# Cross-Contextual Vision-Language Adaptation with LoRA for Personalized Severe Adverse Event Detection in Clinical Wound Monitoring

arXiv: https://arxiv.org/abs/2607.05625 · HTML: https://mlsanity.com/paper/2607.05625/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 43 of its 48 references that are in the map.
- First posted on arXiv 6 Jul 2026.

## Builds on (most cited first, 30 of 43)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [BLIP-2: Bootstrapping Language-Image Pre-training with Frozen Image Encoders and Large Language Models](https://mlsanity.com/paper/2301.12597/) (2023)
- [Parameter-Efficient Transfer Learning for NLP](https://mlsanity.com/paper/1902.00751/) (2019)
- [Prefix-Tuning: Optimizing Continuous Prompts for Generation](https://mlsanity.com/paper/2101.00190/) (2021)
- [A Baseline for Detecting Misclassified and Out-of-Distribution Examples in Neural Networks](https://mlsanity.com/paper/1610.02136/) (2016)
- [Learning to Prompt for Vision-Language Models](https://mlsanity.com/paper/2109.01134/) (2021)
- [A Simple Unified Framework for Detecting Out-of-Distribution Samples and Adversarial Attacks](https://mlsanity.com/paper/1807.03888/) (2018)
- [Conditional Prompt Learning for Vision-Language Models](https://mlsanity.com/paper/2203.05557/) (2022)
- [Enhancing The Reliability of Out-of-distribution Image Detection in Neural Networks](https://mlsanity.com/paper/1706.02690/) (2017)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Energy-based Out-of-distribution Detection](https://mlsanity.com/paper/2010.03759/) (2020)
- [Deep Anomaly Detection with Outlier Exposure](https://mlsanity.com/paper/1812.04606/) (2018)
- [Generalized Out-of-Distribution Detection: A Survey](https://mlsanity.com/paper/2110.11334/) (2021)
- [Out-of-Distribution Detection with Deep Nearest Neighbors](https://mlsanity.com/paper/2204.06507/) (2022)
- [MedCLIP: Contrastive Learning from Unpaired Medical Images and Text](https://mlsanity.com/paper/2210.10163/) (2022)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [ReAct: Out-of-distribution Detection With Rectified Activations](https://mlsanity.com/paper/2111.12797/) (2021)
- [CSI: Novelty Detection via Contrastive Learning on Distributionally Shifted Instances](https://mlsanity.com/paper/2007.08176/) (2020)
- [ViM: Out-Of-Distribution with Virtual-logit Matching](https://mlsanity.com/paper/2203.10807/) (2022)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [AdaLoRA: Adaptive Budget Allocation for Parameter-Efficient Fine-Tuning](https://mlsanity.com/paper/2303.10512/) (2023)
- [WinCLIP: Zero-/Few-Shot Anomaly Classification and Segmentation](https://mlsanity.com/paper/2303.14814/) (2023)
- [OpenOOD: Benchmarking Generalized Out-of-Distribution Detection](https://mlsanity.com/paper/2210.07242/) (2022)
- [Delving into Out-of-Distribution Detection with Vision-Language Representations](https://mlsanity.com/paper/2211.13445/) (2022)
- [Extremely Simple Activation Shaping for Out-of-Distribution Detection](https://mlsanity.com/paper/2209.09858/) (2022)
- [Learning to Exploit Temporal Structure for Biomedical Vision-Language Processing](https://mlsanity.com/paper/2301.04558/) (2023)
- [Autoencoders for Unsupervised Anomaly Segmentation in Brain MR Images: A Comparative Study](https://mlsanity.com/paper/2004.03271/) (2020)
- [CLIPN for Zero-Shot OOD Detection: Teaching CLIP to Say No](https://mlsanity.com/paper/2308.12213/) (2023)

## Abstract (arXiv)

Wound monitoring is a critical yet underserved clinical challenge, where timely identification of severe adverse events (SAEs) such as infection, tissue deterioration, and delayed healing can significantly impact patient outcomes. While vision-language models (VLMs) show strong multimodal reasoning, they often lack domain-specific grounding to integrate wound imagery with heterogeneous clinical information, and provide limited mechanisms for detecting cases that diverge from the training distribution. We present a multimodal framework for automated wound monitoring and SAE detection. Our approach leverages paired clinical notes and wound descriptions capturing visual characteristics such as appearance, surrounding skin condition, color changes, and signs of inflammation or healing progression, encoded through a dual-stream Low-Rank Adaptation (LoRA) framework built on a frozen BiomedCLIP backbone. We introduce a cross-contextual LoRA fusion mechanism enabling information exchange between clinical semantics and visual wound descriptors, producing context-aware multimodal representations without full model fine-tuning. To identify personalized SAEs, we propose a wound-specific out-of-distribution (OOD) detection framework combining semantic matching, visual typicality, caption-text alignment, and caption-visual alignment into a unified SAE (OOD) score. To capture healing dynamics, we incorporate covariate consistency and temporal drift penalties that leverage changes in wound characteristics across visits. Experiments on a longitudinal wound dataset collected through clinical visits show promising performance on both wound healing assessment and SAE detection, highlighting the potential of semantically enriched, temporally aware vision-language systems for clinical wound monitoring and early risk identification.