Mapping the Ictal-Interictal-Injury Continuum Using Interpretable Machine Learning

IMPORTANCE: An interpretable machine learning model can provide faithful explanations of each prediction and yet maintain higher performance than its black box counterpart. OBJECTIVE: To design an interpretable machine learning model which accurately predicts EEG protopatterns while providing an explanation of its predictions with assistance of a specialized GUI. To map the cEEG latent features to a 2D space in order to visualize the ictal-interictal-injury continuum and gain insight into its high-dimensional structure. DESIGN, SETTING, AND PARTICIPANTS: 50,697 50-second cEEG samples from 2,711 ICU patients collected between July 2006 and March 2020 at Massachusetts General Hospital. Samples were labeled as one of 6 EEG activities by domain experts, with 124 different experts providing annotations. MAIN OUTCOMES AND MEASURES: Our neural network is interpretable because it uses case-based reasoning: it compares a new EEG reading to a set of learned prototypical EEG samples from the training dataset. Interpretability was measured with task-specific neighborhood agreement statistics. Discriminatory performance was evaluated with AUROC and AUPRC. RESULTS: The model achieves AUROCs of 0.87, 0.93, 0.96, 0.92, 0.93, 0.80 for classes Seizure, LPD, GPD, LRDA, GRDA, Other respectively. This performance is statistically significantly higher than that of the corresponding uninterpretable (black box) model with p<0.0001. Videos of the ictal-interictal-injury continuum are provided. CONCLUSION AND RELEVANCE: Our interpretable model and GUI can act as a reference for practitioners who work with cEEG patterns. We can now better understand the relationships between different types of cEEG patterns. In the future, this system may allow for targeted intervention and training in clinical settings. It could also be used for re-confirming or providing additional information for diagnostics.

Deformable ProtoPNet: An Interpretable Image Classifier Using Deformable Prototypes

Machine learning has been widely adopted in many domains, including high-stakes applications such as healthcare, finance, and criminal justice. To address concerns of fairness, accountability and transparency, predictions made by machine learning models in these critical domains must be interpretable. One line of work approaches this challenge by integrating the power of deep neural networks and the interpretability of case-based reasoning to produce accurate yet interpretable image classification models. These models generally classify input images by comparing them with prototypes learned during training, yielding explanations in the form of "this looks like that." However, methods from this line of work use spatially rigid prototypes, which cannot explicitly account for pose variations. In this paper, we address this shortcoming by proposing a case-based interpretable neural network that provides spatially flexible prototypes, called a deformable prototypical part network (Deformable ProtoPNet). In a Deformable ProtoPNet, each prototype is made up of several prototypical parts that adaptively change their relative spatial positions depending on the input image. This enables each prototype to detect object features with a higher tolerance to spatial transformations, as the parts within a prototype are allowed to move. Consequently, a Deformable ProtoPNet can explicitly capture pose variations, improving both model accuracy and the richness of explanations provided. Compared to other case-based interpretable models using prototypes, our approach achieves competitive accuracy, gives an explanation with greater context, and is easier to train, thus enabling wider use of interpretable models for computer vision.

Interpretable Mammographic Image Classification using Cased-Based Reasoning and Deep Learning

When we deploy machine learning models in high-stakes medical settings, we must ensure these models make accurate predictions that are consistent with known medical science. Inherently interpretable networks address this need by explaining the rationale behind each decision while maintaining equal or higher accuracy compared to black-box models. In this work, we present a novel interpretable neural network algorithm that uses case-based reasoning for mammography. Designed to aid a radiologist in their decisions, our network presents both a prediction of malignancy and an explanation of that prediction using known medical features. In order to yield helpful explanations, the network is designed to mimic the reasoning processes of a radiologist: our network first detects the clinically relevant semantic features of each image by comparing each new image with a learned set of prototypical image parts from the training images, then uses those clinical features to predict malignancy. Compared to other methods, our model detects clinical features (mass margins) with equal or higher accuracy, provides a more detailed explanation of its prediction, and is better able to differentiate the classification-relevant parts of the image.

IAIA-BL: A Case-based Interpretable Deep Learning Model for Classification of Mass Lesions in Digital Mammography

Interpretability in machine learning models is important in high-stakes decisions, such as whether to order a biopsy based on a mammographic exam. Mammography poses important challenges that are not present in other computer vision tasks: datasets are small, confounding information is present, and it can be difficult even for a radiologist to decide between watchful waiting and biopsy based on a mammogram alone. In this work, we present a framework for interpretable machine learning-based mammography. In addition to predicting whether a lesion is malignant or benign, our work aims to follow the reasoning processes of radiologists in detecting clinically relevant semantic features of each image, such as the characteristics of the mass margins. The framework includes a novel interpretable neural network algorithm that uses case-based reasoning for mammography. Our algorithm can incorporate a combination of data with whole image labelling and data with pixel-wise annotations, leading to better accuracy and interpretability even with a small number of images. Our interpretable models are able to highlight the classification-relevant parts of the image, whereas other methods highlight healthy tissue and confounding information. Our models are decision aids, rather than decision makers, aimed at better overall human-machine collaboration. We do not observe a loss in mass margin classification accuracy over a black box neural network trained on the same data.