Oct 15, 2026J/K move · Enter open · S save
Shrish Shrinath Vaidya, Gowthamaan Palani, Minmini Selvam, Gokulraja Srinivasaraja+1
Department of Data Science and Artificial Intelligence, Indian Institute of Technology Madras, Chennai, India · TANUH – The AI Centre of Excellence in Healthcare, Indian Institute of Science, Bengaluru, India · Department of Radiology (Division of Interventional Radiology), Ramaiah Medical College and Memorial hospital, Bengaluru, India
Despite the remarkable generalization capabilities of Large Language Models, generating clinically accurate and structured radiology reports from medical images remains a significant challenge. Current end-to-end approaches function as black boxes, prone to factual hallucinations and generating ungrounded findings. This lack of reliability and failure to adhere to domain-specific structuring protocols, fundamentally limits their clinical utility. We present MedPAO-VL, a multimodal agent that shifts the paradigm from monolithic generation to explainable, iterative, protocol-compliant structured report generation. Unlike deterministic models, our plan-act-observe loop functions as a goal-oriented agent: it first perceives the Chest X-Ray through an explainable vision module designed to capture inherent diagnostic uncertainty, then iteratively refines the generated report by observing semantic discrepancies and self-correcting its generation for better alignment with visually detected clinical findings. Evaluation of our framework demonstrates that this agentic reasoning improves clinical correctness and completeness, achieving an expert-rated accuracy score of 3.5/5 and a structural score of 4.3/5. By prioritizing pathology specific explainability and iterative refinement over opaque end-to-end mapping, MedPAO-VL offers a transparent and clinically viable alternative for automated structured radiology report generation.