NEARL: Interacted Query Adaptation with Orthogonal Regularization for Medical Vision-Language Understanding

Computer-aided medical image analysis is crucial for disease diagnosis and treatment planning. While vision-language models (VLMs) such as CLIP exhibit strong generalization ability, their direct application to medical imaging remains hindered by a substantial domain gap. Existing methods for bridging this gap, including prompt learning and unidirectional modality interaction, typically introduce domain knowledge into only one modality. However, such approaches fail to fully exploit CLIP's inherent dual-modality structure and overlook the synergistic effect of bidirectional cross-modal interaction, resulting in persistent modality misalignment. In this paper, we propose NEARL (iNteracted quEry Adaptation with oRthogonaL Regularization), a novel parameter-efficient VLM framework for bidirectional cross-modal interaction. NEARL consists of two key components: (1) the Unified Synergy Embedding Transformer (USEformer), which dynamically generates compact cross-modal queries to facilitate interaction; and (2) the Orthogonal Cross-Attention Adapter (OCA), which decouples new knowledge into truly novel and incremental components through orthogonal regularization. This design reduces interference from incremental components, enabling more focused learning of novel information and improving modality interaction in VLMs. Notably, NEARL introduces only 1.46M learnable parameters. Extensive experiments on three medical imaging modalities demonstrate state-of-the-art performance (e.g., a 2.3% relative improvement on the pneumonia dataset), along with fast inference and low memory overhead, highlighting its effectiveness for real-world medical vision-language understanding.