Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec;20(6):e70005.
doi: 10.1002/rcs.70005.

Robotic Assisted Ultrasound-Guided Endovascular Stent Implantation in a Vascular Model

Alexandra Scheibert  1 , Mark Preuss  2 , Jonas Osburg  3 , Floris Ernst  3 , Markus Kleemann  4 , Marco Horn  1
Affiliations

Robotic Assisted Ultrasound-Guided Endovascular Stent Implantation in a Vascular Model

Alexandra Scheibert et al. Int J Med Robot. 2024 Dec.

Abstract

Background: Endovascular procedures are the preferred method for treating peripheral arterial disease. However, limited imaging options during these procedures, such as X-rays and contrast media, expose patients and healthcare professionals to potentially harmful radiation. This study introduces a robotic ultrasound system (RUSS) for navigating endovascular procedures in order to reduce radiation and provide additional information.

Methods: The RUSS comprises a seven-degree-of-freedom robotic arm that navigates an ultrasound transducer across a specific region of interest. The system is controlled by a self-programed software designed to navigate the robotic arm in a methodical and reproducible manner using a foot switch.

Results: An endovascular surgeon investigated the guidance and visibility of various guidewires and successfully implanted three stents in a vascular leg phantom using the RUSS without further radiation exposure.

Conclusions: The innovative set-up has several potential applications, including radiation-free endovascular procedures as well as health screening and diagnostic support in vascular medicine.

Keywords: 3D ultrasound; 3D vessel model; endovascular procedure without radiation; peripheral arterial disease (PAD); robotic ultrasound guidance; robotic ultrasound system (RUSS).

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

The University of Luebeck holds a patent for the project under number DE 102020109593 B3, which is titled ‘Method for navigating an ultrasound augmented reality peripheral endovascular intervention and associated assembly for navigating an ultrasoundaugmented reality peripheral endovascular intervention’.

The University of Luebeck holds a patent for the project under number EP2737455 B1 in DE, GB and FR, filed in July 2011, under the title ‘Method for finding the position of a transducer’.

Figures

FIGURE 1
FIGURE 1
Ultrasound‐capable phantom imitating the superficial femoral artery; sketch of the model (1), image of the model (2) and CT image reconstruction post Stent implantation (3); components of the model: (A) silicone tube inner diameter 6 mm; (B) plastic femur bone; (C) vascular introducer sheath 16F; (D) outer shell made of wax gel; (E) three way stop cock; (F) three endovascular stents in the artificial vessel.
FIGURE 2
FIGURE 2
Experimental setup of the robotic‐guided ultrasound system for endovascular interventions including a foot switch for navigation. (A) Robot arm KUKA iiwa 14 LBR 820 with self‐designed 3D printed ultrasound probe holder (B); (C) Ultrasound system Philips Epiq 7; (D) monitor showing ultrasound image in two positions (cross‐section and longitudinal‐section); (E) ultrasound‐capable three‐dimensional vessel model; (F) foot switch Olympus RS31 controlling the robot arm; (G) interventionalist with both hands free for endovascular procedure.
FIGURE 3
FIGURE 3
Setup of the robotic ultrasound system (RUSS) for the automatised pilot scan. The ultrasound volume from the ultrasound station is sent to a workstation for visualisation and vessel detection, performed using a template matching method. Once the template matching has been processed, the newly calculated position for the ultrasound probe is sent to the robot arm.
FIGURE 4
FIGURE 4
Procedure of template matching vessel tracking. At the beginning of the scan, a vessel template is selected. This template is then searched for in the new ultrasound (US) images during the scan. The position with the highest correlation coefficient is indicated by the thicker dashed yellow box. This position is then updated, and the distance from the vessel's position to the image centre is calculated. If the distance between the detected vessel centre and the centre of the US image displayed is more than 5 mm, the robot will adjust the probe position by moving it towards the centre of the vessel. Otherwise, if the distance is less than 5 mm, the robot moves the probe along the scan.
FIGURE 5
FIGURE 5
Set‐up of a RUSS equipped with a foot switch for the interventionalist to direct the robotic arm in endovascular procedures. The interventionalist can manipulate the robot's motion on the pilot path, forwards (2) and backwards (1), and adjust the 3D ultrasound image visualisation by correcting the cross section (red dotted line) of the vessel, left (3) and right (4). Technical term abbreviations, including ‘3D’, were explained upon first use.
FIGURE 6
FIGURE 6
Robot assisted sonographic images during stent implantation, cross section on the left‐hand side (‐1); the white line in the cross section image marks the section of the three‐dimensional image for the longitudinal section on the right‐hand side (‐2): (a) visualisation of guide wire (marked with arrow); (b) visualisation of stent tip; (c) start stent expansion; (d and e) stent completely expanded.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Bradbury A. W., Moakes C. A., Popplewell M., et al., “A Vein Bypass First Versus a Best Endovascular Treatment First Revascularisation Strategy for Patients With Chronic Limb Threatening Ischaemia Who Required an Infra‐popliteal, With or Without an Additional More Proximal Infra‐Inguinal Revascularisation Procedure to Restore Limb Perfusion (BASIL‐2): An Open‐Label, Randomised, Multicentre, Phase 3 Trial,” Lancet 401, no. 10390 (2023): 1798–1809, 10.1016/S0140-6736(23)00462-2. - DOI - PubMed
    1. Rudnick M. R., Leonberg‐Yoo A. K., Litt H. I., Cohen R. M., Hilton S., and Reese P. P., “The Controversy of Contrast‐Induced Nephropathy With Intravenous Contrast: What Is the Risk?,” American Journal of Kidney Diseases 75, no. 1 (2020): 105–113, 10.1053/J.AJKD.2019.05.022. - DOI - PubMed
    1. Rachoin J. S., Wolfe Y., Patel S., and Cerceo E., “Contrast Associated Nephropathy After Intravenous Administration: What Is the Magnitude of the Problem?,” Renal Failure 43, no. 1 (2021): 1311–1321, 10.1080/0886022X.2021.1978490. - DOI - PMC - PubMed
    1. Bolt L. J. J., Krasznai A. G., Sigterman T. A., Sikkink C. J. J. M., Schurink G. W. H., and Bouwman L. H., “Duplex‐Guided Versus Conventional Percutaneous Transluminal Angioplasty of Iliac TASC II A and B Lesion: A Randomized Controlled Trial,” Annals of Vascular Surgery 55 (2019): 138–147, 10.1016/J.AVSG.2018.07.047. - DOI - PubMed
    1. Ascher E., Marks N. A., Hingorani A. P., Schutzer R. W., and Mutyala M., “Duplex‐Guided Endovascular Treatment for Occlusive and Stenotic Lesions of the Femoral‐Popliteal Arterial Segment: A Comparative Study in the First 253 Cases,” Journal of Vascular Surgery 44, no. 6 (2006): 1230–1237, 10.1016/J.JVS.2006.08.025. - DOI - PubMed

MeSH terms

LinkOut - more resources