Benchmarking CXR Foundation Models With Publicly Available MIMIC-CXR and NIH-CXR14 Datasets

Abstract

Recent foundation models have demonstrated strong performance in medical image representation learning, yet their comparative behaviour across datasets remains underexplored. This work benchmarks two large-scale chest X-ray (CXR) embedding models (CXR-Foundation (ELIXR v2.0) and MedImagelnsight) on public MIMIC-CR and NIH ChestX-ray14 datasets. Each model was evaluated using a unified preprocessing pipeline and fixed downstream classifiers to ensure reproducible comparison. We extracted embeddings directly from pre-trained encoders, trained lightweight LightGBM classifiers on multiple disease labels, and reported mean AUROC, and F1-score with 95% confidence intervals. MedImageInsight achieved slightly higher performance across most tasks, while CXR-Foundation exhibited strong cross-dataset stability. Unsupervised clustering of MedImageIn-sight embeddings further revealed a coherent disease-specific structure consistent with quantitative results. The results highlight the need for standardised evaluation of medical foundation models and establish reproducible baselines for future multimodal and clinical integration studies.