Amal Saqib, Tausifa Jan Saleem, Numan Saeed +1cs.CV cs.LG
Medical image segmentation models are typically trained under the assumption that all data are available simultaneously. However, in clinical practice, datasets often arrive sequentially, requiring models to adapt continuously to evolving data distributions. We study this problem in gynecological image segmentation, where substantial heterogeneity across imaging modalities, anatomical structures, and annotation protocols creates a particularly challenging continual learning setting. Under these large distribution shifts, existing continual learning methods struggle to preserve previously learned knowledge, leading to catastrophic forgetting. To better understand forgetting in this setting, we investigate how different encoder--decoder regions influence segmentation performance and forgetting during continual gynecological segmentation. Through block-wise ablation analysis, we observe that ablating early encoder and late decoder regions results in the largest performance degradation, indicating that segmentation performance depends unevenly across the network hierarchy. Using controlled adaptation experiments, we further show that forgetting remains limited when updates are restricted to bottleneck-adjacent regions, but increases sharply once shallower encoders and decoders become trainable, even when only a small subset of parameters is updated. These findings suggest that forgetting in the encoder-decoder architecture is strongly influenced by where updates occur across network depth during continual learning. Full code and analysis pipelines will be made publicly available upon acceptance.
Michail Mamalakis, Carmen Jimenez-Mesa, Yonghao Li +8cs.CV cs.LG
Brain magnetic resonance imaging (MRI) is central to neuroscience and clinical assessment, but models are commonly developed for individual diseases, populations or imaging protocols. Foundation models promise more general representations, yet they are usually pretrained once and can lose earlier capabilities when updated with new data. Here we show that Alcmaeon, a three-dimensional brain MRI foundation model pretrained without manual labels on more than 425,000 volumes and derived imaging maps, can be expanded sequentially across clinical domains. Alcmaeon combines volumetric encoding and latent diffusion generation with Graph-Blueprint Pruning (GBP), which protects network modules important to earlier domains while leaving the remaining capacity trainable. Across expansion from healthy ageing and neurodegeneration to developmental, psychiatric and tumour imaging, GBP showed less forgetting than sequential adaptation and elastic weight consolidation across voxel-level reconstruction measures, with its largest advantage after adaptation to tumour imaging. The blueprints provided an inspectable record of how model capacity was protected and reused. Representations from different model levels supported image synthesis, disease classification, survival modelling and postoperative prediction, although no single representation was optimal for every task. These findings provide a route towards brain MRI foundation models that can grow with emerging data while retaining earlier capabilities.
Continual learning in clinical imaging faces a dual challenge: a model must assimilate knowledge from new anatomical domains while retaining representations learned from prior tasks, a problem known as catastrophic forgetting. Existing mitigation strategies, including regularization and knowledge distillation, treat all spatial regions equally, ignoring the fact that prediction uncertainty is strongly correlated with the propensity for forgetting. We introduce UCBound-Net, a continual segmentation framework that exploits Monte Carlo (MC) Dropout uncertainty as a spatial proxy for forgetting risk. Our method contributes three synergistic components: (i) uncertainty-weighted boundary distillation, which amplifies the knowledge transfer signal at high-entropy regions of the frozen teacher; (ii) uncertainty-calibration regularization, which explicitly penalizes overconfident erroneous predictions; and (iii) uncertainty-guided exemplar selection, a memory buffer that preferentially stores samples whose boundary regions exhibit the highest predictive entropy. Evaluated on a sequential domain-incremental benchmark comprising breast ultrasound (BUSI, Task 1) followed by thyroid ultrasound (TN3K, Task 2), UCBound-Net reduces forgetting relative to naive fine-tuning, achieving a backward transfer (BWT) of -0.098 compared with -0.173, while obtaining an average Dice Similarity Coefficient (DSC) of 0.755 across both tasks. The proposed framework outperforms baseline methods without requiring task-boundary supervision. An ablation study further demonstrates that each component contributes independently to forgetting mitigation, providing a practical pathway toward uncertainty-aware continual learning for clinical image segmentation.
Continual learning (CL) has been recently employed in biometric identification systems thanks to its ability to integrate new knowledge within a pre-trained model and to the possibility of reducing the computational cost of training. Unfortunately, such approaches pose new challenges both in terms of final accuracy and privacy guarantees since a progressive fine-tuning of the model on small subsets expose them to catastrophic forgetting and successful inference attacks. This paper evaluates the efficiency of code division modulation layers (CDML) on a gait identification system which has been trained following a continual learning policy. The proposed approach preserves accuracy on all the tasks while mitigating membership inference attacks at the same time. Moreover, the impact of retransmission is minimized since replaying data is not necessary.
Model merging offers a practical alternative to conventional continual learning by integrating independently fine-tuned models without retaining previous training data. Recent state-of-the-art model merging methods employ test-time adaptation (TTA-guided merging) to address distribution shifts by adjusting merging-related variables using unlabeled target data. However, these methods have primarily been studied in multi-task or single-target settings, and their behavior under sequential continual learning remains insufficiently understood. We present a benchmark study that maps this family of methods to rehearsal-free continual Whole Slide Image classification and evaluates them against traditional continual-learning approaches. Experiments on six TCGA cancer-subtyping cohorts cover CLASS-IL and TASK-IL scenarios, in-domain and out-of-domain evaluation, and different task orders. The results show that adapting model merging at test time can provide strong task-specific performance and improve retention of previously acquired knowledge without storing historical WSIs. Nevertheless, performance remains sensitive to task order and to the interaction between adaptation on the current distribution and accumulated knowledge. This benchmark identifies model merging with test-time adaptation as a promising direction for continual computational pathology and motivates future methods that balance adaptation to domain shift with explicit preservation of historical knowledge.
Survival analysis on Whole Slide Images (WSIs) is important in computational pathology for prognosis estimation and treatment planning. However, existing survival models are typically trained independently for each cancer cohort, making continual adaptation computationally expensive for gigapixel-scale WSIs. In this study, we propose MergeSurv, a merging-based continual learning framework for WSI survival analysis. A pathology vision-language foundation model is independently fine-tuned on each task, and the learned parameters are sequentially merged into a unified model without storing previous training data. We further investigate two inference strategies: One-for-All (OFA) and Voting-Expert Aggregation (VEA). Experiments on four TCGA cohorts demonstrate that MergeSurv outperforms naive fine-tuning as well as representative regularization-based and rehearsal-based continual learning methods, while effectively reducing catastrophic forgetting. The results suggest that model merging is a promising direction for scalable and privacy-preserving continual learning in computational pathology.
In multi-source ECG deployment, models may need to incorporate new data sources when earlier raw ECGs cannot be retained or replayed. Freezing a pretrained backbone and assigning each source an isolated classifier prevents parameter interference, but deployment still requires selecting an expert when source metadata are unavailable. We study this distinction through \ours{}, an incremental expert bank built on frozen 1024-dimensional ECGFounder features. Each arriving domain adds a balanced-softmax linear expert, while a lightweight router is fitted only on retained training features and domain labels from sources observed so far. A validation-calibrated margin rule fuses the two most likely experts instead of committing to a single routed expert. On CPSC, PTB-XL, Georgia, and Chapman-Shaoxing, source-aware expert selection reaches $0.7915\pm0.0036$ Macro-F1 and a matched offline independent-head reference reaches $0.7885\pm0.0009$, supporting strong source-aware expert retention. Without source IDs, an MLP router reaches $0.7756\pm0.0027$ and top-2 margin fusion reaches $0.7782\pm0.0022$. The top-2 gain over hard MLP routing is small ($+0.0026$), with a 95\% confidence interval from paired bootstrap that includes zero. Across three domain orders, the top-2-to-oracle gap remains $0.0111$--$0.0133$, identifying autonomous source inference as the main remaining bottleneck. No raw ECGs are replayed, but frozen training features are retained for router updates; the method is therefore not memory-free.
Medical vision-language models (VLMs) such as BiomedCLIP generalize broadly, but adapting them to a clinical service is as much a safety problem as an accuracy one. Updating a deployed model for a new imaging modality can fail silently in two ways that harm patients: it can forget modalities it already handled (catastrophic forgetting), and it can drift from its trustworthy pretrained prior toward modality-specific shortcuts. We study parameter-efficient continual adaptation through these two properties rather than leaderboard accuracy, presenting CADRE: a frozen-backbone framework combining low-rank adaptation (LoRA) with an online, self-scaling, similarity-aware elastic weight consolidation term that bounds retained-competence loss, and an anchor-to-prior penalty bounding embedding drift from the frozen prior. Two short guarantees, a bound on total consolidation mass and a scale-invariance property, remove the scale-related sources of vanilla EWC's order fragility. Using breast cancer across three maximally dissimilar modalities (histopathology, ultrasound, chest radiography) as a controlled cross-modality stress test, under a multi-seed, multi-order protocol with paired significance testing and training approximately 0.23% of parameters, CADRE attains the highest accuracy, SPQ, and backward transfer and the lowest forgetting among adapting methods, reducing forgetting roughly sevenfold versus the strongest regularized baseline (0.075 to 0.011; paired p=0.023) and achieving positive backward transfer where every baseline is negative. We frame these as stability properties aligned with clinical-safety desiderata, not a deployment guarantee; robustness to distribution shift and adversarial inputs is out of scope.
Predictive modeling for clinical tabular data is central to clinical decision support and therefore requires not only strong predictive performance but also transparent decision logic. Although deep learning and tree-based ensemble methods can achieve high accuracy, their black-box nature remains a major obstacle to clinical deployment. This challenge is further compounded by common characteristics of medical data, including limited sample sizes, severe class imbalance, and feature evolution arising from changes in diagnostic criteria and clinical documentation. To address these issues, we propose Medical Heuristic Learning (MHL), an instantiation of the learning-beyond-gradients paradigm for clinical tabular prediction. Instead of relying on neural network weight updates, MHL uses a large language model (LLM)-driven workflow that integrates statistical probes, medical knowledge probes, rule synthesis, and code-level iterative refinement to optimize a deterministic and executable decision system. The resulting model is expressed not as opaque parameters, but as versioned pure-Python decision rules that are explicitly interpretable, fully auditable, and clinically grounded. MHL also supports continual learning by starting from previously validated rules and iteratively revising them using updated feature information under data drift or feature evolution. Comprehensive experiments on medical datasets show that MHL achieves performance comparable to state-of-the-art methods while maintaining strong behavior in small-sample and highly imbalanced settings. The results further indicate that this explicit rule update mechanism can help alleviate catastrophic forgetting under feature evolution. Overall, these findings suggest that non-gradient-based heuristic systems offer a transparent and adaptable alternative for high-stakes clinical decision support.
Ventricular tachycardia is a life-threatening rhythm disorder and a major cause of sudden cardiac death. Pace-mapping is a clinical procedure for identifying the intervention target during catheter ablation of VT. It requires clinicians to pace different sites in the ventricles and rapidly interpret the resulting electrocardiograms to determine where to pace next or whether a target site has been identified. Active learning AI models have been proposed to guide clinicians to the next pacing site, showing promise in reducing the number of pacing sites and improving the efficiency of pace-mapping. Existing methods require retraining each target without the ability to transfer knowledge across multiple VTs within the same patient or across patients. We introduce cAPM for continuous AI-assisted pace-mapping to capture and transfer knowledge accumulated from past pace-mapping data to reduce the number of pace-mapping data needed for future target VTs. This is made possible by a task-agnostic surrogate neural network that learns the mapping from pacing sites to 12-lead ECG morphology, an active-learning strategy that refines this surrogate model by selecting the most informative pacing site for each target, and a continual learning strategy to do so sequentially while retaining knowledge from prior targets. Evaluated on an in-silico testbed consisting of sequentially-presented localization tasks across different physiological conditions and ventricular geometries, cAPM with and without replay of past data samples achieved an 81% probability of localizing within clinical tolerance (5 mm accuracy) using 4.5 pace-mapping sites, compared to the state-of-the-art active-learning method achieving 38% probability using 13.7 pacing sites. These results provide a strong basis for preparing cAPM towards in-vivo preclinical and clinical studies where it can be used to guide pace-mapping.
Gait-based Parkinson's disease assessment increasingly relies on heterogeneous sensors, but clinical systems rarely collect all modalities simultaneously. New sensors may arrive through device upgrades, protocol changes, or multi-center deployment, while historical patient data are often unavailable because of privacy and storage constraints. This modality-incremental setting faces three challenges: unreliable cross-modal distillation, modality-specific statistical shifts, and reduced plasticity after preservation. We propose MOSAIC, a compact continual learning framework. First, we identify the Toxic Teacher phenomenon and introduce Modality-Specific Warm-Up to stabilize newly learned modality representations before distillation. Second, we propose a statistics-decoupled MSBN architecture that isolates sensor statistics while maintaining a shared semantic backbone. Third, we design a curriculum-guided repulsive objective for Plasticity Recovery, preserving legacy knowledge while recovering modality-specific capacity. Experiments on three multimodal Parkinson's gait datasets show that MOSAIC improves final performance and mitigates forgetting. Project code is available at: https://github.com/minlinzeng/MOSAIC_Modality-Specific-Adaptation-for-Incremental-Continual-Learning-in-PD-Gait-Assessment.git
Personalized virtual heart simulations face challenges in model personalization and computational cost. While neural surrogates offer state-of-the-art solutions, they typically address either efficient personalization or training generalizable models. Recent work reframes this by learning the process of personalizing a surrogate using limited subject-specific context data, through few-shot generative modeling with set-conditioned surrogates and meta-learned amortized inference. These methods, however, assume a static and diverse training distribution with known task identifiers. When new data becomes available, they require costly retraining with all prior data to avoid catastrophic forgetting - a phenomena where the model forgets earlier tasks when trained on new ones. This is a major limitation in clinical settings where often unlabeled data arrives sequentially and full retraining is infeasible. This paper presents a new continual meta-learning framework to achieve personalized neural surrogates able to not only continually integrate information but also identify whether incoming data stems from a known or unknown dynamics source. By leveraging a continual Bayesian Gaussian Mixture Model over a memory buffer, our framework can infer the identifiers and relationships of data over time - required for effective meta-learning. Empirical results on synthetic cardiac data demonstrate superior simulation forecasting, computational scalability, and resilience to catastrophic forgetting compared to existing baselines.
Continual learning for medical image segmentation remains challenging under domain shift because replay-based methods often preserve appearance information without explicitly modeling anatomical structure. This study investigates whether structural consistency governs knowledge retention in continual cardiac ultrasound segmentation. We propose the Boundary-Balanced Replay Network (BBR-Net), which selects replay samples using boundary-aware priority and class balance to preserve anatomically informative regions. The method is evaluated on CAMUS and CardiacNet under forward (CAMUS to CardiacNet) and reverse (CardiacNet to CAMUS) task orders. In the forward setting, BBR-Net retains source-task performance close to an offline joint-training reference, while markedly reducing catastrophic forgetting and preserving competitive target-task adaptation. Ablation results show that boundary-aware prioritization contributes to retention and improves the balance between source-task preservation and target-task adaptation when combined with class-aware sampling. In contrast, the reverse setting reveals that structure-aware replay fails when initial representations are learned from noisy and structurally inconsistent data. To isolate this effect, we conduct a controlled structural perturbation analysis by progressively corrupting source-task boundaries while keeping the dataset, architecture, and training protocol fixed. Forgetting increases consistently as structural reliability decreases, suggesting that replay effectiveness is strongly influenced by the quality of stored structural information, rather than by memory capacity alone. These findings indicate that preserving anatomical structure under domain shift is a central factor in continual medical image segmentation, and that replay mechanisms should account for structural reliability to support robust knowledge retention.
Electroencephalography (EEG) is the cornerstone of non-invasive brain-computer interfaces (BCIs), yet conventional decoding relies on fragmented, task-specific architectures that severely limit cross-task scalability. While EEG foundation models pre-trained on massive corpora promise universal brain decoding, current post-training depends on task-isolated fine-tuning. This static paradigm restricts knowledge transfer across heterogeneous tasks, hinders model scalability, and incurs computational and storage overheads that scale linearly with task count. To overcome these bottlenecks, we formulate downstream adaptation as a cross-task continual learning problem and propose EvoBrain, a dynamic, task-aware continual learning framework for unified EEG decoding. EvoBrain addresses the plasticity-stability trade-off via two complementary components: (1) Neuro-Spectral Task Normalization (NSN) aligns incoming tasks with historical statistics while recalibrating spectral responses to handle distributional and neuro-spectral shifts; and (2) Response-Affinity Distillation (RAD), combined with time-dependent replay, preserves old-task response geometry and promotes selective knowledge transfer between spectrally compatible tasks, effectively mitigating forgetting. Extensive evaluations across six distinct BCI tasks demonstrate that EvoBrain consistently surpasses state-of-the-art methods across diverse foundation backbones, optimally balancing plasticity and stability. To our knowledge, this work pioneers cross-task continual learning in the EEG domain, advancing the realization of a unified, one-for-all brain decoding system.
Accurate brain lesion segmentation in MRI is vital for effective clinical diagnosis and treatment planning. Due to high annotation costs and strict data privacy regulations, universal models require employing Continual Learning (CL) to adapt to evolving clinical tasks without losing previously acquired knowledge. However, existing CL paradigms often suffer from capacity limits or redundant parameter growth, and even advanced dynamic methods rely mostly on image-perception strategies that struggle to handle the substantial pathological and multimodal heterogeneity inherent in brain imaging. To address this issue, we propose Concept-Reasoning Expansion (CoRE) framework, which establishes a joint decision-making mechanism by integrating visual features with structured concepts. Through the alignment of image tokens with a hierarchical concept library, CoRE simulates clinical reasoning to guide both interpretable expert routing and demand-based model growth. This collaborative process ensures model evolution is grounded in clinical priors, preventing redundant parameter expansion while maximizing knowledge reuse. Extensive evaluations across 12 sequential brain lesion MRI tasks demonstrate that CoRE achieves state-of-the-art performance and provides a high knowledge starting point for efficient future adaptation. Its superior few-shot transferability and clinical interpretability further validate its effectiveness in managing non-stationary clinical data streams. Our code will be released soon.