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1 2025

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Vulnerability to One-Pixel Attacks of Neural Network Architectures in Medical Image Classification

Tajak Wiktoria, Nurzyńska Karolina, Piórkowski Adam

Bio-Algorithms and Med-Systems

2025

Vol. 21, no 1

58--70

Objective: The use of neural networks for disease classification based on medical imaging is susceptible to variations in results caused by even a single-pixel change, a phenomenon known as a one-pixel attack, which should be examined qualitatively and quantitatively. Methods: For an extended dataset of brain MRI images representing four diagnoses, the networks VGG-16, ResNet-50, DenseNet-121, MobileNetV2, EfficientNet-B0, NASNetMobile, and ViT Base were implemented. Each model was trained three times on 96 × 96 inputs, with the best-performing trial selected for adversarial testing (Phase 1). The three most robust models from Phase 1 (VGG-16, MobileNetV2, EfficientNet-B0) were then retrained on 224 × 224 inputs to assess the effect of higher resolution on susceptibility (Phase 2). The susceptibility of a diagnosis change to a single bright pixel alteration in the input image was assessed, and an average number of vulnerable pixels (ANVP) per image was carried out. Results: At 96 × 96 resolution, the least vulnerable model was MobileNetV2 (ANVP: 20.45, susceptibility: 0.22%). This was followed by ViT Base (22.20, 0.24%), EfficientNet-B0 (38.55, 0.42%), DenseNet-121 (43.52, 0.47%), ResNet-50 (69.11, 0.75%), and VGG-16 (78.66, 0.85%). The most vulnerable was NASNetMobile (119.52, 1.30%). At 224 × 224 resolution, robustness further improved for EfficientNet-B0 (37.53, 0.07%) and MobileNetV2 (49.51, 0.10%), while VGG-16 remained less stable (99.44, 0.20%). Conclusions: Implementing disease classification based on medical imaging using neural networks may pose a potential risk of misinterpretation due to changes in data irrelevant to the study, which are clearly noticeable to a human.