Feature importance to explain multimodal prediction models. A clinical use case

Surgery to treat elderly hip fracture patients may cause complications that can lead to early mortality. An early warning system for complications could provoke clinicians to monitor high-risk patients more carefully and address potential complications early, or inform the patient. In this work, we develop a multimodal deep-learning model for post-operative mortality prediction using pre-operative and per-operative data from elderly hip fracture patients. Specifically, we include static patient data, hip and chest images before surgery in pre-operative data, vital signals, and medications administered during surgery in per-operative data. We extract features from image modalities using ResNet and from vital signals using LSTM. Explainable model outcomes are essential for clinical applicability, therefore we compute Shapley values to explain the predictions of our multimodal black box model. We find that i) Shapley values can be used to estimate the relative contribution of each modality both locally and globally, and ii) a modified version of the chain rule can be used to propagate Shapley values through a sequence of models supporting interpretable local explanations. Our findings imply that a multimodal combination of black box models can be explained by propagating Shapley values through the model sequence.

Prototype-based Interpretable Breast Cancer Prediction Models: Analysis and Challenges

Deep learning models have achieved high performance in medical applications, however, their adoption in clinical practice is hindered due to their black-box nature. Self-explainable models, like prototype-based models, can be especially beneficial as they are interpretable by design. However, if the learnt prototypes are of low quality then the prototype-based models are as good as black-box. Having high quality prototypes is a pre-requisite for a truly interpretable model. In this work, we propose a prototype evaluation framework for coherence (PEF-C) for quantitatively evaluating the quality of the prototypes based on domain knowledge. We show the use of PEF-C in the context of breast cancer prediction using mammography. Existing works on prototype-based models on breast cancer prediction using mammography have focused on improving the classification performance of prototype-based models compared to black-box models and have evaluated prototype quality through anecdotal evidence. We are the first to go beyond anecdotal evidence and evaluate the quality of the mammography prototypes systematically using our PEF-C. Specifically, we apply three state-of-the-art prototype-based models, ProtoPNet, BRAIxProtoPNet++ and PIP-Net on mammography images for breast cancer prediction and evaluate these models w.r.t. i) classification performance, and ii) quality of the prototypes, on three public datasets. Our results show that prototype-based models are competitive with black-box models in terms of classification performance, and achieve a higher score in detecting ROIs. However, the quality of the prototypes are not yet sufficient and can be improved in aspects of relevance, purity and learning a variety of prototypes. We call the XAI community to systematically evaluate the quality of the prototypes to check their true usability in high stake decisions and improve such models further.

Weakly Supervised Learning for Breast Cancer Prediction on Mammograms in Realistic Settings

Automatic methods for early detection of breast cancer on mammography can significantly decrease mortality. Broad uptake of those methods in hospitals is currently hindered because the methods have too many constraints. They assume annotations available for single images or even regions-of-interest (ROIs), and a fixed number of images per patient. Both assumptions do not hold in a general hospital setting. Relaxing those assumptions results in a weakly supervised learning setting, where labels are available per case, but not for individual images or ROIs. Not all images taken for a patient contain malignant regions and the malignant ROIs cover only a tiny part of an image, whereas most image regions represent benign tissue. In this work, we investigate a two-level multi-instance learning (MIL) approach for case-level breast cancer prediction on two public datasets (1.6k and 5k cases) and an in-house dataset of 21k cases. Observing that breast cancer is usually only present in one side, while images of both breasts are taken as a precaution, we propose a domain-specific MIL pooling variant. We show that two-level MIL can be applied in realistic clinical settings where only case labels, and a variable number of images per patient are available. Data in realistic settings scales with continuous patient intake, while manual annotation efforts do not. Hence, research should focus in particular on unsupervised ROI extraction, in order to improve breast cancer prediction for all patients.

From Anecdotal Evidence to Quantitative Evaluation Methods: A Systematic Review on Evaluating Explainable AI

The rising popularity of explainable artificial intelligence (XAI) to understand high-performing black boxes, also raised the question of how to evaluate explanations of machine learning (ML) models. While interpretability and explainability are often presented as a subjectively validated binary property, we consider it a multi-faceted concept. We identify 12 conceptual properties, such as Compactness and Correctness, that should be evaluated for comprehensively assessing the quality of an explanation. Our so-called Co-12 properties serve as categorization scheme for systematically reviewing the evaluation practice of more than 300 papers published in the last 7 years at major AI and ML conferences that introduce an XAI method. We find that 1 in 3 papers evaluate exclusively with anecdotal evidence, and 1 in 5 papers evaluate with users. We also contribute to the call for objective, quantifiable evaluation methods by presenting an extensive overview of quantitative XAI evaluation methods. This systematic collection of evaluation methods provides researchers and practitioners with concrete tools to thoroughly validate, benchmark and compare new and existing XAI methods. This also opens up opportunities to include quantitative metrics as optimization criteria during model training in order to optimize for accuracy and interpretability simultaneously.