Vision Foundation Models in Radiology: A Scoping Review of Data, Methodology, Evaluation and Clinical Translation

Vision foundation models (VFMs) are increasingly being developed for radiological imaging, yet their definition, development and evaluation remain heterogeneous. We conducted a PRISMAScR scoping review of peer-reviewed studies published between January 2017 and March 2026 describing foundation models trained exclusively on radiological imaging data. Sixty-seven studies were included and mapped across three pillars: data scale and heterogeneity, architectural and pretraining scalability, and downstream transferability and generalization. Datasets primarily covered brain MRI, thoracoabdominal CT, and chest X-ray, ranging from fewer than 100,000 samples to multi-million-image cohorts. Transformer-based architectures and self-supervised pretraining predominated, particularly masked image modeling, contrastive learning and multi-stage approaches. Evaluation focused mainly on segmentation and classification, whereas cross-center, cross-scanner, anatomical and modality-shift validation was inconsistently reported. Alignment with FUTURE-AI principles was uneven. Overall, radiology-specific VFMs show promising transferability, but clinical translation remains constrained by limited data representativeness, heterogeneous benchmarks, incomplete reporting and insufficient deployment-oriented evaluation.

Automated Machine Learning in Radiomics: A Comparative Evaluation of Performance, Efficiency and Accessibility

Automated machine learning (AutoML) frameworks can lower technical barriers for predictive and prognostic model development in radiomics by enabling researchers without programming expertise to build models. However, their effectiveness in addressing radiomics-specific challenges remains unclear. This study evaluates the performance, efficiency, and accessibility of general-purpose and radiomics-specific AutoML frameworks on diverse radiomics classification tasks, thereby highlighting development needs for radiomics. Ten public/private radiomics datasets with varied imaging modalities (CT/MRI), sizes, anatomies and endpoints were used. Six general-purpose and five radiomics-specific frameworks were tested with predefined parameters using standardized cross-validation. Evaluation metrics included AUC, runtime, together with qualitative aspects related to software status, accessibility, and interpretability. Simplatab, a radiomics-specific tool with a no-code interface, achieved the highest average test AUC (81.81%) with a moderate runtime (~1 hour). LightAutoML, a general-purpose framework, showed the fastest execution with competitive performance (78.74% mean AUC in six minutes). Most radiomics-specific frameworks were excluded from the performance analysis due to obsolescence, extensive programming requirements, or computational inefficiency. Conversely, general-purpose frameworks demonstrated higher accessibility and ease of implementation. Simplatab provides an effective balance of performance, efficiency, and accessibility for radiomics classification problems. However, significant gaps remain, including the lack of accessible survival analysis support and the limited integration of feature reproducibility and harmonization within current AutoML frameworks. Future research should focus on adapting AutoML solutions to better address these radiomics-specific challenges.