# PRIMA: Pre-Training with Risk-Integrated Image--Metadata Alignment for Medical Diagnosis with LLM-Based Feature Aggregation

arXiv: https://arxiv.org/abs/2602.23297 · HTML: https://mlsanity.com/paper/2602.23297/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 11 of its 34 references that are in the map.
- First posted on arXiv 26 Feb 2026.

## Builds on (most cited first, 11 of 11)

- [BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding](https://mlsanity.com/paper/1810.04805/) (2018)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Gemini 2.5: Pushing the Frontier with Advanced Reasoning, Multimodality, Long Context, and Next Generation Agentic Capabilities](https://mlsanity.com/paper/2507.06261/) (2025)
- [EVA: Exploring the Limits of Masked Visual Representation Learning at Scale](https://mlsanity.com/paper/2211.07636/) (2022)
- [PAD-UFES-20: a skin lesion dataset composed of patient data and clinical images collected from smartphones](https://mlsanity.com/paper/2007.00478/) (2020)
- [A Foundation Language-Image Model of the Retina (FLAIR): Encoding Expert Knowledge in Text Supervision](https://mlsanity.com/paper/2308.07898/) (2023)
- [MedBLIP: Bootstrapping Language-Image Pre-training from 3D Medical Images and Texts](https://mlsanity.com/paper/2305.10799/) (2023)
- [Enhanced Contrastive Learning with Multi-view Longitudinal Data for Chest X-ray Report Generation](https://mlsanity.com/paper/2502.20056/) (2025)
- [RET-CLIP: A Retinal Image Foundation Model Pre-trained with Clinical Diagnostic Reports](https://mlsanity.com/paper/2405.14137/) (2024)
- [Clinical ModernBERT: An efficient and long context encoder for biomedical text](https://mlsanity.com/paper/2504.03964/) (2025)
- [Boosting Medical Visual Understanding From Multi-Granular Language Learning](https://mlsanity.com/paper/2511.15943/) (2025)

## Abstract (arXiv)

Medical diagnosis requires the effective synthesis of visual manifestations and clinical metadata. However, existing methods often treat metadata as isolated tags, failing to exploit the rich semantic knowledge embedded in clinical descriptions. We propose PRIMA (Pre-training with Risk-integrated Image-Metadata Alignment), a framework that integrates domain-specific knowledge into multi-modal representation learning. We first curate a corpus of risk--disease correlations via Retrieval-Augmented Generation (RAG) to refine Clinical ModernBERT, embedding diagnostic priors into the text encoder. To bridge the modality gap, we introduce a dual-encoder pre-training strategy utilizing DINOv3 and our refined Clinical ModernBERT, optimized by a suite of four complementary loss functions. These losses are designed to capture multi-granular semantic alignment and handle the ambiguity of clinical correlations through soft labels. Finally, we leverage Qwen3 to fuse these aligned features for precise disease classification. Extensive experiments demonstrate that PRIMA effectively harmonizes pixel-level features with abstract clinical expertise. Across PAD-UFES-20 and AQUA, PRIMA achieves average F1-scores of 72.04% and 85.22%, outperforming strong image-only, metadata-fusion, and medical vision-language baselines. Notably, our framework achieves strong performance without requiring massive data collection or exhaustive computational resources. Our code is available at https://github.com/yqwang01/PRIMA.