Mitigating attribute amplification in counterfactual image generation

Causal generative modelling is gaining interest in medical imaging due to its ability to answer interventional and counterfactual queries. Most work focuses on generating counterfactual images that look plausible, using auxiliary classifiers to enforce effectiveness of simulated interventions. We investigate pitfalls in this approach, discovering the issue of attribute amplification, where unrelated attributes are spuriously affected during interventions, leading to biases across protected characteristics and disease status. We show that attribute amplification is caused by the use of hard labels in the counterfactual training process and propose soft counterfactual fine-tuning to mitigate this issue. Our method substantially reduces the amplification effect while maintaining effectiveness of generated images, demonstrated on a large chest X-ray dataset. Our work makes an important advancement towards more faithful and unbiased causal modelling in medical imaging.