Comparison of telerobotic and conventional ultrasonography in children: a crossover bicentric pilot study

Abstract

Background: The MELODY system allows for performing ultrasonography on a patient remotely and has been proposed to assess disease characteristics in the context of the coronavirus disease 2019 (COVID-19) pandemic. The aim of this interventional crossover study was to address the feasibility of the system in children aged 1 to 10 years old.

Methods: Children underwent ultrasonography with a telerobotic ultrasound system followed by a second conventional examination by a different sonographer.

Results: In total, 38 children were enrolled, and 76 examinations were performed, with 76 scans analyzed. The mean [standard deviation (SD)] age of participants was 5.7 (2.7) years (range, 1-10 years). We found substantial agreement between telerobotic and conventional ultrasonography [κ=0.74 (95% CI: 0.53-0.94), P<0.005]. The mean (SD) duration was longer for telerobotic than conventional examinations [26.0 (2.5) vs. 13.9 (11.2) min, P<0.0001]. Abdominal organs and abnormalities were similarly visualized on telerobotic and conventional ultrasonography. Cardiac echocardiography provided reliable diagnoses, with non-significantly different measurements with both techniques, although the visualization score was significantly higher with conventional than telerobotic ultrasonography (P<0.05). On lung analysis, both examinations identified consolidations and pleural effusion, whereas visualization and total lung score were similar with the 2 techniques. Overall, 45% of parents reported that their children felt less pressure with the telerobotic system.

Conclusions: Telerobotic ultrasonography may be effective, feasible, and well-tolerated in children.

Keywords: Ultrasound echography; children; robot; telemedicine; telerobotic.

Figure 1

System and service architecture of MELODY remote system. The MELODY Patient System consists of a robot, a control panel, and a floor stand. The ultrasound transducer is clamped to the robot. The control panel is connected to the internet and receives signals from the expert site. The signals are translated and sent to the servo motors on the robot, which in turn move the transducer, mimicking the motion of the expert radiologist at the expert site. The videoconferencing system is ideally suited to a tele-ultrasound examination, offering simple operation and excellent communication regarding placement of the robot and the child between the patient and expert sites. The MELODY Expert system consists of a mini control panel and a fictive probe. The shape of the fictive probe resembles an ultrasound transducer and is held and moved by the expert as they might use an ultrasound transducer.

Figure 2

Adaptation of the MELODY system for children. To facilitate the acceptability of the device by children, the patient assistants were pediatric caregivers with specific skills in using the MELODY system with children (A). The patient site was redesigned with wall stickers for children (B,C). To reduce the system pressure on the child’s chest, a soft material was added under the base of the robot (A) and a new protocol for fixing the probe was implemented (D).

Figure 3

Flow chart of the participants in the study.