# MARCH: Multi-Agent Radiology Clinical Hierarchy for CT Report Generation

arXiv: https://arxiv.org/abs/2604.16175 · HTML: https://mlsanity.com/paper/2604.16175/

## Key facts

- Cited by 4 papers in the map (data through 14 Oct 2026).
- Placed in Medical and scientific domain agents, one of 16 directions in LLM agents and tool use.
- Builds on 14 of its 49 references that are in the map.
- First posted on arXiv 17 Apr 2026.

## Placed in

- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 14 of 14)

- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Llama 2: Open Foundation and Fine-Tuned Chat Models](https://mlsanity.com/paper/2307.09288/) (2023)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [R2GenGPT: Radiology Report Generation with Frozen LLMs](https://mlsanity.com/paper/2309.09812/) (2023)
- [MMedAgent: Learning to Use Medical Tools with Multi-modal Agent](https://mlsanity.com/paper/2407.02483/) (2024)
- [Multi-Agent Collaboration via Evolving Orchestration](https://mlsanity.com/paper/2505.19591/) (2025)
- [METransformer: Radiology Report Generation by Transformer with Multiple Learnable Expert Tokens](https://mlsanity.com/paper/2304.02211/) (2023)
- [AI Hospital: Benchmarking Large Language Models in a Multi-agent Medical Interaction Simulator](https://mlsanity.com/paper/2402.09742/) (2024)
- [CT2Rep: Automated Radiology Report Generation for 3D Medical Imaging](https://mlsanity.com/paper/2403.06801/) (2024)
- [Large-Vocabulary Segmentation for Medical Images with Text Prompts](https://mlsanity.com/paper/2312.17183/) (2023)
- [A Comprehensive Survey of Foundation Models in Medicine](https://mlsanity.com/paper/2406.10729/) (2024)
- [Multi-Agent Collaboration via Cross-Team Orchestration](https://mlsanity.com/paper/2406.08979/) (2024)
- [Large Language Model with Region-guided Referring and Grounding for CT Report Generation](https://mlsanity.com/paper/2411.15539/) (2024)
- [AgentMaster: A Multi-Agent Conversational Framework Using A2A and MCP Protocols for Multimodal Information Retrieval and Analysis](https://mlsanity.com/paper/2507.21105/) (2025)

## Built on by (most cited first, 4 of 4)

- [The Path to Self-Evolving Clinical Systems: Scaling Medical Agents from Assistance to Autonomy](https://mlsanity.com/paper/2607.11175/) (2026)
- [G-CARL: Grounded Checklist-Aligned Reward Learning for Patient-Oriented Medical Report Interpretation](https://mlsanity.com/paper/2608.20331/) (2026)
- [Volumetric Radiology AI in the Era of Multimodal Large Language Models](https://mlsanity.com/paper/2608.20549/) (2026)
- [MedPrune: Topology-Efficient Multimodal Multi-Agent Communication Evolution for Medical VQA Tasks](https://mlsanity.com/paper/2610.06695/) (2026)

## Abstract (arXiv)

Automated 3D radiology report generation often suffers from clinical hallucinations and a lack of the iterative verification found in human practice. While recent Vision-Language Models (VLMs) have advanced the field, they typically operate as monolithic "black-box" systems without the collaborative oversight characteristic of clinical workflows. To address these challenges, we propose MARCH (Multi-Agent Radiology Clinical Hierarchy), a multi-agent framework that emulates the professional hierarchy of radiology departments and assigns specialized roles to distinct agents. MARCH utilizes a Resident Agent for initial drafting with multi-scale CT feature extraction, multiple Fellow Agents for retrieval-augmented revision, and an Attending Agent that orchestrates an iterative, stance-based consensus discourse to resolve diagnostic discrepancies. On the RadGenome-ChestCT dataset, MARCH significantly outperforms state-of-the-art baselines in both clinical fidelity and linguistic accuracy. Our work demonstrates that modeling human-like organizational structures enhances the reliability of AI in high-stakes medical domains.