arXiv subjects

Fabio De Sousa Ribeiro

Publications and source records attributed to Fabio De Sousa Ribeiro.

At least 19 recordsLinked to original sources

arXiv2026

Latent-to-Latent Flow for Volumetric Stochastic Segmentation

Uncertainty arising from inter-observer variability in medical image segmentation plays an important role in developing treatment plans. Research in this area is inhibited by the lack of multiple annotations for large-scale medical datasets, especially for volumetric data, which suffers from additional scaling and computational complexity challenges. Flow matching has emerged as a powerful framework for generative modelling and has also been demonstrated to maintain strong performance when working with latent representations of images. In this work, we introduce a latent-to-latent flow technique for stochastic segmentation of medical volumes via encoded representations of both the image and label space. We evaluate our method on two challenging applications covering delineation uncertainty for radiotherapy planning and multiple organ structure segmentation, improving efficiency up to 14x compared with full resolution models while maintaining clinically relevant performance.

cs.CV↗

arXiv2026

Subgroup performance analysis of adaptation strategies for chest X-ray foundation models

Foundation models are increasingly adapted for downstream medical imaging tasks, yet the influence of the chosen adaptation strategy on subgroup fairness remains poorly understood. We investigate how three parameter-efficient adaptation techniques, including linear heads on the raw CLS token, an MLP, and an attention-pooling module over multi-layer patch features, affect both pathology classification performance and subgroup disparities when applied to the frozen Rad-DINO chest X-ray encoder. Using MIMIC-CXR, we evaluate eight pathologies across race, sex, and imaging-view subgroups on a prevalence-preserving, demographically balanced test set, and additionally probe how strongly each adapter encodes protected attributes. We find that attention pooling achieves the strongest overall discriminative performance and encodes attributes, particularly race, most strongly, but that improved overall performance does not consistently reduce subgroup disparities. Notably, stronger attribute encoding did not correspond to larger disparities: early network layers encoded race most weakly yet produced the largest subgroup performance gaps. Exploring different attention-pooling layer combinations further revealed no consistent relationship between the layers pooled, attribute encoding strength, and subgroup fairness. Our results indicate that richer, more expressive representations can improve accuracy while leaving fairness implications task-dependent and unpredictable, which must be assessed directly and per-task rather than inferred from encoding strength or overall performance alone.

cs.CV↗

arXiv2026

Counterfactual Stress Testing for Image Classification Models

Deep learning models in medical imaging often fail when deployed in new clinical environments due to distribution shifts in demographics, scanner hardware, or acquisition protocols. A central challenge is underspecification, where models with similar validation performance exhibit divergent real-world failure modes. Although stress testing has emerged as a tool to assess this, current methods typically rely on simple, uninformed perturbations (e.g., brightness or contrast changes), which fail to capture clinically realistic variation and can overestimate robustness. In this work, we introduce a counterfactual stress testing framework based on causal generative models that create realistic "what if" images by intervening on attributes such as scanner type and recorded sex while largely preserving anatomical identity, enabling controlled and semantically meaningful evaluation under targeted distribution shifts. Across two imaging modalities (chest X-ray and mammography), three model architectures, and multiple shift scenarios, we show that counterfactual stress tests provide a substantially more accurate proxy for real out-of-distribution performance than classical perturbations, capturing the direction and relative magnitude of performance changes and showing stronger overall rank agreement. These results suggest that causal generative models can provide informative synthetic stress tests for assessing robustness under targeted distribution shifts prior to deployment.

cs.CV↗

arXiv2026

Scaling Generative Foundation Models for Chest Radiography with Rectified Flow Transformers

We introduce the first generative foundation model for chest radiograph synthesis trained from scratch at the billion-parameter scale. Existing radiographic AI models often suffer from poor generalisation across patient subpopulations, institutions, and acquisition settings, resulting in limited real-world clinical utility. Controlled, high-fidelity synthesis of chest radiographs is a promising path toward diversifying clinical datasets and evaluating the robustness of diagnostic models. Therefore, we present the largest specialist generative foundation model for chest radiographs to date, with over 1.3B parameters, trained for 1.6T tokens on a curated, heterogeneous dataset comprising 1.2M radiographs and clinical expert-guided metadata. Our model supports controllable radiograph generation and editing across multiple demographic subgroups, acquisition views, and a dozen pathologies. Moreover, we significantly advance the state of the art in radiograph synthesis fidelity, producing images that are indistinguishable from real radiographs to clinical experts.

cs.CV↗

arXiv2026

Factored Classifier-Free Guidance

Counterfactual generation aims to simulate realistic hypothetical outcomes under causal interventions. Diffusion models have emerged as a powerful tool for this task, combining DDIM inversion with conditional generation and classifier-free guidance (CFG). In this work, we identify a key limitation of CFG for counterfactual generation: it prescribes a global guidance scale for all attributes, leading to significant spurious changes in inferred counterfactuals. To mitigate this, we propose Factored Classifier-Free Guidance (FCFG), a flexible and model-agnostic guidance technique that enables attribute-wise control following a causal graph. FCFG complements recent advances in classifier-free guidance and can be seamlessly extended to advanced guidance schemes such as CFG++ and APG. Our experiments demonstrate that FCFG significantly improves the axiomatic soundness of inferred counterfactuals across both natural and medical image datasets, mitigating spurious amplification effects, and enhancing counterfactual reversibility.

cs.CV↗

arXiv2026

Counterfactual Identifiability via Dynamic Optimal Transport

We address the open question of counterfactual identification for high-dimensional multivariate outcomes from observational data. Pearl (2000) argues that counterfactuals must be identifiable (i.e., recoverable from the observed data distribution) to justify causal claims. A recent line of work on counterfactual inference shows promising results but lacks identification, undermining the causal validity of its estimates. To address this, we establish a foundation for multivariate counterfactual identification using continuous-time flows, including non-Markovian settings under standard criteria. We characterise the conditions under which flow matching yields a unique, monotone, and rank-preserving counterfactual transport map with tools from dynamic optimal transport, ensuring consistent inference. Building on this, we validate the theory in controlled scenarios with counterfactual ground-truth and demonstrate improvements in axiomatic counterfactual soundness on real images.

cs.LG↗

arXiv2026

Positional Segmentor-Guided Counterfactual Fine-Tuning for Spatially Localized Image Synthesis

Counterfactual image generation enables controlled data augmentation, bias mitigation, and disease modeling. However, existing methods guided by external classifiers or regressors are limited to subject-level factors (e.g., age) and fail to produce localized structural changes, often resulting in global artifacts. Pixel-level guidance using segmentation masks has been explored, but requires user-defined counterfactual masks, which are tedious and impractical. Segmentor-guided Counterfactual Fine-Tuning (Seg-CFT) addressed this by using segmentation-derived measurements to supervise structure-specific variables, yet it remains restricted to global interventions. We propose Positional Seg-CFT, which subdivides each structure into regional segments and derives independent measurements per region, enabling spatially localized and anatomically coherent counterfactuals. Experiments on coronary CT angiography show that Pos-Seg-CFT generates realistic, region-specific modifications, providing finer spatial control for modeling disease progression.

cs.CV↗

arXiv2026

Latent Causal Modeling for 3D Brain MRI Counterfactuals

The number of samples in structural brain MRI studies is often too small to properly train deep learning models. Generative models show promise in addressing this issue by effectively learning the data distribution and generating high-fidelity MRI. However, they struggle to produce diverse, high-quality data outside the distribution defined by the training data. One way to address this issue is to use causal models developed for 3D volume counterfactuals. However, accurately modeling causality in high-dimensional spaces is challenging, so these models generally generate 3D brain MRIs of lower quality. To address these challenges, we propose a two-stage method that constructs a Structural Causal Model (SCM) within the latent space. In the first stage, we employ a VQ-VAE to learn a compact embedding of the MRI volume. Subsequently, we integrate our causal model into this latent space and execute a three-step counterfactual procedure using a closed-form Generalized Linear Model (GLM). Our experiments conducted on real-world high-resolution MRI data (1 mm) provided by the Alzheimer's Disease Neuroimaging Initiative (ADNI) and the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) demonstrate that our method can generate high-quality 3D MRI counterfactuals.

cs.CV↗

arXiv2026

Pixel-level Counterfactual Contrastive Learning for Medical Image Segmentation

Image segmentation relies on large annotated datasets, which are expensive and slow to produce. Silver-standard (AI-generated) labels are easier to obtain, but they risk introducing bias. Self-supervised learning, needing only images, has become key for pre-training. Recent work combining contrastive learning with counterfactual generation improves representation learning for classification but does not readily extend to pixel-level tasks. We propose a pipeline combining counterfactual generation with dense contrastive learning via Dual-View (DVD-CL) and Multi-View (MVD-CL) methods, along with supervised variants that utilize available silver-standard annotations. A new visualisation algorithm, the Color-coded High Resolution Overlay map (CHRO-map) is also introduced. Experiments show annotation-free DVD-CL outperforms other dense contrastive learning methods, while supervised variants using silver-standard labels outperform training on the silver-standard labeled data directly, achieving $\sim$94% DSC on challenging data. These results highlight that pixel-level contrastive learning, enhanced by counterfactuals and silver-standard annotations, improves robustness to acquisition and pathological variations.

cs.CV↗

arXiv2025

Segmentor-Guided Counterfactual Fine-Tuning for Locally Coherent and Targeted Image Synthesis

Counterfactual image generation is a powerful tool for augmenting training data, de-biasing datasets, and modeling disease. Current approaches rely on external classifiers or regressors to increase the effectiveness of subject-level interventions (e.g., changing the patient's age). For structure-specific interventions (e.g., changing the area of the left lung in a chest radiograph), we show that this is insufficient, and can result in undesirable global effects across the image domain. Previous work used pixel-level label maps as guidance, requiring a user to provide hypothetical segmentations which are tedious and difficult to obtain. We propose Segmentor-guided Counterfactual Fine-Tuning (Seg-CFT), which preserves the simplicity of intervening on scalar-valued, structure-specific variables while producing locally coherent and effective counterfactuals. We demonstrate the capability of generating realistic chest radiographs, and we show promising results for modeling coronary artery disease. Code: https://github.com/biomedia-mira/seg-cft.

cs.CV↗

arXiv2025

Flow Stochastic Segmentation Networks

We introduce the Flow Stochastic Segmentation Network (Flow-SSN), a generative segmentation model family featuring discrete-time autoregressive and modern continuous-time flow variants. We prove fundamental limitations of the low-rank parameterisation of previous methods and show that Flow-SSNs can estimate arbitrarily high-rank pixel-wise covariances without assuming the rank or storing the distributional parameters. Flow-SSNs are also more efficient to sample from than standard diffusion-based segmentation models, thanks to most of the model capacity being allocated to learning the base distribution of the flow, constituting an expressive prior. We apply Flow-SSNs to challenging medical imaging benchmarks and achieve state-of-the-art results. Code available: https://github.com/biomedia-mira/flow-ssn.

cs.CV↗

arXiv2025

CF-Seg: Counterfactuals meet Segmentation

Segmenting anatomical structures in medical images plays an important role in the quantitative assessment of various diseases. However, accurate segmentation becomes significantly more challenging in the presence of disease. Disease patterns can alter the appearance of surrounding healthy tissues, introduce ambiguous boundaries, or even obscure critical anatomical structures. As such, segmentation models trained on real-world datasets may struggle to provide good anatomical segmentation, leading to potential misdiagnosis. In this paper, we generate counterfactual (CF) images to simulate how the same anatomy would appear in the absence of disease without altering the underlying structure. We then use these CF images to segment structures of interest, without requiring any changes to the underlying segmentation model. Our experiments on two real-world clinical chest X-ray datasets show that the use of counterfactual images improves anatomical segmentation, thereby aiding downstream clinical decision-making.

eess.IV↗

arXiv2025

Counterfactual contrastive learning: robust representations via causal image synthesis

Contrastive pretraining is well-known to improve downstream task performance and model generalisation, especially in limited label settings. However, it is sensitive to the choice of augmentation pipeline. Positive pairs should preserve semantic information while destroying domain-specific information. Standard augmentation pipelines emulate domain-specific changes with pre-defined photometric transformations, but what if we could simulate realistic domain changes instead? In this work, we show how to utilise recent progress in counterfactual image generation to this effect. We propose CF-SimCLR, a counterfactual contrastive learning approach which leverages approximate counterfactual inference for positive pair creation. Comprehensive evaluation across five datasets, on chest radiography and mammography, demonstrates that CF-SimCLR substantially improves robustness to acquisition shift with higher downstream performance on both in- and out-of-distribution data, particularly for domains which are under-represented during training.

cs.CV↗

arXiv2025

Diffusion Counterfactual Generation with Semantic Abduction

Counterfactual image generation presents significant challenges, including preserving identity, maintaining perceptual quality, and ensuring faithfulness to an underlying causal model. While existing auto-encoding frameworks admit semantic latent spaces which can be manipulated for causal control, they struggle with scalability and fidelity. Advancements in diffusion models present opportunities for improving counterfactual image editing, having demonstrated state-of-the-art visual quality, human-aligned perception and representation learning capabilities. Here, we present a suite of diffusion-based causal mechanisms, introducing the notions of spatial, semantic and dynamic abduction. We propose a general framework that integrates semantic representations into diffusion models through the lens of Pearlian causality to edit images via a counterfactual reasoning process. To our knowledge, this is the first work to consider high-level semantic identity preservation for diffusion counterfactuals and to demonstrate how semantic control enables principled trade-offs between faithful causal control and identity preservation.

cs.LG↗

arXiv2025

Demystifying Variational Diffusion Models

Despite the growing interest in diffusion models, gaining a deep understanding of the model class remains an elusive endeavour, particularly for the uninitiated in non-equilibrium statistical physics. Thanks to the rapid rate of progress in the field, most existing work on diffusion models focuses on either applications or theoretical contributions. Unfortunately, the theoretical material is often inaccessible to practitioners and new researchers, leading to a risk of superficial understanding in ongoing research. Given that diffusion models are now an indispensable tool, a clear and consolidating perspective on the model class is needed to properly contextualize recent advances in generative modelling and lower the barrier to entry for new researchers. To that end, we revisit predecessors to diffusion models like hierarchical latent variable models and synthesize a holistic perspective using only directed graphical modelling and variational inference principles. The resulting narrative is easier to follow as it imposes fewer prerequisites on the average reader relative to the view from non-equilibrium thermodynamics or stochastic differential equations.

cs.LG↗

arXiv2025

Robust image representations with counterfactual contrastive learning

Contrastive pretraining can substantially increase model generalisation and downstream performance. However, the quality of the learned representations is highly dependent on the data augmentation strategy applied to generate positive pairs. Positive contrastive pairs should preserve semantic meaning while discarding unwanted variations related to the data acquisition domain. Traditional contrastive pipelines attempt to simulate domain shifts through pre-defined generic image transformations. However, these do not always mimic realistic and relevant domain variations for medical imaging, such as scanner differences. To tackle this issue, we herein introduce counterfactual contrastive learning, a novel framework leveraging recent advances in causal image synthesis to create contrastive positive pairs that faithfully capture relevant domain variations. Our method, evaluated across five datasets encompassing both chest radiography and mammography data, for two established contrastive objectives (SimCLR and DINO-v2), outperforms standard contrastive learning in terms of robustness to acquisition shift. Notably, counterfactual contrastive learning achieves superior downstream performance on both in-distribution and external datasets, especially for images acquired with scanners under-represented in the training set. Further experiments show that the proposed framework extends beyond acquisition shifts, with models trained with counterfactual contrastive learning reducing subgroup disparities across biological sex.

cs.CV↗

arXiv2024

Identifiable Object-Centric Representation Learning via Probabilistic Slot Attention

Learning modular object-centric representations is crucial for systematic generalization. Existing methods show promising object-binding capabilities empirically, but theoretical identifiability guarantees remain relatively underdeveloped. Understanding when object-centric representations can theoretically be identified is crucial for scaling slot-based methods to high-dimensional images with correctness guarantees. To that end, we propose a probabilistic slot-attention algorithm that imposes an aggregate mixture prior over object-centric slot representations, thereby providing slot identifiability guarantees without supervision, up to an equivalence relation. We provide empirical verification of our theoretical identifiability result using both simple 2-dimensional data and high-resolution imaging datasets.

cs.LG↗

arXiv2024

Mitigating attribute amplification in counterfactual image generation

Causal generative modelling is gaining interest in medical imaging due to its ability to answer interventional and counterfactual queries. Most work focuses on generating counterfactual images that look plausible, using auxiliary classifiers to enforce effectiveness of simulated interventions. We investigate pitfalls in this approach, discovering the issue of attribute amplification, where unrelated attributes are spuriously affected during interventions, leading to biases across protected characteristics and disease status. We show that attribute amplification is caused by the use of hard labels in the counterfactual training process and propose soft counterfactual fine-tuning to mitigate this issue. Our method substantially reduces the amplification effect while maintaining effectiveness of generated images, demonstrated on a large chest X-ray dataset. Our work makes an important advancement towards more faithful and unbiased causal modelling in medical imaging.

cs.CV↗