Abstract
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.
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Publication details
- DOI
- 10.1016/j.smhl.2026.100689
- Journal
- Not available
- Open access
- Green open access
Cite this article
APA 7
Yang, X., Zhong, Z., Collins, S., Bernstein, M., Baird, G., Healey, T., Atalay, M., Jayaraman, M., Wang, X., & Jiao, Z. (2026). Confidence-Gated Cloud-Edge Cascade Triage via Variational Risk Minimization for Medical Imaging. https://doi.org/10.1016/j.smhl.2026.100689
MLA 9
Yang, Xinye, et al. "Confidence-Gated Cloud-Edge Cascade Triage via Variational Risk Minimization for Medical Imaging." https://doi.org/10.1016/j.smhl.2026.100689.
Chicago (author–date)
Yang, Xinye, Zhusi Zhong, Scott Collins, Michael Bernstein, Grayson Baird, Terrence Healey, Michael Atalay, Mahesh Jayaraman, Xuyu Wang, and Zhicheng Jiao. 2026. "Confidence-Gated Cloud-Edge Cascade Triage via Variational Risk Minimization for Medical Imaging." https://doi.org/10.1016/j.smhl.2026.100689.
Harvard
Yang, X., Zhong, Z., Collins, S., Bernstein, M., Baird, G., Healey, T., Atalay, M., Jayaraman, M., Wang, X. and Jiao, Z. (2026) 'Confidence-Gated Cloud-Edge Cascade Triage via Variational Risk Minimization for Medical Imaging', doi:10.1016/j.smhl.2026.100689.
Vancouver
Yang X, Zhong Z, Collins S, Bernstein M, Baird G, Healey T, et al. Confidence-Gated Cloud-Edge Cascade Triage via Variational Risk Minimization for Medical Imaging. doi:10.1016/j.smhl.2026.100689
IEEE
X. Yang, Z. Zhong, S. Collins, M. Bernstein, G. Baird, T. Healey, M. Atalay, M. Jayaraman, X. Wang, and Z. Jiao, "Confidence-Gated Cloud-Edge Cascade Triage via Variational Risk Minimization for Medical Imaging," doi: 10.1016/j.smhl.2026.100689.