RadZero: Similarity-Based Cross-Attention for Explainable Vision-Language Alignment in Radiology with Zero-Shot Multi-Task Capability

Recent advancements in multi-modal models have significantly improved visionlanguage (VL) alignment in radiology. However, existing approaches struggle to effectively utilize complex radiology reports for learning and offer limited inter pretability through attention probability visualizations. To address these challenges, we introduce RadZero, a novel framework for VL alignment in radiology with zero-shot multi-task capability. A key component of our approach is VL-CABS (Vision-Language Cross-Attention Based on Similarity), which aligns text embeddings with local image features for interpretable, fine-grained VL reasoning. RadZero leverages large language models to extract concise semantic sentences from radiology reports and employs multi-positive contrastive training to effectively capture relationships between images and multiple relevant textual descriptions. It uses a pre-trained vision encoder with additional trainable Transformer layers, allowing efficient high-resolution image processing. By computing similarity between text embeddings and local image patch features, VL-CABS enables zero-shot inference with similarity probability for classification, and pixel-level VL similarity maps for grounding and segmentation. Experimental results on public chest radiograph benchmarks show that RadZero outperforms state-of-the-art methods in zero-shot classification, grounding, and segmentation. Furthermore, VL similarity map analysis highlights the potential of VL-CABS for improving explainability in VL alignment. Additionally, qualitative evaluation demonstrates RadZero’s capability for open-vocabulary semantic segmentation, further validating its effectiveness in medical imaging.