Organizations: Department of Computer Science, University of Pisa, Pisa, Italy · Department of Computer Engineering, Modeling, Electronics and Systems, University of Calabria, Rende, Italy. · Institute of Information Science and Technologies “Alessandro Faedo”, National Research Council, Pisa, Italy. · Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy. · Department of Experimental and Clinical Medicine, University “Magna Græcia” of Catanzaro, Catanzaro, Italy.
Querying clinical trial registries remains a manual and error-prone process, requiring researchers to navigate large volumes of semi-structured data without support for natural language interaction or cross-source synthesis. To address this, we introduce ClinAgent, a conversational system based on agentic Retrieval-Augmented Generation (RAG) that enables clinicians and researchers to query clinical trial information in plain language and receive grounded, up-to-date responses across multi-turn interactions. The system centers on a Large Language Model (LLM) agent following the ReAct paradigm, which iteratively reasons over queries, selects among a set of integrated tools, and refines its actions based on intermediate outputs. These tools include a ClinicalTrials.gov search interface, a PubMed module, and a Python-based analyzer operating on a locally cached structured dataset of clinical trials. We evaluate the system using a three-phase framework assessing operational effectiveness, planning quality, tool-use efficiency, and expert qualitative judgments, comparing three LLM backends: Gemini 3.0 Flash and two variants of DeepSeek V3.2 (thinking and non-thinking). Results reveal complementary strengths, with DeepSeek (thinking mode) excelling in planning quality, while Gemini achieves the highest overall performance and strongest expert ratings. Overall, our findings highlight the potential of agentic AI systems to improve the accessibility and synthesis of clinical trial information, supporting more efficient and user-centered biomedical research workflows.
Figures & tables
Figure 1: High-level architecture of ClinAgent . The LLM agent operates a closed reasoning–action–observation loop, selecting among three specialised tools within a multi-turn user interaction.
Evaluation Phase
Metric
Gemini 3.0 Flash
DeepSeek V3.2 ( tm )
DeepSeek V3.2
Phase 1
Goal Achievement Rate
1.00
0.94
0.88
Phase 2
ReAct Quality
0.75
0.73
0.62
Plan Quality
0.94
0.97
0.85
Tool Use Efficiency
0.56
0.49
0.39
Phase 3
Aggregate Expert Score
0.66
0.45
0.65
Clarity
0.73
0.63
0.75
Table 1: Summary of results across all three evaluation phases. For each metric, the best result across backends is highlighted in bold. DeepSeek’s variant annotated with tm was used in thinking mode.
Large language models (LLMs) and agentic systems have shown promise for clinical decision support, but existing works largely assume that evidence has already been curated and handed to the model. Real-world clinical workflows instead require agents to actively seek, iteratively plan, and synthesize multimodal evidence from heterogeneous sources. In this paper, we introduce ClinSeekAgent, an automated agentic framework for dynamic multimodal evidence seeking that shifts the paradigm from passive evidence consumption to active evidence acquisition. Given only a clinical query and access to raw data sources, ClinSeekAgent gathers evidence by querying medical knowledge bases, navigating raw EHRs, and invoking medical imaging tools; refines its hypotheses as new information emerges; and integrates the collected evidence into grounded clinical decisions. ClinSeekAgent serves both as an inference-time agent for frontier LLMs and as a training-time pipeline for distilling high-quality agent trajectories into compact open-source models. To validate its inference-time effectiveness, we construct ClinSeek-Bench, which pairs Curated Input reasoning from fixed pre-selected evidence with Automated Evidence-Seeking over raw clinical data. On text-only EHR tasks, ClinSeekAgent improves Claude Opus 4.6 from 60.0 to 63.2 overall F1 and MiniMax M2.5 from 43.1 to 47.3, with positive risk-prediction gains in 7 out of 9 evaluated host models. On multimodal tasks, ClinSeekAgent improves Claude Opus 4.6 from 47.5 to 62.6 (+15.1); all evaluated models improve across the three CXR-related task groups. We further validate ClinSeekAgent as a training pipeline by distilling agentic evidence-seeking trajectories into ClinSeek-35B-A3B, which achieves 34.0 average F1 on existing AgentEHR-Bench, improving over its Qwen3.5-35B-A3B baseline by +11.9 points and approaching Claude Opus 4.6.
Patient contexts span hundreds of heterogeneous documents and thousands of structured data points, yet the document-level metadata that AI systems need for retrieval and triage is absent or incomplete. Standard retrieval-augmented generation fails on this data, mishandling temporal reasoning, cross-document dependencies, and missing metadata. We deploy ACIE (Agentic Clinical Information Extraction) at University Medicine Essen: an on-premise agentic RAG pipeline that reasons over complete patient contexts and grounds every answer in source passages for clinician verification. We quantify the metadata gap, trace the architectural decisions it shaped, and evaluate extraction alongside an independent retrospective lymphoma registry study, in which nuclear-medicine physicians verify every extracted value against its cited sources. Across 7,326 judgments, clinicians accepted 96.5% of extractions, with per-type acceptance ranging from 80% to 99%.
Osman Alperen Çinar-Koraş, Marie Bauer, Sameh Khattab +7
Institute for Artificial Intelligence in Medicine (IKIM), University Medicine Essen, Essen, Germany · Faculty of Computer Science, University of Duisburg-Essen, Essen, Germany · Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, Germany +3
We study clinical trial table reasoning, where answers are not directly stored in visible cells but must be reasoned from semantic understanding through normalization, classification, extraction, or lightweight domain reasoning. Motivated by the observation that current LLM approaches often suffer from "bad reasoning" under implicit planning assumptions, we focus on settings in which the model must recover implicit attributes such as therapy type, added agents, endpoint roles, or follow-up status from partially observed clinical-trial tables. We propose SCOPE (Structured Clinical hybrid Planning for Evidence retrieval in clinical trials), a multi-LLM planner-based framework that decomposes the task into row selection, structured planning, and execution. The planner makes the source field, reasoning rules, and output constraints explicit before answer generation, reducing ambiguity relative to direct prompting. We evaluate SCOPE on 1,500 hybrid reasoning questions over oncology clinical-trial tables against zero-shot, few-shot, chain-of-thought, TableGPT2, Blend-SQL, and EHRAgent. Results show that explicit multi-LLM planning improves accuracy for reasoning-based questions while offering a stronger accuracy-efficiency tradeoff than heavier agentic baselines. Our findings position clinical trial reasoning as a distinct table understanding problem and highlight hybrid planner-based decomposition as an effective solution
Suparno Roy Chowdhury, Manan Roy Choudhury, Tejas Anvekar +5