The allegory of the cave: 10 years of AI shadows in radiology

More than two millennia ago, Plato's Allegory of the Cave illustrated how humans may mistake shadows for reality. Over the last decade, radiology has experienced a similar phenomenon with Artificial Intelligence (AI). Early narratives, often promoted by opinion leaders and commercial stakeholders, portrayed AI as an imminent replacement for radiologists, fostering unrealistic expectations, regulatory minimalism, and a climate of urgency. With increasing evidence and clinical experience, these shadows have gradually dissipated. AI has not supplanted radiologists but has demonstrated value when applied to well-defined tasks such as triage, workflow optimization, image quality enhancement, and quantitative analysis. At the same time, limitations have become evident, including hallucinations, lack of transparency, security risks, and the restricted clinical relevance of most marketed solutions. This decade of exaggerated promises has carried tangible costs, from damaged professional perception to adoption skepticism. As radiology enters the era of agentic AI, critical realism, transparency, and radiologist-led development are essential to avoid repeating past illusions.