CheXplain: Enabling Physicians to Explore and Understand Data-Driven, AI-Enabled Medical Imaging Analysis
Open accessAbstract
The recent development of data-driven AI promises to automate medical diagnosis; however, most AI functions as 'black boxes' to physicians with limited computational knowledge. Using medical imaging as a point of departure, we conducted three iterations of design activities to formulate CheXplain — a system that enables physicians to explore and understand AI-enabled chest X-ray analysis: (i) a paired survey between referring physicians and radiologists reveals whether, when, and what kinds of explanations are needed; (ii) a low-fidelity prototype co-designed with three physicians formulates eight key features; and (iii) a high-fidelity prototype evaluated by another six physicians provides detailed summative insights on how each feature enables the exploration and understanding of AI. We summarize by discussing recommendations for future work to design and implement explainable medical AI systems that encompass four recurring themes: motivation, constraint, explanation, and justification.
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Xie et al. showed that XAI provides implications for how physicians can explore and understand data-driven, AI-enabled medical imaging analysis to assist physicians in the medical decision-making process.
“They showed that XAI provides implications for how physicians can explore and understand data-driven, AIenabled medical imaging analysis to assist physicians in the medical decision-making process.”
From Current Challenges and Future Opportunities for XAI in Machine Learning-Based Clinical Decision Support Systems: A Systematic Review (2021) · cites this paper as [116]
XAI could help the user understand when to trust a model and why an error may occur.
“XAI could help the user understand when to trust a model and why an error may occur [97,116].”
From Current Challenges and Future Opportunities for XAI in Machine Learning-Based Clinical Decision Support Systems: A Systematic Review (2021) · cites this paper as [116]
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Corti, L., Oltmans, R., Jung, J., Balayn, A., Wijsenbeek, M. S., & Yang, J. (2024) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3613904.3642551 · Cited by 24 · see citing works
Suresh, H., Lewis, K. M., Guttag, J. V., & Satyanarayan, A. (2022) · ACM International Conference on Intelligent User Interfaces (IUI) · doi:10.1145/3490099.3511160 · Cited by 22 · see citing works
How Can We Develop Explainable Systems? Insights from a Literature Review and an Interview Study
Chazette, L., Klünder, J., Balci, M., & Schneider, K. A. (2022) · doi:10.1145/3529320.3529321 · Cited by 21 · see citing works
Investigation of a Web-Based Explainable AI Screening for Prolonged Grief Disorder
She, W. J., Ang, C. S., Neimeyer, R. A., Burke, L. A., Zhang, Y., Jatowt, A., Kawai, Y., Hu, J., Rauterberg, M., Prigerson, H. G., et al. (2022) · IEEE Access · doi:10.1109/access.2022.3163311 · Cited by 25 · see citing works
Okolo, C. T., Agarwal, D., Dell, N. L., & Vashistha, A. (2024) · Proceedings of the ACM on Human-Computer Interaction · doi:10.1145/3637348 · Cited by 21 · see citing works
Benjamin, J. J., Kinkeldey, C., Müller-Birn, C., Korjakow, T., & Herbst, E.-M. (2022) · Proceedings of the ACM on Human-Computer Interaction · doi:10.1145/3492858 · Cited by 19 · see citing works
de Belen, R. A. J., Bednarz, T. P., & Sowmya, A. (2021) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/3411763.3451784 · Cited by 19 · see citing works
Comparing Zealous and Restrained AI Recommendations in a Real-World Human-AI Collaboration Task
Xu, C., Lien, K.-C., & Höllerer, T. (2023) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3544548.3581282 · Cited by 18 · see citing works
XAlgo: a Design Probe of Explaining Algorithms’ Internal States via Question-Answering
Rebanal, J., Combitsis, J., Tang, Y.-Q., & Chen, X. '. (2021) · International Conference on Intelligent User Interfaces · doi:10.1145/3397481.3450676 · Cited by 20 · see citing works
Self-citationSpataru, A., van Dommelen, P., Arnaud, L., Masne, Q. L., Quarteroni, S., & Koledova, E. B. (2022) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-022-01918-2 · Cited by 18 · see citing works
Question-Driven Design Process for Explainable AI User Experiences
Liao, Q. V., Pribić, M., Han, J., Miller, S., & Sow, D. (2021) · arXiv · doi:10.48550/arxiv.2104.03483 · Cited by 18 · see citing works
Trustworthy machine learning for health care
Pandl, K. D., Feiland, F., Thiebes, S., & Sunyaev, A. (2021) · ACM Conference on Health, Inference, and Learning (CHIL) · doi:10.1145/3450439.3451861 · Cited by 16 · see citing works
Artificial Intelligence in Ischemic Heart Disease Prevention
Parsa, S., Shah, P., Doijad, R., & Rodríguez, F. (2025) · Current Cardiology Reports · doi:10.1007/s11886-025-02203-0 · Cited by 17 · see citing works
Rädsch, T., Eckhardt, S., Leiser, F., Pandl, K. D., Thiebes, S., & Sunyaev, A. (2021) · Hawaii International Conference on System Sciences (HICSS) · doi:10.24251/hicss.2021.157 · Cited by 15 · see citing works
Ferreira, J. J., & Monteiro, M. D. S. (2021) · arXiv (Cornell University) · doi:10.48550/arxiv.2102.05460 · Cited by 15 · see citing works
How do People Perceive the Role of AI in Human-AI Collaboration to Solve Everyday Tasks?
Papachristos, E., Skov Johansen, P., Møberg Jacobsen, R., Bjørn Leer Bysted, L., & Skov, M. B. (2021) · CHI Greece 2021: 1st International Conference of the ACM Greek SIGCHI Chapter · doi:10.1145/3489410.3489420 · Cited by 15 · see citing works
Knowledge Workers' Perspectives on AI Training for Responsible AI Use
Zhang, A., & Lee, M. K. (2025) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3706598.3714100 · Cited by 17 · see citing works
3DPFIX: Improving Remote Novices' 3D Printing Troubleshooting through Human-AI Collaboration Design
Kwon, N., Sun, T., Gao, Y., Zhao, L., Wang, X., Kim, J., & Hong, S.-S. (2024) · Proceedings of the ACM on Human-Computer Interaction · doi:10.1145/3637288 · Cited by 13 · see citing works
Guo, G., Deng, L., Tandon, A. A., Endert, A., & Kwon, B. C. (2024) · ACM Conference on Fairness, Accountability, and Transparency (FAccT) · doi:10.1145/3630106.3659011 · Cited by 13 · see citing works
Radiology Report Annotation Using Generative Large Language Models: Comparative Analysis
Altalla’, B., Ahmad, A., Bitar, L., Al-Bssol, M. O., Al‐Omari, A., & Sultan, I. Y. (2025) · International Journal of Biomedical Imaging · doi:10.1155/ijbi/5019035 · Cited by 13 · see citing works
Saßmannshausen, S. M., Ontika, N. N., de Carvalho, A. F. P., Rouncefield, M., & Pipek, V. (2024) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3613904.3642362 · Cited by 13 · see citing works
"It depends": Configuring AI to Improve Clinical Usefulness Across Contexts
Zając, H. D., Ribeiro, J., Ingala, S., Gentile, S., Wanjohi, R., Gitau, S. N., Carlsen, J. F., Nielsen, M. B., & Andersen, T. O. (2024) · Designing Interactive Systems Conference · doi:10.1145/3643834.3660707 · Cited by 14 · see citing works
Do Humans Trust Advice More if it Comes from AI? An Analysis of Human-AI Interactions
Vodrahalli, K., Daneshjou, R., Gerstenberg, T., & Zou, J. (2021) · arXiv · doi:10.48550/arxiv.2107.07015 · Cited by 16 · see citing works
ContractMind: Trust-calibration interaction design for AI contract review tools
Zeng, J., Chen, K., Wang, R., Li, Y., Fan, M., Wu, K., Qi, X., & Wang, L. (2024) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2024.103411 · Cited by 16 · see citing works
Xu, Y., Shao, Y., Dong, J., Shi, S., Jiang, C., & Li, Q. (2025) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3706598.3713772 · Cited by 13 · see citing works
Brachman, M., Pan, Q., Do, H. J., Dugan, C., Chaudhary, A., Johnson, J. M., Rai, P., Chakraborti, T., Gschwind, T., Laredo, J. A., et al. (2023) · Proceedings of the 28th International Conference on Intelligent User Interfaces · doi:10.1145/3581641.3584088 · Cited by 11 · see citing works
Turri, V., Morrison, K., Robinson, K.-M., Abidi, C., Perer, A., Forlizzi, J., & Dzombak, R. (2024) · The 2024 ACM Conference on Fairness, Accountability, and Transparency · doi:10.1145/3630106.3658985 · Cited by 10 · see citing works
Adjusting Amount of AI Explanation for Visual Tasks
Maehigashi, A., Fukuchi, Y., & Yamada, S. (2024) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/3613905.3650802 · Cited by 10 · see citing works
Zając, H. D., Andersen, T. O., Kwasa, E., Wanjohi, R., Onyinkwa, M. K., Mwaniki, E. K., Gitau, S. N., Yaseen, S. S., Carlsen, J. F., Fraccaro, M., et al. (2025) · ACM Transactions on Computer-Human Interaction · doi:10.1145/3715115 · Cited by 12 · see citing works
Explainable emphysema detection on chest radiographs with deep learning
Çallı, E., Murphy, K., Scholten, E. T., Schalekamp, S., & van Ginneken, B. (2022) · PLoS ONE · doi:10.1371/journal.pone.0267539 · Cited by 10 · see citing works
Trust in Clinical AI: Expanding the Unit of Analysis
Browne, J., Bakker, S., Yu, B., Lloyd, P. A., & Allouch, S. B. (2022) · Frontiers in artificial intelligence and applications · doi:10.3233/faia220192 · Cited by 10 · see citing works
Balayn, A., Rikalo, N., Yang, J., & Bozzon, A. (2023) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3544548.3581555 · Cited by 10 · see citing works
Magboo, M. S. A., & Magboo, V. P. C. (2022) · Procedia Computer Science · doi:10.1016/j.procs.2022.09.195 · Cited by 10 · see citing works
AI-CDSS Design Guidelines and Practice Verification
He, X., Xi, Z., Ding, H., Liu, Y., & Zhu, H. (2023) · International Journal of Human-Computer Interaction · doi:10.1080/10447318.2023.2235882 · Cited by 9 · see citing works
Enabling Multi-modal Conversational Interface for Clinical Imaging
Dayanandan, K., & Lall, B. (2024) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/3613905.3650805 · Cited by 9 · see citing works
Yarmand, M., Chen, C., Cheng, K., Murphy, J. D., & Weibel, N. (2024) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3613904.3642453 · Cited by 9 · see citing works
Meaningful Transparency for Clinicians: Operationalising HCXAI Research with Gynaecologists
Schor, B. G. S., Kallina, E., Singh, J. P., & Blackwell, A. F. (2024) · ACM Conference on Fairness, Accountability, and Transparency (FAccT) · doi:10.1145/3630106.3658971 · Cited by 10 · see citing works
Zhang, T., Chung, T. A., Dey, A. K., & Bae, S. W. (2024) · International Conference on Activity and Behavior Computing (ABC) · doi:10.1109/abc61795.2024.10652070 · Cited by 10 · see citing works
Visual-Conversational Interface for Evidence-Based Explanation of Diabetes Risk Prediction
Samimi, R., Bhattacharya, A., Gosak, L., Štiglic, G., & Verbert, K. (2025) · ACM Conference on Conversational User Interfaces (CUI) · doi:10.1145/3719160.3736616 · Cited by 10 · see citing works
General Roadmap and Core Steps for the Development of AI Tools in Digital Pathology
Makhlouf, Y., Salto‐Tellez, M., James, J. A., O’Reilly, P. G., & Maxwell, P. (2022) · Diagnostics · doi:10.3390/diagnostics12051272 · Cited by 9 · see citing works
Understanding the User Perception and Experience of Interactive Algorithmic Recourse Customization
Koh, S., Kim, B. H., & Jo, S. (2024) · ACM Transactions on Computer-Human Interaction · doi:10.1145/3674503 · Cited by 8 · see citing works
Generating Descriptive Explanations of Machine Learning Models Using LLM
Pang, A., Jang, H., & Fang, S. (2024) · IEEE International Conference on Big Data (BigData) · doi:10.1109/bigdata62323.2024.10825667 · Cited by 8 · see citing works
The Situated, Relational, and Evolving Nature of Epilepsy Diagnosis
Marathe, M., & Toyama, K. (2021) · Proceedings of the ACM on Human-Computer Interaction · doi:10.1145/3432916 · Cited by 8 · see citing works
ScrutinAI: A visual analytics tool supporting semantic assessments of object detection models
Haedecke, E., Möck, M., & Akila, M. (2023) · Computers & Graphics · doi:10.1016/j.cag.2023.06.010 · Cited by 8 · see citing works
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Hamam, H. (2024) · Computing and artificial intelligence. · doi:10.59400/cai.v2i1.416 · Cited by 8 · see citing works
Mastrianni, A., Kim, M. S., Sullivan, T. M., Sippel, G. J., Burd, R. S., Gajos, K. Z., & Sarcevic, A. (2025) · Proceedings of the ACM on Human-Computer Interaction · doi:10.1145/3757512 · Cited by 6 · see citing works
“During resuscitations, a team of providers stabilizes and evaluates the patient before determining a treatment plan and transporting the patient to their next destination in the hospital.”
MR Microsurgical Suture Training System with Level-Appropriate Support
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Füßl, A., & Nissen, V. (2025) · Requirements Engineering · doi:10.1007/s00766-025-00437-6 · Cited by 6 · see citing works
OPG-SHAP: A Dental AI Tool for Explaining Learned Orthopantomogram Image Recognition
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Human-Centered AI for Medical Imaging
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Explainable AI for medical image analysis
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AF’fective Design: Supporting Atrial Fibrillation Post-treatment with Explainable AI
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- Authors
- Xie, Y., Chen, M., Kao, D., Gao, G., & Chen, X. '.
- Affiliations
- University of California, Los Angeles (US)
- University of Maryland, College Park (US)
- Venue
- Proceedings of the 2020 CHI Conference on Human Factors in Computing Systems
- Publisher
- ACM
- Published
- 2020-04-21
- Pages
- 1-13
- OpenAlex
- W2999134777
- Cited by
- 141
- References
- 40
- Citations by year
- 2026: 15 · 2025: 27 · 2024: 35 · 2023: 17 · 2022: 27 · 2021: 20
- FWCI
- 6.10
- Type
- conference paper
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- CHI Conference on Human Factors in Computing Systems (publishedVersion)
- arXiv (Cornell University) (submittedVersion)
- arXiv (Cornell University)
- Funders
- NSF (IIS-1850183)
- Topics
- Physical Sciences › Computer Science › Artificial Intelligence › Explainable Artificial Intelligence (XAI)
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › COVID-19 diagnosis using AI
- Keywords
- explainable AI, chest X-ray interpretation, diagnostic imaging, radiologists, automated medical diagnosis, prototype testing, clinical decision support
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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.
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