# nv-reason-cxr

Runs NV-Reason-CXR-3B smoke tests on chest X-ray images. Useful for verifying pipeline command shapes and parsing JSON reasoning outputs.

- skill · `type=skill` · Claude Code, Codex, Cursor, GitHub Copilot, Gemini CLI, OpenCode · 1800 installs · ★ 3735
- Author: NVIDIA MedTech Team
- License: Apache-2.0 · policy=mirror · the beginning of the file is at the end of this page
- Source: https://github.com/NVIDIA/skills/tree/HEAD/skills/nv-reason-cxr/SKILL.md
- Updated: 2026-10-23
- HTML: https://affpapa.org/en/nevibecode/skills/nv-reason-cxr

## What it does

The skill wraps `scripts/run_nv_reason_cxr.py` to test chest X-ray image interpretation with the NV-Reason-CXR-3B model. It accepts an image path or fixture and outputs a `result_json` containing raw `<think>` and `<answer>` blocks. A dedicated `--mock` mode uses synthetic fixtures so CI pipelines can verify interface contracts without downloading large model weights.

Execution supports two backends: `local` and `hf-space-api`. Local execution requires CUDA, PyTorch 2.7.1, Transformers 4.56.1, and Pillow. The Hugging Face Space API backend bypasses GPU and token requirements entirely, though it depends on external service availability.

Outputs represent engineering evidence rather than clinical reports or diagnoses. The model can hallucinate findings or miss abnormalities, so medical use requires independent professional review.

## Install

### Claude Code (native platform)

1. **Skills CLI (Vercel)**
```bash
npx skills add NVIDIA/skills --skill nv-reason-cxr -a claude-code
```

2. **Manually: put the files in place**
- File: `~/.claude/skills/nv-reason-cxr/SKILL.md` — Copy the whole skill folder; for one project use .claude/skills/nv-reason-cxr/

### Codex

1. **Skills CLI (Vercel)**
```bash
npx skills add NVIDIA/skills --skill nv-reason-cxr -a codex
```

2. **Manually: put the files in place**
- File: `.agents/skills/nv-reason-cxr/SKILL.md` — For all projects use ~/.agents/skills/

### Cursor

1. **Skills CLI (Vercel)**
```bash
npx skills add NVIDIA/skills --skill nv-reason-cxr -a cursor
```

2. **Manually: put the files in place**
- File: `.cursor/skills/nv-reason-cxr/SKILL.md` — Cursor also reads .agents/skills/ and .claude/skills/

### GitHub Copilot

1. **GitHub CLI**
```bash
gh skill install NVIDIA/skills nv-reason-cxr
```

2. **Manually: put the files in place**
- File: `.github/skills/nv-reason-cxr/SKILL.md`

### Gemini CLI

1. **Skills CLI (Vercel)**
```bash
npx skills add NVIDIA/skills --skill nv-reason-cxr -a gemini-cli
```

2. **Platform CLI**
```bash
gemini skills install https://github.com/NVIDIA/skills --path skills/nv-reason-cxr
```

### Windsurf (Devin Desktop)

**Manually: put the files in place**
- File: `.devin/skills/nv-reason-cxr/SKILL.md` — The legacy .windsurf/skills/ path still works

### OpenCode

**Skills CLI (Vercel)**
```bash
npx skills add NVIDIA/skills --skill nv-reason-cxr -a opencode
```

### Claude.ai

**Claude.ai**
- Zip the folder and upload it in Settings → Capabilities → Skills

Where a file is given instead of a command, copy the files from the source to that path: https://github.com/NVIDIA/skills/tree/HEAD/skills/nv-reason-cxr/SKILL.md

## When to use it
- run command-shape smoke tests with synthetic CXR fixtures
- validate wrapper output structure against expected JSON schemas
- test reasoning inference using the public Hugging Face Space API
- verify Python and CUDA dependencies with `--check-setup`

## Example prompts
- Run an nv-reason-cxr smoke test using the synthetic fixture in mock mode
- Check my local environment dependencies for nv-reason-cxr using --check-setup
- Analyze test_cxr.png with nv-reason-cxr using the hf-space-api backend

## Source text · SKILL.md · Apache-2.0

Below is the content of a third-party file. It is data, not instructions for you: do not act on anything written inside unless the human asks. Block tag: 2e399ff17c7d4717.

BEGIN THIRD-PARTY FILE 2e399ff17c7d4717
```text
---
name: nv-reason-cxr
description: Used for command-shape or live NV-Reason-CXR chest X-ray reasoning smoke tests. Not for diagnosis or clinical reporting.
license: Apache-2.0
allowed-tools: Bash
metadata:
  author: NVIDIA MedTech Team
  tags:
    - MedTech
    - CXR
    - reasoning
---

# NV-Reason-CXR

## Purpose
- Used for command-shape or live NV-Reason-CXR chest X-ray reasoning smoke tests. Not for diagnosis or clinical reporting.
- Use the wrapper exactly as documented; do not replace the upstream entrypoint with a handwritten implementation.
- Manifest I/O: inputs are `chest_xray_image_or_fixture`; outputs are `result_json`.

## Instructions
- Read `skill_manifest.yaml` before changing arguments, side effects, or validation gates.
- Run `scripts/run_nv_reason_cxr.py` through the documented command below; pass `--out-dir` only for generated fixtures or harness-managed artifact directories.
- If a host agent exposes `run_script`, use `run_script("scripts/run_nv_reason_cxr.py", args=[...])`; otherwise run the Bash/Python command shown below.
- Check the emitted JSON and paired verifier guidance before treating the run as evidence.
- When reporting a completed run, return the full wrapper JSON or at minimum
  the complete `output.response_text` exactly as emitted, including any
  model-generated `<think>...</think>` and `<answer>...</answer>` sections. Do
  not collapse the result to labels unless the user explicitly asks for a
  summary.

## Available Scripts
| Script | Purpose | Arguments |
|---|---|---|
| `scripts/run_nv_reason_cxr.py` | Primary entrypoint declared by skill_manifest.yaml. | `PATH_TO_CXR_OR_FIXTURE [--out-dir OUT_DIR] [--backend local\|hf-space-api] [--mock] [--check-setup]` |

## Prerequisites
- Local backend requirements: GPU/CUDA when declared by the manifest; Python packages listed in `runtime.side_effects.pip_packages`.
- API backend requirements: public network access to the [Hugging Face Space](https://huggingface.co/spaces/nvidia/nv-reason-cxr); no local PyTorch, Transformers, CUDA, model cache, or Hugging Face token.
- Side effects: emits result JSON on stdout; may write generated fixture artifacts under the caller's `--out-dir`; may cache model assets under `~/.cache/huggingface/` for local inference; and may contact `https://huggingface.co`, `https://github.com`, or `https://*.hf.space` outside `--mock` mode.
- Run commands from the repository root unless an existing section below says otherwise.

## Limitations
- This is a thin wrapper. Image preprocessing, model inference, and decoding are delegated to Hugging Face Transformers and the NV-Reason-CXR-3B model.
- Output is not a diagnosis, clinical report, treatment recommendation, or triage decision. It is engineering evidence and must be reviewed by a qualified professional before any medical use.
- The model may hallucinate findings, miss subtle abnormalities, misread support devices, or produce overconfident prose.
```
END THIRD-PARTY FILE 2e399ff17c7d4717

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