arXiv subjects

Yu Akagi

Publications and source records attributed to Yu Akagi.

3 recordsLinked to original sources

arXiv2026

High-Fidelity Longitudinal Patient Simulation Using Real-World Data

Simulation is a powerful tool for exploring uncertainty. Its potential in clinical medicine is transformative and includes personalized treatment planning and virtual clinical trials. However, simulating patient trajectories is challenging because of complex biological and sociocultural influences. Here, we show that real-world clinical records can be leveraged to empirically model patient timelines. We developed a generative simulator model that takes a patient's history as input and synthesizes fine-grained, realistic future trajectories. The model was pretrained on more than 200 million clinical records. It produced high-fidelity future timelines, closely matching event occurrence rates, laboratory test results, and temporal dynamics in real patient future data. It also accurately estimated future event probabilities, with observed-to-expected ratios consistently near 1.0 across diverse outcomes and time horizons. Our results reveal the untapped value of real-world data in electronic health records and introduce a scalable framework for in silico modeling of clinical care.

cs.AI↗

arXiv2026

Generating Counterfactual Patient Timelines from Real-World Data

Counterfactual simulation - exploring hypothetical consequences under alternative clinical scenarios - holds promise for transformative applications such as personalized medicine and in silico trials. However, it remains challenging due to methodological limitations. Here, we show that an autoregressive generative model trained on real-world data from over 300,000 patients and 400 million patient timeline entries can generate clinically plausible counterfactual trajectories. As a validation task, we applied the model to patients hospitalized with COVID-19 in 2023, modifying age, serum C-reactive protein (CRP), and serum creatinine to simulate 7-day outcomes. Increased in-hospital mortality was observed in counterfactual simulations with older age, elevated CRP, and elevated serum creatinine. Remdesivir prescriptions increased in simulations with higher CRP values and decreased in those with impaired kidney function. These counterfactual trajectories reproduced known clinical patterns. These findings suggest that autoregressive generative models trained on real-world data in a self-supervised manner can establish a foundation for counterfactual clinical simulation.

cs.LG↗

arXiv2023

Can Physician Judgment Enhance Model Trustworthiness? A Case Study on Predicting Pathological Lymph Nodes in Rectal Cancer

Explainability is key to enhancing artificial intelligence's trustworthiness in medicine. However, several issues remain concerning the actual benefit of explainable models for clinical decision-making. Firstly, there is a lack of consensus on an evaluation framework for quantitatively assessing the practical benefits that effective explainability should provide to practitioners. Secondly, physician-centered evaluations of explainability are limited. Thirdly, the utility of built-in attention mechanisms in transformer-based models as an explainability technique is unclear. We hypothesize that superior attention maps should align with the information that physicians focus on, potentially reducing prediction uncertainty and increasing model reliability. We employed a multimodal transformer to predict lymph node metastasis in rectal cancer using clinical data and magnetic resonance imaging, exploring how well attention maps, visualized through a state-of-the-art technique, can achieve agreement with physician understanding. We estimated the model's uncertainty using meta-level information like prediction probability variance and quantified agreement. Our assessment of whether this agreement reduces uncertainty found no significant effect. In conclusion, this case study did not confirm the anticipated benefit of attention maps in enhancing model reliability. Superficial explanations could do more harm than good by misleading physicians into relying on uncertain predictions, suggesting that the current state of attention mechanisms in explainability should not be overestimated. Identifying explainability mechanisms truly beneficial for clinical decision-making remains essential.

eess.IV↗