Experience-Guided Self-Adaptive Cascaded Agents for Breast Cancer Screening and Diagnosis with Reduced Biopsy Referrals

We propose an experience-guided cascaded multi-agent framework for Breast Ultrasound Screening and Diagnosis, called BUSD-Agent, that aims to reduce diagnostic escalation and unnecessary biopsy referrals. Our framework models screening and diagnosis as a two-stage, selective decision-making process. A lightweight `screening clinic' agent, restricted to classification models as tools, selectively filters out benign and normal cases from further diagnostic escalation when malignancy risk and uncertainty are estimated as low. Cases that have higher risks are escalated to the `diagnostic clinic' agent, which integrates richer perception and radiological description tools to make a secondary decision on biopsy referral. To improve agent performance, past records of pathology-confirmed outcomes along with image embeddings, model predictions, and historical agent actions are stored in a memory bank as structured decision trajectories. For each new case, BUSD-Agent retrieves similar past cases based on image, model response and confidence similarity to condition the agent's current decision policy. This enables retrieval-conditioned in-context adaptation that dynamically adjusts model trust and escalation thresholds from prior experiences without parameter updates. Evaluation across 10 breast ultrasound datasets shows that the proposed experience-guided workflow reduces diagnostic escalation in BUSD-Agent from 84.95% to 58.72% and overall biopsy referrals from 59.50% to 37.08%, compared to the same architecture without trajectory conditioning, while improving average screening specificity by 68.48% and diagnostic specificity by 6.33%.

Picking the Right Specialist: Attentive Neural Process-based Selection of Task-Specialized Models as Tools for Agentic Healthcare Systems

Task-specialized models form the backbone of agentic healthcare systems, enabling the agents to answer clinical queries across tasks such as disease diagnosis, localization, and report generation. Yet, for a given task, a single "best" model rarely exists. In practice, each task is better served by multiple competing specialist models where different models excel on different data samples. As a result, for any given query, agents must reliably select the right specialist model from a heterogeneous pool of tool candidates. To this end, we introduce ToolSelect, which adaptively learns model selection for tools by minimizing a population risk over sampled specialist tool candidates using a consistent surrogate of the task-conditional selection loss. Concretely, we propose an Attentive Neural Process-based selector conditioned on the query and per-model behavioral summaries to choose among the specialist models. Motivated by the absence of any established testbed, we, for the first time, introduce an agentic Chest X-ray environment equipped with a diverse suite of task-specialized models (17 disease detection, 19 report generation, 6 visual grounding, and 13 VQA) and develop ToolSelectBench, a benchmark of 1448 queries. Our results demonstrate that ToolSelect consistently outperforms 10 SOTA methods across four different task families.

Towards Human-AI Collaboration in Healthcare: Guided Deferral Systems with Large Language Models

Large language models (LLMs) present a valuable technology for various applications in healthcare, but their tendency to hallucinate introduces unacceptable uncertainty in critical decision-making situations. Human-AI collaboration (HAIC) can mitigate this uncertainty by combining human and AI strengths for better outcomes. This paper presents a novel guided deferral system that provides intelligent guidance when AI defers cases to human decision-makers. We leverage LLMs' verbalisation capabilities and internal states to create this system, demonstrating that fine-tuning smaller LLMs with data from larger models enhances performance while maintaining computational efficiency. A pilot study showcases the effectiveness of our deferral system.