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NeuroVas Copilot: An Interrogable 3D Aneurysm Reasoning Tool What we built Unruptured brain aneurysms present a difficult decision: treat now with clipping, coiling, or a flow diverter, or monitor and wait. Both rupture and intervention carry significant risk. NeuroVas Copilot is a decision-support system that converts a patient's scan into an interactive 3D vessel model paired with a Claude-powered reasoning agent. It grounds every explanation in the patient's anatomy, blood-flow analysis, and medical literature while showing its reasoning directly on the 3D model and explicitly acknowledging uncertainty. The system has three components: Offline Python pipeline: Reconstructs patient-specific 3D vessel meshes from neuroimaging, extracts vessel centerlines, detects aneurysms, and computes morphology. All heavy computation runs offline for instant inference. Claude reasoning agent: Uses six tools for morphology analysis, literature RAG, catheter path planning, PHASES/ELAPSS risk scoring, geometry perturbation, and anatomical highlighting. Literature retrieval includes conflicting evidence so the model must weigh both sides instead of giving one-sided answers. Interactive Three.js viewer: Streams the agent's reasoning live by highlighting anatomy, visualizing blood flow and wall shear stress, and animating catheter routing. What we found Transparency is the key feature. The relationship between wall shear stress and aneurysm rupture remains scientifically debated, and our system surfaces these conflicting findings instead of hiding them. Every claim is tied to patient-specific measurements and cited evidence, with the model explaining what additional information could change its conclusion. The geometry, vessel graph, catheter routing, literature retrieval, and risk scoring are genuine computations. Blood-flow visualization uses an analytic Poiseuille approximation for most datasets and clearly labels this limitation instead of presenting it as full CFD. The reconstruction pipeline is modality agnostic, making it adaptable to other medical imaging tasks such as tumor analysis. Why it matters NeuroVas Copilot is not an AI that replaces clinicians. It is a transparent, evidence-based second opinion that makes its reasoning visible through anatomy, physics, and literature, allowing clinicians to understand, question, and trust its recommendations while remaining firmly in control.

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