Daily Papers

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.

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

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.

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

Vision-language pre-training, i.e., aligning images with paired text, is a powerful paradigm to create encoders that can be directly used for tasks such as classification and retrieval, and for downstream tasks such as segmentation and report generation. In the 3D medical image domain, these capabilities allow vision-language encoders (VLEs) to support radiologists by retrieving patients with similar abnormalities or predicting likelihoods of abnormality. While the methodology holds promise, data availability limits the capabilities of current 3D VLEs. In this paper, we alleviate the lack of data by injecting additional inductive biases: introducing a report generation objective and pairing vision-language pre-training with vision-only pre-training. This allows us to leverage both image-only and paired image-text 3D datasets, increasing the total amount of data to which our model is exposed. Through these additional inductive biases, paired with best practices of the 3D medical imaging domain, we develop the Comprehensive Language-image Pre-training (COLIPRI) encoder family. Our COLIPRI encoders achieve state-of-the-art performance in report generation, classification probing, and zero-shot classification, and remain competitive for semantic segmentation.

Vision-language pre-training has recently gained popularity as it allows learning rich feature representations using large-scale data sources. This paradigm has quickly made its way into the medical image analysis community. In particular, there is an impressive amount of recent literature developing vision-language models for radiology. However, the available medical datasets with image-text supervision are scarce, and medical concepts are fine-grained, involving expert knowledge that existing vision-language models struggle to encode. In this paper, we propose to take a prudent step back from the literature and revisit supervised, unimodal pre-training, using fine-grained labels instead. We conduct an extensive comparison demonstrating that unimodal pre-training is highly competitive and better suited to integrating heterogeneous data sources. Our results also question the potential of recent vision-language models for open-vocabulary generalization, which have been evaluated using optimistic experimental settings. Finally, we study novel alternatives to better integrate fine-grained labels and noisy text supervision.

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.

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.

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.

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 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.

Conversation agents powered by large language models are revolutionizing the way we interact with visual data. Recently, large vision-language models (LVLMs) have been extensively studied for both images and videos. However, these studies typically focus on common scenarios. In this work, we introduce an LVLM specifically designed for surgical scenarios. We integrate visual representations of surgical images and videos into the language feature space. Consequently, we establish a LVLM model, Surgical-LLaVA, fine-tuned on instruction following data of surgical scenarios. Our experiments demonstrate that Surgical-LLaVA exhibits impressive multi-modal chat abilities in surgical contexts, occasionally displaying multi-modal behaviors on unseen instructions. We conduct a quantitative evaluation of visual question-answering datasets for surgical scenarios. The results show superior performance compared to previous works, indicating the potential of our model to tackle more complex surgery scenarios.

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.

Vision-Language Pre-training (VLP) is drawing increasing interest for its ability to minimize manual annotation requirements while enhancing semantic understanding in downstream tasks. However, its reliance on image-text datasets poses challenges due to privacy concerns and the high cost of obtaining paired annotations. Data augmentation emerges as a viable strategy to address this issue, yet existing methods often fall short of capturing the subtle and complex variations in medical data due to limited diversity. To this end, we propose MedCutMix, a novel multi-modal disease-centric data augmentation method. MedCutMix performs diagnostic sentence CutMix within medical reports and establishes the cross-attention between the diagnostic sentence and medical image to guide attentive manifold mix within the imaging modality. Our approach surpasses previous methods across four downstream radiology diagnosis datasets, highlighting its effectiveness in enhancing performance and generalizability in radiology VLP.

Vision-and-language models (VLMs) have been increasingly explored in the medical domain, particularly following the success of CLIP in general domain. However, unlike the relatively straightforward pairing of 2D images and text, curating large-scale paired data in the medical field for volumetric modalities such as CT scans remains a challenging and time-intensive process. This difficulty often limits the performance on downstream tasks. To address these challenges, we propose a novel vision-language pre-training (VLP) framework, termed as VELVET-Med, specifically designed for limited volumetric data such as 3D CT and associated radiology reports. Instead of relying on large-scale data collection, our method focuses on the development of effective pre-training objectives and model architectures. The key contributions are: 1) We incorporate uni-modal self-supervised learning into VLP framework, which are often underexplored in the existing literature. 2) We propose a novel language encoder, termed as TriBERT, for learning multi-level textual semantics. 3) We devise the hierarchical contrastive learning to capture multi-level vision-language correspondence. Using only 38,875 scan-report pairs, our approach seeks to uncover rich spatial and semantic relationships embedded in volumetric medical images and corresponding clinical narratives, thereby enhancing the generalization ability of the learned encoders. The resulting encoders exhibit strong transferability, achieving state-of-the-art performance across a wide range of downstream tasks, including 3D segmentation, cross-modal retrieval, visual question answering, and report generation.

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.

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.

Integration of Vision-Language Models (VLMs) in surgical intelligence is hindered by hallucinations, domain knowledge gaps, and limited understanding of task interdependencies within surgical scenes, undermining clinical reliability. While recent VLMs demonstrate strong general reasoning and thinking capabilities, they still lack the domain expertise and task-awareness required for precise surgical scene interpretation. Although Chain-of-Thought (CoT) can structure reasoning more effectively, current approaches rely on self-generated CoT steps, which often exacerbate inherent domain gaps and hallucinations. To overcome this, we present SurgRAW, a CoT-driven multi-agent framework that delivers transparent, interpretable insights for most tasks in robotic-assisted surgery. By employing specialized CoT prompts across five tasks: instrument recognition, action recognition, action prediction, patient data extraction, and outcome assessment, SurgRAW mitigates hallucinations through structured, domain-aware reasoning. Retrieval-Augmented Generation (RAG) is also integrated to external medical knowledge to bridge domain gaps and improve response reliability. Most importantly, a hierarchical agentic system ensures that CoT-embedded VLM agents collaborate effectively while understanding task interdependencies, with a panel discussion mechanism promotes logical consistency. To evaluate our method, we introduce SurgCoTBench, the first reasoning-based dataset with structured frame-level annotations. With comprehensive experiments, we demonstrate the effectiveness of proposed SurgRAW with 29.32% accuracy improvement over baseline VLMs on 12 robotic procedures, achieving the state-of-the-art performance and advancing explainable, trustworthy, and autonomous surgical assistance.

Every day, countless surgeries are performed worldwide, each within the distinct settings of operating rooms (ORs) that vary not only in their setups but also in the personnel, tools, and equipment used. This inherent diversity poses a substantial challenge for achieving a holistic understanding of the OR, as it requires models to generalize beyond their initial training datasets. To reduce this gap, we introduce ORacle, an advanced vision-language model designed for holistic OR domain modeling, which incorporates multi-view and temporal capabilities and can leverage external knowledge during inference, enabling it to adapt to previously unseen surgical scenarios. This capability is further enhanced by our novel data augmentation framework, which significantly diversifies the training dataset, ensuring ORacle's proficiency in applying the provided knowledge effectively. In rigorous testing, in scene graph generation, and downstream tasks on the 4D-OR dataset, ORacle not only demonstrates state-of-the-art performance but does so requiring less data than existing models. Furthermore, its adaptability is displayed through its ability to interpret unseen views, actions, and appearances of tools and equipment. This demonstrates ORacle's potential to significantly enhance the scalability and affordability of OR domain modeling and opens a pathway for future advancements in surgical data science. We will release our code and data upon acceptance.

Natural language could play an important role in developing generalist surgical models by providing a broad source of supervision from raw texts. This flexible form of supervision can enable the model's transferability across datasets and tasks as natural language can be used to reference learned visual concepts or describe new ones. In this work, we present HecVL, a novel hierarchical video-language pretraining approach for building a generalist surgical model. Specifically, we construct a hierarchical video-text paired dataset by pairing the surgical lecture video with three hierarchical levels of texts: at clip-level, atomic actions using transcribed audio texts; at phase-level, conceptual text summaries; and at video-level, overall abstract text of the surgical procedure. Then, we propose a novel fine-to-coarse contrastive learning framework that learns separate embedding spaces for the three video-text hierarchies using a single model. By disentangling embedding spaces of different hierarchical levels, the learned multi-modal representations encode short-term and long-term surgical concepts in the same model. Thanks to the injected textual semantics, we demonstrate that the HecVL approach can enable zero-shot surgical phase recognition without any human annotation. Furthermore, we show that the same HecVL model for surgical phase recognition can be transferred across different surgical procedures and medical centers. The code is available at https://github.com/CAMMA-public/SurgVLP

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.

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.

Understanding the workflow of surgical procedures in complex operating rooms requires a deep understanding of the interactions between clinicians and their environment. Surgical activity recognition (SAR) is a key computer vision task that detects activities or phases from multi-view camera recordings. Existing SAR models often fail to account for fine-grained clinician movements and multi-view knowledge, or they require calibrated multi-view camera setups and advanced point-cloud processing to obtain better results. In this work, we propose a novel calibration-free multi-view multi-modal pretraining framework called Multiview Pretraining for Video-Pose Surgical Activity Recognition PreViPS, which aligns 2D pose and vision embeddings across camera views. Our model follows CLIP-style dual-encoder architecture: one encoder processes visual features, while the other encodes human pose embeddings. To handle the continuous 2D human pose coordinates, we introduce a tokenized discrete representation to convert the continuous 2D pose coordinates into discrete pose embeddings, thereby enabling efficient integration within the dual-encoder framework. To bridge the gap between these two modalities, we propose several pretraining objectives using cross- and in-modality geometric constraints within the embedding space and incorporating masked pose token prediction strategy to enhance representation learning. Extensive experiments and ablation studies demonstrate improvements over the strong baselines, while data-efficiency experiments on two distinct operating room datasets further highlight the effectiveness of our approach. We highlight the benefits of our approach for surgical activity recognition in both multi-view and single-view settings, showcasing its practical applicability in complex surgical environments. Code will be made available at: https://github.com/CAMMA-public/PreViPS.

Contrastive Language-Image Pre-training (CLIP), a simple yet effective pre-training paradigm, successfully introduces text supervision to vision models. It has shown promising results across various tasks due to its generalizability and interpretability. The use of CLIP has recently gained increasing interest in the medical imaging domain, serving as a pre-training paradigm for image-text alignment, or a critical component in diverse clinical tasks. With the aim of facilitating a deeper understanding of this promising direction, this survey offers an in-depth exploration of the CLIP within the domain of medical imaging, regarding both refined CLIP pre-training and CLIP-driven applications. In this paper, we (1) first start with a brief introduction to the fundamentals of CLIP methodology; (2) then investigate the adaptation of CLIP pre-training in the medical imaging domain, focusing on how to optimize CLIP given characteristics of medical images and reports; (3) further explore practical utilization of CLIP pre-trained models in various tasks, including classification, dense prediction, and cross-modal tasks; and (4) finally discuss existing limitations of CLIP in the context of medical imaging, and propose forward-looking directions to address the demands of medical imaging domain. Studies featuring technical and practical value are both investigated. We expect this survey will provide researchers with a holistic understanding of the CLIP paradigm and its potential implications. The project page of this survey can also be found on https://github.com/zhaozh10/Awesome-CLIP-in-Medical-Imaging.

Quantification of real-time informal feedback delivered by an experienced surgeon to a trainee during surgery is important for skill improvements in surgical training. Such feedback in the live operating room is inherently multimodal, consisting of verbal conversations (e.g., questions and answers) as well as non-verbal elements (e.g., through visual cues like pointing to anatomic elements). In this work, we leverage a clinically-validated five-category classification of surgical feedback: "Anatomic", "Technical", "Procedural", "Praise" and "Visual Aid". We then develop a multi-label machine learning model to classify these five categories of surgical feedback from inputs of text, audio, and video modalities. The ultimate goal of our work is to help automate the annotation of real-time contextual surgical feedback at scale. Our automated classification of surgical feedback achieves AUCs ranging from 71.5 to 77.6 with the fusion improving performance by 3.1%. We also show that high-quality manual transcriptions of feedback audio from experts improve AUCs to between 76.5 and 96.2, which demonstrates a clear path toward future improvements. Empirically, we find that the Staged training strategy, with first pre-training each modality separately and then training them jointly, is more effective than training different modalities altogether. We also present intuitive findings on the importance of modalities for different feedback categories. This work offers an important first look at the feasibility of automated classification of real-world live surgical feedback based on text, audio, and video modalities.

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.

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.

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-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.

Current vision-language models (VLMs) in medicine are primarily designed for categorical question answering (e.g., "Is this normal or abnormal?") or qualitative descriptive tasks. However, clinical decision-making often relies on quantitative assessments, such as measuring the size of a tumor or the angle of a joint, from which physicians draw their own diagnostic conclusions. This quantitative reasoning capability remains underexplored and poorly supported in existing VLMs. In this work, we introduce MedVision, a large-scale dataset and benchmark specifically designed to evaluate and improve VLMs on quantitative medical image analysis. MedVision spans 22 public datasets covering diverse anatomies and modalities, with 30.8 million image-annotation pairs. We focus on three representative quantitative tasks: (1) detection of anatomical structures and abnormalities, (2) tumor/lesion (T/L) size estimation, and (3) angle/distance (A/D) measurement. Our benchmarks show that current off-the-shelf VLMs perform poorly on these tasks. However, with supervised fine-tuning on MedVision, we significantly enhance their performance across detection, T/L estimation, and A/D measurement, demonstrating reduced error rates and improved precision. This work provides a foundation for developing VLMs with robust quantitative reasoning capabilities in medical imaging. Code and data are available at https://medvision-vlm.github.io.

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.

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.

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.

This work introduces the first framework for reconstructing surgical dialogue from unstructured real-world recordings, which is crucial for characterizing teaching tasks. In surgical training, the formative verbal feedback that trainers provide to trainees during live surgeries is crucial for ensuring safety, correcting behavior immediately, and facilitating long-term skill acquisition. However, analyzing and quantifying this feedback is challenging due to its unstructured and specialized nature. Automated systems are essential to manage these complexities at scale, allowing for the creation of structured datasets that enhance feedback analysis and improve surgical education. Our framework integrates voice activity detection, speaker diarization, and automated speech recaognition, with a novel enhancement that 1) removes hallucinations (non-existent utterances generated during speech recognition fueled by noise in the operating room) and 2) separates speech from trainers and trainees using few-shot voice samples. These aspects are vital for reconstructing accurate surgical dialogues and understanding the roles of operating room participants. Using data from 33 real-world surgeries, we demonstrated the system's capability to reconstruct surgical teaching dialogues and detect feedback instances effectively (F1 score of 0.79+/-0.07). Moreover, our hallucination removal step improves feedback detection performance by ~14%. Evaluation on downstream clinically relevant tasks of predicting Behavioral Adjustment of trainees and classifying Technical feedback, showed performances comparable to manual annotations with F1 scores of 0.82+/0.03 and 0.81+/0.03 respectively. These results highlight the effectiveness of our framework in supporting clinically relevant tasks and improving over manual methods.

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.

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.

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.

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.

Modern computer vision is converging on a closed loop in which perception, reasoning and generation mutually reinforce each other. However, this loop remains incomplete: the top-down influence of high-level reasoning on the foundational learning of low-level perceptual features is not yet underexplored. This paper addresses this gap by proposing a new paradigm for pretraining foundation models in downstream domains. We introduce Visual insTruction Pretraining (ViTP), a novel approach that directly leverages reasoning to enhance perception. ViTP embeds a Vision Transformer (ViT) backbone within a Vision-Language Model and pretrains it end-to-end using a rich corpus of visual instruction data curated from target downstream domains. ViTP is powered by our proposed Visual Robustness Learning (VRL), which compels the ViT to learn robust and domain-relevant features from a sparse set of visual tokens. Extensive experiments on 16 challenging remote sensing and medical imaging benchmarks demonstrate that ViTP establishes new state-of-the-art performance across a diverse range of downstream tasks. The code is available at github.com/zcablii/ViTP.

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.

In ophthalmic surgery, developing an AI system capable of interpreting surgical videos and predicting subsequent operations requires numerous ophthalmic surgical videos with high-quality annotations, which are difficult to collect due to privacy concerns and labor consumption. Text-guided video generation (T2V) emerges as a promising solution to overcome this issue by generating ophthalmic surgical videos based on surgeon instructions. In this paper, we present Ophora, a pioneering model that can generate ophthalmic surgical videos following natural language instructions. To construct Ophora, we first propose a Comprehensive Data Curation pipeline to convert narrative ophthalmic surgical videos into a large-scale, high-quality dataset comprising over 160K video-instruction pairs, Ophora-160K. Then, we propose a Progressive Video-Instruction Tuning scheme to transfer rich spatial-temporal knowledge from a T2V model pre-trained on natural video-text datasets for privacy-preserved ophthalmic surgical video generation based on Ophora-160K. Experiments on video quality evaluation via quantitative analysis and ophthalmologist feedback demonstrate that Ophora can generate realistic and reliable ophthalmic surgical videos based on surgeon instructions. We also validate the capability of Ophora for empowering downstream tasks of ophthalmic surgical workflow understanding. Code is available at https://github.com/mar-cry/Ophora.

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.

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.

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.

Modern operating room is becoming increasingly complex, requiring innovative intra-operative support systems. While the focus of surgical data science has largely been on video analysis, integrating surgical computer vision with language capabilities is emerging as a necessity. Our work aims to advance Visual Question Answering (VQA) in the surgical context with scene graph knowledge, addressing two main challenges in the current surgical VQA systems: removing question-condition bias in the surgical VQA dataset and incorporating scene-aware reasoning in the surgical VQA model design. First, we propose a Surgical Scene Graph-based dataset, SSG-QA, generated by employing segmentation and detection models on publicly available datasets. We build surgical scene graphs using spatial and action information of instruments and anatomies. These graphs are fed into a question engine, generating diverse QA pairs. Our SSG-QA dataset provides a more complex, diverse, geometrically grounded, unbiased, and surgical action-oriented dataset compared to existing surgical VQA datasets. We then propose SSG-QA-Net, a novel surgical VQA model incorporating a lightweight Scene-embedded Interaction Module (SIM), which integrates geometric scene knowledge in the VQA model design by employing cross-attention between the textual and the scene features. Our comprehensive analysis of the SSG-QA dataset shows that SSG-QA-Net outperforms existing methods across different question types and complexities. We highlight that the primary limitation in the current surgical VQA systems is the lack of scene knowledge to answer complex queries. We present a novel surgical VQA dataset and model and show that results can be significantly improved by incorporating geometric scene features in the VQA model design. The source code and the dataset will be made publicly available at: https://github.com/CAMMA-public/SSG-QA

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.

Large Language Models (LLMs), despite being trained on text alone, surprisingly develop rich visual priors. These priors allow latent visual capabilities to be unlocked for vision tasks with a relatively small amount of multimodal data, and in some cases, to perform visual tasks without ever having seen an image. Through systematic analysis, we reveal that visual priors-the implicit, emergent knowledge about the visual world acquired during language pre-training-are composed of separable perception and reasoning priors with unique scaling trends and origins. We show that an LLM's latent visual reasoning ability is predominantly developed by pre-training on reasoning-centric data (e.g., code, math, academia) and scales progressively. This reasoning prior acquired from language pre-training is transferable and universally applicable to visual reasoning. In contrast, a perception prior emerges more diffusely from broad corpora, and perception ability is more sensitive to the vision encoder and visual instruction tuning data. In parallel, text describing the visual world proves crucial, though its performance impact saturates rapidly. Leveraging these insights, we propose a data-centric recipe for pre-training vision-aware LLMs and verify it in 1T token scale pre-training. Our findings are grounded in over 100 controlled experiments consuming 500,000 GPU-hours, spanning the full MLLM construction pipeline-from LLM pre-training to visual alignment and supervised multimodal fine-tuning-across five model scales, a wide range of data categories and mixtures, and multiple adaptation setups. Along with our main findings, we propose and investigate several hypotheses, and introduce the Multi-Level Existence Bench (MLE-Bench). Together, this work provides a new way of deliberately cultivating visual priors from language pre-training, paving the way for the next generation of multimodal LLMs.

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.

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.

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.

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.

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.

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 .

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.

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.

Over the past decade, computer vision applications in minimally invasive surgery have rapidly increased. Despite this growth, the impact of surgical computer vision remains limited compared to other medical fields like pathology and radiology, primarily due to the scarcity of representative annotated data. Whereas transfer learning from large annotated datasets such as ImageNet has been conventionally the norm to achieve high-performing models, recent advancements in self-supervised learning (SSL) have demonstrated superior performance. In medical image analysis, in-domain SSL pretraining has already been shown to outperform ImageNet-based initialization. Although unlabeled data in the field of surgical computer vision is abundant, the diversity within this data is limited. This study investigates the role of dataset diversity in SSL for surgical computer vision, comparing procedure-specific datasets against a more heterogeneous general surgical dataset across three different downstream surgical applications. The obtained results show that using solely procedure-specific data can lead to substantial improvements of 13.8%, 9.5%, and 36.8% compared to ImageNet pretraining. However, extending this data with more heterogeneous surgical data further increases performance by an additional 5.0%, 5.2%, and 2.5%, suggesting that increasing diversity within SSL data is beneficial for model performance. The code and pretrained model weights are made publicly available at https://github.com/TimJaspers0801/SurgeNet.

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.

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.

Large annotated datasets are essential for training robust Computer-Aided Diagnosis (CAD) models for breast cancer detection or risk prediction. However, acquiring such datasets with fine-detailed annotation is both costly and time-consuming. Vision-Language Models (VLMs), such as CLIP, which are pre-trained on large image-text pairs, offer a promising solution by enhancing robustness and data efficiency in medical imaging tasks. This paper introduces a novel Multi-View Mammography and Language Model for breast cancer classification and risk prediction, trained on a dataset of paired mammogram images and synthetic radiology reports. Our MV-MLM leverages multi-view supervision to learn rich representations from extensive radiology data by employing cross-modal self-supervision across image-text pairs. This includes multiple views and the corresponding pseudo-radiology reports. We propose a novel joint visual-textual learning strategy to enhance generalization and accuracy performance over different data types and tasks to distinguish breast tissues or cancer characteristics(calcification, mass) and utilize these patterns to understand mammography images and predict cancer risk. We evaluated our method on both private and publicly available datasets, demonstrating that the proposed model achieves state-of-the-art performance in three classification tasks: (1) malignancy classification, (2) subtype classification, and (3) image-based cancer risk prediction. Furthermore, the model exhibits strong data efficiency, outperforming existing fully supervised or VLM baselines while trained on synthetic text reports and without the need for actual radiology reports.

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.

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.

This paper surveys vision-language pre-training (VLP) methods for multimodal intelligence that have been developed in the last few years. We group these approaches into three categories: (i) VLP for image-text tasks, such as image captioning, image-text retrieval, visual question answering, and visual grounding; (ii) VLP for core computer vision tasks, such as (open-set) image classification, object detection, and segmentation; and (iii) VLP for video-text tasks, such as video captioning, video-text retrieval, and video question answering. For each category, we present a comprehensive review of state-of-the-art methods, and discuss the progress that has been made and challenges still being faced, using specific systems and models as case studies. In addition, for each category, we discuss advanced topics being actively explored in the research community, such as big foundation models, unified modeling, in-context few-shot learning, knowledge, robustness, and computer vision in the wild, to name a few.

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.

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 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.

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.

During surgical training, real-time feedback from trainers to trainees is important for preventing errors and enhancing long-term skill acquisition. Accurately predicting the effectiveness of this feedback, specifically whether it leads to a change in trainee behavior, is crucial for developing methods for improving surgical training and education. However, relying on human annotations to assess feedback effectiveness is laborious and prone to biases, underscoring the need for an automated, scalable, and objective method. Creating such an automated system poses challenges, as it requires an understanding of both the verbal feedback delivered by the trainer and the visual context of the real-time surgical scene. To address this, we propose a method that integrates information from transcribed verbal feedback and corresponding surgical video to predict feedback effectiveness. Our findings show that both transcribed feedback and surgical video are individually predictive of trainee behavior changes, and their combination achieves an AUROC of 0.70+/-0.02, improving prediction accuracy by up to 6.6%. Additionally, we introduce self-supervised fine-tuning as a strategy for enhancing surgical video representation learning, which is scalable and further enhances prediction performance. Our results demonstrate the potential of multi-modal learning to advance the automated assessment of surgical feedback.

Purpose: General consensus amongst researchers and industry points to a lack of large, representative annotated datasets as the biggest obstacle to progress in the field of surgical data science. Self-supervised learning represents a solution to part of this problem, removing the reliance on annotations. However, the robustness of current self-supervised learning methods to domain shifts remains unclear, limiting our understanding of its utility for leveraging diverse sources of surgical data. Methods: In this work, we employ self-supervised learning to flexibly leverage diverse surgical datasets, thereby learning taskagnostic representations that can be used for various surgical downstream tasks. Based on this approach, to elucidate the impact of pre-training on downstream task performance, we explore 22 different pre-training dataset combinations by modulating three variables: source hospital, type of surgical procedure, and pre-training scale (number of videos). We then finetune the resulting model initializations on three diverse downstream tasks: namely, phase recognition and critical view of safety in laparoscopic cholecystectomy and phase recognition in laparoscopic hysterectomy. Results: Controlled experimentation highlights sizable boosts in performance across various tasks, datasets, and labeling budgets. However, this performance is intricately linked to the composition of the pre-training dataset, robustly proven through several study stages. Conclusion: The composition of pre-training datasets can severely affect the effectiveness of SSL methods for various downstream tasks and should critically inform future data collection efforts to scale the application of SSL methodologies. Keywords: Self-Supervised Learning, Transfer Learning, Surgical Computer Vision, Endoscopic Videos, Critical View of Safety, Phase Recognition

The lack of labeled datasets in 3D vision for surgical scenes inhibits the development of robust 3D reconstruction algorithms in the medical domain. Despite the popularity of Neural Radiance Fields and 3D Gaussian Splatting in the general computer vision community, these systems have yet to find consistent success in surgical scenes due to challenges such as non-stationary lighting and non-Lambertian surfaces. As a result, the need for labeled surgical datasets continues to grow. In this work, we introduce a differentiable rendering framework for material and lighting estimation from endoscopic images and known geometry. Compared to previous approaches that model lighting and material jointly as radiance, we explicitly disentangle these scene properties for robust and photorealistic novel view synthesis. To disambiguate the training process, we formulate domain-specific properties inherent in surgical scenes. Specifically, we model the scene lighting as a simple spotlight and material properties as a bidirectional reflectance distribution function, parameterized by a neural network. By grounding color predictions in the rendering equation, we can generate photorealistic images at arbitrary camera poses. We evaluate our method with various sequences from the Colonoscopy 3D Video Dataset and show that our method produces competitive novel view synthesis results compared with other approaches. Furthermore, we demonstrate that synthetic data can be used to develop 3D vision algorithms by finetuning a depth estimation model with our rendered outputs. Overall, we see that the depth estimation performance is on par with fine-tuning with the original real images.

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.

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.

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.

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.

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.

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.

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.

Recent progress in vision-language modeling for 3D medical imaging has been fueled by large-scale computed tomography (CT) corpora with paired free-text reports, stronger architectures, and powerful pretrained models. This has enabled applications such as automated report generation and text-conditioned 3D image synthesis. Yet, current approaches struggle with high-resolution, long-sequence volumes: contrastive pretraining often yields vision encoders that are misaligned with clinical language, and slice-wise tokenization blurs fine anatomy, reducing diagnostic performance on downstream tasks. We introduce BTB3D (Better Tokens for Better 3D), a causal convolutional encoder-decoder that unifies 2D and 3D training and inference while producing compact, frequency-aware volumetric tokens. A three-stage training curriculum enables (i) local reconstruction, (ii) overlapping-window tiling, and (iii) long-context decoder refinement, during which the model learns from short slice excerpts yet generalizes to scans exceeding 300 slices without additional memory overhead. BTB3D sets a new state-of-the-art on two key tasks: it improves BLEU scores and increases clinical F1 by 40% over CT2Rep, CT-CHAT, and Merlin for report generation; and it reduces FID by 75% and halves FVD compared to GenerateCT and MedSyn for text-to-CT synthesis, producing anatomically consistent 512*512*241 volumes. These results confirm that precise three-dimensional tokenization, rather than larger language backbones alone, is essential for scalable vision-language modeling in 3D medical imaging. The codebase is available at: https://github.com/ibrahimethemhamamci/BTB3D

The field of surgical computer vision has undergone considerable breakthroughs in recent years with the rising popularity of deep neural network-based methods. However, standard fully-supervised approaches for training such models require vast amounts of annotated data, imposing a prohibitively high cost; especially in the clinical domain. Self-Supervised Learning (SSL) methods, which have begun to gain traction in the general computer vision community, represent a potential solution to these annotation costs, allowing to learn useful representations from only unlabeled data. Still, the effectiveness of SSL methods in more complex and impactful domains, such as medicine and surgery, remains limited and unexplored. In this work, we address this critical need by investigating four state-of-the-art SSL methods (MoCo v2, SimCLR, DINO, SwAV) in the context of surgical computer vision. We present an extensive analysis of the performance of these methods on the Cholec80 dataset for two fundamental and popular tasks in surgical context understanding, phase recognition and tool presence detection. We examine their parameterization, then their behavior with respect to training data quantities in semi-supervised settings. Correct transfer of these methods to surgery, as described and conducted in this work, leads to substantial performance gains over generic uses of SSL - up to 7.4% on phase recognition and 20% on tool presence detection - as well as state-of-the-art semi-supervised phase recognition approaches by up to 14%. Further results obtained on a highly diverse selection of surgical datasets exhibit strong generalization properties. The code is available at https://github.com/CAMMA-public/SelfSupSurg.

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.

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.

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.

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.

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-Language Pretraining (VLP) has achieved remarkable success across various downstream tasks, but such gains are largely driven by scaling up on training data. Yet, literature methods treat image-text pairs as isolated training examples; this neglects the rich relational structure naturally present in many domains, such as e-commerce product co-purchase graphs and social recommendation networks. Inspired by neuroscientific evidence that human encodes knowledge as relationship cognitive maps, we introduce Structure-aware Language-Image Pretraining (SLIP). SLIP integrates a structural contrastive loss to align modalities while also modeling relationships between neighboring entities in a structured graph. To support this paradigm, we construct a large-scale Amazon Product Co-purchase Multimodal Graph Dataset, enabling structured cross-modality supervision at scale. Experiment results show that SLIP consistently outperforms CLIP on cross-modal retrieval and classification tasks in both zero-shot and few-shot settings, showing the value of relational supervision for cross-modal alignment.

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.

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.

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.

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.

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.

Vision-language pretraining has advanced image-text alignment, yet progress in radiology remains constrained by the heterogeneity of clinical reports, including abbreviations, impression-only notes, and stylistic variability. Unlike general-domain settings where more data often leads to better performance, naively scaling to large collections of noisy reports can plateau or even degrade model learning. We ask whether large language model (LLM) encoders can provide robust clinical representations that transfer across diverse styles and better guide image-text alignment. We introduce LLM2VEC4CXR, a domain-adapted LLM encoder for chest X-ray reports, and LLM2CLIP4CXR, a dual-tower framework that couples this encoder with a vision backbone. LLM2VEC4CXR improves clinical text understanding over BERT-based baselines, handles abbreviations and style variation, and achieves strong clinical alignment on report-level metrics. LLM2CLIP4CXR leverages these embeddings to boost retrieval accuracy and clinically oriented scores, with stronger cross-dataset generalization than prior medical CLIP variants. Trained on 1.6M CXR studies from public and private sources with heterogeneous and noisy reports, our models demonstrate that robustness -- not scale alone -- is the key to effective multimodal learning. We release models to support further research in medical image-text representation learning.

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.

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.

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.

Vision-language models (VLMs) pre-trained on natural image and language data, such as CLIP, have exhibited significant potential in few-shot image recognition tasks, leading to development of various efficient transfer learning methods. These methods exploit inherent pre-learned knowledge in VLMs and have achieved strong performance on standard image datasets. However, their effectiveness is often limited when confronted with cross-domain tasks where imaging domains differ from natural images. To address this limitation, we propose Consistency-guided Multi-view Collaborative Optimization (CoMuCo), a novel fine-tuning strategy for VLMs. This strategy employs two functionally complementary expert modules to extract multi-view features, while incorporating prior knowledge-based consistency constraints and information geometry-based consensus mechanisms to enhance the robustness of feature learning. Additionally, a new cross-domain few-shot benchmark is established to help comprehensively evaluate methods on imaging domains distinct from natural images. Extensive empirical evaluations on both existing and newly proposed benchmarks suggest CoMuCo consistently outperforms current methods in few-shot tasks. The code and benchmark will be released.

Echocardiography records ultrasound videos of the heart, enabling clinicians to assess cardiac function. Recent advances in large-scale vision-language models (VLMs) have spurred interest in automating echocardiographic interpretation. However, most existing medical VLMs rely on single-frame (image) inputs, which can reduce diagnostic accuracy for conditions identifiable only through cardiac motion. In addition, echocardiographic videos are captured from multiple views, each varying in suitability for detecting specific conditions. Leveraging multiple views may therefore improve diagnostic performance. We developed a video-language model that processes full video sequences from five standard views, trained on 60,747 echocardiographic video-report pairs. We evaluated the gains in retrieval performance from video input and multi-view support, including the contributions of various pretrained models.

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.

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.

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

In the past several years there has been an explosion of available models for vision-language tasks. Unfortunately, the literature still leaves open a number of questions related to best practices in designing and training such models. In this paper we seek to answer several questions related to the pretraining of vision-language encoders through meta-analysis. In our first set of experiments, we show that we can save significant compute at no cost to downstream performance, by freezing large parts of vision-language models during pretraining. In our second set of experiments we examine the effect of basing a VL transformer on a vision model versus a text model. Additionally, we introduce a VL modeling platform called Renaissance that we use to conduct all of the experiments. This program offers a great deal of flexibility in creating, training and evaluating transformer encoders for VL modeling. The source code for Renaissance can be found at https://github.com/bsu-slim/renaissance.

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.

In this paper, we propose a novel text promptable surgical instrument segmentation approach to overcome challenges associated with diversity and differentiation of surgical instruments in minimally invasive surgeries. We redefine the task as text promptable, thereby enabling a more nuanced comprehension of surgical instruments and adaptability to new instrument types. Inspired by recent advancements in vision-language models, we leverage pretrained image and text encoders as our model backbone and design a text promptable mask decoder consisting of attention- and convolution-based prompting schemes for surgical instrument segmentation prediction. Our model leverages multiple text prompts for each surgical instrument through a new mixture of prompts mechanism, resulting in enhanced segmentation performance. Additionally, we introduce a hard instrument area reinforcement module to improve image feature comprehension and segmentation precision. Extensive experiments on EndoVis2017 and EndoVis2018 datasets demonstrate our model's superior performance and promising generalization capability. To our knowledge, this is the first implementation of a promptable approach to surgical instrument segmentation, offering significant potential for practical application in the field of robotic-assisted surgery.

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.

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

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.

The ability to recognize and reason about text embedded in visual inputs is often lacking in vision-and-language (V&L) models, perhaps because V&L pre-training methods have often failed to include such an ability in their training objective. In this paper, we propose PreSTU, a novel pre-training recipe dedicated to scene-text understanding (STU). PreSTU introduces OCR-aware pre-training objectives that encourage the model to recognize text from an image and connect it to the rest of the image content. We implement PreSTU using a simple transformer-based encoder-decoder architecture, combined with large-scale image-text datasets with scene text obtained from an off-the-shelf OCR system. We empirically demonstrate the effectiveness of this pre-training approach on eight visual question answering and four image captioning benchmarks.

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 models (VLMs) show promise in medical diagnosis, but their performance across demographic subgroups when using in-context learning (ICL) remains poorly understood. We examine how the demographic composition of demonstration examples affects VLM performance in two medical imaging tasks: skin lesion malignancy prediction and pneumothorax detection from chest radiographs. Our analysis reveals that ICL influences model predictions through multiple mechanisms: (1) ICL allows VLMs to learn subgroup-specific disease base rates from prompts and (2) ICL leads VLMs to make predictions that perform differently across demographic groups, even after controlling for subgroup-specific disease base rates. Our empirical results inform best-practices for prompting current VLMs (specifically examining demographic subgroup performance, and matching base rates of labels to target distribution at a bulk level and within subgroups), while also suggesting next steps for improving our theoretical understanding of these models.

Medical decision-making requires integrating diverse medical information, from imaging to clinical narratives. These medical modalities are often acquired in a many-to-many manner. However, current medical vision-language pretraining models (Med-VLPMs) fail to directly account for this many-to-many mapping in their model training and embeddings. To address this, we present Probabilistic Modality-Enhanced Diagnosis (ProbMED), a multimodal Med-VLPM that employs probabilistic contrastive learning to model distributions over embeddings rather than deterministic estimates. ProbMED aligns four distinct modalities -- chest X-rays, electrocardiograms, echocardiograms, and clinical text -- into a unified probabilistic embedding space. We use InfoNCE loss with Hellinger distance to integrate inter-modality distributions. We introduce a probabilistic synthetic sampling loss that captures modality-specific mean and variance to improve intra-modality binding. Extensive experiments across 13 medical datasets demonstrate that our model outperforms current Med-VLPMs in cross-modality retrieval, zero-shot, and few-shot classification. We also demonstrate the robust integration of multiple modalities for prognostication, showing improved intra- and inter-medical modality binding.

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.

Recent advances in vision language models (VLMs) have enabled broad progress in the general medical field. However, pathology still remains a more challenging subdomain, with current pathology specific VLMs exhibiting limitations in both diagnostic accuracy and reasoning plausibility. Such shortcomings are largely attributable to the nature of current pathology datasets, which are primarily composed of image description pairs that lack the depth and structured diagnostic paradigms employed by real world pathologists. In this study, we leverage pathology textbooks and real world pathology experts to construct high-quality, reasoning-oriented datasets. Building on this, we introduce Patho-R1, a multimodal RL-based pathology Reasoner, trained through a three-stage pipeline: (1) continued pretraining on 3.5 million image-text pairs for knowledge infusion; (2) supervised fine-tuning on 500k high-quality Chain-of-Thought samples for reasoning incentivizing; (3) reinforcement learning using Group Relative Policy Optimization and Decoupled Clip and Dynamic sAmpling Policy Optimization strategies for multimodal reasoning quality refinement. To further assess the alignment quality of our dataset, we propose PathoCLIP, trained on the same figure-caption corpus used for continued pretraining. Comprehensive experimental results demonstrate that both PathoCLIP and Patho-R1 achieve robust performance across a wide range of pathology-related tasks, including zero-shot classification, cross-modal retrieval, Visual Question Answering, and Multiple Choice Question. Our project is available at the Patho-R1 repository: https://github.com/Wenchuan-Zhang/Patho-R1.

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

Contrastive language image pretraining (CLIP) is a standard method for training vision-language models. While CLIP is scalable, promptable, and robust to distribution shifts on image classification tasks, it lacks object localization capabilities. This paper studies the following question: Can we augment CLIP training with task-specific vision models from model zoos to improve its visual representations? Towards this end, we leverage open-source task-specific vision models to generate pseudo-labels for an uncurated and noisy image-text dataset. Subsequently, we train CLIP models on these pseudo-labels in addition to the contrastive training on image and text pairs. This simple setup shows substantial improvements of up to 16.3% across different vision tasks, including segmentation, detection, depth estimation, and surface normal estimation. Importantly, these enhancements are achieved without compromising CLIP's existing capabilities, including its proficiency in promptable zero-shot classification.

Surgical scene perception via videos are critical for advancing robotic surgery, telesurgery, and AI-assisted surgery, particularly in ophthalmology. However, the scarcity of diverse and richly annotated video datasets has hindered the development of intelligent systems for surgical workflow analysis. Existing datasets for surgical workflow analysis, which typically face challenges such as small scale, a lack of diversity in surgery and phase categories, and the absence of time-localized annotations, limit the requirements for action understanding and model generalization validation in complex and diverse real-world surgical scenarios. To address this gap, we introduce OphNet, a large-scale, expert-annotated video benchmark for ophthalmic surgical workflow understanding. OphNet features: 1) A diverse collection of 2,278 surgical videos spanning 66 types of cataract, glaucoma, and corneal surgeries, with detailed annotations for 102 unique surgical phases and 150 granular operations; 2) It offers sequential and hierarchical annotations for each surgery, phase, and operation, enabling comprehensive understanding and improved interpretability; 3) Moreover, OphNet provides time-localized annotations, facilitating temporal localization and prediction tasks within surgical workflows. With approximately 205 hours of surgical videos, OphNet is about 20 times larger than the largest existing surgical workflow analysis benchmark. Our dataset and code have been made available at: https://github.com/minghu0830/OphNet-benchmark.

We explore the use of language as a perceptual representation for vision-and-language navigation. Our approach uses off-the-shelf vision systems (for image captioning and object detection) to convert an agent's egocentric panoramic view at each time step into natural language descriptions. We then finetune a pretrained language model to select an action, based on the current view and the trajectory history, that would best fulfill the navigation instructions. In contrast to the standard setup which adapts a pretrained language model to work directly with continuous visual features from pretrained vision models, our approach instead uses (discrete) language as the perceptual representation. We explore two use cases of our language-based navigation (LangNav) approach on the R2R vision-and-language navigation benchmark: generating synthetic trajectories from a prompted large language model (GPT-4) with which to finetune a smaller language model; and sim-to-real transfer where we transfer a policy learned on a simulated environment (ALFRED) to a real-world environment (R2R). Our approach is found to improve upon strong baselines that rely on visual features in settings where only a few gold trajectories (10-100) are available, demonstrating the potential of using language as a perceptual representation for navigation tasks.

Contrastive Language-Image Pre-training (CLIP) plays an essential role in extracting valuable content information from images across diverse tasks. It aligns textual and visual modalities to comprehend the entire image, including all the details, even those irrelevant to specific tasks. However, for a finer understanding and controlled editing of images, it becomes crucial to focus on specific regions of interest, which can be indicated as points, masks, or boxes by humans or perception models. To fulfill the requirements, we introduce Alpha-CLIP, an enhanced version of CLIP with an auxiliary alpha channel to suggest attentive regions and fine-tuned with constructed millions of RGBA region-text pairs. Alpha-CLIP not only preserves the visual recognition ability of CLIP but also enables precise control over the emphasis of image contents. It demonstrates effectiveness in various tasks, including but not limited to open-world recognition, multimodal large language models, and conditional 2D / 3D generation. It has a strong potential to serve as a versatile tool for image-related tasks.

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.

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.

In this paper, we examine the effectiveness of pre-training for visuo-motor control tasks. We revisit a simple Learning-from-Scratch (LfS) baseline that incorporates data augmentation and a shallow ConvNet, and find that this baseline is surprisingly competitive with recent approaches (PVR, MVP, R3M) that leverage frozen visual representations trained on large-scale vision datasets -- across a variety of algorithms, task domains, and metrics in simulation and on a real robot. Our results demonstrate that these methods are hindered by a significant domain gap between the pre-training datasets and current benchmarks for visuo-motor control, which is alleviated by finetuning. Based on our findings, we provide recommendations for future research in pre-training for control and hope that our simple yet strong baseline will aid in accurately benchmarking progress in this area.

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.

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.