Transferable Low-Rank Convolutional Bases for Onboarding Unseen Medical Imaging Modalities

Deploying a medical imaging model that must later accommodate a modality it has never seen is a recurring practical problem: retraining the shared representation is expensive and destroys performance on the modalities already in service. We study this onboarding problem under a strict leave-one-domain-out protocol, in which a convolutional backbone is pre-trained on source modalities (Kidney CT and Brain MRI), frozen permanently, and then required to accommodate an unseen modality (Chest X-ray). Under this protocol we establish three findings. First, decision-layer parameter-efficient fine-tuning is insufficient when the backbone has never observed the target modality: a linear probe and fully-connected LoRA both fall well short, whereas convolutional LoRA recovers most of the achievable accuracy, showing that adaptation must reach the convolutional features. Second, and centrally, the low-rank convolutional basis learned on the source modalities transfers: freezing that basis and training only its up-projections onboards the unseen modality using just 0.78% of full fine-tuning's parameters, at an accuracy 6.11 percentage points above a random basis of identical size, while an equivalent decision-layer basis exhibits no reliable transfer. Third, adapter-based onboarding leaves source-modality accuracy exactly unchanged (Delta = 0.00 pp), whereas full fine-tuning reaches the highest target accuracy only by catastrophically degrading the source modalities. A Mahalanobis score on frozen backbone features detects the unseen modality with high sensitivity at a strict source-retention threshold, providing a practical trigger for when onboarding is required. All results are reported over three seeds with paired bootstrap confidence intervals.