# Soft-CAM: Making black box models self-explainable for medical image analysis

arXiv: https://arxiv.org/abs/2505.17748 · HTML: https://mlsanity.com/paper/2505.17748/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 20 of its 38 references that are in the map.
- First posted on arXiv 23 May 2025.

## Builds on (most cited first, 20 of 20)

- [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)
- [Axiomatic Attribution for Deep Networks](https://mlsanity.com/paper/1703.01365/) (2017)
- [Learning Deep Features for Discriminative Localization](https://mlsanity.com/paper/1512.04150/) (2015)
- [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)
- [Score-CAM: Score-Weighted Visual Explanations for Convolutional Neural Networks](https://mlsanity.com/paper/1910.01279/) (2019)
- [Captum: A unified and generic model interpretability library for PyTorch](https://mlsanity.com/paper/2009.07896/) (2020)
- [A Survey of Convolutional Neural Networks: Analysis, Applications, and Prospects](https://mlsanity.com/paper/2004.02806/) (2020)
- [Top-down Neural Attention by Excitation Backprop](https://mlsanity.com/paper/1608.00507/) (2016)
- [On the (In)fidelity and Sensitivity for Explanations](https://mlsanity.com/paper/1901.09392/) (2019)
- [Approximating CNNs with Bag-of-local-Features models works surprisingly well on ImageNet](https://mlsanity.com/paper/1904.00760/) (2019)
- [B-cos Networks: Alignment is All We Need for Interpretability](https://mlsanity.com/paper/2205.10268/) (2022)
- [IAIA-BL: A Case-based Interpretable Deep Learning Model for Classification of Mass Lesions in Digital Mammography](https://mlsanity.com/paper/2103.12308/) (2021)
- [This actually looks like that: Proto-BagNets for local and global interpretability-by-design](https://mlsanity.com/paper/2406.15168/) (2024)
- [Transferability of Deep Learning Algorithms for Malignancy Detection in Confocal Laser Endomicroscopy Images from Different Anatomical Locations of the Upper Gastrointestinal Tract](https://mlsanity.com/paper/1902.08985/) (2019)

## Abstract (arXiv)

Convolutional neural networks (CNNs) are widely used for high-stakes applications like medicine, often surpassing human performance. However, most explanation methods rely on post-hoc attribution, approximating the decision-making process of already trained black-box models. These methods are often sensitive, unreliable, and fail to reflect true model reasoning, limiting their trustworthiness in critical applications. In this work, we introduce SoftCAM, a straightforward yet effective approach that makes standard CNN architectures inherently interpretable. By removing the global average pooling layer and replacing the fully connected classification layer with a convolution-based class evidence layer, SoftCAM preserves spatial information and produces explicit class activation maps that form the basis of the model's predictions. Evaluated on three medical datasets, SoftCAM maintains classification performance while significantly improving both the qualitative and quantitative explanation compared to existing post-hoc methods. Our results demonstrate that CNNs can be inherently interpretable without compromising performance, advancing the development of self-explainable deep learning for high-stakes decision-making. The code is available at https://github.com/kdjoumessi/SoftCAM