CADRE: Stable, Parameter Efficient Adaptation of Medical Vision Language Models with Bounded Forgetting and Prior Drift
The authors introduce CADRE, a parameter-efficient framework for adapting medical vision-language models while preventing catastrophic forgetting and prior drift. The method combines low-rank adaptation with an online, self-scaling elastic weight consolidation term to bound retained-competence loss. It also employs an anchor-to-prior penalty to restrict embedding drift from the frozen pretrained model. Two short guarantees regarding consolidation mass and scale invariance address the order fragility found in vanilla EWC. The approach was evaluated on breast cancer data across histopathology, ultrasound, and chest radiography modalities. Training approximately 0.23% of parameters, CADRE achieved the lowest forgetting rate among adapting methods. This represented a sevenfold reduction compared to the strongest regularized baseline, dropping from 0.075 to 0.011. The model also demonstrated positive backward transfer where all baselines showed negative results.