In medical imaging, it is common to use learned perceptual image patch similarity (LPIPS) to compare images semantically in feature space. Although backbones pretrained on natural images are widely used for LPIPS computation, B-mode ultrasound images possess distinct speckle patterns and acoustic-specific image statistics that are fundamentally different from natural images and even from other images in radiology. Consequently, we propose that domain-specific models are needed to measure perceptual similarity in ultrasound data, a finding which is not necessarily the case for other imaging modalities. We compare LPIPS metrics across downstream tasks like classification, segmentation and reconstruction using natural image, medical generalist and ultrasound backbone models and show that selection of LPIPS backbone is a non-trivial design choice. In particular, the ultrasound backbone models were more correlated with downstream performance of supervised models than classical and natural image models, and optimization of the LPIPS loss with an ultrasound backbone achieved a strong balance between reconstruction quality and realism. Our code is available at https://github.com/talg2324/UltraPIPS and introduces the UltraPIPS library, a set of LPIPS metrics based on the open-source foundation models analyzed in this paper.
Human visual similarity judgments are context-dependent. For example, two images may be similar in shape but distinct in color. Existing perceptual similarity metrics, however, collapse these nuances into a single scalar value, offering no mechanism to condition on specific aspects. To bridge this gap, we introduce a large-scale dataset of human similarity judgments over image triplets, where each triplet is annotated across multiple, free-form semantic aspects of similarity. Benchmarking a broad range of frontier vision-language models (VLMs) reveals a considerable performance gap compared to human annotators' consensus. Leveraging our data, we fine-tune a VLM to produce our Text-Prompted Image Perceptual Similarity (TPIPS) metric, capturing multiple senses of visual similarity depending on the specified text prompt. We demonstrate that TPIPS aligns more closely with human perception and generalizes reliably beyond the training distribution. Finally, we show that TPIPS unlocks new capabilities in text-guided retrieval, compositional search, and the fine-grained evaluation of generative models. Our code, data, and trained models are at https://peterwang512.github.io/TPIPS