Evaluation of Augmented Reality-based Intuitive Interface for Robot-Assisted Transesophageal Echocardiography: A User Study

2026-06-18

AI Summary

This study addresses the limitations of conventional transesophageal echocardiography (TEE), which relies heavily on highly skilled operators, imposes significant physical demands, and entails radiation exposure when combined with X-ray fluoroscopy, while existing robotic systems suffer from unintuitive human–machine interfaces. To overcome these challenges, this work proposes a novel interaction paradigm integrating immersive augmented reality (AR) with advanced hierarchical control. Leveraging an electromagnetic tracking system and a virtual simulation platform, the authors systematically evaluate the impact of different visualization and interaction modalities on spatial perception and operational intuitiveness. Experimental results demonstrate that the proposed 3D-TI interface reduces positional error from 13 mm to 3 mm and cuts angular error by 50%, significantly decreasing task completion time, lowering NASA-TLX cognitive workload, and improving procedural consistency—offering a more efficient and precise human–robot collaboration framework for robot-assisted TEE.

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.

Problem

• robot-assisted TEE
• intuitive interface
• augmented reality
• user interface design
• spatial awareness

Innovation

• Augmented Reality
• Robot-assisted TEE
• Intuitive Interface
• Tip-level Control
• 3D Visualization