Agentic AI in Radiology: Evolution from Large Language Models to Future Clinical Integration

The introduction of foundational models, specifically large language models, has promised a health care transformation. However, the field is rapidly evolving toward autonomous agent systems, defined as AI entities that perceive and react to their environment to achieve specific goals–representing a paradigm shift from passive information retrieval to proactive, goal-oriented clinical assistance. Agentic AI systems transcend static knowledge limitations through core capabilities including persistent memory systems that maintain context across patient encounters, knowledge retrieval tools connecting to medical repositories through retrieval-augmented generation techniques, and computer use functionality enabling navigation of clinical software interfaces. Agentic workflows introduce sophisticated coordination mechanisms including hierarchical, collaborative, and sequential patterns demonstrating superior performance compared with single-agent approaches. Multiagent systems can autonomously coordinate entire clinical workflows across the entire radiology lifecycle, from preacquisition protocol optimization through initial image analysis, specialized tool deployment, and preliminary report generation. However, successful clinical deployment requires systematic consideration of complexity thresholds, economic sustainability, cybersecurity frameworks, bias mitigation strategies, and appropriate governance structures. Critical challenges include managing the probabilistic nature of underlying models within deterministic clinical workflows, ensuring adequate human supervision, and preventing overcomplication of established processes. A structured four-phase implementation roadmap addresses these considerations through incremental progression from low-risk automation to comprehensive workflow orchestration while maintaining rigorous safety standards. As foundation models advance and interoperability standards mature, agentic AI will reshape radiology practice paradigms. Success depends on resolving stakeholder responsibility questions while orchestrating technological capabilities with clinical accountability, ensuring autonomous systems augment rather than replace professional judgment in pursuit of improved patient outcomes. ©RSNA, 2026