# More performant and scalable: Rethinking contrastive vision-language pre-training of radiology in the LLM era

arXiv: https://arxiv.org/abs/2509.13175 · HTML: https://mlsanity.com/paper/2509.13175/

## Key facts

- Cited by 6 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 17 of its 28 references that are in the map.
- First posted on arXiv 16 Sep 2025.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)
- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 17 of 17)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [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)
- [Rethinking the Inception Architecture for Computer Vision](https://mlsanity.com/paper/1512.00567/) (2015)
- [Flamingo: a Visual Language Model for Few-Shot Learning](https://mlsanity.com/paper/2204.14198/) (2022)
- [Qwen Technical Report](https://mlsanity.com/paper/2309.16609/) (2023)
- [The Kinetics Human Action Video Dataset](https://mlsanity.com/paper/1705.06950/) (2017)
- [DeepSeekMoE: Towards Ultimate Expert Specialization in Mixture-of-Experts Language Models](https://mlsanity.com/paper/2401.06066/) (2024)
- [LiT: Zero-Shot Transfer with Locked-image text Tuning](https://mlsanity.com/paper/2111.07991/) (2021)
- [Making the Most of Text Semantics to Improve Biomedical Vision--Language Processing](https://mlsanity.com/paper/2204.09817/) (2022)
- [Knowledge-enhanced Visual-Language Pre-training on Chest Radiology Images](https://mlsanity.com/paper/2302.14042/) (2023)
- [Merlin: A Computed Tomography Vision-Language Foundation Model and Dataset](https://mlsanity.com/paper/2406.06512/) (2024)
- [Machine-Learning-Based Multiple Abnormality Prediction with Large-Scale Chest Computed Tomography Volumes](https://mlsanity.com/paper/2002.04752/) (2020)
- [Large-scale and Fine-grained Vision-language Pre-training for Enhanced CT Image Understanding](https://mlsanity.com/paper/2501.14548/) (2025)
- [Bootstrapping Chest CT Image Understanding by Distilling Knowledge from X-ray Expert Models](https://mlsanity.com/paper/2404.04936/) (2024)
- [Bridged Semantic Alignment for Zero-shot 3D Medical Image Diagnosis](https://mlsanity.com/paper/2501.03565/) (2025)
- [Automated Spinal MRI Labelling from Reports Using a Large Language Model](https://mlsanity.com/paper/2410.17235/) (2024)

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

- [OmniCT: Towards a Unified Slice-Volume LVLM for Comprehensive CT Analysis](https://mlsanity.com/paper/2602.16110/) (2026)
- [Learning to Read Where to Look: Disease-Aware Vision-Language Pretraining for 3D CT](https://mlsanity.com/paper/2603.02026/) (2026)
- [GreenRFM: Learning a resource-efficient radiology vision-language foundation model via supervision-centric pre-training](https://mlsanity.com/paper/2603.06467/) (2026)
- [Disease-Centric Vision-Language Pretraining with Hybrid Visual Encoding for 3D Computed Tomography](https://mlsanity.com/paper/2606.25546/) (2026)
- [ARC-CT: Anatomy-Routed Contrastive Vision-Language Learning for 3D Chest CT](https://mlsanity.com/paper/2608.28455/) (2026)
- [BioFact-MoE: Biologically Factorized Mixture of Experts for Vision-Language Prognostic Modeling in Hepatocellular Carcinoma](https://mlsanity.com/paper/2605.26376/) (2026)

## Abstract (arXiv)

The emergence of Large Language Models (LLMs) presents unprecedented opportunities to revolutionize medical contrastive vision-language pre-training. In this paper, we show how LLMs can facilitate large-scale supervised pre-training, thereby advancing vision-language alignment. We begin by demonstrate that modern LLMs can automatically extract diagnostic labels from radiology reports with remarkable precision (>96% AUC in our experiments) without complex prompt engineering, enabling the creation of large-scale "silver-standard" datasets at a minimal cost (~3 for 50k CT image-report pairs). Further, we find that vision encoder trained on this "silver-standard" dataset achieves performance comparable to those trained on labels extracted by specialized BERT-based models, thereby democratizing the access to large-scale supervised pre-training. Building on this foundation, we proceed to reveal that supervised pre-training fundamentally improves contrastive vision-language alignment. Our approach achieves state-of-the-art performance using only a 3D ResNet-18 with vanilla CLIP training, including 83.8% AUC for zero-shot diagnosis on CT-RATE, 77.3% AUC on RAD-ChestCT, and substantial improvements in cross-modal retrieval (MAP@50=53.7% for image-image, Recall@100=52.2% for report-image). These results demonstrate the potential of utilizing LLMs to facilitate bf more performant and scalable medical AI systems. Our code is avaiable at https://github.com/SadVoxel/More-performant-and-scalable.