LLaVA-RadZ: Can Multimodal Large Language Models Effectively Tackle Zero-shot Radiology Recognition?

Recently, multimodal large models (MLLMs) have demonstrated exceptional capabilities in visual understanding and reasoning across various vision-language tasks. However, MLLMs usually perform poorly in zero-shot medical disease recognition, as they do not fully exploit the captured features and available medical knowledge. To address this challenge, we propose LLaVA-RadZ, a simple yet effective framework for zero-shot medical disease recognition. Specifically, we design an end-to-end training strategy, termed Decoding-Side Feature Alignment Training (DFAT) to take advantage of the characteristics of the MLLM decoder architecture and incorporate modality-specific tokens tailored for different modalities, which effectively utilizes image and text representations and facilitates robust cross-modal alignment. Additionally, we introduce a Domain Knowledge Anchoring Module (DKAM) to exploit the intrinsic medical knowledge of large models, which mitigates the category semantic gap in image-text alignment. DKAM improves category-level alignment, allowing for accurate disease recognition. Extensive experiments on multiple benchmarks demonstrate that our LLaVA-RadZ significantly outperforms traditional MLLMs in zero-shot disease recognition and exhibits the state-of-the-art performance compared to the well-established and highly-optimized CLIP-based approaches.