Autonomous Skeletal Landmark Localization towards Agentic C-Arm Control
Authors: Jay Jung, Ahmad Arrabi, Jax Luo, Scott Raymond, Safwan Wshah
Organizations: University of Vermont, Burlington, 05405, Vermont, U.S.A. · Cleveland Clinic, Cleveland, 44195, Ohio, U.S.A.
Abstract
Purpose: Automated C-arm positioning ensures timely treatment in patients requiring emergent interventions. When a conventional Deep Learning (DL) approach for C-arm control fails, clinicians must revert to manual operation, resulting in additional delays. Consequently, an agentic C-arm control framework based on multimodal large language models (MLLMs) is highly desirable, as it can incorporate clinician feedback and use reasoning to make adjustments toward more accurate positioning. Skeletal landmark localization is essential for C-arm control, and we investigate adapting MLLMs for autonomous landmark localization. Methods: We used an annotated synthetic X-ray dataset and a real X-ray dataset. Each X-ray in both datasets is paired with several skeletal landmarks. We fine-tuned two MLLMs and tasked them with retrieving the closest landmarks from each X-ray. Quantitative evaluations of landmark localization were performed and compared against a leading DL approach. We further conducted qualitative experiments demonstrating: (1) how an MLLM can correct an initially incorrect prediction through reasoning, and (2) how the MLLM can sequentially navigate the C-arm toward a target location. Results: On both datasets, fine-tuned MLLMs demonstrate competitive performance across all localization tasks when compared with the DL approach. In the qualitative experiments, the MLLMs provide evidence of reasoning and spatial awareness. Conclusion: This study shows that fine-tuned MLLMs achieve accurate skeletal landmark localization and hold promise for agentic autonomous C-arm control. Our code is available athttps://github.com/marszzibros/C-arm-localization-LLMs.git
Whole-body humanoid loco-manipulation requires coordinating the robot's entire kinematic chain. However, most existing systems typically decouple the upper and lower bodies into separate controllers, limiting such coordination and yielding behaviors similar to those of a wheeled dual-arm platform. In this paper, we ask what it takes to build a whole-body native vision-language-action (VLA) model that maps language and pixels directly to all of the humanoid's degrees of freedom. We conduct a systematic empirical study organized as a roadmap of one-variable-at-a-time experiments across three phases: whole-body teleoperation, VLA model design, and heterogeneous co-training. Our study yields several intriguing findings: a joint-based whole-body teleoperation interface outperforms alternatives that only partially expose the humanoid's degrees of freedom; a VLA pretrained on static and wheeled dual-arm platforms transfers surprisingly well to a humanoid's full action space; and co-training with HuMI, the humanoid analog of UMI, extends the policy to new objects and instructions without additional whole-body teleoperation on those targets. Following this roadmap yields OpenHLM, an open-source recipe for whole-body humanoid loco-manipulation. In a challenging long-horizon task that spans a wide vertical range of the humanoid, OpenHLM outperforms two state-of-the-art humanoid VLA baselines (GR00T N1.6 and Ψ0) using less than half the total demonstration time. Our code, training data, and model checkpoints are available at [https://openhlm-project.github.io/].
Robotic manipulation has increasingly adopted vision-language-action (VLA) models, which achieve strong performance but typically require task-specific demonstrations and fine-tuning, and often generalize poorly under domain shift. We investigate whether general-purpose large language model (LLM) agent frameworks, originally developed for software engineering, can serve as an alternative control paradigm for embodied manipulation. We introduce FAEA (Frontier Agent as Embodied Agent), which applies an LLM agent framework directly to embodied manipulation without modification. Using the same iterative reasoning that enables software agents to debug code, FAEA enables embodied agents to reason through manipulation strategies. We evaluate an unmodified frontier agent, Claude Agent SDK, across the LIBERO, ManiSkill3, and MetaWorld benchmarks. With privileged environment state access, FAEA achieves success rates of 84.9%, 85.7%, and 96%, respectively. This level of task success approaches that of VLA models trained with less than 100 demonstrations per task, without requiring demonstrations or fine-tuning. With one round of human feedback as an optional optimization, performance increases to 88.2% on LIBERO. This demonstration-free capability has immediate practical value: FAEA can autonomously explore novel scenarios in simulation and generate successful trajectories for training data augmentation in embodied learning. Our results indicate that general-purpose agents are sufficient for a class of manipulation tasks dominated by deliberative, task-level planning. This opens a path for robotics systems to leverage actively maintained agent infrastructure and benefit directly from ongoing advances in frontier models. Code is available at https://github.com/robiemusketeer/faea-sim
3D localization in Multimodal Large Language Models (MLLMs), including 3D object detection and 3D visual grounding, is fundamentally limited by camera intrinsic ambiguity: the same image admits different 3D scenes under different cameras. Existing MLLMs either ignore camera parameters and overfit to a canonical training intrinsic, or retrieve depth and 3D cues from external tools but treat the returned values as reference cues (numerical hints that the model is free to interpret implicitly), both preventing camera information from being deterministically propagated into the prediction. We propose an equation-anchored tool-use framework that re-purposes spatial tools as formula variables. The proposed framework proactively retrieves camera intrinsics and samples multi-point metric depths, writes the pinhole back-projection equation X^=(uc−cx)Zˉ/fx explicitly in Chain-of-Thought (CoT), and substitutes tool outputs into the formula before regressing the final 9-DoF bounding box. On both 3D object detection and 3D visual grounding tasks under rescaled camera intrinsics from 0.5× to 1.5×, our method outperforms RGB-only and tool-augmented baselines, with significant gains where the camera deviates most from the training scale. Code and data will be released.