# Adversarial Medical Image with Hierarchical Feature Hiding

arXiv: https://arxiv.org/abs/2312.01679 · HTML: https://mlsanity.com/paper/2312.01679/

## Key facts

- Cited by 3 papers in the map (data through 14 Oct 2026).
- Builds on 47 of its 63 references that are in the map.
- First posted on arXiv 4 Dec 2023.

## Builds on (most cited first, 30 of 47)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Adam: A Method for Stochastic Optimization](https://mlsanity.com/paper/1412.6980/) (2014)
- [Very Deep Convolutional Networks for Large-Scale Image Recognition](https://mlsanity.com/paper/1409.1556/) (2014)
- [Explaining and Harnessing Adversarial Examples](https://mlsanity.com/paper/1412.6572/) (2014)
- [Towards Deep Learning Models Resistant to Adversarial Attacks](https://mlsanity.com/paper/1706.06083/) (2017)
- [Intriguing properties of neural networks](https://mlsanity.com/paper/1312.6199/) (2013)
- [Towards Evaluating the Robustness of Neural Networks](https://mlsanity.com/paper/1608.04644/) (2016)
- [A Simple Unified Framework for Detecting Out-of-Distribution Samples and Adversarial Attacks](https://mlsanity.com/paper/1807.03888/) (2018)
- [Reliable evaluation of adversarial robustness with an ensemble of diverse parameter-free attacks](https://mlsanity.com/paper/2003.01690/) (2020)
- [DeepFool: a simple and accurate method to fool deep neural networks](https://mlsanity.com/paper/1511.04599/) (2015)
- [Obfuscated Gradients Give a False Sense of Security: Circumventing Defenses to Adversarial Examples](https://mlsanity.com/paper/1802.00420/) (2018)
- [Adversarial Machine Learning at Scale](https://mlsanity.com/paper/1611.01236/) (2016)
- [Practical Black-Box Attacks against Machine Learning](https://mlsanity.com/paper/1602.02697/) (2016)
- [Ensemble Adversarial Training: Attacks and Defenses](https://mlsanity.com/paper/1705.07204/) (2017)
- [Distillation as a Defense to Adversarial Perturbations against Deep Neural Networks](https://mlsanity.com/paper/1511.04508/) (2015)
- [On Adaptive Attacks to Adversarial Example Defenses](https://mlsanity.com/paper/2002.08347/) (2020)
- [Adversarial Examples Are Not Easily Detected: Bypassing Ten Detection Methods](https://mlsanity.com/paper/1705.07263/) (2017)
- [Feature Squeezing: Detecting Adversarial Examples in Deep Neural Networks](https://mlsanity.com/paper/1704.01155/) (2017)
- [Evading Defenses to Transferable Adversarial Examples by Translation-Invariant Attacks](https://mlsanity.com/paper/1904.02884/) (2019)
- [Deep Learning for Medical Image Analysis](https://mlsanity.com/paper/1708.08987/) (2017)
- [Defense against Adversarial Attacks Using High-Level Representation Guided Denoiser](https://mlsanity.com/paper/1712.02976/) (2017)
- [Parseval Networks: Improving Robustness to Adversarial Examples](https://mlsanity.com/paper/1704.08847/) (2017)
- [Characterizing Adversarial Subspaces Using Local Intrinsic Dimensionality](https://mlsanity.com/paper/1801.02613/) (2018)
- [MagNet: a Two-Pronged Defense against Adversarial Examples](https://mlsanity.com/paper/1705.09064/) (2017)
- [Detecting Adversarial Samples from Artifacts](https://mlsanity.com/paper/1703.00410/) (2017)
- [Improving the Adversarial Robustness and Interpretability of Deep Neural Networks by Regularizing their Input Gradients](https://mlsanity.com/paper/1711.09404/) (2017)
- [On Detecting Adversarial Perturbations](https://mlsanity.com/paper/1702.04267/) (2017)
- [A review of deep learning in medical imaging: Imaging traits, technology trends, case studies with progress highlights, and future promises](https://mlsanity.com/paper/2008.09104/) (2020)
- [Deep k-Nearest Neighbors: Towards Confident, Interpretable and Robust Deep Learning](https://mlsanity.com/paper/1803.04765/) (2018)
- [A study of the effect of JPG compression on adversarial images](https://mlsanity.com/paper/1608.00853/) (2016)

## Built on by (most cited first, 3 of 3)

- [AA-CLIP: Enhancing Zero-shot Anomaly Detection via Anomaly-Aware CLIP](https://mlsanity.com/paper/2503.06661/) (2025)
- [Towards Accurate Unified Anomaly Segmentation](https://mlsanity.com/paper/2501.12295/) (2025)
- [Generalized Biomedicine Discovery](https://mlsanity.com/paper/2610.00120/) (2026)

## Abstract (arXiv)

Deep learning based methods for medical images can be easily compromised by adversarial examples (AEs), posing a great security flaw in clinical decision-making. It has been discovered that conventional adversarial attacks like PGD which optimize the classification logits, are easy to distinguish in the feature space, resulting in accurate reactive defenses. To better understand this phenomenon and reassess the reliability of the reactive defenses for medical AEs, we thoroughly investigate the characteristic of conventional medical AEs. Specifically, we first theoretically prove that conventional adversarial attacks change the outputs by continuously optimizing vulnerable features in a fixed direction, thereby leading to outlier representations in the feature space. Then, a stress test is conducted to reveal the vulnerability of medical images, by comparing with natural images. Interestingly, this vulnerability is a double-edged sword, which can be exploited to hide AEs. We then propose a simple-yet-effective hierarchical feature constraint (HFC), a novel add-on to conventional white-box attacks, which assists to hide the adversarial feature in the target feature distribution. The proposed method is evaluated on three medical datasets, both 2D and 3D, with different modalities. The experimental results demonstrate the superiority of HFC, i.e., it bypasses an array of state-of-the-art adversarial medical AE detectors more efficiently than competing adaptive attacks, which reveals the deficiencies of medical reactive defense and allows to develop more robust defenses in future.