In a world first, a remote ultrasound robot is being tested inside a hospital with real patients, in the hopes it will show this technology is effective to roll out in regional and remote areas where access to testing services can be dangerously limited.
The robot dubbed ‘HERCULES’ – Haptically-Enabled Robotically Controlled ULtrasound Examination System – was developed by researchers at Deakin University’s Institute for Intelligent Systems Research and Innovation (IISRI) and is being trialled at Austin Health in Melbourne.
Lead developer Dr Parham Kebria said it was extremely difficult to get the necessary approvals for a robot like HERCULES to be tested on humans, so to be able to carry out a controlled trial with hospital patients was a major step.
“This gives us the opportunity to keep honing HERCULES’s development with the feedback and input from sonographers, radiologists and other specialists so we can modify the robot in a way that’s useful to their needs,” Dr Kebria said.
HERCULES is a remotely operated, haptically enabled robotic arm that can carry out ultrasounds without patients needing to be in the same room, or even the same country, as clinicians.
Operators use a stylus that mimics exactly the feel of a sonographer’s wand. Sensory information is taken from the robot working on the patient, so the operator can feel how much force is being used and adjust accordingly.
Cameras at multiple angles help the sonographer get to the right spots, and a live feed allows multiple clinicians, including the patient’s specialist for example, to observe the scanning in real time.
As part of the HERCULES trial in the Austin’s radiology department, eligible patients requiring an abdominal scan can volunteer to have HERCULES complete the scan, as well as undergo the traditional procedure.
Sonographers do the same scanning manually and robotically and collect the imagery information for the research team to compare. The patients are also surveyed about their experience.
Austin Health’s Radiology Medical Director, Associate Professor Natalie Yang, said the team – including Austin Health clinician Dr Numan Kutaiba and sonographer Niki Koutrouza – was already getting plenty of positive feedback.
“They have received feedback that some participants prefer the robotic way, because they felt more comfortable not having to have a person come so close to them,” Associate Professor Yang said.
“They also felt the pressure and force while being scanned by robot was much less than the conventional way. Some patients even fell asleep while they were being scanned by the robot.
“It’s exciting to see how far we are advancing in the space of radiology, and this is the just the first step for us in providing our community with a new tool to enhance their experience while also benefiting our staff.”
Dr Kebria said clinicians often had to put significant pressure when they were doing scans manually, especially if there was a lot of fatty tissue, which can often be the case with abdominal scans, and can become very tiring.
In fact, one in five sonographers will develop lifelong injuries as a result of their manual work. Dr Kebria hopes HERCULES could go some way in addressing this issue.
“We are using sensors to track the impact of this work on their bodies, especially where they typically get injuries. Potentially HERCULES can be a win-win for both patients and the sonographers,” he said.
The Austin Health trial is focussed on testing HERCULES for abdominal scans, typically used to assess the liver, kidneys and/or gall bladder. This is the most common scan that sonographers at the Austin do, and is a common scan generally, especially with rising national rates of liver and kidney disease.
“At the moment the sonographers are operating HERCULES from just a few metres away, separated by a curtain. But they could be anywhere with a good internet connection,” Dr Kebria said.
“The goal is to show that these robots provide as good results (or better) than traditional methods, so they can be rolled out in regional and remote areas where it is hard for patients to access these services.
“So many people are suffering and losing their lives in these areas because of the lack of clinicians. They can’t get the tests and care they need because of workforce shortages or lack of accessible services outside of city centres.
“These robots could offer one cost-effective solution. They’re a novel technology but affordable, as they’re mainly constructed from ‘off the shelf’ components. Once set up in a community, clinicians could remotely operate them from anywhere.”
HERCULES could even be adapted for other uses. During the COVID pandemic it was adapted for use in remote testing and assessment, where there was a need for clinicians and patients to physically distance and protect themselves from virus transmission.
“The applications are potentially endless,” Dr Kebria said.
