Chest X-ray Dataset Research Articles

Optimizing Cardiomegaly Detection: A Random Forest Approach to Processed Chest X-ray Imagery

This study explores the application of a Random Forest Classifier for the automated detection of Cardiomegaly from chest X-ray images, utilizing a dataset processed and derived from the NIH Chest X-ray Dataset. Given the crucial need for accurate and timely diagnosis of Cardiomegaly to inform appropriate treatment decisions, this research aims to determine the efficacy of machine learning models in augmenting diagnostic processes. Employing image pre-processing techniques such as Sobel filtering for edge detection and Hu Moments for feature extraction, the study enhances the input features for the model. The performance of the classifier was evaluated using a 5-fold cross-validation approach, yielding results with average accuracy, precision, recall, and F1-scores ranging approximately between 52% and 54%. These findings suggest a moderate level of reliability and consistency, indicating the potential utility of ensemble machine learning methods in medical imaging analysis. However, the variability in performance across different data subsets highlights the challenges and necessitates further optimization. This research contributes to the ongoing discourse on integrating machine learning into clinical settings, demonstrating the potential benefits and current limitations. Future research is recommended to expand the dataset variety, integrate advanced deep learning methodologies, and rigorously test these models in clinical environments. The findings hold significant implications for the development of automated diagnostic tools in healthcare, potentially leading to enhanced diagnostic accuracy and efficiency.

Diagnosing Necrotizing Enterocolitis via Fine-Grained Visual Classification.

Necrotizing Enterocolitis (NEC) is a devastating condition affecting prematurely born neonates. Reviewing Abdominal X-rays (AXRs) is a key step in NEC diagnosis, staging and treatment decision-making, but poses significant challenges due to the subtle, difficult-to-identify radiological signs of the disease. In this paper, we propose AIDNEC - AI Diagnosis of NECrotizing enterocolitis, a deep learning method to automatically detect and stratify the severity (surgical or medical) of NEC from no pathology in AXRs. The model is trainable end-to-end and integrates a Detection Transformer and Graph Convolution modules for localizing discriminative areas in AXRs, used to formulate subtle local embeddings. These are then combined with global image features to perform Fine-Grained Visual Classification (FGVC). We evaluate AIDNEC on our GOSH NEC dataset of 1153 images from 334 patients, achieving 79.7% accuracy in classifying NEC against No Pathology. AIDNEC outperforms the backbone by 2.6%, FGVC models by 2.5% and CheXNet by 4.2%, with statistically significant (two-tailed p 0.05) improvements, while providing meaningful discriminative regions to support the classification decision. Additional validation in the publicly available Chest X-ray14 dataset yields comparable performance to state-of-the-art methods, illustrating AIDNEC's robustness in a different X-ray classification task.

Enhancing chest X-ray datasets with privacy-preserving large language models and multi-type annotations: A data-driven approach for improved classification

In chest X-ray (CXR) image analysis, rule-based systems are usually employed to extract labels from reports for dataset releases. However, there is still room for improvement in label quality. These labelers typically output only presence labels, sometimes with binary uncertainty indicators, which limits their usefulness. Supervised deep learning models have also been developed for report labeling but lack adaptability, similar to rule-based systems. In this work, we present MAPLEZ (Medical report Annotations with Privacy-preserving Large language model using Expeditious Zero shot answers), a novel approach leveraging a locally executable Large Language Model (LLM) to extract and enhance findings labels on CXR reports. MAPLEZ extracts not only binary labels indicating the presence or absence of a finding but also the location, severity, and radiologists’ uncertainty about the finding. Over eight abnormalities from five test sets, we show that our method can extract these annotations with an increase of 3.6 percentage points (pp) in macro F1 score for categorical presence annotations and more than 20 pp increase in F1 score for the location annotations over competing labelers. Additionally, using the combination of improved annotations and multi-type annotations in classification supervision in a dataset of limited-resolution CXRs, we demonstrate substantial advancements in proof-of-concept classification quality, with an increase of 1.1 pp in AUROC over models trained with annotations from the best alternative approach. We share code and annotations.

Significantly improving zero-shot X-ray pathology classification via fine-tuning pre-trained image-text encoders

Deep neural networks are increasingly used in medical imaging for tasks such as pathological classification, but they face challenges due to the scarcity of high-quality, expert-labeled training data. Recent efforts have utilized pre-trained contrastive image-text models like CLIP, adapting them for medical use by fine-tuning the model with chest X-ray images and corresponding reports for zero-shot pathology classification, thus eliminating the need for pathology-specific annotations. However, most studies continue to use the same contrastive learning objectives as in the general domain, overlooking the multi-labeled nature of medical image-report pairs. In this paper, we propose a new fine-tuning strategy that includes positive-pair loss relaxation and random sentence sampling. We aim to improve the performance of zero-shot pathology classification without relying on external knowledge. Our method can be applied to any pre-trained contrastive image-text encoder and easily transferred to out-of-domain datasets without further training, as it does not use external data. Our approach consistently improves overall zero-shot pathology classification across four chest X-ray datasets and three pre-trained models, with an average macro AUROC increase of 4.3%. Additionally, our method outperforms the state-of-the-art and marginally surpasses board-certified radiologists in zero-shot classification for the five competition pathologies in the CheXpert dataset.

A Distance Transformation Deep Forest Framework With Hybrid-Feature Fusion for CXR Image Classification.

Detecting pneumonia, especially coronavirus disease 2019 (COVID-19), from chest X-ray (CXR) images is one of the most effective ways for disease diagnosis and patient triage. The application of deep neural networks (DNNs) for CXR image classification is limited due to the small sample size of the well-curated data. To tackle this problem, this article proposes a distance transformation-based deep forest framework with hybrid-feature fusion (DTDF-HFF) for accurate CXR image classification. In our proposed method, hybrid features of CXR images are extracted in two ways: hand-crafted feature extraction and multigrained scanning. Different types of features are fed into different classifiers in the same layer of the deep forest (DF), and the prediction vector obtained at each layer is transformed to form distance vector based on a self-adaptive scheme. The distance vectors obtained by different classifiers are fused and concatenated with the original features, then input into the corresponding classifier at the next layer. The cascade grows until DTDF-HFF can no longer gain benefits from the new layer. We compare the proposed method with other methods on the public CXR datasets, and the experimental results show that the proposed method can achieve state-of-the art (SOTA) performance. The code will be made publicly available at https://github.com/hongqq/DTDF-HFF.

Multimodal masked siamese network improves chest X-ray representation learning

Self-supervised learning methods for medical images primarily rely on the imaging modality during pretraining. Although such approaches deliver promising results, they do not take advantage of the associated patient or scan information collected within Electronic Health Records (EHR). This study aims to develop a multimodal pretraining approach for chest radiographs that considers EHR data incorporation as an additional modality that during training. We propose to incorporate EHR data during self-supervised pretraining with a Masked Siamese Network (MSN) to enhance the quality of chest radiograph representations. We investigate three types of EHR data, including demographic, scan metadata, and inpatient stay information. We evaluate the multimodal MSN on three publicly available chest X-ray datasets, MIMIC-CXR, CheXpert, and NIH-14, using two vision transformer (ViT) backbones, specifically ViT-Tiny and ViT-Small. In assessing the quality of the representations through linear evaluation, our proposed method demonstrates significant improvement compared to vanilla MSN and state-of-the-art self-supervised learning baselines. In particular, our proposed method achieves an improvement of of 2% in the Area Under the Receiver Operating Characteristic Curve (AUROC) compared to vanilla MSN and 5% to 8% compared to other baselines, including uni-modal ones. Furthermore, our findings reveal that demographic features provide the most significant performance improvement. Our work highlights the potential of EHR-enhanced self-supervised pretraining for medical imaging and opens opportunities for future research to address limitations in existing representation learning methods for other medical imaging modalities, such as neuro-, ophthalmic, and sonar imaging.

A Novel Approach for Stratifying Pulmonary Edema Severity on Chest X-ray via Dual-Mechanic Self-Learning and Bidirectional Multi-Modal Cross-Attention Algorithms

Abstract Accurate assessment of pulmonary edema severity in acute decompensated congestive heart failure (CHF) patients is vital for treatment decisions. Traditional methods face challenges due to the complexity of chest X-ray (CXR) and unstructured radiology reports. We proposed a method combining self-supervised learning and multimodal cross-attention to address these challenges. Dual-mechanic self-supervised pre-training enhances feature extraction using contrastive learning between text and image features, and generative learning between images. A bidirectional multi-modal cross-attention model integrates image and text information for fine-tuning, improving model performance. Four CXR datasets consisting of 519, 437 images were used for pre-training; 1200 randomly selected image-text pairs were used for fine-tuning and partitioned into train, validation, and test sets at 3: 1: 1. Ablation studies for pre-training and fine-tuning approaches indicated their practicality as evidenced by the optimal macro F1 score of 0.667 and optimal macro-AUC of 0.904. It also outperformed other state-of-the-art multi-modality methods. The novel approach could accurately assess pulmonary edema severity, offering crucial support for CHF patient management.

Acquisition parameters influence AI recognition of race in chest x-rays and mitigating these factors reduces underdiagnosis bias

A core motivation for the use of artificial intelligence (AI) in medicine is to reduce existing healthcare disparities. Yet, recent studies have demonstrated two distinct findings: (1) AI models can show performance biases in underserved populations, and (2) these same models can be directly trained to recognize patient demographics, such as predicting self-reported race from medical images alone. Here, we investigate how these findings may be related, with an end goal of reducing a previously identified underdiagnosis bias. Using two popular chest x-ray datasets, we first demonstrate that technical parameters related to image acquisition and processing influence AI models trained to predict patient race, where these results partly reflect underlying biases in the original clinical datasets. We then find that mitigating the observed differences through a demographics-independent calibration strategy reduces the previously identified bias. While many factors likely contribute to AI bias and demographics prediction, these results highlight the importance of carefully considering data acquisition and processing parameters in AI development and healthcare equity more broadly.

Automated quantification of SARS-CoV-2 pneumonia with large vision model knowledge adaptation

BackgroundLarge vision models (LVM) pretrained by large datasets have demonstrated their enormous capacity to understand visual patterns and capture semantic information from images. We proposed a novel method of knowledge domain adaptation with pretrained LVM for a low-cost artificial intelligence (AI) model to quantify the severity of SARS-CoV-2 pneumonia based on frontal chest X-ray (CXR) images. MethodsOur method used the pretrained LVMs as the primary feature extractor and self-supervised contrastive learning for domain adaptation. An encoder with a 2048-dimensional feature vector output was first trained by self-supervised learning for knowledge domain adaptation. Then a multi-layer perceptron (MLP) was trained for the final severity prediction. A dataset with 2599 CXR images was used for model training and evaluation. ResultsThe model based on the pretrained vision transformer (ViT) and self-supervised learning achieved the best performance in cross validation, with mean squared error (MSE) of 23.83 (95 % CI 22.67–25.00) and mean absolute error (MAE) of 3.64 (95 % CI 3.54–3.73). Its prediction correlation has the R2 of 0.81 (95 % CI 0.79–0.82) and Spearman ρ of 0.80 (95 % CI 0.77–0.81), which are comparable to the current state-of-the-art (SOTA) methods trained by much larger CXR datasets. ConclusionThe proposed new method has achieved the SOTA performance to quantify the severity of SARS-CoV-2 pneumonia at a significantly lower cost. The method can be extended to other infectious disease detection or quantification to expedite the application of AI in medical research.

An open chest X-ray dataset with benchmarks for automatic radiology report generation in French

Medical report generation (MRG), which aims to automatically generate a textual description of a specific medical image (e.g., a chest X-ray), has recently received increasing research interest. Building on the success of image captioning, MRG has become achievable. However, generating language-specific radiology reports poses a challenge for data-driven models due to their reliance on paired image-report chest X-ray datasets, which are labor-intensive, time-consuming, and costly. In this paper, we introduce a chest X-ray benchmark dataset, namely CASIA-CXR, consisting of high-resolution chest radiographs accompanied by narrative reports originally written in French. To the best of our knowledge, this is the first public chest radiograph dataset with medical reports in this particular language. Importantly, we propose a simple yet effective multimodal encoder–decoder contextually-guided framework for medical report generation in French. We validated our framework through intra-language and cross-language contextual analysis, supplemented by expert evaluation performed by radiologists. The dataset is freely available at: https://www.casia-cxr.net/.

UniChest: Conquer-and-Divide Pre-Training for Multi-Source Chest X-Ray Classification.

Vision-Language Pre-training (VLP) that utilizes the multi-modal information to promote the training efficiency and effectiveness, has achieved great success in vision recognition of natural domains and shown promise in medical imaging diagnosis for the Chest X-Rays (CXRs). However, current works mainly pay attention to the exploration on single dataset of CXRs, which locks the potential of this powerful paradigm on larger hybrid of multi-source CXRs datasets. We identify that although blending samples from the diverse sources offers the advantages to improve the model generalization, it is still challenging to maintain the consistent superiority for the task of each source due to the existing heterogeneity among sources. To handle this dilemma, we design a Conquer-and-Divide pre-training framework, termed as UniChest, aiming to make full use of the collaboration benefit of multiple sources of CXRs while reducing the negative influence of the source heterogeneity. Specially, the "Conquer" stage in UniChest encourages the model to sufficiently capture multi-source common patterns, and the "Divide" stage helps squeeze personalized patterns into different small experts (query networks). We conduct thorough experiments on many benchmarks, e.g., ChestX-ray14, CheXpert, Vindr-CXR, Shenzhen, Open-I and SIIM-ACR Pneumothorax, verifying the effectiveness of UniChest over a range of baselines, and release our codes and pre-training models at https://github.com/Elfenreigen/UniChest.

Three-Stage Framework for Accurate Pediatric Chest X-ray Diagnosis Using Self-Supervision and Transfer Learning on Small Datasets.

Pediatric respiratory disease diagnosis and subsequent treatment require accurate and interpretable analysis. A chest X-ray is the most cost-effective and rapid method for identifying and monitoring various thoracic diseases in children. Recent developments in self-supervised and transfer learning have shown their potential in medical imaging, including chest X-ray areas. In this article, we propose a three-stage framework with knowledge transfer from adult chest X-rays to aid the diagnosis and interpretation of pediatric thorax diseases. We conducted comprehensive experiments with different pre-training and fine-tuning strategies to develop transformer or convolutional neural network models and then evaluate them qualitatively and quantitatively. The ViT-Base/16 model, fine-tuned with the CheXpert dataset, a large chest X-ray dataset, emerged as the most effective, achieving a mean AUC of 0.761 (95% CI: 0.759-0.763) across six disease categories and demonstrating a high sensitivity (average 0.639) and specificity (average 0.683), which are indicative of its strong discriminative ability. The baseline models, ViT-Small/16 and ViT-Base/16, when directly trained on the Pediatric CXR dataset, only achieved mean AUC scores of 0.646 (95% CI: 0.641-0.651) and 0.654 (95% CI: 0.648-0.660), respectively. Qualitatively, our model excels in localizing diseased regions, outperforming models pre-trained on ImageNet and other fine-tuning approaches, thus providing superior explanations. The source code is available online and the data can be obtained from PhysioNet.

AssistDistil for Medical Image Segmentation

Deep learning models have demonstrated significant effectiveness in addressing intricate object segmentation and image classification tasks. Nevertheless, their widespread use is impeded by high computational demands, limiting their applicability on resource-constrained devices and in contexts like medical image segmentation. This paper proposes AssistDistil, a semi-knowledge distillation technique designed to facilitate the transfer of knowledge from a larger teacher network to a more compact student model. During the inference process, the student model works in conjunction with the teacher model by condensing the teacher model’s latent information into its own latent representation, thereby boosting its representational capacity. The effectiveness of the proposed approach is demonstrated for multiple case studies in medical image segmentation task of eye segmentation, skin lesion segmentation, and chest X-ray segmentation. Experimental results on the IIITD Cataract Surgery, HAM10000, PH2, Shenzhen and Montgomery chest X-ray datasets demonstrate the efficacy of the proposed approach both in terms of accuracy and computational cost. For example, in comparison to the AUNet-based teacher model, the proposed approach achieves a similar mIOU with only 0.5% of the model size. In the future, we plan to explore knowledge distillation approaches to improve the distillation process in case of large model capacity gap between teacher and student networks. With fewer parameters, we intend for the student model to attain performance comparable to that of the teacher model without additional assistance.

Deep Learning for Pneumonia Detection in Chest X-ray Images: A Comprehensive Survey.

This paper addresses the significant problem of identifying the relevant background and contextual literature related to deep learning (DL) as an evolving technology in order to provide a comprehensive analysis of the application of DL to the specific problem of pneumonia detection via chest X-ray (CXR) imaging, which is the most common and cost-effective imaging technique available worldwide for pneumonia diagnosis. This paper in particular addresses the key period associated with COVID-19, 2020-2023, to explain, analyze, and systematically evaluate the limitations of approaches and determine their relative levels of effectiveness. The context in which DL is applied as both an aid to and an automated substitute for existing expert radiography professionals, who often have limited availability, is elaborated in detail. The rationale for the undertaken research is provided, along with a justification of the resources adopted and their relevance. This explanatory text and the subsequent analyses are intended to provide sufficient detail of the problem being addressed, existing solutions, and the limitations of these, ranging in detail from the specific to the more general. Indeed, our analysis and evaluation agree with the generally held view that the use of transformers, specifically, vision transformers (ViTs), is the most promising technique for obtaining further effective results in the area of pneumonia detection using CXR images. However, ViTs require extensive further research to address several limitations, specifically the following: biased CXR datasets, data and code availability, the ease with which a model can be explained, systematic methods of accurate model comparison, the notion of class imbalance in CXR datasets, and the possibility of adversarial attacks, the latter of which remains an area of fundamental research.

ALFREDO: Active Learning with FeatuRe disEntangelement and DOmain adaptation for medical image classification

State-of-the-art deep learning models often fail to generalize in the presence of distribution shifts between training (source) data and test (target) data. Domain adaptation methods are designed to address this issue using labeled samples (supervised domain adaptation) or unlabeled samples (unsupervised domain adaptation). Active learning is a method to select informative samples to obtain maximum performance from minimum annotations. Selecting informative target domain samples can improve model performance and robustness, and reduce data demands. This paper proposes a novel pipeline called ALFREDO (Active Learning with FeatuRe disEntangelement and DOmain adaptation) that performs active learning under domain shift. We propose a novel feature disentanglement approach to decompose image features into domain specific and task specific components. Domain specific components refer to those features that provide source specific information, e.g., scanners, vendors or hospitals. Task specific components are discriminative features for classification, segmentation or other tasks. Thereafter we define multiple novel cost functions that identify informative samples under domain shift. We test our proposed method for medical image classification using one histopathology dataset and two chest X-ray datasets. Experiments show our method achieves state-of-the-art results compared to other domain adaptation methods, as well as state of the art active domain adaptation methods.

Advanced Lung Disease Detection and Classification Using Ge-U-Net-ODLwith Gabor Filters and Entropy-Based Feature Selection

Lung X-ray images play a crucial role in the detection and diagnosis of various lung diseases,including pneumonia, tuberculosis, and lung cancer. These images provide a non-invasive method for visualizing lung structures, allowing radiologists and machine learning models to identify abnormalities such as nodules, masses, or fluid accumulation. With the advancement of deep learning techniques, lung X-ray images are now used in automated systems that can detect and classify diseases with high accuracy. By applying sophisticated algorithms like GE-U-Net-ODL, Gabor filters, and entropy-based feature extraction, these images are analyzed pixel by pixel to enhance feature representation and improve diagnostic precision. This paper presents a novel approach for lung disease detection and classification using the GE-U-Net-ODL model, which integrates advanced preprocessing techniques and deep learning architectures. The study leverages the NIH Chest X-ray dataset and employs a variety of feature extraction and selection methods, including Gabor filters, entropy-based techniques, and multi-scale inputs. A detailed comparative analysis of different model configurations demonstrates that the GE-U-Net-ODL model with Transfer Learning achieves the highest classification accuracy of 95.0%, alongside superior precision (93.5%), recall (94.0%), and F1-score (93.7%). Other configurations, such as those utilizing data augmentation and hybrid filters, also showed notable performance improvements. The research underscores the model's effectiveness in enhancing diagnostic accuracy for lung diseases while balancing training and inference times.

Evaluating Diagnostic Thresholds for Pneumonia Severity Using HOG Features and Deep Learning Models

Pneumonia severity diagnosis is vital for effective and efficient patient treatment and management. This study evaluates the efficacy of different diagnostic thresholds for pneumonia severity using Histogram of Oriented Gradients (HOG) features and deep learning models on chest X-ray images. Utilizing the Kaggle chest X-ray dataset, HOG feature extraction was applied, followed by Pearson correlation to compare a randomly selected X-ray with pneumonia images. Three diagnostic thresholds were used for severity diagnosis. The results demonstrated that all thresholds performed well in detecting moderate cases, with Threshold1 and Threshold2 both achieving an accuracy of 89% and an F1-score of 0.94. Threshold3 had an accuracy of 66% and F1-scores of 0.62 and 0.94 in identifying mild and moderate cases, respectively. The evaluation metrics included accuracy, precision, recall, and F1-score. These findings suggest that careful selection of diagnostic thresholds can significantly impact the accuracy and reliability of pneumonia severity diagnosis using deep learning models, with potential applications in clinical settings.

Literature Study: Transfer Learning for COVID-19 Disease Analysis Based on Chest X-ray Dataset

The urgency of the impact of the COVID-19 disease that attacks people around the world encourages special research, especially in the field of artificial intelligence. This study aims to conduct a literature study related to the use of artificial intelligence, especially transfer learning in analyzing COVID-19 disease based on chest X-ray datasets. The research method of this research adapts the Preferred Reporting for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The results of the analysis of this data to answer research questions regarding the transfer learning model for the analysis of COVID-19 disease based on the chest X-ray dataset, it is known that the models used are MobileNet, Inception, VGG and ResNet. MobileNetV2 can be optimized by adding a global average pooling layer, dropout layer and dense layer and get an accuracy of 98.65%. InceptionV3 can be combined with Xception and get 98.8% accuracy. VGG-16 can be combined with ResNet-50 Xception and get 98.93% accuracy. ResNet-50 can be optimized by adding a dropout layer and a dense layer and getting an accuracy of 97.65%.

The limits of fair medical imaging AI in real-world generalization

As artificial intelligence (AI) rapidly approaches human-level performance in medical imaging, it is crucial that it does not exacerbate or propagate healthcare disparities. Previous research established AI’s capacity to infer demographic data from chest X-rays, leading to a key concern: do models using demographic shortcuts have unfair predictions across subpopulations? In this study, we conducted a thorough investigation into the extent to which medical AI uses demographic encodings, focusing on potential fairness discrepancies within both in-distribution training sets and external test sets. Our analysis covers three key medical imaging disciplines—radiology, dermatology and ophthalmology—and incorporates data from six global chest X-ray datasets. We confirm that medical imaging AI leverages demographic shortcuts in disease classification. Although correcting shortcuts algorithmically effectively addresses fairness gaps to create ‘locally optimal’ models within the original data distribution, this optimality is not true in new test settings. Surprisingly, we found that models with less encoding of demographic attributes are often most ‘globally optimal’, exhibiting better fairness during model evaluation in new test environments. Our work establishes best practices for medical imaging models that maintain their performance and fairness in deployments beyond their initial training contexts, underscoring critical considerations for AI clinical deployments across populations and sites.

Saliency-driven explainable deep learning in medical imaging: bridging visual explainability and statistical quantitative analysis

Deep learning shows great promise for medical image analysis but often lacks explainability, hindering its adoption in healthcare. Attribution techniques that explain model reasoning can potentially increase trust in deep learning among clinical stakeholders. In the literature, much of the research on attribution in medical imaging focuses on visual inspection rather than statistical quantitative analysis.In this paper, we proposed an image-based saliency framework to enhance the explainability of deep learning models in medical image analysis. We use adaptive path-based gradient integration, gradient-free techniques, and class activation mapping along with its derivatives to attribute predictions from brain tumor MRI and COVID-19 chest X-ray datasets made by recent deep convolutional neural network models.The proposed framework integrates qualitative and statistical quantitative assessments, employing Accuracy Information Curves (AICs) and Softmax Information Curves (SICs) to measure the effectiveness of saliency methods in retaining critical image information and their correlation with model predictions. Visual inspections indicate that methods such as ScoreCAM, XRAI, GradCAM, and GradCAM++ consistently produce focused and clinically interpretable attribution maps. These methods highlighted possible biomarkers, exposed model biases, and offered insights into the links between input features and predictions, demonstrating their ability to elucidate model reasoning on these datasets. Empirical evaluations reveal that ScoreCAM and XRAI are particularly effective in retaining relevant image regions, as reflected in their higher AUC values. However, SICs highlight variability, with instances of random saliency masks outperforming established methods, emphasizing the need for combining visual and empirical metrics for a comprehensive evaluation.The results underscore the importance of selecting appropriate saliency methods for specific medical imaging tasks and suggest that combining qualitative and quantitative approaches can enhance the transparency, trustworthiness, and clinical adoption of deep learning models in healthcare. This study advances model explainability to increase trust in deep learning among healthcare stakeholders by revealing the rationale behind predictions. Future research should refine empirical metrics for stability and reliability, include more diverse imaging modalities, and focus on improving model explainability to support clinical decision-making.