Radiologists read CT as a sequential decision process, actively scrolling, zooming, adjusting windows, comparing with prior scans, and measuring structures, where each observation guides the next action. Current VLMs instead answer from passively sampled views, missing the multi-step reasoning that clinical reading demands. We address this by aligning the agent’s action space to the radiologists’ operations within the Picture Archiving and Communication System (PACS), enabling active, multi-step CT reading with inherently transparent reasoning for clinical decision support. In particular, we build **ACTOR**, a unified framework comprising: (1) a PACS-like interactive CT environment with five radiologist-aligned tools; (2) **ActiveCTR-Bench**, spanning 7 tasks across a Perception–Interpretation–Reasoning hierarchy (7,112 items with visual ground truth and verified vision necessity); and (3) **ActiveCTReasoner**, a 7B model trained on 108K synthesized trajectories via SFT and reinforcement learning. ActiveCTReasoner achieves 73.2% close-ended accuracy, outperforming GPT-5.4 (47.3%) remarkably. In open-ended evaluations, it scores 44.2% compared to 23.8% for the best baseline. A radiologist collaboration study provides preliminary evidence for the decision-support utility of radiologist-aligned agentic reasoning.