PRIDE: Pediatric Radiological Image Diagnosis Engine Guided by Medical Domain Knowledge

Pediatric chest X-rays (CXRs) are crucial for diagnosing respiratory diseases in children. However, most deep learning models perform poorly on pediatric data due to domain gaps, as they are primarily trained on adult datasets with limited pediatric samples. Recent large models, though effective, still struggle with domain-specific terminology and specialized medical reasoning essential for pediatric diagnoses. To address these challenges, we propose PRIDE: a two-stage Pediatric Radiological Image Diagnosis Engine guided by medical knowledge. PRIDE works consistently with real clinical workflows by first gathering medical evidence from patient data, followed by applying clinical knowledge to enhance diagnostic accuracy. In the Multi-source Radiological Findings Recognition Stage, PRIDE integrates insights from generalized medical models and fine-tuned adult and pediatric radiological models to provide comprehensive findings results. In the Knowledge and Evidence-guided Diagnosis Stage, a Multimodal Large Language Model (MLLM) acts as a pediatric clinician, making diagnostic decisions using CXRs, radiological findings, demographic data, and clinical knowledge. Our evaluation on the VinDr-PCXR pediatric dataset demonstrates that PRIDE outperforms existing methods. Ablation studies further confirm the importance and effectiveness of its key components.