Learning Causal Alignment for Reliable Disease Diagnosis
Mingzhou Liu, Ching-Wen Lee, Xinwei Sun, Yu Qiao, Yizhou Wang

TL;DR
This paper introduces a causality-based framework for aligning machine learning decision processes with radiologists' reasoning in disease diagnosis, improving reliability and transferability of medical AI models.
Contribution
It proposes a novel causal alignment loss using counterfactuals and implicit function theorem to align model decision chains with expert reasoning.
Findings
Effective alignment with radiologists demonstrated on medical diagnosis tasks
Improved robustness and interpretability of diagnosis models
Causal alignment outperforms associational methods in transferability
Abstract
Aligning the decision-making process of machine learning algorithms with that of experienced radiologists is crucial for reliable diagnosis. While existing methods have attempted to align their diagnosis behaviors to those of radiologists reflected in the training data, this alignment is primarily associational rather than causal, resulting in pseudo-correlations that may not transfer well. In this paper, we propose a causality-based alignment framework towards aligning the model's decision process with that of experts. Specifically, we first employ counterfactual generation to identify the causal chain of model decisions. To align this causal chain with that of experts, we propose a causal alignment loss that enforces the model to focus on causal factors underlying each decision step in the whole causal chain. To optimize this loss that involves the counterfactual generator as an…
Peer Reviews
Decision·ICLR 2025 Poster
- To address the limitations in previous literature, where identified image regions align with expert behaviors only associationally, this paper proposes using counterfactual generation to identify regions that causally determine the model’s decision. The authors show that the generated counterfactual images maximize the probability of causation. - To align the identified causal factors with radiologist-annotated areas, the paper introduces a causal alignment loss and an algorithm to estimate th
- The selection of the set of attributes that are causally related to the label requires further justification. The paper claims that the subset $S$ maximizing the CCCE represents the causally related attributes. However, if an attribute $A_k$ is not a cause of $Y$ for some $k \in \{1:p\}$, then we would have $Y_{A_k = 1, A_{-k} = a_{-k}} = Y_{A_k = 0, A_{-k} = a_{-k}}$ for any fixed $a_{-k}$. Thus, the CCCE would be the same for the true causally related subset $S$ and any superset of $S$. It s
This is a good paper, I think. The presentation is concise, and the explanation of theory is clear. Numerical experiments are solid, with detailed description of implementation and comparison of baselines. Also, I think the idea of designing causal alignment loss based on counterfactual generation very fascinating.
My major question or concern for the causality-based alignment framework is computation cost, or scalability. For example, when solving for $x^*$, what if there are multiple counterfactual classes, or even more challenging, $y^*$ is continuous? I guess a straightforward solution would be to bin $y^*$ into binary classes, but that might sacrifice the granularity of counterfactual generation. Also, for hierarchical alignment, conditional counterfactual causal effect score is calculated for each at
The results are compelling, and the problem it takes up is relevant and timely and promises immediate practical benefits if other researchers pursue it. Further elaboration of the idea shows promise. The math used makes sense, given the causal model employed. I have some questions about the causal model that can be fixed in the presentation, which I describe below. I am especially impressed with Figure 4, which shows that the method can infer regions of interest that are closely aligned with t
The main weakness in the paper, which, as I said, can I think be addressed textually, concerns the causal diagram in Figure 3. This diagram implies that the attributes selected by the procedure are independent of each other and conditional on the existence of a mass. There is no reason I can think of that this must be the case. For example, there could be a latent variable L such that X -> L -> {A1, A2}, in which case conditioning on X would not be sufficient to separate A1 and A2. Also, there's
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Taxonomy
TopicsExplainable Artificial Intelligence (XAI) · Machine Learning in Healthcare · COVID-19 diagnosis using AI
MethodsALIGN
