# Learning A Multi-Task Transformer Via Unified And Customized Instruction Tuning For Chest Radiograph Interpretation

arXiv: https://arxiv.org/abs/2311.01092 · HTML: https://mlsanity.com/paper/2311.01092/

## Key facts

- Cited by 14 papers in the map (data through 14 Oct 2026).
- Builds on 40 of its 59 references that are in the map.
- First posted on arXiv 2 Nov 2023.

## Builds on (most cited first, 30 of 40)

- [BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding](https://mlsanity.com/paper/1810.04805/) (2018)
- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Training language models to follow instructions with human feedback](https://mlsanity.com/paper/2203.02155/) (2022)
- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [BART: Denoising Sequence-to-Sequence Pre-training for Natural Language Generation, Translation, and Comprehension](https://mlsanity.com/paper/1910.13461/) (2019)
- [PaLM: Scaling Language Modeling with Pathways](https://mlsanity.com/paper/2204.02311/) (2022)
- [OPT: Open Pre-trained Transformer Language Models](https://mlsanity.com/paper/2205.01068/) (2022)
- [Scaling Instruction-Finetuned Language Models](https://mlsanity.com/paper/2210.11416/) (2022)
- [BLOOM: A 176B-Parameter Open-Access Multilingual Language Model](https://mlsanity.com/paper/2211.05100/) (2022)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Bottom-Up and Top-Down Attention for Image Captioning and Visual Question Answering](https://mlsanity.com/paper/1707.07998/) (2017)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [ChestX-ray8: Hospital-scale Chest X-ray Database and Benchmarks on Weakly-Supervised Classification and Localization of Common Thorax Diseases](https://mlsanity.com/paper/1705.02315/) (2017)
- [GLaM: Efficient Scaling of Language Models with Mixture-of-Experts](https://mlsanity.com/paper/2112.06905/) (2021)
- [GLM-130B: An Open Bilingual Pre-trained Model](https://mlsanity.com/paper/2210.02414/) (2022)
- [Self-critical Sequence Training for Image Captioning](https://mlsanity.com/paper/1612.00563/) (2016)
- [Towards Expert-Level Medical Question Answering with Large Language Models](https://mlsanity.com/paper/2305.09617/) (2023)
- [Med-BERT: pre-trained contextualized embeddings on large-scale structured electronic health records for disease prediction](https://mlsanity.com/paper/2005.12833/) (2020)
- [Making the Most of Text Semantics to Improve Biomedical Vision--Language Processing](https://mlsanity.com/paper/2204.09817/) (2022)
- [PadChest: A large chest x-ray image dataset with multi-label annotated reports](https://mlsanity.com/paper/1901.07441/) (2019)
- [Towards Generalist Biomedical AI](https://mlsanity.com/paper/2307.14334/) (2023)
- [TransVG: End-to-End Visual Grounding with Transformers](https://mlsanity.com/paper/2104.08541/) (2021)
- [VinDr-CXR: An open dataset of chest X-rays with radiologist's annotations](https://mlsanity.com/paper/2012.15029/) (2020)
- [BiomedGPT: A Generalist Vision-Language Foundation Model for Diverse Biomedical Tasks](https://mlsanity.com/paper/2305.17100/) (2023)
- [Referring Transformer: A One-step Approach to Multi-task Visual Grounding](https://mlsanity.com/paper/2106.03089/) (2021)
- [Interactive and Explainable Region-guided Radiology Report Generation](https://mlsanity.com/paper/2304.08295/) (2023)
- [SeqTR: A Simple yet Universal Network for Visual Grounding](https://mlsanity.com/paper/2203.16265/) (2022)

## Built on by (most cited first, 14 of 14)

- [TC-SSA: Token Compression via Semantic Slot Aggregation for Gigapixel Pathology Reasoning](https://mlsanity.com/paper/2603.01143/) (2026)
- [A foundation model for generalizable disease diagnosis in chest X-ray images](https://mlsanity.com/paper/2410.08861/) (2024)
- [The Model Knows Which Tokens Matter: Automatic Token Selection via Noise Gating](https://mlsanity.com/paper/2603.07135/) (2026)
- [Efficient Chest X-ray Representation Learning via Semantic-Partitioned Contrastive Learning](https://mlsanity.com/paper/2603.07113/) (2026)
- [Zero-Shot Medical Phrase Grounding with Off-the-shelf Diffusion Models](https://mlsanity.com/paper/2404.12920/) (2024)
- [Beyond Surrogate Gradients: Fully Differentiable Token Pruning for Vision-Language Models](https://mlsanity.com/paper/2605.28051/) (2026)
- [Multimodal Model for Computational Pathology:Representation Learning and Image Compression](https://mlsanity.com/paper/2603.18660/) (2026)
- [XrayClaw: Cooperative-Competitive Multi-Agent Alignment for Trustworthy Chest X-ray Diagnosis](https://mlsanity.com/paper/2604.02695/) (2026)
- [Unified Supervision For Vision-Language Modeling in 3D Computed Tomography](https://mlsanity.com/paper/2509.01554/) (2025)
- [Foundation X: Integrating Classification, Localization, and Segmentation through Lock-Release Pretraining Strategy for Chest X-ray Analysis](https://mlsanity.com/paper/2503.09860/) (2025)
- [Seeing Through Experts Eyes A Foundational Vision Language Model Trained on Radiologists Gaze and Reasoning](https://mlsanity.com/paper/2604.14316/) (2026)
- [DiffPrune: differentiable information throttling for token pruning in vision-language models](https://mlsanity.com/paper/2608.01985/) (2026)
- [From Snapshots to Symphonies: The Evolution of Protein Prediction from Static Structures to Generative Dynamics and Multimodal Interactions](https://mlsanity.com/paper/2603.18505/) (2026)
- [StepPrune: Adaptive Sequential Visual Token Selection across Multimodal Large Language Models](https://mlsanity.com/paper/2609.13804/) (2026)

## Abstract (arXiv)

The emergence of multi-modal deep learning models has made significant impacts on clinical applications in the last decade. However, the majority of models are limited to single-tasking, without considering disease diagnosis is indeed a multi-task procedure. Here, we demonstrate a unified transformer model specifically designed for multi-modal clinical tasks by incorporating customized instruction tuning. We first compose a multi-task training dataset comprising 13.4 million instruction and ground-truth pairs (with approximately one million radiographs) for the customized tuning, involving both image- and pixel-level tasks. Thus, we can unify the various vision-intensive tasks in a single training framework with homogeneous model inputs and outputs to increase clinical interpretability in one reading. Finally, we demonstrate the overall superior performance of our model compared to prior arts on various chest X-ray benchmarks across multi-tasks in both direct inference and finetuning settings. Three radiologists further evaluate the generated reports against the recorded ones, which also exhibit the enhanced explainability of our multi-task model.