{"paper":{"title":"Rethinking Clinical Relevance in Chest X-ray Machine Learning: How Evaluation References Define Performance","license":"http://arxiv.org/licenses/nonexclusive-distrib/1.0/","headline":"","cross_cats":["cs.CV","cs.LG"],"primary_cat":"eess.IV","authors_text":"Alex Sawer, Anna Breger, Anna Korhonen, Arthikkaa Thavakumar, Carola-Bibiane Sch\\\"onlieb, Clemens Karner, Ian Selby, Jake Beckford, J. H. F. Rudd, John Li Chen, Jonathan Weir-McCall, Judith Babar, Michael Roberts, Panagiotis Fytas, Shahab Shahipasand, Simon Baker, Timothy J. Sadler","submitted_at":"2026-07-28T23:11:04Z","abstract_excerpt":"Chest X-ray (CXR) machine learning relies heavily on automated evaluation using reference standards that aim to approximate clinical judgment. However, commonly used report-derived labels for pathology classification or generic image quality metrics for reconstruction may not reliably reflect clinical judgment. We systematically investigate how evaluation-reference choices affect model performance and ranking in both pathology classification and image quality assessment (IQA). To enable controlled comparison across evaluation references, we collected paired expert image- and report-derived lab"},"claims":{"count":0,"items":[],"snapshot_sha256":"258153158e38e3291e3d48162225fcdb2d5a3ed65a07baac614ab91432fd4f57"},"source":{"id":"2607.26333","kind":"arxiv","version":1},"verdict":{"id":null,"model_set":{},"created_at":null,"strongest_claim":"","one_line_summary":"","pipeline_version":null,"weakest_assumption":"","pith_extraction_headline":""},"integrity":{"clean":true,"summary":{"advisory":0,"critical":0,"by_detector":{},"informational":0},"endpoint":"/pith/2607.26333/integrity.json","findings":[],"available":true,"detectors_run":[],"snapshot_sha256":"c28c3603d3b5d939e8dc4c7e95fa8dfce3d595e45f758748cecf8e644a296938"},"references":{"count":0,"sample":[],"resolved_work":0,"snapshot_sha256":"258153158e38e3291e3d48162225fcdb2d5a3ed65a07baac614ab91432fd4f57","internal_anchors":0},"formal_canon":{"evidence_count":0,"snapshot_sha256":"258153158e38e3291e3d48162225fcdb2d5a3ed65a07baac614ab91432fd4f57"},"author_claims":{"count":0,"strong_count":0,"snapshot_sha256":"258153158e38e3291e3d48162225fcdb2d5a3ed65a07baac614ab91432fd4f57"},"builder_version":"pith-number-builder-2026-05-17-v1"}