COMPARE: Clinical Optimization with Modular Planning and Assessment via RAG-Enhanced AI-OCT: Superior Decision Support for Percutaneous Coronary Intervention Compared to ChatGPT-5 and Junior Operators

Wei Fang; Chiyao Wang; Wenshuai Ma; Hui Liu; Jianqiang Hu; Xiaona Niu; Yi Chu; Mingming Zhang; Jingxiao Yang; Dongwei Zhang; Zelin Li; Pengyun Liu; Jiawei Zheng; Pengke Zhang; Chaoshi Qin; Wangang Guo; Bin Wang; Yugang Xue; Wei Zhang; Zikuan Wang; Rui Zhu; Yihui Cao; Quanmao Lu; Rui Meng; Yan Li

arXiv · 2512.10702

COMPARE: Clinical Optimization with Modular Planning and Assessment via RAG-Enhanced AI-OCT: Superior Decision Support for Percutaneous Coronary Intervention Compared to ChatGPT-5 and Junior Operators

View original source ↗Read source document ↗Export metadata ↓

Abstract

Background: While intravascular imaging, particularly optical coherence tomography (OCT), improves percutaneous coronary intervention (PCI) outcomes, its interpretation is operator-dependent. General-purpose artificial intelligence (AI) shows promise but lacks domain-specific reliability. We evaluated the performance of CA-GPT, a novel large model deployed on an AI-OCT system, against that of the general-purpose ChatGPT-5 and junior physicians for OCT-guided PCI planning and assessment. Methods: In this single-center analysis of 96 patients who underwent OCT-guided PCI, the procedural decisions generated by the CA-GPT, ChatGPT-5, and junior physicians were compared with an expert-derived procedural record. Agreement was assessed using ten pre-specified metrics across pre-PCI and post-PCI phases. Results: For pre-PCI planning, CA-GPT demonstrated significantly higher median agreement scores (5[IQR 3.75-5]) compared to both ChatGPT-5 (3[2-4], P<0.001) and junior physicians (4[3-4], P<0.001). CA-GPT significantly outperformed ChatGPT-5 across all individual pre-PCI metrics and showed superior performance to junior physicians in stent diameter (90.3% vs. 72.2%, P<0.05) and length selection (80.6% vs. 52.8%, P<0.01). In post-PCI assessment, CA-GPT maintained excellent overall agreement (5[4.75-5]), significantly higher than both ChatGPT-5 (4[4-5], P<0.001) and junior physicians (5[4-5], P<0.05). Subgroup analysis confirmed CA-GPT's robust performance advantage in complex scenarios. Conclusion: The CA-GPT-based AI-OCT system achieved superior decision-making agreement versus a general-purpose large language model and junior physicians across both PCI planning and assessment phases. This approach provides a standardized and reliable method for intravascular imaging interpretation, demonstrating significant potential to augment operator expertise and optimize OCT-guided PCI.

Explore related subjects

cs.AI

Keep this discovery

Explore connections, maps & timelines

BibTeX RIS

Wei Fang, Chiyao Wang, Wenshuai Ma, Hui Liu, Jianqiang Hu, Xiaona Niu, Yi Chu, Mingming Zhang, Jingxiao Yang, Dongwei Zhang, Zelin Li, Pengyun Liu, Jiawei Zheng, Pengke Zhang, Chaoshi Qin, Wangang Guo, Bin Wang, Yugang Xue, Wei Zhang, Zikuan Wang, Rui Zhu, Yihui Cao, Quanmao Lu, Rui Meng, Yan Li. 2025-12-11. COMPARE: Clinical Optimization with Modular Planning and Assessment via RAG-Enhanced AI-OCT: Superior Decision Support for Percutaneous Coronary Intervention Compared to ChatGPT-5 and Junior Operators. https://arxiv.org/abs/2512.10702

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related papers

arXiv2026

Small Language Models are the Future of Agentic AI

Large language models (LLMs) are often praised for exhibiting near-human performance on a wide range of tasks and valued for their ability to hold a general conversation. The rise of agentic AI systems is, however, ushering in a mass of applications in which language models perform a small number of specialized tasks repetitively and with little variation. Here we lay out the position that small language models (SLMs) are sufficiently powerful, inherently more suitable, and necessarily more economical for many invocations in agentic systems, and are therefore the future of agentic AI. Our argumentation is grounded in the current level of capabilities exhibited by SLMs, the common architectures of agentic systems, and the economy of LM deployment. We further argue that in situations where general-purpose conversational abilities are essential, heterogeneous agentic systems (i.e., agents invoking multiple different models) are the natural choice. We discuss the potential barriers for the adoption of SLMs in agentic systems and outline a general LLM-to-SLM agent conversion algorithm. Our position, formulated as a value statement, highlights the significance of the operational and economic impact even a partial shift from LLMs to SLMs is to have on the AI agent industry. We aim to stimulate the discussion on the effective use of AI resources and hope to advance the efforts to lower the costs of AI of the present day. Calling for both contributions to and critique of our position, we commit to publishing all such correspondence at https://research.nvidia.com/labs/lpr/slm-agents.

cs.AI↗

arXiv2026

EndoCogniAgent: Closed-Loop Agentic Reasoning with Self-Consistency Validation for Endoscopic Diagnosis

Endoscopic diagnosis is an iterative process in which clinicians acquire, compare, and verify local visual evidence before reaching a conclusion. Current AI systems do not adequately support this process because fine-grained evidence acquisition and multi-step reasoning remain weakly coupled, complicating reconciliation of image-derived findings with their textual interpretations. This gives rise to two failure modes, hallucinated evidence and uncorrected error accumulation, that undermine diagnostic reliability. We propose EndoCogniAgent, a closed-loop agentic framework that formulates endoscopic diagnosis as a controlled state update process for integrating complementary visual and textual evidence. At each reasoning round, a central planner selects an evidence acquisition action, specialized expert tools extract spatial and semantic observations as structured textual evidence, and a self-consistency validation mechanism examines this evidence along two dimensions, knowledge consistency against the input image and temporal consistency with prior validated findings, before updating the diagnostic state. Validated observations are admitted into the evolving state to condition subsequent planning, while insufficiently supported or conflicting findings are retained with corrective feedback that redirects the planner toward additional verification. We further introduce EndoAgentBench, a workflow-oriented benchmark comprising 6,132 question-answer pairs from 11 endoscopic datasets, to evaluate diagnostic agents across a comprehensive diagnostic chain, from fine-grained visual perception to high-level diagnostic reasoning. EndoCogniAgent achieves 85.23% overall accuracy on perception tasks and 71.13% clinical acceptance rate on reasoning tasks. Blinded clinician evaluation further shows consistent improvements in diagnostic response quality over the evaluated baselines.

cs.AI↗

arXiv2026

Ultra Strong Machine Learning: LLM-Generated Explanations Do Not Yet Suffice for Teaching Humans Active Learning Strategy

Active learning is a general learning mechanism shared by artificial and human learners. Whether AI can teach humans such a strategy that transfers across domains is an open question. Ultra Strong Machine Learning (USML), a system whose explanations quantifiably improve human out-of-sample performance compared to self-learning, is uniquely positioned to answer this question. Prior USML work relied on hand-crafted explanation templates that require expert effort for each new domain and do not scale. We developed an explanation pipeline combining Inductive Logic Programming (ILP) with large language models (LLMs) to automate explanation generation and scoring. We tested whether these explanations achieve USML in a human trial teaching active learning strategies across three related domains. Our exploratory results show that concise, expert-written explanations benefit learners with higher initial performance, while pipeline-generated explanations provide no advantage over self-learning despite being rated as higher quality from an LLM-as-judge evaluation. This case study reveals a systematic gap that LLM quality metrics do not predict human learning outcomes. Our findings point to explanation complexity relative to task difficulty as a key factor, and call for explanation methods and evaluation criteria grounded in human cognitive constraints rather than LLM preference.

cs.AI↗