# Multimodal Attention-Aware Fusion for Diagnosing Distal Myopathy: Evaluating Model Interpretability and Clinician Trust

arXiv: https://arxiv.org/abs/2508.01316 · HTML: https://mlsanity.com/paper/2508.01316/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 30 of its 58 references that are in the map.
- First posted on arXiv 2 Aug 2025.

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

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [PyTorch: An Imperative Style, High-Performance Deep Learning Library](https://mlsanity.com/paper/1912.01703/) (2019)
- [A Unified Approach to Interpreting Model Predictions](https://mlsanity.com/paper/1705.07874/) (2017)
- [Optuna: A Next-generation Hyperparameter Optimization Framework](https://mlsanity.com/paper/1907.10902/) (2019)
- [Learning Important Features Through Propagating Activation Differences](https://mlsanity.com/paper/1704.02685/) (2017)
- [Towards A Rigorous Science of Interpretable Machine Learning](https://mlsanity.com/paper/1702.08608/) (2017)
- [This Looks Like That: Deep Learning for Interpretable Image Recognition](https://mlsanity.com/paper/1806.10574/) (2018)
- [Evaluating the visualization of what a Deep Neural Network has learned](https://mlsanity.com/paper/1509.06321/) (2015)
- [A Survey on Explainable Artificial Intelligence (XAI): Towards Medical XAI](https://mlsanity.com/paper/1907.07374/) (2019)
- [From Anecdotal Evidence to Quantitative Evaluation Methods: A Systematic Review on Evaluating Explainable AI](https://mlsanity.com/paper/2201.08164/) (2022)
- [Attention Gated Networks: Learning to Leverage Salient Regions in Medical Images](https://mlsanity.com/paper/1808.08114/) (2018)
- [Approximating CNNs with Bag-of-local-Features models works surprisingly well on ImageNet](https://mlsanity.com/paper/1904.00760/) (2019)
- [Deep Learning for Case-Based Reasoning through Prototypes: A Neural Network that Explains Its Predictions](https://mlsanity.com/paper/1710.04806/) (2017)
- [Explainable artificial intelligence (XAI) in deep learning-based medical image analysis](https://mlsanity.com/paper/2107.10912/) (2021)
- [Ground Truth Evaluation of Neural Network Explanations with CLEVR-XAI](https://mlsanity.com/paper/2003.07258/) (2020)
- [Connecting the Dots in Trustworthy Artificial Intelligence: From AI Principles, Ethics, and Key Requirements to Responsible AI Systems and Regulation](https://mlsanity.com/paper/2305.02231/) (2023)
- [Interpretable Neural-Symbolic Concept Reasoning](https://mlsanity.com/paper/2304.14068/) (2023)
- [How model accuracy and explanation fidelity influence user trust](https://mlsanity.com/paper/1907.12652/) (2019)
- [Energy-Based Concept Bottleneck Models: Unifying Prediction, Concept Intervention, and Probabilistic Interpretations](https://mlsanity.com/paper/2401.14142/) (2024)
- [Global Concept-Based Interpretability for Graph Neural Networks via Neuron Analysis](https://mlsanity.com/paper/2208.10609/) (2022)
- [HEALNet: Multimodal Fusion for Heterogeneous Biomedical Data](https://mlsanity.com/paper/2311.09115/) (2023)
- [RadFormer: Transformers with Global-Local Attention for Interpretable and Accurate Gallbladder Cancer Detection](https://mlsanity.com/paper/2211.04793/) (2022)
- [Prompt-CAM: Making Vision Transformers Interpretable for Fine-Grained Analysis](https://mlsanity.com/paper/2501.09333/) (2025)
- [Why is plausibility surprisingly problematic as an XAI criterion?](https://mlsanity.com/paper/2303.17707/) (2023)
- [Interpretable multimodal fusion networks reveal mechanisms of brain cognition](https://mlsanity.com/paper/2006.09454/) (2020)
- [Class-Dependent Perturbation Effects in Evaluating Time Series Attributions](https://mlsanity.com/paper/2502.17022/) (2025)
- [Learning Transferable Conceptual Prototypes for Interpretable Unsupervised Domain Adaptation](https://mlsanity.com/paper/2310.08071/) (2023)
- [Information Bottleneck-Guided Heterogeneous Graph Learning for Interpretable Neurodevelopmental Disorder Diagnosis](https://mlsanity.com/paper/2502.20769/) (2025)
- [Measuring Perceived Trust in XAI-Assisted Decision-Making by Eliciting a Mental Model](https://mlsanity.com/paper/2307.11765/) (2023)

## Abstract (arXiv)

Distal myopathy represents a genetically heterogeneous group of skeletal muscle disorders with broad clinical manifestations, posing diagnostic challenges in radiology. To address this, we propose a novel multimodal attention-aware fusion architecture that combines features extracted from two distinct deep learning models, one capturing global contextual information and the other focusing on local details, representing complementary aspects of the input data. Uniquely, our approach integrates these features through an attention gate mechanism, enhancing both predictive performance and interpretability. Our method achieves a high classification accuracy on the BUSI benchmark and a proprietary distal myopathy dataset, while also generating clinically relevant saliency maps that support transparent decision-making in medical diagnosis. We rigorously evaluated interpretability through (1) functionally grounded metrics, coherence scoring against reference masks and incremental deletion analysis, and (2) application-grounded validation with seven expert radiologists. While our fusion strategy boosts predictive performance relative to single-stream and alternative fusion strategies, both quantitative and qualitative evaluations reveal persistent gaps in anatomical specificity and clinical usefulness of the interpretability. These findings highlight the need for richer, context-aware interpretability methods and human-in-the-loop feedback to meet clinicians' expectations in real-world diagnostic settings.