Multimodal physiological data powers clinical AI systems from intensive care units to wearable devices, but sensors routinely fail in practice. Two failure modes are common: modality missing, where an entire channel is absent, and within-modality missing, where a contiguous time segment is lost. No existing benchmark evaluates multiple fusion architectures under both failure modes at controlled severity levels across diverse clinical datasets. We present MuteBench, a benchmark covering 9 datasets from 7 clinical domains, 6 fusion architectures, and 2 missing-data modes over 125,000 samples. Through this benchmark, we find that architecture family is the strongest predictor of robustness, outweighing parameter count. Channel-independent models tolerate modality missing well but can be sensitive to within-modality missing, especially on short sequences. Curriculum modality dropout protects reliably only up to the maximum dropout rate used in training. We also find that channel count, sequence length, and modality alignment jointly determine which failure mode poses the greater threat. Finally, a PTB-XL case study suggests that diffusion-based imputation can improve downstream classification under within-modality missing, with the largest gains for models whose expert routing is most sensitive to corrupted inputs, though broader validation across datasets remains an open direction. MuteBench provides practitioners with concrete guidance for both selecting existing architectures and informing the design of future robust multimodal fusion methods.
Multimodal fusion architectures typically assume all modalities are available at inference, yet sensor failures, acquisition variability, and cost constraints routinely produce incomplete observations. Existing work treats modality absence as a prediction-accuracy problem, leaving a more basic question unanswered: whether a model's confidence estimates remain calibrated when an entire input stream is removed. We argue that missing-modality robustness and calibrated uncertainty are a single coupled property, and introduce Modality-Conditioned Conformal Fusion (MCCF), an architecture that addresses both at once. MCCF combines a multimodal bottleneck fusion backbone trained with modality dropout, per-modality evidential heads producing modality-decomposed Dirichlet distributions, and a Dempster-Shafer combination rule that fuses the per-modality evidence into a joint predictive distribution; an absent modality contributes vacuous evidence that is structurally ignored, so the fused uncertainty automatically reflects the reduced information without test-time imputation. A Mondrian conformal calibration module keyed on the modality-presence mask then provides finite-sample group-conditional coverage for every non-empty modality subset. MCCF is, to our knowledge, the first method with formal coverage guarantees under arbitrary modality availability through architectural integration rather than post-hoc recalibration, and the evidential decomposition yields per-modality vacuity scores that localise uncertainty to the absent modality responsible. Across a synthetic problem and three real multimodal benchmarks, MCCF holds its target coverage on every modality-presence subset, substantially narrows the coverage gap between full and partial modalities relative to a marginal split-conformal baseline, and imposes no measurable accuracy cost relative to temperature-scaled and evidential baselines.
Multimodal clinical models are usually judged on accuracy with every modality present, but deployment removes modalities; an echocardiogram is often unavailable where an ECG is routine. Two questions then matter beyond the size of the accuracy loss: which modality was responsible, and whether the model fails loudly or silently once that modality is dropped. The distinction is per-example and modality-level, and is separate from post-hoc feature attribution (e.g. SHAP). Models are replaced often; the evaluation that answers these questions is reused. We present a model-agnostic modality-failure framework: given N modality embeddings, any mask-aware probe, and labels, it returns a per-example failure taxonomy, a per-modality complementarity matrix that attributes error to modalities, and a loud-vs-silent dropout profile separating monitorable failures from those that pass unflagged far from the decision boundary, using only deployment-observable signals. We release it as a small, unit-tested harness and validate it against planted ground truth. Across seeds it recovers that planted modality dominance and complementary subset, reports per-modality loud-vs-silent rates, and scales to a three-modality complementarity matrix; because the planted structure is known by construction, this validates recovery of per-example attribution rather than clinical performance. We then instantiate the framework on frozen EchoJEPA and HuBERT-ECG embeddings for LVEF and the EF <= 40% HFrEF gate over a paired MIMIC-IV cohort, where on the held-out test split (n = 245) dropping echo nearly doubles error. The narrow echo-to-ECG overlap that bounds cohort size is itself a deployment finding for cardiac foundation models. All of our work can be found at https://github.com/criticaldata/PRIMED-AI.
Multimodal deep learning has shown strong potential in medical applications by integrating heterogeneous data sources such as medical images and structured clinical variables. However, most existing approaches implicitly assume complete modality availability, an assumption that rarely holds in real-world clinical settings where entire modalities and individual features are frequently missing. In this work, we propose a multimodal transformer framework for joint vision-tabular learning explicitly designed to operate under pervasive modality missingness, without relying on imputation or heuristic model switching. The architecture integrates three components: a vision, a tabular, and a multimodal fusion encoder. Unimodal representations are weighted through learnable modality tokens and fused via intermediate fusion with masked self-attention, which excludes missing tokens and modalities from information aggregation and gradient propagation. To further enhance resilience, we introduce a modality-dropout regularization strategy that stochastically removes available modalities during training, encouraging the model to exploit complementary information under partial data availability. We evaluate our approach on the MIMIC-CXR dataset paired with structured clinical data from MIMIC-IV for multilabel classification of 14 diagnostic findings with incomplete annotations. Two parallel systematic stress-test protocols progressively increase training and inference missingness in each modality separately, spanning fully multimodal to fully unimodal scenarios. Across all missingness regimes, the proposed method consistently outperforms representative baselines, showing smoother performance degradation and improved robustness. Ablation studies further demonstrate that attention-level masking and intermediate fusion with joint fine-tuning are key to resilient multimodal inference.
Camillo Maria Caruso, Valerio Guarrasi, Paolo Soda