Promise and Limits of Cross-Architecture Knowledge Distillation for Lightweight Medical Vision Transformers (LiteMed-ViT)

The reasoning gap between large and compact vision-language models (VLMs) limits the deployment of medical AI on portable clinical devices. Compact VLMs of 2--4B parameters can run on resource-constrained hardware but lack the multi-step reasoning capacity needed for interpretable clinical decision support. Existing knowledge distillation methods transfer answers without the reasoning process behind them. Medical visual question answering (VQA) serves as a testbed for this problem, as it requires models to integrate visual evidence with clinical knowledge through structured reasoning chains. We introduce LiteMedCoT-VL, a pipeline that transfers chain-of-thought reasoning from a 235B teacher model to 2B student models through LoRA-based fine-tuning on explanation-enriched training data. All inference is conducted without image captions by default, simulating the clinical scenario in which a physician interprets a medical image directly without an accompanying radiology report. On the PMC-VQA benchmark, LiteMedCoT-VL achieves 64.9% accuracy, exceeding the zero-shot Qwen3-VL-4B baseline of 53.9% by 11.0 percentage points and outperforming all published baselines. This result indicates that a 2B model with reasoning distillation can match or exceed models with twice the parameters. Visual grounding analysis shows that the model relies on image content rather than exploiting textual priors. Our code is publicly available at https://anonymous.4open.science/r/LiteMedCoT-VL.

Automated tea leaf disease classification supports precision agriculture, yet deploying accurate models on edge devices remains challenging under tight compute budgets. Self-supervised vision foundation models such as DINOv2 provide strong features but are too large for field deployment, while lightweight models trained from scratch on small agricultural datasets often underfit. We study cross-architecture knowledge distillation (KD) from a fine-tuned DINOv2 teacher (Vision Transformer) to a compact bidirectional Visual State Space Model (LVSSM) student, an underexplored direction because the architectures use fundamentally different token-mixing mechanisms. We identify and fix two training-stability problems that prevent the from-scratch SSM student from learning on limited data: a single large patch-embedding convolution and a fusion layer that severs the residual path. With a progressive convolutional stem and gated bidirectional selective-scan block, the 4.45M-parameter student trains stably. Across three seeds, temperature-scaled logit distillation raises test accuracy from 92.32+/-2.14% to 95.41+/-1.17% (best single run: 96.20%; macro-F1: 94.45%), a +3.09 percentage-point mean gain. The student uses 5.0 times fewer parameters than the 22M-parameter teacher while retaining 98.3% of its accuracy. Ablations show that intermediate feature-alignment losses reduce accuracy, making simple logit-level KD the strongest configuration. A fair from-scratch comparison shows the gain is specific to students that start below the teacher. We report per-class metrics, confusion matrices, bootstrap confidence intervals, and FLOPs/latency measurements, and discuss limitations including the single-dataset scope and simplified non-official SSM implementation.

Vision Transformers rely on positional embeddings and class tokens encoding fixed spatial priors. While effective for natural images, these priors may be suboptimal when spatial layout is weakly informative, a frequent condition in medical imaging. We introduce ZACH-ViT (Zero-token Adaptive Compact Hierarchical Vision Transformer), a compact Vision Transformer that removes positional embeddings and the [CLS] token, achieving permutation-invariant patch processing via global average pooling. Zero-token denotes removal of the dedicated aggregation token and positional encodings. Patch tokens remain unchanged. Adaptive residual projections preserve training stability under strict parameter constraints. We evaluate ZACH-ViT across seven MedMNIST datasets under a strict few-shot protocol (50 samples/class, fixed hyperparameters, five seeds). Results reveal regime-dependent behavior: ZACH-ViT (0.25M parameters, trained from scratch) achieves strongest advantage on BloodMNIST and remains competitive on PathMNIST, while relative advantage decreases on datasets with stronger anatomical priors (OCTMNIST, OrganAMNIST), consistent with our hypothesis. Component and pooling ablations show positional support becomes mildly beneficial as spatial structure increases, whereas reintroducing a [CLS] token is consistently unfavorable. These findings support that architectural alignment with data structure can outweigh universal benchmark dominance. Despite minimal size and no pretraining, ZACH-ViT achieves competitive performance under data-scarce conditions, relevant for compact medical imaging and low-resource settings. Code: https://github.com/Bluesman79/ZACH-ViT