FedPref: Federated Preference Learning for Structured Radiology Report Extraction

Artificial intelligence models are promising for medical diagnosis, but they require large numbers of unbiased data, which in medicine are distributed across hospitals and cannot be centralized to protect patient privacy. Federated Learning (FL) addresses this, since hospitals train one shared diagnostic model while patient data remain local. Training proceeds in communication rounds, in which each hospital trains the shared model locally and returns it to the server for merging by weighted average. This aggregation weight determines whose institutional knowledge shapes the result. Federated averaging (FedAvg) sets it in proportion to local sample count, so a small but informative hospital is permanently assigned a small influence, andl argest clients could dominate the global model even when they are less informative. We propose Federated Dual Reputation Annealing Weighting (FedDRAW), a server-side aggregation method that combines a data-size prior with the cosine similarity between client and global parameters under two coupled annealing schedules. An inner schedule shifts client reputation from the size prior towards similarity. An outer, deferred annealing schedule on the softmax inverse temperature keeps the weighting selective in the early and middle rounds and relaxes it to uniformity at convergence. We evaluate FedDRAW on 12 simulated client-partition scenarios of two chest radiograph datasets (CheXpert and ChestMNIST), against seven federated baselines under identical local training settings. FedDRAW achieved the highest average rank among all eight methods under both AUC and the geometric mean (GM) of sensitivity and specificity, which a Friedman test with Nemenyi post-hoc analysis confirmed to be a statistically significant difference between the methods. Scheduling two signals, rather than fixing the weights by sample count alone, could enable less biased diagnostic models.

Structured phenotype extraction from radiology reports supports cohort construction, quality auditing, and clinical analytics, but practical deployment requires local inference and auditable predictions, while expert annotations remain scarce. Conventional labelers provide structured findings and assertion states but no supporting evidence, while API-hosted large language models may be unsuitable when clinical text cannot leave institutional infrastructure. We present CHESTPHENOT, a compact 0.5-3B language model that jointly extracts finding labels, three-class status (present/absent/uncertain), and verbatim supporting evidence spans. CHESTPHENOT is trained using hybrid CheXbert+72B silver supervision followed by supervised fine-tuning and lightweight GRPO refinement. Across three human-annotated gold sets spanning in-distribution, cross-taxonomy, and cross-institution evaluation, the 3B model remains below its CheXbert silver teacher in distribution but is competitive under distribution shift, significantly surpassing CheXbert on cross-institution detection (+2.0 F1). Task-specific training also enables the 3B model to match or exceed substantially larger prompted models on most detection and status comparisons. For evidence-grounded extraction, over 99% of final evidence spans are locatable in the source report, and the 3B model achieves 47.5 auditable-F1, outperforming Qwen2.5-7B one-shot prompting by 7.6 points and approaching Qwen2.5-72B. These results demonstrate that locally deployable models can provide competitive and directly auditable radiology-report extraction without relying on external inference APIs. Code and the full extraction/judge prompts will be made available at https://github.com/yukkai/ChestPheNoT.

Federated Direct Preference Optimization (FedDPO) enables privacy-preserving alignment of language models across distributed agents without centralizing sensitive preference data. However, existing FedDPO analysis assumes all clients converge to a single shared policy, which is fundamentally at odds with the heterogeneous preference distributions present in practice. We propose Personalized FedDPO (pFedDPO), in which each client maintains a small private LoRA adapter atop a shared global base model. In pFedDPO, the base model is synchronized via FedAvg each round, while LoRA adapters remain local and capture client-specific preference patterns. We prove that this decomposition replaces the gradient diversity $κ^2$ in the FedDPO bound with a residual heterogeneity $κ^2_{\mathrm{eff}}$, which is no larger than $κ^2$ when adapters absorb client-specific directions, at the cost of an additive adapter-bias term that vanishes as adapters converge. Experiments on preference datasets show that pFedDPO consistently attains a lower gradient norm than vanilla FedDPO while remaining competitive in training loss and per-client reward accuracy.