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Federated learning for secure IoMT-applications in smart healthcare systems: A comprehensive review
Open accessAbstract
Recent developments in the Internet of Things (IoT) and various communication technologies have reshaped numerous application areas. Nowadays, IoT is assimilated into various medical devices and equipment, leading to the progression of the Internet of Medical Things (IoMT). Therefore, various IoMT-based healthcare applications are deployed and used in the day-to-day scenario. Traditionally, machine learning (ML) models use centralized data compilation and learning that is impractical in pragmatic healthcare frameworks due to rising privacy and data security issues. Federated Learning (FL) has been observed as a developing distributed collective paradigm, the most appropriate for modern healthcare framework, that manages various stakeholders (e.g., patients, hospitals, laboratories, etc.) to carry out training of the models without the actual exchange of sensitive medical data. Consequently, in this work, the authors present an exhaustive survey on the security of FL-based IoMT applications in smart healthcare frameworks. First, the authors introduced IoMT devices, their types, applications, datasets, and the IoMT security framework in detail. Subsequently, the concept of FL, its application domains, and various tools used to develop FL applications are discussed. The significant contribution of FL in deploying secure IoMT systems is presented by focusing on FL-based IoMT applications, patents, real-world FL-based healthcare projects, and datasets. A comparison of FL-based security techniques with other schemes in the smart healthcare ecosystem is also presented. Finally, the authors discussed the challenges faced and potential future research recommendations to deploy secure FL-based IoMT applications in smart healthcare frameworks.
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“For example, one study discovered that, in contrast to metropolitan settings with reliable internet access, remote healthcare institutions with inadequate internet access had communication delays that prolonged training periods by more than 50%.”
From Federated Learning in Smart Healthcare: A Comprehensive Review on Privacy, Security, and Predictive Analytics with IoT Integration (2024) · cites this paper as [29]
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“Moreover, in some remote regions, internet access is so limited that models are only able to synchronize every few days, which significantly limits the overall learning process [29].”
From Federated Learning in Smart Healthcare: A Comprehensive Review on Privacy, Security, and Predictive Analytics with IoT Integration (2024) · cites this paper as [29]
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Optimize the model performance in federated learning: a contract theory-based heuristic approach
Wan, T., Jiang, T., Liao, W., & Jiang, N. (2025) · Peer-to-Peer Networking and Applications · doi:10.1007/s12083-025-02136-z
Sakib, N., Rahat, M. F. R., Hasan, M. M., & Xie, Z. (2025) · IEEE/ACM Conference on Connected Health: Applications, Systems and Engineering Technologies · doi:10.1145/3721201.3724412
FedDFS: Data filtering for stable federated learning
Zha, X., & Shen, D. (2025) · Knowledge-Based Systems · doi:10.1016/j.knosys.2025.114934
Priyadarshini, S. H., Deivasigamani, D., Kumar, R., Suganya, K., Uma, K. P., & Pradeep, H. (2025) · International Conference on Intelligent Cyber Physical Systems and Internet of Things (ICoICI) · doi:10.1109/icoici65217.2025.11254186
Bozzi, L., Celidonio, C., Nuzzi, U., Biagini, M., Cherubin, S., Djupdal, A., Haugdahl, T. A., Aliverti, A., Angelucci, A., Agosta, G., et al. (2025) · Euromicro Conference on Digital System Design (DSD) · doi:10.1109/dsd67783.2025.00086
“In parallel, federated learning [21], [22] offers a decentralized training method where multiple devices collaboratively build a shared model without transferring local data, making it suitable for privacy-sensitive and distributed scenarios [23], [24].”
Shakir, I. A., Yaseen, W. Y., Shalal, A. A., Salman, D. S., Ahmed, A. A., Ibrahim, H. S., Awad, A. S., & Rasool, Z. H. (2025) · International Conference on Cyber Resilience (ICCR) · doi:10.1109/iccr67387.2025.11292446
“• Vertical FL (VFL): Same patients, different feature spaces [29].”
Sutoyo, A. A., Putra, E. H., Gabriella, T., Manuaba, I. B. K., Chen, Y., & Setiawan, F. (2025) · International Conference on Computer Engineering, Network, and Intelligent Multimedia (CENIM) · doi:10.1109/cenim67940.2025.11325803
“This decentralized approach not only mitigates privacy risks but also enhances the robustness and scalability of obesity prediction models in real-world healthcare settings [18].”
1356 Fuzzy-Based Trust Management for Preventing Attacks in Internet of Medical Things
Arjun, K. P., & Arockiam, D. (2025) · De Gruyter eBooks · doi:10.1515/9783112215722-006
Kanthasamy, D., & Kumar, C. N. S. V. (2026) · Australian Journal of Electrical & Electronics Engineering · doi:10.1080/1448837x.2025.2612429
Telephone Communication, ICT Use, and Digitalization in Healthcare Performance
Manu, E. K., Dadzie, F. A., & Asongu, S. A. (2026) · World Affairs · doi:10.1002/waf2.70054
Federated learning-based IoMT networks for improved performance of smart health
Öksüz, C., & Sağbaş, M. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-36556-0.00010-8
Nikhila, A. N. N., & Devarapalli, D. (2026) · International Journal of Innovative Technology and Exploring Engineering · doi:10.35940/ijitee.b1208.15020126
Scalable Model Aggregation and Interoperability Solutions in Healthcare Systems
Shafik, W. (2026) · Studies in computational intelligence · doi:10.1007/978-3-032-03985-9_18
Future Trends in Federated Learning for Next-Generation Healthcare
Shafik, W., & Abdul, S. M. (2026) · Studies in computational intelligence · doi:10.1007/978-3-032-03985-9_32
Potla, R. T. (2025) · IEEE International Conference on Information, Communication and Networks (ICICN) · doi:10.1109/icicn67355.2025.11430417 · Cited by 1
“FL lets devices train models by sharing only weight updates, not patient records [4].”
FedSSV: Client Contribution for Secure Federated Learning Aggregation Using Scaled Shapley Values
Sani, S. D., Olapojoye, R., Salman, T., Ji, T., & Teixeira, M. A. (2026) · IEEE Transactions on Network Science and Engineering · doi:10.1109/tnse.2026.3674950 · Cited by 1
Personalised and Secured Melanoma Diagnosis Using Meta-Learning Driven Decentralised Framework
Sudha, D., & Naresh, R. (2025) · IEEE International Conference on Emerging Trends in Computing and Communication (ETCOM) · doi:10.1109/etcom66606.2025.11437297
“To overcome challenges such as privacy leakage, heterogeneity, and scalability, [7] provided a complete review of FL applications in IoMT security, and [8] proposed a FL-based intrusion detection system (IDS) with standardised valuation metrics for secure IoMT deployment.”
Secure collaborative management platform applied to IoT Networks
Atia, O. B. (2024) · theses.fr (ABES) · doi:10.70675/6c43d453z9fb0z4a37z8123z35304e4a31cc
Mondal, S., Das, P., Saif, S., Saha, R., & Khan, S. (2026) · Springer optimization and its applications · doi:10.1007/978-3-032-15092-9_11
QSFedMA: Quantum‐Secured Authentication Protocol for Privacy‐Preserving Federated IoMT
Goel, A., Nair, A., Chawla, D., Mehra, P. S., Rathore, R. S., & Jiang, W. (2026) · Software Practice and Experience · doi:10.1002/spe.70071
“Noise makes it impossible to reverse engineer training gradients, leading to the privacy of each node’s data Robustness [10] Clipping provides partial protection against poisoning and outlier effects.”
Metadata
- Authors
- Rani, S., Kataria, A., Kumar, S., & Tiwari, P.
- Affiliations
- Guru Nanak Dev University (IN)
- Central Scientific Instruments Organisation (IN)
- South Ural State University (RU)
- Halmstad University (SE)
- Corresponding author
- Tiwari, Prayag
- Venue
- Knowledge-Based Systems
- Publisher
- Elsevier BV
- Published
- 2023-08
- Volume
- 274
- Pages
- 110658
- ISSN
- 0950-7051 (ISSN-L)
- OpenAlex
- W4377294193
- Semantic Scholar
- f1ac75d96c85121f4e0e52ff8c001ac7f3173f8b
- Cited by
- 228
- References
- 352
- Citations by year
- 2026: 54 · 2025: 94 · 2024: 65 · 2023: 15
- FWCI
- 20.18
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Knowledge-Based Systems (publishedVersion, cc-by)
- Funders
- Russian Science Foundation (23-21-10009)
- Topics
- Physical Sciences › Computer Science › Artificial Intelligence › Privacy-Preserving Technologies in Data
- Physical Sciences › Computer Science › Information Systems › Internet of Things and AI
- Physical Sciences › Computer Science › Computer Networks and Communications › IoT and Edge/Fog Computing
- Keywords
- federated learning, Internet of Medical Things, smart healthcare, data privacy, medical device security, secure machine learning, distributed training, healthcare data security, privacy-preserving healthcare
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