Xun Shen

Yuepeng Wang, Ken Kawano, Yongqi Zhou et al.

Medical treatment recommendation poses several challenges to reinforcement learning (RL): patient physiology evolves in continuous time, measurements and interventions are performed at irregular intervals, and treatment effects vary substantially across individuals. Existing RL formulations and simulated environments, however, are based on discrete-time MDP or POMDP abstractions with fixed or pre-specified decision intervals. Thus, it remains difficult to evaluate whether RL methods can handle time-interval-dependent disease progression, personalized treatment response, and safety between consecutive measurement points. To address this gap, we introduce MedGym, a benchmark environment for dynamic treatment recommendation. MedGym models longitudinal patient evolution in a continuous-time framework and constructs a configurable medical RL benchmark from clinical data by using Physics-Informed Neural Networks. The resulting benchmark supports both offline and online RL, and enables direct comparison between discrete-time and continuous-time methods under irregular treatment timing and patient-specific dynamics. Besides, MedGym supports evaluation from clinically important perspectives, including personalization, trajectory-level safety, and the performance gap between model-based offline learning and online deployment. By providing a standardized and configurable benchmark for continuous-time dynamic treatment, MedGym aims to facilitate more realistic and informative evaluation of medical RL methods.

Xun Shen, Yuepeng Wang, Akifumi Wachi et al.

Dynamic medical treatment requires deciding treatment intensity and intervention timing, while patient states evolve continuously and adverse events may occur between clinical interactions. Most existing treatment learning methods assume fixed schedules or enforce safety only at discrete decision points. We propose Interaction-Limited Safe Continuous-Time Reinforcement Learning, a framework that jointly optimizes treatment administration and clinical interaction timing under trajectory-level safety constraints. Our key idea is to reformulate the continuous time treatment problem as an option-based semi-Markov decision process, where each option specifies a continuous-time treatment policy and its duration. We develop a safety-tightening mechanism showing that suitably constructed constraints at interaction times guarantee safety over the full continuous-time trajectory with high probability. We further establish finite-sample guarantees for policy learning from logged treatment trajectories and introduce a practical data-driven conservative surrogate. Experiments show that the proposed adaptive interaction-timing mechanism improves both safety and treatment effectiveness over equidistant interaction schemes across different safe policy optimization methods.

Akifumi Wachi, Wataru Hashimoto, Xun Shen et al.

Safe exploration is essential for the practical use of reinforcement learning (RL) in many real-world scenarios. In this paper, we present a generalized safe exploration (GSE) problem as a unified formulation of common safe exploration problems. We then propose a solution of the GSE problem in the form of a meta-algorithm for safe exploration, MASE, which combines an unconstrained RL algorithm with an uncertainty quantifier to guarantee safety in the current episode while properly penalizing unsafe explorations before actual safety violation to discourage them in future episodes. The advantage of MASE is that we can optimize a policy while guaranteeing with a high probability that no safety constraint will be violated under proper assumptions. Specifically, we present two variants of MASE with different constructions of the uncertainty quantifier: one based on generalized linear models with theoretical guarantees of safety and near-optimality, and another that combines a Gaussian process to ensure safety with a deep RL algorithm to maximize the reward. Finally, we demonstrate that our proposed algorithm achieves better performance than state-of-the-art algorithms on grid-world and Safety Gym benchmarks without violating any safety constraints, even during training.

Akifumi Wachi, Xun Shen, Yanan Sui

Safety is critical when applying reinforcement learning (RL) to real-world problems. As a result, safe RL has emerged as a fundamental and powerful paradigm for optimizing an agent's policy while incorporating notions of safety. A prevalent safe RL approach is based on a constrained criterion, which seeks to maximize the expected cumulative reward subject to specific safety constraints. Despite recent effort to enhance safety in RL, a systematic understanding of the field remains difficult. This challenge stems from the diversity of constraint representations and little exploration of their interrelations. To bridge this knowledge gap, we present a comprehensive review of representative constraint formulations, along with a curated selection of algorithms designed specifically for each formulation. In addition, we elucidate the theoretical underpinnings that reveal the mathematical mutual relations among common problem formulations. We conclude with a discussion of the current state and future directions of safe reinforcement learning research.

Mengmou Li, Yu Zhou, Xun Shen et al.

This work introduces a canonical structure for a broad class of unconstrained first-order algorithms that admit a Lur'e representation, including systems with relative degree greater than one, e.g., systems with delayed gradient feedback. The proposed canonical structure is obtained through a simple linear transformation. It enables a direct extension from unconstrained optimization algorithms to set-constrained ones through projection in a Lyapunov-induced norm. The resulting projected algorithms attain the optimal solution while preserving the convergence rates of their unconstrained counterparts.

Runze Yan, Xun Shen, Akifumi Wachi et al.

When applying offline reinforcement learning (RL) in healthcare scenarios, the out-of-distribution (OOD) issues pose significant risks, as inappropriate generalization beyond clinical expertise can result in potentially harmful recommendations. While existing methods like conservative Q-learning (CQL) attempt to address the OOD issue, their effectiveness is limited by only constraining action selection by suppressing uncertain actions. This action-only regularization imitates clinician actions that prioritize short-term rewards, but it fails to regulate downstream state trajectories, thereby limiting the discovery of improved long-term treatment strategies. To safely improve policy beyond clinician recommendations while ensuring that state-action trajectories remain in-distribution, we propose \textit{Offline Guarded Safe Reinforcement Learning} ($\mathsf{OGSRL}$), a theoretically grounded model-based offline RL framework. $\mathsf{OGSRL}$ introduces a novel dual constraint mechanism for improving policy with reliability and safety. First, the OOD guardian is established to specify clinically validated regions for safe policy exploration. By constraining optimization within these regions, it enables the reliable exploration of treatment strategies that outperform clinician behavior by leveraging the full patient state history, without drifting into unsupported state-action trajectories. Second, we introduce a safety cost constraint that encodes medical knowledge about physiological safety boundaries, providing domain-specific safeguards even in areas where training data might contain potentially unsafe interventions. Notably, we provide theoretical guarantees on safety and near-optimality: policies that satisfy these constraints remain in safe and reliable regions and achieve performance close to the best possible policy supported by the data.