{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T05:27:41Z","timestamp":1766122061469,"version":"3.48.0"},"reference-count":65,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011950","name":"ITEA 3","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100011950","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["MAKE"],"abstract":"<jats:p>In this study, a structured and methodological evaluation approach for eXplainable Artificial Intelligence (XAI) methods in medical image classification is proposed and implemented using LIME and SHAP explanations for chest X-ray interpretations. The evaluation framework integrates two critical perspectives: predictive model-centered and human-centered evaluations. Predictive model-centered evaluations examine the explanations\u2019 ability to reflect changes in input and output data and the internal model structure. Human-centered evaluations, conducted with 97 medical experts, assess trust, confidence, and agreements with AI\u2019s indicative and contra-indicative reasoning as well as their changes before and after provision of explainability. Key findings of our study include explanation of sensitivity of LIME and SHAP to model changes, their effectiveness in identifying critical features, and SHAP\u2019s significant impact on diagnosis changes. Our results show that both LIME and SHAP negatively affected contra-indicative agreement. Case-based analysis revealed AI explanations reinforce trust and agreement when participant\u2019s initial diagnoses are correct. In these cases, SHAP effectively facilitated correct diagnostic changes. This study establishes a benchmark for future research in XAI for medical image analysis, providing a robust foundation for evaluating and comparing different XAI methods.<\/jats:p>","DOI":"10.3390\/make7040168","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T12:13:03Z","timestamp":1765973583000},"page":"168","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["XIMED: A Dual-Loop Evaluation Framework Integrating Predictive Model and Human-Centered Approaches for Explainable AI in Medical Imaging"],"prefix":"10.3390","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1126-3239","authenticated-orcid":false,"given":"Gizem","family":"Karagoz","sequence":"first","affiliation":[{"name":"Mathematics and Computer Science, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands"}]},{"given":"Tanir","family":"Ozcelebi","sequence":"additional","affiliation":[{"name":"Mathematics and Computer Science, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands"}]},{"given":"Nirvana","family":"Meratnia","sequence":"additional","affiliation":[{"name":"Mathematics and Computer Science, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"ref_1","first-page":"44","article-title":"DARPA\u2019s explainable artificial intelligence (XAI) program","volume":"40","author":"Gunning","year":"2019","journal-title":"AI Mag."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1038\/s42256-019-0048-x","article-title":"Stop explaining black box models for high stakes decisions and use interpretable models instead","volume":"1","author":"Rudin","year":"2019","journal-title":"Nat. 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