What Do Medical Vision-Language Models Learn in Radiology? Transfer, Alignment, and Source-Proxy Leakage Under Distribution Shift

The paper investigates how medical vision‑language models (VLMs) behave when faced with distribution shifts such as changes in acquisition domain, supervision, or evaluation protocol. Using datasets like NIH ChestXray14, CheXpert, PadChest, and OpenI, the authors isolate cross‑dataset visual transfer, evaluate multimodal alignment, and quantify source‑proxy leakage in frozen embeddings. They find that self‑supervised visual initialization improves transfer, adversarial adaptation is only marginally helpful, and that multimodal retrieval performance drops under external stress tests while source‑proxy information remains recoverable, highlighting hidden failure modes in medical VLMs.

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• llms
• rag
• multimodal
• safety