Michele Caprio, David Stutz, Shuo Li, Arnaud Doucet
An open question in \emph{Imprecise Probabilistic Machine Learning} is how to empirically derive a credal region (i.e., a closed and convex family of probabilities on the output space) from the available data, without any prior knowledge or assumption. In classification problems, credal regions are a tool that is able to provide provable guarantees under realistic assumptions by characterizing the uncertainty about the distribution of the labels. Building on previous work, we show that credal regions can be directly constructed using conformal methods. This allows us to provide a novel extension of classical conformal prediction to problems with ambiguous ground truth, that is, when the exact labels for given inputs are not exactly known. The resulting construction enjoys desirable practical and theoretical properties: (i) conformal coverage guarantees, (ii) smaller prediction sets (compared to classical conformal prediction regions) and (iii) disentanglement of uncertainty sources (epistemic, aleatoric). We empirically verify our findings on both synthetic and real datasets.
Peter Brodeur, Jacob M. Koshy, Anil Palepu, Khaled Saab, Ava Homiar, Roma Ruparel, Charles Wu, Ryutaro Tanno 等 48 位作者
Large language model (LLM)-based AI systems have shown promise for patient-facing diagnostic and management conversations in simulated settings. Translating these systems into clinical practice requires assessment in real-world workflows with rigorous safety oversight. We report a prospective, single-arm feasibility study of an LLM-based conversational AI, the Articulate Medical Intelligence Explorer (AMIE), conducting clinical history taking and presentation of potential diagnoses for patients to discuss with their provider at urgent care appointments at a leading academic medical center. 100 adult patients completed an AMIE text-chat interaction up to 5 days before their appointment. We sought to assess the conversational safety and quality, patient and clinician experience, and clinical reasoning capabilities compared to primary care providers (PCPs). Human safety supervisors monitored all patient-AMIE interactions in real time and did not need to intervene to stop any consultations based on pre-defined criteria. Patients reported high satisfaction and their attitudes towards AI improved after interacting with AMIE (p < 0.001). PCPs found AMIE's output useful with a positive impact on preparedness. AMIE's differential diagnosis (DDx) included the final diagnosis, per chart review 8 weeks post-encounter, in 90% of cases, with 75% top-3 accuracy. Blinded assessment of AMIE and PCP DDx and management (Mx) plans suggested similar overall DDx and Mx plan quality, without significant differences for DDx (p = 0.6) and appropriateness and safety of Mx (p = 0.1 and 1.0, respectively). PCPs outperformed AMIE in the practicality (p = 0.003) and cost effectiveness (p = 0.004) of Mx. While further research is needed, this study demonstrates the initial feasibility, safety, and user acceptance of conversational AI in a real-world setting, representing crucial steps towards clinical translation.
Mertcan Sevgi, Fares Antaki, Abdullah Zafar Khan, Ariel Yuhan Ong, David Adrian Merle, Kuang Hu, Shafi Balal, Sophie-Christin Kornelia Ernst 等 29 位作者
Vision impairment and blindness are a major global health challenge where gaps in the ophthalmology workforce limit access to specialist care. We evaluate AMIE, a medically fine-tuned conversational system based on Gemini with integrated web search and self-critique reasoning, using real-world clinical vignettes that reflect scenarios a general ophthalmologist would be expected to manage. We conducted two complementary evaluations: (1) a human-AI interactive diagnostic reasoning study in which ophthalmologists recorded initial differentials and plans, then reviewed AMIE's structured output and revised their answers; and (2) a masked preference and quality study comparing AMIE's narrative outputs with case author reference answers using a predefined rubric. AMIE showed standalone diagnostic performance comparable to clinicians at baseline. Crucially, after reviewing AMIE's responses, ophthalmologists tended to rank the correct diagnosis higher, reached greater agreement with one another, and enriched their investigation and management plans. Improvements were observed even when AMIE's top choice differed from or underperformed the clinician baseline, consistent with a complementary effect in which structured reasoning support helps clinicians re-rank rather than simply accept the model output. Preferences varied by clinical grade, suggesting opportunities to personalise responses by experience. Without ophthalmology-specific fine-tuning, AMIE matched clinician baseline and augmented clinical reasoning at the point of need, motivating multi-axis evaluation, domain adaptation, and prospective multimodal studies in real-world settings.
Anil Palepu, Valentin Liévin, Wei-Hung Weng, Khaled Saab, David Stutz, Yong Cheng, Kavita Kulkarni, S. Sara Mahdavi 等 20 位作者
While large language models (LLMs) have shown promise in diagnostic dialogue, their capabilities for effective management reasoning - including disease progression, therapeutic response, and safe medication prescription - remain under-explored. We advance the previously demonstrated diagnostic capabilities of the Articulate Medical Intelligence Explorer (AMIE) through a new LLM-based agentic system optimised for clinical management and dialogue, incorporating reasoning over the evolution of disease and multiple patient visit encounters, response to therapy, and professional competence in medication prescription. To ground its reasoning in authoritative clinical knowledge, AMIE leverages Gemini's long-context capabilities, combining in-context retrieval with structured reasoning to align its output with relevant and up-to-date clinical practice guidelines and drug formularies. In a randomized, blinded virtual Objective Structured Clinical Examination (OSCE) study, AMIE was compared to 21 primary care physicians (PCPs) across 100 multi-visit case scenarios designed to reflect UK NICE Guidance and BMJ Best Practice guidelines. AMIE was non-inferior to PCPs in management reasoning as assessed by specialist physicians and scored better in both preciseness of treatments and investigations, and in its alignment with and grounding of management plans in clinical guidelines. To benchmark medication reasoning, we developed RxQA, a multiple-choice question benchmark derived from two national drug formularies (US, UK) and validated by board-certified pharmacists. While AMIE and PCPs both benefited from the ability to access external drug information, AMIE outperformed PCPs on higher difficulty questions. While further research would be needed before real-world translation, AMIE's strong performance across evaluations marks a significant step towards conversational AI as a tool in disease management.
Disentangling Adversarial Robustness and Generalization
David Stutz, Matthias Hein, Bernt Schiele
AI 速览：论文通过假设低维数据流形，论证对抗鲁棒性与泛化性并非必然冲突，并区分流形外与流形上对抗样本。
Obtaining deep networks that are robust against adversarial examples and generalize well is an open problem. A recent hypothesis even states that both robust and accurate models are impossible, i.e., adversarial robustness and generalization are conflicting goals. In an effort to clarify the relationship between robustness and generalization, we assume an underlying, low-dimensional data manifold and show that: 1. regular adversarial examples leave the manifold; 2. adversarial examples constrained to the manifold, i.e., on-manifold adversarial examples, exist; 3. on-manifold adversarial examples are generalization errors, and on-manifold adversarial training boosts generalization; 4. regular robustness and generalization are not necessarily contradicting goals. These assumptions imply that both robust and accurate models are possible. However, different models (architectures, training strategies etc.) can exhibit different robustness and generalization characteristics. To confirm our claims, we present extensive experiments on synthetic data (with known manifold) as well as on EMNIST, Fashion-MNIST and CelebA.