# Evaluating the Explainability of Vision Transformers in Medical Imaging

arXiv: https://arxiv.org/abs/2510.12021 · HTML: https://mlsanity.com/paper/2510.12021/

## Key facts

- Cited by 4 papers in the map (data through 14 Oct 2026).
- Builds on 12 of its 20 references that are in the map.
- First posted on arXiv 13 Oct 2025.

## Builds on (most cited first, 12 of 12)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [Emerging Properties in Self-Supervised Vision Transformers](https://mlsanity.com/paper/2104.14294/) (2021)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- ["Why Should I Trust You?": Explaining the Predictions of Any Classifier](https://mlsanity.com/paper/1602.04938/) (2016)
- [Training data-efficient image transformers & distillation through attention](https://mlsanity.com/paper/2012.12877/) (2020)
- [RISE: Randomized Input Sampling for Explanation of Black-box Models](https://mlsanity.com/paper/1806.07421/) (2018)
- [Quantifying Attention Flow in Transformers](https://mlsanity.com/paper/2005.00928/) (2020)
- [Transformer Interpretability Beyond Attention Visualization](https://mlsanity.com/paper/2012.09838/) (2020)
- [Towards Evaluating Explanations of Vision Transformers for Medical Imaging](https://mlsanity.com/paper/2304.06133/) (2023)
- [Explainability of Vision Transformers: A Comprehensive Review and New Perspectives](https://mlsanity.com/paper/2311.06786/) (2023)

## Built on by (most cited first, 4 of 4)

- [Toward Aristotelian Medical Representations: Backpropagation-Free Layer-wise Analysis for Interpretable Generalized Metric Learning on MedMNIST](https://mlsanity.com/paper/2604.06017/) (2026)
- [CLARiTy: A Vision Transformer for Multi-Label Classification and Weakly-Supervised Localization of Chest X-ray Pathologies](https://mlsanity.com/paper/2512.16700/) (2025)
- [UbiQVision: Quantifying Uncertainty in XAI for Image Recognition](https://mlsanity.com/paper/2512.20288/) (2025)
- [Faithful Faithfulness Evaluations: Challenges & Pitfalls Learned from a Breast MRI Case Study](https://mlsanity.com/paper/2609.25978/) (2026)

## Abstract (arXiv)

Understanding model decisions is crucial in medical imaging, where interpretability directly impacts clinical trust and adoption. Vision Transformers (ViTs) have demonstrated state-of-the-art performance in diagnostic imaging; however, their complex attention mechanisms pose challenges to explainability. This study evaluates the explainability of different Vision Transformer architectures and pre-training strategies - ViT, DeiT, DINO, and Swin Transformer - using Gradient Attention Rollout and Grad-CAM. We conduct both quantitative and qualitative analyses on two medical imaging tasks: peripheral blood cell classification and breast ultrasound image classification. Our findings indicate that DINO combined with Grad-CAM offers the most faithful and localized explanations across datasets. Grad-CAM consistently produces class-discriminative and spatially precise heatmaps, while Gradient Attention Rollout yields more scattered activations. Even in misclassification cases, DINO with Grad-CAM highlights clinically relevant morphological features that appear to have misled the model. By improving model transparency, this research supports the reliable and explainable integration of ViTs into critical medical diagnostic workflows.