Robotic Lung Ultrasound for Triage of COVID-19 Patients in a Resource-Limited Environment

项目总结 新的严重急性呼吸综合征冠状病毒2(SARS-CoV-2)已经呈现出一场史诗般的大流行 据估计，100个国家中有800多万人受到影响。全球应对措施为健康做好准备 世界各地的系统是至关重要的。呼吸道症状是COVID-19的主要表现， 由SARS-CoV-2引起的疾病可从轻微疾病到严重、急性和暴发性呼吸道疾病。 苦恼。面对全球大流行，这种不同的严重性需要快速诊断，以提供 对病人进行适当的分流和处置。诊断性检查，如平片摄影(x光)和胸部检查 计算机体层摄影术(CT)被认为是诊断肺部相关疾病的主要方法 疾病。肺部超声(Lus)已成为x射线和胸部ct的替代方法，可用于快速诊断。 新冠肺炎感染患者的主要优势包括安全、无辐射、成本低，以及其 便于携带，便于床边诊断。已经提出了新冠肺炎患者的LUS成像指南。 然而，LUS成像高度依赖于操作员。在资源有限的地区，可访问性受到 在提供准确诊断方面受过适当培训的少数内科医生和超声师。 此外，lus成像要求操作员和患者之间有密切的身体接触，这可能会导致 增加了新冠肺炎传播的风险。因此，有一种未得到满足的需求，即开发一种更容易获得的 新冠肺炎患者的LUS系统，从而减少操作员和患者之间的身体接触。 在这个计划中，我们的目标是开发一个安全、低成本和易于使用的机器人逻辑单元平台，以1)最大限度地 在资源有限的环境中实现可访问性，以及2)最大限度地降低新冠肺炎在 病人和医护人员。该机器人平台将被设计为执行以下逻辑单元程序 已建立的诊断工作流程，同时确保足够的安全性。提出的基于龙门式机器人平台 允许操作员基于来自以下位置的视觉信息远程操作超声探头 摄像机。因此，操作员不需要与患者在一起，从而提高了可达性。一个最优的 组织探头接触压力将通过无电子被动机械配置来保持，以 避免过大的接触力，确保患者安全。该龙门系统结构简单、成本低、 在研究有限的环境中易于实施。具体地说，我们建议评估机器人逻辑单元 采用主动-被动混合控制(目标1)的平台，展示了安全性和健康交叉验证 志愿者(目标2)，并在COVID19名患者(目标3)中展示了系统的可靠性和性能。这 所提出的机器人LU平台(1)使得LU过程在资源有限的环境中更容易访问， (2)将患者和医护人员之间的传染风险降至最低，以及(3)建立标准化 收集LU数据，提高疗效。拟议的系统有可能在以下方面发挥关键作用 通过对疑似或已被诊断为新冠肺炎的患者进行分诊，最大限度地发挥医疗功能。

PROJECT SUMMARY Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already taken on a pandemic of epic proportions, affecting over 8 million humans in an estimated 100 countries. A global response to prepare health systems worldwide is of utmost importance. Respiratory symptoms are the primary manifestation of COVID-19, and the disease caused by SARS-CoV-2 can range from mild illness to severe, acute and fulminant respiratory distress. This varying severity in the face of a worldwide pandemic necessitates rapid diagnosis to provide the proper triage and disposition of patients. Diagnostic testing such as plain-film radiography (x-ray) and chest computed tomography (CT) are considered the mainstay of diagnostic imaging in the detection of lung-related disease. Lung ultrasound (LUS) has emerged as an alternative to x-ray and chest CT for rapid diagnosis of COVID-19 affected patients with major advantages include safety, absence of radiation, low cost, and its portability for ease of bedside diagnosis. Guidelines for LUS imaging in COVID-19 patients have been proposed. However, LUS imaging is highly operator dependent. In resource-limited areas, the accessibility is limited by the small number of physicians and sonographers who are properly trained in providing accurate diagnosis. Additionally, LUS imaging requires close physical proximity between the operator and patient, which could lead to an increased risk of COVID-19 transmission. Therefore, there is a unmet need to develop a more accessible LUS system for COVID-19 patients, whereby reducing physical contact between the operator and patient. In this proposal, we aim to develop a safe, low-cost, and easy-to-use robotic LUS platform to 1) maximize the accessibility in a resource-limited environment and 2) minimize the risk of COVID-19 transmission between patients and healthcare workers. This robotic platform will be designed to conduct LUS procedures following established diagnostic workflows, while ensuring adequate safety. The proposed gantry-based robot platform allows the operator to tele-operatively manipulate the ultrasound probe based on visual information from cameras. Thus, the operator is not required to be present with the patient, improving accessibility. An optimal tissue-probe contact pressure will be maintained by an electronics-free passive mechanical configuration to avoid excessive contact forces and ensure patient safety. The gantry system is structurally simple, low-cost, and easy to implement in a research-limited environment. Specifically, we propose to evaluate the robotic LUS platform with the active-passive hybrid control (Aim 1), demonstrate the safety and cross-validation in healthy volunteers (Aim 2), and demonstrate the system reliability and performance in COVID19 patients (Aim 3). This proposed robotic LUS platform (1) makes the LUS procedure more accessible in a resource-limited environment, (2) minimizes the risk of contagion between patients and healthcare workers and, (3) establishes standardized data collection of LUS to improve the efficacy. The proposed system has the potential to play a critical role in maximizing healthcare function via triaging of patients suspected to or have been diagnosed with COVID-19.