# Evaluating Vision Language Models (VLMs) for Radiology: A Comprehensive Analysis

arXiv: https://arxiv.org/abs/2504.16047 · HTML: https://mlsanity.com/paper/2504.16047/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 16 of its 20 references that are in the map.
- First posted on arXiv 22 Apr 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, 16 of 16)

- [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)
- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [On the Opportunities and Risks of Foundation Models](https://mlsanity.com/paper/2108.07258/) (2021)
- [Probing Classifiers: Promises, Shortcomings, and Advances](https://mlsanity.com/paper/2102.12452/) (2021)
- [Mind the Gap: Understanding the Modality Gap in Multi-modal Contrastive Representation Learning](https://mlsanity.com/paper/2203.02053/) (2022)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [Exploring scalable medical image encoders beyond text supervision](https://mlsanity.com/paper/2401.10815/) (2024)
- [A Vision-Language Foundation Model to Enhance Efficiency of Chest X-ray Interpretation](https://mlsanity.com/paper/2401.12208/) (2024)
- [ELIXR: Towards a general purpose X-ray artificial intelligence system through alignment of large language models and radiology vision encoders](https://mlsanity.com/paper/2308.01317/) (2023)
- [MedImageInsight: An Open-Source Embedding Model for General Domain Medical Imaging](https://mlsanity.com/paper/2410.06542/) (2024)
- [CheXmask: a large-scale dataset of anatomical segmentation masks for multi-center chest x-ray images](https://mlsanity.com/paper/2307.03293/) (2023)
- [A generalizable 3D framework and model for self-supervised learning in medical imaging](https://mlsanity.com/paper/2501.11755/) (2025)
- [EVA-X: A Foundation Model for General Chest X-ray Analysis with Self-supervised Learning](https://mlsanity.com/paper/2405.05237/) (2024)
- [Interpretable and Testable Vision Features via Sparse Autoencoders](https://mlsanity.com/paper/2502.06755/) (2025)
- [Advancing human-centric AI for robust X-ray analysis through holistic self-supervised learning](https://mlsanity.com/paper/2405.01469/) (2024)

## Abstract (arXiv)

Foundation models, trained on vast amounts of data using self-supervised techniques, have emerged as a promising frontier for advancing artificial intelligence (AI) applications in medicine. This study evaluates three different vision-language foundation models (RAD-DINO, CheXagent, and BiomedCLIP) on their ability to capture fine-grained imaging features for radiology tasks. The models were assessed across classification, segmentation, and regression tasks for pneumothorax and cardiomegaly on chest radiographs. Self-supervised RAD-DINO consistently excelled in segmentation tasks, while text-supervised CheXagent demonstrated superior classification performance. BiomedCLIP showed inconsistent performance across tasks. A custom segmentation model that integrates global and local features substantially improved performance for all foundation models, particularly for challenging pneumothorax segmentation. The findings highlight that pre-training methodology significantly influences model performance on specific downstream tasks. For fine-grained segmentation tasks, models trained without text supervision performed better, while text-supervised models offered advantages in classification and interpretability. These insights provide guidance for selecting foundation models based on specific clinical applications in radiology.