IMACT-CXR is an interactive multi-agent conversational tutor that helps trainees interpret chest X-rays by unifying spatial annotation, gaze analysis, knowledge retrieval, and image-grounded reasoning in a single AutoGen-based workflow. The tutor simultaneously ingests learner bounding boxes, gaze samples, and free-text observations. Specialized agents evaluate localization quality, generate Socratic coaching, retrieve PubMed evidence, suggest similar cases from REFLACX, and trigger NV-Reason-CXR-3B for vision-language reasoning when mastery remains low or the learner explicitly asks. Bayesian Knowledge Tracing (BKT) maintains skill-specific mastery estimates that drive both knowledge reinforcement and case similarity retrieval. A lung-lobe segmentation module derived from a TensorFlow U-Net enables anatomically aware gaze feedback, and safety prompts prevent premature disclosure of ground-truth labels. We describe the system architecture, implementation highlights, and integration with the REFLACX dataset for real DICOM cases. IMACT-CXR demonstrates responsive tutoring flows with bounded latency, precise control over answer leakage, and extensibility toward live residency deployment. Preliminary evaluation shows improved localization and diagnostic reasoning compared to baselines.

W e assemble a large, domain - specialized clinical corpus and a clinician - validated reasoning set, and develop RareSeek - R1 via staged instruction tuning, chain - of - thought learning, and graph - grounded retrieval. Across multicenter EHR narratives and public benchmarks, RareSeek - R1 attains state - of - the - art accuracy, robust generalization, and stability under noisy or overlapping phenotypes. Augmented retrieval yields the largest gains when narratives pair with prioritized variants by resolving ambiguity and aligning candidates to mechanisms. Human studies show performance on par with experienced physicians and consistent gains in assistive use. Notably, transparent reasoning highlights decisive non - phenotypic evidence (median 23.1%, such as imaging, interventions, functional tests) underpinning many correct diagnoses. This work advances a narrative - first, knowledge - integrated reasoning paradigm that shortens the diagnostic odyssey and enables auditable, clinically translatable decision support.

Radiologists compose diagnostic reports through a structured workflow: they describe visual findings, summarize them into impressions, and carefully refine statements in clinically critical cases. However, most existing medical report generation (MRG) systems treat reports as flat sequences, overlooking this hierarchical organization and leading to inconsistencies between descriptive and diagnostic content. To align model behavior with real-world reporting practices, we propose RadFlow, a hierarchical workflow-guided reinforcement optimization framework that explicitly models the structured nature of clinical reporting. RadFlow introduces a clinically grounded reward hierarchy that mirrors the organization of radiological reports. At the global level, the reward integrates linguistic fluency, medical-domain correctness, and cross-sectional consistency between Finding and Impression, promoting coherent and clinically faithful narratives. At the local level, a section-specific reward emphasizes Impression quality, reflecting its central role in diagnostic accuracy. Furthermore, a critical-aware policy optimization mechanism adaptively regularizes learning for high-risk or clinically sensitive cases, emulating the cautious refinement behavior of radiologists when documenting critical findings. Together, these components translate the structured reporting paradigm into the reinforcement fine-tuning process, enabling the model to generate reports that are both linguistically consistent and clinically aligned. Experiments on chest X-ray and carotid ultrasound datasets demonstrate that RadFlow consistently improves diagnostic coherence and overall report quality compared with state-of-the-art baselines.

Rare diseases represent the long tail of medical imaging, where AI models often fail due to the scarcity of representative training data. In clinical workflows, radiologists frequently consult case reports and literature when confronted with unfamiliar findings. Following this line of reasoning, we introduce RADAR, Retrieval Augmented Diagnostic Reasoning Agents, an agentic system for rare disease detection in brain MRI. Our approach uses AI agents with access to external medical knowledge by embedding both case reports and literature using sentence transformers and indexing them with FAISS to enable efficient similarity search. The agent retrieves clinically relevant evidence to guide diagnostic decision making on unseen diseases, without the need of additional training. Designed as a model-agnostic reasoning module, RADAR can be seamlessly integrated with diverse large language models, consistently improving their rare pathology recognition and interpretability. On the NOVA dataset comprising 280 distinct rare diseases, RADAR achieves up to a 10.2% performance gain, with the strongest improvements observed for open source models such as DeepSeek. Beyond accuracy, the retrieved examples provide interpretable, literature grounded explanations, highlighting retrieval-augmented reasoning as a powerful paradigm for low-prevalence conditions in medical imaging.

An effective physician should possess a combination of empathy, expertise, patience, and clear communication when treating a patient. Recent advances have successfully endowed AI doctors with expert diagnostic skills, particularly the ability to actively seek information through inquiry. However, other essential qualities of a good doctor remain overlooked. It features 3,000 realistically simulated patient agents that exhibit diverse linguistic patterns, cognitive limitations, emotional responses, and tendencies for passive disclosure. We also introduce a multi-faceted evaluation framework, covering task success, inquiry proficiency, dialogue competence, inquiry efficiency, and patient experience. Experiments on different LLMs reveal substantial challenges across the evaluation aspects. Even state-of-the-art models show significant room for improvement in their inquiry capabilities. These models are highly sensitive to variations in realistic patient behavior, which considerably impacts diagnostic accuracy. Furthermore, our fine-grained metrics expose trade-offs between different evaluation perspectives, highlighting the challenge of balancing performance and practicality in real-world clinical settings.Figure 1: Comparison between MAQ E enables more realistic patient simulation by integrating diverse behaviors and evaluates doctor inquiries from more comprehensive and fine-grained perspectives. A medical career is among the most demanding professions to master. A physician's role extends far beyond treating diseases; it also involves employing nuanced conversational skills to understand a patient's condition and guide them through moments of vulnerability. Current Large Language Models (LLMs) have reached the initial stage of this journey by grasping extensive medical knowledge and expertise in clinical examinations (Nori et al., 2023; Wang et al., 2023; Saab et al., 2024; Singhal et al., 2025; Dou et al., 2025). However, their passive, response-driven nature (Li et al., 2024)--an inherent tendency to answer user queries directly rather than to engage in goal-oriented dialogue--limits their practical utility. This shortcoming is particularly critical in clinical consultation, the focus of this work, where an LLM must proactively converse with patients to gather information through thoughtful and compassionate inquiry. Existing studies (Liao et al., 2023; Li et al., 2024; Schmidgall et al., 2024; Nori et al., 2025) have proposed several benchmarks to evaluate the inquiry capabilities of LLMs. A prevalent method is to develop a virtual interaction environment in which a patient is simulated by an LLM based on a synthesized profile.

Ultrasound is crucial in modern medicine but faces challenges like operator dependence, image noise, and real-time scanning, hindering AI integration. While large multimodal models excel in other medical imaging areas, they struggle with ultrasound's complexities. To address this, we introduce Dolphin v1.0 (V1) and its reasoning-augmented version, Dolphin R1-the first large-scale multimodal ultrasound foundation models unifying diverse clinical tasks in a single vision-language framework.To tackle ultrasound variability and noise, we curated a 2-million-scale multimodal dataset, combining textbook knowledge, public data, synthetic samples, and general corpora. This ensures robust perception, generalization, and clinical adaptability.The Dolphin series employs a three-stage training strategy: domain-specialized pretraining, instruction-driven alignment, and reinforcement-based refinement. Dolphin v1.0 delivers reliable performance in classification, detection, regression, and report generation. Dolphin R1 enhances diagnostic inference, reasoning transparency, and interpretability through reinforcement learning with ultrasound-specific rewards.Evaluated on U2-Bench across eight ultrasound tasks, Dolphin R1 achieves a U2-score of 0.5835-over twice the second-best model (0.2968) setting a new state of the art. Dolphin v1.0 also performs competitively, validating the unified framework. Comparisons show reasoning-enhanced training significantly improves diagnostic accuracy, consistency, and interpretability, highlighting its importance for high-stakes medical AI.

Structured reporting (SR) and artificial intelligence (AI) may transform how radiologists interact with imaging studies. This prospective study (July to December 2024) evaluated the impact of three reporting modes: free-text (FT), structured reporting (SR), and AI-assisted structured reporting (AI-SR), on image analysis behavior, diagnostic accuracy, efficiency, and user experience. Four novice and four non-novice readers (radiologists and medical students) each analyzed 35 bedside chest radiographs per session using a customized viewer and an eye-tracking system. Outcomes included diagnostic accuracy (compared with expert consensus using Cohen's $κ$), reporting time per radiograph, eye-tracking metrics, and questionnaire-based user experience. Statistical analysis used generalized linear mixed models with Bonferroni post-hoc tests with a significance level of ($P \le .01$). Diagnostic accuracy was similar in FT ($κ= 0.58$) and SR ($κ= 0.60$) but higher in AI-SR ($κ= 0.71$, $P < .001$). Reporting times decreased from $88 \pm 38$ s (FT) to $37 \pm 18$ s (SR) and $25 \pm 9$ s (AI-SR) ($P < .001$). Saccade counts for the radiograph field ($205 \pm 135$ (FT), $123 \pm 88$ (SR), $97 \pm 58$ (AI-SR)) and total fixation duration for the report field ($11 \pm 5$ s (FT), $5 \pm 3$ s (SR), $4 \pm 1$ s (AI-SR)) were lower with SR and AI-SR ($P < .001$ each). Novice readers shifted gaze towards the radiograph in SR, while non-novice readers maintained their focus on the radiograph. AI-SR was the preferred mode. In conclusion, SR improves efficiency by guiding visual attention toward the image, and AI-prefilled SR further enhances diagnostic accuracy and user satisfaction.

Large language models (LLMs) have demonstrated excellent capabilities in the field of biomedical question answering, but their application in real-world clinical consultations still faces core challenges. Single-round consultation systems require patients to describe all symptoms upfront, leading to vague diagnosis with unclear complaints. Traditional multi-turn dialogue models, constrained by static supervised learning, lack flexibility and fail to intelligently extract key clinical information. To address these limitations, we propose \Ours{}, a reinforcement learning (RL)-based multi-agent collaborative framework that models medical consultations as a dynamic decision-making process under uncertainty. The doctor agent continuously optimizes its questioning strategy within the RL framework through multi-turn interactions with the patient agent, dynamically adjusting its information-gathering path based on comprehensive rewards from the Consultation Evaluator. This RL fine-tuning mechanism enables LLMs to autonomously develop interaction strategies aligned with clinical reasoning logic, rather than superficially imitating patterns in existing dialogue data. Notably, we constructed MTMedDialog, the first English multi-turn medical consultation dataset capable of simulating patient interactions. Experiments demonstrate that \Ours{} outperforms existing models in both multi-turn reasoning capability and final diagnostic performance. This approach shows immense practical value by reducing misdiagnosis risks in time-pressured settings, freeing clinicians for complex cases, and pioneering a strategy to optimize medical resource allocation and alleviate workforce shortages. Code and data are available at https://github.com/JarvisUSTC/DoctorAgent-RL

Abstract--Autonomous agents utilizing Large Language Models (LLMs) have demonstrated remarkable capabilities in isolated medical tasks like diagnosis and image analysis, but struggle with integrated clinical workflows that connect diagnostic reasoning and medication decisions. We identify a core limitation: existing medical AI systems process tasks in isolation without the cross-validation and knowledge integration found in clinical teams, reducing their effectiveness in real-world healthcare scenarios. T o transform the isolation paradigm into a collaborative approach, we propose MedCoAct, a confidence-aware multi-agent framework that simulates clinical collaboration by integrating specialized doctor and pharmacist agents, and present a benchmark, DrugCareQA, to evaluate medical AI capabilities in integrated diagnosis and treatment workflows. Our results demonstrate that MedCoAct achieves 67.58% diagnostic accuracy and 67.58% medication recommendation accuracy, outperforming single agent framework by 7.04% and 7.08% respectively. In healthcare, LLMs have demonstrated capabilities across diverse applications. Medical question-answering systems provide rapid access to comprehensive clinical knowledge and evidence-based recommendations [1]-[3]. LLMs assist also with medical imaging report generation, significantly reducing physician workload [4]. Moreover, LLMs help drug discovery research by accelerating molecular design and optimization processes [5].

Large Language Models (LLMs) demonstrate strong generalization and reasoning abilities, making them well-suited for complex decision-making tasks such as medical consultation (MC). However, existing LLM-based methods often fail to capture the dual nature of MC, which entails two distinct sub-tasks: symptom inquiry, a sequential decision-making process, and disease diagnosis, a classification problem. This mismatch often results in ineffective symptom inquiry and unreliable disease diagnosis. To address this, we propose \textbf{DDO}, a novel LLM-based framework that performs \textbf{D}ual-\textbf{D}ecision \textbf{O}ptimization by decoupling the two sub-tasks and optimizing them with distinct objectives through a collaborative multi-agent workflow. Experiments on three real-world MC datasets show that DDO consistently outperforms existing LLM-based approaches and achieves competitive performance with state-of-the-art generation-based methods, demonstrating its effectiveness in the MC task. The code is available at https://github.com/zh-jia/DDO.