The emerging field of eXplainable AI (XAI) in the medical domain is considered to be of utmost importance. Meanwhile, incorporating explanations in the medical domain with respect to legal and ethical AI is necessary to understand detailed decisions, results, and current status of the patient’s conditions. Successively, we will be presenting a detailed survey for the medical XAI with the model enhancements, evaluation methods, significant overview of case studies with open box architecture, medical open datasets, and future improvements. Potential differences in AI and XAI methods are provided with the recent XAI methods stated as (i) local and global methods for preprocessing, (ii) knowledge base and distillation algorithms, and (iii) interpretable machine learning. XAI characteristics details with future healthcare explainability is included prominently, whereas the pre-requisite provides insights for the brainstorming sessions before beginning a medical XAI project. Practical case study determines the recent XAI progress leading to the advance developments within the medical field. Ultimately, this survey proposes critical ideas surrounding a user-in-the-loop approach, with an emphasis on human–machine collaboration, to better produce explainable solutions. The surrounding details of the XAI feedback system for human rating-based evaluation provides intelligible insights into a constructive method to produce human enforced explanation feedback. For a long time, XAI limitations of the ratings, scores and grading are present. Therefore, a novel XAI recommendation system and XAI scoring system are designed and approached from this work. Additionally, this paper encourages the importance of implementing explainable solutions into the high impact medical field.

Open-box models in medical domain have high acceptance and demand by many medical examiners. Even though the accuracy predicted by most of convolutional neural network (CNN) models is high, it is still not convincing as the detail discussion regarding the outcome is semi-transparent in the functioning process. As pneumonia is one of the top contagious infection that makes most of the population affected due to low immunity. Therefore, the goal of this paper is to implement an interpretable classification of pneumonia infection using eXplainable AI (XAI-ICP). Thus, XAI-ICP is the highly efficient system designed to solve this challenge by adapting to the recent population health conditions. The aim is to design an interpretable deep classification and transfer learning based evaluation for pneumonia infection classification. The model is primarily pre-trained using the open Chest X-Ray (CXR) dataset from National Institutes of Health (NIH). Whereas, the training input and testing given to this system is Taichung Veterans General Hospital (TCVGH) for independent learning, Taiwan + VinDr open dataset for transfer learning of pneumonia affected patients with labelled CXR images possessing three features of infiltrate, cardiomegaly and effusion. The data labelling is performed by the medical examiners with the XAI human-in-the-loop approach. The XAI-ICP demonstrates the XAI based re-configurable DCNN with human-in-the-loop as a novel approach. The interpretable deep classification provides detail transparency analysis and transfer learning for competitive accuracy. The purpose of this work, to design a re-configurable model that can continuously improve itself by using feedback system and provide feasibility for the model deployment across multiple countries to provide an efficient system for the pneumonia infection classification. The designed model then provides detail decisions taken at each step as transparency and features used within the algorithm for the pneumonia classification during the hospitalization. Thus, the scope can be given as explainable AI usage for the diagnosis classification using data preprocessing and interpretable deep convolutional neural network by the CXR evaluation. The accuracy achieved by using independent learning classification is 92.14% and is further improved based on successive transfer learning based evaluation is 93.29%. The XAI-ICP model adapts to the different population by using transfer learning, while providing competitive results to the affected conditions.

Evaluating several vital signs and chest X-ray (CXR) reports regularly to determine the recovery of the pneumonia patients at general wards is a challenge for doctors. A recent study shows the identification of pneumonia by the history of symptoms and signs including vital signs, CXR, and other clinical parameters, but they lack predicting the recovery status after starting treatment. The goal of this paper is to provide a pneumonia status prediction system for the early affected patient’s discharge from the hospital within 7 days or late discharge more than 7 days. This paper aims to design a multimodal data analysis for pneumonia status prediction using deep learning classification (MDA-PSP). We have developed a system that takes an input of vital signs and CXR images of the affected patient with pneumonia from admission day 1 to day 3. The deep learning then classifies the health status improvement or deterioration for predicting the possible discharge state. Therefore, the scope is to provide a highly accurate prediction of the pneumonia recovery on the 7th day after 3-day treatment by the SHAP (SHapley Additive exPlanation), imputation, adaptive imputation-based preprocessing of the vital signs, and CXR image feature extraction using deep learning based on dense layers-batch normalization (BN) with class weights for the first 7 days’ general ward patient in MDA-PSP. A total of 3972 patients with pneumonia were enrolled by de-identification with an adult age of 71 mean ± 17 sd and 64% of them were male. After analyzing the data behavior, appropriate improvement measures are taken by data preprocessing and feature vectorization algorithm. The deep learning method of Dense-BN with SHAP features has an accuracy of 0.77 for vital signs, 0.92 for CXR, and 0.75 for the combined model with class weights. The MDA-PSP hybrid method-based experiments are proven to demonstrate higher prediction accuracy of 0.75 for pneumonia patient status. Henceforth, the hybrid methods of machine and deep learning for pneumonia patient discharge are concluded to be a better approach.

Authentication is essential for the prevention of various types of attacks in fog/edge computing. So, a novel mode-based hash chain for secure mutual authentication is necessary to address the Internet of Things (IoT) devices’ vulnerability, as there have been several years of growing concerns regarding their security. Therefore, a novel model is designed that is stronger and effective against any kind of unauthorized attack, as IoT devices’ vulnerability is on the rise due to the mass production of IoT devices (embedded processors, camera, sensors, etc.), which ignore the basic security requirements (passwords, secure communication), making them vulnerable and easily accessible. Furthermore, crackable passwords indicate that the security measures taken are insufficient. As per the recent studies, several applications regarding its requirements are the IoT distributed denial of service attack (IDDOS), micro-cloud, secure university, Secure Industry 4.0, secure government, secure country, etc. The problem statement is formulated as the “design and implementation of dynamically interconnecting fog servers and edge devices using the mode-based hash chain for secure mutual authentication protocol”, which is stated to be an NP-complete problem. The hash-chain fog/edge implementation using timestamps, mode-based hash chaining, the zero-knowledge proof property, a distributed database/blockchain, and cryptography techniques can be utilized to establish the connection of smart devices in large numbers securely. The hash-chain fog/edge uses blockchain for identity management only, which is used to store the public keys in distributed ledger form, and all these keys are immutable. In addition, it has no overhead and is highly secure as it performs fewer calculations and requires minimum infrastructure. So, we designed the hash-chain fog/edge (HCFE) protocol, which provides a novel mutual authentication scheme for effective session key agreement (using ZKP properties) with secure protocol communications. The experiment outcomes proved that the hash-chain fog/edge is more efficient at interconnecting various devices and competed favorably in the benchmark comparison.