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Agentic Automation of BT-RADS Scoring: End-to-End Multi-Agent System for Standardized Brain Tumor Follow-up Assessment

Mohamed Sobhi Jabal, Jikai Zhang, Dominic LaBella, Jessica L. Houk, Dylan Zhang, Jeffrey D. Rudie, Kirti Magudia, Maciej A. Mazurowski, Evan Calabrese · Mar 23, 2026 · Citations: 0

Automatic Metrics Medicine Multi Agent
Open arXiv Find Implementation RSS feed Shortlist (0)

How to use this page

Low trust

Use this as background context only. Do not make protocol decisions from this page alone.

Best use

Background context only

What to verify

Validate the evaluation procedure and quality controls in the full paper before operational use.

Evidence quality

Low

Derived from extracted protocol signals and abstract evidence.

Abstract

The Brain Tumor Reporting and Data System (BT-RADS) standardizes post-treatment MRI response assessment in patients with diffuse gliomas but requires complex integration of imaging trends, medication effects, and radiation timing. This study evaluates an end-to-end multi-agent large language model (LLM) and convolutional neural network (CNN) system for automated BT-RADS classification. A multi-agent LLM system combined with automated CNN-based tumor segmentation was retrospectively evaluated on 509 consecutive post-treatment glioma MRI examinations from a single high-volume center. An extractor agent identified clinical variables (steroid status, bevacizumab status, radiation date) from unstructured clinical notes, while a scorer agent applied BT-RADS decision logic integrating extracted variables with volumetric measurements. Expert reference standard classifications were established by an independent board-certified neuroradiologist. Of 509 examinations, 492 met inclusion criteria. The system achieved 374/492 (76.0%; 95% CI, 72.1%-79.6%) accuracy versus 283/492 (57.5%; 95% CI, 53.1%-61.8%) for initial clinical assessments (+18.5 percentage points; P<.001). Context-dependent categories showed high sensitivity (BT-1b 100%, BT-1a 92.7%, BT-3a 87.5%), while threshold-dependent categories showed moderate sensitivity (BT-3c 74.8%, BT-2 69.2%, BT-4 69.3%, BT-3b 57.1%). For BT-4, positive predictive value was 92.9%. The multi-agent LLM system achieved higher BT-RADS classification agreement with expert reference standard compared to initial clinical scoring, with high accuracy for context-dependent scores and high positive predictive value for BT-4 detection.

Low-signal caution for protocol decisions

Use this page for context, then validate protocol choices against stronger HFEPX references before implementation decisions.

  • The available metadata is too thin to trust this as a primary source.
Human Eval Hub LLM-as-Judge Hub Pairwise Preference Hub

Should You Rely On This Paper?

This paper is adjacent to HFEPX scope and is best used for background context, not as a primary protocol reference.

Best use

Background context only

Use if you need

A secondary eval reference to pair with stronger protocol papers.

Main weakness

The available metadata is too thin to trust this as a primary source.

Trust level

Low

Usefulness score

25/100 • Low

Treat as adjacent context, not a core eval-method reference.

Human Feedback Signal

Not explicit in abstract metadata

Evaluation Signal

Detected

Usefulness for eval research

Adjacent candidate

Extraction confidence 45%

If you are doing eval pipeline work, start here:

Human Eval Hub LLM-as-Judge Hub Pairwise Preference Hub Tool-Use Eval Hub

What We Could Verify

These are the protocol signals we could actually recover from the available paper metadata. Use them to decide whether this paper is worth deeper reading.

Human Feedback Types

missing

None explicit

No explicit feedback protocol extracted.

"The Brain Tumor Reporting and Data System (BT-RADS) standardizes post-treatment MRI response assessment in patients with diffuse gliomas but requires complex integration of imaging trends, medication effects, and radiation timing."

Evaluation Modes

partial

Automatic Metrics

Includes extracted eval setup.

"The Brain Tumor Reporting and Data System (BT-RADS) standardizes post-treatment MRI response assessment in patients with diffuse gliomas but requires complex integration of imaging trends, medication effects, and radiation timing."

Quality Controls

missing

Not reported

No explicit QC controls found.

"The Brain Tumor Reporting and Data System (BT-RADS) standardizes post-treatment MRI response assessment in patients with diffuse gliomas but requires complex integration of imaging trends, medication effects, and radiation timing."

Benchmarks / Datasets

missing

Not extracted

No benchmark anchors detected.

"The Brain Tumor Reporting and Data System (BT-RADS) standardizes post-treatment MRI response assessment in patients with diffuse gliomas but requires complex integration of imaging trends, medication effects, and radiation timing."

Reported Metrics

partial

Accuracy

Useful for evaluation criteria comparison.

"The system achieved 374/492 (76.0%; 95% CI, 72.1%-79.6%) accuracy versus 283/492 (57.5%; 95% CI, 53.1%-61.8%) for initial clinical assessments (+18.5 percentage points; P<.001)."

Rater Population

partial

Domain Experts

Helpful for staffing comparability.

"Expert reference standard classifications were established by an independent board-certified neuroradiologist."

Human Feedback Details

  • Uses human feedback: No
  • Feedback types: None
  • Rater population: Domain Experts
  • Expertise required: Medicine

Evaluation Details

  • Evaluation modes: Automatic Metrics
  • Agentic eval: Multi Agent
  • Quality controls: Not reported
  • Evidence quality: Low
  • Use this page as: Background context only

Protocol And Measurement Signals

Benchmarks / Datasets

No benchmark or dataset names were extracted from the available abstract.

Reported Metrics

accuracy

Research Brief

Metadata summary

The Brain Tumor Reporting and Data System (BT-RADS) standardizes post-treatment MRI response assessment in patients with diffuse gliomas but requires complex integration of imaging trends, medication effects, and radiation timing.

Based on abstract + metadata only. Check the source paper before making high-confidence protocol decisions.

Key Takeaways

  • The Brain Tumor Reporting and Data System (BT-RADS) standardizes post-treatment MRI response assessment in patients with diffuse gliomas but requires complex integration of imaging trends, medication effects, and radiation timing.
  • This study evaluates an end-to-end multi-agent large language model (LLM) and convolutional neural network (CNN) system for automated BT-RADS classification.
  • A multi-agent LLM system combined with automated CNN-based tumor segmentation was retrospectively evaluated on 509 consecutive post-treatment glioma MRI examinations from a single high-volume center.

Researcher Actions

  • Compare this paper against nearby papers in the same arXiv category before using it for protocol decisions.
  • Validate inferred eval signals (Automatic metrics) against the full paper.
  • Use related-paper links to find stronger protocol-specific references.

Caveats

  • Generated from abstract + metadata only; no PDF parsing.
  • Signals below are heuristic and may miss details reported outside the abstract.

Research Summary

Contribution Summary

  • This study evaluates an end-to-end multi-agent large language model (LLM) and convolutional neural network (CNN) system for automated BT-RADS classification.
  • A multi-agent LLM system combined with automated CNN-based tumor segmentation was retrospectively evaluated on 509 consecutive post-treatment glioma MRI examinations from a single high-volume center.
  • The multi-agent LLM system achieved higher BT-RADS classification agreement with expert reference standard compared to initial clinical scoring, with high accuracy for context-dependent scores and high positive predictive value for BT-4…

Why It Matters For Eval

  • This study evaluates an end-to-end multi-agent large language model (LLM) and convolutional neural network (CNN) system for automated BT-RADS classification.
  • The multi-agent LLM system achieved higher BT-RADS classification agreement with expert reference standard compared to initial clinical scoring, with high accuracy for context-dependent scores and high positive predictive value for BT-4…

Researcher Checklist

  • Gap: Human feedback protocol is explicit

    No explicit human feedback protocol detected.

  • Pass: Evaluation mode is explicit

    Detected: Automatic Metrics

  • Gap: Quality control reporting appears

    No calibration/adjudication/IAA control explicitly detected.

  • Gap: Benchmark or dataset anchors are present

    No benchmark/dataset anchor extracted from abstract.

  • Pass: Metric reporting is present

    Detected: accuracy

Related Papers

Papers are ranked by protocol overlap, extraction signal alignment, and semantic proximity.

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