Machine learning for dose-volume histogram based clinical decision-making support system in radiation therapy plans for brain tumors

Utilization of model-agnostic explainable artificial intelligence frameworks in oncology: a narrative review

Background and Objective

Machine learning (ML) models are increasingly being utilized in oncology research for use in the clinic. However, while more complicated models may provide improvements in predictive or prognostic power, a hurdle to their adoption are limits of model interpretability, wherein the inner workings can be perceived as a "black box". Explainable artificial intelligence (XAI) frameworks including Local Interpretable Model-agnostic Explanations (LIME) and SHapley Additive exPlanations (SHAP) are novel, model-agnostic approaches that aim to provide insight into the inner workings of the "black box" by producing quantitative visualizations of how model predictions are calculated. In doing so, XAI can transform complicated ML models into easily understandable charts and interpretable sets of rules, which can give providers with an intuitive understanding of the knowledge generated, thus facilitating the deployment of such models in routine clinical workflows.

Methods

We performed a comprehensive, non-systematic review of the latest literature to define use cases of model-agnostic XAI frameworks in oncologic research. The examined database was PubMed/MEDLINE. The last search was run on May 1, 2022.

Key Content and Findings

In this review, we identified several fields in oncology research where ML models and XAI were utilized to improve interpretability, including prognostication, diagnosis, radiomics, pathology, treatment selection, radiation treatment workflows, and epidemiology. Within these fields, XAI facilitates determination of feature importance in the overall model, visualization of relationships and/or interactions, evaluation of how individual predictions are produced, feature selection, identification of prognostic and/or predictive thresholds, and overall confidence in the models, among other benefits. These examples provide a basis for future work to expand on, which can facilitate adoption in the clinic when the complexity of such modeling would otherwise be prohibitive.

Conclusions

Model-agnostic XAI frameworks offer an intuitive and effective means of describing oncology ML models, with applications including prognostication and determination of optimal treatment regimens. Using such frameworks presents an opportunity to improve understanding of ML models, which is a critical step to their adoption in the clinic.

Explanations of Machine Learning Models in Repeated Nested Cross-Validation: An Application in Age Prediction Using Brain Complexity Features

SHAP (Shapley additive explanations) is a framework for explainable AI that makes explanations locally and globally. In this work, we propose a general method to obtain representative SHAP values within a repeated nested cross-validation procedure and separately for the training and test sets of the different cross-validation rounds to assess the real generalization abilities of the explanations. We applied this method to predict individual age using brain complexity features extracted from MRI scans of 159 healthy subjects. In particular, we used four implementations of the fractal dimension (FD) of the cerebral cortex—a measurement of brain complexity. Representative SHAP values highlighted that the most recent implementation of the FD had the highest impact over the others and was among the top-ranking features for predicting age. SHAP rankings were not the same in the training and test sets, but the top-ranking features were consistent. In conclusion, we propose a method—and share all the source code—that allows a rigorous assessment of the SHAP explanations of a trained model in a repeated nested cross-validation setting.