# Adaptation of Foundation Models for Medical Image Analysis: Strategies, Challenges, and Future Directions

arXiv: https://arxiv.org/abs/2511.01284 · HTML: https://mlsanity.com/paper/2511.01284/

## Key facts

- Cited by 3 papers in the map (data through 14 Oct 2026).
- Builds on 100 of its 143 references that are in the map.
- First posted on arXiv 3 Nov 2025.

## Builds on (most cited first, 30 of 100)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [A Simple Framework for Contrastive Learning of Visual Representations](https://mlsanity.com/paper/2002.05709/) (2020)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [Masked Autoencoders Are Scalable Vision Learners](https://mlsanity.com/paper/2111.06377/) (2021)
- [BLIP: Bootstrapping Language-Image Pre-training for Unified Vision-Language Understanding and Generation](https://mlsanity.com/paper/2201.12086/) (2022)
- [Parameter-Efficient Transfer Learning for NLP](https://mlsanity.com/paper/1902.00751/) (2019)
- [On the Opportunities and Risks of Foundation Models](https://mlsanity.com/paper/2108.07258/) (2021)
- [Prefix-Tuning: Optimizing Continuous Prompts for Generation](https://mlsanity.com/paper/2101.00190/) (2021)
- [The Power of Scale for Parameter-Efficient Prompt Tuning](https://mlsanity.com/paper/2104.08691/) (2021)
- [Emergent Abilities of Large Language Models](https://mlsanity.com/paper/2206.07682/) (2022)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [BitFit: Simple Parameter-efficient Fine-tuning for Transformer-based Masked Language-models](https://mlsanity.com/paper/2106.10199/) (2021)
- [How transferable are features in deep neural networks?](https://mlsanity.com/paper/1411.1792/) (2014)
- [Swin-Unet: Unet-like Pure Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2105.05537/) (2021)
- [A Survey on Deep Learning in Medical Image Analysis](https://mlsanity.com/paper/1702.05747/) (2017)
- [SimMIM: A Simple Framework for Masked Image Modeling](https://mlsanity.com/paper/2111.09886/) (2021)
- [Experience Replay for Continual Learning](https://mlsanity.com/paper/1811.11682/) (2018)
- [Towards a Unified View of Parameter-Efficient Transfer Learning](https://mlsanity.com/paper/2110.04366/) (2021)
- [AdapterFusion: Non-Destructive Task Composition for Transfer Learning](https://mlsanity.com/paper/2005.00247/) (2020)
- [Fine-Tuning can Distort Pretrained Features and Underperform Out-of-Distribution](https://mlsanity.com/paper/2202.10054/) (2022)
- [Self-supervised Learning: Generative or Contrastive](https://mlsanity.com/paper/2006.08218/) (2020)
- [MedMNIST v2 -- A large-scale lightweight benchmark for 2D and 3D biomedical image classification](https://mlsanity.com/paper/2110.14795/) (2021)

## Built on by (most cited first, 3 of 3)

- [Geometry-Consistent Endoscopic Representations for Image-Guided Navigation via Structured Foundation Model Adaptation](https://mlsanity.com/paper/2606.17340/) (2026)
- [CoM3eT: A foundation model for medical image analysis through federated, multidimensional context integration](https://mlsanity.com/paper/2608.16268/) (2026)
- [FAN-LoRA: A Fourier-Adaptive Nonlinear Low-Rank Adaptor for Medical Foundation Model Domain Adaptation](https://mlsanity.com/paper/2608.26531/) (2026)

## Abstract (arXiv)

Foundation models (FMs) have emerged as a transformative paradigm in medical image analysis, offering the potential to provide generalizable, task-agnostic solutions across a wide range of clinical tasks and imaging modalities. Their capacity to learn transferable representations from large-scale data has the potential to address the limitations of conventional task-specific models. However, adaptation of FMs to real-world clinical practice remains constrained by key challenges, including domain shifts, limited availability of high-quality annotated data, substantial computational demands, and strict privacy requirements. This review presents a comprehensive assessment of strategies for adapting FMs to the specific demands of medical imaging. We examine approaches such as supervised fine-tuning, domain-specific pretraining, parameter-efficient fine-tuning, self-supervised learning, hybrid methods, and multimodal or cross-modal frameworks. For each, we evaluate reported performance gains, clinical applicability, and limitations, while identifying trade-offs and unresolved challenges that prior reviews have often overlooked. Beyond these established techniques, we also highlight emerging directions aimed at addressing current gaps. These include continual learning to enable dynamic deployment, federated and privacy-preserving approaches to safeguard sensitive data, hybrid self-supervised learning to enhance data efficiency, data-centric pipelines that combine synthetic generation with human-in-the-loop validation, and systematic benchmarking to assess robust generalization under real-world clinical variability. By outlining these strategies and associated research gaps, this review provides a roadmap for developing adaptive, trustworthy, and clinically integrated FMs capable of meeting the demands of real-world medical imaging.