M-IDoL: Information Decomposition for Modality-Specific and Diverse Representation Learning in Medical Foundation Model

Multi-modality medical vision (MV) foundation models (FM) are fundamentally challenged by pronounced Non-IID feature statistics across heterogeneous imaging modalities. Monolithic self-supervised optimization on such data induces conflicting gradients, driving representations to collapse toward modality-dominant shortcuts. This work reframes this failure as an imbalance between specialization and coordination in emergent modularity, and proposes Director-Experts (DEX), a modular network that explicitly regulates these dynamics in stacked modules. Each DEX module comprises a pool of experts, dynamically adapted by our image-wise activation strategy, autonomously specializing in modality-dominant statistics, together with a director, updated via our group exponential moving average, which distills multi-expert knowledge into a shared space for semantic integration across modalities, thus driving the emergence of modular representations. We curate a new benchmark, Medical Vision Universe, over 4 million images across 10 modalities, which provides a FM-level pre-training with the broadest coverage of distinct imaging modalities to our DEX. Extensive evaluations on 26 downstream tasks demonstrate improved optimization behavior and transferability, indicating DEX as a principled step toward general-purpose multi-modality medical AI. Our code and dataset will be opened at https://github.com/YutingHe-list/DEX.

Building foundation models for medical imaging requires pooling data across institutions, yet privacy regulations prohibit centralized aggregation. Existing Federated Foundation Models either fine-tune natural-image models with poor medical-domain transfer, or train from scratch within a single modality, lacking the flexibility to unify tasks. We identify an under-explored challenge, Imaging Modality Heterogeneity, where clients operate under two structural regimes: Overlapped (shared modalities with heterogeneous label distributions) and Non-overlapped (fully disjoint modalities per client). We propose FM$^2$, a unified framework that trains the core backbone from scratch to preserve medical domain fidelity while optionally incorporating biomedical pretrained encoders for vision-language alignment. FM$^2$ equips each client with dual Mixture-of-Experts modules (a Class-wise MoE for personalized category knowledge and a Domain-wise MoE for shared cross-modality representations), coupled with a Heterogeneous Modality Alignment (HMA) regularizer that explicitly aligns modality-specific expert parameters, admitting provable $O(1/\sqrt{T})$ convergence and generalization guarantees. FM$^2$ further incorporates Caption-Enhanced Learning (CEL), where locally retained GPT-4o-generated captions serve as a textual semantic bridge enabling representation transfer across clients with disjoint modalities, and demonstrates extensibility to Federated Medical VQA. Experiments on our MIMH benchmark (classification and CEL) and real-world medical VQA datasets confirm consistent superiority over state-of-the-art federated baselines and strong out-of-modality generalization across all three tasks.

Medical foundation models improve generalization when training AI models with limited labeled data, but remain confined to a single specialty, such as pathology or radiology, and to either sparse or dense outputs, such as classification or segmentation. Here, we present CoM$^3$eT (Co-representation Multidimensional Multitask Medical Transformer), a medical vision foundation model that unifies pathology and radiology, sparse and dense predictions, and two- and higher-dimensional inputs by modeling multidimensional context with attention. CoM$^3$eT outperformed other medical foundation models in an open competition spanning five tomographic, four whole-specimen, and three two-dimensional datasets, covering sparse and dense prediction tasks as well as report generation. When adapted across diverse clinical applications, training fewer than 2.5% of parameters achieved performance comparable to full fine-tuning, enabling research without access to high-performance GPU clusters. Applied to federated learning across hospitals, this approach achieved performance comparable to pooled-data training over internet connections and with consumer-grade hardware.