# XAI-MeD: Explainable Knowledge Guided Neuro-Symbolic Framework for Domain Generalization and Rare Class Detection in Medical Imaging

arXiv: https://arxiv.org/abs/2601.02008 · HTML: https://mlsanity.com/paper/2601.02008/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 11 of its 36 references that are in the map.
- First posted on arXiv 5 Jan 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 11 of 11)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [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)
- [Mask R-CNN](https://mlsanity.com/paper/1703.06870/) (2017)
- [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)
- [Outrageously Large Neural Networks: The Sparsely-Gated Mixture-of-Experts Layer](https://mlsanity.com/paper/1701.06538/) (2017)
- [In Search of Lost Domain Generalization](https://mlsanity.com/paper/2007.01434/) (2020)
- [Do Vision Transformers See Like Convolutional Neural Networks?](https://mlsanity.com/paper/2108.08810/) (2021)
- [Hidden Stratification Causes Clinically Meaningful Failures in Machine Learning for Medical Imaging](https://mlsanity.com/paper/1909.12475/) (2019)
- [Unifying Neural Learning and Symbolic Reasoning for Spinal Medical Report Generation](https://mlsanity.com/paper/2004.13577/) (2020)

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

- [PARAGraph: Pathology-Anatomy-Aware Hierarchical Graph for Diabetic Retinopathy Grading](https://mlsanity.com/paper/2608.08368/) (2026)

## Abstract (arXiv)

Explainability domain generalization and rare class reliability are critical challenges in medical AI where deep models often fail under real world distribution shifts and exhibit bias against infrequent clinical conditions This paper introduces XAIMeD an explainable medical AI framework that integrates clinically accurate expert knowledge into deep learning through a unified neuro symbolic architecture XAIMeD is designed to improve robustness under distribution shift enhance rare class sensitivity and deliver transparent clinically aligned interpretations The framework encodes clinical expertise as logical connectives over atomic medical propositions transforming them into machine checkable class specific rules Their diagnostic utility is quantified through weighted feature satisfaction scores enabling a symbolic reasoning branch that complements neural predictions A confidence weighted fusion integrates symbolic and deep outputs while a Hunt inspired adaptive routing mechanism guided by Entropy Imbalance Gain EIG and Rare Class Gini mitigates class imbalance high intra class variability and uncertainty We evaluate XAIMeD across diverse modalities on four challenging tasks i Seizure Onset Zone SOZ localization from rs fMRI ii Diabetic Retinopathy grading across 6 multicenter datasets demonstrate substantial performance improvements including 6 percent gains in cross domain generalization and a 10 percent improved rare class F1 score far outperforming state of the art deep learning baselines Ablation studies confirm that the clinically grounded symbolic components act as effective regularizers ensuring robustness to distribution shifts XAIMeD thus provides a principled clinically faithful and interpretable approach to multimodal medical AI.