Evaluation of Augmented Reality-based Intuitive Interface for Robot-Assisted Transesophageal Echocardiography: A User Study
Authors: Xiu Zhang*, Matteo Di Mauro*, Sofia Breschi, Angela Peloso, Emiliano Votta, Arianna Menciassi, Elena De Momi
Abstract
TransEsophageal Echocardiography (TEE) is essential for diagnosing and guiding Structural Heart Disease (SHD) interventions. However, manual TEE manipulation demands significant operator expertise, is physically demanding, and exposes clinicians to radiation when performed alongside fluoroscopy. Robotic-assisted TEE systems have been introduced to improve probe handling and reduce operator fatigue, yet the design of intuitive and effective user interfaces remains an open challenge. This study presents and evaluates a model-enhanced, Augmented Reality (AR)-based intuitive interface for robot-assisted TEE, designed to improve spatial awareness and control intuitiveness. A robotic TEE platform integrated with electromagnetic tracking and a virtual simulator was used to compare three user interfaces differing in visualization and interaction modalities: 2D jointlevel (2D-JI), 3D joint-level (3D-JI), and 3D tip-level (3D-TI). Thirty six participants performed standardized navigation tasks to reproduce target echocardiographic views, with performance assessed via position and orientation errors, completion time, and NASA-TLX workload scores. Results show that 3D visualization significantly improved spatial accuracy, reducing median position error from 13 mm to 3 mm and halving the orientation error compared with the 2D interface. Tip-level interaction yielded a further 50% reduction in orientation error and reduced interuser variability relative to joint-level control. Overall, the 3D-TI configuration, combining immersive visualization with direct tip-level control, proved the most effective and ergonomic interface, supporting the integration of AR-based visualization and intuitive control paradigms into next-generation robotic TEE systems to enhance operator performance and procedural safety.
The integration of augmented reality (AR) and EEG-based brain-computer interfaces (BCIs) offers a promising path for enabling intuitive control of robots for assistive purposes. However, existing AR brain-robot interface (BRI) systems are often constrained to task-specific structures, limiting their utility in real-world environments. We present an AR BRI designed for generalist robot arm manipulation that combines gaze-based object selection with motor imagery action control. Our system uses eye-tracking for intuitive object targeting and context-aware visual overlays ("Place" and "Use") to guide the user through tasks within a shared autonomy framework. We evaluated the interface through a feasibility study with 18 healthy participants performing three multi-step activities of daily living: drinking, using a drawer, and operating an oven. Our results demonstrate that this interaction paradigm enables effective sequential task execution and high user engagement, achieving a "Good" usability rating (SUS > 70). These findings support the feasibility of the proposed interaction paradigm for complex BCI-driven robotic assistance, and motivate future evaluation with the intended target population. Project website: https://ar-bri-manip.github.io/.
Objective: To evaluate robotic controller interfaces for interventional neuroradiology procedures in-vitro incorporating a force-sensing platform to assess safety. Methods: A custom endovascular robot, device-mimicking controller, and sensorized neurovascular phantom were developed. Ten interventional neuroradiologists (4 novices, 6 experts) performed simulated navigations using four control modalities: device-mimicking controllers with and without haptic feedback, joystick-based input, and manual navigation. Navigation time, peak vessel-wall forces, incorrect catheterisations, and prolapse events were assessed, alongside user analyses. Results: Manual navigation was fastest (mean 47.7 s) compared to haptic-on (248.7 s), haptic-off (314.7 s), and joystick (392.6 s) modalities (p<0.001). Regardless of controller type, vessel-wall forces were below the 0.70 N puncture threshold; therefore all modalities were considered safe. Joystick produced significantly more prolapse events than manual control (1.56 vs 0.13; p=0.018). Operator experience was relevant to performance: experts made fewer incorrect catheterisations than novices (0.25 vs 0.62; p=0.035) and applied less vessel-wall force (p<0.0005); these effects were sustained across controllers but accentuated when haptics were on. Users perceived haptic on and haptic off as similarly intuitive, and more intuitive than joystick (p=0.033). Conclusion: Device-mimicking robotic controllers outperform joystick interfaces on most metrics; haptic feedback shows promising but non-significant performance benefits.
Benjamin Jackson, Nikola Fischer, Harry Robershaw +16
Despite advances in 3D ultrasound, most percutaneous cardiac interventions still rely on 2D visualization, limiting depth perception and spatial understanding. To address this challenge, we developed an Extended Reality (XR)-based platform that enables real-time six-degree-of-freedom (6-DOF) catheter tracking and visualization within a patient-specific 3D heart model. The system combines a custom machine-vision algorithm for 5-DOF catheter tracking with a 3D-printed electromechanical encoder that measures catheter roll, providing complete 6-DOF motion reconstruction. In a proof-of-concept study, 20 novice medical students navigated an intracardiac echocardiography (ICE) catheter to six anatomical targets using either immersive 3D visualization or a conventional 2D cathlab-style view. Participants in the 3D condition completed the task in 54.6 seconds and traveled 1,939 mm on average, compared with 267.5 seconds and 7,854 mm in the 2D condition. Therefore, the XR-based 3D system was more than 5x faster and required ~5x less catheter travel. The 3D mode also improved targeting precision and reduced performance variability. Participants consistently rated immersive visualization higher for accuracy, speed, usability, and clinical value. Kinematic analysis showed smoother depth-axis navigation in 3D, whereas 2D users relied on repeated corrective movements. These findings demonstrate that XR-based visualization can substantially improve procedural training efficiency, precision, and motor control.
Mohsen Annabestani, Sandhya Sriram, Andrew Kuzemczak +3