The natural language explanation algorithms for the lung cancer computer-aided diagnosis system

Human-annotated rationales and explainable text classification: a survey

Asking annotators to explain "why" they labeled an instance yields annotator rationales: natural language explanations that provide reasons for classifications. In this work, we survey the collection and use of annotator rationales. Human-annotated rationales can improve data quality and form a valuable resource for improving machine learning models. Moreover, human-annotated rationales can inspire the construction and evaluation of model-annotated rationales, which can play an important role in explainable artificial intelligence.

A scoping review of interpretability and explainability concerning artificial intelligence methods in medical imaging

PURPOSE

To review eXplainable Artificial Intelligence/(XAI) methods available for medical imaging/(MI).

METHOD

A scoping review was conducted following the Joanna Briggs Institute's methodology. The search was performed on Pubmed, Embase, Cinhal, Web of Science, BioRxiv, MedRxiv, and Google Scholar. Studies published in French and English after 2017 were included. Keyword combinations and descriptors related to explainability, and MI modalities were employed. Two independent reviewers screened abstracts, titles and full text, resolving differences through discussion.

RESULTS

228 studies met the criteria. XAI publications are increasing, targeting MRI (n = 73), radiography (n = 47), CT (n = 46). Lung (n = 82) and brain (n = 74) pathologies, Covid-19 (n = 48), Alzheimer's disease (n = 25), brain tumors (n = 15) are the main pathologies explained. Explanations are presented visually (n = 186), numerically (n = 67), rule-based (n = 11), textually (n = 11), and example-based (n = 6). Commonly explained tasks include classification (n = 89), prediction (n = 47), diagnosis (n = 39), detection (n = 29), segmentation (n = 13), and image quality improvement (n = 6). The most frequently provided explanations were local (78.1 %), 5.7 % were global, and 16.2 % combined both local and global approaches. Post-hoc approaches were predominantly employed. The used terminology varied, sometimes indistinctively using explainable (n = 207), interpretable (n = 187), understandable (n = 112), transparent (n = 61), reliable (n = 31), and intelligible (n = 3).

CONCLUSION

The number of XAI publications in medical imaging is increasing, primarily focusing on applying XAI techniques to MRI, CT, and radiography for classifying and predicting lung and brain pathologies. Visual and numerical output formats are predominantly used. Terminology standardisation remains a challenge, as terms like "explainable" and "interpretable" are sometimes being used indistinctively. Future XAI development should consider user needs and perspectives.

Real-world data to build explainable trustworthy artificial intelligence models for prediction of immunotherapy efficacy in NSCLC patients

Introduction

Artificial Intelligence (AI) methods are being increasingly investigated as a means to generate predictive models applicable in the clinical practice. In this study, we developed a model to predict the efficacy of immunotherapy (IO) in patients with advanced non-small cell lung cancer (NSCLC) using eXplainable AI (XAI) Machine Learning (ML) methods.

Methods

We prospectively collected real-world data from patients with an advanced NSCLC condition receiving immune-checkpoint inhibitors (ICIs) either as a single agent or in combination with chemotherapy. With regards to six different outcomes - Disease Control Rate (DCR), Objective Response Rate (ORR), 6 and 24-month Overall Survival (OS6 and OS24), 3-months Progression-Free Survival (PFS3) and Time to Treatment Failure (TTF3) - we evaluated five different classification ML models: CatBoost (CB), Logistic Regression (LR), Neural Network (NN), Random Forest (RF) and Support Vector Machine (SVM). We used the Shapley Additive Explanation (SHAP) values to explain model predictions.

Results

Of 480 patients included in the study 407 received immunotherapy and 73 chemo- and immunotherapy. From all the ML models, CB performed the best for OS6 and TTF3, (accuracy 0.83 and 0.81, respectively). CB and LR reached accuracy of 0.75 and 0.73 for the outcome DCR. SHAP for CB demonstrated that the feature that strongly influences models' prediction for all three outcomes was Neutrophil to Lymphocyte Ratio (NLR). Performance Status (ECOG-PS) was an important feature for the outcomes OS6 and TTF3, while PD-L1, Line of IO and chemo-immunotherapy appeared to be more important in predicting DCR.

Conclusions

In this study we developed a ML algorithm based on real-world data, explained by SHAP techniques, and able to accurately predict the efficacy of immunotherapy in sets of NSCLC patients.

Applications of Explainable Artificial Intelligence in Diagnosis and Surgery

In recent years, artificial intelligence (AI) has shown great promise in medicine. However, explainability issues make AI applications in clinical usages difficult. Some research has been conducted into explainable artificial intelligence (XAI) to overcome the limitation of the black-box nature of AI methods. Compared with AI techniques such as deep learning, XAI can provide both decision-making and explanations of the model. In this review, we conducted a survey of the recent trends in medical diagnosis and surgical applications using XAI. We have searched articles published between 2019 and 2021 from PubMed, IEEE Xplore, Association for Computing Machinery, and Google Scholar. We included articles which met the selection criteria in the review and then extracted and analyzed relevant information from the studies. Additionally, we provide an experimental showcase on breast cancer diagnosis, and illustrate how XAI can be applied in medical XAI applications. Finally, we summarize the XAI methods utilized in the medical XAI applications, the challenges that the researchers have met, and discuss the future research directions. The survey result indicates that medical XAI is a promising research direction, and this study aims to serve as a reference to medical experts and AI scientists when designing medical XAI applications.

Unbox the black-box for the medical explainable AI via multi-modal and multi-centre data fusion: A mini-review, two showcases and beyond

Explainable Artificial Intelligence (XAI) is an emerging research topic of machine learning aimed at unboxing how AI systems' black-box choices are made. This research field inspects the measures and models involved in decision-making and seeks solutions to explain them explicitly. Many of the machine learning algorithms cannot manifest how and why a decision has been cast. This is particularly true of the most popular deep neural network approaches currently in use. Consequently, our confidence in AI systems can be hindered by the lack of explainability in these black-box models. The XAI becomes more and more crucial for deep learning powered applications, especially for medical and healthcare studies, although in general these deep neural networks can return an arresting dividend in performance. The insufficient explainability and transparency in most existing AI systems can be one of the major reasons that successful implementation and integration of AI tools into routine clinical practice are uncommon. In this study, we first surveyed the current progress of XAI and in particular its advances in healthcare applications. We then introduced our solutions for XAI leveraging multi-modal and multi-centre data fusion, and subsequently validated in two showcases following real clinical scenarios. Comprehensive quantitative and qualitative analyses can prove the efficacy of our proposed XAI solutions, from which we can envisage successful applications in a broader range of clinical questions.

Concatenation of Pre-Trained Convolutional Neural Networks for Enhanced COVID-19 Screening Using Transfer Learning Technique

Coronavirus (COVID-19) is the most prevalent coronavirus infection with respiratory symptoms such as fever, cough, dyspnea, pneumonia, and weariness being typical in the early stages. On the other hand, COVID-19 has a direct impact on the circulatory and respiratory systems as it causes a failure to some human organs or severe respiratory distress in extreme circumstances. Early diagnosis of COVID-19 is extremely important for the medical community to limit its spread. For a large number of suspected cases, manual diagnostic methods based on the analysis of chest images are insufficient. Faced with this situation, artificial intelligence (AI) techniques have shown great potential in automatic diagnostic tasks. This paper aims at proposing a fast and precise medical diagnosis support system (MDSS) that can distinguish COVID-19 precisely in chest-X-ray images. This MDSS uses a concatenation technique that aims to combine pre-trained convolutional neural networks (CNN) depend on the transfer learning (TL) technique to build a highly accurate model. The models enable storage and application of knowledge learned from a pre-trained CNN to a new task, viz., COVID-19 case detection. For this purpose, we employed the concatenation method to aggregate the performances of numerous pre-trained models to confirm the reliability of the proposed method for identifying the patients with COVID-19 disease from X-ray images. The proposed system was trialed on a dataset that included four classes: normal, viral-pneumonia, tuberculosis, and COVID-19 cases. Various general evaluation methods were used to evaluate the effectiveness of the proposed model. The first proposed model achieved an accuracy rate of 99.80% while the second model reached an accuracy of 99.71%.

A Convolutional Neural Network-Based Intelligent Medical System with Sensors for Assistive Diagnosis and Decision-Making in Non-Small Cell Lung Cancer

In many regions of the world, early diagnosis of non-small cell lung cancer (NSCLC) is a major challenge due to the large population and lack of medical resources, which is difficult toeffectively address via limited physician manpower alone. Therefore, we developed a convolutional neural network (CNN)-based assisted diagnosis and decision-making intelligent medical system with sensors. This system analyzes NSCLC patients' medical records using sensors to assist staging a diagnosis and provides recommended treatment plans to physicians. To address the problem of unbalanced case samples across pathological stages, we used transfer learning and dynamic sampling techniques to reconstruct and iteratively train the model to improve the accuracy of the prediction system. In this paper, all data for training and testing the system were obtained from the medical records of 2,789,675 patients with NSCLC, which were recorded in three hospitals in China over a five-year period. When the number of case samples reached 8000, the system achieved an accuracy rate of 0.84, which is already close to that of the doctors (accuracy: 0.86). The experimental results proved that the system can quickly and accurately analyze patient data and provide decision information support for physicians.