The Impact of Preprocessing Methods on Racial Encoding and Model Robustness in CXR Diagnosis

Deep learning models can identify racial identity with high accuracy from chest X-ray (CXR) recordings. Thus, there is widespread concern about the potential for racial shortcut learning, where a model inadvertently learns to systematically bias its diagnostic predictions as a function of racial identity. Such racial biases threaten healthcare equity and model reliability, as models may systematically misdiagnose certain demographic groups. Since racial shortcuts are diffuse - non-localized and distributed throughout the whole CXR recording - image preprocessing methods may influence racial shortcut learning, yet the potential of such methods for reducing biases remains underexplored. Here, we investigate the effects of image preprocessing methods including lung masking, lung cropping, and Contrast Limited Adaptive Histogram Equalization (CLAHE). These approaches aim to suppress spurious cues encoding racial information while preserving diagnostic accuracy. Our experiments reveal that simple bounding box-based lung cropping can be an effective strategy for reducing racial shortcut learning while maintaining diagnostic model performance, bypassing frequently postulated fairness-accuracy trade-offs.

meval: A Statistical Toolbox for Fine-Grained Model Performance Analysis

Analyzing machine learning model performance stratified by patient and recording properties is becoming the accepted norm and often yields crucial insights about important model failure modes. Performing such analyses in a statistically rigorous manner is non-trivial, however. Appropriate performance metrics must be selected that allow for valid comparisons between groups of different sample sizes and base rates; metric uncertainty must be determined and multiple comparisons be corrected for, in order to assess whether any observed differences may be purely due to chance; and in the case of intersectional analyses, mechanisms must be implemented to find the most `interesting' subgroups within combinatorially many subgroup combinations. We here present a statistical toolbox that addresses these challenges and enables practitioners to easily yet rigorously assess their models for potential subgroup performance disparities. While broadly applicable, the toolbox is specifically designed for medical imaging applications. The analyses provided by the toolbox are illustrated in two case studies, one in skin lesion malignancy classification on the ISIC2020 dataset and one in chest X-ray-based disease classification on the MIMIC-CXR dataset.