# CADRE: Stable, Parameter Efficient Adaptation of Medical Vision Language Models with Bounded Forgetting and Prior Drift

arXiv: https://arxiv.org/abs/2606.23487 · HTML: https://mlsanity.com/paper/2606.23487/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 23 of its 34 references that are in the map.
- First posted on arXiv 22 Jun 2026.

## Placed in

- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 23 of 23)

- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Rethinking the Inception Architecture for Computer Vision](https://mlsanity.com/paper/1512.00567/) (2015)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Overcoming catastrophic forgetting in neural networks](https://mlsanity.com/paper/1612.00796/) (2016)
- [Parameter-Efficient Transfer Learning for NLP](https://mlsanity.com/paper/1902.00751/) (2019)
- [Learning without Forgetting](https://mlsanity.com/paper/1606.09282/) (2016)
- [iCaRL: Incremental Classifier and Representation Learning](https://mlsanity.com/paper/1611.07725/) (2016)
- [Gradient Episodic Memory for Continual Learning](https://mlsanity.com/paper/1706.08840/) (2017)
- [Visual Prompt Tuning](https://mlsanity.com/paper/2203.12119/) (2022)
- [Continual Lifelong Learning with Neural Networks: A Review](https://mlsanity.com/paper/1802.07569/) (2018)
- [Averaging Weights Leads to Wider Optima and Better Generalization](https://mlsanity.com/paper/1803.05407/) (2018)
- [Memory Aware Synapses: Learning what (not) to forget](https://mlsanity.com/paper/1711.09601/) (2017)
- [When Does Label Smoothing Help?](https://mlsanity.com/paper/1906.02629/) (2019)
- [Learning to Prompt for Continual Learning](https://mlsanity.com/paper/2112.08654/) (2021)
- [DualPrompt: Complementary Prompting for Rehearsal-free Continual Learning](https://mlsanity.com/paper/2204.04799/) (2022)
- [MedCLIP: Contrastive Learning from Unpaired Medical Images and Text](https://mlsanity.com/paper/2210.10163/) (2022)
- [Progress & Compress: A scalable framework for continual learning](https://mlsanity.com/paper/1805.06370/) (2018)
- [Orthogonal Subspace Learning for Language Model Continual Learning](https://mlsanity.com/paper/2310.14152/) (2023)
- [InfLoRA: Interference-Free Low-Rank Adaptation for Continual Learning](https://mlsanity.com/paper/2404.00228/) (2024)
- [Functional Regularisation for Continual Learning with Gaussian Processes](https://mlsanity.com/paper/1901.11356/) (2019)
- [Continual Learning for Domain Adaptation in Chest X-ray Classification](https://mlsanity.com/paper/2001.05922/) (2020)
- [Continual Learning in Medical Imaging: A Survey and Practical Analysis](https://mlsanity.com/paper/2405.13482/) (2024)
- [Prompt-Aware Adaptive Elastic Weight Consolidation for Continual Learning in Medical Vision-Language Models](https://mlsanity.com/paper/2511.20732/) (2025)

## Abstract (arXiv)

Medical vision-language models (VLMs) such as BiomedCLIP generalize broadly, but adapting them to a clinical service is as much a safety problem as an accuracy one. Updating a deployed model for a new imaging modality can fail silently in two ways that harm patients: it can forget modalities it already handled (catastrophic forgetting), and it can drift from its trustworthy pretrained prior toward modality-specific shortcuts. We study parameter-efficient continual adaptation through these two properties rather than leaderboard accuracy, presenting CADRE: a frozen-backbone framework combining low-rank adaptation (LoRA) with an online, self-scaling, similarity-aware elastic weight consolidation term that bounds retained-competence loss, and an anchor-to-prior penalty bounding embedding drift from the frozen prior. Two short guarantees, a bound on total consolidation mass and a scale-invariance property, remove the scale-related sources of vanilla EWC's order fragility. Using breast cancer across three maximally dissimilar modalities (histopathology, ultrasound, chest radiography) as a controlled cross-modality stress test, under a multi-seed, multi-order protocol with paired significance testing and training approximately 0.23% of parameters, CADRE attains the highest accuracy, SPQ, and backward transfer and the lowest forgetting among adapting methods, reducing forgetting roughly sevenfold versus the strongest regularized baseline (0.075 to 0.011; paired p=0.023) and achieving positive backward transfer where every baseline is negative. We frame these as stability properties aligned with clinical-safety desiderata, not a deployment guarantee; robustness to distribution shift and adversarial inputs is out of scope.