# IMACT-CXR: An Interactive Multi-Agent Conversational Tutoring System for Chest X-Ray Interpretation

arXiv: https://arxiv.org/abs/2511.15825 · HTML: https://mlsanity.com/paper/2511.15825/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 5 of its 13 references that are in the map.
- First posted on arXiv 19 Nov 2025.

## Builds on (most cited first, 5 of 5)

- [AutoGen: Enabling Next-Gen LLM Applications via Multi-Agent Conversation](https://mlsanity.com/paper/2308.08155/) (2023)
- [A Vision-Language Foundation Model to Enhance Efficiency of Chest X-ray Interpretation](https://mlsanity.com/paper/2401.12208/) (2024)
- [Radiology-GPT: A Large Language Model for Radiology](https://mlsanity.com/paper/2306.08666/) (2023)
- [Large Language Models for Medicine: A Survey](https://mlsanity.com/paper/2405.13055/) (2024)
- [REFLACX, a dataset of reports and eye-tracking data for localization of abnormalities in chest x-rays](https://mlsanity.com/paper/2109.14187/) (2021)

## Abstract (arXiv)

IMACT-CXR is an interactive multi-agent conversational tutor that helps trainees interpret chest X-rays by unifying spatial annotation, gaze analysis, knowledge retrieval, and image-grounded reasoning in a single AutoGen-based workflow. The tutor simultaneously ingests learner bounding boxes, gaze samples, and free-text observations. Specialized agents evaluate localization quality, generate Socratic coaching, retrieve PubMed evidence, suggest similar cases from REFLACX, and trigger NV-Reason-CXR-3B for vision-language reasoning when mastery remains low or the learner explicitly asks. Bayesian Knowledge Tracing (BKT) maintains skill-specific mastery estimates that drive both knowledge reinforcement and case similarity retrieval. A lung-lobe segmentation module derived from a TensorFlow U-Net enables anatomically aware gaze feedback, and safety prompts prevent premature disclosure of ground-truth labels. We describe the system architecture, implementation highlights, and integration with the REFLACX dataset for real DICOM cases. IMACT-CXR demonstrates responsive tutoring flows with bounded latency, precise control over answer leakage, and extensibility toward live residency deployment. Preliminary evaluation shows improved localization and diagnostic reasoning compared to baselines.