NEJM AI

@ai.nejm.org

NEJM AI, a new monthly journal from the publisher of @nejm.org, explores the cutting-edge applications of artificial intelligence and machine learning in clinical medicine. Online at ai.nejm.org.

A new study evaluates Flourish, a mobile app using generative AI to deliver personalized, strengths-based well-being support to young adults through an AI well-being coach, in a 6-week randomized trial across three U.S. campuses. Learn more: https://nejm.ai/3TJ9iVy

Illustration of three individuals walking across large, stacked smartphone screens. A heading below reads: "AI for Proactive Mental Health: A Multi-Institutional, Longitudinal Randomized Controlled Trial."

Before a drug reaches patients, it has to clear a critical gate. In the latest episode of the NEJM AI Grand Rounds podcast, Brandon Rice of Weave explains why the Investigational New Drug (IND) process shapes everything that follows. Learn more: https://nejm.ai/ep44

Drug development has embraced cutting-edge science. The paperwork often hasn’t. In the latest episode of the NEJM AI Grand Rounds podcast, Brandon Rice of Weave explains why regulatory workflows are a major opportunity for AI. Full episode: https://nejm.ai/ep44

A new Perspective examines why pathology, despite being foundational to modern diagnostics, has seen limited clinical adoption of AI-enabled imaging tools. It outlines barriers and pathways for AI-assisted workflows and clinical trial applications. Learn more: https://nejm.ai/44xQhI1

A quote from a Perspective published in NEJM AI reads as follows: "Standard pathology slides remain a largely untapped resource for precision medicine, but realizing their value requires more than algorithmic advances." The Perspective is titled “Bridging the Gap — Translating AI in Pathology into Clinical Impact” and the authors are F.-Y. Su et al. The background color is orange and includes the NEJM AI logo.

Curiosity came first. Entrepreneurship came later. In the latest episode of the NEJM AI Grand Rounds podcast, Brandon Rice traces the path from building computers as a kid to building Weave. Listen to the full episode: https://nejm.ai/ep44

An AI-derived and validated machine-learning system appeared to predict the risk of Hirschsprung disease with the use of genetic and demographic data from participants in China. Learn more in a correspondence published in NEJM: https://nej.md/4xVlzWE

This image contains a flowchart and line graphs illustrating use of the machine-learning system for the detection of Hirschsprung disease in the validation and external testing datasets. The flowchart in Panel A shows training and testing of machine-learning system for detection of Hirschsprung disease risk. Panel B presents the area under the ROC curves for Hirschsprung disease risk detection models.

A new Perspective examines the first European Medicines Agency and U.S. Food and Drug Administration endorsements of an AI-enabled clinical trial end point tool — AIM-NASH — and explores implications for evidence generation. Learn more: https://nejm.ai/4wkloTl

Table outlining potential applications of artificial intelligence for clinical trial endpoints. It includes focus areas such as histopathology, anatomical imaging, and physiological imaging. Descriptions and current examples are provided alongside AI-enabled future possibilities for each category.

A new study introduces a decentralized, privacy-preserving pipeline that combines weakly supervised deep learning with Swarm Learning to predict patient-level labels from laparoscopic appendectomy videos. Learn more about this approach: https://nejm.ai/44Ap0V9

A digital illustration showing a medical diagram of human organs overlaid with surgical tools. At the bottom, there's a text box containing the article title: "Privacy-Preserving Surgical Video Analysis with Swarm Learning — Results from a Multinational Appendectomy Cohort" by O.L. Saldanha and Others.

In the latest episode of the NEJM AI Grand Rounds podcast, Brandon Rice of Weave discusses the challenge of organizing scientific knowledge, communicating with regulators, and navigating processes that can span more than a decade. Listen now: https://nejm.ai/ep44

Promotional image for episode 44 of the NEJM AI Grand Rounds podcast featuring Weave’s Brandon Rice on rebuilding drug regulation with AI. Includes a photo of the guest.

SmartAlert — a machine learning–driven clinical decision support system targeting inpatient complete blood count utilization — reduced repetitive testing. Success depended on end-user engagement, implementation, and governance. Learn more: https://nejm.ai/4ezJxzb

Table depicting demographics and outcomes of CBC Utilization SmartAlert Pilot. It displays data for treatment and control groups, including number of encounters, alerts, ages, and race percentages. Rates for ICU admission and mortality are included.

ReXGroundingCT is the first publicly available manually annotated dataset to link free-text radiology findings with 3D segmentations in chest CT scans, enabling research in grounded radiology report generation. Learn more: https://nejm.ai/4giw8N6

Figure 1 illustrates the ReXGroundingCT Dataset. Panel A displays lung CT scan findings. Panel B highlights a bar chart of findings per category across the dataset, grouped by typical pattern (nonfocal vs. focal). Panel C details an example of anatomical chain-of-thought reasoning.

A new Case Study evaluates an LLM–assisted genomic reanalysis workflow that integrates clinician notes, Human Phenotype Ontology terms, and filtered variant data to generate diagnostic hypotheses for expert review. Learn more: https://nejm.ai/4eMh8pu

Diagram showing protein structure predictions related to the pathological mechanism of the Sphingosine-1-Phosphate Receptor 1 (S1PR1) c.850_882del variant in a vitiligo patient. Image includes a protein sequence diagram, ribbon model structures, and molecular surface models.

A new Perspective proposes that open-weight, peer-reviewed retrieval-augmented medical artificial intelligence assistants, used with physician review, may be better understood as published clinical methodologies rather than regulated devices. Learn more: https://nejm.ai/4e7q6MA

The image contains a quote about medical artificial intelligence, emphasizing its value in methodology rather than being a device. The quote mentions embedding strategy, retrieval parameters, clinical workflow, and validation. It is attributed to Adrian Gropper, M.D., from the Perspective titled “The Medical AI Assistant as Publication, Not Device — Why Peer-Reviewed, Open-Source AI Belongs in the Standard of Care.” The NEJM AI logo is displayed in the lower-right corner. The background is a blue gradient.