Maryam Dialameh, Hossein Rajabzadeh, Jung Suk Sim et al.
Papillary thyroid microcarcinoma (PTMC) is increasingly managed with radio-frequency ablation (RFA), yet accurate lesion segmentation in ultrasound videos remains difficult due to low contrast, probe-induced motion, and heat-related artifacts. The recent Segment Anything Model 2 (SAM-2) generalizes well to static images, but its frame-independent design yields unstable predictions and temporal drift in interventional ultrasound. We introduce \textbf{EMA-SAM}, a lightweight extension of SAM-2 that incorporates a confidence-weighted exponential moving average pointer into the memory bank, providing a stable latent prototype of the tumour across frames. This design preserves temporal coherence through probe pressure and bubble occlusion while rapidly adapting once clear evidence reappears. On our curated PTMC-RFA dataset (124 minutes, 13 patients), EMA-SAM improves \emph{maxDice} from 0.82 (SAM-2) to 0.86 and \emph{maxIoU} from 0.72 to 0.76, while reducing false positives by 29\%. On external benchmarks, including VTUS and colonoscopy video polyp datasets, EMA-SAM achieves consistent gains of 2--5 Dice points over SAM-2. Importantly, the EMA pointer adds \textless0.1\% FLOPs, preserving real-time throughput of $\sim$30\,FPS on a single A100 GPU. These results establish EMA-SAM as a robust and efficient framework for stable tumour tracking, bridging the gap between foundation models and the stringent demands of interventional ultrasound. Codes are available here \hyperref[code {https://github.com/mdialameh/EMA-SAM}.