On the feasibility of a robotic probe manipulator for echocardiography in the prone position.

Robotic probe manipulator for echocardography (echo) can potentially reduce cardiac radiologists' physical burden. Echo procedure with industrial robots has wide Range of Motion (RoM) but poses safety risks because the robot may clamp the patient against the bed. Conversely, a soft robotic manipulator for echo has safe contact force but suffers from a limited RoM. Due to COVID-19, cardiac radiologists explored performing echo in the prone-positioned patients, which yielded good-quality images but was difficult to perform manually. From robot design perspective, prone position allows safer robot without clamping issue because all actuators are under the patient with minimal RoM to reach the cardiac windows. In this work, we propose a robotic probe manipulator for echo in the prone position employing a combination of a delta 3D printer and a soft end-effector and investigate its feasibility in a clinical setting. We implemented the robot as a scanner type device in which the probe manipulator scans from under a bed with an opening around the chest area. The doctor controls the robot with a joystick and a keypad while looking at a camera view of the chest area and the ultrasound display as feedback. For the experiments, three doctors and three medical students scanned the parasternal window of the same healthy subject with the robot and then manually. Two expert cardiologists evaluated the captured ultrasound images. All medical personnel could obtain all the required views with the robot, but the scanning time was considerably longer than the manual one. The ultrasound image quality scores of the doctors' group remained constant between manual and robotic scans. However, the image scores of the robotic scan were lower in the students' group. In summary, this work verified the ability to obtain clinically sufficient images in echocardiography in the prone position by expert medical doctors using the proposed robotic probe manipulator. Our robot can be further developed with semi automatic procedure to serve as a platform for safe and ergonomic echocardiography.