CalTwin: Towards Calibrated, Shift-Robust Medical World Models via Fisher-Information Regularisation

Medical world models aim to learn a latent state of patient or organ physiology and a transition function that forecasts how that state evolves under interventions, supporting downstream tasks from imaging-based diagnosis to digital-twin treatment planning. Two failure modes threaten the reliability of such models in clinical deployment: (i)~\emph{covariate shift}, because training data are fragmented across hospitals, scanners, and time, so the feature distribution seen by the latent-dynamics predictor differs across fragments and from the distribution at deployment; and (ii)~\emph{confidence misalignment}, because multi-step forecasts are often overconfident exactly where clinical risk is highest. We argue that both problems admit a unified treatment via a single lightweight regularisation objective, \textbf{CalTwin}, which combines a Fisher-Information-based shift penalty adapted from our prior work on fragmented covariate-shift remediation~\cite{khan2025mitigating,khan2025causal} with a Confidence Misalignment Penalty adapted from our prior work on calibrated vision-language classification~\cite{khan2025confidence}, applied here to a GRU-based medical world model's latent transition predictor. We derive the combined objective, establish which proof steps transfer from the classification setting without modification and which require adaptation, and evaluate it on the PhysioNet 2019 Sepsis Challenge, treating the two hospital systems as sequential training fragments and the unseen system as an out-of-distribution test. CalTwin reduces OOD next-step latent-state MSE by 9.1\% relative to the no-penalty baseline (FIM penalty alone accounts for 7.0\%); the ECE reduction from the Confidence Misalignment Penalty is real but small (0.7\% for CalTwin, 1.3\% for CMP alone).

Realistic noise synthesis reduces bias and improves tissue microstructure estimation with supervised machine learning

Diffusion MRI enables non-invasive probing of tissue microstructure, but accurate parameter estimation is challenged by noise-related effects. In supervised machine learning frameworks trained on simulated data, discrepancies between the noise characteristics of simulated and acquired signals introduce a form of covariate shift, whereby the input signal distribution differs between training and inference. We investigated the impact of this mismatch on microstructure parameter estimation and propose a realistic noise synthesis (RNS) framework to mitigate it. RNS incorporates both the Rician expectation and the effective post-processing noise variance into simulated training signals. The Rician expectation was modelled using a noise standard deviation estimated with MPPCA, while the effective standard deviation was derived from spherical harmonic residuals of preprocessed data. The method was evaluated using the cylinder-zeppelin and the SANDI models on simulated datasets across multiple SNR levels and on in vivo diffusion data with repeated acquisitions. Sensitivity to noise misestimation was also assessed. Ignoring magnitude-induced noise effects during training produced systematic, SNR-dependent parameter bias, particularly at low SNR. Incorporating the Rician expectation substantially reduced bias to the level of noise-aware nonlinear least-squares fitting. Modelling the effective standard deviation further improved precision. Performance was largely independent of regression architecture but sensitive to accurate noise estimation. These findings demonstrate that realistic noise modelling in simulated training data mitigates signal-domain covariate shift and is essential for unbiased supervised microstructure estimation, particularly in low-SNR regimes associated with high b-values or high spatial resolution.