I agree it's not impenetrable, that's why I'm working on this problem. What I disagree with is the "this is trivial" statements.
> 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.
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.