Deep learning methods have been very effective for a variety of medical diagnostic tasks and have even outperformed human experts on some of those. However, the black-box nature of the algorithms has restricted their clinical use. Recent explainability studies aim to show the features that influence the decision of a model the most. The majority of literature reviews of this area have focused on taxonomy, ethics, and the need for explanations. A review of the current applications of explainable deep learning for different medical imaging tasks is presented here. The various approaches, challenges for clinical deployment, and the areas requiring further research are discussed here from a practical standpoint of a deep learning researcher designing a system for the clinical end-users.

Background: The lack of explanations for the decisions made by deep learning algorithms has hampered their acceptance by the clinical community despite highly accurate results on multiple problems. Attribution methods explaining deep learning models have been tested on medical imaging problems. The performance of various attribution methods has been compared for models trained on standard machine learning datasets but not on medical images. In this study, we performed a comparative analysis to determine the method with the best explanations for retinal OCT diagnosis. Methods: A well-known deep learning model, Inception-v3 was trained to diagnose 3 retinal diseases – choroidal neovascularization (CNV), diabetic macular edema (DME), and drusen. The explanations from 13 different attribution methods were rated by a panel of 14 clinicians for clinical significance. Feedback was obtained from the clinicians regarding the current and future scope of such methods. Results: An attribution method based on Taylor series expansion, called Deep Taylor, was rated the highest by clinicians with a median rating of 3.85/5. It was followed by Guided backpropagation (GBP), and SHapley Additive exPlanations (SHAP). Conclusion: Explanations from the top methods were able to highlight the structures for each disease – fluid accumulation for CNV, the boundaries of edema for DME, and bumpy areas of retinal pigment epithelium (RPE) for drusen. The most suitable method for a specific medical diagnosis task may be different from the one considered best for conventional tasks. Overall, there was a high degree of acceptance from the clinicians surveyed in the study.

Deep learning methods have been very effective for a variety of medical diagnostic tasks and has even beaten human experts on some of those. However, the black-box nature of the algorithms has restricted clinical use. Recent explainability studies aim to show the features that influence the decision of a model the most. The majority of literature reviews of this area have focused on taxonomy, ethics, and the need for explanations. A review of the current applications of explainable deep learning for different medical imaging tasks is presented here. The various approaches, challenges for clinical deployment, and the areas requiring further research are discussed here from a practical standpoint of a deep learning researcher designing a system for the clinical end-users.

Background: The lack of explanations for the decisions made by algorithms such as deep learning has hampered their acceptance by the clinical community despite highly accurate results on multiple problems. Recently, attribution methods have emerged for explaining deep learning models, and they have been tested on medical imaging problems. The performance of attribution methods is compared on standard machine learning datasets and not on medical images. In this study, we perform a comparative analysis to determine the most suitable explainability method for retinal OCT diagnosis. Methods: A commonly used deep learning model known as Inception v3 was trained to diagnose 3 retinal diseases - choroidal neovascularization (CNV), diabetic macular edema (DME), and drusen. The explanations from 13 different attribution methods were rated by a panel of 14 clinicians for clinical significance. Feedback was obtained from the clinicians regarding the current and future scope of such methods. Results: An attribution method based on a Taylor series expansion, called Deep Taylor was rated the highest by clinicians with a median rating of 3.85/5. It was followed by two other attribution methods, Guided backpropagation and SHAP (SHapley Additive exPlanations). Conclusion: Explanations of deep learning models can make them more transparent for clinical diagnosis. This study compared different explanations methods in the context of retinal OCT diagnosis and found that the best performing method may not be the one considered best for other deep learning tasks. Overall, there was a high degree of acceptance from the clinicians surveyed in the study. Keywords: explainable AI, deep learning, machine learning, image processing, Optical coherence tomography, retina, Diabetic macular edema, Choroidal Neovascularization, Drusen