Contrastive Language-Image Pre-training (CLIP), a straightforward yet effective pre-training paradigm, successfully introduces semantic-rich text supervision to vision models and has demonstrated promising results in various tasks due to its generalizability and interpretability. It has recently gained increasing interest in the medical imaging domain, either as a powerful pre-training paradigm for medical vision language alignment or a pre-trained key component for various clinical tasks. With the aim of facilitating a deeper understanding of this promising direction, this survey offers an in-depth exploration of the CLIP paradigm within the domain of medical imaging, regarding both refined CLIP pre-training and CLIP-driven applications. Our survey (1) starts with a brief introduction to the fundamentals of CLIP methodology. (2) Then, we investigate the adaptation of CLIP pre-training in the medical domain, focusing on how to optimize CLIP given characteristics of medical images and reports. (3) Furthermore, we explore the practical utilization of CLIP pre-trained models in various tasks, including classification, dense prediction, and cross-modal tasks. (4) Finally, we discuss existing limitations of CLIP in the context of medical imaging and propose forward-looking directions to address the demands of medical imaging domain. We expect that this comprehensive survey will provide researchers in the field of medical image analysis with a holistic understanding of the CLIP paradigm and its potential implications. The project page is available at https://github.com/zhaozh10/Awesome-CLIP-in-Medical-Imaging, which will be regularly updated.
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