# SAIL: Structure-Aware Interpretable Learning for Anatomy-Aligned Post-hoc Explanations in OCT

arXiv: https://arxiv.org/abs/2605.02707 · HTML: https://mlsanity.com/paper/2605.02707/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 22 of its 75 references that are in the map.
- First posted on arXiv 4 May 2026.

## Builds on (most cited first, 22 of 22)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [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)
- [Fully Convolutional Networks for Semantic Segmentation](https://mlsanity.com/paper/1411.4038/) (2014)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [Grad-CAM++: Improved Visual Explanations for Deep Convolutional Networks](https://mlsanity.com/paper/1710.11063/) (2017)
- [Attention is not Explanation](https://mlsanity.com/paper/1902.10186/) (2019)
- [Quantifying Attention Flow in Transformers](https://mlsanity.com/paper/2005.00928/) (2020)
- [Transformer Interpretability Beyond Attention Visualization](https://mlsanity.com/paper/2012.09838/) (2020)
- [Interpretable Explanations of Black Boxes by Meaningful Perturbation](https://mlsanity.com/paper/1704.03296/) (2017)
- [Visual Transformers: Token-based Image Representation and Processing for Computer Vision](https://mlsanity.com/paper/2006.03677/) (2020)
- [CE-Net: Context Encoder Network for 2D Medical Image Segmentation](https://mlsanity.com/paper/1903.02740/) (2019)
- [Layer-wise Relevance Propagation for Neural Networks with Local Renormalization Layers](https://mlsanity.com/paper/1604.00825/) (2016)
- [From Attribution Maps to Human-Understandable Explanations through Concept Relevance Propagation](https://mlsanity.com/paper/2206.03208/) (2022)
- [Ground Truth Evaluation of Neural Network Explanations with CLEVR-XAI](https://mlsanity.com/paper/2003.07258/) (2020)
- [Use HiResCAM instead of Grad-CAM for faithful explanations of convolutional neural networks](https://mlsanity.com/paper/2011.08891/) (2020)
- [ReLayNet: Retinal Layer and Fluid Segmentation of Macular Optical Coherence Tomography using Fully Convolutional Network](https://mlsanity.com/paper/1704.02161/) (2017)
- [A Feature Transfer Enabled Multi-Task Deep Learning Model on Medical Imaging](https://mlsanity.com/paper/1906.01828/) (2019)
- [Demystifying Deep Learning Models for Retinal OCT Disease Classification using Explainable AI](https://mlsanity.com/paper/2111.03890/) (2021)
- [The Eye as a Window to Systemic Health: A Survey of Retinal Imaging from Classical Techniques to Oculomics](https://mlsanity.com/paper/2505.04006/) (2025)

## Abstract (arXiv)

Optical coherence tomography (OCT), a commonly used retinal imaging modality, plays a central role in retinal disease diagnosis by providing high-resolution visualization of retinal layers. While deep learning (DL) has achieved expert-level accuracy in OCT-based retinal disease detection, its "black box" nature poses challenges for clinical adoption, where explainability is essential for clinical trust and regulatory approval. Existing post-hoc explainable AI (XAI) methods often struggle to delineate fine-grained lesion structures, respect anatomical boundaries, or suppress noise, limiting the trustworthiness of their explanations. To bridge these gaps, we propose a Structure-Aware Interpretable Learning (SAIL) framework that integrates retinal anatomical priors at the representation level and couples them with semantic features via a fusion design. Without modifying standard post-hoc explainability methods, this representation yields sharper and more anatomically aligned attribution maps. Comprehensive experiments on diverse OCT datasets demonstrate that our structure-aware method consistently enhances interpretability, producing clinically meaningful and anatomy-aware explanations. Ablation studies further show that strong interpretability requires both structural priors and semantic features, and that properly fusing the two is critical to achieve the best explanation quality. Together, these results highlight structure-aware representations as a key step toward reliable explainability in OCT.