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arXiv · 2603.26049

Seeing Like Radiologists: Context- and Gaze-Guided Vision-Language Pretraining for Chest X-rays

Kang Liu·Zhuoqi Ma·Siyu Liang·Yunan Li·Xiyue Gao·Chao Liang·Kun Xie·Qiguang Miao
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Abstract

Despite recent advances in medical vision-language pretraining, existing models still struggle to capture the diagnostic workflow: radiographs are typically treated as context-agnostic images, while radiologists' gaze -- a crucial cue for visual reasoning -- remains largely underexplored by existing methods. These limitations hinder the modeling of disease-specific patterns and weaken cross-modal alignment. To bridge this gap, we introduce CoGaze, a Context- and Gaze-guided vision-language pretraining framework for chest X-rays. We first propose a context-infused vision encoder that models how radiologists integrate clinical context -- including patient history, symptoms, and diagnostic intent -- to guide diagnostic reasoning. We then present a multi-level supervision paradigm that (1) enforces intra- and inter-modal semantic alignment through hybrid-positive contrastive learning, (2) injects diagnostic priors via disease-aware cross-modal representation learning, and (3) leverages radiologists' gaze as probabilistic priors to guide attention toward diagnostically salient regions. Extensive experiments demonstrate that CoGaze consistently outperforms state-of-the-art methods across diverse tasks, achieving up to +2.0% CheXbertF1 and +1.2% BLEU2 for free-text and structured report generation, +23.2% AUROC for zero-shot classification, and +12.2% Precision@1 for image-text retrieval. Code is available at https://github.com/mk-runner/CoGaze.

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Kang Liu, Zhuoqi Ma, Siyu Liang, Yunan Li, Xiyue Gao, Chao Liang, Kun Xie, Qiguang Miao. 2026-03-27. Seeing Like Radiologists: Context- and Gaze-Guided Vision-Language Pretraining for Chest X-rays. https://arxiv.org/abs/2603.26049

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