NEURO-GUARD: Neuro-Symbolic Generalization and Unbiased Adaptive Routing for Diagnostics -- Explainable Medical AI

Abstract

Accurate yet interpretable image-based diagnosis remains a central challenge in medical AI, particularly in settings characterized by limited data, subtle visual cues, and high-stakes clinical decision-making. Most existing vision models rely on purely data-driven learning and produce black-box predictions with limited interpretability and poor cross-domain generalization, hindering their real-world clinical adoption. We present NEURO-GUARD, a novel knowledge-guided vision framework that integrates Vision Transformers (ViTs) with language-driven reasoning to improve performance, transparency, and domain robustness. NEURO-GUARD employs a retrieval-augmented generation (RAG) mechanism for self-verification, in which a large language model (LLM) iteratively generates, evaluates, and refines feature-extraction code for medical images. By grounding this process in clinical guidelines and expert knowledge, the framework progressively enhances feature detection and classification beyond purely data-driven baselines. Extensive experiments on diabetic retinopathy classification across four benchmark datasets APTOS, EyePACS, Messidor-1, and Messidor-2 demonstrate that NEURO-GUARD improves accuracy by 6.2% over a ViT-only baseline (84.69% vs. 78.4%) and achieves a 5% gain in domain generalization. Additional evaluations on MRI-based seizure detection further confirm its cross-domain robustness, consistently outperforming existing methods. Overall, NEURO-GUARD bridges symbolic medical reasoning with subsymbolic visual learning, enabling interpretable, knowledge-aware, and generalizable medical image diagnosis while achieving state-of-the-art performance across multiple datasets.