CARDEA: Auditable Reasoning Grounded in Spatial Evidence for End-to-End Coronary Angiography Interpretation
CARDEA, a vision-language model trained only on public data, matches cardiologists on coronary angiography complexity assessment while exposing auditable bounding-box evidence.
CARDEA is a unified large vision-language model serving as the inference core of an end-to-end coronary angiography pipeline from multi-view videos to study-level diagnosis. It was trained on public datasets through visual alignment, self-distilled Chain-of-Box cold start, and reinforcement learning with verifiable rewards encouraging bounding-box reasoning. It reached 0.91 accuracy on dominance classification under domain shift and 0.90 on complexity assessment, comparable to two interventional cardiologists. RLVR raised zero-shot report generation vessel-severity macro-F1 from 0.513 to 0.686, while supervised imitation alone did not.