Explainable artificial intelligence (XAI) in deep learning-based medical image analysis

With an increase in deep learning-based methods, the call for explainability of such methods grows, especially in high-stakes decision making areas such as medical image analysis. This survey presents an overview of eXplainable Artificial Intelligence (XAI) used in deep learning-based medical image analysis. A framework of XAI criteria is introduced to classify deep learning-based medical image analysis methods. Papers on XAI techniques in medical image analysis are then surveyed and categorized according to the framework and according to anatomical location. The paper concludes with an outlook of future opportunities for XAI in medical image analysis.Comment: Submitted for publication. Comments welcome by email to first autho

Towards PACE-CAD Systems

Despite phenomenal advancements in the availability of medical image datasets and the development of modern classification algorithms, Computer-Aided Diagnosis (CAD) has had limited practical exposure in the real-world clinical workflow. This is primarily because of the inherently demanding and sensitive nature of medical diagnosis that can have far-reaching and serious repercussions in case of misdiagnosis. In this work, a paradigm called PACE (Pragmatic, Accurate, Confident, & Explainable) is presented as a set of some of must-have features for any CAD. Diagnosis of glaucoma using Retinal Fundus Images (RFIs) is taken as the primary use case for development of various methods that may enrich an ordinary CAD system with PACE. However, depending on specific requirements for different methods, other application areas in ophthalmology and dermatology have also been explored. Pragmatic CAD systems refer to a solution that can perform reliably in day-to-day clinical setup. In this research two, of possibly many, aspects of a pragmatic CAD are addressed. Firstly, observing that the existing medical image datasets are small and not representative of images taken in the real-world, a large RFI dataset for glaucoma detection is curated and published. Secondly, realising that a salient attribute of a reliable and pragmatic CAD is its ability to perform in a range of clinically relevant scenarios, classification of 622 unique cutaneous diseases in one of the largest publicly available datasets of skin lesions is successfully performed. Accuracy is one of the most essential metrics of any CAD system's performance. Domain knowledge relevant to three types of diseases, namely glaucoma, Diabetic Retinopathy (DR), and skin lesions, is industriously utilised in an attempt to improve the accuracy. For glaucoma, a two-stage framework for automatic Optic Disc (OD) localisation and glaucoma detection is developed, which marked new state-of-the-art for glaucoma detection and OD localisation. To identify DR, a model is proposed that combines coarse-grained classifiers with fine-grained classifiers and grades the disease in four stages with respect to severity. Lastly, different methods of modelling and incorporating metadata are also examined and their effect on a model's classification performance is studied. Confidence in diagnosing a disease is equally important as the diagnosis itself. One of the biggest reasons hampering the successful deployment of CAD in the real-world is that medical diagnosis cannot be readily decided based on an algorithm's output. Therefore, a hybrid CNN architecture is proposed with the convolutional feature extractor trained using point estimates and a dense classifier trained using Bayesian estimates. Evaluation on 13 publicly available datasets shows the superiority of this method in terms of classification accuracy and also provides an estimate of uncertainty for every prediction. Explainability of AI-driven algorithms has become a legal requirement after Europe’s General Data Protection Regulations came into effect. This research presents a framework for easy-to-understand textual explanations of skin lesion diagnosis. The framework is called ExAID (Explainable AI for Dermatology) and relies upon two fundamental modules. The first module uses any deep skin lesion classifier and performs detailed analysis on its latent space to map human-understandable disease-related concepts to the latent representation learnt by the deep model. The second module proposes Concept Localisation Maps, which extend Concept Activation Vectors by locating significant regions corresponding to a learned concept in the latent space of a trained image classifier. This thesis probes many viable solutions to equip a CAD system with PACE. However, it is noted that some of these methods require specific attributes in datasets and, therefore, not all methods may be applied on a single dataset. Regardless, this work anticipates that consolidating PACE into a CAD system can not only increase the confidence of medical practitioners in such tools but also serve as a stepping stone for the further development of AI-driven technologies in healthcare

Artificial intelligence in histopathology image analysis for cancer precision medicine

In recent years, there have been rapid advancements in the field of computational pathology. This has been enabled through the adoption of digital pathology workflows that generate digital images of histopathological slides, the publication of large data sets of these images and improvements in computing infrastructure. Objectives in computational pathology can be subdivided into two categories, first the automation of routine workflows that would otherwise be performed by pathologists and second the addition of novel capabilities. This thesis focuses on the development, application, and evaluation of methods in this second category, specifically the prediction of gene expression from pathology images and the registration of pathology images among each other. In Study I, we developed a computationally efficient cluster-based technique to perform transcriptome-wide predictions of gene expression in prostate cancer from H&E-stained whole-slide-images (WSIs). The suggested method outperforms several baseline methods and is non-inferior to single-gene CNN predictions, while reducing the computational cost with a factor of approximately 300. We included 15,586 transcripts that encode proteins in the analysis and predicted their expression with different modelling approaches from the WSIs. In a cross-validation, 6,618 of these predictions were significantly associated with the RNA-seq expression estimates with FDR-adjusted p-values <0.001. Upon validation of these 6,618 expression predictions in a held-out test set, the association could be confirmed for 5,419 (81.9%). Furthermore, we demonstrated that it is feasible to predict the prognostic cell-cycle progression score with a Spearman correlation to the RNA-seq score of 0.527 [0.357, 0.665]. The objective of Study II is the investigation of attention layers in the context of multiple-instance-learning for regression tasks, exemplified by a simulation study and gene expression prediction. We find that for gene expression prediction, the compared methods are not distinguishable regarding their performance, which indicates that attention mechanisms may not be superior to weakly supervised learning in this context. Study III describes the results of the ACROBAT 2022 WSI registration challenge, which we organised in conjunction with the MICCAI 2022 conference. Participating teams were ranked on the median 90th percentile of distances between registered and annotated target landmarks. Median 90th percentiles for eight teams that were eligible for ranking in the test set consisting of 303 WSI pairs ranged from 60.1 µm to 15,938.0 µm. The best performing method therefore has a score slightly below the median 90th percentile of distances between first and second annotator of 67.0 µm. Study IV describes the data set that we published to facilitate the ACROBAT challenge. The data set is available publicly through the Swedish National Data Service SND and consists of 4,212 WSIs from 1,153 breast cancer patients. Study V is an example of the application of WSI registration for computational pathology. In this study, we investigate the possibility to register invasive cancer annotations from H&E to KI67 WSIs and then subsequently train cancer detection models. To this end, we compare the performance of models optimised with registered annotations to the performance of models that were optimised with annotations generated for the KI67 WSIs. The data set consists of 272 female breast cancer cases, including an internal test set of 54 cases. We find that in this test set, the performance of both models is not distinguishable regarding performance, while there are small differences in model calibration