Recent advancements in multimodal models have significantly improved visionlanguage (VL) alignment in radiology. However, existing approaches struggle to effectively utilize complex radiology reports for learning and offer limited interpretability through attention probability visualizations. To address these challenges, we introduce RadZero, a novel framework for VL alignment in chest X-ray with zero-shot multi-task capability. A key component of our approach is VL-CABS (Vision-Language Cross-Attention Based on Similarity), which aligns text embeddings with local image features for interpretable, fine-grained VL reasoning. RadZero leverages large language models to extract concise semantic sentences from radiology reports and employs multi-positive contrastive training to effectively capture relationships between images and multiple relevant textual descriptions. It uses a pre-trained vision encoder with additional trainable Transformer layers, allowing efficient high-resolution image processing.

Recent advancements in multimodal models have significantly improved vision-language (VL) alignment in radiology. However, existing approaches struggle to effectively utilize complex radiology reports for learning and offer limited interpretability through attention probability visualizations. To address these challenges, we introduce $\textbf{RadZero}$, a novel framework for VL alignment in chest X-ray with zero-shot multi-task capability. A key component of our approach is $\textbf{VL-CABS}$ ($\textbf{V}$ision-$\textbf{L}$anguage $\textbf{C}$ross-$\textbf{A}$ttention $\textbf{B}$ased on $\textbf{S}$imilarity), which aligns text embeddings with local image features for interpretable, fine-grained VL reasoning. RadZero leverages large language models to extract concise semantic sentences from radiology reports and employs multi-positive contrastive training to effectively capture relationships between images and multiple relevant textual descriptions. It uses a pre-trained vision encoder with additional trainable Transformer layers, allowing efficient high-resolution image processing. By computing similarity between text embeddings and local image patch features, VL-CABS enables zero-shot inference with similarity probability for classification, and pixel-level VL similarity maps for grounding and segmentation. Experimental results on public chest radiograph benchmarks show that RadZero outperforms state-of-the-art methods in zero-shot classification, grounding, and segmentation. Furthermore, VL similarity map analysis highlights the potential of VL-CABS for improving explainability in VL alignment. Additionally, qualitative evaluation demonstrates RadZero's capability for open-vocabulary semantic segmentation, further validating its effectiveness in medical imaging. Code is available at $\href{https://github.com/deepnoid-ai/RadZero}{https://github.com/deepnoid-ai/RadZero}$.

Tuberculosis remains a critical global health issue, particularly in resource-limited and remote areas. Early detection is vital for treatment, yet the lack of skilled radiologists underscores the need for artificial intelligence (AI)-driven screening tools. Developing reliable AI models is challenging due to the necessity for large, high-quality datasets, which are costly to obtain. To tackle this, we propose a teacher--student framework which enhances both disease and symptom detection on chest X-rays by integrating two supervised heads and a self-supervised head. Our model achieves an accuracy of 98.85% for distinguishing between COVID-19, tuberculosis, and normal cases, and a macro-F1 score of 90.09% for multilabel symptom detection, significantly outperforming baselines. The explainability assessments also show the model bases its predictions on relevant anatomical features, demonstrating promise for deployment in clinical screening and triage settings.

Background: Pleural Effusions (PE) is a common finding in many different clinical conditions, but accurately measuring their volume from CT scans is challenging. Purpose: To improve PE segmentation and quantification for enhanced clinical management, we have developed and trained a semi-supervised deep learning framework on contrast-enhanced CT volumes. Materials and Methods: This retrospective study collected CT Pulmonary Angiogram (CTPA) data from internal and external datasets. A subset of 100 cases was manually annotated for model training, while the remaining cases were used for testing and validation. A novel semi-supervised deep learning framework, Teacher-Teaching Assistant-Student (TTAS), was developed and used to enable efficient training in non-segmented examinations. Segmentation performance was compared to that of state-of-the-art models. Results: 100 patients (mean age, 72 years, 28 [standard deviation]; 55 men) were included in the study. The TTAS model demonstrated superior segmentation performance compared to state-of-the-art models, achieving a mean Dice score of 0.82 (95% CI, 0.79 - 0.84) versus 0.73 for nnU-Net (p < 0.0001, Student's T test). Additionally, TTAS exhibited a four-fold lower mean Absolute Volume Difference (AbVD) of 6.49 mL (95% CI, 4.80 - 8.20) compared to nnU-Net's AbVD of 23.16 mL (p < 0.0001). Conclusion: The developed TTAS framework offered superior PE segmentation, aiding accurate volume determination from CT scans.

Automatically generated radiology reports often receive high scores from existing evaluation metrics but fail to earn clinicians' trust. This gap reveals fundamental flaws in how current metrics assess the quality of generated reports. We rethink the design and evaluation of these metrics and propose a clinically grounded Meta-Evaluation framework. We define clinically grounded criteria spanning clinical alignment and key metric capabilities, including discrimination, robustness, and monotonicity. Using a fine-grained dataset of ground truth and rewritten report pairs annotated with error types, clinical significance labels, and explanations, we systematically evaluate existing metrics and reveal their limitations in interpreting clinical semantics, such as failing to distinguish clinically significant errors, over-penalizing harmless variations, and lacking consistency across error severity levels. Our framework offers guidance for building more clinically reliable evaluation methods.

Artificial intelligence has shown significant promise in chest radiography, where deep learning models can approach radiologist-level diagnostic performance. Progress has been accelerated by large public datasets such as MIMIC-CXR, ChestX-ray14, PadChest, and CheXpert, which provide hundreds of thousands of labelled images with pathology annotations. However, these datasets also present important limitations. Automated label extraction from radiology reports introduces errors, particularly in handling uncertainty and negation, and radiologist review frequently disagrees with assigned labels. In addition, domain shift and population bias restrict model generalisability, while evaluation practices often overlook clinically meaningful measures. We conduct a systematic analysis of these challenges, focusing on label quality, dataset bias, and domain shift. Our cross-dataset domain shift evaluation across multiple model architectures revealed substantial external performance degradation, with pronounced reductions in AUPRC and F1 scores relative to internal testing. To assess dataset bias, we trained a source-classification model that distinguished datasets with near-perfect accuracy, and performed subgroup analyses showing reduced performance for minority age and sex groups. Finally, expert review by two board-certified radiologists identified significant disagreement with public dataset labels. Our findings highlight important clinical weaknesses of current benchmarks and emphasise the need for clinician-validated datasets and fairer evaluation frameworks.

As text-to-image generative models rapidly improve, AI researchers are making significant advances in developing domain-specific models capable of generating complex medical imagery from text prompts. Despite this, these technical advancements have overlooked whether and how medical professionals would benefit from and use text-to-image generative AI (GenAI) in practice. By developing domain-specific GenAI without involving stakeholders, we risk the potential of building models that are either not useful or even more harmful than helpful. In this paper, we adopt a human-centered approach to responsible model development by involving stakeholders in evaluating and reflecting on the promises, risks, and challenges of a novel text-to-CT Scan GenAI model. Through exploratory model prompting activities, we uncover the perspectives of medical students, radiology trainees, and radiologists on the role that text-to-CT Scan GenAI can play across medical education, training, and practice. This human-centered approach additionally enabled us to surface technical challenges and domain-specific risks of generating synthetic medical images. We conclude by reflecting on the implications of medical text-to-image GenAI.

Medical image captioning is a challenging task that requires generating clinically accurate and semantically meaningful descriptions of radiology images. While recent vision-language models (VLMs) such as BLIP, BLIP2, Gemini and ViT-GPT2 show strong performance on natural image datasets, they often produce generic or imprecise captions when applied to specialized medical domains. In this project, we explore the effectiveness of fine-tuning the BLIP model on the ROCO dataset for improved radiology captioning. We compare the fine-tuned BLIP against its zero-shot version, BLIP-2 base, BLIP-2 Instruct and a ViT-GPT2 transformer baseline. Our results demonstrate that domain-specific fine-tuning on BLIP significantly improves performance across both quantitative and qualitative evaluation metrics. We also visualize decoder cross-attention maps to assess interpretability and conduct an ablation study to evaluate the contributions of encoder-only and decoder-only fine-tuning. Our findings highlight the importance of targeted adaptation for medical applications and suggest that decoder-only fine-tuning (encoder-frozen) offers a strong performance baseline with 5% lower training time than full fine-tuning, while full model fine-tuning still yields the best results overall.

Deep learning models for medical image classification tasks are becoming widely implemented in AI-assisted diagnostic tools, aiming to enhance diagnostic accuracy, reduce clinician workloads, and improve patient outcomes. However, their vulnerability to adversarial attacks poses significant risks to patient safety. Current attack methodologies use general techniques such as model querying or pixel value perturbations to generate adversarial examples designed to fool a model. These approaches may not adequately address the unique characteristics of clinical errors stemming from missed or incorrectly identified clinical features. We propose the Concept-based Report Perturbation Attack (CoRPA), a clinically-focused black-box adversarial attack framework tailored to the medical imaging domain. CoRPA leverages clinical concepts to generate adversarial radiological reports and images that closely mirror realistic clinical misdiagnosis scenarios. We demonstrate the utility of CoRPA using the MIMIC-CXR-JPG dataset of chest X-rays and radiological reports. Our evaluation reveals that deep learning models exhibiting strong resilience to conventional adversarial attacks are significantly less robust when subjected to CoRPA's clinically-focused perturbations. This underscores the importance of addressing domain-specific vulnerabilities in medical AI systems. By introducing a specialized adversarial attack framework, this study provides a foundation for developing robust, real-world-ready AI models in healthcare, ensuring their safe and reliable deployment in high-stakes clinical environments.

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.