Biomedical image analysis spans diverse modalities and tasks, yet real-world deployment is hindered by severe distribution shifts across scanners, protocols, and patient populations. High-performing models consequently require repeated domain-specific fine-tuning, which is a costly cycle that becomes impractical when labels are scarce or privacy constraints limit data sharing. We propose OPERA (Offline Policy-guided Expert Routing and Adaptation), a multi-agent ensemble framework that addresses this deployment bottleneck by treating expert weight assignment as an offline policy learning problem: a routing policy is learned from a small validation set without gradient updates to any expert agent, then deployed with test-time adaptation to handle distribution shift. OPERA coordinates heterogeneous specialist agents through complementary mechanisms. The expert profiling module learns selection policies offline, enabling informed allocation of expertise. Each agent undergoes confidence calibration through temperature adjustment, ensuring more reliable probabilistic outputs. OPERA also incorporates distribution aware adaptation, where class weights are dynamically adjusted at the batch level using statistics derived from unlabeled test data. Instance level routing assigns each sample to the most suitable expert by leveraging inter model agreement and predictive entropy. We evaluate OPERA on 9 datasets covering fundus photography, chest X-ray, CT, MRI, and multimodal diagnostic benchmarks, comparing against 30+ baselines across classification, segmentation, and multimodal settings. OPERA consistently improves performance and calibration quality, demonstrating that offline policy-guided expert agents coordination is a practical path to deployable biomedical AI without retraining. Code is on \href{https://github.com/HUANGLIZI/OPERA}{GitHub}.
Active learning (AL) promises to reduce the cost of medical imaging projects by lowering the number of clinical labels required. However, practical deployment requires committing to a sampling strategy before the full annotation budget is spent, and choosing the wrong strategy can increase rather than decrease costs. We propose Active-Learning Deployment Advisor (ALDA), a deployment-oriented framework for AL method selection under clinical performance constraints. Given a short pilot phase, ALDA fits a parametric learning-curve model to each candidate strategy, estimates whether that strategy is expected to reach a required clinical performance target, and predicts the number of expert annotations needed to do so. In addition to absolute annotation cost, ALDA introduces a deployment window that quantifies the sensitivity of this cost estimate to uncertainty in the clinical threshold. The final recommendation follows a risk-aware rule: among strategies with near-optimal predicted cost, ALDA prefers the strategy with the narrowest deployment window, the most robust to threshold revisions. Experiments on four medical imaging classification domains show that ALDA predicts the deployment-optimal method from a pilot of 15-30% of the intended budget and reduces annotation costs by up to 82% compared with a poor strategy choice. Rather than introducing a new sampling heuristic, ALDA provides a practical decision layer that answers a deployment-critical question: how many labels are enough?
Julia Machnio, Mads Nielsen, Mostafa Mehdipour Ghazi
Adapting deep learning models to profound clinical heterogeneity typically relies on parameter-efficient fine-tuning (PEFT) to avoid the severe overfitting associated with full end-to-end network updates. Although PEFT successfully navigates limited data scenarios, it inherently forces the training of a separate, isolated adapter for every specific diagnostic task. Consolidating these isolated adapters into a single generalist network risks negative transfer, as optimization gradients from conflicting visual domains interfere. To address this, we propose MoPET, a mixture-of-experts (MoE) method that uses a learned sparse router to direct each input through a small subset of low-rank PEFT experts injected into a frozen foundation model, sharing capacity across datasets while limiting cross-domain gradient conflict. Through selected evaluations on the MedMNIST benchmark, we first establish that PEFT outperforms full network updates, improving average accuracy from 86.50% to 88.97%. We then show that a single MoPET model consolidates four heterogeneous datasets into one network, improving average accuracy over the best isolated PEFT adapters (93.46% versus 92.83%). Finally, we show that co-training with auxiliary datasets improves accuracy on data-constrained clinical targets, raising average target accuracy over the strongest isolated adapter from 81.58% to 83.58%. Our source code is publicly available at https://github.com/sdoerrich97/mopet.
Sebastian Doerrich, Daniel Würtinger, Francesco Di Salvo +2
Medical vision-language models (MVLMs) promise broad zero-shot generalization, yet their reliability collapses when confronted with unseen modalities and domains, precisely where clinical robustness matters most. To address this gap, we revisit test-time modality generalization from the perspective of Mixture-of-Experts (MoE) and ask: can experts route-and-adapt without any optimization during inference? We identify a fundamental specialization-generalization dilemma at test time, where blindly aggregating modality experts dilutes modality-specific knowledge, while selecting one highly confident expert risks mismatch under shift. To address this, we propose MoBE: a fully optimization-free framework that performs dynamic expert selection and adaptation at test time. MoBE combines entropy-guided dynamic routing in MoE settings with expert-wise Bayesian adaptation, enabling experts to update their confidence and adapt online without gradient updates. Without parametric updates, MoBE augments a static MVLM with test-time routing and online statistics, achieving average accuracy gains of +4.72, +7.17, and +4.3 over state-of-the-art TTA methods across seen, unseen, and heterogeneous medical benchmarks, highlighting the effectiveness of training-free expert adaptation for robust modality generalization.