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[Submitted on 13 Sep 2026] Title:Performance vs Consistency: Evaluating a Foundation Model in Lung-RADS Screening View a PDF of the paper titled Performance vs Consistency: Evaluating a Foundation Model in Lung-RADS Screening, by Benjamin Renoust and 11 other authors View PDF HTML (experimental) Abstract:Foundation models have recently demonstrated strong capabilities across a wide range of medical imaging tasks. However, their performance in structured clinical interpretation settings remains insufficiently explored. In lung cancer screening, interpretative variability persists despite standardized frameworks such as Lung-RADS. In this study, we evaluate MedGemma, a medical general-purpose foundation model derived from Gemini and its fine-tuned version adapted for lung cancer detection and diagnosis, compared against radiologists performing Lung-RADS v2022 assessment on the NLST dataset. Twelve radiologists independently evaluated each case in a multi-reader design, enabling quantification of inter-reader variability. Radiologists achieved a mean AUC of 0.90, with substantial variability across readers (range: 0.80-0.94). The native foundation model achieved an AUC of 0.70, failing to reach clinically relevant performance. In contrast, fine-tuning significantly improved performance to an AUC of 0.83, placing the model within the lower range of individual radiologists performance. These findings highlight a trade-off between peak accuracy and prediction consistency. Unlike radiologists, under fixed conditions, the model produces deterministic outputs, removing inter-run variability under identical inputs, in contrast to inter-reader variability observed among radiologists. This supports the role of fine-tuned foundation models potential complementary tools for clinical decision support, particularly in settings with limited expertise. However, evaluation is performed on a case-enriched cohort from NLST and does not account for real-world prevalence or external validation, limiting direct clinical generalization. Comments: MICCAI CAPTION 2026 Subjects: Computer Vision and Pattern Recognition (cs.CV); Artificial Intelligence (cs.AI) MSC classes: 92C50, 68T45 ACM classes: J.3; I.4.6; I.4.7; I.4.8; I.4.9; I.4.10; I.4.m; I.2.10; I.5.4 Cite as: arXiv:2609.22281 [cs.CV] (or arXiv:2609.22281v1 [cs.CV] for this version) https://doi.org/10.48550/arXiv.2609.22281 arXiv-issued DOI via DataCite (pending registration) Submission history From: Benjamin Renoust [view email] [v1] Sun, 13 Sep 2026 02:43:46 UTC (508 KB) Full-text links: Access Paper: View a PDF of the paper titled Performance vs Consistency: Evaluating a Foundation Model in Lung-RADS Screening, by Benjamin Renoust and 11 other authors View PDF HTML (experimental) TeX Source view license Current browse context: cs.CV new | recent | 2026-09 Change to browse by: cs cs.AI References & Citations NASA ADS Google Scholar Semantic Scholar Loading... Data provided by: Bibliographic Tools Bibliographic and Citation Tools Bibliographic Explorer Toggle Bibliographic Explorer (What is the Explorer?) Connected Papers Toggle Connected Papers (What is Connected Papers?) Litmaps Toggle Litmaps (What is Litmaps?) scite.ai Toggle scite Smart Citations (What are Smart Citations?) Code, Data, Media Code, Data and Media Associated with this Article alphaXiv Toggle alphaXiv (What is alphaXiv?) Links to Code Toggle CatalyzeX Code Finder for Papers (What is CatalyzeX?) DagsHub Toggle DagsHub (What is DagsHub?) GotitPub Toggle Gotit.pub (What is GotitPub?) Huggingface Toggle Hugging Face (What is Huggingface?) ScienceCast Toggle ScienceCast (What is ScienceCast?) Demos Demos Replicate Toggle Replicate (What is Replicate?) Spaces Toggle Hugging Face Spaces (What is Spaces?) Spaces Toggle TXYZ.AI (What is TXYZ.AI?) Related Papers Recommenders and Search Tools Link to Influence Flower Influence Flower (What are Influence Flowers?) Core recommender toggle CORE Recommender (What is CORE?) Author Venue Institution Topic About arXivLabs arXivLabs: experimental projects with community collaborators arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website. Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them. Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs. Which authors of this paper are endorsers? | Disable MathJax (What is MathJax?)