mlsanityData to 7 Oct 2026

GANterfactual - Counterfactual Explanations for Medical Non-Experts using Generative Adversarial Learning

arXiv 2012.11905 ↗First posted 22 Dec 2020cs.LG cs.AI cs.CVcited by 50

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Abstract (arXiv)

With the ongoing rise of machine learning, the need for methods for explaining decisions made by artificial intelligence systems is becoming a more and more important topic. Especially for image classification tasks, many state-of-the-art tools to explain such classifiers rely on visual highlighting of important areas of the input data. Contrary, counterfactual explanation systems try to enable a counterfactual reasoning by modifying the input image in a way such that the classifier would have made a different prediction. By doing so, the users of counterfactual explanation systems are equipped with a completely different kind of explanatory information. However, methods for generating realistic counterfactual explanations for image classifiers are still rare. Especially in medical contexts, where relevant information often consists of textural and structural information, high-quality counterfactual images have the potential to give meaningful insights into decision processes. In this work, we present GANterfactual, an approach to generate such counterfactual image explanations based on adversarial image-to-image translation techniques. Additionally, we conduct a user study to evaluate our approach in an exemplary medical use case. Our results show that, in the chosen medical use-case, counterfactual explanations lead to significantly better results regarding mental models, explanation satisfaction, trust, emotions, and self-efficacy than two state-of-the-art systems that work with saliency maps, namely LIME and LRP.

Key facts. Cited by 50 papers in the map (data through 7 Oct 2026). First posted on arXiv 22 Dec 2020.

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Citing papers per year: 2021: 1; 2022: 6; 2023: 9; 2024: 11; 2025: 13; 2026: 10.

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  1. 2023FUTURE-AI: International consensus guideline for trustworthy and deployable artificial intelligence in healthcarecited by 59
  2. 2023Adversarial Counterfactual Visual Explanationscited by 47
  3. 2023Fast Diffusion-Based Counterfactuals for Shortcut Removal and Generationcited by 41
  4. 2022Robust Bayesian Recoursecited by 18
  5. 2023GANterfactual-RL: Understanding Reinforcement Learning Agents' Strategies through Visual Counterfactual Explanationscited by 17
  6. 2025PRISM: High-Resolution & Precise Counterfactual Medical Image Generation using Language-guided Stable Diffusioncited by 17
  7. 2022Do Users Benefit From Interpretable Vision? A User Study, Baseline, And Datasetcited by 13
  8. 2023Debiasing Counterfactuals In the Presence of Spurious Correlationscited by 12
  9. 2024Explainable Artificial Intelligence for Medical Applications: A Reviewcited by 12
  10. 2024Probabilistically Plausible Counterfactual Explanations with Normalizing Flowscited by 11
  11. 2022medXGAN: Visual Explanations for Medical Classifiers through a Generative Latent Spacecited by 10
  12. 2024Counterfactual Explanations with Probabilistic Guarantees on their Robustness to Model Changecited by 10
38 more
  1. 2022Alterfactual Explanations -- The Relevance of Irrelevance for Explaining AI Systemscited by 7
  2. 2024A multi-criteria approach for selecting an explanation from the set of counterfactuals produced by an ensemble of explainerscited by 7
  3. 2024Explainable AI for Mental Disorder Detection via Social Media: A survey and outlookcited by 6
  4. 2021Counterfactual Explanation of Brain Activity Classifiers using Image-to-Image Transfer by Generative Adversarial Networkcited by 5
  5. 2023Using generative AI to investigate medical imagery models and datasetscited by 5
  6. 2024DiffExplainer: Unveiling Black Box Models Via Counterfactual Generationcited by 5
  7. 2025LeapFactual: Reliable Visual Counterfactual Explanation Using Conditional Flow Matchingcited by 4
  8. 2023Towards Interpretability in Audio and Visual Affective Machine Learning: A Reviewcited by 3
  9. 2024Relevant Irrelevance: Generating Alterfactual Explanations for Image Classifierscited by 3
  10. 2023Towards Regulatable AI Systems: Technical Gaps and Policy Opportunitiescited by 2
  11. 2025Flexible Counterfactual Explanations with Generative Modelscited by 2
  12. 2025A Survey on Interpretability in Visual Recognitioncited by 2
  13. 2026Counterfactual Explanations on Robust Perceptual Geodesicscited by 2
  14. 2026Auditing Sybil: Explaining Deep Lung Cancer Risk Prediction Through Generative Interventional Attributionscited by 2
  15. 2024MiMICRI: Towards Domain-centered Counterfactual Explanations of Cardiovascular Image Classification Modelscited by 1
  16. 2024Decoding Decision Reasoning: A Counterfactual-Powered Model for Knowledge Discoverycited by 1
  17. 2024Learning from the few: Fine-grained approach to pediatric wrist pathology recognition on a limited datasetcited by 1
  18. 2024Cyclic Vision-Language Manipulator: Towards Reliable and Fine-Grained Image Interpretation for Automated Report Generationcited by 1
  19. 2022"GAN I hire you?" -- A System for Personalized Virtual Job Interview Trainingcited by 0
  20. 2022Do We Need Explainable AI in Companies? Investigation of Challenges, Expectations, and Chances from Employees' Perspectivecited by 0
  21. 2023DXAI: Explaining Classification by Image Decompositioncited by 0
  22. 2025Model-Free Counterfactual Subset Selection at Scalecited by 0
  23. 2025Explaining Low Perception Model Competency with High-Competency Counterfactualscited by 0
  24. 2025Diffusion-based Counterfactual Augmentation: Towards Robust and Interpretable Knee Osteoarthritis Gradingcited by 0
  25. 2025Pixel Perfect MegaMed: A Megapixel-Scale Vision-Language Foundation Model for Generating High Resolution Medical Imagescited by 0
  26. 2025Your Model Is Unfair, Are You Even Aware? Inverse Relationship Between Comprehension and Trust in Explainability Visualizations of Biased ML Modelscited by 0
  27. 2025Perceptual Evaluation of GANs and Diffusion Models for Generating X-rayscited by 0
  28. 2025On the notion of missingness for path attribution explainability methods in medical settings: Guiding the selection of medically meaningful baselinescited by 0
  29. 2025UniCoMTE: A Universal Counterfactual Framework for Explaining Time-Series Classifiers on ECG Datacited by 0
  30. 2025UbiQVision: Quantifying Uncertainty in XAI for Image Recognitioncited by 0
  31. 2026EvoMorph: Counterfactual Explanations for Continuous Time-Series Extrinsic Regression Applied to Photoplethysmographycited by 0
  32. 2026Improving understanding and trust in AI: How users benefit from interval-based counterfactual explanationscited by 0
  33. 2026A Probabilistic Consensus-Driven Approach for Robust Counterfactual Explanationscited by 0
  34. 2026Scientific Explanations in Health Sciences: Causality, Trust, and Epistemic Adequacycited by 0
  35. 2026Counterfactual Explainability Framework With CycleGAN And Counterfactual-Classifier Alignnment Score for Retinal Disease Classificationcited by 0
  36. 2026Concept-based Visual Counterfactual Explanations with Diffusion Modelscited by 0
  37. 2026Challenges in Evaluating Explanation Methods for Static and Evolving Datacited by 0
  38. 2026Generating Medical Image Counterfactuals using Causal Explanationscited by 0