Xiaohao Mao

Xuanzhong Chen, Xiaohao Mao, Qihan Guo et al.

Generalist Large Language Models (LLMs), such as GPT-4, have shown considerable promise in various domains, including medical diagnosis. Rare diseases, affecting approximately 300 million people worldwide, often have unsatisfactory clinical diagnosis rates primarily due to a lack of experienced physicians and the complexity of differentiating among many rare diseases. In this context, recent news such as "ChatGPT correctly diagnosed a 4-year-old's rare disease after 17 doctors failed" underscore LLMs' potential, yet underexplored, role in clinically diagnosing rare diseases. To bridge this research gap, we introduce RareBench, a pioneering benchmark designed to systematically evaluate the capabilities of LLMs on 4 critical dimensions within the realm of rare diseases. Meanwhile, we have compiled the largest open-source dataset on rare disease patients, establishing a benchmark for future studies in this domain. To facilitate differential diagnosis of rare diseases, we develop a dynamic few-shot prompt methodology, leveraging a comprehensive rare disease knowledge graph synthesized from multiple knowledge bases, significantly enhancing LLMs' diagnostic performance. Moreover, we present an exhaustive comparative study of GPT-4's diagnostic capabilities against those of specialist physicians. Our experimental findings underscore the promising potential of integrating LLMs into the clinical diagnostic process for rare diseases. This paves the way for exciting possibilities in future advancements in this field.

Xuanzhong Chen, Ye Jin, Xiaohao Mao et al.

Rare diseases, despite their low individual incidence, collectively impact around 300 million people worldwide due to the vast number of diseases. The involvement of multiple organs and systems, and the shortage of specialized doctors with relevant experience, make diagnosing and treating rare diseases more challenging than common diseases. Recently, agents powered by large language models (LLMs) have demonstrated notable applications across various domains. In the medical field, some agent methods have outperformed direct prompts in question-answering tasks from medical examinations. However, current agent frameworks are not well-adapted to real-world clinical scenarios, especially those involving the complex demands of rare diseases. To bridge this gap, we introduce RareAgents, the first LLM-driven multi-disciplinary team decision-support tool designed specifically for the complex clinical context of rare diseases. RareAgents integrates advanced Multidisciplinary Team (MDT) coordination, memory mechanisms, and medical tools utilization, leveraging Llama-3.1-8B/70B as the base model. Experimental results show that RareAgents outperforms state-of-the-art domain-specific models, GPT-4o, and current agent frameworks in diagnosis and treatment for rare diseases. Furthermore, we contribute a novel rare disease dataset, MIMIC-IV-Ext-Rare, to facilitate further research in this field.

Weijie He, Xiaohao Mao, Chao Ma et al.

A growing number of people are seeking healthcare advice online. Usually, they diagnose their medical conditions based on the symptoms they are experiencing, which is also known as self-diagnosis. From the machine learning perspective, online disease diagnosis is a sequential feature (symptom) selection and classification problem. Reinforcement learning (RL) methods are the standard approaches to this type of tasks. Generally, they perform well when the feature space is small, but frequently become inefficient in tasks with a large number of features, such as the self-diagnosis. To address the challenge, we propose a non-RL Bipartite Scalable framework for Online Disease diAgnosis, called BSODA. BSODA is composed of two cooperative branches that handle symptom-inquiry and disease-diagnosis, respectively. The inquiry branch determines which symptom to collect next by an information-theoretic reward. We employ a Product-of-Experts encoder to significantly improve the handling of partial observations of a large number of features. Besides, we propose several approximation methods to substantially reduce the computational cost of the reward to a level that is acceptable for online services. Additionally, we leverage the diagnosis model to estimate the reward more precisely. For the diagnosis branch, we use a knowledge-guided self-attention model to perform predictions. In particular, BSODA determines when to stop inquiry and output predictions using both the inquiry and diagnosis models. We demonstrate that BSODA outperforms the state-of-the-art methods on several public datasets. Moreover, we propose a novel evaluation method to test the transferability of symptom checking methods from synthetic to real-world tasks. Compared to existing RL baselines, BSODA is more effectively scalable to large search spaces.