Towards Fully Automated Medical Imaging Code Generation via Validation-based Context Engineering

Large language model (LLM) agents are beginning to automate machine learning engineering (MLE) by coupling planning, code execution, debugging, and empirical feedback. Translating this capability to medical imaging remains difficult because each task imposes modality-specific experimentation and strict requirements for validation protocols and prediction artifacts. Here we introduce AMID, an autonomous multi-agent framework for medical imaging model development. AMID first proposes Data-Conditioned Method Planning, which refines coarse task-level search spaces into executable, parallelizable method lanes grounded in task-specific data analysis and runnable medical-imaging resources. It then develops Verification-Guided Two-Stage Optimization, moving from broad early exploration of diverse method lanes to selective exploitation of promising candidates while enforcing strict verification of validation protocols, metric computation, and prediction artifacts throughout the optimization. Across 20 medical imaging challenge tasks spanning diverse modalities and prediction types, AMID outperformed evaluated general-purpose MLE systems and, on several tasks, approached or matched strong human-designed challenge solutions. These results suggest that AMID can turn task-specific medical imaging model development from bespoke manual engineering into an agentic workflow for producing high-performing and auditable model artifacts across heterogeneous tasks.

Developing competitive deep learning baselines for medical imaging remains a highly iterative process requiring literature review, implementation, experimentation, and expert refinement. Existing automation approaches typically optimize isolated components, such as architecture search or hyperparameter tuning, rather than the complete baseline development process. We present an agentic AI Scientist workflow that combines literature-guided reasoning, automated code generation, and hypothesis-driven experimentation to generate competitive baseline models for medical imaging challenges. The framework is evaluated on four public benchmarks spanning segmentation, classification, and detection. Across all tasks, the Experimentation Pipeline consistently improves validation performance, achieving competitive leaderboard results, including 6th place on both PUMA tracks (15 teams) and 31st place on MILK10k (125 teams). On MIDOG25, the resulting model also demonstrates strong domain generalization across scanners, tumor types, and species. Using the same workflow across all challenges without task-specific redesign, we demonstrate that skill-based, literature-guided agentic workflows can substantially reduce the engineering effort required to develop competitive medical imaging baselines.

Autonomous agents are increasingly expected to support end-to-end medical-AI research workflows, moving beyond isolated prediction tasks or short-form clinical question answering. However, existing medical agent benchmarks primarily evaluate final outputs, providing limited visibility into agent behavior within the research process. To address this gap, we present AutoMedBench, a workflow-aware benchmark for autonomous medical-AI research across diverse medical imaging and multimodal inference tasks, organizing agent execution into a unified five-stage workflow (S1-S5): Plan, Setup, Validate, Inference, and Submit. It comprises long-horizon tasks with each run averaging 33 agent turns, spanning five research tracks: segmentation, image enhancement, visual question answering (VQA), report generation, and lesion detection. Each task is evaluated under two difficulty tiers, Lite and Standard, which use the same data and metrics but differ in the amount of task-brief scaffolding, and each run is scored using both final task performance and S1-S5 stage scores, enabling stage-level analysis from the initial task brief to the final submitted artifact. Across thousands of recorded runs, stage-level scoring reveals that Validate is the weakest workflow stage on average, whereas Setup is the strongest, suggesting that current agents are better at making pipelines executable than at verifying their reliability. Post-run error analysis further shows that verification and submission failures dominate tagged errors, accounting for 37.7% and 38.1% of fired codes respectively, whereas task-understanding errors are rare at 0.9%, and runs with one fired error code have a 48% lower overall score than runs with no error code on average.