# Is visual explanation with Grad-CAM more reliable for deeper neural networks? a case study with automatic pneumothorax diagnosis

arXiv: https://arxiv.org/abs/2308.15172 · HTML: https://mlsanity.com/paper/2308.15172/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Builds on 11 of its 17 references that are in the map.
- First posted on arXiv 29 Aug 2023.

## Builds on (most cited first, 11 of 11)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Very Deep Convolutional Networks for Large-Scale Image Recognition](https://mlsanity.com/paper/1409.1556/) (2014)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [Explainable Artificial Intelligence (XAI): Concepts, Taxonomies, Opportunities and Challenges toward Responsible AI](https://mlsanity.com/paper/1910.10045/) (2019)
- [How to train your ViT? Data, Augmentation, and Regularization in Vision Transformers](https://mlsanity.com/paper/2106.10270/) (2021)
- [DeepViT: Towards Deeper Vision Transformer](https://mlsanity.com/paper/2103.11886/) (2021)
- [Deep Learning for Chest X-ray Analysis: A Survey](https://mlsanity.com/paper/2103.08700/) (2021)
- [Attention-based Saliency Maps Improve Interpretability of Pneumothorax Classification](https://mlsanity.com/paper/2303.01871/) (2023)
- [Inherently Interpretable Multi-Label Classification Using Class-Specific Counterfactuals](https://mlsanity.com/paper/2303.00500/) (2023)

## Built on by (most cited first, 2 of 2)

- [Clinical Domain Knowledge-Derived Template Improves Post Hoc AI Explanations in Pneumothorax Classification](https://mlsanity.com/paper/2403.18871/) (2024)
- [CLARiTy: A Vision Transformer for Multi-Label Classification and Weakly-Supervised Localization of Chest X-ray Pathologies](https://mlsanity.com/paper/2512.16700/) (2025)

## Abstract (arXiv)

While deep learning techniques have provided the state-of-the-art performance in various clinical tasks, explainability regarding their decision-making process can greatly enhance the credence of these methods for safer and quicker clinical adoption. With high flexibility, Gradient-weighted Class Activation Mapping (Grad-CAM) has been widely adopted to offer intuitive visual interpretation of various deep learning models' reasoning processes in computer-assisted diagnosis. However, despite the popularity of the technique, there is still a lack of systematic study on Grad-CAM's performance on different deep learning architectures. In this study, we investigate its robustness and effectiveness across different popular deep learning models, with a focus on the impact of the networks' depths and architecture types, by using a case study of automatic pneumothorax diagnosis in X-ray scans. Our results show that deeper neural networks do not necessarily contribute to a strong improvement of pneumothorax diagnosis accuracy, and the effectiveness of GradCAM also varies among different network architectures.