Beyond Forgetting in Continual Medical Image Segmentation: A Comprehensive Benchmark Study

Continual learning (CL) is essential for deploying medical image segmentation models in clinical environments where imaging domains, anatomical targets, and diagnostic tasks evolve over time. However, continual segmentation still faces three main challenges. First, the scenarios for this task remain insufficiently standardized for real-world clinical settings. Second, existing research has been primarily focused on mitigating forgetting, overlooking the other essential properties such as plasticity. Third, a benchmark work with comprehensive evaluation on existing methods is stll desirable. To address these gaps, we present such benchmark study of continual medical image segmentation. We first define three clinically motivated scenarios, namely Domain-CL, Class-CL, and Organ-CL, to respectively capture the cross-center domain shift, the incremental anatomical structure segmentation, and the cross-organ segmentation. We then introduce an evaluation framework that measures not only general performance and forgetting, but also plasticity, forward generalizability, parameter efficiency, and replay burden. The results, from extensive experiments with representative CL methods, showed that it was still challenging to develop a model that could satisfy all the requirements simultaneously. Nevertheless, these studies also suggested that the replay-based methods achieve the best overall balance between stability and plasticity, the parameter-isolation methods should be effective at reducing forgetting, though at the cost of increased model size, and the forward generalizability remain a significantly understudied aspect of this research field. Finally, we discuss related learning paradigms and outline future directions for continual medical image segmentation.