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We introduce a foundation model-driven framework for cross-modal representation alignment between CT imaging and longitudinal EHR data, designed to generalize across tasks and institutions. CT and EHR modalities are encoded independently using domain-specific foundation models and aligned in a shared latent space through four principled fusion strategies: late fusion, contrastive alignment, cross-attention, and co-attention. We evaluate two clinically distinct TTE tasks: pulmonary embolism (PE) mortality and cardiovascular disease (CVD) outcomes, on large-scale multi-institutional cohorts (PE: N=3,099 train; 1,098 internal; 435 external; CVD: N=2,951 train; 837 internal; 682 external). Fusion consistently improves concordance index by 1.5-5.4% over unimodal baselines when modalities contribute compar","title":"Fusion is not one-size-fits-all: Cross-Modal Representation Alignment for Time-to-Event Modeling","url":"https://arxiv.org/abs/2606.15038","vendor":"arxiv_cs_ai"},"summary":"arXiv:2606.15038v1 Announce Type: new \nAbstract: Accurate time-to-event (TTE) prediction from multimodal clinical data remains challenging due to modality imbalance and distribution shift. We introduce a foundation model-driven framework for cross-modal representation alignment between CT imaging and longitudinal EHR data, designed to generalize across tasks and institutions. CT and EHR modalities are encoded independently using domain-specific foundation models and aligned in a shared latent space through four principled fusion strategies: late fusion, contrastive alignment, cross-attention, and co-attention. We evaluate two clinically distinct TTE tasks: pulmonary embolism (PE) mortality and cardiovascular disease (CVD) outcomes, on large-scale multi-institutional cohorts (PE: N=3,099 train; 1,098 internal; 435 external; CVD: N=2,951 train; 837 internal; 682 external). Fusion consistently improves concordance index by 1.5-5.4% over unimodal baselines when modalities contribute compar","title":"Fusion is not one-size-fits-all: Cross-Modal Representation Alignment for Time-to-Event Modeling","vendor":"arxiv_cs_ai"},"confidence":{"method":"deterministic"},"decision":"POSITIVE","issued_at":"2026-06-16T04:43:43Z","notes":"Spider vendor_press (news) news.vendor_press.v1","object":{"captured_by":"crovia.spider.vendor_press","primary_source_url":"https://arxiv.org/abs/2606.15038"},"predecessors":[],"schema":"crovia.axiom.v1","signature":"ed25519:7b988e72a19862fb4a0100cb5603562ca9d65c6844c57331468b7b85ac1c93cb4bb980a881569d776e888b4fe931cd7b60d2627d8ebe5b48762aaeecd4c7de0a","signer":"crovia.substrate","subject":{"observed_at":"2026-06-16T04:43:43Z","source_collector":"spider:vendor_press","target_id":"https://arxiv.org/abs/2606.15038"},"tsa":{"authority":"crovia.substrate.bootstrap","rfc3161_token":"{\"kind\":\"crovia.bootstrap.tsa\",\"source_jsonl\":\"/opt/crovia/spider/data/news/vendor_press_v1.jsonl\",\"source_seal_merkle_root\":\"spider_vendor_press_v1\",\"upgrade_path\":\"Sessione H \\u2014 OpenTimestamps weekly anchor\"}"},"zk_mode":"clear","zk_proof":null},"ledger":{"leaf_hash":"ab578d83bdf4fdf2f45ffaeb89e22dabbf941a8dfe5a74c98eebbf0d2000f74f","leaf_index":230190,"ledger_path":"/opt/crovia/substrate/axiom_ledger.jsonl"},"merkle_proof":{"hash_alg":"sha256","leaf_prefix":"0x00","node_prefix":"0x01","odd_leaf_rule":"duplicate_last","path":[{"sibling":"e4789f028eb1930ae5c95cdc7f50e64b5b9d28bd82d1c242400bb9955ebe5ee8","side":"right"},{"sibling":"f3439e863757e510f3f5e2fb5477f9d82a31d0f7ae433d42cdcd99376032afd8","side":"left"},{"sibling":"b60e3715dbc416a4b3b19f869742d4918e3c11f6cbd1e17b281bf0ec623f55b8","side":"left"},{"sibling":"c2192f512745da24231d58dc242aad4d27a5f46f9c09ff3056402a11408c482e","side":"left"},{"sibling":"7408d4f90b7bf8d58907d742403bc99e6ff296c4b556808a9d81b689582f4ba3","side":"right"},{"sibling":"23d5413d8ea70f9db15c1c228bf60d43a7bdc40d249c7858cef5968660288734","side":"left"},{"sibling":"a614bf836a660bcfb12080603c3b0e05178718e35625a1678b12d5a40d44e0f7","side":"right"},{"sibling":"0d60a870c104823e0ebbac1aad5395bcb88f28b6928636cce19a16b0cfa21564","side":"right"},{"sibling":"03ebe4791d56166247160f6ee7788c15745bdd7e274c62ec21b2438669941587","side":"left"},{"sibling":"74897e850164dddc689c3c65b33f9bae0268ab0bf429867a4e193d9b9b685040","side":"left"},{"sibling":"bde25d7e94e64717e426a97f6fcb4907e92b5c61fc89d92d7e0947a2249c3f6b","side":"right"},{"sibling":"d10d772a4984cae00e65ab24af21d1d260e475bbaae3f17871859eb705bd3999","side":"right"},{"sibling":"e79159853f2f35ddae8e3247d515e433c534277b287d65bbd77ae989aa4992fa","side":"right"},{"sibling":"3054319f1840cce0eaaf0bc4b1ae38e5bf8b6210927d924a750775cc7d77cca6","side":"right"},{"sibling":"0fd8b5059f279c4a4a6688de2472fdbc25543fee183df19b21dacca880354cff","side":"right"},{"sibling":"a04392fb9f2a3a620840e3b3fecd93d12e6d224e481c162389d8ae64e7194599","side":"left"},{"sibling":"c300cf0154c136afc09b1702a0be98f4ba5b6dc5cf57e8cc714ec1eaf4196eff","side":"left"},{"sibling":"d841ad93efda0869e5eb97678f348f03f5caab4353e05ff4bf18f47fb945b822","side":"left"}]},"schema":"crovia.axiom_proof.v1","seal":{"first_collector_run_id":"","first_receipt_hash":"","jsonl_path":"/opt/crovia/substrate/axiom_ledger.jsonl","key_id":"430895f101d38164","last_collector_run_id":"","last_receipt_hash":"","leaf_count":232015,"merkle_root":"62bfb7809bb55667ad7eeebdb48267b9b2c1ee89bb808ea1e6d3a814a15aa402","public_key_hex":"cf742e26f75669dc673cb5c0786a1ae23ae8ca19c347317192ce40c28a7ff25c","run_id":"hourly_json_retrofit_20260617T133701Z","schema":"crovia.seal.v1","seal_family_version":"crovia-seal-family/1","seal_kind":"substrate_batch","sealed_at":"2026-06-17T13:39:59Z","sig_algorithm":"ed25519","signature":"930a3563c643cc7518d048b12a1f5392a96a5edce49533ba0a56f11b6cc69319bb1c800aacc46b52a6941c4d05dae255a45cac757d6093c971b96852c24f140e","signer_version":"1.1.0"},"trust_root":{"key_id":"430895f101d38164","public_key_hex":"cf742e26f75669dc673cb5c0786a1ae23ae8ca19c347317192ce40c28a7ff25c","signature_algorithm":"ed25519","url":"/registry/canon/TRUST_ROOT.md"},"verifier":{"spec":"/registry/canon/AXIOM_RECEIPT_v1.md","url":"/v/axm_211177bf2ba4568dfe1a245e7e984b5e64cd06ac496fcc77ddcb0359f8064977"}}