# Med-AR: Autoregressive Vision-Language Pretraining for Long-Tailed Chest X-Ray Classification and Uncertainty-Aware Evaluation

arXiv: https://arxiv.org/abs/2609.29156 · HTML: https://mlsanity.com/paper/2609.29156/

## 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 5 of its 56 references that are in the map.
- First posted on arXiv 24 Sep 2026.

## Placed in

- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 5 of 5)

- [Qwen3 Technical Report](https://mlsanity.com/paper/2505.09388/) (2025)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [SimVLM: Simple Visual Language Model Pretraining with Weak Supervision](https://mlsanity.com/paper/2108.10904/) (2021)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [Enhancing disease detection in radiology reports through fine-tuning lightweight LLM on weak labels](https://mlsanity.com/paper/2409.16563/) (2024)

## Abstract (arXiv)

Long-tailed chest X-ray classification requires visual representations that capture both common abnormalities and subtle, infrequent findings. We propose Med-AR-8B and Med-AR-2B, two radiology-native autoregressive vision-language models pretrained with structured reports, abnormality-focused text, and region annotations. We evaluate the transfer of their visual encoders to multi-label classification against contrastive, self-supervised, and supervised pretrained encoders, including Med-CLIP, CheXFound, EVA-Base, ARK, and BioViL-T, using a common ML-Decoder classification head. To assess fine-grained recognition, we also construct LLM-expanded, report-derived label sets for MIMIC-CXR and CheXpert. Across PadChest, MIMIC-CXR, and CheXpert, Med-AR-8B outperforms Med-CLIP in mean AUROC and AUPRC for head, medium, and tail findings. On MIMIC-CXR, it increases tail-label mean AUPRC from 0.1033 to 0.1441. Med-AR-2B achieves the strongest discrimination results on PadChest. Across the broader encoder comparison, a Med-AR variant achieves the highest mean AUROC and AUPRC in every reported prevalence group on each public dataset. Both Med-AR variants also achieve lower excess area under the risk-coverage curve than Med-CLIP on all three public datasets, indicating improved selective-prediction performance under the evaluated protocol. Internal results are metric-dependent, with Med-CLIP retaining advantages in overall and tail AUPRC and in selective prediction. These findings establish Med-AR as a strong pretraining recipe for long-tailed chest X-ray classification on the evaluated public benchmarks and demonstrate the value of assessing discrimination and selective prediction together.