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REVIEW article

Front. Radiol.

Sec. Artificial Intelligence in Radiology

Volume 5 - 2025 | doi: 10.3389/fradi.2025.1627169

Explainable AI in Medicine: Challenges of Integrating XAI into the Future Clinical Routine

Provisionally accepted
  • University of Bern, Bern, Switzerland

The final, formatted version of the article will be published soon.

Future AI systems may need to provide medical professionals with explanations of AI predictions and decisions. While current XAI methods match these requirements in principle, they are too inflexible and not sufficiently geared toward clinicians' needs to fulfill this role. This paper offers a conceptual roadmap for how XAI may be integrated into future medical practice. We identify three desiderata of increasing difficulty: First, explanations need to be provided in a context-and user-dependent manner. Second, explanations need to be created through a genuine dialogue between AI and human users. Third, AI systems need genuine social capabilities. We use an imaginary stroke treatment scenario as a foundation for our roadmap to explore how the three challenges emerge at different stages of clinical practice. We provide definitions of key concepts such as genuine dialogue and social capability, we discuss why these capabilities are desirable, and we identify major roadblocks. Our goal is to help practitioners and researchers in developing future XAI that is capable of operating as a participant in complex medical environments. We employ an interdisciplinary methodology that integrates medical XAI, medical practice, and philosophy.

Keywords: Explainable AI, Interpretability, multimodal AI, clinical applications, Philosophy of AI

Received: 12 May 2025; Accepted: 22 Jul 2025.

Copyright: © 2025 Räz, Pahud De Mortanges and Reyes. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Tim Räz, University of Bern, Bern, Switzerland

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