Dhruv Gupta, Emma A. M. Stanley, Fabio De Sousa Ribeiro +2cs.CV
Foundation models are increasingly adapted for downstream medical imaging tasks, yet the influence of the chosen adaptation strategy on subgroup fairness remains poorly understood. We investigate how three parameter-efficient adaptation techniques, including linear heads on the raw CLS token, an MLP, and an attention-pooling module over multi-layer patch features, affect both pathology classification performance and subgroup disparities when applied to the frozen Rad-DINO chest X-ray encoder. Using MIMIC-CXR, we evaluate eight pathologies across race, sex, and imaging-view subgroups on a prevalence-preserving, demographically balanced test set, and additionally probe how strongly each adapter encodes protected attributes. We find that attention pooling achieves the strongest overall discriminative performance and encodes attributes, particularly race, most strongly, but that improved overall performance does not consistently reduce subgroup disparities. Notably, stronger attribute encoding did not correspond to larger disparities: early network layers encoded race most weakly yet produced the largest subgroup performance gaps. Exploring different attention-pooling layer combinations further revealed no consistent relationship between the layers pooled, attribute encoding strength, and subgroup fairness. Our results indicate that richer, more expressive representations can improve accuracy while leaving fairness implications task-dependent and unpredictable, which must be assessed directly and per-task rather than inferred from encoding strength or overall performance alone.
Recent advances in vision-language models (VLMs) such as CLIP have demonstrated strong generalization across natural-image domains. However, adapting these models to biomedical imaging is non-trivial: full-model fine-tuning is computationally expensive, while medical data are often scarce and exhibit subtle, fine-grained inter-class differences, making parameter-efficient adaptation particularly critical. Visual Reprogramming (VR) offers a parameter-efficient alternative by injecting learnable perturbations into the input space, but existing VR approaches for VLMs mainly focus on positive class prompts and overlook confusing negatives, leading to miscalibrated predictions in fine-grained medical scenarios. We present BioMedVR, the first VR-based framework for biomedical imaging, enabling few-shot adaptation of pretrained VLMs through compact learnable VR modules. To mitigate class confusion, we introduce a Confusion Minimization Mechanism that leverages LLM-generated confusion-aware attributes together with a Confusion-Suppression Loss to explicitly reduce false-positive alignment. Moreover, the designed Mixture-of-Prompt Experts combines a positive expert for main-class discrimination and a negative expert for confusion suppression, balanced via adaptive gating. Extensive experiments on 18 datasets, including 11 biomedical datasets and 7 natural image benchmarks, demonstrate that BioMedVR achieves superior accuracy and generalization, effectively bridging VR and VLMs in biomedical domains.
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.