Interpretable AI Framework for Secure and Reliable Medical Image Analysis in IoMT Systems

The integration of artificial intelligence (AI) into medical image analysis has transformed healthcare, offering unprecedented precision in diagnosis, treatment planning, and disease monitoring. However, its adoption within the Internet of Medical Things (IoMT) raises significant challenges related to transparency, trustworthiness, and security. This paper introduces a novel Explainable AI (XAI) framework tailored for Medical Cyber-Physical Systems (MCPS), addressing these challenges by combining deep neural networks with symbolic knowledge reasoning to deliver clinically interpretable insights. The framework incorporates an Enhanced Dynamic Confidence-Weighted Attention (Enhanced DCWA) mechanism, which improves interpretability and robustness by dynamically refining attention maps through adaptive normalization and multi-level confidence weighting. Additionally, a Resilient Observability and Detection Engine (RODE) leverages sparse observability principles to detect and mitigate adversarial threats, ensuring reliable performance in dynamic IoMT environments. Evaluations conducted on benchmark datasets, including CheXpert, RSNA Pneumonia Detection Challenge, and NIH Chest X-ray Dataset, demonstrate significant advancements in classification accuracy, adversarial robustness, and explainability. The framework achieves a 15% increase in lesion classification accuracy, a 30% reduction in robustness loss, and a 20% improvement in the Explainability Index compared to state-of-the-art methods.