated Learning with Local and Global Representations](https://mlsanity.com/paper/2001.01523/) (2020)
- [FedDG: Federated Domain Generalization on Medical Image Segmentation via Episodic Learning in Continuous Frequency Space](https://mlsanity.com/paper/2103.06030/) (2021)
- [Closing the Generalization Gap of Cross-silo Federated Medical Image Segmentation](https://mlsanity.com/paper/2203.10144/) (2022)
- [Personalizing Federated Medical Image Segmentation via Local Calibration](https://mlsanity.com/paper/2207.04655/) (2022)
- [ECG-Image-Kit: A Synthetic Image Generation Toolbox to Facilitate Deep Learning-Based Electrocardiogram Digitization](https://mlsanity.com/paper/2307.01946/) (2023)
- [Regularized Weight Aggregation in Networked Federated Learning for Glioblastoma Segmentation](https://mlsanity.com/paper/2301.12617/) (2023)
- [Comparative Analysis of Data Augmentation for Clinical ECG Classification with STAR](https://mlsanity.com/paper/2510.24740/) (2025)
- [Enhancing Maritime Object Detection in Real-Time with RT-DETR and Data Augmentation](https://mlsanity.com/paper/2510.07346/) (2025)

## Abstract (arXiv)

Deep neural networks can convert ECG page images into analyzable waveforms, yet centralized training often conflicts with cross-institutional privacy and deployment constraints. A cross-silo federated digitization framework is presented that trains a full-model nnU-Net segmentation backbone without sharing images and aggregates updates across sites under realistic non-IID heterogeneity (layout, grid style, scanner profile, noise). The protocol integrates three standard server-side aggregators--FedAvg, FedProx, and FedAdam--and couples secure aggregation with central, user-level differential privacy to align utility with formal guarantees. Key features include: (i) end-to-end full-model training and synchronization across clients; (ii) secure aggregation so the server only observes a clipped, weighted sum once a participation threshold is met; (iii) central Gaussian DP with Renyi accounting applied post-aggregation for auditable user-level privacy; and (iv) a calibration-aware digitization pipeline comprising page normalization, trace segmentation, grid-leakage suppression, and vectorization to twelve-lead signals. Experiments on ECG pages rendered from PTB-XL show consistently faster convergence and higher late-round plateaus with adaptive server updates (FedAdam) relative to FedAvg and FedProx, while approaching centralized performance. The privacy mechanism maintains competitive accuracy while preventing exposure of raw images or per-client updates, yielding deployable, auditable guarantees suitable for multi-institution settings.