# Causally Guided Gaussian Perturbations for Out-Of-Distribution Generalization in Medical Imaging

arXiv: https://arxiv.org/abs/2509.26027 · HTML: https://mlsanity.com/paper/2509.26027/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 31 of its 36 references that are in the map.
- First posted on arXiv 30 Sep 2025.

## Builds on (most cited first, 30 of 31)

- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [End-to-End Object Detection with Transformers](https://mlsanity.com/paper/2005.12872/) (2020)
- [Shortcut Learning in Deep Neural Networks](https://mlsanity.com/paper/2004.07780/) (2020)
- [Invariant Risk Minimization](https://mlsanity.com/paper/1907.02893/) (2019)
- [WILDS: A Benchmark of in-the-Wild Distribution Shifts](https://mlsanity.com/paper/2012.07421/) (2020)
- [Rethinking Semantic Segmentation from a Sequence-to-Sequence Perspective with Transformers](https://mlsanity.com/paper/2012.15840/) (2020)
- [Distributionally Robust Neural Networks for Group Shifts: On the Importance of Regularization for Worst-Case Generalization](https://mlsanity.com/paper/1911.08731/) (2019)
- [Transformers in Vision: A Survey](https://mlsanity.com/paper/2101.01169/) (2021)
- [Out-of-Distribution Generalization via Risk Extrapolation (REx)](https://mlsanity.com/paper/2003.00688/) (2020)
- [Recognition in Terra Incognita](https://mlsanity.com/paper/1807.04975/) (2018)
- [A Survey on Visual Transformer](https://mlsanity.com/paper/2012.12556/) (2020)
- [Towards Out-Of-Distribution Generalization: A Survey](https://mlsanity.com/paper/2108.13624/) (2021)
- [Confounding variables can degrade generalization performance of radiological deep learning models](https://mlsanity.com/paper/1807.00431/) (2018)
- [Learning Pixel-level Semantic Affinity with Image-level Supervision for Weakly Supervised Semantic Segmentation](https://mlsanity.com/paper/1803.10464/) (2018)
- [Simple Does It: Weakly Supervised Instance and Semantic Segmentation](https://mlsanity.com/paper/1603.07485/) (2016)
- [Seed, Expand and Constrain: Three Principles for Weakly-Supervised Image Segmentation](https://mlsanity.com/paper/1603.06098/) (2016)
- [Quantifying the effects of data augmentation and stain color normalization in convolutional neural networks for computational pathology](https://mlsanity.com/paper/1902.06543/) (2019)
- [Does Invariant Risk Minimization Capture Invariance?](https://mlsanity.com/paper/2101.01134/) (2021)
- [Generative models improve fairness of medical classifiers under distribution shifts](https://mlsanity.com/paper/2304.09218/) (2023)
- [OoD-Bench: Quantifying and Understanding Two Dimensions of Out-of-Distribution Generalization](https://mlsanity.com/paper/2106.03721/) (2021)
- [Delving Deep into the Generalization of Vision Transformers under Distribution Shifts](https://mlsanity.com/paper/2106.07617/) (2021)
- [Causal Attention for Unbiased Visual Recognition](https://mlsanity.com/paper/2108.08782/) (2021)
- [Improved OOD Generalization via Adversarial Training and Pre-training](https://mlsanity.com/paper/2105.11144/) (2021)
- [Out-of-distribution Generalization with Causal Invariant Transformations](https://mlsanity.com/paper/2203.11528/) (2022)
- [ID and OOD Performance Are Sometimes Inversely Correlated on Real-world Datasets](https://mlsanity.com/paper/2209.00613/) (2022)
- [Max Pooling with Vision Transformers reconciles class and shape in weakly supervised semantic segmentation](https://mlsanity.com/paper/2210.17400/) (2022)
- [Pareto Invariant Risk Minimization: Towards Mitigating the Optimization Dilemma in Out-of-Distribution Generalization](https://mlsanity.com/paper/2206.07766/) (2022)
- [Self-Distilled Vision Transformer for Domain Generalization](https://mlsanity.com/paper/2207.12392/) (2022)
- [Understanding and Improving Feature Learning for Out-of-Distribution Generalization](https://mlsanity.com/paper/2304.11327/) (2023)
- [Causal Disentanglement for Semantics-Aware Intent Learning in Recommendation](https://mlsanity.com/paper/2202.02576/) (2022)

## Abstract (arXiv)

Out-of-distribution (OOD) generalization remains a central challenge in deploying deep learning models to real-world scenarios, particularly in domains such as biomedical images, where distribution shifts are both subtle and pervasive. While existing methods often pursue domain invariance through complex generative models or adversarial training, these approaches may overlook the underlying causal mechanisms of generalization.In this work, we propose Causally-Guided Gaussian Perturbations (CGP)-a lightweight framework that enhances OOD generalization by injecting spatially varying noise into input images, guided by soft causal masks derived from Vision Transformers. By applying stronger perturbations to background regions and weaker ones to foreground areas, CGP encourages the model to rely on causally relevant features rather than spurious correlations.Experimental results on the challenging WILDS benchmark Camelyon17 demonstrate consistent performance gains over state-of-the-art OOD baselines, highlighting the potential of causal perturbation as a tool for reliable and interpretable generalization.