Definitions and Characteristics of Patient Digital Twins Being Developed for Clinical Use: Scoping Review

Abstract

Background: The concept of digital twins, widely adopted in industry, is entering health care. However, there is a lack of consensus on what constitutes the digital twin of a patient.

Objective: The objective of this scoping review was to analyze definitions and characteristics of patient digital twins being developed for clinical use, as reported in the scientific literature.

Methods: We searched PubMed, Scopus, Embase, IEEE, and Google Scholar for studies claiming digital twin development or evaluation until August 2023. Data on definitions, characteristics, and development phase were extracted. Unsupervised classification of claimed digital twins was performed.

Results: We identified 86 papers representing 80 unique claimed digital twins, with 98% (78/80) in preclinical phases. Among the 55 papers defining "digital twin," 76% (42/55) described a digital replica, 42% (23/55) mentioned real-time updates, 24% (13/55) emphasized patient specificity, and 15% (8/55) included 2-way communication. Among claimed digital twins, 60% (48/80) represented specific organs (primarily heart: 15/48, 31%; bones or joints: 10/48, 21%; lung: 6/48, 12%; and arteries: 5/48, 10%); 14% (11/80) embodied biological systems such as the immune system; and 26% (21/80) corresponded to other products (prediction models, etc). The patient data used to develop and run the claimed digital twins encompassed medical imaging examinations (35/80, 44% of publications), clinical notes (15/80, 19% of publications), laboratory test results (13/80, 16% of publications), wearable device data (12/80, 15% of publications), and other modalities (32/80, 40% of publications). Regarding data flow between patients and their virtual counterparts, 16% (13/80) claimed that digital twins involved no flow from patient to digital twin, 73% (58/80) used 1-way flow from patient to digital twin, and 11% (9/80) enabled 2-way data flow between patient and digital twin. Based on these characteristics, unsupervised classification revealed 3 clusters: simulation patient digital twins in 54% (43/80) of publications, monitoring patient digital twins in 28% (22/80) of publications, and research-oriented models unlinked to specific patients in 19% (15/80) of publications. Simulation patient digital twins used computational modeling for personalized predictions and therapy evaluations, mostly for one-time assessments, and monitoring digital twins harnessed aggregated patient data for continuous risk or outcome forecasting and care optimization.

Conclusions: We propose defining a patient digital twin as "a viewable digital replica of a patient, organ, or biological system that contains multidimensional, patient-specific information and informs decisions" and to distinguish simulation and monitoring digital twins. These proposed definitions and subtypes offer a framework to guide research into realizing the potential of these personalized, integrative technologies to advance clinical care.

Keywords: cyber-physical systems; digital twin; patient simulation; personalized medicine; precision medicine; telemonitoring.

Figure 1

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart.

Figure 2

Dimensions of digital twins included in definitions provided by authors (gray) and included in the claimed digital twins (black). Created with BioRender [111] which is published under Creative Commons Attribution 4.0 International License [112].

Figure 3

Distribution of organs or systems modeled in the claimed digital twins identified. N=48 claimed digital twin representing specific organs. Created with BioRender [111] which is published under Creative Commons Attribution 4.0 International License [112].

Figure 4

Clusters of claimed digital twins identified. Each point and its associated number correspond to 1 study and its study identification number. Cluster 1: simulation digital twins; cluster 2: monitoring digital twins; cluster 3: research-oriented models.

Figure 5

Proposed definitions and characteristics of patient digital twins. PDT: patient digital twin. Created with BioRender [111] which is published under Creative Commons Attribution 4.0 International License [112].