# Understanding-informed Bias Mitigation for Fair CMR Segmentation

arXiv: https://arxiv.org/abs/2503.17089 · HTML: https://mlsanity.com/paper/2503.17089/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 22 of its 45 references that are in the map.
- First posted on arXiv 21 Mar 2025.

## Builds on (most cited first, 22 of 22)

- [Mask R-CNN](https://mlsanity.com/paper/1703.06870/) (2017)
- [A Survey on Bias and Fairness in Machine Learning](https://mlsanity.com/paper/1908.09635/) (2019)
- [Distributionally Robust Neural Networks for Group Shifts: On the Importance of Regularization for Worst-Case Generalization](https://mlsanity.com/paper/1911.08731/) (2019)
- [Mitigating Unwanted Biases with Adversarial Learning](https://mlsanity.com/paper/1801.07593/) (2018)
- [Learning Adversarially Fair and Transferable Representations](https://mlsanity.com/paper/1802.06309/) (2018)
- [CheXclusion: Fairness gaps in deep chest X-ray classifiers](https://mlsanity.com/paper/2003.00827/) (2020)
- [Minimax Pareto Fairness: A Multi Objective Perspective](https://mlsanity.com/paper/2011.01821/) (2020)
- [Disparities in Dermatology AI: Assessments Using Diverse Clinical Images](https://mlsanity.com/paper/2111.08006/) (2021)
- [Bias Mitigation Post-processing for Individual and Group Fairness](https://mlsanity.com/paper/1812.06135/) (2018)
- [MEDFAIR: Benchmarking Fairness for Medical Imaging](https://mlsanity.com/paper/2210.01725/) (2022)
- [Fairness in Cardiac MR Image Analysis: An Investigation of Bias Due to Data Imbalance in Deep Learning Based Segmentation](https://mlsanity.com/paper/2106.12387/) (2021)
- [Improving the Fairness of Chest X-ray Classifiers](https://mlsanity.com/paper/2203.12609/) (2022)
- [Diagnosing failures of fairness transfer across distribution shift in real-world medical settings](https://mlsanity.com/paper/2202.01034/) (2022)
- [Risk of Training Diagnostic Algorithms on Data with Demographic Bias](https://mlsanity.com/paper/2005.10050/) (2020)
- [Feature robustness and sex differences in medical imaging: a case study in MRI-based Alzheimer's disease detection](https://mlsanity.com/paper/2204.01737/) (2022)
- [A Study of Demographic Bias in CNN-based Brain MR Segmentation](https://mlsanity.com/paper/2208.06613/) (2022)
- [Bias in Machine Learning Models Can Be Significantly Mitigated by Careful Training: Evidence from Neuroimaging Studies](https://mlsanity.com/paper/2205.13421/) (2022)
- [Slicing Through Bias: Explaining Performance Gaps in Medical Image Analysis using Slice Discovery Methods](https://mlsanity.com/paper/2406.12142/) (2024)
- [A systematic study of race and sex bias in CNN-based cardiac MR segmentation](https://mlsanity.com/paper/2209.01627/) (2022)
- [An investigation into the impact of deep learning model choice on sex and race bias in cardiac MR segmentation](https://mlsanity.com/paper/2308.13415/) (2023)
- [PASSION for Dermatology: Bridging the Diversity Gap with Pigmented Skin Images from Sub-Saharan Africa](https://mlsanity.com/paper/2411.04584/) (2024)
- [An investigation into the causes of race bias in AI-based cine CMR segmentation](https://mlsanity.com/paper/2408.02462/) (2024)

## Built on by (most cited first, 1 of 1)

- [Understanding Sources of Demographic Predictability in Brain MRI via Disentangling Anatomy and Contrast](https://mlsanity.com/paper/2603.04113/) (2026)

## Abstract (arXiv)

Artificial intelligence (AI) is increasingly being used for medical imaging tasks. However, there can be biases in AI models, particularly when they are trained using imbalanced training datasets. One such example has been the strong ethnicity bias effect in cardiac magnetic resonance (CMR) image segmentation models. Although this phenomenon has been reported in a number of publications, little is known about the effectiveness of bias mitigation algorithms in this domain. We aim to investigate the impact of common bias mitigation methods to address bias between Black and White subjects in AI-based CMR segmentation models. Specifically, we use oversampling, importance reweighing and Group DRO as well as combinations of these techniques to mitigate the ethnicity bias. Second, motivated by recent findings on the root causes of AI-based CMR segmentation bias, we evaluate the same methods using models trained and evaluated on cropped CMR images. We find that bias can be mitigated using oversampling, significantly improving performance for the underrepresented Black subjects whilst not significantly reducing the majority White subjects' performance. Using cropped images increases performance for both ethnicities and reduces the bias, whilst adding oversampling as a bias mitigation technique with cropped images reduces the bias further. When testing the models on an external clinical validation set, we find high segmentation performance and no statistically significant bias.