Confounders are extraneous variables that affect both the input and the target, resulting in spurious correlations and biased predictions. There are recent advances in dealing with or removing confounders in traditional models, such as metadata normalization (MDN), where the distribution of the learned features is adjusted based on the study confounders. However, in the context of continual learning, where a model learns continuously from new data over time without forgetting, learning feature representations that are invariant to confounders remains a significant challenge. To remove their influence from intermediate feature representations, we introduce the Recursive MDN (R-MDN) layer, which can be integrated into any deep learning architecture, including vision transformers, and at any model stage. R-MDN performs statistical regression via the recursive least squares algorithm to maintain and continually update an internal model state with respect to changing distributions of data and confounding variables. Our experiments demonstrate that R-MDN promotes equitable predictions across population groups, both within static learning and across different stages of continual learning, by reducing catastrophic forgetting caused by confounder effects changing over time.

Continual learning (CL) methods designed for natural image classification often fail to reach basic quality standards for medical image segmentation. Atlas-based segmentation, a well-established approach in medical imaging, incorporates domain knowledge on the region of interest, leading to semantically coherent predictions. This is especially promising for CL, as it allows us to leverage structural information and strike an optimal balance between model rigidity and plasticity over time. When combined with privacy-preserving prototypes, this process offers the advantages of rehearsal-based CL without compromising patient privacy. We propose Atlas Replay, an atlas-based segmentation approach that uses prototypes to generate high-quality segmentation masks through image registration that maintain consistency even as the training distribution changes. We explore how our proposed method performs compared to state-of-the-art CL methods in terms of knowledge transferability across seven publicly available prostate segmentation datasets. Prostate segmentation plays a vital role in diagnosing prostate cancer, however, it poses challenges due to substantial anatomical variations, benign structural differences in older age groups, and fluctuating acquisition parameters. Our results show that Atlas Replay is both robust and generalizes well to yet-unseen domains while being able to maintain knowledge, unlike end-to-end segmentation methods. Our code base is available under https://github.com/MECLabTUDA/Atlas-Replay.