Papers › The Effect of Counterfactuals on Reading Chest X-rays

The Effect of Counterfactuals on Reading Chest X-rays

2 Apr 2023arXiv:2304.00487archive 2025-07-28

Joseph Paul Cohen, Rupert Brooks, Sovann En, Evan Zucker, Anuj Pareek, Matthew Lungren, Akshay Chaudhari

This study evaluates the effect of counterfactual explanations on the interpretation of chest X-rays. We conduct a reader study with two radiologists assessing 240 chest X-ray predictions to rate their confidence that the model's prediction is correct using a 5 point scale. Half of the predictions are false positives. Each prediction is explained twice, once using traditional attribution methods and once with a counterfactual explanation. The overall results indicate that counterfactual explanations allow a radiologist to have more confidence in true positive predictions compared to traditional approaches (0.15±0.95 with p=0.01) with only a small increase in false positive predictions (0.04±1.06 with p=0.57). We observe the specific prediction tasks of Mass and Atelectasis appear to benefit the most compared to other tasks.

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