ORACLE-CT: Anatomy-Aware Support Pooling for CT Classification

Abdominal CT disease classification is challenging because each scan is a large 3D volume with many possible findings, while diagnostic evidence is often confined to specific organs or anatomical compartments. Most study-level classifiers aggregate encoder features using anatomy-agnostic pooling or attention, creating a mismatch between localized disease evidence and global evidence aggregation. We propose ORACLE--CT, an encoder-agnostic anatomy-aware aggregation framework that uses multi-organ segmentation to define label-specific anatomical supports and restrict attention pooling to relevant regions. The framework supports single-organ, multi-organ union, comparative, localized, and global support strategies. We evaluate ORACLE--CT with three encoder families: DINOv3, I3D--ResNet-121, and the radiology-native Pillar--0 encoder. Models are trained end-to-end on MERLIN and evaluated internally and under frozen external transfer to Duke--Abdomen and AMOS. Compared with global average pooling, support-masked pooling improved MERLIN macro-AUROC/AUPRC from 0.838/0.638 to 0.858/0.676 for DINOv3 and from 0.829/0.617 to 0.848/0.659 for I3D--ResNet-121. On harmonized 10-label external evaluation, DINOv3 improved on Duke--Abdomen from 0.802/0.628 to 0.835/0.683 and on AMOS from 0.742/0.313 to 0.762/0.350, with similar gains for I3D--ResNet-121. For Pillar--0, most gains came from learned attention, with smaller additional benefit from anatomical masking. ORACLE--CT improves discrimination and external robustness while preserving an auditable link between predictions and anatomical evidence.

JANUS: Anatomy-Conditioned Gating for Robust CT Triage Under Distribution Shift

Automated CT triage requires models that are simultaneously accurate across diverse pathologies and reliable under institutional shift. While Vision Transformers provide strong visual representations, many clinically significant findings are defined by quantitative imaging biomarkers rather than appearance alone. We introduce JANUS, a physiology-guided dual-stream architecture that conditions visual embeddings on macro-radiomic priors via Anatomically Guided Gating. On the MERLIN test set (N=5082), JANUS attains macro-AUROC 0.88 and AUPRC 0.74, outperforming all reproduced baselines. It generalizes to an external dataset N=2000; AUROC 0.87), with the largest gains on findings defined by size and attenuation as well as improved calibration on both datasets. We further quantify prediction suppression using the Physiological Veto Rate (PVR), showing that under domain shift JANUS reduces high-confidence false positives substantially more often than true positives. Together, these results are consistent with physically grounded conditioning that improves both discrimination and reliability in CT triage. Code is made publicly available at github repository https://github.com/lavsendahal/janus and model weights are at https://huggingface.co/lavsendahal/janus.

Learning to Diagnose Privately: DP-Powered LLMs for Radiology Report Classification

Purpose: This study proposes a framework for fine-tuning large language models (LLMs) with differential privacy (DP) to perform multi-abnormality classification on radiology report text. By injecting calibrated noise during fine-tuning, the framework seeks to mitigate the privacy risks associated with sensitive patient data and protect against data leakage while maintaining classification performance. Materials and Methods: We used 50,232 radiology reports from the publicly available MIMIC-CXR chest radiography and CT-RATE computed tomography datasets, collected between 2011 and 2019. Fine-tuning of LLMs was conducted to classify 14 labels from MIMIC-CXR dataset, and 18 labels from CT-RATE dataset using Differentially Private Low-Rank Adaptation (DP-LoRA) in high and moderate privacy regimes (across a range of privacy budgets = {0.01, 0.1, 1.0, 10.0}). Model performance was evaluated using weighted F1 score across three model architectures: BERT-medium, BERT-small, and ALBERT-base. Statistical analyses compared model performance across different privacy levels to quantify the privacy-utility trade-off. Results: We observe a clear privacy-utility trade-off through our experiments on 2 different datasets and 3 different models. Under moderate privacy guarantees the DP fine-tuned models achieved comparable weighted F1 scores of 0.88 on MIMIC-CXR and 0.59 on CT-RATE, compared to non-private LoRA baselines of 0.90 and 0.78, respectively. Conclusion: Differentially private fine-tuning using LoRA enables effective and privacy-preserving multi-abnormality classification from radiology reports, addressing a key challenge in fine-tuning LLMs on sensitive medical data.