# FUTURE-AI: Guiding Principles and Consensus Recommendations for Trustworthy Artificial Intelligence in Medical Imaging

arXiv: https://arxiv.org/abs/2109.09658 · HTML: https://mlsanity.com/paper/2109.09658/

## Key facts

- Cited by 13 papers in the map (data through 14 Oct 2026).
- Builds on 47 of its 218 references that are in the map.
- First posted on arXiv 20 Sep 2021.

## Builds on (most cited first, 30 of 47)

- [Explaining and Harnessing Adversarial Examples](https://mlsanity.com/paper/1412.6572/) (2014)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [A Unified Approach to Interpreting Model Predictions](https://mlsanity.com/paper/1705.07874/) (2017)
- ["Why Should I Trust You?": Explaining the Predictions of Any Classifier](https://mlsanity.com/paper/1602.04938/) (2016)
- [Axiomatic Attribution for Deep Networks](https://mlsanity.com/paper/1703.01365/) (2017)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Towards A Rigorous Science of Interpretable Machine Learning](https://mlsanity.com/paper/1702.08608/) (2017)
- [Datasheets for Datasets](https://mlsanity.com/paper/1803.09010/) (2018)
- [Interpretability Beyond Feature Attribution: Quantitative Testing with Concept Activation Vectors (TCAV)](https://mlsanity.com/paper/1711.11279/) (2017)
- [Sanity Checks for Saliency Maps](https://mlsanity.com/paper/1810.03292/) (2018)
- [Concept Bottleneck Models](https://mlsanity.com/paper/2007.04612/) (2020)
- [Striving for Simplicity: The All Convolutional Net](https://mlsanity.com/paper/1412.6806/) (2014)
- [This Looks Like That: Deep Learning for Interpretable Image Recognition](https://mlsanity.com/paper/1806.10574/) (2018)
- [Interpretation of Neural Networks is Fragile](https://mlsanity.com/paper/1710.10547/) (2017)
- [Evaluating the visualization of what a Deep Neural Network has learned](https://mlsanity.com/paper/1509.06321/) (2015)
- [On Fairness and Calibration](https://mlsanity.com/paper/1709.02012/) (2017)
- [Embracing Imperfect Datasets: A Review of Deep Learning Solutions for Medical Image Segmentation](https://mlsanity.com/paper/1908.10454/) (2019)
- [Deep Learning for Segmentation using an Open Large-Scale Dataset in 2D Echocardiography](https://mlsanity.com/paper/1908.06948/) (2019)
- [A Deep Cascade of Convolutional Neural Networks for Dynamic MR Image Reconstruction](https://mlsanity.com/paper/1704.02422/) (2017)
- [Deep Structural Causal Models for Tractable Counterfactual Inference](https://mlsanity.com/paper/2006.06485/) (2020)
- [To Trust Or Not To Trust A Classifier](https://mlsanity.com/paper/1805.11783/) (2018)
- [Fairness in Machine Learning](https://mlsanity.com/paper/2012.15816/) (2020)
- [Causality matters in medical imaging](https://mlsanity.com/paper/1912.08142/) (2019)
- [CheXclusion: Fairness gaps in deep chest X-ray classifiers](https://mlsanity.com/paper/2003.00827/) (2020)
- [Test-Time Adaptable Neural Networks for Robust Medical Image Segmentation](https://mlsanity.com/paper/2004.04668/) (2020)
- [Unbox the Black-box for the Medical Explainable AI via Multi-modal and Multi-centre Data Fusion: A Mini-Review, Two Showcases and Beyond](https://mlsanity.com/paper/2102.01998/) (2021)
- [This Looks Like That... Does it? Shortcomings of Latent Space Prototype Interpretability in Deep Networks](https://mlsanity.com/paper/2105.02968/) (2021)
- [Measuring the Quality of Explanations: The System Causability Scale (SCS). Comparing Human and Machine Explanations](https://mlsanity.com/paper/1912.09024/) (2019)
- [Image biomarker standardisation initiative](https://mlsanity.com/paper/1612.07003/) (2016)
- [Fairness in Cardiac MR Image Analysis: An Investigation of Bias Due to Data Imbalance in Deep Learning Based Segmentation](https://mlsanity.com/paper/2106.12387/) (2021)

## Built on by (most cited first, 13 of 13)

- [medigan: a Python library of pretrained generative models for medical image synthesis](https://mlsanity.com/paper/2209.14472/) (2022)
- [Revisiting Skin Tone Fairness in Dermatological Lesion Classification](https://mlsanity.com/paper/2308.09640/) (2023)
- [Reproducibility of Machine Learning: Terminology, Recommendations and Open Issues](https://mlsanity.com/paper/2302.12691/) (2023)
- [Sharing Generative Models Instead of Private Data: A Simulation Study on Mammography Patch Classification](https://mlsanity.com/paper/2203.04961/) (2022)
- [COVID-19 Detection from Respiratory Sounds with Hierarchical Spectrogram Transformers](https://mlsanity.com/paper/2207.09529/) (2022)
- [Trustworthy and Responsible AI for Human-Centric Autonomous Decision-Making Systems](https://mlsanity.com/paper/2408.15550/) (2024)
- [DURA-CPS: A Multi-Role Orchestrator for Dependability Assurance in LLM-Enabled Cyber-Physical Systems](https://mlsanity.com/paper/2506.06381/) (2025)
- [Leveraging Computer Vision in the Intensive Care Unit (ICU) for Examining Visitation and Mobility](https://mlsanity.com/paper/2403.06322/) (2024)
- [A review of handcrafted and deep radiomics in neurological diseases: transitioning from oncology to clinical neuroimaging](https://mlsanity.com/paper/2407.13813/) (2024)
- [Robust Training with Data Augmentation for Medical Imaging Classification](https://mlsanity.com/paper/2506.17133/) (2025)
- [RAD: Towards Trustworthy Retrieval-Augmented Multi-modal Clinical Diagnosis](https://mlsanity.com/paper/2509.19980/) (2025)
- [AI-Driven Approaches for Glaucoma Detection -- A Comprehensive Review](https://mlsanity.com/paper/2410.15947/) (2024)
- [From Awareness to Action: Understanding and Overcoming the Research-Practice Gap in Algorithmic Fairness for Public Health](https://mlsanity.com/paper/2606.11214/) (2026)

## Abstract (arXiv)

The recent advancements in artificial intelligence (AI) combined with the extensive amount of data generated by today's clinical systems, has led to the development of imaging AI solutions across the whole value chain of medical imaging, including image reconstruction, medical image segmentation, image-based diagnosis and treatment planning. Notwithstanding the successes and future potential of AI in medical imaging, many stakeholders are concerned of the potential risks and ethical implications of imaging AI solutions, which are perceived as complex, opaque, and difficult to comprehend, utilise, and trust in critical clinical applications. Addressing these concerns and risks, the FUTURE-AI framework has been proposed, which, sourced from a global multi-domain expert consensus, comprises guiding principles for increased trust, safety, and adoption for AI in healthcare. In this paper, we transform the general FUTURE-AI healthcare principles to a concise and specific AI implementation guide tailored to the needs of the medical imaging community. To this end, we carefully assess each building block of the FUTURE-AI framework consisting of (i) Fairness, (ii) Universality, (iii) Traceability, (iv) Usability, (v) Robustness and (vi) Explainability, and respectively define concrete best practices based on accumulated AI implementation experiences from five large European projects on AI in Health Imaging. We accompany our concrete step-by-step medical imaging development guide with a practical AI solution maturity checklist, thus enabling AI development teams to design, evaluate, maintain, and deploy technically, clinically and ethically trustworthy imaging AI solutions into clinical practice.