Med-RADIO: Reducing All Medical Domains Into One via Multi-Teacher Distillation

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 pre-trained on large-scale datasets have shown powerful versatile performance. However, when adapting medical foundation models for specific medical scenarios, it remains the inevitable challenge due to the gap induced by the discrepancy between pre-training and downstream tasks, the real-world computation, and speed constraints. Relevant techniques that probably handle this challenge more or less suffer from some intrinsic limitations. For example, knowledge distillation (KD) assumes that teacher and student models share the same task, training strategy, and model structure family, while prevalent parameter-efficient fine-tuning (PEFT) fails to achieve personalized and lightweight deployment. Even the combination of PEFT and KD still struggles to resolve model structures and training strategies inconsistencies between teacher and student models, leading to inefficient knowledge transfer. In this study, we propose a novel framework called Deep Reprogramming Distillation (DRD) to combat the general adaptation challenge. Specifically, DRD introduces the novel reprogramming module that on the one side overcomes the domain and task discrepancy between pretraining and downstream scenarios, and on the other side builds the student-friendly efficient distillation from foundation models to lightweight downstream models. Furthermore, to mitigate variability under different training conditions, we design a centered kernel alignment (CKA) distillation method to promote robust knowledge transfer. Empirical results show that DRD surpasses previous PEFT and KD methods across 18 medical downstream tasks under different foundation models, covering various scenarios including 2D/3D classification and 2D/3D segmentation.

Multi-modal medical imaging enables comprehensive diagnostics, yet current foundation models process 2D (e.g. X-ray) and 3D (e.g. CT) data with separate, dimensionality-specific architectures. We present MultiMedVision, a unified framework for joint 2D/3D representation learning built on a Sparse Vision Transformer. Our model uses 3D Rotary Positional Embeddings and variable-length sequence packing to process mixed-modality batches natively within a shared latent space, without modality-specific adapters or treating 3D volumes as 2D slice sequences. Trained with a self-supervised objective on chest X-rays (MIMIC-CXR) and CT scans (CT-RATE), and using a single shared encoder with 5x less data, MultiMedVision achieves competitive performance on both 2D benchmarks (Macro AUROC 0.82 on MIMIC, 0.84 on CheXpert) and 3D tasks (0.85 on CT-RATE). Analysis of the learned representations reveals coexisting modality-specific and shared feature subspaces, demonstrating that unified cross-dimensional representation learning is feasible without sacrificing modality-specific performance.