Title: Transparent and Clinically Interpretable AI for Lung Cancer Detection in Chest X-Rays

Abstract: The rapidly advancing field of Explainable Artificial Intelligence (XAI) aims to tackle the issue of trust regarding the use of complex black-box deep learning models in real-world applications. Existing post-hoc XAI techniques have recently been shown to have poor performance on medical data, producing unreliable explanations which are infeasible for clinical use. To address this, we propose an ante-hoc approach based on concept bottleneck models which introduces for the first time clinical concepts into the classification pipeline, allowing the user valuable insight into the decision-making process. On a large public dataset of chest X-rays and associated medical reports, we focus on the binary classification task of lung cancer detection. Our approach yields improved classification performance in lung cancer detection when compared to baseline deep learning models (F1 > 0.9), while also generating clinically relevant and more reliable explanations than existing techniques. We evaluate our approach against post-hoc image XAI techniques LIME and SHAP, as well as CXR-LLaVA, a recent textual XAI tool which operates in the context of question answering on chest X-rays.