Eleftherios Tzanis

Eleftherios Tzanis, Michail E. Klontzas

Agentic systems built on large language models (LLMs) offer promising capabilities for automating complex workflows in healthcare AI. We introduce mAIstro, an open-source, autonomous multi-agentic framework for end-to-end development and deployment of medical AI models. The system orchestrates exploratory data analysis, radiomic feature extraction, image segmentation, classification, and regression through a natural language interface, requiring no coding from the user. Built on a modular architecture, mAIstro supports both open- and closed-source LLMs, and was evaluated using a large and diverse set of prompts across 16 open-source datasets, covering a wide range of imaging modalities, anatomical regions, and data types. The agents successfully executed all tasks, producing interpretable outputs and validated models. This work presents the first agentic framework capable of unifying data analysis, AI model development, and inference across varied healthcare applications, offering a reproducible and extensible foundation for clinical and research AI integration. The code is available at: https://github.com/eltzanis/mAIstro

Eleftherios Tzanis, Michail E. Klontzas, Antonios Tzortzakakis

Purpose: To develop and evaluate DosimeTron, an agentic AI system for automated patient-specific MC internal radiation dosimetry in PET/CT examinations. Materials and Methods: In this retrospective study, DosimeTron was evaluated on a publicly available PSMA-PET/CT dataset comprising 597 studies from 378 male patients acquired on three scanner models (18-F, n = 369; 68-Ga, n = 228). The system uses GPT-5.2 as its reasoning engine and 23 tools exposed via four Model Context Protocol servers, automating DICOM metadata extraction, image preprocessing, MC simulation, organ segmentation, and dosimetric reporting through natural-language interaction. Agentic performance was assessed using diverse prompt templates spanning single-turn instructions of varying specificity and multi-turn conversational exchanges, monitored via OpenTelemetry traces. Dosimetric accuracy was validated against OpenDose3D across 114 cases and 22 organs using Pearson's r, Lin's concordance correlation coefficient (CCC), and Bland-Altman analysis. Results: Across all prompt templates and all runs, no execution failures, pipeline errors, or hallucinated outputs were observed. Pearson's r ranged from 0.965 to 1.000 (median 0.997; all p < 0.001) and CCC from 0.963 to 1.000 (median 0.996). Mean absolute percentage difference was below 5% for 19 of 22 organs (median 2.5%). Total per-study processing time (SD) was 32.3 (6.0) minutes. Conclusion: DosimeTron autonomously executed complex dosimetry pipelines across diverse prompt configurations and achieved high dosimetric agreement with OpenDose3D at clinically acceptable processing times, demonstrating the feasibility of agentic AI for patient-specific Monte Carlo dosimetry in PET/CT.

Konstantinos Vrettos, Galini Papadaki, Emmanouil Brilakis et al.

The rapid developments in artificial intelligence (AI) research in radiology have produced numerous models that are scattered across various platforms and sources, limiting discoverability, reproducibility and clinical translation. Herein, OpenRad was created, a curated, standardized, open-access repository that aggregates radiology AI models and providing details such as the availability of pretrained weights and interactive applications. Retrospective analysis of peer reviewed literature and preprints indexed in PubMed, arXiv and Scopus was performed until Dec 2025 (n = 5239 records). Model records were generated using a locally hosted LLM (gpt-oss:120b), based on the RSNA AI Roadmap JSON schema, and manually verified by ten expert reviewers. Stability of LLM outputs was assessed on 225 randomly selected papers using text similarity metrics. A total of 1694 articles were included after review. Included models span all imaging modalities (CT, MRI, X-ray, US) and radiology subspecialties. Automated extraction demonstrated high stability for structured fields (Levenshtein ratio > 90%), with 78.5% of record edits being characterized as minor during expert review. Statistical analysis of the repository revealed CNN and transformer architectures as dominant, while MRI was the most commonly used modality (in 621 neuroradiology AI models). Research output was mostly concentrated in China and the United States. The OpenRad web interface enables model discovery via keyword search and filters for modality, subspecialty, intended use, verification status and demo availability, alongside live statistics. The community can contribute new models through a dedicated portal. OpenRad contains approx. 1700 open access, curated radiology AI models with standardized metadata, supplemented with analysis of code repositories, thereby creating a comprehensive, searchable resource for the radiology community.

Eleftherios Tzanis, Michail E. Klontzas

Ensuring the long-term reliability of AI models in clinical practice requires continuous performance monitoring and corrective actions when degradation occurs. Addressing this need, this manuscript presents ReclAIm, a multi-agent framework capable of autonomously monitoring, evaluating, and fine-tuning medical image classification models. The system, built on a large language model core, operates entirely through natural language interaction, eliminating the need for programming expertise. ReclAIm successfully trains, evaluates, and maintains consistent performance of models across MRI, CT, and X-ray datasets. Once ReclAIm detects significant performance degradation, it autonomously executes state-of-the-art fine-tuning procedures that substantially reduce the performance gap. In cases with performance drops of up to -41.1% (MRI InceptionV3), ReclAIm managed to readjust performance metrics within 1.5% of the initial model results. ReclAIm enables automated, continuous maintenance of medical imaging AI models in a user-friendly and adaptable manner that facilitates broader adoption in both research and clinical environments.