Medical video diagnosis involves inferring clinical decisions from dynamic tissue responses throughout examination processes. Existing methods rely on an end-to-end learning paradigm that i) focuses on appearance rather than pathology, ii) lacks clinical priors, and iii) reasons solely from observations without counterfactual comparison. This work introduces MedVCR, a counterfactual reasoning framework that mimics clinical diagnostic thinking. MedVCR comprises three components: a Counterfactual Generator that synthesizes tissue evolution under specified pathological states via a diffusion-based manner; a Counterfactual Representation Learning module that encodes diagnostic knowledge through clinical rules (i.e., temporal consistency, pathological separability, and counterfactual alignment); and a Dual Diagnostic Prediction strategy that integrates video-level assessment with frame-level counterfactual analysis. MedVCR is evaluated under both fully supervised (e.g., colposcopy) and weakly supervised (e.g., colonoscopy) video diagnosis settings, yielding 2.6%-10.2% performance gains compared with leading baselines. Comprehensive ablation studies further validate the effectiveness of each component. The code will be released.
Counterfactual video understanding evaluates whether models grasp physical and commonsense regularities. However, existing multiple-choice question (MCQ) benchmarks inadvertently leak target events through their questions and candidate options. This reduces the core challenge from active discovery to text-guided verification. In this paper, we present FADE, an effective training framework for counterfactual discovery and explanation. Our method is built on an evidence-first, two-stage training paradigm. First, evidence-internalized supervised fine-tuning grounds the model's predictions in decisive visual anomalies. Second, we apply a fading-anchor reinforcement learning strategy that progressively removes textual guidance, compelling the model to independently discover and explain evidence. To rigorously evaluate this capability, we also introduce an effective pipeline that converts existing MCQ datasets into aligned MCQ, open-ended question answering (OQA), and captioning tasks without requiring additional data curation. Our simple approach yields strong results. Using Qwen3-VL-8B as the baseline, FADE achieves state-of-the-art strict paired scores across all three tasks on DualityVidQA-test and IPV-Bench, outperforming GPT-5.6. In specific, when transitioning from constrained MCQs to unconstrained OQA and captioning, our model demonstrates remarkable robustness. Its performance retention is 90.4% and 67.4% on DualityVidQA-test-substantially higher than the 48.1% and 30.7% retained by GPT-5.6. We hope this simple framework can serve as a solid baseline for future research in unconstrained counterfactual video understanding.
Visual Counterfactual Explanations (VCEs) aim to explain image classifiers by generating minimally edited and realistic versions of an input image that change the classifier's prediction. Existing VCE methods are inherently classifier-dependent and therefore susceptible to classifier biases and failure modes, such as sensitivity to shortcut features and calibration errors. In this paper, we propose a classifier-free approach for visual counterfactual generation based on Contrastive Analysis (CA). Given two datasets corresponding to different classes (e.g., healthy and patients), we disentangle the generative factors that are common across the two datasets from those that are salient to each dataset, and generate counterfactual images by swapping only the salient factors. By operating directly on data distributions rather than decision boundaries, our method provides model-agnostic VCEs that are less sensitive to classifier biases. Our approach leverages the high-quality synthesis and well-structured latent space of StyleGAN2. We use the feature space F, instead than the usual W-space, to improve detail preservation. Unlike conventional CA approaches, which typically assume salient factors in only one dataset, we introduce an adapted framework and loss functions for VCE that allow multiple salient factors in each dataset. We evaluate our method on three medical imaging datasets and demonstrate superior counterfactual generation quality compared to existing approaches.
Ascription of an image gives insights into the objects that influence the classification of the whole image or its pixels towards a specific category. These insights help radiologists to visualize deformities in medical imaging. Most of the existing visualization techniques are based on discriminative models and highlight regions of the input image participating in the decision-making of a classifier. However, these approaches do not take all noticeable objects into account as their objective is to classify the input by using a minimal set of discriminative features. To overcome the issue, a counterfactual explanation (CX) based class-oriented feature attribution method is proposed. A counterfactual explanation (CX) explicates a causal reasoning process of the form: "if X had not happened, then Y would not have happened". The method is built on generative adversarial networks (GANs) with a cyclical-consistent loss function. We evaluate our method on three datasets: synthetic, tuberculosis and BraTS. All experiments confirm the efficacy of the proposed method. This study also highlighted the limitations of existing counterfactual explanation techniques in producing plausible counterfactual instances (CIs). Accompanying CXs with believable CIs thus provides self-explanatory analogy-based explanations. To this end, a CI generation method is proposed. Also, a novel technique is used to evaluate the quality of CI. The baseline results are produced on the BraTS dataset.