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Vision-language pre-training (VLP) holds great promise for general-purpose medical AI by leveraging radiology reports as rich textual supervision, yet existing methods struggle with 3D CT imaging due to inefficient visual backbones and coarse semantic alignment. To address these issues, we propose a tailored VLP framework featuring three key components: (1) a CNN-ViT hybrid encoder that replaces ViT's patch embedding with a 3D CNN backbone to efficiently capture local anatomical details while preserving global attention and compatibility with pre-trained cross-modal priors; (2) a disease-level contrastive learning mechanism using learnable query tokens to dynamically extract disease-specific semantics from full reports and align them with corresponding visual features, thereby disentangling distinct diseases within the same anatomical region; and (3) a diagnosis-aware prompt strategy that employs real clinical phrases and aggregated disease prototypes to bridge the pre-training-inference gap and enhance zero-shot diagnostic reliability.
The paper investigates how to incorporate biomedical knowledge graphs (KGs) into large language models (LLMs) for clinical diagnosis. It evaluates five KG task formulations, three training paradigms, two KGs, and three base LLMs, finding that all paradigms outperform a non‑finetuned baseline but differ in knowledge transfer behavior. Introducing Gradient Intervention Density (GID) and Gradient Distortion (GD) metrics, the study identifies a ‘surgical alignment’ regime—sparse, localized updates achieved by KG‑judgment training with KL regularization—that improves reasoning quality even when in‑domain accuracy is lower than task‑specific supervised fine‑tuning.
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