The images in radiology definitely make these types of things harder, and the sparsity is an enormous issue. However, working with some projects in this area, I don't think it's as impenetrable as a lot of radiologists in AI suggest. The main thing needed in the field is adoption of better techniques and architectures to deal with these problems.
> A Longformer with full attention to input sequence, and sliding window attention to a large dictionary could be a decent way to find tune a system like this, but there are few that try it.
> Unfortunately there's a lot of stupidity going around right now in thinking the answer is just to 'pRoOoMpT tHe LLm RiGhT'
I agree with that this is not the right approach despite all the media hype (and that fine-tuning is), my research has been (more or less) attempting what you've proposed.
The problem right now is that there is no good dictionary (ontology). RadLex and UMLS have inadequate coverage. Working on a better one as we speak. Context length isn't an issue but Longformer/BigBird are good ideas, it's what I've tried as well.
No PACS that I know of even wants to tackle digital pathology in a significant way, which last I heard had about 5% adoption versus glass slides.
I am seeing this trend - everyone can explain at length why AI is "not quite up there" in their own field, but believes it's "near AGI" in other fields. We find it hard to imagine future difficulties AI will have to face in general, we can only do that in our own field where we have learned from direct experience.