PASS: Probabilistic Agentic Supernet Sampling for Interpretable and Adaptive Chest X-Ray Reasoning

Abstract

Existing tool-augmented agentic systems are limited in the real world by (i) black-box reasoning steps that undermine trust of decision-making and pose safety risks, (ii) poor multimodal integration, which is inherently critical for healthcare tasks, and (iii) rigid and computationally inefficient agentic pipelines. We introduce PASS (Probabilistic Agentic Supernet Sampling), the first multimodal framework to address these challenges for Chest X-Ray (CXR) reasoning. PASS adaptively samples agentic workflows over a multi-tool graph, yielding decision paths annotated with interpretable probabilities. Given the complex CXR reasoning task with multimodal medical data, PASS leverages its learned task-conditioned distribution over the agentic supernet. Thus, it adaptively selects the most suitable tool at each supernet layer, offering probability-annotated trajectories for post-hoc audits and directly enhancing medical AI safety. PASS also continuously compresses salient findings into an evolving personalized memory, while dynamically deciding whether to deepen its reasoning path or invoke an early exit for efficiency. To optimize a Pareto frontier balancing performance and cost, we design a novel three-stage training procedure, including expert knowledge warm-up, contrastive path-ranking, and cost-aware reinforcement learning. To facilitate rigorous evaluation, we introduce CAB-E, a comprehensive benchmark for multi-step, safety-critical, free-form reasoning. Experiments across various benchmarks validate that PASS significantly outperforms strong baselines in multiple metrics (e.g., accuracy, LLM-Judge, semantic similarity, etc.) while balancing computational costs, pushing a new paradigm shift towards interpretable, adaptive, and multimodal medical agentic systems.