# LLaVA-RadZ: Can Multimodal Large Language Models Effectively Tackle Zero-shot Radiology Recognition?

arXiv: https://arxiv.org/abs/2503.07487 · HTML: https://mlsanity.com/paper/2503.07487/

## Key facts

- Cited by 6 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 31 of its 47 references that are in the map.
- First posted on arXiv 10 Mar 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 31)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [BLIP-2: Bootstrapping Language-Image Pre-training with Frozen Image Encoders and Large Language Models](https://mlsanity.com/paper/2301.12597/) (2023)
- [PaLM: Scaling Language Modeling with Pathways](https://mlsanity.com/paper/2204.02311/) (2022)
- [Qwen2.5 Technical Report](https://mlsanity.com/paper/2412.15115/) (2024)
- [MiniGPT-4: Enhancing Vision-Language Understanding with Advanced Large Language Models](https://mlsanity.com/paper/2304.10592/) (2023)
- [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)
- [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)
- [Eyes Wide Shut? Exploring the Visual Shortcomings of Multimodal LLMs](https://mlsanity.com/paper/2401.06209/) (2024)
- [Vision-R1: Incentivizing Reasoning Capability in Multimodal Large Language Models](https://mlsanity.com/paper/2503.06749/) (2025)
- [Contrastive Learning of Medical Visual Representations from Paired Images and Text](https://mlsanity.com/paper/2010.00747/) (2020)
- [NExT-GPT: Any-to-Any Multimodal LLM](https://mlsanity.com/paper/2309.05519/) (2023)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [Making the Most of Text Semantics to Improve Biomedical Vision--Language Processing](https://mlsanity.com/paper/2204.09817/) (2022)
- [ChatDoctor: A Medical Chat Model Fine-Tuned on a Large Language Model Meta-AI (LLaMA) Using Medical Domain Knowledge](https://mlsanity.com/paper/2303.14070/) (2023)
- [MedAlpaca -- An Open-Source Collection of Medical Conversational AI Models and Training Data](https://mlsanity.com/paper/2304.08247/) (2023)
- [Visual CoT: Advancing Multi-Modal Language Models with a Comprehensive Dataset and Benchmark for Chain-of-Thought Reasoning](https://mlsanity.com/paper/2403.16999/) (2024)
- [MedKLIP: Medical Knowledge Enhanced Language-Image Pre-Training in Radiology](https://mlsanity.com/paper/2301.02228/) (2023)
- [Knowledge-enhanced Visual-Language Pre-training on Chest Radiology Images](https://mlsanity.com/paper/2302.14042/) (2023)
- [Why are Visually-Grounded Language Models Bad at Image Classification?](https://mlsanity.com/paper/2405.18415/) (2024)
- [KAM-CoT: Knowledge Augmented Multimodal Chain-of-Thoughts Reasoning](https://mlsanity.com/paper/2401.12863/) (2024)
- [Dynamic-LLaVA: Efficient Multimodal Large Language Models via Dynamic Vision-language Context Sparsification](https://mlsanity.com/paper/2412.00876/) (2024)
- [CARZero: Cross-Attention Alignment for Radiology Zero-Shot Classification](https://mlsanity.com/paper/2402.17417/) (2024)
- [Analyzing and Boosting the Power of Fine-Grained Visual Recognition for Multi-modal Large Language Models](https://mlsanity.com/paper/2501.15140/) (2025)
- [Decomposing Disease Descriptions for Enhanced Pathology Detection: A Multi-Aspect Vision-Language Pre-training Framework](https://mlsanity.com/paper/2403.07636/) (2024)
- [COVID-Net CXR-2: An Enhanced Deep Convolutional Neural Network Design for Detection of COVID-19 Cases from Chest X-ray Images](https://mlsanity.com/paper/2105.06640/) (2021)
- [ERA-CoT: Improving Chain-of-Thought through Entity Relationship Analysis](https://mlsanity.com/paper/2403.06932/) (2024)

## Built on by (most cited first, 6 of 6)

- [CompBench: Benchmarking Complex Instruction-guided Image Editing](https://mlsanity.com/paper/2505.12200/) (2025)
- [TimeSoccer: An End-to-End Multimodal Large Language Model for Soccer Commentary Generation](https://mlsanity.com/paper/2504.17365/) (2025)
- [TPRU: Advancing Temporal and Procedural Understanding in Large Multimodal Models](https://mlsanity.com/paper/2602.18884/) (2026)
- [LookWise: Knowing When and Where to Look for Fine-Grained Visual Reasoning in Multimodal Large Language Models](https://mlsanity.com/paper/2603.00171/) (2026)
- [KOM: A Multi-Agent Artificial Intelligence System for Precision Management of Knee Osteoarthritis (KOA)](https://mlsanity.com/paper/2511.19798/) (2025)
- [Decoupling Vision and Language: Codebook Anchored Visual Adaptation](https://mlsanity.com/paper/2602.19449/) (2026)

## Abstract (arXiv)

Recently, Multimodal Large Language Models (MLLMs) have demonstrated exceptional capabilities in visual understanding and reasoning across various vision-language tasks. However, we found that MLLMs cannot process effectively from fine-grained medical image data in the traditional Visual Question Answering (VQA) pipeline, as they do not exploit the captured features and available medical knowledge fully, results in MLLMs usually performing poorly in zero-shot medical disease recognition. Fortunately, this limitation does not indicate that MLLMs are fundamentally incapable of addressing fine-grained recognition tasks. From a feature representation perspective, MLLMs demonstrate considerable potential for tackling such challenging problems. Thus, to address this challenge, we propose LLaVA-RadZ, a simple yet effective framework for zero-shot medical disease recognition via utilizing the existing MLLM features. Specifically, we design an end-to-end training strategy, termed Decoding-Side Feature Alignment Training (DFAT) to take advantage of the characteristics of the MLLM decoder architecture and incorporate modality-specific tokens tailored for different modalities. Additionally, we introduce a Domain Knowledge Anchoring Module (DKAM) to exploit the intrinsic medical knowledge of large models, which mitigates the category semantic gap in image-text alignment. Extensive experiments demonstrate that our LLaVA-RadZ significantly outperforms traditional MLLMs in zero-shot disease recognition, achieving the comparable performance to the well-established and highly-optimized CLIP-based approaches.