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Big, Bright, or Invisible: A Frozen-Feature Benchmark of 3D CT Foundation Models

Research Medical/Healthcare AI

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TL;DR - A benchmark of ten frozen 3D CT foundation-model encoders across three thoracic CT cohorts (including an unseen internal clinical set) using k-NN, zero-shot prompting, and linear probing. It matters because it shows no universal state-of-the-art exists, and that physical detectability — not architecture — is the dominant limit on diagnostic breadth.

  • Rankings fluctuate substantially with evaluation context; models pairing fine-grained image tokenization with vision-language alignment generally lead, but a lightweight supervised encoder stays competitive, indicating explicit labels can substitute for scale.
  • The primary performance determinant is a physical bottleneck: a finding's detectability scales with its contrast against surrounding tissue and its spatial extent.
  • Controlled within-organ comparisons show widespread/high-contrast abnormalities (devices, effusions) are reliably recovered, while small, low-contrast focal lesions fail across all encoders.
  • Authors attribute this to globally pooled embeddings and argue region- or lesion-level pretraining is needed to represent small, low-contrast structures.

Sources (1)

Big, Bright, or Invisible: A Frozen-Feature Benchmark of 3D CT Foundation Models

arXiv cs.CV Maulik Chevli, Johannes Brandt, Rickmer Braren, Daniel Rueckert, Philip Müller 2026-08-06 arXiv:2608.05960
Public signals Semantic Scholar citations 0 · Semantic Scholar influential citations 0
Providers: Hugging Face · N/A OpenAlex · N/A Publisher · N/A Semantic Scholar · Citations 0 · Influential citations 0 X · N/A Fetched 2026-08-10 02:43:00.188012 UTC

TL;DR - A benchmark of ten frozen 3D CT foundation-model encoders across three thoracic CT cohorts (including an unseen internal clinical set) using k-NN, zero-shot prompting, and linear probing. It matters because it shows no universal state-of-the-art exists, and that physical detectability — not architecture — is the dominant limit on diagnostic breadth.

  • Rankings fluctuate substantially with evaluation context; models pairing fine-grained image tokenization with vision-language alignment generally lead, but a lightweight supervised encoder stays competitive, indicating explicit labels can substitute for scale.
  • The primary performance determinant is a physical bottleneck: a finding's detectability scales with its contrast against surrounding tissue and its spatial extent.
  • Controlled within-organ comparisons show widespread/high-contrast abnormalities (devices, effusions) are reliably recovered, while small, low-contrast focal lesions fail across all encoders.
  • Authors attribute this to globally pooled embeddings and argue region- or lesion-level pretraining is needed to represent small, low-contrast structures.
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