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

Analysis of QoS Requirements for e-Health Services and Mapping to Evolved Packet System QoS Classes

E-Health services comprise a broad range of healthcare services delivered by using information and communication technology. In order to support existing as well as emerging e-Health services over converged next generation network (NGN) architectures, there is a need for network QoS control mechanisms that meet the often stringent requirements of such services. In this paper, we evaluate the QoS support for e-Health services in the context of the Evolved Packet System (EPS), specified by the Third Generation Partnership Project (3GPP) as a multi-access all-IP NGN. We classify heterogeneous e-Health services based on context and network QoS requirements and propose a mapping to existing 3GPP QoS Class Identifiers (QCIs) that serve as a basis for the class-based QoS concept of the EPS. The proposed mapping aims to provide network operators with guidelines for meeting heterogeneous e-Health service requirements. As an example, we present the QoS requirements for a prototype e-Health service supporting tele-consultation between a patient and a doctor and illustrate the use of the proposed mapping to QCIs in standardized QoS control procedures

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

Towards the development of safe, collaborative robotic freehand ultrasound

The use of robotics in medicine is of growing importance for modern health services, as robotic systems have the capacity to improve upon human tasks, thereby enhancing the treatment ability of a healthcare provider. In the medical sector, ultrasound imaging is an inexpensive approach without the high radiation emissions often associated with other modalities, especially when compared to MRI and CT imaging respectively. Over the past two decades, considerable effort has been invested into freehand ultrasound robotics research and development. However, this research has focused on the feasibility of the application, not the robotic fundamentals, such as motion control, calibration, and contextual awareness. Instead, much of the work is concentrated on custom designed robots, ultrasound image generation and visual servoing, or teleoperation. Research based on these topics often suffer from important limitations that impede their use in an adaptable, scalable, and real-world manner. Particularly, while custom robots may be designed for a specific application, commercial collaborative robots are a more robust and economical solution. Otherwise, various robotic ultrasound studies have shown the feasibility of using basic force control, but rarely explore controller tuning in the context of patient safety and deformable skin in an unstructured environment. Moreover, many studies evaluate novel visual servoing approaches, but do not consider the practicality of relying on external measurement devices for motion control. These studies neglect the importance of robot accuracy and calibration, which allow a system to safely navigate its environment while reducing the imaging errors associated with positioning. Hence, while the feasibility of robotic ultrasound has been the focal point in previous studies, there is a lack of attention to what occurs between system design and image output. This thesis addresses limitations of the current literature through three distinct contributions. Given the force-controlled nature of an ultrasound robot, the first contribution presents a closed-loop calibration approach using impedance control and low-cost equipment. Accuracy is a fundamental requirement for high-quality ultrasound image generation and targeting. This is especially true when following a specified path along a patient or synthesizing 2D slices into a 3D ultrasound image. However, even though most industrial robots are inherently precise, they are not necessarily accurate. While robot calibration itself has been extensively studied, many of the approaches rely on expensive and highly delicate equipment. Experimental testing showed that this method is comparable in quality to traditional calibration using a laser tracker. As demonstrated through an experimental study and validated with a laser tracker, the absolute accuracy of a collaborative robot was improved to a maximum error of 0.990mm, representing a 58.4% improvement when compared to the nominal model. The second contribution explores collisions and contact events, as they are a natural by-product of applications involving physical human-robot interaction (pHRI) in unstructured environments. Robot-assisted medical ultrasound is an example of a task where simply stopping the robot upon contact detection may not be an appropriate reaction strategy. Thus, the robot should have an awareness of body contact location to properly plan force-controlled trajectories along the human body using the imaging probe. This is especially true for remote ultrasound systems where safety and manipulability are important elements to consider when operating a remote medical system through a communication network. A framework is proposed for robot contact classification using the built-in sensor data of a collaborative robot. Unlike previous studies, this classification does not discern between intended vs. unintended contact scenarios, but rather classifies what was involved in the contact event. The classifier can discern different ISO/TS 15066:2016 specific body areas along a human-model leg with 89.37% accuracy. Altogether, this contact distinction framework allows for more complex reaction strategies and tailored robot behaviour during pHRI. Lastly, given that the success of an ultrasound task depends on the capability of the robot system to handle pHRI, pure motion control is insufficient. Force control techniques are necessary to achieve effective and adaptable behaviour of a robotic system in the unstructured ultrasound environment while also ensuring safe pHRI. While force control does not require explicit knowledge of the environment, to achieve an acceptable dynamic behaviour, the control parameters must be tuned. The third contribution proposes a simple and effective online tuning framework for force-based robotic freehand ultrasound motion control. Within the context of medical ultrasound, different human body locations have a different stiffness and will require unique tunings. Through real-world experiments with a collaborative robot, the framework tuned motion control for optimal and safe trajectories along a human leg phantom. The optimization process was able to successfully reduce the mean absolute error (MAE) of the motion contact force to 0.537N through the evolution of eight motion control parameters. Furthermore, contextual awareness through motion classification can offer a framework for pHRI optimization and safety through predictive motion behaviour with a future goal of autonomous pHRI. As such, a classification pipeline, trained using the tuning process motion data, was able to reliably classify the future force tracking quality of a motion session with an accuracy of 91.82 %

ROBOTIC INTERACTION AND COOPERATION. Industrial and rehabilitative applications

The main goal of the thesis is the development of human-robotic interaction control strategies, which enable close collaboration between human and robot. In this framework we studied two di erent aspects, with applications respectively in industrial and rehabilitation domains. In the rst part safety issues are examined on a scenario in which a robot manipulator and a human perform the same task and in the same workspace. During the task execution the human should be able to get into contact with the robot and in this case an estimation algorithm of both interaction forces and contact point is proposed in order to guarantee safety conditions. At the same time, all the unintended contacts have to be avoided, and a suitable post collision strategy has been studied to move away the robot from the collision area or to reduce the impact e orts. However, the second part of the thesis focus on the cooperation between an orthesis and a patient. Indeed, in order to support a rehabilitation process, gait parameters, such as hip and knee angles or the beginning of a gait phase, have been estimated. For this purpose a sensor system, consisting of accelerometers and gyroscopes, and algorithms, developed in order to avoid the error accumulation due to the gyroscopes drift and the vibrations related to the beginning of the stance phase due to the accelerometers, have been proposed.The main goal of the thesis is the development of human-robotic interaction control strategies, which enable close collaboration between human and robot. In this framework we studied two di erent aspects, with applications respectively in industrial and rehabilitation domains. In the rst part safety issues are examined on a scenario in which a robot manipulator and a human perform the same task and in the same workspace. During the task execution the human should be able to get into contact with the robot and in this case an estimation algorithm of both interaction forces and contact point is proposed in order to guarantee safety conditions. At the same time, all the unintended contacts have to be avoided, and a suitable post collision strategy has been studied to move away the robot from the collision area or to reduce the impact e orts. However, the second part of the thesis focus on the cooperation between an orthesis and a patient. Indeed, in order to support a rehabilitation process, gait parameters, such as hip and knee angles or the beginning of a gait phase, have been estimated. For this purpose a sensor system, consisting of accelerometers and gyroscopes, and algorithms, developed in order to avoid the error accumulation due to the gyroscopes drift and the vibrations related to the beginning of the stance phase due to the accelerometers, have been proposed

Monolithic self-supportive bi-directional bending pneumatic bellows catheter

The minimally invasive surgery has proven to be advantageous over conventional open surgery in terms of reduction in recovery time, patient trauma, and overall cost of treatment. To perform a minimally invasive procedure, preliminary insertion of a flexible tube or catheter is crucial without sacrificing its ability to manoeuvre. Nevertheless, despite the vast amount of research reported on catheters, the ability to implement active catheters in the minimally invasive application is still limited. To date, active catheters are made of rigid structures constricted to the use of wires or on-board power supplies for actuation, which increases the risk of damaging the internal organs and tissues. To address this issue, an active catheter made of soft, flexible and biocompatible structure, driven via nonelectric stimulus is of utmost importance. This thesis presents the development of a novel monolithic self-supportive bi-directional bending pneumatic bellows catheter using a sacrificial molding technique. As a proof of concept, in order to understand the effects of structural parameters on the bending performance of a bellows-structured actuator, a single channel circular bellows pneumatic actuator was designed. The finite element analysis was performed in order to analyze the unidirectional bending performance, while the most optimal model was fabricated for experimental validation. Moreover, to attain biocompatibility and bidirectional bending, the novel monolithic polydimethylsiloxane (PDMS)-based dual-channel square bellows pneumatic actuator was proposed. The actuator was designed with an overall cross-sectional area of 5 x 5 mm2, while the input sequence and the number of bellows were characterized to identify their effects on the bending performance. A novel sacrificial molding technique was adopted for developing the monolithic-structured actuator, which enabled simple fabrication for complex designs. The experimental validation revealed that the actuator model with a size of5 x 5 x 68.4 mm3 i.e. having the highest number of bellows, attained optimal bi-directional bending with maximum angles of -65° and 75°, and force of 0.166 and 0.221 N under left and right channel actuation, respectively, at 100 kPa pressure. The bending performance characterization and thermal insusceptibility achieved by the developed pneumatic catheter presents a promising implementation of flexibility and thermal stability for various biomedical applications, such as dialysis and cardiac catheterization

The emerging role of telehealth in a New Zealand ambulance service

Telehealth systems – using ICT to manage health from a distance – have been developing for decades, including within the ambulance sector. The author undertook this research to better understand how telehealth could improve patient outcomes, improve effectiveness, or create efficiencies for the St John ambulance service. To achieve this, current literature was reviewed and a small group of experts were interviewed whose experience lies in either the ambulance service or the health sector. Key recommendations are described below: • It is of strategic importance to design ambulance telehealth systems with interoperability and interconnectivity – this will maximise health sector integration and governmental support. • Telehealth solutions should be based on simple, well-established, easy to use, and ubiquitous technologies. This reduces fear, limits technical challenges, enables technology adoption, and improves chances of success. Of all available technologies, video-calling provides the most opportunity at present. • Consistent with the 111 Clinical Hub model, St John should centralise specialists to provide telehealth support. This approach is cost effective as only a small number of specialists is required. It also supports effective clinical decision-making as this group routinely make complex decisions. • It is realistic for St John to integrate video-calling as a telehealth solution into the 111 Clinical Hub. As a patient-to-clinician tool, 111 Clinical Hub staff could use video connections to call back low acuity patients to perform a secondary triage. As a clinician-to-clinician tool, paramedics could video-call the 111 Clinical Hub for clinical support. This would increase the richness of communication, and enable better clinical decisions to be made. • While it is unclear the role that remote monitoring will play in improving an ambulance service, it is clear is that medical alarms will evolve to have much greater functionality, including sharing of biometric information. St John needs to make a strategic decision as to whether it wants to play the role of monitoring those with long-term conditions – and therefore being responsible for taking action when there are any signs of deterioration – or whether that should be the role of general practitioners (GPs). • When designing telehealth solutions, St John must consider whether it is creating unequal access to healthcare and, where created, take actions to mitigate these inequities. • It is important that St John clearly communicates any new telehealth interventions – resistance to change must be anticipated and therefore strong communication strategies must be part of the design process. • There is limited evidence to support telehealth solutions in terms of improved patient satisfaction, improved patient outcomes, or greater efficiencies. With the impending implementation of electronic patient report form (ePRF) there is opportunity to evaluate a telehealth solution in these terms. • It’s important to note that, regardless of the telehealth system adopted, no single solution will be effective – real improvements will require multiple integrated systems

Study on a Robotic Carotid Blood Flow Measurement System

制度:新 ; 報告番号:甲3589号 ; 学位の種類:博士(工学) ; 授与年月日:2012/3/15 ; 早大学位記番号:新592

Comparison of the effect of Platelet Rich Plasma (PRP) with Hyaluronic Acid (HA) injections to treat chronic Jumper's knee

Introduction: Patellar Tendinopathies (PT) represent a very frequent disorder which incidence can reach 30-50% among jumping sports. This trouble is often rebel to classical treatment. Objective: To compare the efficacy of a single injection of RPR to a double infiltration of HA at one week interval. Patients/Methods: Thirty-three patients suffering from PT were enrolled into the study and split into two randomized groups . Eighteen patients (Group 1) have received one PRP injection and the other fifteen subjects (Group 2) received two HA infiltrations. Pain and functionality of the knee were evaluated before injection (T0), 6 weeks (T2) and 3 months (T3) after injections: pain with VAS and pressure algometer, algofunctional scores with IKDC and VISA-P questionnaires, ultrasound, isokinetic evaluation (quadriceps contractions : concentric 60°/sec (C60), concentric 240°/sec (C240), excentric 30°/sec (E30) and VAS during testing). Results: At baseline, difference existed only between groups for algometer, tendon thickness and axial hypoechoic area. In both groups, VAS, algometer, IKCD, VISA-P, VAS for isokinetic testing C60, C240 and E30 were significantly improved at T2 and T3 compared to T0. Comparison between the 2 groups showed no difference excepted for algometer, tendon thickness (T2, T3) and axial hypoechoic area (T2). Discussion and conclusions: There existed a similar improvement of the symptoms in both groups. PRP has already shown its efficacy in PT. HA should probably be a new therapeutic opportunity in this indication. Nevertheless, it should better, for further studies, to include a more homogeneous population and a longer follow-up period of time