MedImageOSWorld: Benchmarking GUI Agents for Medical Image Consoles

Graphical consoles offer a practical interface for medical acquisition assistance, allowing agents to work through the controls and visual feedback used by human operators. Reliable assistance requires linking on-screen anatomy to acquisition decisions that determine what image evidence becomes available next. We introduce MedImageOSWorld, a benchmark for evaluating this capability in simulated CT, MR, and ultrasound consoles. Using screenshots and mouse-and-keyboard actions, agents configure protocols, plan acquisitions, inspect the resulting images, and make corrective adjustments across seven capability levels, from console operation to feedback-driven control. Evaluation combines task-specific workflow checks with hidden anatomical ground truth to assess procedural completion and acquisition outcomes separately. A common evaluation protocol specifies episode conditions and interaction budgets, while recorded trajectories support analysis of how agents observe, act, and respond to acquisition feedback. Across eleven open-weight agents, success rates range from 3.0 to 25.0 on a 0-100 scale while workflow-progress rates reach 21.5-74.5: agents complete much of the console workflow but rarely acquire the intended anatomy. Success collapses between perception and planning, from 79-90% at the lowest three levels for the best agent to at most 12% for millimetre-level planning and 0% for closed-loop control among open-weight agents. Two proprietary agents reach success rates of about 34 and exceed the best open-weight agent mainly in acquisition quality (61 versus 42). MedImageOSWorld provides a controlled setting for studying whether general-purpose GUI agents can translate visual observations into effective medical acquisition decisions.