# Uncertainty-Calibrated Explainable Artificial Intelligence for Fetal Ultrasound Plane Classification: A Systematic Review

arXiv: https://arxiv.org/abs/2601.00990 · HTML: https://mlsanity.com/paper/2601.00990/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 27 of its 73 references that are in the map.
- First posted on arXiv 2 Jan 2026.

## Builds on (most cited first, 27 of 27)

- [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)
- [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)
- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Dropout as a Bayesian Approximation: Representing Model Uncertainty in Deep Learning](https://mlsanity.com/paper/1506.02142/) (2015)
- [Simple and Scalable Predictive Uncertainty Estimation using Deep Ensembles](https://mlsanity.com/paper/1612.01474/) (2016)
- [What Uncertainties Do We Need in Bayesian Deep Learning for Computer Vision?](https://mlsanity.com/paper/1703.04977/) (2017)
- [Interpretability Beyond Feature Attribution: Quantitative Testing with Concept Activation Vectors (TCAV)](https://mlsanity.com/paper/1711.11279/) (2017)
- [Can You Trust Your Model's Uncertainty? Evaluating Predictive Uncertainty Under Dataset Shift](https://mlsanity.com/paper/1906.02530/) (2019)
- [Sanity Checks for Saliency Maps](https://mlsanity.com/paper/1810.03292/) (2018)
- [Concept Bottleneck Models](https://mlsanity.com/paper/2007.04612/) (2020)
- [Grad-CAM++: Improved Visual Explanations for Deep Convolutional Networks](https://mlsanity.com/paper/1710.11063/) (2017)
- [Selective Classification for Deep Neural Networks](https://mlsanity.com/paper/1705.08500/) (2017)
- [This Looks Like That: Deep Learning for Interpretable Image Recognition](https://mlsanity.com/paper/1806.10574/) (2018)
- [Evidential Deep Learning to Quantify Classification Uncertainty](https://mlsanity.com/paper/1806.01768/) (2018)
- [Score-CAM: Score-Weighted Visual Explanations for Convolutional Neural Networks](https://mlsanity.com/paper/1910.01279/) (2019)
- [Confounding variables can degrade generalization performance of radiological deep learning models](https://mlsanity.com/paper/1807.00431/) (2018)
- [Disparities in Dermatology AI: Assessments Using Diverse Clinical Images](https://mlsanity.com/paper/2111.08006/) (2021)
- [Use HiResCAM instead of Grad-CAM for faithful explanations of convolutional neural networks](https://mlsanity.com/paper/2011.08891/) (2020)
- [SonoNet: Real-Time Detection and Localisation of Fetal Standard Scan Planes in Freehand Ultrasound](https://mlsanity.com/paper/1612.05601/) (2016)
- [USFM: A Universal Ultrasound Foundation Model Generalized to Tasks and Organs towards Label Efficient Image Analysis](https://mlsanity.com/paper/2401.00153/) (2023)
- [A Review on Deep-Learning Algorithms for Fetal Ultrasound-Image Analysis](https://mlsanity.com/paper/2201.12260/) (2022)
- [Automatic Probe Movement Guidance for Freehand Obstetric Ultrasound](https://mlsanity.com/paper/2007.04480/) (2020)
- [Towards Evaluating Explanations of Vision Transformers for Medical Imaging](https://mlsanity.com/paper/2304.06133/) (2023)
- [Generalisability of fetal ultrasound deep learning models to low-resource imaging settings in five African countries](https://mlsanity.com/paper/2209.09610/) (2022)

## Abstract (arXiv)

Fetal ultrasound is the cornerstone of antenatal care, and accurate recognition of a small set of standard anatomical planes underpins biometry, growth surveillance, and detection of structural anomalies. Deep learning classifiers now match or exceed expert accuracy on curated benchmarks, but most remain opaque and miscalibrated, leaving clinicians without the calibrated confidence or faithful explanations needed for safe decision support. We systematically reviewed 78 studies published between January 1, 2015 and April 30, 2026 that paired automated fetal plane classification with explainability or predictive uncertainty quantification, following PRISMA 2020. Pooled balanced accuracy across six standard planes was 0.93 (95% CI 0.91 to 0.95), but only 19 studies (24%) reported calibration and 14 (18%) reported selective prediction. We propose CALIB-XFUS, a 22-item reporting framework that operationalises calibration, explanation faithfulness, and fairness for regulated fetal ultrasound artificial intelligence. The framework spans six domains: clinical task and indication for use; dataset provenance and representativeness; model and training pipeline; calibration and selective prediction; explanation faithfulness and clinician validation; and post-market surveillance. We argue that uncertainty-calibrated, faithfully explained, and fairness-audited fetal ultrasound AI is now both technically feasible and regulatorily expected under the FDA Good Machine Learning Practice principles and the EU AI Act high-risk obligations.