Bhawesh Kumar, Anil Palepu, Rudraksh Tuwani, Andrew Beam
Self-supervised models trained with a contrastive loss such as CLIP have shown to be very powerful in zero-shot classification settings. However, to be used as a zero-shot classifier these models require the user to provide new captions over a fixed set of labels at test time. In many settings, it is hard or impossible to know if a new query caption is compatible with the source captions used to train the model. We address these limitations by framing the zero-shot classification task as an outlier detection problem and develop a conformal prediction procedure to assess when a given test caption may be reliably used. On a real-world medical example, we show that our proposed conformal procedure improves the reliability of CLIP-style models in the zero-shot classification setting, and we provide an empirical analysis of the factors that may affect its performance.
Bhawesh Kumar, Charlie Lu, Gauri Gupta, Anil Palepu, David Bellamy, Ramesh Raskar, Andrew Beam
As large language models continue to be widely developed, robust uncertainty quantification techniques will become crucial for their safe deployment in high-stakes scenarios. In this work, we explore how conformal prediction can be used to provide uncertainty quantification in language models for the specific task of multiple-choice question-answering. We find that the uncertainty estimates from conformal prediction are tightly correlated with prediction accuracy. This observation can be useful for downstream applications such as selective classification and filtering out low-quality predictions. We also investigate the exchangeability assumption required by conformal prediction to out-of-subject questions, which may be a more realistic scenario for many practical applications. Our work contributes towards more trustworthy and reliable usage of large language models in safety-critical situations, where robust guarantees of error rate are required.
Anil Palepu, Andrew L Beam
Deep learning models trained in a fully supervised manner have been shown to rely on so-called "shortcut" features. Shortcut features are inputs that are associated with the outcome of interest in the training data, but are either no longer associated or not present in testing or deployment settings. Here we provide experiments that show recent self-supervised models trained on images and text provide more robust image representations and reduce the model's reliance on visual shortcut features on a realistic medical imaging example. Additionally, we find that these self-supervised models "forget" shortcut features more quickly than fully supervised ones when fine-tuned on labeled data. Though not a complete solution, our experiments provide compelling evidence that self-supervised models trained on images and text provide some resilience to visual shortcut features.
Tao Tu, Anil Palepu, Mike Schaekermann, Khaled Saab, Jan Freyberg, Ryutaro Tanno, Amy Wang, Brenna Li, Mohamed Amin, Nenad Tomasev, Shekoofeh Azizi, Karan Singhal, Yong Cheng, Le Hou, Albert Webson, Kavita Kulkarni, S Sara Mahdavi, Christopher Semturs, Juraj Gottweis, Joelle Barral, Katherine Chou, Greg S Corrado, Yossi Matias, Alan Karthikesalingam, Vivek Natarajan
At the heart of medicine lies the physician-patient dialogue, where skillful history-taking paves the way for accurate diagnosis, effective management, and enduring trust. Artificial Intelligence (AI) systems capable of diagnostic dialogue could increase accessibility, consistency, and quality of care. However, approximating clinicians' expertise is an outstanding grand challenge. Here, we introduce AMIE (Articulate Medical Intelligence Explorer), a Large Language Model (LLM) based AI system optimized for diagnostic dialogue. AMIE uses a novel self-play based simulated environment with automated feedback mechanisms for scaling learning across diverse disease conditions, specialties, and contexts. We designed a framework for evaluating clinically-meaningful axes of performance including history-taking, diagnostic accuracy, management reasoning, communication skills, and empathy. We compared AMIE's performance to that of primary care physicians (PCPs) in a randomized, double-blind crossover study of text-based consultations with validated patient actors in the style of an Objective Structured Clinical Examination (OSCE). The study included 149 case scenarios from clinical providers in Canada, the UK, and India, 20 PCPs for comparison with AMIE, and evaluations by specialist physicians and patient actors. AMIE demonstrated greater diagnostic accuracy and superior performance on 28 of 32 axes according to specialist physicians and 24 of 26 axes according to patient actors. Our research has several limitations and should be interpreted with appropriate caution. Clinicians were limited to unfamiliar synchronous text-chat which permits large-scale LLM-patient interactions but is not representative of usual clinical practice. While further research is required before AMIE could be translated to real-world settings, the results represent a milestone towards conversational diagnostic AI.
Anil Palepu, Andrew L. Beam
In this paper, we introduce a novel regularization scheme on contrastive language-image pre-trained (CLIP) medical vision models. Our approach is based on the observation that on many medical imaging tasks text tokens should only describe a small number of image regions and, likewise, each image region should correspond to only a few text tokens. In CLIP-style models, this implies that text-token embeddings should have high similarity to only a small number of image-patch embeddings for a given image-text pair. We formalize this observation using a novel regularization scheme that penalizes the entropy of the text-token to image-patch similarity scores. We qualitatively and quantitatively demonstrate that the proposed regularization scheme shrinks most of the pairwise text-token and image-patch similarity scores towards zero, thus achieving the desired effect. We demonstrate the promise of our approach in an important medical context, chest x-rays, where this underlying sparsity hypothesis naturally arises. Using our proposed approach, we achieve state of the art (SOTA) average zero-shot performance on the CheXpert and Padchest chest x-ray datasets, outperforming an unregularized version of the model and several recently published self-supervised models.
Daniel McDuff, Mike Schaekermann, Tao Tu, Anil Palepu, Amy Wang, Jake Garrison, Karan Singhal, Yash Sharma, Shekoofeh Azizi, Kavita Kulkarni, Le Hou, Yong Cheng, Yun Liu, S Sara Mahdavi, Sushant Prakash, Anupam Pathak, Christopher Semturs, Shwetak Patel, Dale R Webster, Ewa Dominowska, Juraj Gottweis, Joelle Barral, Katherine Chou, Greg S Corrado, Yossi Matias, Jake Sunshine, Alan Karthikesalingam, Vivek Natarajan
An accurate differential diagnosis (DDx) is a cornerstone of medical care, often reached through an iterative process of interpretation that combines clinical history, physical examination, investigations and procedures. Interactive interfaces powered by Large Language Models (LLMs) present new opportunities to both assist and automate aspects of this process. In this study, we introduce an LLM optimized for diagnostic reasoning, and evaluate its ability to generate a DDx alone or as an aid to clinicians. 20 clinicians evaluated 302 challenging, real-world medical cases sourced from the New England Journal of Medicine (NEJM) case reports. Each case report was read by two clinicians, who were randomized to one of two assistive conditions: either assistance from search engines and standard medical resources, or LLM assistance in addition to these tools. All clinicians provided a baseline, unassisted DDx prior to using the respective assistive tools. Our LLM for DDx exhibited standalone performance that exceeded that of unassisted clinicians (top-10 accuracy 59.1% vs 33.6%, [p = 0.04]). Comparing the two assisted study arms, the DDx quality score was higher for clinicians assisted by our LLM (top-10 accuracy 51.7%) compared to clinicians without its assistance (36.1%) (McNemar's Test: 45.7, p < 0.01) and clinicians with search (44.4%) (4.75, p = 0.03). Further, clinicians assisted by our LLM arrived at more comprehensive differential lists than those without its assistance. Our study suggests that our LLM for DDx has potential to improve clinicians' diagnostic reasoning and accuracy in challenging cases, meriting further real-world evaluation for its ability to empower physicians and widen patients' access to specialist-level expertise.
Jack W. O'Sullivan, Anil Palepu, Khaled Saab, Wei-Hung Weng, Yong Cheng, Emily Chu, Yaanik Desai, Aly Elezaby, Daniel Seung Kim, Roy Lan, Wilson Tang, Natalie Tapaskar, Victoria Parikh, Sneha S. Jain, Kavita Kulkarni, Philip Mansfield, Dale Webster, Juraj Gottweis, Joelle Barral, Mike Schaekermann, Ryutaro Tanno, S. Sara Mahdavi, Vivek Natarajan, Alan Karthikesalingam, Euan Ashley, Tao Tu
The scarcity of subspecialist medical expertise, particularly in rare, complex and life-threatening diseases, poses a significant challenge for healthcare delivery. This issue is particularly acute in cardiology where timely, accurate management determines outcomes. We explored the potential of AMIE (Articulate Medical Intelligence Explorer), a large language model (LLM)-based experimental AI system optimized for diagnostic dialogue, to potentially augment and support clinical decision-making in this challenging context. We curated a real-world dataset of 204 complex cases from a subspecialist cardiology practice, including results for electrocardiograms, echocardiograms, cardiac MRI, genetic tests, and cardiopulmonary stress tests. We developed a ten-domain evaluation rubric used by subspecialists to evaluate the quality of diagnosis and clinical management plans produced by general cardiologists or AMIE, the latter enhanced with web-search and self-critique capabilities. AMIE was rated superior to general cardiologists for 5 of the 10 domains (with preference ranging from 9% to 20%), and equivalent for the rest. Access to AMIE's response improved cardiologists' overall response quality in 63.7% of cases while lowering quality in just 3.4%. Cardiologists' responses with access to AMIE were superior to cardiologist responses without access to AMIE for all 10 domains. Qualitative examinations suggest AMIE and general cardiologist could complement each other, with AMIE thorough and sensitive, while general cardiologist concise and specific. Overall, our results suggest that specialized medical LLMs have the potential to augment general cardiologists' capabilities by bridging gaps in subspecialty expertise, though further research and validation are essential for wide clinical utility.
Anil Palepu, Vikram Dhillon, Polly Niravath, Wei-Hung Weng, Preethi Prasad, Khaled Saab, Ryutaro Tanno, Yong Cheng, Hanh Mai, Ethan Burns, Zainub Ajmal, Kavita Kulkarni, Philip Mansfield, Dale Webster, Joelle Barral, Juraj Gottweis, Mike Schaekermann, S. Sara Mahdavi, Vivek Natarajan, Alan Karthikesalingam, Tao Tu
Large language models (LLMs) have shown remarkable progress in encoding clinical knowledge and responding to complex medical queries with appropriate clinical reasoning. However, their applicability in subspecialist or complex medical settings remains underexplored. In this work, we probe the performance of AMIE, a research conversational diagnostic AI system, in the subspecialist domain of breast oncology care without specific fine-tuning to this challenging domain. To perform this evaluation, we curated a set of 50 synthetic breast cancer vignettes representing a range of treatment-naive and treatment-refractory cases and mirroring the key information available to a multidisciplinary tumor board for decision-making (openly released with this work). We developed a detailed clinical rubric for evaluating management plans, including axes such as the quality of case summarization, safety of the proposed care plan, and recommendations for chemotherapy, radiotherapy, surgery and hormonal therapy. To improve performance, we enhanced AMIE with the inference-time ability to perform web search retrieval to gather relevant and up-to-date clinical knowledge and refine its responses with a multi-stage self-critique pipeline. We compare response quality of AMIE with internal medicine trainees, oncology fellows, and general oncology attendings under both automated and specialist clinician evaluations. In our evaluations, AMIE outperformed trainees and fellows demonstrating the potential of the system in this challenging and important domain. We further demonstrate through qualitative examples, how systems such as AMIE might facilitate conversational interactions to assist clinicians in their decision making. However, AMIE's performance was overall inferior to attending oncologists suggesting that further research is needed prior to consideration of prospective uses.
Peter Brodeur, Jacob M. Koshy, Anil Palepu, Khaled Saab, Ava Homiar, Roma Ruparel, Charles Wu, Ryutaro Tanno, Joseph Xu, Amy Wang, David Stutz, Wei-Hung Weng, Hannah M. Ferrera, David Barrett, Lindsey Crowley, Jihyeon Lee, Spencer E. Rittner, Ellery Wulczyn, Selena K. Zhang, Elahe Vedadi, Christine G. Kohn, Kavita Kulkarni, Vinay Kadiyala, Sara Mahdavi, Wendy Du, Jessica M. Williams, David Feinbloom, Renee Wong, Tao Tu, Petar Sirkovic, Alessio Orlandi, Christopher Semturs, Yun Liu, Juraj Gottweis, Dale R. Webster, Joëlle Barral, Katherine Chou, Pushmeet Kohli, Avinatan Hassidim, Yossi Matias, James Manyika, Rob Fields, Jonathan X. Li, Marc L. Cohen, Vivek Natarajan, Mike Schaekermann, Alan Karthikesalingam, Adam Rodman
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.
Khaled Saab, Tao Tu, Wei-Hung Weng, Ryutaro Tanno, David Stutz, Ellery Wulczyn, Fan Zhang, Tim Strother, Chunjong Park, Elahe Vedadi, Juanma Zambrano Chaves, Szu-Yeu Hu, Mike Schaekermann, Aishwarya Kamath, Yong Cheng, David G. T. Barrett, Cathy Cheung, Basil Mustafa, Anil Palepu, Daniel McDuff, Le Hou, Tomer Golany, Luyang Liu, Jean-baptiste Alayrac, Neil Houlsby, Nenad Tomasev, Jan Freyberg, Charles Lau, Jonas Kemp, Jeremy Lai, Shekoofeh Azizi, Kimberly Kanada, SiWai Man, Kavita Kulkarni, Ruoxi Sun, Siamak Shakeri, Luheng He, Ben Caine, Albert Webson, Natasha Latysheva, Melvin Johnson, Philip Mansfield, Jian Lu, Ehud Rivlin, Jesper Anderson, Bradley Green, Renee Wong, Jonathan Krause, Jonathon Shlens, Ewa Dominowska, S. M. Ali Eslami, Katherine Chou, Claire Cui, Oriol Vinyals, Koray Kavukcuoglu, James Manyika, Jeff Dean, Demis Hassabis, Yossi Matias, Dale Webster, Joelle Barral, Greg Corrado, Christopher Semturs, S. Sara Mahdavi, Juraj Gottweis, Alan Karthikesalingam, Vivek Natarajan
Excellence in a wide variety of medical applications poses considerable challenges for AI, requiring advanced reasoning, access to up-to-date medical knowledge and understanding of complex multimodal data. Gemini models, with strong general capabilities in multimodal and long-context reasoning, offer exciting possibilities in medicine. Building on these core strengths of Gemini, we introduce Med-Gemini, a family of highly capable multimodal models that are specialized in medicine with the ability to seamlessly use web search, and that can be efficiently tailored to novel modalities using custom encoders. We evaluate Med-Gemini on 14 medical benchmarks, establishing new state-of-the-art (SoTA) performance on 10 of them, and surpass the GPT-4 model family on every benchmark where a direct comparison is viable, often by a wide margin. On the popular MedQA (USMLE) benchmark, our best-performing Med-Gemini model achieves SoTA performance of 91.1% accuracy, using a novel uncertainty-guided search strategy. On 7 multimodal benchmarks including NEJM Image Challenges and MMMU (health & medicine), Med-Gemini improves over GPT-4V by an average relative margin of 44.5%. We demonstrate the effectiveness of Med-Gemini's long-context capabilities through SoTA performance on a needle-in-a-haystack retrieval task from long de-identified health records and medical video question answering, surpassing prior bespoke methods using only in-context learning. Finally, Med-Gemini's performance suggests real-world utility by surpassing human experts on tasks such as medical text summarization, alongside demonstrations of promising potential for multimodal medical dialogue, medical research and education. Taken together, our results offer compelling evidence for Med-Gemini's potential, although further rigorous evaluation will be crucial before real-world deployment in this safety-critical domain.
Elahe Vedadi, David Barrett, Natalie Harris, Ellery Wulczyn, Shashir Reddy, Roma Ruparel, Mike Schaekermann, Tim Strother, Ryutaro Tanno, Yash Sharma, Jihyeon Lee, Cían Hughes, Dylan Slack, Anil Palepu, Jan Freyberg, Khaled Saab, Valentin Liévin, Wei-Hung Weng, Tao Tu, Yun Liu, Nenad Tomasev, Kavita Kulkarni, S. Sara Mahdavi, Kelvin Guu, Joëlle Barral, Dale R. Webster, James Manyika, Avinatan Hassidim, Katherine Chou, Yossi Matias, Pushmeet Kohli, Adam Rodman, Vivek Natarajan, Alan Karthikesalingam, David Stutz
Recent work has demonstrated the promise of conversational AI systems for diagnostic dialogue. However, real-world assurance of patient safety means that providing individual diagnoses and treatment plans is considered a regulated activity by licensed professionals. Furthermore, physicians commonly oversee other team members in such activities, including nurse practitioners (NPs) or physician assistants/associates (PAs). Inspired by this, we propose a framework for effective, asynchronous oversight of the Articulate Medical Intelligence Explorer (AMIE) AI system. We propose guardrailed-AMIE (g-AMIE), a multi-agent system that performs history taking within guardrails, abstaining from individualized medical advice. Afterwards, g-AMIE conveys assessments to an overseeing primary care physician (PCP) in a clinician cockpit interface. The PCP provides oversight and retains accountability of the clinical decision. This effectively decouples oversight from intake and can thus happen asynchronously. In a randomized, blinded virtual Objective Structured Clinical Examination (OSCE) of text consultations with asynchronous oversight, we compared g-AMIE to NPs/PAs or a group of PCPs under the same guardrails. Across 60 scenarios, g-AMIE outperformed both groups in performing high-quality intake, summarizing cases, and proposing diagnoses and management plans for the overseeing PCP to review. This resulted in higher quality composite decisions. PCP oversight of g-AMIE was also more time-efficient than standalone PCP consultations in prior work. While our study does not replicate existing clinical practices and likely underestimates clinicians' capabilities, our results demonstrate the promise of asynchronous oversight as a feasible paradigm for diagnostic AI systems to operate under expert human oversight for enhancing real-world care.
Mertcan Sevgi, Fares Antaki, Abdullah Zafar Khan, Ariel Yuhan Ong, David Adrian Merle, Kuang Hu, Shafi Balal, Sophie-Christin Kornelia Ernst, Josef Huemer, Gabriel T. Kaufmann, Hagar Khalid, Faye Levina, Celeste Limoli, Ana Paula Ribeiro Reis, Samir Touma, Anil Palepu, Khaled Saab, Ryutaro Tanno, Valentin Liévin, Tao Tu, Yong Cheng, Mike Schaekermann, S. Sara Mahdavi, Elahe Vedadi, David Stutz, Vivek Natarajan, Alan Karthikesalingam, Pearse A. Keane, Wei-Hung Weng
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.
Juraj Gottweis, Wei-Hung Weng, Alexander Daryin, Tao Tu, Anil Palepu, Petar Sirkovic, Artiom Myaskovsky, Felix Weissenberger, Keran Rong, Ryutaro Tanno, Khaled Saab, Dan Popovici, Jacob Blum, Fan Zhang, Katherine Chou, Avinatan Hassidim, Burak Gokturk, Amin Vahdat, Pushmeet Kohli, Yossi Matias, Andrew Carroll, Kavita Kulkarni, Nenad Tomasev, Yuan Guan, Vikram Dhillon, Eeshit Dhaval Vaishnav, Byron Lee, Tiago R D Costa, José R Penadés, Gary Peltz, Yunhan Xu, Annalisa Pawlosky, Alan Karthikesalingam, Vivek Natarajan
Scientific discovery relies on scientists generating novel hypotheses that undergo rigorous experimental validation. To augment this process, we introduce an AI co-scientist, a multi-agent system built on Gemini 2.0. The AI co-scientist is intended to help uncover new, original knowledge and to formulate demonstrably novel research hypotheses and proposals, building upon prior evidence and aligned to scientist-provided research objectives and guidance. The system's design incorporates a generate, debate, and evolve approach to hypothesis generation, inspired by the scientific method and accelerated by scaling test-time compute. Key contributions include: (1) a multi-agent architecture with an asynchronous task execution framework for flexible compute scaling; (2) a tournament evolution process for self-improving hypotheses generation. Automated evaluations show continued benefits of test-time compute, improving hypothesis quality. While general purpose, we focus development and validation in three biomedical areas: drug repurposing, novel target discovery, and explaining mechanisms of bacterial evolution and anti-microbial resistance. For drug repurposing, the system proposes candidates with promising validation findings, including candidates for acute myeloid leukemia that show tumor inhibition in vitro at clinically applicable concentrations. For novel target discovery, the AI co-scientist proposed new epigenetic targets for liver fibrosis, validated by anti-fibrotic activity and liver cell regeneration in human hepatic organoids. Finally, the AI co-scientist recapitulated unpublished experimental results via a parallel in silico discovery of a novel gene transfer mechanism in bacterial evolution. These results, detailed in separate, co-timed reports, demonstrate the potential to augment biomedical and scientific discovery and usher an era of AI empowered scientists.
Anil Palepu, Valentin Liévin, Wei-Hung Weng, Khaled Saab, David Stutz, Yong Cheng, Kavita Kulkarni, S. Sara Mahdavi, Joëlle Barral, Dale R. Webster, Katherine Chou, Avinatan Hassidim, Yossi Matias, James Manyika, Ryutaro Tanno, Vivek Natarajan, Adam Rodman, Tao Tu, Alan Karthikesalingam, Mike Schaekermann
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.
Khaled Saab, Jan Freyberg, Chunjong Park, Tim Strother, Yong Cheng, Wei-Hung Weng, David G. T. Barrett, David Stutz, Nenad Tomasev, Anil Palepu, Valentin Liévin, Yash Sharma, Roma Ruparel, Abdullah Ahmed, Elahe Vedadi, Kimberly Kanada, Cian Hughes, Yun Liu, Geoff Brown, Yang Gao, Sean Li, S. Sara Mahdavi, James Manyika, Katherine Chou, Yossi Matias, Avinatan Hassidim, Dale R. Webster, Pushmeet Kohli, S. M. Ali Eslami, Joëlle Barral, Adam Rodman, Vivek Natarajan, Mike Schaekermann, Tao Tu, Alan Karthikesalingam, Ryutaro Tanno
Large Language Models (LLMs) have demonstrated great potential for conducting diagnostic conversations but evaluation has been largely limited to language-only interactions, deviating from the real-world requirements of remote care delivery. Instant messaging platforms permit clinicians and patients to upload and discuss multimodal medical artifacts seamlessly in medical consultation, but the ability of LLMs to reason over such data while preserving other attributes of competent diagnostic conversation remains unknown. Here we advance the conversational diagnosis and management performance of the Articulate Medical Intelligence Explorer (AMIE) through a new capability to gather and interpret multimodal data, and reason about this precisely during consultations. Leveraging Gemini 2.0 Flash, our system implements a state-aware dialogue framework, where conversation flow is dynamically controlled by intermediate model outputs reflecting patient states and evolving diagnoses. Follow-up questions are strategically directed by uncertainty in such patient states, leading to a more structured multimodal history-taking process that emulates experienced clinicians. We compared AMIE to primary care physicians (PCPs) in a randomized, blinded, OSCE-style study of chat-based consultations with patient actors. We constructed 105 evaluation scenarios using artifacts like smartphone skin photos, ECGs, and PDFs of clinical documents across diverse conditions and demographics. Our rubric assessed multimodal capabilities and other clinically meaningful axes like history-taking, diagnostic accuracy, management reasoning, communication, and empathy. Specialist evaluation showed AMIE to be superior to PCPs on 7/9 multimodal and 29/32 non-multimodal axes (including diagnostic accuracy). The results show clear progress in multimodal conversational diagnostic AI, but real-world translation needs further research.
Andrew Sellergren, Chufan Gao, Fereshteh Mahvar, Timo Kohlberger, Fayaz Jamil, Madeleine Traverse, Alberto Tono, Bashir Sadjad, Lin Yang, Charles Lau, Liron Yatziv, Tiffany Chen, Bram Sterling, Kenneth Philbrick, Richa Tiwari, Yun Liu, Madhuram Jajoo, Chandrashekar Sankarapu, Swapnil Vispute, Harshad Purandare, Abhishek Bijay Mishra, Sam Schmidgall, Tao Tu, Anil Palepu, Chunjong Park, Tim Strother, Rahul Thapa, Yong Cheng, Preeti Singh, Kat Black, Yossi Matias, Katherine Chou, Avinatan Hassidim, Kavi Goel, Joelle Barral, Tris Warkentin, Shravya Shetty, Dale Webster, Sunny Virmani, David F. Steiner, Can Kirmizibayrak, Daniel Golden
We introduce MedGemma 1.5 4B, the latest model in the MedGemma collection. MedGemma 1.5 expands on MedGemma 1 by integrating additional capabilities: high-dimensional medical imaging (CT/MRI volumes and histopathology whole slide images), anatomical localization via bounding boxes, multi-timepoint chest X-ray analysis, and improved medical document understanding (lab reports, electronic health records). We detail the innovations required to enable these modalities within a single architecture, including new training data, long-context 3D volume slicing, and whole-slide pathology sampling. Compared to MedGemma 1 4B, MedGemma 1.5 4B demonstrates significant gains in these new areas, improving 3D MRI condition classification accuracy by 11% and 3D CT condition classification by 3% (absolute improvements). In whole slide pathology imaging, MedGemma 1.5 4B achieves a 47% macro F1 gain. Additionally, it improves anatomical localization with a 35% increase in Intersection over Union on chest X-rays and achieves a 4% macro accuracy for longitudinal (multi-timepoint) chest x-ray analysis. Beyond its improved multimodal performance over MedGemma 1, MedGemma 1.5 improves on text-based clinical knowledge and reasoning, improving by 5% on MedQA accuracy and 22% on EHRQA accuracy. It also achieves an average of 18% macro F1 on 4 different lab report information extraction datasets (EHR Datasets 2, 3, 4, and Mendeley Clinical Laboratory Test Reports). Taken together, MedGemma 1.5 serves as a robust, open resource for the community, designed as an improved foundation on which developers can create the next generation of medical AI systems. Resources and tutorials for building upon MedGemma 1.5 can be found at https://goo.gle/MedGemma.