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8 papers in the last four weeks, down 20% on the four weeks before. 0.1% of all new papers.

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Latest papers 60

Sep 28, 2026cs.CV

Impact of Patient Orientation in Single- and Multi-View Camera Environments for AI-based Rehabilitation Monitoring

Automated quality assessment of rehabilitation exercises relies heavily on accurate human pose estimation from video data. Although numerous RGB-based pose estimation methods have been proposed, the impact of camera placement on detecting clinically relevant movement errors remains insufficiently explored. To address this gap, we introduce REHAB26-ViewAngles, a dataset comprising correct and incorrect rehabilitation exercise executions captured from a wide range of camera angles. Furthermore, we propose a novel separability metric to quantify an algorithm's ability to distinguish between valid and faulty exercise repetitions. Using these tools, we analyze how various RGB-based pose-estimation strategies are suitable for exercise quality assessment under varying camera placements. In particular, we analyze single-camera 2D and 3D pose estimation and four multi-camera strategies: a combination of two orthogonal 2D views, 3D triangulation, weighted 3D fusion, and an AI-based pose-estimation transformer model specifically trained from two synchronized cameras. Our findings reveal that an optimally placed 2D camera can improve the separability by 16.9% over the commonly used 0° frontal view and frequently outperforms single-camera 3D estimation, while combining two views can further improve accuracy by up to 13.1%. These results offer practical guidance for deploying rehabilitation monitoring in both home and clinical settings.

Miriama Jánošová, Andreas Lang, Petra Budikova +1

Faculty of Informatics, Masaryk University, Brno, Czech Republic · TU Dortmund University, Dortmund, Germany · VisionCraft, Brno, Czech Republic

Category-Level Object Pose Estimation Rehabilitation Camera Control Physical Activities Patients Ai-Based

Sep 28, 2026cs.LG

A Multimodal Autonomic Sensing Framework for Objective Assessment of Patient Responses to Dental Pulp Stimulation

Patient responses to dental pulp testing, ranging from no sensation to intense pain, provide important information for assessing pulp status in endodontic diagnosis. However, pain is a subjective sensory and emotional experience that varies considerably across individuals and can be difficult to communicate. We investigated whether complementary autonomic signals could support objective assessment of responses during dental examination. Forty-nine patients underwent cold pulp testing, yielding no-response, mild-response, and intense-response conditions. The framework integrated ECG-derived skin nerve activity (SKNA) and R-R intervals (RRI), together with electrodermal activity (EDA), using temporal convolutional network encoders with attention-based mid-level fusion. Individual baseline signals and subject-level covariates, including anxiety scores and biological sex, were also incorporated. The framework achieved 80.2% balanced accuracy, 75.2% sensitivity, and 85.2% specificity for binary classification of no response versus mild or intense response. For three-class classification, it achieved 60.0% balanced accuracy and a 58.8% macro-averaged F1 score. Ablation and attention-weight analyses indicated that EDA contributed most strongly to model performance, followed by RRI, while SKNA improved balanced accuracy by approximately five percentage points. Age was significantly associated with model performance. These findings support the feasibility of multimodal autonomic sensing for objective, non-invasive assessment of responses to dental pulp stimulation.

Youngsun Kong, Yubin Choi, Dongjin Song +3

Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269 USA · Department of Endodontics, University of Connecticut Health, Farmington, CT 06030 USA · School of Computing, University of Connecticut, Storrs, CT 06269 USA

Occlusal Constraint Multi-Modal Sensing Patients Objectives

Sep 24, 2026cs.AI

Wearable ECG Quality Assessment: A Deep Learning and Ambulatory Context-Awareness Approach

This paper presents and evaluates a Deep Learning-based (DL-based) Signal Quality Assessment (SQA) model to distinguish between clean and noisy ambulatory Electrocardiograms (ECG). The model is trained on Copenhagen Center for Health Technology-Contextualized Arrhythmia Database (CACHET-CADB), which, to the best of our knowledge, is the first ambulatory ECG database with both physical and patient-reported contextual data. The model shows stable performance on different databases such as MIT-databases and the latest PyhsioNet/Cinc Challenge 2021 databases. Subsequently, the paper demonstrates how complicated ECG noise can be investigated by the SQA model and the physical contextual data.

Xiaopeng Mao, Marike Weisbjerg, Sadasivan Puthusserypady

Health Technology department Technical University of Denmark Kongens Lyngby, Denmark

Arrhythmia Classification Deep Learning Signal-To-Noise Ratio Context-Awareness Patients

Sep 23, 2026cs.LG

Fed-ReMasker: Federated Tabular Imputation under Feature-Level Missingness

Multi-center clinical studies and biomedical research collaborations increasingly seek to utilize data across centers to build models that generalize beyond any single center. This creates two distinct challenges: data protection regulations may restrict the sharing of raw patient data across institutions, while centers may collect only partially overlapping sets of features under different protocols. Federated learning enables collaborative model training without centralizing raw data. However, existing federated imputation methods rarely evaluate feature-level missingness, in which entire features are unobserved at some centers. To address this setting, we adapt the ReMasker masked autoencoder to federated learning (Fed-ReMasker), enabling centers to impute features never observed locally by leveraging knowledge learned across collaborating centers. We evaluate Fed-ReMasker in a benchmark spanning synthetic datasets with linear and nonlinear relationships and real-world tabular datasets, including clinical data. The benchmark varies the number of centers, the missingness ratios, and client heterogeneity. Fed-ReMasker achieves the lowest imputation error in 93.2% of value-level and 96.7% of feature-level scenarios in the homogeneous benchmark. It also remains robust to client heterogeneity using simple federated averaging, outperforming all baselines in all 36 value-level scenarios and each baseline in at least 35 of 36 feature-level scenarios, and comes within 3.0% on average of a centralized model trained on the pooled data.

Ioannis Papathanail, Rooholla Poursoleymani, Lubnaa Abdur Rahman +1

ARTORG Center for Biomedical Engineering Research University of Bern, Bern, Switzerland · Graduate School for Cellular and Biomedical Sciences University of Bern, Bern, Switzerland

Imputation Federated Learning Missing Data Missing Modalities Imbalanced Classification Patients+1

Sep 21, 2026cs.LG

A Federated Artificial Intelligence Framework for Optimizing Pancreatic Cancer Treatment - Strategy Update

While a centralized approach involving patient consent to collect and analyze data centrally would theoretically offer the best data quality and predictive performance, it is not always feasible in practice. Federated Learning (FL) architectures have shown to be a very promising approach to use and access distributed disease related resources within the GDPR boundaries. In a previous case report, we described the preconditions at the participating sites and necessary administrative and process related steps to prepare data, people and infrastructure for improving subtype identification and assessing treatment options in pancreatic cancer. We update this report sharing our experience in tackling the challenges and show preliminary results of the actual federated learning AI pipelines. At the participating sites, we have to identify and annotate the data being accessible after extraction and transformation in a local FL hub - in our case a centrally developed and distributively deployed Docker container. This container comprises the FL scripts generating local models. We apply a newly developed FL algorithm considering all local features, including partial overlapping features specific to the local sites. Theoretically, an annotation in a cancer setting should succeed using the German oncology core data set (oBDS), which is already utilized for mandatory reporting to cancer registries, and can be sustained in the FL setting. The FL algorithms deal robustly with partially overlapping features as we showed with public data sets. Major roadblocks including straightening operational concepts for the infrastructures, ethics approval for such novel architectures and support for every site have been addressed. However, scaling up this approach in the future faces hurdles; while including broader multi-modal data sets should be feasible, large-scale deployment to more sites remains challenging.

Anne-Christin Hauschild, Amirreza Aleyasin, Nils H. Beyer +12

University Medical Center Göttingen, Department of Medical Informatics, Göttingen, Germany · University of Göttingen, Campus Institute Data Science (CIDAS), Section of Medical Data Science, Göttingen, Germany · Institute for Predictive Deep Learning for Medicine and Healthcare, Justus-Liebig University, Gießen, Germany +13

Federated Learning Multidisciplinary Tumor Boards Patients

Sep 14, 2026cs.AI

Medical Knowledge Simplification for Patients in the Era of LLMs: A Case Study on Diabetes

Complex medical information is often difficult for patients to understand, making effective medical knowledge simplification essential for improving patient comprehension, informed decision-making, and health outcomes. Recent advances in large language models (LLMs) provide a promising approach for simplifying complex medical information into patient-friendly language; however, their effectiveness in real-world patient education remains insufficiently explored through human evaluation. To investigate their practical effectiveness, this paper presents a case study on diabetes knowledge simplification through the implementation and evaluation of MediClear, an LLM-based medical knowledge simplification system enhanced with Retrieval-Augmented Generation (RAG). Public diabetes-related articles from Diabetes Australia, WHO, American Diabetes Association (ADA), NIDDK, and AIHW are indexed in the RAG knowledge base to retrieve clinically grounded information, which is then simplified by the LLM into accessible patient explanations. We evaluate the generated responses using standard readability metrics, including the Flesch-Kincaid Grade Level (FKGL), and conduct a human study involving 10 participants. Results show that MediClear consistently reduces the reading level of generated responses to the recommended patient literacy range while achieving high user satisfaction and willingness for future use. This case study demonstrates the potential of LLMs to improve the accessibility of medical knowledge for patient education.

Pallika Kafle, Yipeng Zhou, Guanfeng Liu +2

Macquarie University, Sydney, Australia · Beijing Normal–Hong Kong Baptist University, Zhuhai, China · National Tsing Hua University, Hsinchu, Taiwan

Multilingual Healthcare Q&A Patients Diabetes Case Study

Sep 14, 2026cs.LG

Patient-Reported Survey Data Improve Prediction of Opioid Use Disorder

Electronic health records (EHRs) may incompletely capture patient-reported factors associated with opioid use disorder (OUD). We evaluated whether survey data improve prediction of a first recorded OUD diagnosis among 267,747 All of Us participants with documented opioid exposure, including 15,287 OUD cases. We compared EHR-only and EHR+survey models across 6-, 12-, and 24-month look-back windows using logistic regression, random forest, XGBoost, LightGBM, multilayer perceptron, LSTM, GRU, and Transformer. Survey augmentation improved PR-AUC across all 24 model-window combinations by 0.0087-0.0505; the best 24-month LightGBM model improved from 0.6219 to 0.6603. Survey coverage increased with longer windows and differed by OUD status (24 months: 21.7% OUD-positive vs. 60.7% OUD-negative). Permutation analysis ranked survey features as the second most important information domain at 24 months in both evaluated models. Patient-reported data provide complementary predictive signals beyond structured EHRs while highlighting the importance of survey availability.

Xiyue Jiang, Zihan Ding, Grace Han +3

Department of Applied Mathematics & Statistics, Stony Brook University, Stony Brook, NY, USA · Department of Computer Science, Stony Brook University, Stony Brook, NY, USA · Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA +1

Electronic Health Records Patients Survey Logistic Regression

Sep 8, 2026cs.LG

Geographically Regularized AUC-Maximizing Personalized Federated Learning

Accurate diagnostic and risk-prediction models are important for supporting clinical decision-making during infectious disease outbreaks. However, privacy and governance requirements may restrict patient-level data sharing across healthcare institutions, and data distributions often vary. Moreover, AUC is widely used to evaluate discriminative performance, motivating its direct optimization in model development. We propose geographically regularized AUC-maximizing personalized federated learning (GrAUC-PFL), which directly optimizes a smooth pairwise AUC surrogate to learn personalized models while keeping patient-level data local and accounting for institutional heterogeneity. Graph-based regularization encourages geographically neighboring institutions to have similar coefficient vectors while retaining a personalized models. Simulations and a real-data application suggest improved discriminative performance, particularly when geographically neighboring institutions have similar data-generating characteristics.

Mayu Hiraishi, Kensuke Tanioka, Toshio Shimokawa

Department of Medicine · Wakayama Medical University · Wakayama, Japan +3

Healthcare Patients Regularization Geometric Regularization

Sep 2, 2026cs.CL

Counterfactual Fairness Audits of Multi-Step Clinical LLM Agents Require a Measured Per-Action Instability Floor

Counterfactual audits are the standard tool for checking whether a clinical agent treats demographically distinct but clinically identical patients differently. They report a flip rate: how often an action changes when only the patient descriptor changes. We show that this quantity is uninterpretable on its own. Re-running an identical condition ten times over sixteen vignettes (same narrative, same descriptor string, nothing varied) moved a clinical agent's action in 8.7% of outcome-vignette cells, and instability was heterogeneous across actions by a factor of eight, from 0.022 for ICU escalation to 0.179 for controlled-substance caution. No demographic contrast in our data was distinguishable from that floor. A second model gives a pooled floor of 6.7% and ranks the six actions almost identically (Spearman 0.94, exact p=0.017), so the floor is not one system's artefact. Majority-vote aggregation over five draws removes 39% of it and then flattens, and a null simulation attributes the residue to heterogeneous per-cell rates, so replication mitigates without eliminating. Any counterfactual fairness estimate reported without a per-action floor beside it therefore cannot be read as evidence of disparity. The measurements were taken with FairMedAgent, an evaluation harness for disparity in the actions of clinical LLM agents whose estimand, the within-range counterfactual flip rate, counts only flips between actions a published decision rule admits and a clinician has adjudicated. That estimand requires band adjudication, which is under way; no disparity result is claimed here. Each synthetic vignette runs a six-stage trajectory (five model-facing decisions around a deterministic environment step) under fixed-form conditions spanning race, sex, age, insurance, English proficiency, and their intersections. The harness, the floor protocol, and every analysis script are released.

Rohith Reddy Bellibaltu, Manpreet Singh, Deepak Parashar +1

Florida International University · Boston University, Boston, MA 02215 USA · Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India +1

Fairness Audits Patients Floor Instability Large Language Model Agents

Aug 31, 2026cs.HC

Augmenting Interviewer Judgments of Patient Experience with Automatic Language Analysis

Understanding how psychiatric patients subjectively experienced a clinical conversation is important for feedback and alliance-related process monitoring. While interviewers form post-session judgments about patient experience, these judgments do not always match patients' self-reports. Automatic approaches for predicting perceived interaction quality from conversation have been proposed, but it remains unclear whether such approaches can complement human judgment rather than simply replicate it. To address this gap, we evaluate a clinician-support framework in which post-session interviewer ratings are combined with automatic language-based predictions to estimate patient-reported interaction quality in free clinical interviews. We assess this integration across multiple standard model types, including Ridge, SVR, MLP, GRU, and BiLSTM, all trained on sentence embeddings extracted from dyadic transcripts of 107 free conversations between psychiatric patients and interviewers. Our results show that combining interviewer judgments with model predictions through simple averaging yields the strongest overall performance. The interviewer-only baseline reached a Pearson correlation of 0.365. Among fully automatic models, Ridge achieved the strongest Pearson correlation (r = 0.286), while BiLSTM achieved r = 0.270. The strongest result was obtained by BiLSTM interviewer integration (r = 0.403). Our findings suggest that automatic language analysis and interviewer judgment capture complementary aspects of patient experience and that their combination provides a more accurate approximation of the patient's own report than either source alone.

Aowen Shi, Michal Balazia, Danilo Postin +4

INRIA Universit´e Cˆote d’Azur, Valbonne, France · Carl von Ossietzky University of Oldenburg, Germany · German Research Center for Artificial Intelligence, Saarbrücken, Germany +1

Interviews Clinician Trust Inter-Annotator Agreement Patients Bidirectional Long Short-Term Memory

Aug 29, 2026cs.AI

Extending TotalSegmentator: Predicting Patient and Acquisition Characteristics from CT and MR Images

Background: Patient details and acquisition metadata are important for clinical decisions, image quality control, and automated research pipelines, but may be missing or unreliable in imaging archives. Purpose: To develop and evaluate a fast open-source model that predicts patient and acquisition characteristics directly from CT and MR images. Materials and Methods: Separate 3D ResNet-10 ensembles for CT and MR were trained on 57,291 and 43,200 clinical examinations acquired from 2011 to 2025. Both predicted weight, height, age, sex, contrast presence, vertebral coverage, and image noise. The CT model additionally predicted scanner manufacturer, tube voltage, tube current, convolution kernel, and post-injection time; the MR model predicted sequence class. Performance was evaluated on internal CT (n=501) and MR (n=636) test sets and an external CT dataset (n=54). Results: Internal CT MAEs were 3.90 kg, 3.68 cm, and 4.42 years for weight, height, and age, with sex F1=0.990; corresponding MR results were 4.34 kg, 4.62 cm, 7.13 years, and F1=0.970. The CNN outperformed a segmentation-derived XGBoost baseline for all four core targets in both modalities (adjusted P<=.042). F1 scores were 0.963 for CT contrast, 0.953 for MR sequence, and 0.823 for MR contrast. External CT MAEs were 4.45 kg, 4.05 cm, and 5.17 years, with sex F1=0.971. CPU inference required 20 seconds for CT and 12 seconds for MR. Conclusion: One 3D multitask model per modality can rapidly recover patient and acquisition characteristics from heterogeneous CT and MR examinations. Models are available in TotalSegmentator: https://github.com/wasserth/TotalSegmentator

Jakob Wasserthal, Joshy Cyriac, Michael Bach +7

Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland · Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran · Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran +7

Cone-Beam Computed Tomography Metamorphic Relation Adequacy Patients Acquisition

Aug 13, 2026cs.CL

PatientAct: Theory-Grounded Mental Health Client Simulation

LLM-based simulated clients are increasingly used to train novice counselors, evaluate LLM therapists, and generate synthetic data. However, current simulators produce overly cooperative clients that disclose too readily, accept therapeutic reframes without resistance, and resolve core issues within a single session. We trace these issues to profiles that lack causal depth and behavioral mechanisms that treat all content as equally accessible. We present PatientAct, a framework for client simulation grounded in established clinical theories. Our profiles integrate the 5Ps clinical case formulation, providing causal depth without tying the design to any single therapeutic modality. During simulation, profiles include a dynamic memory layer in which items carry trust thresholds (e.g., symptoms are available early, whereas formative memories require a sustained therapeutic alliance). At each turn, the client's emotional reaction and behavior are modeled before generating a response. If the therapist approaches gated content, PatientAct expresses resistance in terms of quantity, content, and style rather than defaulting to cooperation or a single resistance pattern. We evaluate our framework on 40 clinical situations and demonstrate that it generates diverse profiles with high clinical plausibility. Moreover, PatientAct significantly outperforms the baselines, yielding substantial gains in resistance quality and behavioral realism. Our code and data will be publicly available via github.com/Sahandfer/PatientHub.

Sahand Sabour, TszYam NG, Yaqian Chen +3

The CoAI Group, DCST, Institute for Artificial Intelligence, Tsinghua University, Beijing, China · Department of Psychology, Beijing Normal University, Beijing, China · Counseling and Psychological Development Guidance Center, Tsinghua University, Beijing, China

Simulated Patients User Simulation Patients Treatment Clients Agent Behavior Modeling+1

Aug 10, 2026cs.IR

Listwise Cross-Encoder Fine-Tuning vs. Agentic Instruction Tuning for LLM Rerankers: A Systematic Study in Medical Procedure Reranking

Reranking medical procedures against patient queries is a critical component of health insurance information retrieval, complicated by a substantial lexical gap between patient language and clinical nomenclature. We present a systematic comparison of two reranking paradigms for this production task: (1) small cross-encoders (MedCPT, MiniLM-L12) fine-tuned with listwise learning-to-rank objectives across layer freezing configurations, and (2) Qwen3-Reranker-4B, a 4B-parameter instruction reranker whose prompt is iteratively refined via an agentic optimization loop driven by GPT-4.1. On a purpose-built dataset of 2,647 queries across 708 insurance services, we find that a 109M-parameter cross-encoder fine-tuned with ListNet outperforms the 4B-parameter model by 2.6 percentage points on NDCG@3 and 13.3 points on Spearman correlation - at 37x fewer parameters. We report practical findings, a scalable LLM based dataset construction pipeline, and deployment trade-offs relevant to production reranking systems. We release our code and a sample dataset to support reproducibility and adaptation to other domains.

Matan Fainzilber, Shlomit Plavner

Healthee

Cross-Encoder Reranking Reranking Cross-Encoder Large Language Model Pipelines Model Fine-Tuning Patients+1

Aug 9, 2026cs.CL

Conversation as Measurement in Clinical Encounters: Observable Phase Structure, Partially Observable Patient State

Many modern AI systems analyze conversational traces to infer aspects of human interaction and state, implicitly assuming that such information is recoverable from conversation. We study observability: whether a target is recoverable from conversational transcripts alone. Observability is difficult to assess because transcripts may provide only a partial view of many targets, and large-scale analysis requires model-based annotation, making true limits of the conversational signal hard to distinguish from annotator error. We therefore study clinical encounters, where patient-reported outcome measures (PROMs) provide an external anchor for patient state, and visits follow broadly structured patterns. We study observability of patient state and conversational phase structure using 439 real-world clinical encounter transcripts spanning 134 hours, including 245 ENT transcripts paired with 273 PROM surveys. We operationalize patient state using PROM scores for voice, cough, and swallowing; phase structure using conversational phase segmentation. To make these analyses credible at scale, we use a PHI-compliant GPT-5 deployment for transcript annotation and conduct 40 hours of manual validation, reducing the risk that apparent limits of observability simply reflect annotator error. Our core finding is an observability asymmetry: phase structure is observable and useful for characterizing clinical encounter organization, while patient state is only partially observable, even in a setting designed to elicit patient symptoms and experiences, cautioning against transcript-only inference of human state.

Lily Chen, Ted Mau, Michael Gensheimer +3

Stanford University

Patients Partial Observability Transcript Conversational Context Measures

Aug 9, 2026cs.AI

Scale-to-Dialogue: Low-Burden Elicitation of Daily Premenstrual Symptom Ratings with Small Language Models

Prospective daily symptom tracking is central to premenstrual health assessment, but repeated ordinal forms impose substantial response burden. We formulate conversational administration as an ordinal label-recovery problem: the system actively elicits a small set of symptom clusters and maps each response to the original severity labels. We used 3,320 complete participant-days from the mcPHASES dataset, covering cramps, mood swing, fatigue, sleep issues, stress, and bloating on a six-level scale. Six participants were reserved for development and 36 for a frozen evaluation comprising 360 participant-days and 2,160 item labels. A ModernBERT evidence gate detected whether a symptom was expressed, and Qwen2.5-1.5B-Instruct produced deterministic structured severity scores. Fixed six-item questioning achieved a quadratic weighted kappa of 0.976, whereas three joint symptom-cluster questions achieved 0.913, 97.45% agreement within one severity level, and 80.94% recall for moderate-or-higher symptoms while reducing questions by 50%. Open-first adaptive policies required 3.92-5.98 questions and produced lower agreement than the corresponding fixed policies. Participant-cluster bootstrap analysis estimated a kappa difference of -0.062 (95% CI -0.076 to -0.048) between the three-cluster and six-item strategies. Active cluster-level elicitation provides a direct, local-model route from natural conversation to reusable daily symptom labels.

Yifan Wang

The Chinese University of Hong Kong, Shenzhen (CUHK-Shenzhen)

Elicitation Patients Model-Based Bootstrap

Aug 6, 2026cs.CV

Patient Pose Assessment Using a CT-Based Framework for Synthetic Data Generation

An adequate diagnostic quality of radiographs is essential for reliable diagnoses and treatment planning. The patient's pose during radiography is one of the most important factors determining the diagnostic quality. Since patient positioning is difficult and not standardized, an automated AI-based approach using depth images to automatically assess the patient's pose before the radiograph has been taken would be helpful. Due to regulatory hurdles, however, it is difficult in practice to acquire the required depth images and corresponding radiographs. In this paper, we present a framework that can generate such training data synthetically from Computed Tomography scans. We further show that by pretraining on our generated synthetic dataset consisting of 3077 image pairs of upper ankle joints, the pose assessment of real upper ankle joints can be improved by up to 11 percentage points.

Manuel Laufer, Dominik Mairhöfer, Malte Sieren +7

Institute for Neuro- and Bioinformatics, University of Lübeck, Germany · University Medical Center Schleswig-Holstein, Lübeck, Germany · IMAGE Information Systems Europe GmbH, Rostock, Germany +1

Digitally Reconstructed Radiographs Cone-Beam Computed Tomography Synthetic Data Feet Patients

Aug 6, 2026cs.CV

MirrorNet: Can Medical Image Anonymization Really Protect Patient Identity?

Medical images are routinely de-identified---names, dates, and other metadata removed---and then shared for research, teaching, and public benchmarks under the assumption that this renders them anonymous. Such de-identification protects the metadata but not the pixels, and---apart from scans that directly contain facial structures---whether the image content itself identifies the patient has received little scrutiny. We investigate this question by learning a cycle-consistent correspondence between a cross-sectional medical image and a non-medical, patient-identifying image, using a pair of coupled, cycle-consistent variational autoencoders. From a held-out scan, the model recovers a recognisable likeness of the patient (identity-region MAE = 0.163); conversely, it synthesises a scan from such an image. These results indicate that a de-identified medical scan remains identifying---it is, in effect, a photograph of the patient---and that imaging data should be governed as biometric data rather than as anonymisable records. To support reproducibility, the code and trained models are shared at https://github.com/attilasimko/public-repository.

Attila Simkó

Department of Diagnostics and Intervention Umeå University, Umeå, Sweden

Medical Images Biometrics Patients Cone-Beam Computed Tomography Conditional Variational Autoencoder

Aug 6, 2026cs.CY

The Judgment-Consequence Gap: LLM Moral Reasoning in Healthcare Decisions

As large language models (LLMs) enter high-stakes domains such as healthcare, understanding their moral reasoning becomes essential. Decisions about scarce medical resources often hinge on judgments of responsibility, particularly when patients' own actions contribute to illness. We investigate how LLMs reason about responsibility and its consequences, tracing their judgments across successive levels, from the behavior, to the resulting illness, to the denial of care. We evaluate a wide range of LLMs, spanning different model families and capability levels, on various clinical vignettes adapted from prior studies. Our results identify a judgment-consequence gap: LLMs largely agree with humans that patients bear responsibility for health-harming behaviors, yet overwhelmingly refuse to let that judgment influence how they allocate scarce resources. Specifically, LLMs default to random allocation, whereas humans consistently favor the less-culpable patient. Compared to humans, LLMs also place greater emphasis on access to information, reducing responsibility judgments when health-risk knowledge is unavailable. These findings reveal that LLMs apply a systematically different moral framework than humans when responsibility and resource scarcity intersect, surprisingly often amplifying normative disagreement with humans as reasoning capability increases.

Hadi Hosseini, Samarth Khanna, Leona Pierce

Pennsylvania State University

Moral Reasoning Clinical Reasoning Training Human Judgment LLM Reasoning Strategies Harmful Content Patients

Aug 4, 2026cs.CL

Patients-like-me: A Variational LM--GNN Framework for Explainable Clinical Prediction

Language models (LMs) offer strong textual representations for electronic health records (EHRs), but they encode patient sequences in isolation and provide limited explainability. Graph neural networks (GNNs) complement LMs by incorporating inter-patient relationships and enabling reference-patient attribution, yet they rely on high-quality patient representations. We propose Patients-like-me (PLM), a unified LM--GNN framework that integrates local patient semantics with global cohort structure. To train PLM efficiently, we introduce a Variational Expectation-Maximization algorithm that alternates LM and GNN updates under a supervised variational objective. Extensive experiments on MIMIC-III and MIMIC-IV show that PLM consistently outperforms state-of-the-art methods, with improvements generalizing across encoder-only and decoder-only LM backbones. These gains are achieved with only modest additional computational overhead. PLM also provides reference-patient explanations by retrieving influential similar patients, while edge-masking experiments confirm that the highest-ranked references have the greatest impact on model predictions.

Xinyu Wang, Yixuan Li, Hanwei Wu +4

1McGill University · 2Université de Montréal · 3Georgia State University +1

Medical World Model Clinical Prediction Electronic Health Records Patients Explainability Graph Neural Networks+1

Aug 4, 2026cs.AI

Evaluating Counterfactual Sensitivity to Patient Information in Medication-Safety Reasoning

Applying a valid medication-safety rule when its patient-specific conditions are not met can produce an incorrect decision. Existing medical evaluations largely use isolated and fixed scenarios. A model may therefore answer correctly by recalling a drug-risk association without showing that it used patient information to decide whether the rule applies. To address this gap, we introduce MedPIC-Bench, a benchmark of source-verifiable recommendations and expert-validated questions for patient-specific medication-safety reasoning. It combines guideline-following questions with paired counterfactual questions in which a controlled change in patient information changes whether a rule applies. The benchmark contains 467 questions annotated along six clinical and reasoning dimensions. Across 28 medical-specific, general, and proprietary LLMs, every model performs worse on counterfactual questions, with mean accuracy falling from 63.6% to 45.1%. Models perform well when an explicit patient attribute directly signals a familiar contraindication, but struggle when patient information must narrow or withdraw a safety warning. Model rationales often acknowledge the changed patient information, yet the final answers retain the previous safety judgment. This vulnerability persists among medical-specific LLMs, whose average CF performance trails that of general LLMs. MedPIC-Bench therefore makes conditional rule application measurable and highlights the limitations of static medication-safety accuracy for assessing patient-specific reliability.

Zhitian Hou, Yuhang Liu, Pengkai Wang +8

The Hong Kong Polytechnic University · Sun Yat-sen University

Medication Leaflet Patients Safety Benchmarks

Jul 31, 2026cs.CV

Learning How Much, Not Just What: Cross-Patient Burden Order for CT Vision-Language Pretraining

Volumetric CT vision-language pretraining learns 3D representations from scan-report pairs, but global and anatomy-aware objectives supervise only correspondence: they establish what is present and leave how much unconstrained. Nothing separates a mild from an extensive case of the same finding along a consistent direction, so the graded burden language in reports collapses into a present/absent signal. Longitudinal supervision would supply this order, but patient-matched CT pairs are scarce at scale; cross-sectional cohorts already encode weak burden cues across different patients. We introduce Spectrum, an anatomy-conditioned framework that represents each study at whole-study and organ scopes. For each organ-mapped pathology, a rule-based scorer mines confidence-filtered lower-to-higher pairs of different patients, and Burden-Direction Alignment (BDA) aligns the pathology-conditioned image delta with the report delta at each scope, separating that direction from its reverse. Because the endpoints are different people, a target-conditioned aligner first makes them comparable, so the delta reflects burden rather than between-patient variation. BDA further separates the selected direction from its reverse, anchors it to the observed higher-burden endpoint, and enforces consistency across ordered triplets. Since every pair is drawn within a single pathology, BDA is designed to constrain intra-class structure that image-report contrast alone never touches. Spectrum attains 85.6 zero-shot AUROC on CT-RATE and 72.7 on external RAD-ChestCT, with consistent gains in linear probing and retrieval. Weak cross-patient order is thus a scalable complement to anatomy-aware correspondence, yielding burden-aware CT representations without longitudinal data.

Guoliang You, Haifan Gong, Xiaomeng Chu

University of Pennsylvania · The Chinese University of Hong Kong, Shenzhen · Yale University

Cone-Beam Computed Tomography Patients Digital Pathology Order

Jul 31, 2026cs.CY

From Prediction to Explainable Provider Behavior Profiles for Fraud, Waste, and Abuse Review

Claims data can show that provider behavior changed but cannot by itself explain why. Fraud, waste, and abuse (FWA) review requires identifying material behavior, locating the codes and dollars driving it, and testing plausible explanations. Forecast residuals conflate growth, service-line shifts, code maintenance, and incomplete observation with potentially concerning behavior. We instead formulate provider review as a descriptive representation problem: observed amount

y_{ijt}=s_{it}p_{ijt}

, where

s_{it}

is provider scale and

p_{ijt}

is procedure composition. The profile records scale history, effective-dated code lineage, clinical-family shares, first-use events, billing context, and Medicare-versus-client differences. An optional rank-32 nonnegative factorization of procedure co-occurrence adds a fixed semantic geometry for similarity and retrieval. The profile surfaces evidence for review without inferring intent or adjudicating FWA, and is one engine within Falcon's broader review system. In a ten-quarter proprietary Medicare Carrier and DME build (1.27 million providers; 9.2 million provider-quarter profiles through 2026~Q2), the semantic dictionary covers 3,641 procedures and raises recall at 10 from 36.0% to 44.4%; for high-cost rare events, recall at 50 is 56.1% versus zero for popularity. Under the governed eligibility contract, 414,093 providers enter the national review population, with 81.8% and 90.8% remaining eligible across adjacent quarters. Replication across eight client panels preserves 86.9--95.2% amount-weighted semantic coverage. Transparent descriptions thus form the core, with learned representations adding optional semantic context.

Yubin Park, Evan Brociner

Falcon Health, Inc.

Fraud Detection Generation Provenance Patients Review Populations Token Co-Occurrence Graphs

Jul 28, 2026cs.CL

MyMentorLLM: A psychotherapy GenAI environment with multimodal voice/text patients, trainees and experts for deliberate practice

Psychotherapists need repeated training and supervision; however, scalability is problematic. We present MyMentorLLM, a multimodal voice- and text-based deliberate-practice environment with 2,100 complete Cognitive Behavioural Therapy (CBT) sessions. Each session links a DSM-5-TR-grounded LLM patient (with major depressive, generalised anxiety or borderline personality disorder), an LLM therapist-in-training and an LLM expert supervisor (powered by Gemma-4, Gemini-3.1-Flash-Live and Qwen-3.6). Sessions were analysed for emotional dynamics, therapeutic competence and diagnostic accuracy against human psychotherapy data. Simulated patients expressed disorder-congruent emotional profiles, which therapists mirrored as in human counselling. LLM trainee competence was rated above human levels in most conditions, while native speech-to-speech was closest to human scores. Supervisor feedback improved diagnostic accuracy in 5 of 7 LLM conditions, whereas symptom identification accuracy increased with model size. This work shows deliberate practice can be simulated for CBT training, although patient fidelity, supervisor calibration and harmful feedback require evaluation via a complex systems perspective.

Rodolfo Rizzi, Alessandro Grecucci, Massimo Stella

CogNosco Lab, Department of Psychology and Cognitive Science, University of Trento, Italy. · Department of Education, Psychology and Communication Sciences, University of Bari, Italy.

Cognitive Behavioral Therapy Simulated Patients Counseling Tutors Treatment Patients

Jul 28, 2026cs.AI

PatientAgentBench: A Benchmark Framework for Evaluating Patient-Facing Health AI Agents

Health AI is evolving from answering questions to agentic systems that converse with patients, reason about health records, and act on their behalf. Primary care guards against diagnostic errors and unsafe care; agents assisting in this domain warrant evaluation against the same risks. Current benchmarks focus on medical knowledge, assessed through isolated question-answering or clinician-facing tasks. PatientAgentBench benchmarks patient-facing agentic healthcare; it evaluates a foundation model, wrapped in an agent with a sandbox of healthcare tools, conversing with a simulated patient. Each conversation is scored by an LLM-as-a-Jury across six dimensions via over a hundred conversation-agnostic, clinician-grounded criteria. To validate alignment, licensed clinicians annotated shared conversations, yielding 79-93% adjacent agreement between jury and expert raters, on par with or exceeding clinician inter-rater agreement. We benchmarked 10 models across four families on the same 1,200 scenarios and found clinical gaps. Triage quality is the most discriminating dimension: pass rates rise from 32% for the weakest models to 88% for the strongest, with agents often acting on administrative requests without clinical screening. Clinical safety and workflow accuracy follow the same pattern: the weakest models fail often, fabricating unexecuted actions, while frontier models fail on only 1-3% of cases, from unverified tool outputs and omitted crisis resources in an emergency. More capable models narrow these gaps but do not close them; the strongest scores only 4.25 of 5 overall. These failures surface only in sustained, tool-using conversations against realistic patient records, confirming that static benchmarks are insufficient as healthcare agentic systems gain autonomy. We release the framework as a reproducible, clinician-validated evaluation standard to help the field close this gap.

Korosh Vatanparvar, Ashutosh Joshi, Maria Xenochristou +11

Amazon Health AI

Patients Diagnostic Benchmark Artificial Intelligence Agents Artificial Intelligence Systems

Jul 24, 2026cs.LG

Dysphagia Risk Stratification in Head and Neck Cancer via Two-Stage PRO-Clinical Stacking

Dysphagia is a debilitating late effect of head and neck cancer (HNC) treatment, yet timely identification of at-risk patients remains challenging in survivorship care. Definitive assessment relies on videofluoroscopic imaging, as captured by the Dynamic Imaging Grade of Swallowing Toxicity (CTCAE-DIGEST), which, while validated, requires specialized equipment, trained personnel, and significant patient burden, limiting its routine use in surveillance. Patient-reported outcomes (PROs), by contrast, are low-cost, scalable, and easily collected at any clinical encounter, making them an attractive alternative signal for identifying patients who may warrant further evaluation. However, a clear clinical framework for translating PRO responses into actionable interventions is still evolving. In particular, uncertainty remains regarding when a patient's self-reported symptom burden should prompt escalation of care. This study addresses this gap by formulating a single-visit PRO-clinical prediction framework and introducing a clinically interpretable two-stage stacking model to predict swallowing impairment risk using PRO responses and structured clinical variables, without requiring videofluoroscopic imaging. The proposed framework quantifies the independent contributions of patient-reported symptoms and clinical factors within a unified and interpretable risk assessment model. Our findings demonstrate that individual MDADI responses contain predictive information beyond that captured by composite or global summary scores, while interpretability analyses reveal symptom patterns and clinical risk factors associated with swallowing impairment. Together, these results support the use of structured PRO-clinical integration as a practical, imaging-free approach for dysphagia risk stratification in HNC survivorship.

Siyuan Zhao, Eric Ababio Anyimadu, Zachary G. Brumm +5

Department of Computer Science, University of Illinois Chicago, Chicago, IL, USA · Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA · Department of Otolaryngology, University of California, San Francisco, San Francisco, CA, USA +1

Multidisciplinary Tumor Boards Tumor Clinical Prediction Patients

Jul 10, 2026cs.LG

A Personalized Computational Framework for Assessing the Sufficiency of Partially Observed Data in Healthcare AI models

Achieving early and timely diagnosis and treatment for disease is a major challenge. Recent applications of machine learning (ML) algorithms trained on patient data have shown promise in many different settings for predicting the patient health state. A challenge often faced when applying these ML algorithms is that at any given time, not all clinical variables (features) needed as input to perform prediction tasks are available. We define the concept of full-feature-capacity (FFC) to refer to prediction performance when such algorithms make use of all features on which they were trained. We then introduce Feature Sufficiency Analysis (FSA) - an analysis for determining whether a subset of all clinical features needed by an AI model is sufficient to achieve FFC. FSA estimates the underlying distributions of missing variables conditioned on features that are available. FSA provides a patient-specific assessment of whether the existing set of measured features achieves FFC. If yes, then there is no need to acquire further inputs and a ML-based prediction. We provide two case studies: prediction of need for postoperative prolonged ventilation in patients recovering from heart surgery; 10-year mortality prediction in an outpatient cohort. We also demonstrate that FSA also provides a clinically interpretable feature-ranking methodology based on prediction sufficiency, identifies intrinsically hard-to-predict patient populations, and has the potential to perform cost-aware optimization for clinical data acquisition. FSA provides a generic computational approach for determining whether incomplete clinical information is sufficient to support trustworthy AI-assisted clinical decision-making, thereby facilitating the prospective deployment of healthcare AI systems across diverse clinical settings.

Qingchu Jin, Felistas Mazhude, Jamie B. Rabb +3

Roux Institute, Northeastern University, ME USA · MaineHealth Institute for Research, ME USA · MaineHealth, ME USA +3

Clinical Prediction Intensive Care Unit Mortality Prediction Patients Sufficiency

Jul 7, 2026stat.ML

EHR-MPC: Inference-Time Control for Sepsis Treatment with Generative Patient Digital Twins

Sepsis is a leading cause of mortality, yet optimal treatment policies remain contested. Existing reinforcement learning (RL) approaches learn fixed strategies for sepsis treatment, limiting adaptability to changing clinical objectives during inference. We propose EHRMPC, a framework that decouples learning patient dynamics from optimizing treatment by training a patient digital twin in the form of a generative electronic health record (EHR) model. The digital twin predicts clinical trajectories under interventions and enables model predictive control (MPC) to optimize treatments via inference-time planning over simulations. We evaluate EHR-MPC on a multicenter ICU sepsis cohort spanning 8 hospitals in the Mass General Brigham health system using both off-policy importance sampling and on-policy simulation-based evaluation. Relative to RL baselines, EHR-MPC achieves comparable off-policy performance and improved simulation performance. Unlike RL, this work frames sepsis treatment optimization as inference-time control over learned patient dynamics, establishing a general framework for decision making with generative clinical models.

Joshua Pickard, Wei Qi, Na Li +4

Broad Institute of MIT and Harvard · Harvard University · Brigham and Women’s Hospital +2

Sepsis Patients Inference-Time Steering Digital Twins Generative Models

Jun 25, 2026cs.AI

A Pipeline for Generating Longitudinal Synthetic Clinical Notes Using Large Language Models

Synthetic data is increasingly used to enable the development and evaluation of AI systems in domains where access to real-world data is restricted. In healthcare, clinical documentation presents particular challenges due to its sensitivity. This work introduces a synthetic clinical notes pipeline and dataset designed to support the development of clinical AI tools while avoiding the privacy risks associated with real patient data. The dataset is generated using a modular pipeline that combines structured patient generation, semi-structured patient journey simulation, and unstructured clinical note generation using large language models. The pipeline is designed to prioritise internal consistency across longitudinal patient records, while also capturing variation in writing style, note structure, and clinical detail. Additional mechanisms, including LLM-based validation and augmentation steps, are used to improve faithfulness, realism, and diversity of the generated notes. We release a dataset of 70 synthetic patients, each associated with 20-50 clinical notes spanning a full hospital journey. The dataset is provided at multiple levels of validation, enabling users to balance realism and scalability depending on their use case. This dataset supports the development, testing, and evaluation of clinical AI systems, including summarisation tools, coding models, and decision support systems, without reliance on real patient data.

William Poulett, Alice Waterhouse, Ben Wallace +4

NHS England Data Science and Applied AI Team

Clinical Notes Patients

Jun 22, 2026cs.LG

Federated Survival Analysis in Healthcare: A Multi-Model Evaluation on Cross-Institutional Heterogeneous Breast Cancer Data

Survival analysis is central to clinical decision-making, yet reliable time-to-event models require large, diverse cohorts that are rarely available at a single institution, while privacy regulations restrict the centralization of patient data. Federated learning (FL) offers a privacy-preserving alternative by training shared models without exchanging raw data, but its effectiveness for survival modeling under realistic, heterogeneous conditions remains insufficiently understood. This paper presents a systematic, multi-model evaluation of federated survival analysis on a cross-institutional breast cancer cohort with naturally heterogeneous distributed clients. Three representative survival models, the Cox Proportional Hazards model, DeepSurv, and Random Survival Forest (RSF), are compared across centralized, local, and federated training, and three federated optimization strategies (FedAvg, FedProx, and FedAdam) are assessed for the gradient-based models. Results show that FL consistently outperforms local training and approaches, and occasionally exceeds, centralized performance, while RSF offers the best overall balance of discrimination, calibration, and robustness across heterogeneous clients. We further find that performance depends on the diversity of client distributions, and that FedAvg and FedProx are stronger and more stable than FedAdam. Based on these findings, we derive practical, decision-oriented guidelines mapping data, privacy, interpretability, and resource constraints to recommended model and training-paradigm choices for federated survival modeling in healthcare.

Natalia Moreno-Blasco, Anusha Ihalapathirana, Pekka Siirtola +1

Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland · Biomimetics and Intelligent Systems Group, University of Oulu, Oulu, Finland · Faculty of Engineering, University of Deusto, Bilbao, Spain

Survival Analysis Multidisciplinary Tumor Boards Time-To-Event Data Cross Validation Healthcare Patients

Jun 22, 2026cs.AI

AI-driven Optimisation of Quality of Recovery (QoR) in Remote Patient Monitoring

Remote patient monitoring depends on patient-reported data to capture the subjective dimension of recovery that devices cannot measure. The Quality of Recovery (QoR-15) survey is the gold-standard instrument for this purpose. It was designed and validated for occasional in-hospital assessment, yet remote monitoring now administers it to patients daily. In our own post-surgical deployment, only 55% of patients submitted the survey more than 14 days of 30 monitoring days. We developed QoR-compact, a five-item daily input for the RPM prediction pathway. Setting a deployment-driven target of one-third of the daily items, we exhaustively evaluated all 3,003 five-question subsets of the QoR-15 and tested whether the best of them matches the full instrument in predicting near-term postoperative recovery severity. QoR-compact achieves a mean AUC-ROC of 0.968 (95% CI 0.915-0.988), statistically comparable to the 0.964 baseline obtained with one-third of the items. Patient-level backtesting indicates that it tracks readmission events as faithfully as the full form. Its five items span the physical and psychological axes of recovery: Q3 (feeling rested), Q9 (feeling comfortable and in control), Q10 (general well-being), Q12 (severe pain), and Q14 (feeling worried or anxious). The QoR-15 remains the gold-standard measure of recovery; QoR-compact complements it as a shorter daily input designed for prediction. This parity provides the basis for a prospective study of whether a lighter daily input is, in turn, completed more consistently. External validation on larger cohorts is required before clinical use.

Yansong Liu, Li-Hsi, Lin +4

Sonny · University College London, London, United Kingdom · Ethera Health Ltd, London, United Kingdom

Patients Optimization Modeling

Jun 22, 2026cs.LG

Patient-Aware Contrastive Learning Preserves Per-Patient Structure in RR-Interval Representations

Contrastive representation learning struggles on physiological signals when each subject contributes a distinct baseline pattern. If class differences overlap with subject differences,class-level objectives such as supervised contrastive learning tend to merge per-subject structure into a single per-class cluster,removing the individual variation that a model needs to generalize to unseen patients. We study this problem in the setting of Paroxysmal Atrial Fibrillation(PAF) detection from RR-interval(RRI) sequences and propose a patient-aware contrastive objective that forms positive pairs only from same-patient, same-class segments, preserving each patient's own sinus rhythm(SR) baseline while still pushing the two classes apart. Examining the learned embeddings directly, our objective achieves the most consistent per-patient SR structure (cohesion

0.850

vs.

0.800

for supervised contrastive loss (SupCon) and

0.772

for binary cross-entropy (BCE)). We also identify that BCE produces the cleanest global class separation yet the most disordered per-patient structure. This is precisely why a linear probe trained on its features breaks down on unseen patients. On the IRIDIA-AF dataset, the resulting representation reaches a patient-independent Area Under the Receiver Operating Characteristic Curve (AUROC) of

0.989 \pm 0.003

with

2.6\times

lower seed variance than supervised contrastive baselines.These results highlight that per-subject geometric consistency, rather than global class separability, is key to robust cross-patient generalization.

Yasantha Niroshana, Weijith Wimalasiri, Chathuranga Hettiarachchi

Department of Computer Science, University of Moratuwa, Sri Lanka.

Arrhythmia Classification Physiological Signals Patients Contrastive Learning Separation

Jun 16, 2026cs.HC

Toward Accessible Psychotherapy Training Using AI-Driven Interactive Patient Avatars

Training psychotherapists in evidence-based interventions such as Acceptance and Commitment Therapy (ACT) requires repeated practice with meaningful feedback, yet opportunities for safe, standardized training are limited by ethical, logistical, and resource constraints. We introduce a system designed to support ACT-oriented psychotherapy training through spoken dialogue with an embodied virtual patient. The system uses large language models to simulate patient behavior conditioned on profiles derived from real therapy sessions and configurable clinical scenarios, while a separate automated evaluator provides turn-by-turn feedback on therapist responses based on established ACT fidelity criteria. Rather than aiming to replace supervision, the system is intended to support deliberate practice by enabling experimentation, reflection, and immediate feedback in low-risk settings. Expert evaluation with practicing psychologists confirmed high realism in patient behavior and demonstrated that immediate turn-by-turn ACT feedback increased therapists' awareness of intervention choices and enabled effective experimentation with alternative responses. Quantitative evaluation across 49 therapy transcripts identified GPT-4o-mini as the optimal feedback model, achieving the lowest mean absolute error (MAE = 6.12) in replicating human supervisor ACT fidelity ratings with statistically significant agreement. This work demonstrates the potential of fidelity-aware simulated patients as a scalable complement to psychotherapy training.

Pascal Riachi, Sofie Kamber, Stella Brogna +2

ETH Zurich · Switzerland · University of Lucerne

Cognitive Behavioral Therapy Simulated Patients Patients Feedback Avatars

Jun 15, 2026cs.AI

Medical world models: representing medical states, modelling clinical dynamics and guiding intervention policies

Medical diagnosis and treatment are dynamic processes in which patient states evolve over time and clinical interventions alter future outcomes. Although current medical AI can detect disease, estimate risk and generate reports, many systems still return static labels or scores, offering limited insight into how illness may progress or how alternative interventions may reshape its trajectory. Medical world models adapt the world-model idea from artificial intelligence to healthcare by learning internal simulators of patient-state dynamics. Their long-term goal is to help clinicians anticipate deterioration, compare treatment-conditioned futures and tailor care to individual patients. Yet relevant work remains scattered across foundation models, longitudinal modelling, disease simulation, treatment-effect estimation, reinforcement learning and digital twins. To bridge this gap, this review outlines a roadmap for advancing medical AI from isolated diagnosis and prediction toward medical world models that simulate disease evolution and support intervention decisions. This roadmap is organized around three coupled capabilities: patient-state construction, clinical dynamics modelling and intervention decision support. Across representative systems, the comparison highlights what each capability contributes and how partial components can be integrated into more mature perception--dynamics--planning systems. Finally, we identify the challenges involved in turning plausible rollouts into clinically useful simulators. Related literature is available at https://github.com/1999kevin/awesome_medical_world_models.

Ke Liu, Mengxuan Li, Yanyi Bao +4

College of Computer Science, Zhejiang University, Hangzhou, China. · School of Medicine, Zhejiang University, China. · Department of Biomedical Informatics, Harvard University, USA.

Medical World Model World Models Clinical Patients Long-Horizon Inference

Jun 13, 2026eess.SP

CAP: Towards PPG Universal Representation Learning with Patient-level Supervision

Photoplethysmography (PPG) plays a central role in wearable health monitoring and clinical decision support. Yet existing approaches to universal PPG representation learning largely focus on signal-level objectives and often overlook patient-level health context, which limits generalization to complex clinical tasks and heterogeneous cohorts. To address this gap, we construct a large-scale paired PPG-EHR multimodal dataset by distilling fragmented medical histories and clinical records into cohesive, patient-level electronic health records (EHR). Building on this resource, we propose Clinical Anchored Pretraining for PPG (CAP). During pretraining, CAP performs cross-modal contrastive alignment that anchors PPG representations to patient-level clinical semantics, guiding the encoder beyond waveform fitting toward modeling consistency in a patient's overall physiological state. During downstream adaptation, the pretrained PPG encoder provides clinically grounded representations that strengthen inductive bias and improve robustness and transferability. Experiments demonstrate that CAP consistently outperforms strong baselines on four diverse downstream tasks. CAP achieves a particularly large gain on respiratory rate prediction (up to +87.6% relative improvement over the state-of-the-art baseline) and delivers an average relative +26.7% across all tasks. We further enhance the interpretability of our approach through comprehensive analyses, including ablations and multiple complementary visualizations of the learned representations. The code for our experiments is available at: https://github.com/gody123gody/CAP .

Chenyang He, Xinyi Shao, Shun Huang +4

Nanjing University of Aeronautics and Astronautics Nanjing, Jiangsu, China · Peking University Beijing, Beijing, China · Independent Researcher +1

Remote Photoplethysmography Medical World Model Patients Electronic Health Records Representation Learning Pretraining

Jun 10, 2026cs.LG

Fed-FBD: Federated Functional Block Diversification for Isolation, Privacy, and Surgical Unlearning

Federated learning (FL) enables collaborative model training without sharing raw patient data, but standard approaches such as FedAvg treat each client as a black box and provide no mechanism for isolating an adversarial contributor, auditing per-client influence, or honoring a departed participant's right to be forgotten. We present Fed-FBD (Federated Functional Block Diversification), a modular federated architecture that decomposes a ResNet backbone into six functional blocks (the stem, four residual groups, and the classification head) and maintains a warehouse of N color variants, each assembled from independently tracked and contributor-stamped blocks. Fed-FBD provides three capabilities absent in FedAvg: (i) architecturally guaranteed block-level isolation, so that an adversarial or mislabelled client cannot contaminate the clean colous; (ii) privacy-by-design, where membership inference advantage is already indistinguishable from chance before any privacy mechanism is applied; and (iii) surgical machine unlearning of a departed participant's contribution at sub-second cost and without retraining. Experiments on six MedMNIST-2D datasets, PathMNIST at 224x224, and CIFAR-10 show that Fed-FBD trades a modest 0.3%-3.1% IID accuracy gap on the adequately sized datasets for these guarantees, remains within 0.8%-4.0% of FedAvg at Dirichlet alpha=1.0 on three of four datasets, and confines all six adversarial attacks we study to the poisoned client's own blocks with at most +/-0.01 AUC drift on the clean colors.

Weijie Chen, Alan B. McMillan

Department of Radiology, University of Wisconsin–Madison

Federated Learning Federated Averaging Adversarial Training Privacy Patients

Jun 9, 2026cs.CV

From Patches to Patients: A study of the tile-to-slide performance transferability in Digital Pathology

Foundation Models (FMs) have recently redefined the state-of-the-art in histopathology by providing robust representations for whole-slide image (WSI) analysis. However, selecting the optimal foundation model (FM) for a specific clinical cohort currently requires multiple preprocessing steps, followed by computationally expensive feature extraction and the training of a Multiple Instance Learning (MIL) aggregator for every model. In this work, we investigate whether efficient tile-level linear probing can serve as a reliable proxy for slide-level performance, reducing the need to run full slide-level pipelines for every candidate encoder. We benchmark 19 state-of-the-art FMs on 42 slide-level and 16 tile-level tasks, comparing tile probing metrics against slide-level outcomes using ABMIL and Mean Pooling aggregations. We observe a high correlation between tile and slide performance across varying task difficulties, indicating that encoder representation quality is the primary determinant of WSI success. Sensitivity analyses show that transferability is stable across models and is more influenced by cohort sizes and numbers of tiles per slide than by average task difficulty. We also measure the agreement in best performing models between tile and slide-level tasks, showing tile benchmarks reliably shortlist strong candidates. Overall, our study indicates that tile-level benchmarking provides an efficient and practical first step for narrowing down candidate models, while slide-level evaluation remains essential for final validation on clinical tasks.

Sofiène Boutaj, Leo Fillioux, Maria Vakalopoulou +2

Université Paris-Saclay, CentraleSupélec, Gustave Roussy, INSERM, IHU PRISM, Cancer Data Science Unit, France · Université Paris-Saclay, CentraleSupélec, MICS Laboratory, France

Wireless Foundation Models Multiple Instance Learning Cohort Sentence Encoders Patients

Jun 8, 2026cs.RO

Exploration of Foundation Model-Based Robots in Patient and Elderly Care

Demand for older-adult and patient care is growing rapidly as populations age worldwide. Foundation models are increasingly being integrated into robots and interactive agents, with the promise of more flexible communication and personalized assistance. However, care settings require reliable and workflow-compatible systems with accountable human oversight, and it remains unclear whether current embodied systems can translate technical advances into clinical impact. This Perspective synthesizes foundation model-based care robots across three areas: design features, user experience, and evidence for care-related outcomes. Current systems most commonly use foundation models as conversational and reasoning layers within voice-centered socially assistive embodiments, while multimodal grounding and physical autonomy remain limited. Empirical evaluations report positive usability and engagement benefits, but reliability failures persist across the interaction pipeline such as hallucinations and conversational breakdowns. Evidence for care impact remains concentrated in proximal outcomes such as cognitive engagement and participation, with limited evidence for validated clinical or care-related changes. We argue that future research should transition toward care-specific evaluation standards, accountable autonomy, and integration into care workflows to support more responsive and responsible care technologies.

Zhiwen Qiu, Wei Liu, Yuexing Hao

1Cornell University, Ithaca, 14850, USA · Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, 85054, USA · 3Massachusetts Institute of Technology, Cambridge, MA, 02139, USA

Human-Centered Framework Assistive Agents Patients Robot Systems Cognitive Science Exploration

Jun 3, 2026cs.AI

PSEBench: A Controllable and Verifiable Benchmark for Evaluating LLMs in Patient Safety Event Triage

Patient safety event triage, determining whether a clinical event is reportable under jurisdiction-specific policy, is a high-stakes task typically performed manually by patient safety experts. Although LLMs may support this workflow, reliable evaluation is limited by the lack of benchmarks to capture evidence-grounded policy reasoning, proactive information seeking for incomplete reports, and principled abstention in irreducibly ambiguous cases. We address this gap with a policy-grounded construction methodology centered on the clause card, a structured representation that factorizes regulatory text into auditable decision specifications. Combining clause cards with anchor-driven instantiation and closed-loop verification, our scalable pipeline produces narratives with by-construction ground truth and naturally supports generating missing information and uncertain variants. We instantiate this method on Minnesota's 29 Reportable Adverse Health Events, producing PSEBench, a 5,074-case benchmark with an agentic evaluation environment. Evaluation on 15 representative LLMs reveals consistent capability trends, demonstrates the benchmark's utility, and identifies actionable gaps toward reliable LLM-based patient safety event triage.

Keqi Han, Ryan Young, Annabel Strauss +7

1Emory University · 2Scale AI · 3Mayo Clinic +1

Triage Patients Regulation

May 28, 2026cs.CV

Genetically Aligned Patient Representations Improve Hematological Diagnosis

Multimodal alignment of histopathology encoders with transcriptomic and genomic data has been shown to significantly improve performance in downstream diagnostic tasks. Hematological cytology is unique in that visual single-cell evaluation is often paired with cytogenetics and molecular genetics for blood cancer diagnosis. In this study, we present a framework to align single white blood cell images with chromosomal aberrations (karyotype) and somatic mutations from targeted gene panels. Our training strategy follows a two-stage approach: (i) self-supervised, vision-only pretraining of a transformer aggregator using an iBOT head on a cohort of over 1500 patients, and (ii) genetic alignment via supervised contrastive loss on acute myeloid leukemia patients. Our genetically aligned patient encoder improves hematological diagnostic tasks, outperforming slide-level histopathology foundation models. Additionally, the model provides off-the-shelf retrieval capabilities for diseases and genetic alterations. Incorporating genetic data into patient encoders increases the quality of patient representations, providing a framework that aligns with clinical diagnostic workflows and paves the way for future multimodal hematology-specific AI. The code and model weights are available at https://github.com/marrlab/GenBloom.

Muhammed Furkan Dasdelen, Fatih Ozlugedik, Ilaria Looser +3

Institute of AI for Health, Helmholtz Munich, Germany · International School of Medicine, Istanbul Medipol University, Türkiye · Munich Leukemia Laboratory, Germany +4

Acute Myeloid Leukemia Medical World Model Multimodal Clinical Data Feature Alignment Patients

May 27, 2026cs.AI

Do Clinical Models Change Treatment Decisions?

Clinical foundation models are evaluated with factual or exam-style medical QA, but treatment decisions must change when patient context changes. We introduce ClinPivot, an auditable treatment-decision benchmark built from biomedical relations and pivoted patient contexts. ClinPivot asks whether models change treatment choices when new clinical constraints shift the action space. We find that strong medical QA performance does not reliably predict decision-making performance: frontier models and task-adapted Qwen variants often fail to change decisions correctly, and model rankings shift across evaluation regimes. Decision-structured supervision improves pivot-sensitive decision-making and medical QA under matched knowledge budgets, while lightweight replay reduces losses in general assistant ability.

Dongkyu Cho, Miao Zhang, Rumi Chunara

New York University

Clinical Decision Support Clinical Patients Treatment Decisions

May 18, 2026cs.LG

CLIC: Contextual Language-Informed Cardiac Pathology Classification

The electrocardiogram (ECG) is the gold standard for non-invasive diagnosis of cardiac pathologies and is a fundamental pillar of cardiovascular medicine. Recent progress in deep learning has led to the development of robust automated classifiers that achieve high performance by processing raw physiological signals. However, in clinical practice, diagnosis is rarely based solely on the signal. Cardiologists commonly support their interpretation with the patient's characteristics and the specific data-acquisition context. Despite this, most current algorithms remain restricted to signal-only analysis, failing to integrate technical metadata and demographic variables. This paper proposes Contextual Language-Informed Cardiac pathology classification (CLIC), a multimodal framework that significantly enhances diagnostic precision by encoding these variables through natural language. We demonstrate that translating patient-level contextual data into descriptive text provides an informative anchor that helps the model disambiguate complex physiological patterns. We further investigate the use of Large Language Models to synthesize richer clinical descriptions and observe that, while these generated texts remain competitive, controlled template-based contextual clinical text leads to consistent improvements in downstream classification performance.

Giovani D. Lucafo, Rafael da Costa Silva, João Lucas Luz Lima Sarcinelli +2

Institute of Mathematical and Computer Sciences Universidade de S˜ao Paulo S˜ao Carlos, S˜ao Paulo, Brazil

Electrocardiogram Classification Multimodal Clinical Data Physiological Signals Clinical Notes Patients

May 13, 2026cs.HC

Patients With Personality: Realistic Patient Simulation through Controlled Diversity and Selective Disclosure

Simulating realistic patient interactions is a key requirement to testing clinical applications of LLMs at scale without time-consuming and expensive user studies. However, existing approaches often lack realism and controllability, often oversharing information unprompted, and failing to capture the wide variability of patient behavior. Here, we introduce PatientsWithPersonality (PWP), a patient simulation framework that generates realistic yet diverse virtual patient responses through explicit personality parametrization over a latent patient state. Grounded in HEXACO, a six-dimensional personality space used to quantify and parameterize human behavioral traits, our approach enables fine-grained control over conversational style, cooperativeness, and information disclosure within a unified framework. In a clinician evaluation, PWP is judged nearly as realistic as recorded human actors and clearly ahead of prior simulators, while being flagged as "too informative" far less often. Conditioning on HEXACO axes yields personas whose configured traits are recoverable by both clinicians and an autorater, span a substantially wider behavioral footprint than the closest baseline, and prevent oversharing. Altogether, our framework paves the way for more accurate and informative LLM benchmarking through our realistic and steerable patient simulator.

Moritz Schlager, Friederike Jungmann, Samuel Schmidgall +12

Technical University of Munich (TUM) · Munich Center for Machine Learning (MCML) · TUM University Hospital +3

Simulated Patients Personality Patients Behavioral Divergence Disclosures Diversity

May 13, 2026cs.LG

Multimodal Graph-based Classification of Esophageal Motility Disorders

Diagnosing esophageal motility disorders pose significant challenges due to the complexity of high-resolution impedance manometry (HRIM) data and variability in clinical interpretation. This work explores the feasibility of a multimodal Machine Learning (ML)-based classification approach that combines HRIM recordings with patient-specific information and incorporates a graph-based modeling of esophageal physiology. We analyze HRIM recordings with corresponding patient information from 104 patients with esophageal motility disorders. Patient data includes demographic, clinical, and symptom information extracted from structured questionnaires and free-text notes using keyword detection and large language model-based processing. HRIM data is represented as spatio-temporal graphs, where nodes correspond to pressure values along the esophagus and edges encode spatial adjacency and impedance dynamics. A graph neural network (GNN) is applied to learn physiologically meaningful representations, which are fused with patient embeddings for multi-category, multi-class classification of swallow events. The impact of patient features and graph-based modeling is evaluated by ablation studies and comparison to vision-based classifier baselines. The proposed multimodal approach indicates improvements over models that rely solely on HRIM-derived features across all classification categories. Additionally, the graph-based modeling provides gains compared to vision-based baselines. Our experiments systematically assess the complementary contribution of multiple modalities, as well as demonstrate the feasibility of our proposed graph-based approach. Our initial findings demonstrate that integrating patient-level data with graph-based representations of HRIM signals appears to be a promising direction for more accurate classification of esophageal motility disorders.

Alexander Geiger, Lars Wagner, Daniel Rueckert +3

Technical University of Munich, School of Medicine and Health, TUM University Hospital Rechts der Isar, Research Group MITI, Munich, Germany. · Technical University of Munich, School of Computation, Information and Technology, Chair for AI in Healthcare and Medicine, Munich, Germany. · Imperial College London, Department of Computing, London, UK. +2

Physiological Signals Multimodal Learning Colorectal Cancer Patients

May 13, 2026cs.AI

Multi-Agent Systems in Emergency Departments: Validation Study on a ED Digital Twin

Emergency departments (ED) face challenges in patient care and resource management. We propose to explore optimization strategies in a realistic and flexible model and develop a hybrid Discrete Event Simulation (DES) and Agent-Based Model (ABM) simulating highly configurable ED environments. We specifically focus on the validation of the modeling approach. We derive configurations for ED sizes, patient load, and staffing from real-world studies. We then validate the model expressivity by matching its key performance indicators and metrics with their values known from literature. We proceed by implementing scientifically established and practice-proven resource optimization strategies. Comparing the documented real-world outcomes with our model's results demonstrates that the DES-ABM based simulation can effectively replicate real-world ER dynamics under interventions. We lastly integrate a Proof-of-Concept multi-agent system (MAS) that can autonomously explore resource allocation strategies within the simulated ER environment based on a temporal ledger of ED event records. This modular DES-ABM-MAS framework offers a powerful tool to explore resource optimization strategies in emergency departments.

Markus Wenzel, Tobias Strapatsas, Jessika Kress +3

Constructor University, Bremen, Germany · Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany · Asklepios Kliniken Hamburg GmbH, Hamburg, Germany

Agent-Based Model Emergency Departments Patients

May 12, 2026cs.LG

Training Large Language Models to Predict Clinical Events

Longitudinal clinical notes contain rich evidence of how patients evolve over time, but converting this signal into training supervision for clinical prediction remains challenging. We extend Foresight Learning to clinical prediction by converting time-ordered MIMIC-III notes into examples consisting of past patient context, a natural-language question about a possible future event, and a label resolved from later documentation. This process yields 6,900 prediction examples from 702 admissions across medications, procedures, organ support, microbiology, and mortality. A small LoRA adapter trained on these examples improves over the prompted base model, reducing expected calibration error from 0.1269 to 0.0398 and Brier score from 0.199 to 0.145, while slightly outperforming GPT-5 point estimates on held-out questions. The approach enables reusable clinical prediction supervision from longitudinal notes without hand-engineered structured features or endpoint-specific classifiers.

Benjamin Turtel, Paul Wilczewski, Kris Skotheim

Lightning Rod Labs

Clinical Prediction Mimic-Iv Datasets Patients Longitudinal Foresight Large Language Model Training

May 9, 2026cs.LG

Machine Learning-Based Pre-Test Risk Stratification for PCR-Confirmed Chlamydia Using Patient-Reported Data and Urine Biomarkers

Early identification of individuals at elevated risk of Chlamydia trachomatis infection may enable optimal use of molecular testing in resource-aware screening. We evaluate the feasibility of pre-test risk stratification (PTRS) using machine-learning models trained on routinely available, non-invasive clinical data. A curated dataset of 93 urine samples with PCR reference labels was analyzed using three feature groups: patient-reported history and symptoms, urine biomarkers from standard urinalysis, and their combination. Five supervised classifiers were evaluated using stratified 5-fold cross-validation with out-of-fold probability estimates. Performance was assessed using area under the receiver operating characteristic curve (AUC) and threshold-dependent metrics, with uncertainty quantified via bootstrap confidence intervals. Models using only patient-reported data showed moderate discrimination (AUC up to 0.72). Urine biomarker-based models demonstrated slightly lower peak discrimination but more consistent performance, with ensemble methods yielding the strongest results. Combining feature groups marginally increased the peak AUC and reduced performance variability across models, indicating improved robustness. Findings indicate that urine biomarkers provide a reliable predictive signal for PTRS that is complementary to patient-reported information, while feature integration enhances robustness. This work supports the integration of non-invasive, routinely available information for PTRS into screening workflows, including decentralized or home-based PCR contexts, to optimize testing prioritization.

Mehrab Mahdian, Marko Lehes, Katrin Krolov +1

Tallinn University of Technology (TalTech), Tallinn, Estonia · Selfdiagnostics Deutschland GmbH, Tallinn, Estonia · Capitol Technology University, Laurel, MD, USA +1

Risk Stratification Biomarker Screening Patients

May 9, 2026cs.LG

Outlier detection for patient monitoring and alerting

We develop and evaluate a data-driven approach for detecting unusual (anomalous) patient-management decisions using past patient cases stored in electronic health records (EHRs). Our hypothesis is that a patient-management decision that is unusual with respect to past patient care may be due to an error and that it is worthwhile to generate an alert if such a decision is encountered. We evaluate this hypothesis using data obtained from EHRs of 4486 post-cardiac surgical patients and a subset of 222 alerts generated from the data. We base the evaluation on the opinions of a panel of experts. The results of the study support our hypothesis that the outlier-based alerting can lead to promising true alert rates. We observed true alert rates that ranged from 25% to 66% for a variety of patient-management actions, with 66% corresponding to the strongest outliers.

Miloš Hauskrecht, Iyad Batal, Michal Valko +3

Department of Computer Science, University of Pittsburgh, Pittsburgh, PA, USA · The Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, USA · Inria Lille-Nord Europe, equipe SequeL, Lille, France +2

Electronic Health Records Patients Clinical Decision Support Outliers Data-Driven

May 6, 2026cs.LG

Conditional outlier detection for clinical alerting

We develop and evaluate a data-driven approach for detecting unusual (anomalous) patient-management actions using past patient cases stored in an electronic health record (EHR) system. Our hypothesis is that patient-management actions that are unusual with respect to past patients may be due to a potential error and that it is worthwhile to raise an alert if such a condition is encountered. We evaluate this hypothesis using data obtained from the electronic health records of 4,486 post-cardiac surgical patients. We base the evaluation on the opinions of a panel of experts. The results support that anomaly-based alerting can have reasonably low false alert rates and that stronger anomalies are correlated with higher alert rates.

Milos Hauskrecht, Michal Valko, Shyam Visweswaran +3

Computer Science Department · Department of Biomedical Informatics · Department of Critical Care Medicine

Alarm Fatigue Electronic Health Records Patients Outliers Data-Driven

Apr 24, 2026cs.LG

Beyond Patient Invariance: Learning Cardiac Dynamics via Action-Conditioned JEPAs

Self-supervised learning in healthcare has largely relied on invariance-based objectives, which maximize similarity between different views of the same patient. While effective for static anatomy, this paradigm is fundamentally misaligned with clinical diagnosis, as it mathematically compels the model to suppress the transient pathological changes it is intended to detect. We propose a shift towards Action-Conditioned World Models that learn to simulate the dynamics of disease progression, or Event-Conditioned. Adapting the LeJEPA framework to physiological time-series, we define pathology not as a static label, but as a transition vector acting on a patient's latent state. By predicting the future electrophysiological state of the heart given a disease onset, our model explicitly disentangles stable anatomical features from dynamic pathological forces. Evaluated on the MIMIC-IV-ECG dataset, our approach outperforms fully supervised baselines on the critical triage task. Crucially, we demonstrate superior sample efficiency: in low-resource regimes, our world model outperforms supervised learning by over 0.05 AUROC. These results suggest that modeling biological dynamics provides a dense supervision signal that is far more robust than static classification. Source code is available at https://github.com/cljosegfer/lesaude-dynamics

Jose Geraldo Fernandes, Luiz Facury, Pedro Robles Dutenhefner +1

Department of Computer Science Universidade Federal de Minas Gerais Belo Horizonte, Brazil

Cardiac Medical World Model Patients Sparse Supervision

Apr 24, 2026eess.IV

Generalizable CT-Free PET Attenuation and Scatter Correction for Pediatric Patients

Computed tomography (CT)-based attenuation and scatter correction improves quantitative PET but adds radiation exposure that is particularly undesirable in pediatric imaging. Existing CT-free methods are commonly trained in homogeneous settings and often degrade under scanner or radiotracer shifts, which limits their clinical utility. We propose the Generalizable PET Correction Network (GPCN), a dual-domain network for domain-robust CT-free PET attenuation and scatter correction. GPCN combines a multi-band contextual refinement module, which models pediatric anatomical variability through wavelet-based multiscale decomposition and long-range spatial context modeling, with a frequency-aware spectral decoupling module, which performs coordinate-conditioned amplitude/phase refinement in the Fourier domain. By synergizing multi-band spatial contextual modeling with asymmetric frequency-spectrum decoupling, the network explicitly separates invariant topological structures from domain-specific noise, thereby achieving precise quantitative recovery of both anatomical organs and focal lesions. This design aims to separate anatomy-dominant structures from domain-sensitive spectral residuals and to improve robustness across heterogeneous imaging conditions. We train and evaluate the method on 1085 pediatric whole-body PET scans acquired with two scanners and five radiotracers. In both joint training and zero-shot cross-domain evaluation, GPCN outperforms representative baselines and maintains stable quantitative accuracy on unseen scanner-tracer combinations. The method is further supported by ablation, region-wise quantitative analysis, and downstream segmentation experiments. In our cohort, the CT component of the conventional protocol corresponded to an average effective dose of 10.8 mSv, indicating the potential clinical value of reliable CT-free correction for pediatric PET.

Jia-Mian Wu, Jun Liu, Siqi Li +7

School of Computing and Artificial Intelligence, Southwestern University of Finance and Economics, Chengdu 611130, China · Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China · Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China

Positron Emission Tomography Anatomy Patients

Apr 22, 2026cs.LG

Validating a Deep Learning Algorithm to Identify Patients with Glaucoma using Systemic Electronic Health Records

We evaluated whether a glaucoma risk assessment (GRA) model trained on All of Us national data can identify patients at high probability of glaucoma using only systemic electronic health records (EHR) at an independent institution. In this cross-sectional study, 20,636 Stanford patients seen from November 2013 to January 2024 were included (15% with glaucoma). A pretrained GRA model was fine-tuned on the Stanford cohort and tested on a held-out set using demographics, systemic diagnoses, medications, laboratory results, and physical examination measurements as inputs. The best model achieved AUROC 0.883 and PPV 0.657. Calibration was consistent with clinical risk: the highest prediction decile showed the greatest glaucoma diagnosis rate (65.7%) and treatment rate (57.0%). Performance improved with more trainable layers up to 15 and with additional data. An EHR-only GRA model may enable scalable and accessible pre-screening without specialized imaging.

John Xiang, Rohith Ravindranath, Sophia Y. Wang

Department of Ophthalmology, Byers Eye Institute, Stanford University, Stanford, California, USA

Glaucoma Detection Electronic Health Records Roc-Auc Screening Patients

Apr 16, 2026cs.AI

Rethinking Patient Education as Multi-turn Multi-modal Interaction

Most medical multimodal benchmarks focus on static tasks such as image question answering, report generation, and plain-language rewriting. Patient education is more demanding: systems must identify relevant evidence across images, show patients where to look, explain findings in accessible language, and handle confusion or distress. Yet most patient education work remains text-only, even though combined image-and-text explanations may better support understanding. We introduce MedImageEdu, a benchmark for multi-turn, evidence-grounded radiology patient education. Each case provides a radiology report with report text and case images. A DoctorAgent interacts with a PatientAgent, conditioned on a hidden profile that captures factors such as education level, health literacy, and personality. When a patient question would benefit from visual support, the DoctorAgent can issue drawing instructions grounded in the report, case images, and the current question to a benchmark-provided drawing tool. The tool returns image(s), after which the DoctorAgent produces a final multimodal response consisting of the image(s) and a grounded plain-language explanation. MedImageEdu contains 150 cases from three sources and evaluates both the consultation process and the final multimodal response along five dimensions: Consultation, Safety and Scope, Language Quality, Drawing Quality, and Image-Text Response Quality. Across representative open- and closed-source vision-language model agents, we find three consistent gaps: fluent language often outpaces faithful visual grounding, safety is the weakest dimension across disease categories, and emotionally tense interactions are harder than low education or low health literacy. MedImageEdu provides a controlled testbed for assessing whether multimodal agents can teach from evidence rather than merely answer from text.

Zonghai Yao, Zhipeng Tang, Chengtao Lin +5

1VA Bedford Health Care · 2UMass Amherst · 4Yale University +3

Multimodal Clinical Data Medical Visual Question Answering Radiology Report Generation Patients Explainable AI Methods

Mar 31, 2026cs.CL

Beyond Idealized Patients: Evaluating LLMs under Challenging Patient Behaviors in Medical Consultations

Large language models (LLMs) are increasingly used for medical consultation and health information support, where safety depends not only on medical knowledge but also on robust responses to unclear, inconsistent, or misleading patient input. However, most existing medical LLM evaluations assume idealized and well-posed patient questions, limiting their realism. We study challenging patient behaviors that commonly arise in real medical consultations and complicate safe clinical reasoning. We define four clinically grounded categories of such behaviors: information contradiction, factual inaccuracy, self-diagnosis, and care resistance. For each behavior, we specify concrete failure criteria that capture unsafe responses. Building on four existing medical dialogue datasets, we introduce CPB-Bench (Challenging Patient Behaviors Benchmark), a bilingual (English and Chinese) benchmark of multi-turn dialogues annotated for these behaviors. We find that although models perform well overall, they exhibit consistent behavior-specific failures, especially when handling contradictory or medically implausible patient information. We further evaluate four intervention strategies and find inconsistent improvements, with some interventions introducing unnecessary corrections.

Yahan Li, Xinyi Jie, Wanjia Ruan +5

University of Southern California

Clinical Reasoning Training Patients Large Language Model Evaluation

Mar 18, 2026cs.CL

PACE-RAG: Patient-Aware Contextual and Evidence-Constrained RAG for Clinical Drug Recommendation

Drug recommendation requires a deep understanding of individual patient context, especially for complex conditions like Parkinson's disease. While LLMs possess broad medical knowledge, they fail to capture the subtle nuances of actual prescribing patterns. Existing RAG methods also struggle with these complexities because guideline-based retrieval remains too generic and similar-patient retrieval often replicates majority patterns without accounting for the unique clinical nuances of individual patients. To bridge this gap, we propose PACE-RAG (Patient-Aware Contextual and Evidence-Constrained RAG). Rather than directly copying frequent medications from retrieved patients, PACE-RAG personalizes recommendations by first extracting patient-specific clinical features, retrieving cases around these features, and then refining the final prescription using the patient's current symptoms, active medication history, and focus-specific prescribing tendencies. By analyzing treatment patterns tailored to specific clinical features, PACE-RAG generates patient-specific medication recommendations along with an explainable clinical summary. PACE-RAG achieved the strongest performance among the evaluated inference-only LLM-based methods, reaching F1 scores of 80.84% and 47.22% on the Parkinson's disease and MIMIC-IV cohorts, respectively. Our code is available at: https://github.com/ChaeYoungHuh/PACE-RAG.

Chaeyoung Huh, Hyunmin Hwang, Jung Hwan Shin +3

1Korea Advanced Institute of Science and Technology, KAIST, Republic of Korea · Department of Neurology, Seoul National University Hospital, Republic of Korea · 3Asan Medical Center, University of Ulsan, College of Medicine, Republic of Korea +1

Medication Leaflet Clinical Reasoning Training Hievi-Rag Patients Agentic Retrieval-Augmented Generation Systems

Feb 2, 2026cs.AI

Think Like a Doctor: Conversational Diagnosis through the Exploration of Diagnostic Knowledge Graphs

Conversational diagnosis requires multi-turn history-taking, where an agent asks clarifying questions to refine differential diagnoses under incomplete information. Existing approaches often rely on the parametric knowledge of a model or assume that patients provide rich and concrete information, which is unrealistic. To address these limitations, we propose a conversational diagnosis system that explores a diagnostic knowledge graph to reason in two steps: (i) generating diagnostic hypotheses from the dialogue context, and (ii) verifying hypotheses through clarifying questions, which are repeated until a final diagnosis is reached. Since evaluating the system requires a realistic patient simulator that responds to the system's questions, we adopt PatientSim, a persona-driven patient simulator, together with patient profiles from MIMIC-IV. We further adapt it with low-specificity symptom reporting to reflect how real-world patients describe symptoms vaguely during early clinical encounters. Experiments show improved diagnostic accuracy and efficiency over strong baselines, and physician evaluations support the realism of our simulator and the clinical utility of the generated clarifying questions. Our code will be released upon publication.

Jeongmoon Won, Seungwon Kook, Yohan Jo

Graduate School of Data Science, Seoul National University

Simulated Patients Diagnosis Patients Biomedical Knowledge Graph

Jul 4, 2025math.OC

Instance Generation for Patient-to-room Assignment and Admission Scheduling Based on Real Hospital Data

Developing algorithms for real-life problems that perform well in practice depends on the availability of realistic data for testing. Obtaining real-life data for optimization problems in health care, however, is often difficult, and such data typically cannot be published, which limits reproducibility by other researchers. This is especially true for patient-related problems because of data privacy policies such as the patient-to-room assignment problem. Therefore, artificially generated instances are commonly used. To improve the generation of realistic instances, we develop a configurable instance generator for the patient-to-room assignment problem and other patient-related problems, featuring an easy-to-use graphical user interface. The design of the generator is based on an extensive empirical analysis of real hospital data, which identifies relevant ward-specific patterns such as patients' age and length-of-stay distributions. Moreover, as randomly generated instances are often infeasible, we address this issue in two ways. We implement a dynamic programming approach in the generator to optionally enforce feasibility and extend existing results from the literature to derive new combinatorial insights into patient-to-room feasibility.

Tabea Brandt, Christina Büsing, Johanna Leweke +2

Chair of Combinatorial Optimization, RWTH Aachen University, Im Süsterfeld 9, 52072 Aachen, Germany · Chair of Algorithms and Complexity, RWTH Aachen University, Ahornstraße 55, 52074 Aachen, Germany

Patients Admissibility

Mar 17, 2025cs.LG

Cohort-attention Evaluation Metrics for Tied Data

Artificial intelligence (AI) has significantly improved medical screening accuracy, particularly in cancer detection and risk assessment. However, traditional classification metrics often fail to account for imbalanced data, varying performance across cohorts, and patient-level inconsistencies, leading to biased evaluations. We propose the cohort-attention evaluation metrics for tied data (CAT). CAT introduces patient-level assessment, entropy-based distribution weighting, and cohort-weighted sensitivity and specificity. Key metrics like CAT Sensitivity, CAT Specificity, and CAT Mean ensure balanced and fair evaluation across diverse populations. This approach enhances predictive reliability, fairness, and interpretability, providing a robust evaluation method for AI-driven medical screening models.

Dongjing Jiang, Qingchong Jiao

DeepCox, Canada

Evaluation Metrics Screening Cancer Detection Patients

Jul 7, 2024cs.CV

Replication in Visual Diffusion Models: A Survey and Outlook

Visual diffusion models have revolutionized the field of creative AI, producing high-quality and diverse content. However, they inevitably memorize training images or videos, subsequently replicating their concepts, content, or styles during inference. This phenomenon raises significant concerns about privacy, security, and copyright within generated outputs. In this survey, we provide the first comprehensive review of replication in visual diffusion models, marking a novel contribution to the field by systematically categorizing the existing studies into unveiling, understanding, and mitigating this phenomenon. Specifically, unveiling mainly refers to the methods used to detect replication instances. Understanding involves analyzing the underlying mechanisms and factors that contribute to this phenomenon. Mitigation focuses on developing strategies to reduce or eliminate replication. Beyond these aspects, we also review papers focusing on its real-world influence. For instance, in the context of healthcare, replication is critically worrying due to privacy concerns related to patient data. Finally, the paper concludes with a discussion of the ongoing challenges, such as the difficulty in detecting and benchmarking replication, and outlines future directions including the development of more robust mitigation techniques. By synthesizing insights from diverse studies, this paper aims to equip researchers and practitioners with a deeper understanding at the intersection between AI technology and social good. We release this project at https://github.com/WangWenhao0716/Awesome-Diffusion-Replication.

Wenhao Wang, Yifan Sun, Zongxin Yang +3

College of Computer Science and Technology, Zhejiang University, Hangzhou, Zhejiang, China

Diffusion Models Survey Real-World Patients

Nov 9, 2021cs.LG

Subtyping patients with chronic disease using longitudinal BMI patterns

Obesity is a major health problem, increasing the risk of various major chronic diseases, such as diabetes, cancer, and stroke. While the role of obesity identified by cross-sectional BMI recordings has been heavily studied, the role of BMI trajectories is much less explored. In this study, we use a machine-learning approach to subtype individuals' risk of developing 18 major chronic diseases by using their BMI trajectories extracted from a large and geographically diverse EHR dataset capturing the health status of around two million individuals for a period of six years. We define nine new interpretable and evidence-based variables based on the BMI trajectories to cluster the patients into subgroups using the k-means clustering method. We thoroughly review each cluster's characteristics in terms of demographic, socioeconomic, and physiological measurement variables to specify the distinct properties of the patients in the clusters. In our experiments, the direct relationship of obesity with diabetes, hypertension, Alzheimer's, and dementia has been re-established and distinct clusters with specific characteristics for several of the chronic diseases have been found to be conforming or complementary to the existing body of knowledge.

Md Mozaharul Mottalib, Jessica C Jones-Smith, Bethany Sheridan +1

Cluster Patients

Date pendingcs.MA

ETHOS: Towards a Modular Ethics Framework for Clinical Multi-Agent Systems

The rapid adoption of large language models has enabled the development of clinical multi-agent systems (MAS) capable of integrating multimodal patient data and supporting increasingly complex clinical decision-making. However, the deployment of these systems in real-world healthcare settings raises critical ethical concerns related to safety, fairness, accountability, transparency, and patient trust. While numerous organizations, including the World Health Organization, the National Academy of Medicine, and the FUTURE-AI consortium, have proposed ethical frameworks and governance principles for healthcare AI, these efforts remain largely conceptual. To address this challenge, we present ETHOS (Ethics and Trust through Hierarchical Oversight System), a modular ethics framework designed as a governance meta-agent that can be integrated with any existing multi-agent system without requiring changes to its underlying architecture. ETHOS translates stakeholder-informed ethical requirements into executable runtime oversight through a layered governance approach consisting of deterministic checks, contextual reviews, and a final ethics critic. These components continuously evaluate intermediate reasoning steps and final outputs, enabling the system to identify ethical risks, request revisions, or suppress responses that fail predefined safety and trustworthiness criteria. We demonstrate ETHOS within a hepatology clinical decision-support MAS. Results show that ETHOS improves decision reliability by detecting incomplete, inconsistent, or out-of-scope evidence and appropriately increasing abstention when safe recommendations cannot be supported. By embedding ethical governance directly into system operation, ETHOS provides a practical and auditable mechanism for transforming high-level AI ethics principles into deployable safeguards.

Rakesh Sharma, Sydney Pugh, Cameron Beeche +14

Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA · Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA · Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA 19104, USA +6

Ethics Patients