The BBE consists of the following three elements:
This is a modified portable massage table with a hole in the place where the patient’s heart is located. A person requiring a heart echo would need to lay down “face-down”, just like on a massage table.
This part, which looks like a microphone, transmits sound waves that are reflected by the body. The information contained in the reflected waves is then used to generate the heart echo.
This arm is positioned under the bed, and will move the probe automatically over the body of the patient to obtain the optimum heart echo. The software used to control the arm will improve the quality of the echo through supervised learning algorithms. The robot-arm can be controlled on-site but also remotely (i.e. from a completely different location).
The robot-arm is the heart of the BBE. It replaces a cardiac sonographer who would otherwise manually move an echo probe over the body of a patient. The robot-arm also allows a patient to remain in a resting position (whereas s/he would regularly need to move for a traditional heart echo). This is not on only more comfortable for the patient, but the absence of movement and the face-down position are also expected to result in higher-quality echoes as images would be less distorted by the ribcage and lung tissue. The echo can thus be acquired with less risk of virus spread as well.
The BBE has been under development since 2019 with the support of the Delft University of Technology and the Reinier de Graaf Gasthuis, a hospital that is also located in Delft (see Chapter 5 for details on technology partners). A fully functioning prototype was completed in January 2020 and presented at a national meeting for engineers in early 2020 (Image 2). A second prototype is currently being developed and will be able to produce better quality heart echoes through the use of a more advanced echo probe and more sophisticated software.
of the BedBasedEcho
The BBE is designed to provide heart echoes at nearly the same quality and cost as traditional imaging devices, and—crucially—without requiring a specialist to operate the device (for a small percentage of inconclusive heart echoes, traditional imaging device will remain necessary). The BedBasedEcho will be costlier than most quick-look echo devices, but, as mentioned before, such devices will not meet the requirements of most cardiologists. In summary, the value proposition of the BBE is as follows:
• Deliver high-quality heart echoes,
• Without the involvement of a medical specialist, with a platform that is less easy to clean and involves less risk of virus spread during image acquisition
• At a cost per ultrasound that is less than 50% of the cost of traditional imaging devices
The ability to produce high-quality heart echoes without the involvement of scarce specialists will allow heart care providers to use more heart echoes than would otherwise be the case—thereby saving costs and, more importantly, lives.
In addition to the abovementioned “core values”, there are two important advantages of the BedBasedEcho that are inherent in its design. These additional values are:
• Patient comfort. The BBE does not require patients to change their position during the preparation of a heart echo, which is an advantage over traditional or “quick-look” imaging devices. The BBE also minimizes interaction between patients and human operators, which may alleviate fears of by COVID-19 or other communicable diseases.
• Consistency of image quality. A robotic system will be able to make more consistent images than a human sonographer. In addition, the use of artificial intelligence will allow the software to “learn” to improve the quality of the heart echoes over time. In the long term, this would result in heart echoes of better quality than those generated by traditional imaging devices operated by human sonographers.