Mixed Reality Tele-Ultrasound over 750 km: A Feasibility Study

Abstract: To address the lack of access to ultrasound in remote communities, previous work introduced human teleoperation, a mixed reality and haptics-based tele-ultrasound system. In this approach, a novice takes the role of a cognitive robot controlled remotely by an expert through mixed reality. In this manuscript we summarize new developments to this system and describe a feasibility study assessing its use for long-distance remote abdominal ultrasound examinations. To provide simple but effective haptic feedback, we used an ellipsoid model of the patient with its parameters calibrated using our system's position and force sensors. We tested the system in Skidegate, Haida Gwaii, Canada, with the experts positioned 754 km away in Vancouver, Canada. We performed 11 total scans with 10 novices and 2 sonographers. The sonographers were tasked with acquiring 5 target images in the epigastric region. The image acquisition quality was assessed by 2 radiologists. We collected alignment data and the novices completed task load and usability questionnaires. Both the novices and sonographers provided written and verbal feedback to inform future design iterations. 92% of the acquired images had sufficient quality for interpretation by both radiologists. The mean task load reported by the novices was below reference values reported in literature and the usability was unanimously positive. No correlation was found between image quality and the follower's alignment error with the virtual transducer. Overall, we show that human teleoperation enables sonographers to perform remote abdominal ultrasound imaging with high performance, even across large distances and with novice followers. Future work will compare human teleoperation to conventional, robotic and tele-mentored ultrasound.