# Time-to-Event Pretraining for 3D Medical Imaging

arXiv: https://arxiv.org/abs/2411.09361 · HTML: https://mlsanity.com/paper/2411.09361/

## Key facts

- Cited by 7 papers in the map (data through 14 Oct 2026).
- Builds on 26 of its 61 references that are in the map.
- First posted on arXiv 14 Nov 2024.

## Builds on (most cited first, 26 of 26)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [A Simple Framework for Contrastive Learning of Visual Representations](https://mlsanity.com/paper/2002.05709/) (2020)
- [Masked Autoencoders Are Scalable Vision Learners](https://mlsanity.com/paper/2111.06377/) (2021)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [LAION-5B: An open large-scale dataset for training next generation image-text models](https://mlsanity.com/paper/2210.08402/) (2022)
- [Quo Vadis, Action Recognition? A New Model and the Kinetics Dataset](https://mlsanity.com/paper/1705.07750/) (2017)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Contrastive Learning of Medical Visual Representations from Paired Images and Text](https://mlsanity.com/paper/2010.00747/) (2020)
- [TotalSegmentator: robust segmentation of 104 anatomical structures in CT images](https://mlsanity.com/paper/2208.05868/) (2022)
- [MedCLIP: Contrastive Learning from Unpaired Medical Images and Text](https://mlsanity.com/paper/2210.10163/) (2022)
- [Self-Supervised Pre-Training of Swin Transformers for 3D Medical Image Analysis](https://mlsanity.com/paper/2111.14791/) (2021)
- [DeepSurv: Personalized Treatment Recommender System Using A Cox Proportional Hazards Deep Neural Network](https://mlsanity.com/paper/1606.00931/) (2016)
- [Capabilities of Gemini Models in Medicine](https://mlsanity.com/paper/2404.18416/) (2024)
- [Merlin: A Computed Tomography Vision-Language Foundation Model and Dataset](https://mlsanity.com/paper/2406.06512/) (2024)
- [MedTrinity-25M: A Large-scale Multimodal Dataset with Multigranular Annotations for Medicine](https://mlsanity.com/paper/2408.02900/) (2024)
- [MOTOR: A Time-To-Event Foundation Model For Structured Medical Records](https://mlsanity.com/paper/2301.03150/) (2023)
- [Masked Image Modeling Advances 3D Medical Image Analysis](https://mlsanity.com/paper/2204.11716/) (2022)
- [CheXtransfer: Performance and Parameter Efficiency of ImageNet Models for Chest X-Ray Interpretation](https://mlsanity.com/paper/2101.06871/) (2021)
- [A Toolbox for Surfacing Health Equity Harms and Biases in Large Language Models](https://mlsanity.com/paper/2403.12025/) (2024)
- [Robust and Efficient Medical Imaging with Self-Supervision](https://mlsanity.com/paper/2205.09723/) (2022)
- [COVID-19 Prognosis via Self-Supervised Representation Learning and Multi-Image Prediction](https://mlsanity.com/paper/2101.04909/) (2021)
- [Disruptive Autoencoders: Leveraging Low-level features for 3D Medical Image Pre-training](https://mlsanity.com/paper/2307.16896/) (2023)
- [Disparate Censorship & Undertesting: A Source of Label Bias in Clinical Machine Learning](https://mlsanity.com/paper/2208.01127/) (2022)
- [Deep survival analysis with longitudinal X-rays for COVID-19](https://mlsanity.com/paper/2108.09641/) (2021)

## Built on by (most cited first, 7 of 7)

- [BIOMEDICA: An Open Biomedical Image-Caption Archive, Dataset, and Vision-Language Models Derived from Scientific Literature](https://mlsanity.com/paper/2501.07171/) (2025)
- [Benchmarking Foundation Models and Parameter-Efficient Fine-Tuning for Prognosis Prediction in Medical Imaging](https://mlsanity.com/paper/2506.18434/) (2025)
- [Stochastic Siamese MAE Pretraining for Longitudinal Medical Images](https://mlsanity.com/paper/2512.23441/) (2025)
- [Subgroup Discovery with the Cox Model](https://mlsanity.com/paper/2512.20762/) (2025)
- [Investigating Trustworthiness of Nonparametric Deep Survival Models for Alzheimer's Disease Progression Analysis](https://mlsanity.com/paper/2605.04063/) (2026)
- [Fusion is not one-size-fits-all: Cross-Modal Representation Alignment for Time-to-Event Modeling](https://mlsanity.com/paper/2606.15038/) (2026)
- [NOAH: Learning the Full Patient Journey. A Longitudinal Multimodal Time-Aware Model for Representation and Forecasting](https://mlsanity.com/paper/2609.09140/) (2026)

## Abstract (arXiv)

With the rise of medical foundation models and the growing availability of imaging data, scalable pretraining techniques offer a promising way to identify imaging biomarkers predictive of future disease risk. While current self-supervised methods for 3D medical imaging models capture local structural features like organ morphology, they fail to link pixel biomarkers with long-term health outcomes due to a missing context problem. Current approaches lack the temporal context necessary to identify biomarkers correlated with disease progression, as they rely on supervision derived only from images and concurrent text descriptions. To address this, we introduce time-to-event pretraining, a pretraining framework for 3D medical imaging models that leverages large-scale temporal supervision from paired, longitudinal electronic health records (EHRs). Using a dataset of 18,945 CT scans (4.2 million 2D images) and time-to-event distributions across thousands of EHR-derived tasks, our method improves outcome prediction, achieving an average AUROC increase of 23.7% and a 29.4% gain in Harrell's C-index across 8 benchmark tasks. Importantly, these gains are achieved without sacrificing diagnostic classification performance. This study lays the foundation for integrating longitudinal EHR and 3D imaging data to advance clinical risk prediction.