arXiv subjects

Amy Rafferty

Publications and source records attributed to Amy Rafferty.

7 recordsLinked to original sources

arXiv2026

Radiologist-Guided Causal Concept Bottleneck Models for Chest X-Ray Interpretation

Concept Bottleneck Models (CBMs) in medical imaging aim to improve model interpretability by predicting intermediate clinical concepts before final diagnoses. However, most existing CBMs treat concepts as discriminative predictors of pathology labels, without explicitly modelling the underlying clinical generative process where diseases produce observable radiographic findings. We propose XpertCausal, a radiologist-guided causal CBM for chest X-ray interpretation which models pathology-to-concept relationships using a probabilistic noisy-OR framework. This generative model is then inverted via Bayesian inference to estimate pathology probabilities from predicted concepts. Radiologist-curated concept-pathology associations are used to constrain model structure to radiologist-defined clinically plausible reasoning pathways. We evaluate XpertCausal on MIMIC-CXR across pathology classification performance, calibration, explanation quality, and alignment with radiologist-defined reasoning pathways. Compared with both a non-causal CBM baseline and a causal ablation with unconstrained learned associations, XpertCausal achieves improved AUROC, calibration, and clinically relevant explanation quality, while learning concept-pathology relationships that more closely align with expert knowledge. These results demonstrate that incorporating clinically motivated causal structure and expert domain knowledge into CBMs can lead to more accurate, interpretable, and clinically aligned models for CXR interpretation.

cs.CV↗

arXiv2026

Clinically Aware Synthetic Image Generation for Concept Coverage in Chest X-ray Models

Deep learning models for chest X-ray diagnosis are constrained by limited coverage of clinically meaningful concept combinations in publicly available training datasets. While synthetic image generation has been explored to increase data diversity, existing methods rarely enforce clinical or anatomical constraints, limiting utility for improving model reliability. We propose CARPA, a clinically aware and anatomically grounded framework for synthetic chest X-ray generation that applies targeted perturbations to clinical concept vectors while preserving anatomical structure. By producing anatomically faithful synthetic images with controlled concept insertions and deletions, CARPA expands clinically relevant concept coverage. We evaluate CARPA across seven backbone architectures by fine-tuning models on synthetic subsets and testing on a held-out MIMIC-CXR benchmark. Compared to prior concept perturbation approaches, fine-tuning on CARPA-generated images consistently improves precision-recall performance, reduces predictive uncertainty, and improves model calibration. Structural and semantic analyses demonstrate high anatomical fidelity, strong concept alignment, and low semantic uncertainty. Evaluation by two expert radiologists further confirms realism and clinical agreement. Together, these results show that anatomically grounded concept perturbations enable more effective use of synthetic data, improving both performance and reliability of chest X-ray classification models and supporting safer clinical deployment.

cs.CV↗

arXiv2025

Limitations of Public Chest Radiography Datasets for Artificial Intelligence: Label Quality, Domain Shift, Bias and Evaluation Challenges

Artificial intelligence has shown significant promise in chest radiography, where deep learning models can approach radiologist-level diagnostic performance. Progress has been accelerated by large public datasets such as MIMIC-CXR, ChestX-ray14, PadChest, and CheXpert, which provide hundreds of thousands of labelled images with pathology annotations. However, these datasets also present important limitations. Automated label extraction from radiology reports introduces errors, particularly in handling uncertainty and negation, and radiologist review frequently disagrees with assigned labels. In addition, domain shift and population bias restrict model generalisability, while evaluation practices often overlook clinically meaningful measures. We conduct a systematic analysis of these challenges, focusing on label quality, dataset bias, and domain shift. Our cross-dataset domain shift evaluation across multiple model architectures revealed substantial external performance degradation, with pronounced reductions in AUPRC and F1 scores relative to internal testing. To assess dataset bias, we trained a source-classification model that distinguished datasets with near-perfect accuracy, and performed subgroup analyses showing reduced performance for minority age and sex groups. Finally, expert review by two board-certified radiologists identified significant disagreement with public dataset labels. Our findings highlight important clinical weaknesses of current benchmarks and emphasise the need for clinician-validated datasets and fairer evaluation frameworks.

cs.LG↗

arXiv2025

Explainability Through Human-Centric Design for XAI in Lung Cancer Detection

Deep learning models have shown promise in lung pathology detection from chest X-rays, but widespread clinical adoption remains limited due to opaque model decision-making. In prior work, we introduced ClinicXAI, a human-centric, expert-guided concept bottleneck model (CBM) designed for interpretable lung cancer diagnosis. We now extend that approach and present XpertXAI, a generalizable expert-driven model that preserves human-interpretable clinical concepts while scaling to detect multiple lung pathologies. Using a high-performing InceptionV3-based classifier and a public dataset of chest X-rays with radiology reports, we compare XpertXAI against leading post-hoc explainability methods and an unsupervised CBM, XCBs. We assess explanations through comparison with expert radiologist annotations and medical ground truth. Although XpertXAI is trained for multiple pathologies, our expert validation focuses on lung cancer. We find that existing techniques frequently fail to produce clinically meaningful explanations, omitting key diagnostic features and disagreeing with radiologist judgments. XpertXAI not only outperforms these baselines in predictive accuracy but also delivers concept-level explanations that better align with expert reasoning. While our focus remains on explainability in lung cancer detection, this work illustrates how human-centric model design can be effectively extended to broader diagnostic contexts - offering a scalable path toward clinically meaningful explainable AI in medical diagnostics.

cs.AI↗

arXiv2025

CoRPA: Adversarial Image Generation for Chest X-rays Using Concept Vector Perturbations and Generative Models

Deep learning models for medical image classification tasks are becoming widely implemented in AI-assisted diagnostic tools, aiming to enhance diagnostic accuracy, reduce clinician workloads, and improve patient outcomes. However, their vulnerability to adversarial attacks poses significant risks to patient safety. Current attack methodologies use general techniques such as model querying or pixel value perturbations to generate adversarial examples designed to fool a model. These approaches may not adequately address the unique characteristics of clinical errors stemming from missed or incorrectly identified clinical features. We propose the Concept-based Report Perturbation Attack (CoRPA), a clinically-focused black-box adversarial attack framework tailored to the medical imaging domain. CoRPA leverages clinical concepts to generate adversarial radiological reports and images that closely mirror realistic clinical misdiagnosis scenarios. We demonstrate the utility of CoRPA using the MIMIC-CXR-JPG dataset of chest X-rays and radiological reports. Our evaluation reveals that deep learning models exhibiting strong resilience to conventional adversarial attacks are significantly less robust when subjected to CoRPA's clinically-focused perturbations. This underscores the importance of addressing domain-specific vulnerabilities in medical AI systems. By introducing a specialized adversarial attack framework, this study provides a foundation for developing robust, real-world-ready AI models in healthcare, ensuring their safe and reliable deployment in high-stakes clinical environments.

eess.IV↗

arXiv2024

Leveraging Expert Input for Robust and Explainable AI-Assisted Lung Cancer Detection in Chest X-rays

Deep learning models show significant potential for advancing AI-assisted medical diagnostics, particularly in detecting lung cancer through medical image modalities such as chest X-rays. However, the black-box nature of these models poses challenges to their interpretability and trustworthiness, limiting their adoption in clinical practice. This study examines both the interpretability and robustness of a high-performing lung cancer detection model based on InceptionV3, utilizing a public dataset of chest X-rays and radiological reports. We evaluate the clinical utility of multiple explainable AI (XAI) techniques, including both post-hoc and ante-hoc approaches, and find that existing methods often fail to provide clinically relevant explanations, displaying inconsistencies and divergence from expert radiologist assessments. To address these limitations, we collaborated with a radiologist to define diagnosis-specific clinical concepts and developed ClinicXAI, an expert-driven approach leveraging the concept bottleneck methodology. ClinicXAI generated clinically meaningful explanations which closely aligned with the practical requirements of clinicians while maintaining high diagnostic accuracy. We also assess the robustness of ClinicXAI in comparison to the original InceptionV3 model by subjecting both to a series of widely utilized adversarial attacks. Our analysis demonstrates that ClinicXAI exhibits significantly greater resilience to adversarial perturbations. These findings underscore the importance of incorporating domain expertise into the design of interpretable and robust AI systems for medical diagnostics, paving the way for more trustworthy and effective AI solutions in healthcare.

cs.LG↗

arXiv2022

A Robust Bias Mitigation Procedure Based on the Stereotype Content Model

The Stereotype Content model (SCM) states that we tend to perceive minority groups as cold, incompetent or both. In this paper we adapt existing work to demonstrate that the Stereotype Content model holds for contextualised word embeddings, then use these results to evaluate a fine-tuning process designed to drive a language model away from stereotyped portrayals of minority groups. We find the SCM terms are better able to capture bias than demographic agnostic terms related to pleasantness. Further, we were able to reduce the presence of stereotypes in the model through a simple fine-tuning procedure that required minimal human and computer resources, without harming downstream performance. We present this work as a prototype of a debiasing procedure that aims to remove the need for a priori knowledge of the specifics of bias in the model.

cs.CL↗