A Utility-preserving De-identification Pipeline for Cross-hospital Radiology Data Sharing

Large-scale radiology data are critical for developing robust medical AI systems. However, sharing such data across hospitals remains heavily constrained by privacy concerns. Existing de-identification research in radiology mainly focus on removing identifiable information to enable compliant data release. Yet whether de-identified radiology data can still preserve sufficient utility for large-scale vision-language model training and cross-hospital transfer remains underexplored. In this paper, we introduce a utility-preserving de-identification pipeline (UPDP) for cross-hospital radiology data sharing. Specifically, we compile a blacklist of privacy-sensitive terms and a whitelist of pathology-related terms. For radiology images, we use a generative filtering mechanism that synthesis a privacy-filtered and pathology-reserved counterparts of the original images. These synthetic image counterparts, together with ID-filtered reports, can then be securely shared across hospitals for downstream model development and evaluation. Experiments on public chest X-ray benchmarks demonstrate that our method effectively removes privacy-sensitive information while preserving diagnostically relevant pathology cues. Models trained on the de-identified data maintain competitive diagnostic accuracy compared with those trained on the original data, while exhibiting a marked decline in identity-related accuracy, confirming effective privacy protection. In the cross-hospital setting, we further show that de-identified data can be combined with local data to yield better performance.

Simple Radiology VLLM Test-time Scaling with Thought Graph Traversal

Test-time scaling offers a promising way to improve the reasoning performance of vision-language large models (VLLMs) without additional training. In this paper, we explore a simple but effective approach for applying test-time scaling to radiology report generation. Specifically, we introduce a lightweight Thought Graph Traversal (TGT) framework that guides the model to reason through organ-specific findings in a medically coherent order. This framework integrates structured medical priors into the prompt, enabling deeper and more logical analysis with no changes to the underlying model. To further enhance reasoning depth, we apply a reasoning budget forcing strategy that adjusts the model's inference depth at test time by dynamically extending its generation process. This simple yet powerful combination allows a frozen radiology VLLM to self-correct and generate more accurate, consistent chest X-ray reports. Our method outperforms baseline prompting approaches on standard benchmarks, and also reveals dataset biases through traceable reasoning paths. Code and prompts are open-sourced for reproducibility at https://github.com/glerium/Thought-Graph-Traversal.