Domain Incremental Learning for Pandemic-Resilient Chest X-Ray Analysis

Deep learning models detect pneumonia from chest X-rays with high accuracy, but the performance declines under domain shifts caused by differences in devices, patients, or institutions. We present PneumoNet, a domain-incremental learning method for point-of-care pneumonia diagnosis in resource-limited settings. PneumoNet combines a lightweight CNN for on-device prediction, a dual-stage balanced buffer for class-balanced replay, and a dynamic class-weighted loss to correct training-batch imbalances. Evaluated on a domain-shifted PneumoniaMNIST dataset simulating five realistic domain change scenarios, PneumoNet achieves 86.6% accuracy with 1.4% forgetting while being smaller and faster than existing baselines. These results highlight PneumoNet's potential to enable adaptive, privacy-preserving diagnostic AI directly on point-of-care medical devices in real-world and pandemic-ready healthcare.

Deep-learning models can achieve strong chest X-ray (CXR) classification performance without establishing whether their predictions predominantly rely on pulmonary image content. This study evaluates pulmonary attribution containment as an anatomy-related reliability property distinct from diagnostic performance. We propose DBCA-SegNet-MGAP, a multi-task anatomy-guided CNN-Transformer framework that combines complementary feature representations through bidirectional cross-backbone attention, predicts a soft lung mask, and incorporates this anatomical prior directly into classification through Mask-Guided Adaptive Global Average Pooling (MGAP). Pulmonary attribution containment is quantified using the Anatomical Local Energy Ratio (ALR) and high-intensity cumulative ALR (cALR@0.9). Experiments were repeated across three training seeds using the COVID-19 Radiography Database for four-class internal testing and a locked Shenzhen-to-Montgomery protocol for zero-shot external tuberculosis testing. On COVID-19, the proposed model achieved a weighted F1 of $0.9615 \pm 0.0015$ and macro ROC-AUC of $0.9906 \pm 0.0007$. In an architecture-matched dual-bridge comparison, replacing conventional GAP with MGAP increased ALR from $0.3878 \pm 0.0098$ to $0.7086 \pm 0.0104$ and cALR@0.9 from $0.5265 \pm 0.0101$ to $0.9905 \pm 0.0018$, while weighted F1 remained essentially unchanged ($0.9618 \pm 0.0015$ vs. $0.9615 \pm 0.0015$). Under locked external transfer to Montgomery, ROC-AUC remained $0.9080 \pm 0.0043$ and pulmonary ALR remained $0.6466 \pm 0.0081$, whereas weighted F1 decreased to $0.7528 \pm 0.0080$ and ECE increased to $0.1683 \pm 0.0055$. These findings show that diagnostic discrimination, calibration, and pulmonary attribution containment are distinct model properties and support their joint evaluation under internal testing and external domain shift.

Deep neural networks excel in various tasks but struggle to generalize across evolving data distributions, leading to significant performance degradation under domain shifts. Domain incremental learning (DIL) addresses this challenge by enabling models to continuously adapt while retaining prior knowledge. Among existing DIL approaches, the parameter-isolation paradigm achieves state-of-the-art performance. However, these methods often adopt a one-size-fits-all approach to adapt to new domains, resulting in either insufficient learning capacity or redundant parameters. In this work, we propose BPG, a unified framework that addresses both challenges through two complementary components: BPG-Adapter, which dynamically determines each domain's adapter hidden dimension based on domain-specific feature separability, and BPG-Inference, a soft domain mixture strategy that integrates multiple domain-specific models at test time, mitigating domain ID misselection. Experimental results on DomainNet, CDDB, and CORe50 demonstrate that BPG consistently outperforms uniform adapter-based approaches and hard domain selection strategies, achieving state-of-the-art average accuracy while reducing forgetting to as low as 0.22% on DomainNet.