Bridging Human and Machine Intelligence: Reverse-Engineering Radiologist Intentions for Clinical Trust and Adoption

Abstract

In the rapidly evolving landscape of medical imaging, the integration of artificial intelligence (AI) with clinical expertise offers unprecedented opportunities to enhance diagnostic precision and accuracy. Yet, the "black box" nature of AI models often limits their integration into clinical practice, where transparency and interpretability are important. This paper presents a novel system leveraging the Large Multimodal Model (LMM) to bridge the gap between AI predictions and the cognitive processes of radiologists. This system consists of two core modules, Temporally Grounded Intention Detection (TGID) and Region Extraction (RE). The TGID module predicts the radiologist's intentions by analyzing eye gaze fixation heatmap videos and corresponding radiology reports. Additionally, the RE module extracts regions of interest that align with these intentions, mirroring the radiologist’s diagnostic focus. This approach introduces a new task, radiologist intention detection, and is the first application of Dense Video Captioning (DVC) in the medical domain. By making AI systems more interpretable and aligned with radiologist’s cognitive processes, this proposed system aims to enhance trust, improve diagnostic accuracy, and support medical education. Additionally, it holds the potential for automated error correction, guiding junior radiologists, and fostering more effective training and feedback mechanisms. This work sets a precedent for future research in AI-driven healthcare, offering a pathway towards transparent, trustworthy, and human-centered AI systems. We evaluated this model using NLG(Natural Language Generation), time-related, and vision-based metrics, demonstrating superior performance in generating temporally grounded intentions on REFLACX and EGD-CXR datasets. This model also demonstrated strong predictive accuracy in overlap scores for medical abnormalities and effective region extraction with high IoU(Intersection over Union), especially in complex cases like cardiomegaly and edema. These results highlight the system's potential to enhance diagnostic accuracy and support continuous learning in radiology. We are also releasing the source code for our project, available here.