CARL-CXR: Continual Adapter-Based Routing for Task-Unknown Chest Radiograph Classification

Class-incremental learning (CIL) requires a model to incrementally learn tasks that contain new classes without accessing earlier training data while preserving the ability to recognize all seen classes. Recently, pretrained-model-based approaches have become prevalent by adapting a frozen backbone with additional lightweight trainable modules. Existing methods, however, exhibit limitations: task-specific adapters learn explicit per-task representations but are parameter- and computation-inefficient, while LoRA-based merging methods combine per-task LoRA parameters into a single model whose static aggregated weights cause representation interference during inference. To address these problems, we present FACET: task-conditioned FeAture transformation with ConditionEd feature consisTency, achieving excellent parameter efficiency while producing highly discriminative features during inference. When continually trained on a task sequence, FACET learns a single shared adapter that employs a dynamic task-conditioned feature transformation, shaping the overall feature distribution of the adapter into a mixture of overlap-reduced task-specific components. On the other hand, we propose an efficient replay-free task-conditioned feature consistency loss, aiming to mitigate catastrophic forgetting of the learned mixture distribution in the adapter's feature space. Even when maintaining only a single adapter, FACET demonstrates robust scalability. On both very long task sequences (e.g., 200 tasks) and standard short task sequences (e.g., 20 tasks), our method achieves superior performance while using significantly fewer trainable parameters and GFLOPs. The code will be made open source upon acceptance.

Recent advances in vision--language pretraining have enabled strong medical foundation models, yet most analyze radiographs in isolation, overlooking the key clinical task of comparing prior and current images to assess interval change. For chest radiographs (CXRs), capturing interval change is essential, as radiologists must evaluate not only the static appearance of findings but also how they evolve over time. We introduce TILA (Temporal Inversion-aware Learning and Alignment), a simple yet effective framework that uses temporal inversion, reversing image pairs, as a supervisory signal to enhance the sensitivity of existing temporal vision-language models to directional change. TILA integrates inversion-aware objectives across pretraining, fine-tuning, and inference, complementing conventional appearance modeling with explicit learning of temporal order. We also propose a unified evaluation protocol to assess order sensitivity and consistency under temporal inversion, and introduce MS-CXR-Tretrieval, a retrieval evaluation set constructed through a general protocol that can be applied to any temporal CXR dataset. Experiments on public datasets and real-world hospital cohorts demonstrate that TILA consistently improves progression classification and temporal embedding alignment when applied to multiple existing architectures.

This challenge tackles multi-label classification for known chest X-ray (CXR) lesions and zero-shot classification for unseen ones. To handle diverse CXR projections, we integrate projection-specific models via a classification network into a unified framework. For zero-shot classification (Task 2), we extend CheXzero with a novel dual-branch architecture that combines contrastive learning, Asymmetric Loss (ASL), and LLM-generated descriptive prompts. This effectively mitigates severe long-tail imbalances and maximizes zero-shot generalization. Additionally, strong data and test-time augmentations (TTA) ensure robustness across both tasks.