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medRxiv PreprintsInternational15 October 2026

Calibration, Uncertainty, and Data Efficiency of Deep Learning Chest Radiograph Classifiers Under Cross-Dataset Distribution Shift: A Multi-Dataset Benchmark

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Purpose To evaluate the external transportability of source-derived probability calibration for chest radiograph deep learning classifiers under distribution shift and determine its dependence on sample size and disease prevalence. Materials and Methods This retrospective secondary computational analysis of public, de-identified radiographic datasets involved no participant contact or new data collection. Cohort sizes were prespecified by availability without prospective power calculation: 106,686 NIH ChestX-ray14 images (29,323 patients; 1992-2015) for development and internal testing, 20,000
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