Abstract:Vision-language models (VLM) have markedly advanced AI-driven interpretation and reporting of complex medical imaging, such as computed tomography (CT). Yet, existing methods largely relegate clinicians to passive observers of final outputs, offering no interpretable reasoning trace for them to inspect, validate, or refine. To address this, we introduce RadAgent, a tool-using AI agent that generates CT reports through a stepwise and interpretable process. Each resulting report is accompanied by a fully inspectable trace of intermediate decisions and tool interactions, allowing clinicians to examine how the reported findings are derived. In our experiments, we observe that RadAgent improves Chest CT report generation over its 3D VLM counterpart, CT-Chat, across three dimensions. Clinical accuracy improves by 6.0 points (36.4% relative) in macro-F1 and 5.4 points (19.6% relative) in micro-F1. Robustness under adversarial conditions improves by 24.7 points (41.9% relative). Furthermore, RadAgent achieves 37.0% in faithfulness, a new capability entirely absent in its 3D VLM counterpart. By structuring the interpretation of chest CT as an explicit, tool-augmented and iterative reasoning trace, RadAgent brings us closer toward transparent and reliable AI for radiology.
Abstract:Reasoning in knowledge-intensive domains remains challenging as intermediate steps are often not locally verifiable: unlike math or code, evaluating step correctness may require synthesizing clues across large external knowledge sources. As a result, subtle errors can propagate through reasoning traces, potentially never to be detected. Prior work has proposed process reward models (PRMs), including retrieval-augmented variants, but these methods operate post hoc, scoring completed trajectories, which prevents their integration into dynamic inference procedures. Here, we introduce Process Reward Agents (PRA), a test-time method for providing domain-grounded, online, step-wise rewards to a frozen policy. In contrast to prior retrieval-augmented PRMs, PRA enables search-based decoding to rank and prune candidate trajectories at every generation step. Experiments on multiple medical reasoning benchmarks demonstrate that PRA consistently outperforms strong baselines, achieving 80.8% accuracy on MedQA with Qwen3-4B, a new state of the art at the 4B scale. Importantly, PRA generalizes to unseen frozen policy models ranging from 0.5B to 8B parameters, improving their accuracy by up to 25.7% without any policy model updates. More broadly, PRA suggests a paradigm in which frozen reasoners are decoupled from domain-specific reward modules, allowing the deployment of new backbones in complex domains without retraining.