AdaLoRA-QAT, a novel two-stage fine-tuning framework, addresses the computational constraints of deploying large foundation models in clinical settings for chest X-ray segmentation. By combining adaptive low-rank encoder adaptation with full quantization-aware training, this approach improves parameter efficiency. The adaptive rank allocation enables more efficient use of model parameters, making it suitable for resource-constrained clinical environments. This development is significant as it enables the deployment of accurate computer-aided diagnosis models in settings where computational resources are limited1. The implications of this research extend beyond the medical field, as efficient model deployment can also impact other areas where resources are scarce. The ability to efficiently deploy models can raise the stakes from a technical challenge to a strategic advantage, making it a crucial consideration for practitioners. So what matters is that this framework can facilitate the adoption of AI-powered diagnosis in resource-constrained environments.