Large language models (LLMs) have demonstrated considerable promise in program generation for small-scale and conventional application development; however, they remain limited when applied to complex, domain-specific tasks such as medical image processing. General-purpose models lack explicit domain knowledge and robust validation mechanisms to ensure correctness, often requiring substantial human intervention to produce reliable processing pipelines. To address these limitations, we propose AutoMedImg, a multi-agent framework for fully automated medical image processing code generation. AutoMedImg orchestrates specialised agents across two phases: a Planning Phase that performs dataset analysis and architecture design with semantic and formal verification, and a Coding Phase that generates modules in parallel with static checking, execution testing, and assembly validation. This multi-stage validation mitigates error propagation throughout generation, while comprehensive auto-context engineering combining domain-specific knowledge bases, shared memory, and validation feedback automates context construction without manual prompting. A cross-project adaptive pipeline synthesis mechanism further accumulates validated pipelines and retrieves proven components for new tasks based on project similarity, enhancing generation efficiency through cross-project learning. Extensive evaluation across six diverse and well-established medical imaging datasets with five backbone LLMs demonstrates that AutoMedImg achieves zero human intervention, with Dice scores of up to 0.90 for segmentation tasks and 99% accuracy for classification.

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