Artificial intelligence in healthcare requires models that are accurate and interpretable. We advance mechanistic interpretability in medical vision by applying Medical Sparse Autoencoders (MedSAEs) to the latent space of MedCLIP, a vision-language model trained on chest radiographs and reports. To quantify interpretability, we propose an evaluation framework that combines correlation metrics, entropy analyzes, and automated neuron naming via the MedGEMMA foundation model. Experiments on the CheXpert dataset show that MedSAE neurons achieve higher monosemanticity and interpretability than raw MedCLIP features. Our findings bridge high-performing medical AI and transparency, offering a scalable step toward clinically reliable representations.

Medical images and reports offer invaluable insights into patient health. The heterogeneity and complexity of these data hinder effective analysis. To bridge this gap, we investigate contrastive learning models for cross-domain retrieval, which associates medical images with their corresponding clinical reports. This study benchmarks the robustness of four state-of-the-art contrastive learning models: CLIP, CXR-RePaiR, MedCLIP, and CXR-CLIP. We introduce an occlusion retrieval task to evaluate model performance under varying levels of image corruption. Our findings reveal that all evaluated models are highly sensitive to out-of-distribution data, as evidenced by the proportional decrease in performance with increasing occlusion levels. While MedCLIP exhibits slightly more robustness, its overall performance remains significantly behind CXR-CLIP and CXR-RePaiR. CLIP, trained on a general-purpose dataset, struggles with medical image-report retrieval, highlighting the importance of domain-specific training data. The evaluation of this work suggests that more effort needs to be spent on improving the robustness of these models. By addressing these limitations, we can develop more reliable cross-domain retrieval models for medical applications.

In recent years, foundation models (FMs) have solidified their role as cornerstone advancements in the deep learning domain. By extracting intricate patterns from vast datasets, these models consistently achieve state-of-the-art results across a spectrum of downstream tasks, all without necessitating extensive computational resources. Notably, MedCLIP, a vision-language contrastive learning-based medical FM, has been designed using unpaired image-text training. While the medical domain has often adopted unpaired training to amplify data, the exploration of potential security concerns linked to this approach hasn't kept pace with its practical usage. Notably, the augmentation capabilities inherent in unpaired training also indicate that minor label discrepancies can result in significant model deviations. In this study, we frame this label discrepancy as a backdoor attack problem. We further analyze its impact on medical FMs throughout the FM supply chain. Our evaluation primarily revolves around MedCLIP, emblematic of medical FM employing the unpaired strategy. We begin with an exploration of vulnerabilities in MedCLIP stemming from unpaired image-text matching, termed BadMatch. BadMatch is achieved using a modest set of wrongly labeled data. Subsequently, we disrupt MedCLIP's contrastive learning through BadDist-assisted BadMatch by introducing a Bad-Distance between the embeddings of clean and poisoned data. Additionally, combined with BadMatch and BadDist, the attacking pipeline consistently fends off backdoor assaults across diverse model designs, datasets, and triggers. Also, our findings reveal that current defense strategies are insufficient in detecting these latent threats in medical FMs' supply chains.

Existing vision-text contrastive learning like CLIP aims to match the paired image and caption embeddings while pushing others apart, which improves representation transferability and supports zero-shot prediction. However, medical image-text datasets are orders of magnitude below the general images and captions from the internet. Moreover, previous methods encounter many false negatives, i.e., images and reports from separate patients probably carry the same semantics but are wrongly treated as negatives. In this paper, we decouple images and texts for multimodal contrastive learning thus scaling the usable training data in a combinatorial magnitude with low cost. We also propose to replace the InfoNCE loss with semantic matching loss based on medical knowledge to eliminate false negatives in contrastive learning. We prove that MedCLIP is a simple yet effective framework: it outperforms state-of-the-art methods on zero-shot prediction, supervised classification, and image-text retrieval. Surprisingly, we observe that with only 20K pre-training data, MedCLIP wins over the state-of-the-art method (using around 200K data). Our code is available at https://github.com/RyanWangZf/MedCLIP.