Radiology Report Generation (RRG) draws attention as an interaction between vision and language fields. Previous works inherited the ideology of vision-to-language generation tasks,aiming to generate paragraphs with high consistency as reports. However, one unique characteristic of RRG, the independence between diseases, was neglected, leading to the injection of disease co-occurrence as a confounder that effects the results through backdoor path. Unfortunately, this confounder confuses the process of report generation worse because of the biased RRG data distribution. In this paper, to rethink this issue thoroughly, we reason about its causes and effects from a novel perspective of statistics and causality, where the Joint Vision Coupling and the Conditional Sentence Coherence Coupling are two aspects prone to implicitly decrease the accuracy of reports. Then, a counterfactual augmentation strategy that contains the Counterfactual Sample Synthesis and the Counterfactual Report Reconstruction sub-methods is proposed to break these two aspects of spurious effects. Experimental results and further analyses on two widely used datasets justify our reasoning and proposed methods.
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