EchoAgent: Guideline-Centric Reasoning Agent for Echocardiography Measurement and Interpretation

Abstract: Purpose: Echocardiographic interpretation requires video-level reasoning and guideline-based measurement analysis, which current deep learning models for cardiac ultrasound do not support. We present EchoAgent, a framework that enables structured, interpretable automation for this domain. Methods: EchoAgent orchestrates specialized vision tools under LLM control to perform temporal localization, spatial measurement, and clinical interpretation. A key contribution is a measurement-feasibility prediction model that determines whether anatomical structures are reliably measurable in each frame, enabling autonomous tool selection. We curated a benchmark of diverse, clinically validated video-query pairs for evaluation. Results: EchoAgent achieves accurate, interpretable results despite added complexity of spatiotemporal video analysis. Outputs are grounded in visual evidence and clinical guidelines, supporting transparency and traceability. Conclusion: This work demonstrates the feasibility of agentic, guideline-aligned reasoning for echocardiographic video analysis, enabled by task-specific tools and full video-level automation. EchoAgent sets a new direction for trustworthy AI in cardiac ultrasound.