MedOpenClaw and MedFlowBench: Auditing Medical Agents in Full-Study Workflows

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Main Authors: Shen, Weixiang, Shen, Chengzhi, Hu, Yanzhu, Liu, Che, Wu, Junde, Zhu, Jiayuan, Han, Xiao, Li, Zongyue, Wu, Jingpei, Xu, Min, Xu, Daguang, Jin, Yueming, Wiestler, Benedikt, Rueckert, Daniel, Pan, Jiazhen
Format: Preprint
Published: 2026
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author Shen, Weixiang
Shen, Chengzhi
Hu, Yanzhu
Liu, Che
Wu, Junde
Zhu, Jiayuan
Han, Xiao
Li, Zongyue
Wu, Jingpei
Xu, Min
Xu, Daguang
Jin, Yueming
Wiestler, Benedikt
Rueckert, Daniel
Pan, Jiazhen
author_facet Shen, Weixiang
Shen, Chengzhi
Hu, Yanzhu
Liu, Che
Wu, Junde
Zhu, Jiayuan
Han, Xiao
Li, Zongyue
Wu, Jingpei
Xu, Min
Xu, Daguang
Jin, Yueming
Wiestler, Benedikt
Rueckert, Daniel
Pan, Jiazhen
contents Medical imaging benchmarks often evaluate VLMs on pre-selected 2D images, slices, crops, or patches, making evaluation closer to visual recognition. Real clinical workflows impose a different burden: readers must search through complete studies, operate imaging software, navigate across slices and magnifications, and document visual evidence that can be audited. We argue that this evidence-producing workflow is a critical missing evaluation axis for medical imaging agents. To study it, we introduce MedFlowBench, a full-study benchmark for VLM agents, together with MedOpenClaw, a controlled and replayable runtime in which agents operate medical imaging viewers such as 3D Slicer and QuPath. In each episode, an agent inspects a complete radiology study or whole-slide pathology image, returns a task answer, and submits structured evidence, including key slices, coordinates, regions of interest, or lesion-state fields. This evidence is automatically checked against withheld masks, annotations, and labels. Across evaluated models, final answer-only scoring gives an overly optimistic picture: when answers must also be supported by correct evidence, performance drops substantially on complex workflows. We further find that adding image-analysis tools does not by itself solve the problem. Tools help when they make a complex procedure simple and reliable, but agents still struggle when they must choose inputs, manage viewer state, and verify intermediate outputs over multiple steps. MedFlowBench exposes whether medical imaging agents can produce auditable evidence from complete studies, rather than plausible answers from selected images.
format Preprint
id arxiv_https___arxiv_org_abs_2603_24649
institution arXiv
publishDate 2026
record_format arxiv
spellingShingle MedOpenClaw and MedFlowBench: Auditing Medical Agents in Full-Study Workflows
Shen, Weixiang
Shen, Chengzhi
Hu, Yanzhu
Liu, Che
Wu, Junde
Zhu, Jiayuan
Han, Xiao
Li, Zongyue
Wu, Jingpei
Xu, Min
Xu, Daguang
Jin, Yueming
Wiestler, Benedikt
Rueckert, Daniel
Pan, Jiazhen
Computer Vision and Pattern Recognition
Medical imaging benchmarks often evaluate VLMs on pre-selected 2D images, slices, crops, or patches, making evaluation closer to visual recognition. Real clinical workflows impose a different burden: readers must search through complete studies, operate imaging software, navigate across slices and magnifications, and document visual evidence that can be audited. We argue that this evidence-producing workflow is a critical missing evaluation axis for medical imaging agents. To study it, we introduce MedFlowBench, a full-study benchmark for VLM agents, together with MedOpenClaw, a controlled and replayable runtime in which agents operate medical imaging viewers such as 3D Slicer and QuPath. In each episode, an agent inspects a complete radiology study or whole-slide pathology image, returns a task answer, and submits structured evidence, including key slices, coordinates, regions of interest, or lesion-state fields. This evidence is automatically checked against withheld masks, annotations, and labels. Across evaluated models, final answer-only scoring gives an overly optimistic picture: when answers must also be supported by correct evidence, performance drops substantially on complex workflows. We further find that adding image-analysis tools does not by itself solve the problem. Tools help when they make a complex procedure simple and reliable, but agents still struggle when they must choose inputs, manage viewer state, and verify intermediate outputs over multiple steps. MedFlowBench exposes whether medical imaging agents can produce auditable evidence from complete studies, rather than plausible answers from selected images.
title MedOpenClaw and MedFlowBench: Auditing Medical Agents in Full-Study Workflows
topic Computer Vision and Pattern Recognition
url https://arxiv.org/abs/2603.24649