Computed Tomography (CT) diagnosis often relies on dynamic selection of imaging phases, such as non-contrast, arterial, or venous phases, based on preliminary findings, clinical suspicion, and diagnostic guidelines. This phase-wise decision process is critical for reducing unnecessary radiation exposure while supporting timely staging and treatment planning. However, phase-selection protocols can vary across hospitals, regions, and guidelines, while most existing CT-based AI methods assume that all phases are available and focus on static tasks under a fixed imaging phase, failing to model whether additional phases are required. This limitation stems from heterogeneous multi-phase representations, the need for knowledge-guided phase control beyond visual cues, and the lack of supervision for phase-sufficiency decisions in existing datasets. To address these challenges, we propose Policy-Driven CT-Agent (PD-CTAgent) for clinically consistent CT phase selection and diagnostic reasoning. PD-CTAgent introduces a Clinical Structure Abstraction Module (CSAM) to harmonize heterogeneous CT phases into a unified, phase-aware evidence representation. Based on this representation, a Knowledge-Guided Diagnostic Control Model (KDCM) evaluates phase sufficiency and iteratively requests additional phases when necessary. The policy-driven agent design further allows PD-CTAgent to flexibly follow different institutional, regional, or guideline-specific diagnostic protocols. Together, PD-CTAgent bridges static CT analysis and real-world clinical workflows. Experiments on two public datasets, LIDC and MCT-LTDiag, and one private dataset demonstrate its effectiveness and clinical consistency. Code will be made public upon acceptance.
Heterogeneous computed tomography (CT) acquisitions and diverse downstream task requirements limit the transferability of fixed data preparation workflows across data sources and tasks. Existing approaches typically rely on manually designed or dataset-specific rules, making it difficult to accommodate changes in acquisition conditions and analytical objectives without manual intervention. Large language model (LLM)-based agents have shown promise for automating medical workflows, yet their potential for adaptive CT data preparation remains largely unexplored. To bridge this gap, we propose CT-PrepAgent, which enables adaptive CT data preparation through a bounded policy and controlled deterministic execution. Deterministic inspection constructs structured data--task profiles, from which a policy decides an eligible DICOM series or predefined preprocessing profile, while the controlled execution flow guards, resolves, executes, and verifies the decision with bounded recovery when enabled and safe quarantine otherwise. Across three public CT segmentation tasks, CT-PrepAgent derived data-task adaptive preprocessing decisions and achieved the highest macro-average Dice. On two private raw-DICOM cohorts, CT-PrepAgent increased verified output yield from 61.7% to 70.0% and yielded similar registration metrics on common verified outputs. Controlled fault and replay tests validate bounded recovery, safe quarantine, and policy-free replay under tested fault and drift settings.
Multi-phase Contrast-Enhanced Computed Tomography (CECT) plays a central role in the diagnosis and characterization of focal lesions by capturing temporal enhancement patterns across multiple acquisition phases. Accurate lesion segmentation from such data remains challenging because clinically relevant contrast kinetics are distributed across phases, while anatomical inconsistencies, respiratory motion, and incomplete acquisitions often lead to inter-phase misalignment and interrupted temporal information. Conventional segmentation frameworks typically process each phase independently or rely on simple fusion strategies, limiting their temporal reasoning capability. To address these challenges, we propose DynoDINO, a unified framework tailored to address the core challenges of multi-phase medical image segmentation. DynoDINO first performs slice-level alignment to establish inter-phase anatomical correspondence and then employs a Multi-phase Fusion Model to jointly enhance temporal correlations across phases. Our fusion model incorporates a Mix-attention (MA) mechanism for efficient multi-phase feature calibration and an Adaptive Gating Mechanism with difference-based residual learning to selectively preserve diagnostically relevant contrast variations while suppressing artifacts caused by residual misalignment. In addition, the adaptive gating mechanism improves training stability by preventing feature degradation caused by unguided subtraction operations. Experiments on three large-scale datasets, including LiTS, PLC-CECT, and WAW-TACE, demonstrate that DynoDINO consistently improves boundary delineation and structural fidelity under standard, shifted, and missing-phase conditions.
Chest X-ray (CXR) plays a pivotal role in clinical diagnosis, and a variety of task-specific and foundation models have been developed for automatic CXR interpretation. However, these models often struggle to adapt to new diagnostic tasks and complex reasoning scenarios. Recently, LLM-based agent models have emerged as a promising paradigm for CXR analysis, enhancing model's capability through tool coordination, multi-step reasoning, and team collaboration, etc. However, existing agents often rely on a single diagnostic pipeline and lack mechanisms for assessing tools' reliability, limiting their adaptability and credibility. To this end, we propose CXRAgent, a director-orchestrated, multi-stage agent for CXR interpretation, where a central director coordinates the following stages: (1) Tool Invocation: The agent strategically orchestrates a set of CXR-analysis tools, with outputs normalized and verified by the Evidence-driven Validator (EDV), which grounds diagnostic outputs with visual evidence to support reliable downstream diagnosis; (2) Diagnostic Planning: Guided by task requirements and intermediate findings, the agent formulates a targeted diagnostic plan. It then assembles an expert team accordingly, defining member roles and coordinating their interactions to enable adaptive and collaborative reasoning; (3) Collaborative Decision-making: The agent integrates insights from the expert team with accumulated contextual memories, synthesizing them into an evidence-backed diagnostic conclusion. Experiments on various CXR interpretation tasks show that CXRAgent delivers strong performance, providing visual evidence and generalizes well to clinical tasks of different complexity. Code and data are valuable at this \href{https://github.com/laojiahuo2003/CXRAgent/}{link}.