# Confidence-Gated Cloud-Edge Cascade Triage via Variational Risk Minimization for Medical Imaging

arXiv: https://arxiv.org/abs/2610.02269 · HTML: https://mlsanity.com/paper/2610.02269/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 17 of its 26 references that are in the map.
- First posted on arXiv 1 Oct 2026.

## Builds on (most cited first, 17 of 17)

- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [Distilling the Knowledge in a Neural Network](https://mlsanity.com/paper/1503.02531/) (2015)
- [DINOv2: Learning Robust Visual Features without Supervision](https://mlsanity.com/paper/2304.07193/) (2023)
- [BLIP-2: Bootstrapping Language-Image Pre-training with Frozen Image Encoders and Large Language Models](https://mlsanity.com/paper/2301.12597/) (2023)
- [Qwen2-VL: Enhancing Vision-Language Model's Perception of the World at Any Resolution](https://mlsanity.com/paper/2409.12191/) (2024)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [How Far Are We to GPT-4V? Closing the Gap to Commercial Multimodal Models with Open-Source Suites](https://mlsanity.com/paper/2404.16821/) (2024)
- [Semantic Uncertainty: Linguistic Invariances for Uncertainty Estimation in Natural Language Generation](https://mlsanity.com/paper/2302.09664/) (2023)
- [MobileViT: Light-weight, General-purpose, and Mobile-friendly Vision Transformer](https://mlsanity.com/paper/2110.02178/) (2021)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [PadChest: A large chest x-ray image dataset with multi-label annotated reports](https://mlsanity.com/paper/1901.07441/) (2019)
- [Towards Generalist Biomedical AI](https://mlsanity.com/paper/2307.14334/) (2023)
- [Benchmarking TinyML Systems: Challenges and Direction](https://mlsanity.com/paper/2003.04821/) (2020)
- [Evaluating General Purpose Vision Foundation Models for Medical Image Analysis: An Experimental Study of DINOv2 on Radiology Benchmarks](https://mlsanity.com/paper/2312.02366/) (2023)
- [EVA-X: A Foundation Model for General Chest X-ray Analysis with Self-supervised Learning](https://mlsanity.com/paper/2405.05237/) (2024)
- [MM-DINOv2: Adapting Foundation Models for Multi-Modal Medical Image Analysis](https://mlsanity.com/paper/2509.06617/) (2025)

## Abstract (arXiv)

Emergency chest X-ray (CXR) triage has a structural modality gap: reports arrive after triage decisions, yet multimodal foundation models require image-text inputs. We present Variational Risk Minimization (VRM), a distillation framework that treats LVLM-generated report variants as Monte Carlo samples of latent clinical interpretations. Rather than distilling from a single teacher target, VRM learns from a variationally marginalized teacher distribution, enabling uncertainty-aware supervision under missing-modality constraints. Under matched encoder families, VRM outperforms direct fine-tuning baselines and improves calibration with strong recovery from hallucinated supervision. Marginalized supervision reduces report-selection instability. In our compact edge-student instantiation, a confidence-gated cascade reaches AUC 0.941 at 103ms average latency with 20.3% cloud escalation, yielding an explicit reliability-latency operating point for cloud-edge clinical workflows.