EEG-AS: Instance-Level Foundation Model Selection for EEG Foundation Models via Behavior Reconstruction

Electroencephalography (EEG) is a non-invasive technique for measuring neural activity and has been widely used in neuroscience applications. Recent advances in EEG foundation models have enabled strong performance across diverse neural decoding tasks. However, no single foundation model consistently performs best across datasets or individual EEG instances, while instance-level model selection remains largely unexplored. To address this limitation, we formulate EEG foundation model selection as an instance-level Algorithm Selection (AS) problem. We propose \textbf{EEG-AS}, an instance-level algorithm selection framework that characterizes each EEG instance using inference-available latent EEG embeddings, handcrafted neurophysiological features, and an anchor foundation model. During training, EEG-AS learns to reconstruct unavailable foundation-model behaviors from privileged prediction tokens conditioned on an anchor foundation model, while during inference it estimates these behaviors without executing the entire model portfolio, enabling efficient selection from seven EEG foundation models. Experiments on seven public EEG benchmarks demonstrate that EEG-AS substantially narrows the gap between the Single Best Solver (SBS) and the oracle upper bound for each instance. These results highlight the effectiveness of instance-level AS for adaptive deployment of EEG foundation models.

Label-Free Foundational Model Selection for Medical Image Classification under Distribution Shift via Pseudo Label Discrepancy

Foundation models are increasingly deployed for medical image analysis. However, under the inter-institutional distribution shift typical of deployment, their performance varies widely and cannot be known without target-domain labels, which are rarely available. This leaves a practical question unresolved: given several candidate foundational models and labeled-data from a source domain, which one to deploy in an unlabeled target domain? We propose a label-free selection criterion built on SUDO, a framework for evaluating clinical AI systems without ground-truth annotations. SUDO partitions the unlabeled target data by predicted probability and, for each region, measures a pseudo-label discrepancy reflecting class contamination; aggregated across regions, this yields a score (AURCC) requiring neither target annotation nor fine-tuning. We show that AURCC can be used to rank a variety of vision-language models (BioMedCLIP, CXR-CLIP, CheXzero, MedCLIP, MedImageInsight, CLIP) on chest X-ray classification across three inter-hospital shift scenarios, under zero-shot and MLP-probe regimes. The AURCC ranking recovers the ground-truth ranking with Spearman rho up to 0.943 (p<0.05). Against the natural baseline of ranking by held-out source accuracy, AURCC is competitive when the labeled source is large and yields a more accurate ranking once it is small; the regime of interest in resource-constrained settings.

CRS-Bench: A Reference-Relative Reliability Benchmark for Medical Image Encoders

Pretrained image encoders are central to medical image classification, where expert annotation is costly and task-specific cohorts are often limited. As the model space expands from general-purpose to broad-medical and specialty-specific encoders, selecting the representation becomes a substantive modeling decision. Clean-test discrimination alone is insufficient for this purpose: encoders with similar AUROC can differ in calibration, label efficiency, and stability under acquisition perturbations or distribution shift. We introduce CRS-Bench, a controlled benchmark for multi-objective medical encoder selection. CRS-Bench evaluates 15 pretrained encoder families across dermatology, ophthalmology, and radiology using ISIC 2019, APTOS 2019, and CheXpert, with CheXpert-to-MIMIC-CXR as an observed institutional shift, yielding 17,575 controlled run records and 3,515 seed-aggregated metric rows. Each encoder is characterized along four operational reliability dimensions: discrimination, calibration, label efficiency, and robustness. We summarize these dimensions using the Clinical Reliability Score (CRS), a Pareto-aware, reference-relative score combining dominance, profile balance, and worst-axis performance. AUROC and CRS are positively associated but not decision-equivalent: 21 of 105 pairwise orderings reverse, with a mean absolute rank displacement of 1.87. Paired-seed bootstrap analysis identifies PanDerm, MedSigLIP, and MedGemma as a stable leading reliability tier rather than a statistically resolved single leader. CRS-Bench provides a controlled framework for selecting medical image encoders from multi-axis reliability profiles rather than clean-test AUROC alone.

How Far from Clinical Deployment? Evaluating the Complete Unsupervised Domain Adaptation Pipeline in Medical Imaging

Deploying unsupervised domain adaptation (UDA) in clinical practice requires choosing which algorithm to use and which of its trained models to ship. However, the deployment (target) domain is unlabeled, so models cannot be evaluated directly on it, leaving it unclear which to select. We address this by evaluating the complete UDA pipeline, considering both adaptation and label-free selection together. Our study covers eleven clinically relevant cross-domain scenarios from nine medical imaging datasets, with ten UDA algorithms and 13 label-free selection methods (validators), evaluating over 80,000 trained models in total. By this, we find that a capable adapted model usually exists, but identifying it without target labels is difficult: the validator-selected models leave a large and structural target performance gap to the best available one, with no evaluated validator consistently reliable. Towards closing it, we explore two strategies, ensembling and a small target-labeling budget; both narrow this gap but do not close it entirely. Overall, deployable UDA depends on the complete pipeline; addressing the less explored selection step could bring much of current UDA closer to clinical use.

Robustness of transferability estimation metrics for medical imaging

In transfer learning, the choice of source model largely influences the performance on a target dataset. Still, selecting a fitting source remains a challenging task, especially in medical imaging where one has to decide between models pre-trained on off-the-shelf options, such as ImageNet, and domain specific datasets. Transferability estimation (TE) metrics address this problem by aiming to predict the best performing source model in a computationally cost effective way. However, previous work has reported conflicting TE metric performances due to differences in experimental setups. Moreover, most TE metrics are designed for and evaluated on natural images, while being optimized for accuracy, whereas in medical imaging metrics that are more robust to class imbalance are typically used. We study the impact of varying the target dataset as an isolated factor, by constructing miniature populations of different sample sizes and random seeds. In addition, we investigate the influence of the evaluation metric used to obtain the reference ranking. We find that small modifications to the target dataset change the rankings. Furthermore, we show that the choice of evaluation metric affects the reference rankings and therefore the evaluation of TE metrics. Overall, we observe a low agreement between rankings from TE metrics and reference. The code, model checkpoints and data splits used in this work are available through https://github.com/niclasclassen/robustness-of-transferability-estimation-metrics-for-medical-imaging.

How Many Labels Are Enough? ALDA: Active Learning Deployment Advisor for Medical Image Classification

Active learning (AL) promises to reduce the cost of medical imaging projects by lowering the number of clinical labels required. However, practical deployment requires committing to a sampling strategy before the full annotation budget is spent, and choosing the wrong strategy can increase rather than decrease costs. We propose Active-Learning Deployment Advisor (ALDA), a deployment-oriented framework for AL method selection under clinical performance constraints. Given a short pilot phase, ALDA fits a parametric learning-curve model to each candidate strategy, estimates whether that strategy is expected to reach a required clinical performance target, and predicts the number of expert annotations needed to do so. In addition to absolute annotation cost, ALDA introduces a deployment window that quantifies the sensitivity of this cost estimate to uncertainty in the clinical threshold. The final recommendation follows a risk-aware rule: among strategies with near-optimal predicted cost, ALDA prefers the strategy with the narrowest deployment window, the most robust to threshold revisions. Experiments on four medical imaging classification domains show that ALDA predicts the deployment-optimal method from a pilot of 15-30% of the intended budget and reduces annotation costs by up to 82% compared with a poor strategy choice. Rather than introducing a new sampling heuristic, ALDA provides a practical decision layer that answers a deployment-critical question: how many labels are enough?

Towards Practical Algorithm Selection for Unsupervised Domain Adaptation in Medical Imaging

Numerous unsupervised domain adaptation (UDA) algori-thms exist, but for clinical practice, selecting the best-suited one along with proper hyperparameters often remains unclear, as the unlabeled deployment (target) domain prevents direct evaluation. We propose a label-free criterion that jointly selects the algorithm and hyperparameters for UDA. Given a pool of candidate models from multiple algorithms trained with different hyperparameters, our approach scores each candidate against an agreement reference, and selects the one with the highest score. The agreement reference is constructed in two levels without using target labels. First, we leverage multiple label-free selection signals, using each to nominate a model within every algorithm. Second, the nominated models are aggregated across algorithms to form a reference prediction for each unlabeled target sample. The candidate whose predictions agree most with this reference is then selected for deployment. Experimental results on four brain MRI and four chest X-ray datasets across seven clinically relevant transfer scenarios show that our method achieves better selection performance than other methods and remains effective across different algorithm pools. Our approach takes a step towards practical, label-free algorithm selection for clinical deployment of UDA.

Beyond Counts: A Distributional Robustness Margin For Pathology Foundation Models

Pathology foundation models are approaching clinical deployment, yet remain vulnerable to systematic non-biological variation across centres. Differences in tissue preparation, staining and scanning are strongly encoded in their representations, enabling shortcut learning and weakening generalisation across cohorts and institutions. The Robustness Index (RI) quantifies whether local representation geometry is dominated by biology or by non-biological variation, but its count-based formulation discards distance information. We show that adding distance weights changes little because the deeper limitation lies in RI's pooled, fixed-neighbourhood design, which obscures sample-level heterogeneity and effectively evaluates only a model-dependent subset of samples. We introduce the Cross-confounder Robustness Margin (CRoMa), a sample-resolved measure that directly compares distances to cross-confounder biological matches and same-confounder biological distractors. CRoMa recasts robustness as a cohort-wide margin distribution rather than a single pooled score. We evaluated frozen representations from 20 tile-level encoders across three benchmarks and 4 slide-level encoders on a fourth. Rankings by median CRoMa were broadly consistent across datasets, while the underlying distributions revealed substantial within-model heterogeneity. Every tile encoder retained a confounder-dominated lower tail, whose prevalence and severity varied markedly across models. These distinct robustness profiles frame model selection as a Pareto trade-off between typical and lower-tail robustness. Higher CRoMa was also associated with smaller shortcut-induced performance drops after supervised adaptation. By turning representation geometry into a distributional robustness readout that anticipates downstream shortcut susceptibility, CRoMa provides a principled basis for robustness assessment and model selection.

Benchmarking the Domain Gap: Model Selection Instability Under Domain Shift in Video Capsule Endoscopy

Video capsule endoscopy (VCE) classification is typically evaluated within a single dataset, yet clinical deployment demands robustness across acquisition sources, labeling policies, and patient populations. We examine this gap using Kvasir-Capsule, Capsule Vision 2024 (CV2024), and a shared-label subset of Galar. We fine-tune a suite of general-domain pretrained backbones on the official Kvasir-Capsule folds under a standardized protocol and evaluate the same checkpoints on two non-source targets within a documented shared-label decision space. We find that the predictive value of in-domain ranking is target-dependent: Kvasir-Capsule ranking aligns more closely with Galar than with CV2024, while the two non-source targets agree only weakly. Consequently, the strongest in-domain backbone leads on one target yet falls to mid-pack on the other, and no single evaluation target reliably predicts the others. A second CV2024-trained configuration set reproduces this target-dependent instability. We conclude that capsule endoscopy model selection should report cross-target ranking stability rather than peak single-dataset performance.

Average Rankings Mask Per-Subject Optimality: A Friedman-Nemenyi Benchmark of EEG Motor-Imagery BCI Decoders

Electroencephalography (EEG) is the dominant non-invasive modality for brain-computer interfaces (BCIs), yet reliable decoding of motor imagery is hampered by inter- and intra-individual variability. A recurring claim is that one decoding pipeline, most often a spatial or Riemannian method, is broadly preferable. We test the weakest version of that claim under the most favourable conditions. Using the Mother of All BCI Benchmarks (MOABB) framework, we evaluated 1,056 decoding configurations (feature extractor x scaler x classifier), >340,000 subject-level model fits, across three public left-versus-right motor-imagery datasets (PhysionetMI, 109 participants; Cho2017, 52; Zhou2016, 4) and two frequency bands (8-15 Hz, 8-30 Hz). Every model is fit and tested within a single session of a single participant, the easiest regime, giving every pipeline its best chance. We apply the statistics standard for multi-classifier comparison: Friedman omnibus tests, Nemenyi critical-difference analysis and Wilcoxon signed-rank tests with effect sizes. Covariance tangent-space projection (cov-tgsp) and Common Spatial Patterns (CSP) are the strongest families, but their ordering is dataset-dependent and, on the largest and most heterogeneous cohort (PhysionetMI), statistically indistinguishable (Nemenyi p = 0.27; Kendall's W = 0.11). At the individual level the single best pipeline is optimal for only 35% of PhysionetMI participants, and nonlinear descriptors are best for roughly one third; matching pipeline to participant adds about seven accuracy points over the best fixed choice. The ranking is not an artefact of dimensionality, and classifier and scaler choices are secondary to the feature representation. Even in the easiest regime, no single pipeline dominates: a lower bound on the personalization problem and a quantitative case for participant-aware model selection rather than a universal decoder.

The Critical Role of Model Selection in Causal Inference: A Comparative Analysis of Classification Models within the InferBERT Framework for Pharmacovigilance

Distinguishing causal adverse drug events (ADEs) from spurious correlations remains a central challenge in pharmacovigilance. The InferBERT framework integrates transformer models with Do-calculus, but its success hinges on the underlying classification model. This study evaluates the impact of model choice in InferBERT, assessing whether simpler models suffice, if domain-specific pre-training helps, whether scaling to LLMs improves causal detection, and the effect of post-hoc calibration. We performed a comparative study on two benchmarks: Analgesics-induced Acute Liver Failure (AILF) and Tramadol-related Mortalities (TRAM). Four models were evaluated-XGBoost (baseline), ALBERT (original InferBERT), BioBERT (biomedical transformer), and Med-LLaMA (medical LLM)-using 5-fold cross-validation repeated over 20 runs. We measured accuracy, Expected Calibration Error (ECE) pre- and post-isotonic regression, and Jaccard concordance of causal terms with PRR, ROR, and EBGM; significance was tested with paired t-tests. BioBERT achieved the highest accuracy on both datasets, while Med-LLaMA underperformed despite its size and parameter-efficient fine-tuning. Domain-specific pre-training was decisive. Calibration improved ECE but had mixed effects on accuracy and causal discovery. BioBERT's superiority also yielded the strongest concordance with traditional pharmacovigilance signals. These results show that domain-specific pre-training provides a clear advantage over simpler baselines and larger LLMs. Investing in manageable, domain-aware models is more effective for computational pharmacovigilance than simply scaling model size.

AUCp: Pseudo-AUC for Inference Model Selection with Unlabeled Validation Data in Abnormality Detection

Abnormality detection is a crucial yet challenging task in medical image analysis. Distinguishing abnormalities from normal data by learning to reconstruct normal-only data alleviates the reliance on labeled datasets. However, many studies, even if unsupervised, rely on a labeled validation set to select the best model for inference from multiple training iterations. For many diseases labeled data are unavailable and substantially time consuming to obtain. To address this, AUCp - a novel metric that supports abnormality detection for unsupervised and self-supervised methods is proposed. Instead of evaluating the realism of reconstructed images to select the best of model for inference, it focuses on actual detection performance and without requiring an annotated test set. Assuming the pseudo ground truth of all unannotated samples in the test set as abnormal/positive and using traditional AUC calculation, AUCp scores are derived. Given a large and representative training set of normal samples, we show mathematical and empirical evidence that model selection using AUCp scores improves disease detection in terms of unsupervised and self-supervised methods over conventional metrics. Using two unsupervised methods for neurologic disease detection and self-supervised methods on diverse datasets, our results demonstrate that the AUCp score effectively identifies the optimal model for inference, significantly enhancing abnormality and disease detection. The corresponding implementations are available in https://github.com/mahfuzmohammad/AUCp.