Feasibility, Reliability and Acceptability of a Haptically Enabled Robot for Teleoperated Echocardiography

Haptically Enabled Robotic Teleoperated Echocardiography (HERTEC) could improve access of patients in rural and remote areas to skilled sonographers. We sought to determine the feasibility, measurement accuracy and participants' responses to the performance of a robotic echocardiogram performed by a sonographer at distance.

In this cross-sectional study, 41 asymptomatic adults without known cardiac disease underwent focused echocardiography studies using a handheld ultrasound (HHU) device and robot. This device employed a collaborative robotic arm, force-torque sensors, and remote haptic control. Image quality was assessed using the 5-point American College of Emergency Physicians (ACEP) scale from 1 (no recognizable structures) to 5 (excellent quality fully supporting diagnosis). A 5-point Likert scale questionnaire assessing participant feedback on safety was obtained post-test.

ACEP scores of the HERTEC system indicated 95% adequate quality (≥3) for parasternal long-axis, 91% for aortic valve-level parasternal short-axis, 93% for apical 4-chamber, but lower rates for apical 2- and 3-chamber views (71%), with significant differences across windows. All HHU images reached adequate quality for each view. Structural measures demonstrated minor differences between robotic and HHU for LV diastolic dimension (HHU 4.6 vs HERTEC 4.4 cm, p<0.001) and LV mass (HHU 126 vs HERTEC 115 g, p=0.002). Quality scores were significantly different between methods for the mitral valve short-axis (p=0.008), papillary muscle (p=0.008), apical 2ch (p<0.001) and apical long-axis (p<0.001). Time to complete study was the most significant difference between the HHU and HERTEC (5.2±1.8 vs 25.2±8.1 minutes, p<0.001). Participants felt safe and informed, and were willing to repeat robotic scans, with confidence in control features and diagnostic ability. Compared to traditional ultrasounds, 16% were less comfortable with robotic pressure and 10% expressed less overall comfort with the procedure.

HERTEC consistently produced lower-quality images than a standard HHU, but achieved echocardiography measurements comparable to HHU in most views, with excellent participant safety perceptions and high acceptability despite minor comfort differences. These findings indicate that robotic teleoperated heart ultrasound may have future potential, but technical advances to improve image quality and speed are required before clinical application.