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.
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.
AI models for multimodal medical imaging must balance modality-specific specialization with cross-modal shared representations, a trade-off that pure Mixture-of-Experts (MoE) architectures currently fail to satisfy. Expert-based routing improves in-domain learning but may sacrifice cross-modal signals, which appear particularly important for rare (low-prevalence) pathologies in our experiments. To resolve this, we introduce Generalist-Specialist-MoE (GS-MoE), a two-branch (MoE) architecture that couples a cross-modal generalist model with distinct modality-specific specialists (experts) via domain-constrained feature fusion. On RadImageNet (1.35M images, 165 pathologies, three modalities), GS-MoE recovers detection of six low-prevalence pathologies on which every baseline scores F1 = 0, with per-class gains up to +0.60 F1. It attains this while even slightly exceeding dense and specialist-only MoE aggregate baselines (MCC 0.770), while using ∼53% fewer active parameters at inference than the strongest investigated dense model.
Johannes Kaiser, Florian Braunmiller, Daniel Rückert +1
Mixture-of-Experts (MoE) models scale efficiently but remain costly to adapt due to redundant experts and uniform parameter allocation. Existing parameter-efficient fine-tuning (PEFT) methods such as LoRA ignore MoE routing dynamics, leading to suboptimal resource use. We propose EPnG, an adaptive prune-and-grow framework that reallocates LoRA capacity based on expert importance derived from router gate probabilities. EPnG prunes under-utilized experts and expands high-importance experts via rank growth with orthogonal initialization, while maintaining a fixed parameter budget. Across OLMoE and Qwen1.5-MoE, EPnG consistently outperforms LoRA under the same budget and achieves performance comparable to full fine-tuning while updating only 0.55%-0.72% of parameters (up to 140x-180x fewer). These results demonstrate that aligning PEFT with MoE routing yields a more effective and scalable fine-tuning strategy.