The pretraining domain outweighs the training objective in setting the privacy-utility trade-off of differentially private medical image analysis

Many machine learning applications involve sensitive data and therefore require training under differential privacy (DP). However, DP training often degrades model utility. In some cases, first pre-training the model on "public" data before finetuning with DP on the sensitive data can reduce the drop in utility. However, the success of this depends on how relevant the selected public dataset is to the sensitive data. We introduce the first pipeline that privately learns the mixture of several public datasets to pretrain on for a given sensitive downstream task. Our key insight is that we can privately find the best mixture of multiple public datasets by privately learning a low-dimensional linear model. We tested our method on the NIH dataset for X-ray classification and the ENRON email dataset for language modeling. Applying our method to find tailored mixtures of X-ray datasets to pretrain on for diseases in the NIH ChestX-ray14 dataset, we improved macro AUC by up to 0.037 across privacy budgets compared to the baselines, with gains as large as +22.8% relative AUC on Cardiomegaly at $ε=1$. For DP training on the ENRON dataset, pre-training on our mixture of The Common Pile (a collection of public-domain text datasets) decreased test perplexity by 16% relative to the baseline mixtures.

Differential privacy (DP)'s effect in medical imaging is typically evaluated only through end-to-end performance, leaving the mechanism of privacy-induced utility loss unclear. We introduce Differential Privacy Representation Geometry for Medical Imaging (DP-RGMI), a framework that interprets DP as a structured transformation of representation space and decomposes performance degradation into encoder geometry and task-head utilization. Geometry is quantified by representation displacement from initialization and spectral effective dimension, while utilization is measured as the gap between linear-probe and end-to-end utility. Across over 594,000 images from four chest X-ray datasets and multiple pretrained initializations, we show that DP is consistently associated with a utilization gap even when linear separability is largely preserved. At the same time, displacement and spectral dimension exhibit non-monotonic, initialization- and dataset-dependent reshaping, indicating that DP alters representation anisotropy rather than uniformly collapsing features. Correlation analysis reveals that the association between end-to-end performance and utilization is robust across datasets but can vary by initialization, while geometric quantities capture additional prior- and dataset-conditioned variation. These findings position DP-RGMI as a reproducible framework for diagnosing privacy-induced failure modes and informing privacy model selection.

Differentially private machine learning enables model training on sensitive data while ensuring that individual data is unlikely to be recoverable from the parameters of the resulting model. However, existing work often privatizes both training inputs and their labels, and these protections may be conservative when labels are public or can be safely made public. Therefore, in this work we propose a novel private training framework that instead privatizes training inputs while keeping labels public. We consider neural networks with softmax output layers, and thus the mapping from training inputs to the output of the softmax layer is a mapping onto the unit simplex. We randomize softmax outputs during training by applying the Dirichlet mechanism to enforce differential privacy for the training inputs, hence the ``end-to-end'' label. Because training data is reused across multiple training epochs, we use the notion of \Renyi differential privacy to formulate tight bounds on the strength of privacy provided by the Dirichlet mechanism across repeated uses. We show empirically that we attain new state-of-the-art accuracy when training from scratch on CIFAR10, MNIST, MedMNIST, FashionMNIST, and SVHN across all privacy budgets evaluated. Notably, when implementing $(ε, δ)$-differential privacy with $δ=10^{-5}$, we improve the prior state-of-the-art accuracy from $78.37\%$ to $88.17\%$ at $ε=4$ on CIFAR10, and our approach has $82.96\%$ accuracy even for $ε=1$, which significantly outperforms prior work.