Abstract
The remarkable success of deep learning has prompted interest in its application to medical imaging diagnosis. Even though state-of-the-art deep learning models have achieved human-level accuracy on the classification of different types of medical data, these models are hardly adopted in clinical workflows, mainly due to their lack of interpretability. The black-box nature of deep learning models has raised the need for devising strategies to explain the decision process of these models, leading to the creation of the topic of eXplainable Artificial Intelligence (XAI). In this context, we provide a thorough survey of XAI applied to medical imaging diagnosis, including visual, textual, example-based and concept-based explanation methods. Moreover, this work reviews the existing medical imaging datasets and the existing metrics for evaluating the quality of the explanations. In addition, we include a performance comparison among a set of report generation-based methods. Finally, the major challenges in applying XAI to medical imaging and the future research directions on the topic are discussed.

Abstract
Concept-based models naturally lend themselves to the development of inherently interpretable skin lesion diagnosis, as medical experts make decisions based on a set of visual patterns of the lesion. Nevertheless, the development of these models depends on the existence of concept-annotated datasets, whose availability is scarce due to the specialized knowledge and expertise required in the annotation process. In this work, we show that vision-language models can be used to alleviate the dependence on a large number of concept-annotated samples. In particular, we propose an embedding learning strategy to adapt CLIP to the downstream task of skin lesion classification using concept-based descriptions as textual embeddings. Our experiments reveal that vision-language models not only attain better accuracy when using concepts as textual embeddings, but also require a smaller number of concept-annotated samples to attain comparable performance to approaches specifically devised for automatic concept generation. © 2024 IEEE.

Abstract

Abstract
In fields that rely on high-stakes decisions, such as medicine, interpretability plays a key role in promoting trust and facilitating the adoption of deep learning models by the clinical communities. In the medical image analysis domain, gradient-based class activation maps are the most widely used explanation methods and the field lacks a more in depth investigation into inherently interpretable models that focus on integrating knowledge that ensures the model is learning the correct rules. A new approach, B-cos networks, for increasing the interpretability of deep neural networks by inducing weight-input alignment during training showed promising results on natural image classification. In this work, we study the suitability of these B-cos networks to the medical domain by testing them on different use cases (skin lesions, diabetic retinopathy, cervical cytology, and chest X-rays) and conducting a thorough evaluation of several explanation quality assessment metrics. We find that, just like in natural image classification, B-cos explanations yield more localised maps, but it is not clear that they are better than other methods' explanations when considering more explanation properties. © 2024 IEEE.

Abstract