Robotic arm will be used to perform distant echocardiograms, study shows

“Comprehensive echocardiographic exam with a 5G cellular network and robotic arm-based distant system is possible with relatively good diagnostic accuracy,” said study writer Dr Yu Liu, Zhongshan Hospital, Shanghai, China.

Echocardiography is the test-of-choice for the initial evaluation of many cardiac diseases and requires the expertise of a cardiologist for interpretation. Nevertheless, this expertise is commonly limited or unavailable in rural or indeed smaller urban areas. Robotic arm-assisted distant echocardiograms have been attempted for teleconsultation in previous studies, but evaluation was limited to heart failure patients, primarily as a consequence of the network delay in telecommunications and the following inadequate control of the robotic arm equipment.

On this study, the authors assessed the feasibility and diagnostic accuracy of a 5G cellular network and robotic arm-based distant echocardiographic system in an outpatient clinic based 20 kilometres away from Zhongshan Hospital. A complete of 51 patients were enrolled from the outpatient cardiology clinic. All underwent standard comprehensive echocardiography on a 5G cellular network robotic arm-based distant echocardiographic system, in addition to a standard echocardiographic platform (at Zhongshan Hospital) successively.

The order by which patients were examined on the distant and traditional instruments was randomly determined. There was no interval between the 2 examinations, and examinations of the identical patient were performed by experienced but different cardiologists, who were blinded to one another’s diagnosis. The doctor who used the distant system was also randomly allocated and had not been previously specifically trained. The examinations were real time and diagnoses were made immediately after the examinations.

From the 51 patients, the image quality was sufficient for diagnosis in 50 patients (24 (48%) female). A single patient was excluded because some key views couldn’t be obtained using the distant system, meaning 98% of the examinations had been technically successful.

Around one third (17 patients) had a heart problem identified using conventional in person echocardiography, including 10 with a primary diagnosis of valvulopathy (1 Barlow’s syndrome, 1 bicuspid aortic valve and eight less-than-moderate regurgitation), 2 cardiac surgery follow-ups (1 case of aortic valve substitute and septal myectomy, and 1 case of mitral valve substitute and tricuspid annuloplasty), and a couple of hypertrophy cardiomyopathy (including 1 case of obstruction at papillary muscle level), 2 with abnormal left ventricular wall motion (including 1 case of apical mural thrombus), and 1 with congenital heart disease (secumdum atrial septal defect).

Echocardiograms using the robotic arm resulted in the identical diagnosis as conventional in-person echocardiography in 98% of cases (papillary muscle level obstruction was missed in a single case).

Time for image acquisition using distant echocardiography was significantly longer (around 50% longer) than conventional (24 mins 36 secs vs. 16 mins 15 secs).

A previous version of the robotic arm has been cleared for clinical use in scanning the abdomen (China, Europe, Australia and Singapore), which requires less complex scanning manoeuvres. Nevertheless, the authors say a multi-centre study at a bigger scale with each other local hospital and referral centres involved ought to be carried out before this latest technology ought to be used.

Although 5G technology isn’t available in every single place, lead-author Xianhong Shu, also of Zhongshan Hospital, said: “This method would increase the accessibility of higher medical resources as patients may travel less to get diagnosis and medical advice from cardiologists based in referral centres.”

She adds there are further potential benefits: “A distant robotic echo system may help protect more health professionals from the chance of exposure during pandemics just like the COVID-19 because the cardiologist may not should be in close contact with the patient if only echocardiogram consultation is required.”