Télé Echography using a Robotic Arm to operate the probe - OR - 3D Capture with Delayed Processing.

Transcription

1 Télé Echography using a Robotic Arm to operate the probe - OR - 3D Capture with Delayed Processing. Project R & D supported by European Space Agency ESA & CNES ESA-BNSC Forum Harwel Sept 3 rd 2008 Ph Arbeille, Unite Medecine et Physiologie Spatiales Dept Med Nucléaire & Ultrasons CHU Trousseau TOURS - France. arbeille@med.univ-tours.fr

2 Clinical Background : Echography 1 rst intention First imaging following clinical examination. Visualize the main abdominal & Pelvic organs (Liver, Gall bladder, pancréas, Kidney, Spleen, Uterus, Bladder ) muscles, Heart and Vessels. Eliminate serious diagnostic, Confirm level of gravity (Make transfer quicker)

3 Tele échography Background WHY a REMOTE Echography Patients in Geographically isolated sites Human on moving structures (Boat, plane, ISS) In Europ: No radiologist after 18h30 & weekend Need for second opinion when diagnostic difficult. In all that cases there is an Echo machine BUT No expert to serve it. WHY a Tele- Echography Echography is operator dependent need for assisting the Non skilled operator (voice, robot..) which require REALTIME COM If NO REALTIME high flow communication Blind capture of volume => Internet => 3D post processing

4 Primary Echographic Diagnosis (1rst imaging after clinical exam) First imaging method for primary medical evaluation Visualize the main abdominal organs: abdomen & Pelvis (liver, gall-bladder, pancreas, kidney, spleen, uterus, bladder, ), muscles, heart & vessels. Eliminate any serious diagnostic (patient remains home), Confirm severe clinical stage. (induce immediat transfer)

5 Secundary Echography (2 ière opinion) 2 Experts Exchange imaging & clinical data. Confirm suspected severe disease (malformation) Evaluate fetal growth and behaviour (1rst opinion) Patient remains in his home area, while having acces to the expert of the expert site.

6 Tele-operated Echography using a Robotic Arm Concept & design: Ph Arbeille (1997) => first prototype built: LVR Bourges 1998 TERESA (Sinters C i - ESA prog 2002) ESTELE (Robosoft C i -ESA-CNES ) ESA doc

7 TILTER prototype (Arbeille UMPS Tours) & scanning parameter.

8 REALTIME Communication ROBOTIC ARM

9 ISDN - TELEPHONNE link ARH (Gov Healthcare Adm) France (Region centre) Tele-echography network: Tours Hospital as Expert centre Serving 4 Patient isolated sites

10 Medical structures 50 km far from University Hospital Objective where there is no sonographer. Vendome Amboise Loches

11 ESTELE (Expert System for TELe Echography) Tours Univ Hospital & Loches (50km)

12 SATELLITE link

13 Eutelsat W1 D or V SAT protocols: 250 Kbits/s >15 frame/s

14 RESULTS Published and present RESULTS = 87 Abdomen. (Arbeille et al - AJR 2007) 256Kb/s & Medium level echo (>50K ) => no loss of info in image Diagnostic Score: 87.4% (12,6% cases Spleen difficult) RESULTS = 30 Obstetrics. (Arbeille et al Ultrasound Ob/Gy 2005) 250Kb/s-- Good-medium echo (>60K ) no loss of info in image Diagnostic Score: 93.4% means: (6.6 % femur or BIP not well visualized & measured) Presently 350 examinations (score Abdom 85% fetus 95%) Tested successfully during Week end One MD on call instead of 4 => NEXT Evaluation: multi center pilote study end to end diagnostic chaiin 300 cases (ARTIS project)

15 TIME DELAY SATELLITE INDUCED and REDUCED FLOW RATE

16 NO Realtime communication DELAY SATELLITE INDUCED TOO HIGH or REDUCED FLOW RATE 3D Capture and post processing

17 Volumic capture: Technical Procedure and Design - Volumic Automated Capture (by probe Tilting) of all images of the volume inside which the organ is supposed to be. - Automated Capture by a NON Echographic person. - Positioning based on the use of basic anatomical reference and WEBCAM control - Processing volume of image, using virtual navigation plan at the expert centre.

18 Native images of the acquisition plan (vertical blue plan), and reconstructed image in both a vertical plan perpendicular to the previous one and in a horizontal plan. 50 images (80 ) native Perpendicular reconstructed Horizontal reconstructed 50 images (80 ) 20 images (80 )

19 Localization of Robotic Arm or 3D Tilter ORGAN ACOUSTIC WINDOWS BODY MAPPING

20 Neck vessels Gall Bladder Aorta Pancreas Right Kidney Xyphoid e Left Kidney Bladder Prost Ut. Femoral vessels Tib Gast A & Vein

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22 Present & Future projects ROBOT in Region Centre: 4 hospitals ARH Loches,Vendome,Amboise Hospital (Abdom) Bourges maternity (Fetal echo 2nd opinion) ROBOT in France: Lannemezan, Toulouse ROBOT : Guyana dispensary (Maripasoula) Project 2008 (Tilter 3D + Robot) Europ centers: ARTIS Romania, Spain Onboard International Space Station In Antartica: CONCORDIA base (Dec 08) European Navy

23 Next Steps CONCORDIA Amazonia (French Guyana) Rescue Navy Ship

24 END END