arXiv:2502.19175cs.CLcs.AI2025-02ACL被引 33

MEDDxAgent通过迭代交互提升疾病诊断准确率,支持不完整病历场景。

MEDDxAgent: A Unified Modular Agent Framework for Explainable Automatic Differential Diagnosis

  • 模块化框架分三步:引导问诊、知识检索、策略决策
  • 在呼吸/皮肤/罕见病数据集上提升超10%诊断准确率
  • 适合临床辅助系统开发与可解释医疗AI研究

鉴别诊断(DDx)是临床决策的核心但复杂环节,医生需基于症状、病史和医学知识逐步优化疾病排序。尽管大语言模型(LLMs)在支持DDx方面展现出潜力,现有方法存在单一数据集评估、组件孤立优化、假设患者信息完整、仅一次诊断尝试等局限。我们提出模块化可解释的DDx智能体框架MEDDxAgent,适用于交互式诊断,其诊断推理通过迭代学习演化,无需初始完整病历。该框架包含三个模块:(1) 诊断调度器(DDxDriver),(2) 病史采集模拟器,(3) 专用于知识检索与诊断策略的两个智能体。为确保评估稳健性,我们构建覆盖呼吸、皮肤及罕见病的综合性DDx基准。分析表明,在病历不完整前提下,迭代式诊断优于单次决策。广泛评估显示,MEDDxAgent在大模型与小模型上均实现超过10%的准确率提升,并提供关键诊断推理可解释性。

原文摘要 · Abstract (English)

Differential Diagnosis (DDx) is a fundamental yet complex aspect of clinical decision-making, in which physicians iteratively refine a ranked list of possible diseases based on symptoms, antecedents, and medical knowledge. While recent advances in large language models (LLMs) have shown promise in supporting DDx, existing approaches face key limitations, including single-dataset evaluations, isolated optimization of components, unrealistic assumptions about complete patient profiles, and single-attempt diagnosis. We introduce a Modular Explainable DDx Agent (MEDDxAgent) framework designed for interactive DDx, where diagnostic reasoning evolves through iterative learning, rather than assuming a complete patient profile is accessible. MEDDxAgent integrates three modular components: (1) an orchestrator (DDxDriver), (2) a history taking simulator, and (3) two specialized agents for knowledge retrieval and diagnosis strategy. To ensure robust evaluation, we introduce a comprehensive DDx benchmark covering respiratory, skin, and rare diseases. We analyze single-turn diagnostic approaches and demonstrate the importance of iterative refinement when patient profiles are not available at the outset. Our broad evaluation demonstrates that MEDDxAgent achieves over 10% accuracy improvements in interactive DDx across both large and small LLMs, while offering critical explainability into its diagnostic reasoning process.

疾病诊断可解释AILLM应用医疗智能体

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