CLEAR: An Auditable Foundation Model for Radiology Grounded in Clinical Concepts
Han, T.; Wu, R.; Tian, Y.; Khader, F.; Adams, L.; Bressem, K.; Davatzikos, C.; Kather, J. N.; Shen, L.; Mankoff, D.; Barbosa, E.; Truhn, D.
Show abstract
"Black box" deep learning models for medical image interpretation limit clinical trust and analysis of performance degradation. Here, we introduce Concept-Level Embeddings for Auditable Radiology (CLEAR), an auditable foundation model based on clinical concepts. Trained on over 0.87 million image-report pairs from 239,091 patients, CLEAR learns a visual representation and projects chest X-rays into a semantically rich space defined by large language model embeddings, making every prediction traceable to specific radiological observations. External validation on four large, physician-annotated datasets from the United States, Europe, and Asia shows that CLEAR not only achieves state-of-the-art classification performance but also enables novel applications: auditable zero-shot pathology detection, systematic identification of radiological confounders, and the creation of expert-level concept bottleneck models from data-driven concepts. By integrating clinical knowledge directly into its reasoning process, CLEAR offers a framework for robust model auditing, safer deployment, and enhanced physician-AI collaboration, advancing towards trustworthy medical AI.
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