# From Detection to Mitigation: Addressing Bias in Deep Learning Models for Chest X-Ray Diagnosis

arXiv: https://arxiv.org/abs/2510.10822 · HTML: https://mlsanity.com/paper/2510.10822/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 9 of its 23 references that are in the map.
- First posted on arXiv 12 Oct 2025.

## Builds on (most cited first, 9 of 9)

- [Distilling the Knowledge in a Neural Network](https://mlsanity.com/paper/1503.02531/) (2015)
- [XGBoost: A Scalable Tree Boosting System](https://mlsanity.com/paper/1603.02754/) (2016)
- [Equality of Opportunity in Supervised Learning](https://mlsanity.com/paper/1610.02413/) (2016)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [CheXNet: Radiologist-Level Pneumonia Detection on Chest X-Rays with Deep Learning](https://mlsanity.com/paper/1711.05225/) (2017)
- [Last Layer Re-Training is Sufficient for Robustness to Spurious Correlations](https://mlsanity.com/paper/2204.02937/) (2022)
- [Reading Race: AI Recognises Patient's Racial Identity In Medical Images](https://mlsanity.com/paper/2107.10356/) (2021)
- [TorchXRayVision: A library of chest X-ray datasets and models](https://mlsanity.com/paper/2111.00595/) (2021)
- [CheXpert Plus: Augmenting a Large Chest X-ray Dataset with Text Radiology Reports, Patient Demographics and Additional Image Formats](https://mlsanity.com/paper/2405.19538/) (2024)

## Abstract (arXiv)

Deep learning models have shown promise in improving diagnostic accuracy from chest X-rays, but they also risk perpetuating healthcare disparities when performance varies across demographic groups. In this work, we present a comprehensive bias detection and mitigation framework targeting sex, age, and race-based disparities when performing diagnostic tasks with chest X-rays. We extend a recent CNN-XGBoost pipeline to support multi-label classification and evaluate its performance across four medical conditions. We show that replacing the final layer of CNN with an eXtreme Gradient Boosting classifier improves the fairness of the subgroup while maintaining or improving the overall predictive performance. To validate its generalizability, we apply the method to different backbones, namely DenseNet-121 and ResNet-50, and achieve similarly strong performance and fairness outcomes, confirming its model-agnostic design. We further compare this lightweight adapter training method with traditional full-model training bias mitigation techniques, including adversarial training, reweighting, data augmentation, and active learning, and find that our approach offers competitive or superior bias reduction at a fraction of the computational cost. Finally, we show that combining eXtreme Gradient Boosting retraining with active learning yields the largest reduction in bias across all demographic subgroups, both in and out of distribution on the CheXpert and MIMIC datasets, establishing a practical and effective path toward equitable deep learning deployment in clinical radiology.