将症状理解与诊断推理分离,提升AI医疗系统的可靠性与可解释性
SymptomWise: A Deterministic Reasoning Layer for Reliable and Efficient AI Systems
- 用确定性推理模块处理症状,避免生成式模型的幻觉
- 在42个儿科神经病例中,正确诊断前五名覆盖率达88%
- 适合对安全性和可追溯性要求高的临床决策场景
基于AI的症状分析系统在可靠性、可解释性和幻觉问题上面临持续挑战。端到端生成方法常缺乏可追溯性,在关键安全场景下可能产生无依据或不一致的诊断结果。我们提出SymptomWise框架,将语言理解与诊断推理分离。系统结合专家整理的医学知识、确定性Codex驱动的推理机制以及受限使用的大型语言模型。自由文本输入被映射为验证过的症状表示,再由在有限假设空间内运行的确定性推理模块评估,生成排序后的鉴别诊断列表。语言模型仅用于症状提取和可选解释,不参与诊断推断。该架构提升了可追溯性,减少了无支持结论,并支持组件的模块化评估。在42例专家编写的复杂儿科神经学病例中的初步评估显示,与临床医生共识有显著重叠,正确诊断出现在前五名鉴别诊断中的比例达88%。该框架还可推广至其他归纳推理领域,有望作为基础模型的确定性结构与路由层,提升精度并降低特定任务的计算开销。
原文摘要 · Abstract (English)
AI-driven symptom analysis systems face persistent challenges in reliability, interpretability, and hallucination. End-to-end generative approaches often lack traceability and may produce unsupported or inconsistent diagnostic outputs in safety-critical settings. We present SymptomWise, a framework that separates language understanding from diagnostic reasoning. The system combines expert-curated medical knowledge, deterministic codex-driven inference, and constrained use of large language models. Free-text input is mapped to validated symptom representations, then evaluated by a deterministic reasoning module operating over a finite hypothesis space to produce a ranked differential diagnosis. Language models are used only for symptom extraction and optional explanation, not for diagnostic inference. This architecture improves traceability, reduces unsupported conclusions, and enables modular evaluation of system components. Preliminary evaluation on 42 expert-authored challenging pediatric neurology cases shows meaningful overlap with clinician consensus, with the correct diagnosis appearing in the top five differentials in 88% of cases. Beyond medicine, the framework generalizes to other abductive reasoning domains and may serve as a deterministic structuring and routing layer for foundation models, improving precision and potentially reducing unnecessary computational overhead in bounded tasks.
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