Parameter-efficient adaptation of vision-language foundation models is crucial for precise multimodal understanding of biomedical images, yet existing methods remain deterministic and often struggle under domain shift or ambiguous image-text alignment. This limitation is particularly critical in the clinic, where models should remain robust in low-data regimes and domain shifts. We present Evi-Steer, an evidential cross-modal low-dimensional steering framework for BiomedCLIP that enables uncertainty-aware parameter-efficient fine-tuning while updating only 0.11% of total model parameters. Our approach performs lightweight low-dimensional token updates in both vision and text encoders while simultaneously estimating epistemic uncertainty. These uncertainty estimates update gate residuals, allowing the model to adapt conservatively when evidence is weak. Furthermore, we introduce cross-modal confidence fusion based on Dempster-Shafer theory, enabling visual adaptation to be conditioned on textual confidence and suppressing conflicting or uncertain cross-modal updates. We conduct a comprehensive evaluation on 15 biomedical imaging datasets spanning 8 organs and 8 imaging modalities under few-shot learning and domain generalization settings. Evi-Steer consistently outperforms state-of-the-art methods under few-shot learning and domain shift settings, demonstrating a practical and robust pathway for deploying vision-language models in real-world clinical settings. Code is available at https://github.com/HealthX-Lab/Evi-Steer.
Accurate biomedical image classification under low-resource conditions remains challenging due to limited annotations, subtle inter-class visual differences, and complex disease semantics. While vision--language models offer a promising foundation for mitigating data scarcity, their effective adaptation in biomedical settings is constrained by the need for parameter-efficient tuning alongside fine-grained and semantically consistent representation learning. In this work, we propose Multi-View Synergistic Learning (MVSL), a unified framework that addresses these challenges by jointly considering adaptation paradigms, representation granularity, and disease semantic relationships. MVSL decouples the adaptation of visual and textual encoders to respect their distinct representational characteristics, enabling more stable and effective parameter-efficient fine-tuning. It further introduces multi-granularity contrastive learning to explicitly model both global image semantics and localized lesion-level evidence, improving fine-grained discrimination for visually similar disease categories. In addition, MVSL preserves disease-level semantic structure by incorporating structured supervision derived from large language models, which constrains textual representations at the class level and indirectly regularizes visual embeddings through cross-modal alignment. Together, these components enable more stable cross-modal alignment and improved discrimination under limited supervision. Extensive experiments on 11 public biomedical datasets spanning 9 imaging modalities and 10 anatomical regions demonstrate that MVSL consistently outperforms state-of-the-art methods in few-shot and zero-shot classification settings.
Biomedical Vision--Language Models (VLMs) have shown remarkable promise in few-shot medical diagnosis but face a critical bottleneck: \textit{fragility to prompt variations}.Existing adaptation frameworks typically optimize visual and textual prompts as independent streams, relying on ideal ``Golden Prompts''. In clinical reality, where descriptions are often noisy and heterogeneous, this modality isolation leads to unstable cross-modal alignment. To address this, we propose BiomedAP, a vision-informed dual-anchor framework with gated cross-modal fusion.BiomedAP enforces synergistic alignment through two mechanisms: (1) Gated Cross-Modal Fusion, which enables layer-wise interaction between modalities, acting as a dynamic noise regulator to suppress irrelevant textual cues; and (2) a Dual-Anchor Constraint that regularizes learnable prompts toward stable semantic centroids derived from both expert templates (High Anchors) and few-shot visual prototypes (Low Anchors). Extensive experiments across 11 benchmarks demonstrate that BiomedAP consistently surpasses baselines, achieving competitive few-shot accuracy and markedly enhanced robustness under prompt perturbations. Our code is available at: https://github.com/tongdiedie/BiomedAP. Keywords: Vision-Language Models; Prompt Learning; Parameter-Efficient Fine-Tuning; Few-shot Learning
Pretrained biomedical vision-language models (VLMs) such as BioMedCLIP perform well on average but often degrade on challenging modalities where inter-class margins are small and acquisition-specific variations are pronounced, especially under few-shot supervision and when modality priors differ from pretraining corpora substantially. We propose BioVLM, a prompt-learning framework that improves cross-domain generalization without extensive backbone fine-tuning. BioVLM learns a diverse prompt bank and introduces dynamic prompt selection: for each input, it selects the most discriminative prompts via a low-entropy criterion on the predictive distribution, effectively coupling sparse few-shot evidence with rich LLM semantic priors. To strengthen this coupling, we distill high-confidence LLM-derived attributes and enforce robust knowledge transfer through strong/weak augmentation consistency. At test time, BioVLM adapts by choosing modality-appropriate prompts, enabling transfer to unseen categories and domains, while keeping training lightweight and inference efficient. On 11 MedMNIST+ 2D datasets, BioVLM achieves new state of the art across three distinct generalization settings. Codes are available at https://github.com/mainaksingha01/BioVLM.