KEPIL: Knowledge-Enhanced Prompt-Image Learning for Prompt-Robust Disease Detection

Vision--language models (VLMs) show promise for clinical decision support in radiology because they enable joint reasoning over radiological images and clinical text, thereby leveraging complementary clinical information. However, radiological findings are long-tailed in practice, leaving some conditions underrepresented and making zero-shot inference essential. Yet current CLIP-style medical VLMs are sensitive to prompt variations and often lack trustworthy external knowledge at inference time, which hinders reliable clinical deployment. We present textitKEPIL, a prompt-robust framework that integrates curated medical knowledge to stabilize zero-shot generalization. KEPIL comprises: (i) dynamic prompt enrichment using ontologies with LLM assistance, (ii) a semantic-aware contrastive loss aligning embeddings of equivalent prompt variants via a dual-embedding objective, and (iii) entity-centric report standardization to yield ontology-aligned representations. Across seven benchmarks, KEPIL achieves state-of-the-art zero-shot inference performance; under prompt-variation tests, it improves AUC by (6.37%) on textitCheXpert and by (4.11%) on average. These results suggest that structured knowledge and robust prompt design are key to clinically reliable radiology-facing VLMs. Code will be released at https://github.com/Roypic/KEPIL.