Recent developments in research on artificial intelligence (AI) in medicine deal with the analysis of image data such as Magnetic Resonance Imaging (MRI) scans to support the of decision-making of medical personnel. For this purpose, machine learning (ML) algorithms are often used, which do not explain the internal decision-making process at all. Thus, it is often difficult to validate or interpret the results of the applied AI methods. This manuscript aims to overcome this problem by using methods of explainable AI (XAI) to interpret the decision-making of an ML algorithm in the use case of predicting the survival rate of patients with brain tumors based on MRI scans. Therefore, we explore the analysis of brain images together with survival data to predict survival in gliomas with a focus on improving the interpretability of the results. Using the Brain Tumor Segmentation dataset BraTS 2020, we used a well-validated dataset for evaluation and relied on a convolutional neural network structure to improve the explainability of important features by adding Shapley overlays. The trained network models were used to evaluate SHapley Additive exPlanations (SHAP) directly and were not optimized for accuracy. The resulting overfitting of some network structures is therefore seen as a use case of the presented interpretation method. It is shown that the network structure can be validated by experts using visualizations, thus making the decision-making of the method interpretable. Our study highlights the feasibility of combining explainers with 3D voxels and also the fact that the interpretation of prediction results significantly supports the evaluation of results. The implementation in python is available on gitlab as “XAIforBrainImgSurv”.
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