# CBVLM: Training-free Explainable Concept-based Large Vision Language Models for Medical Image Classification

arXiv: https://arxiv.org/abs/2501.12266 · HTML: https://mlsanity.com/paper/2501.12266/

## Key facts

- Cited by 4 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 41 of its 60 references that are in the map.
- First posted on arXiv 21 Jan 2025.

## 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 41)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [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)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [Flamingo: a Visual Language Model for Few-Shot Learning](https://mlsanity.com/paper/2204.14198/) (2022)
- [LLaVA-OneVision: Easy Visual Task Transfer](https://mlsanity.com/paper/2408.03326/) (2024)
- [Qwen-VL: A Versatile Vision-Language Model for Understanding, Localization, Text Reading, and Beyond](https://mlsanity.com/paper/2308.12966/) (2023)
- [Expanding Performance Boundaries of Open-Source Multimodal Models with Model, Data, and Test-Time Scaling](https://mlsanity.com/paper/2412.05271/) (2024)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [MiniCPM-V: A GPT-4V Level MLLM on Your Phone](https://mlsanity.com/paper/2408.01800/) (2024)
- [Concept Bottleneck Models](https://mlsanity.com/paper/2007.04612/) (2020)
- [EVA-CLIP: Improved Training Techniques for CLIP at Scale](https://mlsanity.com/paper/2303.15389/) (2023)
- [VILA: On Pre-training for Visual Language Models](https://mlsanity.com/paper/2312.07533/) (2023)
- [OpenFlamingo: An Open-Source Framework for Training Large Autoregressive Vision-Language Models](https://mlsanity.com/paper/2308.01390/) (2023)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [What matters when building vision-language models?](https://mlsanity.com/paper/2405.02246/) (2024)
- [An Empirical Study of GPT-3 for Few-Shot Knowledge-Based VQA](https://mlsanity.com/paper/2109.05014/) (2021)
- [mPLUG-Owl3: Towards Long Image-Sequence Understanding in Multi-Modal Large Language Models](https://mlsanity.com/paper/2408.04840/) (2024)
- [Long-context LLMs Struggle with Long In-context Learning](https://mlsanity.com/paper/2404.02060/) (2024)
- [Evaluating Deep Neural Networks Trained on Clinical Images in Dermatology with the Fitzpatrick 17k Dataset](https://mlsanity.com/paper/2104.09957/) (2021)
- [Building and better understanding vision-language models: insights and future directions](https://mlsanity.com/paper/2408.12637/) (2024)
- [Interactive Concept Bottleneck Models](https://mlsanity.com/paper/2212.07430/) (2022)
- [A Foundation Language-Image Model of the Retina (FLAIR): Encoding Expert Knowledge in Text Supervision](https://mlsanity.com/paper/2308.07898/) (2023)
- ["My Answer is C": First-Token Probabilities Do Not Match Text Answers in Instruction-Tuned Language Models](https://mlsanity.com/paper/2402.14499/) (2024)
- [CARES: A Comprehensive Benchmark of Trustworthiness in Medical Vision Language Models](https://mlsanity.com/paper/2406.06007/) (2024)
- [MedImageInsight: An Open-Source Embedding Model for General Domain Medical Imaging](https://mlsanity.com/paper/2410.06542/) (2024)

## Built on by (most cited first, 4 of 4)

- [Heart2Mind: Human-Centered Contestable Psychiatric Disorder Diagnosis System using Wearable ECG Monitors](https://mlsanity.com/paper/2505.11612/) (2025)
- [Weakly Supervised Concept Learning with Class-Level Priors for Interpretable Medical Diagnosis](https://mlsanity.com/paper/2511.01131/) (2025)
- [VL-MedGuide: A Visual-Linguistic Large Model for Intelligent and Explainable Skin Disease Auxiliary Diagnosis](https://mlsanity.com/paper/2508.06624/) (2025)
- [Less Annotation, More Interpretation: Prior-Guided Concept Bottleneck Models for Interpretable Cancer Imaging Diagnosis](https://mlsanity.com/paper/2608.13148/) (2026)

## Abstract (arXiv)

The main challenges limiting the adoption of deep learning-based solutions in medical workflows are the availability of annotated data and the lack of interpretability of such systems. Concept Bottleneck Models (CBMs) tackle the latter by constraining the model output on a set of predefined and human-interpretable concepts. However, the increased interpretability achieved through these concept-based explanations implies a higher annotation burden. Moreover, if a new concept needs to be added, the whole system needs to be retrained. Inspired by the remarkable performance shown by Large Vision-Language Models (LVLMs) in few-shot settings, we propose a simple, yet effective, methodology, CBVLM, which tackles both of the aforementioned challenges. First, for each concept, we prompt the LVLM to answer if the concept is present in the input image. Then, we ask the LVLM to classify the image based on the previous concept predictions. Moreover, in both stages, we incorporate a retrieval module responsible for selecting the best examples for in-context learning. By grounding the final diagnosis on the predicted concepts, we ensure explainability, and by leveraging the few-shot capabilities of LVLMs, we drastically lower the annotation cost. We validate our approach with extensive experiments across four medical datasets and twelve LVLMs (both generic and medical) and show that CBVLM consistently outperforms CBMs and task-specific supervised methods without requiring any training and using just a few annotated examples. More information on our project page: https://cristianopatricio.github.io/CBVLM/.