用强化学习让大模型学会解释小模型的诊断逻辑,提升医疗决策可读性。
CANDLE: A Cross-Modal Agentic Knowledge Distillation Framework for Interpretable Sarcopenia Diagnosis
- 用SHAP值将传统模型推理转为大模型可理解的结构化知识
- 通过强化学习训练大模型生成可信诊断理由并提高准确率
- 适合需要透明、可复现医疗决策的临床场景
大型语言模型(LLMs)在海量文本和网络数据上学习后展现出卓越的泛化与迁移能力,其语义表征支持跨任务知识迁移与推理,为数据稀疏且异构的临床医学领域带来新机遇。然而,在肌肉减少症等诊断任务中,仍面临可解释性、透明度和部署效率等挑战。传统机器学习(TML)模型性能稳定且具备特征级归因能力,决策逻辑可追溯、可审计,但缺乏语义广度;而大模型虽能灵活推理,却常作为黑箱预测器。现有融合策略多停留于表面,极少将TML的结构化推理嵌入大模型推理过程。本研究以肌肉减少症诊断为例,从基准XGBoost模型提取SHapley Additive exPlanations(SHAP)值,并转化为大模型兼容的结构化表示。采用基于演员-评论家的强化学习(RL)策略,引导大模型基于这些SHAP输入进行推理,生成校准后的推理过程与优化决策规则。提炼出的推理知识被整合为结构化知识库,并通过检索增强生成(RAG)机制实现案例导向的推理部署。结果表明,该框架有效缓解了可解释性与性能之间的权衡,提升了预测准确率并保持高决策一致性。该方法为传统机器学习模型的知识资产化提供了可扩展路径,可在肌肉减少症乃至更广泛的医疗领域实现可解释、可复现、符合临床需求的决策支持。
原文摘要 · Abstract (English)
Background and Aims: Large language models (LLMs) have shown remarkable generalization and transfer capabilities by learning from vast corpora of text and web data. Their semantic representations allow cross-task knowledge transfer and reasoning, offering promising opportunities for data-scarce and heterogeneous domains such as clinical medicine. Yet, in diagnostic tasks like sarcopenia, major challenges remain: interpretability, transparency, and deployment efficiency. Traditional machine learning (TML) models provide stable performance and feature-level attribution, ensuring traceable and auditable decision logic, but lack semantic breadth. Conversely, LLMs enable flexible inference but often function as opaque predictors. Existing integration strategies remain shallow, rarely embedding the structured reasoning of TML into LLM inference. Methods: Using sarcopenia diagnosis as a case study, SHapley Additive exPlanations (SHAP) were extracted from a baseline XGBoost model and transformed into structured, LLM-compatible representations. An actor-critic reinforcement learning (RL) strategy guided the LLM to reason over these SHAP-based inputs, producing calibrated rationales and refined decision rules. The distilled reasoning was consolidated into a structured knowledge repository and deployed via retrieval-augmented generation (RAG) for case-based inference. Results: (Omitted here.) Conclusion: By coupling SHAP-derived statistical evidence with reinforcement-trained LLM reasoning, CANDLE mitigates the interpretability-performance trade-off, enhances predictive accuracy, and preserves high decision consistency. The framework offers a scalable approach to knowledge assetization of TML models, enabling interpretable, reproducible, and clinically aligned decision support in sarcopenia and potentially broader medical domains.
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