Foundation Models in Biomedical Imaging: Turning Hype into Reality

Foundation models (FMs) are driving a prominent shift in artificial intelligence across different domains, including biomedical imaging. These models are designed to move beyond narrow pattern recognition towards emulating sophisticated clinical reasoning, understanding complex spatial relationships, and integrating multimodal data with unprecedented flexibility. However, a critical gap exists between this potential and the current reality, where the clinical evaluation and deployment of FMs are hampered by significant challenges. Herein, we critically assess the current state-of-the-art, analyzing hype by examining the core capabilities and limitations of FMs in the biomedical domain. We also provide a taxonomy of reasoning, ranging from emulated sequential logic and spatial understanding to the integration of explicit symbolic knowledge, to evaluate whether these models exhibit genuine cognition or merely mimic surface-level patterns. We argue that a critical frontier lies beyond statistical correlation, in the pursuit of causal inference, which is essential for building robust models that understand cause and effect. Furthermore, we discuss the paramount issues in deployment stemming from trustworthiness, bias, and safety, dissecting the challenges of algorithmic bias, data bias and privacy, and model hallucinations. We also draw attention to the need for more inclusive, rigorous, and clinically relevant validation frameworks to ensure their safe and ethical application. We conclude that while the vision of autonomous AI-doctors remains distant, the immediate reality is the emergence of powerful technology and assistive tools that would benefit clinical practice. The future of FMs in biomedical imaging hinges not on scale alone, but on developing hybrid, causally aware, and verifiably safe systems that augment, rather than replace, human expertise.

The Next Layer: Augmenting Foundation Models with Structure-Preserving and Attention-Guided Learning for Local Patches to Global Context Awareness in Computational Pathology

Foundation models have recently emerged as powerful feature extractors in computational pathology, yet they typically omit mechanisms for leveraging the global spatial structure of tissues and the local contextual relationships among diagnostically relevant regions - key elements for understanding the tumor microenvironment. Multiple instance learning (MIL) remains an essential next step following foundation model, designing a framework to aggregate patch-level features into slide-level predictions. We present EAGLE-Net, a structure-preserving, attention-guided MIL architecture designed to augment prediction and interpretability. EAGLE-Net integrates multi-scale absolute spatial encoding to capture global tissue architecture, a top-K neighborhood-aware loss to focus attention on local microenvironments, and background suppression loss to minimize false positives. We benchmarked EAGLE-Net on large pan-cancer datasets, including three cancer types for classification (10,260 slides) and seven cancer types for survival prediction (4,172 slides), using three distinct histology foundation backbones (REMEDIES, Uni-V1, Uni2-h). Across tasks, EAGLE-Net achieved up to 3% higher classification accuracy and the top concordance indices in 6 of 7 cancer types, producing smooth, biologically coherent attention maps that aligned with expert annotations and highlighted invasive fronts, necrosis, and immune infiltration. These results position EAGLE-Net as a generalizable, interpretable framework that complements foundation models, enabling improved biomarker discovery, prognostic modeling, and clinical decision support

Thinking Beyond Tokens: From Brain-Inspired Intelligence to Cognitive Foundations for Artificial General Intelligence and its Societal Impact

Can machines truly think, reason and act in domains like humans? This enduring question continues to shape the pursuit of Artificial General Intelligence (AGI). Despite the growing capabilities of models such as GPT-4.5, DeepSeek, Claude 3.5 Sonnet, Phi-4, and Grok 3, which exhibit multimodal fluency and partial reasoning, these systems remain fundamentally limited by their reliance on token-level prediction and lack of grounded agency. This paper offers a cross-disciplinary synthesis of AGI development, spanning artificial intelligence, cognitive neuroscience, psychology, generative models, and agent-based systems. We analyze the architectural and cognitive foundations of general intelligence, highlighting the role of modular reasoning, persistent memory, and multi-agent coordination. In particular, we emphasize the rise of Agentic RAG frameworks that combine retrieval, planning, and dynamic tool use to enable more adaptive behavior. We discuss generalization strategies, including information compression, test-time adaptation, and training-free methods, as critical pathways toward flexible, domain-agnostic intelligence. Vision-Language Models (VLMs) are reexamined not just as perception modules but as evolving interfaces for embodied understanding and collaborative task completion. We also argue that true intelligence arises not from scale alone but from the integration of memory and reasoning: an orchestration of modular, interactive, and self-improving components where compression enables adaptive behavior. Drawing on advances in neurosymbolic systems, reinforcement learning, and cognitive scaffolding, we explore how recent architectures begin to bridge the gap between statistical learning and goal-directed cognition. Finally, we identify key scientific, technical, and ethical challenges on the path to AGI.