XrayClaw: Cooperative-Competitive Multi-Agent Alignment for Trustworthy Chest X-ray Diagnosis

Chest X-ray (CXR) interpretation is a fundamental yet complex clinical task that increasingly relies on artificial intelligence for automation. However, traditional monolithic models often lack the nuanced reasoning required for trustworthy diagnosis, frequently leading to logical inconsistencies and diagnostic hallucinations. While multi-agent systems offer a potential solution by simulating collaborative consultations, existing frameworks remain susceptible to consensus-based errors when instantiated by a single underlying model. This paper introduces XrayClaw, a novel framework that operationalizes multi-agent alignment through a sophisticated cooperative-competitive architecture. XrayClaw integrates four specialized cooperative agents to simulate a systematic clinical workflow, alongside a competitive agent that serves as an independent auditor. To reconcile these distinct diagnostic pathways, we propose Competitive Preference Optimization, a learning objective that penalizes illogical reasoning by enforcing mutual verification between analytical and holistic interpretations. Extensive empirical evaluations on the MS-CXR-T, MIMIC-CXR, and CheXbench benchmarks demonstrate that XrayClaw achieves state-of-the-art performance in diagnostic accuracy, clinical reasoning fidelity, and zero-shot domain generalization. Our results indicate that XrayClaw effectively mitigates cumulative hallucinations and enhances the overall reliability of automated CXR diagnosis, establishing a new paradigm for trustworthy medical imaging analysis.

TC-SSA: Token Compression via Semantic Slot Aggregation for Gigapixel Pathology Reasoning

The application of large vision-language models to computational pathology holds great promise for diagnostic assistants but faces a critical computational bottleneck: the gigapixel scale of Whole Slide Images (WSIs). A single WSI typically contains over 105 patches, creating sequence lengths that exceed the constraints of standard Transformer architectures. Existing solutions often resort to spatial sampling, which risks discarding diagnostically critical evidence. To address this, we propose TC-SSA (Token Compression via Semantic Slot Aggregation), a learnable token compression framework that aggregates patch features into a fixed number of semantic slots. A gated routing module assigns patches to slots using sparse Top-2 routing, followed by weighted aggregation, enabling global slide coverage under a strict token budget. The resulting representation retains diagnostically relevant information while reducing the number of visual tokens to 1.7% of the original sequence. On the SlideBench(TCGA), our model achieves 78.34% overall accuracy and 77.14% on the diagnosis subset, outperforming sampling-based baselines under comparable token budgets. The method also generalizes to MIL classification, reaching AUC of 95.83% on TCGA-BRCA, 98.27% on TCGA-NSCLC and 79.80% on PANDA. These results suggest that learnable semantic aggregation provides an effective trade-off between efficiency and diagnostic performance for gigapixel pathology reasoning.