Computer Science > Artificial Intelligence
[Submitted on 26 Oct 2026]
Title:Ontology-guided multi-agent reasoning for explainable differential diagnosis
View PDF HTML (experimental)Abstract:Effective differential diagnosis depends on well structured and unambiguous patient case descriptions, since incomplete or ambiguous clinical information readily leads to diagnostic errors and inconsistent reasoning. Large Language Models (LLMs) have recently shown promising capabilities in medical question answering and clinical reasoning; however, even when achieving competitive performance on medical benchmarks, they often rely on pattern recognition learned from training data rather than grounded clinical evidence, and can generate plausible yet unsupported diagnostic conclusions. Their reasoning remains largely opaque, making it difficult for clinicians to assess the evidence and rationale behind a given recommendation. To address this gap, we propose an ontology-guided, multiagent differential diagnosis framework that replicates the iterative reasoning process of physicians. The framework grounds diagnostic inference in a structured, expert-curated medical knowledge base, enabling interpretation of symptoms, clinical findings, or disease relationships, while decomposing diagnosis into explicit, auditable reasoning steps. This ontology-based grounding constrains inference to evidence-backed associations, reducing hallucination and improving diagnostic transparency, traceability, and consistency. The system then identifies the most discriminative missing symptoms and generates targeted follow-up questions to reduce uncertainty through a process that mirrors to clinical inquiry. Together, these components improve the reliability, explainability, and diagnostic accuracy of AI-assisted differential diagnosis. The source code is publicly available.
Loading...
Bibliographic and Citation Tools
Bibliographic Explorer (What is the Explorer?)
Connected Papers (What is Connected Papers?)
Litmaps (What is Litmaps?)
scite Smart Citations (What are Smart Citations?)
Code, Data and Media Associated with this Article
alphaXiv (What is alphaXiv?)
CatalyzeX Code Finder for Papers (What is CatalyzeX?)
DagsHub (What is DagsHub?)
Gotit.pub (What is GotitPub?)
Hugging Face (What is Huggingface?)
ScienceCast (What is ScienceCast?)
Recommenders and Search Tools
Influence Flower (What are Influence Flowers?)
CORE Recommender (What is CORE?)
arXivLabs: experimental projects with community collaborators
arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website.
Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them.
Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs.