Accountability means a decision can be examined, justified, and contested. LLMs make this hard: fluent output may be ungrounded, incomplete, or unfaithful to the decision process. Achieving accountability requires verified rationales (how was the decision reached), assumptions (what was assumed rather than known), policy consistency (the same treatment for the same facts), and pivotal conditions (what would change the outcome). We introduce self-faithfulness as an automatic test of accountability: changing the pivotal conditions should change the decision. We examine accountable AI through clinical trial matching, a high-stakes task central to evidence-based medicine. Although LLM-based matchers match patients to trials reasonably accurately, they apply decision policies inconsistently and produce rationales that are unfaithful to their own decisions. We introduce VERDICT, an LLM-based agent that translates a decision task, its constraints, and its policy into Satisfiability Modulo Theories (SMT), then derives the decision with SMT and MaxSMT solvers -- so policies are applied consistently and decisions are accountable by construction. Across a SIGIR 2016-derived dataset and TREC 2021, VERDICT achieves the strongest decision accuracy among LLM-only and neurosymbolic baselines, applies policies with perfect consistency, and produces clinician-preferred rationales grounded in explicit assumptions and pivotal conditions, with improved counterfactual self-faithfulness.
The convergence of the Metaverse and Large Language Model (LLM)-based AI agent is catalyzing a shift toward autonomous, immersive, and personalized pedagogical frameworks in medical education. This paper presents a novel agentic AI-driven immersive simulation specifically designed for High Dose Rate (HDR) vaginal cylinder (VC) brachytherapy in cancer care. By integrating Virtual Reality (VR) and mobile computing, the system establishes a high-fidelity, risk-free environment that allows trainees to master complex procedural skills without the facility or safety constraints posed by physical anatomy or live radioactive sources. A core contribution of this work is the seamless integration of a knowledge-aware assistant leveraging Retrieval-Augmented Generation (RAG) to ground agent interactions in authoritative clinical guidelines. This architecture also enables an interactive agent to provide natural language interfaces and hands-free, real-time guidance during intricate medical maneuvers. We validate the proposed system through a prototype deployment comprising a Meta Quest 3 interface linked to a local GPU-accelerated AI backend, demonstrating a feasible architecture for HDR brachytherapy simulation. Experimental results indicate that the system maintains suitable end-to-end latency and high context precision, answer completeness, and relevance in the RAG-enhanced pedagogical support.
CASCADE is an agentic framework that predicts downstream transcriptional effects of gene perturbation from precomputed ARACNe regulatory networks, exposed via MCP. Prior work validates such tools by checking whether predicted genes are known cancer genes (membership); we instead test whether the predicted direction of change matches reality, using focal-gene copy-number amplification as a dosage-based proxy for the inverse of knockdown against real TCGA patient tumor data. For MYC, CASCADE's predicted knockdown targets show strong concordance with real amplified-vs-non-amplified tumor expression across three cancer types (BRCA: 90.0%, COAD: 72.0%, STAD: 85.7%; all p<0.0013), well above permutation baselines, surviving a PAM50 subtype control and replicating in an independent cohort (METABRIC, 87.2%). Compared against curated MSigDB gene-set baselines via Fisher's exact test, CASCADE's accuracy is not shown to exceed existing public knowledge of MYC- or E2F-driven biology, though its gene-specific direction-calling clearly outperforms a naive uniform guess. Extending to fifteen additional genes, validation proves gene-specific rather than universal: proliferation-machinery regulators mostly replicate, while lineage-identity transcription factors and one cyclin-D paralog (CCND2) consistently fail, a pattern we discuss as a hedged, post-hoc hypothesis. We separately benchmark whether an LLM-based agent correctly grounds natural-language requests into CASCADE's real MCP tool calls. Across 35 queries, a documented local model reaches 71.4% exact match (85.7% for a larger model); schema and gene-alias failures are resolved by scale or server-side correction, but both models confidently default to the wrong perturbation type on ambiguous queries, a failure a targeted fix could not resolve because its trigger condition never occurs.
Heterogeneous computed tomography (CT) acquisitions and diverse downstream task requirements limit the transferability of fixed data preparation workflows across data sources and tasks. Existing approaches typically rely on manually designed or dataset-specific rules, making it difficult to accommodate changes in acquisition conditions and analytical objectives without manual intervention. Large language model (LLM)-based agents have shown promise for automating medical workflows, yet their potential for adaptive CT data preparation remains largely unexplored. To bridge this gap, we propose CT-PrepAgent, which enables adaptive CT data preparation through a bounded policy and controlled deterministic execution. Deterministic inspection constructs structured data--task profiles, from which a policy decides an eligible DICOM series or predefined preprocessing profile, while the controlled execution flow guards, resolves, executes, and verifies the decision with bounded recovery when enabled and safe quarantine otherwise. Across three public CT segmentation tasks, CT-PrepAgent derived data-task adaptive preprocessing decisions and achieved the highest macro-average Dice. On two private raw-DICOM cohorts, CT-PrepAgent increased verified output yield from 61.7\% to 70.0\% and yielded similar registration metrics on common verified outputs. Controlled fault and replay tests validate bounded recovery, safe quarantine, and policy-free replay under tested fault and drift settings.
Deep models have substantially advanced 12-lead ECG classification, yet their refinement still relies heavily on human experts to inspect failures and iteratively revise classifier designs. Recent LLM-based agents have demonstrated the potential for automated model design, but when guided only by aggregate performance metrics, they lack insight into why individual cases fail and how the classifier should be revised. We present RecursiveECG, an evidence-driven LLM-as-Designer framework in which an LLM serves as an offline model designer that refines ECG classifiers based on concrete failures and objective ECG evidence. To ground failure diagnosis in executable evidence, Criteria-to-Measurement Compilation converts curated ECG criteria into validated deterministic functions that produce reproducible, reference-backed measurements for individual ECGs. Building on these measurements, Evidence-Grounded Failure Review analyzes failed and comparator cases by jointly considering raw waveforms, measurements, and model outputs, enabling the LLM to diagnose classifier limitations and formulate targeted revisions. Candidate revisions are executed and re-evaluated under a fixed problem contract, and only evidence-supported updates are retained. The resulting predictor is frozen after refinement and requires no LLM inference during deployment, while an audit trail links each accepted revision to its supporting evidence. Across PTB-XL, Georgia, and CPSC2018, RecursiveECG consistently outperforms strong baselines, achieving an average relative improvement of 10.0%. Extensive ablation and transfer studies further validate the effectiveness of its evidence-grounded refinement process.
Hanning Yang, Meropi Karakioulaki, Lennart Purucker +3cs.LG cs.AI
Mechanistic modeling via ordinary differential equations (ODEs) provides interpretable descriptions of complex dynamics and enables inference of underlying mechanisms, which is particularly valuable in clinical settings. However, in rare diseases, both the structure and parameters of the model are typically unknown, while individual-level data is scarce, noisy, heterogeneous, and subject to privacy constraints. In such settings, population-level summary statistics provide a practical privacy-preserving data representation, while capturing heterogeneity further requires modeling parameters as distributions rather than fixed values. Yet no existing method jointly discovers ODE structure and refines parameter distributions solely from summary statistics. We present AgentODE, an end-to-end framework that addresses this gap. An LLM proposes candidate ODE structures, while a tool-augmented inference agent iteratively refines parameter distributions through a diagnosis--update loop, operating on population-level summary statistics alone. We evaluate AgentODE on three benchmark problems across different fields and two clinical datasets, including the rare disease recessive dystrophic epidermolysis bullosa (RDEB), with only 231 observations across 46 patients. AgentODE recovers functionally consistent ODE structures across all settings, and experiments on RDEB demonstrates that in sparse and noisy data settings reasoning from summary statistics promotes mechanistically principled structure discovery, whereas baselines with individual-level data access recover implausible structures despite better predictive performance. AgentODE opens new possibilities for mechanistic modeling of rare diseases directly from population-level summary statistics, where data scarcity and privacy constraints have traditionally limited such analyses.
Building personalized cardiac electrophysiology (EP) digital twins requires identifying the appropriate model structure for each patient, not merely fitting parameters. Traditional methods rely on experts to manually prescribe hybrid physics-neural architectures, which requires deep domain expertise and does not transfer across patients. Recent works have applied large language models (LLMs) to generate or act as hybrid models. However, despite their promising generalization capacity, these LLM-based methods lack the structural priors needed for stable cardiac simulations. Hence, we propose LEADS, a framework that formulates cardiac EP domain knowledge as a structured action space and utilizes an LLM agent to discover hybrid models. The agent follows an iterative reasoning-and-action loop to select, combine, and refine hybrid models, whilst gradient descent handles parameter fitting. The proposed LEADS designs every candidate model towards physically grounded, interpretable, and numerically stable, while allowing open-ended architectural discovery. We validate LEADS on synthetic data with three ground-truth reaction models and on real cardiac EP data, demonstrating that it outperforms both human-designed hybrid models and other LLM-based hybrid modeling.