Fang Chen

Jia Guo, Jiawei Du, Shengzhu Yang et al.

Current retinal foundation models remain constrained by curated research datasets that lack authentic clinical context, and require extensive task-specific optimization for each application, limiting their deployment efficiency in low-resource settings. Here, we show that these barriers can be overcome by building clinical native intelligence directly from real-world medical practice. Our key insight is that large-scale telemedicine programs, where expert centers provide remote consultations across distributed facilities, represent a natural reservoir for learning clinical image interpretation. We present ReVision, a retinal foundation model that learns from the natural alignment between 485,980 color fundus photographs and their corresponding diagnostic reports, accumulated through a decade-long telemedicine program spanning 162 medical institutions across China. Through extensive evaluation across 27 ophthalmic benchmarks, we demonstrate that ReVison enables deployment efficiency with minimal local resources. Without any task-specific training, ReVision achieves zero-shot disease detection with an average AUROC of 0.946 across 12 public benchmarks and 0.952 on 3 independent clinical cohorts. When minimal adaptation is feasible, ReVision matches extensively fine-tuned alternatives while requiring orders of magnitude fewer trainable parameters and labeled examples. The learned representations also transfer effectively to new clinical sites, imaging domains, imaging modalities, and systemic health prediction tasks. In a prospective reader study with 33 ophthalmologists, ReVision's zero-shot assistance improved diagnostic accuracy by 14.8% across all experience levels. These results demonstrate that clinical native intelligence can be directly extracted from clinical archives without any further annotation to build medical AI systems suited to various low-resource settings.

Zhuhao Wang, Yihua Sun, Zihan Li et al.

Drafting radiology reports is a complex task requiring flexibility, where radiologists tail content to available information and particular clinical demands. However, most current radiology report generation (RRG) models are constrained to a fixed task paradigm, such as predicting the full ``finding'' section from a single image, inherently involving a mismatch between inputs and outputs. The trained models lack the flexibility for diverse inputs and could generate harmful, input-agnostic hallucinations. To bridge the gap between current RRG models and the clinical demands in practice, we first develop a data generation pipeline to create a new MIMIC-RG4 dataset, which considers four common radiology report drafting scenarios and has perfectly corresponded input and output. Secondly, we propose a novel large language model (LLM) based RRG framework, namely LLM-RG4, which utilizes LLM's flexible instruction-following capabilities and extensive general knowledge. We further develop an adaptive token fusion module that offers flexibility to handle diverse scenarios with different input combinations, while minimizing the additional computational burden associated with increased input volumes. Besides, we propose a token-level loss weighting strategy to direct the model's attention towards positive and uncertain descriptions. Experimental results demonstrate that LLM-RG4 achieves state-of-the-art performance in both clinical efficiency and natural language generation on the MIMIC-RG4 and MIMIC-CXR datasets. We quantitatively demonstrate that our model has minimal input-agnostic hallucinations, whereas current open-source models commonly suffer from this problem.