Learning Pathology-Localized Medical Vision–Language Representations with Atomic and Grounded Disease Supervision

Mong Yuan Sim, Wei Emma Zhang, Xiang Dai, Byron Fang, Miao Liu


Abstract
Medical vision-language models are typically trained by aligning whole images with entire radiology reports, assuming that global correspondence is sufficient for learning clinically meaningful representations. We argue that effective medical representation learning requires pathology-localized supervision, which explicitly aligns specific disease observations with their corresponding anatomical image regions. To enable this at scale, we propose a fully automated pipeline that decomposes radiology reports into atomic disease observations, identifies relevant regions, and pairs them with corresponding image regions without manual annotation, resulting in a fine-grained dataset, LocalizedCXR, with over 6 million region–caption pairs. Through extensive experiments, we demonstrate that our pathology-localized semantic supervision significantly improve performance in cross-modal retrieval, image classification, and phrase grounding of radiology findings. Our results suggest that moving beyond global alignment to disease-aware region-level alignment is essential for developing effective medical vision-language representation learning.
Anthology ID:
2026.findings-emnlp.2309
Volume:
Findings of the Association for Computational Linguistics: EMNLP 2026
Month:
October
Year:
2026
Address:
Budapest, Hungary
Editors:
Hung-Yi Lee, Sunipa Dev, Jessy Li, Desmond Elliott
Venue:
Findings
SIG:
SIGDAT
Publisher:
Association for Computational Linguistics
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Pages:
49550–49564
Language:
URL:
https://aclanthology.org/2026.findings-emnlp.2309/
DOI:
Bibkey:
Cite (ACL):
Mong Yuan Sim, Wei Emma Zhang, Xiang Dai, Byron Fang, and Miao Liu. 2026. Learning Pathology-Localized Medical Vision–Language Representations with Atomic and Grounded Disease Supervision. In Findings of the Association for Computational Linguistics: EMNLP 2026, pages 49550–49564, Budapest, Hungary. Association for Computational Linguistics.
Cite (Informal):
Learning Pathology-Localized Medical Vision–Language Representations with Atomic and Grounded Disease Supervision (Sim et al., Findings 2026)
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https://aclanthology.org/2026.findings-emnlp.2309.pdf