Prospective clinical indication, post-hoc report leakage, and fusion design in multi-image chest radiograph classification: a patient-clustered evaluation 文章

arXiv:2607.13800v1 Announce Type: cross Abstract: Chest radiograph datasets often combine multiple images with Clinical Indication, Findings, and Impression, although these inputs are produced at different stages of care. We evaluated 15,000 ReXGradient-160K studies with two readable images and five CheXbert-derived report observations. Frozen DenseNet-121 and Bio+ClinicalBERT encoders were used to compare image-only, Indication-only, fixed-order multimodal, random-swap, DeepSets, and SectionGuard-MI models. Findings and Impression were evaluated only as post-hoc leakage controls. Models were trained with five seeds, and public-test uncertainty was estimated with 2,000 patient-cluster bootstrap replicates. Under U-Ones, macro AUROC was 0.643 for the primary image, 0.694 for two images, 0.749 for Indication, and 0.780 for ordinary two-image-plus-Indication fusion. SectionGuard-MI achieved AUROC 0.783 and AUPRC 0.260. Relative to ordinary fusion, its paired AUROC difference was 0.