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Annals of biomedical engineering

Prompt Injection in Clinical Artificial Intelligence Systems: The Emerging Security Challenge of Large Language Models and Agentic AI

This article argues that prompt injection is a failure mode distinct from accuracy, bias, and hallucination—a model performing exactly as instructed by an instruction the clinician neither wrote nor can see—arising from a fundamental property of current language-model architectures that receive an undifferentiated stream of tokens and possess no mechanism for distinguishing content that carries authority from content that does not, with medicine particularly exposed because the clinical record is assembled from material originating outside the institution, including referral correspondence, patient-entered messages, external reports, scanned documents, and imaging acquired elsewhere; the authors argue that prompt injection warrants classification as a patient safety hazard with an articula