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[Submitted on 15 Oct 2026] Title:CF-NODE: Counterfactual Spatial Node Intervention for Test-Time Adaptation Under Domain Shift, Evaluated Across Five Diabetic Retinopathy Datasets View a PDF of the paper titled CF-NODE: Counterfactual Spatial Node Intervention for Test-Time Adaptation Under Domain Shift, Evaluated Across Five Diabetic Retinopathy Datasets, by Sabarish G and Deepak Parashar View PDF Abstract:Automated fundus-based diabetic retinopathy (DR) grading can substantially expand screening capacity, but source-trained models degrade sharply across different cameras, clinics, and patient populations. Existing test-time adaptation methods depend on entropy minimization or target information accumulated from image batches and streams. These mechanisms can reinforce confidently incorrect predictions and break down when clinical images arrive independently. We introduce CF-NODE, a novel counterfactual test-time adaptation framework for cross- domain DR grading. Instead of trusting prediction confidence or estimating a target distribution, CF-NODE asks how each prediction responds under a controlled intervention on the evidence supporting it. CF-NODE ranks internal spatial nodes using model-derived attention, feature magnitude, and node-set similarity, progressively attenuates the highest-ranked nodes, and uses the stability of the resulting expected-grade response to apply a bounded calibration of the predicted grade distribution. The framework is fully frozen and adapts every image independently using only geometric views and a fixed source-derived prior, requiring no target-derived information or model updates. We evaluate CF-NODE on five external DR datasets under repeated-seed evaluation against TENT, EATA, SAR, and T3A. CF-NODE outperforms all four methods with statistically significant improvements over the second-best method, improves AUC on every target domain, and attains the highest average AUC and macro-F1, delivering stronger grade discrimination together with more balanced recognition across DR severity levels. These results demonstrate that counterfactual intervention sensitivity provides consistent and deployment-ready domain robustness for single-image clinical inference. Subjects: Machine Learning (cs.LG); Computer Vision and Pattern Recognition (cs.CV) Cite as: arXiv:2610.22437 [cs.LG] (or arXiv:2610.22437v1 [cs.LG] for this version) https://doi.org/10.48550/arXiv.2610.22437 arXiv-issued DOI via DataCite Submission history From: Sabarish G [view email] [v1] Thu, 15 Oct 2026 12:44:10 UTC (1,090 KB) Full-text links: Access Paper: View a PDF of the paper titled CF-NODE: Counterfactual Spatial Node Intervention for Test-Time Adaptation Under Domain Shift, Evaluated Across Five Diabetic Retinopathy Datasets, by Sabarish G and Deepak Parashar View PDF view license Additional Features Audio Summary Current browse context: cs.LG new | recent | 2026-10 Change to browse by: cs cs.CV References & Citations NASA ADS Google Scholar Semantic Scholar Loading... Data provided by: Bibliographic Tools Bibliographic and Citation Tools Bibliographic Explorer Toggle Bibliographic Explorer (What is the Explorer?) Connected Papers Toggle Connected Papers (What is Connected Papers?) Litmaps Toggle Litmaps (What is Litmaps?) scite.ai Toggle scite Smart Citations (What are Smart Citations?) Code, Data, Media Code, Data and Media Associated with this Article alphaXiv Toggle alphaXiv (What is alphaXiv?) Links to Code Toggle CatalyzeX Code Finder for Papers (What is CatalyzeX?) DagsHub Toggle DagsHub (What is DagsHub?) GotitPub Toggle Gotit.pub (What is GotitPub?) Huggingface Toggle Hugging Face (What is Huggingface?) ScienceCast Toggle ScienceCast (What is ScienceCast?) Demos Demos Replicate Toggle Replicate (What is Replicate?) Spaces Toggle Hugging Face Spaces (What is Spaces?) Spaces Toggle TXYZ.AI (What is TXYZ.AI?) Related Papers Recommenders and Search Tools Link to Influence Flower Influence Flower (What are Influence Flowers?) Core recommender toggle CORE Recommender (What is CORE?) IArxiv recommender toggle IArxiv Recommender (What is IArxiv?) Author Venue Institution Topic About arXivLabs arXivLabs: experimental projects with community collaborators arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website. Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them. Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs. Which authors of this paper are endorsers? | Disable MathJax (What is MathJax?)