With an increase in deep learning-based methods, the call for explainability of such methods grows, especially in high-stakes decision making areas such as medical image analysis. This survey presents an overview of eXplainable Artificial Intelligence (XAI) used in deep learning-based medical image analysis. A framework of XAI criteria is introduced to classify deep learning-based medical image analysis methods. Papers on XAI techniques in medical image analysis are then surveyed and categorized according to the framework and according to anatomical location. The paper concludes with an outlook of future opportunities for XAI in medical image analysis.

Explainable artificial intelligence (XAI) in deep learning-based medical image analysis.

A scoping review of transfer learning research on medical image analysis using ImageNet.

Background Patients with fractures are a common emergency presentation and may be misdiagnosed at radiologic imaging. An increasing number of studies apply artificial intelligence (AI) techniques to fracture detection as an adjunct to clinician diagnosis. Purpose To perform a systematic review and meta-analysis comparing the diagnostic performance in fracture detection between AI and clinicians in peer-reviewed publications and the gray literature (ie, articles published on preprint repositories). Materials and Methods A search of multiple electronic databases between January 2018 and July 2020 (updated June 2021) was performed that included any primary research studies that developed and/or validated AI for the purposes of fracture detection at any imaging modality and excluded studies that evaluated image segmentation algorithms. Meta-analysis with a hierarchical model to calculate pooled sensitivity and specificity was used. Risk of bias was assessed by using a modified Prediction Model Study Risk of Bias Assessment Tool, or PROBAST, checklist. Results Included for analysis were 42 studies, with 115 contingency tables extracted from 32 studies (55 061 images). Thirty-seven studies identified fractures on radiographs and five studies identified fractures on CT images. For internal validation test sets, the pooled sensitivity was 92% (95% CI: 88, 93) for AI and 91% (95% CI: 85, 95) for clinicians, and the pooled specificity was 91% (95% CI: 88, 93) for AI and 92% (95% CI: 89, 92) for clinicians. For external validation test sets, the pooled sensitivity was 91% (95% CI: 84, 95) for AI and 94% (95% CI: 90, 96) for clinicians, and the pooled specificity was 91% (95% CI: 81, 95) for AI and 94% (95% CI: 91, 95) for clinicians. There were no statistically significant differences between clinician and AI performance. There were 22 of 42 (52%) studies that were judged to have high risk of bias. Meta-regression identified multiple sources of heterogeneity in the data, including risk of bias and fracture type. Conclusion Artificial intelligence (AI) and clinicians had comparable reported diagnostic performance in fracture detection, suggesting that AI technology holds promise as a diagnostic adjunct in future clinical practice. Clinical trial registration no. CRD42020186641 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Cohen and McInnes in this issue.

Artificial Intelligence in Fracture Detection: A Systematic Review and Meta-Analysis.

Osteoporosis and its clinical consequence, bone fracture, is a multifactorial disease that has been the object of extensive research. Recent advances in machine learning (ML) have enabled the field of artificial intelligence (AI) to make impressive breakthroughs in complex data environments where human capacity to identify high-dimensional relationships is limited. The field of osteoporosis is one such domain, notwithstanding technical and clinical concerns regarding the application of ML methods. This qualitative review is intended to outline some of these concerns and to inform stakeholders interested in applying AI for improved management of osteoporosis. A systemic search in PubMed and Web of Science resulted in 89 studies for inclusion in the review. These covered one or more of four main areas in osteoporosis management: bone properties assessment (n = 13), osteoporosis classification (n = 34), fracture detection (n = 32), and risk prediction (n = 14). Reporting and methodological quality was determined by means of a 12-point checklist. In general, the studies were of moderate quality with a wide range (mode score 6, range 2 to 11). Major limitations were identified in a significant number of studies. Incomplete reporting, especially over model selection, inadequate splitting of data, and the low proportion of studies with external validation were among the most frequent problems. However, the use of images for opportunistic osteoporosis diagnosis or fracture detection emerged as a promising approach and one of the main contributions that ML could bring to the osteoporosis field. Efforts to develop ML-based models for identifying novel fracture risk factors and improving fracture prediction are additional promising lines of research. Some studies also offered insights into the potential for model-based decision-making. Finally, to avoid some of the common pitfalls, the use of standardized checklists in developing and sharing the results of ML models should be encouraged. © 2021 American Society for Bone and Mineral Research (ASBMR)..

Machine Learning Solutions for Osteoporosis-A Review.

With the advent of machine learning (ML) applications in daily life, the questions about liability, trust, and interpretability of their outputs are raising, especially for healthcare applications. The black-box nature of ML models is a roadblock for clinical utilization. Therefore, to gain the trust of clinicians and patients, researchers need to provide explanations of how and why the model is making a specific decision. With the promise of enhancing the trust and transparency of black-box models, researchers are in the phase of maturing the field of eXplainable ML (XML). In this paper, we provide a comprehensive review of explainable and interpretable ML techniques implemented for providing the reasons behind their decisions for various healthcare applications. Along with highlighting various security, safety, and robustness challenges that hinder the trustworthiness of ML we also discussed the ethical issues of healthcare ML and describe how explainable and trustworthy ML can resolve these ethical problems. Finally, we elaborate on the limitations of existing approaches and highlight various open research problems that require further development.

/pdf/explainable-trustworthy-and-ethical-machine-learning-for-2zavk0c1kb.pdf

Explainable, Trustworthy, and Ethical Machine Learning for Healthcare: A Survey

A graphical user interface promoted involvement of local-expert subspecialty radiologists in ongoing image data curation, including case-by-case annotation, potentially concurrent with artificial i...

https://pubs.rsna.org/doi/pdf/10.1148/ryai.2019180095

A User Interface for Optimizing Radiologist Engagement in Image Data Curation for Artificial Intelligence.

Acute Proximal Femoral Fractures are a growing health concern among the aging population. These fractures are often associated with significant morbidity and mortality as well as reduced quality of life. Furthermore, with the increasing life expectancy owing to advances in healthcare, the number of proximal femoral fractures may increase by a factor of 2 to 3, since the majority of fractures occur in patients over the age of 65. In this paper, we show that by using transfer learning and leveraging pre-trained models, we can achieve very high accuracy in detecting fractures and that they can be localized utilizing class activation maps.

Using Transfer Learning and Class Activation Maps Supporting Detection and Localization of Femoral Fractures on Anteroposterior Radiographs

Emergencies that involve the soft tissues of the musculoskeletal system are common; however, these conditions often are difficult to differentiate clinically.1 Early detection and diagnosis have a significant impact on treatment. Although many disorders present with similar symptoms, some laboratory and constitutional findings are helpful in diagnosing specific diseases. MRI is well-established as the preferred imaging modality for evaluation of soft tissue disorders because of its excellent contrast resolution, sensitivity for pathologic fluid accumulation, and depiction of abnormal tissue compartments; thus, recognizing differentiating characteristics enables diagnosis.2,3

MRI of Urgent Soft Tissue Conditions of the Musculoskeletal System

Detection and localisation of hip fractures on anteroposterior radiographs with artificial intelligence: proof of concept.

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A User Interface for Optimizing Radiologist Engagement in Image Data Curation for Artificial Intelligence.

Using Transfer Learning and Class Activation Maps Supporting Detection and Localization of Femoral Fractures on Anteroposterior Radiographs

MRI of Urgent Soft Tissue Conditions of the Musculoskeletal System

Detection and localisation of hip fractures on anteroposterior radiographs with artificial intelligence: proof of concept.