arXiv subjects

Aasa Feragen

Publications and source records attributed to Aasa Feragen.

At least 19 recordsLinked to original sources

arXiv2026

Intersectional Disentangling of Temporal and Acquisition Bias in Fetal Ultrasound

Fairness studies of medical imaging AI often explain subgroup performance gaps through under-representation in the training data. We show that intersectional analysis can disentangle fairness and performance gaps arising from clinical and acquisition confounders that co-vary with the target. As a case, we study scan-time fetal weight estimation from obstetric ultrasound, analyzing two models: a state-of-the-art deep learning (DL) model and the clinical gold-standard Hadlock formula. Using unsupervised slice discovery, we find that high-error subgroups share extreme in the image-acquisition pixel spacing (PS) and in the scan-to-delivery (STD) interval. Of these, PS is an acquisition parameter that can be optimized, while STD is a potential confounder for both PS and our bias diagnostics. Subgroup inspection alone cannot separate them. We disentangle the factors using a model-agnostic analysis with identical metadata partitions and partial regression. Holding STD fixed, the apparent PS effect collapses to a small residual (standardized coefficient $β=-0.17$), whereas holding PS fixed, STD dominates error ($β=+0.56$). Both models degrade with increasing STD, including the biometric formula, indicating much of the error is intrinsic to the prediction target rather than imaging. The DL model is $\sim$1.5$\times$ more sensitive to STD than Hadlock, though it remains more accurate in every subgroup. We conclude that fairness analyses need to carefully analyze potential confounds, or risk attributing an effect such as temporal or acquisition-related dependency to demographics.

cs.LG↗

arXiv2026

False Confidence: Automated Labels Confound Fairness Audits in Cervical Spine Segmentation

Automated segmentation of cervical-spine MRI is increasingly used in clinical workflows, yet no fairness audit exists for this anatomy. We show that auditing these segmentation tasks is complicated by a common property of modern segmentation datasets: expert-annotated gold labels are expensive, so abundant machine-generated (silver) labels are added to limit annotation cost. This matters because the reference used to judge a model can itself be biased. In this study, we present the first fairness audit of cervical-spine MRI segmentation across sex, age, and race using the CSpineSeg dataset. We observe that the deployed model is demographically fair, but the choice of reference label, however, is not neutral. Because a dataset's silver labels are generated by a model trained on its gold labels, any new model trained on those same gold labels agrees more with the silver labels than with expert truth: scoring identical predictions against silver rather than gold overestimates performance by ~8 Dice points and turns the fairness verdict for age from non-significant to significant - not by the gap inflation Parikh et al. report (which we term false magnitude) but by collapsing within-group variance (which we term false confidence). Reference-label provenance is thus a first-order confounder in segmentation evaluation: performance and fairness should be reported against expert labels, and any fairness claim stated together with the provenance of its reference.

eess.IV↗

arXiv2026

Towards Fairness under Label Bias in Image Segmentation: Impact, Measurement and Mitigation

Labeled datasets reflect the biases of their annotation pipelines, which sometimes introduce label bias: group-conditional label errors that cause systematic performance disparities across demographic subgroups. Label bias in image segmentation remains underexplored, as even detecting it typically requires clean, unbiased annotations, which are not readily available. We present a data-centric adaptation of Confident Learning to segmentation, allowing detection of label bias directly in the training data without a clean, unbiased ground truth. By comparing the provided training labels to the model's confident predictions, we isolate directional errors that quantify the presence and nature of bias, where standard overlap metrics like Dice fail. We further show that label bias influences subgroup separability in the encoder's feature space, an artifact we leverage for bias mitigation rather than suppressing it. We evaluate three datasets, spanning from synthetic to real-life bias, showing how our framework reliably detects and mitigates bias without access to clean labels, achieving equitable performance across experimental conditions.

cs.CV↗

arXiv2026

Fair Lung Disease Diagnosis from Chest CT via Gender-Adversarial Attention Multiple Instance Learning

We present a fairness-aware framework for multi-class lung disease diagnosis from chest CT volumes, developed for the Fair Disease Diagnosis Challenge at the PHAROS-AIF-MIH Workshop (CVPR 2026). The challenge requires classifying CT scans into four categories -- Healthy, COVID-19, Adenocarcinoma, and Squamous Cell Carcinoma -- with performance measured as the average of per-gender macro F1 scores, explicitly penalizing gender-inequitable predictions. Our approach addresses two core difficulties: the sparse pathological signal across hundreds of slices, and a severe demographic imbalance compounded across disease class and gender. We propose an attention-based Multiple Instance Learning (MIL) model on a ConvNeXt backbone that learns to identify diagnostically relevant slices without slice-level supervision, augmented with a Gradient Reversal Layer (GRL) that adversarially suppresses gender-predictive structure in the learned scan representation. Training incorporates focal loss with label smoothing, stratified cross-validation over joint (class, gender) strata, and targeted oversampling of the most underrepresented subgroup. At inference, all five-fold checkpoints are ensembled with horizontal-flip test-time augmentation via soft logit voting and out-of-the-fold threshold optimization for robustness. Our model achieves a mean validation competition score of 0.685 (std - 0.030), with the best single fold reaching 0.759. All training and inference code is publicly available at https://github.com/ADE-17/cvpr-fair-chest-ct

cs.CV↗

arXiv2026

Measuring What VLMs Don't Say: Validation Metrics Hide Clinical Terminology Erasure in Radiology Report Generation

Reliable deployment of Vision-Language Models (VLMs) in radiology requires validation metrics that go beyond surface-level text similarity to ensure clinical fidelity and demographic fairness. This paper investigates a critical blind spot in current model evaluation: the use of decoding strategies that lead to high aggregate token-overlap scores despite succumbing to template collapse, in which models generate only repetitive, safe generic text and omit clinical terminology. Unaddressed, this blind spot can lead to metric gaming, where models that perform well on benchmarks prove clinically uninformative. Instead, we advocate for lexical diversity measures to check model generations for clinical specificity. We introduce Clinical Association Displacement (CAD), a vocabulary-level framework that quantifies shifts in demographic-based word associations in generated reports. Weighted Association Erasure (WAE) aggregates these shifts to measure the clinical signal loss across demographic groups. We show that deterministic decoding produces high levels of semantic erasure, while stochastic sampling generates diverse outputs but risks introducing new bias, motivating a fundamental rethink of how "optimal" reporting is defined.

cs.CL↗

arXiv2026

Weight Space Correlation Analysis: Quantifying Feature Utilization in Deep Learning Models

Deep learning models in medical imaging are susceptible to shortcut learning, relying on confounding metadata (e.g., scanner model) that is often encoded in image embeddings. The crucial question is whether the model actively utilizes this encoded information for its final prediction. We introduce Weight Space Correlation Analysis, an interpretable methodology that quantifies feature utilization by measuring the alignment between the classification heads of a primary clinical task and auxiliary metadata tasks. We first validate our method by successfully detecting artificially induced shortcut learning. We then apply it to probe the feature utilization of an SA-SonoNet model trained for Spontaneous Preterm Birth (sPTB) prediction. Our analysis confirmed that while the embeddings contain substantial metadata, the sPTB classifier's weight vectors were highly correlated with clinically relevant factors (e.g., birth weight) but decoupled from clinically irrelevant acquisition factors (e.g. scanner). Our methodology provides a tool to verify model trustworthiness, demonstrating that, in the absence of induced bias, the clinical model selectively utilizes features related to the genuine clinical signal.

cs.CV↗

arXiv2026

Patronus: Interpretable Diffusion Models with Prototypes

Uncovering the opacity of diffusion-based generative models is urgently needed, as their applications continue to expand while their underlying procedures largely remain a black box. With a critical question -- how can the diffusion generation process be interpreted and understood? -- we proposed Patronus, an interpretable diffusion model that incorporates a prototypical network to encode semantics in visual patches, revealing what visual patterns are modeled and where and when they emerge throughout denoising. This interpretability of Patronus provides deeper insights into the generative mechanism, enabling the detection of shortcut learning via unwanted correlations and the tracing of semantic emergence across timesteps. We evaluate Patronus on four natural image datasets and one medical imaging dataset, demonstrating both faithful interpretability and strong generative performance. With this work, we open new avenues for understanding and steering diffusion models through prototype-based interpretability.\\ Our code is available at https://github.com/nina-weng/patronus}{https://github.com/nina-weng/patronus.

cs.CV↗

arXiv2026

Testing of Deep Learning Model in Real World Clinical Setting: A Case Study in Obstetric Ultrasound

Despite the rapid development of AI models in medical image analysis, their validation in real-world clinical settings remains limited. To address this, we introduce a generic framework designed for deploying image-based AI models in such settings. Using this framework, we deployed a trained model for fetal ultrasound standard plane detection, and evaluated it in real-time sessions with both novice and expert users. Feedback from these sessions revealed that while the model offers potential benefits to medical practitioners, the need for navigational guidance was identified as a key area for improvement. These findings underscore the importance of early deployment of AI models in real-world settings, leading to insights that can guide the refinement of the model and system based on actual user feedback.

cs.HC↗

arXiv2025

Investigating Label Bias and Representational Sources of Age-Related Disparities in Medical Segmentation

Algorithmic bias in medical imaging can perpetuate health disparities, yet its causes remain poorly understood in segmentation tasks. While fairness has been extensively studied in classification, segmentation remains underexplored despite its clinical importance. In breast cancer segmentation, models exhibit significant performance disparities against younger patients, commonly attributed to physiological differences in breast density. We audit the MAMA-MIA dataset, establishing a quantitative baseline of age-related bias in its automated labels, and reveal a critical Biased Ruler effect where systematically flawed labels for validation misrepresent a model's actual bias. However, whether this bias originates from lower-quality annotations (label bias) or from fundamentally more challenging image characteristics remains unclear. Through controlled experiments, we systematically refute hypotheses that the bias stems from label quality sensitivity or quantitative case difficulty imbalance. Balancing training data by difficulty fails to mitigate the disparity, revealing that younger patient cases are intrinsically harder to learn. We provide direct evidence that systemic bias is learned and amplified when training on biased, machine-generated labels, a critical finding for automated annotation pipelines. This work introduces a systematic framework for diagnosing algorithmic bias in medical segmentation and demonstrates that achieving fairness requires addressing qualitative distributional differences rather than merely balancing case counts.

eess.IV↗

arXiv2025

Who Does Your Algorithm Fail? Investigating Age and Ethnic Bias in the MAMA-MIA Dataset

Deep learning models aim to improve diagnostic workflows, but fairness evaluation remains underexplored beyond classification, e.g., in image segmentation. Unaddressed segmentation bias can lead to disparities in the quality of care for certain populations, potentially compounded across clinical decision points and amplified through iterative model development. Here, we audit the fairness of the automated segmentation labels provided in the breast cancer tumor segmentation dataset MAMA-MIA. We evaluate automated segmentation quality across age, ethnicity, and data source. Our analysis reveals an intrinsic age-related bias against younger patients that continues to persist even after controlling for confounding factors, such as data source. We hypothesize that this bias may be linked to physiological factors, a known challenge for both radiologists and automated systems. Finally, we show how aggregating data from multiple data sources influences site-specific ethnic biases, underscoring the necessity of investigating data at a granular level.

cs.CV↗

arXiv2025

Onto-Epistemological Analysis of AI Explanations

Artificial intelligence (AI) is being applied in almost every field. At the same time, the currently dominant deep learning methods are fundamentally black-box systems that lack explanations for their inferences, significantly limiting their trustworthiness and adoption. Explainable AI (XAI) methods aim to overcome this challenge by providing explanations of the models' decision process. Such methods are often proposed and developed by engineers and scientists with a predominantly technical background and incorporate their assumptions about the existence, validity, and explanatory utility of different conceivable explanatory mechanisms. However, the basic concept of an explanation -- what it is, whether we can know it, whether it is absolute or relative -- is far from trivial and has been the subject of deep philosophical debate for millennia. As we point out here, the assumptions incorporated into different XAI methods are not harmless and have important consequences for the validity and interpretation of AI explanations in different domains. We investigate ontological and epistemological assumptions in explainability methods when they are applied to AI systems, meaning the assumptions we make about the existence of explanations and our ability to gain knowledge about those explanations. Our analysis shows how seemingly small technical changes to an XAI method may correspond to important differences in the underlying assumptions about explanations. We furthermore highlight the risks of ignoring the underlying onto-epistemological paradigm when choosing an XAI method for a given application, and we discuss how to select and adapt appropriate XAI methods for different domains of application.

cs.AI↗

arXiv2025

Influence of Classification Task and Distribution Shift Type on OOD Detection in Fetal Ultrasound

Reliable out-of-distribution (OOD) detection is important for safe deployment of deep learning models in fetal ultrasound amidst heterogeneous image characteristics and clinical settings. OOD detection relies on estimating a classification model's uncertainty, which should increase for OOD samples. While existing research has largely focused on uncertainty quantification methods, this work investigates the impact of the classification task itself. Through experiments with eight uncertainty quantification methods across four classification tasks, we demonstrate that OOD detection performance significantly varies with the task, and that the best task depends on the defined ID-OOD criteria; specifically, whether the OOD sample is due to: i) an image characteristic shift or ii) an anatomical feature shift. Furthermore, we reveal that superior OOD detection does not guarantee optimal abstained prediction, underscoring the necessity to align task selection and uncertainty strategies with the specific downstream application in medical image analysis.

cs.CV↗

arXiv2025

Diffusion-based Iterative Counterfactual Explanations for Fetal Ultrasound Image Quality Assessment

Obstetric ultrasound image quality is crucial for accurate diagnosis and monitoring of fetal health. However, acquiring high-quality standard planes is difficult, influenced by the sonographer's expertise and factors like the maternal BMI or fetus dynamics. In this work, we explore diffusion-based counterfactual explainable AI to generate realistic, high-quality standard planes from low-quality non-standard ones. Through quantitative and qualitative evaluation, we demonstrate the effectiveness of our approach in generating plausible counterfactuals of increased quality. This shows future promise for enhancing training of clinicians by providing visual feedback and potentially improving standard plane quality and acquisition for downstream diagnosis and monitoring.

eess.IV↗

arXiv2025

General Methods Make Great Domain-specific Foundation Models: A Case-study on Fetal Ultrasound

With access to large-scale, unlabeled medical datasets, researchers are confronted with two questions: Should they attempt to pretrain a custom foundation model on this medical data, or use transfer-learning from an existing generalist model? And, if a custom model is pretrained, are novel methods required? In this paper we explore these questions by conducting a case-study, in which we train a foundation model on a large regional fetal ultrasound dataset of 2M images. By selecting the well-established DINOv2 method for pretraining, we achieve state-of-the-art results on three fetal ultrasound datasets, covering data from different countries, classification, segmentation, and few-shot tasks. We compare against a series of models pretrained on natural images, ultrasound images, and supervised baselines. Our results demonstrate two key insights: (i) Pretraining on custom data is worth it, even if smaller models are trained on less data, as scaling in natural image pretraining does not translate to ultrasound performance. (ii) Well-tuned methods from computer vision are making it feasible to train custom foundation models for a given medical domain, requiring no hyperparameter tuning and little methodological adaptation. Given these findings, we argue that a bias towards methodological innovation should be avoided when developing domain specific foundation models under common computational resource constraints.

cs.CV↗

arXiv2025

In the Picture: Medical Imaging Datasets, Artifacts, and their Living Review

Datasets play a critical role in medical imaging research, yet issues such as label quality, shortcuts, and metadata are often overlooked. This lack of attention may harm the generalizability of algorithms and, consequently, negatively impact patient outcomes. While existing medical imaging literature reviews mostly focus on machine learning (ML) methods, with only a few focusing on datasets for specific applications, these reviews remain static -- they are published once and not updated thereafter. This fails to account for emerging evidence, such as biases, shortcuts, and additional annotations that other researchers may contribute after the dataset is published. We refer to these newly discovered findings of datasets as research artifacts. To address this gap, we propose a living review that continuously tracks public datasets and their associated research artifacts across multiple medical imaging applications. Our approach includes a framework for the living review to monitor data documentation artifacts, and an SQL database to visualize the citation relationships between research artifact and dataset. Lastly, we discuss key considerations for creating medical imaging datasets, review best practices for data annotation, discuss the significance of shortcuts and demographic diversity, and emphasize the importance of managing datasets throughout their entire lifecycle. Our demo is publicly available at http://inthepicture.itu.dk/.

cs.CV↗

arXiv2025

Bayesian generative models can flag performance loss, bias, and out-of-distribution image content

Generative models are popular for medical imaging tasks such as anomaly detection, feature extraction, data visualization, or image generation. Since they are parameterized by deep learning models, they are often sensitive to distribution shifts and unreliable when applied to out-of-distribution data, creating a risk of, e.g. underrepresentation bias. This behavior can be flagged using uncertainty quantification methods for generative models, but their availability remains limited. We propose SLUG: A new UQ method for VAEs that combines recent advances in Laplace approximations with stochastic trace estimators to scale gracefully with image dimensionality. We show that our UQ score -- unlike the VAE's encoder variances -- correlates strongly with reconstruction error and racial underrepresentation bias for dermatological images. We also show how pixel-wise uncertainty can detect out-of-distribution image content such as ink, rulers, and patches, which is known to induce learning shortcuts in predictive models.

cs.LG↗

arXiv2025

Explainable fetal ultrasound quality assessment with progressive concept bottleneck models

The quality of fetal ultrasound screening scans directly influences the precision of biometric measurements. However, acquiring high-quality scans is labor-intensive and highly relies on the operator's skills. Considering the low contrastiveness and imaging artifacts that widely exist in ultrasound, even a dedicated deep-learning model can be vulnerable to learning from confounding information in the image. In this paper, we propose a holistic and explainable method for fetal ultrasound quality assessment, where we design a hierarchical concept bottleneck model by introducing human-readable ``concepts" into the task and imitating the sequential expert decision-making process. This hierarchical information flow forces the model to learn concepts from semantically meaningful areas: The model first passes through a layer of visual, segmentation-based concepts, and next a second layer of property concepts directly associated with the decision-making task. We consider the quality assessment to be in a more challenging but more realistic setting, with fine-grained image recognition. Experiments show that our model outperforms equivalent concept-free models on an in-house dataset, and shows better generalizability on two public benchmarks, one from Spain and one from Africa, without any fine-tuning.

cs.CV↗

arXiv2025

Are generative models fair? A study of racial bias in dermatological image generation

Racial bias in medicine, such as in dermatology, presents significant ethical and clinical challenges. This is likely to happen because there is a significant underrepresentation of darker skin tones in training datasets for machine learning models. While efforts to address bias in dermatology have focused on improving dataset diversity and mitigating disparities in discriminative models, the impact of racial bias on generative models remains underexplored. Generative models, such as Variational Autoencoders (VAEs), are increasingly used in healthcare applications, yet their fairness across diverse skin tones is currently not well understood. In this study, we evaluate the fairness of generative models in clinical dermatology with respect to racial bias. For this purpose, we first train a VAE with a perceptual loss to generate and reconstruct high-quality skin images across different skin tones. We utilize the Fitzpatrick17k dataset to examine how racial bias influences the representation and performance of these models. Our findings indicate that VAE performance is, as expected, influenced by representation, i.e. increased skin tone representation comes with increased performance on the given skin tone. However, we also observe, even independently of representation, that the VAE performs better for lighter skin tones. Additionally, the uncertainty estimates produced by the VAE are ineffective in assessing the model's fairness. These results highlight the need for more representative dermatological datasets, but also a need for better understanding the sources of bias in such model, as well as improved uncertainty quantification mechanisms to detect and address racial bias in generative models for trustworthy healthcare technologies.

cs.CV↗