Kazuhiko Ohe

Yu Akagi, Tomohisa Seki, Toru Takiguchi et al.

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.

Kenya Sakka, Kotaro Nakayama, Nisei Kimura et al.

Chest radiography is a general method for diagnosing a patient's condition and identifying important information; therefore, radiography is used extensively in routine medical practice in various situations, such as emergency medical care and medical checkup. However, a high level of expertise is required to interpret chest radiographs. Thus, medical specialists spend considerable time in diagnosing such huge numbers of radiographs. In order to solve these problems, methods for generating findings have been proposed. However, the study of generating chest radiograph findings has primarily focused on the English language, and to the best of our knowledge, no studies have studied Japanese data on this subject. There are two challenges involved in generating findings in the Japanese language. The first challenge is that word splitting is difficult because the boundaries of Japanese word are not clear. The second challenge is that there are numerous orthographic variants. For deal with these two challenges, we proposed an end-to-end model that generates Japanese findings at the character-level from chest radiographs. In addition, we introduced the attention mechanism to improve not only the accuracy, but also the interpretation ability of the results. We evaluated the proposed method using a public dataset with Japanese findings. The effectiveness of the proposed method was confirmed using the Bilingual Evaluation Understudy score. And, we were confirmed from the generated findings that the proposed method was able to consider the orthographic variants. Furthermore, we confirmed via visual inspection that the attention mechanism captures the features and positional information of radiographs.