COGENT: Counterfactual Gaussian Explanations for Volumetric Medical Images
arXiv:2608.11422v1 Announce Type: new Abstract: Explainability is essential for deploying deep learning models in high-stakes medical applications. Existing explainability methods for volumetric imaging predominantly operate in voxel space, overlooking the structured representations introduced by recent advances in 3D scene modeling. We present COGENT (Counterfactual Gaussian Explanations), a framework that generates counterfactual explanations directly in the parameter space of Gaussian-based volumetric representations. Built upon MedGS and the Sybil lung cancer risk prediction model, COGENT optimizes selected Gaussian primitives through a differentiable rendering pipeline, enabling gradients from the downstream predictor to identify representation components that most influence model decisions. Unlike conventional pixel- or voxel-level attribution methods, our approach formulates explainability as a counterfactual optimization problem over an explicit 3D scene representation, producing sparse and spatially localized explanations while preserving anatomical consistency. We evaluate COGENT on lung CT scans using quantitative comparisons with existing explainability methods together with qualitative analysis by medical experts. The results demonstrate that representation-space counterfactual optimization provides clinically meaningful explanations while offering a new perspective on interpreting volumetric deep learning models.
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[Submitted on 11 Aug 2026]
Title:COGENT: Counterfactual Gaussian Explanations for Volumetric Medical Images
View a PDF of the paper titled COGENT: Counterfactual Gaussian Explanations for Volumetric Medical Images, by Dorian Rz\k{a}sa and 9 other authors
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Abstract:Explainability is essential for deploying deep learning models in high-stakes medical applications. Existing explainability methods for volumetric imaging predominantly operate in voxel space, overlooking the structured representations introduced by recent advances in 3D scene modeling. We present COGENT (Counterfactual Gaussian Explanations), a framework that generates counterfactual explanations directly in the parameter space of Gaussian-based volumetric representations. Built upon MedGS and the Sybil lung cancer risk prediction model, COGENT optimizes selected Gaussian primitives through a differentiable rendering pipeline, enabling gradients from the downstream predictor to identify representation components that most influence model decisions. Unlike conventional pixel- or voxel-level attribution methods, our approach formulates explainability as a counterfactual optimization problem over an explicit 3D scene representation, producing sparse and spatially localized explanations while preserving anatomical consistency. We evaluate COGENT on lung CT scans using quantitative comparisons with existing explainability methods together with qualitative analysis by medical experts. The results demonstrate that representation-space counterfactual optimization provides clinically meaningful explanations while offering a new perspective on interpreting volumetric deep learning models.
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Computer Vision and Pattern Recognition (cs.CV)
Cite as: arXiv:2608.11422 [cs.CV]
(or arXiv:2608.11422v1 [cs.CV] for this version)
https://doi.org/10.48550/arXiv.2608.11422
arXiv-issued DOI via DataCite (pending registration)
Submission history
From: Przemysław Spurek [view email] [v1] Tue, 11 Aug 2026 20:40:45 UTC (3,011 KB)
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