The quality of breast ultrasound imaging is greatly affected by the contact force of the probe, which largely requires experienced sonographers to complete the clinical examination. We propose a flexible and fully autonomous ultrasound scanning system for breast ultrasound imaging. It consists of an ultrasound machine, a dual robotic arms system, a multi-structured light system, a human–computer interaction system, and a flexible ultrasound probe clamping device (FUPCD). First, the dynamics model of the FUPCD was analyzed, and a closed-loop force control strategy was established. We then implemented an automatic scanning system. The hysteresis characteristics of the FUPCD and transient response of the force controller were experimentally verified. The system could keep the steady-state error less than <inline-formula> <tex-math notation="LaTeX">$\pm$</tex-math> </inline-formula> 5<inline-formula> <tex-math notation="LaTeX">$\%$</tex-math> </inline-formula> within 0.5 s. Second, the performance of the control system to maintain constant contact force at different scanning speeds (<inline-formula> <tex-math notation="LaTeX">$<$</tex-math> </inline-formula>20 mm/s) was evaluated. In a series of comparative studies, the fluctuation range of the target contact force applied by the flexible automatic scanning was 10<inline-formula> <tex-math notation="LaTeX">$\%$</tex-math> </inline-formula>. The force control capability of the system was 30.84 times higher than that of traditional manual scanning, 18.48 times higher than that of flexible automatic scanning (FC off), and 24.3 times higher than that of rigid automatic scanning (FC on). Furthermore, the effectiveness of the FUPCD arc design and flexibility was verified. In addition, the change trend of the average grayscale level (GSL) of the ultrasound image was basically the same as the contact force, demonstrating that the stability and repeatability of the ultrasound image can be improved by controlling the stability of the contact force. In conclusion, the proposed system can simplify the workflow of breast ultrasound examination and improve the diagnostic capabilities of the ultrasound imaging system. <i>Note to Practitioners</i>—The motivation of this study is to solve the problem of poor image reproducibility in breast ultrasound scanning, but the proposed system can also be applied to ultrasound scanning of other parts of the body. The position, direction, and contact force of the ultrasound probe affects the image quality and repeatability of the ultrasound, thereby affecting the diagnostic ability. Therefore, we propose and develop a flexible and fully autonomous breast ultrasound scanning system. We aimed to improve the autonomy and stability of the scanning process by designing end-to-end automated scanning strategies, flexible clamping devices, and closed-loop force control strategies. Among them, the fully automatic three-dimensional perception and trajectory planning can provide global fitting capabilities to different forms of breast surfaces and control the probe to maintain the best contact posture. At the same time, the fully automatic workflow reduces additional interference and reduces the complexity of the workflow. The flexible ultrasound probe clamping device improves the passive applicability to flexible tissues and reduces the resistance in the scanning process. The closed-loop force control strategy can adjust the contact force in real time. Experiments verified that the repeatability could be evaluated by contact force. A series of human–machine comparison experiments verified the advancement and effectiveness of the system. In future research, we will further solve the problem of abnormalities and repeatability of ultrasound images acquired during the scanning process by combining the multi-modal feedback of images and forces.
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