| Summary: | Abstract Background Deep learning has demonstrated significant advancements across various domains. However, its implementation in specialized areas, such as medical settings, remains approached with caution. In these high-stake environments, understanding the model's decision-making process is critical. This study assesses the performance of different pretrained Bidirectional Encoder Representations from Transformers (BERT) models and delves into understanding its decision-making within the context of medical image protocol assignment. Methods Four different pre-trained BERT models (BERT, BioBERT, ClinicalBERT, RoBERTa) were fine-tuned for the medical image protocol classification task. Word importance was measured by attributing the classification output to every word using a gradient-based method. Subsequently, a trained radiologist reviewed the resulting word importance scores to assess the model’s decision-making process relative to human reasoning. Results The BERT model came close to human performance on our test set. The BERT model successfully identified relevant words indicative of the target protocol. Analysis of important words in misclassifications revealed potential systematic errors in the model. Conclusions The BERT model shows promise in medical image protocol assignment by reaching near human level performance and identifying key words effectively. The detection of systematic errors paves the way for further refinements to enhance its safety and utility in clinical settings.
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