Tele echography (Tele-operation, 3D reconstruction, remote guidance)
Tele-operated ultrasound system (Tours) for tele-operating echographic examination in realtime in rural areas and in space. (PI Pr Arbeille)
Objective
Design and validate tele-operated systems (robots, motorized probes..) or volumic capture with 3D reconstruction, and remote guidance method for performing tele echographies on patient in isolated rural areas and on astronaut in the ISS. Several project were run from 1997 up to now.
Past and present program in Tele echograhy
- Between 1997 and 1998 a robotic arm was developed by our lab (UMPS Tours ESA-MAP) in collaboration with LVR (Bourges – ESA-SME) for tele-operating ultrasound probe from distance for performing an echography on a patient located in an isolated site where there is no expert in echography (Syrtec). Most of the recent projects are still based on the use of the robotic system which applies on a conventional ultrasound probe in contact with the patient skin, all the movement that the expert applies on a dummy probe located at the expert centre.
- The first clinically operational prototype built in collaboration with Sinters Cie in Toulouse (ESA Contracts - 2002) was rather heavy, did not accept all the ultrasound probe (Teresa), and the order to the Robot as well as the video files had to travel through ISDN lines or satellite network, both being expensive and not available in all the isolated sites. Otelo was developed under a UE support (LVR UMPS contract 3004) and implemented with an XY translation integrated into the Robotic arm. For all these prototypes our UMPS lab designed and tested the technical requirement, and validated the medical application. The LVR built up the prototypes and the Sinters company delivered the final product to be used on patients (Arbeille et al 2003, 2005).
- In 2007 and 2010 other models based on the same robotic concept and technique were developed by UMPS and LVR in collaboration with 2 other companies (Robosoft and Adechotech). These new devices (Estele 2008 & Melody 2011) were definitely more adapted to medical ultrasound activity as they were compatible with most of the probes and worked through low cost network like Internet widely distributed among most of the countries. These robotic systems were validated for abdominal, pelvic, and fetal application. The Robot provided the right diagnostic in 85% of the patient on abdominal and pelvic pathologies and in 92% for the fetuses (Arbeille 2007, 2009). More than 500 patient were successfully investigated by this method.
- By the same time ESA funded another project (ARTIS 2008-2010) based on another robotic system. The system allowed to teleoperate the probe from distance but the movements kinetic was pretty low and the manipulation not easier compare to the Robosoft (Estele) system. At last only the Adechoteh (Melody) model was commercialized in 2011.
- In 2011 and 2012 three medical sites (small hospital) have been equipped for practicing tele echography in routine (Maripasoula dispensary in French Guyana served by Cayenne University Hospital at 500km, and 2 Medical centre at Montoire sur Loir, and Richelieu (cities of 3500 habitant in Region Centre France) served by Tours University Hospital at 50km. The Melody Robots had a volume of around (40x45x35 cm3) and weighted approximately 4kg. Consequently a mechanical support close to the patient bed became necessary otherwise the paramedic could not move easily such robotic arms over the patient and keep it motionless for several minutes when the organ acoustic window was found. The system was tested in routine practice over 1 year (Georgescu 2015).
- In April 2011 our lab UMPS-CERCOM designed an XY translation system for translating the existing robotic systems, such translator being fixed to a 3DDL orientable mechanic arm. A copy of this prototype was motorized by the company Adechotech (June 2011). With a robotic arm Melody, translated by the XY translator, and fixed to an orientable mechanic arm we designed a validation in echocardiography. Among the 41 patient with cardiac disease the full robotic system provided the right diagnostic in 83% of the cases which prove that the systems is also reliable for Cardiac application (Arbeille et al 2014.
Limitation of the present Robotic arms : The major problem is that the robot plus the translator weights approximately 8 kg which require a strong mechanical and orientable arm and have a volume of “40x45x35 cm3” for the robotic arm, plus “30x30x20 cm3” for the translator, plus the orientable mechanical support necessary for tele-echocardiography. Despite the encouraging result obtained with the present Robotic arms (Estele, Melody) it appears that in routine the Robotic arms are rather heavy and big (40x35x35cm3 and 4 kg) and not easy to be manipulated by nurses or other paramedics even when using a support. For example if the patient cannot be easily moved it is difficult to locate the robot at the place indicated by the expert, moreover if the expert need a slight translation of the Robotic arm it is not easy to move it on a short distance (1-2 cm). On the other hand the Robot in its present concept cannot be miniaturized and the additional mechanical support needed to hold it on top of the patient is not suitable around the patient in the emergency room. At last due to its weight and volume it will be difficult to fly such device onboard the space station.
Thus a 2 new device were designed : - Volumic capture & 3D reconstruction (CNES-CNIS) (2009) : This system was based on the volumic capture of images while scanning the volume in which the organ is supposed to be by TILTING the probe from 90° to -90° from the vertical to the skin. After having collected all the images during the scan (in 3 to 5 s) a dedicated software allowed us to reconstruct the volume scanned in 3D (Soft CNES LIPAD Univ Paris V Pr N Vincent publication Arbeille et al 2014) The Volumic capture and 3D mode was successfully used during several spaceflights onboard ISS (Vessel Imaging) the astronaut was guided from the ground to locate the probe on top of the acoustic window of the organ then he tilted manually and slowly the probe and the PI collected the video at the space control center. ( Publication Arbeille et al 2014; 2016)
- Tele Operated ultrasound system (Tours) Sonoscanner Motor probe (2013) : This system was based on the development of a motorized probe inside which 2 adapted micro engine allow the expert to orientate the transducer (TilT +/-90° and Rotate +/-180°) from away. The probe was designed not to exceed 450g and 450cm3 and both the probe tranducer (Tilt rotate) and the Echograph settings (gain, depth..) and function (PW color mode, measures..) were tele-operated from away. The system named TOURS (acronym of TeleOperated UltRasound System) was delivered to CNES in Sept 2014 and validate on patient in rural places and overseas location (Arbeille et al 2016 Publication below).
All the 3 methods presently available on the market (Remote guidance, Robotic arm and Motorized probe) were tested in routine practice in an isolated medical center on 340 patients (Arbeille et l 2016).