Explaining deep neural networks for knowledge discovery in electrocardiogram analysis

Steven A. Hicks*, Jonas L. Isaksen, Vajira Thambawita, Jonas Ghouse, Gustav Ahlberg, Allan Linneberg, Niels Grarup, Inga Strümke, Christina Ellervik, Morten Salling Olesen, Torben Hansen, Claus Graff, Niels-Henrik Holstein-Rathlou, Pål Halvorsen, Mary M. Maleckar, Michael A. Riegler, Jørgen K. Kanters


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Deep learning-based tools may annotate and interpret medical tests more quickly, consistently, and accurately than medical doctors. However, as medical doctors remain ultimately responsible for clinical decision-making, any deep learning-based prediction must necessarily be accompanied by an explanation that can be interpreted by a human. In this study, we present an approach, called ECGradCAM, which uses attention maps to explain the reasoning behind AI decision-making and how interpreting these explanations can be used to discover new medical knowledge. Attention maps are visualizations of how a deep learning network makes, which may be used in the clinic to aid diagnosis, and in research to identify novel features and characteristics of diagnostic medical tests. Here, we showcase the use of ECGradCAM attention maps using a novel deep learning model capable of measuring both amplitudes and intervals in 12-lead electrocardiograms.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis work is funded in part by Novo Nordisk Foundation project number NNF18CC0034900.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:We confirm that all experiments were performed in accordance with Helsinki guidelines and regulations of the Danish Regional Committees for Medical and Health Research Ethics. The data studies were approved by the ethical committee of Region Zealand (SJ-113, SJ-114, SJ-191), ethical committee of Copenhagen Amt (KA 98 155). All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesThe data is not available to the public.
TidsskriftScientific Reports
Udgave nummer1
StatusUdgivet - 2021


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  • Explaining deep neural networks for knowledge discovery in electrocardiogram analysis

    Hicks, S. A., Isaksen, J. L., Thambawita, V., Ghouse, J., Ahlberg, G., Linneberg, A., Grarup, N., Strümke, I., Ellervik, C., Olesen, M. S., Hansen, T., Graff, C., Holstein-Rathlou, N-H., Halvorsen, P., Maleckar, M. M., Riegler, M. A. & Kanters, J. K., 2021, I: Scientific Reports. 11, 1, 10949 .

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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    23 Citationer (Scopus)
    32 Downloads (Pure)