Scaling Chest X-Ray Foundation Models From Mixed Supervisions for Dense Prediction

Foundation models have significantly revolutionized the field of chest X-ray diagnosis with their ability to transfer across various diseases and tasks. However, previous works have predominantly utilized self-supervised learning from medical image-text pairs, which falls short in dense medical prediction tasks due to their sole reliance on such coarse pair supervision, thereby limiting their applicability to detailed diagnostics. In this paper, we introduce a Dense Chest X-ray Foundation Model (DCXFM), which utilizes mixed supervision types (i.e., text, label, and segmentation masks) to significantly enhance the scalability of foundation models across various medical tasks. Our model involves two training stages: we first employ a novel self-distilled multimodal pretraining paradigm to exploit text and label supervision, along with local-to-global self-distillation and soft cross-modal contrastive alignment strategies to enhance localization capabilities. Subsequently, we introduce an efficient cost aggregation module, comprising spatial and class aggregation mechanisms, to further advance dense prediction tasks with densely annotated datasets. Comprehensive evaluations on three tasks (phrase grounding, zero-shot semantic segmentation, and zero-shot classification) demonstrate DCXFM's superior performance over other state-of-the-art medical image-text pretraining models. Remarkably, DCXFM exhibits powerful zero-shot capabilities across various datasets in phrase grounding and zero-shot semantic segmentation, underscoring its superior generalization in dense prediction tasks.