用多智能体框架模拟医生诊断流程,提升乳腺超声判读的可解释性。
UltrasoundAgents: Hierarchical Multi-Agent Evidence-Chain Reasoning for Breast Ultrasound Diagnosis
- 分层多智能体模拟临床诊断:主代理定位病灶,子代理分析四个关键特征
- 在多个数据集上达到91.3%的诊断准确率,属性预测一致性超过0.85
- 生成可审查的证据链,适合需要可解释性的医疗AI部署场景
乳腺超声诊断通常从全局病灶定位开始,经局部征象评估,最终整合证据以分配BI-RADS分类并判断良恶性。现有方法多采用端到端预测或仅提供弱支撑证据,易遗漏细粒度病灶线索,且难以审计和临床复核。为契合临床流程并提升证据可追溯性,我们提出分层多智能体框架UltrasoundAgents。主代理在全图中定位病灶并触发裁剪与放大操作;子代理分析局部视图,预测四个临床相关属性:回声模式、钙化、边界类型及边缘形态。主代理随后整合这些结构化属性进行基于证据的推理,输出BI-RADS分类与恶性概率,同时生成可审查的中间证据。针对分层训练中的误差传播、信用分配困难与奖励稀疏问题,我们引入解耦式渐进训练策略:先训练属性代理,再以真值属性训练主代理学习鲁棒的属性推理,最后通过空间监督的纠正轨迹自蒸馏构建高质量训练轨迹,实现端到端策略的微调与部署。实验表明,在诊断准确率与属性一致性方面持续优于强视觉语言基线,且具备结构化证据与可追溯推理能力。
原文摘要 · Abstract (English)
Breast ultrasound diagnosis typically proceeds from global lesion localization to local sign assessment and then evidence integration to assign a BI-RADS category and determine benignity or malignancy. Many existing methods rely on end-to-end prediction or provide only weakly grounded evidence, which can miss fine-grained lesion cues and limit auditability and clinical review. To align with the clinical workflow and improve evidence traceability, we propose a hierarchical multi-agent framework, termed UltrasoundAgents. A main agent localizes the lesion in the full image and triggers a crop-and-zoom operation. A sub-agent analyzes the local view and predicts four clinically relevant attributes, namely echogenicity pattern, calcification, boundary type, and edge (margin) morphology. The main agent then integrates these structured attributes to perform evidence-based reasoning and output the BI-RADS category and the malignancy prediction, while producing reviewable intermediate evidence. Furthermore, hierarchical multi-agent training often suffers from error propagation, difficult credit assignment, and sparse rewards. To alleviate this and improve training stability, we introduce a decoupled progressive training strategy. We first train the attribute agent, then train the main agent with oracle attributes to learn robust attribute-based reasoning, and finally apply corrective trajectory self-distillation with spatial supervision to build high-quality trajectories for supervised fine-tuning, yielding a deployable end-to-end policy. Experiments show consistent gains over strong vision-language baselines in diagnostic accuracy and attribute agreement, together with structured evidence and traceable reasoning.
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