Artificial intelligence provides a promising solution for streamlining COVID-19 diagnoses; however, concerns surrounding security and trustworthiness impede the collection of large-scale representative medical data, posing a considerable challenge for training a well-generalized model in clinical practices. To address this, we launch the Unified CT-COVID AI Diagnostic Initiative (UCADI), where the artificial intelligence (AI) model can be distributedly trained and independently executed at each host institution under a federated learning framework without data sharing. Here we show that our federated learning framework model considerably outperformed all of the local models (with a test sensitivity/specificity of 0.973/0.951 in China and 0.730/0.942 in the United Kingdom), achieving comparable performance with a panel of professional radiologists. We further evaluated the model on the hold-out (collected from another two hospitals without the federated learning framework) and heterogeneous (acquired with contrast materials) data, provided visual explanations for decisions made by the model, and analysed the trade-offs between the model performance and the communication costs in the federated training process. Our study is based on 9,573 chest computed tomography scans from 3,336 patients collected from 23 hospitals located in China and the United Kingdom. Collectively, our work advanced the prospects of utilizing federated learning for privacy-preserving AI in digital health.

41Artificial intelligence can potentially provide a substantial role in streamlining chest computed 42 tomography (CT) diagnosis of COVID-19 patients. However, several critical hurdles have 43 impeded the development of robust AI model, which include deficiency, isolation, and 44 heterogeneity of CT data generated from diverse institutions. These bring about lack of 45 generalization of AI model and therefore prevent it from applications in clinical practices. To 46 overcome this, we proposed a federated learning-based Unified CT-COVID AI Diagnostic 47The online application of AI model is publicly available at

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