ArthroCut: Autonomous Policy Learning for Robotic Bone Resection in Knee Arthroplasty

Despite rapid commercialization of surgical robots, their autonomy and real-time decision-making remain limited in practice. To address this gap, we propose ArthroCut, an autonomous policy learning framework that upgrades knee arthroplasty robots from assistive execution to context-aware action generation. ArthroCut fine-tunes a Qwen--VL backbone on a self-built, time-synchronized multimodal dataset from 21 complete cases (23,205 RGB--D pairs), integrating preoperative CT/MR, intraoperative NDI tracking of bones and end effector, RGB--D surgical video, robot state, and textual intent. The method operates on two complementary token families -- Preoperative Imaging Tokens (PIT) to encode patient-specific anatomy and planned resection planes, and Time-Aligned Surgical Tokens (TAST) to fuse real-time visual, geometric, and kinematic evidence -- and emits an interpretable action grammar under grammar/safety-constrained decoding. In bench-top experiments on a knee prosthesis across seven trials, ArthroCut achieves an average success rate of 86% over the six standard resections, significantly outperforming strong baselines trained under the same protocol. Ablations show that TAST is the principal driver of reliability while PIT provides essential anatomical grounding, and their combination yields the most stable multi-plane execution. These results indicate that aligning preoperative geometry with time-aligned intraoperative perception and translating that alignment into tokenized, constrained actions is an effective path toward robust, interpretable autonomy in orthopedic robotic surgery.

Native Intelligence Emerges from Large-Scale Clinical Practice: A Retinal Foundation Model with Deployment Efficiency

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.