RoentMod: A Synthetic Chest X-Ray Modification Model to Identify and Correct Image Interpretation Model Shortcuts

Chest radiographs (CXRs) are among the most common tests in medicine. Automated image interpretation may reduce radiologists\' workload and expand access to diagnostic expertise. Deep learning multi-task and foundation models have shown strong performance for CXR interpretation but are vulnerable to shortcut learning, where models rely on spurious and off-target correlations rather than clinically relevant features to make decisions. We introduce RoentMod, a counterfactual image editing framework that generates anatomically realistic CXRs with user-specified, synthetic pathology while preserving unrelated anatomical features of the original scan. RoentMod combines an open-source medical image generator (RoentGen) with an image-to-image modification model without requiring retraining. In reader studies with board-certified radiologists and radiology residents, RoentMod-produced images appeared realistic in 93\% of cases, correctly incorporated the specified finding in 89-99\% of cases, and preserved native anatomy comparable to real follow-up CXRs. Using RoentMod, we demonstrate that state-of-the-art multi-task and foundation models frequently exploit off-target pathology as shortcuts, limiting their specificity. Incorporating RoentMod-generated counterfactual images during training mitigated this vulnerability, improving model discrimination across multiple pathologies by 3-19\% AUC in internal validation and by 1-11\% for 5 out of 6 tested pathologies in external testing. These findings establish RoentMod as a broadly applicable tool for probing and correcting shortcut learning in medical AI. By enabling controlled counterfactual interventions, RoentMod enhances the robustness and interpretability of CXR interpretation models and provides a generalizable strategy for improving foundation models in medical imaging.

Toward Computationally Efficient Inverse Reinforcement Learning via Reward Shaping

Inverse reinforcement learning (IRL) is computationally challenging, with common approaches requiring the solution of multiple reinforcement learning (RL) sub-problems. This work motivates the use of potential-based reward shaping to reduce the computational burden of each RL sub-problem. This work serves as a proof-of-concept and we hope will inspire future developments towards computationally efficient IRL.