AURORA: Adaptive Unified Representation for Robust Ultrasound Analysis

Ultrasound image analysis plays a crucial role in cancer screening and prenatal diagnosis, yet comprehensive assessment requires jointly addressing tasks such as lesion segmentation and benign-malignant classification. While recent vision foundation models have shown remarkable universal representations, unlocking their potential for ultrasound is bottlenecked by the considerable domain gap from natural images. Existing methods typically fine-tune heavy vision encoders for isolated tasks, incurring substantial computational overhead while overlooking the underlying commonalities across heterogeneous tasks. In this work, we propose FreqDINO++, a frequency-guided multi-task routing vision foundation model for universal ultrasound analysis. We first introduce a Multi-task Routing Adapter (MR-Adapter) to support parameter-efficient integration of task-common and task-specific knowledge, a Frequency-aware Feature Enhancer (F$^2$-Enhancer) is then designed to capture the rich multi-scale frequency characteristics of ultrasound images, and a Task-aligned Collaborative Decoder (TC-Decoder) is devised to promote collaboration between dense and global prediction tasks through global-local token interaction. Extensive experiments on large-scale multi-task and external single-task ultrasound benchmarks demonstrate that FreqDINO++ consistently outperforms strong baselines and recent foundation models across 27 diverse clinical task scenarios, while also showing promising generalization to unseen data. The code is at https://github.com/MingLang-FD/FreqDINO-Plus.

Executing multiple tasks simultaneously in medical image analysis, including segmentation, classification, detection, and regression, often introduces significant challenges regarding model generalizability and the optimization of shared feature representations. While Vision Foundation Models (VFMs) provide powerful general representations, full fine-tuning on limited medical data is prone to overfitting and incurs high computational costs. Moreover, existing parameter-efficient fine-tuning approaches typically adopt task-agnostic adaptation protocols, overlooking both task-specific mechanisms and the varying sensitivity of model layers during fine-tuning. In this work, we propose Task-Aware Prompting and Selective Layer Fine-Tuning (TAP-SLF), a unified framework for multi-task ultrasound image analysis. TAP-SLF incorporates task-aware soft prompts to encode task-specific priors into the input token sequence and applies LoRA to selected specific top layers of the encoder. This strategy updates only a small fraction of the VFM parameters while keeping the pre-trained backbone frozen. By combining task-aware prompts with selective high-layer fine-tuning, TAP-SLF enables efficient VFM adaptation to diverse medical tasks within a shared backbone. Results on the FMC_UIA 2026 Challenge test set, where TAP-SLF wins fifth place, combined with evaluations on the officially released training dataset using an 8:2 train-test split, demonstrate that task-aware prompting and selective layer tuning are effective strategies for efficient VFM adaptation.

Clinical ultrasound analysis demands models that generalize across heterogeneous organs, views, and devices, while supporting interpretable workflow-level analysis. Existing methods often rely on task-wise adaptation, and joint learning may be unstable due to cross-task interference, making it hard to deliver workflow-level outputs in practice. To address these challenges, we present USTri, a tri-stage ultrasound intelligence pipeline for unified multi-organ, multi-task analysis. Stage I trains a universal generalist USGen on different domains to learn broad, transferable priors that are robust to device and protocol variability. To better handle domain shifts and reach task-aligned performance while preserving ultrasound shared knowledge, Stage II builds USpec by keeping USGen frozen and finetuning dataset-specific heads. Stage III introduces USAgent, which mimics clinician workflows by orchestrating USpec specialists for multi-step inference and deterministic structured reports. On the FMC_UIA validation set, our model achieves the best overall performance across 4 task types and 27 datasets, outperforming state-of-the-art methods. Moreover, qualitative results show that USAgent produces clinically structured reports with high accuracy and interpretability. Our study suggests a scalable path to ultrasound intelligence that generalizes across heterogeneous ultrasound tasks and supports consistent end-to-end clinical workflows. The code is publicly available at: https://github.com/MacDunno/USTri.