MAGIS: Evidence-Based Multi-Agent Reasoning for Interpretable Strabismus Clinical Decision-Making
Authors: Xikai Tang, Yifan Wang, Jiafan Zhuang, Li Luo, Jinming Guo, Xiaoling Xie, Jiacheng Liu, Peiwei Wei, +7 more
Organizations: School of Information and Software Engineering, University of Electronic Science and Technology of China, Chengdu, 611731, China · Shenzhen Institute for Advanced Study, University of Electronic Science and Technology of China, Shenzhen, 518000, China · Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, 515041, China · School of Artificial Intelligence, Guangzhou City Polytechnic, Guangzhou, 510405, China · Medical College, Shantou University, Shantou, 515041, China · College of Engineering, Shantou University, Shantou, 515063, China · Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China · Shenzhen Loop Area Institute, Shenzhen, 518048, China
Abstract
Strabismus is a common ocular disorder that requires fine-grained subtype diagnosis for individualized treatment planning. However, existing deep learning methods mainly provide diagnostic predictions without transparent reasoning, while recent large vision-language models (LVLMs), although promising for joint image understanding and report generation, remain highly prone to hallucination in this evidence-sensitive and rule-driven medical task. To address these challenges, we propose MAGIS, an evidence-based Multi-AGent reasoning for Interpretable Strabismus diagnosis framework. MAGIS transforms black-box end-to-end generation into a structured diagnostic process consisting of candidate hypothesis generation, dual-evidence constrained context, evidence-based corrective verification, and report generation. Specifically, we introduce a Dual-Evidence Constrained Context (DECC) mechanism that jointly organizes visual evidence from the photograph of the nine cardinal positions of gaze and evidence-based clinical diagnostic rules into a constrained context for reliable diagnostic reasoning. We further develop an Evidence-Based Corrective Verification (EBCV) mechanism that verifies whether the current diagnostic hypothesis is supported by visual evidence, heatmap-based visual cues, and evidence-based clinical diagnostic rules. Hypothesis refinement is triggered when inconsistency is detected. Experiments on a fine-grained strabismus benchmark demonstrate that MAGIS not only significantly outperforms other state-of-the-art diagnostic systems, improving the weighted F1 score from 72.0% to 91.3%, but also substantially improves the clinical reliability (consistency, alignment, and completeness) of generated diagnostic reports. These results demonstrate that MAGIS provides an effective solution for building accurate, evidence-based, and clinically interpretable strabismus diagnosis systems.
Diabetic Retinopathy (DR) is a leading cause of preventable blindness among working-age adults worldwide, yet most automated screening systems are limited to image-level classification and lack clinically structured reporting. We propose Retina-RAG, a low-cost modular framework that jointly performs DR severity grading, macular edema (ME) detection, and report generation. The architecture decouples a high-performance retinal classifier and a parameter-efficient vision-language model (Qwen2.5-VL-7B-Instruct) adapted via Low-Rank Adaptation (LoRA), enabling flexible component integration. A retrieval-augmented generation (RAG) module injects curated ophthalmic knowledge together with structured classifier outputs at inference time to improve diagnostic consistency and reduce hallucinations. Retina-RAG achieves an F1-score of 0.731 for DR grading and 0.948 for ME detection, substantially outperforming zero-shot Qwen (0.096, 0.732) and MMed-RAG (0.541, 0.641) on a retinal disease detection dataset with captions. For report generation, Retina-RAG attains ROUGE-L 0.438 and SBERT similarity 0.884, exceeding all baselines. The full framework operates on a single consumer-grade GPU, demonstrating that clinically structured retinal AI can be achieved with modest computational resources.
Vision-Language models (VLMs) reliability in medical diagnosis is challenged by trust-undermining hallucinations. Existing hallucination detection approaches mainly focus on identifying factual inconsistencies between generated text and reference data. While some studies analyze where models attend in images, they seldom verify whether such attention truly reflects the visual evidence supporting the generated text. To address this gap, we propose Co}unter-Evidence Verification (CoEV), a training-free plug-and-play framework that detects and corrects hallucinations through evidence-based factual consistency verification. CoEV performs bidirectional verification between textual assertions and visual evidence, testing whether each statement is supported by its corresponding evidence region, and assigns each statement into a four-quadrant diagnostic map capturing combinations of text factuality and visual grounding. CoEV detects hallucinated content and serves as a post hoc refinement tool, correcting hallucinations without retraining. Extensive experiments on four medical datasets show that CoEV combats hallucinations in VLMs.For hallucination detection, CoEV consistently outperforms existing methods, improving average PR-AUC and ROC-AUC by 3.0% and 3.9% absolute points respectively, with notable gains of up to 18.5% in specific VQA scenarios. For hallucination correction, it improves Micro-F1 by up to 12.5%, reduces hallucination rates by over 11.9% on medical report generation, and also boosts medical VQA accuracy. These results show that CoEV enables reliable detection and correction of hallucinations, providing clinicians with dependable, evidence-based cues for diagnosis. Code will be released upon acceptance.
Medical visual agents can use tools to inspect images and retrieve external knowledge, but indiscriminate tool use may introduce noisy or misleading evidence. Reliable diagnosis therefore requires not only acquiring additional observations, but also verifying whether tool actions are necessary and whether the resulting evidence supports the current hypothesis. We introduce MIRA (Medical Image Reflection for Agentic Diagnosis), a medical visual diagnostic framework for autonomous evidence search and reflective verification. MIRA dynamically invokes image-processing operations, including zooming, grounding, pointing, rotation, and measurement, as well as web search, while evaluating the relevance and consistency of the acquired evidence. We develop MIRA through a two-stage training strategy. First, a tool-augmented Monte Carlo Tree Search data engine explores diverse diagnostic hypotheses and jointly verifies visual grounding accuracy and semantic consistency to construct supervised fine-tuning trajectories. Second, reinforcement learning further improves decision-making through online reflective principle evolution: failure cases are distilled into candidate principles, and only principles that improve held-out rollout rewards are retained. Across nine medical visual reasoning benchmarks, MIRA achieves an average score of 64.73, improving its Qwen3-VL-8B backbone by 7.44 points. It also increases useful tool-use judgments from 56.2% to 73.8% and reduces harmful judgments from 8.9% to 1.6%. Qualitative analyses show that MIRA can re-examine evidence, correct premature conclusions, and adapt its tool-use strategy. Project page: https://MIRA-VL.github.io/