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ChristinaChristinaKalogeropoulouKardamakis, Dimitrios MDimitrios MKardamakisLuo, BingBingLuoPoisson, Laila MLaila MPoissonWen, NingNingWenVallières, MartinMartinVallièresLoutfi, Mahdi Ait LhajMahdi Ait LhajLoutfiFortin, DavidDavidFortinLepage, MartinMartinLepageMorón, FannyFannyMorónMandel, JacobJacobMandelShukla, GauravGauravShuklaLiem, SpencerSpencerLiemAlexandre, Gregory SGregory SAlexandreLombardo, JosephJosephLombardoPalmer, Joshua DJoshua DPalmerFlanders, Adam EAdam EFlandersDicker, Adam PAdam PDickerOgbole, GodwinGodwinOgboleOyekunle, DotunDotunOyekunleOdafe-Oyibotha, OlubunmiOlubunmiOdafe-OyibothaOsobu, BabatundeBabatundeOsobuShu'aibu Hikima, MustaphaMustaphaShu'aibu HikimaSoneye, MayowaMayowaSoneyeDako, FaroukFaroukDakoDorcas, AdeleyeAdeleyeDorcasMurcia, DerrickDerrickMurciaFu, EricEricFuHaas, RourkeRourkeHaasThompson, John AJohn AThompsonOrmond, David RyanDavid RyanOrmondCurrie, StuartStuartCurrieFatania, KaviKaviFataniaFrood, RussellRussellFroodSimpson, Amber LAmber LSimpsonPeoples, Jacob JJacob JPeoplesHu, RickyRickyHuCutler, DanielleDanielleCutlerMoraes, Fabio YFabio YMoraesTran, AnhAnhTranHamghalam, MohammadMohammadHamghalamBoss, Michael AMichael ABossGimpel, JamesJamesGimpelKattil Veettil, DeepakDeepakKattil VeettilSchmidt, KendallKendallSchmidtCimino, LisaLisaCiminoPrice, CynthiaCynthiaPriceBialecki, BrianBrianBialeckiMarella, SailajaSailajaMarellaApgar, CharlesCharlesApgarJakab, AndrasAndrasJakabWeber, Marc-AndréMarc-AndréWeberColak, ErrolErrolColakKleesiek, JensJensKleesiekFreymann, John BJohn BFreymannKirby, Justin SJustin SKirbyMaier-Hein, LenaLenaMaier-HeinAlbrecht, JakeJakeAlbrechtMattson, PeterPeterMattsonKarargyris, AlexandrosAlexandrosKarargyrisShah, PrashantPrashantShahMenze, BjoernBjoernMenzeMaier-Hein, KlausKlausMaier-HeinBakas, SpyridonSpyridonBakas2025-07-102025-07-102025-07-08https://boris-portal.unibe.ch/handle/20.500.12422/213140Computational competitions are the standard for benchmarking medical image analysis algorithms, but they typically use small curated test datasets acquired at a few centers, leaving a gap to the reality of diverse multicentric patient data. To this end, the Federated Tumor Segmentation (FeTS) Challenge represents the paradigm for real-world algorithmic performance evaluation. The FeTS challenge is a competition to benchmark (i) federated learning aggregation algorithms and (ii) state-of-the-art segmentation algorithms, across multiple international sites. Weight aggregation and client selection techniques were compared using a multicentric brain tumor dataset in realistic federated learning simulations, yielding benefits for adaptive weight aggregation, and efficiency gains through client sampling. Quantitative performance evaluation of state-of-the-art segmentation algorithms on data distributed internationally across 32 institutions yielded good generalization on average, albeit the worst-case performance revealed data-specific modes of failure. Similar multi-site setups can help validate the real-world utility of healthcare AI algorithms in the future.en600 - Technology::610 - Medicine & healtharticle10.48620/893664062869610.1038/s41467-025-60466-1