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Tele-echography

Robotized tele-echography.

Thanks to the development of new information and communication technologies, telemedicine is growing more and more, proposing a fantastic tool to counter medical desertification. Remote echography is totally part of these new practices (teleconsultation and tele-expertise).

This new technology has been developed to give a response to issues related to ‘isolated’ patients. Whatever the time, a patient will be able to benefit from a reliable ultrasound exam, performed by a recognized expert, even if this patient is located 1000 km away from the expert.

This high tech solution can meet many requirements in France and abroad. It can:

  • ensure a permanent medical care,
  • limit transfers of patients,
  • rationalize or mutualize carer,
  • counter medical desertification,
  • propose an efficient diagnosis imaging technique in places where access to it was impossible before (islands, ship, military fields, space, places where disasters occur…).

 

The specific features of an echography examination

Here are a few points to help you better understand the use of robotised tele-echography:

  • The examination is carried out by an expert in real-time.
  • The probe is manipulated directly by the expert to get the exact views required, and the probe can be rotated and angled very precisely.
  • The examination is said to be “manipulator dependent” as the analysis and expertise are conducted during the examination itself, and the report cannot subsequently be changed.

Principle

The robotized tele-echography is a new concept, and results from the migration of research in space medicine aiming to providing better auscultations of isolated patients.

Today, the robotized tele-echography is part of telemedicine and allows, from an expert centre, to handle an ultrsound probe located where the patient is. Interpretion of the examination results is performed by the expert, in real time. Communication link between both sites can be performed using various technologies, depending on the isolation or local communication possibilities (satellite, internet, ISDN…).

 

Few dates

  • 1995: Exploratory studies into space medicine. He rapidly established the concept of remote echography.
  • 1998: A team from the Bourges Robotics IUT carried out a tele-echography at the summit of Shisha (Himalaya) using the first prototype of the robot operated 6000 kilometres away in Bourges.
  • 1998-2005: During this period extensive research was carried out resulting in some new prototypes of the remote echography robot. Two patents were filed by the PRISME laboratory in Bourges.
  • 2006: Study commissioned by the ARH Centre regional hospital trust and entrusted to carry out remote echographies at the four regional hospitals, including Vendôme hospital and the Tours University Hospital, in order to confirm the technique worked in everyday usage. Dr Lefebvre took part in this study.
  • 2009: Robotised tele-echography nominated for the Victoires de la Médecine.
  • 2009: Experiment conducted in Cyprus by the PRISME laboratory and the University of Cyprus showing that is possible to carry out a tele-echography in a moving ambulance via satellite link with the device being remotely operated from the hospital.
  • 2010: A large-scale experiment organised between Madrid and Afghanistan by satellite link as part of a partnership between the Spanish army and ESA (European Space Agency).
  • 2011: The Cayenne hospital and the CNES decided to install a MELODY tele-echography robot in French Guiana so as to assess the technique before rolling it out throughout Guiana as a whole.
  • 2012: Full-scale international experiment as part of WORTEX 2012. This experiment was supported by various hospitals and universities from all around the world (including in France, Peru, the USA, and Cyprus). The robots used in this experiment were supplied by AdEchoTech.
  • 2012: ESA invested funds in research into robotised tele-echography working with AdEchoTech.
  • 2013: After three years of development and scientific validation the MELODY robot is brought to market.

Scientific references

Robotised tele-echography has already been scientifically proven to be effective by clinical validations published in international journals. The results are extremely encouraging and show how reliable the technique is.

These studies show that there is about 90% concordance between a normal echography and one carried out with a robotic tele-echography system. Furthermore, at the medical level, there was not a single false positive or false negative in any of these examinations, for which a time limit of 15 minutes was applied.
Here are a few bibliographic references for tele-echography:
  • P. Vieyres, G. Poisson, F. Courrege, O Merigeaux, Ph. Arbeille. ‘The TERESA project: from space research to ground tele-echography’. Industrial Robot: An International Journal. 30 (1): 77-82. 2003.
  • Ph. Arbeille, G. Poisson, J. Ayoub, P. Vieyres, M. Chevillot, Ph. Hervé, M. Porcher, JL. Boulay. ‘Echographic examination in isolated sites controlled from an expert center using a 2D Echograph guided by a robotic arm’. Ultrasound Med Biol. 29 (7): 993-1000. 2003. (link to the study)
  • Arbeille P, Ruiz J, Ayoub J, Vieyres P, Porcher M, Boulay J, Moreau V, Poisson G. ‘The robot and the satellite for tele-operating echographic examination in Earth isolated sites, or onboard ISS.’ 2004 Jul;11(2):P233-4. (link to the study)
  • P. Arbeille, J. Ruiz, P. Herve, M. Chevillot, G. Poisson, F. Perrotin. ‘Fetal tele-echography, using a robotic arm and a satellite link’. Ultrasound Obstet Gynecol; 26 (3): 221-226. 2005.
  • F. Courreges, P. Vieyres, RS. Istepanian, Ph. Arbeille, C. Bru. ‘Clinical Trial and evaluation of a mobile, robotic tele-ultrasound system’. J Telemed Telecare. 11; suppl 1: 46-55. 2005.
  • P. Arbeille, J. Ayoub, V. Kieffer, B. Combes, A. Coitrieux, P. Herve, S. Garnier, B. Leportz, E. Lefbvre, G. Poisson, P. Vieyres, F. Perrotin, ‘Abdominal and fetal echography tele-operated in several medical centres sites, from an expert center, using a robotic arm & telephone or satellite link’. J Gravit Physiol 2007;14: 139-40.
  • P. Arbeille, A. Capri, J. Ayoub, V. Kieffer, M. Georgescu, G. Poisson. ‘Use of a robotic arm to perform tele operated abdominal ultrasound’. Am J Roentgenology; 188: 317-322. 2007.

 

What kind of future for the Tele-echography

On first inspection tele-echography might not necessarily seem of great interest in Europe. However, current changes in medicine, the lack of availability of experts, the need to improve the working conditions of imaging practitioners who are often overworked and reduce their duty hours, or simply reduce the amount of travelling done by patients and transfers between hospitals offer significant perspectives for the development of this technique. Especially as telemedicine is currently becoming a development priority and tele-echography is the missing link in what would otherwise be a complete tele-imaging chain.

Outside Europe the problems are a little different, but there are many applications. Many countries are medically isolated and this new technology offers an important service in managing emergencies and pregnancies for instance. This is the case in French overseas territories where settlements are scattered over large areas, but it is true in many other countries. There are many applications which improve access to health care in otherwise underequipped areas. There are many sectors offering promising perspectives for this new technique: merchant and cruise ships, military sites, oil rigs, prisons, and so on.