A multimodal slice discovery framework for systematic failure detection and explanation in medical image classification

Explainability is increasingly seen as a crucial requirement in AI-based medical diagnosis, particularly in safety-critical clinical decision-making. Most existing explainability methods in healthcare operate in a post-hoc manner and are predominantly designed for unimodal data, which limits their applicability in increasingly prevalent multimodal diagnostic settings. This paper addresses the problem of self-explainable multimodal diagnosis by formulating it within the information bottleneck (IB) framework. We propose a unified learning paradigm that jointly optimizes predictive performance and modality-specific explainability by identifying the most informative elements inside each modality that contribute to diagnostic decisions. To enable tractable and stable optimization, we employ a matrix-based Renyi's $α$-order entropy functional under the assumption of sufficiently expressive encoders. Extensive experiments on representative medical datasets spanning heterogeneous modalities demonstrate that the proposed method consistently achieves strong diagnostic performance, including an absolute accuracy improvement of 9.1 percentage points on the iCTCF dataset. Moreover, the learned explanations provide transparent and modality-aware insights into feature relevance, thereby improving both the explainability and generalization.

Multimodal Fusion Learning (MFL), leveraging disparate data from various imaging modalities (e.g., MRI, CT, SPECT), has shown great potential for addressing medical problems such as skin cancer and brain tumor prediction. However, existing MFL methods face three key limitations: a) they often specialize in specific modalities, and overlook effective shared complementary information across diverse modalities, hence limiting their generalizability for multi-disease analysis; b) they rely on computationally expensive models, restricting their applicability in resource-limited settings; and c) they lack robustness against adversarial attacks, compromising reliability in medical AI applications. To address these limitations, we propose a novel Multi-Attention Integration Learning (MAIL) network, incorporating two key components: a) an efficient residual learning attention block for capturing refined modality-specific multi-scale patterns and b) an efficient multimodal cross-attention module for learning enriched complementary shared representations across diverse modalities. Furthermore, to ensure adversarial robustness, we extend MAIL network to design Robust-MAIL by incorporating random projection filters and modulated attention noise. Extensive evaluations on 20 public datasets show that both MAIL and Robust-MAIL outperform existing methods, achieving performance gains of up to 9.34% while reducing computational costs by up to 78.3%. These results highlight the superiority of our approaches, ensuring more reliable predictions than top competitors. Code: https://github.com/misti1203/MAIL-Robust-MAIL.

This paper introduces a new benchmark test, Medical-Checklist, for assessing medical multimodal models. The recent advancements in multimodal models have demonstrated significant potential in the field of medical vision-language tasks. However, it is becoming increasingly clear that evaluating these models' performance, whether they are applied to natural or medical images, is challenging. The critical question is whether the models can accurately understand an input image while associating it with relevant input text. To address this, Medical-Checklist imposes a binary test on the models: they are given an image and two captions, where one is correct and the other incorrect, and the model must select the correct one. The incorrect caption contains a single medical concept (word or phrase) that is inaccurately substituted from the correct caption. Although the task is simple, this simplicity enables the unified assessment of diverse multimodal models designed and learned on different principles. It also enables us to verify whether models correctly understand a wide range of medical concepts across various medical sub-domains. Medical-Checklist is designed to reduce potential biases in data and to enable evaluation of the models' ability to handle out-of-distribution inputs, which were difficult in existing datasets. When evaluating four state-of-the-art medical multimodal models with Medical-Checklist, it was revealed that despite their excellent performance in specific tasks such as Med-VQA, they may not correctly understand images, suggesting a long journey ahead for clinical application. The dataset and code will be made public upon acceptance.