Parameter-efficient fine-tuning for medical image analysis: The missed opportunity

Foundation models have significantly advanced medical image analysis through the pre-train fine-tune paradigm. Among various fine-tuning algorithms, Parameter-Efficient Fine-Tuning (PEFT) is increasingly utilized for knowledge transfer across diverse tasks, including vision-language and text-to-image generation. However, its application in medical image analysis is relatively unexplored due to the lack of a structured benchmark for evaluating PEFT methods. This study fills this gap by evaluating 17 distinct PEFT algorithms across convolutional and transformer-based networks on image classification and text-to-image generation tasks using six medical datasets of varying size, modality, and complexity. Through a battery of over 700 controlled experiments, our findings demonstrate PEFT's effectiveness, particularly in low data regimes common in medical imaging, with performance gains of up to 22% in discriminative and generative tasks. These recommendations can assist the community in incorporating PEFT into their workflows and facilitate fair comparisons of future PEFT methods, ensuring alignment with advancements in other areas of machine learning and AI.