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arXiv 2509.06409cs.AI

利用报告引导的思维链学习教授AI逐步诊断推理

Teaching AI Stepwise Diagnostic Reasoning with Report-Guided Chain-of-Thought Learning

Fujian University of Technology(福建工程学院);Fujian Provincial Key Laboratory of Big Data Mining and Applications(福建省大数据挖掘与应用重点实验室);Key Laboratory of Biomedical Imaging Science and System, Chinese Academy of Sciences(生物医学成像科学与系统重点实验室,中国科学院)

Yihong Luo, Wenwu He, Zhuo-Xu Cui, Dong Liang

AI总结:

本文提出DiagCoT框架,通过对比调优、思维链监督和强化调优,将放射报告转化为结构化监督,显著提升VLM在胸部X光诊断中的分类、定位和报告生成性能。

摘要:

本研究提出了DiagCoT,一个多阶段框架,将监督微调应用于通用视觉语言模型(VLMs),仅利用自由文本报告来模拟放射科医生的逐步诊断推理。DiagCoT结合了用于领域对齐的对比图像-报告调优、用于捕捉推理逻辑的思维链监督,以及带有临床奖励信号的强化调优,以增强事实准确性和流畅性。在MIMIC-CXR基准上,DiagCoT将零样本疾病分类AUC从0.52提升至0.76(绝对增益0.24),病理定位mIoU从0.08提升至0.31(绝对增益0.23),报告生成BLEU从0.11提升至0.33(绝对增益0.22)。在长尾疾病和外部数据集上,它优于包括LLaVA-Med和CXR-LLAVA在内的最先进模型。通过将非结构化的临床叙述转化为结构化监督,DiagCoT为开发可解释且具有诊断能力的放射学AI系统提供了一种可扩展的方法。

英文摘要:

This study presents DiagCoT, a multi-stage framework that applies supervised fine-tuning to general-purpose vision-language models (VLMs) to emulate radiologists' stepwise diagnostic reasoning using only free-text reports. DiagCoT combines contrastive image-report tuning for domain alignment, chain-of-thought supervision to capture inferential logic, and reinforcement tuning with clinical reward signals to enhance factual accuracy and fluency. On the MIMIC-CXR benchmark, DiagCoT improved zero-shot disease classification AUC from 0.52 to 0.76 (absolute gain of 0.24), pathology grounding mIoU from 0.08 to 0.31 (absolute gain of 0.23), and report generation BLEU from 0.11 to 0.33 (absolute gain of 0.22). It outperformed state-of-the-art models including LLaVA-Med and CXR-LLAVA on long-tailed diseases and external datasets. By converting unstructured clinical narratives into structured supervision, DiagCoT offers a scalable approach for developing interpretable and diagnostically competent AI systems for radiology.

机构、总结、中文摘要均由AI分析而来,可能存在错误,请以论文正文为准。

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