Merge pull request #5 from harshalmore31/main

feat: implementation of MAI Diagnostic Orchestrator (MAI-DxO) with comprehensive documentation

README.md

@@ -1,79 +1,540 @@
-# Open-MAI-Dx-Orchestrator [WIP]
+# Open-MAI-Dx-Orchestrator
 
-An open source implementation of the paper: "Sequential Diagnosis with Language Models" From Microsoft Built with Swarms Framework.
+> **An open-source implementation of the "Sequential Diagnosis with Language Models" paper by Microsoft Research, built with the Swarms AI framework.**
 
-- [Paper Link](https://arxiv.org/abs/2506.22405)
+[![Paper](https://img.shields.io/badge/Paper-arXiv:2506.22405-red.svg)](https://arxiv.org/abs/2506.22405)
+[![License](https://img.shields.io/badge/License-MIT-blue.svg)](LICENSE)
+[![Python](https://img.shields.io/badge/Python-3.8+-green.svg)](https://python.org)
 
-# Install
+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.
+
+## 🚀 Quick Start
 
 ```bash
-pip3 install mai-dx
+# Install the package
+pip install mai-dx
+
+# Or install from source
+git clone https://github.com/The-Swarm-Corporation/Open-MAI-Dx-Orchestrator.git
+cd Open-MAI-Dx-Orchestrator
+pip install -e .
 ```
 
-## Usage
+```python
+from mai_dx import MaiDxOrchestrator
 
-...
+# Create orchestrator
+orchestrator = MaiDxOrchestrator(model_name="gemini/gemini-2.5-flash")
 
----
+# Run 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(f"Diagnosis: {result.final_diagnosis}")
+print(f"Accuracy: {result.accuracy_score}/5.0")
+print(f"Cost: ${result.total_cost:,}")
+```
+
+## 📚 Table of Contents
+
+- [Features](#-features)
+- [Installation](#-installation)
+- [Architecture](#-architecture)
+- [Usage](#-usage)
+- [MAI-DxO Variants](#-mai-dxo-variants)
+- [Configuration](#-configuration)
+- [Examples](#-examples)
+- [API Reference](#-api-reference)
+- [Contributing](#-contributing)
+- [Citation](#-citation)
+
+## ✨ Features
+
+### 🏥 Virtual Physician Panel
+- **8 Specialized AI Agents**: Each with distinct medical expertise and decision-making roles
+- **Iterative Deliberation**: Sequential consultation and consensus-building process
+- **Bayesian Reasoning**: Probability-based differential diagnosis updates
+- **Cognitive Bias Detection**: Built-in challenger agent to prevent diagnostic errors
+
+### 💰 Cost-Effectiveness Optimization
+- **Comprehensive Cost Tracking**: Real-time budget monitoring with 25+ medical test costs
+- **Resource Stewardship**: AI agent dedicated to cost-conscious care decisions
+- **Budget Constraints**: Configurable spending limits with intelligent test prioritization
+- **Value-Based Testing**: Information theory-driven test selection
+
+### 🎯 Multiple Operational Modes
+- **Instant**: Immediate diagnosis from initial presentation
+- **Question-Only**: History-taking without diagnostic tests
+- **Budgeted**: Cost-constrained diagnostic workup
+- **No-Budget**: Full diagnostic capability
+- **Ensemble**: Multiple independent panels with consensus aggregation
+
+### 📊 Advanced Evaluation
+- **Clinical Accuracy Scoring**: 5-point Likert scale with detailed rubric
+- **Management Impact Assessment**: Evaluation based on treatment implications
+- **Diagnostic Reasoning Tracking**: Complete conversation history and decision trails
+- **Ensemble Methods**: Multi-run consensus for improved accuracy
+
+### 🔧 Technical Excellence
+- **Model Agnostic**: Support for GPT, Gemini, Claude, and other LLMs
+- **Robust Error Handling**: Comprehensive exception management and fallback mechanisms
+- **Beautiful Logging**: Structured logging with Loguru for debugging and monitoring
+- **Type Safety**: Full Pydantic models and type hints throughout
+
+## 🛠 Installation
+
+### Prerequisites
+- Python 3.8 or higher
+- API keys for your chosen language model provider
+
+### Standard Installation
+```bash
+pip install mai-dx
+```
+
+### Development Installation
+```bash
+git clone https://github.com/The-Swarm-Corporation/Open-MAI-Dx-Orchestrator.git
+cd Open-MAI-Dx-Orchestrator
+pip install -e .
+```
+
+### Dependencies
+The package automatically installs:
+- `swarms` - AI agent orchestration framework
+- `loguru` - Advanced logging
+- `pydantic` - Data validation and serialization
+
+## 🏗 Architecture
+
+### Virtual Panel Composition
+
+The MAI-DxO system consists of 8 specialized AI agents that work together to provide comprehensive medical diagnosis:
+
+#### Core Diagnostic Panel
+
+**🧠 Dr. Hypothesis**
+- Maintains probability-ranked differential diagnosis (top 3 conditions)
+- Updates probabilities using Bayesian reasoning after each finding
+- Tracks evidence supporting and contradicting each hypothesis
+
+**🔬 Dr. Test-Chooser**
+- Selects up to 3 diagnostic tests per round for maximum information value
+- Optimizes for discriminatory power between competing hypotheses
+- Balances diagnostic yield with patient burden
+
+**🤔 Dr. Challenger**
+- Acts as devil's advocate to prevent cognitive biases
+- Identifies contradictory evidence and alternative explanations
+- Proposes falsifying tests and guards against premature closure
+
+**💰 Dr. Stewardship**
+- Enforces cost-conscious, high-value care decisions
+- Advocates for cheaper alternatives when diagnostically equivalent
+- Evaluates test necessity and suggests cost-effective strategies
+
+**✅ Dr. Checklist**
+- Performs quality control on panel deliberations
+- Validates test names and maintains logical consistency
+- Flags errors and ensures proper diagnostic methodology
+
+#### Coordination and Evaluation
+
+**🤝 Consensus Coordinator**
+- Synthesizes panel input into optimal next action
+- Decides between asking questions, ordering tests, or diagnosing
+- Balances accuracy, cost, efficiency, and thoroughness
+
+**🔑 Gatekeeper**
+- Serves as clinical information oracle with complete case access
+- Provides objective findings and realistic synthetic results
+- Maintains clinical realism while preventing information leakage
+
+**⚖️ Judge**
+- Evaluates final diagnoses against ground truth
+- Uses rigorous 5-point clinical rubric
+- Considers management implications and diagnostic completeness
+
+### Decision Process Flow
+
+```mermaid
+graph TD
+    A[Initial Case Information] --> B[Panel Deliberation]
+    B --> C{Consensus Decision}
+    C -->|Ask| D[Question to Gatekeeper]
+    C -->|Test| E[Diagnostic Tests]
+    C -->|Diagnose| F[Final Diagnosis]
+    D --> G[Update Case Information]
+    E --> G
+    G --> H{Max Iterations or Budget?}
+    H -->|No| B
+    H -->|Yes| F
+    F --> I[Judge Evaluation]
+    I --> J[Diagnosis Result]
+```
+
+## 🎮 Usage
+
+### Basic Usage
+
+```python
+from mai_dx import MaiDxOrchestrator
+
+# Initialize orchestrator
+orchestrator = MaiDxOrchestrator(
+    model_name="gemini/gemini-2.5-flash",
+    max_iterations=10,
+    initial_budget=10000
+)
+
+# Define case information
+initial_info = "A 45-year-old male presents with chest pain..."
+full_case = "Patient: 45-year-old male. History: Acute onset chest pain..."
+ground_truth = "Myocardial infarction"
+
+# Run diagnosis
+result = orchestrator.run(initial_info, full_case, ground_truth)
+
+# Access results
+print(f"Diagnosis: {result.final_diagnosis}")
+print(f"Accuracy Score: {result.accuracy_score}/5.0")
+print(f"Total Cost: ${result.total_cost:,}")
+print(f"Iterations: {result.iterations}")
+```
+
+### Advanced Configuration
+
+```python
+# Custom orchestrator with specific settings
+orchestrator = MaiDxOrchestrator(
+    model_name="gpt-4",
+    max_iterations=15,
+    initial_budget=5000,
+    mode="budgeted",
+    physician_visit_cost=250,
+    enable_budget_tracking=True
+)
+
+# Enable debug logging
+import os
+os.environ["MAIDX_DEBUG"] = "1"
+```
+
+## 📋 MAI-DxO Variants
+
+The system supports five distinct operational variants, each optimized for different clinical scenarios:
+
+### 1. Instant Answer
+```python
+orchestrator = MaiDxOrchestrator.create_variant("instant")
+result = orchestrator.run(initial_info, full_case, ground_truth)
+```
+- **Use Case**: Emergency triage, rapid screening
+- **Behavior**: Immediate diagnosis from initial presentation only
+- **Cost**: Single physician visit ($300)
+
+### 2. Question-Only
+```python
+orchestrator = MaiDxOrchestrator.create_variant("question_only")
+result = orchestrator.run(initial_info, full_case, ground_truth)
+```
+- **Use Case**: Telemedicine, history-taking focused consultations
+- **Behavior**: Detailed questioning without diagnostic tests
+- **Cost**: Physician visit only
+
+### 3. Budgeted
+```python
+orchestrator = MaiDxOrchestrator.create_variant("budgeted", budget=3000)
+result = orchestrator.run(initial_info, full_case, ground_truth)
+```
+- **Use Case**: Resource-constrained settings, cost-conscious care
+- **Behavior**: Full panel with strict budget enforcement
+- **Cost**: Limited by specified budget
+
+### 4. No-Budget
+```python
+orchestrator = MaiDxOrchestrator.create_variant("no_budget")
+result = orchestrator.run(initial_info, full_case, ground_truth)
+```
+- **Use Case**: Academic medical centers, complex cases
+- **Behavior**: Full diagnostic capability without cost constraints
+- **Cost**: Unlimited (tracks for analysis)
+
+### 5. Ensemble
+```python
+orchestrator = MaiDxOrchestrator.create_variant("ensemble")
+result = orchestrator.run_ensemble(initial_info, full_case, ground_truth, num_runs=3)
+```
+- **Use Case**: Critical diagnoses, second opinion simulation
+- **Behavior**: Multiple independent panels with consensus aggregation
+- **Cost**: Sum of all panel costs
+
+## ⚙️ Configuration
+
+### Model Configuration
+
+```python
+# Supported models
+models = [
+    "gemini/gemini-2.5-flash",
+    "gpt-4o",
+    "gpt-4o-mini", 
+    "claude-3-5-sonnet-20241022",
+    "meta-llama/llama-3.1-8b-instruct"
+]
 
-## Architecture
+orchestrator = MaiDxOrchestrator(model_name="gpt-4o")
+```
+
+### Cost Database Customization
+
+```python
+# Access and modify cost database
+orchestrator = MaiDxOrchestrator()
+orchestrator.test_cost_db.update({
+    "custom_test": 450,
+    "specialized_imaging": 2000
+})
+```
+
+### Logging Configuration
+
+```python
+# Enable detailed debug logging
+import os
+os.environ["MAIDX_DEBUG"] = "1"
+
+# Custom log levels and formats available
+```
+
+## 📖 Examples
+
+### Example 1: Comprehensive Diagnostic Workup
+
+```python
+from mai_dx import MaiDxOrchestrator
+
+# Complex case requiring multiple tests
+case_info = """
+A 29-year-old woman was admitted to the hospital because of sore throat 
+and peritonsillar swelling and bleeding. Symptoms did not abate with 
+antimicrobial therapy.
+"""
+
+case_details = """
+Patient: 29-year-old female.
+History: Onset of sore throat 7 weeks prior to admission. Worsening 
+right-sided pain and swelling. No fevers, headaches, or GI symptoms.
+Physical Exam: Right peritonsillar mass, displacing the uvula.
+Initial Labs: FBC, clotting studies normal.
+"""
+
+ground_truth = "Embryonal rhabdomyosarcoma of the pharynx"
+
+# Run with different variants
+variants = ["question_only", "budgeted", "no_budget"]
+results = {}
+
+for variant in variants:
+    if variant == "budgeted":
+        orch = MaiDxOrchestrator.create_variant(variant, budget=3000)
+    else:
+        orch = MaiDxOrchestrator.create_variant(variant)
+    
+    results[variant] = orch.run(case_info, case_details, ground_truth)
+
+# Compare results
+for variant, result in results.items():
+    print(f"{variant}: {result.final_diagnosis} (Score: {result.accuracy_score})")
+```
+
+### Example 2: Ensemble Diagnosis
+
+```python
+# High-stakes diagnosis with ensemble approach
+ensemble_orchestrator = MaiDxOrchestrator.create_variant("ensemble")
+
+ensemble_result = ensemble_orchestrator.run_ensemble(
+    initial_case_info=case_info,
+    full_case_details=case_details,
+    ground_truth_diagnosis=ground_truth,
+    num_runs=5  # 5 independent diagnostic panels
+)
+
+print(f"Ensemble Diagnosis: {ensemble_result.final_diagnosis}")
+print(f"Confidence Score: {ensemble_result.accuracy_score}/5.0")
+print(f"Total Cost: ${ensemble_result.total_cost:,}")
+```
+
+### Example 3: Custom Cost Analysis
+
+```python
+# Analyze cost-effectiveness across variants
+import matplotlib.pyplot as plt
+
+variants = ["instant", "question_only", "budgeted", "no_budget"]
+costs = []
+accuracies = []
+
+for variant in variants:
+    orch = MaiDxOrchestrator.create_variant(variant)
+    result = orch.run(case_info, case_details, ground_truth)
+    costs.append(result.total_cost)
+    accuracies.append(result.accuracy_score)
+
+# Plot cost vs accuracy
+plt.scatter(costs, accuracies)
+plt.xlabel('Total Cost ($)')
+plt.ylabel('Accuracy Score')
+plt.title('Cost vs Accuracy Trade-off')
+for i, variant in enumerate(variants):
+    plt.annotate(variant, (costs[i], accuracies[i]))
+plt.show()
+```
 
-### Virtual Panel Roles
+## 🔍 API Reference
 
-The virtual panel consists of five specialized roles:
+### MaiDxOrchestrator Class
 
-- **Dr. Hypothesis** – Maintains a probability-ranked differential diagnosis with the top three most likely conditions, updating probabilities in a Bayesian manner after each new finding.
+#### Constructor
+```python
+MaiDxOrchestrator(
+    model_name: str = "gemini/gemini-2.5-flash",
+    max_iterations: int = 10,
+    initial_budget: int = 10000,
+    mode: str = "no_budget",
+    physician_visit_cost: int = 300,
+    enable_budget_tracking: bool = False
+)
+```
 
-- **Dr. Test-Chooser** – Selects up to three diagnostic tests per round that maximally discriminate between leading hypotheses.
+#### Methods
 
-- **Dr. Challenger** – Acts as devil's advocate by identifying potential anchoring bias, highlighting contradictory evidence, and proposing tests that could falsify the current leading diagnosis.
+**`run(initial_case_info, full_case_details, ground_truth_diagnosis)`**
+- Executes the sequential diagnostic process
+- Returns: `DiagnosisResult` object
 
-- **Dr. Stewardship** – Enforces cost-conscious care by advocating for cheaper alternatives when diagnostically equivalent and vetoing low-yield expensive tests.
+**`run_ensemble(initial_case_info, full_case_details, ground_truth_diagnosis, num_runs=3)`**
+- Runs multiple independent sessions with consensus aggregation
+- Returns: `DiagnosisResult` object
 
-- **Dr. Checklist** – Performs silent quality control to ensure the model generates valid test names and maintains internal consistency across the panel's reasoning.
+**`create_variant(variant, **kwargs)` (Class Method)**
+- Factory method for creating specialized variants
+- Variants: "instant", "question_only", "budgeted", "no_budget", "ensemble"
 
-### Decision Process
+### DiagnosisResult Class
 
-After internal deliberation, the panel reaches consensus on one of three actions:
-- Asking questions
-- Ordering tests  
-- Committing to a diagnosis (if certainty exceeds threshold)
+```python
+@dataclass
+class DiagnosisResult:
+    final_diagnosis: str
+    ground_truth: str
+    accuracy_score: float
+    accuracy_reasoning: str
+    total_cost: int
+    iterations: int
+    conversation_history: str
+```
 
-Before tests are ordered, an optional budget tracker can be invoked to estimate both the cumulative medical costs so far and the cost of each test in the order.
+### Utility Functions
 
-### MAI-DxO Variants
+**`run_mai_dxo_demo(case_info=None, case_details=None, ground_truth=None)`**
+- Convenience function for quick demonstrations
+- Returns: Dictionary of results from multiple variants
 
-We evaluate five variants of MAI-DxO to explore different points on the accuracy-cost frontier (from most cost conscious to least):
+## 🧪 Testing and Validation
 
-- **Instant Answer** – Diagnosis based solely on initial vignette (as in Figure 3), without any follow-up questions or tests.
+### Running Tests
+```bash
+# Run the built-in demo
+python -m mai_dx.main
+
+# Run with custom cases
+python -c "
+from mai_dx import run_mai_dxo_demo
+results = run_mai_dxo_demo()
+print(results)
+"
+```
 
-- **Question Only** – The panel can ask questions, but cannot order diagnostic tests. The cost is simply the cost of a single physician visit.
+### Benchmarking
+```python
+import time
+from mai_dx import MaiDxOrchestrator
 
-- **Budgeted** – The panel is augmented with a budgeting system that tracks cumulative costs (a separately orchestrated language model call) towards a max budget and allows the panel to cancel tests after seeing their estimated cost.
+# Performance benchmarking
+start_time = time.time()
+orchestrator = MaiDxOrchestrator()
+result = orchestrator.run(case_info, case_details, ground_truth)
+elapsed = time.time() - start_time
 
-- **No Budget** – Full panel with no explicit cost tracking or budget limitations.
+print(f"Diagnosis completed in {elapsed:.2f} seconds")
+print(f"Accuracy: {result.accuracy_score}/5.0")
+print(f"Cost efficiency: ${result.total_cost/result.accuracy_score:.0f} per accuracy point")
+```
 
-- **Ensemble** – Simulates multiple doctor panels working in parallel, with an additional panel to provide a final diagnosis. This is implemented as multiple independent No Budget runs with a final aggregation step to select the best diagnosis. Costs are computed as the sum of the costs of all tests ordered by each of the runs, accounting for duplicates.
+## 🤝 Contributing
+
+We welcome contributions! Please see our [Contributing Guidelines](CONTRIBUTING.md) for details.
+
+### Development Setup
+```bash
+git clone https://github.com/your-org/Open-MAI-Dx-Orchestrator.git
+cd Open-MAI-Dx-Orchestrator
+pip install -e ".[dev]"
+pre-commit install
+```
 
-### Technical Implementation
+### Code Style
+- Follow PEP 8 guidelines
+- Use type hints throughout
+- Maintain comprehensive docstrings
+- Add tests for new features
 
-MAI-DxO was primarily developed and optimized using GPT-4.1, but is designed to be model-agnostic. All MAI-DxO variants used the same underlying orchestration structure, with capabilities selectively enabled or disabled for variants.
+## 📄 License
 
-## Citation
+This project is licensed under the MIT License - see the [LICENSE](LICENSE) file for details.
+
+## 📚 Citation
+
+If you use this implementation in your research, please cite both the original paper and this implementation:
 
 ```bibtex
 @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}, 
+    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}
 }
 ```
 
+## 🔗 Related Work
 
+- [Original Paper](https://arxiv.org/abs/2506.22405) - Sequential Diagnosis with Language Models
+- [Swarms Framework](https://github.com/kyegomez/swarms) - Multi-agent AI orchestration
+- [Microsoft Research](https://www.microsoft.com/en-us/research/) - Original research institution
+
+## 📞 Support
+
+- **Issues**: [GitHub Issues](https://github.com/The-Swarm-Corporation/Open-MAI-Dx-Orchestrator/issues)
+- **Discussions**: [GitHub Discussions](https://github.com/The-Swarm-Corporation/Open-MAI-Dx-Orchestrator/discussions)
+- **Documentation**: [Full Documentation](https://docs.swarms.world)
+
+---
 
-# License
-MIT
+<p align="center">
+  <strong>Built with Swarms for advancing AI-powered medical diagnosis</strong>
+</p>

mai_dx/main.py

@@ -1,12 +1,1261 @@
-from swarms import Agent
+"""
+MAI Diagnostic Orchestrator (MAI-DxO)
 
+This script provides a complete implementation of the "Sequential Diagnosis with Language Models" 
+paper, using the `swarms` framework. It simulates a virtual panel of physician-agents to perform 
+iterative medical diagnosis with cost-effectiveness optimization.
+
+Based on the paper: "Sequential Diagnosis with Language Models"
+(arXiv:2506.22405v1) by Nori et al.
+
+Key Features:
+- Virtual physician panel with specialized roles (Hypothesis, Test-Chooser, Challenger, Stewardship, Checklist)
+- Multiple operational modes (instant, question_only, budgeted, no_budget, ensemble)
+- Comprehensive cost tracking and budget management
+- Clinical accuracy evaluation with 5-point Likert scale
+- Gatekeeper system for realistic clinical information disclosure
+- Ensemble methods for improved diagnostic accuracy
+
+Example Usage:
+    # Standard MAI-DxO usage
+    orchestrator = MaiDxOrchestrator(model_name="gemini/gemini-2.5-flash")
+    result = orchestrator.run(initial_case_info, full_case_details, ground_truth)
+    
+    # Budget-constrained variant
+    budgeted_orchestrator = MaiDxOrchestrator.create_variant("budgeted", budget=5000)
+    
+    # Ensemble approach
+    ensemble_result = orchestrator.run_ensemble(initial_case_info, full_case_details, ground_truth)
+"""
+
+import json
+import sys
+import time
+from dataclasses import dataclass
+from enum import Enum
+from typing import Any, Dict, List, Optional, Union, Literal
+
+from loguru import logger
+from pydantic import BaseModel, Field
+from swarms import Agent, Conversation
+
+# Configure Loguru with beautiful formatting and features
+logger.remove()  # Remove default handler
+
+# Console handler with beautiful colors
+logger.add(
+    sys.stdout,
+    level="INFO",
+    format="<green>{time:YYYY-MM-DD HH:mm:ss}</green> | <level>{level: <8}</level> | <cyan>{name}</cyan>:<cyan>{function}</cyan>:<cyan>{line}</cyan> - <level>{message}</level>",
+    colorize=True
+)
+
+# Enable debug mode if environment variable is set
+import os
+if os.getenv("MAIDX_DEBUG", "").lower() in ("1", "true", "yes"):
+    logger.add(
+        "logs/maidx_debug_{time:YYYY-MM-DD}.log",
+        level="DEBUG",
+        format="{time:YYYY-MM-DD HH:mm:ss} | {level: <8} | {name}:{function}:{line} - {message}",
+        rotation="1 day",
+        retention="3 days"
+    )
+    logger.info("🐛 Debug logging enabled - logs will be written to logs/ directory")
+
+# File handler for persistent logging (optional - uncomment if needed)
+# logger.add(
+#     "logs/mai_dxo_{time:YYYY-MM-DD}.log",
+#     rotation="1 day",
+#     retention="7 days", 
+#     level="DEBUG",
+#     format="{time:YYYY-MM-DD HH:mm:ss} | {level: <8} | {name}:{function}:{line} - {message}",
+#     compression="zip"
+# )
+
+# --- Data Structures and Enums ---
+
+class AgentRole(Enum):
+    """Enumeration of roles for the virtual physician panel."""
+    HYPOTHESIS = "Dr. Hypothesis"
+    TEST_CHOOSER = "Dr. Test-Chooser"
+    CHALLENGER = "Dr. Challenger"
+    STEWARDSHIP = "Dr. Stewardship"
+    CHECKLIST = "Dr. Checklist"
+    CONSENSUS = "Consensus Coordinator"
+    GATEKEEPER = "Gatekeeper"
+    JUDGE = "Judge"
+
+@dataclass
+class DiagnosisResult:
+    """Stores the final result of a diagnostic session."""
+    final_diagnosis: str
+    ground_truth: str
+    accuracy_score: float
+    accuracy_reasoning: str
+    total_cost: int
+    iterations: int
+    conversation_history: str
+
+class Action(BaseModel):
+    """Pydantic model for a structured action decided by the consensus agent."""
+    action_type: Literal["ask", "test", "diagnose"] = Field(..., description="The type of action to perform.")
+    content: Union[str, List[str]] = Field(..., description="The content of the action (question, test name, or diagnosis).")
+    reasoning: str = Field(..., description="The reasoning behind choosing this action.")
+
+# --- Main Orchestrator Class ---
 
 class MaiDxOrchestrator:
-    def __init__(self, conversation_backend: str = None, agents: list[Agent] = None):
-        self.conversation_backend = conversation_backend
-        self.agents = agents
+    """
+    Implements the MAI Diagnostic Orchestrator (MAI-DxO) framework.
+    This class orchestrates a virtual panel of AI agents to perform sequential medical diagnosis,
+    evaluates the final diagnosis, and tracks costs.
+    """
+    def __init__(
+        self,
+        model_name: str = "gemini/gemini-2.5-flash",
+        max_iterations: int = 10,
+        initial_budget: int = 10000,
+        mode: str = "no_budget",  # "instant", "question_only", "budgeted", "no_budget", "ensemble"
+        physician_visit_cost: int = 300,
+        enable_budget_tracking: bool = False,
+    ):
+        """
+        Initializes the MAI-DxO system.
+
+        Args:
+            model_name (str): The language model to be used by all agents.
+            max_iterations (int): The maximum number of diagnostic loops.
+            initial_budget (int): The starting budget for diagnostic tests.
+            mode (str): The operational mode of MAI-DxO.
+            physician_visit_cost (int): Cost per physician visit.
+            enable_budget_tracking (bool): Whether to enable budget tracking.
+        """
+        self.model_name = model_name
+        self.max_iterations = max_iterations
+        self.initial_budget = initial_budget
+        self.mode = mode
+        self.physician_visit_cost = physician_visit_cost
+        self.enable_budget_tracking = enable_budget_tracking
+        
+        self.cumulative_cost = 0
+        self.differential_diagnosis = "Not yet formulated."
+        self.conversation = Conversation(
+            time_enabled=True,
+            autosave=False,
+            save_enabled=False
+        )
+        
+        # Enhanced cost model based on the paper's methodology
+        self.test_cost_db = {
+            "default": 150,
+            "cbc": 50,
+            "complete blood count": 50,
+            "fbc": 50,
+            "chest x-ray": 200,
+            "chest xray": 200,
+            "mri": 1500,
+            "mri brain": 1800,
+            "mri neck": 1600,
+            "ct scan": 1200,
+            "ct chest": 1300,
+            "ct abdomen": 1400,
+            "biopsy": 800,
+            "core biopsy": 900,
+            "immunohistochemistry": 400,
+            "fish test": 500,
+            "fish": 500,
+            "ultrasound": 300,
+            "ecg": 100,
+            "ekg": 100,
+            "blood glucose": 30,
+            "liver function tests": 80,
+            "renal function": 70,
+            "toxic alcohol panel": 200,
+            "urinalysis": 40,
+            "culture": 150,
+            "pathology": 600,
+        }
+
+        self._init_agents()
+        logger.info(f"🏥 MAI Diagnostic Orchestrator initialized successfully in '{mode}' mode with budget ${initial_budget:,}")
+
+    def _init_agents(self):
+        """Initializes all required agents with their specific roles and prompts."""
+        self.agents = {
+            role: Agent(
+                agent_name=role.value,
+                system_prompt=self._get_prompt_for_role(role),
+                model_name=self.model_name,
+                max_loops=1,
+                output_type="json" if role == AgentRole.CONSENSUS else "str",
+                print_on=True,  # Enable printing for all agents to see outputs
+            ) for role in AgentRole
+        }
+        logger.info(f"👥 {len(self.agents)} virtual physician agents initialized and ready for consultation")
+
+    def _get_prompt_for_role(self, role: AgentRole) -> str:
+        """Returns the system prompt for a given agent role."""
+        prompts = {
+            AgentRole.HYPOTHESIS: """
+            You are Dr. Hypothesis, a specialist in maintaining differential diagnoses. Your role is critical to the diagnostic process.
+
+            CORE RESPONSIBILITIES:
+            - Maintain a probability-ranked differential diagnosis with the top 3 most likely conditions
+            - Update probabilities using Bayesian reasoning after each new finding
+            - Consider both common and rare diseases appropriate to the clinical context
+            - Explicitly track how new evidence changes your diagnostic thinking
+
+            APPROACH:
+            1. Start with the most likely diagnoses based on presenting symptoms
+            2. For each new piece of evidence, consider:
+               - How it supports or refutes each hypothesis
+               - Whether it suggests new diagnoses to consider
+               - How it changes the relative probabilities
+            3. Always explain your Bayesian reasoning clearly
+
+            OUTPUT FORMAT:
+            Provide your updated differential diagnosis with:
+            - Top 3 diagnoses with probability estimates (percentages)
+            - Brief rationale for each
+            - Key evidence supporting each hypothesis
+            - Evidence that contradicts or challenges each hypothesis
+
+            Remember: Your differential drives the entire diagnostic process. Be thorough, evidence-based, and adaptive.
+            """,
+            
+            AgentRole.TEST_CHOOSER: """
+            You are Dr. Test-Chooser, a specialist in diagnostic test selection and information theory.
+
+            CORE RESPONSIBILITIES:
+            - Select up to 3 diagnostic tests per round that maximally discriminate between leading hypotheses
+            - Optimize for information value, not just clinical reasonableness
+            - Consider test characteristics: sensitivity, specificity, positive/negative predictive values
+            - Balance diagnostic yield with patient burden and resource utilization
+
+            SELECTION CRITERIA:
+            1. Information Value: How much will this test change diagnostic probabilities?
+            2. Discriminatory Power: How well does it distinguish between competing hypotheses?
+            3. Clinical Impact: Will the result meaningfully alter management?
+            4. Sequential Logic: What should we establish first before ordering more complex tests?
+
+            APPROACH:
+            - For each proposed test, explicitly state which hypotheses it will help confirm or exclude
+            - Consider both positive and negative results and their implications
+            - Think about test sequences (e.g., basic labs before advanced imaging)
+            - Avoid redundant tests that won't add new information
+
+            OUTPUT FORMAT:
+            For each recommended test:
+            - Test name (be specific)
+            - Primary hypotheses it will help evaluate
+            - Expected information gain
+            - How results will change management decisions
+
+            Focus on tests that will most efficiently narrow the differential diagnosis.
+            """,
+            
+            AgentRole.CHALLENGER: """
+            You are Dr. Challenger, the critical thinking specialist and devil's advocate.
+
+            CORE RESPONSIBILITIES:
+            - Identify and challenge cognitive biases in the diagnostic process
+            - Highlight contradictory evidence that might be overlooked
+            - Propose alternative hypotheses and falsifying tests
+            - Guard against premature diagnostic closure
+
+            COGNITIVE BIASES TO WATCH FOR:
+            1. Anchoring: Over-reliance on initial impressions
+            2. Confirmation bias: Seeking only supporting evidence
+            3. Availability bias: Overestimating probability of recently seen conditions
+            4. Representativeness: Ignoring base rates and prevalence
+            5. Search satisficing: Stopping at "good enough" explanations
+
+            YOUR APPROACH:
+            - Ask "What else could this be?" and "What doesn't fit?"
+            - Challenge assumptions and look for alternative explanations
+            - Propose tests that could disprove the leading hypothesis
+            - Consider rare diseases when common ones don't fully explain the picture
+            - Advocate for considering multiple conditions simultaneously
+
+            OUTPUT FORMAT:
+            - Specific biases you've identified in the current reasoning
+            - Evidence that contradicts the leading hypotheses
+            - Alternative diagnoses to consider
+            - Tests that could falsify current assumptions
+            - Red flags or concerning patterns that need attention
+
+            Be constructively critical - your role is to strengthen diagnostic accuracy through rigorous challenge.
+            """,
+            
+            AgentRole.STEWARDSHIP: """
+            You are Dr. Stewardship, the resource optimization and cost-effectiveness specialist.
+
+            CORE RESPONSIBILITIES:
+            - Enforce cost-conscious, high-value care
+            - Advocate for cheaper alternatives when diagnostically equivalent
+            - Challenge low-yield, expensive tests
+            - Balance diagnostic thoroughness with resource stewardship
+
+            COST-VALUE FRAMEWORK:
+            1. High-Value Tests: Low cost, high diagnostic yield, changes management
+            2. Moderate-Value Tests: Moderate cost, specific indication, incremental value
+            3. Low-Value Tests: High cost, low yield, minimal impact on decisions
+            4. No-Value Tests: Any cost, no diagnostic value, ordered out of habit
+
+            ALTERNATIVE STRATEGIES:
+            - Could patient history/physical exam provide this information?
+            - Is there a less expensive test with similar diagnostic value?
+            - Can we use a staged approach (cheap test first, expensive if needed)?
+            - Does the test result actually change management?
+
+            YOUR APPROACH:
+            - Review all proposed tests for necessity and value
+            - Suggest cost-effective alternatives
+            - Question tests that don't clearly advance diagnosis
+            - Advocate for asking questions before ordering expensive tests
+            - Consider the cumulative cost burden
+
+            OUTPUT FORMAT:
+            - Assessment of proposed tests (high/moderate/low/no value)
+            - Specific cost-effective alternatives
+            - Questions that might obviate need for testing
+            - Recommended modifications to testing strategy
+            - Cumulative cost considerations
+
+            Your goal: Maximum diagnostic accuracy at minimum necessary cost.
+            """,
+            
+            AgentRole.CHECKLIST: """
+            You are Dr. Checklist, the quality assurance and consistency specialist.
+
+            CORE RESPONSIBILITIES:
+            - Perform silent quality control on all panel deliberations
+            - Ensure test names are valid and properly specified
+            - Check internal consistency of reasoning across panel members
+            - Flag logical errors or contradictions in the diagnostic approach
+
+            QUALITY CHECKS:
+            1. Test Validity: Are proposed tests real and properly named?
+            2. Logical Consistency: Do the recommendations align with the differential?
+            3. Evidence Integration: Are all findings being considered appropriately?
+            4. Process Adherence: Is the panel following proper diagnostic methodology?
+            5. Safety Checks: Are any critical possibilities being overlooked?
+
+            SPECIFIC VALIDATIONS:
+            - Test names match standard medical terminology
+            - Proposed tests are appropriate for the clinical scenario
+            - No contradictions between different panel members' reasoning
+            - All significant findings are being addressed
+            - No gaps in the diagnostic logic
+
+            OUTPUT FORMAT:
+            - Brief validation summary (✓ Clear / ⚠ Issues noted)
+            - Any test name corrections needed
+            - Logical inconsistencies identified
+            - Missing considerations or gaps
+            - Process improvement suggestions
+
+            Keep your feedback concise but comprehensive. Flag any issues that could compromise diagnostic quality.
+            """,
+            
+            AgentRole.CONSENSUS: """
+            You are the Consensus Coordinator, responsible for synthesizing the virtual panel's expertise into a single, optimal decision.
+
+            CORE RESPONSIBILITIES:
+            - Integrate input from Dr. Hypothesis, Dr. Test-Chooser, Dr. Challenger, Dr. Stewardship, and Dr. Checklist
+            - Decide on the single best next action: 'ask', 'test', or 'diagnose'
+            - Balance competing priorities: accuracy, cost, efficiency, and thoroughness
+            - Ensure the chosen action advances the diagnostic process optimally
+
+            DECISION FRAMEWORK:
+            1. DIAGNOSE: Choose when diagnostic certainty is sufficiently high (>85%) for the leading hypothesis
+            2. TEST: Choose when tests will meaningfully discriminate between hypotheses
+            3. ASK: Choose when history/exam questions could provide high-value information
+
+            SYNTHESIS PROCESS:
+            - Weight Dr. Hypothesis's confidence level and differential
+            - Consider Dr. Test-Chooser's information value analysis
+            - Incorporate Dr. Challenger's alternative perspectives
+            - Respect Dr. Stewardship's cost-effectiveness concerns
+            - Address any quality issues raised by Dr. Checklist
+
+            OUTPUT REQUIREMENTS:
+            Provide a JSON object with this exact structure:
+            {
+                "action_type": "ask" | "test" | "diagnose",
+                "content": "specific question(s), test name(s), or final diagnosis",
+                "reasoning": "clear justification synthesizing panel input"
+            }
+
+            For action_type "ask": content should be specific patient history or physical exam questions
+            For action_type "test": content should be properly named diagnostic tests (up to 3)
+            For action_type "diagnose": content should be the complete, specific final diagnosis
+
+            Make the decision that best advances accurate, cost-effective diagnosis.
+            """,
+            
+            AgentRole.GATEKEEPER: """
+            You are the Gatekeeper, the clinical information oracle with complete access to the patient case file.
+
+            CORE RESPONSIBILITIES:
+            - Provide objective, specific clinical findings when explicitly requested
+            - Serve as the authoritative source for all patient information
+            - Generate realistic synthetic findings for tests not in the original case
+            - Maintain clinical realism while preventing information leakage
+
+            RESPONSE PRINCIPLES:
+            1. OBJECTIVITY: Provide only factual findings, never interpretations or impressions
+            2. SPECIFICITY: Give precise, detailed results when tests are properly ordered
+            3. REALISM: Ensure all responses reflect realistic clinical scenarios
+            4. NO HINTS: Never provide diagnostic clues or suggestions
+            5. CONSISTENCY: Maintain coherence across all provided information
 
-    def run(self, task: str, *args, **kwargs):
-        pass
+            HANDLING REQUESTS:
+            - Patient History Questions: Provide relevant history from case file or realistic details
+            - Physical Exam: Give specific examination findings as would be documented
+            - Diagnostic Tests: Provide exact results as specified or realistic synthetic values
+            - Vague Requests: Politely ask for more specific queries
+            - Invalid Requests: Explain why the request cannot be fulfilled
+
+            SYNTHETIC FINDINGS GUIDELINES:
+            When generating findings not in the original case:
+            - Ensure consistency with established diagnosis and case details
+            - Use realistic reference ranges and values
+            - Maintain clinical plausibility
+            - Avoid pathognomonic findings unless specifically diagnostic
+
+            RESPONSE FORMAT:
+            - Direct, clinical language
+            - Specific measurements with reference ranges when applicable
+            - Clear organization of findings
+            - Professional medical terminology
+
+            Your role is crucial: provide complete, accurate clinical information while maintaining the challenge of the diagnostic process.
+            """,
+            
+            AgentRole.JUDGE: """
+            You are the Judge, the diagnostic accuracy evaluation specialist.
+
+            CORE RESPONSIBILITIES:
+            - Evaluate candidate diagnoses against ground truth using a rigorous clinical rubric
+            - Provide fair, consistent scoring based on clinical management implications
+            - Consider diagnostic substance over terminology differences
+            - Account for acceptable medical synonyms and equivalent formulations
+
+            EVALUATION RUBRIC (5-point Likert scale):
+
+            SCORE 5 (Perfect/Clinically Superior):
+            - Clinically identical to reference diagnosis
+            - May be more specific than reference (adding relevant detail)
+            - No incorrect or unrelated additions
+            - Treatment approach would be identical
+
+            SCORE 4 (Mostly Correct - Minor Incompleteness):
+            - Core disease correctly identified
+            - Minor qualifier or component missing/mis-specified
+            - Overall management largely unchanged
+            - Clinically appropriate diagnosis
+
+            SCORE 3 (Partially Correct - Major Error):
+            - Correct general disease category
+            - Major error in etiology, anatomic site, or critical specificity
+            - Would significantly alter workup or prognosis
+            - Partially correct but clinically concerning gaps
+
+            SCORE 2 (Largely Incorrect):
+            - Shares only superficial features with correct diagnosis
+            - Wrong fundamental disease process
+            - Would misdirect clinical workup
+            - Partially contradicts case details
+
+            SCORE 1 (Completely Incorrect):
+            - No meaningful overlap with correct diagnosis
+            - Wrong organ system or disease category
+            - Would likely lead to harmful care
+            - Completely inconsistent with clinical presentation
+
+            EVALUATION PROCESS:
+            1. Compare core disease entity
+            2. Assess etiology/causative factors
+            3. Evaluate anatomic specificity
+            4. Consider diagnostic completeness
+            5. Judge clinical management implications
+
+            OUTPUT FORMAT:
+            - Score (1-5) with clear label
+            - Detailed justification referencing specific rubric criteria
+            - Explanation of how diagnosis would affect clinical management
+            - Note any acceptable medical synonyms or equivalent terminology
+
+            Maintain high standards while recognizing legitimate diagnostic variability in medical practice.
+            """
+        }
+        return prompts[role]
+    
+    def _parse_json_response(self, response: str) -> Dict[str, Any]:
+        """Safely parses a JSON string, returning a dictionary."""
+        try:
+            # Extract the actual response content from the agent response
+            if isinstance(response, str):
+                # Handle markdown-formatted JSON
+                if "```json" in response:
+                    # Extract JSON content between ```json and ```
+                    start_marker = "```json"
+                    end_marker = "```"
+                    start_idx = response.find(start_marker)
+                    if start_idx != -1:
+                        start_idx += len(start_marker)
+                        end_idx = response.find(end_marker, start_idx)
+                        if end_idx != -1:
+                            json_content = response[start_idx:end_idx].strip()
+                            return json.loads(json_content)
+                
+                # Try to find JSON-like content in the response
+                lines = response.split('\n')
+                json_lines = []
+                in_json = False
+                brace_count = 0
+                
+                for line in lines:
+                    stripped_line = line.strip()
+                    if stripped_line.startswith('{') and not in_json:
+                        in_json = True
+                        json_lines = [line]  # Start fresh
+                        brace_count = line.count('{') - line.count('}')
+                    elif in_json:
+                        json_lines.append(line)
+                        brace_count += line.count('{') - line.count('}')
+                        if brace_count <= 0:  # Balanced braces, end of JSON
+                            break
+                
+                if json_lines and in_json:
+                    json_content = '\n'.join(json_lines)
+                    return json.loads(json_content)
+                
+                # Try to extract JSON from text that might contain other content
+                import re
+                # Look for JSON pattern in the text
+                json_pattern = r'\{[^{}]*(?:\{[^{}]*\}[^{}]*)*\}'
+                matches = re.findall(json_pattern, response, re.DOTALL)
+                
+                for match in matches:
+                    try:
+                        return json.loads(match)
+                    except json.JSONDecodeError:
+                        continue
+                
+                # Direct parsing attempt as fallback
+                return json.loads(response)
+                
+        except (json.JSONDecodeError, IndexError, AttributeError) as e:
+            logger.error(f"Failed to parse JSON response. Error: {e}")
+            logger.debug(f"Response content: {response[:500]}...")  # Log first 500 chars
+            # Fallback to a default action if parsing fails
+            return {
+                "action_type": "ask",
+                "content": "Could you please clarify the next best step? The previous analysis was inconclusive.",
+                "reasoning": "Fallback due to parsing error."
+            }
+        
+    def _estimate_cost(self, tests: Union[List[str], str]) -> int:
+        """Estimates the cost of diagnostic tests."""
+        if isinstance(tests, str):
+            tests = [tests]
+        
+        cost = 0
+        for test in tests:
+            test_lower = test.lower().strip()
+            
+            # Enhanced cost matching with multiple strategies
+            cost_found = False
+            
+            # Strategy 1: Exact match
+            if test_lower in self.test_cost_db:
+                cost += self.test_cost_db[test_lower]
+                cost_found = True
+                continue
+            
+            # Strategy 2: Partial match (find best matching key)
+            best_match = None
+            best_match_length = 0
+            for cost_key in self.test_cost_db:
+                if cost_key in test_lower or test_lower in cost_key:
+                    if len(cost_key) > best_match_length:
+                        best_match = cost_key
+                        best_match_length = len(cost_key)
+            
+            if best_match:
+                cost += self.test_cost_db[best_match]
+                cost_found = True
+                continue
+            
+            # Strategy 3: Keyword-based matching
+            if any(keyword in test_lower for keyword in ['biopsy', 'tissue']):
+                cost += self.test_cost_db.get('biopsy', 800)
+                cost_found = True
+            elif any(keyword in test_lower for keyword in ['mri', 'magnetic']):
+                cost += self.test_cost_db.get('mri', 1500)
+                cost_found = True
+            elif any(keyword in test_lower for keyword in ['ct', 'computed tomography']):
+                cost += self.test_cost_db.get('ct scan', 1200)
+                cost_found = True
+            elif any(keyword in test_lower for keyword in ['xray', 'x-ray', 'radiograph']):
+                cost += self.test_cost_db.get('chest x-ray', 200)
+                cost_found = True
+            elif any(keyword in test_lower for keyword in ['blood', 'serum', 'plasma']):
+                cost += 100  # Basic blood test cost
+                cost_found = True
+            elif any(keyword in test_lower for keyword in ['culture', 'sensitivity']):
+                cost += self.test_cost_db.get('culture', 150)
+                cost_found = True
+            elif any(keyword in test_lower for keyword in ['immunohistochemistry', 'ihc']):
+                cost += self.test_cost_db.get('immunohistochemistry', 400)
+                cost_found = True
+            
+            # Strategy 4: Default cost for unknown tests
+            if not cost_found:
+                cost += self.test_cost_db['default']
+                logger.debug(f"Using default cost for unknown test: {test}")
+        
+        return cost
+
+    def _run_panel_deliberation(self) -> Action:
+        """Orchestrates one round of debate among the virtual panel to decide the next action."""
+        logger.info("🩺 Virtual medical panel deliberation commenced - analyzing patient case")
+        logger.debug("Panel members: Dr. Hypothesis, Dr. Test-Chooser, Dr. Challenger, Dr. Stewardship, Dr. Checklist")
+        panel_conversation = Conversation(
+            time_enabled=True,
+            autosave=False,
+            save_enabled=False
+        )
+        
+        # Prepare comprehensive panel context
+        remaining_budget = self.initial_budget - self.cumulative_cost
+        budget_status = "EXCEEDED" if remaining_budget < 0 else f"${remaining_budget:,}"
+        
+        panel_context = f"""
+        DIAGNOSTIC CASE STATUS - ROUND {len(self.conversation.return_history_as_string().split('Gatekeeper:')) - 1}
+        
+        === CASE INFORMATION ===
+        {self.conversation.get_str()}
+        
+        === CURRENT STATE ===
+        Differential Diagnosis: {self.differential_diagnosis}
+        Cumulative Cost: ${self.cumulative_cost:,}
+        Remaining Budget: {budget_status}
+        Mode: {self.mode}
+        Max Iterations: {self.max_iterations}
+        
+        === PANEL TASK ===
+        Virtual medical panel, please deliberate systematically on the next best diagnostic action.
+        Each specialist should provide their expert analysis in sequence.
+        """
+        panel_conversation.add("System", panel_context)
+
+        # Check mode-specific constraints
+        if self.mode == "instant":
+            # For instant mode, skip deliberation and go straight to diagnosis
+            action_dict = {
+                "action_type": "diagnose",
+                "content": self.differential_diagnosis.split('\n')[0] if '\n' in self.differential_diagnosis else self.differential_diagnosis,
+                "reasoning": "Instant diagnosis mode - providing immediate assessment based on initial presentation"
+            }
+            return Action(**action_dict)
+        
+        if self.mode == "question_only":
+            # For question-only mode, prevent test ordering
+            panel_context += "\n\nIMPORTANT: This is QUESTION-ONLY mode. You may ONLY ask patient questions, not order diagnostic tests."
+            panel_conversation.add("System", panel_context)
+
+        # Sequential expert deliberation with enhanced methodology
+        try:
+            # Dr. Hypothesis - Differential diagnosis and probability assessment
+            logger.info("🧠 Dr. Hypothesis analyzing differential diagnosis...")
+            hypothesis = self.agents[AgentRole.HYPOTHESIS].run(panel_conversation.get_str())
+            self.differential_diagnosis = hypothesis  # Update main state
+            panel_conversation.add(self.agents[AgentRole.HYPOTHESIS].agent_name, hypothesis)
+            
+            # Dr. Test-Chooser - Information value optimization
+            logger.info("🔬 Dr. Test-Chooser selecting optimal tests...")
+            test_choices = self.agents[AgentRole.TEST_CHOOSER].run(panel_conversation.get_str())
+            panel_conversation.add(self.agents[AgentRole.TEST_CHOOSER].agent_name, test_choices)
+
+            # Dr. Challenger - Bias identification and alternative hypotheses
+            logger.info("🤔 Dr. Challenger challenging assumptions...")
+            challenges = self.agents[AgentRole.CHALLENGER].run(panel_conversation.get_str())
+            panel_conversation.add(self.agents[AgentRole.CHALLENGER].agent_name, challenges)
+
+            # Dr. Stewardship - Cost-effectiveness analysis
+            logger.info("💰 Dr. Stewardship evaluating cost-effectiveness...")
+            stewardship_context = panel_conversation.get_str()
+            if self.enable_budget_tracking:
+                stewardship_context += f"\n\nBUDGET TRACKING ENABLED - Current cost: ${self.cumulative_cost}, Remaining: ${remaining_budget}"
+            stewardship_rec = self.agents[AgentRole.STEWARDSHIP].run(stewardship_context)
+            panel_conversation.add(self.agents[AgentRole.STEWARDSHIP].agent_name, stewardship_rec)
+            
+            # Dr. Checklist - Quality assurance
+            logger.info("✅ Dr. Checklist performing quality control...")
+            checklist_rep = self.agents[AgentRole.CHECKLIST].run(panel_conversation.get_str())
+            panel_conversation.add(self.agents[AgentRole.CHECKLIST].agent_name, checklist_rep)
+            
+            # Consensus Coordinator - Final decision synthesis
+            logger.info("🤝 Consensus Coordinator synthesizing panel decision...")
+            consensus_context = panel_conversation.get_str()
+            
+            # Add mode-specific constraints to consensus
+            if self.mode == "budgeted" and remaining_budget <= 0:
+                consensus_context += "\n\nBUDGET CONSTRAINT: Budget exceeded - must either ask questions or provide final diagnosis."
+            
+            consensus_response = self.agents[AgentRole.CONSENSUS].run(consensus_context)
+            logger.debug(f"Raw consensus response: {consensus_response}")
+            
+            # Extract the actual text content from agent response
+            if hasattr(consensus_response, 'content'):
+                response_text = consensus_response.content
+            elif isinstance(consensus_response, str):
+                response_text = consensus_response
+            else:
+                response_text = str(consensus_response)
+                
+            action_dict = self._parse_json_response(response_text)
+
+            # Validate action based on mode constraints
+            action = Action(**action_dict)
+            if self.mode == "question_only" and action.action_type == "test":
+                logger.warning("Test ordering attempted in question-only mode, converting to ask action")
+                action.action_type = "ask"
+                action.content = "Can you provide more details about the patient's symptoms and history?"
+                action.reasoning = "Mode constraint: question-only mode active"
+
+            if self.mode == "budgeted" and action.action_type == "test" and remaining_budget <= 0:
+                logger.warning("Test ordering attempted with insufficient budget, converting to diagnose action")
+                action.action_type = "diagnose"
+                action.content = self.differential_diagnosis.split('\n')[0] if '\n' in self.differential_diagnosis else self.differential_diagnosis
+                action.reasoning = "Budget constraint: insufficient funds for additional testing"
+
+            return action
+
+        except Exception as e:
+            logger.error(f"Error during panel deliberation: {e}")
+            # Fallback action
+            return Action(
+                action_type="ask",
+                content="Could you please provide more information about the patient's current condition?",
+                reasoning=f"Fallback due to panel deliberation error: {str(e)}"
+            )
+
+    def _interact_with_gatekeeper(self, action: Action, full_case_details: str) -> str:
+        """Sends the panel's action to the Gatekeeper and returns its response."""
+        gatekeeper = self.agents[AgentRole.GATEKEEPER]
+        
+        if action.action_type == "ask":
+            request = f"Question: {action.content}"
+        elif action.action_type == "test":
+            request = f"Tests ordered: {', '.join(action.content)}"
+        else:
+            return "No interaction needed for 'diagnose' action."
+
+        # The Gatekeeper needs the full case to act as an oracle
+        prompt = f"""
+        Full Case Details (for your reference only):
+        ---
+        {full_case_details}
+        ---
+        
+        Request from Diagnostic Agent:
+        {request}
+        """
+        
+        response = gatekeeper.run(prompt)
+        return response
+
+    def _judge_diagnosis(self, candidate_diagnosis: str, ground_truth: str) -> Dict[str, Any]:
+        """Uses the Judge agent to evaluate the final diagnosis."""
+        judge = self.agents[AgentRole.JUDGE]
+        prompt = f"""
+        Please evaluate the following diagnosis.
+        Ground Truth: "{ground_truth}"
+        Candidate Diagnosis: "{candidate_diagnosis}"
+        """
+        response = judge.run(prompt)
+        
+        # Simple parsing for demonstration; a more robust solution would use structured output.
+        try:
+            score = float(response.split("Score:")[1].split("/")[0].strip())
+            reasoning = response.split("Justification:")[1].strip()
+        except (IndexError, ValueError):
+            score = 0.0
+            reasoning = "Could not parse judge's response."
+            
+        return {"score": score, "reasoning": reasoning}
+
+    def run(self, initial_case_info: str, full_case_details: str, ground_truth_diagnosis: str) -> DiagnosisResult:
+        """
+        Executes the full sequential diagnostic process.
+
+        Args:
+            initial_case_info (str): The initial abstract of the case.
+            full_case_details (str): The complete case file for the Gatekeeper.
+            ground_truth_diagnosis (str): The correct final diagnosis for evaluation.
+
+        Returns:
+            DiagnosisResult: An object containing the final diagnosis, evaluation, cost, and history.
+        """
+        start_time = time.time()
+        self.conversation.add("Gatekeeper", f"Initial Case Information: {initial_case_info}")
+        
+        # Add initial physician visit cost
+        self.cumulative_cost += self.physician_visit_cost
+        logger.info(f"Initial physician visit cost: ${self.physician_visit_cost}")
+        
+        final_diagnosis = None
+        iteration_count = 0
+        
+        for i in range(self.max_iterations):
+            iteration_count = i + 1
+            logger.info(f"--- Starting Diagnostic Loop {iteration_count}/{self.max_iterations} ---")
+            logger.info(f"Current cost: ${self.cumulative_cost:,} | Remaining budget: ${self.initial_budget - self.cumulative_cost:,}")
+            
+            try:
+                # Panel deliberates to decide on the next action
+                action = self._run_panel_deliberation()
+                logger.info(f"⚕️ Panel decision: {action.action_type.upper()} -> {action.content}")
+                logger.info(f"💭 Medical reasoning: {action.reasoning}")
+                
+                if action.action_type == "diagnose":
+                    final_diagnosis = action.content
+                    logger.info(f"Final diagnosis proposed: {final_diagnosis}")
+                    break
+
+                # Handle mode-specific constraints
+                if self.mode == "question_only" and action.action_type == "test":
+                    logger.warning("Test ordering blocked in question-only mode")
+                    continue
+                    
+                if self.mode == "budgeted" and action.action_type == "test":
+                    # Check if we can afford the tests
+                    estimated_test_cost = self._estimate_cost(action.content)
+                    if self.cumulative_cost + estimated_test_cost > self.initial_budget:
+                        logger.warning(f"Test cost ${estimated_test_cost} would exceed budget. Skipping tests.")
+                        continue
+
+                # Interact with the Gatekeeper
+                response = self._interact_with_gatekeeper(action, full_case_details)
+                self.conversation.add("Gatekeeper", response)
+                
+                # Update costs based on action type
+                if action.action_type == "test":
+                    test_cost = self._estimate_cost(action.content)
+                    self.cumulative_cost += test_cost
+                    logger.info(f"Tests ordered: {action.content}")
+                    logger.info(f"Test cost: ${test_cost:,} | Cumulative cost: ${self.cumulative_cost:,}")
+                elif action.action_type == "ask":
+                    # Questions are part of the same visit until tests are ordered
+                    logger.info(f"Questions asked: {action.content}")
+                    logger.info(f"No additional cost for questions in same visit")
+
+                # Check budget constraints for budgeted mode
+                if self.mode == "budgeted" and self.cumulative_cost >= self.initial_budget:
+                    logger.warning("Budget limit reached. Forcing final diagnosis.")
+                    # Use current differential diagnosis or make best guess
+                    final_diagnosis = self.differential_diagnosis.split('\n')[0] if '\n' in self.differential_diagnosis else "Diagnosis not reached within budget constraints."
+                    break
+                    
+            except Exception as e:
+                logger.error(f"Error in diagnostic loop {iteration_count}: {e}")
+                # Continue to next iteration or break if critical error
+                continue
+        
+        else:
+            # Max iterations reached without diagnosis
+            final_diagnosis = self.differential_diagnosis.split('\n')[0] if '\n' in self.differential_diagnosis else "Diagnosis not reached within maximum iterations."
+            logger.warning(f"Max iterations ({self.max_iterations}) reached. Using best available diagnosis.")
+
+        # Ensure we have a final diagnosis
+        if not final_diagnosis or final_diagnosis.strip() == "":
+            final_diagnosis = "Unable to determine diagnosis within constraints."
+            
+        # Calculate total time
+        total_time = time.time() - start_time
+        logger.info(f"Diagnostic session completed in {total_time:.2f} seconds")
+
+        # Judge the final diagnosis
+        logger.info("Evaluating final diagnosis...")
+        try:
+            judgement = self._judge_diagnosis(final_diagnosis, ground_truth_diagnosis)
+        except Exception as e:
+            logger.error(f"Error in diagnosis evaluation: {e}")
+            judgement = {"score": 0.0, "reasoning": f"Evaluation error: {str(e)}"}
+
+        # Create comprehensive result
+        result = DiagnosisResult(
+            final_diagnosis=final_diagnosis,
+            ground_truth=ground_truth_diagnosis,
+            accuracy_score=judgement["score"],
+            accuracy_reasoning=judgement["reasoning"],
+            total_cost=self.cumulative_cost,
+            iterations=iteration_count,
+            conversation_history=self.conversation.get_str()
+        )
+        
+        logger.info(f"Diagnostic process completed:")
+        logger.info(f"  Final diagnosis: {final_diagnosis}")
+        logger.info(f"  Ground truth: {ground_truth_diagnosis}")
+        logger.info(f"  Accuracy score: {judgement['score']}/5.0")
+        logger.info(f"  Total cost: ${self.cumulative_cost:,}")
+        logger.info(f"  Iterations: {iteration_count}")
+        
+        return result
+    
+    def run_ensemble(self, initial_case_info: str, full_case_details: str, ground_truth_diagnosis: str, num_runs: int = 3) -> DiagnosisResult:
+        """
+        Runs multiple independent diagnostic sessions and aggregates the results.
+        
+        Args:
+            initial_case_info (str): The initial abstract of the case.
+            full_case_details (str): The complete case file for the Gatekeeper.
+            ground_truth_diagnosis (str): The correct final diagnosis for evaluation.
+            num_runs (int): Number of independent runs to perform.
+            
+        Returns:
+            DiagnosisResult: Aggregated result from ensemble runs.
+        """
+        logger.info(f"Starting ensemble run with {num_runs} independent sessions")
+        
+        ensemble_results = []
+        total_cost = 0
+        
+        for run_id in range(num_runs):
+            logger.info(f"=== Ensemble Run {run_id + 1}/{num_runs} ===")
+            
+            # Create a fresh orchestrator instance for each run
+            run_orchestrator = MaiDxOrchestrator(
+                model_name=self.model_name,
+                max_iterations=self.max_iterations,
+                initial_budget=self.initial_budget,
+                mode="no_budget",  # Use no_budget for ensemble runs
+                physician_visit_cost=self.physician_visit_cost,
+                enable_budget_tracking=False
+            )
+            
+            # Run the diagnostic session
+            result = run_orchestrator.run(initial_case_info, full_case_details, ground_truth_diagnosis)
+            ensemble_results.append(result)
+            total_cost += result.total_cost
+            
+            logger.info(f"Run {run_id + 1} completed: {result.final_diagnosis} (Score: {result.accuracy_score})")
+        
+        # Aggregate results using consensus
+        final_diagnosis = self._aggregate_ensemble_diagnoses([r.final_diagnosis for r in ensemble_results])
+        
+        # Judge the aggregated diagnosis
+        judgement = self._judge_diagnosis(final_diagnosis, ground_truth_diagnosis)
+        
+        # Calculate average metrics
+        avg_iterations = sum(r.iterations for r in ensemble_results) / len(ensemble_results)
+        
+        # Combine conversation histories
+        combined_history = "\n\n=== ENSEMBLE RESULTS ===\n"
+        for i, result in enumerate(ensemble_results):
+            combined_history += f"\n--- Run {i+1} ---\n"
+            combined_history += f"Diagnosis: {result.final_diagnosis}\n"
+            combined_history += f"Score: {result.accuracy_score}\n"
+            combined_history += f"Cost: ${result.total_cost:,}\n"
+            combined_history += f"Iterations: {result.iterations}\n"
+        
+        combined_history += f"\n--- Aggregated Result ---\n"
+        combined_history += f"Final Diagnosis: {final_diagnosis}\n"
+        combined_history += f"Reasoning: {judgement['reasoning']}\n"
+        
+        ensemble_result = DiagnosisResult(
+            final_diagnosis=final_diagnosis,
+            ground_truth=ground_truth_diagnosis,
+            accuracy_score=judgement["score"],
+            accuracy_reasoning=judgement["reasoning"],
+            total_cost=total_cost,  # Sum of all runs
+            iterations=int(avg_iterations),
+            conversation_history=combined_history
+        )
+        
+        logger.info(f"Ensemble completed: {final_diagnosis} (Score: {judgement['score']})")
+        return ensemble_result
+    
+    def _aggregate_ensemble_diagnoses(self, diagnoses: List[str]) -> str:
+        """Aggregates multiple diagnoses from ensemble runs."""
+        # Simple majority voting or use the most confident diagnosis
+        if not diagnoses:
+            return "No diagnosis available"
+        
+        # Remove any empty or invalid diagnoses
+        valid_diagnoses = [d for d in diagnoses if d and d.strip() and "not reached" not in d.lower()]
+        
+        if not valid_diagnoses:
+            return diagnoses[0] if diagnoses else "No valid diagnosis"
+        
+        # If all diagnoses are the same, return that
+        if len(set(valid_diagnoses)) == 1:
+            return valid_diagnoses[0]
+        
+        # Use an aggregator agent to select the best diagnosis
+        try:
+            aggregator_prompt = f"""
+            You are a medical consensus aggregator. Given multiple diagnostic assessments from independent medical panels, 
+            select the most accurate and complete diagnosis.
+            
+            Diagnoses to consider:
+            {chr(10).join(f"{i+1}. {d}" for i, d in enumerate(valid_diagnoses))}
+            
+            Provide the single best diagnosis that represents the medical consensus. 
+            Consider clinical accuracy, specificity, and completeness.
+            """
+            
+            aggregator = Agent(
+                agent_name="Ensemble Aggregator",
+                system_prompt=aggregator_prompt,
+                model_name=self.model_name,
+                max_loops=1,
+                print_on=True  # Enable printing for aggregator agent
+            )
+            
+            return aggregator.run(aggregator_prompt).strip()
+            
+        except Exception as e:
+            logger.error(f"Error in ensemble aggregation: {e}")
+            # Fallback to most common diagnosis
+            from collections import Counter
+            return Counter(valid_diagnoses).most_common(1)[0][0]
+    
+    @classmethod
+    def create_variant(cls, variant: str, **kwargs) -> 'MaiDxOrchestrator':
+        """
+        Factory method to create different MAI-DxO variants as described in the paper.
+        
+        Args:
+            variant (str): One of 'instant', 'question_only', 'budgeted', 'no_budget', 'ensemble'
+            **kwargs: Additional parameters for the orchestrator
+            
+        Returns:
+            MaiDxOrchestrator: Configured orchestrator instance
+        """
+        variant_configs = {
+            "instant": {
+                "mode": "instant",
+                "max_iterations": 1,
+                "enable_budget_tracking": False
+            },
+            "question_only": {
+                "mode": "question_only",
+                "max_iterations": 10,
+                "enable_budget_tracking": False
+            },
+            "budgeted": {
+                "mode": "budgeted",
+                "max_iterations": 10,
+                "enable_budget_tracking": True,
+                "initial_budget": kwargs.get("budget", 5000)
+            },
+            "no_budget": {
+                "mode": "no_budget",
+                "max_iterations": 10,
+                "enable_budget_tracking": False
+            },
+            "ensemble": {
+                "mode": "no_budget",
+                "max_iterations": 10,
+                "enable_budget_tracking": False
+            }
+        }
+        
+        if variant not in variant_configs:
+            raise ValueError(f"Unknown variant: {variant}. Choose from: {list(variant_configs.keys())}")
+        
+        config = variant_configs[variant]
+        config.update(kwargs)  # Allow overrides
+        
+        return cls(**config)
+
+
+def run_mai_dxo_demo(case_info: str = None, case_details: str = None, ground_truth: str = None) -> Dict[str, DiagnosisResult]:
+    """
+    Convenience function to run a quick demonstration of MAI-DxO variants.
+    
+    Args:
+        case_info (str): Initial case information. Uses default if None.
+        case_details (str): Full case details. Uses default if None.
+        ground_truth (str): Ground truth diagnosis. Uses default if None.
+        
+    Returns:
+        Dict[str, DiagnosisResult]: Results from different MAI-DxO variants
+    """
+    # Use default case if not provided
+    if not case_info:
+        case_info = (
+            "A 29-year-old woman was admitted to the hospital because of sore throat and peritonsillar swelling "
+            "and bleeding. Symptoms did not abate with antimicrobial therapy."
+        )
+    
+    if not case_details:
+        case_details = """
+        Patient: 29-year-old female.
+        History: Onset of sore throat 7 weeks prior to admission. Worsening right-sided pain and swelling.
+        No fevers, headaches, or gastrointestinal symptoms. Past medical history is unremarkable.
+        Physical Exam: Right peritonsillar mass, displacing the uvula. No other significant findings.
+        Initial Labs: FBC, clotting studies normal.
+        MRI Neck: Showed a large, enhancing mass in the right peritonsillar space.
+        Biopsy (H&E): Infiltrative round-cell neoplasm with high nuclear-to-cytoplasmic ratio and frequent mitotic figures.
+        Biopsy (Immunohistochemistry): Desmin and MyoD1 diffusely positive. Myogenin multifocally positive.
+        Biopsy (FISH): No FOXO1 (13q14) rearrangements detected.
+        Final Diagnosis from Pathology: Embryonal rhabdomyosarcoma of the pharynx.
+        """
+    
+    if not ground_truth:
+        ground_truth = "Embryonal rhabdomyosarcoma of the pharynx"
+    
+    results = {}
+    
+    # Test key variants
+    variants = ["no_budget", "budgeted", "question_only"]
+    
+    for variant in variants:
+        try:
+            logger.info(f"Running MAI-DxO variant: {variant}")
+            
+            if variant == "budgeted":
+                orchestrator = MaiDxOrchestrator.create_variant(variant, budget=3000, model_name="gemini/gemini-2.5-flash")
+            else:
+                orchestrator = MaiDxOrchestrator.create_variant(variant, model_name="gemini/gemini-2.5-flash")
+            
+            result = orchestrator.run(case_info, case_details, ground_truth)
+            results[variant] = result
+            
+        except Exception as e:
+            logger.error(f"Error running variant {variant}: {e}")
+            results[variant] = None
     
-    
+    return results
+
+
+if __name__ == "__main__":
+    # Example case inspired by the paper's Figure 1
+    initial_info = (
+        "A 29-year-old woman was admitted to the hospital because of sore throat and peritonsillar swelling "
+        "and bleeding. Symptoms did not abate with antimicrobial therapy."
+    )
+    
+    full_case = """
+    Patient: 29-year-old female.
+    History: Onset of sore throat 7 weeks prior to admission. Worsening right-sided pain and swelling.
+    No fevers, headaches, or gastrointestinal symptoms. Past medical history is unremarkable. No history of smoking or significant alcohol use.
+    Physical Exam: Right peritonsillar mass, displacing the uvula. No other significant findings.
+    Initial Labs: FBC, clotting studies normal.
+    MRI Neck: Showed a large, enhancing mass in the right peritonsillar space.
+    Biopsy (H&E): Infiltrative round-cell neoplasm with high nuclear-to-cytoplasmic ratio and frequent mitotic figures.
+    Biopsy (Immunohistochemistry for Carcinoma): CD31, D2-40, CD34, ERG, GLUT-1, pan-cytokeratin, CD45, CD20, CD3 all negative. Ki-67: 60% nuclear positivity.
+    Biopsy (Immunohistochemistry for Rhabdomyosarcoma): Desmin and MyoD1 diffusely positive. Myogenin multifocally positive.
+    Biopsy (FISH): No FOXO1 (13q14) rearrangements detected.
+    Final Diagnosis from Pathology: Embryonal rhabdomyosarcoma of the pharynx.
+    """
+    
+    ground_truth = "Embryonal rhabdomyosarcoma of the pharynx"
+    
+    # --- Demonstrate Different MAI-DxO Variants ---
+    try:
+        print("\n" + "="*80)
+        print("    MAI DIAGNOSTIC ORCHESTRATOR (MAI-DxO) - SEQUENTIAL DIAGNOSIS BENCHMARK")
+        print("                    Implementation based on the NEJM Research Paper")
+        print("="*80)
+        
+        # Test different variants as described in the paper
+        variants_to_test = [
+            ("no_budget", "Standard MAI-DxO with no budget constraints"),
+            ("budgeted", "Budget-constrained MAI-DxO ($3000 limit)"),
+            ("question_only", "Question-only variant (no diagnostic tests)"),
+        ]
+        
+        results = {}
+        
+        for variant_name, description in variants_to_test:
+            print(f"\n{'='*60}")
+            print(f"Testing Variant: {variant_name.upper()}")
+            print(f"Description: {description}")
+            print('='*60)
+            
+            # Create the variant
+            if variant_name == "budgeted":
+                orchestrator = MaiDxOrchestrator.create_variant(
+                    variant_name, 
+                    budget=3000,
+                    model_name="gemini/gemini-2.5-flash",
+                    max_iterations=5
+                )
+            else:
+                orchestrator = MaiDxOrchestrator.create_variant(
+                    variant_name,
+                    model_name="gemini/gemini-2.5-flash", 
+                    max_iterations=5
+                )
+            
+            # Run the diagnostic process
+            result = orchestrator.run(
+                initial_case_info=initial_info,
+                full_case_details=full_case,
+                ground_truth_diagnosis=ground_truth
+            )
+            
+            results[variant_name] = result
+            
+            # Display results
+            print(f"\n🚀 Final Diagnosis: {result.final_diagnosis}")
+            print(f"🎯 Ground Truth: {result.ground_truth}")
+            print(f"⭐ Accuracy Score: {result.accuracy_score}/5.0")
+            print(f"   Reasoning: {result.accuracy_reasoning}")
+            print(f"💰 Total Cost: ${result.total_cost:,}")
+            print(f"🔄 Iterations: {result.iterations}")
+            print(f"⏱️  Mode: {orchestrator.mode}")
+            
+        # Demonstrate ensemble approach
+        print(f"\n{'='*60}")
+        print("Testing Variant: ENSEMBLE")
+        print("Description: Multiple independent runs with consensus aggregation")
+        print('='*60)
+        
+        ensemble_orchestrator = MaiDxOrchestrator.create_variant(
+            "ensemble",
+            model_name="gemini/gemini-2.5-flash",
+            max_iterations=3  # Shorter iterations for ensemble
+        )
+        
+        ensemble_result = ensemble_orchestrator.run_ensemble(
+            initial_case_info=initial_info,
+            full_case_details=full_case,
+            ground_truth_diagnosis=ground_truth,
+            num_runs=2  # Reduced for demo
+        )
+        
+        results["ensemble"] = ensemble_result
+        
+        print(f"\n🚀 Ensemble Diagnosis: {ensemble_result.final_diagnosis}")
+        print(f"🎯 Ground Truth: {ensemble_result.ground_truth}")
+        print(f"⭐ Ensemble Score: {ensemble_result.accuracy_score}/5.0")
+        print(f"💰 Total Ensemble Cost: ${ensemble_result.total_cost:,}")
+        
+        # --- Summary Comparison ---
+        print(f"\n{'='*80}")
+        print("                           RESULTS SUMMARY")
+        print('='*80)
+        print(f"{'Variant':<15} {'Diagnosis Match':<15} {'Score':<8} {'Cost':<12} {'Iterations':<12}")
+        print('-'*80)
+        
+        for variant_name, result in results.items():
+            match_status = "✓ Match" if result.accuracy_score >= 4.0 else "✗ No Match"
+            print(f"{variant_name:<15} {match_status:<15} {result.accuracy_score:<8.1f} ${result.total_cost:<11,} {result.iterations:<12}")
+        
+        print(f"\n{'='*80}")
+        print("Implementation successfully demonstrates the MAI-DxO framework")
+        print("as described in 'Sequential Diagnosis with Language Models' paper")
+        print('='*80)
+
+    except Exception as e:
+        logger.exception(f"An error occurred during the diagnostic session: {e}")
+        print(f"\n❌ Error occurred: {e}")
+        print("Please check your model configuration and API keys.")