A review of methods for trustworthy AI in medical imaging: The FUTURE-AI guidelines (March 2026)

Summary

Recent advancements in artificial intelligence (AI) and the vast data generated by modern clinical systems have driven the development of AI solutions in medical imaging, encompassing image reconstruction, segmentation, diagnosis, and treatment planning. Despite these successes and potential, many stakeholders worry about the risks and ethical implications of imaging AI, viewing it as complex, opaque, and challenging to understand, use, and trust in critical clinical applications.

The FUTURE-AI guideline for trustworthy AI in healthcare was established based on six guiding principles:

• Fairness.
• Universality.
• Traceability.
• Usability.
• Robustness.
• Explainability.

Through international consensus, a set of recommendations was defined, covering the entire lifecycle of medical AI tools, from design, development, and validation to regulation, deployment, and monitoring. In this paper, the authors describe how these specific recommendations can be instantiated in the domain of medical imaging, providing an overview of current best practices along with guidelines and concrete metrics on how those recommendations could be met, offering a valuable resource to the international medical imaging community.