VoxelSage: Tool-Augmented 3D CT Analysis and Simulator-Shielded Sequential Resection Planning for Liver Tumors

Binghong Qian, Xuanhe Liu, Yifan Xing, Wenjie Deng, Jian Wu +1

Preoperative liver-tumor assessment requires segmentation, physical-space measurement, visual evidence, and resection planning from the same three-dimensional CT volume. Existing tools often handle these steps separately, while language models cannot reliably compute physical measurements from CT. To provide an integrated workflow, we present VoxelSage, a multi-modal system for two- and three-dimensional visualization, liver-tumor analysis, and preoperative resection planning. Its dual-port architecture separates language-model orchestration from image computation: Port A interprets requests and selects skills, while Port B applies them to CT volumes and segmentation masks and returns structured results. Keeping physical measurements in Port B prevents the LLM from computing them directly and reduces the risk of fabricated numerical results. Eight built-in skills support quantitative analysis, visual evidence generation, three-dimensional reconstruction, segmentation refinement, and sequential resection planning; user-defined skills can extend these functions. For sequence planning, a behavior-cloned neural ranker orders candidate resection targets, while a simulator-based shield…