Evaluating Explainable AI on a Multi-Modal Medical Imaging Task: Can Existing Algorithms Fulfill Clinical Requirements?
Bibliographic record
Abstract
Being able to explain the prediction to clinical end-users is a necessity to leverage the power of artificial intelligence (AI) models for clinical decision support. For medical images, a feature attribution map, or heatmap, is the most common form of explanation that highlights important features for AI models' prediction. However, it is unknown how well heatmaps perform on explaining decisions on multi-modal medical images, where each image modality or channel visualizes distinct clinical information of the same underlying biomedical phenomenon. Understanding such modality-dependent features is essential for clinical users' interpretation of AI decisions. To tackle this clinically important but technically ignored problem, we propose the modality-specific feature importance (MSFI) metric. It encodes clinical image and explanation interpretation patterns of modality prioritization and modality-specific feature localization. We conduct a clinical requirement-grounded, systematic evaluation using computational methods and a clinician user study. Results show that the examined 16 heatmap algorithms failed to fulfill clinical requirements to correctly indicate AI model decision process or decision quality. The evaluation and MSFI metric can guide the design and selection of explainable AI algorithms to meet clinical requirements on multi-modal explanation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.136 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".