RealICU: Do LLM Agents Understand Long-Context ICU Data? A Benchmark Beyond Behavior Imitation

Intensive care units (ICU) generate long, dense and evolving streams of clinical information, where physicians must repeatedly reassess patient states under time pressure, underscoring a clear need for reliable AI decision support. Existing ICU benchmarks typically treat historical clinician actions as ground truth. However, these actions are made under incomplete information and limited temporal context of the underlying patient state, and may therefore be suboptimal, making it difficult to assess the true reasoning capabilities of AI systems. We introduce RealICU, a hindsight-annotated benchmark for evaluating large language models (LLMs) under realistic ICU conditions, where labels are created after senior physicians review the full patient trajectory. We formulate four physician-motivated tasks: assess Patient Status, Acute Problems, Recommended Actions, and Red Flag actions that risk unsafe outcomes. We partition each trajectory with 30-min windows and release two datasets: RealICU-Gold with 930-window annotations from 94 MIMIC-IV patients, and RealICU-Scale with 11,862 windows extended by Oracle, a physician-validated LLM hindsight labeler. Existing LLMs including memory-augmented ones performed poorly on RealICU, exposing two failure modes: a recall-safety tradeoff for clinical recommendations, and an anchoring bias to early interpretations of the patient. We further introduce ICU-Evo to study structured-memory agents that improves long-horizon reasoning but does not fully eliminate safety failures. Together, RealICU provides a clinically grounded testbed for measuring and improving AI sequential decision-support in high-stakes care. Project page: https://chengzhi-leo.github.io/RealICU-Bench/

BioMedArena: An Open-source Toolkit for Building and Evaluating Biomedical Deep Research Agents

Building a deep research agent today is an exercise in glue code: the same backbone evaluated on the same benchmark can report different accuracies in different papers because harness and tool registry all differ, and integrating a new foundation model into a comparable evaluation surface costs weeks of model-specific engineering. We call this the per-paper engineering tax and release BioMedArena, an open-source toolkit that not only alleviates it but also provides an arena for fair comparison of different foundation models when evaluating them as deep-research agents. BioMedArena decouples six layers of biomedical agent evaluation -- benchmark loading, tool exposure, tool selection, execution mode, context management, and scoring -- and exposes 147 biomedical benchmarks and 75 biomedical tools across 9 functional families. Adding a new model, benchmark, or tool reduces to registering a few-line provider adapter. We further provide 6 agent harnesses with 6 context-management strategies, which provide 12 backbones with competitive research capabilities and significantly improved performance, achieving state-of-the-art (SOTA) results on 8 representative biomedical benchmarks, with an average lift of +15.03 percentage points over prior SOTA. The toolkit, configurations, and per-task traces are available at https://github.com/AI-in-Health/BioMedArena

Dynamic Decision Learning: Test-Time Evolution for Abnormality Grounding in Rare Diseases

Clinical abnormality grounding for rare diseases is often hindered by data scarcity, making supervised fine-tuning impractical and single-pass inference highly unstable. We propose Dynamic Decision Learning (DDL), a framework that enables frozen large vision-language models (LVLMs) to refine their decisions across both language and visual spaces by optimizing instructions and consolidating predictions under visual perturbations. This process improves localization quality and produces a consensus-based reliability score that quantifies model confidence. Results on brain imaging benchmarks, including a rare-disease dataset with 281 pathology types across models ranging from 3B to 72B parameters, show that DDL improves mAP@75 by up to 105% on rare-disease cases and outperforms adaptation baselines and supervised fine-tuning. Furthermore, DDL demonstrates stronger calibration between reliability scores and localization accuracy under severe distribution shifts and increasing task difficulty. Code is available at: https://lijunrio.github.io/DDL/

Agentic clinical reasoning over longitudinal myeloma records: a retrospective evaluation against expert consensus

Multiple myeloma is managed through sequential lines of therapy over years to decades, with each decision depending on cumulative disease history distributed across dozens to hundreds of heterogeneous clinical documents. Whether LLM-based systems can synthesise this evidence at a level approaching expert agreement has not been established. A retrospective evaluation was conducted on longitudinal clinical records of 811 myeloma patients treated at a tertiary centre (2001-2026), covering 44,962 documents and 1,334,677 laboratory values, with external validation on MIMIC-IV. An agentic reasoning system was compared against single-pass retrieval-augmented generation (RAG), iterative RAG, and full-context input on 469 patient-question pairs from 48 templates at three complexity levels. Reference labels came from double annotation by four oncologists with senior haematologist adjudication. Iterative RAG and full-context input converged on a shared ceiling (75.4% vs 75.8%, p = 1.00). The agentic system reached 79.6% concordance (95% CI 76.4-82.8), exceeding both baselines (+3.8 and +4.2 pp; p = 0.006 and 0.007). Gains rose with question complexity, reaching +9.4 pp on criteria-based synthesis (p = 0.032), and with record length, reaching +13.5 pp in the top decile (n = 10). The system error rate (12.2%) was comparable to expert disagreement (13.6%), but severity was inverted: 57.8% of system errors were clinically significant versus 18.8% of expert disagreements. Agentic reasoning was the only approach to exceed the shared ceiling, with gains concentrated on the most complex questions and longest records. The greater clinical consequence of residual system errors indicates that prospective evaluation in routine care is required before these findings translate into patient benefit.

Evo-MedAgent: Beyond One-Shot Diagnosis with Agents That Remember, Reflect, and Improve

Tool-augmented large language model (LLM) agents can orchestrate specialist classifiers, segmentation models, and visual question-answering modules to interpret chest X-rays. However, these agents still solve each case in isolation: they fail to accumulate experience across cases, correct recurrent reasoning mistakes, or adapt their tool-use behavior without expensive reinforcement learning. While a radiologist naturally improves with every case, current agents remain static. In this work, we propose Evo-MedAgent, a self-evolving memory module that equips a medical agent with the capacity for inter-case learning at test time. Our memory comprises three complementary stores: (1)~\emph{Retrospective Clinical Episodes} that retrieve problem-solving experiences from similar past cases, (2)~an \emph{Adaptive Procedural Heuristics} bank curating priority-tagged diagnostic rules that evolves via reflection, much like a physician refining their internal criteria, and (3)~a \emph{Tool Reliability Controller} that tracks per-tool trustworthiness. On ChestAgentBench, Evo-MedAgent raises multiple-choice question (MCQ) accuracy from 0.68 to 0.79 on GPT-5-mini, and from 0.76 to 0.87 on Gemini-3 Flash. With a strong base model, evolving memory improves performance more effectively than orchestrating external tools on qualitative diagnostic tasks. Because Evo-MedAgent requires no training, its per-case overhead is bounded by one additional retrieval pass and a single reflection call, making it deployable on top of any frozen model.

MedOpenClaw: Auditable Medical Imaging Agents Reasoning over Uncurated Full Studies

Currently, evaluating vision-language models (VLMs) in medical imaging tasks oversimplifies clinical reality by relying on pre-selected 2D images that demand significant manual labor to curate. This setup misses the core challenge of realworld diagnostics: a true clinical agent must actively navigate full 3D volumes across multiple sequences or modalities to gather evidence and ultimately support a final decision. To address this, we propose MEDOPENCLAW, an auditable runtime designed to let VLMs operate dynamically within standard medical tools or viewers (e.g., 3D Slicer). On top of this runtime, we introduce MEDFLOWBENCH, a full-study medical imaging benchmark covering multi-sequence brain MRI and lung CT/PET. It systematically evaluates medical agentic capabilities across viewer-only, tool-use, and open-method tracks. Initial results reveal a critical insight: while state-of-the-art LLMs/VLMs (e.g., Gemini 3.1 Pro and GPT-5.4) can successfully navigate the viewer to solve basic study-level tasks, their performance paradoxically degrades when given access to professional support tools due to a lack of precise spatial grounding. By bridging the gap between static-image perception and interactive clinical workflows, MEDOPENCLAW and MEDFLOWBENCH establish a reproducible foundation for developing auditable, full-study medical imaging agents.

Opportunistic Cardiac Health Assessment: Estimating Phenotypes from Localizer MRI through Multi-Modal Representations

Cardiovascular diseases are the leading cause of death. Cardiac phenotypes (CPs), e.g., ejection fraction, are the gold standard for assessing cardiac health, but they are derived from cine cardiac magnetic resonance imaging (CMR), which is costly and requires high spatio-temporal resolution. Every magnetic resonance (MR) examination begins with rapid and coarse localizers for scan planning, which are discarded thereafter. Despite non-diagnostic image quality and lack of temporal information, localizers can provide valuable structural information rapidly. In addition to imaging, patient-level information, including demographics and lifestyle, influence the cardiac health assessment. Electrocardiograms (ECGs) are inexpensive, routinely ordered in clinical practice, and capture the temporal activity of the heart. Here, we introduce C-TRIP (Cardiac Tri-modal Representations for Imaging Phenotypes), a multi-modal framework that aligns localizer MRI, ECG signals, and tabular metadata to learn a robust latent space and predict CPs using localizer images as an opportunistic alternative to CMR. By combining these three modalities, we leverage cheap spatial and temporal information from localizers, and ECG, respectively while benefiting from patient-specific context provided by tabular data. Our pipeline consists of three stages. First, encoders are trained independently to learn uni-modal representations. The second stage fuses the pre-trained encoders to unify the latent space. The final stage uses the enriched representation space for CP prediction, with inference performed exclusively on localizer MRI. Proposed C-TRIP yields accurate functional CPs, and high correlations for structural CPs. Since localizers are inherently rapid and low-cost, our C-TRIP framework could enable better accessibility for CP estimation.

No Image, No Problem: End-to-End Multi-Task Cardiac Analysis from Undersampled k-Space

Conventional clinical CMR pipelines rely on a sequential "reconstruct-then-analyze" paradigm, forcing an ill-posed intermediate step that introduces avoidable artifacts and information bottlenecks. This creates a fundamental mathematical paradox: it attempts to recover high-dimensional pixel arrays (i.e., images) from undersampled k-space, rather than directly extracting the low-dimensional physiological labels actually required for diagnosis. To unlock the direct diagnostic potential of k-space, we propose k-MTR (k-space Multi-Task Representation), a k-space representation learning framework that aligns undersampled k-space data and fully-sampled images into a shared semantic manifold. Leveraging a large-scale controlled simulation of 42,000 subjects, k-MTR forces the k-space encoder to restore anatomical information lost to undersampling directly within the latent space, bypassing the explicit inverse problem for downstream analysis. We demonstrate that this latent alignment enables the dense latent space embedded with high-level physiological semantics directly from undersampled frequencies. Across continuous phenotype regression, disease classification, and anatomical segmentation, k-MTR achieves highly competitive performance against state-of-the-art image-domain baselines. By showcasing that precise spatial geometries and multi-task features can be successfully recovered directly from the k-space representations, k-MTR provides a robust architectural blueprint for task-aware cardiac MRI workflows.

Reconstruction-free segmentation from undersampled k-space using transformers

Motivation: High acceleration factors place a limit on MRI image reconstruction. This limit is extended to segmentation models when treating these as subsequent independent processes. Goal: Our goal is to produce segmentations directly from sparse k-space measurements without the need for intermediate image reconstruction. Approach: We employ a transformer architecture to encode global k-space information into latent features. The produced latent vectors condition queried coordinates during decoding to generate segmentation class probabilities. Results: The model is able to produce better segmentations across high acceleration factors than image-based segmentation baselines. Impact: Cardiac segmentation directly from undersampled k-space samples circumvents the need for an intermediate image reconstruction step. This allows the potential to assess myocardial structure and function on higher acceleration factors than methods that rely on images as input.

AortaDiff: A Unified Multitask Diffusion Framework For Contrast-Free AAA Imaging

While contrast-enhanced CT (CECT) is standard for assessing abdominal aortic aneurysms (AAA), the required iodinated contrast agents pose significant risks, including nephrotoxicity, patient allergies, and environmental harm. To reduce contrast agent use, recent deep learning methods have focused on generating synthetic CECT from non-contrast CT (NCCT) scans. However, most adopt a multi-stage pipeline that first generates images and then performs segmentation, which leads to error accumulation and fails to leverage shared semantic and anatomical structures. To address this, we propose a unified deep learning framework that generates synthetic CECT images from NCCT scans while simultaneously segmenting the aortic lumen and thrombus. Our approach integrates conditional diffusion models (CDM) with multi-task learning, enabling end-to-end joint optimization of image synthesis and anatomical segmentation. Unlike previous multitask diffusion models, our approach requires no initial predictions (e.g., a coarse segmentation mask), shares both encoder and decoder parameters across tasks, and employs a semi-supervised training strategy to learn from scans with missing segmentation labels, a common constraint in real-world clinical data. We evaluated our method on a cohort of 264 patients, where it consistently outperformed state-of-the-art single-task and multi-stage models. For image synthesis, our model achieved a PSNR of 25.61 dB, compared to 23.80 dB from a single-task CDM. For anatomical segmentation, it improved the lumen Dice score to 0.89 from 0.87 and the challenging thrombus Dice score to 0.53 from 0.48 (nnU-Net). These segmentation enhancements led to more accurate clinical measurements, reducing the lumen diameter MAE to 4.19 mm from 5.78 mm and the thrombus area error to 33.85% from 41.45% when compared to nnU-Net. Code is available at https://github.com/yuxuanou623/AortaDiff.git.