healthcare ai operations teams

Abstract: Objective: To develop a unified vision-language model for prompt-conditioned quantitative ultrasound measurement that addresses the mismatch between continuous measurement targets and discrete token-based numerical prediction. Methods: This article presents HAD-VLM, a hybrid autoregressive-diffusion framework that combines autoregressive text generation with continuous measurement prediction within a shared backbone. Visual prompt tuning adapts the vision encoder to ultrasound images. A diffusion process predicts a five-component representation comprising caliper endpoint coordinates and measurement length. A post-processing strategy combining the proposed coordinate-length consistency mechanism with ensemble prediction is introduced to refine measurement estimates. We evaluate four echocardiographic measurement tasks on EchoNet-LVH, with additional assessments of medical question answering and X-ray vertebral measurement. Results: HAD-VLM achieves mean absolute errors of 1.36, 2.77, 3.05, and 1.16 mm for IVSd, LVIDd, LVIDs, and LVPWd, respectively, reducing errors by 21.4-37.6\% relative to the Vicuna-based autoregressive baseline. It also outperforms fine-tuned Qwen3-VL and direct MLP regression across all four tasks. Medical question answering performance is preserved on the evaluated dataset. For X-ray vertebral measurement, HAD-VLM reduces mean absolute error from 11.4 to 6.7 pixels. Conclusion: Integrating autoregressive language generation with diffusion-based continuous prediction improves quantitative medical image measurement while retaining prompt-conditioned task flexibility. Significance: HAD-VLM provides a unified approach to combining language interaction with anatomically grounded numerical prediction for quantitative medical image analysis.

Abstract: Medical agents increasingly combine general reasoning models with specialized clinical tools, yet their capabilities remain largely fixed by what clinicians and engineers design before deployment. Recursive self-improvement (RSI) offers a different paradigm in which agents learn from their own failures and autonomously expand their capabilities, but directly applying RSI to medicine introduces fundamental safety challenges. We introduce MedRSI, the first recursive self-improvement framework for medicine, which continuously transforms diagnostic failures into new clinical capabilities through tool composition and task-specific model training. Inspired by clinical practice, MedRSI introduces two mechanisms for clinically aligned self-evolution. Clinical-cost-aware failure prioritization directs improvement toward errors according to their potential clinical consequences rather than frequency alone. Fast discovery with slow registration separates rapid capability invention from conservative adoption, allowing new tools to enter the persistent agent only after demonstrating sustained benefit across subsequent patient cohorts. Across public glaucoma and heart disease benchmarks and two private clinical tasks, MedRSI progressively develops segmentation, measurement, prediction, multimodal reasoning, and generative capabilities, surpasses manually engineered medical agents, and autonomously discovers solutions to clinical problems not anticipated by its original designers. Our results show that medical agents need not remain constrained by capabilities specified before deployment: with clinically grounded mechanisms governing what to improve and what to retain, they can continuously construct, validate, and accumulate new capabilities from diagnostic experience. Code is available at https://github.com/ImprintLab/MedRSI.