When Calibration Fails the Vulnerable Hospital: Federated Conformal Risk Control via Risk-Curve Shrinkage

Conformal risk control (CRC) provides distribution-free guarantees on segmentation quality by calibrating a prediction-set threshold on held-out data. In federated deployments, the standard approach pools calibration scores across sites into a single threshold. We provide the first quantification, on real multi-institutional brain tumor data (FeTS-2022, 1,251 subjects, 20 institutions), showing that this naive pooled CRC protects the average hospital but violates coverage at 40% of individual institutions, with the worst site exceeding the target false-negative rate by 7.8 percentage points. The naive alternative, per-site local CRC, largely restores coverage but inflates prediction sets by 83x, rendering them clinically useless. We propose a shrinkage-based federated CRC protocol: each site transmits only its empirical risk curve (G scalars) to a server, which computes a shrinkage-regularized threshold per site. A single hyperparameter n0 smoothly trades worst-case coverage for prediction-set efficiency; leave-one-site-out sensitivity analysis identifies n0=19, achieving 2.7/20 violations at 2.0x stretch. We further show that direct Lagrangian optimization of coverage budgets fails, concentrating risk on vulnerable hospitals, and that the finite-sample correction term is essential: removing it triples violations. The marginal CRC guarantee is preserved by construction under the stated site-mixture assumption; per-site coverage is validated across four targets with three seeds. No patient-level images, masks, or per-volume scores leave any site.