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

Clinical deployment of chest radiograph classifiers requires models that can be updated as new datasets become available without retraining on previously observed data or degrading validated performance. We study a task-incremental continual learning setting for chest radiograph classification under task-unknown inference, where heterogeneous chest X-ray datasets arrive sequentially and task identity is unavailable at deployment time. We propose CARL-CXR, a continual adapter-based routing framework that maintains a fixed high-capacity backbone while incrementally introducing lightweight task-specific adapters and classifier heads. A latent task selector operates on adapter-conditioned features to dynamically route each input to the most relevant task pathway, leveraging compact task prototypes and feature-level experience replay to preserve task identity across sequential updates without storing raw images. Experiments on MIMIC-CXR and CheXpert two large-scale datasets with distinct patient populations, imaging devices, and annotation pipelines demonstrate that CARL-CXR achieves minimal catastrophic forgetting (0.012 AUROC drop), representing a 6X and 11X reduction over established continual learning baselines LwF and EWC respectively, while maintaining competitive diagnostic performance (AUROC 0.74). Under task unknown deployment, CARL-CXR outperforms joint training by 12.5 points in routing accuracy (75.0% vs. 62.5%): unlike LwF and EWC, which require explicit task identifiers at inference and provide no routing mechanism.