We describe the DS@GT submissions to the ImageCLEFmedical Caption 2026 challenge, which continues a long-running benchmark on the ROCOv2 dataset with two tracks: Concept Detection (Task 1), assigning UMLS Concept Unique Identifiers (CUIs) to radiology images, and Caption Prediction (Task 2), generating natural-language captions. For Task 1, our primary submission was a three-way late-fusion ensemble of ConvNeXt-V2, BiomedCLIP ViT-B/16, and DenseNet-169 with a regularized ''Honest Threshold Tuning'' procedure designed to avoid validation overfitting on rare concepts; this submission ranked first on the official submission with a primary $F_1$ of $0.5790$ and a secondary $F_1$ of $0.9657$. In parallel, we submitted a training-free KNN retrieval pipeline over frozen BiomedCLIP embeddings, which reached a primary $F_1$ of $0.5780$ and a secondary $F_1$ of $0.9599$-essentially matching the fine-tuned ensemble on the primary track at a fraction of the cost. For Task 2, our submissions included a fine-tuned Gemma-3 27B model (overall $0.3571$, ranking third in the official submission), a fully fine-tuned BLIP pipeline with custom Vizwins merging ($0.3564$), and a zero-shot MedGemma-4B run with a PubMed-style prompt ($0.3186$), spanning a wide range of model scales and training costs. Code: https://github.com/dsgt-arc/imageclef-caption-2026.

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