Cross-Modal Knowledge Distillation for precision oncology clinical workflows across multilingual stakeholder groups It started with a moment of profound frustration during a late-night debugging session. I was working on a multimodal AI system designed to assist oncologists in interpreting genomic reports, pathology slides, and clinical notes—all in English. The system performed admirably, achieving state-of-the-art results on benchmark datasets. But when I tried to deploy it in a real-world hospital setting in São Paulo, Brazil, where clinical notes were in Portuguese, pathology reports mixed Spanish and English, and genomic data came annotated in Japanese, the entire system collapsed. Accuracy dropped by over 40%, and the stakeholder groups—oncologists, genetic counselors, nurses, and patients—could no longer trust the outputs. That night, as I stared at the error logs, I realized the core issue wasn't just language.…