MedAdaptAgent: An Automatic Harness for Adapting Medical Imaging Models to New Sites

Hanxue Gu, Zhonghao Liu, Xingrui Gu, Kang Wang, Yang Yang

Reusing pretrained medical-imaging models offers an alternative to training from scratch. A model trained for the same task may perform poorly at a new hospital because imaging protocols and preprocessing differ. Effective adaptation depends on the model architecture, domain shift, and available labels and compute. Adaptation can improve scores on a small labeled set yet reduce performance on unseen data. We present MedAdaptAgent, an automatic harness that turns a supplied model, target data, and a free-text request into a new-site adaptation workflow. Its LLM-driven Adaptation Planner uses model-site evidence to choose compatible experiments and revise subsequent adjustments. The harness requires evidence of improvement over the pretrained model, then delivers the selected model as a complete, runnable package. Evaluation spans 26 segmentation and classification transfers across architectures and compute settings, with segmentation annotation budgets ranging from zero-shot transfer to few-shot adaptation. With 20 local annotations, mean segmentation Dice rises from 0.483 to 0.774 across 10 transfers, a 60.1% relative gain, with no harmful replacements. Mean classification AUROC…