Fine-grained vision-language alignment in chest radiography enables zero-shot classification, grounding, and segmentation without task-specific annotations. However, this alignment is fundamentally hindered by two intertwined sources of ambiguity: projection-induced visual mismatch and patient-agnostic semantic overlap. First, at the local feature level, frontal and lateral radiographs exhibit distinct appearances for the same clinical finding, rendering a shared patch-text similarity geometry inherently suboptimal. Compounding this visual ambiguity is a semantic mismatch during global contrastive optimization, where instance-level objectives penalize cross-patient pairs as strict negatives even when they share identical positive clinical concepts. To address this dual ambiguity, we propose PLRS-IC, a unified dual-calibration framework for chest X-ray representation learning. At the local alignment stage, Projection-Conditioned Low-Rank Residual Similarity (PLRS) dynamically adapts patch-text matching to projection-specific manifolds using a bounded, parameter-efficient low-rank residual. At the global optimization stage, Information-Content-Calibrated Soft False-Negative Suppression (IC-SFNS) leverages a corpus-derived information-theoretic prior to soften the penalty of semantically overlapping negatives without altering original contrastive assignments. Extensive experiments across nine public zero-shot benchmark settings demonstrate that our framework yields consistent improvements in classification, grounding, and segmentation, validating the necessity of dual-calibration in medical vision-language pre-training.

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