# Medical Image Understanding Improves Survival Prediction via Visual Instruction Tuning

arXiv: https://arxiv.org/abs/2604.18250 · HTML: https://mlsanity.com/paper/2604.18250/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 14 of its 34 references that are in the map.
- First posted on arXiv 20 Apr 2026.

## Builds on (most cited first, 14 of 14)

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- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Generalist Foundation Models from a Multimodal Dataset for 3D Computed Tomography](https://mlsanity.com/paper/2403.17834/) (2024)
- [Pathomic Fusion: An Integrated Framework for Fusing Histopathology and Genomic Features for Cancer Diagnosis and Prognosis](https://mlsanity.com/paper/1912.08937/) (2019)
- [How to Exploit Hyperspherical Embeddings for Out-of-Distribution Detection?](https://mlsanity.com/paper/2203.04450/) (2022)
- [Multimodal Optimal Transport-based Co-Attention Transformer with Global Structure Consistency for Survival Prediction](https://mlsanity.com/paper/2306.08330/) (2023)
- [Cross-Modal Translation and Alignment for Survival Analysis](https://mlsanity.com/paper/2309.12855/) (2023)
- [Diffuse and Disperse: Image Generation with Representation Regularization](https://mlsanity.com/paper/2506.09027/) (2025)
- [Deep Orthogonal Fusion: Multimodal Prognostic Biomarker Discovery Integrating Radiology, Pathology, Genomic, and Clinical Data](https://mlsanity.com/paper/2107.00648/) (2021)
- [INSPECT: A Multimodal Dataset for Pulmonary Embolism Diagnosis and Prognosis](https://mlsanity.com/paper/2311.10798/) (2023)

## Abstract (arXiv)

Accurate prognostication and risk estimation are essential for guiding clinical decision-making and optimizing patient management. While radiologist-assessed features from CT scans provide valuable indicators of disease severity and outcomes, interpreting such images requires expert knowledge, and translating rich visual information into textual summaries inevitably leads to information loss. In this work, we propose a vision-language framework for 3D CT image understanding that leverages large-scale open-sourced CT images paired with radiology reports through visual instruction tuning. This pre-training enables the model to learn clinically meaningful visual-textual representations, which can then be adapted to downstream survival prediction tasks. By incorporating a survival prediction head on top of the pre-trained model, our approach improves survival prediction from CT images and clinical data while generating clinically meaningful language responses to predefined questions. Experimental results demonstrate that our method outperforms baseline methods in survival prediction, particularly, when clinical data alone is less predictive. The code will be released upon acceptance.