# MedVA: An End-to-End Neuro-Symbolic Agentic System for Medical Volume Visualization

arXiv: https://arxiv.org/abs/2609.14874 · HTML: https://mlsanity.com/paper/2609.14874/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical and scientific domain agents, one of 16 directions in LLM agents and tool use.
- Builds on 15 of its 42 references that are in the map.
- First posted on arXiv 14 Sep 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, 15 of 15)

- [TotalSegmentator: robust segmentation of 104 anatomical structures in CT images](https://mlsanity.com/paper/2208.05868/) (2022)
- [The RSNA-ASNR-MICCAI BraTS 2021 Benchmark on Brain Tumor Segmentation and Radiogenomic Classification](https://mlsanity.com/paper/2107.02314/) (2021)
- [Logic-LM: Empowering Large Language Models with Symbolic Solvers for Faithful Logical Reasoning](https://mlsanity.com/paper/2305.12295/) (2023)
- [Evaluation of Algorithms for Multi-Modality Whole Heart Segmentation: An Open-Access Grand Challenge](https://mlsanity.com/paper/1902.07880/) (2019)
- [VISTA3D: A Unified Segmentation Foundation Model For 3D Medical Imaging](https://mlsanity.com/paper/2406.05285/) (2024)
- [Towards Data-and Knowledge-Driven Artificial Intelligence: A Survey on Neuro-Symbolic Computing](https://mlsanity.com/paper/2210.15889/) (2022)
- [AVA: Towards Autonomous Visualization Agents through Visual Perception-Driven Decision-Making](https://mlsanity.com/paper/2312.04494/) (2023)
- [NLI4VolVis: Natural Language Interaction for Volume Visualization via LLM Multi-Agents and Editable 3D Gaussian Splatting](https://mlsanity.com/paper/2507.12621/) (2025)
- [VoxTell: Free-Text Promptable Universal 3D Medical Image Segmentation](https://mlsanity.com/paper/2511.11450/) (2025)
- [medIKAL: Integrating Knowledge Graphs as Assistants of LLMs for Enhanced Clinical Diagnosis on EMRs](https://mlsanity.com/paper/2406.14326/) (2024)
- [ChatVis: Automating Scientific Visualization with a Large Language Model](https://mlsanity.com/paper/2410.11863/) (2024)
- [VizGenie: Toward Self-Refining, Domain-Aware Workflows for Next-Generation Scientific Visualization](https://mlsanity.com/paper/2507.21124/) (2025)
- [Benchmark of Segmentation Techniques for Pelvic Fracture in CT and X-ray: Summary of the PENGWIN 2024 Challenge](https://mlsanity.com/paper/2504.02382/) (2025)
- [IntuiTF: MLLM-Guided Transfer Function Optimization for Direct Volume Rendering](https://mlsanity.com/paper/2506.18407/) (2025)
- [HiLSVA: Design and Evaluation of a Human-in-the-Loop Agentic System for Scientific Visualization](https://mlsanity.com/paper/2606.26614/) (2026)

## Abstract (arXiv)

Medical volume visualization requires selecting regions of interest (ROIs) and carefully controlling their relative visual emphasis according to a given clinical intent. Implementing these decisions in conventional workflows demands substantial clinical and visualization expertise and often involves trial-and-error optimization. Recent agentic systems have introduced natural-language interaction and autonomous visualization operations but largely rely on MLLM-based inference throughout the workflow. Although MLLMs encode broad medical knowledge and provide strong reasoning capabilities, such inference may be suboptimal for medical volume visualization, potentially leading to clinically incomplete interpretations of user requests and unreliable ROI identification and visualization optimization. In this work, we present MedVA, an end-to-end neuro-symbolic agentic system for medical volume visualization that addresses these limitations through three complementary agents. The neuro-symbolic intent formulation agent refines MLLM-based interpretations of natural-language requests through symbolic reasoning over established clinical knowledge, which provides more complete, clinically grounded ROI specifications than MLLM-only reasoning. The multi-model ROI identification agent directly identifies semantically specified ROIs in the original volume by leveraging complementary large-scale pretrained medical segmentation models. The objective-driven visualization optimization agent explicitly evaluates ROI visibility and occlusion in the original volume using a volume-based visibility objective. Extensive agent-level and system-level evaluations across diverse medical datasets and interaction scenarios support the effectiveness of the individual agents. A formative user study further indicates high usability and practical value among users with different levels of expertise.