Semantically Calibrated Evidence Composition for CT Vision-Language Learning

Learning transferable representations from CT-report pairs requires combining whole-volume context with anatomy-specific evidence. Existing methods typically emphasize either global CT-report alignment or fine-grained anatomy-level correspondence. Global alignment preserves broad study context but leaves the contribution of localized evidence implicit, whereas anatomy-level alignment explicitly grounds local findings but does not specify how independently represented evidence should interact, acquire study-level meaning, and contribute to a global CT representation. To address this gap, we propose SCOPE (Semantic Calibration Of comPosed Evidence), a framework for semantically calibrated evidence composition in CT vision-language learning. Under organ-specific report supervision, mask-guided queries with fixed anatomical identities extract context-aware organ evidence from shared, uncropped volumetric features, while an unrestricted global query retains access to whole-volume context. The global query then drives Local-Global Coupling to compose the organ evidence into a unified evidence representation. The composed evidence is subsequently calibrated using the diagnostic summary, providing study-level semantic supervision beyond local organ descriptions, and is finally integrated as a controlled residual into a context-preserving whole-volume representation aligned with the complete report. This progressive pathway connects localized evidence with study-level semantics without reducing the CT representation to a predefined set of organs. On CT-RATE and RadChestCT, SCOPE achieves macro AUCs of 85.0 and 72.2, respectively, outperforming the previous SOTA by 7.2 and 4.2, while also yielding substantial gains in linear probing and cross-modal retrieval. These results demonstrate the effectiveness of semantically calibrated evidence composition.

Towards Grounded GI Endoscopy VQA via Multi-Task Learning on Small VLMs

Gastrointestinal (GI) endoscopic image analysis has shifted from single-label classification toward visual question answering (VQA), where a model must answer free-form clinical questions about an image. While recent vision-language models (VLMs) achieve promising answer accuracy on this task, clinical adoption also requires the model's internal representations to reflect the visual evidence behind its answers. We propose a simple multi-task fine-tuning recipe that constructs auxiliary grounding and description tasks from an existing VQA dataset with minimal additional annotation: expert-annotated polyp masks are reused directly, while a GI-domain pretrained classifier with Grad-CAM localization provides weak supervision for finding categories that lack ground-truth masks. Three small VLM backbones are fine-tuned with low-rank adaptation under matched VQA-only and multi-task recipes on Kvasir-VQA-x1, and we show consistent accuracy gains together with improved implicit alignment between answer tokens and the relevant image region, evaluated on both in-distribution and out-of-distribution data.

Beyond Symmetric Alignment: Spectral Diagnostics of Modality Imbalance in Vision-Language Models in the Medical Domain

Vision-Language Models (VLMs) struggle when applied to medical image-text data, yet the tools available to diagnose this failure remain limited. Existing representation alignment metrics are symmetric, collapsing both modalities into a single score and hiding which modality drives cross-modal degradation. We introduce the Spectral Alignment Score (SAS), an asymmetric metric that projects both modalities onto the principal eigenbasis of an anchor modality and computes eigenvalue-weighted per-eigenmode correlations, resulting in directional scores whose difference quantifies modality information imbalance. We embed SAS within a benchmarking framework evaluating 15 VLMs across natural and medical image-text datasets alongside 6 alignment metrics and bidirectional retrieval. Our experiments show that medical images retain richer structural information than their paired clinical reports, a directional asymmetry invisible to all competing metrics, and that SAS achieves the strongest zero-label correlation with retrieval performance in the medical domain, positioning it as a practical diagnostic tool for clinical deployment. Code is available at this URL: https://github.com/iamalegambetti/medical-vlms-assessment.

Ultrasound Vision-Language Alignment via Contrastive Learning

Ultrasound foundation models have achieved strong performance on structured prediction tasks but remain exclusively vision-based, limiting zero-shot and few-shot transfer to novel tasks where task-specific annotation is scarce. We address this gap with EchoCare-CLIP, a CLIP-style dual-encoder contrastive framework that aligns ultrasound images with clinical text in a shared embedding space. We curate a multi-organ corpus of over 16K image-text pairs spanning breast, liver, lung, and thyroid, with over 78% of captions derived from expert-annotated reports, and complement the remainder with a three-tier template-based and LLM-based caption generation pipeline. We evaluate model configurations spanning two text encoder families (CLIP, BioClinicalBERT) and two caption strategies (template-based, LLM-generated) against OpenAI CLIP and BiomedCLIP baselines. Our trained models consistently improve cross-modal alignment over baselines, with the best configuration achieving a paired alignment score of 0.682. However, stronger alignment does not guarantee better downstream performance: CLIP-based variants with partial fine-tuning achieve the strongest zero-shot classification on external held-out datasets (0.709 on BUSI; 0.626 on AULI), while full end-to-end fine-tuning degrades transfer due to overfitting. On linear probing and few-shot adaptation, model rankings are dataset-dependent, reflecting a trade-off between domain adaptation and representational generalizability. We further show that template-based captions match or outperform LLM-generated captions, suggesting lexical diversity is not a proxy for caption quality. Taken together, our results demonstrate that ultrasound vision-language alignment is achievable from public data alone, but robust clinical transfer requires careful balancing of domain adaptation, encoder capacity, and caption supervision quality.