Treatment Stitching with Schrödinger Bridge for Enhancing Offline Reinforcement Learning in Adaptive Treatment Strategies

Adaptive treatment strategies (ATS) are sequential decision-making processes that enable personalized care by dynamically adjusting treatment decisions in response to evolving patient symptoms. While reinforcement learning (RL) offers a promising approach for optimizing ATS, its conventional online trial-and-error learning mechanism is not permissible in clinical settings due to risks of harm to patients. Offline RL tackles this limitation by learning policies exclusively from historical treatment data, but its performance is often constrained by data scarcity-a pervasive challenge in clinical domains. To overcome this, we propose Treatment Stitching (TreatStitch), a novel data augmentation framework that generates clinically valid treatment trajectories by intelligently stitching segments from existing treatment data. Specifically, TreatStitch identifies similar intermediate patient states across different trajectories and stitches their respective segments. Even when intermediate states are too dissimilar to stitch directly, TreatStitch leverages the Schrödinger bridge method to generate smooth and energy-efficient bridging trajectories that connect dissimilar states. By augmenting these synthetic trajectories into the original dataset, offline RL can learn from a more diverse dataset, thereby improving its ability to optimize ATS. Extensive experiments across multiple treatment datasets demonstrate the effectiveness of TreatStitch in enhancing offline RL performance. Furthermore, we provide a theoretical justification showing that TreatStitch maintains clinical validity by avoiding out-of-distribution transitions.

DART: Disease-aware Image-Text Alignment and Self-correcting Re-alignment for Trustworthy Radiology Report Generation

The automatic generation of radiology reports has emerged as a promising solution to reduce a time-consuming task and accurately capture critical disease-relevant findings in X-ray images. Previous approaches for radiology report generation have shown impressive performance. However, there remains significant potential to improve accuracy by ensuring that retrieved reports contain disease-relevant findings similar to those in the X-ray images and by refining generated reports. In this study, we propose a Disease-aware image-text Alignment and self-correcting Re-alignment for Trustworthy radiology report generation (DART) framework. In the first stage, we generate initial reports based on image-to-text retrieval with disease-matching, embedding both images and texts in a shared embedding space through contrastive learning. This approach ensures the retrieval of reports with similar disease-relevant findings that closely align with the input X-ray images. In the second stage, we further enhance the initial reports by introducing a self-correction module that re-aligns them with the X-ray images. Our proposed framework achieves state-of-the-art results on two widely used benchmarks, surpassing previous approaches in both report generation and clinical efficacy metrics, thereby enhancing the trustworthiness of radiology reports.