Bi-CRCL: Bidirectional Conservative-Radical Complementary Learning with Pre-trained Foundation Models for Class-incremental Medical Image Analysis

Class-Incremental Learning (CIL) aims to continually learn new categories without forgetting previously acquired knowledge. Vision-language models such as CLIP offer strong transferable representations via multi-modal supervision, making them promising for CIL. However, applying CLIP to CIL poses two major challenges: (1) adapting to downstream tasks often requires additional learnable modules, increasing model complexity and susceptibility to forgetting; and (2) while multi-modal representations offer complementary strengths, existing methods have yet to fully realize their potential in effectively integrating visual and textual modalities. To address these issues, we propose BOFA (Bridge-layer Orthogonal Fusion for Adaptation), a novel framework for CIL. BOFA confines all model adaptation exclusively to CLIP's existing cross-modal bridge-layer, thereby adding no extra parameters or inference cost. To prevent forgetting within this layer, it leverages Orthogonal Low-Rank Fusion, a mechanism that constrains parameter updates to a low-rank ``safe subspace" mathematically constructed to be orthogonal to past task features. This ensures stable knowledge accumulation without data replay. Furthermore, BOFA employs a cross-modal hybrid prototype that synergizes stable textual prototypes with visual counterparts derived from our stably adapted bridge-layer, enhancing classification performance. Extensive experiments on standard benchmarks show that BOFA achieves superior accuracy and efficiency compared to existing methods.

Class-Incremental Learning (CIL) requires models to learn new classes without forgetting old ones. A common method is to freeze a pre-trained model and train a new, lightweight adapter for each task. While this prevents forgetting, it treats the learned knowledge as a simple, unstructured collection and fails to use the relationships between tasks. To this end, we propose the Semantic-guided Adaptive Expert Forest (SAEF), a new method that organizes adapters into a structured hierarchy for better knowledge sharing. SAEF first groups tasks into conceptual clusters based on their semantic relationships. Then, within each cluster, it builds a balanced expert tree by creating new adapters from merging the adapters of similar tasks. At inference time, SAEF finds and activates a set of relevant experts from the forest for any given input. The final prediction is made by combining the outputs of these activated experts, weighted by how confident each expert is. Experiments on several benchmark datasets show that SAEF achieves SOTA performance.

Medical image segmentation faces a fundamental challenge in continual learning: data arrives sequentially from heterogeneous sources, yet effective continual learning requires discovering which tasks share sufficient structure to benefit from joint learning. Existing methods either apply uniform constraints across all tasks, causing catastrophic forgetting when tasks conflict, or require predefined task groupings that cannot anticipate future task diversity. We introduce MedCRP-CL, a framework that performs online task structure discovery and structure-aware continual learning. Leveraging the Chinese Restaurant Process (CRP), our method dynamically infers task groupings from clinical text prompts as tasks arrive, without requiring predefined cluster counts or access to future tasks. We term these discovered groupings semantic modalities, as they capture finer-grained structure than physical imaging modalities by integrating anatomical region and pathological context. Guided by this discovered structure, we maintain semantic modality-specific LoRA adapters regularized by intra-modality EWC, ensuring parameter isolation across dissimilar task groups while facilitating knowledge transfer within similar ones. The framework is also replay-free, storing only aggregate statistics rather than raw patient data. Experiments on 16 medical segmentation tasks across four imaging modalities demonstrate that MedCRP-CL achieves 73.3% Dice score with only 4.1% forgetting, outperforming the best baseline by 8.0% while requiring 6$\times$ fewer parameters. Code is available at https://github.com/zygao930/MedCRP-CL.