Robotic Ultrasound Imaging: State-of-the-Art and Future Perspectives

Ultrasound (US) is one of the most widely used modalities for clinical intervention and diagnosis due to the merits of providing non-invasive, radiation-free, and real-time images. However, free-hand US examinations are highly operator-dependent. Robotic US System (RUSS) aims at overcoming this shortcoming by offering reproducibility, while also aiming at improving dexterity, and intelligent anatomy and disease-aware imaging. In addition to enhancing diagnostic outcomes, RUSS also holds the potential to provide medical interventions for populations suffering from the shortage of experienced sonographers. In this paper, we categorize RUSS as teleoperated or autonomous. Regarding teleoperated RUSS, we summarize their technical developments, and clinical evaluations, respectively. This survey then focuses on the review of recent work on autonomous robotic US imaging. We demonstrate that machine learning and artificial intelligence present the key techniques, which enable intelligent patient and process-specific, motion and deformation-aware robotic image acquisition. We also show that the research on artificial intelligence for autonomous RUSS has directed the research community toward understanding and modeling expert sonographers' semantic reasoning and action. Here, we call this process, the recovery of the "language of sonography". This side result of research on autonomous robotic US acquisitions could be considered as valuable and essential as the progress made in the robotic US examination itself. This article will provide both engineers and clinicians with a comprehensive understanding of RUSS by surveying underlying techniques.Comment: Accepted by Medical Image Analysi

Improving access to ultrasound imaging in northern, remote communities

Access to healthcare services—including access to medical imaging—is an important determinant of health outcomes. This thesis aims to improve understanding of and address gaps in access to ultrasound imaging for patients in northern, remote communities, and advance a novel ultrasound technology with the ultimate goal of improving patient care and health outcomes. This thesis first brings greater understanding of patients’ perceptions of access and factors which shape access to ultrasound imaging in northern, remote communities in Saskatchewan, Canada. A qualitative study was performed using interpretive description as a methodological approach and a multi-dimensional conceptualization of access to care as a theoretical framework. The study identified barriers which patients in northern, remote communities face in accessing ultrasound imaging, and demonstrated that geographic remoteness from imaging facilities was a central barrier. To determine whether disparities in access to ultrasound imaging resulted in disparities in utilization of ultrasound services, two population-based studies assessed the association between sociodemographic and geographic factors and obstetrical and non-obstetrical ultrasound utilization in Saskatchewan. In the first study investigating obstetrical ultrasound utilization, multivariate logistic regression analysis demonstrated that women living in rural areas, remote areas, and low income neighbourhoods, as well as status First Nations women, were less likely to have a second trimester ultrasound, an important aspect of prenatal care. In a second study investigating non-obstetrical ultrasound utilization across the entire provincial population, multivariate Poisson regression analysis similarly demonstrated lower rates of non-obstetrical ultrasound utilization among individuals living in rural and remote areas, individuals residing in low income neighbourhoods, and status First Nations persons. To address the barriers which patients in northern, remote communities face in accessing ultrasound imaging and to minimize disparities in ultrasound imaging utilization as identified in previous studies in this thesis, telerobotic ultrasound technology was investigated as a solution to improve access to ultrasound imaging. Using this technology, radiologists and sonographers could remotely manipulate an ultrasound probe via a robotic arm, thereby remotely performing an ultrasound exam while patients remained in their home community. A clinical trial comparing conventional and telerobotic ultrasound approaches was undertaken, validating this technology for obstetrical ultrasound imaging. To determine the feasibility of using telerobotic technology to establish an ultrasound service delivery model to remotely provide diagnostic ultrasound exams in underserved communities, pilot telerobotic ultrasound clinics were developed in three northern, remote communities. Telerobotic ultrasound exams were sufficient for diagnosis in the majority of cases, minimizing travel or reducing wait times for these patients. This technology was subsequently evaluated during a COVID-19 outbreak in northern Saskatchewan, demonstrating the potential of this technology to provide critical ultrasound services to an underserved northern population and minimize health inequities during the COVID-19 pandemic. An economic evaluation was performed to compare a service delivery model using telerobotic ultrasound technology to alternative service delivery models. Telerobotic ultrasound combined with an itinerant sonographer service was found to be the lowest cost option from both a publicly funded healthcare payer perspective and a societal perspective for many northern, remote communities. This thesis provides key insights for health system leaders seeking improved understanding and novel solutions to improve access to ultrasound imaging in northern, remote communities. Findings suggest that telerobotic ultrasound is a viable solution to improve access to ultrasound imaging and reduce costs associated with ultrasound service delivery. Evidence in this thesis may be used to help improve ultrasound services and health equity for patients in underserved northern, remote communities. Continued respectful collaboration with northern, remote, Indigenous peoples and communities will be a critical aspect to ensure that ultrasound services meet community needs

Kinematics and Robot Design II (KaRD2019) and III (KaRD2020)

This volume collects papers published in two Special Issues “Kinematics and Robot Design II, KaRD2019” (https://www.mdpi.com/journal/robotics/special_issues/KRD2019) and “Kinematics and Robot Design III, KaRD2020” (https://www.mdpi.com/journal/robotics/special_issues/KaRD2020), which are the second and third issues of the KaRD Special Issue series hosted by the open access journal robotics.The KaRD series is an open environment where researchers present their works and discuss all topics focused on the many aspects that involve kinematics in the design of robotic/automatic systems. It aims at being an established reference for researchers in the field as other serial international conferences/publications are. Even though the KaRD series publishes one Special Issue per year, all the received papers are peer-reviewed as soon as they are submitted and, if accepted, they are immediately published in MDPI Robotics. Kinematics is so intimately related to the design of robotic/automatic systems that the admitted topics of the KaRD series practically cover all the subjects normally present in well-established international conferences on “mechanisms and robotics”.KaRD2019 together with KaRD2020 received 22 papers and, after the peer-review process, accepted only 17 papers. The accepted papers cover problems related to theoretical/computational kinematics, to biomedical engineering and to other design/applicative aspects

A novel Diagnostician Haptic Interface for Tele-palpation

The shortage of specialist caused by the increased need for medical examinations has stimulated the application of robotics technologies to telemedicine. For some of the most common medical examinations such as ultrasonography and palpation, doctors exploit haptic feedback to formulate a diagnosis. This is especially true for palpation, where haptic feedback plays the biggest role. In this paper, we present a novel 3-Degrees-of-Freedom (DoFs) robotic interface which is designed to be integrated into a telepalpation system. In particular, this haptic interface is the master of a teleoperation loop in which the slave operates on the patient. Therefore, its design allows the doctor to explore the whole patient's abdomen while providing the doctor with a haptic feedback when in contact with the patient. A preliminary assessment of the interface is also presented: three participants were asked to detect the presence and the size of a sphere without visual clues. Results show that the interface is suitable for the application in remote palpation