I saw, I conceived, I concluded: Progressive Concepts as Bottlenecks

Concept bottleneck models (CBMs) include a bottleneck of human-interpretable concepts providing explainability and intervention during inference by correcting the predicted, intermediate concepts. This makes CBMs attractive for high-stakes decision-making. In this paper, we take the quality assessment of fetal ultrasound scans as a real-life use case for CBM decision support in healthcare. For this case, simple binary concepts are not sufficiently reliable, as they are mapped directly from images of highly variable quality, for which variable model calibration might lead to unstable binarized concepts. Moreover, scalar concepts do not provide the intuitive spatial feedback requested by users. To address this, we design a hierarchical CBM imitating the sequential expert decision-making process of "seeing", "conceiving" and "concluding". Our model first passes through a layer of visual, segmentation-based concepts, and next a second layer of property concepts directly associated with the decision-making task. We note that experts can intervene on both the visual and property concepts during inference. Additionally, we increase the bottleneck capacity by considering task-relevant concept interaction. Our application of ultrasound scan quality assessment is challenging, as it relies on balancing the (often poor) image quality against an assessment of the visibility and geometric properties of standardized image content. Our validation shows that -- in contrast with previous CBM models -- our CBM models actually outperform equivalent concept-free models in terms of predictive performance. Moreover, we illustrate how interventions can further improve our performance over the state-of-the-art.