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

arXiv: https://arxiv.org/abs/2012.11905 · HTML: https://mlsanity.com/paper/2012.11905/

## Key facts

- Cited by 50 papers in the map (data through 14 Oct 2026).
- First posted on arXiv 22 Dec 2020.

## Built on by (most cited first, 30 of 50)

- [FUTURE-AI: International consensus guideline for trustworthy and deployable artificial intelligence in healthcare](https://mlsanity.com/paper/2309.12325/) (2023)
- [Adversarial Counterfactual Visual Explanations](https://mlsanity.com/paper/2303.09962/) (2023)
- [Fast Diffusion-Based Counterfactuals for Shortcut Removal and Generation](https://mlsanity.com/paper/2312.14223/) (2023)
- [Robust Bayesian Recourse](https://mlsanity.com/paper/2206.10833/) (2022)
- [GANterfactual-RL: Understanding Reinforcement Learning Agents' Strategies through Visual Counterfactual Explanations](https://mlsanity.com/paper/2302.12689/) (2023)
- [PRISM: High-Resolution & Precise Counterfactual Medical Image Generation using Language-guided Stable Diffusion](https://mlsanity.com/paper/2503.00196/) (2025)
- [Do Users Benefit From Interpretable Vision? A User Study, Baseline, And Dataset](https://mlsanity.com/paper/2204.11642/) (2022)
- [Debiasing Counterfactuals In the Presence of Spurious Correlations](https://mlsanity.com/paper/2308.10984/) (2023)
- [Explainable Artificial Intelligence for Medical Applications: A Review](https://mlsanity.com/paper/2412.01829/) (2024)
- [Probabilistically Plausible Counterfactual Explanations with Normalizing Flows](https://mlsanity.com/paper/2405.17640/) (2024)
- [medXGAN: Visual Explanations for Medical Classifiers through a Generative Latent Space](https://mlsanity.com/paper/2204.05376/) (2022)
- [Counterfactual Explanations with Probabilistic Guarantees on their Robustness to Model Change](https://mlsanity.com/paper/2408.04842/) (2024)
- [Alterfactual Explanations -- The Relevance of Irrelevance for Explaining AI Systems](https://mlsanity.com/paper/2207.09374/) (2022)
- [A multi-criteria approach for selecting an explanation from the set of counterfactuals produced by an ensemble of explainers](https://mlsanity.com/paper/2403.13940/) (2024)
- [Explainable AI for Mental Disorder Detection via Social Media: A survey and outlook](https://mlsanity.com/paper/2406.05984/) (2024)
- [Counterfactual Explanation of Brain Activity Classifiers using Image-to-Image Transfer by Generative Adversarial Network](https://mlsanity.com/paper/2110.14927/) (2021)
- [Using generative AI to investigate medical imagery models and datasets](https://mlsanity.com/paper/2306.00985/) (2023)
- [DiffExplainer: Unveiling Black Box Models Via Counterfactual Generation](https://mlsanity.com/paper/2406.15182/) (2024)
- [LeapFactual: Reliable Visual Counterfactual Explanation Using Conditional Flow Matching](https://mlsanity.com/paper/2510.14623/) (2025)
- [Towards Interpretability in Audio and Visual Affective Machine Learning: A Review](https://mlsanity.com/paper/2306.08933/) (2023)
- [Relevant Irrelevance: Generating Alterfactual Explanations for Image Classifiers](https://mlsanity.com/paper/2405.05295/) (2024)
- [Towards Regulatable AI Systems: Technical Gaps and Policy Opportunities](https://mlsanity.com/paper/2306.12609/) (2023)
- [Flexible Counterfactual Explanations with Generative Models](https://mlsanity.com/paper/2502.17613/) (2025)
- [A Survey on Interpretability in Visual Recognition](https://mlsanity.com/paper/2507.11099/) (2025)
- [Counterfactual Explanations on Robust Perceptual Geodesics](https://mlsanity.com/paper/2601.18678/) (2026)
- [Auditing Sybil: Explaining Deep Lung Cancer Risk Prediction Through Generative Interventional Attributions](https://mlsanity.com/paper/2602.02560/) (2026)
- [MiMICRI: Towards Domain-centered Counterfactual Explanations of Cardiovascular Image Classification Models](https://mlsanity.com/paper/2404.16174/) (2024)
- [Decoding Decision Reasoning: A Counterfactual-Powered Model for Knowledge Discovery](https://mlsanity.com/paper/2406.18552/) (2024)
- [Learning from the few: Fine-grained approach to pediatric wrist pathology recognition on a limited dataset](https://mlsanity.com/paper/2408.13542/) (2024)
- [Cyclic Vision-Language Manipulator: Towards Reliable and Fine-Grained Image Interpretation for Automated Report Generation](https://mlsanity.com/paper/2411.05261/) (2024)

## 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.