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Chunzheng Zhu, Lei Tian, Bohan Tan, Ziqi Zhou, Yuxuan Sun, Yijun Wang, Chengchao Lv, Yilin Wen, Yijun He, Jinghao Lin, Yihang Chen, Cheewei Tan, Qianshan Wei, Lei Zhao, Bin Pu, Kenli Li, Yuan Xue, Jianxin Lin
The growing ability of large language models and vision language models to jointly interpret and reason over images and text is reshaping medical agents, moving them from task specific predictors toward autonomous systems that perceive, reason, plan, remember, and act in clinical environments. This work departs from the capability first perspective of existing literature and instead begins from clinical deployment, asking what tasks, contamination resistant benchmarks, and interactive training environments are required before medical agents can be trusted in practice. Medical agents are formalized as sequential decision making systems under partial observability, together with a three level autonomy taxonomy spanning assisted, cooperative, and fully autonomous operation. The field is organized along a unified scaling spine consisting of framework scaling, capability scaling, and environment scaling. Within this framework, clinical environment scaling, the integration of tools, data, and clinical gyms, is identified as the most actionable yet underexplored direction for agents operating in PACS, EHR, and FHIR ecosystems. Clinical self evolution, where agents improve through interaction with their environments rather than parameter scaling alone, is further positioned as a key research frontier, drawing insights from self improving agents, agent gyms, and test time compute scaling. Applications across radiology, pathology, ophthalmology, and hospital workflows are examined together with deployment challenges including hallucination, cascading failures, and fairness. By consolidating more than 300 references, with particular emphasis on advances from 2025 to 2026, this work provides a roadmap toward trustworthy, self improving medical imaging systems for real clinical practice.
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@article{zhu2026path,
title = {The Path to Self-Evolving Clinical Systems: Scaling Medical Agents from Assistance to Autonomy},
author = {Chunzheng Zhu and Lei Tian and Bohan Tan and Ziqi Zhou and Yuxuan Sun and Yijun Wang and Chengchao Lv and Yilin Wen and Yijun He and Jinghao Lin and Yihang Chen and Cheewei Tan and Qianshan Wei and Lei Zhao and Bin Pu and Kenli Li and Yuan Xue and Jianxin Lin},
year = {2026},
abstract = {The growing ability of large language models and vision language models to jointly interpret and reason over images and text is reshaping medical agents, moving them from task specific predictors toward autonomous systems that perceive, reason, plan, remember, and act in clinical environments. This work departs from the capability first perspective of existing literature and instead begins from clinical deployment, asking what tasks, contamination resistant benchmarks, and interactive training e},
url = {https://arxiv.org/abs/2607.11175},
keywords = {cs.AI},
eprint = {2607.11175},
archiveprefix = {arXiv},
}
{}