MARR: Decoupling Policy, Execution, and Calibration for All-in-One Medical Image Restoration

All-in-one medical image restoration seeks to recover heterogeneous clinical images with a single model, but PET, CT, and MRI differ substantially in degradation statistics, anatomical contrast, and output-space bias. A fully shared network can entangle modality-specific residual errors, whereas separate modality-specific networks sacrifice the practical advantages of unified deployment. We therefore recast all-in-one restoration as a question of where limited adaptation should be placed: policy selection, feature execution, or output calibration. We propose MARR, a compact restoration framework that constrains multi-modality adaptation into degradation-aware policy routing, modality-private residual execution, and image-domain residual correction without requiring degradation labels or separate modality-specific models. The policy branch forms a routing prompt from input statistics, latent content, and modality identity, and uses it only as a control signal. Prompt-gated modality-private adapters then perform lightweight residual refinement at intermediate decoder stages, while zero-initialized modality-specific output heads calibrate the final image-domain residual without perturbing the initial shared prediction. On an all-in-one PET, CT, and MRI restoration benchmark, MARR outperforms thirteen methods re-trained under the same protocol, achieving PSNR values of 37.34 dB, 33.85 dB, and 32.09 dB on PET, CT, and MRI, respectively, and the best modality-average PSNR of 34.43 dB. The code is publicly available at https://github.com/CHB-learner/MARR.