Current Status and Pending Developments of Robotic Tele-Echocardiography

Echocardiography is the gateway to appropriate therapy for many cardiovascular diseases, but access to this test is sometimes challenging. The consequence is that patients in rural and remote areas need to travel for testing, and the resulting time and monetary costs may prove a barrier, especially for hospital inpatients. Delays in obtaining echocardiograms lead to delayed diagnosis and treatment. Technological advances in miniaturization and processing power, and reductions in cost, have enabled diagnostic images to be obtained from inexpensive echocardiography machines. However, imaging by nonexperts is difficult, even with guidance by artificial intelligence. An alternative strategy is to use high-bandwidth, low-latency communication systems to bring the expertise of an expert sonographer to a remote patient by using a robot. Previous work has shown that remote robots are able to reproduce the hand movements performed by sonographers, and multiple types of robot-guided ultrasound examinations have been performed successfully in remote areas. However, despite clear clinical need and ongoing interest, the promise of robotic tele-echocardiography awaits clinical translation. Existing research points toward longer examination times and a need for additional personnel for local supervision of remotely acquired echocardiograms. The efficiencies of longer examinations and more personnel may be worthwhile to facilitate remote access, or within a hospital to avoid sonographer injury, or to improve safety from infection or radiation exposure during structural heart disease interventions. Potentially, autonomous robot-assisted ultrasound may replace the sonographer, by interfacing with artificial intelligence-guided acquisition, although this remains futuristic and uncertain. This paper reviews recent developments in controlling the speed and force of a recently developed robotic system, means of facilitating positioning of the probe, and haptic control. It emphasizes the primary concerns to be imaging time and safety.