Medical image classification requires labeled, task-specific datasets which are used to train deep learning networks de novo, or to fine-tune foundation models. However, this process is computationally and technically demanding. In language processing, in-context learning provides an alternative, where models learn from within prompts, bypassing the need for parameter updates. Yet, in-context learning remains underexplored in medical image analysis. Here, we systematically evaluate the model Generative Pretrained Transformer 4 with Vision capabilities (GPT-4V) on cancer image processing with in-context learning on three cancer histopathology tasks of high importance: Classification of tissue subtypes in colorectal cancer, colon polyp subtyping and breast tumor detection in lymph node sections. Our results show that in-context learning is sufficient to match or even outperform specialized neural networks trained for particular tasks, while only requiring a minimal number of samples. In summary, this study demonstrates that large vision language models trained on non-domain specific data can be applied out-of-the box to solve medical image-processing tasks in histopathology. This democratizes access of generalist AI models to medical experts without technical background especially for areas where annotated data is scarce.

Georg Wölflein, Dyke Ferber, Daniel Truhn, Ognjen Arandjelovic, Jakob Nikolas Kather. Proceedings of the 63rd Annual Meeting of the Association for Computational Linguistics (Volume 1: Long Papers). 2025.

Large language models (LLMs) show great potential for clinical decision-making, yet most applications remain narrow, task-specific chat tools rather than systems integrated into clinical workflows ^1,2 . However, building physician copilots will require models that operate within the electronic health record (EHR), with governed access to patient data and the ability to initiate permitted EHR actions within defined safety constraints. Yet it remains unproven whether such a system can manage patient cases with physician-level performance. Here we show that MIRA (Medical Intelligence for Reasoning and Action), an autonomous artificial intelligence agent operating in a sandboxed EHR environment, can navigate a large clinical action space to obtain patient histories; order and interpret laboratory, imaging and microbiology tests; generate differential diagnoses; and formulate treatment plans such as prescribing medications, scheduling surgical procedures and planning admissions. In simulations on real patient cases spanning multiple diagnoses, MIRA outperformed physicians in diagnostic accuracy and made guideline-concordant, medication-safe and appropriate admission decisions. Compared with previous LLM applications that addressed isolated subtasks or provided free-text advice, these results suggest that an EHR-integrated artificial intelligence agent can turn clinical intent into structured, actionable EHR operations, possibly making it a more effective decision-support partner for physicians. Further work is needed to establish generalization, safety and governance through prospective, real-world studies.

Identifying the configuration of chess pieces from an image of a chessboard is a problem in computer vision that has not yet been solved accurately. However, it is important for helping amateur chess players improve their games by facilitating automatic computer analysis without the overhead of manually entering the pieces. Current approaches are limited by the lack of large datasets and are not designed to adapt to unseen chess sets. This paper puts forth a new dataset synthesised from a 3D model that is an order of magnitude larger than existing ones. Trained on this dataset, a novel end-to-end chess recognition system is presented that combines traditional computer vision techniques with deep learning. It localises the chessboard using a RANSAC-based algorithm that computes a projective transformation of the board onto a regular grid. Using two convolutional neural networks, it then predicts an occupancy mask for the squares in the warped image and finally classifies the pieces. The described system achieves an error rate of 0.23% per square on the test set, 28 times better than the current state of the art. Further, a few-shot transfer learning approach is developed that is able to adapt the inference system to a previously unseen chess set using just two photos of the starting position, obtaining a per-square accuracy of 99.83% on images of that new chess set. The code, dataset, and trained models are made available online.