Teleoperation Architectures for Remote Ultrasound Diagnostic Imaging: A Systematic Review

Teleultrasound is a promising application of telemedicine, enabling remote diagnostic imaging through teleoperated systems. While previous reviews have addressed various aspects such as clinical applications, autonomy levels, or assistive functionalities, a systematic analysis of teleoperation architectures-the core enabler of remote manipulation and feedback-remains lacking. This paper presents a comprehensive review of thirty-nine teleultrasound systems, focusing specifically on teleoperation architectures. Each system is examined in terms of leader and follower design, control strategies, force-feedback implementation, time delay handling, communication infrastructure, and anatomical targets. The aim of this review is the evaluation of system transparency and stability, analyzed not only in relation to devices' mechanical design and control implementation, but specifically from a comprehensive architectural point of view. Also, the evaluation critically takes into account the realism of the test conditions. Through this lens, the review shows how architectural choices critically shape the performance and safety of remote ultrasound interactions. Open challenges and future directions are also discussed, offering a reference framework for researchers and developers working on next-generation remote ultrasound technologies.