Cited by 372Explainable Artificial Intelligence (XAI)Artificial Intelligence in Healthcare and EducationMachine Learning in Healthcare

The DOI matches its Crossref record; 219 of the 219 references it cites were found in a registry or an index; 5 of the 77 sources its claims cite were checked for support.

Explainable, trustworthy, and ethical machine learning for healthcare: A survey

Open access
Rasheed, Khansa, Qayyum, Adnan, Ghaly, Mohammed, Al-Fuqaha, Ala, Razi, Adeel, Qadir, Junaid·2022·Computers in Biology and Medicine

Published version of a preprint

Abstract

With the advent of machine learning (ML) and deep learning (DL) empowered applications for critical applications like healthcare, the questions about liability, trust, and interpretability of their outputs are raising. The black-box nature of various DL models is a roadblock to clinical utilization. Therefore, to gain the trust of clinicians and patients, we need to provide explanations about the decisions of models. With the promise of enhancing the trust and transparency of black-box models, researchers are in the phase of maturing the field of eXplainable ML (XML). In this paper, we provided a comprehensive review of explainable and interpretable ML techniques for various healthcare applications. Along with highlighting security, safety, and robustness challenges that hinder the trustworthiness of ML, we also discussed the ethical issues arising because of the use of ML/DL for healthcare. We also describe how explainable and trustworthy ML can resolve all these ethical problems. Finally, we elaborate on the limitations of existing approaches and highlight various open research problems that require further development.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This survey reviews explainable, trustworthy, and ethical machine learning for healthcare, covering XML methods, security/robustness challenges, and bioethical issues. It proposes a development-to-deployment pipeline and argues explainability is needed to build clinician/patient trust and address ethical/legal requirements.

Key findings

  • The survey distinguishes explainability from interpretability, taxonomizes XML into intrinsic/post-hoc, model-specific/agnostic, surrogate, and visualization methods, and reviews healthcare applications of DT, rule-lists, RF, GAM, PDP, CAM/GradCAM, LRP, LIME, DeepLIFT, SHAP, SA, GBP, IG, AM, HSCNN, P2V, and EMANet.
  • It proposes a pipeline from development to deployment: data explication, data annotation, feature extraction, black-box or inherently explainable model, XML method, validation, clinical validation, and clinical implementation.
  • It identifies trustworthiness barriers including adversarial attacks, privacy breaches, distribution shifts, data imperfections, and a trade-off among accuracy, explainability, and robustness; it cites a study of 18 ImageNet classifiers showing an accuracy–robustness trade-off.
  • Ethical review covers principlism (beneficence, non-maleficence, autonomy, justice; explicability added for AI) and concerns such as imbalanced data, data bias, privacy, informed consent, and care ethics; examples include the Google Health breast cancer study accused of transparency/reproducibility violations and racial bias in healthcare spending data.

Methods

  • Design: narrative survey/review of explainable, trustworthy, and ethical ML for healthcare, with comparison tables of prior surveys and XML methods.
  • Data/sample: published literature and cited healthcare ML/XML studies; no primary dataset or new empirical experiment.
  • Analysis: thematic synthesis of XML techniques, security/safety/robustness issues, ethical frameworks, pitfalls, and future research directions.

Limitations

  • Paper-stated limitations of existing approaches: no formal definitions, lack of standardized representation and requirements, inadequate validation metrics, lack of theoretical understanding and causality, ethical constraints, and security challenges; pitfalls include explanations vulnerable to input changes, sub-optimal explanations, dependence on data/model, unclear accountability, and need for rigorous evaluation.
  • Evident: as a survey, it does not conduct a systematic search protocol, meta-analysis, or primary validation; the ethics review is explicitly selective because “Due to space availability, we will not be able to provide a comprehensive review of all the relevant publications.”

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.compbiomed.2022.106043

Cites

219 of 219 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

68 Not checked yet · 50 No basis given · 41 Own interpretation · 3 Couldn’t confirm · 1 Supported so far · accuracy not yet measured

Verify all 72 references — free account

Show all 45 claims

  • Probably not a substantial claim. 99
  • It may state two separate claims as one. 36
118 of 118
  • The paper relies on this without support.

    DL models produce more accurate results than conventional ML techniques.

    “These complex and dense DL models produce more accurate results than conventional ML techniques.”
  • The paper relies on this without support.

    Simple ML is easy to explain with less accurate results and complex DL produce more accurate results with fewer explanations due to their complex non-linear structures.

    “It is a well-known problem of XML that the simple ML is easy to explain with less accurate results and complex DL produce more accurate results with fewer explanations due to their complex non-linear structures.”
  • The paper relies on this without support.

    There is no consistency in the use of terms like feature relevance, feature importance, saliency maps, and heatmaps.

    “There is also the need for defining terms like feature relevance, feature importance, saliency maps, heatmaps, etc.As there is no consistency in the use of these terms.”
  • The paper relies on this without support.

    It is not standardized whether radiologists or neurologists are interested in visualization-based explanations.

    “However, it is not standardized yet whether the radiologists or neurologists are interested in these explanations or not.”
  • The paper relies on this without support.

    The measures to validate the quality of produced explanations are not adequate.

    “The measures to validate the quality of produced explanations are not adequate.”
  • The paper relies on this without support.

    There does not exist any standard method for measuring the quality of explained healthcare decisions.

    “There does not exist any standard method for measuring the quality of explained healthcare decisions.”
  • The paper relies on this without support.

    DL is not efficient to infer causal relations between decisions and data.

    “However, DL is not efficient to infer causal relations between decisions and data.”
  • The paper relies on this without support.

    Causal links are required for taking fair decisions.

    “These causal links are required for taking fair decisions.”
  • The paper relies on this without support.

    The excellent performance of ML/DL cannot be evidence of its safety.

    “As the excellent performance of a ML/DL cannot be evidence of its safety, which is simply the determination of how safe is the ML/DL empowered system for humans, i.e., patients.”
  • The paper relies on this without support.

    The employment of ML algorithms for clinical practice or use of patients is still distant.

    “However, the employment of these algorithms for clinical practice or the use of patients is still distant.”
  • The paper relies on this without support.

    The primary reason for the gap between healthcare ML research and clinical practice is the unexplained results of algorithms and sometimes poor performance.

    “The primary reason for this gap is the unexplained results of algorithms and sometimes the poor performance of the algorithm.”
  • The paper relies on this without support.

    Any bias in data, subjectivity, redundancy, or problem in data representation causes misleading results.

    “Any bias in the data, subjectivity, redundancy, or problem in data representation causes misleading results.”
  • The paper relies on this without support.

    If ML learns from data of patients denied medical care because of no health insurance, it will generate biased results.

    “Another example can be the data of patients who were denied to take medical care because of no health insurance.If ML learns from that data, it will generate biased results.”
  • The paper relies on this without support.

    If understandable explanations are given, a doctor is far better prepared to make a decision using these explainable models.

    “It is clear that if understandable explanations are given, a doctor is far better prepared to make a decision using these explainable models.”
  • The paper relies on this without support.

    Humans typically have foreknowledge of the problem domain, which they will use to believe or deny a prediction if they understand the explanation of results by the algorithm.

    “Humans typically have foreknowledge of the problem domain, which they will use to believe or deny a prediction if they understand the explanation of results by the algorithm.”
  • The paper relies on this without support.

    There is no definite method to calculate the properties of good quality XML methods.

    “The only limitation is that there is no definite method to calculate these properties.”
  • The paper relies on this without support.

    Healthcare has unique legal, regulatory, and ethical challenges that must be considered when integrating ML/DL into clinical settings while ensuring deployed systems are robust and free from algorithmic bias.

    “Moreover, unlike other domains, healthcare has unique challenges that involve legal, regulatory, and ethical challenges that need to be considered while integrating ML/DL based algorithms into actual clinical settings while ensuring that the deployed systems are robust and free from algorithmic bias.”
  • The paper relies on this without support.

    Data imperfections in real-world data result in biased training and increase false positives and negatives.

    “These data imperfections will eventually result in biased training and will increase the false positives and negatives.”
  • The paper relies on this without support.

    The explainability of black-box models can assure reliable and ethical use in the medical field.

    “The explainability of black-box models can assure reliable and ethical use in the medical field.”
  • The paper relies on this without support.

    Class activation maps are only applicable for a specific CNN architecture that has a dense and global averaging pooling layer after the last convolutional layer.

    “However, CAMs are only applicable for specific CNN architecture, i.e., CNN must have a dense and global averaging pooling layer after the last convolutional layer.”
  • The paper relies on this without support.

    Online healthcare websites are not always concerned about the privacy of users' data.

    “These websites also provide free data storing facility and are not always concerned about the privacy of the users' data.”
  • The paper relies on this without support.

    Explanation of ML/DL techniques is required to gain the trust of clinicians in ML/DL empowered healthcare solutions.

    “It is well established that the explanation of the ML/DL techniques is required to gain the trust of clinicians in ML/DL empowered healthcare solutions.”
  • The paper relies on this without support.

    HCI is a well-developed technique to empower users.

    “For example, humancomputer interaction (HCI) is a well-developed technique to empower users.”
  • The paper relies on this without support.

    Advancements in ML/DL techniques have a great potential to revolutionize healthcare.

    “The advancements in ML/DL techniques have a great potential to revolutionize healthcare.”
24 of 24

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

4 of 4

Citations

Cites

Show all 217 references

Research works printed but not linked: 2

  1. Betancur, 2018, Deep learning for prediction of obstructive disease from fast myocardial perfusion SPECT: a multicenter study, JACC: Cardiovasc. Imaging, 11, 1654
  2. Wierzynski, 2018, The challenges and opportunities of explainable AI, Intel. Com, 12

Cited by

Sorted by citations

Items 201–300 of 371

Metadata

Authors
Rasheed, K., Qayyum, A., Ghaly, M., Al-Fuqaha, A., Razi, A., & Qadir, J.
Affiliations
  • Information Technology University (PK)
  • Hamad bin Khalifa University (QA)
  • Canadian Institute for Advanced Research (CA)
  • Qatar University (QA)
Corresponding author
Qadir, Junaid
Venue
Computers in Biology and Medicine
Publisher
Elsevier BV
Published
2022-10
Volume
149
Pages
106043
ISSN
0010-4825 (ISSN-L)
OpenAlex
W4294839477
Cited by
372
References
217
Citations by year
2026: 77 · 2025: 134 · 2024: 104 · 2023: 43 · 2022: 11
FWCI
5.10
Type
journal article
Language
en
Open access
Locations
  • Computers in Biology and Medicine (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Figshare (submittedVersion, cc-by)
  • Qatar University QSpace (Qatar University) (submittedVersion)
Funders
  • Qatar National Research Fund
  • Qatar National Library
  • Qatar Foundation
Topics
  • Physical Sciences › Computer Science › Artificial Intelligence › Explainable Artificial Intelligence (XAI)
  • Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
  • Physical Sciences › Computer Science › Artificial Intelligence › Machine Learning in Healthcare
Keywords
explainable machine learning, model interpretability, health care, trustworthiness, ethical considerations, black-box models, clinical decision support, liability
MeSH terms
Machine Learning, Delivery of Health Care, Health Facilities, Humans, Surveys and Questionnaires

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-10-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Cited sources are checked with a language model’s help (gpt-6-sol).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review