Abstract & Overview
Background Reliable artificial intelligence (AI) models for medical image analysis often depend on large and diverse labeled datasets. Federated learning (FL) offers a decentralized and privacy-preserving approach to training but struggles in highly non-independent and identically distributed (non-IID) settings, where institutions with more representative data may experience degraded performance. Moreover, existing large-scale FL studies have been limited to adult datasets, neglecting the unique challenges posed by pediatric data, which introduces additional non-IID variability. Methods To address these limitations, we analyzed n=398,523 adult chest radiographs from diverse institutions across multiple countries and n=9,125 pediatric images, leveraging transfer learning from general-purpose self-supervised image representations to classify pneumonia and cases with no abnormality. Results Using state-of-the-art vision transformers, we found that FL improved performance only for smaller adult datasets (P<0.001) but degraded performance for larger datasets (P≤0.063) and pediatric cases (P=0.242). However, equipping FL with self-supervised weights significantly enhanced outcomes across pediatric cases (P=0.031) and most adult datasets (P≤0.007), except the largest dataset (P=0.052). Conclusions These findings underscore the potential of easily deployable general-purpose self-supervised image representations to address non-IID challenges in clinical FL applications and highlight their promise for enhancing patient outcomes and advancing pediatric healthcare, where data scarcity and variability remain persistent obstacles.