Vision-language (VL) pretraining using paired chest X-ray (CXR) images and radiology reports has shown strong potential for medical image understanding. However, existing methods often remain dependent on task-specific finetuning because radiology reports are lengthy, clinically dense, and difficult to align with simple zero-shot prompts. Recent sentence-level approaches partially address this limitation using clinical phrases extracted by large language models (LLMs), but they largely overlook the intrinsic characteristics of radiology discourse. In particular, limited positive-pair diversity constrains further gains, while clinically equivalent sentences frequently recur across patients, creating false negatives in contrastive learning. To address these issues, we propose SentZero, an enhanced sentence-centric VL pretraining framework for zero-shot, multi-task CXR analysis. SentZero introduces LLM-based abstract-level sentence structuring and mapping to expand positive-pair diversity, together with an additional loss term to mitigate false negatives. We further introduce sentence-conditioned residual modulation of visual embeddings, enabling visual features to adapt to the semantic characteristics of each input sentence. Across diverse downstream tasks and datasets, SentZero improves zero-shot generalization and outperforms prior multi-task zero-shot methods.
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Visual backbones have evolved from Convolutional Neural Networks (CNNs) with local aggregation to Vision Transformers (ViTs) with global interactions, State-Space Models (SSMs) with input-dependent state transitions, and Test-Time Training (TTT) layers that adapt an inner learner while processing an image. Across this progression, visual computation has become increasingly adaptive to each input, yet the rules governing that adaptation remain largely prescribed by the trained backbone. We introduce VisionHOPE, the first generic visual backbone formulated as a self-modifying learning system, in which what the model remembers and how it learns co-evolve within an image. Building on the self-referential construction of Nested Learning (NL), VisionHOPE realizes this co-evolution through five coupled memories that store content, generate key and value representations, and govern learning rate and retention. These memories evolve jointly as visual context accumulates along each scan. However, directly applying the unconstrained self-referential update to a visual backbone leads to instability. We therefore derive a stability-matched step-size control scheme that combines a soft cap on self-referential injection with a spectral clamp on the retained memory transition, and prove that the resulting memory dynamics are non-expansive along each scan. For two-dimensional feature maps, we adapt NL's chunk formulation by aligning chunks with image rows and columns across four directional scans. The proposed VisionHOPE achieves competitive results on ImageNet-1K, COCO, and ADE20K, establishing self-modifying learning systems as a practical foundation for general-purpose visual backbones. The code is available at https://github.com/PSRben/VisionHOPE.
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