Despite strong performance in medical question answering, large language models remain limited in clinical cold-start settings, where little patient information is initially available and key evidence must be acquired through dialogue. This requires models to decide what to ask under a limited turn budget, balancing broad history taking with targeted clarification of high-risk cues. To address the aforementioned challenges, we propose **MedCIA**, a two-stage framework for improving clinical information acquisition. First, it reconstructs patient records into structured inquiry trajectories, enabling supervised learning of expert-guided information-seeking intents and the breadth-depth trade-off in clinical questioning. Second, it refines the policy with Adaptive Tree Policy Optimization (ATPO), an uncertainty-aware reinforcement learning procedure that allocates rollout computation to ambiguous dialogue states in a profile-anchored patient simulator. Furthermore, we curate a multi-turn dataset (MedIntake) for active clinical intake with progressive patient information disclosure and diverse inquiry strategies. Experiments on an EHR-derived benchmark show that **MedCIA** improves importance-weighted coverage, early acquisition, and cost control under controlled simulation.

Three-dimensional Computed Tomography (3D CT) is a cornerstone of precision medicine. Most AI diagnostic models analyze large num bers of CTslices uniformly, treating all slices as equally important. While this has partly accel erated radiologists’workflows, it overlooks that clinically relevant information is often sparsely distributed throughout a volume. Without tar geted or weighted processing, fine-grained cues may be missed and substantial computation wasted on diagnostically uninformative slices. Wepropose aradiologist-simulating framework for selective and efficient 3D CT interpreta tion. Evaluated on a 3D CT dataset covering eight thoracic lesion types, it was compared with state-of-the-art multimodal large language models such as GPT-4o and supervised visual backbones including ViT and ResNet-50. Us ing accuracy, F1-score, AUC, and blind radiolo gist assessment, Screen-CLIP achieved an AUC of 0.87 and F1-score of 0.82, surpassing ViT Base (AUC: 0.84). For report generation, our method outperformed M3D across all metrics, reaching a BLEU-Avg of 29.03, and achieved the highest average Doctors’ Score (6.16/10) in a preliminary human evaluation.