arXiv:2507.23638v1 Announce Type: cross Abstract: Federated Learning (FL) enables collaborative model training across distributed medical institutions while preserving patient privacy, but remains vulnerable to Byzantine attacks and statistical heterogeneity. We present OptiGradTrust, a comprehensive defense framework that evaluates gradient updates through a novel six-dimensional fingerprint including VAE reconstruction error, cosine similarity metrics, $L_2$ norm, sign-consistency ratio, and Monte Carlo Shapley value, which drive a hybrid RL-attention module for adaptive trust scoring. To address convergence challenges under data heterogeneity, we develop FedBN-Prox (FedBN-P), combining Federated Batch Normalization with proximal regularization for optimal accuracy-convergence trade-offs. Extensive evaluation across MNIST, CIFAR-10, and Alzheimer's MRI datasets under various Byzantine attack scenarios demonstrates significant improvements over state-of-the-art defenses, achieving up to +1.6 percentage points over FLGuard under non-IID conditions while maintaining robust performance against diverse attack patterns through our adaptive learning approach.