DuetFair: Coupling Inter- and Intra-Subgroup Robustness for Fair Medical Image Segmentation

Medical image segmentation models can perform unevenly across subgroups. Most existing fairness methods focus on improving average subgroup performance, implicitly treating each subgroup as internally homogeneous. However, this can hide difficult cases within a subgroup, where high-loss samples are obscured by the subgroup mean. We call this problem \textbf{intra-group hidden failure}. To solve this, we propose \textbf{DuetFair} mechanism, a dual-axis fairness framework that jointly considers inter-subgroup adaptation and intra-subgroup robustness. Based on DuetFair, we introduce \textbf{FairDRO}, which combines distribution-aware mixture-of-experts (dMoE) with subgroup-conditioned distributionally robust optimization (DRO) loss aggregation. This design allows the model to adapt across subgroups while also reducing hidden failures within each subgroup. We evaluate FairDRO on three medical image segmentation benchmarks with varying degrees of within-group heterogeneity. FairDRO achieves the best equity-scaled performance on Harvard-FairSeg and improves worst-case subgroup performance on HAM10000 under both age- and race-based grouping schemes. On the 3D radiotherapy target cohort, FairDRO further improves worst-group Dice by 3.5 points ($\uparrow 6.0\%$) under the tumor-stage grouping and by 4.1 points ($\uparrow 7.4\%$) under the institution grouping over the strongest baseline.

RODS: Robust Optimization Inspired Diffusion Sampling for Detecting and Reducing Hallucination in Generative Models

Diffusion models have achieved state-of-the-art performance in generative modeling, yet their sampling procedures remain vulnerable to hallucinations, often stemming from inaccuracies in score approximation. In this work, we reinterpret diffusion sampling through the lens of optimization and introduce RODS (Robust Optimization-inspired Diffusion Sampler), a novel method that detects and corrects high-risk sampling steps using geometric cues from the loss landscape. RODS enforces smoother sampling trajectories and adaptively adjusts perturbations, reducing hallucinations without retraining and at minimal additional inference cost. Experiments on AFHQv2, FFHQ, and 11k-hands demonstrate that RODS improves both sampling fidelity and robustness, detecting over 70% of hallucinated samples and correcting more than 25%, all while avoiding the introduction of new artifacts.