# Explainable Artificial Intelligence in Biomedical Image Analysis: A Comprehensive Survey

arXiv: https://arxiv.org/abs/2507.07148 · HTML: https://mlsanity.com/paper/2507.07148/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 68 of its 251 references that are in the map.
- First posted on arXiv 9 Jul 2025.

## Builds on (most cited first, 30 of 68)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [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)
- [UMAP: Uniform Manifold Approximation and Projection for Dimension Reduction](https://mlsanity.com/paper/1802.03426/) (2018)
- [VQA: Visual Question Answering](https://mlsanity.com/paper/1505.00468/) (2015)
- [Learning Deep Features for Discriminative Localization](https://mlsanity.com/paper/1512.04150/) (2015)
- [Deep Inside Convolutional Networks: Visualising Image Classification Models and Saliency Maps](https://mlsanity.com/paper/1312.6034/) (2013)
- [Visualizing and Understanding Convolutional Networks](https://mlsanity.com/paper/1311.2901/) (2013)
- [CIDEr: Consensus-based Image Description Evaluation](https://mlsanity.com/paper/1411.5726/) (2014)
- [Understanding Black-box Predictions via Influence Functions](https://mlsanity.com/paper/1703.04730/) (2017)
- [Learning Important Features Through Propagating Activation Differences](https://mlsanity.com/paper/1704.02685/) (2017)
- [Show, Attend and Tell: Neural Image Caption Generation with Visual Attention](https://mlsanity.com/paper/1502.03044/) (2015)
- [Interpretability Beyond Feature Attribution: Quantitative Testing with Concept Activation Vectors (TCAV)](https://mlsanity.com/paper/1711.11279/) (2017)
- [SmoothGrad: removing noise by adding noise](https://mlsanity.com/paper/1706.03825/) (2017)
- [Concept Bottleneck Models](https://mlsanity.com/paper/2007.04612/) (2020)
- [Striving for Simplicity: The All Convolutional Net](https://mlsanity.com/paper/1412.6806/) (2014)
- [Grad-CAM++: Improved Visual Explanations for Deep Convolutional Networks](https://mlsanity.com/paper/1710.11063/) (2017)
- [RISE: Randomized Input Sampling for Explanation of Black-box Models](https://mlsanity.com/paper/1806.07421/) (2018)
- [SPICE: Semantic Propositional Image Caption Evaluation](https://mlsanity.com/paper/1607.08822/) (2016)
- [Quantifying Attention Flow in Transformers](https://mlsanity.com/paper/2005.00928/) (2020)
- [Score-CAM: Score-Weighted Visual Explanations for Convolutional Neural Networks](https://mlsanity.com/paper/1910.01279/) (2019)
- [MedCLIP: Contrastive Learning from Unpaired Medical Images and Text](https://mlsanity.com/paper/2210.10163/) (2022)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [Evaluating the visualization of what a Deep Neural Network has learned](https://mlsanity.com/paper/1509.06321/) (2015)
- [Visual Dialog](https://mlsanity.com/paper/1611.08669/) (2016)
- [Top-down Neural Attention by Excitation Backprop](https://mlsanity.com/paper/1608.00507/) (2016)
- [Explanations based on the Missing: Towards Contrastive Explanations with Pertinent Negatives](https://mlsanity.com/paper/1802.07623/) (2018)
- [Real Time Image Saliency for Black Box Classifiers](https://mlsanity.com/paper/1705.07857/) (2017)

## Built on by (most cited first, 1 of 1)

- [XDR-LVLM: An Explainable Vision-Language Large Model for Diabetic Retinopathy Diagnosis](https://mlsanity.com/paper/2508.15168/) (2025)

## Abstract (arXiv)

Explainable artificial intelligence (XAI) has become increasingly important in biomedical image analysis to promote transparency, trust, and clinical adoption of DL models. While several surveys have reviewed XAI techniques, they often lack a modality-aware perspective, overlook recent advances in multimodal and vision-language paradigms, and provide limited practical guidance. This survey addresses this gap through a comprehensive and structured synthesis of XAI methods tailored to biomedical image analysis.We systematically categorize XAI methods, analyzing their underlying principles, strengths, and limitations within biomedical contexts. A modality-centered taxonomy is proposed to align XAI methods with specific imaging types, highlighting the distinct interpretability challenges across modalities. We further examine the emerging role of multimodal learning and vision-language models in explainable biomedical AI, a topic largely underexplored in previous work. Our contributions also include a summary of widely used evaluation metrics and open-source frameworks, along with a critical discussion of persistent challenges and future directions. This survey offers a timely and in-depth foundation for advancing interpretable DL in biomedical image analysis.