Weight-space programming for auditing clinical decision networks

Humza Nusrat, Omar Nusrat

Machine learning models in radiotherapy are commissioned by testing them on cases with known answers, which may not reveal a shortcut that the test cases share with the training data. Frontier language models have recently been reported to read and write the raw weights of small neural networks, an ability called weight-space programming. The purpose of this study was to determine whether such a model, given only a clinical protocol and a network's weights, can audit and repair the network. Networks with 433 to 4,801 parameters were trained to screen head-and-neck planning requests against four rules. Flaws were planted through the training data: confounds that hid each rule, a 3 Gy shift in the cord threshold, and a hidden trigger. Claude Opus 5.5 audited each network blind, without tools, data or code execution, and every claim and repair was tested on about 420,000 requests. The language model named the broken rule in 16 of 18 flawed networks (95% CI 67% to 97%), including all 15 with a confound or a threshold shift. It repaired each of the 16 by changing a median of 3 parameters. Fine-tuning on protocol-labeled requests also repaired every network, but changed nearly every…