# Explanation-Aware Learning for Enhanced Interpretability in Biomedical Imaging

arXiv: https://arxiv.org/abs/2605.10054 · HTML: https://mlsanity.com/paper/2605.10054/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 23 of its 31 references that are in the map.
- First posted on arXiv 11 May 2026.

## Builds on (most cited first, 23 of 23)

- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [A Unified Approach to Interpreting Model Predictions](https://mlsanity.com/paper/1705.07874/) (2017)
- ["Why Should I Trust You?": Explaining the Predictions of Any Classifier](https://mlsanity.com/paper/1602.04938/) (2016)
- [Towards A Rigorous Science of Interpretable Machine Learning](https://mlsanity.com/paper/1702.08608/) (2017)
- [A Survey on Deep Learning in Medical Image Analysis](https://mlsanity.com/paper/1702.05747/) (2017)
- [Sanity Checks for Saliency Maps](https://mlsanity.com/paper/1810.03292/) (2018)
- [A Survey Of Methods For Explaining Black Box Models](https://mlsanity.com/paper/1802.01933/) (2018)
- [CheXNet: Radiologist-Level Pneumonia Detection on Chest X-Rays with Deep Learning](https://mlsanity.com/paper/1711.05225/) (2017)
- [A Survey on Explainable Artificial Intelligence (XAI): Towards Medical XAI](https://mlsanity.com/paper/1907.07374/) (2019)
- [Confounding variables can degrade generalization performance of radiological deep learning models](https://mlsanity.com/paper/1807.00431/) (2018)
- [Unmasking Clever Hans Predictors and Assessing What Machines Really Learn](https://mlsanity.com/paper/1902.10178/) (2019)
- [The (Un)reliability of saliency methods](https://mlsanity.com/paper/1711.00867/) (2017)
- [Right for the Right Reasons: Training Differentiable Models by Constraining their Explanations](https://mlsanity.com/paper/1703.03717/) (2017)
- [VinDr-CXR: An open dataset of chest X-rays with radiologist's annotations](https://mlsanity.com/paper/2012.15029/) (2020)
- [Explainable Artificial Intelligence: Understanding, Visualizing and Interpreting Deep Learning Models](https://mlsanity.com/paper/1708.08296/) (2017)
- [Interpretations are useful: penalizing explanations to align neural networks with prior knowledge](https://mlsanity.com/paper/1909.13584/) (2019)
- [What Clinicians Want: Contextualizing Explainable Machine Learning for Clinical End Use](https://mlsanity.com/paper/1905.05134/) (2019)
- [Explanation-Guided Training for Cross-Domain Few-Shot Classification](https://mlsanity.com/paper/2007.08790/) (2020)
- [Thoracic Disease Identification and Localization with Limited Supervision](https://mlsanity.com/paper/1711.06373/) (2017)
- [Deep Learning Predicts Hip Fracture using Confounding Patient and Healthcare Variables](https://mlsanity.com/paper/1811.03695/) (2018)
- [Explainable Deep Learning in Medical Imaging: Brain Tumor and Pneumonia Detection](https://mlsanity.com/paper/2510.21823/) (2025)
- [Explainability of CNN Based Classification Models for Acoustic Signal](https://mlsanity.com/paper/2509.08717/) (2025)

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

- [Spatial Supervision Without Attribution Optimization: Improving Post-Hoc Class Activation Maps via Box-Guided Evidence Routing](https://mlsanity.com/paper/2610.05891/) (2026)

## Abstract (arXiv)

Deep neural networks for medical image diagnosis often achieve high predictive accuracy while relying on spurious or clinically irrelevant visual cues, limiting their trustworthiness in practice. Post-hoc explanation methods are widely used to visualize model decisions in the form of saliency maps; however, these explanations do not influence how models learn during training, allowing non-causal or confounding features to persist. This motivates the incorporation of explanation supervision directly into the training objective to guide model attention toward clinically meaningful regions and promote clinically grounded decision-making. This paper presents a systematic approach to integrate explanation loss into model training and analyzes how different explanation loss designs and supervision strengths influence both predictive performance and spatial faithfulness of explanations. To quantitatively assess interpretability, two complementary explanation performance metrics-annotation coverage and saliency precision-are introduced, enabling rigorous evaluation beyond qualitative visualization. Our experimental results reveal a clear trade-off between explanation quality and explanation loss coefficients. Furthermore, quantitative statistical analysis yields consistently improved explanation alignment while maintaining comparable accuracy. Experiments were conducted on annotated chest X-ray datasets; however, the proposed framework is applicable to a broad range of annotated biomedical imaging modalities. Overall, these findings demonstrate that explanation supervision is not a monolithic design choice and provide practical guidance for incorporating explanation loss into training objectives under noisy clinical annotations.