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

Haptically enabled robotic teleoperated echocardiography (HERTEC) could improve access to skilled sonographers for patients in rural and remote areas. We sought to determine the feasibility, measurement accuracy, and participant responses to the performance of a robotic echocardiogram performed by a sonographer at a 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 posttest.

American College of Emergency Physicians scores of the HERTEC system indicated 95% adequate quality (≥3) for parasternal long-axis, 91% for aortic valve-level parasternal short-axis, and 93% for apical 4-chamber views 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 left ventricular diastolic dimension (HHU 4.6 vs HERTEC 4.4 cm, P < .001) and left ventricular mass (HHU 126 vs HERTEC 115 g, P = .002). Quality scores were significantly different between methods for the mitral valve short-axis (P = .008), papillary muscle (P = .008), apical 2-chamber (P < .001), and apical long-axis (P < .001) views. The time to complete the study was the most significant difference between the HHU and HERTEC (5.2 ± 1.8 vs 25.2 ± 8.1 minutes, P < .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.