Current Applications of Remote Robot-Assisted Cardiac Ultrasound Examination: A Systematic Review of Clinical Use and Technological limitations

Abstract

The use of robot-assisted ultrasound systems (RAUS) has the potential to overcome the lack of access to care in remote locations. This review aims to systematically gather, compare, and discuss the current state-of-the-art of RAUS. A systematic search was performed in Embase, PubMed, MEDLINE and Scopus in March 2021. We analysed the robot type, communication link between master and slave, control distances, visual interface, and type of feedback control. 2,997 articles were screened, with 25 articles included for review. The articles identified were clinical (n=10) or preclinical studies (n=15). Of the clinical studies, 40% were cardiovascular. The cardiac RAUS included 113 participants who showed similar findings to traditional ultrasound, although limitations with valvular assessments exist. A lack of control of the ultrasound settings at the master site was prevalent. The majority of the studies required assistants to adjust settings following verbal instructions (increasing examination time). Image Quality: Errors primarily arose from image resolution, highlighting the importance of image quality. Low bandwidth links could be used to control a robot; however, higher bandwidth is required for video and ultrasound image transmission. Feedback. Visual (56%) and a combination of visual and force (36%) were the most prevalent feedback systems. Force-feedback allowed smoother robot control and made sonographers aware of the pressure applied to the patient’s skin. The combination of robotics, AI, and telecommunications can further revolutionise the use of medical ultrasound in the future. Further developments should focus on the control algorithms, communication system and the front-end interface.