Counterfactual Data Augmentation

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.

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.

Generative diffusion models are increasingly used for medical imaging data augmentation, but text prompting cannot produce causal training data. Re-prompting rerolls the entire generation trajectory, altering anatomy, texture, and background. Inversion-based editing methods introduce reconstruction error that causes structural drift. We propose PolypSteer, a training-free activation-steering framework for endoscopic synthesis. PolypSteer identifies a pathology vector for each contrastive prompt pair in the cross-attention layers of a diffusion transformer. At inference time, it steers image activations along this vector, generating counterfactual pairs from scratch where the only difference is the steered concept. All other structure is preserved by construction. We evaluate PolypSteer across three experiments on Kvasir v3 and HyperKvasir. On counterfactual generation across three clinical concept pairs, PolypSteer achieves flip rates of 0.800, 0.925, and 0.950, outperforming the best inversion-based baseline in both concept flip rate and structural preservation. On dye disentanglement, PolypSteer achieves 75% dye removal against 20% (PnP) and 10% (h-Edit). On downstream polyp detection, augmenting with PolypSteer counterfactual pairs achieves ViT AUC of 0.9755 versus 0.9083 for quantity-matched re-prompting, confirming that counterfactual structure drives the gain. Code is at link https://github.com/UARK-AICV/PolypSteer

Purpose: Curating large-scale datasets of operating room (OR) workflow, encompassing rare, safety-critical, or atypical events, remains operationally and ethically challenging. This data bottleneck complicates the development of ambient intelligence for detecting, understanding, and mitigating rare or safety-critical events in the OR. Methods: This work presents an OR video diffusion framework that enables controlled synthesis of rare and safety-critical events. The framework integrates a geometric abstraction module, a conditioning module, and a fine-tuned diffusion model to first transform OR scenes into abstract geometric representations, then condition the synthesis process, and finally generate realistic OR event videos. Using this framework, we also curate a synthetic dataset to train and validate AI models for detecting near-misses of sterile-field violations. Results: In synthesizing routine OR events, our method outperforms off-the-shelf video diffusion baselines, achieving lower FVD/LPIPS and higher SSIM/PSNR in both in- and out-of-domain datasets. Through qualitative results, we illustrate its ability for controlled video synthesis of counterfactual events. An AI model trained and validated on the generated synthetic data achieved a RECALL of 70.13% in detecting near safety-critical events. Finally, we conduct an ablation study to quantify performance gains from key design choices. Conclusion: Our solution enables controlled synthesis of routine and rare OR events from abstract geometric representations. Beyond demonstrating its capability to generate rare and safety-critical scenarios, we show its potential to support the development of ambient intelligence models.

Machine-learning models applied to skin images often have degraded performance when the skin colour captured in images (SCCI) differs between training and deployment. These discrepancies arise from a combination of entangled environmental factors (e.g., illumination, camera settings) and intrinsic factors (e.g., skin tone) that cannot be accurately described by a single "skin tone" scalar -- a simplification commonly adopted by prior work. To mitigate such colour mismatches, we propose a skin-colour disentangling framework that adapts disentanglement-by-compression to learn a structured, manipulable latent space for SCCI from unlabelled dermatology images. To prevent information leakage that hinders proper learning of dark colour features, we introduce a randomized, mostly monotonic decolourization mapping. To suppress unintended colour shifts of localized patterns (e.g., ink marks, scars) during colour manipulation, we further propose a geometry-aligned post-processing step. Together, these components enable faithful counterfactual editing and answering an essential question: "What would this skin condition look like under a different SCCI?", as well as direct colour transfer between images and controlled traversal along physically meaningful directions (e.g., blood perfusion, camera white balance), enabling educational visualization of skin conditions under varying SCCI. We demonstrate that dataset-level augmentation and colour normalization based on our framework achieve competitive lesion classification performance. Ultimately, our work promotes equitable diagnosis through creating diverse training datasets that include different skin tones and image-capturing conditions.

Counterfactual explanations (CFEs) provide human-centric interpretability by identifying the minimal, actionable changes required to alter a machine learning model's prediction. Therefore, CFs can be used as (i) interventions for abnormality prevention and (ii) augmented data for training robust models. We conduct a comprehensive evaluation of CF generation using large language models (LLMs), including GPT-4 (zero-shot and few-shot) and two open-source models-BioMistral-7B and LLaMA-3.1-8B, in both pretrained and fine-tuned configurations. Using the multimodal AI-READI clinical dataset, we assess CFs across three dimensions: intervention quality, feature diversity, and augmentation effectiveness. Fine-tuned LLMs, particularly LLaMA-3.1-8B, produce CFs with high plausibility (up to 99%), strong validity (up to 0.99), and realistic, behaviorally modifiable feature adjustments. When used for data augmentation under controlled label-scarcity settings, LLM-generated CFs substantially restore classifier performance, yielding an average 20% F1 recovery across three scarcity scenarios. Compared with optimization-based baselines such as DiCE, CFNOW, and NICE, LLMs offer a flexible, model-agnostic approach that generates more clinically actionable and semantically coherent counterfactuals. Overall, this work demonstrates the promise of LLM-driven counterfactuals for both interpretable intervention design and data-efficient model training in sensor-based digital health. Impact: SenseCF fine-tunes an LLM to generate valid, representative counterfactual explanations and supplement minority class in an imbalanced dataset for improving model training and boosting model robustness and predictive performance

Despite recent progress in 3D-LLMs, they remain limited in accurately grounding language to visual and spatial elements in 3D environments. This limitation stems in part from training data that focuses on language reasoning rather than spatial understanding due to scarce 3D resources, leaving inherent grounding biases unresolved. To address this, we propose 3D scene editing as a key mechanism to generate visual counterfactuals that mitigate these biases through fine-grained spatial manipulation, without requiring costly scene reconstruction or large-scale 3D data collection. Furthermore, to make these edits targeted and directly address the specific weaknesses of the model, we introduce DEER-3D, an error-driven framework that diagnoses grounding failures and generates targeted counterfactual training supervision via a structured "Decompose, Diagnose, Edit, and Retrain" loop. Specifically, given a grounding failure, DEER-3D first identifies the predicate-level error (e.g., attribute or spatial relation). It then performs minimal predicate-aligned scene edits, such as recoloring or repositioning, and constructs aligned question-answer pairs that explicitly target the failed predicate, forming targeted counterfactual training examples. We evaluate our editing pipeline across multiple benchmarks for 3D grounding and scene understanding tasks, consistently demonstrating improvements across all grounding datasets through iterative refinement (4-6% gains). DEER-3D underscores the effectiveness of targeted, error-driven scene editing in bridging linguistic reasoning with spatial grounding in 3D LLMs.

Current visual models often make predictions based on a limited set of discriminative visual cues. As a result, they may become unreliable when the distribution shifts or when these cues are missing. Faithful attribution methods can reveal such problematic reliance through localized explanations, but they are typically used post hoc and are not fed back into the model. To address this limitation, we propose Subset-Selected Counterfactual Augmentation (SS-CA), a training strategy that masks decision-relevant regions to construct counterfactual samples and guide the model toward more robust decision boundaries. Specifically, we extend LIMA, a subset-selection-based faithful attribution method, to Counterfactual LIMA to identify regions whose removal shifts the model toward a competing class. SS-CA then selects near-boundary masks that reduce the logit gap while preserving the original semantics, and applies an adaptive counterfactual filling strategy to replace the masked regions without introducing external semantics. Feeding these counterfactual samples back into training encourages the model to exploit the remaining informative evidence and shifts the decision boundary toward a more robust one. Extensive experiments across five ImageNet variants show that SS-CA effectively improves ID accuracy, OOD generalization, and perturbation robustness, achieving gains of 5.70%/18.04% on ImageNet-1k/ImageNet-R with CLIP ViT/32b, 9.52%/11.33% on ImageNet-R/ImageNet-S on TinyImageNet-200 with ResNet-101, and about 4% under Gaussian Noise corruption. The code will be released soon.