Generative AI and Foundation Models in Radiology: Applications, Opportunities, and Potential Challenges

Foundation models (FMs) represent a transformative advancement in artificial intelligence (AI), with growing applications in medical imaging. These models leverage self-attention mechanisms and are capable of processing multimodal data, such as images, text, audio, and video, across multiple scales. Although FMs require large datasets for initial training, they can be adapted to specific medical imaging tasks using smaller labeled datasets through techniques such as transfer learning, fine-tuning, prompt engineering, few-shot learning, and zero-shot learning, making them especially valuable in data-scarce settings. Many FMs also incorporate generative AI capabilities that support the creation of synthetic medical images to further address annotation limitations. Current applications span various imaging modalities in radiology, where FMs have shown potential to improve diagnostic accuracy and streamline workflows. However, clinical integration remains challenging due to issues such as limited interpretability, potential bias, privacy concerns, regulatory constraints, high computational costs, and domain shifts between training data and real-world clinical environments. Addressing these barriers will require coordinated efforts among technical developers, health care providers, and regulatory bodies. This review explores the evolving role of FMs and generative AI in radiology, highlighting recent research advances, clinical applications, and the key challenges that must be addressed for responsible deployment.