{
  "abstract": "Frontier artificial intelligence (AI) models have advanced rapidly through training on internet-scale public data, yet such systems lack access to private clinical data. Neuroimaging is underrepresented in the public domain due to identifiable facial features within magnetic resonance imaging (MRI) and computed tomography (CT) scans, restricting model performance in clinical medicine. Here we show that frontier models underperform on neuroimaging tasks and that learning directly from uncurated data generated during routine clinical care at health systems, a paradigm we call 'health system learning', yields high-performance, generalist neuroimaging models. We introduce NeuroVFM, a visual foundation model trained on 5.24 million clinical MRI and CT volumes using a scalable volumetric predictive architecture. NeuroVFM learns comprehensive representations of brain anatomy and pathology, achieving state-of-the-art performance across multiple clinical tasks, including radiologic diagnosis and report generation. The model embeds MRI and CT scans into a shared neuroanatomic latent space and grounds diagnostic findings. When paired with open-source language models, NeuroVFM generates radiology reports that surpass frontier models in accuracy, clinical triage and expert preference. NeuroVFM reduces hallucinated findings and critical errors, offering safer clinical decision support. These results establish health system learning as a paradigm for building generalist medical AI and provide a scalable framework for clinical foundation models.",
  "abstract_shown": true,
  "affiliations": [
    "Machine Learning in Neurosurgery Lab, University of Michigan, Ann Arbor, MI, USA",
    "University of Michigan Computational Medicine and Bioinformatics, Ann Arbor, MI, USA",
    "University of Michigan Computer Science and Engineering, Ann Arbor, MI, USA",
    "University of Michigan Neurosurgery, Ann Arbor, MI, USA",
    "University of Cologne Neurosurgery, Cologne, Germany",
    "University of Michigan Radiology, Ann Arbor, MI, USA",
    "Machine Learning in Neurosurgery Lab, University of Michigan, Ann Arbor, MI, USA. tocho@med.umich.edu",
    "University of Michigan Computational Medicine and Bioinformatics, Ann Arbor, MI, USA. tocho@med.umich.edu",
    "University of Michigan Computer Science and Engineering, Ann Arbor, MI, USA. tocho@med.umich.edu",
    "University of Michigan Neurosurgery, Ann Arbor, MI, USA. tocho@med.umich.edu"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 18,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Akhil Kondepudi",
      "orcid": "0000-0002-2643-7580"
    },
    {
      "affs": [
        0
      ],
      "name": "Akshay T Rao",
      "orcid": "0000-0001-6920-6355"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Chenhui Zhao"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Yiwei Lyu",
      "orcid": "0000-0002-3882-4246"
    },
    {
      "affs": [
        0
      ],
      "name": "Edward Samir Harake",
      "orcid": "0000-0002-8865-1267"
    },
    {
      "affs": [
        0
      ],
      "name": "Soumyanil Banerjee",
      "orcid": "0000-0003-4165-8637"
    },
    {
      "affs": [
        0
      ],
      "name": "Jacob D. Ogle"
    },
    {
      "affs": [
        0,
        3
      ],
      "name": "Rushikesh Sanjeev Joshi",
      "orcid": "0000-0001-5251-5856"
    },
    {
      "affs": [
        4
      ],
      "name": "Anna-Katharina Meißner",
      "orcid": "0000-0003-4150-7265"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Xinhai Hou",
      "orcid": "0000-0002-6576-6264"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Cheng Jiang",
      "orcid": "0000-0003-1759-4960"
    },
    {
      "affs": [
        0
      ],
      "name": "Asadur Chowdury",
      "orcid": "0000-0002-5653-9721"
    },
    {
      "affs": [
        5
      ],
      "name": "Ashok Srinivasan"
    },
    {
      "affs": [
        1
      ],
      "name": "Brian D. Athey"
    },
    {
      "affs": [
        5
      ],
      "name": "Vikas Gulani",
      "orcid": "0000-0003-0889-5999"
    },
    {
      "affs": [
        3
      ],
      "name": "Aditya Pandey",
      "orcid": "0009-0009-5525-5864"
    },
    {
      "affs": [
        2
      ],
      "name": "Honglak Lee",
      "orcid": "0000-0002-4109-327X"
    },
    {
      "affs": [
        6,
        7,
        8,
        9
      ],
      "name": "Todd Charles Hollon",
      "orcid": "0000-0001-5987-6531"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0mk3tn6rcef8p.bib",
  "cited_by": 17,
  "doi": "10.1038/s41591-026-04497-1",
  "fulltext_url": null,
  "id": "0mk3tn6rcef8p",
  "issns": [
    "1078-8956",
    "1546-170X",
    "1744-7933"
  ],
  "landing_url": "https://doi.org/10.1038/s41591-026-04497-1",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
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      "openalex",
      "2718|Artificial Intelligence in Healthcare and Education"
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  "openalex": "W7167936829",
  "pdf_url": null,
  "pmcid": "PMC12687827",
  "pmid": "41377995",
  "published": "2026-07-10",
  "publisher": "Nature Portfolio",
  "ris": "https://research.draconitic.com/paper/0mk3tn6rcef8p.ris",
  "sources": [
    {
      "first_seen": "2026-11-08T13:20:51Z",
      "native_id": "W7167936829",
      "source": "openalex",
      "url": "https://doi.org/10.1038/s41591-026-04497-1"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2718|Artificial Intelligence in Healthcare and Education",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Health system learning enables generalist neuroimaging models",
  "title_text": "Health system learning enables generalist neuroimaging models",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T13:21:15Z",
  "url": "https://research.draconitic.com/paper/0mk3tn6rcef8p",
  "venue": "Nature Medicine",
  "versions": []
}