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arXiv · 2605.29862

Mitigating Stethoscope-Induced Shortcuts in Respiratory Sound Classification under Federated Domain Generalization with Causality-Inspired Interventions

Heejoon Koo·Yoon Tae Kim·Miika Toikkanen·June-Woo Kim
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Abstract

AI-driven respiratory sound classification (RSC) is promising for automated pulmonary disease detection, yet multi-site deployment is hindered by inter-stethoscope variability. We introduce a federated domain generalization (FedDG) formulation for RSC in which clients hold recordings from different stethoscopes and the model is evaluated on an unseen device. Our empirical analysis shows that stethoscope-induced style and disease-relevant content are partially entangled, making deterministic style removal unreliable. In response, we propose BTS-CAFE, a framework combining (i) causality-inspired device-style interventions with constraints designed to limit content distortion, (ii) counterfactual metadata augmentation to relieve device and demographic shortcuts, and (iii) gradient alignment to promote device-invariant decision boundaries across clients. Built on BTS with CLAP, a multimodal language-audio pretraining model, BTS-CAFE improves the out-of-distribution ICBHI Score by 3.69 points on average over five held-out devices relative to its backbone, and outperforms conventional data augmentation and federated learning baselines in simulated device leave-out evaluations on the ICBHI and SPRSound datasets.

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Heejoon Koo, Yoon Tae Kim, Miika Toikkanen, June-Woo Kim. 2026-09-17. Mitigating Stethoscope-Induced Shortcuts in Respiratory Sound Classification under Federated Domain Generalization with Causality-Inspired Interventions. https://arxiv.org/abs/2605.29862

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