Route, Retrieve, Reflect, Repair: Self-Improving Agentic Framework for Visual Detection and Linguistic Reasoning in Medical Imaging

Fuente: arXiv
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Autores principales: Sayeedi, Md. Faiyaz Abdullah, Rahman, Rashedur, Bhuiyan, Siam Tahsin, Wasi, Sefatul, Islam, Ashraful, Alam, Saadia Binte, Rahman, AKM Mahbubur
Formato: Preprint
Publicado: 2026
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author Sayeedi, Md. Faiyaz Abdullah
Rahman, Rashedur
Bhuiyan, Siam Tahsin
Wasi, Sefatul
Islam, Ashraful
Alam, Saadia Binte
Rahman, AKM Mahbubur
author_facet Sayeedi, Md. Faiyaz Abdullah
Rahman, Rashedur
Bhuiyan, Siam Tahsin
Wasi, Sefatul
Islam, Ashraful
Alam, Saadia Binte
Rahman, AKM Mahbubur
contents Medical image analysis increasingly relies on large vision-language models (VLMs), yet most systems remain single-pass black boxes that offer limited control over reasoning, safety, and spatial grounding. We propose R^4, an agentic framework that decomposes medical imaging workflows into four coordinated agents: a Router that configures task- and specialization-aware prompts from the image, patient history, and metadata; a Retriever that uses exemplar memory and pass@k sampling to jointly generate free-text reports and bounding boxes; a Reflector that critiques each draft-box pair for key clinical error modes (negation, laterality, unsupported claims, contradictions, missing findings, and localization errors); and a Repairer that iteratively revises both narrative and spatial outputs under targeted constraints while curating high-quality exemplars for future cases. Instantiated on chest X-ray analysis with multiple modern VLM backbones and evaluated on report generation and weakly supervised detection, R^4 consistently boosts LLM-as-a-Judge scores by roughly +1.7-+2.5 points and mAP50 by +2.5-+3.5 absolute points over strong single-VLM baselines, without any gradient-based fine-tuning. These results show that agentic routing, reflection, and repair can turn strong but brittle VLMs into more reliable and better grounded tools for clinical image interpretation. Our code can be found at: https://github.com/faiyazabdullah/MultimodalMedAgent
format Preprint
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institution arXiv
publishDate 2026
record_format arxiv
spellingShingle Route, Retrieve, Reflect, Repair: Self-Improving Agentic Framework for Visual Detection and Linguistic Reasoning in Medical Imaging
Sayeedi, Md. Faiyaz Abdullah
Rahman, Rashedur
Bhuiyan, Siam Tahsin
Wasi, Sefatul
Islam, Ashraful
Alam, Saadia Binte
Rahman, AKM Mahbubur
Computer Vision and Pattern Recognition
Medical image analysis increasingly relies on large vision-language models (VLMs), yet most systems remain single-pass black boxes that offer limited control over reasoning, safety, and spatial grounding. We propose R^4, an agentic framework that decomposes medical imaging workflows into four coordinated agents: a Router that configures task- and specialization-aware prompts from the image, patient history, and metadata; a Retriever that uses exemplar memory and pass@k sampling to jointly generate free-text reports and bounding boxes; a Reflector that critiques each draft-box pair for key clinical error modes (negation, laterality, unsupported claims, contradictions, missing findings, and localization errors); and a Repairer that iteratively revises both narrative and spatial outputs under targeted constraints while curating high-quality exemplars for future cases. Instantiated on chest X-ray analysis with multiple modern VLM backbones and evaluated on report generation and weakly supervised detection, R^4 consistently boosts LLM-as-a-Judge scores by roughly +1.7-+2.5 points and mAP50 by +2.5-+3.5 absolute points over strong single-VLM baselines, without any gradient-based fine-tuning. These results show that agentic routing, reflection, and repair can turn strong but brittle VLMs into more reliable and better grounded tools for clinical image interpretation. Our code can be found at: https://github.com/faiyazabdullah/MultimodalMedAgent
title Route, Retrieve, Reflect, Repair: Self-Improving Agentic Framework for Visual Detection and Linguistic Reasoning in Medical Imaging
topic Computer Vision and Pattern Recognition
url https://arxiv.org/abs/2601.08192