# TrustFed: Enabling Trustworthy Medical AI under Data Privacy Constraints

arXiv: https://arxiv.org/abs/2603.21656 · HTML: https://mlsanity.com/paper/2603.21656/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 18 of its 40 references that are in the map.
- First posted on arXiv 23 Mar 2026.

## Builds on (most cited first, 18 of 18)

- [Communication-Efficient Learning of Deep Networks from Decentralized Data](https://mlsanity.com/paper/1602.05629/) (2016)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Simple and Scalable Predictive Uncertainty Estimation using Deep Ensembles](https://mlsanity.com/paper/1612.01474/) (2016)
- [Advances and Open Problems in Federated Learning](https://mlsanity.com/paper/1912.04977/) (2019)
- [Federated Optimization in Heterogeneous Networks](https://mlsanity.com/paper/1812.06127/) (2018)
- [What Uncertainties Do We Need in Bayesian Deep Learning for Computer Vision?](https://mlsanity.com/paper/1703.04977/) (2017)
- [Can You Trust Your Model's Uncertainty? Evaluating Predictive Uncertainty Under Dataset Shift](https://mlsanity.com/paper/1906.02530/) (2019)
- [Federated Learning with Non-IID Data](https://mlsanity.com/paper/1806.00582/) (2018)
- [Adaptive Federated Optimization](https://mlsanity.com/paper/2003.00295/) (2020)
- [MedMNIST v2 -- A large-scale lightweight benchmark for 2D and 3D biomedical image classification](https://mlsanity.com/paper/2110.14795/) (2021)
- [The Future of Digital Health with Federated Learning](https://mlsanity.com/paper/2003.08119/) (2020)
- [Federated Learning on Non-IID Data Silos: An Experimental Study](https://mlsanity.com/paper/2102.02079/) (2021)
- [Federated Learning Based on Dynamic Regularization](https://mlsanity.com/paper/2111.04263/) (2021)
- [Differentially Private Federated Learning: A Client Level Perspective](https://mlsanity.com/paper/1712.07557/) (2017)
- [Federated Learning Enables Big Data for Rare Cancer Boundary Detection](https://mlsanity.com/paper/2204.10836/) (2022)
- [Federated Conformal Predictors for Distributed Uncertainty Quantification](https://mlsanity.com/paper/2305.17564/) (2023)
- [Conformal Prediction for Federated Uncertainty Quantification Under Label Shift](https://mlsanity.com/paper/2306.05131/) (2023)
- [CortiNet: A Physics-Perception Hybrid Cortical-Inspired Dual-Stream Network for Gallbladder Disease Diagnosis from Ultrasound](https://mlsanity.com/paper/2602.01000/) (2026)

## Abstract (arXiv)

Protecting patient privacy remains a fundamental barrier to scaling machine learning across healthcare institutions, where centralizing sensitive data is often infeasible due to ethical, legal, and regulatory constraints. Federated learning offers a promising alternative by enabling privacy-preserving, multi-institutional training without sharing raw patient data; however, real-world deployments face severe challenges from data heterogeneity, site-specific biases, and class imbalance, which degrade predictive reliability and render existing uncertainty quantification methods ineffective. Here, we present TrustFed, a federated uncertainty quantification framework that provides distribution-free, finite-sample coverage guarantees under heterogeneous and imbalanced healthcare data, without requiring centralized access. TrustFed introduces a representation-aware client assignment mechanism that leverages internal model representations to enable effective calibration across institutions, along with a soft-nearest threshold aggregation strategy that mitigates assignment uncertainty while producing compact and reliable prediction sets. Using over 430,000 medical images across six clinically distinct imaging modalities, we conduct one of the most comprehensive evaluations of uncertainty-aware federated learning in medical imaging, demonstrating robust coverage guarantees across datasets with diverse class cardinalities and imbalance regimes. By validating TrustFed at this scale and breadth, our study advances uncertainty-aware federated learning from proof-of-concept toward clinically meaningful, modality-agnostic deployment, positioning statistically guaranteed uncertainty as a core requirement for next-generation healthcare AI systems.