解决胸部CT诊断中性别与病种双重偏倚,提升公平性与准确率。
Robust Fair Disease Diagnosis in CT Images
- 双层级损失:样本级调整分类边界,组级聚焦高误差群体。
- 性别平均宏F1达0.8403,公平差距降低78%。
- 适合医疗AI公平性研究者,尤其关注数据偏斜场景。
深度学习虽显著提升胸部CT自动诊断能力,但训练数据分布不均会导致不同人群表现差异。临床数据中类别不平衡与群体代表性不足常共现,形成复合失效模式,仅靠重加权或公平性修正无法解决。本文提出双层级目标:样本级采用对数调整交叉熵损失,按类别频率动态调整决策边界,具理论一致性保障;组级采用条件风险价值聚合,将优化压力集中于当前损失更高的性别群体。在包含腺癌、鳞状细胞癌、新冠和正常四类的公平诊断基准上评估,模型基于预训练的3D ResNet-18,使用患者性别标注。训练集显示:鳞状细胞癌共84例,其中仅5例女性。联合损失使性别平均宏F1达0.8403,公平差距为0.0239,相较基线分数提升13.3%,群体差异降低78%。消融实验表明各组件单独使用效果不足。
原文摘要 · Abstract (English)
Automated diagnosis from chest CT has improved considerably with deep learning, but models trained on skewed datasets tend to perform unevenly across patient demographics. However, the situation is worse than simple demographic bias. In clinical data, class imbalance and group underrepresentation often coincide, creating compound failure modes that neither standard rebalancing nor fairness corrections can fix alone. We introduce a two-level objective that targets both axes of this problem. Logit-adjusted cross-entropy loss operates at the sample level, shifting decision margins by class frequency with provable consistency guarantees. Conditional Value at Risk aggregation operates at the group level, directing optimization pressure toward whichever demographic group currently has the higher loss. We evaluate on the Fair Disease Diagnosis benchmark using a 3D ResNet-18 pretrained on Kinetics-400, classifying CT volumes into Adenocarcinoma, Squamous Cell Carcinoma, COVID-19, and Normal groups with patient sex annotations. The training set illustrates the compound problem concretely: squamous cell carcinoma has 84 samples total, 5 of them female. The combined loss reaches a gender-averaged macro F1 of 0.8403 with a fairness gap of 0.0239, a 13.3% improvement in score and 78% reduction in demographic disparity over the baseline. Ablations show that each component alone falls short. The code is publicly available at https://github.com/Purdue-M2/Fair-Disease-Diagnosis.
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