An open-source implementation of Microsoft Research's "Sequential Diagnosis with Language Models" paper, built with the Swarms AI framework.

MAI-DxO (MAI Diagnostic Orchestrator) is a sophisticated AI-powered diagnostic system that simulates a virtual panel of physician-agents to perform iterative medical diagnosis with cost-effectiveness optimization. This implementation faithfully reproduces the methodology described in the Microsoft Research paper while providing additional features and flexibility.

• 8 AI Physician Agents: Specialized roles for comprehensive diagnosis.
• 5 Operational Modes: Instant, question-only, budgeted, no-budget, and ensemble modes.
• Cost Tracking: Real-time budget monitoring with costs for 25+ medical tests.
• Clinical Evaluation: 5-point accuracy scoring with detailed feedback.
• Model Agnostic: Works with GPT, Gemini, Claude, and other leading LLMs.
• Token-Optimized Prompts: Ultra-compact role prompts reduce token usage and latency without sacrificing reasoning quality.

Install the package directly via pip:

pip install mai-dx

Or, for development, clone the repository and install the requirements:

git clone https://github.com/The-Swarm-Corporation/Open-MAI-Dx-Orchestrator.git
cd Open-MAI-Dx-Orchestrator
pip install -r requirements.txt

Create a .env file in your project root and add your API keys:

OPENAI_API_KEY="Your OpenAI API key"
GEMINI_API_KEY="Your Gemini API key"
ANTHROPIC_API_KEY="Your Anthropic API key"

from mai_dx import MaiDxOrchestrator

# Create the orchestrator (defaults to a capable model)
orchestrator = MaiDxOrchestrator()

# Run a diagnosis
result = orchestrator.run(
    initial_case_info="29-year-old woman with sore throat and peritonsillar swelling...",
    full_case_details="Patient: 29-year-old female. History: Onset of sore throat...",
    ground_truth_diagnosis="Embryonal rhabdomyosarcoma of the pharynx"
)

# Print the results
print(f"Final Diagnosis: {result.final_diagnosis}")
print(f"Accuracy: {result.accuracy_score}/5.0")
print(f"Total Cost: ${result.total_cost:,.2f}")

Customize the orchestrator's model, budget, and operational mode.

from mai_dx import MaiDxOrchestrator

# Configure with a specific model and budget
orchestrator = MaiDxOrchestrator(
    model_name="gemini/gemini-2.5-flash",  # or "gpt-4", "claude-3-5-sonnet"
    max_iterations=10,
    initial_budget=3000,
    mode="budgeted"  # Other modes: "instant", "question_only", "no_budget"
)

# Run the diagnosis
# ...

MAI-DxO employs a multi-agent system where each agent has a specific role:

• 🧠 Dr. Hypothesis: Maintains the differential diagnosis.
• 🔬 Dr. Test-Chooser: Selects the most cost-effective diagnostic tests.
• 🤔 Dr. Challenger: Prevents cognitive biases and diagnostic errors.
• 💰 Dr. Stewardship: Ensures cost-effective care.
• ✅ Dr. Checklist: Performs quality control checks.
• 🤝 Consensus Coordinator: Synthesizes panel decisions.
• 🔑 Gatekeeper: Acts as the clinical information oracle.
• ⚖️ Judge: Evaluates the final diagnostic accuracy.

Learn more about this repository with the docs

We welcome contributions! Please feel free to open an issue or submit a pull request.

This project is licensed under the MIT License. See the LICENSE file for details.

If you use this work in your research, please cite both the original paper and this software implementation.

@misc{nori2025sequentialdiagnosislanguagemodels,
    title={Sequential Diagnosis with Language Models}, 
    author={Harsha Nori and Mayank Daswani and Christopher Kelly and Scott Lundberg and Marco Tulio Ribeiro and Marc Wilson and Xiaoxuan Liu and Viknesh Sounderajah and Jonathan Carlson and Matthew P Lungren and Bay Gross and Peter Hames and Mustafa Suleyman and Dominic King and Eric Horvitz},
    year={2025},
    eprint={2506.22405},
    archivePrefix={arXiv},
    primaryClass={cs.CL},
    url={https://arxiv.org/abs/2506.22405}, 
}

@software{mai_dx_orchestrator,
    title={Open-MAI-Dx-Orchestrator: An Open Source Implementation of Sequential Diagnosis with Language Models},
    author={The-Swarm-Corporation},
    year={2025},
    url={https://github.com/The-Swarm-Corporation/Open-MAI-Dx-Orchestrator.git}
}

• Original Paper - Sequential Diagnosis with Language Models
• Swarms Framework - Multi-agent AI orchestration
• Microsoft Research - Original research institution

• Issues: GitHub Issues
• Discussions: GitHub Discussions
• Documentation: Full Documentation

Built with Swarms for advancing AI-powered medical diagnosis