Explainable and reliable kidney CT image classification using self-supervised DeiT-Tiny transformer.

Introduction: Kidney-related disorders are one of the global health concerns that require timely detection to prevent severe health complications. The use of computed tomography (CT) images for accurate classification of kidney diseases is important. However, it is challenging to differentiate between classes due to the subtle visual differences. This study introduces a novel two-stage deep learning architecture that integrates self-supervised representation learning with supervised classification for kidney CT image analysis using a publicly available kidney CT image dataset. Methods: In the first stage, the DINO framework with a Data-efficient Image Transformer (DeiT-Tiny) backbone is used to learn useful features from kidney CT images independent of labels. In the second stage, the pre-trained model is fine-tuned using labeled data to classify kidney abnormalities. To ensure model transparency and clinical trustworthiness, two explainable AI techniques are applied. Grad-CAM++ is used to highlight important regions contributing to predictions in kidney CT images. In addition, DINO's inherent multi-head self-attention mechanism is analyzed across all attention heads to capture diverse attention patterns. Results and discussion: Experimental findings indicate that the proposed framework achieves strong classification performance, with a test accuracy of 99.16%, AUC-ROC of 99.99%, F1 score of 98.97%, precision of 98.90%, and recall of 99.05%, while also providing clear interpretability for automated kidney disease classification. External validation on a CT dataset from Iraq has yielded 97.03% accuracy, supporting the generalizability of the proposed framework.