Daily Papers

Medical vision-language models enable co-learning and integrating features from medical imaging and clinical text. However, these models are not easy to train and the latent representation space can be complex. Here we propose a novel way for pre-training and regularising medical vision-language models. The proposed method, named Medical vision-language pre-training with Frozen language models and Latent spAce Geometry optimization (M-FLAG), leverages a frozen language model for training stability and efficiency and introduces a novel orthogonality loss to harmonize the latent space geometry. We demonstrate the potential of the pre-trained model on three downstream tasks: medical image classification, segmentation, and object detection. Extensive experiments across five public datasets demonstrate that M-FLAG significantly outperforms existing medical vision-language pre-training approaches and reduces the number of parameters by 78\%. Notably, M-FLAG achieves outstanding performance on the segmentation task while using only 1\% of the RSNA dataset, even outperforming ImageNet pre-trained models that have been fine-tuned using 100\% of the data.

Vision-language pre-training for chest X-rays has made significant strides, primarily by utilizing paired radiographs and radiology reports. However, existing approaches often face challenges in encoding medical knowledge effectively. While radiology reports provide insights into the current disease manifestation, medical definitions (as used by contemporary methods) tend to be overly abstract, creating a gap in knowledge. To address this, we propose DeViDe, a novel transformer-based method that leverages radiographic descriptions from the open web. These descriptions outline general visual characteristics of diseases in radiographs, and when combined with abstract definitions and radiology reports, provide a holistic snapshot of knowledge. DeViDe incorporates three key features for knowledge-augmented vision language alignment: First, a large-language model-based augmentation is employed to homogenise medical knowledge from diverse sources. Second, this knowledge is aligned with image information at various levels of granularity. Third, a novel projection layer is proposed to handle the complexity of aligning each image with multiple descriptions arising in a multi-label setting. In zero-shot settings, DeViDe performs comparably to fully supervised models on external datasets and achieves state-of-the-art results on three large-scale datasets. Additionally, fine-tuning DeViDe on four downstream tasks and six segmentation tasks showcases its superior performance across data from diverse distributions.

Recently a number of studies demonstrated impressive performance on diverse vision-language multi-modal tasks such as image captioning and visual question answering by extending the BERT architecture with multi-modal pre-training objectives. In this work we explore a broad set of multi-modal representation learning tasks in the medical domain, specifically using radiology images and the unstructured report. We propose Medical Vision Language Learner (MedViLL), which adopts a BERT-based architecture combined with a novel multi-modal attention masking scheme to maximize generalization performance for both vision-language understanding tasks (diagnosis classification, medical image-report retrieval, medical visual question answering) and vision-language generation task (radiology report generation). By statistically and rigorously evaluating the proposed model on four downstream tasks with three radiographic image-report datasets (MIMIC-CXR, Open-I, and VQA-RAD), we empirically demonstrate the superior downstream task performance of MedViLL against various baselines, including task-specific architectures. The source code is publicly available at: https://github.com/SuperSupermoon/MedViLL

Trustworthiness is essential for the precise and interpretable application of artificial intelligence (AI) in medical imaging. Traditionally, precision and interpretability have been addressed as separate tasks, namely medical image analysis and explainable AI, each developing its own models independently. In this study, for the first time, we investigate the development of a unified medical vision-language pre-training model that can achieve both accurate analysis and interpretable understanding of medical images across various modalities. To build the model, we construct MedConcept-23M, a large-scale dataset comprising 23 million medical image-text pairs extracted from 6.2 million scientific articles, enriched with concepts from the Unified Medical Language System (UMLS). Based on MedConcept-23M, we introduce ConceptCLIP, a medical AI model utilizing concept-enhanced contrastive language-image pre-training. The pre-training of ConceptCLIP involves two primary components: image-text alignment learning (IT-Align) and patch-concept alignment learning (PC-Align). This dual alignment strategy enhances the model's capability to associate specific image regions with relevant concepts, thereby improving both the precision of analysis and the interpretability of the AI system. We conducted extensive experiments on 5 diverse types of medical image analysis tasks, spanning 51 subtasks across 10 image modalities, with the broadest range of downstream tasks. The results demonstrate the effectiveness of the proposed vision-language pre-training model. Further explainability analysis across 6 modalities reveals that ConceptCLIP achieves superior performance, underscoring its robust ability to advance explainable AI in medical imaging. These findings highlight ConceptCLIP's capability in promoting trustworthy AI in the field of medicine.

Medical vision-language pre-training shows great potential in learning representative features from massive paired radiographs and reports. However, in computed tomography (CT) scans, the distribution of lesions which contain intricate structures is characterized by spatial sparsity. Besides, the complex and implicit relationships between different pathological descriptions in each sentence of the report and their corresponding sub-regions in radiographs pose additional challenges. In this paper, we propose a Similarity-Driven Cross-Granularity Pre-training (SimCroP) framework on chest CTs, which combines similarity-driven alignment and cross-granularity fusion to improve radiograph interpretation. We first leverage multi-modal masked modeling to optimize the encoder for understanding precise low-level semantics from radiographs. Then, similarity-driven alignment is designed to pre-train the encoder to adaptively select and align the correct patches corresponding to each sentence in reports. The cross-granularity fusion module integrates multimodal information across instance level and word-patch level, which helps the model better capture key pathology structures in sparse radiographs, resulting in improved performance for multi-scale downstream tasks. SimCroP is pre-trained on a large-scale paired CT-reports dataset and validated on image classification and segmentation tasks across five public datasets. Experimental results demonstrate that SimCroP outperforms both cutting-edge medical self-supervised learning methods and medical vision-language pre-training methods. Codes and models are available at https://github.com/ToniChopp/SimCroP.

Medical vision-and-language pre-training (Med-VLP) has shown promising improvements on many downstream medical tasks owing to its applicability to extracting generic representations from medical images and texts. Practically, there exist two typical types, i.e., the fusion-encoder type and the dual-encoder type, depending on whether a heavy fusion module is used. The former is superior at multi-modal tasks owing to the sufficient interaction between modalities; the latter is good at uni-modal and cross-modal tasks due to the single-modality encoding ability. To take advantage of these two types, we propose an effective yet straightforward scheme named PTUnifier to unify the two types. We first unify the input format by introducing visual and textual prompts, which serve as a feature bank that stores the most representative images/texts. By doing so, a single model could serve as a foundation model that processes various tasks adopting different input formats (i.e., image-only, text-only, and image-text-pair). Furthermore, we construct a prompt pool (instead of static ones) to improve diversity and scalability. Experimental results show that our approach achieves state-of-the-art results on a broad range of tasks, spanning uni-modal tasks (i.e., image/text classification and text summarization), cross-modal tasks (i.e., image-to-text generation and image-text/text-image retrieval), and multi-modal tasks (i.e., visual question answering), demonstrating the effectiveness of our approach. Note that the adoption of prompts is orthogonal to most existing Med-VLP approaches and could be a beneficial and complementary extension to these approaches.

Medical vision-and-language pre-training (Med-VLP) has received considerable attention owing to its applicability to extracting generic vision-and-language representations from medical images and texts. Most existing methods mainly contain three elements: uni-modal encoders (i.e., a vision encoder and a language encoder), a multi-modal fusion module, and pretext tasks, with few studies considering the importance of medical domain expert knowledge and explicitly exploiting such knowledge to facilitate Med-VLP. Although there exist knowledge-enhanced vision-and-language pre-training (VLP) methods in the general domain, most require off-the-shelf toolkits (e.g., object detectors and scene graph parsers), which are unavailable in the medical domain. In this paper, we propose a systematic and effective approach to enhance Med-VLP by structured medical knowledge from three perspectives. First, considering knowledge can be regarded as the intermediate medium between vision and language, we align the representations of the vision encoder and the language encoder through knowledge. Second, we inject knowledge into the multi-modal fusion model to enable the model to perform reasoning using knowledge as the supplementation of the input image and text. Third, we guide the model to put emphasis on the most critical information in images and texts by designing knowledge-induced pretext tasks. To perform a comprehensive evaluation and facilitate further research, we construct a medical vision-and-language benchmark including three tasks. Experimental results illustrate the effectiveness of our approach, where state-of-the-art performance is achieved on all downstream tasks. Further analyses explore the effects of different components of our approach and various settings of pre-training.

Medical vision-and-language pre-training provides a feasible solution to extract effective vision-and-language representations from medical images and texts. However, few studies have been dedicated to this field to facilitate medical vision-and-language understanding. In this paper, we propose a self-supervised learning paradigm with multi-modal masked autoencoders (M^3AE), which learn cross-modal domain knowledge by reconstructing missing pixels and tokens from randomly masked images and texts. There are three key designs to make this simple approach work. First, considering the different information densities of vision and language, we adopt different masking ratios for the input image and text, where a considerably larger masking ratio is used for images. Second, we use visual and textual features from different layers to perform the reconstruction to deal with different levels of abstraction in visual and language. Third, we develop different designs for vision and language decoders (i.e., a Transformer for vision and a multi-layer perceptron for language). To perform a comprehensive evaluation and facilitate further research, we construct a medical vision-and-language benchmark including three tasks. Experimental results demonstrate the effectiveness of our approach, where state-of-the-art results are achieved on all downstream tasks. Besides, we conduct further analysis to better verify the effectiveness of different components of our approach and various settings of pre-training. The source code is available at~https://github.com/zhjohnchan/M3AE.

Medical imaging plays a pivotal role in modern healthcare, with computed tomography pulmonary angiography (CTPA) being a critical tool for diagnosing pulmonary embolism and other thoracic conditions. However, the complexity of interpreting CTPA scans and generating accurate radiology reports remains a significant challenge. This paper introduces Abn-BLIP (Abnormality-aligned Bootstrapping Language-Image Pretraining), an advanced diagnosis model designed to align abnormal findings to generate the accuracy and comprehensiveness of radiology reports. By leveraging learnable queries and cross-modal attention mechanisms, our model demonstrates superior performance in detecting abnormalities, reducing missed findings, and generating structured reports compared to existing methods. Our experiments show that Abn-BLIP outperforms state-of-the-art medical vision-language models and 3D report generation methods in both accuracy and clinical relevance. These results highlight the potential of integrating multimodal learning strategies for improving radiology reporting. The source code is available at https://github.com/zzs95/abn-blip.

Within the domain of medical analysis, extensive research has explored the potential of mutual learning between Masked Autoencoders(MAEs) and multimodal data. However, the impact of MAEs on intermodality remains a key challenge. We introduce MedFLIP, a Fast Language-Image Pre-training method for Medical analysis. We explore MAEs for zero-shot learning with crossed domains, which enhances the model's ability to learn from limited data, a common scenario in medical diagnostics. We verify that masking an image does not affect inter-modal learning. Furthermore, we propose the SVD loss to enhance the representation learning for characteristics of medical images, aiming to improve classification accuracy by leveraging the structural intricacies of such data. Our theory posits that masking encourages semantic preservation, robust feature extraction, regularization, domain adaptation, and invariance learning. Lastly, we validate using language will improve the zero-shot performance for the medical image analysis. MedFLIP's scaling of the masking process marks an advancement in the field, offering a pathway to rapid and precise medical image analysis without the traditional computational bottlenecks. Through experiments and validation, MedFLIP demonstrates efficient performance improvements, helps for future research and application in medical diagnostics.

Vision-language pre-training (VLP) models have shown significant advancements in the medical domain. Yet, most VLP models align raw reports to images at a very coarse level, without modeling fine-grained relationships between anatomical and pathological concepts outlined in reports and the corresponding semantic counterparts in images. To address this problem, we propose a Medical Dual-Stream Language-Image Pre-training (MeDSLIP) framework. Specifically, MeDSLIP establishes vision-language fine-grained alignments via disentangling visual and textual representations into anatomy-relevant and pathology-relevant streams. Moreover, a novel vision-language Prototypical Contr-astive Learning (ProtoCL) method is adopted in MeDSLIP to enhance the alignment within the anatomical and pathological streams. MeDSLIP further employs cross-stream Intra-image Contrastive Learning (ICL) to ensure the consistent coexistence of paired anatomical and pathological concepts within the same image. Such a cross-stream regularization encourages the model to exploit the synchrony between two streams for a more comprehensive representation learning. MeDSLIP is evaluated under zero-shot and supervised fine-tuning settings on three public datasets: NIH CXR14, RSNA Pneumonia, and SIIM-ACR Pneumothorax. Under these settings, MeDSLIP outperforms six leading CNN-based models on classification, grounding, and segmentation tasks.

Generalist vision language models (VLMs) have made significant strides in computer vision, but they fall short in specialized fields like healthcare, where expert knowledge is essential. In traditional computer vision tasks, creative or approximate answers may be acceptable, but in healthcare, precision is paramount.Current large multimodal models like Gemini and GPT-4o are insufficient for medical tasks due to their reliance on memorized internet knowledge rather than the nuanced expertise required in healthcare. VLMs are usually trained in three stages: vision pre-training, vision-language pre-training, and instruction fine-tuning (IFT). IFT has been typically applied using a mixture of generic and healthcare data. In contrast, we propose that for medical VLMs, a fourth stage of specialized IFT is necessary, which focuses on medical data and includes information from domain expert models. Domain expert models developed for medical use are crucial because they are specifically trained for certain clinical tasks, e.g. to detect tumors and classify abnormalities through segmentation and classification, which learn fine-grained features of medical data-features that are often too intricate for a VLM to capture effectively especially in radiology. This paper introduces a new framework, VILA-M3, for medical VLMs that utilizes domain knowledge via expert models. Through our experiments, we show an improved state-of-the-art (SOTA) performance with an average improvement of ~9% over the prior SOTA model Med-Gemini and ~6% over models trained on the specific tasks. Our approach emphasizes the importance of domain expertise in creating precise, reliable VLMs for medical applications.

Medical visual question answering (VQA) is a challenging multimodal task, where Vision-Language Pre-training (VLP) models can effectively improve the generalization performance. However, most methods in the medical field treat VQA as an answer classification task which is difficult to transfer to practical application scenarios. Additionally, due to the privacy of medical images and the expensive annotation process, large-scale medical image-text pairs datasets for pretraining are severely lacking. In this paper, we propose a large-scale MultI-task Self-Supervised learning based framework (MISS) for medical VQA tasks. Unlike existing methods, we treat medical VQA as a generative task. We unify the text encoder and multimodal encoder and align image-text features through multi-task learning. Furthermore, we propose a Transfer-and-Caption method that extends the feature space of single-modal image datasets using large language models (LLMs), enabling those traditional medical vision field task data to be applied to VLP. Experiments show that our method achieves excellent results with fewer multimodal datasets and demonstrates the advantages of generative VQA models. The code and model weights will be released upon the paper's acceptance.

Contrastive learning based vision-language joint pre-training has emerged as a successful representation learning strategy. In this paper, we present a prototype representation learning framework incorporating both global and local alignment between medical images and reports. In contrast to standard global multi-modality alignment methods, we employ a local alignment module for fine-grained representation. Furthermore, a cross-modality conditional reconstruction module is designed to interchange information across modalities in the training phase by reconstructing masked images and reports. For reconstructing long reports, a sentence-wise prototype memory bank is constructed, enabling the network to focus on low-level localized visual and high-level clinical linguistic features. Additionally, a non-auto-regressive generation paradigm is proposed for reconstructing non-sequential reports. Experimental results on five downstream tasks, including supervised classification, zero-shot classification, image-to-text retrieval, semantic segmentation, and object detection, show the proposed method outperforms other state-of-the-art methods across multiple datasets and under different dataset size settings. The code is available at https://github.com/QtacierP/PRIOR.

Language-supervised pre-training has proven to be a valuable method for extracting semantically meaningful features from images, serving as a foundational element in multimodal systems within the computer vision and medical imaging domains. However, resulting features are limited by the information contained within the text. This is particularly problematic in medical imaging, where radiologists' written findings focus on specific observations; a challenge compounded by the scarcity of paired imaging-text data due to concerns over leakage of personal health information. In this work, we fundamentally challenge the prevailing reliance on language supervision for learning general purpose biomedical imaging encoders. We introduce RAD-DINO, a biomedical image encoder pre-trained solely on unimodal biomedical imaging data that obtains similar or greater performance than state-of-the-art biomedical language supervised models on a diverse range of benchmarks. Specifically, the quality of learned representations is evaluated on standard imaging tasks (classification and semantic segmentation), and a vision-language alignment task (text report generation from images). To further demonstrate the drawback of language supervision, we show that features from RAD-DINO correlate with other medical records (e.g., sex or age) better than language-supervised models, which are generally not mentioned in radiology reports. Finally, we conduct a series of ablations determining the factors in RAD-DINO's performance; notably, we observe that RAD-DINO's downstream performance scales well with the quantity and diversity of training data, demonstrating that image-only supervision is a scalable approach for training a foundational biomedical image encoder.

Self-Supervised Learning (SSL) presents an exciting opportunity to unlock the potential of vast, untapped clinical datasets, for various downstream applications that suffer from the scarcity of labeled data. While SSL has revolutionized fields like natural language processing and computer vision, its adoption in 3D medical image computing has been limited by three key pitfalls: Small pre-training dataset sizes, architectures inadequate for 3D medical image analysis, and insufficient evaluation practices. In this paper, we address these issues by i) leveraging a large-scale dataset of 39k 3D brain MRI volumes and ii) using a Residual Encoder U-Net architecture within the state-of-the-art nnU-Net framework. iii) A robust development framework, incorporating 5 development and 8 testing brain MRI segmentation datasets, allowed performance-driven design decisions to optimize the simple concept of Masked Auto Encoders (MAEs) for 3D CNNs. The resulting model not only surpasses previous SSL methods but also outperforms the strong nnU-Net baseline by an average of approximately 3 Dice points setting a new state-of-the-art. Our code and models are made available here.

Medical Vision-Language Pretraining (MedVLP) shows promise in learning generalizable and transferable visual representations from paired and unpaired medical images and reports. MedVLP can provide useful features to downstream tasks and facilitate adapting task-specific models to new setups using fewer examples. However, existing MedVLP methods often differ in terms of datasets, preprocessing, and finetuning implementations. This pose great challenges in evaluating how well a MedVLP method generalizes to various clinically-relevant tasks due to the lack of unified, standardized, and comprehensive benchmark. To fill this gap, we propose BenchX, a unified benchmark framework that enables head-to-head comparison and systematical analysis between MedVLP methods using public chest X-ray datasets. Specifically, BenchX is composed of three components: 1) Comprehensive datasets covering nine datasets and four medical tasks; 2) Benchmark suites to standardize data preprocessing, train-test splits, and parameter selection; 3) Unified finetuning protocols that accommodate heterogeneous MedVLP methods for consistent task adaptation in classification, segmentation, and report generation, respectively. Utilizing BenchX, we establish baselines for nine state-of-the-art MedVLP methods and found that the performance of some early MedVLP methods can be enhanced to surpass more recent ones, prompting a revisiting of the developments and conclusions from prior works in MedVLP. Our code are available at https://github.com/yangzhou12/BenchX.

Dermatological diagnosis represents a complex multimodal challenge that requires integrating visual features with specialized clinical knowledge. While vision-language pretraining (VLP) has advanced medical AI, its effectiveness in dermatology is limited by text length constraints and the lack of structured texts. In this paper, we introduce MAKE, a Multi-Aspect Knowledge-Enhanced vision-language pretraining framework for zero-shot dermatological tasks. Recognizing that comprehensive dermatological descriptions require multiple knowledge aspects that exceed standard text constraints, our framework introduces: (1) a multi-aspect contrastive learning strategy that decomposes clinical narratives into knowledge-enhanced sub-texts through large language models, (2) a fine-grained alignment mechanism that connects subcaptions with diagnostically relevant image features, and (3) a diagnosis-guided weighting scheme that adaptively prioritizes different sub-captions based on clinical significance prior. Through pretraining on 403,563 dermatological image-text pairs collected from education resources, MAKE significantly outperforms state-of-the-art VLP models on eight datasets across zero-shot skin disease classification, concept annotation, and cross-modal retrieval tasks. Our code will be made publicly available at https: //github.com/SiyuanYan1/MAKE.

Objective: While recent advances in text-conditioned generative models have enabled the synthesis of realistic medical images, progress has been largely confined to 2D modalities such as chest X-rays. Extending text-to-image generation to volumetric Computed Tomography (CT) remains a significant challenge, due to its high dimensionality, anatomical complexity, and the absence of robust frameworks that align vision-language data in 3D medical imaging. Methods: We introduce a novel architecture for Text-to-CT generation that combines a latent diffusion model with a 3D contrastive vision-language pretraining scheme. Our approach leverages a dual-encoder CLIP-style model trained on paired CT volumes and radiology reports to establish a shared embedding space, which serves as the conditioning input for generation. CT volumes are compressed into a low-dimensional latent space via a pretrained volumetric VAE, enabling efficient 3D denoising diffusion without requiring external super-resolution stages. Results: We evaluate our method on the CT-RATE dataset and conduct a comprehensive assessment of image fidelity, clinical relevance, and semantic alignment. Our model achieves competitive performance across all tasks, significantly outperforming prior baselines for text-to-CT generation. Moreover, we demonstrate that CT scans synthesized by our framework can effectively augment real data, improving downstream diagnostic performance. Conclusion: Our results show that modality-specific vision-language alignment is a key component for high-quality 3D medical image generation. By integrating contrastive pretraining and volumetric diffusion, our method offers a scalable and controllable solution for synthesizing clinically meaningful CT volumes from text, paving the way for new applications in data augmentation, medical education, and automated clinical simulation.

Surgical practice involves complex visual interpretation, procedural skills, and advanced medical knowledge, making surgical vision-language pretraining (VLP) particularly challenging due to this complexity and the limited availability of annotated data. To address the gap, we propose OphCLIP, a hierarchical retrieval-augmented vision-language pretraining framework specifically designed for ophthalmic surgical workflow understanding. OphCLIP leverages the OphVL dataset we constructed, a large-scale and comprehensive collection of over 375K hierarchically structured video-text pairs with tens of thousands of different combinations of attributes (surgeries, phases/operations/actions, instruments, medications, as well as more advanced aspects like the causes of eye diseases, surgical objectives, and postoperative recovery recommendations, etc). These hierarchical video-text correspondences enable OphCLIP to learn both fine-grained and long-term visual representations by aligning short video clips with detailed narrative descriptions and full videos with structured titles, capturing intricate surgical details and high-level procedural insights, respectively. Our OphCLIP also designs a retrieval-augmented pretraining framework to leverage the underexplored large-scale silent surgical procedure videos, automatically retrieving semantically relevant content to enhance the representation learning of narrative videos. Evaluation across 11 datasets for phase recognition and multi-instrument identification shows OphCLIP's robust generalization and superior performance.

Radiologic diagnostic errors-under-reading errors, inattentional blindness, and communication failures-remain prevalent in clinical practice. These issues often stem from missed localized abnormalities, limited global context, and variability in report language. These challenges are amplified in 3D imaging, where clinicians must examine hundreds of slices per scan. Addressing them requires systems with precise localized detection, global volume-level reasoning, and semantically consistent natural language reporting. However, existing 3D vision-language models are unable to meet all three needs jointly, lacking local-global understanding for spatial reasoning and struggling with the variability and noise of uncurated radiology reports. We present MedVista3D, a multi-scale semantic-enriched vision-language pretraining framework for 3D CT analysis. To enable joint disease detection and holistic interpretation, MedVista3D performs local and global image-text alignment for fine-grained representation learning within full-volume context. To address report variability, we apply language model rewrites and introduce a Radiology Semantic Matching Bank for semantics-aware alignment. MedVista3D achieves state-of-the-art performance on zero-shot disease classification, report retrieval, and medical visual question answering, while transferring well to organ segmentation and prognosis prediction. Code and datasets will be released.

The previous advancements in pathology image understanding primarily involved developing models tailored to specific tasks. Recent studies has demonstrated that the large vision-language model can enhance the performance of various downstream tasks in medical image understanding. In this study, we developed a domain-specific large language-vision assistant (PA-LLaVA) for pathology image understanding. Specifically, (1) we first construct a human pathology image-text dataset by cleaning the public medical image-text data for domain-specific alignment; (2) Using the proposed image-text data, we first train a pathology language-image pretraining (PLIP) model as the specialized visual encoder for pathology image, and then we developed scale-invariant connector to avoid the information loss caused by image scaling; (3) We adopt two-stage learning to train PA-LLaVA, first stage for domain alignment, and second stage for end to end visual question \& answering (VQA) task. In experiments, we evaluate our PA-LLaVA on both supervised and zero-shot VQA datasets, our model achieved the best overall performance among multimodal models of similar scale. The ablation experiments also confirmed the effectiveness of our design. We posit that our PA-LLaVA model and the datasets presented in this work can promote research in field of computational pathology. All codes are available at: https://github.com/ddw2AIGROUP2CQUPT/PA-LLaVA}{https://github.com/ddw2AIGROUP2CQUPT/PA-LLaVA

Several recent works seek to develop foundation models specifically for medical applications, adapting general-purpose large language models (LLMs) and vision-language models (VLMs) via continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining (DAPT) improves performance on downstream medical tasks, such as answering medical licensing exam questions. In this paper, we compare seven public "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting regime for medical question-answering (QA) tasks. For instance, across the tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 12.1% of cases, reach a (statistical) tie in 49.8% of cases, and are significantly worse than their base models in the remaining 38.2% of cases. Our conclusions are based on (i) comparing each medical model head-to-head, directly against the corresponding base model; (ii) optimizing the prompts for each model separately; and (iii) accounting for statistical uncertainty in comparisons. While these basic practices are not consistently adopted in the literature, our ablations show that they substantially impact conclusions. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

Vision-Language Models (VLMs) trained via contrastive learning have achieved notable success in natural image tasks. However, their application in the medical domain remains limited due to the scarcity of openly accessible, large-scale medical image-text datasets. Existing medical VLMs either train on closed-source proprietary or relatively small open-source datasets that do not generalize well. Similarly, most models remain specific to a single or limited number of medical imaging domains, again restricting their applicability to other modalities. To address this gap, we introduce UniMed, a large-scale, open-source multi-modal medical dataset comprising over 5.3 million image-text pairs across six diverse imaging modalities: X-ray, CT, MRI, Ultrasound, Pathology, and Fundus. UniMed is developed using a data-collection framework that leverages Large Language Models (LLMs) to transform modality-specific classification datasets into image-text formats while incorporating existing image-text data from the medical domain, facilitating scalable VLM pretraining. Using UniMed, we trained UniMed-CLIP, a unified VLM for six modalities that significantly outperforms existing generalist VLMs and matches modality-specific medical VLMs, achieving notable gains in zero-shot evaluations. For instance, UniMed-CLIP improves over BiomedCLIP (trained on proprietary data) by an absolute gain of +12.61, averaged over 21 datasets, while using 3x less training data. To facilitate future research, we release UniMed dataset, training codes, and models at https://github.com/mbzuai-oryx/UniMed-CLIP.

Several recent works seek to develop foundation models specifically for medical applications, adapting general-purpose large language models (LLMs) and vision-language models (VLMs) via continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining (DAPT) improves performance on downstream medical tasks, such as answering medical licensing exam questions. In this paper, we compare ten public "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting and supervised fine-tuning regimes for medical question-answering (QA). For instance, across all tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 22.7% of cases, reach a (statistical) tie in 36.8% of cases, and are significantly worse than their base models in the remaining 40.5% of cases. Our conclusions are based on (i) comparing each medical model head-to-head, directly against the corresponding base model; (ii) optimizing the prompts for each model separately in zero-/few-shot prompting; and (iii) accounting for statistical uncertainty in comparisons. While these basic practices are not consistently adopted in the literature, our ablations show that they substantially impact conclusions. Meanwhile, we find that after fine-tuning on specific QA tasks, medical LLMs can show performance improvements, but the benefits do not carry over to tasks based on clinical notes. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

Vision-Language Models (VLMs) have shown promise in various 2D visual tasks, yet their readiness for 3D clinical diagnosis remains unclear due to stringent demands for recognition precision, reasoning ability, and domain knowledge. To systematically evaluate these dimensions, we present DeepTumorVQA, a diagnostic visual question answering (VQA) benchmark targeting abdominal tumors in CT scans. It comprises 9,262 CT volumes (3.7M slices) from 17 public datasets, with 395K expert-level questions spanning four categories: Recognition, Measurement, Visual Reasoning, and Medical Reasoning. DeepTumorVQA introduces unique challenges, including small tumor detection and clinical reasoning across 3D anatomy. Benchmarking four advanced VLMs (RadFM, M3D, Merlin, CT-CHAT), we find current models perform adequately on measurement tasks but struggle with lesion recognition and reasoning, and are still not meeting clinical needs. Two key insights emerge: (1) large-scale multimodal pretraining plays a crucial role in DeepTumorVQA testing performance, making RadFM stand out among all VLMs. (2) Our dataset exposes critical differences in VLM components, where proper image preprocessing and design of vision modules significantly affect 3D perception. To facilitate medical multimodal research, we have released DeepTumorVQA as a rigorous benchmark: https://github.com/Schuture/DeepTumorVQA.

Pre-trained LLMs that are further trained with image data perform well on vision-language tasks. While adding images during a second training phase effectively unlocks this capability, it is unclear how much of a gain or loss this two-step pipeline gives over VLMs which integrate images earlier into the training process. To investigate this, we train models spanning various datasets, scales, image-text ratios, and amount of pre-training done before introducing vision tokens. We then fine-tune these models and evaluate their downstream performance on a suite of vision-language and text-only tasks. We find that pre-training with a mixture of image and text data allows models to perform better on vision-language tasks while maintaining strong performance on text-only evaluations. On an average of 6 diverse tasks, we find that for a 1B model, introducing visual tokens 80% of the way through pre-training results in a 2% average improvement over introducing visual tokens to a fully pre-trained model.

Vision-language pre-training (VLP) offers unique advantages for surgery by aligning language with surgical videos, enabling workflow understanding and transfer across tasks without relying on expert-labeled datasets. However, progress in surgical VLP remains constrained by the limited scale, procedural diversity, semantic quality, and hierarchical structure of existing datasets. In this work, we present SurgLaVi, the largest and most diverse surgical vision-language dataset to date, comprising nearly 240k clip-caption pairs from more than 200 procedures, and comprising hierarchical levels at phase-, step-, and task-level. At the core of SurgLaVi lies a fully automated pipeline that systematically generates fine-grained transcriptions of surgical videos and segments them into coherent procedural units. To ensure high-quality annotations, it applies dual-modality filtering to remove irrelevant and noisy samples. Within this framework, the resulting captions are enriched with contextual detail, producing annotations that are both semantically rich and easy to interpret. To ensure accessibility, we release SurgLaVi-eta, an open-source derivative of 113k clip-caption pairs constructed entirely from public data, which is over four times larger than existing surgical VLP datasets. To demonstrate the value of SurgLaVi datasets, we introduce SurgCLIP, a CLIP-style video-text contrastive framework with dual encoders, as a representative base model. SurgCLIP achieves consistent improvements across phase, step, action, and tool recognition, surpassing prior state-of-the-art methods, often by large margins. These results validate that large-scale, semantically rich, and hierarchically structured datasets directly translate into stronger and more generalizable representations, establishing SurgLaVi as a key resource for developing surgical foundation models.

Vision-language (VL) pre-training has recently received considerable attention. However, most existing end-to-end pre-training approaches either only aim to tackle VL tasks such as image-text retrieval, visual question answering (VQA) and image captioning that test high-level understanding of images, or only target region-level understanding for tasks such as phrase grounding and object detection. We present FIBER (Fusion-In-the-Backbone-based transformER), a new VL model architecture that can seamlessly handle both these types of tasks. Instead of having dedicated transformer layers for fusion after the uni-modal backbones, FIBER pushes multimodal fusion deep into the model by inserting cross-attention into the image and text backbones, bringing gains in terms of memory and performance. In addition, unlike previous work that is either only pre-trained on image-text data or on fine-grained data with box-level annotations, we present a two-stage pre-training strategy that uses both these kinds of data efficiently: (i) coarse-grained pre-training based on image-text data; followed by (ii) fine-grained pre-training based on image-text-box data. We conduct comprehensive experiments on a wide range of VL tasks, ranging from VQA, image captioning, and retrieval, to phrase grounding, referring expression comprehension, and object detection. Using deep multimodal fusion coupled with the two-stage pre-training, FIBER provides consistent performance improvements over strong baselines across all tasks, often outperforming methods using magnitudes more data. Code is available at https://github.com/microsoft/FIBER.

Recent advancements in surgical computer vision have been driven by vision-only models, which lack language semantics, relying on manually annotated videos to predict fixed object categories. This limits their generalizability to unseen surgical procedures and tasks. We propose leveraging surgical video lectures from e-learning platforms to provide effective vision and language supervisory signals for multi-modal representation learning, bypassing manual annotations. We address surgery-specific linguistic challenges using multiple automatic speech recognition systems for text transcriptions. We introduce SurgVLP - Surgical Vision Language Pre-training - a novel method for multi-modal representation learning. SurgVLP employs a new contrastive learning objective, aligning video clip embeddings with corresponding multiple text embeddings in a joint latent space. We demonstrate the representational capability of this space through several vision-and-language surgical tasks and vision-only tasks specific to surgery. Unlike current fully supervised approaches, SurgVLP adapts to different surgical procedures and tasks without specific fine-tuning, achieving zero-shot adaptation to tasks such as surgical tool, phase, and triplet recognition without manual annotation. These results highlight the transferability and versatility of the learned multi-modal representations in surgical video analysis. The code is available at https://github.com/CAMMA-public/SurgVLP

In this paper, we consider enhancing medical visual-language pre-training (VLP) with domain-specific knowledge, by exploiting the paired image-text reports from the radiological daily practice. In particular, we make the following contributions: First, unlike existing works that directly process the raw reports, we adopt a novel triplet extraction module to extract the medical-related information, avoiding unnecessary complexity from language grammar and enhancing the supervision signals; Second, we propose a novel triplet encoding module with entity translation by querying a knowledge base, to exploit the rich domain knowledge in medical field, and implicitly build relationships between medical entities in the language embedding space; Third, we propose to use a Transformer-based fusion model for spatially aligning the entity description with visual signals at the image patch level, enabling the ability for medical diagnosis; Fourth, we conduct thorough experiments to validate the effectiveness of our architecture, and benchmark on numerous public benchmarks, e.g., ChestX-ray14, RSNA Pneumonia, SIIM-ACR Pneumothorax, COVIDx CXR-2, COVID Rural, and EdemaSeverity. In both zero-shot and fine-tuning settings, our model has demonstrated strong performance compared with the former methods on disease classification and grounding.

Vision-language pre-training has significantly elevated performance across a wide range of image-language applications. Yet, the pre-training process for video-related tasks demands exceptionally large computational and data resources, which hinders the progress of video-language models. This paper investigates a straightforward, highly efficient, and resource-light approach to adapting an existing image-language pre-trained model for dense video understanding. Our preliminary experiments reveal that directly fine-tuning pre-trained image-language models with multiple frames as inputs on video datasets leads to performance saturation or even a drop. Our further investigation reveals that it is largely attributed to the bias of learned high-norm visual features. Motivated by this finding, we propose a simple but effective pooling strategy to smooth the feature distribution along the temporal dimension and thus reduce the dominant impacts from the extreme features. The new model is termed Pooling LLaVA, or in short. achieves new state-of-the-art performance on modern benchmark datasets for both video question-answer and captioning tasks. Notably, on the recent popular Video ChatGPT benchmark, PLLaVA achieves a score of 3.48 out of 5 on average of five evaluated dimensions, exceeding the previous SOTA results from GPT4V (IG-VLM) by 9\%. On the latest multi-choice benchmark MVBench, PLLaVA achieves 58.1\% accuracy on average across 20 sub-tasks, 14.5\% higher than GPT4V (IG-VLM). Code is available at https://github.com/magic-research/PLLaVA.

Clinicians spend a significant amount of time reviewing medical images and transcribing their findings regarding patient diagnosis, referral and treatment in text form. Vision-language models (VLMs), which automatically interpret images and summarize their findings as text, have enormous potential to alleviate clinical workloads and increase patient access to high-quality medical care. While foundational models have stirred considerable interest in the medical community, it is unclear whether their general capabilities translate to real-world clinical utility. In this work, we show that foundation VLMs markedly underperform compared to practicing ophthalmologists on specialist tasks crucial to the care of patients with age-related macular degeneration (AMD). To address this, we initially identified the essential capabilities required for image-based clinical decision-making, and then developed a curriculum to selectively train VLMs in these skills. The resulting model, RetinaVLM, can be instructed to write reports that significantly outperform those written by leading foundation medical VLMs in disease staging (F1 score of 0.63 vs. 0.11) and patient referral (0.67 vs. 0.39), and approaches the diagnostic performance of junior ophthalmologists (who achieve 0.77 and 0.78 on the respective tasks). Furthermore, in a reader study involving two senior ophthalmologists with up to 32 years of experience, RetinaVLM's reports were found to be similarly correct (78.6% vs. 82.1%) and complete (both 78.6%) as reports written by junior ophthalmologists with up to 10 years of experience. These results demonstrate that our curriculum-based approach provides a blueprint for specializing generalist foundation medical VLMs to handle real-world clinical tasks.

3D Vision-Language Pre-training (3D-VLP) aims to provide a pre-train model which can bridge 3D scenes with natural language, which is an important technique for embodied intelligence. However, current 3D-VLP datasets are hindered by limited scene-level diversity and insufficient fine-grained annotations (only 1.2K scenes and 280K textual annotations in ScanScribe), primarily due to the labor-intensive of collecting and annotating 3D scenes. To overcome these obstacles, we construct SynVL3D, a comprehensive synthetic scene-text corpus with 10K indoor scenes and 1M descriptions at object, view, and room levels, which has the advantages of diverse scene data, rich textual descriptions, multi-grained 3D-text associations, and low collection cost. Utilizing the rich annotations in SynVL3D, we pre-train a simple and unified Transformer for aligning 3D and language with multi-grained pretraining tasks. Moreover, we propose a synthetic-to-real domain adaptation in downstream task fine-tuning process to address the domain shift. Through extensive experiments, we verify the effectiveness of our model design by achieving state-of-the-art performance on downstream tasks including visual grounding, dense captioning, and question answering.

Vision-Language Models (VLM) can support clinicians by analyzing medical images and engaging in natural language interactions to assist in diagnostic and treatment tasks. However, VLMs often exhibit "hallucinogenic" behavior, generating textual outputs not grounded in contextual multimodal information. This challenge is particularly pronounced in the medical domain, where we do not only require VLM outputs to be accurate in single interactions but also to be consistent with clinical reasoning and diagnostic pathways throughout multi-turn conversations. For this purpose, we propose a new alignment algorithm that uses symbolic representations of clinical reasoning to ground VLMs in medical knowledge. These representations are utilized to (i) generate GPT-4-guided visual instruction tuning data at scale, simulating clinician-VLM conversations with demonstrations of clinical reasoning, and (ii) create an automatic reward function that evaluates the clinical validity of VLM generations throughout clinician-VLM interactions. Our algorithm eliminates the need for human involvement in training data generation or reward model construction, reducing costs compared to standard reinforcement learning with human feedback (RLHF). We apply our alignment algorithm to develop Dr-LLaVA, a conversational VLM finetuned for analyzing bone marrow pathology slides, demonstrating strong performance in multi-turn medical conversations.

Vision Transformer (ViT) has become one of the most popular neural architectures due to its great scalability, computational efficiency, and compelling performance in many vision tasks. However, ViT has shown inferior performance to Convolutional Neural Network (CNN) on medical tasks due to its data-hungry nature and the lack of annotated medical data. In this paper, we pre-train ViTs on 266,340 chest X-rays using Masked Autoencoders (MAE) which reconstruct missing pixels from a small part of each image. For comparison, CNNs are also pre-trained on the same 266,340 X-rays using advanced self-supervised methods (e.g., MoCo v2). The results show that our pre-trained ViT performs comparably (sometimes better) to the state-of-the-art CNN (DenseNet-121) for multi-label thorax disease classification. This performance is attributed to the strong recipes extracted from our empirical studies for pre-training and fine-tuning ViT. The pre-training recipe signifies that medical reconstruction requires a much smaller proportion of an image (10% vs. 25%) and a more moderate random resized crop range (0.5~1.0 vs. 0.2~1.0) compared with natural imaging. Furthermore, we remark that in-domain transfer learning is preferred whenever possible. The fine-tuning recipe discloses that layer-wise LR decay, RandAug magnitude, and DropPath rate are significant factors to consider. We hope that this study can direct future research on the application of Transformers to a larger variety of medical imaging tasks.

Recent advances in natural language processing (NLP) can be largely attributed to the advent of pre-trained language models such as BERT and RoBERTa. While these models demonstrate remarkable performance on general datasets, they can struggle in specialized domains such as medicine, where unique domain-specific terminologies, domain-specific abbreviations, and varying document structures are common. This paper explores strategies for adapting these models to domain-specific requirements, primarily through continuous pre-training on domain-specific data. We pre-trained several German medical language models on 2.4B tokens derived from translated public English medical data and 3B tokens of German clinical data. The resulting models were evaluated on various German downstream tasks, including named entity recognition (NER), multi-label classification, and extractive question answering. Our results suggest that models augmented by clinical and translation-based pre-training typically outperform general domain models in medical contexts. We conclude that continuous pre-training has demonstrated the ability to match or even exceed the performance of clinical models trained from scratch. Furthermore, pre-training on clinical data or leveraging translated texts have proven to be reliable methods for domain adaptation in medical NLP tasks.

With the recent success of the pre-training technique for NLP and image-linguistic tasks, some video-linguistic pre-training works are gradually developed to improve video-text related downstream tasks. However, most of the existing multimodal models are pre-trained for understanding tasks, leading to a pretrain-finetune discrepancy for generation tasks. This paper proposes UniVL: a Unified Video and Language pre-training model for both multimodal understanding and generation. It comprises four components, including two single-modal encoders, a cross encoder, and a decoder with the Transformer backbone. Five objectives, including video-text joint, conditioned masked language model (CMLM), conditioned masked frame model (CMFM), video-text alignment, and language reconstruction, are designed to train each of the components. We further develop two pre-training strategies, stage by stage pre-training (StagedP) and enhanced video representation (EnhancedV), to make the training process of the UniVL more effective. The pre-train is carried out on a sizeable instructional video dataset HowTo100M. Experimental results demonstrate that the UniVL can learn strong video-text representation and achieves state-of-the-art results on five downstream tasks.

Large Language Models (LLMs) have introduced a new era of proficiency in comprehending complex healthcare and biomedical topics. However, there is a noticeable lack of models in languages other than English and models that can interpret multi-modal input, which is crucial for global healthcare accessibility. In response, this study introduces Qilin-Med-VL, the first Chinese large vision-language model designed to integrate the analysis of textual and visual data. Qilin-Med-VL combines a pre-trained Vision Transformer (ViT) with a foundational LLM. It undergoes a thorough two-stage curriculum training process that includes feature alignment and instruction tuning. This method enhances the model's ability to generate medical captions and answer complex medical queries. We also release ChiMed-VL, a dataset consisting of more than 1M image-text pairs. This dataset has been carefully curated to enable detailed and comprehensive interpretation of medical data using various types of images.

Medicine, by its nature, is a multifaceted domain that requires the synthesis of information across various modalities. Medical generative vision-language models (VLMs) make a first step in this direction and promise many exciting clinical applications. However, existing models typically have to be fine-tuned on sizeable down-stream datasets, which poses a significant limitation as in many medical applications data is scarce, necessitating models that are capable of learning from few examples in real-time. Here we propose Med-Flamingo, a multimodal few-shot learner adapted to the medical domain. Based on OpenFlamingo-9B, we continue pre-training on paired and interleaved medical image-text data from publications and textbooks. Med-Flamingo unlocks few-shot generative medical visual question answering (VQA) abilities, which we evaluate on several datasets including a novel challenging open-ended VQA dataset of visual USMLE-style problems. Furthermore, we conduct the first human evaluation for generative medical VQA where physicians review the problems and blinded generations in an interactive app. Med-Flamingo improves performance in generative medical VQA by up to 20\% in clinician's rating and firstly enables multimodal medical few-shot adaptations, such as rationale generation. We release our model, code, and evaluation app under https://github.com/snap-stanford/med-flamingo.

Surgical video-language pretraining (VLP) faces unique challenges due to the knowledge domain gap and the scarcity of multi-modal data. This study aims to bridge the gap by addressing issues regarding textual information loss in surgical lecture videos and the spatial-temporal challenges of surgical VLP. We propose a hierarchical knowledge augmentation approach and a novel Procedure-Encoded Surgical Knowledge-Augmented Video-Language Pretraining (PeskaVLP) framework to tackle these issues. The knowledge augmentation uses large language models (LLM) for refining and enriching surgical concepts, thus providing comprehensive language supervision and reducing the risk of overfitting. PeskaVLP combines language supervision with visual self-supervision, constructing hard negative samples and employing a Dynamic Time Warping (DTW) based loss function to effectively comprehend the cross-modal procedural alignment. Extensive experiments on multiple public surgical scene understanding and cross-modal retrieval datasets show that our proposed method significantly improves zero-shot transferring performance and offers a generalist visual representation for further advancements in surgical scene understanding.The code is available at https://github.com/CAMMA-public/SurgVLP

We present a pre-training approach for vision and language transformer models, which is based on a mixture of diverse tasks. We explore both the use of image-text captioning data in pre-training, which does not need additional supervision, as well as object-aware strategies to pre-train the model. We evaluate the method on a number of textgenerative vision+language tasks, such as Visual Question Answering, visual entailment and captioning, and demonstrate large gains over standard pre-training methods.

In standard large vision-language models (LVLMs) pre-training, the model typically maximizes the joint probability of the caption conditioned on the image via next-token prediction (NTP); however, since only a small subset of caption tokens directly relates to the visual content, this naive NTP unintentionally fits the model to noise and increases the risk of hallucination. We present PRIOR, a simple vision-language pre-training approach that addresses this issue by prioritizing image-related tokens through differential weighting in the NTP loss, drawing from the importance sampling framework. PRIOR introduces a reference model-a text-only large language model (LLM) trained on the captions without image inputs, to weight each token based on its probability for LVLMs training. Intuitively, tokens that are directly related to the visual inputs are harder to predict without the image and thus receive lower probabilities from the text-only reference LLM. During training, we implement a token-specific re-weighting term based on the importance scores to adjust each token's loss. We implement PRIOR in two distinct settings: LVLMs with visual encoders and LVLMs without visual encoders. We observe 19% and 8% average relative improvement, respectively, on several vision-language benchmarks compared to NTP. In addition, PRIOR exhibits superior scaling properties, as demonstrated by significantly higher scaling coefficients, indicating greater potential for performance gains compared to NTP given increasing compute and data.

Following the impressive development of LLMs, vision-language alignment in LLMs is actively being researched to enable multimodal reasoning and visual IO. This direction of research is particularly relevant to medical imaging because medical image analysis and generation consist of reasoning based on a combination of visual features and prior knowledge. Many recent works have focused on training adapter networks that serve as an information bridge between image processing networks and LLMs; but presumably, in order to achieve maximum reasoning potential of LLMs on visual information as well, visual and language features should be allowed to interact more freely. This is especially important in the medical domain because understanding and generating medical images such as chest X-rays (CXR) require not only accurate visual and language-based reasoning but also a more intimate mapping between the two modalities. Thus, taking inspiration from previous work on the transformer and VQ-GAN combination for bidirectional image and text generation, we build upon this approach and develop a method for instruction-tuning an LLM pre-trained only on text to gain vision-language capabilities for medical images. Specifically, we leverage a pretrained LLM's existing question-answering and instruction-following abilities to teach it to understand visual inputs by instructing it to answer questions about image inputs and, symmetrically, output both text and image responses appropriate to a given query by tuning the LLM with diverse tasks that encompass image-based text-generation and text-based image-generation. We show that our model, LLM-CXR, trained in this approach shows better image-text alignment in both CXR understanding and generation tasks while being smaller in size compared to previously developed models that perform a narrower range of tasks. The code is at https://github.com/hyn2028/llm-cxr.

While Large Language Models (LLMs) excel in world knowledge understanding, adapting them to specific subfields requires precise adjustments. Due to the model's vast scale, traditional global fine-tuning methods for large models can be computationally expensive and impact generalization. To address this challenge, a range of innovative Parameters-Efficient Fine-Tuning (PEFT) methods have emerged and achieved remarkable success in both LLMs and Large Vision-Language Models (LVLMs). In the medical domain, fine-tuning a medical Vision-Language Pretrained (VLP) model is essential for adapting it to specific tasks. Can the fine-tuning methods for large models be transferred to the medical field to enhance transfer learning efficiency? In this paper, we delve into the fine-tuning methods of LLMs and conduct extensive experiments to investigate the impact of fine-tuning methods for large models on the existing multimodal model in the medical domain from the training data level and the model structure level. We show the different impacts of fine-tuning methods for large models on medical VLMs and develop the most efficient ways to fine-tune medical VLP models. We hope this research can guide medical domain researchers in optimizing VLMs' training costs, fostering the broader application of VLMs in healthcare fields. The code and dataset have been released at https://github.com/TIMMY-CHAN/MILE.

Vision-language pre-training (VLP) methods are blossoming recently, and its crucial goal is to jointly learn visual and textual features via a transformer-based architecture, demonstrating promising improvements on a variety of vision-language tasks. Prior arts usually focus on how to align visual and textual features, but strategies for improving the robustness of model and speeding up model convergence are left insufficiently explored. In this paper, we propose a novel method ViLTA, comprising of two components to further facilitate the model to learn fine-grained representations among image-text pairs. For Masked Language Modeling (MLM), we propose a cross-distillation method to generate soft labels to enhance the robustness of model, which alleviates the problem of treating synonyms of masked words as negative samples in one-hot labels. For Image-Text Matching (ITM), we leverage the current language encoder to synthesize hard negatives based on the context of language input, encouraging the model to learn high-quality representations by increasing the difficulty of the ITM task. By leveraging the above techniques, our ViLTA can achieve better performance on various vision-language tasks. Extensive experiments on benchmark datasets demonstrate that the effectiveness of ViLTA and its promising potential for vision-language pre-training.

This paper investigates the challenges of developing large language models (LLMs) proficient in both multilingual understanding and medical knowledge. We demonstrate that simply translating medical data does not guarantee strong performance on clinical tasks in the target language. Our experiments reveal that the optimal language mix in training data varies significantly across different medical tasks. We find that larger models with carefully calibrated language ratios achieve superior performance on native-language clinical tasks. Furthermore, our results suggest that relying solely on fine-tuning may not be the most effective approach for incorporating new language knowledge into LLMs. Instead, data and computationally intensive pretraining methods may still be necessary to achieve optimal performance in multilingual medical settings. These findings provide valuable guidance for building effective and inclusive medical AI systems for diverse linguistic communities.

The need for improved diagnostic methods in ophthalmology is acute, especially in the underdeveloped regions with limited access to specialists and advanced equipment. Therefore, we introduce VisionUnite, a novel vision-language foundation model for ophthalmology enhanced with clinical knowledge. VisionUnite has been pretrained on an extensive dataset comprising 1.24 million image-text pairs, and further refined using our proposed MMFundus dataset, which includes 296,379 high-quality fundus image-text pairs and 889,137 simulated doctor-patient dialogue instances. Our experiments indicate that VisionUnite outperforms existing generative foundation models such as GPT-4V and Gemini Pro. It also demonstrates diagnostic capabilities comparable to junior ophthalmologists. VisionUnite performs well in various clinical scenarios including open-ended multi-disease diagnosis, clinical explanation, and patient interaction, making it a highly versatile tool for initial ophthalmic disease screening. VisionUnite can also serve as an educational aid for junior ophthalmologists, accelerating their acquisition of knowledge regarding both common and underrepresented ophthalmic conditions. VisionUnite represents a significant advancement in ophthalmology, with broad implications for diagnostics, medical education, and understanding of disease mechanisms. The source code is at https://github.com/HUANGLIZI/VisionUnite.

Deep learning has enabled the development of highly robust foundation models for various pathological tasks across diverse diseases and patient cohorts. Among these models, vision-language pre-training, which leverages large-scale paired data to align pathology image and text embedding spaces, and provides a novel zero-shot paradigm for downstream tasks. However, existing models have been primarily data-driven and lack the incorporation of domain-specific knowledge, which limits their performance in cancer diagnosis, especially for rare tumor subtypes. To address this limitation, we establish a Knowledge-enhanced Pathology (KEEP) foundation model that harnesses disease knowledge to facilitate vision-language pre-training. Specifically, we first construct a disease knowledge graph (KG) that covers 11,454 human diseases with 139,143 disease attributes, including synonyms, definitions, and hypernym relations. We then systematically reorganize the millions of publicly available noisy pathology image-text pairs, into 143K well-structured semantic groups linked through the hierarchical relations of the disease KG. To derive more nuanced image and text representations, we propose a novel knowledge-enhanced vision-language pre-training approach that integrates disease knowledge into the alignment within hierarchical semantic groups instead of unstructured image-text pairs. Validated on 18 diverse benchmarks with more than 14,000 whole slide images (WSIs), KEEP achieves state-of-the-art performance in zero-shot cancer diagnostic tasks. Notably, for cancer detection, KEEP demonstrates an average sensitivity of 89.8% at a specificity of 95.0% across 7 cancer types. For cancer subtyping, KEEP achieves a median balanced accuracy of 0.456 in subtyping 30 rare brain cancers, indicating strong generalizability for diagnosing rare tumors.

Inevitable domain and task discrepancies in real-world scenarios can impair the generalization performance of the pre-trained deep models for medical data. Therefore, we audaciously propose that we should build a general-purpose medical AI system that can be seamlessly adapted to downstream domains/tasks. Since the domain/task adaption procedures usually involve additional labeling work for the target data, designing a data-efficient adaption algorithm is desired to save the cost of transferring the learned knowledge. Our recent work found that vision-language models (VLMs) are efficient learners with extraordinary cross-domain ability. Therefore, in this work, we further explore the possibility of leveraging pre-trained VLMs as medical foundation models for building general-purpose medical AI, where we thoroughly investigate three machine-learning paradigms, i.e., domain/task-specialized learning, joint learning, and continual learning, for training the VLMs and evaluate their generalization performance on cross-domain and cross-task test sets. To alleviate the catastrophic forgetting during sequential training, we employ rehearsal learning and receive a sharp boost in terms of generalization capability. In a nutshell, our empirical evidence suggests that continual learning may be a practical and efficient learning paradigm for the medical foundation model. And we hope researchers can use our empirical evidence as basement to further explore the path toward medical foundation model.

The recent upsurge in pre-trained large models (e.g. GPT-4) has swept across the entire deep learning community. Such powerful large language models (LLMs) demonstrate advanced generative ability and multimodal understanding capability, which quickly achieve new state-of-the-art performances on a variety of benchmarks. The pre-trained LLM usually plays the role as a universal AI model that can conduct various tasks, including context reasoning, article analysis and image content comprehension. However, considering the prohibitively high memory and computational cost for implementing such a large model, the conventional models (such as CNN and ViT), are still essential for many visual perception tasks. In this paper, we propose to enhance the representation ability of ordinary vision models for perception tasks (e.g. image classification) by taking advantage of large pre-trained models. We present a new learning paradigm in which the knowledge extracted from large pre-trained models are utilized to help models like CNN and ViT learn enhanced representations and achieve better performance. Firstly, we curate a high quality description set by prompting a multimodal LLM to generate descriptive text for all training images. Furthermore, we feed these detailed descriptions into a pre-trained encoder to extract text embeddings with rich semantic information that encodes the content of images. During training, text embeddings will serve as extra supervising signals and be aligned with image representations learned by vision models. The alignment process helps vision models learn better and achieve higher accuracy with the assistance of pre-trained LLMs. We conduct extensive experiments to verify that the proposed algorithm consistently improves the performance for various vision models with heterogeneous architectures.

We introduce a radiology-focused visual language model designed to generate radiology reports from chest X-rays. Building on previous findings that large language models (LLMs) can acquire multimodal capabilities when aligned with pretrained vision encoders, we demonstrate similar potential with chest X-ray images. This integration enhances the ability of model to understand and describe chest X-ray images. Our model combines an image encoder with a fine-tuned LLM based on the Vicuna-7B architecture, enabling it to generate different sections of a radiology report with notable accuracy. The training process involves a two-stage approach: (i) initial alignment of chest X-ray features with the LLM (ii) followed by fine-tuning for radiology report generation.

We present HealthGPT, a powerful Medical Large Vision-Language Model (Med-LVLM) that integrates medical visual comprehension and generation capabilities within a unified autoregressive paradigm. Our bootstrapping philosophy is to progressively adapt heterogeneous comprehension and generation knowledge to pre-trained large language models (LLMs). This is achieved through a novel heterogeneous low-rank adaptation (H-LoRA) technique, which is complemented by a tailored hierarchical visual perception approach and a three-stage learning strategy. To effectively learn the HealthGPT, we devise a comprehensive medical domain-specific comprehension and generation dataset called VL-Health. Experimental results demonstrate exceptional performance and scalability of HealthGPT in medical visual unified tasks. Our project can be accessed at https://github.com/DCDmllm/HealthGPT.

In this paper, we propose ``SimVLG'', a streamlined framework for the pre-training of computationally intensive vision-language generative models, leveraging frozen pre-trained large language models (LLMs). The prevailing paradigm in vision-language pre-training (VLP) typically involves a two-stage optimization process: an initial resource-intensive phase dedicated to general-purpose vision-language representation learning, aimed at extracting and consolidating pertinent visual features, followed by a subsequent phase focusing on end-to-end alignment between visual and linguistic modalities. Our one-stage, single-loss framework circumvents the aforementioned computationally demanding first stage of training by gradually merging similar visual tokens during training. This gradual merging process effectively compacts the visual information while preserving the richness of semantic content, leading to fast convergence without sacrificing performance. Our experiments show that our approach can speed up the training of vision-language models by a factor times 5 without noticeable impact on the overall performance. Additionally, we show that our models can achieve comparable performance to current vision-language models with only 1/10 of the data. Finally, we demonstrate how our image-text models can be easily adapted to video-language generative tasks through a novel soft attentive temporal token merging modules.

Clinical decision-making relies heavily on understanding relative positions of anatomical structures and anomalies. Therefore, for Vision-Language Models (VLMs) to be applicable in clinical practice, the ability to accurately determine relative positions on medical images is a fundamental prerequisite. Despite its importance, this capability remains highly underexplored. To address this gap, we evaluate the ability of state-of-the-art VLMs, GPT-4o, Llama3.2, Pixtral, and JanusPro, and find that all models fail at this fundamental task. Inspired by successful approaches in computer vision, we investigate whether visual prompts, such as alphanumeric or colored markers placed on anatomical structures, can enhance performance. While these markers provide moderate improvements, results remain significantly lower on medical images compared to observations made on natural images. Our evaluations suggest that, in medical imaging, VLMs rely more on prior anatomical knowledge than on actual image content for answering relative position questions, often leading to incorrect conclusions. To facilitate further research in this area, we introduce the MIRP , Medical Imaging Relative Positioning, benchmark dataset, designed to systematically evaluate the capability to identify relative positions in medical images.

The pre-trained image-text models, like CLIP, have demonstrated the strong power of vision-language representation learned from a large scale of web-collected image-text data. In light of the well-learned visual features, some existing works transfer image representation to video domain and achieve good results. However, how to utilize image-language pre-trained model (e.g., CLIP) for video-language pre-training (post-pretraining) is still under explored. In this paper, we investigate two questions: 1) what are the factors hindering post-pretraining CLIP to further improve the performance on video-language tasks? and 2) how to mitigate the impact of these factors? Through a series of comparative experiments and analyses, we find that the data scale and domain gap between language sources have great impacts. Motivated by these, we propose a Omnisource Cross-modal Learning method equipped with a Video Proxy mechanism on the basis of CLIP, namely CLIP-ViP. Extensive results show that our approach improves the performance of CLIP on video-text retrieval by a large margin. Our model also achieves SOTA results on a variety of datasets, including MSR-VTT, DiDeMo, LSMDC, and ActivityNet. We will release our code and pre-trained CLIP-ViP models at https://github.com/microsoft/XPretrain/tree/main/CLIP-ViP.

Visual-language pre-training (VLP) has achieved remarkable success in multi-modal tasks, largely attributed to the availability of large-scale image-text datasets. In this work, we demonstrate that multi-modal large language models (MLLMs) can enhance visual-language representation learning by improving data quality. Our approach is simple, utilizing MLLMs to extend multiple captions for each image. To prevent the bias introduced by MLLMs' hallucinations and intrinsic caption styles, we propose "text shearing" to maintain the same length for extended captions as that of the original captions. In image-text retrieval, our method consistently obtains 5.6 ~ 35.0% and 16.8 ~ 46.1% improvement on R@1 under the fine-tuning and zero-shot settings, respectively. Notably, we obtain zero-shot results that are comparable to fine-tuning on target datasets, which encourages more exploration of the versatile use of MLLMs.

In this paper, we propose a Vision-Audio-Language Omni-peRception pretraining model (VALOR) for multi-modal understanding and generation. Different from widely-studied vision-language pretraining models, VALOR jointly models relationships of vision, audio and language in an end-to-end manner. It contains three separate encoders for single modality representations, and a decoder for multimodal conditional text generation. We design two pretext tasks to pretrain VALOR model, including Multimodal Grouping Alignment (MGA) and Multimodal Grouping Captioning (MGC). MGA projects vision, language and audio to the same common space, building vision-language, audio-language and audiovisual-language alignment simultaneously. MGC learns how to generate text tokens in conditions of vision, audio or their both. To promote vision-audio-language pretraining research, we construct a large-scale high-quality tri-modality dataset named VALOR-1M, which contains 1M audiable videos with human annotated audiovisual captions. Extensive experiments show that VALOR can learn strong multimodal correlations and be generalized to various downstream tasks (e.g., retrieval, captioning and question answering), with different input modalities (e.g., vision-language, audio-language and audiovisual-language). VALOR achieves new state-of-the-art performances on series of public cross-modality benchmarks. Code and data are available at project page https://casia-iva-group.github.io/projects/VALOR.

Conversational generative AI has demonstrated remarkable promise for empowering biomedical practitioners, but current investigations focus on unimodal text. Multimodal conversational AI has seen rapid progress by leveraging billions of image-text pairs from the public web, but such general-domain vision-language models still lack sophistication in understanding and conversing about biomedical images. In this paper, we propose a cost-efficient approach for training a vision-language conversational assistant that can answer open-ended research questions of biomedical images. The key idea is to leverage a large-scale, broad-coverage biomedical figure-caption dataset extracted from PubMed Central, use GPT-4 to self-instruct open-ended instruction-following data from the captions, and then fine-tune a large general-domain vision-language model using a novel curriculum learning method. Specifically, the model first learns to align biomedical vocabulary using the figure-caption pairs as is, then learns to master open-ended conversational semantics using GPT-4 generated instruction-following data, broadly mimicking how a layperson gradually acquires biomedical knowledge. This enables us to train a Large Language and Vision Assistant for BioMedicine (LLaVA-Med) in less than 15 hours (with eight A100s). LLaVA-Med exhibits excellent multimodal conversational capability and can follow open-ended instruction to assist with inquiries about a biomedical image. On three standard biomedical visual question answering datasets, LLaVA-Med outperforms previous supervised state-of-the-art on certain metrics. To facilitate biomedical multimodal research, we will release our instruction-following data and the LLaVA-Med model.

Pre-trained Vision Language Models (VLMs) have demonstrated notable progress in various zero-shot tasks, such as classification and retrieval. Despite their performance, because improving performance on new tasks requires task-specific knowledge, their adaptation is essential. While labels are needed for the adaptation, acquiring them is typically expensive. To overcome this challenge, active learning, a method of achieving a high performance by obtaining labels for a small number of samples from experts, has been studied. Active learning primarily focuses on selecting unlabeled samples for labeling and leveraging them to train models. In this study, we pose the question, "how can the pre-trained VLMs be adapted under the active learning framework?" In response to this inquiry, we observe that (1) simply applying a conventional active learning framework to pre-trained VLMs even may degrade performance compared to random selection because of the class imbalance in labeling candidates, and (2) the knowledge of VLMs can provide hints for achieving the balance before labeling. Based on these observations, we devise a novel active learning framework for VLMs, denoted as PCB. To assess the effectiveness of our approach, we conduct experiments on seven different real-world datasets, and the results demonstrate that PCB surpasses conventional active learning and random sampling methods. Code will be available in https://github.com/kaist-dmlab/pcb .

Pre-training lays the foundation for recent successes in radiograph analysis supported by deep learning. It learns transferable image representations by conducting large-scale fully-supervised or self-supervised learning on a source domain. However, supervised pre-training requires a complex and labor intensive two-stage human-assisted annotation process while self-supervised learning cannot compete with the supervised paradigm. To tackle these issues, we propose a cross-supervised methodology named REviewing FreE-text Reports for Supervision (REFERS), which acquires free supervision signals from original radiology reports accompanying the radiographs. The proposed approach employs a vision transformer and is designed to learn joint representations from multiple views within every patient study. REFERS outperforms its transfer learning and self-supervised learning counterparts on 4 well-known X-ray datasets under extremely limited supervision. Moreover, REFERS even surpasses methods based on a source domain of radiographs with human-assisted structured labels. Thus REFERS has the potential to replace canonical pre-training methodologies.

Vision-and-Language Pre-training (VLP) has improved performance on various joint vision-and-language downstream tasks. Current approaches to VLP heavily rely on image feature extraction processes, most of which involve region supervision (e.g., object detection) and the convolutional architecture (e.g., ResNet). Although disregarded in the literature, we find it problematic in terms of both (1) efficiency/speed, that simply extracting input features requires much more computation than the multimodal interaction steps; and (2) expressive power, as it is upper bounded to the expressive power of the visual embedder and its predefined visual vocabulary. In this paper, we present a minimal VLP model, Vision-and-Language Transformer (ViLT), monolithic in the sense that the processing of visual inputs is drastically simplified to just the same convolution-free manner that we process textual inputs. We show that ViLT is up to tens of times faster than previous VLP models, yet with competitive or better downstream task performance. Our code and pre-trained weights are available at https://github.com/dandelin/vilt.

The integration of artificial intelligence (AI) with radiology marks a transformative era in medicine. Vision foundation models have been adopted to enhance radiologic imaging analysis. However, the distinct complexities of radiologic 2D and 3D radiologic data pose unique challenges that existing models, pre-trained on general non-medical images, fail to address adequately. To bridge this gap and capitalize on the diagnostic precision required in radiologic imaging, we introduce Radiologic Contrastive Language-Image Pre-training (RadCLIP): a cross-modal vision-language foundational model that harnesses Vision Language Pre-training (VLP) framework to improve radiologic image analysis. Building upon Contrastive Language-Image Pre-training (CLIP), RadCLIP incorporates a slice pooling mechanism tailored for volumetric image analysis and is pre-trained using a large and diverse dataset of radiologic image-text pairs. The RadCLIP was pre-trained to effectively align radiologic images with their corresponding text annotations, creating a robust vision backbone for radiologic images. Extensive experiments demonstrate RadCLIP's superior performance in both uni-modal radiologic image classification and cross-modal image-text matching, highlighting its significant promise for improving diagnostic accuracy and efficiency in clinical settings. Our Key contributions include curating a large dataset with diverse radiologic 2D/3D radiologic image-text pairs, a slice pooling adapter using an attention mechanism for integrating 2D images, and comprehensive evaluations of RadCLIP on various radiologic downstream tasks.

We investigate fine-tuning Vision-Language Models (VLMs) for multi-task medical image understanding, focusing on detection, localization, and counting of findings in medical images. Our objective is to evaluate whether instruction-tuned VLMs can simultaneously improve these tasks, with the goal of enhancing diagnostic accuracy and efficiency. Using MedMultiPoints, a multimodal dataset with annotations from endoscopy (polyps and instruments) and microscopy (sperm cells), we reformulate each task into instruction-based prompts suitable for vision-language reasoning. We fine-tune Qwen2.5-VL-7B-Instruct using Low-Rank Adaptation (LoRA) across multiple task combinations. Results show that multi-task training improves robustness and accuracy. For example, it reduces the Count Mean Absolute Error (MAE) and increases Matching Accuracy in the Counting + Pointing task. However, trade-offs emerge, such as more zero-case point predictions, indicating reduced reliability in edge cases despite overall performance gains. Our study highlights the potential of adapting general-purpose VLMs to specialized medical tasks via prompt-driven fine-tuning. This approach mirrors clinical workflows, where radiologists simultaneously localize, count, and describe findings - demonstrating how VLMs can learn composite diagnostic reasoning patterns. The model produces interpretable, structured outputs, offering a promising step toward explainable and versatile medical AI. Code, model weights, and scripts will be released for reproducibility at https://github.com/simula/PointDetectCount.

State-of-the-art vision and vision-and-language models rely on large-scale visio-linguistic pretraining for obtaining good performance on a variety of downstream tasks. Generally, such models are often either cross-modal (contrastive) or multi-modal (with earlier fusion) but not both; and they often only target specific modalities or tasks. A promising direction would be to use a single holistic universal model, as a "foundation", that targets all modalities at once -- a true vision and language foundation model should be good at vision tasks, language tasks, and cross- and multi-modal vision and language tasks. We introduce FLAVA as such a model and demonstrate impressive performance on a wide range of 35 tasks spanning these target modalities.

Medical vision-and-language models (MVLMs) have attracted substantial interest due to their capability to offer a natural language interface for interpreting complex medical data. Their applications are versatile and have the potential to improve diagnostic accuracy and decision-making for individual patients while also contributing to enhanced public health monitoring, disease surveillance, and policy-making through more efficient analysis of large data sets. MVLMS integrate natural language processing with medical images to enable a more comprehensive and contextual understanding of medical images alongside their corresponding textual information. Unlike general vision-and-language models trained on diverse, non-specialized datasets, MVLMs are purpose-built for the medical domain, automatically extracting and interpreting critical information from medical images and textual reports to support clinical decision-making. Popular clinical applications of MVLMs include automated medical report generation, medical visual question answering, medical multimodal segmentation, diagnosis and prognosis and medical image-text retrieval. Here, we provide a comprehensive overview of MVLMs and the various medical tasks to which they have been applied. We conduct a detailed analysis of various vision-and-language model architectures, focusing on their distinct strategies for cross-modal integration/exploitation of medical visual and textual features. We also examine the datasets used for these tasks and compare the performance of different models based on standardized evaluation metrics. Furthermore, we highlight potential challenges and summarize future research trends and directions. The full collection of papers and codes is available at: https://github.com/YtongXie/Medical-Vision-and-Language-Tasks-and-Methodologies-A-Survey.

Vision-language models in pathology enable multimodal case retrieval and automated report generation. Many of the models developed so far, however, have been trained on pathology reports that include information which cannot be inferred from paired whole slide images (e.g., patient history), potentially leading to hallucinated sentences in generated reports. To this end, we investigate how the selection of information from pathology reports for vision-language modeling affects the quality of the multimodal representations and generated reports. More concretely, we compare a model trained on full reports against a model trained on preprocessed reports that only include sentences describing the cell and tissue appearances based on the H&E-stained slides. For the experiments, we built upon the BLIP-2 framework and used a cutaneous melanocytic lesion dataset of 42,433 H&E-stained whole slide images and 19,636 corresponding pathology reports. Model performance was assessed using image-to-text and text-to-image retrieval, as well as qualitative evaluation of the generated reports by an expert pathologist. Our results demonstrate that text preprocessing prevents hallucination in report generation. Despite the improvement in the quality of the generated reports, training the vision-language model on full reports showed better cross-modal retrieval performance.

Obtaining large pre-trained models that can be fine-tuned to new tasks with limited annotated samples has remained an open challenge for medical imaging data. While pre-trained deep networks on ImageNet and vision-language foundation models trained on web-scale data are prevailing approaches, their effectiveness on medical tasks is limited due to the significant domain shift between natural and medical images. To bridge this gap, we introduce LVM-Med, the first family of deep networks trained on large-scale medical datasets. We have collected approximately 1.3 million medical images from 55 publicly available datasets, covering a large number of organs and modalities such as CT, MRI, X-ray, and Ultrasound. We benchmark several state-of-the-art self-supervised algorithms on this dataset and propose a novel self-supervised contrastive learning algorithm using a graph-matching formulation. The proposed approach makes three contributions: (i) it integrates prior pair-wise image similarity metrics based on local and global information; (ii) it captures the structural constraints of feature embeddings through a loss function constructed via a combinatorial graph-matching objective; and (iii) it can be trained efficiently end-to-end using modern gradient-estimation techniques for black-box solvers. We thoroughly evaluate the proposed LVM-Med on 15 downstream medical tasks ranging from segmentation and classification to object detection, and both for the in and out-of-distribution settings. LVM-Med empirically outperforms a number of state-of-the-art supervised, self-supervised, and foundation models. For challenging tasks such as Brain Tumor Classification or Diabetic Retinopathy Grading, LVM-Med improves previous vision-language models trained on 1 billion masks by 6-7% while using only a ResNet-50.

Pre-trained Vision Foundation Models (VFMs) provide strong visual representations for a wide range of applications. In this paper, we continually pre-train prevailing VFMs in a multimodal manner such that they can effortlessly process visual inputs of varying sizes and produce visual representations that are more aligned with language representations, regardless of their original pre-training process. To this end, we introduce CoMP, a carefully designed multimodal pre-training pipeline. CoMP uses a Continual Rotary Position Embedding to support native resolution continual pre-training, and an Alignment Loss between visual and textual features through language prototypes to align multimodal representations. By three-stage training, our VFMs achieve remarkable improvements not only in multimodal understanding but also in other downstream tasks such as classification and segmentation. Remarkably, CoMP-SigLIP achieves scores of 66.7 on ChartQA and 75.9 on DocVQA with a 0.5B LLM, while maintaining an 87.4% accuracy on ImageNet-1K and a 49.5 mIoU on ADE20K under frozen chunk evaluation.

Recently, several multi-modal models have been developed for joint image and language understanding, which have demonstrated impressive chat abilities by utilizing advanced large language models (LLMs). The process of developing such models is straightforward yet effective. It involves pre-training an adaptation module to align the semantics of the vision encoder and language model, followed by fine-tuning on the instruction-following data. However, despite the success of this pipeline in image and language understanding, its effectiveness in joint video and language understanding has not been widely explored. In this paper, we aim to develop a novel multi-modal foundation model capable of perceiving video, image, and language within a general framework. To achieve this goal, we introduce Valley: Video Assistant with Large Language model Enhanced ability. Specifically, our proposed Valley model is designed with a simple projection module that bridges video, image, and language modalities, and is further unified with a multi-lingual LLM. We also collect multi-source vision-text pairs and adopt a spatio-temporal pooling strategy to obtain a unified vision encoding of video and image input for pre-training. Furthermore, we generate multi-task instruction-following video data, including multi-shot captions, long video descriptions, action recognition, causal relationship inference, etc. To obtain the instruction-following data, we design diverse rounds of task-oriented conversations between humans and videos, facilitated by ChatGPT. Qualitative examples demonstrate that our proposed model has the potential to function as a highly effective multilingual video assistant that can make complex video understanding scenarios easy. Code, data, and models will be available at https://github.com/RupertLuo/Valley.

Recent advancements in artificial intelligence (AI) have precipitated significant breakthroughs in healthcare, particularly in refining diagnostic procedures. However, previous studies have often been constrained to limited functionalities. This study introduces MiniGPT-Med, a vision-language model derived from large-scale language models and tailored for medical applications. MiniGPT-Med demonstrates remarkable versatility across various imaging modalities, including X-rays, CT scans, and MRIs, enhancing its utility. The model is capable of performing tasks such as medical report generation, visual question answering (VQA), and disease identification within medical imagery. Its integrated processing of both image and textual clinical data markedly improves diagnostic accuracy. Our empirical assessments confirm MiniGPT-Med's superior performance in disease grounding, medical report generation, and VQA benchmarks, representing a significant step towards reducing the gap in assisting radiology practice. Furthermore, it achieves state-of-the-art performance on medical report generation, higher than the previous best model by 19\% accuracy. MiniGPT-Med promises to become a general interface for radiology diagnoses, enhancing diagnostic efficiency across a wide range of medical imaging applications.

Our approach to training 3D vision-language understanding models is to train a feedforward model that makes predictions in 3D, but never requires 3D labels and is supervised only in 2D, using 2D losses and differentiable rendering. The approach is new for vision-language understanding. By treating the reconstruction as a ``latent variable'', we can render the outputs without placing unnecessary constraints on the network architecture (e.g. can be used with decoder-only models). For training, only need images and camera pose, and 2D labels. We show that we can even remove the need for 2D labels by using pseudo-labels from pretrained 2D models. We demonstrate this to pretrain a network, and we finetune it for 3D vision-language understanding tasks. We show this approach outperforms baselines/sota for 3D vision-language grounding, and also outperforms other 3D pretraining techniques. Project page: https://liftgs.github.io.

Several medical Multimodal Large Languange Models (MLLMs) have been developed to address tasks involving visual images with textual instructions across various medical modalities, achieving impressive results. Most current medical generalist models are region-agnostic, treating the entire image as a holistic representation. However, they struggle to identify which specific regions they are focusing on when generating a sentence. To mimic the behavior of doctors, who typically begin by reviewing the entire image before concentrating on specific regions for a thorough evaluation, we aim to enhance the capability of medical MLLMs in understanding anatomical regions within entire medical scans. To achieve it, we first formulate Region-Centric tasks and construct a large-scale dataset, MedRegInstruct, to incorporate regional information into training. Combining our collected dataset with other medical multimodal corpora for training, we propose a Region-Aware medical MLLM, MedRegA, which is the first bilingual generalist medical AI system to simultaneously handle image-level and region-level medical vision-language tasks across a broad range of modalities. Our MedRegA not only enables three region-centric tasks, but also achieves the best performance for visual question answering, report generation and medical image classification over 8 modalities, showcasing significant versatility. Experiments demonstrate that our model can not only accomplish powerful performance across various medical vision-language tasks in bilingual settings, but also recognize and detect structures in multimodal medical scans, boosting the interpretability and user interactivity of medical MLLMs. Our project page is https://medrega.github.io.

Standard practice in pretraining multimodal models, such as vision-language models, is to rely on pairs of aligned inputs from both modalities, for example, aligned image-text pairs. However, such pairs can be difficult to obtain in low-resource settings and for some modality pairs (e.g., structured tables and images). In this work, we investigate the extent to which we can reduce the reliance on such parallel data, which we term bimodal supervision, and use models that are pretrained on each modality independently. We experiment with a high-performing vision-language model, and analyze the effect of bimodal supervision on three vision-language tasks. We find that on simpler tasks, such as VQAv2 and GQA, one can eliminate bimodal supervision completely, suffering only a minor loss in performance. Conversely, for NLVR2, which requires more complex reasoning, training without bimodal supervision leads to random performance. Nevertheless, using only 5\% of the bimodal data (142K images along with their captions), or leveraging weak supervision in the form of a list of machine-generated labels for each image, leads to only a moderate degradation compared to using 3M image-text pairs: 74\%rightarrowsim70\%. Our code is available at https://github.com/eladsegal/less-bimodal-sup.

Vision-Language Pre-training (VLP) has advanced the performance for many vision-language tasks. However, most existing pre-trained models only excel in either understanding-based tasks or generation-based tasks. Furthermore, performance improvement has been largely achieved by scaling up the dataset with noisy image-text pairs collected from the web, which is a suboptimal source of supervision. In this paper, we propose BLIP, a new VLP framework which transfers flexibly to both vision-language understanding and generation tasks. BLIP effectively utilizes the noisy web data by bootstrapping the captions, where a captioner generates synthetic captions and a filter removes the noisy ones. We achieve state-of-the-art results on a wide range of vision-language tasks, such as image-text retrieval (+2.7% in average recall@1), image captioning (+2.8% in CIDEr), and VQA (+1.6% in VQA score). BLIP also demonstrates strong generalization ability when directly transferred to video-language tasks in a zero-shot manner. Code, models, and datasets are released at https://github.com/salesforce/BLIP.

Medical image segmentation allows quantifying target structure size and shape, aiding in disease diagnosis, prognosis, surgery planning, and comprehension.Building upon recent advancements in foundation Vision-Language Models (VLMs) from natural image-text pairs, several studies have proposed adapting them to Vision-Language Segmentation Models (VLSMs) that allow using language text as an additional input to segmentation models. Introducing auxiliary information via text with human-in-the-loop prompting during inference opens up unique opportunities, such as open vocabulary segmentation and potentially more robust segmentation models against out-of-distribution data. Although transfer learning from natural to medical images has been explored for image-only segmentation models, the joint representation of vision-language in segmentation problems remains underexplored. This study introduces the first systematic study on transferring VLSMs to 2D medical images, using carefully curated 11 datasets encompassing diverse modalities and insightful language prompts and experiments. Our findings demonstrate that although VLSMs show competitive performance compared to image-only models for segmentation after finetuning in limited medical image datasets, not all VLSMs utilize the additional information from language prompts, with image features playing a dominant role. While VLSMs exhibit enhanced performance in handling pooled datasets with diverse modalities and show potential robustness to domain shifts compared to conventional segmentation models, our results suggest that novel approaches are required to enable VLSMs to leverage the various auxiliary information available through language prompts. The code and datasets are available at https://github.com/naamiinepal/medvlsm.

With the advent of Vision-Language Models (VLMs), medical artificial intelligence (AI) has experienced significant technological progress and paradigm shifts. This survey provides an extensive review of recent advancements in Medical Vision-Language Models (Med-VLMs), which integrate visual and textual data to enhance healthcare outcomes. We discuss the foundational technology behind Med-VLMs, illustrating how general models are adapted for complex medical tasks, and examine their applications in healthcare. The transformative impact of Med-VLMs on clinical practice, education, and patient care is highlighted, alongside challenges such as data scarcity, narrow task generalization, interpretability issues, and ethical concerns like fairness, accountability, and privacy. These limitations are exacerbated by uneven dataset distribution, computational demands, and regulatory hurdles. Rigorous evaluation methods and robust regulatory frameworks are essential for safe integration into healthcare workflows. Future directions include leveraging large-scale, diverse datasets, improving cross-modal generalization, and enhancing interpretability. Innovations like federated learning, lightweight architectures, and Electronic Health Record (EHR) integration are explored as pathways to democratize access and improve clinical relevance. This review aims to provide a comprehensive understanding of Med-VLMs' strengths and limitations, fostering their ethical and balanced adoption in healthcare.

There has been a growing interest in developing multimodal machine translation (MMT) systems that enhance neural machine translation (NMT) with visual knowledge. This problem setup involves using images as auxiliary information during training, and more recently, eliminating their use during inference. Towards this end, previous works face a challenge in training powerful MMT models from scratch due to the scarcity of annotated multilingual vision-language data, especially for low-resource languages. Simultaneously, there has been an influx of multilingual pre-trained models for NMT and multimodal pre-trained models for vision-language tasks, primarily in English, which have shown exceptional generalisation ability. However, these are not directly applicable to MMT since they do not provide aligned multimodal multilingual features for generative tasks. To alleviate this issue, instead of designing complex modules for MMT, we propose CLIPTrans, which simply adapts the independently pre-trained multimodal M-CLIP and the multilingual mBART. In order to align their embedding spaces, mBART is conditioned on the M-CLIP features by a prefix sequence generated through a lightweight mapping network. We train this in a two-stage pipeline which warms up the model with image captioning before the actual translation task. Through experiments, we demonstrate the merits of this framework and consequently push forward the state-of-the-art across standard benchmarks by an average of +2.67 BLEU. The code can be found at www.github.com/devaansh100/CLIPTrans.

In this work, we address the problem of grounding abnormalities in medical images, where the goal is to localize clinical findings based on textual descriptions. While generalist Vision-Language Models (VLMs) excel in natural grounding tasks, they often struggle in the medical domain due to rare, compositional, and domain-specific terms that are poorly aligned with visual patterns. Specialized medical VLMs address this challenge via large-scale domain pretraining, but at the cost of substantial annotation and computational resources. To overcome these limitations, we propose Knowledge to Sight (K2Sight), a framework that introduces structured semantic supervision by decomposing clinical concepts into interpretable visual attributes, such as shape, density, and anatomical location. These attributes are distilled from domain ontologies and encoded into concise instruction-style prompts, which guide region-text alignment during training. Unlike conventional report-level supervision, our approach explicitly bridges domain knowledge and spatial structure, enabling data-efficient training of compact models. We train compact models with 0.23B and 2B parameters using only 1.5\% of the data required by state-of-the-art medical VLMs. Despite their small size and limited training data, these models achieve performance on par with or better than 7B+ medical VLMs, with up to 9.82\% improvement in mAP_{50}. Code and models: https://lijunrio.github.io/K2Sight/{SOTAPink{https://lijunrio.github.io/K2Sight/}}.

The rapid development of multimodal large language models (MLLMs), such as GPT-4V, has led to significant advancements. However, these models still face challenges in medical multimodal capabilities due to limitations in the quantity and quality of medical vision-text data, stemming from data privacy concerns and high annotation costs. While pioneering approaches utilize PubMed's large-scale, de-identified medical image-text pairs to address these limitations, they still fall short due to inherent data noise. To tackle this, we refined medical image-text pairs from PubMed and employed MLLMs (GPT-4V) in an 'unblinded' capacity to denoise and reformat the data, resulting in the creation of the PubMedVision dataset with 1.3 million medical VQA samples. Our validation demonstrates that: (1) PubMedVision can significantly enhance the medical multimodal capabilities of current MLLMs, showing significant improvement in benchmarks including the MMMU Health & Medicine track; (2) manual checks by medical experts and empirical results validate the superior data quality of our dataset compared to other data construction methods. Using PubMedVision, we train a 34B medical MLLM HuatuoGPT-Vision, which shows superior performance in medical multimodal scenarios among open-source MLLMs.

Despite significant advancements in general artificial intelligence, such as GPT-4, their effectiveness in the medical domain (general medical AI, GMAI) remains constrained due to the absence of specialized medical knowledge. To address this challenge, we present GMAI-VL-5.5M, a comprehensive multimodal medical dataset created by converting hundreds of specialized medical datasets into meticulously constructed image-text pairs. This dataset features comprehensive task coverage, diverse modalities, and high-quality image-text data. Building upon this multimodal dataset, we propose GMAI-VL, a general medical vision-language model with a progressively three-stage training strategy. This approach significantly enhances the model's ability by integrating visual and textual information, thereby improving its ability to process multimodal data and support accurate diagnosis and clinical decision-making. Experimental evaluations demonstrate that GMAI-VL achieves state-of-the-art results across a wide range of multimodal medical tasks, such as visual question answering and medical image diagnosis. Our contributions include the development of the GMAI-VL-5.5M dataset, the introduction of the GMAI-VL model, and the establishment of new benchmarks in multiple medical domains. Code and dataset will be released at https://github.com/uni-medical/GMAI-VL.

Language-image pre-training has demonstrated strong performance in 2D medical imaging, but its success in 3D modalities such as CT and MRI remains limited due to the high computational demands of volumetric data, which pose a significant barrier to training on large-scale, uncurated clinical studies. In this study, we introduce Hierarchical attention for Language-Image Pre-training (HLIP), a scalable pre-training framework for 3D medical imaging. HLIP adopts a lightweight hierarchical attention mechanism inspired by the natural hierarchy of radiology data: slice, scan, and study. This mechanism exhibits strong generalizability, e.g., +4.3% macro AUC on the Rad-ChestCT benchmark when pre-trained on CT-RATE. Moreover, the computational efficiency of HLIP enables direct training on uncurated datasets. Trained on 220K patients with 3.13 million scans for brain MRI and 240K patients with 1.44 million scans for head CT, HLIP achieves state-of-the-art performance, e.g., +32.4% balanced ACC on the proposed publicly available brain MRI benchmark Pub-Brain-5; +1.4% and +6.9% macro AUC on head CT benchmarks RSNA and CQ500, respectively. These results demonstrate that, with HLIP, directly pre-training on uncurated clinical datasets is a scalable and effective direction for language-image pre-training in 3D medical imaging. The code is available at https://github.com/Zch0414/hlip

The rapid advancement of large-scale vision-language models has showcased remarkable capabilities across various tasks. However, the lack of extensive and high-quality image-text data in medicine has greatly hindered the development of large-scale medical vision-language models. In this work, we present a diagnosis-guided bootstrapping strategy that exploits both image and label information to construct vision-language datasets. Based on the constructed dataset, we developed MedDr, a generalist foundation model for healthcare capable of handling diverse medical data modalities, including radiology, pathology, dermatology, retinography, and endoscopy. Moreover, during inference, we propose a simple but effective retrieval-augmented medical diagnosis strategy, which enhances the model's generalization ability. Extensive experiments on visual question answering, medical report generation, and medical image diagnosis demonstrate the superiority of our method.

Contrastive pretraining on parallel image-text data has attained great success in vision-language processing (VLP), as exemplified by CLIP and related methods. However, prior explorations tend to focus on general domains in the web. Biomedical images and text are rather different, but publicly available datasets are small and skew toward chest X-ray, thus severely limiting progress. In this paper, we conducted by far the largest study on biomedical VLP, using 15 million figure-caption pairs extracted from biomedical research articles in PubMed Central. Our dataset (PMC-15M) is two orders of magnitude larger than existing biomedical image-text datasets such as MIMIC-CXR, and spans a diverse range of biomedical images. The standard CLIP method is suboptimal for the biomedical domain. We propose BiomedCLIP with domain-specific adaptations tailored to biomedical VLP. We conducted extensive experiments and ablation studies on standard biomedical imaging tasks from retrieval to classification to visual question-answering (VQA). BiomedCLIP established new state of the art in a wide range of standard datasets, substantially outperformed prior VLP approaches. Surprisingly, BiomedCLIP even outperformed radiology-specific state-of-the-art models such as BioViL on radiology-specific tasks such as RSNA pneumonia detection, thus highlighting the utility in large-scale pretraining across all biomedical image types. We will release our models at https://aka.ms/biomedclip to facilitate future research in biomedical VLP.

Background: General-purpose large language models that utilize both text and images have not been evaluated on a diverse array of challenging medical cases. Methods: Using 934 cases from the NEJM Image Challenge published between 2005 and 2023, we evaluated the accuracy of the recently released Generative Pre-trained Transformer 4 with Vision model (GPT-4V) compared to human respondents overall and stratified by question difficulty, image type, and skin tone. We further conducted a physician evaluation of GPT-4V on 69 NEJM clinicopathological conferences (CPCs). Analyses were conducted for models utilizing text alone, images alone, and both text and images. Results: GPT-4V achieved an overall accuracy of 61% (95% CI, 58 to 64%) compared to 49% (95% CI, 49 to 50%) for humans. GPT-4V outperformed humans at all levels of difficulty and disagreement, skin tones, and image types; the exception was radiographic images, where performance was equivalent between GPT-4V and human respondents. Longer, more informative captions were associated with improved performance for GPT-4V but similar performance for human respondents. GPT-4V included the correct diagnosis in its differential for 80% (95% CI, 68 to 88%) of CPCs when using text alone, compared to 58% (95% CI, 45 to 70%) of CPCs when using both images and text. Conclusions: GPT-4V outperformed human respondents on challenging medical cases and was able to synthesize information from both images and text, but performance deteriorated when images were added to highly informative text. Overall, our results suggest that multimodal AI models may be useful in medical diagnostic reasoning but that their accuracy may depend heavily on context.

Methods based on Contrastive Language-Image Pre-training (CLIP) are nowadays extensively used in support of vision-and-language tasks involving remote sensing data, such as cross-modal retrieval. The adaptation of CLIP to this specific domain has relied on model fine-tuning with the standard contrastive objective, using existing human-labeled image-caption datasets, or using synthetic data corresponding to image-caption pairs derived from other annotations over remote sensing images (e.g., object classes). The use of different pre-training mechanisms has received less attention, and only a few exceptions have considered multilingual inputs. This work proposes a novel vision-and-language model for the remote sensing domain, exploring the fine-tuning of a multilingual CLIP model and testing the use of a self-supervised method based on aligning local and global representations from individual input images, together with the standard CLIP objective. Model training relied on assembling pre-existing datasets of remote sensing images paired with English captions, followed by the use of automated machine translation into nine additional languages. We show that translated data is indeed helpful, e.g. improving performance also on English. Our resulting model, which we named Remote Sensing Multilingual CLIP (RS-M-CLIP), obtains state-of-the-art results in a variety of vision-and-language tasks, including cross-modal and multilingual image-text retrieval, or zero-shot image classification.

Pre-trained large vision-language models (VLMs) like CLIP have revolutionized visual representation learning using natural language as supervisions, and demonstrated promising generalization ability. In this work, we propose ViP, a novel visual symptom-guided prompt learning framework for medical image analysis, which facilitates general knowledge transfer from CLIP. ViP consists of two key components: a visual symptom generator (VSG) and a dual-prompt network. Specifically, VSG aims to extract explicable visual symptoms from pre-trained large language models, while the dual-prompt network utilizes these visual symptoms to guide the training on two learnable prompt modules, i.e., context prompt and merge prompt, which effectively adapts our framework to medical image analysis via large VLMs. Extensive experimental results demonstrate that ViP can outperform state-of-the-art methods on two challenging datasets.

Modular vision-language models (Vision-LLMs) align pretrained image encoders with (pretrained) large language models (LLMs), representing a computationally much more efficient alternative to end-to-end training of large vision-language models from scratch, which is prohibitively expensive for most. Vision-LLMs instead post-hoc condition LLMs to `understand' the output of an image encoder. With the abundance of readily available high-quality English image-text data as well as monolingual English LLMs, the research focus has been on English-only Vision-LLMs. Multilingual vision-language models are still predominantly obtained via expensive end-to-end pretraining, resulting in comparatively smaller models, trained on limited multilingual image data supplemented with text-only multilingual corpora. In this work, we present mBLIP, the first multilingual Vision-LLM, which we obtain in a computationally efficient manner -- on consumer hardware using only a few million training examples -- by leveraging a pretrained multilingual LLM. To this end, we re-align an image encoder previously tuned to an English LLM to a new, multilingual LLM -- for this, we leverage multilingual data from a mix of vision-and-language tasks, which we obtain by machine-translating high-quality English data to 95 languages. On the IGLUE benchmark, mBLIP yields results competitive with state-of-the-art models. Moreover, in image captioning on XM3600, mBLIP (zero-shot) even outperforms PaLI-X (a model with 55B parameters). Compared to these very large multilingual vision-language models trained from scratch, we obtain mBLIP by training orders of magnitude fewer parameters on magnitudes less data. We release our model and code at https://github.com/gregor-ge/mBLIP.

This paper introduces MedTrinity-25M, a comprehensive, large-scale multimodal dataset for medicine, covering over 25 million images across 10 modalities, with multigranular annotations for more than 65 diseases. These enriched annotations encompass both global textual information, such as disease/lesion type, modality, region-specific descriptions, and inter-regional relationships, as well as detailed local annotations for regions of interest (ROIs), including bounding boxes, segmentation masks. Unlike existing approach which is limited by the availability of image-text pairs, we have developed the first automated pipeline that scales up multimodal data by generating multigranular visual and texual annotations (in the form of image-ROI-description triplets) without the need for any paired text descriptions. Specifically, data from over 90 different sources have been collected, preprocessed, and grounded using domain-specific expert models to identify ROIs related to abnormal regions. We then build a comprehensive knowledge base and prompt multimodal large language models to perform retrieval-augmented generation with the identified ROIs as guidance, resulting in multigranular texual descriptions. Compared to existing datasets, MedTrinity-25M provides the most enriched annotations, supporting a comprehensive range of multimodal tasks such as captioning and report generation, as well as vision-centric tasks like classification and segmentation. Pretraining on MedTrinity-25M, our model achieves state-of-the-art performance on VQA-RAD and PathVQA, surpassing both multimodal large language models and other representative SoTA approaches. This dataset can also be utilized to support large-scale pre-training of multimodal medical AI models, contributing to the development of future foundation models in the medical domain.

Recently, vision model pre-training has evolved from relying on manually annotated datasets to leveraging large-scale, web-crawled image-text data. Despite these advances, there is no pre-training method that effectively exploits the interleaved image-text data, which is very prevalent on the Internet. Inspired by the recent success of compression learning in natural language processing, we propose a novel vision model pre-training method called Latent Compression Learning (LCL) for interleaved image-text data. This method performs latent compression learning by maximizing the mutual information between the inputs and outputs of a causal attention model. The training objective can be decomposed into two basic tasks: 1) contrastive learning between visual representation and preceding context, and 2) generating subsequent text based on visual representation. Our experiments demonstrate that our method not only matches the performance of CLIP on paired pre-training datasets (e.g., LAION), but can also leverage interleaved pre-training data (e.g., MMC4) to learn robust visual representation from scratch, showcasing the potential of vision model pre-training with interleaved image-text data. Code is released at https://github.com/OpenGVLab/LCL.

With recent progress in joint modeling of visual and textual representations, Vision-Language Pretraining (VLP) has achieved impressive performance on many multimodal downstream tasks. However, the requirement for expensive annotations including clean image captions and regional labels limits the scalability of existing approaches, and complicates the pretraining procedure with the introduction of multiple dataset-specific objectives. In this work, we relax these constraints and present a minimalist pretraining framework, named Simple Visual Language Model (SimVLM). Unlike prior work, SimVLM reduces the training complexity by exploiting large-scale weak supervision, and is trained end-to-end with a single prefix language modeling objective. Without utilizing extra data or task-specific customization, the resulting model significantly outperforms previous pretraining methods and achieves new state-of-the-art results on a wide range of discriminative and generative vision-language benchmarks, including VQA (+3.74% vqa-score), NLVR2 (+1.17% accuracy), SNLI-VE (+1.37% accuracy) and image captioning tasks (+10.1% average CIDEr score). Furthermore, we demonstrate that SimVLM acquires strong generalization and transfer ability, enabling zero-shot behavior including open-ended visual question answering and cross-modality transfer.

Vision-Language Pretraining (VLP) models have recently successfully facilitated many cross-modal downstream tasks. Most existing works evaluated their systems by comparing the fine-tuned downstream task performance. However, only average downstream task accuracy provides little information about the pros and cons of each VLP method, let alone provides insights on how the community can improve the systems in the future. Inspired by the CheckList for testing natural language processing, we exploit VL-CheckList, a novel framework to understand the capabilities of VLP models. The proposed method divides the image-texting ability of a VLP model into three categories: objects, attributes, and relations, and uses a novel taxonomy to further break down these three aspects. We conduct comprehensive studies to analyze seven recently popular VLP models via the proposed framework. Results confirm the effectiveness of the proposed method by revealing fine-grained differences among the compared models that were not visible from downstream task-only evaluation. Further results show promising research direction in building better VLP models. Our data and code are available at: https://github.com/om-ai-lab/VL-CheckList.

Language-image pre-training largely relies on how precisely and thoroughly a text describes its paired image. In practice, however, the contents of an image can be so rich that well describing them requires lengthy captions (e.g., with 10 sentences), which are usually missing in existing datasets. Consequently, there are currently no clear evidences on whether and how language-image pre-training could benefit from long captions. To figure this out, we first re-caption 30M images with detailed descriptions using a pre-trained Multi-modality Large Language Model (MLLM), and then study the usage of the resulting captions under a contrastive learning framework. We observe that, each sentence within a long caption is very likely to describe the image partially (e.g., an object). Motivated by this, we propose to dynamically sample sub-captions from the text label to construct multiple positive pairs, and introduce a grouping loss to match the embeddings of each sub-caption with its corresponding local image patches in a self-supervised manner. Experimental results on a wide rage of downstream tasks demonstrate the consistent superiority of our method, termed DreamLIP, over previous alternatives, highlighting its fine-grained representational capacity. It is noteworthy that, on the tasks of image-text retrieval and semantic segmentation, our model trained with 30M image-text pairs achieves on par or even better performance than CLIP trained with 400M pairs. Project page is available at https://zyf0619sjtu.github.io/dream-lip.

In Natural Language Processing (NLP), Machine Reading Comprehension (MRC) is the task of answering a question based on a given context. To handle questions in the medical domain, modern language models such as BioBERT, SciBERT and even ChatGPT are trained on vast amounts of in-domain medical corpora. However, in-domain pre-training is expensive in terms of time and resources. In this paper, we propose a resource-efficient approach for injecting domain knowledge into a model without relying on such domain-specific pre-training. Knowledge graphs are powerful resources for accessing medical information. Building on existing work, we introduce a method using Multi-Layer Perceptrons (MLPs) for aligning and integrating embeddings extracted from medical knowledge graphs with the embedding spaces of pre-trained language models (LMs). The aligned embeddings are fused with open-domain LMs BERT and RoBERTa that are fine-tuned for two MRC tasks, span detection (COVID-QA) and multiple-choice questions (PubMedQA). We compare our method to prior techniques that rely on a vocabulary overlap for embedding alignment and show how our method circumvents this requirement to deliver better performance. On both datasets, our method allows BERT/RoBERTa to either perform on par (occasionally exceeding) with stronger domain-specific models or show improvements in general over prior techniques. With the proposed approach, we signal an alternative method to in-domain pre-training to achieve domain proficiency.

As the performance of Large-scale Vision Language Models (LVLMs) improves, they are increasingly capable of responding in multiple languages, and there is an expectation that the demand for explanations generated by LVLMs will grow. However, pre-training of Vision Encoder and the integrated training of LLMs with Vision Encoder are mainly conducted using English training data, leaving it uncertain whether LVLMs can completely handle their potential when generating explanations in languages other than English. In addition, multilingual QA benchmarks that create datasets using machine translation have cultural differences and biases, remaining issues for use as evaluation tasks. To address these challenges, this study created an extended dataset in multiple languages without relying on machine translation. This dataset that takes into account nuances and country-specific phrases was then used to evaluate the generation explanation abilities of LVLMs. Furthermore, this study examined whether Instruction-Tuning in resource-rich English improves performance in other languages. Our findings indicate that LVLMs perform worse in languages other than English compared to English. In addition, it was observed that LVLMs struggle to effectively manage the knowledge learned from English data.

Medical Visual Language Models have shown great potential in various healthcare applications, including medical image captioning and diagnostic assistance. However, most existing models rely on text-based instructions, limiting their usability in real-world clinical environments especially in scenarios such as surgery, text-based interaction is often impractical for physicians. In addition, current medical image analysis models typically lack comprehensive reasoning behind their predictions, which reduces their reliability for clinical decision-making. Given that medical diagnosis errors can have life-changing consequences, there is a critical need for interpretable and rational medical assistance. To address these challenges, we introduce an end-to-end speech-driven medical VLM, SilVar-Med, a multimodal medical image assistant that integrates speech interaction with VLMs, pioneering the task of voice-based communication for medical image analysis. In addition, we focus on the interpretation of the reasoning behind each prediction of medical abnormalities with a proposed reasoning dataset. Through extensive experiments, we demonstrate a proof-of-concept study for reasoning-driven medical image interpretation with end-to-end speech interaction. We believe this work will advance the field of medical AI by fostering more transparent, interactive, and clinically viable diagnostic support systems. Our code and dataset are publicly available at SiVar-Med.

In recent times, we have seen a rapid development of large Vision-Language Models (VLMs). They have shown impressive results on academic benchmarks, primarily in widely spoken languages but lack performance on low-resource languages and varied cultural contexts. To address these limitations, we introduce Maya, an open-source Multilingual VLM. Our contributions are: 1) a multilingual image-text pretraining dataset in eight languages, based on the LLaVA pretraining dataset; and 2) a multilingual image-text model supporting these languages, enhancing cultural and linguistic comprehension in vision-language tasks. Code available at https://github.com/nahidalam/maya.

Medical Vision-Language Models (MVLMs) have achieved par excellence generalization in medical image analysis, yet their performance under noisy, corrupted conditions remains largely untested. Clinical imaging is inherently susceptible to acquisition artifacts and noise; however, existing evaluations predominantly assess generally clean datasets, overlooking robustness -- i.e., the model's ability to perform under real-world distortions. To address this gap, we first introduce MediMeta-C, a corruption benchmark that systematically applies several perturbations across multiple medical imaging datasets. Combined with MedMNIST-C, this establishes a comprehensive robustness evaluation framework for MVLMs. We further propose RobustMedCLIP, a visual encoder adaptation of a pretrained MVLM that incorporates few-shot tuning to enhance resilience against corruptions. Through extensive experiments, we benchmark 5 major MVLMs across 5 medical imaging modalities, revealing that existing models exhibit severe degradation under corruption and struggle with domain-modality tradeoffs. Our findings highlight the necessity of diverse training and robust adaptation strategies, demonstrating that efficient low-rank adaptation when paired with few-shot tuning, improves robustness while preserving generalization across modalities.

We present DeepSeek-VL, an open-source Vision-Language (VL) Model designed for real-world vision and language understanding applications. Our approach is structured around three key dimensions: We strive to ensure our data is diverse, scalable, and extensively covers real-world scenarios including web screenshots, PDFs, OCR, charts, and knowledge-based content, aiming for a comprehensive representation of practical contexts. Further, we create a use case taxonomy from real user scenarios and construct an instruction tuning dataset accordingly. The fine-tuning with this dataset substantially improves the model's user experience in practical applications. Considering efficiency and the demands of most real-world scenarios, DeepSeek-VL incorporates a hybrid vision encoder that efficiently processes high-resolution images (1024 x 1024), while maintaining a relatively low computational overhead. This design choice ensures the model's ability to capture critical semantic and detailed information across various visual tasks. We posit that a proficient Vision-Language Model should, foremost, possess strong language abilities. To ensure the preservation of LLM capabilities during pretraining, we investigate an effective VL pretraining strategy by integrating LLM training from the beginning and carefully managing the competitive dynamics observed between vision and language modalities. The DeepSeek-VL family (both 1.3B and 7B models) showcases superior user experiences as a vision-language chatbot in real-world applications, achieving state-of-the-art or competitive performance across a wide range of visual-language benchmarks at the same model size while maintaining robust performance on language-centric benchmarks. We have made both 1.3B and 7B models publicly accessible to foster innovations based on this foundation model.

Vision-language models have revolutionized human-computer interaction and shown significant progress in multi-modal tasks. However, applying these models to complex visual tasks like medical image analysis remains challenging. In this study, we propose ViLaM, a unified Vision-Language transformer model that integrates instruction tuning predicated on a large language model. This approach enables us to optimally utilize the knowledge and reasoning capacities of large pre-trained language models for an array of tasks encompassing both language and vision. We employ frozen pre-trained encoders to encode and align both image and text features, enabling ViLaM to handle a variety of visual tasks following textual instructions. Besides, we've designed cycle training for referring expressions to address the need for high-quality, paired referring expression datasets for training large models in terms of both quantity and quality. We evaluated ViLaM's exceptional performance on public general datasets and further confirmed its generalizability on medical datasets. Importantly, we've observed the model's impressive zero-shot learning ability, indicating the potential future application of ViLaM in the medical field.

Foundation Vision-Language Models (VLMs) trained using large-scale open-domain images and text pairs have recently been adapted to develop Vision-Language Segmentation Models (VLSMs) that allow providing text prompts during inference to guide image segmentation. If robust and powerful VLSMs can be built for medical images, it could aid medical professionals in many clinical tasks where they must spend substantial time delineating the target structure of interest. VLSMs for medical images resort to fine-tuning base VLM or VLSM pretrained on open-domain natural image datasets due to fewer annotated medical image datasets; this fine-tuning is resource-consuming and expensive as it usually requires updating all or a significant fraction of the pretrained parameters. Recently, lightweight blocks called adapters have been proposed in VLMs that keep the pretrained model frozen and only train adapters during fine-tuning, substantially reducing the computing resources required. We introduce a novel adapter, VLSM-Adapter, that can fine-tune pretrained vision-language segmentation models using transformer encoders. Our experiments in widely used CLIP-based segmentation models show that with only 3 million trainable parameters, the VLSM-Adapter outperforms state-of-the-art and is comparable to the upper bound end-to-end fine-tuning. The source code is available at: https://github.com/naamiinepal/vlsm-adapter.

Vision-language pretraining models have achieved great success in supporting multimedia applications by understanding the alignments between images and text. While existing vision-language pretraining models primarily focus on understanding single image associated with a single piece of text, they often ignore the alignment at the intra-document level, consisting of multiple sentences with multiple images. In this work, we propose DocumentCLIP, a salience-aware contrastive learning framework to enforce vision-language pretraining models to comprehend the interaction between images and longer text within documents. Our model is beneficial for the real-world multimodal document understanding like news article, magazines, product descriptions, which contain linguistically and visually richer content. To the best of our knowledge, we are the first to explore multimodal intra-document links by contrastive learning. In addition, we collect a large Wikipedia dataset for pretraining, which provides various topics and structures. Experiments show DocumentCLIP not only outperforms the state-of-the-art baselines in the supervised setting, but also achieves the best zero-shot performance in the wild after human evaluation. Our code is available at https://github.com/FuxiaoLiu/DocumentCLIP.

Pre-training large-scale neural language models on raw texts has made a significant contribution to improving transfer learning in natural language processing (NLP). With the introduction of transformer-based language models, such as bidirectional encoder representations from transformers (BERT), the performance of information extraction from a free text by NLP has significantly improved for both the general domain and medical domain; however, it is difficult to train specific BERT models that perform well for domains in which there are few publicly available databases of high quality and large size. We hypothesized that this problem can be addressed by up-sampling a domain-specific corpus and using it for pre-training with a larger corpus in a balanced manner. Our proposed method consists of a single intervention with one option: simultaneous pre-training after up-sampling and amplified vocabulary. We conducted three experiments and evaluated the resulting products. We confirmed that our Japanese medical BERT outperformed conventional baselines and the other BERT models in terms of the medical document classification task and that our English BERT pre-trained using both the general and medical-domain corpora performed sufficiently well for practical use in terms of the biomedical language understanding evaluation (BLUE) benchmark. Moreover, our enhanced biomedical BERT model, in which clinical notes were not used during pre-training, showed that both the clinical and biomedical scores of the BLUE benchmark were 0.3 points above that of the ablation model trained without our proposed method. Well-balanced pre-training by up-sampling instances derived from a corpus appropriate for the target task allows us to construct a high-performance BERT model.

Large Vision-Language Models (LVLMs) are capable of handling diverse data types such as imaging, text, and physiological signals, and can be applied in various fields. In the medical field, LVLMs have a high potential to offer substantial assistance for diagnosis and treatment. Before that, it is crucial to develop benchmarks to evaluate LVLMs' effectiveness in various medical applications. Current benchmarks are often built upon specific academic literature, mainly focusing on a single domain, and lacking varying perceptual granularities. Thus, they face specific challenges, including limited clinical relevance, incomplete evaluations, and insufficient guidance for interactive LVLMs. To address these limitations, we developed the GMAI-MMBench, the most comprehensive general medical AI benchmark with well-categorized data structure and multi-perceptual granularity to date. It is constructed from 285 datasets across 39 medical image modalities, 18 clinical-related tasks, 18 departments, and 4 perceptual granularities in a Visual Question Answering (VQA) format. Additionally, we implemented a lexical tree structure that allows users to customize evaluation tasks, accommodating various assessment needs and substantially supporting medical AI research and applications. We evaluated 50 LVLMs, and the results show that even the advanced GPT-4o only achieves an accuracy of 52%, indicating significant room for improvement. Moreover, we identified five key insufficiencies in current cutting-edge LVLMs that need to be addressed to advance the development of better medical applications. We believe that GMAI-MMBench will stimulate the community to build the next generation of LVLMs toward GMAI. Project Page: https://uni-medical.github.io/GMAI-MMBench.github.io/

Most Large Vision-Language Models (LVLMs) to date are trained predominantly on English data, which makes them struggle to understand non-English input and fail to generate output in the desired target language. Existing efforts mitigate these issues by adding multilingual training data, but do so in a largely ad-hoc manner, lacking insight into how different training mixes tip the scale for different groups of languages. In this work, we present a comprehensive investigation into the training strategies for massively multilingual LVLMs. First, we conduct a series of multi-stage experiments spanning 13 downstream vision-language tasks and 43 languages, systematically examining: (1) the number of training languages that can be included without degrading English performance and (2) optimal language distributions of pre-training as well as (3) instruction-tuning data. Further, we (4) investigate how to improve multilingual text-in-image understanding, and introduce a new benchmark for the task. Surprisingly, our analysis reveals that one can (i) include as many as 100 training languages simultaneously (ii) with as little as 25-50\% of non-English data, to greatly improve multilingual performance while retaining strong English performance. We further find that (iii) including non-English OCR data in pre-training and instruction-tuning is paramount for improving multilingual text-in-image understanding. Finally, we put all our findings together and train Centurio, a 100-language LVLM, offering state-of-the-art performance in an evaluation covering 14 tasks and 56 languages.

Vision-Language Pre-Training (VLP) has shown promising capabilities to align image and text pairs, facilitating a broad variety of cross-modal learning tasks. However, we observe that VLP models often lack the visual grounding/localization capability which is critical for many downstream tasks such as visual reasoning. In this work, we propose a novel Position-guided Text Prompt (PTP) paradigm to enhance the visual grounding ability of cross-modal models trained with VLP. Specifically, in the VLP phase, PTP divides the image into Ntimes N blocks, and identifies the objects in each block through the widely used object detector in VLP. It then reformulates the visual grounding task into a fill-in-the-blank problem given a PTP by encouraging the model to predict the objects in the given blocks or regress the blocks of a given object, e.g. filling `P" or ``O" in aPTP ``The block P has a O". This mechanism improves the visual grounding capability of VLP models and thus helps them better handle various downstream tasks. By introducing PTP into several state-of-the-art VLP frameworks, we observe consistently significant improvements across representative cross-modal learning model architectures and several benchmarks, e.g. zero-shot Flickr30K Retrieval (+4.8 in average recall@1) for ViLT vilt baseline, and COCO Captioning (+5.3 in CIDEr) for SOTA BLIP blip baseline. Moreover, PTP achieves comparable results with object-detector based methods, and much faster inference speed since PTP discards its object detector for inference while the later cannot. Our code and pre-trained weight will be released at https://github.com/sail-sg/ptp.

Most existing methods in vision language pre-training rely on object-centric features extracted through object detection and make fine-grained alignments between the extracted features and texts. It is challenging for these methods to learn relations among multiple objects. To this end, we propose a new method called X-VLM to perform `multi-grained vision language pre-training.' The key to learning multi-grained alignments is to locate visual concepts in the image given the associated texts, and in the meantime align the texts with the visual concepts, where the alignments are in multi-granularity. Experimental results show that X-VLM effectively leverages the learned multi-grained alignments to many downstream vision language tasks and consistently outperforms state-of-the-art methods.

Recently, the success of pre-training in text domain has been fully extended to vision, audio, and cross-modal scenarios. The proposed pre-training models of different modalities are showing a rising trend of homogeneity in their model structures, which brings the opportunity to implement different pre-training models within a uniform framework. In this paper, we present TencentPretrain, a toolkit supporting pre-training models of different modalities. The core feature of TencentPretrain is the modular design. The toolkit uniformly divides pre-training models into 5 components: embedding, encoder, target embedding, decoder, and target. As almost all of common modules are provided in each component, users can choose the desired modules from different components to build a complete pre-training model. The modular design enables users to efficiently reproduce existing pre-training models or build brand-new one. We test the toolkit on text, vision, and audio benchmarks and show that it can match the performance of the original implementations.

Vision-language pre-training (VLP) on large-scale datasets has shown premier performance on various downstream tasks. In contrast to plenty of available benchmarks with English corpus, large-scale pre-training datasets and downstream datasets with Chinese corpus remain largely unexplored. In this work, we build a large-scale high-quality Chinese Cross-Modal Benchmark named CCMB for the research community, which contains the currently largest public pre-training dataset Zero and five human-annotated fine-tuning datasets for downstream tasks. Zero contains 250 million images paired with 750 million text descriptions, plus two of the five fine-tuning datasets are also currently the largest ones for Chinese cross-modal downstream tasks. Along with the CCMB, we also develop a VLP framework named R2D2, applying a pre-Ranking + Ranking strategy to learn powerful vision-language representations and a two-way distillation method (i.e., target-guided Distillation and feature-guided Distillation) to further enhance the learning capability. With the Zero and the R2D2 VLP framework, we achieve state-of-the-art performance on twelve downstream datasets from five broad categories of tasks including image-text retrieval, image-text matching, image caption, text-to-image generation, and zero-shot image classification. The datasets, models, and codes are available at https://github.com/yuxie11/R2D2

The availability of large-scale image captioning and visual question answering datasets has contributed significantly to recent successes in vision-and-language pre-training. However, these datasets are often collected with overrestrictive requirements inherited from their original target tasks (e.g., image caption generation), which limit the resulting dataset scale and diversity. We take a step further in pushing the limits of vision-and-language pre-training data by relaxing the data collection pipeline used in Conceptual Captions 3M (CC3M) [Sharma et al. 2018] and introduce the Conceptual 12M (CC12M), a dataset with 12 million image-text pairs specifically meant to be used for vision-and-language pre-training. We perform an analysis of this dataset and benchmark its effectiveness against CC3M on multiple downstream tasks with an emphasis on long-tail visual recognition. Our results clearly illustrate the benefit of scaling up pre-training data for vision-and-language tasks, as indicated by the new state-of-the-art results on both the nocaps and Conceptual Captions benchmarks.

Large pre-trained vision-language models have shown great prominence in transferring pre-acquired knowledge to various domains and downstream tasks with appropriate prompting or tuning. Existing prevalent tuning methods can be generally categorized into three genres: 1) prompt engineering by creating suitable prompt texts, which is time-consuming and requires domain expertise; 2) or simply fine-tuning the whole model, which is extremely inefficient; 3) prompt tuning through parameterized prompt embeddings with the text encoder. Nevertheless, all methods rely on the text encoder for bridging the modality gap between vision and language. In this work, we question the necessity of the cumbersome text encoder for a more lightweight and efficient tuning paradigm as well as more representative prompt embeddings closer to the image representations. To achieve this, we propose a Concept Embedding Search (ConES) approach by optimizing prompt embeddings -- without the need of the text encoder -- to capture the 'concept' of the image modality through a variety of task objectives. By dropping the text encoder, we are able to significantly speed up the learning process, \eg, from about an hour to just ten minutes in our experiments for personalized text-to-image generation without impairing the generation quality. Moreover, our proposed approach is orthogonal to current existing tuning methods since the searched concept embeddings can be further utilized in the next stage of fine-tuning the pre-trained large models for boosting performance. Extensive experiments show that our approach can beat the prompt tuning and textual inversion methods in a variety of downstream tasks including objection detection, instance segmentation, and image generation. Our approach also shows better generalization capability for unseen concepts in specialized domains, such as the medical domain.

Effective scaling and a flexible task interface enable large language models to excel at many tasks. We present PaLI (Pathways Language and Image model), a model that extends this approach to the joint modeling of language and vision. PaLI generates text based on visual and textual inputs, and with this interface performs many vision, language, and multimodal tasks, in many languages. To train PaLI, we make use of large pre-trained encoder-decoder language models and Vision Transformers (ViTs). This allows us to capitalize on their existing capabilities and leverage the substantial cost of training them. We find that joint scaling of the vision and language components is important. Since existing Transformers for language are much larger than their vision counterparts, we train a large, 4-billion parameter ViT (ViT-e) to quantify the benefits from even larger-capacity vision models. To train PaLI, we create a large multilingual mix of pretraining tasks, based on a new image-text training set containing 10B images and texts in over 100 languages. PaLI achieves state-of-the-art in multiple vision and language tasks (such as captioning, visual question-answering, scene-text understanding), while retaining a simple, modular, and scalable design.

In this paper, we introduce an open-source Korean-English vision-language model (VLM), VARCO-VISION. We incorporate a step-by-step training strategy that allows a model learn both linguistic and visual information while preserving the backbone model's knowledge. Our model demonstrates outstanding performance in diverse settings requiring bilingual image-text understanding and generation abilities compared to models of similar size. VARCO-VISION is also capable of grounding, referring, and OCR, expanding its usage and potential applications for real-world scenarios. In addition to the model, we release five Korean evaluation datasets, including four closed-set and one openset benchmarks. We anticipate that our milestone will broaden the opportunities for AI researchers aiming to train VLMs. VARCO-VISION is available at https://huggingface.co/NCSOFT/VARCO-VISION-14B.

We present the Modality Integration Rate (MIR), an effective, robust, and generalized metric to indicate the multi-modal pre-training quality of Large Vision Language Models (LVLMs). Large-scale pre-training plays a critical role in building capable LVLMs, while evaluating its training quality without the costly supervised fine-tuning stage is under-explored. Loss, perplexity, and in-context evaluation results are commonly used pre-training metrics for Large Language Models (LLMs), while we observed that these metrics are less indicative when aligning a well-trained LLM with a new modality. Due to the lack of proper metrics, the research of LVLMs in the critical pre-training stage is hindered greatly, including the training data choice, efficient module design, etc. In this paper, we propose evaluating the pre-training quality from the inter-modal distribution distance perspective and present MIR, the Modality Integration Rate, which is 1) Effective to represent the pre-training quality and show a positive relation with the benchmark performance after supervised fine-tuning. 2) Robust toward different training/evaluation data. 3) Generalize across training configurations and architecture choices. We conduct a series of pre-training experiments to explore the effectiveness of MIR and observe satisfactory results that MIR is indicative about training data selection, training strategy schedule, and model architecture design to get better pre-training results. We hope MIR could be a helpful metric for building capable LVLMs and inspire the following research about modality alignment in different areas. Our code is at: https://github.com/shikiw/Modality-Integration-Rate.

Large Language Models (LLMs) have so far impressed the world, with unprecedented capabilities that emerge in models at large scales. On the vision side, transformer models (i.e., ViT) are following the same trend, achieving the best performance on challenging benchmarks. With the abundance of such unimodal models, a natural question arises; do we need also to follow this trend to tackle multimodal tasks? In this work, we propose to rather direct effort to efficient adaptations of existing models, and propose to augment Language Models with perception. Existing approaches for adapting pretrained models for vision-language tasks still rely on several key components that hinder their efficiency. In particular, they still train a large number of parameters, rely on large multimodal pretraining, use encoders (e.g., CLIP) trained on huge image-text datasets, and add significant inference overhead. In addition, most of these approaches have focused on Zero-Shot and In Context Learning, with little to no effort on direct finetuning. We investigate the minimal computational effort needed to adapt unimodal models for multimodal tasks and propose a new challenging setup, alongside different approaches, that efficiently adapts unimodal pretrained models. We show that by freezing more than 99\% of total parameters, training only one linear projection layer, and prepending only one trainable token, our approach (dubbed eP-ALM) significantly outperforms other baselines on VQA and Captioning across Image, Video, and Audio modalities, following the proposed setup. The code will be available here: https://github.com/mshukor/eP-ALM.

The extent to which text-only language models (LMs) learn to represent features of the non-linguistic world is an open question. Prior work has shown that pretrained LMs can be taught to caption images when a vision model's parameters are optimized to encode images in the language space. We test a stronger hypothesis: that the conceptual representations learned by frozen text-only models and vision-only models are similar enough that this can be achieved with a linear map. We show that the image representations from vision models can be transferred as continuous prompts to frozen LMs by training only a single linear projection. Using these to prompt the LM achieves competitive performance on captioning and visual question answering tasks compared to models that tune both the image encoder and text decoder (such as the MAGMA model). We compare three image encoders with increasing amounts of linguistic supervision seen during pretraining: BEIT (no linguistic information), NF-ResNET (lexical category information), and CLIP (full natural language descriptions). We find that all three encoders perform equally well at transferring visual property information to the language model (e.g., whether an animal is large or small), but that image encoders pretrained with linguistic supervision more saliently encode category information (e.g., distinguishing hippo vs. elephant) and thus perform significantly better on benchmark language-and-vision tasks. Our results indicate that LMs encode conceptual information structurally similarly to vision-based models, even those that are solely trained on images. Code is available here: https://github.com/jmerullo/limber

The rapid development of large Vision-Language Models (VLMs) has led to impressive results on academic benchmarks, primarily in widely spoken languages. However, significant gaps remain in the ability of current VLMs to handle low-resource languages and varied cultural contexts, largely due to a lack of high-quality, diverse, and safety-vetted data. Consequently, these models often struggle to understand low-resource languages and cultural nuances in a manner free from toxicity. To address these limitations, we introduce Maya, an open-source Multimodal Multilingual model. Our contributions are threefold: 1) a multilingual image-text pretraining dataset in eight languages, based on the LLaVA pretraining dataset; 2) a thorough analysis of toxicity within the LLaVA dataset, followed by the creation of a novel toxicity-free version across eight languages; and 3) a multilingual image-text model supporting these languages, enhancing cultural and linguistic comprehension in vision-language tasks. Code available at https://github.com/nahidalam/maya.

Research on language technology for the development of medical applications is currently a hot topic in Natural Language Understanding and Generation. Thus, a number of large language models (LLMs) have recently been adapted to the medical domain, so that they can be used as a tool for mediating in human-AI interaction. While these LLMs display competitive performance on automated medical texts benchmarks, they have been pre-trained and evaluated with a focus on a single language (English mostly). This is particularly true of text-to-text models, which typically require large amounts of domain-specific pre-training data, often not easily accessible for many languages. In this paper, we address these shortcomings by compiling, to the best of our knowledge, the largest multilingual corpus for the medical domain in four languages, namely English, French, Italian and Spanish. This new corpus has been used to train Medical mT5, the first open-source text-to-text multilingual model for the medical domain. Additionally, we present two new evaluation benchmarks for all four languages with the aim of facilitating multilingual research in this domain. A comprehensive evaluation shows that Medical mT5 outperforms both encoders and similarly sized text-to-text models for the Spanish, French, and Italian benchmarks, while being competitive with current state-of-the-art LLMs in English.

Large vision language models (LVLMs) integrate large language models (LLMs) with pre-trained vision encoders, thereby activating the perception capability of the model to understand image inputs for different queries and conduct subsequent reasoning. Improving this capability requires high-quality vision-language data, which is costly and labor-intensive to acquire. Self-training approaches have been effective in single-modal settings to alleviate the need for labeled data by leveraging model's own generation. However, effective self-training remains a challenge regarding the unique visual perception and reasoning capability of LVLMs. To address this, we introduce Self-Training on Image Comprehension (STIC), which emphasizes a self-training approach specifically for image comprehension. First, the model self-constructs a preference dataset for image descriptions using unlabeled images. Preferred responses are generated through a step-by-step prompt, while dis-preferred responses are generated from either corrupted images or misleading prompts. To further self-improve reasoning on the extracted visual information, we let the model reuse a small portion of existing instruction-tuning data and append its self-generated image descriptions to the prompts. We validate the effectiveness of STIC across seven different benchmarks, demonstrating substantial performance gains of 4.0% on average while using 70% less supervised fine-tuning data than the current method. Further studies investigate various components of STIC and highlight its potential to leverage vast quantities of unlabeled images for self-training. Code and data are made publicly available.

Pre-trained vision-language (V-L) models such as CLIP have shown excellent generalization ability to downstream tasks. However, they are sensitive to the choice of input text prompts and require careful selection of prompt templates to perform well. Inspired by the Natural Language Processing (NLP) literature, recent CLIP adaptation approaches learn prompts as the textual inputs to fine-tune CLIP for downstream tasks. We note that using prompting to adapt representations in a single branch of CLIP (language or vision) is sub-optimal since it does not allow the flexibility to dynamically adjust both representation spaces on a downstream task. In this work, we propose Multi-modal Prompt Learning (MaPLe) for both vision and language branches to improve alignment between the vision and language representations. Our design promotes strong coupling between the vision-language prompts to ensure mutual synergy and discourages learning independent uni-modal solutions. Further, we learn separate prompts across different early stages to progressively model the stage-wise feature relationships to allow rich context learning. We evaluate the effectiveness of our approach on three representative tasks of generalization to novel classes, new target datasets and unseen domain shifts. Compared with the state-of-the-art method Co-CoOp, MaPLe exhibits favorable performance and achieves an absolute gain of 3.45% on novel classes and 2.72% on overall harmonic-mean, averaged over 11 diverse image recognition datasets. Our code and pre-trained models are available at https://github.com/muzairkhattak/multimodal-prompt-learning.

Self-supervised learning in vision-language processing exploits semantic alignment between imaging and text modalities. Prior work in biomedical VLP has mostly relied on the alignment of single image and report pairs even though clinical notes commonly refer to prior images. This does not only introduce poor alignment between the modalities but also a missed opportunity to exploit rich self-supervision through existing temporal content in the data. In this work, we explicitly account for prior images and reports when available during both training and fine-tuning. Our approach, named BioViL-T, uses a CNN-Transformer hybrid multi-image encoder trained jointly with a text model. It is designed to be versatile to arising challenges such as pose variations and missing input images across time. The resulting model excels on downstream tasks both in single- and multi-image setups, achieving state-of-the-art performance on (I) progression classification, (II) phrase grounding, and (III) report generation, whilst offering consistent improvements on disease classification and sentence-similarity tasks. We release a novel multi-modal temporal benchmark dataset, MS-CXR-T, to quantify the quality of vision-language representations in terms of temporal semantics. Our experimental results show the advantages of incorporating prior images and reports to make most use of the data.

Vision-Language Models (VLMs), such as GPT-4V and Llama 3.2 vision, have garnered significant research attention for their ability to leverage Large Language Models (LLMs) in multimodal tasks. However, their potential is constrained by inherent challenges, including proprietary restrictions, substantial computational demands, and limited accessibility. Smaller models, such as GIT and BLIP, exhibit marked limitations, often failing to generate coherent and consistent text beyond a few tokens, even with extensive training. This underscores a pivotal inquiry: how small can a VLM be and still produce fluent and consistent text? Drawing inspiration from the exceptional learning process of 3-4 year old children, who rely heavily on visual cues for understanding and communication, we introduce two novel datasets: ShortDesc (featuring concise image descriptions) and LongDesc (containing more detailed image descriptions). These datasets consist of image-text pairs where the text is restricted to the simple vocabulary and syntax typically used by young children, generated with a scaled- down model, GPT-4o. Using these datasets, we demonstrate that it is possible to train VLMs that are significantly smaller, up to 10 times smaller than state of the art(SOTA) small VLMs while maintaining architectural simplicity. To evaluate the outputs, we leverage GPT-4o to grade the text, as if stories written by students, on creativity, meaningfulness, and consistency, assigning scores out of 10. This method addresses limitations of standard benchmarks by accommodating unstructured outputs and providing a multidimensional evaluation of the model capabilities. Our findings contribute to the development of lightweight, accessible multimodal models for resource constrained environments.

Large-scale pretraining is fast becoming the norm in Vision-Language (VL) modeling. However, prevailing VL approaches are limited by the requirement for labeled data and the use of complex multi-step pretraining objectives. We present MAGMA - a simple method for augmenting generative language models with additional modalities using adapter-based finetuning. Building on Frozen, we train a series of VL models that autoregressively generate text from arbitrary combinations of visual and textual input. The pretraining is entirely end-to-end using a single language modeling objective, simplifying optimization compared to previous approaches. Importantly, the language model weights remain unchanged during training, allowing for transfer of encyclopedic knowledge and in-context learning abilities from language pretraining. MAGMA outperforms Frozen on open-ended generative tasks, achieving state of the art results on the OKVQA benchmark and competitive results on a range of other popular VL benchmarks, while pretraining on 0.2% of the number of samples used to train SimVLM.

Current ophthalmology clinical workflows are plagued by over-referrals, long waits, and complex and heterogeneous medical records. Large language models (LLMs) present a promising solution to automate various procedures such as triaging, preliminary tests like visual acuity assessment, and report summaries. However, LLMs have demonstrated significantly varied performance across different languages in natural language question-answering tasks, potentially exacerbating healthcare disparities in Low and Middle-Income Countries (LMICs). This study introduces the first multilingual ophthalmological question-answering benchmark with manually curated questions parallel across languages, allowing for direct cross-lingual comparisons. Our evaluation of 6 popular LLMs across 7 different languages reveals substantial bias across different languages, highlighting risks for clinical deployment of LLMs in LMICs. Existing debiasing methods such as Translation Chain-of-Thought or Retrieval-augmented generation (RAG) by themselves fall short of closing this performance gap, often failing to improve performance across all languages and lacking specificity for the medical domain. To address this issue, We propose CLARA (Cross-Lingual Reflective Agentic system), a novel inference time de-biasing method leveraging retrieval augmented generation and self-verification. Our approach not only improves performance across all languages but also significantly reduces the multilingual bias gap, facilitating equitable LLM application across the globe.

Multimodal/vision language models (VLMs) are increasingly being deployed in healthcare settings worldwide, necessitating robust benchmarks to ensure their safety, efficacy, and fairness. Multiple-choice question and answer (QA) datasets derived from national medical examinations have long served as valuable evaluation tools, but existing datasets are largely text-only and available in a limited subset of languages and countries. To address these challenges, we present WorldMedQA-V, an updated multilingual, multimodal benchmarking dataset designed to evaluate VLMs in healthcare. WorldMedQA-V includes 568 labeled multiple-choice QAs paired with 568 medical images from four countries (Brazil, Israel, Japan, and Spain), covering original languages and validated English translations by native clinicians, respectively. Baseline performance for common open- and closed-source models are provided in the local language and English translations, and with and without images provided to the model. The WorldMedQA-V benchmark aims to better match AI systems to the diverse healthcare environments in which they are deployed, fostering more equitable, effective, and representative applications.

Vision-Language Pre-training has demonstrated its remarkable zero-shot recognition ability and potential to learn generalizable visual representations from language supervision. Taking a step ahead, language-supervised semantic segmentation enables spatial localization of textual inputs by learning pixel grouping solely from image-text pairs. Nevertheless, the state-of-the-art suffers from clear semantic gaps between visual and textual modality: plenty of visual concepts appeared in images are missing in their paired captions. Such semantic misalignment circulates in pre-training, leading to inferior zero-shot performance in dense predictions due to insufficient visual concepts captured in textual representations. To close such semantic gap, we propose Concept Curation (CoCu), a pipeline that leverages CLIP to compensate for the missing semantics. For each image-text pair, we establish a concept archive that maintains potential visually-matched concepts with our proposed vision-driven expansion and text-to-vision-guided ranking. Relevant concepts can thus be identified via cluster-guided sampling and fed into pre-training, thereby bridging the gap between visual and textual semantics. Extensive experiments over a broad suite of 8 segmentation benchmarks show that CoCu achieves superb zero-shot transfer performance and greatly boosts language-supervised segmentation baseline by a large margin, suggesting the value of bridging semantic gap in pre-training data.

Pre-trained Vision-Language Models (VLMs) utilizing extensive image-text paired data have demonstrated unprecedented image-text association capabilities, achieving remarkable results across various downstream tasks. A critical challenge is how to make use of existing large-scale pre-trained VLMs, which are trained on common objects, to perform the domain-specific transfer for accomplishing domain-related downstream tasks. A critical challenge is how to make use of existing large-scale pre-trained VLMs, which are trained on common objects, to perform the domain-specific transfer for accomplishing domain-related downstream tasks. In this paper, we propose a new framework that includes the Domain pre-trained Vision-Language Model (DVLM), bridging the gap between the General Vision-Language Model (GVLM) and domain-specific downstream tasks. Moreover, we present an image-text paired dataset in the field of remote sensing (RS), RS5M, which has 5 million RS images with English descriptions. The dataset is obtained from filtering publicly available image-text paired datasets and captioning label-only RS datasets with pre-trained VLM. These constitute the first large-scale RS image-text paired dataset. Additionally, we fine-tuned the CLIP model and tried several Parameter-Efficient Fine-Tuning methods on RS5M to implement the DVLM. Experimental results show that our proposed dataset is highly effective for various tasks, and our model GeoRSCLIP improves upon the baseline or previous state-of-the-art model by 3%sim20% in Zero-shot Classification (ZSC), 3%sim6% in Remote Sensing Cross-Modal Text-Image Retrieval (RSCTIR) and 4%sim5% in Semantic Localization (SeLo) tasks. Dataset and models have been released in: https://github.com/om-ai-lab/RS5M.

We study joint video and language (VL) pre-training to enable cross-modality learning and benefit plentiful downstream VL tasks. Existing works either extract low-quality video features or learn limited text embedding, while neglecting that high-resolution videos and diversified semantics can significantly improve cross-modality learning. In this paper, we propose a novel High-resolution and Diversified VIdeo-LAnguage pre-training model (HD-VILA) for many visual tasks. In particular, we collect a large dataset with two distinct properties: 1) the first high-resolution dataset including 371.5k hours of 720p videos, and 2) the most diversified dataset covering 15 popular YouTube categories. To enable VL pre-training, we jointly optimize the HD-VILA model by a hybrid Transformer that learns rich spatiotemporal features, and a multimodal Transformer that enforces interactions of the learned video features with diversified texts. Our pre-training model achieves new state-of-the-art results in 10 VL understanding tasks and 2 more novel text-to-visual generation tasks. For example, we outperform SOTA models with relative increases of 40.4% R@1 in zero-shot MSR-VTT text-to-video retrieval task and 55.4% in high-resolution dataset LSMDC. The learned VL embedding is also effective in generating visually pleasing and semantically relevant results in text-to-visual editing and super-resolution tasks.

In recent years, large language models (LLMs) have made significant progress in natural language processing (NLP), with models like ChatGPT and GPT-4 achieving impressive capabilities in various linguistic tasks. However, training models on such a large scale is challenging, and finding datasets that match the model's scale is often difficult. Fine-tuning and training models with fewer parameters using novel methods have emerged as promising approaches to overcome these challenges. One such model is MiniGPT-4, which achieves comparable vision-language understanding to GPT-4 by leveraging novel pre-training models and innovative training strategies. However, the model still faces some challenges in image understanding, particularly in artistic pictures. A novel multimodal model called ArtGPT-4 has been proposed to address these limitations. ArtGPT-4 was trained on image-text pairs using a Tesla A100 device in just 2 hours, using only about 200 GB of data. The model can depict images with an artistic flair and generate visual code, including aesthetically pleasing HTML/CSS web pages. Furthermore, the article proposes novel benchmarks for evaluating the performance of vision-language models. In the subsequent evaluation methods, ArtGPT-4 scored more than 1 point higher than the current state-of-the-art model and was only 0.25 points lower than artists on a 6-point scale. Our code and pre-trained model are available at https://huggingface.co/Tyrannosaurus/ArtGPT-4.

Large-scale pretraining and instruction tuning have been successful for training general-purpose language models with broad competencies. However, extending to general-purpose vision-language models is challenging due to the distributional diversity in visual inputs. A recent line of work explores vision-language instruction tuning, taking inspiration from the Query Transformer (QFormer) approach proposed in BLIP-2 models for bridging frozen modalities. However, these approaches rely heavily on large-scale multi-modal pretraining for representation learning before eventual finetuning, incurring a huge computational overhead, poor scaling, and limited accessibility. To that end, we propose a more efficient method for QFormer-based vision-language alignment and demonstrate the effectiveness of our strategy compared to existing baselines in improving the efficiency of vision-language pretraining.

Medical image segmentation remains a formidable challenge due to the label scarcity. Pre-training Vision Transformer (ViT) through masked image modeling (MIM) on large-scale unlabeled medical datasets presents a promising solution, providing both computational efficiency and model generalization for various downstream tasks. However, current ViT-based MIM pre-training frameworks predominantly emphasize local aggregation representations in output layers and fail to exploit the rich representations across different ViT layers that better capture fine-grained semantic information needed for more precise medical downstream tasks. To fill the above gap, we hereby present Hierarchical Encoder-driven MAE (Hi-End-MAE), a simple yet effective ViT-based pre-training solution, which centers on two key innovations: (1) Encoder-driven reconstruction, which encourages the encoder to learn more informative features to guide the reconstruction of masked patches; and (2) Hierarchical dense decoding, which implements a hierarchical decoding structure to capture rich representations across different layers. We pre-train Hi-End-MAE on a large-scale dataset of 10K CT scans and evaluated its performance across seven public medical image segmentation benchmarks. Extensive experiments demonstrate that Hi-End-MAE achieves superior transfer learning capabilities across various downstream tasks, revealing the potential of ViT in medical imaging applications. The code is available at: https://github.com/FengheTan9/Hi-End-MAE

Visual language models (VLMs) rapidly progressed with the recent success of large language models. There have been growing efforts on visual instruction tuning to extend the LLM with visual inputs, but lacks an in-depth study of the visual language pre-training process, where the model learns to perform joint modeling on both modalities. In this work, we examine the design options for VLM pre-training by augmenting LLM towards VLM through step-by-step controllable comparisons. We introduce three main findings: (1) freezing LLMs during pre-training can achieve decent zero-shot performance, but lack in-context learning capability, which requires unfreezing the LLM; (2) interleaved pre-training data is beneficial whereas image-text pairs alone are not optimal; (3) re-blending text-only instruction data to image-text data during instruction fine-tuning not only remedies the degradation of text-only tasks, but also boosts VLM task accuracy. With an enhanced pre-training recipe we build VILA, a Visual Language model family that consistently outperforms the state-of-the-art models, e.g., LLaVA-1.5, across main benchmarks without bells and whistles. Multi-modal pre-training also helps unveil appealing properties of VILA, including multi-image reasoning, enhanced in-context learning, and better world knowledge.

Large Language Models (LLMs) have demonstrated a remarkable potential in medical knowledge acquisition and question-answering. However, LLMs can potentially hallucinate and yield factually incorrect outcomes, even with domain-specific pretraining. Previously, retrieval augmented generation (RAG) has limited success in addressing hallucinations. Unlike previous methods in RAG where the retrieval model was trained separately from the LLM, we introduce JMLR (for Jointly trains LLM and information Retrieval) during the fine-tuning phase. The synchronized training mechanism enhances JMLR's ability to retrieve clinical guidelines and leverage medical knowledge to reason and answer questions and reduces the demand for computational resources. We evaluated JMLR on the important medical question-answering application. Our experimental results demonstrate that JMLR-13B (70.5%) outperforms a previous state-of-the-art open-source model using conventional pre-training and fine-tuning Meditron-70B (68.9%) and Llama2-13B with RAG (67.7%) on a medical question-answering dataset. Comprehensive evaluations reveal JMLR-13B enhances reasoning quality and reduces hallucinations better than Claude3-Opus. Additionally, JMLR-13B (148 GPU hours) also trains much faster than Meditron-70B (42630 GPU hours). Through this work, we provide a new and efficient knowledge enhancement method for healthcare, demonstrating the potential of integrating retrieval and LLM training for medical question-answering systems.

Foundation vision-language models are currently transforming computer vision, and are on the rise in medical imaging fueled by their very promising generalization capabilities. However, the initial attempts to transfer this new paradigm to medical imaging have shown less impressive performances than those observed in other domains, due to the significant domain shift and the complex, expert domain knowledge inherent to medical-imaging tasks. Motivated by the need for domain-expert foundation models, we present FLAIR, a pre-trained vision-language model for universal retinal fundus image understanding. To this end, we compiled 37 open-access, mostly categorical fundus imaging datasets from various sources, with up to 97 different target conditions and 284,660 images. We integrate the expert's domain knowledge in the form of descriptive textual prompts, during both pre-training and zero-shot inference, enhancing the less-informative categorical supervision of the data. Such a textual expert's knowledge, which we compiled from the relevant clinical literature and community standards, describes the fine-grained features of the pathologies as well as the hierarchies and dependencies between them. We report comprehensive evaluations, which illustrate the benefit of integrating expert knowledge and the strong generalization capabilities of FLAIR under difficult scenarios with domain shifts or unseen categories. When adapted with a lightweight linear probe, FLAIR outperforms fully-trained, dataset-focused models, more so in the few-shot regimes. Interestingly, FLAIR outperforms by a large margin more generalist, larger-scale image-language models, which emphasizes the potential of embedding experts' domain knowledge and the limitations of generalist models in medical imaging.

Radiologists play a crucial role by translating medical images into medical reports. However, the field faces staffing shortages and increasing workloads. While automated approaches using vision-language models (VLMs) show promise as assistants, they require exceptionally high accuracy. Most current VLMs in radiology rely solely on supervised fine-tuning (SFT). Meanwhile, in the general domain, additional preference fine-tuning has become standard practice. The challenge in radiology lies in the prohibitive cost of obtaining radiologist feedback. We propose a scalable automated preference alignment technique for VLMs in radiology, focusing on chest X-ray (CXR) report generation. Our method leverages publicly available datasets with an LLM-as-a-Judge mechanism, eliminating the need for additional expert radiologist feedback. We evaluate and benchmark five direct alignment algorithms (DAAs). Our results show up to a 57.4% improvement in average GREEN scores, a LLM-based metric for evaluating CXR reports, and a 9.2% increase in an average across six metrics (domain specific and general), compared to the SFT baseline. We study reward overoptimization via length exploitation, with reports lengthening by up to 3.2x. To assess a potential alignment tax, we benchmark on six additional diverse tasks, finding no significant degradations. A reader study involving four board-certified radiologists indicates win rates of up to 0.62 over the SFT baseline, while significantly penalizing verbosity. Our analysis provides actionable insights for the development of VLMs in high-stakes fields like radiology.

Recent advances in Large Language Models (LLMs) have catalyzed the development of Large Multimodal Models (LMMs). However, existing research primarily focuses on tuning language and image instructions, ignoring the critical pretraining phase where models learn to process textual and visual modalities jointly. In this paper, we propose a new pretraining paradigm for LMMs to enhance the visual comprehension capabilities of LLMs by introducing a novel cross-modal comprehension stage. Specifically, we design a dynamically learnable prompt token pool and employ the Hungarian algorithm to replace part of the original visual tokens with the most relevant prompt tokens. Then, we conceptualize visual tokens as analogous to a "foreign language" for the LLMs and propose a mixed attention mechanism with bidirectional visual attention and unidirectional textual attention to comprehensively enhance the understanding of visual tokens. Meanwhile, we integrate a detailed caption generation task, leveraging rich descriptions to further facilitate LLMs in understanding visual semantic information. After pretraining on 1.5 million publicly accessible data, we present a new foundation model called Croc. Experimental results demonstrate that Croc achieves new state-of-the-art performance on massive vision-language benchmarks. To support reproducibility and facilitate further research, we release the training code and pre-trained model weights at https://github.com/deepglint/Croc.

Leading vision-language models (VLMs) are trained on general Internet content, overlooking scientific journals' rich, domain-specific knowledge. Training on specialty-specific literature could yield high-performance, task-specific tools, enabling generative AI to match generalist models in specialty publishing, educational, and clinical tasks. We created NeuroPubs, a multimodal dataset of 23,000 Neurosurgery Publications articles (134M words, 78K image-caption pairs). Using NeuroPubs, VLMs generated publication-ready graphical abstracts (70% of 100 abstracts) and board-style questions indistinguishable from human-written ones (54% of 89,587 questions). We used these questions to train CNS-Obsidian, a 34B-parameter VLM. In a blinded, randomized controlled trial, our model demonstrated non-inferiority to then state-of-the-art GPT-4o in neurosurgical differential diagnosis (clinical utility, 40.62% upvotes vs. 57.89%, p=0.1150; accuracy, 59.38% vs. 65.79%, p=0.3797). Our pilot study demonstrates how training generative AI models on specialty-specific journal content - without large-scale internet data - results in high-performance academic and clinical tools, enabling domain-tailored AI across diverse fields.

Contrastive Language--Image Pre-training (CLIP) has shown remarkable success in learning with cross-modal supervision from extensive amounts of image--text pairs collected online. Thus far, the effectiveness of CLIP has been investigated primarily in general-domain multimodal problems. This work evaluates the effectiveness of CLIP for the task of Medical Visual Question Answering (MedVQA). To this end, we present PubMedCLIP, a fine-tuned version of CLIP for the medical domain based on PubMed articles. Our experiments are conducted on two MedVQA benchmark datasets and investigate two MedVQA methods, MEVF (Mixture of Enhanced Visual Features) and QCR (Question answering via Conditional Reasoning). For each of these, we assess the merits of visual representation learning using PubMedCLIP, the original CLIP, and state-of-the-art MAML (Model-Agnostic Meta-Learning) networks pre-trained only on visual data. We open source the code for our MedVQA pipeline and pre-training PubMedCLIP. CLIP and PubMedCLIP achieve improvements in comparison to MAML's visual encoder. PubMedCLIP achieves the best results with gains in the overall accuracy of up to 3%. Individual examples illustrate the strengths of PubMedCLIP in comparison to the previously widely used MAML networks. Visual representation learning with language supervision in PubMedCLIP leads to noticeable improvements for MedVQA. Our experiments reveal distributional differences in the two MedVQA benchmark datasets that have not been imparted in previous work and cause different back-end visual encoders in PubMedCLIP to exhibit different behavior on these datasets. Moreover, we witness fundamental performance differences of VQA in general versus medical domains.

Large vision-language models (LVLMs) have shown great promise in medical applications, particularly in visual question answering (MedVQA) and diagnosis from medical images. However, existing datasets and models often fail to consider critical aspects of medical diagnostics, such as the integration of historical records and the analysis of disease progression over time. In this paper, we introduce MMXU (Multimodal and MultiX-ray Understanding), a novel dataset for MedVQA that focuses on identifying changes in specific regions between two patient visits. Unlike previous datasets that primarily address single-image questions, MMXU enables multi-image questions, incorporating both current and historical patient data. We demonstrate the limitations of current LVLMs in identifying disease progression on MMXU-test, even those that perform well on traditional benchmarks. To address this, we propose a MedRecord-Augmented Generation (MAG) approach, incorporating both global and regional historical records. Our experiments show that integrating historical records significantly enhances diagnostic accuracy by at least 20\%, bridging the gap between current LVLMs and human expert performance. Additionally, we fine-tune models with MAG on MMXU-dev, which demonstrates notable improvements. We hope this work could illuminate the avenue of advancing the use of LVLMs in medical diagnostics by emphasizing the importance of historical context in interpreting medical images. Our dataset is released at https://github.com/linjiemu/MMXU{https://github.com/linjiemu/MMXU}.

Large Vision-Language Models (LVLMs) have demonstrated outstanding performance across various multimodal tasks. However, they suffer from a problem known as language prior, where responses are generated based solely on textual patterns while disregarding image information. Addressing the issue of language prior is crucial, as it can lead to undesirable biases or hallucinations when dealing with images that are out of training distribution. Despite its importance, current methods for accurately measuring language priors in LVLMs are poorly studied. Although existing benchmarks based on counterfactual or out-of-distribution images can partially be used to measure language priors, they fail to disentangle language priors from other confounding factors. To this end, we propose a new benchmark called VLind-Bench, which is the first benchmark specifically designed to measure the language priors, or blindness, of LVLMs. It not only includes tests on counterfactual images to assess language priors but also involves a series of tests to evaluate more basic capabilities such as commonsense knowledge, visual perception, and commonsense biases. For each instance in our benchmark, we ensure that all these basic tests are passed before evaluating the language priors, thereby minimizing the influence of other factors on the assessment. The evaluation and analysis of recent LVLMs in our benchmark reveal that almost all models exhibit a significant reliance on language priors, presenting a strong challenge in the field.

In this work, we introduce Vision-Language Generative Pre-trained Transformer (VL-GPT), a transformer model proficient at concurrently perceiving and generating visual and linguistic data. VL-GPT achieves a unified pre-training approach for both image and text modalities by employing a straightforward auto-regressive objective, thereby enabling the model to process image and text as seamlessly as a language model processes text. To accomplish this, we initially propose a novel image tokenizer-detokenizer framework for visual data, specifically designed to transform raw images into a sequence of continuous embeddings and reconstruct them accordingly. In combination with the existing text tokenizer and detokenizer, this framework allows for the encoding of interleaved image-text data into a multimodal sequence, which can subsequently be fed into the transformer model. Consequently, VL-GPT can perform large-scale pre-training on multimodal corpora utilizing a unified auto-regressive objective (i.e., next-token prediction). Upon completion of pre-training, VL-GPT exhibits remarkable zero-shot and few-shot performance across a diverse range of vision and language understanding and generation tasks, including image captioning, visual question answering, text-to-image generation, and more. Additionally, the pre-trained model retrains in-context learning capabilities when provided with multimodal prompts. We further conduct instruction tuning on our VL-GPT, highlighting its exceptional potential for multimodal assistance. The source code and model weights shall be released.

We propose Strongly Supervised pre-training with ScreenShots (S4) - a novel pre-training paradigm for Vision-Language Models using data from large-scale web screenshot rendering. Using web screenshots unlocks a treasure trove of visual and textual cues that are not present in using image-text pairs. In S4, we leverage the inherent tree-structured hierarchy of HTML elements and the spatial localization to carefully design 10 pre-training tasks with large scale annotated data. These tasks resemble downstream tasks across different domains and the annotations are cheap to obtain. We demonstrate that, compared to current screenshot pre-training objectives, our innovative pre-training method significantly enhances performance of image-to-text model in nine varied and popular downstream tasks - up to 76.1% improvements on Table Detection, and at least 1% on Widget Captioning.

This paper presents a unified Vision-Language Pre-training (VLP) model. The model is unified in that (1) it can be fine-tuned for either vision-language generation (e.g., image captioning) or understanding (e.g., visual question answering) tasks, and (2) it uses a shared multi-layer transformer network for both encoding and decoding, which differs from many existing methods where the encoder and decoder are implemented using separate models. The unified VLP model is pre-trained on a large amount of image-text pairs using the unsupervised learning objectives of two tasks: bidirectional and sequence-to-sequence (seq2seq) masked vision-language prediction. The two tasks differ solely in what context the prediction conditions on. This is controlled by utilizing specific self-attention masks for the shared transformer network. To the best of our knowledge, VLP is the first reported model that achieves state-of-the-art results on both vision-language generation and understanding tasks, as disparate as image captioning and visual question answering, across three challenging benchmark datasets: COCO Captions, Flickr30k Captions, and VQA 2.0. The code and the pre-trained models are available at https://github.com/LuoweiZhou/VLP.

This paper examines the problems of severe image-text misalignment and high redundancy in the widely-used large-scale Vision-Language Pre-Training (VLP) datasets. To address these issues, we propose an efficient and straightforward Vision-Language learning algorithm called TL;DR, which aims to compress the existing large VLP data into a small, high-quality set. Our approach consists of two major steps. First, a codebook-based encoder-decoder captioner is developed to select representative samples. Second, a new caption is generated to complement the original captions for selected samples, mitigating the text-image misalignment problem while maintaining uniqueness. As the result, TL;DR enables us to reduce the large dataset into a small set of high-quality data, which can serve as an alternative pre-training dataset. This algorithm significantly speeds up the time-consuming pretraining process. Specifically, TL;DR can compress the mainstream VLP datasets at a high ratio, e.g., reduce well-cleaned CC3M dataset from 2.82M to 0.67M (sim24\%) and noisy YFCC15M from 15M to 2.5M (sim16.7\%). Extensive experiments with three popular VLP models over seven downstream tasks show that VLP model trained on the compressed dataset provided by TL;DR can perform similar or even better results compared with training on the full-scale dataset. The code will be made available at https://github.com/showlab/datacentric.vlp.

Pre-Trained Vision-Language Models (VL-PTMs) have shown promising capabilities in grounding natural language in image data, facilitating a broad variety of cross-modal tasks. However, we note that there exists a significant gap between the objective forms of model pre-training and fine-tuning, resulting in a need for large amounts of labeled data to stimulate the visual grounding capability of VL-PTMs for downstream tasks. To address the challenge, we present Cross-modal Prompt Tuning (CPT, alternatively, Colorful Prompt Tuning), a novel paradigm for tuning VL-PTMs, which reformulates visual grounding into a fill-in-the-blank problem with color-based co-referential markers in image and text, maximally mitigating the gap. In this way, CPT enables strong few-shot and even zero-shot visual grounding capabilities of VL-PTMs. Comprehensive experimental results show that the prompt-tuned VL-PTMs outperform their fine-tuned counterparts by a large margin (e.g., 17.3% absolute accuracy improvement, and 73.8% relative standard deviation reduction on average with one shot in RefCOCO evaluation). We make the data and code for this paper publicly available at https://github.com/thunlp/CPT.

This paper introduces AIM, a collection of vision models pre-trained with an autoregressive objective. These models are inspired by their textual counterparts, i.e., Large Language Models (LLMs), and exhibit similar scaling properties. Specifically, we highlight two key findings: (1) the performance of the visual features scale with both the model capacity and the quantity of data, (2) the value of the objective function correlates with the performance of the model on downstream tasks. We illustrate the practical implication of these findings by pre-training a 7 billion parameter AIM on 2 billion images, that achieves 84.0% on ImageNet-1k with a frozen trunk. Interestingly, even at this scale, we observe no sign of saturation in performance, suggesting that AIM potentially represents a new frontier for training large-scale vision models. The pre-training of AIM is similar to the pre-training of LLMs, and does not require any image-specific strategy to stabilize the training at scale.

Over 85 million computed tomography (CT) scans are performed annually in the US, of which approximately one quarter focus on the abdomen. Given the current radiologist shortage, there is a large impetus to use artificial intelligence to alleviate the burden of interpreting these complex imaging studies. Prior state-of-the-art approaches for automated medical image interpretation leverage vision language models (VLMs). However, current medical VLMs are generally limited to 2D images and short reports, and do not leverage electronic health record (EHR) data for supervision. We introduce Merlin - a 3D VLM that we train using paired CT scans (6+ million images from 15,331 CTs), EHR diagnosis codes (1.8+ million codes), and radiology reports (6+ million tokens). We evaluate Merlin on 6 task types and 752 individual tasks. The non-adapted (off-the-shelf) tasks include zero-shot findings classification (31 findings), phenotype classification (692 phenotypes), and zero-shot cross-modal retrieval (image to findings and image to impressions), while model adapted tasks include 5-year disease prediction (6 diseases), radiology report generation, and 3D semantic segmentation (20 organs). We perform internal validation on a test set of 5,137 CTs, and external validation on 7,000 clinical CTs and on two public CT datasets (VerSe, TotalSegmentator). Beyond these clinically-relevant evaluations, we assess the efficacy of various network architectures and training strategies to depict that Merlin has favorable performance to existing task-specific baselines. We derive data scaling laws to empirically assess training data needs for requisite downstream task performance. Furthermore, unlike conventional VLMs that require hundreds of GPUs for training, we perform all training on a single GPU.

Obtaining text datasets with semantic annotations is an effortful process, yet crucial for supervised training in natural language processsing (NLP). In general, developing and applying new NLP pipelines in domain-specific contexts for tasks often requires custom designed datasets to address NLP tasks in supervised machine learning fashion. When operating in non-English languages for medical data processing, this exposes several minor and major, interconnected problems such as lack of task-matching datasets as well as task-specific pre-trained models. In our work we suggest to leverage pretrained language models for training data acquisition in order to retrieve sufficiently large datasets for training smaller and more efficient models for use-case specific tasks. To demonstrate the effectiveness of your approach, we create a custom dataset which we use to train a medical NER model for German texts, GPTNERMED, yet our method remains language-independent in principle. Our obtained dataset as well as our pre-trained models are publicly available at: https://github.com/frankkramer-lab/GPTNERMED

We apply pre-trained architectures, originally developed for the ImageNet Large Scale Visual Recognition Challenge, for periocular recognition. These architectures have demonstrated significant success in various computer vision tasks beyond the ones for which they were designed. This work builds on our previous study using off-the-shelf Convolutional Neural Network (CNN) and extends it to include the more recently proposed Vision Transformers (ViT). Despite being trained for generic object classification, middle-layer features from CNNs and ViTs are a suitable way to recognize individuals based on periocular images. We also demonstrate that CNNs and ViTs are highly complementary since their combination results in boosted accuracy. In addition, we show that a small portion of these pre-trained models can achieve good accuracy, resulting in thinner models with fewer parameters, suitable for resource-limited environments such as mobiles. This efficiency improves if traditional handcrafted features are added as well.

We present a novel methodology aimed at optimizing the application of frozen large language models (LLMs) for resource-intensive vision-language (VL) pre-training. The current paradigm uses visual features as prompts to guide language models, with a focus on determining the most relevant visual features for corresponding text. Our approach diverges by concentrating on the language component, specifically identifying the optimal prompts to align with visual features. We introduce the Prompt-Transformer (P-Former), a model that predicts these ideal prompts, which is trained exclusively on linguistic data, bypassing the need for image-text pairings. This strategy subtly bifurcates the end-to-end VL training process into an additional, separate stage. Our experiments reveal that our framework significantly enhances the performance of a robust image-to-text baseline (BLIP-2), and effectively narrows the performance gap between models trained with either 4M or 129M image-text pairs. Importantly, our framework is modality-agnostic and flexible in terms of architectural design, as validated by its successful application in a video learning task using varied base modules. The code is available at https://github.com/yiren-jian/BLIText

In this paper, we focus on the problem of Medical Visual Question Answering (MedVQA), which is crucial in efficiently interpreting medical images with vital clinic-relevant information. Firstly, we reframe the problem of MedVQA as a generation task that naturally follows the human-machine interaction, we propose a generative-based model for medical visual understanding by aligning visual information from a pre-trained vision encoder with a large language model. Secondly, we establish a scalable pipeline to construct a large-scale medical visual question-answering dataset, named PMC-VQA, which contains 227k VQA pairs of 149k images that cover various modalities or diseases. Thirdly, we pre-train our proposed model on PMC-VQA and then fine-tune it on multiple public benchmarks, e.g., VQA-RAD and SLAKE, outperforming existing work by a large margin. Additionally, we propose a test set that has undergone manual verification, which is significantly more challenging, even the best models struggle to solve.

This paper provides a simplification on OpenVision's architecture and loss design for enhancing its training efficiency. Following the prior vision-language pretraining works CapPa and AIMv2, as well as modern multimodal designs like LLaVA, our changes are straightforward: we remove the text encoder (and therefore the contrastive loss), retaining only the captioning loss as a purely generative training signal. We name this new version OpenVision 2. The initial results are promising: despite this simplification, OpenVision 2 competitively matches the original model's performance on a broad set of multimodal benchmarks while substantially cutting both training time and memory consumption. For example, with ViT-L/14, it reduces training time by about 1.5x (from 83h to 57h), and memory usage by about 1.8x (from 24.5GB to 13.8GB, equivalently allowing the maximum batch size to grow from 2k to 8k). This superior training efficiency also allows us to scale far beyond the largest vision encoder used in OpenVision, reaching more than 1 billion parameters. We hold a strong belief that this lightweight, generative-only paradigm is compelling for future vision encoder development in multimodal foundation models.

Large language models (LLMs) have demonstrated remarkable capabilities in natural language understanding and generation across various domains, including medicine. We present a comprehensive evaluation of GPT-4, a state-of-the-art LLM, on medical competency examinations and benchmark datasets. GPT-4 is a general-purpose model that is not specialized for medical problems through training or engineered to solve clinical tasks. Our analysis covers two sets of official practice materials for the USMLE, a three-step examination program used to assess clinical competency and grant licensure in the United States. We also evaluate performance on the MultiMedQA suite of benchmark datasets. Beyond measuring model performance, experiments were conducted to investigate the influence of test questions containing both text and images on model performance, probe for memorization of content during training, and study probability calibration, which is of critical importance in high-stakes applications like medicine. Our results show that GPT-4, without any specialized prompt crafting, exceeds the passing score on USMLE by over 20 points and outperforms earlier general-purpose models (GPT-3.5) as well as models specifically fine-tuned on medical knowledge (Med-PaLM, a prompt-tuned version of Flan-PaLM 540B). In addition, GPT-4 is significantly better calibrated than GPT-3.5, demonstrating a much-improved ability to predict the likelihood that its answers are correct. We also explore the behavior of the model qualitatively through a case study that shows the ability of GPT-4 to explain medical reasoning, personalize explanations to students, and interactively craft new counterfactual scenarios around a medical case. Implications of the findings are discussed for potential uses of GPT-4 in medical education, assessment, and clinical practice, with appropriate attention to challenges of accuracy and safety.

3D vision-language (VL) reasoning has gained significant attention due to its potential to bridge the 3D physical world with natural language descriptions. Existing approaches typically follow task-specific, highly specialized paradigms. Therefore, these methods focus on a limited range of reasoning sub-tasks and rely heavily on the hand-crafted modules and auxiliary losses. This highlights the need for a simpler, unified and general-purpose model. In this paper, we leverage the inherent connection between 3D scene graphs and natural language, proposing a 3D scene graph-guided vision-language pre-training (VLP) framework. Our approach utilizes modality encoders, graph convolutional layers and cross-attention layers to learn universal representations that adapt to a variety of 3D VL reasoning tasks, thereby eliminating the need for task-specific designs. The pre-training objectives include: 1) Scene graph-guided contrastive learning, which leverages the strong correlation between 3D scene graphs and natural language to align 3D objects with textual features at various fine-grained levels; and 2) Masked modality learning, which uses cross-modality information to reconstruct masked words and 3D objects. Instead of directly reconstructing the 3D point clouds of masked objects, we use position clues to predict their semantic categories. Extensive experiments demonstrate that our pre-training model, when fine-tuned on several downstream tasks, achieves performance comparable to or better than existing methods in tasks such as 3D visual grounding, 3D dense captioning, and 3D question answering.

Visual Language Models (VLMs) have demonstrated impressive capabilities in visual grounding tasks. However, their effectiveness in the medical domain, particularly for abnormality detection and localization within medical images, remains underexplored. A major challenge is the complex and abstract nature of medical terminology, which makes it difficult to directly associate pathological anomaly terms with their corresponding visual features. In this work, we introduce a novel approach to enhance VLM performance in medical abnormality detection and localization by leveraging decomposed medical knowledge. Instead of directly prompting models to recognize specific abnormalities, we focus on breaking down medical concepts into fundamental attributes and common visual patterns. This strategy promotes a stronger alignment between textual descriptions and visual features, improving both the recognition and localization of abnormalities in medical images.We evaluate our method on the 0.23B Florence-2 base model and demonstrate that it achieves comparable performance in abnormality grounding to significantly larger 7B LLaVA-based medical VLMs, despite being trained on only 1.5% of the data used for such models. Experimental results also demonstrate the effectiveness of our approach in both known and previously unseen abnormalities, suggesting its strong generalization capabilities.

Learning visual representations of medical images (e.g., X-rays) is core to medical image understanding but its progress has been held back by the scarcity of human annotations. Existing work commonly relies on fine-tuning weights transferred from ImageNet pretraining, which is suboptimal due to drastically different image characteristics, or rule-based label extraction from the textual report data paired with medical images, which is inaccurate and hard to generalize. Meanwhile, several recent studies show exciting results from unsupervised contrastive learning from natural images, but we find these methods help little on medical images because of their high inter-class similarity. We propose ConVIRT, an alternative unsupervised strategy to learn medical visual representations by exploiting naturally occurring paired descriptive text. Our new method of pretraining medical image encoders with the paired text data via a bidirectional contrastive objective between the two modalities is domain-agnostic, and requires no additional expert input. We test ConVIRT by transferring our pretrained weights to 4 medical image classification tasks and 2 zero-shot retrieval tasks, and show that it leads to image representations that considerably outperform strong baselines in most settings. Notably, in all 4 classification tasks, our method requires only 10\% as much labeled training data as an ImageNet initialized counterpart to achieve better or comparable performance, demonstrating superior data efficiency.

Although vision models such as Contrastive Language-Image Pre-Training (CLIP) show impressive generalization performance, their zero-shot robustness is still limited under Out-of-Distribution (OOD) scenarios without fine-tuning. Instead of undesirably providing human supervision as commonly done, it is possible to take advantage of Multi-modal Large Language Models (MLLMs) that hold powerful visual understanding abilities. However, MLLMs are shown to struggle with vision problems due to the incompatibility of tasks, thus hindering their utilization. In this paper, we propose to effectively leverage MLLMs to conduct Machine Vision Therapy which aims to rectify the noisy predictions from vision models. By fine-tuning with the denoised labels, the learning model performance can be boosted in an unsupervised manner. To solve the incompatibility issue, we propose a novel Denoising In-Context Learning (DICL) strategy to align vision tasks with MLLMs. Concretely, by estimating a transition matrix that captures the probability of one class being confused with another, an instruction containing a correct exemplar and an erroneous one from the most probable noisy class can be constructed. Such an instruction can help any MLLMs with ICL ability to detect and rectify incorrect predictions of vision models. Through extensive experiments on ImageNet, WILDS, DomainBed, and other OOD datasets, we carefully validate the quantitative and qualitative effectiveness of our method. Our code is available at https://github.com/tmllab/Machine_Vision_Therapy.

Conventional wisdom suggests that pre-training Vision Transformers (ViT) improves downstream performance by learning useful representations. Is this actually true? We investigate this question and find that the features and representations learned during pre-training are not essential. Surprisingly, using only the attention patterns from pre-training (i.e., guiding how information flows between tokens) is sufficient for models to learn high quality features from scratch and achieve comparable downstream performance. We show this by introducing a simple method called attention transfer, where only the attention patterns from a pre-trained teacher ViT are transferred to a student, either by copying or distilling the attention maps. Since attention transfer lets the student learn its own features, ensembling it with a fine-tuned teacher also further improves accuracy on ImageNet. We systematically study various aspects of our findings on the sufficiency of attention maps, including distribution shift settings where they underperform fine-tuning. We hope our exploration provides a better understanding of what pre-training accomplishes and leads to a useful alternative to the standard practice of fine-tuning

Medical image analysis is a fundamental component. As deep learning progresses, the focus has shifted from single-task applications, such as classification and segmentation, to more complex multimodal tasks, including medical visual question answering and report generation. Traditional shallow and task-specific models are increasingly limited in addressing the complexity and scalability required in clinical practice. The emergence of large language models (LLMs) has driven the development of medical Large Vision-Language Models (LVLMs), offering a unified solution for diverse vision-language tasks. In this study, we investigate various architectural designs for medical LVLMs based on the widely adopted LLaVA framework, which follows an encoder-connector-LLM paradigm. We construct two distinct models targeting 2D and 3D modalities, respectively. These models are designed to support both general-purpose medical tasks and domain-specific fine-tuning, thereby serving as effective foundation models. To facilitate reproducibility and further research, we develop a modular and extensible codebase, MedM-VL, and release two LVLM variants: MedM-VL-2D for 2D medical image analysis and MedM-VL-CT-Chest for 3D CT-based applications. The code and models are available at: https://github.com/MSIIP/MedM-VL

Large pre-trained vision-language models like CLIP have shown great potential in learning representations that are transferable across a wide range of downstream tasks. Different from the traditional representation learning that is based mostly on discretized labels, vision-language pre-training aligns images and texts in a common feature space, which allows zero-shot transfer to a downstream task via prompting, i.e., classification weights are synthesized from natural language describing classes of interest. In this work, we show that a major challenge for deploying such models in practice is prompt engineering, which requires domain expertise and is extremely time-consuming -- one needs to spend a significant amount of time on words tuning since a slight change in wording could have a huge impact on performance. Inspired by recent advances in prompt learning research in natural language processing (NLP), we propose Context Optimization (CoOp), a simple approach specifically for adapting CLIP-like vision-language models for downstream image recognition. Concretely, CoOp models a prompt's context words with learnable vectors while the entire pre-trained parameters are kept fixed. To handle different image recognition tasks, we provide two implementations of CoOp: unified context and class-specific context. Through extensive experiments on 11 datasets, we demonstrate that CoOp requires as few as one or two shots to beat hand-crafted prompts with a decent margin and is able to gain significant improvements over prompt engineering with more shots, e.g., with 16 shots the average gain is around 15% (with the highest reaching over 45%). Despite being a learning-based approach, CoOp achieves superb domain generalization performance compared with the zero-shot model using hand-crafted prompts.

The scarcity of annotations poses a significant challenge in medical image analysis. Large-scale pre-training has emerged as a promising label-efficient solution, owing to the utilization of large-scale data, large models, and advanced pre-training techniques. However, its development in medical images remains underexplored. The primary challenge lies in harnessing large-scale unlabeled data and learning high-level semantics without annotations. We observe that 3D medical images exhibit consistent geometric context, i.e., consistent geometric relations between different organs, which leads to a promising way for learning consistent representations. Motivated by this, we introduce a simple-yet-effective Volume Contrast (VoCo) framework to leverage geometric context priors for self-supervision. Given an input volume, we extract base crops from different regions to construct positive and negative pairs for contrastive learning. Then we predict the contextual position of a random crop by contrasting its similarity to the base crops. In this way, VoCo encodes the inherent geometric context into model representations, facilitating high-level semantic learning without annotations. Specifically, we (1) introduce the largest medical pre-training dataset PreCT-160K; (2) investigate scaling laws and propose guidelines for tailoring different model sizes to various medical tasks; (3) build a benchmark encompassing 48 medical tasks. Extensive experiments highlight the superiority of VoCo. Codes at https://github.com/Luffy03/Large-Scale-Medical.

Vision-language models (VLMs) have advanced reasoning in natural scenes, but their role in medical imaging remains underexplored. Medical reasoning tasks demand robust image analysis and well-justified answers, posing challenges due to the complexity of medical images. Transparency and trustworthiness are essential for clinical adoption and regulatory compliance. We introduce Med-R1, a framework exploring reinforcement learning (RL) to enhance VLMs' generalizability and trustworthiness in medical reasoning. Leveraging the DeepSeek strategy, we employ Group Relative Policy Optimization (GRPO) to guide reasoning paths via reward signals. Unlike supervised fine-tuning (SFT), which often overfits and lacks generalization, RL fosters robust and diverse reasoning. Med-R1 is evaluated across eight medical imaging modalities: CT, MRI, Ultrasound, Dermoscopy, Fundus Photography, Optical Coherence Tomography (OCT), Microscopy, and X-ray Imaging. Compared to its base model, Qwen2-VL-2B, Med-R1 achieves a 29.94% accuracy improvement and outperforms Qwen2-VL-72B, which has 36 times more parameters. Testing across five question types-modality recognition, anatomy identification, disease diagnosis, lesion grading, and biological attribute analysis Med-R1 demonstrates superior generalization, exceeding Qwen2-VL-2B by 32.06% and surpassing Qwen2-VL-72B in question-type generalization. These findings show that RL improves medical reasoning and enables parameter-efficient models to outperform significantly larger ones. With interpretable reasoning outputs, Med-R1 represents a promising step toward generalizable, trustworthy, and clinically viable medical VLMs.

Contrastive Language-Image Pre-training (CLIP) demonstrates strong potential in medical image analysis but requires substantial data and computational resources. Due to these restrictions, existing CLIP applications in medical imaging focus mainly on modalities like chest X-rays that have abundant image-report data available, leaving many other important modalities underexplored. Here, we propose one of the first adaptations of the full CLIP model to mammography, which presents significant challenges due to labeled data scarcity, high-resolution images with small regions of interest, and class-wise imbalance. We first develop a specialized supervision framework for mammography that leverages its multi-view nature. Furthermore, we design a symmetric local alignment module to better focus on detailed features in high-resolution images. Lastly, we incorporate a parameter-efficient fine-tuning approach for large language models pre-trained with medical knowledge to address data limitations. Our multi-view and multi-scale alignment (MaMA) method outperforms state-of-the-art baselines for three different tasks on two large real-world mammography datasets, EMBED and RSNA-Mammo, with only 52% model size compared with the largest baseline. The code is available at https://github.com/XYPB/MaMA

While deep networks have achieved broad success in analyzing natural images, when applied to medical scans, they often fail in unexcepted situations. We investigate this challenge and focus on model sensitivity to domain shifts, such as data sampled from different hospitals or data confounded by demographic variables such as sex, race, etc, in the context of chest X-rays and skin lesion images. A key finding we show empirically is that existing visual backbones lack an appropriate prior from the architecture for reliable generalization in these settings. Taking inspiration from medical training, we propose giving deep networks a prior grounded in explicit medical knowledge communicated in natural language. To this end, we introduce Knowledge-enhanced Bottlenecks (KnoBo), a class of concept bottleneck models that incorporates knowledge priors that constrain it to reason with clinically relevant factors found in medical textbooks or PubMed. KnoBo uses retrieval-augmented language models to design an appropriate concept space paired with an automatic training procedure for recognizing the concept. We evaluate different resources of knowledge and recognition architectures on a broad range of domain shifts across 20 datasets. In our comprehensive evaluation with two imaging modalities, KnoBo outperforms fine-tuned models on confounded datasets by 32.4% on average. Finally, evaluations reveal that PubMed is a promising resource for making medical models less sensitive to domain shift, outperforming other resources on both diversity of information and final prediction performance.

Vision-Language Pretraining (VLP) has shown impressive results on diverse downstream tasks by offline training on large-scale datasets. Regarding the growing nature of real-world data, such an offline training paradigm on ever-expanding data is unsustainable, because models lack the continual learning ability to accumulate knowledge constantly. However, most continual learning studies are limited to uni-modal classification and existing multi-modal datasets cannot simulate continual non-stationary data stream scenarios. To support the study of Vision-Language Continual Pretraining (VLCP), we first contribute a comprehensive and unified benchmark dataset P9D which contains over one million product image-text pairs from 9 industries. The data from each industry as an independent task supports continual learning and conforms to the real-world long-tail nature to simulate pretraining on web data. We comprehensively study the characteristics and challenges of VLCP, and propose a new algorithm: Compatible momentum contrast with Topology Preservation, dubbed CTP. The compatible momentum model absorbs the knowledge of the current and previous-task models to flexibly update the modal feature. Moreover, Topology Preservation transfers the knowledge of embedding across tasks while preserving the flexibility of feature adjustment. The experimental results demonstrate our method not only achieves superior performance compared with other baselines but also does not bring an expensive training burden. Dataset and codes are available at https://github.com/KevinLight831/CTP.

General-purpose language models that can solve various language-domain tasks have emerged driven by the pre-training and instruction-tuning pipeline. However, building general-purpose vision-language models is challenging due to the increased task discrepancy introduced by the additional visual input. Although vision-language pre-training has been widely studied, vision-language instruction tuning remains relatively less explored. In this paper, we conduct a systematic and comprehensive study on vision-language instruction tuning based on the pre-trained BLIP-2 models. We gather a wide variety of 26 publicly available datasets, transform them into instruction tuning format and categorize them into two clusters for held-in instruction tuning and held-out zero-shot evaluation. Additionally, we introduce instruction-aware visual feature extraction, a crucial method that enables the model to extract informative features tailored to the given instruction. The resulting InstructBLIP models achieve state-of-the-art zero-shot performance across all 13 held-out datasets, substantially outperforming BLIP-2 and the larger Flamingo. Our models also lead to state-of-the-art performance when finetuned on individual downstream tasks (e.g., 90.7% accuracy on ScienceQA IMG). Furthermore, we qualitatively demonstrate the advantages of InstructBLIP over concurrent multimodal models. All InstructBLIP models have been open-sourced at https://github.com/salesforce/LAVIS/tree/main/projects/instructblip.

In recent years, pre-trained language models (PLMs) achieve the best performance on a wide range of natural language processing (NLP) tasks. While the first models were trained on general domain data, specialized ones have emerged to more effectively treat specific domains. In this paper, we propose an original study of PLMs in the medical domain on French language. We compare, for the first time, the performance of PLMs trained on both public data from the web and private data from healthcare establishments. We also evaluate different learning strategies on a set of biomedical tasks. In particular, we show that we can take advantage of already existing biomedical PLMs in a foreign language by further pre-train it on our targeted data. Finally, we release the first specialized PLMs for the biomedical field in French, called DrBERT, as well as the largest corpus of medical data under free license on which these models are trained.

A Vision Transformer (ViT) is a simple neural architecture amenable to serve several computer vision tasks. It has limited built-in architectural priors, in contrast to more recent architectures that incorporate priors either about the input data or of specific tasks. Recent works show that ViTs benefit from self-supervised pre-training, in particular BerT-like pre-training like BeiT. In this paper, we revisit the supervised training of ViTs. Our procedure builds upon and simplifies a recipe introduced for training ResNet-50. It includes a new simple data-augmentation procedure with only 3 augmentations, closer to the practice in self-supervised learning. Our evaluations on Image classification (ImageNet-1k with and without pre-training on ImageNet-21k), transfer learning and semantic segmentation show that our procedure outperforms by a large margin previous fully supervised training recipes for ViT. It also reveals that the performance of our ViT trained with supervision is comparable to that of more recent architectures. Our results could serve as better baselines for recent self-supervised approaches demonstrated on ViT.

Pretraining general-purpose visual features has become a crucial part of tackling many computer vision tasks. While one can learn such features on the extensively-annotated ImageNet dataset, recent approaches have looked at ways to allow for noisy, fewer, or even no annotations to perform such pretraining. Starting from the observation that captioned images are easily crawlable, we argue that this overlooked source of information can be exploited to supervise the training of visual representations. To do so, motivated by the recent progresses in language models, we introduce {\em image-conditioned masked language modeling} (ICMLM) -- a proxy task to learn visual representations over image-caption pairs. ICMLM consists in predicting masked words in captions by relying on visual cues. To tackle this task, we propose hybrid models, with dedicated visual and textual encoders, and we show that the visual representations learned as a by-product of solving this task transfer well to a variety of target tasks. Our experiments confirm that image captions can be leveraged to inject global and localized semantic information into visual representations. Project website: https://europe.naverlabs.com/icmlm.

Medical Large Vision-Language Models (Med-LVLMs) have shown strong potential in multimodal diagnostic tasks. However, existing single-agent models struggle to generalize across diverse medical specialties, limiting their performance. Recent efforts introduce multi-agent collaboration frameworks inspired by clinical workflows, where general practitioners (GPs) and specialists interact in a fixed sequence. Despite improvements, these static pipelines lack flexibility and adaptability in reasoning. To address this, we propose MMedAgent-RL, a reinforcement learning (RL)-based multi-agent framework that enables dynamic, optimized collaboration among medical agents. Specifically, we train two GP agents based on Qwen2.5-VL via RL: the triage doctor learns to assign patients to appropriate specialties, while the attending physician integrates the judgments from multi-specialists and its own knowledge to make final decisions. To address the inconsistency in specialist outputs, we introduce a curriculum learning (CL)-guided RL strategy that progressively teaches the attending physician to balance between imitating specialists and correcting their mistakes. Experiments on five medical VQA benchmarks demonstrate that MMedAgent-RL not only outperforms both open-source and proprietary Med-LVLMs, but also exhibits human-like reasoning patterns. Notably, it achieves an average performance gain of 20.7% over supervised fine-tuning baselines.

Large language models (LLMs) can potentially democratize access to medical knowledge. While many efforts have been made to harness and improve LLMs' medical knowledge and reasoning capacities, the resulting models are either closed-source (e.g., PaLM, GPT-4) or limited in scale (<= 13B parameters), which restricts their abilities. In this work, we improve access to large-scale medical LLMs by releasing MEDITRON: a suite of open-source LLMs with 7B and 70B parameters adapted to the medical domain. MEDITRON builds on Llama-2 (through our adaptation of Nvidia's Megatron-LM distributed trainer), and extends pretraining on a comprehensively curated medical corpus, including selected PubMed articles, abstracts, and internationally-recognized medical guidelines. Evaluations using four major medical benchmarks show significant performance gains over several state-of-the-art baselines before and after task-specific finetuning. Overall, MEDITRON achieves a 6% absolute performance gain over the best public baseline in its parameter class and 3% over the strongest baseline we finetuned from Llama-2. Compared to closed-source LLMs, MEDITRON-70B outperforms GPT-3.5 and Med-PaLM and is within 5% of GPT-4 and 10% of Med-PaLM-2. We release our code for curating the medical pretraining corpus and the MEDITRON model weights to drive open-source development of more capable medical LLMs.

Video-language pre-training (VLP) has become increasingly important due to its ability to generalize to various vision and language tasks. However, existing egocentric VLP frameworks utilize separate video and language encoders and learn task-specific cross-modal information only during fine-tuning, limiting the development of a unified system. In this work, we introduce the second generation of egocentric video-language pre-training (EgoVLPv2), a significant improvement from the previous generation, by incorporating cross-modal fusion directly into the video and language backbones. EgoVLPv2 learns strong video-text representation during pre-training and reuses the cross-modal attention modules to support different downstream tasks in a flexible and efficient manner, reducing fine-tuning costs. Moreover, our proposed fusion in the backbone strategy is more lightweight and compute-efficient than stacking additional fusion-specific layers. Extensive experiments on a wide range of VL tasks demonstrate the effectiveness of EgoVLPv2 by achieving consistent state-of-the-art performance over strong baselines across all downstream. Our project page can be found at https://shramanpramanick.github.io/EgoVLPv2/.

Does the prior knowledge of the vision encoder constrain the capability boundary of Multi-modal Large Language Models (MLLMs)? While most existing research treats MLLMs as unified systems optimized through end-to-end training, the impact of vision encoder's prior knowledge is seldom investigated. In this work, we introduce a novel metric, Rank_e, to quantify the effect of the vision encoder's prior knowledge on MLLM performance. Our analysis reveals a positive correlation between prior knowledge and MLLM performance. Moreover, we find that domain-specific fine-tuning using solely end-to-end visual question answering (VQA) data is insufficient--particularly for entities with low inherent visual prior knowledge. To address this issue, we propose VisPRE (Vision Prior Remediation), a two-stage training framework that explicitly incorporates prior knowledge at the vision encoder level. Experimental results demonstrate that augmenting vision encoder's prior knowledge substantially boosts the visual understanding capabilities of MLLMs, offering a novel and effective strategy for improving performance, especially in scenarios involving uncommon visual entities.

Recent advances in generative vision-language models (VLMs) have exciting potential implications for AI in radiology, yet VLMs are also known to produce hallucinations, nonsensical text, and other unwanted behaviors that can waste clinicians' time and cause patient harm. Drawing on recent work on direct preference optimization (DPO), we propose a simple method for modifying the behavior of pretrained VLMs performing radiology report generation by suppressing unwanted types of generations. We apply our method to the prevention of hallucinations of prior exams, addressing a long-established problem behavior in models performing chest X-ray report generation. Across our experiments, we find that DPO fine-tuning achieves a 3.2-4.8x reduction in lines hallucinating prior exams while maintaining model performance on clinical accuracy metrics. Our work is, to the best of our knowledge, the first work to apply DPO to medical VLMs, providing a data- and compute- efficient way to suppress problem behaviors while maintaining overall clinical accuracy.

Artificial Intelligence (AI) has demonstrated significant potential in healthcare, particularly in disease diagnosis and treatment planning. Recent progress in Medical Large Vision-Language Models (Med-LVLMs) has opened up new possibilities for interactive diagnostic tools. However, these models often suffer from factual hallucination, which can lead to incorrect diagnoses. Fine-tuning and retrieval-augmented generation (RAG) have emerged as methods to address these issues. However, the amount of high-quality data and distribution shifts between training data and deployment data limit the application of fine-tuning methods. Although RAG is lightweight and effective, existing RAG-based approaches are not sufficiently general to different medical domains and can potentially cause misalignment issues, both between modalities and between the model and the ground truth. In this paper, we propose a versatile multimodal RAG system, MMed-RAG, designed to enhance the factuality of Med-LVLMs. Our approach introduces a domain-aware retrieval mechanism, an adaptive retrieved contexts selection method, and a provable RAG-based preference fine-tuning strategy. These innovations make the RAG process sufficiently general and reliable, significantly improving alignment when introducing retrieved contexts. Experimental results across five medical datasets (involving radiology, ophthalmology, pathology) on medical VQA and report generation demonstrate that MMed-RAG can achieve an average improvement of 43.8% in the factual accuracy of Med-LVLMs. Our data and code are available in https://github.com/richard-peng-xia/MMed-RAG.

Is vision good enough for language? Recent advancements in multimodal models primarily stem from the powerful reasoning abilities of large language models (LLMs). However, the visual component typically depends only on the instance-level contrastive language-image pre-training (CLIP). Our research reveals that the visual capabilities in recent multimodal LLMs (MLLMs) still exhibit systematic shortcomings. To understand the roots of these errors, we explore the gap between the visual embedding space of CLIP and vision-only self-supervised learning. We identify ''CLIP-blind pairs'' - images that CLIP perceives as similar despite their clear visual differences. With these pairs, we construct the Multimodal Visual Patterns (MMVP) benchmark. MMVP exposes areas where state-of-the-art systems, including GPT-4V, struggle with straightforward questions across nine basic visual patterns, often providing incorrect answers and hallucinated explanations. We further evaluate various CLIP-based vision-and-language models and found a notable correlation between visual patterns that challenge CLIP models and those problematic for multimodal LLMs. As an initial effort to address these issues, we propose a Mixture of Features (MoF) approach, demonstrating that integrating vision self-supervised learning features with MLLMs can significantly enhance their visual grounding capabilities. Together, our research suggests visual representation learning remains an open challenge, and accurate visual grounding is crucial for future successful multimodal systems.

Pre-trained vision-language (V-L) models such as CLIP have shown excellent performance in many downstream cross-modal tasks. However, most of them are only applicable to the English context. Subsequent research has focused on this problem and proposed improved models, such as CN-CLIP and AltCLIP, to facilitate their applicability to Chinese and even other languages. Nevertheless, these models suffer from high latency and a large memory footprint in inference, which limits their further deployment on resource-constrained edge devices. In this work, we propose a conceptually simple yet effective multilingual CLIP Compression framework and train a lightweight multilingual vision-language model, called DC-CLIP, for both Chinese and English context. In this framework, we collect high-quality Chinese and English text-image pairs and design two training stages, including multilingual vision-language feature distillation and alignment. During the first stage, lightweight image/text student models are designed to learn robust visual/multilingual textual feature representation ability from corresponding teacher models, respectively. Subsequently, the multilingual vision-language alignment stage enables effective alignment of visual and multilingual textual features to further improve the model's multilingual performance. Comprehensive experiments in zero-shot image classification, conducted based on the ELEVATER benchmark, showcase that DC-CLIP achieves superior performance in the English context and competitive performance in the Chinese context, even with less training data, when compared to existing models of similar parameter magnitude. The evaluation demonstrates the effectiveness of our designed training mechanism.

Large Language Models (LLMs) have demonstrated significant potential in transforming clinical applications. In this study, we investigate the efficacy of four techniques in adapting LLMs for clinical use-cases: continuous pretraining, instruct fine-tuning, NEFTune, and prompt engineering. We employ these methods on Mistral 7B and Mixtral 8x7B models, leveraging a large-scale clinical pretraining dataset of 50 billion tokens and an instruct fine-tuning dataset of 500 million tokens. Our evaluation across various clinical tasks reveals the impact of each technique. While continuous pretraining beyond 250 billion tokens yields marginal improvements on its own, it establishes a strong foundation for instruct fine-tuning. Notably, NEFTune, designed primarily to enhance generation quality, surprisingly demonstrates additional gains on our benchmark. Complex prompt engineering methods further enhance performance. These findings show the importance of tailoring fine-tuning strategies and exploring innovative techniques to optimize LLM performance in the clinical domain.

Generative Vision-Language Models (VLMs) are prone to generate plausible-sounding textual answers that, however, are not always grounded in the input image. We investigate this phenomenon, usually referred to as "hallucination" and show that it stems from an excessive reliance on the language prior. In particular, we show that as more tokens are generated, the reliance on the visual prompt decreases, and this behavior strongly correlates with the emergence of hallucinations. To reduce hallucinations, we introduce Multi-Modal Mutual-Information Decoding (M3ID), a new sampling method for prompt amplification. M3ID amplifies the influence of the reference image over the language prior, hence favoring the generation of tokens with higher mutual information with the visual prompt. M3ID can be applied to any pre-trained autoregressive VLM at inference time without necessitating further training and with minimal computational overhead. If training is an option, we show that M3ID can be paired with Direct Preference Optimization (DPO) to improve the model's reliance on the prompt image without requiring any labels. Our empirical findings show that our algorithms maintain the fluency and linguistic capabilities of pre-trained VLMs while reducing hallucinations by mitigating visually ungrounded answers. Specifically, for the LLaVA 13B model, M3ID and M3ID+DPO reduce the percentage of hallucinated objects in captioning tasks by 25% and 28%, respectively, and improve the accuracy on VQA benchmarks such as POPE by 21% and 24%.

Recent studies have shown that Large Vision-Language Models (VLMs) tend to neglect image content and over-rely on language-model priors, resulting in errors in visually grounded tasks and hallucinations. We hypothesize that this issue arises because existing VLMs are not explicitly trained to generate texts that are accurately grounded in fine-grained image details. To enhance visual feedback during VLM training, we propose S-VCO (Symmetrical Visual Contrastive Optimization), a novel finetuning objective that steers the model toward capturing important visual details and aligning them with corresponding text tokens. To further facilitate this detailed alignment, we introduce MVC, a paired image-text dataset built by automatically filtering and augmenting visual counterfactual data to challenge the model with hard contrastive cases involving Minimal Visual Contrasts. Experiments show that our method consistently improves VLM performance across diverse benchmarks covering various abilities and domains, achieving up to a 22% reduction in hallucinations, and significant gains in vision-centric and general tasks. Notably, these improvements become increasingly pronounced in benchmarks with higher visual dependency. In short, S-VCO offers a significant enhancement of VLM's visually-dependent task performance while retaining or even improving the model's general abilities. We opensource our code at https://s-vco.github.io/

In recent years, advancements in Natural Language Processing (NLP) techniques have revolutionized the field of accessibility and exclusivity of testing, particularly for visually impaired students (VIS). CBT has shown in years back its relevance in terms of administering exams electronically, making the test process easier, providing quicker and more accurate results, and offering greater flexibility and accessibility for candidates. Yet, its relevance was not felt by the visually impaired students as they cannot access printed documents. Hence, in this paper, we present an NLP-driven Computer-Based Test guide for visually impaired students. It employs a speech technology pre-trained methods to provide real-time assistance and support to visually impaired students. The system utilizes NLP technologies to convert the text-based questions and the associated options in a machine-readable format. Subsequently, the speech technology pre-trained model processes the converted text enabling the VIS to comprehend and analyze the content. Furthermore, we validated that this pre-trained model is not perverse by testing for accuracy using sample audio datasets labels (A, B, C, D, E, F, G) to compare with the voice recordings obtained from 20 VIS which is been predicted by the system to attain values for precision, recall, and F1-scores. These metrics are used to assess the performance of the pre-trained model and have indicated that it is proficient enough to give its better performance to the evaluated system. The methodology adopted for this system is Object Oriented Analysis and Design Methodology (OOADM) where Objects are discussed and built by modeling real-world instances.

The development of vision-language models (VLMs) is driven by large-scale and diverse multimodal datasets. However, progress toward generalist biomedical VLMs is limited by the lack of annotated, publicly accessible datasets across biology and medicine. Existing efforts are restricted to narrow domains, missing the full diversity of biomedical knowledge encoded in scientific literature. To address this gap, we introduce BIOMEDICA, a scalable, open-source framework to extract, annotate, and serialize the entirety of the PubMed Central Open Access subset into an easy-to-use, publicly accessible dataset.Our framework produces a comprehensive archive with over 24 million unique image-text pairs from over 6 million articles. Metadata and expert-guided annotations are also provided. We demonstrate the utility and accessibility of our resource by releasing BMCA-CLIP, a suite of CLIP-style models continuously pre-trained on the BIOMEDICA dataset via streaming, eliminating the need to download 27 TB of data locally.On average, our models achieve state-of-the-art performance across 40 tasks - spanning pathology, radiology, ophthalmology, dermatology, surgery, molecular biology, parasitology, and cell biology - excelling in zero-shot classification with a 6.56% average improvement (as high as 29.8% and 17.5% in dermatology and ophthalmology, respectively), and stronger image-text retrieval, all while using 10x less compute. To foster reproducibility and collaboration, we release our codebase and dataset for the broader research community.

In recent years, multimodal large language models (MLLMs) have shown strong potential in real-world applications. They are developing rapidly due to their remarkable ability to comprehend multimodal information and their inherent powerful cognitive and reasoning capabilities. Among MLLMs, vision language models (VLM) stand out for their ability to understand vision information. However, the scaling trend of VLMs under the current mainstream paradigm has not been extensively studied. Whether we can achieve better performance by training even larger models is still unclear. To address this issue, we conducted experiments on the pretraining stage of MLLMs. We conduct our experiment using different encoder sizes and large language model (LLM) sizes. Our findings indicate that merely increasing the size of encoders does not necessarily enhance the performance of VLMs. Moreover, we analyzed the effects of LLM backbone parameter size and data quality on the pretraining outcomes. Additionally, we explored the differences in scaling laws between LLMs and VLMs.

Large language models have exhibited exceptional performance on various Natural Language Processing (NLP) tasks, leveraging techniques such as the pre-training, and instruction fine-tuning. Despite these advances, their effectiveness in medical applications is limited, due to challenges such as factual inaccuracies, reasoning abilities, and lack grounding in real-world experience. In this study, we present ClinicalGPT, a language model explicitly designed and optimized for clinical scenarios. By incorporating extensive and diverse real-world data, such as medical records, domain-specific knowledge, and multi-round dialogue consultations in the training process, ClinicalGPT is better prepared to handle multiple clinical task. Furthermore, we introduce a comprehensive evaluation framework that includes medical knowledge question-answering, medical exams, patient consultations, and diagnostic analysis of medical records. Our results demonstrate that ClinicalGPT significantly outperforms other models in these tasks, highlighting the effectiveness of our approach in adapting large language models to the critical domain of healthcare.

Vision language models (VLMs) demonstrate remarkable capabilities on English multimodal tasks, but their performance on low-resource languages with genuinely multimodal educational content remains largely unexplored. In this work, we test how VLMs perform on Vietnamese educational assessments, investigating whether VLMs trained predominantly on English data can handle real-world cross-lingual multimodal reasoning. Our work presents the first comprehensive evaluation of VLM capabilities on multimodal Vietnamese exams through proposing ViExam, a benchmark containing 2,548 multimodal questions. We find that state-of-the-art VLMs achieve only 57.74% while open-source models achieve 27.70% mean accuracy across 7 academic domains, including Mathematics, Physics, Chemistry, Biology, Geography, Driving Test, and IQ Test. Most VLMs underperform average human test-takers (66.54%), with only the thinking VLM o3 (74.07%) exceeding human average performance, yet still falling substantially short of human best performance (99.60%). Cross-lingual prompting with English instructions while maintaining Vietnamese content fails to improve performance, decreasing accuracy by 1 percentage point for SOTA VLMs. Human-in-the-loop collaboration can partially improve VLM performance by 5 percentage points. Code and data are available at: https://vi-exam.github.io.

Visually-situated language is ubiquitous -- sources range from textbooks with diagrams to web pages with images and tables, to mobile apps with buttons and forms. Perhaps due to this diversity, previous work has typically relied on domain-specific recipes with limited sharing of the underlying data, model architectures, and objectives. We present Pix2Struct, a pretrained image-to-text model for purely visual language understanding, which can be finetuned on tasks containing visually-situated language. Pix2Struct is pretrained by learning to parse masked screenshots of web pages into simplified HTML. The web, with its richness of visual elements cleanly reflected in the HTML structure, provides a large source of pretraining data well suited to the diversity of downstream tasks. Intuitively, this objective subsumes common pretraining signals such as OCR, language modeling, image captioning. In addition to the novel pretraining strategy, we introduce a variable-resolution input representation and a more flexible integration of language and vision inputs, where language prompts such as questions are rendered directly on top of the input image. For the first time, we show that a single pretrained model can achieve state-of-the-art results in six out of nine tasks across four domains: documents, illustrations, user interfaces, and natural images.

Recent advancements in multimodal fusion have witnessed the remarkable success of vision-language (VL) models, which excel in various multimodal applications such as image captioning and visual question answering. However, building VL models requires substantial hardware resources, where efficiency is restricted by two key factors: the extended input sequence of the language model with vision features demands more computational operations, and a large number of additional learnable parameters increase memory complexity. These challenges significantly restrict the broader applicability of such models. To bridge this gap, we propose ADEM-VL, an efficient vision-language method that tunes VL models based on pretrained large language models (LLMs) by adopting a parameter-free cross-attention mechanism for similarity measurements in multimodal fusion. This approach only requires embedding vision features into the language space, significantly reducing the number of trainable parameters and accelerating both training and inference speeds. To enhance representation learning in fusion module, we introduce an efficient multiscale feature generation scheme that requires only a single forward pass through the vision encoder. Moreover, we propose an adaptive fusion scheme that dynamically discards less relevant visual information for each text token based on its attention score. This ensures that the fusion process prioritizes the most pertinent visual features. With experiments on various tasks including visual question answering, image captioning, and instruction-following, we demonstrate that our framework outperforms existing approaches. Specifically, our method surpasses existing methods by an average accuracy of 0.77% on ScienceQA dataset, with reduced training and inference latency, demonstrating the superiority of our framework. The code is available at https://github.com/Hao840/ADEM-VL.

Language-image pre-training is an effective technique for learning powerful representations in general domains. However, when directly turning to person representation learning, these general pre-training methods suffer from unsatisfactory performance. The reason is that they neglect critical person-related characteristics, i.e., fine-grained attributes and identities. To address this issue, we propose a novel language-image pre-training framework for person representation learning, termed PLIP. Specifically, we elaborately design three pretext tasks: 1) Text-guided Image Colorization, aims to establish the correspondence between the person-related image regions and the fine-grained color-part textual phrases. 2) Image-guided Attributes Prediction, aims to mine fine-grained attribute information of the person body in the image; and 3) Identity-based Vision-Language Contrast, aims to correlate the cross-modal representations at the identity level rather than the instance level. Moreover, to implement our pre-train framework, we construct a large-scale person dataset with image-text pairs named SYNTH-PEDES by automatically generating textual annotations. We pre-train PLIP on SYNTH-PEDES and evaluate our models by spanning downstream person-centric tasks. PLIP not only significantly improves existing methods on all these tasks, but also shows great ability in the zero-shot and domain generalization settings. The code, dataset and weights will be released at~https://github.com/Zplusdragon/PLIP

Multimodal magnetic resonance imaging (MRI) constitutes the first line of investigation for clinicians in the care of brain tumors, providing crucial insights for surgery planning, treatment monitoring, and biomarker identification. Pre-training on large datasets have been shown to help models learn transferable representations and adapt with minimal labeled data. This behavior is especially valuable in medical imaging, where annotations are often scarce. However, applying this paradigm to multimodal medical data introduces a challenge: most existing approaches assume that all imaging modalities are available during both pre-training and fine-tuning. In practice, missing modalities often occur due to acquisition issues, specialist unavailability, or specific experimental designs on small in-house datasets. Consequently, a common approach involves training a separate model for each desired modality combination, making the process both resource-intensive and impractical for clinical use. Therefore, we introduce BM-MAE, a masked image modeling pre-training strategy tailored for multimodal MRI data. The same pre-trained model seamlessly adapts to any combination of available modalities, extracting rich representations that capture both intra- and inter-modal information. This allows fine-tuning on any subset of modalities without requiring architectural changes, while still benefiting from a model pre-trained on the full set of modalities. Extensive experiments show that the proposed pre-training strategy outperforms or remains competitive with baselines that require separate pre-training for each modality subset, while substantially surpassing training from scratch on several downstream tasks. Additionally, it can quickly and efficiently reconstruct missing modalities, highlighting its practical value. Code and trained models are available at: https://github.com/Lucas-rbnt/BM-MAE

Recent advances in large vision-language models (LVLMs) have demonstrated strong performance on general-purpose medical tasks. However, their effectiveness in specialized domains such as dentistry remains underexplored. In particular, panoramic X-rays, a widely used imaging modality in oral radiology, pose interpretative challenges due to dense anatomical structures and subtle pathological cues, which are not captured by existing medical benchmarks or instruction datasets. To this end, we introduce MMOral, the first large-scale multimodal instruction dataset and benchmark tailored for panoramic X-ray interpretation. MMOral consists of 20,563 annotated images paired with 1.3 million instruction-following instances across diverse task types, including attribute extraction, report generation, visual question answering, and image-grounded dialogue. In addition, we present MMOral-Bench, a comprehensive evaluation suite covering five key diagnostic dimensions in dentistry. We evaluate 64 LVLMs on MMOral-Bench and find that even the best-performing model, i.e., GPT-4o, only achieves 41.45% accuracy, revealing significant limitations of current models in this domain. To promote the progress of this specific domain, we also propose OralGPT, which conducts supervised fine-tuning (SFT) upon Qwen2.5-VL-7B with our meticulously curated MMOral instruction dataset. Remarkably, a single epoch of SFT yields substantial performance enhancements for LVLMs, e.g., OralGPT demonstrates a 24.73% improvement. Both MMOral and OralGPT hold significant potential as a critical foundation for intelligent dentistry and enable more clinically impactful multimodal AI systems in the dental field. The dataset, model, benchmark, and evaluation suite are available at https://github.com/isbrycee/OralGPT.

This work presents biomedical and clinical language models for Spanish by experimenting with different pretraining choices, such as masking at word and subword level, varying the vocabulary size and testing with domain data, looking for better language representations. Interestingly, in the absence of enough clinical data to train a model from scratch, we applied mixed-domain pretraining and cross-domain transfer approaches to generate a performant bio-clinical model suitable for real-world clinical data. We evaluated our models on Named Entity Recognition (NER) tasks for biomedical documents and challenging hospital discharge reports. When compared against the competitive mBERT and BETO models, we outperform them in all NER tasks by a significant margin. Finally, we studied the impact of the model's vocabulary on the NER performances by offering an interesting vocabulary-centric analysis. The results confirm that domain-specific pretraining is fundamental to achieving higher performances in downstream NER tasks, even within a mid-resource scenario. To the best of our knowledge, we provide the first biomedical and clinical transformer-based pretrained language models for Spanish, intending to boost native Spanish NLP applications in biomedicine. Our best models are freely available in the HuggingFace hub: https://huggingface.co/BSC-TeMU.

Recent advancements in vision-language pre-training (e.g. CLIP) have shown that vision models can benefit from language supervision. While many models using language modality have achieved great success on 2D vision tasks, the joint representation learning of 3D point cloud with text remains under-explored due to the difficulty of 3D-Text data pair acquisition and the irregularity of 3D data structure. In this paper, we propose a novel Text4Point framework to construct language-guided 3D point cloud models. The key idea is utilizing 2D images as a bridge to connect the point cloud and the language modalities. The proposed Text4Point follows the pre-training and fine-tuning paradigm. During the pre-training stage, we establish the correspondence of images and point clouds based on the readily available RGB-D data and use contrastive learning to align the image and point cloud representations. Together with the well-aligned image and text features achieved by CLIP, the point cloud features are implicitly aligned with the text embeddings. Further, we propose a Text Querying Module to integrate language information into 3D representation learning by querying text embeddings with point cloud features. For fine-tuning, the model learns task-specific 3D representations under informative language guidance from the label set without 2D images. Extensive experiments demonstrate that our model shows consistent improvement on various downstream tasks, such as point cloud semantic segmentation, instance segmentation, and object detection. The code will be available here: https://github.com/LeapLabTHU/Text4Point

Multi-modal data abounds in biomedicine, such as radiology images and reports. Interpreting this data at scale is essential for improving clinical care and accelerating clinical research. Biomedical text with its complex semantics poses additional challenges in vision--language modelling compared to the general domain, and previous work has used insufficiently adapted models that lack domain-specific language understanding. In this paper, we show that principled textual semantic modelling can substantially improve contrastive learning in self-supervised vision--language processing. We release a language model that achieves state-of-the-art results in radiology natural language inference through its improved vocabulary and novel language pretraining objective leveraging semantics and discourse characteristics in radiology reports. Further, we propose a self-supervised joint vision--language approach with a focus on better text modelling. It establishes new state of the art results on a wide range of publicly available benchmarks, in part by leveraging our new domain-specific language model. We release a new dataset with locally-aligned phrase grounding annotations by radiologists to facilitate the study of complex semantic modelling in biomedical vision--language processing. A broad evaluation, including on this new dataset, shows that our contrastive learning approach, aided by textual-semantic modelling, outperforms prior methods in segmentation tasks, despite only using a global-alignment objective.

To effectively exploit the potential of large-scale models, various pre-training strategies supported by massive data from different sources are proposed, including supervised pre-training, weakly-supervised pre-training, and self-supervised pre-training. It has been proved that combining multiple pre-training strategies and data from various modalities/sources can greatly boost the training of large-scale models. However, current works adopt a multi-stage pre-training system, where the complex pipeline may increase the uncertainty and instability of the pre-training. It is thus desirable that these strategies can be integrated in a single-stage manner. In this paper, we first propose a general multi-modal mutual information formula as a unified optimization target and demonstrate that all existing approaches are special cases of our framework. Under this unified perspective, we propose an all-in-one single-stage pre-training approach, named Maximizing Multi-modal Mutual Information Pre-training (M3I Pre-training). Our approach achieves better performance than previous pre-training methods on various vision benchmarks, including ImageNet classification, COCO object detection, LVIS long-tailed object detection, and ADE20k semantic segmentation. Notably, we successfully pre-train a billion-level parameter image backbone and achieve state-of-the-art performance on various benchmarks. Code shall be released at https://github.com/OpenGVLab/M3I-Pretraining.

Different medical imaging modalities capture diagnostic information at varying spatial resolutions, from coarse global patterns to fine-grained localized structures. However, most existing vision-language frameworks in the medical domain apply a uniform strategy for local feature extraction, overlooking the modality-specific demands. In this work, we present MedMoE, a modular and extensible vision-language processing framework that dynamically adapts visual representation based on the diagnostic context. MedMoE incorporates a Mixture-of-Experts (MoE) module conditioned on the report type, which routes multi-scale image features through specialized expert branches trained to capture modality-specific visual semantics. These experts operate over feature pyramids derived from a Swin Transformer backbone, enabling spatially adaptive attention to clinically relevant regions. This framework produces localized visual representations aligned with textual descriptions, without requiring modality-specific supervision at inference. Empirical results on diverse medical benchmarks demonstrate that MedMoE improves alignment and retrieval performance across imaging modalities, underscoring the value of modality-specialized visual representations in clinical vision-language systems.