# MedFL-Stress: A Systematic Robustness Evaluation of Federated Brain Tumor Segmentation under Cross-Hospital MRI Appearance Shift

arXiv: https://arxiv.org/abs/2605.09025 · HTML: https://mlsanity.com/paper/2605.09025/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 10 of its 17 references that are in the map.
- First posted on arXiv 9 May 2026.

## Builds on (most cited first, 10 of 10)

- [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)
- [The Future of Digital Health with Federated Learning](https://mlsanity.com/paper/2003.08119/) (2020)
- [FedBN: Federated Learning on Non-IID Features via Local Batch Normalization](https://mlsanity.com/paper/2102.07623/) (2021)
- [Identifying the Best Machine Learning Algorithms for Brain Tumor Segmentation, Progression Assessment, and Overall Survival Prediction in the BRATS Challenge](https://mlsanity.com/paper/1811.02629/) (2018)
- [Multi-Institutional Deep Learning Modeling Without Sharing Patient Data: A Feasibility Study on Brain Tumor Segmentation](https://mlsanity.com/paper/1810.04304/) (2018)
- [Federated Learning for Medical Image Analysis: A Survey](https://mlsanity.com/paper/2306.05980/) (2023)
- [The Federated Tumor Segmentation (FeTS) Challenge](https://mlsanity.com/paper/2105.05874/) (2021)
- [Federated brain tumor segmentation: an extensive benchmark](https://mlsanity.com/paper/2410.17265/) (2024)

## Abstract (arXiv)

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.