Daily Papers

The COVID-19 pandemic strained healthcare resources and prompted discussion about how machine learning can alleviate physician burdens and contribute to diagnosis. Chest x-rays (CXRs) are used for diagnosis of COVID-19, but few studies predict the severity of a patient's condition from CXRs. In this study, we produce a large COVID severity dataset by merging three sources and investigate the efficacy of transfer learning using ImageNet- and CXR-pretrained models and vision transformers (ViTs) in both severity regression and classification tasks. A pretrained DenseNet161 model performed the best on the three class severity prediction problem, reaching 80% accuracy overall and 77.3%, 83.9%, and 70% on mild, moderate and severe cases, respectively. The ViT had the best regression results, with a mean absolute error of 0.5676 compared to radiologist-predicted severity scores. The project's source code is publicly available.

Foundation models for medical imaging are typically pretrained on increasingly large datasets, following a "scale-at-all-costs" paradigm. However, this strategy faces two critical challenges: large-scale medical datasets often contain substantial redundancy and severe class imbalance that bias representation learning toward over-represented patterns, and indiscriminate training regardless of heterogeneity in data quality incurs considerable computational inefficiency. Here we demonstrate that active, principled data curation during pretraining can serve as a viable, cost-effective alternative to brute-force dataset enlargement. We introduce CheXficient, a chest X-ray (CXR) foundation model that selectively prioritizes informative training samples. CheXficient is pretrained on only 22.7% of 1,235,004 paired CXR images and reports while consuming under 27.3% of the total compute budget, yet achieving comparable or superior performance to its full-data counterpart and other large-scale pretrained models. We assess CheXficient across 20 individual benchmarks spanning 5 task types, including non-adapted off-the-shelf evaluations (zero-shot findings classification and crossmodal retrieval) and adapted downstream tasks (disease prediction, semantic segmentation, and radiology report generation). Further analyses show that CheXficient systematically prioritizes under-represented training samples, improving generalizability on long-tailed or rare conditions. Overall, our work offers practical insights into the data and computation demands for efficient pretraining and downstream adaptation of medical vision-language foundation models.

Chest X-ray (CXR) classification in clinical practice is often limited by imperfect supervision, arising from (i) extreme long-tailed multi-label disease distributions and (ii) missing annotations for rare or previously unseen findings. The CXR-LT 2026 challenge addresses these issues on a PadChest-based benchmark with a 36-class label space split into 30 in-distribution classes for training and 6 out-of-distribution (OOD) classes for zero-shot evaluation. We present task-specific solutions tailored to the distinct supervision regimes. For Task 1 (long-tailed multi-label classification), we adopt an imbalance-aware multi-label learning strategy to improve recognition of tail classes while maintaining stable performance on frequent findings. For Task 2 (zero-shot OOD recognition), we propose a prediction approach that produces scores for unseen disease categories without using any supervised labels or examples from the OOD classes during training. Evaluated with macro-averaged mean Average Precision (mAP), our method achieves strong performance on both tasks, ranking first on the public leaderboard of the development phase. Code and pre-trained models are available at https://github.com/hieuphamha19/CXR_LT.

Chest X-Ray (CXR) report generation is a promising approach to improving the efficiency of CXR interpretation. However, a significant increase in diagnostic accuracy is required before that can be realised. Motivated by this, we propose a framework that is more inline with a radiologist's workflow by considering longitudinal data. Here, the decoder is additionally conditioned on the report from the subject's previous imaging study via a prompt. We also propose a new reward for reinforcement learning based on CXR-BERT, which computes the similarity between reports. We conduct experiments on the MIMIC-CXR dataset. The results indicate that longitudinal data improves CXR report generation. CXR-BERT is also shown to be a promising alternative to the current state-of-the-art reward based on RadGraph. This investigation indicates that longitudinal CXR report generation can offer a substantial increase in diagnostic accuracy. Our Hugging Face model is available at: https://huggingface.co/aehrc/cxrmate and code is available at: https://github.com/aehrc/cxrmate.

Chest X-ray (CXR) is the most frequently ordered imaging test, supporting diverse clinical tasks from thoracic disease detection to postoperative monitoring. However, task-specific classification models are limited in scope, require costly labeled data, and lack generalizability to out-of-distribution datasets. To address these challenges, we introduce CheXFound, a self-supervised vision foundation model that learns robust CXR representations and generalizes effectively across a wide range of downstream tasks. We pretrain CheXFound on a curated CXR-1M dataset, comprising over one million unique CXRs from publicly available sources. We propose a Global and Local Representations Integration (GLoRI) module for downstream adaptations, by incorporating disease-specific local features with global image features for enhanced performance in multilabel classification. Our experimental results show that CheXFound outperforms state-of-the-art models in classifying 40 disease findings across different prevalence levels on the CXR-LT 24 dataset and exhibits superior label efficiency on downstream tasks with limited training data. Additionally, CheXFound achieved significant improvements on new tasks with out-of-distribution datasets, including opportunistic cardiovascular disease risk estimation and mortality prediction. These results highlight CheXFound's strong generalization capabilities, enabling diverse adaptations with improved label efficiency. The project source code is publicly available at https://github.com/RPIDIAL/CheXFound.

Purpose: Recent advancements in large language models (LLMs) have expanded their capabilities in a multimodal fashion, potentially replicating the image interpretation of human radiologists. This study aimed to develop open-source multimodal large language model for interpreting chest X-ray images (CXR-LLaVA). We also examined the effect of prompt engineering and model parameters such as temperature and nucleus sampling. Materials and Methods: For training, we collected 659,287 publicly available CXRs: 417,336 CXRs had labels for certain radiographic abnormalities (dataset 1); 241,951 CXRs provided free-text radiology reports (dataset 2). After pre-training the Resnet50 as an image encoder, the contrastive language-image pre-training was used to align CXRs and corresponding radiographic abnormalities. Then, the Large Language Model Meta AI-2 was fine-tuned using dataset 2, which were refined using GPT-4, with generating various question answering scenarios. The code can be found at https://github.com/ECOFRI/CXR_LLaVA. Results: In the test set, we observed that the model's performance fluctuated based on its parameters. On average, it achieved F1 score of 0.34 for five pathologic findings (atelectasis, cardiomegaly, consolidation, edema, and pleural effusion), which was improved to 0.46 through prompt engineering. In the independent set, the model achieved an average F1 score of 0.30 for the same pathologic findings. Notably, for the pediatric chest radiograph dataset, which was unseen during training, the model differentiated abnormal radiographs with an F1 score ranging from 0.84 to 0.85. Conclusion: CXR-LLaVA demonstrates promising potential in CXR interpretation. Both prompt engineering and model parameter adjustments can play pivotal roles in interpreting CXRs.

The rapid evolution of artificial intelligence, especially in large language models (LLMs), has significantly impacted various domains, including healthcare. In chest X-ray (CXR) analysis, previous studies have employed LLMs, but with limitations: either underutilizing the multi-tasking capabilities of LLMs or lacking clinical accuracy. This paper presents M4CXR, a multi-modal LLM designed to enhance CXR interpretation. The model is trained on a visual instruction-following dataset that integrates various task-specific datasets in a conversational format. As a result, the model supports multiple tasks such as medical report generation (MRG), visual grounding, and visual question answering (VQA). M4CXR achieves state-of-the-art clinical accuracy in MRG by employing a chain-of-thought prompting strategy, in which it identifies findings in CXR images and subsequently generates corresponding reports. The model is adaptable to various MRG scenarios depending on the available inputs, such as single-image, multi-image, and multi-study contexts. In addition to MRG, M4CXR performs visual grounding at a level comparable to specialized models and also demonstrates outstanding performance in VQA. Both quantitative and qualitative assessments reveal M4CXR's versatility in MRG, visual grounding, and VQA, while consistently maintaining clinical accuracy.

Chest X-ray imaging (CXR) is an important diagnostic tool used in hospitals to assess patient conditions and monitor changes over time. Generative models, specifically diffusion-based models, have shown promise in generating realistic synthetic X-rays. However, these models mainly focus on conditional generation using single-time-point data, i.e., typically CXRs taken at a specific time with their corresponding reports, limiting their clinical utility, particularly for capturing temporal changes. To address this limitation, we propose a novel framework, EHRXDiff, which predicts future CXR images by integrating previous CXRs with subsequent medical events, e.g., prescriptions, lab measures, etc. Our framework dynamically tracks and predicts disease progression based on a latent diffusion model, conditioned on the previous CXR image and a history of medical events. We comprehensively evaluate the performance of our framework across three key aspects, including clinical consistency, demographic consistency, and visual realism. We demonstrate that our framework generates high-quality, realistic future images that capture potential temporal changes, suggesting its potential for further development as a clinical simulation tool. This could offer valuable insights for patient monitoring and treatment planning in the medical field.

Despite the progress in automatic detection of radiologic findings from chest X-ray (CXR) images in recent years, a quantitative evaluation of the explainability of these models is hampered by the lack of locally labeled datasets for different findings. With the exception of a few expert-labeled small-scale datasets for specific findings, such as pneumonia and pneumothorax, most of the CXR deep learning models to date are trained on global "weak" labels extracted from text reports, or trained via a joint image and unstructured text learning strategy. Inspired by the Visual Genome effort in the computer vision community, we constructed the first Chest ImaGenome dataset with a scene graph data structure to describe 242,072 images. Local annotations are automatically produced using a joint rule-based natural language processing (NLP) and atlas-based bounding box detection pipeline. Through a radiologist constructed CXR ontology, the annotations for each CXR are connected as an anatomy-centered scene graph, useful for image-level reasoning and multimodal fusion applications. Overall, we provide: i) 1,256 combinations of relation annotations between 29 CXR anatomical locations (objects with bounding box coordinates) and their attributes, structured as a scene graph per image, ii) over 670,000 localized comparison relations (for improved, worsened, or no change) between the anatomical locations across sequential exams, as well as ii) a manually annotated gold standard scene graph dataset from 500 unique patients.

A large-scale image-text pair dataset has greatly contributed to the development of vision-language pre-training (VLP) models, which enable zero-shot or few-shot classification without costly annotation. However, in the medical domain, the scarcity of data remains a significant challenge for developing a powerful VLP model. In this paper, we tackle the lack of image-text data in chest X-ray by expanding image-label pair as image-text pair via general prompt and utilizing multiple images and multiple sections in a radiologic report. We also design two contrastive losses, named ICL and TCL, for learning study-level characteristics of medical images and reports, respectively. Our model outperforms the state-of-the-art models trained under the same conditions. Also, enlarged dataset improve the discriminative power of our pre-trained model for classification, while sacrificing marginal retrieval performance. Code is available at https://github.com/kakaobrain/cxr-clip.

Xmodel-2 is a 1.2-billion-parameter large language model designed specifically for reasoning tasks. Its architecture enables different model scales to share a unified set of hyperparameters, allowing for extensive experimentation on smaller models and seamless transfer of optimal configurations to larger models. To maximize training efficiency and stability, Xmodel-2 employs the WSD learning rate scheduler from MiniCPM. Pretrained on 1.5 trillion tokens from diverse sources, Xmodel-2 achieves state-of-the-art performance in complex reasoning and agent-based tasks, while maintaining low training costs. These results highlight the potential of efficient model design and training strategies in advancing reasoning capabilities. Model checkpoints and code are publicly available on GitHub at https://github.com/XiaoduoAILab/Xmodel-2

Chest X-ray (CXR) radiology report generation (RRG) models have shown rapid progress, yet their clinical utility remains uncertain due to limited evaluation by radiologists. We present CXRMate-2, a state-of-the-art CXR RRG model that integrates structured multimodal conditioning and reinforcement learning with a composite reward for semantic alignment with radiologist reports. Across the MIMIC-CXR, CheXpert Plus, and ReXgradient datasets, CXRMate-2 achieves statistically significant improvements over strong benchmarks, including gains of 11.2% and 24.4% in GREEN and RadGraph-XL, respectively, on MIMIC-CXR relative to MedGemma 1.5 (4B). To directly compare CXRMate-2 against radiologist reporting, we conduct a blinded, randomised qualitative retrospective evaluation. Three consultant radiologists compare generated and radiologist reports across 120 studies from the MIMIC-CXR test set. Generated reports were deemed acceptable (defined as preferred or rated equally to radiologist reports) in 45% of ratings, with no statistically significant difference in preference rates between radiologist reports and acceptable generated reports for seven of the eight analysed findings. Preference for radiologist reports was driven primarily by higher recall, while generated reports were often preferred for readability. Together, these results suggest a credible pathway to clinically acceptable CXR RRG. Improvements in recall, alongside better detection of subtle findings (e.g., pulmonary congestion), are likely sufficient to achieve non-inferiority to radiologist reporting. With these targeted advances, CXR RRG systems may be ready for prospective evaluation in assistive roles within radiologist-led workflows.

Chest X-rays (CXR) are the most common medical imaging study and are used to diagnose multiple medical conditions. This study examines the impact of synthetic data supplementation, using diffusion models, on the performance of deep learning (DL) classifiers for CXR analysis. We employed three datasets: CheXpert, MIMIC-CXR, and Emory Chest X-ray, training conditional denoising diffusion probabilistic models (DDPMs) to generate synthetic frontal radiographs. Our approach ensured that synthetic images mirrored the demographic and pathological traits of the original data. Evaluating the classifiers' performance on internal and external datasets revealed that synthetic data supplementation enhances model accuracy, particularly in detecting less prevalent pathologies. Furthermore, models trained on synthetic data alone approached the performance of those trained on real data. This suggests that synthetic data can potentially compensate for real data shortages in training robust DL models. However, despite promising outcomes, the superiority of real data persists.

Multimodal models trained on large natural image-text pair datasets have exhibited astounding abilities in generating high-quality images. Medical imaging data is fundamentally different to natural images, and the language used to succinctly capture relevant details in medical data uses a different, narrow but semantically rich, domain-specific vocabulary. Not surprisingly, multi-modal models trained on natural image-text pairs do not tend to generalize well to the medical domain. Developing generative imaging models faithfully representing medical concepts while providing compositional diversity could mitigate the existing paucity of high-quality, annotated medical imaging datasets. In this work, we develop a strategy to overcome the large natural-medical distributional shift by adapting a pre-trained latent diffusion model on a corpus of publicly available chest x-rays (CXR) and their corresponding radiology (text) reports. We investigate the model's ability to generate high-fidelity, diverse synthetic CXR conditioned on text prompts. We assess the model outputs quantitatively using image quality metrics, and evaluate image quality and text-image alignment by human domain experts. We present evidence that the resulting model (RoentGen) is able to create visually convincing, diverse synthetic CXR images, and that the output can be controlled to a new extent by using free-form text prompts including radiology-specific language. Fine-tuning this model on a fixed training set and using it as a data augmentation method, we measure a 5% improvement of a classifier trained jointly on synthetic and real images, and a 3% improvement when trained on a larger but purely synthetic training set. Finally, we observe that this fine-tuning distills in-domain knowledge in the text-encoder and can improve its representation capabilities of certain diseases like pneumothorax by 25%.

Automated multi-label chest X-rays (CXR) image classification has achieved substantial progress in clinical diagnosis via utilizing sophisticated deep learning approaches. However, most deep models have high computational demands, which makes them less feasible for compact devices with low computational requirements. To overcome this problem, we propose a knowledge distillation (KD) strategy to create the compact deep learning model for the real-time multi-label CXR image classification. We study different alternatives of CNNs and Transforms as the teacher to distill the knowledge to a smaller student. Then, we employed explainable artificial intelligence (XAI) to provide the visual explanation for the model decision improved by the KD. Our results on three benchmark CXR datasets show that our KD strategy provides the improved performance on the compact student model, thus being the feasible choice for many limited hardware platforms. For instance, when using DenseNet161 as the teacher network, EEEA-Net-C2 achieved an AUC of 83.7%, 87.1%, and 88.7% on the ChestX-ray14, CheXpert, and PadChest datasets, respectively, with fewer parameters of 4.7 million and computational cost of 0.3 billion FLOPS.

Chest X-rays (CXRs) are the most frequently performed imaging test in clinical practice. Recent advances in the development of vision-language foundation models (FMs) give rise to the possibility of performing automated CXR interpretation, which can assist physicians with clinical decision-making and improve patient outcomes. However, developing FMs that can accurately interpret CXRs is challenging due to the (1) limited availability of large-scale vision-language datasets in the medical image domain, (2) lack of vision and language encoders that can capture the complexities of medical data, and (3) absence of evaluation frameworks for benchmarking the abilities of FMs on CXR interpretation. In this work, we address these challenges by first introducing CheXinstruct - a large-scale instruction-tuning dataset curated from 28 publicly-available datasets. We then present CheXagent - an instruction-tuned FM capable of analyzing and summarizing CXRs. To build CheXagent, we design a clinical large language model (LLM) for parsing radiology reports, a vision encoder for representing CXR images, and a network to bridge the vision and language modalities. Finally, we introduce CheXbench - a novel benchmark designed to systematically evaluate FMs across 8 clinically-relevant CXR interpretation tasks. Extensive quantitative evaluations and qualitative reviews with five expert radiologists demonstrate that CheXagent outperforms previously-developed general- and medical-domain FMs on CheXbench tasks. Furthermore, in an effort to improve model transparency, we perform a fairness evaluation across factors of sex, race and age to highlight potential performance disparities. Our project is at https://stanford-aimi.github.io/chexagent.html.

Frontier models have demonstrated remarkable capabilities in understanding and reasoning with natural-language text, but they still exhibit major competency gaps in multimodal understanding and reasoning especially in high-value verticals such as biomedicine. Medical imaging report generation is a prominent example. Supervised fine-tuning can substantially improve performance, but they are prone to overfitting to superficial boilerplate patterns. In this paper, we introduce Universal Report Generation (UniRG) as a general framework for medical imaging report generation. By leveraging reinforcement learning as a unifying mechanism to directly optimize for evaluation metrics designed for end applications, UniRG can significantly improve upon supervised fine-tuning and attain durable generalization across diverse institutions and clinical practices. We trained UniRG-CXR on publicly available chest X-ray (CXR) data and conducted a thorough evaluation in CXR report generation with rigorous evaluation scenarios. On the authoritative ReXrank benchmark, UniRG-CXR sets new overall SOTA, outperforming prior state of the art by a wide margin.

We present a radiology-specific multimodal model for the task for generating radiological reports from chest X-rays (CXRs). Our work builds on the idea that large language model(s) can be equipped with multimodal capabilities through alignment with pre-trained vision encoders. On natural images, this has been shown to allow multimodal models to gain image understanding and description capabilities. Our proposed model (MAIRA-1) leverages a CXR-specific image encoder in conjunction with a fine-tuned large language model based on Vicuna-7B, and text-based data augmentation, to produce reports with state-of-the-art quality. In particular, MAIRA-1 significantly improves on the radiologist-aligned RadCliQ metric and across all lexical metrics considered. Manual review of model outputs demonstrates promising fluency and accuracy of generated reports while uncovering failure modes not captured by existing evaluation practices. More information and resources can be found on the project website: https://aka.ms/maira.

Existing works, including ELMO and BERT, have revealed the importance of pre-training for NLP tasks. While there does not exist a single pre-training model that works best in all cases, it is of necessity to develop a framework that is able to deploy various pre-training models efficiently. For this purpose, we propose an assemble-on-demand pre-training toolkit, namely Universal Encoder Representations (UER). UER is loosely coupled, and encapsulated with rich modules. By assembling modules on demand, users can either reproduce a state-of-the-art pre-training model or develop a pre-training model that remains unexplored. With UER, we have built a model zoo, which contains pre-trained models based on different corpora, encoders, and targets (objectives). With proper pre-trained models, we could achieve new state-of-the-art results on a range of downstream datasets.

Chest X-rays (CXRs) are among the most frequently performed imaging examinations worldwide, yet rising imaging volumes increase radiologist workload and the risk of diagnostic errors. Although artificial intelligence (AI) systems have shown promise for CXR interpretation, most generate only final predictions, without making explicit how visual evidence is translated into radiographic findings and diagnostic predictions. We present CheXOne, a reasoning-enabled vision-language model for CXR interpretation. CheXOne jointly generates diagnostic predictions and explicit, clinically grounded reasoning traces that connect visual evidence, radiographic findings, and these predictions. The model is trained on 14.7 million instruction and reasoning samples curated from 30 public datasets spanning 36 CXR interpretation tasks, using a two-stage framework that combines instruction tuning with reinforcement learning to improve reasoning quality. We evaluate CheXOne in zero-shot settings across visual question answering, report generation, visual grounding and reasoning assessment, covering 17 evaluation settings. CheXOne outperforms existing medical and general-domain foundation models and achieves strong performance on independent public benchmarks. A clinical reader study demonstrates that CheXOne-drafted reports are comparable to or better than resident-written reports in 55% of cases, while effectively addressing clinical indications and enhancing both report writing and CXR interpretation efficiency. Further analyses involving radiologists reveal that the generated reasoning traces show high clinical factuality and provide causal support for the final predictions, offering a plausible explanation for the performance gains. These results suggest that explicit reasoning can improve model performance, interpretability and clinical utility in AI-assisted CXR interpretation.

Our approach, which we call Embeddings for Language/Image-aligned X-Rays, or ELIXR, leverages a language-aligned image encoder combined or grafted onto a fixed LLM, PaLM 2, to perform a broad range of tasks. We train this lightweight adapter architecture using images paired with corresponding free-text radiology reports from the MIMIC-CXR dataset. ELIXR achieved state-of-the-art performance on zero-shot chest X-ray (CXR) classification (mean AUC of 0.850 across 13 findings), data-efficient CXR classification (mean AUCs of 0.893 and 0.898 across five findings (atelectasis, cardiomegaly, consolidation, pleural effusion, and pulmonary edema) for 1% (~2,200 images) and 10% (~22,000 images) training data), and semantic search (0.76 normalized discounted cumulative gain (NDCG) across nineteen queries, including perfect retrieval on twelve of them). Compared to existing data-efficient methods including supervised contrastive learning (SupCon), ELIXR required two orders of magnitude less data to reach similar performance. ELIXR also showed promise on CXR vision-language tasks, demonstrating overall accuracies of 58.7% and 62.5% on visual question answering and report quality assurance tasks, respectively. These results suggest that ELIXR is a robust and versatile approach to CXR AI.

This study investigates the integration of diverse patient data sources into multimodal language models for automated chest X-ray (CXR) report generation. Traditionally, CXR report generation relies solely on CXR images and limited radiology data, overlooking valuable information from patient health records, particularly from emergency departments. Utilising the MIMIC-CXR and MIMIC-IV-ED datasets, we incorporate detailed patient information such as aperiodic vital signs, medications, and clinical history to enhance diagnostic accuracy. We introduce a novel approach to transform these heterogeneous data sources into embeddings that prompt a multimodal language model, significantly enhancing the diagnostic accuracy of generated radiology reports. Our comprehensive evaluation demonstrates the benefits of using a broader set of patient data, underscoring the potential for enhanced diagnostic capabilities and better patient outcomes through the integration of multimodal data in CXR report generation.

Medical imaging is frequently used in clinical practice and trials for diagnosis and treatment. Writing imaging reports is time-consuming and can be error-prone for inexperienced radiologists. Therefore, automatically generating radiology reports is highly desired to lighten the workload of radiologists and accordingly promote clinical automation, which is an essential task to apply artificial intelligence to the medical domain. In this paper, we propose to generate radiology reports with memory-driven Transformer, where a relational memory is designed to record key information of the generation process and a memory-driven conditional layer normalization is applied to incorporating the memory into the decoder of Transformer. Experimental results on two prevailing radiology report datasets, IU X-Ray and MIMIC-CXR, show that our proposed approach outperforms previous models with respect to both language generation metrics and clinical evaluations. Particularly, this is the first work reporting the generation results on MIMIC-CXR to the best of our knowledge. Further analyses also demonstrate that our approach is able to generate long reports with necessary medical terms as well as meaningful image-text attention mappings.

This paper proposes one of the first clinical applications of multimodal large language models (LLMs) as an assistant for radiologists to check errors in their reports. We created an evaluation dataset from two real-world radiology datasets (MIMIC-CXR and IU-Xray), with 1,000 subsampled reports each. A subset of original reports was modified to contain synthetic errors by introducing various type of mistakes. The evaluation contained two difficulty levels: SIMPLE for binary error-checking and COMPLEX for identifying error types. LLaVA (Large Language and Visual Assistant) variant models, including our instruction-tuned model, were used for the evaluation. Additionally, a domain expert evaluation was conducted on a small test set. At the SIMPLE level, the LLaVA v1.5 model outperformed other publicly available models. Instruction tuning significantly enhanced performance by 47.4% and 25.4% on MIMIC-CXR and IU-Xray data, respectively. The model also surpassed the domain experts accuracy in the MIMIC-CXR dataset by 1.67%. Notably, among the subsets (N=21) of the test set where a clinician did not achieve the correct conclusion, the LLaVA ensemble mode correctly identified 71.4% of these cases. This study marks a promising step toward utilizing multi-modal LLMs to enhance diagnostic accuracy in radiology. The ensemble model demonstrated comparable performance to clinicians, even capturing errors overlooked by humans. Nevertheless, future work is needed to improve the model ability to identify the types of inconsistency.

Radiology reports are crucial for planning treatment strategies and enhancing doctor-patient communication, yet manually writing these reports is burdensome for radiologists. While automatic report generation offers a solution, existing methods often rely on single-view radiographs, limiting diagnostic accuracy. To address this problem, we propose MCL, a Multi-view enhanced Contrastive Learning method for chest X-ray report generation. Specifically, we first introduce multi-view enhanced contrastive learning for visual representation by maximizing agreements between multi-view radiographs and their corresponding report. Subsequently, to fully exploit patient-specific indications (e.g., patient's symptoms) for report generation, we add a transitional ``bridge" for missing indications to reduce embedding space discrepancies caused by their presence or absence. Additionally, we construct Multi-view CXR and Two-view CXR datasets from public sources to support research on multi-view report generation. Our proposed MCL surpasses recent state-of-the-art methods across multiple datasets, achieving a 5.0% F1 RadGraph improvement on MIMIC-CXR, a 7.3% BLEU-1 improvement on MIMIC-ABN, a 3.1% BLEU-4 improvement on Multi-view CXR, and an 8.2% F1 CheXbert improvement on Two-view CXR.

Automated radiology report generation offers an effective solution to alleviate radiologists' workload. However, most existing methods focus primarily on single or fixed-view images to model current disease conditions, which limits diagnostic accuracy and overlooks disease progression. Although some approaches utilize longitudinal data to track disease progression, they still rely on single images to analyze current visits. To address these issues, we propose enhanced contrastive learning with Multi-view Longitudinal data to facilitate chest X-ray Report Generation, named MLRG. Specifically, we introduce a multi-view longitudinal contrastive learning method that integrates spatial information from current multi-view images and temporal information from longitudinal data. This method also utilizes the inherent spatiotemporal information of radiology reports to supervise the pre-training of visual and textual representations. Subsequently, we present a tokenized absence encoding technique to flexibly handle missing patient-specific prior knowledge, allowing the model to produce more accurate radiology reports based on available prior knowledge. Extensive experiments on MIMIC-CXR, MIMIC-ABN, and Two-view CXR datasets demonstrate that our MLRG outperforms recent state-of-the-art methods, achieving a 2.3% BLEU-4 improvement on MIMIC-CXR, a 5.5% F1 score improvement on MIMIC-ABN, and a 2.7% F1 RadGraph improvement on Two-view CXR.

Deep learning methods have shown outstanding classification accuracy in medical imaging problems, which is largely attributed to the availability of large-scale datasets manually annotated with clean labels. However, given the high cost of such manual annotation, new medical imaging classification problems may need to rely on machine-generated noisy labels extracted from radiology reports. Indeed, many Chest X-ray (CXR) classifiers have already been modelled from datasets with noisy labels, but their training procedure is in general not robust to noisy-label samples, leading to sub-optimal models. Furthermore, CXR datasets are mostly multi-label, so current noisy-label learning methods designed for multi-class problems cannot be easily adapted. In this paper, we propose a new method designed for the noisy multi-label CXR learning, which detects and smoothly re-labels samples from the dataset, which is then used to train common multi-label classifiers. The proposed method optimises a bag of multi-label descriptors (BoMD) to promote their similarity with the semantic descriptors produced by BERT models from the multi-label image annotation. Our experiments on diverse noisy multi-label training sets and clean testing sets show that our model has state-of-the-art accuracy and robustness in many CXR multi-label classification benchmarks.

Chest Xray imaging is a widely used diagnostic tool in modern medicine, and its high utilization creates substantial workloads for radiologists. To alleviate this burden, vision language models are increasingly applied to automate Chest Xray radiology report generation (CXRRRG), aiming for clinically accurate descriptions while reducing manual effort. Conventional approaches, however, typically rely on single images, failing to capture the longitudinal context necessary for producing clinically faithful comparison statements. Recently, growing attention has been directed toward incorporating longitudinal data into CXR RRG, enabling models to leverage historical studies in ways that mirror radiologists diagnostic workflows. Nevertheless, existing surveys primarily address single image CXRRRG and offer limited guidance for longitudinal settings, leaving researchers without a systematic framework for model design. To address this gap, this survey provides the first comprehensive review of longitudinal radiology report generation (LRRG). Specifically, we examine dataset construction strategies, report generation architectures alongside longitudinally tailored designs, and evaluation protocols encompassing both longitudinal specific measures and widely used benchmarks. We further summarize LRRG methods performance, alongside analyses of different ablation studies, which collectively highlight the critical role of longitudinal information and architectural design choices in improving model performance. Finally, we summarize five major limitations of current research and outline promising directions for future development, aiming to lay a foundation for advancing this emerging field.

Building generalizable AI models is one of the primary challenges in the healthcare domain. While radiologists rely on generalizable descriptive rules of abnormality, Neural Network (NN) models suffer even with a slight shift in input distribution (e.g., scanner type). Fine-tuning a model to transfer knowledge from one domain to another requires a significant amount of labeled data in the target domain. In this paper, we develop an interpretable model that can be efficiently fine-tuned to an unseen target domain with minimal computational cost. We assume the interpretable component of NN to be approximately domain-invariant. However, interpretable models typically underperform compared to their Blackbox (BB) variants. We start with a BB in the source domain and distill it into a mixture of shallow interpretable models using human-understandable concepts. As each interpretable model covers a subset of data, a mixture of interpretable models achieves comparable performance as BB. Further, we use the pseudo-labeling technique from semi-supervised learning (SSL) to learn the concept classifier in the target domain, followed by fine-tuning the interpretable models in the target domain. We evaluate our model using a real-life large-scale chest-X-ray (CXR) classification dataset. The code is available at: https://github.com/batmanlab/MICCAI-2023-Route-interpret-repeat-CXRs.

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.

Chest X-rays (CXRs) play an integral role in driving critical decisions in disease management and patient care. While recent innovations have led to specialized models for various CXR interpretation tasks, these solutions often operate in isolation, limiting their practical utility in clinical practice. We present MedRAX, the first versatile AI agent that seamlessly integrates state-of-the-art CXR analysis tools and multimodal large language models into a unified framework. MedRAX dynamically leverages these models to address complex medical queries without requiring additional training. To rigorously evaluate its capabilities, we introduce ChestAgentBench, a comprehensive benchmark containing 2,500 complex medical queries across 7 diverse categories. Our experiments demonstrate that MedRAX achieves state-of-the-art performance compared to both open-source and proprietary models, representing a significant step toward the practical deployment of automated CXR interpretation systems. Data and code have been publicly available at https://github.com/bowang-lab/MedRAX

Integrating multi-modal clinical data, such as electronic health records (EHR) and chest X-ray images (CXR), is particularly beneficial for clinical prediction tasks. However, in a temporal setting, multi-modal data are often inherently asynchronous. EHR can be continuously collected but CXR is generally taken with a much longer interval due to its high cost and radiation dose. When clinical prediction is needed, the last available CXR image might have been outdated, leading to suboptimal predictions. To address this challenge, we propose DDL-CXR, a method that dynamically generates an up-to-date latent representation of the individualized CXR images. Our approach leverages latent diffusion models for patient-specific generation strategically conditioned on a previous CXR image and EHR time series, providing information regarding anatomical structures and disease progressions, respectively. In this way, the interaction across modalities could be better captured by the latent CXR generation process, ultimately improving the prediction performance. Experiments using MIMIC datasets show that the proposed model could effectively address asynchronicity in multimodal fusion and consistently outperform existing methods.

In this work we design an end-to-end deep learning architecture for predicting, on Chest X-rays images (CXR), a multi-regional score conveying the degree of lung compromise in COVID-19 patients. Such semi-quantitative scoring system, namely Brixia~score, is applied in serial monitoring of such patients, showing significant prognostic value, in one of the hospitals that experienced one of the highest pandemic peaks in Italy. To solve such a challenging visual task, we adopt a weakly supervised learning strategy structured to handle different tasks (segmentation, spatial alignment, and score estimation) trained with a "from-the-part-to-the-whole" procedure involving different datasets. In particular, we exploit a clinical dataset of almost 5,000 CXR annotated images collected in the same hospital. Our BS-Net demonstrates self-attentive behavior and a high degree of accuracy in all processing stages. Through inter-rater agreement tests and a gold standard comparison, we show that our solution outperforms single human annotators in rating accuracy and consistency, thus supporting the possibility of using this tool in contexts of computer-assisted monitoring. Highly resolved (super-pixel level) explainability maps are also generated, with an original technique, to visually help the understanding of the network activity on the lung areas. We also consider other scores proposed in literature and provide a comparison with a recently proposed non-specific approach. We eventually test the performance robustness of our model on an assorted public COVID-19 dataset, for which we also provide Brixia~score annotations, observing good direct generalization and fine-tuning capabilities that highlight the portability of BS-Net in other clinical settings. The CXR dataset along with the source code and the trained model are publicly released for research purposes.

Pre-training datasets, like ImageNet, have become the gold standard in medical image analysis. However, the emergence of self-supervised learning (SSL), which leverages unlabeled data to learn robust features, presents an opportunity to bypass the intensive labeling process. In this study, we explored if SSL for pre-training on non-medical images can be applied to chest radiographs and how it compares to supervised pre-training on non-medical images and on medical images. We utilized a vision transformer and initialized its weights based on (i) SSL pre-training on natural images (DINOv2), (ii) SL pre-training on natural images (ImageNet dataset), and (iii) SL pre-training on chest radiographs from the MIMIC-CXR database. We tested our approach on over 800,000 chest radiographs from six large global datasets, diagnosing more than 20 different imaging findings. Our SSL pre-training on curated images not only outperformed ImageNet-based pre-training (P<0.001 for all datasets) but, in certain cases, also exceeded SL on the MIMIC-CXR dataset. Our findings suggest that selecting the right pre-training strategy, especially with SSL, can be pivotal for improving artificial intelligence (AI)'s diagnostic accuracy in medical imaging. By demonstrating the promise of SSL in chest radiograph analysis, we underline a transformative shift towards more efficient and accurate AI models in medical imaging.

In this paper, we present Chain-of-Models Pre-Training (CoM-PT), a novel performance-lossless training acceleration method for vision foundation models (VFMs). This approach fundamentally differs from existing acceleration methods in its core motivation: rather than optimizing each model individually, CoM-PT is designed to accelerate the training pipeline at the model family level, scaling efficiently as the model family expands. Specifically, CoM-PT establishes a pre-training sequence for the model family, arranged in ascending order of model size, called model chain. In this chain, only the smallest model undergoes standard individual pre-training, while the other models are efficiently trained through sequential inverse knowledge transfer from their smaller predecessors by jointly reusing the knowledge in the parameter space and the feature space. As a result, CoM-PT enables all models to achieve performance that is mostly superior to standard individual training while significantly reducing training cost, and this is extensively validated across 45 datasets spanning zero-shot and fine-tuning tasks. Notably, its efficient scaling property yields a remarkable phenomenon: training more models even results in higher efficiency. For instance, when pre-training on CC3M: i) given ViT-L as the largest model, progressively prepending smaller models to the model chain reduces computational complexity by up to 72%; ii) within a fixed model size range, as the VFM family scales across 3, 4, and 7 models, the acceleration ratio of CoM-PT exhibits a striking leap: from 4.13X to 5.68X and 7.09X. Since CoM-PT is naturally agnostic to specific pre-training paradigms, we open-source the code to spur further extensions in more computationally intensive scenarios, such as large language model pre-training.

With the success of pretraining techniques in representation learning, a number of continual learning methods based on pretrained models have been proposed. Some of these methods design continual learning mechanisms on the pre-trained representations and only allow minimum updates or even no updates of the backbone models during the training of continual learning. In this paper, we question whether the complexity of these models is needed to achieve good performance by comparing them to a simple baseline that we designed. We argue that the pretrained feature extractor itself can be strong enough to achieve a competitive or even better continual learning performance on Split-CIFAR100 and CoRe 50 benchmarks. To validate this, we conduct a very simple baseline that 1) use the frozen pretrained model to extract image features for every class encountered during the continual learning stage and compute their corresponding mean features on training data, and 2) predict the class of the input based on the nearest neighbor distance between test samples and mean features of the classes; i.e., Nearest Mean Classifier (NMC). This baseline is single-headed, exemplar-free, and can be task-free (by updating the means continually). This baseline achieved 88.53% on 10-Split-CIFAR-100, surpassing most state-of-the-art continual learning methods that are all initialized using the same pretrained transformer model. We hope our baseline may encourage future progress in designing learning systems that can continually add quality to the learning representations even if they started from some pretrained weights.

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.

The surge of pre-training has witnessed the rapid development of document understanding recently. Pre-training and fine-tuning framework has been effectively used to tackle texts in various formats, including plain texts, document texts, and web texts. Despite achieving promising performance, existing pre-trained models usually target one specific document format at one time, making it difficult to combine knowledge from multiple document formats. To address this, we propose XDoc, a unified pre-trained model which deals with different document formats in a single model. For parameter efficiency, we share backbone parameters for different formats such as the word embedding layer and the Transformer layers. Meanwhile, we introduce adaptive layers with lightweight parameters to enhance the distinction across different formats. Experimental results have demonstrated that with only 36.7% parameters, XDoc achieves comparable or even better performance on a variety of downstream tasks compared with the individual pre-trained models, which is cost effective for real-world deployment. The code and pre-trained models will be publicly available at https://aka.ms/xdoc.

Pretraining data selection has the potential to improve language model pretraining efficiency by utilizing higher-quality data from massive web data corpora. Current data selection methods, which rely on either hand-crafted rules or larger reference models, are conducted statically and do not capture the evolving data preferences during pretraining. In this paper, we introduce model-aware data selection with data influence models (MATES), where a data influence model continuously adapts to the evolving data preferences of the pretraining model and then selects the data most effective for the current pretraining progress. Specifically, we fine-tune a small data influence model to approximate oracle data preference signals collected by locally probing the pretraining model and to select data accordingly for the next pretraining stage. Experiments on Pythia and the C4 dataset demonstrate that MATES significantly outperforms random data selection on extensive downstream tasks in both zero- and few-shot settings. It doubles the gains achieved by recent data selection approaches that leverage larger reference models and reduces the total FLOPs required to reach certain performances by half. Further analysis validates the ever-changing data preferences of pretraining models and the effectiveness of our data influence models to capture them. Our code is open-sourced at https://github.com/cxcscmu/MATES.

Inspired by the success of large language models (LLMs), there is growing research interest in developing LLMs in the medical domain to assist clinicians. However, for hospitals, using closed-source commercial LLMs involves privacy issues, and developing open-source public LLMs requires large-scale computational resources, which are usually limited, especially in resource-efficient regions and low-income countries. We propose an open-source Small Language and Vision Assistant (SLaVA-CXR) that can be used for Chest X-Ray report automation. To efficiently train a small assistant, we first propose the Re^3Training method, which simulates the cognitive development of radiologists and optimizes the model in the Recognition, Reasoning, and Reporting training manner. Then, we introduce a data synthesis method, RADEX, which can generate a high-quality and diverse training corpus with privacy regulation compliance. The extensive experiments show that our SLaVA-CXR built on a 2.7B backbone not only outperforms but also achieves 6 times faster inference efficiency than previous state-of-the-art larger models.

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

Large, high-capacity models trained on diverse datasets have shown remarkable successes on efficiently tackling downstream applications. In domains from NLP to Computer Vision, this has led to a consolidation of pretrained models, with general pretrained backbones serving as a starting point for many applications. Can such a consolidation happen in robotics? Conventionally, robotic learning methods train a separate model for every application, every robot, and even every environment. Can we instead train generalist X-robot policy that can be adapted efficiently to new robots, tasks, and environments? In this paper, we provide datasets in standardized data formats and models to make it possible to explore this possibility in the context of robotic manipulation, alongside experimental results that provide an example of effective X-robot policies. We assemble a dataset from 22 different robots collected through a collaboration between 21 institutions, demonstrating 527 skills (160266 tasks). We show that a high-capacity model trained on this data, which we call RT-X, exhibits positive transfer and improves the capabilities of multiple robots by leveraging experience from other platforms. More details can be found on the project website https://robotics-transformer-x.github.io{robotics-transformer-x.github.io}.

Applying a pre-trained large model to downstream tasks is prohibitive under resource-constrained conditions. Recent dominant approaches for addressing efficiency issues involve adding a few learnable parameters to the fixed backbone model. This strategy, however, leads to more challenges in loading large models for downstream fine-tuning with limited resources. In this paper, we propose a novel method for increasing the parameter efficiency of pre-trained models by introducing an intermediate pre-training stage. To this end, we first employ low-rank approximation to compress the original large model and then devise a feature distillation module and a weight perturbation regularization module. These modules are specifically designed to enhance the low-rank model. In particular, we update only the low-rank model while freezing the backbone parameters during pre-training. This allows for direct and efficient utilization of the low-rank model for downstream fine-tuning tasks. The proposed method achieves both efficiencies in terms of required parameters and computation time while maintaining comparable results with minimal modifications to the backbone architecture. Specifically, when applied to three vision-only and one vision-language Transformer models, our approach often demonstrates a merely sim0.6 point decrease in performance while reducing the original parameter size by 1/3 to 2/3.

Automatic radiology report generation is a promising application of multimodal deep learning, aiming to reduce reporting workload and improve consistency. However, current state-of-the-art (SOTA) systems - such as Multimodal AI for Radiology Applications (MAIRA-2) and Medical Pathways Language Model-Multimodal (MedPaLM-M) - depend on large-scale multimodal training, clinical metadata, and multiple imaging views, making them resource-intensive and inaccessible for most settings. We introduce a compact image-to-text architecture that generates the Findings section of chest X-ray reports from a single frontal image. The model combines a frozen Self-Distillation with No Labels v3 (DINOv3) Vision Transformer (ViT) encoder with a Generative Pre-trained Transformer 2 (GPT-2) decoder enhanced by layer-wise anatomical attention. This mechanism integrates lung and heart segmentation masks through hierarchical Gaussian smoothing, biasing attention toward clinically relevant regions without adding trainable parameters. Evaluated on the official Medical Information Mart for Intensive Care-Chest X-ray (MIMIC-CXR) dataset using Chest Radiograph Expert (CheXpert) and Radiology Graph (RadGraph) metrics, our approach achieved substantial gains: CheXpert Macro-F1 for five key pathologies increased by 168% (0.083 -> 0.238) and Micro-F1 by 146% (0.137 -> 0.337), while broader performance across 14 observations improved by 86% (0.170 -> 0.316). Structural coherence also improved, with RadGraph F1 rising by 9.7%. Despite its small size and purely image-conditioned design, the model demonstrates that decoder-level anatomical guidance improves spatial grounding and enhances coherence in clinically relevant regions. The source code is publicly available at: https://github.com/devMuniz02/UDEM-CXR-Reporting-Thesis-2025.

Synthetic medical data generation has opened up new possibilities in the healthcare domain, offering a powerful tool for simulating clinical scenarios, enhancing diagnostic and treatment quality, gaining granular medical knowledge, and accelerating the development of unbiased algorithms. In this context, we present a novel approach called ViewXGen, designed to overcome the limitations of existing methods that rely on general domain pipelines using only radiology reports to generate frontal-view chest X-rays. Our approach takes into consideration the diverse view positions found in the dataset, enabling the generation of chest X-rays with specific views, which marks a significant advancement in the field. To achieve this, we introduce a set of specially designed tokens for each view position, tailoring the generation process to the user's preferences. Furthermore, we leverage multi-view chest X-rays as input, incorporating valuable information from different views within the same study. This integration rectifies potential errors and contributes to faithfully capturing abnormal findings in chest X-ray generation. To validate the effectiveness of our approach, we conducted statistical analyses, evaluating its performance in a clinical efficacy metric on the MIMIC-CXR dataset. Also, human evaluation demonstrates the remarkable capabilities of ViewXGen, particularly in producing realistic view-specific X-rays that closely resemble the original images.

Generative models, particularly text-to-image (T2I) diffusion models, play a crucial role in medical image analysis. However, these models are prone to training data memorization, posing significant risks to patient privacy. Synthetic chest X-ray generation is one of the most common applications in medical image analysis with the MIMIC-CXR dataset serving as the primary data repository for this task. This study adopts a data-driven approach and presents the first systematic attempt to identify prompts and text tokens in MIMIC-CXR that contribute the most to training data memorization. Our analysis reveals an unexpected finding: prompts containing traces of de-identification procedures are among the most memorized, with de-identification markers contributing the most. Furthermore, we also find existing inference-time memorization mitigation strategies are ineffective and fail to sufficiently reduce the model's reliance on memorized text tokens highlighting a broader issue in T2I synthesis with MIMIC-CXR. On this front, we propose actionable strategies to enhance privacy and improve the reliability of generative models in medical imaging. Finally, our results provide a foundation for future work on developing and benchmarking memorization mitigation techniques for synthetic chest X-ray generation using the MIMIC-CXR dataset.

The evaluation of vision-language models (VLMs) for chest X-ray (CXR) analysis has largely been limited to disease-presence classification without visual grounding. Such evaluations fail to verify the expert-level lesion perception necessary to ensure the clinical reliability of VLMs. To address these limitations, we introduce CheXpercept, a sequential, multi-level perception benchmark that mirrors a radiologist's cognitive workflow across coarse-level detection, fine-level contour evaluation and revision, and semantic-level attribute extraction. To ensure high clinical fidelity at scale, we construct the dataset using a semi-automated generation pipeline paired with a review by six medical experts. CheXpercept contains 10,400 QA items derived from 2,100 CXRs, covering seven clinically critical pulmonary and cardiac lesions. To demonstrate the current landscape of VLM perception, we benchmark 14 general and medical VLMs on CheXpercept. The models achieve adequate performance only at the coarse level, with accuracy degrading precipitously on deeper visual tasks. Notably, medical VLMs show almost no perceptual advantage over their general-domain counterparts, highlighting a systemic flaw in current domain adaptation. The code and dataset will be publicly available.

Chest radiography is an extremely powerful imaging modality, allowing for a detailed inspection of a patient's thorax, but requiring specialized training for proper interpretation. With the advent of high performance general purpose computer vision algorithms, the accurate automated analysis of chest radiographs is becoming increasingly of interest to researchers. However, a key challenge in the development of these techniques is the lack of sufficient data. Here we describe MIMIC-CXR-JPG v2.0.0, a large dataset of 377,110 chest x-rays associated with 227,827 imaging studies sourced from the Beth Israel Deaconess Medical Center between 2011 - 2016. Images are provided with 14 labels derived from two natural language processing tools applied to the corresponding free-text radiology reports. MIMIC-CXR-JPG is derived entirely from the MIMIC-CXR database, and aims to provide a convenient processed version of MIMIC-CXR, as well as to provide a standard reference for data splits and image labels. All images have been de-identified to protect patient privacy. The dataset is made freely available to facilitate and encourage a wide range of research in medical computer vision.

Automated chest X-ray report generation has recently benefited from reinforcement learning (RL) and large language models. However, RL training often suffers from instability or limited exploration due to fixed Kullback-Leibler (KL) regularization and a static reference policy that accumulates KL pressure over time. We propose Response-Weighted and Validation-Anchored Policy Optimization (REVA-PO), a RL framework that stabilizes long-term training via Response-Weighted Regularization (RER) and Validation-Anchored Policy Reset (VAPR). RER dynamically adjusts per-response KL weights based on advantage and reference-policy entropy, relaxing constraints for high-quality responses while tightening them for low-quality ones. Complementarily, VAPR periodically synchronizes the reference and current policies to the best validation checkpoint, resetting accumulated regularization pressure to expand the viable exploration space. To ensure a robust starting point, we employ a three-stage pipeline consisting of warm-up training, classifier-guided supervised fine-tuning, and RL. Extensive evaluations on MIMIC-CXR and IU-Xray demonstrate that REVA-PO sets new state-of-the-art benchmarks in both linguistic quality and clinical accuracy. Notably, BLEU-4 improves by 5.1% on MIMIC-CXR and 3.6% on IU-Xray, while CheXpert F1 and RadGraph F1 scores increase by 4.5% and 12.8%, respectively, over prior leading methods. The code is publicly available at https://github.com/LiGuo12/REVA_PO/.

Motivated by the strong performance of CLIP-based models in natural image-text domains, recent efforts have adapted these architectures to medical tasks, particularly in radiology, where large paired datasets of images and reports, such as chest X-rays, are available. While these models have shown encouraging results in terms of accuracy and discriminative performance, their fairness and robustness in the different clinical tasks remain largely underexplored. In this study, we extensively evaluate six widely used CLIP-based models on chest X-ray classification using three publicly available datasets: MIMIC-CXR, NIH-CXR14, and NEATX. We assess the models fairness across six conditions and patient subgroups based on age, sex, and race. Additionally, we assess the robustness to shortcut learning by evaluating performance on pneumothorax cases with and without chest drains. Our results indicate performance gaps between patients of different ages, but more equitable results for the other attributes. Moreover, all models exhibit lower performance on images without chest drains, suggesting reliance on spurious correlations. We further complement the performance analysis with a study of the embeddings generated by the models. While the sensitive attributes could be classified from the embeddings, we do not see such patterns using PCA, showing the limitations of these visualisation techniques when assessing models. Our code is available at https://github.com/TheoSourget/clip_cxr_fairness

Using pre-trained large language models (LLMs) as the backbone for time series prediction has recently gained significant research interest. However, the effectiveness of LLM backbones in this domain remains a topic of debate. Based on thorough empirical analyses, we observe that training and testing LLM-based models on small datasets often leads to the Encoder and Decoder becoming overly adapted to the dataset, thereby obscuring the true predictive capabilities of the LLM backbone. To investigate the genuine potential of LLMs in time series prediction, we introduce three pre-training models with identical architectures but different pre-training strategies. Thereby, large-scale pre-training allows us to create unbiased Encoder and Decoder components tailored to the LLM backbone. Through controlled experiments, we evaluate the zero-shot and few-shot prediction performance of the LLM, offering insights into its capabilities. Extensive experiments reveal that although the LLM backbone demonstrates some promise, its forecasting performance is limited. Our source code is publicly available in the anonymous repository: https://anonymous.4open.science/r/LLM4TS-0B5C.

LLM pretraining is shifting from a compute-bound to a data-bound regime, where available human (organic) text falls far short of scaling demands. However, reaching the data-bound regime does not mean the model has fully utilized its organic corpus. In this paper, we introduce SynPro, a synthetic data generation framework that helps LLMs more thoroughly learn from limited organic data. SynPro applies two operations, rephrasing and reformat, that present the same organic source in diverse forms to facilitate deeper learning without introducing external information. Both generators are optimized via reinforcement learning with quality, faithfulness, and data influence rewards, and are continuously updated as pretraining plateaus to target content the model has yet to absorb. We pretrain 400M and 1.1B models with 10% of their Chinchilla-optimal tokens (0.8B and 2.2B) from DCLM-Baseline, reflecting a realistic data-bound regime in frontier pretraining. Our results reveal that organic data is significantly underutilized by standard repetition: SynPro unlocks 3.7-5.2x the effective tokens of repetition, even surpassing the non-data-bound oracle that trains on equivalent unique data at the 1.1B scale. Analyses confirm that faithful, model-aware synthesis sustains data-bound scaling without causing distribution collapse. We open-source our code at https://github.com/cxcscmu/SynPro.

Large pre-trained models for zero/few-shot learning excel in language and vision domains but encounter challenges in multivariate time series (TS) due to the diverse nature and scarcity of publicly available pre-training data. Consequently, there has been a recent surge in utilizing pre-trained large language models (LLMs) with token adaptations for TS forecasting. These approaches employ cross-domain transfer learning and surprisingly yield impressive results. However, these models are typically very slow and large (~billion parameters) and do not consider cross-channel correlations. To address this, we present Tiny Time Mixers (TTM), a significantly small model based on the lightweight TSMixer architecture. TTM marks the first success in developing fast and tiny general pre-trained models (<1M parameters), exclusively trained on public TS datasets, with effective transfer learning capabilities for forecasting. To tackle the complexity of pre-training on multiple datasets with varied temporal resolutions, we introduce several novel enhancements such as adaptive patching, dataset augmentation via downsampling, and resolution prefix tuning. Moreover, we employ a multi-level modeling strategy to effectively model channel correlations and infuse exogenous signals during fine-tuning, a crucial capability lacking in existing benchmarks. TTM shows significant accuracy gains (12-38\%) over popular benchmarks in few/zero-shot forecasting. It also drastically reduces the compute needs as compared to LLM-TS methods, with a 14X cut in learnable parameters, 106X less total parameters, and substantial reductions in fine-tuning (65X) and inference time (54X). In fact, TTM's zero-shot often surpasses the few-shot results in many popular benchmarks, highlighting the efficacy of our approach. Code and pre-trained models will be open-sourced.

Recently, it has been shown that for offline deep reinforcement learning (DRL), pre-training Decision Transformer with a large language corpus can improve downstream performance (Reid et al., 2022). A natural question to ask is whether this performance gain can only be achieved with language pre-training, or can be achieved with simpler pre-training schemes which do not involve language. In this paper, we first show that language is not essential for improved performance, and indeed pre-training with synthetic IID data for a small number of updates can match the performance gains from pre-training with a large language corpus; moreover, pre-training with data generated by a one-step Markov chain can further improve the performance. Inspired by these experimental results, we then consider pre-training Conservative Q-Learning (CQL), a popular offline DRL algorithm, which is Q-learning-based and typically employs a Multi-Layer Perceptron (MLP) backbone. Surprisingly, pre-training with simple synthetic data for a small number of updates can also improve CQL, providing consistent performance improvement on D4RL Gym locomotion datasets. The results of this paper not only illustrate the importance of pre-training for offline DRL but also show that the pre-training data can be synthetic and generated with remarkably simple mechanisms.

This paper proposes a novel framework for lung segmentation in chest X-rays. It consists of two key contributions, a criss-cross attention based segmentation network and radiorealistic chest X-ray image synthesis (i.e. a synthesized radiograph that appears anatomically realistic) for data augmentation. The criss-cross attention modules capture rich global contextual information in both horizontal and vertical directions for all the pixels thus facilitating accurate lung segmentation. To reduce the manual annotation burden and to train a robust lung segmentor that can be adapted to pathological lungs with hazy lung boundaries, an image-to-image translation module is employed to synthesize radiorealistic abnormal CXRs from the source of normal ones for data augmentation. The lung masks of synthetic abnormal CXRs are propagated from the segmentation results of their normal counterparts, and then serve as pseudo masks for robust segmentor training. In addition, we annotate 100 CXRs with lung masks on a more challenging NIH Chest X-ray dataset containing both posterioranterior and anteroposterior views for evaluation. Extensive experiments validate the robustness and effectiveness of the proposed framework. The code and data can be found from https://github.com/rsummers11/CADLab/tree/master/Lung_Segmentation_XLSor .

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.

Long-tailed class distributions pose a significant challenge for multi-label chest X-ray (CXR) classification, where rare but clinically important findings are severely underrepresented. In this work, we present a systematic empirical evaluation of loss functions, CNN backbone architectures and post-training strategies on the CXR-LT 2026 benchmark, comprising approximately 143K images with 30 disease labels from PadChest. Our experiments demonstrate that LDAM with deferred re-weighting (LDAM-DRW) consistently outperforms standard BCE and asymmetric losses for rare class recognition. Amongst the architectures evaluated, ConvNeXt-Large achieves the best single-model performance with 0.5220 mAP and 0.3765 F1 on our development set, whilst classifier re-training and test-time augmentation further improve ranking metrics. On the official test leaderboard, our submission achieved 0.3950 mAP, ranking 5th amongst all 68 participating teams with total of 1528 submissions. We provide a candid analysis of the development-to-test performance gap and discuss practical insights for handling class imbalance in clinical imaging settings. Code is available at https://github.com/Nikhil-Rao20/Long_Tail.

Humans can develop internal world models that encode common sense knowledge, telling them how the world works and predicting the consequences of their actions. This concept has emerged as a promising direction for establishing general-purpose machine-learning models in recent preliminary works, e.g., for visual representation learning. In this paper, we present CheXWorld, the first effort towards a self-supervised world model for radiographic images. Specifically, our work develops a unified framework that simultaneously models three aspects of medical knowledge essential for qualified radiologists, including 1) local anatomical structures describing the fine-grained characteristics of local tissues (e.g., architectures, shapes, and textures); 2) global anatomical layouts describing the global organization of the human body (e.g., layouts of organs and skeletons); and 3) domain variations that encourage CheXWorld to model the transitions across different appearance domains of radiographs (e.g., varying clarity, contrast, and exposure caused by collecting radiographs from different hospitals, devices, or patients). Empirically, we design tailored qualitative and quantitative analyses, revealing that CheXWorld successfully captures these three dimensions of medical knowledge. Furthermore, transfer learning experiments across eight medical image classification and segmentation benchmarks showcase that CheXWorld significantly outperforms existing SSL methods and large-scale medical foundation models. Code & pre-trained models are available at https://github.com/LeapLabTHU/CheXWorld.

Chemical pretrained models, sometimes referred to as foundation models, are receiving considerable interest for drug discovery applications. The general chemical knowledge extracted from self-supervised training has the potential to improve predictions for critical drug discovery endpoints, including on-target potency and ADMET properties. Multi-task learning has previously been successfully leveraged to improve predictive models. Here, we show that enabling multitasking in finetuning of chemical pretrained graph neural network models such as Kinetic GROVER Multi-Task (KERMT), an enhanced version of the GROVER model, and Knowledge-guided Pre-training of Graph Transformer (KGPT) significantly improves performance over non-pretrained graph neural network models. Surprisingly, we find that the performance improvement from finetuning KERMT in a multitask manner is most significant at larger data sizes. Additionally, we publish two multitask ADMET data splits to enable more accurate benchmarking of multitask deep learning methods for drug property prediction. Finally, we provide an accelerated implementation of the KERMT model on GitHub, unlocking large-scale pretraining, finetuning, and inference in industrial drug discovery workflows.

Automated radiology report generation from chest X-ray (CXR) images has the potential to improve clinical efficiency and reduce radiologists' workload. However, most datasets, including the publicly available MIMIC-CXR and CheXpert Plus, consist entirely of free-form reports, which are inherently variable and unstructured. This variability poses challenges for both generation and evaluation: existing models struggle to produce consistent, clinically meaningful reports, and standard evaluation metrics fail to capture the nuances of radiological interpretation. To address this, we introduce Structured Radiology Report Generation (SRRG), a new task that reformulates free-text radiology reports into a standardized format, ensuring clarity, consistency, and structured clinical reporting. We create a novel dataset by restructuring reports using large language models (LLMs) following strict structured reporting desiderata. Additionally, we introduce SRR-BERT, a fine-grained disease classification model trained on 55 labels, enabling more precise and clinically informed evaluation of structured reports. To assess report quality, we propose F1-SRR-BERT, a metric that leverages SRR-BERT's hierarchical disease taxonomy to bridge the gap between free-text variability and structured clinical reporting. We validate our dataset through a reader study conducted by five board-certified radiologists and extensive benchmarking experiments.

New geospatial foundation models introduce a new model architecture and pretraining dataset, often sampled using different notions of data diversity. Performance differences are largely attributed to the model architecture or input modalities, while the role of the pretraining dataset is rarely studied. To address this research gap, we conducted a systematic study on how the geographic composition of pretraining data affects a model's downstream performance. We created global and per-continent pretraining datasets and evaluated them on global and per-continent downstream datasets. We found that the pretraining dataset from Europe outperformed global and continent-specific pretraining datasets on both global and local downstream evaluations. To investigate the factors influencing a pretraining dataset's downstream performance, we analysed 10 pretraining datasets using diversity across continents, biomes, landcover and spectral values. We found that only spectral diversity was strongly correlated with performance, while others were weakly correlated. This finding establishes a new dimension of diversity to be accounted for when creating a high-performing pretraining dataset. We open-sourced 7 new pretraining datasets, pretrained models, and our experimental framework at https://github.com/kerner-lab/pretrain-where.

In recent years, pretraining models have made significant advancements in the fields of natural language processing (NLP), computer vision (CV), and life sciences. The significant advancements in NLP and CV are predominantly driven by the expansion of model parameters and data size, a phenomenon now recognized as the scaling laws. However, research exploring scaling law in molecular pretraining models remains unexplored. In this work, we present Uni-Mol2 , an innovative molecular pretraining model that leverages a two-track transformer to effectively integrate features at the atomic level, graph level, and geometry structure level. Along with this, we systematically investigate the scaling law within molecular pretraining models, characterizing the power-law correlations between validation loss and model size, dataset size, and computational resources. Consequently, we successfully scale Uni-Mol2 to 1.1 billion parameters through pretraining on 800 million conformations, making it the largest molecular pretraining model to date. Extensive experiments show consistent improvement in the downstream tasks as the model size grows. The Uni-Mol2 with 1.1B parameters also outperforms existing methods, achieving an average 27% improvement on the QM9 and 14% on COMPAS-1D dataset.

Prior-data fitted networks (PFNs) were recently proposed as a new paradigm for machine learning. Instead of training the network to an observed training set, a fixed model is pre-trained offline on small, simulated training sets from a variety of tasks. The pre-trained model is then used to infer class probabilities in-context on fresh training sets with arbitrary size and distribution. Empirically, PFNs achieve state-of-the-art performance on tasks with similar size to the ones used in pre-training. Surprisingly, their accuracy further improves when passed larger data sets during inference. This article establishes a theoretical foundation for PFNs and illuminates the statistical mechanisms governing their behavior. While PFNs are motivated by Bayesian ideas, a purely frequentistic interpretation of PFNs as pre-tuned, but untrained predictors explains their behavior. A predictor's variance vanishes if its sensitivity to individual training samples does and the bias vanishes only if it is appropriately localized around the test feature. The transformer architecture used in current PFN implementations ensures only the former. These findings shall prove useful for designing architectures with favorable empirical behavior.

Extracting structured clinical information from free-text radiology reports can enable the use of radiology report information for a variety of critical healthcare applications. In our work, we present RadGraph, a dataset of entities and relations in full-text chest X-ray radiology reports based on a novel information extraction schema we designed to structure radiology reports. We release a development dataset, which contains board-certified radiologist annotations for 500 radiology reports from the MIMIC-CXR dataset (14,579 entities and 10,889 relations), and a test dataset, which contains two independent sets of board-certified radiologist annotations for 100 radiology reports split equally across the MIMIC-CXR and CheXpert datasets. Using these datasets, we train and test a deep learning model, RadGraph Benchmark, that achieves a micro F1 of 0.82 and 0.73 on relation extraction on the MIMIC-CXR and CheXpert test sets respectively. Additionally, we release an inference dataset, which contains annotations automatically generated by RadGraph Benchmark across 220,763 MIMIC-CXR reports (around 6 million entities and 4 million relations) and 500 CheXpert reports (13,783 entities and 9,908 relations) with mappings to associated chest radiographs. Our freely available dataset can facilitate a wide range of research in medical natural language processing, as well as computer vision and multi-modal learning when linked to chest radiographs.

Large language models (LLMs) are increasingly multilingual, yet open models continue to underperform relative to proprietary systems, with the gap most pronounced for African languages. Continued pre-training (CPT) offers a practical route to language adaptation, but improvements on demanding capabilities such as mathematical reasoning often remain limited. This limitation is driven in part by the uneven domain coverage and missing task-relevant knowledge that characterize many low-resource language corpora. We present AfriqueLLM, a suite of open LLMs adapted to 20 African languages through CPT on 26B tokens. We perform a comprehensive empirical study across five base models spanning sizes and architectures, including Llama 3.1, Gemma 3, and Qwen 3, and systematically analyze how CPT data composition shapes downstream performance. In particular, we vary mixtures that include math, code, and synthetic translated data, and evaluate the resulting models on a range of multilingual benchmarks. Our results identify data composition as the primary driver of CPT gains. Adding math, code, and synthetic translated data yields consistent improvements, including on reasoning-oriented evaluations. Within a fixed architecture, larger models typically improve performance, but architectural choices dominate scale when comparing across model families. Moreover, strong multilingual performance in the base model does not reliably predict post-CPT outcomes; robust architectures coupled with task-aligned data provide a more dependable recipe. Finally, our best models improve long-context performance, including document-level translation. Models have been released on [Huggingface](https://huggingface.co/collections/McGill-NLP/afriquellm).

Despite the success of Large Language Models (LLMs) in general image tasks, a gap persists in the medical field for a multimodal large model adept at handling the nuanced diversity of medical images. Addressing this, we propose MedXChat, a unified multimodal large model designed for seamless interactions between medical assistants and users. MedXChat encompasses three key functionalities: CXR(Chest X-ray)-to-Report generation, CXR-based visual question-answering (VQA), and Text-to-CXR synthesis. Our contributions are as follows. Firstly, our model showcases exceptional cross-task adaptability, displaying adeptness across all three defined tasks and outperforming the benchmark models on the MIMIC dataset in medical multimodal applications. Secondly, we introduce an innovative Text-to-CXR synthesis approach that utilizes instruction-following capabilities within the Stable Diffusion (SD) architecture. This technique integrates smoothly with the existing model framework, requiring no extra parameters, thereby maintaining the SD's generative strength while also bestowing upon it the capacity to render fine-grained medical images with high fidelity. Comprehensive experiments validate MedXChat's synergistic enhancement across all tasks. Our instruction data and model will be open-sourced.

Training large models from scratch usually costs a substantial amount of resources. Towards this problem, recent studies such as bert2BERT and LiGO have reused small pretrained models to initialize a large model (termed the ``target model''), leading to a considerable acceleration in training. Despite the successes of these previous studies, they grew pretrained models by mapping partial weights only, ignoring potential correlations across the entire model. As we show in this paper, there are inter- and intra-interactions among the weights of both the pretrained and the target models. As a result, the partial mapping may not capture the complete information and lead to inadequate growth. In this paper, we propose a method that linearly correlates each weight of the target model to all the weights of the pretrained model to further enhance acceleration ability. We utilize multi-linear operators to reduce computational and spacial complexity, enabling acceptable resource requirements. Experiments demonstrate that our method can save 76\% computational costs on DeiT-base transferred from DeiT-small, which outperforms bert2BERT by +12.0\% and LiGO by +20.7\%, respectively.

Pulmonary opacification is the inflammation in the lungs caused by many respiratory ailments, including the novel corona virus disease 2019 (COVID-19). Chest X-rays (CXRs) with such opacifications render regions of lungs imperceptible, making it difficult to perform automated image analysis on them. In this work, we focus on segmenting lungs from such abnormal CXRs as part of a pipeline aimed at automated risk scoring of COVID-19 from CXRs. We treat the high opacity regions as missing data and present a modified CNN-based image segmentation network that utilizes a deep generative model for data imputation. We train this model on normal CXRs with extensive data augmentation and demonstrate the usefulness of this model to extend to cases with extreme abnormalities.

Vision-language models (VLMs) trained on paired chest radiographs and radiology reports learn a shared embedding space that can preserve instance-level image-report correspondence. This poses a privacy risk in settings where radiographs and reports are deliberately kept separate after acquisition, such as image-only data sharing or access-controlled reports, because a de-identified image may be re-linked to its original narrative report through cosine similarity alone. We formalized this as image-to-report retrieval and used public paired cohorts, in which the true pairing is known by design, as ground-truth benchmarks to audit the risk rather than as the privacy scenario. Evaluating VLMs of increasing clinical specialization on 406,241 paired examples from 126,804 patients across MIMIC-CXR (43,793 held-out pairs) and external CheXpert Plus (29,296 pairs), we found that re-linkage rose systematically with specialization: the strongest VLM retrieved the correct report at 15 times chance at a candidate pool of N = 100, 50 times chance at N = 10,000, and well above chance at full-database scale. The signal persisted under pathology-matched hard negatives that removed disease-label shortcuts, indicating correspondence beyond broad diagnostic categories. To reduce it without retraining, we froze both encoders and applied differentially private optimization only to the projection heads defining the alignment layer (epsilon = 0.34, delta = 6x10-6). This reduced Recall@1 by 61.8% at N = 10,000 on MIMIC-CXR and transferred to CheXpert Plus without retraining, while image-side utility was largely preserved: macro AUROC for linear-probe classification across 14 labels shifted only from 79.63% to 79.43%. Targeted DP finetuning of the shared alignment layer can substantially reduce cross-modal re-linkage without materially degrading the image representations that make these models clinically useful.

Developing an interpretable system for generating reports in chest X-ray (CXR) analysis is becoming increasingly crucial in Computer-aided Diagnosis (CAD) systems, enabling radiologists to comprehend the decisions made by these systems. Despite the growth of diverse datasets and methods focusing on report generation, there remains a notable gap in how closely these models' generated reports align with the interpretations of real radiologists. In this study, we tackle this challenge by initially introducing Fine-Grained CXR (FG-CXR) dataset, which provides fine-grained paired information between the captions generated by radiologists and the corresponding gaze attention heatmaps for each anatomy. Unlike existing datasets that include a raw sequence of gaze alongside a report, with significant misalignment between gaze location and report content, our FG-CXR dataset offers a more grained alignment between gaze attention and diagnosis transcript. Furthermore, our analysis reveals that simply applying black-box image captioning methods to generate reports cannot adequately explain which information in CXR is utilized and how long needs to attend to accurately generate reports. Consequently, we propose a novel explainable radiologist's attention generator network (Gen-XAI) that mimics the diagnosis process of radiologists, explicitly constraining its output to closely align with both radiologist's gaze attention and transcript. Finally, we perform extensive experiments to illustrate the effectiveness of our method. Our datasets and checkpoint is available at https://github.com/UARK-AICV/FG-CXR.

Large-scale self-supervised pre-training has paved the way for one foundation model to handle many different vision tasks. Most pre-training methodologies train a single model of a certain size at one time. Nevertheless, various computation or storage constraints in real-world scenarios require substantial efforts to develop a series of models with different sizes to deploy. Thus, in this study, we propose a novel tri-branch self-supervised training framework, termed as POA (Pre-training Once for All), to tackle this aforementioned issue. Our approach introduces an innovative elastic student branch into a modern self-distillation paradigm. At each pre-training step, we randomly sample a sub-network from the original student to form the elastic student and train all branches in a self-distilling fashion. Once pre-trained, POA allows the extraction of pre-trained models of diverse sizes for downstream tasks. Remarkably, the elastic student facilitates the simultaneous pre-training of multiple models with different sizes, which also acts as an additional ensemble of models of various sizes to enhance representation learning. Extensive experiments, including k-nearest neighbors, linear probing evaluation and assessments on multiple downstream tasks demonstrate the effectiveness and advantages of our POA. It achieves state-of-the-art performance using ViT, Swin Transformer and ResNet backbones, producing around a hundred models with different sizes through a single pre-training session. The code is available at: https://github.com/Qichuzyy/POA.

Radiology report generation (RRG) has attracted significant attention due to its potential to reduce the workload of radiologists. Current RRG approaches are still unsatisfactory against clinical standards. This paper introduces a novel RRG method, LM-RRG, that integrates large models (LMs) with clinical quality reinforcement learning to generate accurate and comprehensive chest X-ray radiology reports. Our method first designs a large language model driven feature extractor to analyze and interpret different regions of the chest X-ray image, emphasizing specific regions with medical significance. Next, based on the large model's decoder, we develop a multimodal report generator that leverages multimodal prompts from visual features and textual instruction to produce the radiology report in an auto-regressive way. Finally, to better reflect the clinical significant and insignificant errors that radiologists would normally assign in the report, we introduce a novel clinical quality reinforcement learning strategy. It utilizes the radiology report clinical quality (RadCliQ) metric as a reward function in the learning process. Extensive experiments on the MIMIC-CXR and IU-Xray datasets demonstrate the superiority of our method over the state of the art.

The rapid progress of Transformers in artificial intelligence has come at the cost of increased resource consumption and greenhouse gas emissions due to growing model sizes. Prior work suggests using pretrained small models to improve training efficiency, but this approach may not be suitable for new model structures. On the other hand, training from scratch can be slow, and progressively stacking layers often fails to achieve significant acceleration. To address these challenges, we propose a novel method called Apollo, which prepares lessons for expanding operations by learning high-layer functionality during training of low layers. Our approach involves low-value-prioritized sampling (LVPS) to train different depths and weight sharing to facilitate efficient expansion. We also introduce an interpolation method for stable model depth extension. Experiments demonstrate that Apollo achieves state-of-the-art acceleration ratios, even rivaling methods using pretrained models, making it a universal and efficient solution for training deep models while reducing time, financial, and environmental costs.

Large language model pre-training has traditionally relied on human experts to craft heuristics for improving the corpora quality, resulting in numerous rules developed to date. However, these rules lack the flexibility to address the unique characteristics of individual example effectively. Meanwhile, applying tailored rules to every example is impractical for human experts. In this paper, we demonstrate that even small language models, with as few as 0.3B parameters, can exhibit substantial data refining capabilities comparable to those of human experts. We introduce Programming Every Example (ProX), a novel framework that treats data refinement as a programming task, enabling models to refine corpora by generating and executing fine-grained operations, such as string normalization, for each individual example at scale. Experimental results show that models pre-trained on ProX-curated data outperform either original data or data filtered by other selection methods by more than 2% across various downstream benchmarks. Its effectiveness spans various model sizes and pre-training corpora, including C4, RedPajama-V2, and FineWeb. Furthermore, ProX exhibits significant potential in domain-specific continual pre-training: without domain specific design, models trained on OpenWebMath refined by ProX outperform human-crafted rule-based methods, improving average accuracy by 7.6% over Mistral-7B, with 14.6% for Llama-2-7B and 20.3% for CodeLlama-7B, all within 10B tokens to be comparable to models like Llemma-7B trained on 200B tokens. Further analysis highlights that ProX significantly saves training FLOPs, offering a promising path for efficient LLM pre-training.We are open-sourcing ProX with >100B corpus, models, and sharing all training and implementation details for reproducible research and future innovation. Code: https://github.com/GAIR-NLP/ProX

Chest X-ray (CXR) segmentation is an important step in computer-aided diagnosis, yet deploying large foundation models in clinical settings remains challenging due to computational constraints. We propose AdaLoRA-QAT, a two-stage fine-tuning framework that combines adaptive low-rank encoder adaptation with full quantization-aware training. Adaptive rank allocation improves parameter efficiency, while selective mixed-precision INT8 quantization preserves structural fidelity crucial for clinical reliability. Evaluated across large-scale CXR datasets, AdaLoRA-QAT achieves 95.6% Dice, matching full-precision SAM decoder fine-tuning while reducing trainable parameters by 16.6\times and yielding 2.24\times model compression. A Wilcoxon signed-rank test confirms that quantization does not significantly degrade segmentation accuracy. These results demonstrate that AdaLoRA-QAT effectively balances accuracy, efficiency, and structural trust-worthiness, enabling compact and deployable foundation models for medical image segmentation. Code and pretrained models are available at: https://prantik-pdeb.github.io/adaloraqat.github.io/

Many applications of machine learning require a model to make accurate pre-dictions on test examples that are distributionally different from training ones, while task-specific labels are scarce during training. An effective approach to this challenge is to pre-train a model on related tasks where data is abundant, and then fine-tune it on a downstream task of interest. While pre-training has been effective in many language and vision domains, it remains an open question how to effectively use pre-training on graph datasets. In this paper, we develop a new strategy and self-supervised methods for pre-training Graph Neural Networks (GNNs). The key to the success of our strategy is to pre-train an expressive GNN at the level of individual nodes as well as entire graphs so that the GNN can learn useful local and global representations simultaneously. We systematically study pre-training on multiple graph classification datasets. We find that naive strategies, which pre-train GNNs at the level of either entire graphs or individual nodes, give limited improvement and can even lead to negative transfer on many downstream tasks. In contrast, our strategy avoids negative transfer and improves generalization significantly across downstream tasks, leading up to 9.4% absolute improvements in ROC-AUC over non-pre-trained models and achieving state-of-the-art performance for molecular property prediction and protein function prediction.

Mimicking human behavior to actively learning from general experience and achieve artificial general intelligence has always been a human dream. Recent reinforcement learning (RL) based large-thinking models demonstrate impressive expert-level abilities, i.e., software and math, but still rely heavily on verifiable rewards in specific domains, placing a significant bottleneck to extend the performance boundary of general reasoning capabilities. In this work, we propose PretrainZero, a reinforcement active learning framework built on the pretraining corpus to extend RL from domain-specific post-training to general pretraining. PretrainZero features the following characteristics: 1) Active pretraining: inspired by the active learning ability of humans, PretrainZero learns a unified reasoning policy to actively identify reasonable and informative contents from pretraining corpus, and reason to predict these contents by RL. 2) Self-supervised learning: without any verifiable labels, pretrained reward models, or supervised fine-tuning, we directly pretrain reasoners from 3 to 30B base models on the general Wikipedia corpus using RL, significantly breaking the verification data-wall for general reasoning. 3) Verification scaling: by tackling increasingly challenging masked spans, PretrainZero substantially enhances the general reasoning abilities of pretrained base models. In reinforcement pretraining, PretrainZero improves Qwen3-4B-Base for 8.43, 5.96 and 10.60 on MMLU-Pro, SuperGPQA and math average benchmarks. In post-training, the pretrained models can also serve as reasoning foundation models for downstream RLVR tasks.

Pretraining produces a learned parameter vector that is typically treated as a starting point for further iterative adaptation. In this work, we instead view the outcome of pretraining as a distribution over parameter vectors, whose support already contains task-specific experts. We show that in small models such expert solutions occupy a negligible fraction of the volume of this distribution, making their discovery reliant on structured optimization methods such as gradient descent. In contrast, in large, well-pretrained models the density of task-experts increases dramatically, so that diverse, task-improving specialists populate a substantial fraction of the neighborhood around the pretrained weights. Motivated by this perspective, we explore a simple, fully parallel post-training method that samples N parameter perturbations at random, selects the top K, and ensembles predictions via majority vote. Despite its simplicity, this approach is competitive with standard post-training methods such as PPO, GRPO, and ES for contemporary large-scale models.

The development of large-scale image-text pair datasets has significantly advanced self-supervised learning in Vision-Language Processing (VLP). However, directly applying general-domain architectures such as CLIP to medical data presents challenges, particularly in handling negations and addressing the inherent data imbalance of medical datasets. To address these issues, we propose a novel approach that integrates clinically-enhanced dynamic soft labels and medical graphical alignment, thereby improving clinical comprehension and the applicability of contrastive loss in medical contexts. Furthermore, we introduce negation-based hard negatives to deepen the model's understanding of the complexities of clinical language. Our approach is easily integrated into the medical CLIP training pipeline and achieves state-of-the-art performance across multiple tasks, including zero-shot, fine-tuned classification, and report retrieval. To comprehensively evaluate our model's capacity for understanding clinical language, we introduce CXR-Align, a benchmark uniquely designed to evaluate the understanding of negation and clinical information within chest X-ray (CXR) datasets. Experimental results demonstrate that our proposed methods are straightforward to implement and generalize effectively across contrastive learning frameworks, enhancing medical VLP capabilities and advancing clinical language understanding in medical imaging.

This report introduces xGen-MM (also known as BLIP-3), a framework for developing Large Multimodal Models (LMMs). The framework comprises meticulously curated datasets, a training recipe, model architectures, and a resulting suite of LMMs. xGen-MM, short for xGen-MultiModal, expands the Salesforce xGen initiative on foundation AI models. Our models undergo rigorous evaluation across a range of tasks, including both single and multi-image benchmarks. Our pre-trained base model exhibits strong in-context learning capabilities and the instruction-tuned model demonstrates competitive performance among open-source LMMs with similar model sizes. In addition, we introduce a safety-tuned model with DPO, aiming to mitigate harmful behaviors such as hallucinations and improve safety. We open-source our models, curated large-scale datasets, and our fine-tuning codebase to facilitate further advancements in LMM research. Associated resources will be available on our project page above.

We introduce TiRex-2, a recurrent xLSTM-based time series foundation model that generalizes the univariate TiRex to multivariate forecasting with both past and future covariates. Real-world forecasting is inherently sequential: observations arrive continuously, variables evolve jointly, and a subset of covariates is known ahead of time. Existing Transformer-based time series foundation models capture cross-variate dependencies but incur quadratic complexity in context length and require full-history recomputation as new observations arrive. TiRex-2 addresses these limitations through a memory-centric recurrent design that operates at constant per-patch cost under streaming. The model combines a bidirectional time mixer with an asymmetric grouped-attention variate mixer, enabling the integration of future-known covariates while preserving strict causality over target variables. To our knowledge, this is the first time series foundation model that achieves this combination of properties. To support scalable multivariate pretraining, we propose a synthetic coupling pipeline that composes diverse multivariate samples on the fly from large univariate corpora. Empirically, TiRex-2 achieves state-of-the-art zero-shot performance on GIFT-Eval and fev-bench, remains stable when streamed to arbitrary context lengths, and maintains constant inference cost per patch. The model uses 38.4M active parameters in univariate mode, with an additional 44.1M parameters activated for multivariate forecasting.

Continued pretraining offers a promising solution for adapting foundation models to a new target domain. However, in specialized domains, available datasets are often very small, limiting the applicability of SSL methods developed for large-scale pretraining and making hyperparameter search infeasible. In addition, pretrained models are usually released as backbone-weights only, lacking important information to continue pretraining. We propose to bridge this gap with DIET-CP, a simple continued pretraining strategy, where any strong foundation model can be steered towards the new data distribution of interest. DIET-CP relies on a very simple objective, requires no labels, and introduces no more hyperparameters than supervised finetuning. It is stable across data modalities and backbone choices, while providing a significant performance boost for state-of-the-art models such as DINOv3 using only 1000 images.

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

A radiology report comprises several sections, including the Findings and Impression of the diagnosis. Automatically generating the Impression from the Findings is crucial for reducing radiologists' workload and improving diagnostic accuracy. Pretrained models that excel in common abstractive summarization problems encounter challenges when applied to specialized medical domains largely due to the complex terminology and the necessity for accurate clinical context. Such tasks in medical domains demand extracting core information, avoiding context shifts, and maintaining proper flow. Misuse of medical terms can lead to drastic clinical errors. To address these issues, we introduce a sequential transfer learning that ensures key content extraction and coherent summarization. Sequential transfer learning often faces challenges like initial parameter decay and knowledge loss, which we resolve with the Fisher matrix regularization. Using MIMIC-CXR and Open-I datasets, our model, CSTRL - Context-driven Sequential TRansfer Learning - achieved state-of-the-art performance, showing 56.2% improvement in BLEU-1, 40.5% in BLEU-2, 84.3% in BLEU-3, 28.9% in ROUGE-1, 41.0% in ROUGE-2 and 26.5% in ROGUE-3 score over benchmark studies. We also analyze factual consistency scores while preserving the medical context. Our code is publicly available at https://github.com/fahmidahossain/Report_Summarization.

Recent work has demonstrated the effectiveness of cross-lingual language model pretraining for cross-lingual understanding. In this study, we present the results of two larger multilingual masked language models, with 3.5B and 10.7B parameters. Our two new models dubbed XLM-R XL and XLM-R XXL outperform XLM-R by 1.8% and 2.4% average accuracy on XNLI. Our model also outperforms the RoBERTa-Large model on several English tasks of the GLUE benchmark by 0.3% on average while handling 99 more languages. This suggests pretrained models with larger capacity may obtain both strong performance on high-resource languages while greatly improving low-resource languages. We make our code and models publicly available.

We introduce Xmodel-LM, a compact and efficient 1.1B language model pre-trained on over 2 trillion tokens. Trained on our self-built dataset (Xdata), which balances Chinese and English corpora based on downstream task optimization, Xmodel-LM exhibits remarkable performance despite its smaller size. It notably surpasses existing open-source language models of similar scale. Our model checkpoints and code are publicly accessible on GitHub at https://github.com/XiaoduoAILab/XmodelLM.

Large language models (LLMs) have demonstrated remarkable capabilities in various domains, including radiology report generation. Previous approaches have attempted to utilize multimodal LLMs for this task, enhancing their performance through the integration of domain-specific knowledge retrieval. However, these approaches often overlook the knowledge already embedded within the LLMs, leading to redundant information integration and inefficient utilization of learned representations. To address this limitation, we propose RADAR, a framework for enhancing radiology report generation with supplementary knowledge injection. RADAR improves report generation by systematically leveraging both the internal knowledge of an LLM and externally retrieved information. Specifically, it first extracts the model's acquired knowledge that aligns with expert image-based classification outputs. It then retrieves relevant supplementary knowledge to further enrich this information. Finally, by aggregating both sources, RADAR generates more accurate and informative radiology reports. Extensive experiments on MIMIC-CXR, CheXpert-Plus, and IU X-ray demonstrate that our model outperforms state-of-the-art LLMs in both language quality and clinical accuracy

Ensuring safety, factuality and overall quality in the generations of large language models is a critical challenge, especially as these models are increasingly deployed in real-world applications. The prevailing approach to addressing these issues involves collecting expensive, carefully curated datasets and applying multiple stages of fine-tuning and alignment. However, even this complex pipeline cannot guarantee the correction of patterns learned during pretraining. Therefore, addressing these issues during pretraining is crucial, as it shapes a model's core behaviors and prevents unsafe or hallucinated outputs from becoming deeply embedded. To tackle this issue, we introduce a new pretraining method that streams documents and uses reinforcement learning (RL) to improve the next K generated tokens at each step. A strong, post-trained model judges candidate generations -- including model rollouts, the original suffix, and a rewritten suffix -- for quality, safety, and factuality. Early in training, the process relies on the original and rewritten suffixes; as the model improves, RL rewards high-quality rollouts. This approach builds higher quality, safer, and more factual models from the ground up. In experiments, our method gives 36.2% and 18.5% relative improvements over standard pretraining in terms of factuality and safety, and up to 86.3% win rate improvements in overall generation quality.

Foundation models have reshaped the landscape of Remote Sensing (RS) by enhancing various image interpretation tasks. Pretraining is an active research topic, encompassing supervised and self-supervised learning methods to initialize model weights effectively. However, transferring the pretrained models to downstream tasks may encounter task discrepancy due to their formulation of pretraining as image classification or object discrimination tasks. In this study, we explore the Multi-Task Pretraining (MTP) paradigm for RS foundation models to address this issue. Using a shared encoder and task-specific decoder architecture, we conduct multi-task supervised pretraining on the SAMRS dataset, encompassing semantic segmentation, instance segmentation, and rotated object detection. MTP supports both convolutional neural networks and vision transformer foundation models with over 300 million parameters. The pretrained models are finetuned on various RS downstream tasks, such as scene classification, horizontal and rotated object detection, semantic segmentation, and change detection. Extensive experiments across 14 datasets demonstrate the superiority of our models over existing ones of similar size and their competitive performance compared to larger state-of-the-art models, thus validating the effectiveness of MTP.

Pretraining is the cornerstone of Large Language Models (LLMs), dominating the vast majority of computational budget and data to serve as the primary engine for their capabilities. During pretraining, LLMs acquire foundational knowledge from an unprecedentedly massive and diverse data sources, encompassing a vast array of domains such as general language, mathematics, code, and complex reasoning. In this work, we investigate an interesting geometric question regarding the converged state of pretraining: Does the model converge to a common minimizer across all data sources (e.g., fig:cwa_illustration:close), or merely a minimizer of the summed loss (e.g., fig:cwa_illustration:distant)? We hypothesize that the geometric "closeness" of task-specific minima is intrinsically linked to downstream generalization. We reveal that standard optimizers (e.g., AdamW) often converge to points where task-specific minima are distant from each other. To address this, we propose the Nexus optimizer, which encourages the closeness of these minima by maximizing gradient similarity during optimization. Experiments across models ranging from 130M to 3B parameters, various data mixtures and hyperparameter schedules, show that Nexus significantly boosts downstream performance, despite achieving the same pretraining loss (see fig:demo:benchmark). Notably, on the 3B model, Nexus reduces the out-of-distribution loss by 0.012 and yields up to a 15.0\% accuracy improvement on complex reasoning tasks (e.g., GSM8k). This finding challenges the reliance on pretraining loss as the sole proxy for model evaluation and demonstrates the importance of implicit biases in unlocking downstream generalization.

Chest X-ray report generation (CXR-RG) has the potential to substantially alleviate radiologists' workload. However, conventional autoregressive vision--language models (VLMs) suffer from high inference latency due to sequential token decoding. Diffusion-based models offer a promising alternative through parallel generation, but they still require multiple denoising iterations. Compressing multi-step denoising to a single step could further reduce latency, but often degrades textual coherence due to the mean-field bias introduced by token-factorized denoisers. To address this challenge, we propose ECHO, an efficient diffusion-based VLM (dVLM) for chest X-ray report generation. ECHO enables stable one-step-per-block inference via a novel Direct Conditional Distillation (DCD) framework, which mitigates the mean-field limitation by constructing unfactorized supervision from on-policy diffusion trajectories to encode joint token dependencies. In addition, we introduce a Response-Asymmetric Diffusion (RAD) training strategy that further improves training efficiency while maintaining model effectiveness. Extensive experiments demonstrate that ECHO surpasses state-of-the-art autoregressive methods, improving RaTE and SemScore by 64.33\% and 60.58\% respectively, while achieving an 8times inference speedup without compromising clinical accuracy.

Pretrained multilingual models are able to perform cross-lingual transfer in a zero-shot setting, even for languages unseen during pretraining. However, prior work evaluating performance on unseen languages has largely been limited to low-level, syntactic tasks, and it remains unclear if zero-shot learning of high-level, semantic tasks is possible for unseen languages. To explore this question, we present AmericasNLI, an extension of XNLI (Conneau et al., 2018) to 10 indigenous languages of the Americas. We conduct experiments with XLM-R, testing multiple zero-shot and translation-based approaches. Additionally, we explore model adaptation via continued pretraining and provide an analysis of the dataset by considering hypothesis-only models. We find that XLM-R's zero-shot performance is poor for all 10 languages, with an average performance of 38.62%. Continued pretraining offers improvements, with an average accuracy of 44.05%. Surprisingly, training on poorly translated data by far outperforms all other methods with an accuracy of 48.72%.

Covariates provide valuable information on external factors that influence time series and are critical in many real-world time series forecasting tasks. For example, in retail, covariates may indicate promotions or peak dates such as holiday seasons that heavily influence demand forecasts. Recent advances in pretraining large language model architectures for time series forecasting have led to highly accurate forecasters. However, the majority of these models do not readily use covariates as they are often specific to a certain task or domain. This paper introduces a new method to incorporate covariates into pretrained time series forecasting models. Our proposed approach incorporates covariate information into pretrained forecasting models through modular blocks that inject past and future covariate information, without necessarily modifying the pretrained model in consideration. In order to evaluate our approach, we introduce a benchmark composed of 32 different synthetic datasets with varying dynamics to evaluate the effectivity of forecasting models with covariates. Extensive evaluations on both synthetic and real datasets show that our approach effectively incorporates covariate information into pretrained models, outperforming existing baselines.

Large pre-trained language models have become popular for many applications and form an important backbone of many downstream tasks in natural language processing (NLP). Applying 'explainable artificial intelligence' (XAI) techniques to enrich such models' outputs is considered crucial for assuring their quality and shedding light on their inner workings. However, large language models are trained on a plethora of data containing a variety of biases, such as gender biases, affecting model weights and, potentially, behavior. Currently, it is unclear to what extent such biases also impact model explanations in possibly unfavorable ways. We create a gender-controlled text dataset, GECO, in which otherwise identical sentences appear in male and female forms. This gives rise to ground-truth 'world explanations' for gender classification tasks, enabling the objective evaluation of the correctness of XAI methods. We also provide GECOBench, a rigorous quantitative evaluation framework benchmarking popular XAI methods, applying them to pre-trained language models fine-tuned to different degrees. This allows us to investigate how pre-training induces undesirable bias in model explanations and to what extent fine-tuning can mitigate such explanation bias. We show a clear dependency between explanation performance and the number of fine-tuned layers, where XAI methods are observed to particularly benefit from fine-tuning or complete retraining of embedding layers. Remarkably, this relationship holds for models achieving similar classification performance on the same task. With that, we highlight the utility of the proposed gender-controlled dataset and novel benchmarking approach for research and development of novel XAI methods. All code including dataset generation, model training, evaluation and visualization is available at: https://github.com/braindatalab/gecobench

The development of successful artificial intelligence models for chest X-ray analysis relies on large, diverse datasets with high-quality annotations. While several databases of chest X-ray images have been released, most include disease diagnosis labels but lack detailed pixel-level anatomical segmentation labels. To address this gap, we introduce an extensive chest X-ray multi-center segmentation dataset with uniform and fine-grain anatomical annotations for images coming from six well-known publicly available databases: CANDID-PTX, ChestX-ray8, Chexpert, MIMIC-CXR-JPG, Padchest, and VinDr-CXR, resulting in 676,803 segmentation masks. Our methodology utilizes the HybridGNet model to ensure consistent and high-quality segmentations across all datasets. Rigorous validation, including expert physician evaluation and automatic quality control, was conducted to validate the resulting masks. Additionally, we provide individualized quality indices per mask and an overall quality estimation per dataset. This dataset serves as a valuable resource for the broader scientific community, streamlining the development and assessment of innovative methodologies in chest X-ray analysis. The CheXmask dataset is publicly available at: https://physionet.org/content/chexmask-cxr-segmentation-data/.

The limited availability of labeled chest X-ray datasets is a significant bottleneck in the development of medical imaging methods. Self-supervised learning (SSL) can mitigate this problem by training models on unlabeled data. Furthermore, self-supervised pretraining has yielded promising results in visual recognition of natural images but has not been given much consideration in medical image analysis. In this work, we propose a self-supervised method, DINO-CXR, which is a novel adaptation of a self-supervised method, DINO, based on a vision transformer for chest X-ray classification. A comparative analysis is performed to show the effectiveness of the proposed method for both pneumonia and COVID-19 detection. Through a quantitative analysis, it is also shown that the proposed method outperforms state-of-the-art methods in terms of accuracy and achieves comparable results in terms of AUC and F-1 score while requiring significantly less labeled data.

The label scarcity problem is the main challenge that hinders the wide application of deep learning systems in automatic cardiovascular diseases (CVDs) detection using electrocardiography (ECG). Tuning pre-trained models alleviates this problem by transferring knowledge learned from large datasets to downstream small datasets. However, bottlenecks in computational efficiency and detection performance limit its clinical applications. It is difficult to improve the detection performance without significantly sacrificing the computational efficiency during model training. Here, we propose a computation-efficient semi-supervised learning paradigm (CE-SSL) for robust and computation-efficient CVDs detection using ECG. It enables a robust adaptation of pre-trained models on downstream datasets with limited supervision and high computational efficiency. First, a random-deactivation technique is developed to achieve robust and fast low-rank adaptation of pre-trained weights. Subsequently, we propose a one-shot rank allocation module to determine the optimal ranks for the update matrices of the pre-trained weights. Finally, a lightweight semi-supervised learning pipeline is introduced to enhance model performance by leveraging labeled and unlabeled data with high computational efficiency. Extensive experiments on four downstream datasets demonstrate that CE-SSL not only outperforms the state-of-the-art methods in multi-label CVDs detection but also consumes fewer GPU footprints, training time, and parameter storage space. As such, this paradigm provides an effective solution for achieving high computational efficiency and robust detection performance in the clinical applications of pre-trained models under limited supervision. Code and Supplementary Materials are available at https://github.com/KAZABANA/CE-SSL

Chagas disease screening via ECGs is limited by scarce and noisy labels in existing datasets. We propose a biomarker-based pretraining approach, where an ECG feature extractor is first trained to predict percentile-binned blood biomarkers from the MIMIC-IV-ECG dataset. The pretrained model is then fine-tuned on Brazilian datasets for Chagas detection. Our 5-model ensemble, developed by the Ahus AIM team, achieved a challenge score of 0.269 on the hidden test set, ranking 5th in Detection of Chagas Disease from the ECG: The George B. Moody PhysioNet Challenge 2025. Source code and the model are shared on GitHub: github.com/Ahus-AIM/physionet-challenge-2025

We introduce X-Adapter, a universal upgrader to enable the pretrained plug-and-play modules (e.g., ControlNet, LoRA) to work directly with the upgraded text-to-image diffusion model (e.g., SDXL) without further retraining. We achieve this goal by training an additional network to control the frozen upgraded model with the new text-image data pairs. In detail, X-Adapter keeps a frozen copy of the old model to preserve the connectors of different plugins. Additionally, X-Adapter adds trainable mapping layers that bridge the decoders from models of different versions for feature remapping. The remapped features will be used as guidance for the upgraded model. To enhance the guidance ability of X-Adapter, we employ a null-text training strategy for the upgraded model. After training, we also introduce a two-stage denoising strategy to align the initial latents of X-Adapter and the upgraded model. Thanks to our strategies, X-Adapter demonstrates universal compatibility with various plugins and also enables plugins of different versions to work together, thereby expanding the functionalities of diffusion community. To verify the effectiveness of the proposed method, we conduct extensive experiments and the results show that X-Adapter may facilitate wider application in the upgraded foundational diffusion model.

Pre-training has been a popular learning paradigm in deep learning era, especially in annotation-insufficient scenario. Better ImageNet pre-trained models have been demonstrated, from the perspective of architecture, by previous research to have better transferability to downstream tasks. However, in this paper, we found that during the same pre-training process, models at middle epochs, which is inadequately pre-trained, can outperform fully trained models when used as feature extractors (FE), while the fine-tuning (FT) performance still grows with the source performance. This reveals that there is not a solid positive correlation between top-1 accuracy on ImageNet and the transferring result on target data. Based on the contradictory phenomenon between FE and FT that better feature extractor fails to be fine-tuned better accordingly, we conduct comprehensive analyses on features before softmax layer to provide insightful explanations. Our discoveries suggest that, during pre-training, models tend to first learn spectral components corresponding to large singular values and the residual components contribute more when fine-tuning.

This paper introduces an innovative approach to Medical Vision-Language Pre-training (Med-VLP) area in the specialized context of radiograph representation learning. While conventional methods frequently merge textual annotations into unified reports, we acknowledge the intrinsic hierarchical relationship between the findings and impression section in radiograph datasets. To establish a targeted correspondence between images and texts, we propose a novel HybridMED framework to align global-level visual representations with impression and token-level visual representations with findings. Moreover, our framework incorporates a generation decoder that employs two proxy tasks, responsible for generating the impression from (1) images, via a captioning branch, and (2) findings, through a summarization branch. Additionally, knowledge distillation is leveraged to facilitate the training process. Experiments on the MIMIC-CXR dataset reveal that our summarization branch effectively distills knowledge to the captioning branch, enhancing model performance without significantly increasing parameter requirements due to the shared self-attention and feed-forward architecture.

Continual pre-training (CPT) has been an important approach for adapting language models to specific domains or tasks. To make the CPT approach more traceable, this paper presents a technical report for continually pre-training Llama-3 (8B), which significantly enhances the Chinese language ability and scientific reasoning ability of the backbone model. To enhance the new abilities while retaining the original abilities, we design specific data mixture and curriculum strategies by utilizing existing datasets and synthesizing high-quality datasets. Specifically, we synthesize multidisciplinary scientific question and answer (QA) pairs based on related web pages, and subsequently incorporate these synthetic data to improve the scientific reasoning ability of Llama-3. We refer to the model after CPT as Llama-3-SynE (Synthetic data Enhanced Llama-3). We also present the tuning experiments with a relatively small model -- TinyLlama, and employ the derived findings to train the backbone model. Extensive experiments on a number of evaluation benchmarks show that our approach can largely improve the performance of the backbone models, including both the general abilities (+8.81 on C-Eval and +6.31 on CMMLU) and the scientific reasoning abilities (+12.00 on MATH and +4.13 on SciEval), without hurting the original capacities. Our model, data, and codes are available at https://github.com/RUC-GSAI/Llama-3-SynE.

Nowadays, pre-training big models on large-scale datasets has become a crucial topic in deep learning. The pre-trained models with high representation ability and transferability achieve a great success and dominate many downstream tasks in natural language processing and 2D vision. However, it is non-trivial to promote such a pretraining-tuning paradigm to the 3D vision, given the limited training data that are relatively inconvenient to collect. In this paper, we provide a new perspective of leveraging pre-trained 2D knowledge in 3D domain to tackle this problem, tuning pre-trained image models with the novel Point-to-Pixel prompting for point cloud analysis at a minor parameter cost. Following the principle of prompting engineering, we transform point clouds into colorful images with geometry-preserved projection and geometry-aware coloring to adapt to pre-trained image models, whose weights are kept frozen during the end-to-end optimization of point cloud analysis tasks. We conduct extensive experiments to demonstrate that cooperating with our proposed Point-to-Pixel Prompting, better pre-trained image model will lead to consistently better performance in 3D vision. Enjoying prosperous development from image pre-training field, our method attains 89.3% accuracy on the hardest setting of ScanObjectNN, surpassing conventional point cloud models with much fewer trainable parameters. Our framework also exhibits very competitive performance on ModelNet classification and ShapeNet Part Segmentation. Code is available at https://github.com/wangzy22/P2P.

The possibility to use widespread and simple chest X-ray (CXR) imaging for early screening of COVID-19 patients is attracting much interest from both the clinical and the AI community. In this study we provide insights and also raise warnings on what is reasonable to expect by applying deep-learning to COVID classification of CXR images. We provide a methodological guide and critical reading of an extensive set of statistical results that can be obtained using currently available datasets. In particular, we take the challenge posed by current small size COVID data and show how significant can be the bias introduced by transfer-learning using larger public non-COVID CXR datasets. We also contribute by providing results on a medium size COVID CXR dataset, just collected by one of the major emergency hospitals in Northern Italy during the peak of the COVID pandemic. These novel data allow us to contribute to validate the generalization capacity of preliminary results circulating in the scientific community. Our conclusions shed some light into the possibility to effectively discriminate COVID using CXR.

Class-incremental learning (CIL) aims to adapt to emerging new classes without forgetting old ones. Traditional CIL models are trained from scratch to continually acquire knowledge as data evolves. Recently, pre-training has achieved substantial progress, making vast pre-trained models (PTMs) accessible for CIL. Contrary to traditional methods, PTMs possess generalizable embeddings, which can be easily transferred. In this work, we revisit CIL with PTMs and argue that the core factors in CIL are adaptivity for model updating and generalizability for knowledge transferring. 1) We first reveal that frozen PTM can already provide generalizable embeddings for CIL. Surprisingly, a simple baseline (SimpleCIL) which continually sets the classifiers of PTM to prototype features can beat state-of-the-art even without training on the downstream task. 2) Due to the distribution gap between pre-trained and downstream datasets, PTM can be further cultivated with adaptivity via model adapting. We propose ADapt And Merge (ADAM), which aggregates the embeddings of PTM and adapted models for classifier construction. ADAM is a general framework that can be orthogonally combined with any parameter-efficient tuning method, which holds the advantages of PTM's generalizability and adapted model's adaptivity. 3) Additionally, we find previous benchmarks are unsuitable in the era of PTM due to data overlapping and propose four new benchmarks for assessment, namely ImageNet-A, ObjectNet, OmniBenchmark, and VTAB. Extensive experiments validate the effectiveness of ADAM with a unified and concise framework.

While traditional machine learning can effectively tackle a wide range of problems, it primarily operates within a closed-world setting, which presents limitations when dealing with streaming data. As a solution, incremental learning emerges to address real-world scenarios involving new data's arrival. Recently, pre-training has made significant advancements and garnered the attention of numerous researchers. The strong performance of these pre-trained models (PTMs) presents a promising avenue for developing continual learning algorithms that can effectively adapt to real-world scenarios. Consequently, exploring the utilization of PTMs in incremental learning has become essential. This paper introduces a pre-trained model-based continual learning toolbox known as PILOT. On the one hand, PILOT implements some state-of-the-art class-incremental learning algorithms based on pre-trained models, such as L2P, DualPrompt, and CODA-Prompt. On the other hand, PILOT also fits typical class-incremental learning algorithms (e.g., DER, FOSTER, and MEMO) within the context of pre-trained models to evaluate their effectiveness.

Large Language Models (LLMs) have transformed the natural language processing landscape and brought to life diverse applications. Pretraining on vast web-scale data has laid the foundation for these models, yet the research community is now increasingly shifting focus toward post-training techniques to achieve further breakthroughs. While pretraining provides a broad linguistic foundation, post-training methods enable LLMs to refine their knowledge, improve reasoning, enhance factual accuracy, and align more effectively with user intents and ethical considerations. Fine-tuning, reinforcement learning, and test-time scaling have emerged as critical strategies for optimizing LLMs performance, ensuring robustness, and improving adaptability across various real-world tasks. This survey provides a systematic exploration of post-training methodologies, analyzing their role in refining LLMs beyond pretraining, addressing key challenges such as catastrophic forgetting, reward hacking, and inference-time trade-offs. We highlight emerging directions in model alignment, scalable adaptation, and inference-time reasoning, and outline future research directions. We also provide a public repository to continually track developments in this fast-evolving field: https://github.com/mbzuai-oryx/Awesome-LLM-Post-training.

ELECTRA, the generator-discriminator pre-training framework, has achieved impressive semantic construction capability among various downstream tasks. Despite the convincing performance, ELECTRA still faces the challenges of monotonous training and deficient interaction. Generator with only masked language modeling (MLM) leads to biased learning and label imbalance for discriminator, decreasing learning efficiency; no explicit feedback loop from discriminator to generator results in the chasm between these two components, underutilizing the course learning. In this study, a multi-perspective course learning (MCL) method is proposed to fetch a many degrees and visual angles for sample-efficient pre-training, and to fully leverage the relationship between generator and discriminator. Concretely, three self-supervision courses are designed to alleviate inherent flaws of MLM and balance the label in a multi-perspective way. Besides, two self-correction courses are proposed to bridge the chasm between the two encoders by creating a "correction notebook" for secondary-supervision. Moreover, a course soups trial is conducted to solve the "tug-of-war" dynamics problem of MCL, evolving a stronger pre-trained model. Experimental results show that our method significantly improves ELECTRA's average performance by 2.8% and 3.2% absolute points respectively on GLUE and SQuAD 2.0 benchmarks, and overshadows recent advanced ELECTRA-style models under the same settings. The pre-trained MCL model is available at https://huggingface.co/McmanusChen/MCL-base.

Can a small amount of verified goal information steer the expensive self-supervised pretraining of foundation models? Standard pretraining optimizes a fixed proxy objective (e.g., next-token prediction), which can misallocate compute away from downstream capabilities of interest. We introduce V-Pretraining: a value-based, modality-agnostic method for controlled continued pretraining in which a lightweight task designer reshapes the pretraining task to maximize the value of each gradient step. For example, consider self-supervised learning (SSL) with sample augmentation. The V-Pretraining task designer selects pretraining tasks (e.g., augmentations) for which the pretraining loss gradient is aligned with a gradient computed over a downstream task (e.g., image segmentation). This helps steer pretraining towards relevant downstream capabilities. Notably, the pretrained model is never updated on downstream task labels; they are used only to shape the pretraining task. Under matched learner update budgets, V-Pretraining of 0.5B--7B language models improves reasoning (GSM8K test Pass@1) by up to 18% relative over standard next-token prediction using only 12% of GSM8K training examples as feedback. In vision SSL, we improve the state-of-the-art results on ADE20K by up to 1.07 mIoU and reduce NYUv2 RMSE while improving ImageNet linear accuracy, and we provide pilot evidence of improved token efficiency in continued pretraining.

The applicability of current lesion segmentation models for chest X-rays (CXRs) has been limited both by a small number of target labels and the reliance on long, detailed expert-level text inputs, creating a barrier to practical use. To address these limitations, we introduce a new paradigm: instruction-guided lesion segmentation (ILS), which is designed to segment diverse lesion types based on simple, user-friendly instructions. Under this paradigm, we construct MIMIC-ILS, the first large-scale instruction-answer dataset for CXR lesion segmentation, using our fully automated multimodal pipeline that generates annotations from chest X-ray images and their corresponding reports. MIMIC-ILS contains 1.1M instruction-answer pairs derived from 192K images and 91K unique segmentation masks, covering seven major lesion types. To empirically demonstrate its utility, we introduce ROSALIA, a vision-language model fine-tuned on MIMIC-ILS. ROSALIA can segment diverse lesions and provide textual explanations in response to user instructions. The model achieves high segmentation and textual accuracy in our newly proposed task, highlighting the effectiveness of our pipeline and the value of MIMIC-ILS as a foundational resource for pixel-level CXR lesion grounding.

We introduce Xmodel-1.5, a novel 1-billion-parameter multilingual large model pretrained on approximately 2 trillion tokens. The model demonstrates strong performance across several languages, with particularly notable results in Thai, Arabic, and French, alongside its effectiveness in Chinese and English. In addition, we contribute to the research community by releasing a Thai evaluation dataset, which includes hundreds of questions annotated by students from Chulalongkorn University's School of Integrated Innovation. While the results are promising, we acknowledge that there is still room for improvement. We hope this work advances ongoing efforts in multilingual AI research and promotes better cross-linguistic understanding in various natural language processing tasks. Our models and code are publicly available on GitHub at https://github.com/XiaoduoAILab/XmodelLM.

Recent advancements in generation models have showcased remarkable capabilities in generating fantastic content. However, most of them are trained on proprietary high-quality data, and some models withhold their parameters and only provide accessible application programming interfaces (APIs), limiting their benefits for downstream tasks. To explore the feasibility of training a text-to-image generation model comparable to advanced models using publicly available resources, we introduce EvolveDirector. This framework interacts with advanced models through their public APIs to obtain text-image data pairs to train a base model. Our experiments with extensive data indicate that the model trained on generated data of the advanced model can approximate its generation capability. However, it requires large-scale samples of 10 million or more. This incurs significant expenses in time, computational resources, and especially the costs associated with calling fee-based APIs. To address this problem, we leverage pre-trained large vision-language models (VLMs) to guide the evolution of the base model. VLM continuously evaluates the base model during training and dynamically updates and refines the training dataset by the discrimination, expansion, deletion, and mutation operations. Experimental results show that this paradigm significantly reduces the required data volume. Furthermore, when approaching multiple advanced models, EvolveDirector can select the best samples generated by them to learn powerful and balanced abilities. The final trained model Edgen is demonstrated to outperform these advanced models. The code and model weights are available at https://github.com/showlab/EvolveDirector.

Self-supervised pre-training bears potential to generate expressive representations without human annotation. Most pre-training in Earth observation (EO) are based on ImageNet or medium-size, labeled remote sensing (RS) datasets. We share an unlabeled RS dataset SSL4EO-S12 (Self-Supervised Learning for Earth Observation - Sentinel-1/2) to assemble a large-scale, global, multimodal, and multi-seasonal corpus of satellite imagery from the ESA Sentinel-1 \& -2 satellite missions. For EO applications we demonstrate SSL4EO-S12 to succeed in self-supervised pre-training for a set of methods: MoCo-v2, DINO, MAE, and data2vec. Resulting models yield downstream performance close to, or surpassing accuracy measures of supervised learning. In addition, pre-training on SSL4EO-S12 excels compared to existing datasets. We make openly available the dataset, related source code, and pre-trained models at https://github.com/zhu-xlab/SSL4EO-S12.

Machine learning methods for satellite data have a range of societally relevant applications, but labels used to train models can be difficult or impossible to acquire. Self-supervision is a natural solution in settings with limited labeled data, but current self-supervised models for satellite data fail to take advantage of the characteristics of that data, including the temporal dimension (which is critical for many applications, such as monitoring crop growth) and availability of data from many complementary sensors (which can significantly improve a model's predictive performance). We present Presto (the Pretrained Remote Sensing Transformer), a model pre-trained on remote sensing pixel-timeseries data. By designing Presto specifically for remote sensing data, we can create a significantly smaller but performant model. Presto excels at a wide variety of globally distributed remote sensing tasks and performs competitively with much larger models while requiring far less compute. Presto can be used for transfer learning or as a feature extractor for simple models, enabling efficient deployment at scale.

Recent work has demonstrated that controlled pretraining experiments are a powerful tool for understanding learning, reasoning, and memorization in large language models (LLMs). However, the computational cost of pretraining presents a significant constraint. To overcome this constraint, we propose to conduct multiple pretraining experiments simultaneously during a single training run. We demonstrate the feasibility of this approach by conducting ten experiments during the training of a 1.5B parameter model on 210B tokens. Although we only train a single model, we can replicate the results from multiple previous works on data contamination, poisoning, and memorization. We also conduct novel investigations into knowledge acquisition, mathematical reasoning, and watermarking. For example, we dynamically update the training data until the model acquires a particular piece of knowledge. Remarkably, the influence of the ten experiments on the model's training dynamics and overall performance is minimal. However, interactions between different experiments may act as a potential confounder in our approach. We propose to test for interactions with continual pretraining experiments, finding them to be negligible in our setup. Overall, our findings suggest that performing multiple pretraining experiments in a single training run can enable rigorous scientific experimentation with large models on a compute budget.

In the past year, distillation has seen a renewed prominence in large language model (LLM) pretraining, exemplified by the Llama-3.2 and Gemma model families. While distillation has historically been shown to improve statistical modeling, its effects on new paradigms that are key to modern LLMs, such as test-time scaling and in-context learning, remain underexplored. In this work, we make three main contributions. First, we show that pretraining with distillation yields models that exhibit remarkably better test-time scaling. Second, we observe that this benefit comes with a trade-off: distillation impairs in-context learning capabilities, particularly the one modeled via induction heads. Third, to demystify these findings, we study distilled pretraining in a sandbox of a bigram model, which helps us isolate the common principal factor behind our observations. Finally, using these insights, we shed light on various design choices for pretraining that should help practitioners going forward.

Current state-of-the-art multi-vector models are obtained through a small Knowledge Distillation (KD) training step on top of strong single-vector models, leveraging the large-scale pre-training of these models. In this paper, we study the pre-training of multi-vector models and show that large-scale multi-vector pre-training yields much stronger multi-vector models. Notably, a fully ColBERT-pre-trained model, ColBERT-Zero, trained only on public data, outperforms GTE-ModernColBERT as well as its base model, GTE-ModernBERT, which leverages closed and much stronger data, setting new state-of-the-art for model this size. We also find that, although performing only a small KD step is not enough to achieve results close to full pre-training, adding a supervised step beforehand allows to achieve much closer performance while skipping the most costly unsupervised phase. Finally, we find that aligning the fine-tuning and pre-training setups is crucial when repurposing existing models. To enable exploration of our results, we release various checkpoints as well as code used to train them.

In this work we introduce Labrador, a pre-trained Transformer model for laboratory data. Labrador and BERT were pre-trained on a corpus of 100 million lab test results from electronic health records (EHRs) and evaluated on various downstream outcome prediction tasks. Both models demonstrate mastery of the pre-training task but neither consistently outperform XGBoost on downstream supervised tasks. Our ablation studies reveal that transfer learning shows limited effectiveness for BERT and achieves marginal success with Labrador. We explore the reasons for the failure of transfer learning and suggest that the data generating process underlying each patient cannot be characterized sufficiently using labs alone, among other factors. We encourage future work to focus on joint modeling of multiple EHR data categories and to include tree-based baselines in their evaluations.

Pre-training (PT) followed by fine-tuning (FT) is an effective method for training neural networks, and has led to significant performance improvements in many domains. PT can incorporate various design choices such as task and data reweighting strategies, augmentation policies, and noise models, all of which can significantly impact the quality of representations learned. The hyperparameters introduced by these strategies therefore must be tuned appropriately. However, setting the values of these hyperparameters is challenging. Most existing methods either struggle to scale to high dimensions, are too slow and memory-intensive, or cannot be directly applied to the two-stage PT and FT learning process. In this work, we propose an efficient, gradient-based algorithm to meta-learn PT hyperparameters. We formalize the PT hyperparameter optimization problem and propose a novel method to obtain PT hyperparameter gradients by combining implicit differentiation and backpropagation through unrolled optimization. We demonstrate that our method improves predictive performance on two real-world domains. First, we optimize high-dimensional task weighting hyperparameters for multitask pre-training on protein-protein interaction graphs and improve AUROC by up to 3.9%. Second, we optimize a data augmentation neural network for self-supervised PT with SimCLR on electrocardiography data and improve AUROC by up to 1.9%.

Large-scale pre-trained models such as CodeBERT, GraphCodeBERT have earned widespread attention from both academia and industry. Attributed to the superior ability in code representation, they have been further applied in multiple downstream tasks such as clone detection, code search and code translation. However, it is also observed that these state-of-the-art pre-trained models are susceptible to adversarial attacks. The performance of these pre-trained models drops significantly with simple perturbations such as renaming variable names. This weakness may be inherited by their downstream models and thereby amplified at an unprecedented scale. To this end, we propose an approach namely ContraBERT that aims to improve the robustness of pre-trained models via contrastive learning. Specifically, we design nine kinds of simple and complex data augmentation operators on the programming language (PL) and natural language (NL) data to construct different variants. Furthermore, we continue to train the existing pre-trained models by masked language modeling (MLM) and contrastive pre-training task on the original samples with their augmented variants to enhance the robustness of the model. The extensive experiments demonstrate that ContraBERT can effectively improve the robustness of the existing pre-trained models. Further study also confirms that these robustness-enhanced models provide improvements as compared to original models over four popular downstream tasks.