Abdominal and fetal echography tele-operated in several medical centres sites, from an expert center, using a robotic arm & telephone or satellite link.

OBJECTIVE: to design and validate a method for tele-operating (from an expert site) an echographic examination in an isolated site where the patient stays. METHOD: A dedicated robotic arm (ESTELE) holding a real ultrasound probe is remotely controlled from the expert site with a fictive probe, and reproduces on the real probe all the movements of the expert hand. The isolated places, are areas with reduced medical facilities, (secondary hospitals 20 to 100 km from the main hospital in Europ, dispensaries in Africa, Amazonia, the a rescue vehicles.... RESULTS: ESTELE was tested on 87 adults and 29 pregnant with ISDN or satellite lines. During fetal tele-operated echography the expert was able to perform appropriate views of the fetal structures in 95% of the cases. During exploration of adult abdomen the expert visualized the main organs in 87% of the cases. Presently the ESTELE system is installed in 4 secondary hospitals, 40 to 100 km from our University Hospital and tele-operated daily by our staff. CONCLUSION: Robotized tele-echography provide similar information as direct examination. No false diagnostic was reported. Moreover the patients were examined by an expert from the University Hospital while staying in the Medical center proximal to their home.

Advances in robotic tele-echography services--the OTELO system.

This paper presents some of the recent advances in mobile robotic tele-echography systems. It discussed the feasibility of a reliable remote ultrasound examination using such robotic systems in wireless environments. That is to say, to make use emerging wireless communications to provide a medical expert or consultant the ability to examine a remote patient. A critical issue of such systems is the accurate interactivity between both remote sides. The paper presents a robotic teleoperated OTELO (mobile tele-echography using an ultra-light robot) system for such purposes. The paper presents an overview of the system and some of preliminary tests and the use of wireless communication in this e-health application.

The robot and the satellite for tele-operating echographic examination in Earth isolated sites, or onboard ISS.

UNLABELLED: The objective was to design and validate a method for tele-operating (from an expert site) an echographic examination in an isolated site. METHOD: The isolated places, defined as areas with reduced medical facilities, could be secondary hospitals 20 to 50 km from the university hospital, or dispensaries in Africa or Amazonia, or a moving structure like a rescue vehicle or the International Space Station (ISS). At the expert center, the ultrasound medical expert moves a fictive probe, connected to a computer (n degrees 1) which sends, the coordinate changes of this probe via an ISDN or satellite line to a second computer (n degrees 2), located at the isolated site, which applies them to the robotic arm holding the real echographic probe. RESULTS: The system was tested at Tours Hospital on 105 patients. A complete investigation (visualization) of all the organs requested for different clinical cases was obtained in 76% of the cases with the robot, and 87% at the reference echography: In 11% of the cases, at least one of the organ visualized at reference echo could not be investigated by the robot, thus the diagnostic was not done. The number of repositioning was higher for the robot (6.5 +/- 2) than for the reference echo (5.1 +/- 2 = or > 24% more with robot). The duration of the examination was higher with the robot (16 +/- 10 min) than for the reference echography (11 +/- 4 min = or > +43% with the robot compare to reference echography. The system was also tested successfully using satellite links in a limited number of cases (approx 30).

3D realtime echography and echography assisted by a robotic arm for investigating astronauts in the ISS from the ground.

As human will stay for long duration in isolated sites like ISS there will be a need to perform quick and reliable diagnosis to evaluate the gravity of the pathology in presence of clinical symptoms. Many pathological situations (abnormal heart rate, pericardic collection, mitral prolaps, cholecystis, renal lithiasis, normal and ectopic pregnancies, ovarian cyst, acute appendicitis, phlebitis ... ) may occur even if all the astronauts are absolutely normal and healthy preflight. Ultrasound echography and Doppler are non invasive methods easy to use in space and very well adapted and used in routine for such diagnosis at the hospital. The objective of the present project was to design a method that guarantee a reliable echographic diagnostic in an isolated site (space station or earth site) by a Medical Doctor located at the expert site that should be the Nasa control center for ISS. It is supposed that there is only a non sonographer person in the isolated site and that the transmission system (audio, video, numeric..) is the only link between the 2 sites. Two options are proposed: (a) A 3D realtime acquisition echograph that can record quickly all the echos of a volume containing the organ suspected to have a lesion, all these echo information being sent to the ground and processed by the ground experts, (b) A robotic arm that hangs the echo probe in the isolated site tele-operated (through sattelite network) from the ground by an expert in clinical ultrasound. (As the expert moves the joystick of his ground computer the robotic arm reproduces the same movements on the probe).

Feto-maternal circulation: mathematical model and comparison with Doppler measurements.

OBJECTIVES: Clinicians are more and more frequently studying fetal blood flow velocity curves recorded by Doppler ultrasound in vital organs such as the placenta and fetal brain to evaluate fetal well-being. We have therefore developed a mathematical model of the utero-placental and fetal circulations which could be used for teaching and for a better understanding of regulatory mechanisms. METHODS: The model is based on two basic elements-an arterial segment and a bifurcation-and we have reproduced the major arteries of the feto-maternal circulation combining these basic elements. The mathematical model of the system is based on the Navier-Stokes equations. The peripheral areas such as the brain, kidneys and placenta are modeled by a simple Windkessel model and the model computes instantaneous flow and pressure at any point in the fetal arterial tree and the uterine arteries. RESULTS: We have compared the computed instantaneous flow curves and pressure with in vivo data and our results agree with the findings in physiological situations and in gravidic hypertension. CONCLUSIONS: Our model provides new interesting insights into fetal hemodynamics such as a better understanding of the mismatch impedance phenomena and is a promising model for the study of blood redistribution mechanisms in hypoxic situations.

Fetal heart modelling based on a pressure-volume relationship.

Study of the cardiovascular system of the human fetus is based on non-invasive measurement methods such as Doppler echography systems. The circulation conditions in fetal vessels are usually evaluated by resistance indices, giving limited physiological information on distal territories such as the placenta or the brain. To enhance the understanding of human fetal haemodynamics, a numerical model of the fetal heart has been developed, using the hydraulic-electric analogy. The model is based on a mechanical hypothesis of parallel functioning of the right and left ventricles, considered to have analogue elastance properties. Their behaviour is equivalent to that of a single ventricle ejecting an equivalent blood volume of 7 ml in the aorta. The characterisation of the equivalent ventricle is based on the determination of a set of four parameters (Emax, Vo, kv and Po) representing the maximum ventricle contractility, a reference volume, and volume and pressure constants, respectively. The model proposed is validated by studying the effects of preload and afterload variations on the fetal heart work, and by comparing the numerical results with literature and measured data. The model constitutes the first step towards a global model of the cardiovascular system of the human fetus.

[In utero measurement of the umbilical cord in full term pregnancy]. / Mesure in utero de la longueur du cordon ombilical au cours de grossesses à terme.

OBJECTIVE: The length of the umbilical cord varies widely from one pregnancy to another. Although its average length is 50 cm, this measurement could vary from as little as 20 cm to more than one metre. The purpose of our study was to evaluate, in utero, the length of the umbilical cord during the third trimester of pregnancy knowing the propagation velocity of the pressure wave along the cord. MATERIAL AND METHODS: The computation of the apparent length requires two ultrasound transducers, one situated at the aortic fetal arch, the other at the placental extremity of the umbilical artery. Knowing the velocity of the pressure wave (v), as well as the time interval between the systolic peak of two waves (delta t), we can deduce the length of the umbilical cord (delta t x v). RESULTS: The comparison between the calculated length and the actual length measured shows a significant correlation with a probability of 1%. CONCLUSION: The knowledge of the length of the umbilical cord is quite useful in the physio-pathological interpretation of the placental resistance index. It is also of interest, before the delivery, to know the length of the cord in order to foresee dystocy and how it relates cord which is either too short or too long.

Experimental and numerical models of acute intracranial hypertension and basilar artery blood flow velocity.

A numerical model based on Navier-Stokes equations was used in conjunction with an experimental model in rabbits to study the effects of acute intracranial hypertension on basilar artery blood flow velocity. The hypertension was induced by pressure transmission via an epidural pressure sensor inserted into a parietal intracranial opening. A critical value of half of the diastolic arterial pressure for the intracranial cerebral pressure was determined by both numerical and experimental models. At this intracranial cerebral pressure level, the total input resistance and total input compliance, determined by the numerical model, exhibited an increase of 27% and 10%, respectively, and the tissular compliance a decrease of 25% from their physiologic baseline values. When the intracranial cerebral pressure reaches the level of the diastolic arterial pressure, a zero diastolic flow is observed into the cerebral vascular system. This study validates the theoretical model, which could be used in assessing intracranial cerebral pressure noninvasively in humans when O2 pressure can be stabilized.

Influence of the measurement location on the resistance index in the umbilical arteries: a hemodynamic approach.

A computer model was used to study the primary factors generating the reduction in resistance index, (S-D)/S, values observed by ultrasonic Doppler measurements in the umbilical artery, from the fetal insertion to the placental insertion (S represents the amplitude of the systolic peak and D the amplitude of the diastolic peak). This hemodynamic approach shows that the placental resistance is the primary factor, the viscosity and the cord length playing secondary roles. Clinically, the position of the measurement along the cord is an important factor. To increase the sensitivity of the index, the Doppler measurement must be performed near the fetal insertion, whereas a measurement near the placental insertion will make the Doppler examination more specific.