The All India Institute of Medical Sciences (AIIMS) has jointly developed a telerobotic ultrasound system in collaboration with IIT Delhi and Addverb Technologies.
The research collaboration between IIT Delhi and AIIMS allows remote ultrasound access through a robotic arm to reduce the contact between Radiologists and anyone who is possible infected by Covid-19.
The research team at AIIMS was led by Chandrashekhara, while Chetan Arora and Subir Kumar Saha led the IIT team. The lead contributor for the research was Suvayan Nandi from Addverb Technologies along with Dr Kritika Ranganathan from AIIMS and Deepak Raina, a PhD Scholar from IIT Delhi.
Tell us about your innovation, what is it about?
Dr. Chandrashekhar – Ultrasound, as you may know, is a commonly used modality that is quick, accurate, and can be used to diagnose problems right away. It is one of the most commonly used modalities in the emergency room. The doctor stays in close contact with the patient for a longer period of time while performing the ultrasound which was not a huge problem until the world was hit by the covid-19 pandemic. We noticed that close proximity between the patients and healthcare workers tends to increase the possibility of infection among healthcare workers. Then we went to IIT Delhi to see if there was a robotic system that could assist us in conducting this ultrasound remotely. What we can do is have a separate seat from the patient and control a robotic arm that is placed right next to the patient, with probe connected to the robotic arm. The images will be sent to us via Wi-Fi so that we can interpret them. First advantage of it being the less human contact there is, the lower the risk of infection or cross infection, and we’ll be saving a lot of PPE kits. We can also do the tele-robotic ultrasound doesn’t quite distinctly if you can extrapolate this same concept to other places.
What is this robotic arm? How does it function? What is the distance between the radiologist and the patient? Does it affect the efficacy of the results?
Dr. Chetan Arora– One of the other key requirements for ultrasound at this time is that the doctor must stand by the patient’s side. This requirement arises because the doctor is required to hold the probe on the patient. Otherwise, it is much easier to move this picture from one building to another via the internet. Now the probe is now being held by the robotic arm rather than the doctor. Now the doctor is standing in the next room, which is a safe distance from the covid, but we can expand into new buildings and cities in the future. The doctor has received a haptic device which sends the commands of the movements that the doctor makes to the robotic arm on the patient’s side.
In this case, however, pressure feedback is also a critical factor which is applied in the same measure by the robotic arm as by the doctor. And just like you do a regular diagnosis by looking at the screen and the image, the same way you can do it. So the key issue here is one manipulating an arm while sitting at a distance and the other transferring this pressure and force feedback both ways. So, from the patient to the doctor and the doctor to the patient.
What was the Genesis of the idea? When did the research work on it?
Dr Kritika Ranganathan – Although the idea has previously occurred to us in relation to distance ultrasound, particularly in a country like India, where a large portion of the population lives in rural areas and lacks access to health care. And, as we previously stated, who does the ultrasound is a critical component. A CT- Scan and an MRI is carried out by a technician, unlike an ultrasound, which must be operated by a specialist. Genesis of the idea came from Covid.
Every time there was a call from the covid ward, the radiologist had to wear a PPE kit, do the check-up and come back. This entailed long duration of waits for Covid patients and a lot of PPE kits being consumed.
Our first set of clinical tests was not carried out on patients but on normal people The first step is to ensure that there is no difference in the type of ultrasound that we can get from a handheld ultrasound probe versus our robotic ultrasound probe in terms of the type of diagnosis we can get.
In addition is that I think credit to Addverb and IIT Delhi. I think the technology then we saw the technology of the kind of dexterity the provides us is hugely different from what was available previously.
Tell us a little bit about adverb Technologies. What’s the role you played? How was the whole experience of building this Innovative robotic arm?
Suvayan Nandi – Addverb Technologies is the Robotics and automation company and we started in the year 2016. It was started with 6 people and now we have more than 500 employees. Mr. S.K. Saha and Mr. Chetan came to us with this idea of developing a telerobotic arm in collaboration with AIIMS. We took this opportunity to start the project under our CSR activity. We donated this robot and we were responsible for developing the first prototype and all the development, assembly and manufacturing was done in our plant only.
What was your experience in for this project?
Deepak Raina – It was an amazing experience, especially given the kind of team that we have. We have doctors from AIIMS,. We have professors from IIT Delhi with continuously giving us idea about how to add up Innovations into the system, and how to make this physical. Whenever there are certain challenges. It becomes quite challenging to ensure the safety of the human as well. So, this was a quite interesting experience for me as I was a PhD student and it was also my research project.
There are various components that are merged into the system. You need to ensure that there is a proper positioning and orientation of the probe, proper pressure is applied and that too in a remote setting. The quality of the system and the ultrasound imaging is comparable to the conventional technique. Overall you overcome all the challenges and maybe made this system operational and hopefully with more effectively we will turn it into a clinical product and bring it into the moment.
What is the next step or the goal that you have in mind?
Dr. Chandrashekhar– Well, we are at a stage where we have developed the Prototype. We have conducted trial on around 20 volunteers, but some refinement, adjustments and improvements are needed from the technological point of view, so that it can be used over the patients. And if we can refine the technology, then maybe the next step is to shift to the robotic system to AIIMS and conduct the ultrasound examination over the patients. Supposing if a patient comes at night in an emergency and the doctor is not available, we can set up a robotic system there and interpret the images sitting at home or maybe office. We want to expand this technology to the rural areas as well.
Speaking of the rural setup, how feasible is it? What is the eventual costing you consider for this?
Dr Chetan Arora- The ultimate goal is that this is a multi-purpose technology that we can potentially apply it in remote areas also.
The expertise of the person doing the ultrasound is extremely important. So this means that with a device like this, which is a high-tech ultrasound device, we can actually make an expert available anywhere in the rural areas.
What is the tentative cost line you are looking at?
Dr. Chetan – I assure you that the cost is going to be much lesser. For example, when we talk about the current surgical robots, even the basic surgical robot will start from few crores. On the other hand, the kind of cost that were expecting for a robotic arm like this is a few lakhs. That’s the order of the difference that we are looking at. So we are aware about the cost implication and this is going to be a low-cost device.
It is a first of it’s kind innovation. Is it happening elsewhere in the world?
Prof. Subir Kumar Saha – Similar attempts have been made elsewhere in the world. Typically a robot follows a command without caring about who or what comes in between, which is called position control. Second aspect is to get a proper quality of the images. You have to have appropriate force to be applied on the body which is called force control. So, here the challenge is to implement force and position together on the robot.
How difficult is it for radiologists to adapt to this technology?
Dr. Kritika Rangarajan – To start it off, we actually practice this on pillows and tended to be a little more resistant to trying anything on even volunteers, although we had that consent and ethical clearance for it. But we did soon realized that required reorientation of our minds and practice a little bit before we could actually go ahead and use it. Radiologist tend to be overburdened with whatever clinical work they already have. To expect them to adapt to a new setting is a little difficult, but having said that this is a problem with all robotic devices and odd new technologies around the world. Every form of robotic surgery, the Da Vinci robot, for example, has a mandatory training period and you cannot go ahead and use it without that training period. We have to enforce something of that sort.
Would the level of comfort a patient has with a doctor remain the same with the robotic arm?
Suvayan Nandi – The robot has a sensor in it, which can get the feedback on how much pressure is being applied on the patient. So we already keep it under check that it is less than 20 Newton so that it doesn’t hurt the patient. Apart from that as a part of what we call as a safety, we have a foot pedal with the doctor and then we have an emergency button with the patient. So whenever he feels any discomfort, any one of them can disengage it and can stop the robot.
Is there any message you want to give to the people?
Deepak Raina – Well, I think as our prime minister also keeps mentioning that Covid like scenario also comes with lot of opportunities and I think our project is basically a good example of that that how we made use of that opportunity and came up with a system which was actually and to do that study the development up to a level where we also did the volunteer trials at the AIIMS. I think we have we have done justice to whatever opportunity has been given to us.
Have you started the trials on the patients in AIIMS and if not then what is the tentative timeline you are looking at?
Dr Chandrashekhar – The robot will be shifted to adverb to further modify and adjust some refinements. As soon as it is over, we will shift it to AIIMS and the trial will start soon. Our goal is to bring health care to people rather than having them travel long distances to us for certain investigations, and we plan to do so using tele-robotic technology so that even the common people can access the expert opinion.