COGENT: Counterfactual Gaussian Explanations for Volumetric Medical Images

Explainability is essential for deploying deep learning models in high-stakes medical applications. Existing explainability methods for volumetric imaging predominantly operate in voxel space, overlooking the structured representations introduced by recent advances in 3D scene modeling. We present COGENT (Counterfactual Gaussian Explanations), a framework that generates counterfactual explanations directly in the parameter space of Gaussian-based volumetric representations. Built upon MedGS and the Sybil lung cancer risk prediction model, COGENT optimizes selected Gaussian primitives through a differentiable rendering pipeline, enabling gradients from the downstream predictor to identify representation components that most influence model decisions. Unlike conventional pixel- or voxel-level attribution methods, our approach formulates explainability as a counterfactual optimization problem over an explicit 3D scene representation, producing sparse and spatially localized explanations while preserving anatomical consistency. We evaluate COGENT on lung CT scans using quantitative comparisons with existing explainability methods together with qualitative analysis by medical experts. The results demonstrate that representation-space counterfactual optimization provides clinically meaningful explanations while offering a new perspective on interpreting volumetric deep learning models.

Counterfactual Explainability Framework With CycleGAN And Counterfactual-Classifier Alignnment Score for Retinal Disease Classification

Automated detection of vision impairing retina-based ocular conditions from fundus images is important for early screening, timely referral and reducing dependency on specialist-only assessment, for which neural network-based deep learning (DL) models have been widely utilized. However, explainability of the DL frameworks remains a major bottleneck for clinical adoption, particularly when model decisions are not linked to retinal regions that are clinically meaningful. To address this issue, this study presents CounterFundus, a novel CycleGAN-driven counterfactual explainability framework, integrating EfficientNet-B5-based retinal disease detection with visually interpretable disease-to-normal fundus image translation. For each pathological image, the counterfactual yielded by the CycleGAN generator represents an estimated healthy counterpart and the resultant difference map is utilized to localize disease-associated retinal changes. Unlike conventional post-hoc saliency methods, CounterFundus provides counterfactual explanations through visually plausible disease-to-normal retinal translation. Thereafter, to quantify the spatial agreement between counterfactual difference maps and classifier saliency, the Counterfactual-Classifier Alignment Score (CCAS) is introduced, embedding Spearman correlation, binary IoU and pointing accuracy into a single assessment protocol. To this end, EigenCAM-aligned evaluation demonstrates that the generated counterfactual explanations remain spatially consistent with classifier-relevant retinal evidence across all CCAS dimensions. Along with that, ablation studies further confirm that CCAS-filtered counterfactual augmentation improves the downstream classification performance in fundus images, establishing CounterFundus as a clinically-grounded, explainable artificially intelligence (XAI) framework for retinal disease detection.

ConceptCF: Concept-based Counterfactuals for the Explainability of Time Series

This paper proposes ConceptCF, a method for counterfactual generation that operates on human-interpretable concepts. In high-stakes domains such as healthcare and predictive maintenance, artificial intelligence models can increase efficiency and safety. Explainability is key to ensure these models rely on causal relationships rather than spurious correlations. Counterfactual explanations identify minimal modifications that would change a model's predictions. Existing methods for time series operate on individual points or subsequences without ensuring interpretability of the mutations. ConceptCF instead modifies meaningful concepts. As a result we can provide explanations in terms of these concepts, for example ``the model's prediction would be `Sit' instead of `Walk' if you increase the scale of the movement''. In this paper, the concepts are constructed through time series decomposition, resulting in concepts such as scale, and frequency bands. Counterfactuals are generated using a genetic algorithm that optimizes the concept mutations. Evaluation against five state-of-the-art approaches demonstrates that ConceptCF consistently achieves top-tier performance across validity, confidence, proximity, sparsity and plausibility metrics.

Adaptive Group-Based Counterfactual Explanations for Time-Series Rehabilitation Data

Counterfactual explanations (CEs) for multivariate time-series classifiers are often difficult to interpret in domains where experts reason in terms of semantic feature groups rather than individual channels. In rehabilitation movement analysis with multi-sensor inertial measurement units (IMUs), clinicians interpret motion through muscle-group and joint-segment abstractions; yet, most existing counterfactual methods operate at the channel level, producing scattered and biomechanically incoherent explanations. We propose a two-stage framework for group-based counterfactual generation in high-dimensional IMU data. We first show that Shapley-Adaptive (SA) group ranking preserves counterfactual validity but fails to enforce group-level sparsity, motivating the need for explicit group selection. We then introduce Learnable Gate (LG) methods, which incorporate trainable per-group relevance gates jointly optimized with perturbation masks. Experiments on the KneE-PAD rehabilitation dataset demonstrate that LG substantially improves modality-group sparsity compared to the channel-level M-CELS baseline while maintaining or improving validity, temporal smoothness, and generation efficiency. Exercise-specific analyses further show that group-structured counterfactuals yield concise, muscle-level corrective guidance aligned with clinical reasoning. Overall, the proposed framework enhances interpretability without sacrificing counterfactual quality, enabling more actionable explanations for rehabilitation movement analysis.