Anatomy-Guided Hybrid CNN–ViT Model with Neuro-Symbolic Reasoning for Early Diagnosis of Thoracic Diseases Multilabel

<b>Background/Objectives</b>: The clinical adoption of AI in radiology requires models that balance high accuracy with interpretable, anatomically plausible reasoning. This study presents an integrated diagnostic framework that addresses this need by unifying a hybrid deep-learning architecture with explicit anatomical guidance and neuro-symbolic inference. <b>Methods</b>: The proposed system employs a dual-path model: an enhanced EfficientNetV2 backbone extracts hierarchical local features, whereas a refined Vision Transformer captures global contextual dependencies across the thoracic cavity. These representations are fused and critically disciplined through auxiliary segmentation supervision using CheXmask. This anchors the learned features to lung and cardiac anatomy, reducing reliance on spurious artifacts. This anatomical basis is fundamental to the interpretability pipeline. It confines Gradient-weighted Class Activation Mapping (Grad-CAM) visual explanations to clinically valid regions. Then, a novel neuro-symbolic reasoning layer is introduced. Using a fuzzy logic engine and radiological ontology, this module translates anatomically aligned neural activations into structured, human-readable diagnostic statements that explicitly articulate the model's clinical rationale. <b>Results</b>: Evaluated on the NIH ChestX-ray14 dataset, the framework achieved a macro-AUROC of 0.9056 and a macro-accuracy of 93.9% across 14 pathologies, with outstanding performance on emphysema (0.9694), hernia (0.9711), and cardiomegaly (0.9589). The model's generalizability was confirmed through external validation on the CheXpert dataset, yielding a macro-AUROC of 0.85. <b>Conclusions</b>: This study demonstrates a cohesive path toward clinically transparent and trustworthy AI by seamlessly integrating data-driven learning with anatomical knowledge and symbolic reasoning.