Unveiling the black box: A systematic review of Explainable Artificial Intelligence in medical image analysis

This systematic literature review examines state-of-the-art Explainable Artificial Intelligence (XAI) methods applied to medical image analysis, discussing current challenges and future research directions, and exploring evaluation metrics used to assess XAI approaches. With the growing efficiency of Machine Learning (ML) and Deep Learning (DL) in medical applications, there's a critical need for adoption in healthcare. However, their "black-box" nature, where decisions are made without clear explanations, hinders acceptance in clinical settings where decisions have significant medicolegal consequences. Our review highlights the advanced XAI methods, identifying how they address the need for transparency and trust in ML/DL decisions. We also outline the challenges faced by these methods and propose future research directions to improve XAI in healthcare. This paper aims to bridge the gap between cutting-edge computational techniques and their practical application in healthcare, nurturing a more transparent, trustworthy, and effective use of AI in medical settings. The insights guide both research and industry, promoting innovation and standardisation in XAI implementation in healthcare.