Test-time compute setting is an underrecognized variable that shifts medical LLM accuracy

Increasing test-time compute ("reasoning effort") can meaningfully change large language model performance on radiology tasks, yet most studies fail to report or control for this budget variable, risking non-reproducible results.

• Perspective/review article—not a primary study—highlighting that the "reasoning effort" hyperparameter (e.g., chain-of-thought steps, beam width) is seldom specified in medical LLM research.
• Failure to report the compute budget prevents apples-to-apples comparison across models and threatens external reproducibility.
• Key limitation: the paper illustrates the problem qualitatively; it does not provide a systematic quantitative meta-analysis of the magnitude of performance shift across studies.

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