RAG-RUSS: A Retrieval-Augmented Robotic Ultrasound for Autonomous Carotid Examination

Robotic ultrasound offers advantages over free-hand scanning, including improved reproducibility and reduced operator dependency. In clinical practice, US acquisition relies heavily on the sonographer's experience and situational judgment. When transferring this process to robotic systems, such expertise is often encoded explicitly through fixed procedures and task-specific models, yielding pipelines that can be difficult to adapt to new scanning tasks. In this work, we propose a unified framework for autonomous robotic US scanning that leverages a LLM-based agent to interpret US scanning guidelines and execute scans by dynamically invoking a set of provided software tools. Instead of encoding fixed scanning procedures, the LLM agent retrieves and reasons over guideline steps from scanning handbooks and adapts its planning decisions based on observations and the current scanning state. This enables the system to handle variable and decision-dependent workflows, such as adjusting scanning strategies, repeating steps, or selecting the appropriate next tool call in response to image quality or anatomical findings. Because the reasoning underlying tool selection is also critical for transparent and trustworthy planning, we further fine tune the LLM agent using a RL based strategy to improve both its reasoning quality and the correctness of tool selection and parameterization, while maintaining robust generalization to unseen guidelines and related tasks. We first validate the approach via verbal execution on 10 US scanning guidelines, assessing reasoning as well as tool selection and parameterization, and showing the benefit of RL fine tuning. We then demonstrate real world feasibility on robotic scanning of the gallbladder, spine, and kidney. Overall, the framework follows diverse guidelines and enables reliable autonomous scanning across multiple anatomical targets within a unified system.

Robotic ultrasound scanning in real clinical environments requires both high-level clinical workflow reasoning and low-level closed-loop execution. Physicians natural-language instructions often contain implicit anatomical targets, procedural logic, image-quality requirements, and safety constraints, while execution is affected by patient motion, contact variations, and target drift. We propose a fast and slow hierarchical embodied ultrasound system for safe and interpretable robotic ultrasound assistance. The Slow Brain performs intent parsing and stage-wise task planning with knowledge augmentation from an API and handbook corpus, and generates executable plans through task-graph construction and structured plan verification. The Fast Brain fuses multimodal feedback, including ultrasound images, robot pose and force states, and patient-motion information, to refine local actions and perform image-quality-guided recovery behaviors. The system further integrates a Safety Shield and a hierarchical escalation policy to constrain risky actions and trigger replanning or human confirmation under persistent failures or safety-bound violations. Experiments on planning evaluation, closed-loop execution under dynamic perturbations, and safety-mechanism validation demonstrate that the proposed hierarchical design improves task success rates while reducing safety violations.

Artificial intelligence-assisted ultrasound scanning enhances diagnostic reliability and efficiency by providing real-time guidance for standardized image acquisition and reducing operator dependence. However, existing reinforcement learning and learning-assisted ultrasound scanning methods typically rely on carefully designed reward functions or extensive interaction data, which limits their generalization ability and stability across different devices, patient populations, and complex clinical scenarios. To address these challenges, we propose an ultrasound vision-language-action model (US-VLA) for automated ultrasound scanning that explicitly encodes clinical semantic goals and generates sequential probe manipulation actions under real-time ultrasound feedback. In particular, we first design an ultrasound-aware expert fusion module to jointly integrate ultrasound observations with auxiliary contextual information, enabling semantic ultrasound feedback to effectively guide the scanning process. Then, we construct US-VLA-Data, a real-world dataset covering liver and kidney examinations, which includes five clinically defined standard planes and comprises 320 expert scanning trajectories with approximately 80,000 synchronized timesteps. Extensive experiments demonstrate that US-VLA achieves competitive performance in ultrasound probe manipulation tasks, indicating its effectiveness and promising generalization within the evaluated abdominal ultrasound setting. The source code is available at https://github.com/VMVLab/US-VLA.