# G2D: From Global to Dense Radiography Representation Learning via Vision-Language Pre-training

arXiv: https://arxiv.org/abs/2312.01522 · HTML: https://mlsanity.com/paper/2312.01522/

## Key facts

- Cited by 12 papers in the map (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 33 of its 47 references that are in the map.
- First posted on arXiv 3 Dec 2023.

## Placed in

- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 30 of 33)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Representation Learning with Contrastive Predictive Coding](https://mlsanity.com/paper/1807.03748/) (2018)
- [Masked Autoencoders Are Scalable Vision Learners](https://mlsanity.com/paper/2111.06377/) (2021)
- [Feature Pyramid Networks for Object Detection](https://mlsanity.com/paper/1612.03144/) (2016)
- [YOLOv3: An Incremental Improvement](https://mlsanity.com/paper/1804.02767/) (2018)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Grounded Language-Image Pre-training](https://mlsanity.com/paper/2112.03857/) (2021)
- [Publicly Available Clinical BERT Embeddings](https://mlsanity.com/paper/1904.03323/) (2019)
- [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)
- [Contrastive Learning of Medical Visual Representations from Paired Images and Text](https://mlsanity.com/paper/2010.00747/) (2020)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [Extract Free Dense Labels from CLIP](https://mlsanity.com/paper/2112.01071/) (2021)
- [Making the Most of Text Semantics to Improve Biomedical Vision--Language Processing](https://mlsanity.com/paper/2204.09817/) (2022)
- [GLIPv2: Unifying Localization and Vision-Language Understanding](https://mlsanity.com/paper/2206.05836/) (2022)
- [COVID-Net: A Tailored Deep Convolutional Neural Network Design for Detection of COVID-19 Cases from Chest X-Ray Images](https://mlsanity.com/paper/2003.09871/) (2020)
- [SegCLIP: Patch Aggregation with Learnable Centers for Open-Vocabulary Semantic Segmentation](https://mlsanity.com/paper/2211.14813/) (2022)
- [Multi-Granularity Cross-modal Alignment for Generalized Medical Visual Representation Learning](https://mlsanity.com/paper/2210.06044/) (2022)
- [MedKLIP: Medical Knowledge Enhanced Language-Image Pre-Training in Radiology](https://mlsanity.com/paper/2301.02228/) (2023)
- [Self-Supervision with Superpixels: Training Few-shot Medical Image Segmentation without Annotation](https://mlsanity.com/paper/2007.09886/) (2020)
- [Knowledge-enhanced Visual-Language Pre-training on Chest Radiology Images](https://mlsanity.com/paper/2302.14042/) (2023)
- [PyramidCLIP: Hierarchical Feature Alignment for Vision-language Model Pretraining](https://mlsanity.com/paper/2204.14095/) (2022)
- [Advancing Radiograph Representation Learning with Masked Record Modeling](https://mlsanity.com/paper/2301.13155/) (2023)
- [Med-UniC: Unifying Cross-Lingual Medical Vision-Language Pre-Training by Diminishing Bias](https://mlsanity.com/paper/2305.19894/) (2023)
- [PRIOR: Prototype Representation Joint Learning from Medical Images and Reports](https://mlsanity.com/paper/2307.12577/) (2023)
- [M-FLAG: Medical Vision-Language Pre-training with Frozen Language Models and Latent Space Geometry Optimization](https://mlsanity.com/paper/2307.08347/) (2023)
- [Enhancing Representation in Radiography-Reports Foundation Model: A Granular Alignment Algorithm Using Masked Contrastive Learning](https://mlsanity.com/paper/2309.05904/) (2023)
- [PixMIM: Rethinking Pixel Reconstruction in Masked Image Modeling](https://mlsanity.com/paper/2303.02416/) (2023)
- [Improving Pixel-based MIM by Reducing Wasted Modeling Capability](https://mlsanity.com/paper/2308.00261/) (2023)

## Built on by (most cited first, 12 of 12)

- [Zero-Shot ECG Classification with Multimodal Learning and Test-time Clinical Knowledge Enhancement](https://mlsanity.com/paper/2403.06659/) (2024)
- [Taming Vision-Language Models for Medical Image Analysis: A Comprehensive Review](https://mlsanity.com/paper/2506.18378/) (2025)
- [Pre-training on High Definition X-ray Images: An Experimental Study](https://mlsanity.com/paper/2404.17926/) (2024)
- [Can Medical Vision-Language Pre-training Succeed with Purely Synthetic Data?](https://mlsanity.com/paper/2410.13523/) (2024)
- [SuPreME: A Supervised Pre-training Framework for Multimodal ECG Representation Learning](https://mlsanity.com/paper/2502.19668/) (2025)
- [Knowledge-enhanced Multimodal ECG Representation Learning with Arbitrary-Lead Inputs](https://mlsanity.com/paper/2502.17900/) (2025)
- [RadZero: Similarity-Based Cross-Attention for Explainable Vision-Language Alignment in Chest X-ray with Zero-Shot Multi-Task Capability](https://mlsanity.com/paper/2504.07416/) (2025)
- [Generative AI for Healthcare: Fundamentals, Challenges, and Perspectives](https://mlsanity.com/paper/2510.24551/) (2025)
- [How Does Diverse Interpretability of Textual Prompts Impact Medical Vision-Language Zero-Shot Tasks?](https://mlsanity.com/paper/2409.00543/) (2024)
- [Improving Medical Visual Representation Learning with Pathological-level Cross-Modal Alignment and Correlation Exploration](https://mlsanity.com/paper/2506.10573/) (2025)
- [ASAP: Advancing Medical Volumetric Representation Learning with Anatomy-aware Semantically-adaptive Pre-training](https://mlsanity.com/paper/2606.00602/) (2026)
- [Decoupling Language Guidance from Backbones for Text-Guided Medical Segmentation](https://mlsanity.com/paper/2607.09481/) (2026)

## Abstract (arXiv)

Recently, medical vision-language pre-training (VLP) has reached substantial progress to learn global visual representation from medical images and their paired radiology reports. However, medical imaging tasks in real world usually require finer granularity in visual features. These tasks include visual localization tasks (e.g., semantic segmentation, object detection) and visual grounding task. Yet, current medical VLP methods face challenges in learning these fine-grained features, as they primarily focus on brute-force alignment between image patches and individual text tokens for local visual feature learning, which is suboptimal for downstream dense prediction tasks. In this work, we propose a new VLP framework, named Global to Dense level representation learning (G2D) that achieves significantly improved granularity and more accurate grounding for the learned features, compared to existing medical VLP approaches. In particular, G2D learns dense and semantically-grounded image representations via a pseudo segmentation task parallel with the global vision-language alignment. Notably, generating pseudo segmentation targets does not incur extra trainable parameters: they are obtained on the fly during VLP with a parameter-free processor. G2D achieves superior performance across 6 medical imaging tasks and 25 diseases, particularly in semantic segmentation, which necessitates fine-grained, semantically-grounded image features. In this task, G2D surpasses peer models even when fine-tuned with just 1% of the training data, compared to the 100% used by these models. The code can be found in https://github.com/cheliu-computation/G2D-NeurIPS24/tree/main.