# OPERA: Offline Policy-guided Expert Routing and Adaptation for Universal Biomedical Image Analysis

arXiv: https://arxiv.org/abs/2607.25108 · HTML: https://mlsanity.com/paper/2607.25108/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical and biomedical MoE, one of 12 directions in Mixture-of-experts.
- Builds on 37 of its 71 references that are in the map.
- First posted on arXiv 27 Jul 2026.

## Placed in

- Mixture-of-experts / [Medical and biomedical MoE](https://mlsanity.com/moe/medical-and-biomedical-moe/)

## Builds on (most cited first, 30 of 37)

- [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)
- [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)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [Parameter-Efficient Transfer Learning for NLP](https://mlsanity.com/paper/1902.00751/) (2019)
- [Outrageously Large Neural Networks: The Sparsely-Gated Mixture-of-Experts Layer](https://mlsanity.com/paper/1701.06538/) (2017)
- [Switch Transformers: Scaling to Trillion Parameter Models with Simple and Efficient Sparsity](https://mlsanity.com/paper/2101.03961/) (2021)
- [InstructBLIP: Towards General-purpose Vision-Language Models with Instruction Tuning](https://mlsanity.com/paper/2305.06500/) (2023)
- [InternVL: Scaling up Vision Foundation Models and Aligning for Generic Visual-Linguistic Tasks](https://mlsanity.com/paper/2312.14238/) (2023)
- [V-Net: Fully Convolutional Neural Networks for Volumetric Medical Image Segmentation](https://mlsanity.com/paper/1606.04797/) (2016)
- [Offline Reinforcement Learning: Tutorial, Review, and Perspectives on Open Problems](https://mlsanity.com/paper/2005.01643/) (2020)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [ChestX-ray8: Hospital-scale Chest X-ray Database and Benchmarks on Weakly-Supervised Classification and Localization of Common Thorax Diseases](https://mlsanity.com/paper/1705.02315/) (2017)
- [Janus-Pro: Unified Multimodal Understanding and Generation with Data and Model Scaling](https://mlsanity.com/paper/2501.17811/) (2025)
- [Mixture-of-Agents Enhances Large Language Model Capabilities](https://mlsanity.com/paper/2406.04692/) (2024)
- [Mini-Gemini: Mining the Potential of Multi-modality Vision Language Models](https://mlsanity.com/paper/2403.18814/) (2024)
- [A Comprehensive Survey on Test-Time Adaptation under Distribution Shifts](https://mlsanity.com/paper/2303.15361/) (2023)
- [Visual-Language Prompt Tuning with Knowledge-guided Context Optimization](https://mlsanity.com/paper/2303.13283/) (2023)
- [Segment Anything Model for Medical Image Analysis: an Experimental Study](https://mlsanity.com/paper/2304.10517/) (2023)
- [Offline-to-Online Reinforcement Learning via Balanced Replay and Pessimistic Q-Ensemble](https://mlsanity.com/paper/2107.00591/) (2021)
- [Multi-Granularity Cross-modal Alignment for Generalized Medical Visual Representation Learning](https://mlsanity.com/paper/2210.06044/) (2022)
- [Exploring scalable medical image encoders beyond text supervision](https://mlsanity.com/paper/2401.10815/) (2024)
- [MosMedData: Chest CT Scans With COVID-19 Related Findings Dataset](https://mlsanity.com/paper/2005.06465/) (2020)
- [A Foundation Language-Image Model of the Retina (FLAIR): Encoding Expert Knowledge in Text Supervision](https://mlsanity.com/paper/2308.07898/) (2023)
- [Delving into Masked Autoencoders for Multi-Label Thorax Disease Classification](https://mlsanity.com/paper/2210.12843/) (2022)
- [The Relative Performance of Ensemble Methods with Deep Convolutional Neural Networks for Image Classification](https://mlsanity.com/paper/1704.01664/) (2017)
- [Accurate Uncertainty Estimation and Decomposition in Ensemble Learning](https://mlsanity.com/paper/1911.04061/) (2019)
- [Large-Scale 3D Medical Image Pre-training with Geometric Context Priors](https://mlsanity.com/paper/2410.09890/) (2024)
- [Deep Learning Ensembles for Melanoma Recognition in Dermoscopy Images](https://mlsanity.com/paper/1610.04662/) (2016)

## Abstract (arXiv)

Biomedical image analysis spans diverse modalities and tasks, yet real-world deployment is hindered by severe distribution shifts across scanners, protocols, and patient populations. High-performing models consequently require repeated domain-specific fine-tuning, which is a costly cycle that becomes impractical when labels are scarce or privacy constraints limit data sharing. We propose OPERA (Offline Policy-guided Expert Routing and Adaptation), a multi-agent ensemble framework that addresses this deployment bottleneck by treating expert weight assignment as an offline policy learning problem: a routing policy is learned from a small validation set without gradient updates to any expert agent, then deployed with test-time adaptation to handle distribution shift. OPERA coordinates heterogeneous specialist agents through complementary mechanisms. The expert profiling module learns selection policies offline, enabling informed allocation of expertise. Each agent undergoes confidence calibration through temperature adjustment, ensuring more reliable probabilistic outputs. OPERA also incorporates distribution aware adaptation, where class weights are dynamically adjusted at the batch level using statistics derived from unlabeled test data. Instance level routing assigns each sample to the most suitable expert by leveraging inter model agreement and predictive entropy. We evaluate OPERA on 9 datasets covering fundus photography, chest X-ray, CT, MRI, and multimodal diagnostic benchmarks, comparing against 30+ baselines across classification, segmentation, and multimodal settings. OPERA consistently improves performance and calibration quality, demonstrating that offline policy-guided expert agents coordination is a practical path to deployable biomedical AI without retraining. Code is on hrefhttps://github.com/HUANGLIZI/OPERAGitHub.