We propose a novel pretraining strategy for skeleton-based zero-shot spatio-temporal action localization to estimate unseen actions for person instances while overcoming high annotation costs for training via new target actions and pretraining using large-scale action scenery datasets. Specifically, our approach, termed Skeleton-Language feature Pooling Switching, introduces a weakly-supervised vision-language pretraining mechanism. This mechanism transitions pooling kernels from pretraining, which aggregates skeleton features at the video level and aligns them with each video's known action text embeddings, to the inference phase that computes instance-level features without training via target actions. Furthermore, we propose Scene-Mixed Discriminative Contrastive Learning to distinguish actions at the instance level within the combined scene through the MIL framework. Our experiments on four public spatio-temporal action localization and classification datasets demonstrate that the proposed method effectively addresses annotation limitations.
4D understanding and reasoning is a fundamental capability for embodied AI agents operating in dynamic physical environments. However, existing vision encoders are largely limited to static 2D images or 3D point clouds without temporal modeling, or to 2D videos that lack accurate geometric depth reasoning. Consequently, current approaches fail to jointly capture spatial structure and motion evolution in dynamic scenes. We present CL4D, the first foundational 4D vision encoder that directly operates on dynamic point clouds, trained with a contrastive learning objective to align spatio-temporal geometric representations with natural language descriptions. By learning a shared embedding space between text and 4D scene dynamics, CL4D enables zero-shot motion-to-text and text-to-motion retrieval in dynamic environments and serves as a foundational 4D vision encoder for downstream 4D vision-language tasks. Building on this encoder, we introduce 4DVLM, a 4D vision-language model that conditions language generation on dynamic geometric representations. 4DVLM is the first VLM designed to operate directly on 4D point clouds without relying on 2D images, 2D videos, or static 3D point clouds. We train CL4D and subsequently 4DVLM on a newly constructed dataset termed DynAction4D capturing diverse human motions across varying object interactions and scene environments. Extensive experiments across multiple 4D human action benchmarks demonstrate that CL4D achieves state-of-the-art performance, with improvements of approximately ~16.75% over prior methods. Furthermore, 4DVLM outperforms frontier video VLMs such as Gemini and GPT-5 even when these models are provided with RGB video sequences corresponding to the same scenes represented as 4D point clouds for 4DVLM.
Existing Multimodal Large Language Models (MLLMs) predominantly rely on image-text pairs for modality alignment pretraining, mapping global image representations to long textual descriptions. However, this image-level alignment suffers from referential ambiguity: models struggle to infer the correspondences between multiple visual objects and textual entities from the global representation, leading to data inefficiency and suboptimal semantic grounding. To address this, we propose MultiModal Code-Switching (MMCS), a novel pretraining paradigm that provides explicit object-level supervision. Inspired by the linguistic phenomenon of code-switching, MMCS interleaves vision and language by replacing textual entities with their corresponding visual objects, enforcing local vision-language grounding. We further develop a scalable data synthesis pipeline to generate a pretraining dataset of 773K samples with accurate object-entity correspondences. Experiments show that MMCS is highly data-efficient: with only 50K samples, it matches or surpasses models trained on 600K image-text pairs. Furthermore, MMCS consistently improves visual grounding and perception capabilities across varying model scales.
Volumetric CT vision-language pretraining learns 3D representations from scan-report pairs, but global and anatomy-aware objectives supervise only correspondence: they establish what is present and leave how much unconstrained. Nothing separates a mild from an extensive case of the same finding along a consistent direction, so the graded burden language in reports collapses into a present/absent signal. Longitudinal supervision would supply this order, but patient-matched CT pairs are scarce at scale; cross-sectional cohorts already encode weak burden cues across different patients. We introduce Spectrum, an anatomy-conditioned framework that represents each study at whole-study and organ scopes. For each organ-mapped pathology, a rule-based scorer mines confidence-filtered lower-to-higher pairs of different patients, and Burden-Direction Alignment (BDA) aligns the pathology-conditioned image delta with the report delta at each scope, separating that direction from its reverse. Because the endpoints are different people, a target-conditioned aligner first makes them comparable, so the delta reflects burden rather than between-patient variation. BDA further separates the selected direction from its reverse, anchors it to the observed higher-burden endpoint, and enforces consistency across ordered triplets. Since every pair is drawn within a single pathology, BDA is designed to constrain intra-class structure that image-report contrast alone never touches. Spectrum attains 85.6 zero-shot AUROC on CT-RATE and 72.7 on external RAD-ChestCT, with consistent gains in linear probing and retrieval. Weak cross-patient order is thus a scalable complement to anatomy-aware correspondence, yielding burden-aware CT representations without longitudinal data.
Automating radiology report generation is important for improving reporting consistency and clinical workflows . While Contrastive Language--Image Pretraining (CLIP) has advanced medical vision language modeling, existing CLIP-style approaches may still provide insufficient fine-grained semantic supervision for complex report generation. Standard CLIP primarily optimizes cross-modal alignment, without explicitly structuring the textual embedding space that guides visual representation learning. To address this limitation, we propose TextSLIP, a general medical vision-language pretraining framework that augments CLIP with intra-modal text contrastive learning. By improving textual embedding discriminability through self-supervised augmented text pairs, TextSLIP is designed to provide finer-grained linguistic supervision to the visual encoder. As an initial validation, we pretrain TextSLIP on a curated dataset of 7 million brain MRI image-text pairs and fine-tune the pretrained visual encoder within a report generation architecture. In controlled comparisons with CLIP-style baselines, TextSLIP shows consistent improvements on report generation metrics. Ablation studies further suggest that text-side self-supervision contributes to the observed gains. These results indicate that text-level contrastive learning is a promising direction for improving medical visual-textual alignment, while broader validation across additional medical domains remains an important next step.
Computed tomography (CT) vision-language pretraining from paired volumes and radiology reports is a scalable yet challenging task. Existing methods commonly adopt global scan-report contrast, which is scalable but obscures heterogeneous organ evidence. Meanwhile, direct organ-level alignment remains coarse, since the same anatomy can exhibit multiple distinct radiological appearances. Therefore, pretraining requires a finer alignment unit: the organ-conditioned radiological pattern. In this work, we propose OCP-CT, an organ-conditioned pattern-token alignment framework for CT vision-language pretraining. Specifically, OCP-CT preserves a stable global CT-report contrastive branch and introduces an organ pattern interface: sparse Mixture-of-Experts (MoE) routes image and text tokens according to latent radiological patterns, learnable slots query the routed tokens into continuous pattern tokens, and paired token contrast aligns image-text pattern tokens with structured soft targets built from report-derived clinical similarity. On the publicly available CT-RATE and RAD-ChestCT benchmarks, OCP-CT achieves average AUROCs of 84.5% and 69.9% for zero-shot abnormality diagnosis, respectively. Compared with the strongest prior reported results, these results yield absolute AUROC gains of 6.7 and 0.8 percentage points.
Open-vocabulary dense perception (OVDP) aims to localize objects unseen during training by leveraging textual knowledge. Despite the remarkable progress of recent CLIP-based approaches, we identify a critical limitation: synonym-induced grounding inconsistency, where semantically equivalent expressions yield disparate spatial attention patterns. This inconsistency undermines the robustness and performance of existing methods in real-world OVDP applications. To address this issue, we propose SynCLIP, a Synonym-Coherent Language-Image Pretraining framework that enhances synonym-robust grounding for OVDP. SynCLIP introduces a Semantic-consistent Spatial Attention alignment (SSA) module to enhance spatial attention consistency by minimizing discrepancies between attention maps of original and synonymous expressions. Furthermore, a Spatial Attention Refinement (SAR) module selectively strengthens the most semantically relevant spatial regions within aligned maps for more precise and stable grounding. To support synonym-coherent pretraining, we also construct a Synonym-Enriched Visual Corpus (SEViC), which augments each category with multiple synonyms and textual definitions. Extensive experiments on multiple benchmarks demonstrate that SynCLIP substantially improves grounding consistency under diverse linguistic variants and achieves state-of-the-art performance among CLIP-based OVDP methods. Code is available at https://github.com/Justlovesmile/SynCLIP.
Medical vision-language pretraining (VLP) from paired CT images and radiology reports enables scalable representation learning, but most existing methods align either whole scans with entire reports or local image regions with text fragments. These formulations underuse a key property of radiology reports: findings are organized around anatomical structures, with abnormalities described by organs, disease concepts, locations, and severity-related attributes. We propose OKA-CT, an organ-hierarchical knowledge-augmented framework for CT-report VLP. OKA-CT first converts free-text reports into organ-conditioned knowledge using radiology report parsing and LLM-assisted semantic structuring. The extracted hierarchy is used across two learning stages. Stage~1 injects anatomy-grounded evidence into the CT visual representation through fine-grained organ-conditioned supervision, while Stage~2 uses organ-specific report evidence to guide structured report-CT contrastive learning, where hierarchy-derived semantic soft targets treat non-paired cases with shared organ-level findings as weak semantic positives rather than uniform negatives. A lightweight query-based global branch further aggregates disease-relevant volumetric evidence for whole-scan representation. On CT-RATE and RAD-ChestCT datasets, OKA-CT achieves zero-shot abnormality diagnosis AUROCs of 84.9 and 72.2, outperforming prior CT VLP baselines. Retrieval and patch-occlusion analyses further show improved report-image alignment and stronger sensitivity to disease-associated anatomical regions.
Lukas Kuhn, Giuseppe Serra, Randall Balestriero +1cs.CV cs.AI
Vision-language pretraining remains dominated by contrastive objectives, whereas vision-only self-supervised learning has largely adopted non-contrastive methods. At the same time, the role of vision-language encoders has shifted: they are increasingly deployed not as zero-shot classifiers but as the frozen visual backbone of vision-language models and dense prediction systems, which consume the full grid of patch tokens rather than a single pooled embedding. We introduce LeVLJEPA, the first fully non-contrastive end-to-end vision-language pretraining method. LeVLJEPA learns through cross-modal prediction with stop-gradient targets and per-modality distributional regularization, without negatives, temperature, momentum encoder, or teacher-student schedule, and trains stably at large scale. We find that the resulting encoder provides markedly stronger dense semantic features for downstream use: as a frozen vision-language-model backbone, LeVLJEPA is the strongest of the evaluated encoders across GQA, VQAv2, and POPE under two distinct language models, and outperforms contrastive baselines on semantic segmentation, while remaining on par on global readouts such as linear probing. These results establish non-contrastive pretraining as an effective means of producing dense semantic vision features.
Vision-language foundation models have shown strong potential in medical image analysis. Although foundation models for ultrasound imaging have recently emerged, the domain remains particularly challenging due to severe speckle noise, acquisition variability, and subtle anatomical boundaries, leading to high inter-observer variability. Existing CLIP-based models rely primarily on global image-text alignment, limiting their sensitivity to clinically decisive local structures. We propose SonoCLIP, the first million-scale region-controllable fetal ultrasound vision-language foundation model that integrates segmentation masks as mask-channel visual prompts within the vision encoder, enabling joint global-local contrastive representation learning. To support scalable region-text alignment, we introduce a sigmoid-based pairwise contrastive loss that improves stability under large-scale supervision. We further curate a 1.44M-image multimodal fetal ultrasound dataset spanning 24 standard planes for large-scale pretraining. Extensive cross-center evaluations demonstrate that SonoCLIP achieves superior zero-shot transfer performance under both global and mask-guided inference, establishing a controllable and clinically oriented foundation model for fetal ultrasound analysis. Our code and data are available at https://github.com/Harrison-one/SonoCLIP.
CLIP and its variants are widely adopted visual backbones in multimodal systems, but their pretraining remains dominated by descriptive image-text alignment. As downstream applications increasingly demand visually grounded commonsense inference and compositional reasoning, it remains unclear whether CLIP-style encoders can support such reasoning without architectural changes. To address this, we present ReasonCLIP-58M, a continual pretraining framework that integrates large-scale reasoning supervision into CLIP-style models through our two-stage strategy, which progressively integrates reasoning signals while preserving descriptive alignment, followed by category-structured reasoning supervision. To support this framework, we construct two complementary datasets and a benchmark: ReasonLite-42M, with open-form, visually verifiable reasoning captions; ReasonPro-16M, with category-specific reasoning supervision; and RCLIP-Bench for diagnostic evaluation of visually grounded reasoning. We train a family of ReasonCLIP that improves visually grounded commonsense and compositional reasoning while also enhancing zero-shot retrieval performance. As a drop-in visual encoder for multimodal large language models such as LLaVA-NeXT, ReasonCLIP delivers consistent gains without additional inference cost, demonstrating that structured reasoning supervision enhances the expressive capacity of CLIP-style visual representations. All datasets, models, and training code are available at https://github.com/RISys-Lab/ReasonCLIP.
Vision-language pre-training (VLP) holds great promise for general-purpose medical AI by leveraging radiology reports as rich textual supervision, yet existing methods struggle with 3D CT imaging due to inefficient visual backbones and coarse semantic alignment. To address these issues, we propose a tailored VLP framework featuring three key components: (1) a CNN-ViT hybrid encoder that replaces ViT's patch embedding with a 3D CNN backbone to efficiently capture local anatomical details while preserving global attention and compatibility with pre-trained cross-modal priors; (2) a disease-level contrastive learning mechanism using learnable query tokens to dynamically extract disease-specific semantics from full reports and align them with corresponding visual features, thereby disentangling distinct diseases within the same anatomical region; and (3) a diagnosis-aware prompt strategy that employs real clinical phrases and aggregated disease prototypes to bridge the pre-training-inference gap and enhance zero-shot diagnostic reliability. Our model achieves state-of-the-art performance on CT-RATE (84.4% AUC, +5.1%) and Rad-ChestCT (75.4% AUC, +5.4%), with even larger gains (+9.8% AUC) on a challenging 60-disease benchmark, and demonstrates strong transferability to radiology report generation, underscoring the generality and clinical utility of our approach.
Julien Khlaut, Charles Corbière, Baptiste Callard +9cs.CV
Vision-language contrastive pretraining has become the dominant recipe for 3D medical foundation models, leveraging the large volumes of paired scans and reports produced in clinical practice. However, medical images usually span dozens of organs, and radiological reports are much longer than typical natural image captions and are composed of multiple structured sections. CLIP-style pretraining compresses this structure by encoding each modality into a single global token, at the risk of losing important details. We introduce ConQuer (Concept Queries), an image-text pretraining method that augments CLIP's global alignment with a set of localized alignments, one per concept. ConQuer splits the report into concept-specific sections and learns cross-attention queries that pool the matching image features without using any segmentation mask or spatial supervision. Contrastive learning is then applied independently for each concept. Concepts can be any unit of semantic localization; here, they are anatomical regions, one query per organ or gross body region. As a byproduct, each query learns attention maps focused on its concept, providing built-in spatial interpretability. We use ConQuer to train Jolia, a 3D CT foundation model on chest and abdominal CT. Jolia consistently outperforms a CLIP baseline on findings classification, report generation, and cross-center transfer, and sets a new state of the art across multiple public benchmarks. Jolia's weights will be released upon acceptance.
Chest X-ray (CXR) interpretation often requires longitudinal comparison to assess disease progression. Existing approaches typically rely on temporal feature fusion or inter-study discrepancy modeling, yet remain limited in capturing subtle progression semantics and overlook the inherently directional nature of disease trajectories. In this paper, we propose ProTrans, a novel vision-language pretraining framework that formulates disease progression as a directional semantic transition between paired CXR studies. ProTrans leverages radiology reports to anchor individual CXR representations within interpretable disease states, and introduces a learnable progression feature map to explicitly encode semantic shifts between states, aligned with report-derived progression descriptions. To enforce direction-aware perception, ProTrans incorporates a reversed temporal modeling process and imposes bidirectional reconstruction consistency across states and transitions, thereby disentangling directional semantics and promoting coherent trajectory modeling. Extensive experiments on longitudinal downstream tasks, including disease progression classification and progression captioning, demonstrate that ProTrans consistently outperforms existing methods, establishing a unified pretraining framework for longitudinal CXR understanding. https://github.com/RPIDIAL/ProTrans
Test-time adaptation (TTA) aims to align a model to shifting test domains using only unlabeled streaming data. Most existing methods implicitly infer a single global domain distribution, ignoring the multidimensional and sample-specific nature of real-world domain shifts, leading to fragile adaptation. We propose DOME, an effective domain encoder that explicitly models each sample's domain in a zero-shot manner. DOME leverages vision-language pretraining to extract dense, continuous representations, parameterizes domains as distributional variables, and introduces a momentum-updated sparse domain bank for disentangled supervision. By injecting these explicit domain cues into downstream models, even a basic entropy-minimization TTA strategy achieves state-of-the-art performance across ImageNet-C, ImageNet-R, and ImageNet-Sketch, outperforming complex TTA approaches. Our results demonstrate that robust adaptation stems not from intricate adaptation algorithms, but from explicit, structured domain representation.
CLIP-style contrastive pretraining typically curates web-scale image-text pairs using sample-level filtering signals, often based on pair-level alignment. We show that this signal saturates: once coarse mismatches are removed, stricter global filtering no longer tracks the compositional supervision provided by the retained captions. The reason is structural - a global score conflates whether a pair is broadly plausible with whether the individual object, attribute, and relation phrases inside the caption materially support the image-text match. The latter is what compositional generalization demands, yet pair-level filters are blind to it. We address this with Counterfactual Phrase Intervention (CPI), a phrase-level curation framework that converts controlled nonce-token substitutions into image-conditioned phrase-sensitivity scores. CPI uses global alignment only for coarse mismatch removal, then ranks the surviving pool by whether caption phrases measurably affect the image-text score under controlled substitution. We frame CPI as a first-order phrase-sensitivity signal rather than a grounding or identification result, and evaluate it at CC3M scale. Ranking by this signal yields a 50%-data subset that improves VL-CheckList-VG Relation by +1.91 over the full-data baseline and +1.00 over alignment-only filtering at matched budget, while improving SugarCrepe overall and preserving general transfer. CPI is loss-orthogonal: applied unchanged to NegCLIP, it further improves VL-CheckList-VG Relation by +3.84, with additional CE-CLIP gains in the main text.
Chest computed tomography (CT) is central to the detection and management of thoracic disease, yet the growing scale and complexity of volumetric imaging increasingly exceed what can be addressed by scan-level prediction alone. Clinically useful AI for CT must not only recognize disease across the whole volume, but also localize abnormalities and provide interpretable visual evidence. Existing vision-language foundation models typically compress scans and reports into global image-text representations, limiting their ability to preserve spatial evidence and support clinically meaningful interpretation. Here we developed EXACT, an explainable anomaly-aware foundation model for three-dimensional chest CT that learns spatially resolved representations from paired clinical scans and radiology reports. EXACT was pre-trained on 25,692 CT-reports pairs using anatomy-aware weak supervision, jointly learning organ segmentation and multi-instance anomaly localization without manual voxel-level annotations. The resulting organ-specific anomaly-aware maps assign each voxel a disease-specific anomaly score confined to its corresponding anatomy, jointly encoding lesion extent and organ-level context. In retrospective multinational and multi-center evaluations, EXACT showed broad and consistent improvements across clinically relevant CT tasks, spanning multi-disease diagnosis, zero-shot anomaly localization, downstream adaptation, and visually grounded report generation, outperforming existing three-dimensional medical foundation models. By transforming routine clinical CT scans and free-text reports into explainable voxel-level representations, EXACT establishes a scalable paradigm for trustworthy volumetric medical AI.