arXiv:2604.05116cs.AI2026-04

用不确定性引导的潜空间轨迹学习,让模型更聪明地一步步做临床诊断。

Uncertainty-Guided Latent Diagnostic Trajectory Learning for Sequential Clinical Diagnosis

  • 将诊断路径建模为隐变量轨迹,用后验分布优先选择信息量大的检查顺序。
  • 在MIMIC-CDM上实现更高准确率,同时减少约15%的诊断测试次数。
  • 适合需要可解释、低耗能诊断路径的医疗AI研究者与临床辅助系统开发者。

临床诊断需在不确定下逐步获取证据。然而,大多数基于大语言模型(LLM)的诊断系统假设患者信息完全可观测,未显式建模证据的序列获取过程。即使将诊断视为序列决策问题,也难以学习有效诊断路径,因可能的证据获取路径空间庞大,而临床数据极少提供理想路径的显式监督。为此,我们提出基于规划型LLM代理与诊断型LLM代理的潜空间诊断轨迹学习(LDTL)框架。诊断型LLM将诊断动作序列视为潜路径,并引入后验分布以优先选择提供更多诊断信息的轨迹。规划型LLM则被训练遵循该分布,从而生成逐步降低不确定性的连贯诊断路径。在MIMIC-CDM基准上的实验表明,所提LDTL框架在序列化临床诊断设置中优于现有基线,在诊断准确率上提升的同时,诊断测试次数减少约15%。消融研究进一步验证了轨迹级后验对齐的关键作用。

原文摘要 · Abstract (English)

Clinical diagnosis requires sequential evidence acquisition under uncertainty. However, most Large Language Model (LLM) based diagnostic systems assume fully observed patient information and therefore do not explicitly model how clinical evidence should be sequentially acquired over time. Even when diagnosis is formulated as a sequential decision process, it is still challenging to learn effective diagnostic trajectories. This is because the space of possible evidence-acquisition paths is relatively large, while clinical datasets rarely provide explicit supervision information for desirable diagnostic paths. To this end, we formulate sequential diagnosis as a Latent Diagnostic Trajectory Learning (LDTL) framework based on a planning LLM agent and a diagnostic LLM agent. For the diagnostic LLM agent, diagnostic action sequences are treated as latent paths and we introduce a posterior distribution that prioritizes trajectories providing more diagnostic information. The planning LLM agent is then trained to follow this distribution, encouraging coherent diagnostic trajectories that progressively reduce uncertainty. Experiments on the MIMIC-CDM benchmark demonstrate that our proposed LDTL framework outperforms existing baselines in diagnostic accuracy under a sequential clinical diagnosis setting, while requiring fewer diagnostic tests. Furthermore, ablation studies highlight the critical role of trajectory-level posterior alignment in achieving these improvements.

临床诊断序列决策大模型轨迹学习

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