Peer-Reviewed Publication
Nat Biomed Eng2026October 13, 2026Journal Article
Repurposing adult AI radiograph models for neonatal care through continual learning: an international multicentre study.
Vishwanatha M Rao1,2,3, Emma Chen1,4, Agustina Saenz1,5, Oishi Banerjee1,4, Henrik Marklund6, Lucas Bijnens1,7, Sung Eun Kim1, Evan Zucker8, Susan Shelmerdine9, Jeremy Palacio10, Kent Ryan Kleinschmidt10, Sathvik Suryadevara10, Sri Sai Dinesh Jaliparthi10, Jiaxi Lu10, Rithvik Akula10, Mario Scala11,12, Julian F Niedermair11,12, Nikolaus Stranger13, Sebastian Tschauner13, Georg M Schmölzer14, Maria Jose Veloza Vega15, Juan Sebastián Osorio Valencia15,16, Oscar Jaramillo Robledo17, Oscar Julian López Uribe18, Saif Afat19, Thomas Küstner20, Soroosh Tayebi Arasteh21,22, Daniel Truhn23, Kelsey L Pomykala24, Jens Kleesiek24, Naela Himayati Afifah25, Rozan M Irfan25, Reza Shahriarirad26, Amirhossein Erfani26, Israel Amirav14,27,28, Moria Be'er27,28, Yasuhito Mitsuyama29, Daiju Ueda30, Alain S Abi-Ghanem31, Safaa Al Zakleet31, Mossad Abdelhak Shaban Mohamed32, Wan Irfan Bin W Mustapha33, Naila Nizami34, Rafeah Khan35, Khalid Al-Kharazi36, Zafar Iqbal37, Abdullah Al Shahrani38, Amna Kashgari39, Tijana Prodanovic40, Nikola Prodanovic41, Desmond Shi Wei Lim42, James Thomas Patrick Decourcy Hallinan42, Phumza Nongena43, Melissa Louise Cooke43, Montserrat Bret-Zurita44, Almudena Alonso-Ojembarrena45, Alexandra Nemes46, Yung-Chieh Lin47, Wei-Ting Lin47, Wen-Hui Fang48, Chin Lin49, Atchara Mahayosnond50, Sira Sriswasdi51, Piyapong Khumrin52,53, Suphakris Tanmuk54, Didem Arman55, Serdar Cömert55, Serdar Alan56, Umit Ayse Tandircioglu56, David Andrew Mong57, Esther Chung58, Michael Sadler58, Morgan P McBee59, Richard H Jones59, Pranav Rajpurkar60
1Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
2Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
3Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA.
4School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.
5Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
6Department of Computer Science, Stanford University, Stanford, CA, USA.
7Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
8Department of Radiology/Pediatric Radiology, Stanford University, Palo Alto, CA, USA.
9Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.
10Saint Louis University School of Medicine, Saint Louis University, Saint Louis, MO, USA.
11Central Radiology Institute, Johannes Kepler University Linz, Kepler University Hospital GmbH, Linz, Austria.
12Division of Virtual Morphology, Institute of Anatomy and Cell Biology, Johannes Kepler University, Linz, Austria.
13Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
14Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
15Artificial Intelligence Committee, Colombian Association of Radiology, Medellín, Colombia.
16Medical Imaging and AI in Health SURA, Bioscience Center, Ayudas Diagnósticas SURA, Medellín, Colombia.
17Education and Research Department, Servicios Especiales de Salud Hospital Universitario de Caldas, Manizales, Colombia.
18Department of Pediatrics and Neonatology, Servicios Especiales de Salud Hospital Universitario de Caldas, Manizales, Colombia.
19Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, Tuebingen, Germany.
20Medical Image and Data Analysis (MIDAS) Laboratory, University Hospital of Tübingen, Tübingen, Germany.
21Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
22Department of Urology, Stanford University, Stanford, CA, USA.
23Lab for AI in Medicine, Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
24Institute for AI in Medicine (IKIM), University Medicine Essen, Essen, Germany.
25Department of Radiology, RSUP Dr Sardjito, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
26Thoracic and Vascular Surgery Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
27Pediatric Pulmonology Institute, Dana Children's Hospital, Tel Aviv Sourasky University Medical Center (Ichilov), Tel Aviv, Israel.
28Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
29Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
30Department of Artificial Intelligence, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
31Department of Diagnostic Radiology, American University of Beirut, Beirut, Lebanon.
32Department of Paediatrics, Sultan Ahmad Shah Medical Centre (SASMEC), International Islamic University Malaysia, Kuantan, Malaysia.
33Department of Radiology, Sultan Ahmad Shah Medical Centre @IIUM, International Islamic University Malaysia, Kuantan, Malaysia.
34Department of Neonatal Pediatrics, The Indus Hospital and Health Network, Karachi, Pakistan.
35Department of Diagnostic Radiology, The Indus Hospital and Health Network, Karachi, Pakistan.
36Department of Neurosurgery, Sidra Medicine, Doha, Qatar.
37Department of Radiology, Sidra Medicine, Doha, Qatar.
38Manager of Diagnostic Imaging Section, King Abdul-Aziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
39Pediatric Radiology Consultant, King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia.
40Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.
41Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.
42Department of Diagnostic Imaging, National University Hospital Singapore, Singapore, Singapore.
43Department of Paediatrics, New Somerset Hospital, University of Cape Town, Cape Town, South Africa.
44Department of Radiology, La Paz University Hospital, Madrid, Spain.
45Neonatal Intensive Care Unit, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cádiz, Spain.
46Department of Neonatology, Life Memorial Hospital, Titu Maiorescu Faculty of Medicine, Bucharest, Romania.
47Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
48Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.
49Medical Technology Education Center, School of Medicine, College of Medicine, National Defense Medical University, Taipei, Taiwan.
50Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
51Center for AI in Medicine, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
52Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
53Bioinformatics Core, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg.
54Ministry of Public Health, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand.
55Department of Pediatrics, Division of Neonatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
56Department of Pediatrics, Division of Neonatology, Kirikkale University School of Medicine, Kirikkale, Turkey.
57University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA.
58Department of Radiology, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, NJ, USA.
59Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
60Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA. pranav_rajpurkar@hms.harvard.edu.
Abstract
Despite growing clinical adoption of artificial intelligence in radiology, fewer than one in five commercially available models are cleared for paediatric use. Existing systems are trained predominantly on adult data and generalize poorly to neonates, yet efficient strategies for repurposing them without data sharing or large-scale local data curation are lacking. Here we present an international…
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