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An Overview of Systems and Techniques for Autonomous Robotic Ultrasound

Acquisitions

Preprint  in  IEEE Transactions on Medical Robotics and Bionics · April 2021

DOI: 10.1109/TMRB.2021.3072190

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JOURNAL OF LATEX CLASS FILES, VOL. 14, NO. 8, AUGUST 2015 1

An Overview of Systems and Techniques for

Autonomous Robotic Ultrasound Acquisitions
Keyu Li, Graduate Student Member, IEEE, Yangxin Xu, Graduate Student Member, IEEE,
and Max Q.-H. Meng∗ , Fellow, IEEE

Abstract—Ultrasound (US) acquisition in standard clinical

procedures requires manual operation of the probe based on the
interpretation of the image. A robotic system for autonomous
US acquisitions holds great promise to relieve the workload of
sonographers, improve access to care, yield more standardized
imaging results, and circumvent the need for direct patient
contact. In this paper, we provide an overview of the current
status of systems and techniques for autonomous robotic US
acquisitions in the literature. Specifically, we first present a
framework to standardize the increasing levels of autonomy in
robotic ultrasonography and briefly discuss the non-autonomous
and semi-autonomous systems. Then, we systematically review
the existing autonomous robotic systems developed for extracor-
poreal US acquisitions based on the hardware components, work-
flow and applications. Besides, we summarize three important
topics related with the autonomous US acquisitions, including the
scanning path planning, contact force control and image quality
optimization, and introduce current methods and techniques
proposed on each topic. Finally, we discuss the challenges and Fig. 1. Representative commercial products for robot-assisted US acquisitions,
including the automated breast US (ABUS) systems (a) Invenia ABUS 2.0
provide some potential directions for future research. We believe (General Electric, USA) [13] and (b) ACUSON S2000 ABVS (Siemens,
that the presented efforts in autonomous robotic US acquisitions Germany) [14], and the robotic transcranial Doppler (TCD) systems (c) Delica
will pave the way for a promising future of medical care and Robotic TCD headband (Shenzhen Delica Medical Equipment Company,
benefit a broad spectrum of clinical procedures. China) [15] and (d) Lucid M1 TCD system (Neural Analytics, USA) [16].
Index Terms—Medical robotics, robotic system and software,
robotic ultrasound, ultrasound imaging.
physical and cognitive burden on the sonographer. As a result,
the quality and repeatability of the acquisitions are highly
I. I NTRODUCTION
dependent on the operator [7], and it is difficult for people

U LTRASOUND (US) imaging, first used as a diagnostic

tool in the 1940s, has become one of the most commonly
used diagnostic modalities in the world [1][2]. Due to the
advantages of portability, non-invasiveness, low cost and real-
time capabilities over other imaging techniques, US imaging
is widely accepted in clinical use in a broad range of medical
disciplines such as cardiology [3], urology [4], neurology [5],
obstetrics and gynecology [6].
In standard US examinations, a skilled sonographer is
required to manually operate a US probe to scan the patient
based on the interpretation of US images and mental con-
struction of the target anatomy, which would impose a heavy
This work was partially supported by National Key R&D program of China
with Grant No. 2019YFB1312400, Hong Kong RGC GRF grant #14210117,
Hong Kong RGC TRS grant T42-409/18-R and Hong Kong RGC GRF grant
#14211420 awarded to Max Q.-H. Meng.
K. Li and Y. Xu are with the Department of Electronic Engi-
neering, The Chinese University of Hong Kong, Hong Kong (e-mail:
kyli@link.cuhk.edu.hk; yxxu@link.cuhk.edu.hk).
Max Q.-H. Meng is with the Department of Electronic and Electrical Engi-
neering of the Southern University of Science and Technology in Shenzhen,
China, on leave from the Department of Electronic Engineering, The Chinese
University of Hong Kong, Hong Kong, and also with the Shenzhen Research
Institute of the Chinese University of Hong Kong in Shenzhen, China (e-mail:
max.meng@ieee.org).
∗ Corresponding author.
in remote or rural areas to undergo such examinations where
a trained sonographer may not be available. Also, the excessive
workload has been exposing the sonographers to health risks
such as regional pain and musculoskeletal disorders, since they
have to continously exert a significant force onto the patient
during imaging [8][9]. Moreover, the frontline sonographers
are vulnerable to infectious diseases due to exposure to the
pathogen caused by direct patient contact, especially during
a pandemic such as COVID-19 [10][11]. This highlights the
need to develop automated or remotely operated systems for
US acquisitions to cope with the insufficient medical resources
and reduce the risk of infection for medical staff [12].
With improved accuracy, dexterity, maneuverability and per-
ception capabilities, modern robotic manipulators are capable
of performing precise force and position control of the probe,
holding great promise to reduce the physical and cognitive
burden on the sonographer, improve access to care, yield
more standardized imaging results, and circumvent the need
for direct contact between medical staff and patients. Since
the first tele-echography systems were developed at the end
of the 20th century [17][18], burgeoning efforts have been
made to automatize the US acquisitions in a broad range of
clinical applications from diagnosis to interventions [19][20].

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 This is the author's version of an article that has been published in this journal. Changes were made to this version by the publisher prior to publication.
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JOURNAL OF LATEX CLASS FILES, VOL. 14, NO. 8, AUGUST 2015
Several teleoperated systems have been successfully applied
in the remote US examination and diagnosis of lung, heart,
and vasculature during the outbreak of COVID-19 supported
by the 5G communication network [12][21][22].
In the field of industry, there have been a few com-
mercialization attempts in robot-assisted US acquisitions for
some specific applications, including the automated breast US
(ABUS) and robotic transcranial Doppler (TCD) systems, as
shown in Fig. 1. Introduced a few decades ago, ABUS has
become a promising new tool to detect cancer in women
with dense breasts [23][24][25][26]. A technologist is required
to manually place the probe on the patient and apply an
appropriate pressure during the scan, and the system can easily
scan the whole breast with a single sweep using a large-
footprint transducer [27]. 3D reconstruction is automatically
performed after acquisition to allow clinicians to view any
slice in the breast. Transcranial Doppler (TCD) is non-invasive
tool to measure cerebral blood flow velocity in the major
intracranial arteries [28]. The robotically assisted TCD systems
are usually designed as a wearable headband or headset that
contains the TCD probes and the robotic drive, as shown
in Fig. 1 (c)(d). After the robot is initiated by a trained
operator, it can automatically adjust the probes to detect and
track intracranial vasculature, which provides the potential
to obtain consistent and reproducible TCD recordings for
extended periods [15][16][29]. The robotic TCD systems have
been successfully applied in the detection of pulmonary vessel
dilatation in patients with COVID-19 pneumonia [30].
Recently, researchers have introduced six levels of au-
tonomy for medical robots characterized by increased au-
tonomous capabilities [31]. These concepts have been applied
to analyse different medical robotic systems such as surgical
robots [32] and robotic colonoscopy systems [33]. In order
to provide a comprehensive overview of the current status of
autonomous robotic ultrasonography, in this work, we first
provide a framework to standardize the increasing levels of
autonomy in robotic ultrasonography and briefly introduce
the non-autonomous and semi-autonomous systems, and then
conduct a systematic review of literature on the systems
and techniques developed for autonomous extracorporeal US
acquisitions.
The rest of this article is organized as follows. In Section II,
we define the levels of autonomy in robotic US acquisition
systems and present our search methodology for the review of
autonomous systems. Section III provides an introduction of
existing robotic systems for autonomous US acquisitions based
on their system design, workflow and target applications. In
Section IV, we present a detailed discussion of related topics
and methods in the autonomous systems and compare their
features, before we discuss the challenges and provide some
future perspectives in Section V.
II. M ETHODOLOGY
A. Autonomy of Robotic US Acquisitions
Following the concept of autonomy levels in medical
robotics [31], we define the increasing levels of autonomy
in robotic ultrasonography to introduce the prior art based on
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2
the levels of computer assistance provided by the systems, i.e.,
to which extent the robotic system may improve ease of use,
relieve operator burden, and reduce the user-dependency in US
acquisitions.
The simplest level is defined as “manual probe manipu-
lation”, which is associated to level 0 or no autonomy in
[31]. The user directly instructs the probe motion and the
robot holding a US probe will automatically compute the
control actions to accomplish the required probe motion.
This level includes two kinds of systems, i.e., the tele-
echography systems [34][35][36][37] and the “teach/replay”
systems [38][39][40][41]. In the teleoperated systems, a re-
mote sonographer can manipulate a robot at the examination
site through a joystick in real time to perform remote US
examinations on people in medically underserved areas. In the
“teach/replay” systems, an experienced sonographer physically
maneuvers the US probe in the teaching phase and the probe
motions are recorded, then the robotic system at the patient
location could automatically execute the US examinations
following the demonstrated trajectories. Compared with the
teleoperated systems, the “teach/replay” mode can avoid the
need for real-time transmission of US images and complex
remote robot control, thereby reducing the bandwidth and
communication requirements in remote US examinations [40].
However, since the probe motion is completely instructed by
the user in the above systems, the workload of the operator
is still heavy and the imaging quality still depends on the
operator. Besides, the complex remote operation may result in
information overload on the remote clinician, and has limited
ability to perform tasks at the patient bedside [20].
Level 1 or robotic assistance, is defined as “human-robot
cooperation” following the classification in [20] to describe the
systems that allow the robot and the operator to have shared
control over the probe motion. Salcudean et al. [17][18][42]
and Abolmaesumi et al. [43][44][45] first utilized US image-
based visual servoing to control up to three degrees-of-freedom
(DoFs) of a conventional 2D US probe to realize shared
control in teleoperated ultrasonography. The visual servoing
techniques allow the robot to automatically track the desired
image features and compensate for unwanted patient motions
during teleoperation, thus partially reducing operator burden
and user-dependency in the acquisitions. Şen et al. [46]
designed a cooperative control strategy using virtual fixture
constraints to help an inexperienced operator reproduce the
planned US acquisition during radiation therapy. They further
incorporated visual servoing to dynamically update the virtual
fixtures based on real-time US images [47]. Fang et al. [48]
developed a dual force sensing system to comply with the
motion of the operator while applying a stable contact force
under admittance control to alleviate the physical burdens on
the sonographers. User studies were performed to study the
effect of the robotic force assistance on US image stability
in [49]. Different from the tele-operated systems, the human-
robot cooperation systems do not rely entirely on the remote
control by a medical expert, but can allow a less experienced
operator to perform US imaging with the assistance of the
robot. Moreover, as the operator is included in the loop of in-
person control, the safety of the patient can be better monitored
 This is the author's version of an article that has been published in this journal. Changes were made to this version by the publisher prior to publication.
The final version of record is available at http://dx.doi.org/10.1109/TMRB.2021.3072190
JOURNAL OF LATEX CLASS FILES, VOL. 14, NO. 8, AUGUST 2015 3

TABLE I
I NCLUSION AND EXCLUSION CRITERIA FOR AUTONOMOUS ROBOTIC US
ACQUISITIONS .

Inclusion Criteria Exclusion Criteria

• Articles in English or
Study translated to English
design • Before November 23, 2020
• Full-text available
• Articles on autonomous robotic
acquisitions for extracorporeal US
Acquisition imaging of human tissues for
purpose medical use (e.g., diagnosis,
biometric measurement and
interventional support)
• Articles that describe systems
or techniques for autonomous US
acquisitions conducted using
physical robotic systems
Acquisition • Details of the robotic system
method and acquisition methods are
presented
• The acquisition process is fully
automatic without human
intervention
• Articles that present the US
Acquisition images acquired by the robotic
result system
• Non-English articles or
without translation to English
• No full-text
• For non-medical use
• Autonomous acquisitions for
other imaging modalities (e.g.
X-ray, CT, MRI)
• Robot-assisted interventions or
surgeries under US guidance
• Intracorporeal US acquisitions
• Articles that do not include
robotic systems, including US
image analysis and simulated US
acquisitions
• Articles without clear
description of the robotic system
or methods for acquisition
• The acquisition process is fully
or patially controlled by human
operators
• Articles that only describe the
robot design without displaying
the acquired images
Fig. 2. Workflow of existing systems for autonomous robotic US acquisitions.

by the on-site clinician and the scanning protocols can be
easily modified through patient-clinician communication [48].
Therefore, the unique features of the human-robot cooperation
systems make them more likely to adapt to clinical practice
compared with the remotely controlled ones.
We further define level 1.5 to describe the systems that
enable fully automatic control of the probe but require manual
operation to initialize the probe position. Examples include
the systems that use visual servoing to autonomously stabilize
an existing target in the image [50][51][52]. The systems of
level 1 and 1.5 are considered as semi-autonomous systems,
as manual operation of the probe is still involved in the
acquisition process.
Level 2 or task autonomy in robotic ultrasonography is
used to describe the systems that can perform autonomous
US acquisition along a manually planned path. The operator
only indicates the scanning strategy in the planning phase,
and no manual operation is required during the robotic acqui-
sition. While the overall procedure is further simplified, the
predefined scanning path may limit the flexibility of the ac-
quisition due to the presence of tissue deformation and patient
movement. Therefore, automatic correction of the manually
planned path or online probe adjustment based on sensor data
are incorporated in some systems to improve the flexibility
of the execution. Level 3 or conditional autonomy describes
the systems that can autonomously plan and execute the US
acquisition without any instruction of the human operator (but
under supervision of the operator). The system should be able
to respond to sensor data and make corresponding decisions
to obtain US images for its target application, which offers the
highest level of assistance to the user.
Several review articles have been written to date that focus
on the non-autonomous and semi-autonomous systems for
robotic US acquisitions [19][20][23][53], which are at level
0, 1, and 1.5 following our standardization. However, the
autonomous systems of level 2 and above have not been sys-
tematically discussed and analysed in the literature. Therefore,
our review will mainly focus on the systems of level 2 and 3
for autonomous US acquisitions.
B. Search Methodology
In order to find relevant literature sources, a search was
conducted by specifying the following keywords (“ultrasound”
OR “ultrasonography”) AND (“robot*”) AND (“automatic”
OR “autonomous”) AND (“imaging” OR “acquisition” OR
“scanning” OR “screening”) in the IEEE Xplore, PubMed
and Google Scholar databases. We adopted a set of inclu-
sion/exclusion criteria as shown in Table I to screen the
resulting records. After reviewing the titles and abstracts of
the results, we removed duplicate, non-English and irrelevant
articles, and accessed the full-text of the remaining articles
to verify whether they met the above criteria. In addition,
works from the same group that had been published multiple
times without significant modifications are manually screened
to include the most representative ones. While this review
focuses on the autonomous US acquisitions, some technolog-
ical developments in the semi-autonomous systems related to
topics involved in the autonomous US acquisitions are also
discussed in this article.
Table II presents a comprehensive description of existing
autonomous robotic systems for extracorporeal US acquisi-
tions. First, the hardware components, including the robotic
manipulator, US devices and additional sensors are sum-
marized for each study. Second, due to the differences in
the scanning algorithms, the controlled degrees of freedom
(DoFs) of the probe and whether preoperative imaging data
is required are also reported to provide an indicator on the

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 This is the author's version of an article that has been published in this journal. Changes were made to this version by the publisher prior to publication.
The final version of record is available at http://dx.doi.org/10.1109/TMRB.2021.3072190
JOURNAL OF LATEX CLASS FILES, VOL. 14, NO. 8, AUGUST 2015 4

application range of each method. Third, since the challenges

and requirements of the systems are application-specific, we
also report the type of the imaging results (i.e., 2D- or 3D-US)
and the anatomical and clinical applications for each study.
The different evaluation metrics used in these methods are
summarized and discussed in Section III-C.

The general workflow of existing systems for autonomous

robotic US acquisitions is illustrated in Fig. 2. The scanning
path is usually planned before acquisition to cover the region
of interest (ROI) in the patient. In some methods, preopera-
tive medical imaging data of the patient such as Computed Fig. 3. Representative autonomous robotic systems for 2D-US acquisitions.
Tomography (CT) and Magnetic Resonance Imaging (MRI) (a) A robotic system for autonomous liver screening [56]. (b) A robotic
platform for imaging of the cervix [57]. (c) A robotic system for fetal US
is used for planning of the US acquisition. Other methods scan with a passive mechanism [67]. (d) A robotic system for breast US
plan the scanning path based on the real-time perception acquisition based on US feedback [68] (e) A robotic system for autonomous
of the patient obtained from external sensors (e.g., RGB-D tissue scanning under free-form motion for intraoperative support [69].
camera), or directly plan the movement of the probe based
on the acquired US images. During acquisition, the position III. ROBOTIC S YSTEMS FOR AUTONOMOUS US
and orientation of the probe are continuously controlled by a ACQUISITIONS
robotic manipulator to scan the patient following the planned
A. Systems for Extracorporeal 2D-US Acquisitions
path. The contact force between the probe and the patient is
monitored and controlled in real time to maintain acoustic In conventional 2D-US scans, the sonographer manually
coupling and ensure patient safety. In some of the reported operates a probe to find the desired imaging plane that can
systems, the acquired US images are processed to detect clearly show the anatomical structures and contains valuable
anatomical structures or reconstruct a 3D volume and used information for identifying abnormalities or performimg bio-
as feedback to update the scanning path or adjust the pose of metric measurements [71][72]. The main challenge of au-
the probe. After acquisition, the system is evaluated with some tonomous robotic 2D-US acquisitions lies in the interpretation
application-specific metrics and the acquired data is used for of the acquired US images and the corresponding robot control
various clinical and anatomical applications. strategies to properly position the probe.

TABLE II
S UMMARY OF AUTONOMOUS ROBOTIC S YSTEMS FOR E XTRACORPOREAL US ACQUISITIONS

Controlled DoFs of Requirement of Imaging Anatomical Clinical

Reference
Nakadate et al. (2010) [54]
Mustafa et al. (2013) [56]
Pahl et al. (2015) [57]
Merouche et al. (2015) [58]
Virga et al. (2016) [59]
Hennersperger et al. (2016) [60]
Graumann et al. (2016) [61]
Kojcev et al. (2016) [62]
Göbl et al. (2017) [63]
Kojcev et al. (2017) [64]
Huang et al. (2018) [65]
Huang et al. (2018) [66]
Tsumura and Iwata (2020) [67]
Welleweerd et al. (2020) [68]
Zhan et al. (2020) [69]
Kaminski et al. (2020) [70]
Robotic manipulator US devices Additional sensors
the US probe preoperative image result application application
A custom-made composed of a
Pro Sound II SSD-6500SV (ALOKA
6-DoF parallel link manipulator and None 6 No 2D-US Carotid artery Diagnosis
Co., Ltd., Japan) with a linear probe
a passive serial link arm [55]
MELFA RV-1 (Mitsubishi Electric, A diagnostic US machine (Hitachi Aloka A web camera, and a six-axis force
6 No 2D-US Liver Diagnosis
Ltd., Japan) (6 DoFs) Medical, Ltd., Japan) sensor
APLIO MX SSA-780A (Toshiba 5 (3 for translation,
A custom-made platform (5 DoFs) None No 2D-US Cervix Diagnosis
Corporation, Japan) with a convex probe 2 for rotation)
F3 articulated robot (CRS Robotics SonixTouch (Analogic Corporation, A six-axis force/torque sensor (Industrial Lower limb Biometric
3 (translation) No 3D-US
Corporation, Canada) (6 DoFs) USA) with a linear probe L14-7 Automation, USA) arteries measurement
KUKA LBR iiwa R800 (KUKA Sonix RP (Analogic Corporation, USA) RGB-D camera (Kinect, Microsoft 4 (3 for translation, Abdominal Biometric
No 3D-US
Roboter GmbH, Germany) (7 DoFs) with a convex probe 4DC7-3/40 Corporation, USA) 1 for rotation) aortic aneurysms measurement
KUKA iiwa (KUKA Roboter Sonix RP (Analogic Corporation, USA) RGB-D camera (Kinect, Microsoft Interventional
6 Yes 3D-US General
GmbH, Germany) (7 DoFs) with a convex probe 4DC7-3/40 Corporation, USA) support
KUKA iiwa LBR5 (KUKA Roboter Ultrasonix (Analogic Corporation, USA) RGB-D camera (Kinect, Microsoft
6 Yes 3D-US General General purpose
GmbH, Germany) (7 DoFs) with a convex probe C5-2 Corporation, USA)
KUKA LBR iiwa7 R800 (KUKA SonixTable (Analogic Corporation, USA) RGB-D camera (RealSense SR300, Intel Interventional
6 No 3D-US General
Roboter GmbH, Germany) (7 DoFs) with a convex probe C5-2/60 Corporation, USA) support
KUKA LBR iiwa R800 (KUKA Sonix RP (Analogic Corporation, USA) RGB-D camera (Kinect, Microsoft
6 Yes 3D-US General General purpose
Roboter GmbH, Germany) (7 DoFs) with a convex probe 4DC7-3/40 Corporation, USA)
KUKA LBR iiwa7 R800 (KUKA SonixTablet (Analogic Corporation, RGB-D camera (RealSense F200, Intel Biometric
6 No 3D-US Thyroid
AG, Germany) (7 DoFs) USA) with a linear probe L14-5 Corporation, USA) measurement
Sonix RP (Analogic Corporation, USA) RGB-D camera (Kinect, Microsoft
A 3D translating device (Leetro
with a linear probe L9-4/38, and a Corporation, USA) and two force sensors 3 (translation) No 3D-US General General purpose
Automation, Ltd., China) (3 DoFs)
convex probe C7-3/50 (IMS-Y-Z03, I-Motion Inc., China)
RGB-D camera (Kinect, Microsoft
Epson C4-A601S (Seiko Epson Sonix RP (Analogic Corporation, USA)
Corporation, USA) and two force sensors 6 No 3D-US General General purpose
Corporation, Japan) (6 DoFs) with a linear probe L9-4/38
(RFP-601, Yubo, Inc., China)
A custom-made platform with two
LOGIQ S8 (General Electric, USA) with A three-axis force sensor (USL06-H5, 5 (3 for translation,
linear stages and a 3-DoF passive No 2D-US Fetus Diagnosis
a convex probe C1-5 Tec Gihan, Japan) 2 for rotation)
mechanism (5 DoFs)
KUKA LBR Med7 R800 (KUKA Siemens X300 (Siemens AG, Germany)
None 6 No 2D-US Breast Diagnosis
Roboter GmbH, Germany) (7 DoFs) with a linear probe VF13-5
ProSound Alpha 10 (Hitachi Aloka
Da Vinci surgical robot (Intuitive A stereo endoscopic camera (da Vinci Interventional
Medical Ltd., Japan) with a linear probe 6 No 2D-US General
Surgical Inc., USA) (7 DoFs) Research Kit) support
UTS-533
Franka Emika Panda (Franka Emika Verasonics Vantage 128 (Verasonics, Inc., RGB-D camera (RealSense D435i, Intel
3 (translation) No 3D-US Thyroid Diagnosis
GmbH, Germany) (7 DoFs) USA) with a linear probe ATL L7-4 Corporation, USA)

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 This is the author's version of an article that has been published in this journal. Changes were made to this version by the publisher prior to publication.
The final version of record is available at
JOURNAL OF LATEX CLASS FILES, VOL. 14, NO. 8, AUGUST 2015
As the first attempt towards autonomous robotic 2D-US
acquisitions, Nakadate et al. [54] developed a robot which is
composed of a 6-DoF parallel link manipulator and a passive
serial link arm [55], and used it in combination with real-time
image processing algorithms to automatically acquire a clear
2D-US image of the longitudinal section of the carotid artery
for diagnostic purposes. Several hand-crafted features are used
to detect the anatomical landmarks in the acquired images, and
a scanning strategy is designed accordingly to search for the
desire imaging plane of the carotid artery.
Mustafa et al. [56] used a commercial robotic manipulator
with 6 DoFs with a web camera to autonomously screen the
liver (see Fig. 3 (a)). The epigastric region of the patient is lo-
cated based on the RGB image of the patient surface obtained
by a web camera, similar as [73], and a scanning protocal
was designed to mimic the clinical 2D-US examination of
the liver. Although the quality of the acquired images cannot
be guaranteed, this work shows the potential of using robotic
systems to autonomously acquire meaningful US images of
the liver for diagnosis.
Pahl et al. [57] proposed a cage-like robotic platform
attached to the patient bed to acquire 2D images of the cervix,
as shown in Fig. 3 (b). The system can scan along manually
defined paths with 3 translational DoFs and 2 rotational DoFs
to acquire coronal and sagittal US images of the cervix.
Similarly, Tsumura and Iwata [67] developed a 5-DoF cage-
like robotic system for fetal ultrasonography (see Fig. 3 (c)).
Different from [57], the robot can only actively move the probe
in the horizontal plane, and a passive mechanism is used to
adjust the height and 2-DoF orientation of the probe and apply
a constant force on the patient. The design of the passive US
probe holding mechanism can avoid directly pushing the probe
toward the patient with actuators and allow safe interaction
between the US probe and the abdominal surface, thereby
improving the safety of the fetus and the pregnant woman.
However, some limitations of the system were also reported,
including the limited scan range and shadow artifacts in the
acquired US images [67]. In addition, the cage-like design
in [57] and [67] may make the patient feel uncomfortable
during the robotic US examination, which should be taken
into consideration in the future mechanical design in order to
improve the clinical acceptance of the system.
Welleweerd et al. [68] used a 7-DoF robotic manipulator
with a linear probe attached to its end-effector to acquire 2D-
US images of the breast along a pre-defined trajectory, assum-
ing that the patient is in a prone position, as shown in Fig. 3
(d). The robot can manipulate the probe to maintain contact
with the breast surface based on the acquired US images. For
safe trajectory following, the authors used the safety aware,
intrinsically passive (SAIP) control framework [74] to adjust
the impedance control parameters according to the energy and
power of the system. Similar to [43][44][45] which use US
image-based tracking to guide the probe, this work also uses
the real-time US feedback for visual servoing adjustment to
adjust the probe pose, in order to maintain contact with the
patient surface and prevent excessive deformation of the breast.
Another system proposed by Zhan et al. [69] focused on
scanning a tissue under free-form motion for intraoperative
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5
applications (see Fig. 3 (e)). A da Vinci surgical robot attached
with a linear US probe is used to scan the tissue along a
pre-defined scanning trajectory, and the image of the tissue
surface captured by a stereo endoscopic camera is processed
to estimate the tissue motion, reconstruct the 3D surface and
correct the scanning trajectory in real time.
B. Systems for Extracorporeal 3D-US Acquisitions
Compared with 2D-US imaging, 3D-US imaging can visu-
alize the entire target anatomy and allow clinicians to view any
slice in the compounded volume, which can provide a better
point of reference for diagnosis [75], allow more repeatable
biometric measurements [76], and the volume data can be
fused with other 3D imaging modalities [77]. Besides, an
overview of the target anatomy of interest may assist in plan-
ning surgery or interventions [58], or providing intraoperative
support [60]. However, the image quality and repeatability of
freehand 3D ultrasound is usually susceptible to the varying
forces exerted by the operator and the motion of the patient,
as the induced inhomogeneous tissue deformation will impair
the volumetric reconstruction [78][79]. The enhanced func-
tionality and maneuverability of modern robotic manipulators
can allow precise position and force control, hence the robots
are advantageous for the probe manipulation tasks in 3D-US
acquisitions. Therefore, a number of robotic systems have been
designed to automatically acquire a 3D image that covers an
ROI, especially for biometric measurement and interventional
applications.
Merouche et al. [58] proposed a robotic US system to
automatically scan the lower limb arteries and reconstruct a
3D volume for assessment of the length and severity of a
stenosis. As shown in Fig. 4 (a), a linear probe is held by a 6-
DoF robotic manipulator to scan along the lower limb artery,
during which the vessel lumen segmented from the B-mode
image in real time and the position of the probe is adjusted
accordingly to maintain the artery in the center of the image.
After the acquisition, a reconstructed 3D volume of the vessel
segment is used to measure the vessel cross-sectional areas
and quantification of stenoses.
Virga et al. [59] developed a robotic system for quantitative
assessment of the abdominal aortic aneurysm (see Fig. 4
(b)). A 7-DoF light weight robot is used to manipulate a
convex probe, and an RGB-D camera is fixed at the ceiling
to obtain the point cloud of the patient. After a planned
path in an MRI atlas is transferred to the RGB-D image,
the US acquisitions can be performed automatically and a
3D volume is subsequently compounded for aortic diameter
measurements. The optimal contact force is estimated in a
patient-specific manner before acquisition, and the out-of-
plane rotation of the probe is adaptively controlled during the
scan to optimize the image quality.
Similarly, Hennersperger et al. [60] developed a robotic
system for autonomous 3D-US acquisitions based on pre-
interventional plans in the pre-interventional MRI data of the
patient. The system consists of a 7-DoF robotic manipulator,
a diagnostic US machine and an RGB-D camera mounted
at the ceiling (see Fig. 4 (c)). A closed-loop calibration
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Fig. 4. Representative autonomous robotic systems for 3D-US acquisitions.
(a) A robotic system for US imaging of the lower limb arteries [58]. (b)
Automatic force-compliant US screening of the abdominal aortic aneurysm
[59]. (c) MRI-based autonomous robotic US acquisitions [60]. (d) A robotic
system to scan a volume of interest defined in CT images [61]. (e) A dual-
robot system for US-guided needle placement [62]. (f) Autonomous 3D-US
imaging and measurement of thyroid lobes [64]. (g) A 3-DoF robotic system
[65] and (h) a 6-DoF robotic system [66] for 3D-US imaging of ROI detected
in the RGB-D image. (i) Autonomous 3D-US imaging of the thyroid [70].
update is conducted based on the registration between the pre-
interventional MRI and acquired US data of the patient to
refine the scanning trajectory, and the robotic US acquisitions
can follow the pre-interventional plan with an accuracy of 2.46
± 0.96 mm.
Graumann et al. [61] used a 7-DoF robotic arm with an
RGB-D camera and a US probe mounted at its end-effector to
autonomously scan a pre-defined volume of interest in the pa-
tient, as shown in Fig. 4 (d). A volume of interest is selected in
a preoperative tomographic image and transferred to the real-
time RGB-D point cloud data. Afterwards, a scanning path is
automatically planned for coverage of the volume, which will
be discussed in detail in Section IV-A. This trajectory planning
method was later used in a dual-robot system for US-guided
needle placement [62], where one robotic arm was used for
autonomous US imaging and the other for needle insertion (see
Fig. 4 (e)). Before the needle insertion, an ROI is selected in
the RGB-D image of the patient, and the robot automatically
performs the US scan along a self-generated path to cover the
region of interest. Then the reconstructed 3D volume is used
for US-based visual servoing during the needle insertion. This
work demonstrates the feasibility of using robotically acquired
3D-US images for interventional support.
In the system developed by Göbl et al. [63], the scanning
path is automatically planned in the pre-interventional CT data
to both cover the region of interest inside the patient and
optimize the acoustic window based on consideration of the
inner anatomy and estimation of acoustic transmission. During
acquisition, an RGB-D camera is positioned above the patient
to calibrate the CT image to the world coordinate system, and
a 7-DoF robotic manipulator is used to manipulate the US
probe.
Kojcev et al. [64] compared the reproduciblity of thyroid
lobe length measurements using 3D-US images autonomously
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acquired by a robotic system with that in expert-operated
2D-US acquisitions (see Fig. 4 (f)). They used a 7-DoF
light weight robot with an RGB-D camera mounted at its
end-effector to scan the thyroid lobe following a scanning
trajectory defined in the RGB-D image. Then a 3D volume
is reconstructed and the measurements are conducted by
clinicians. This study showed that robotic US acquisitions
can allow more repeatable measurement results compared with
expert-operated sonography.
Huang et al. [65] used a 3D translating device as the
manipulator to hold a probe for 3D-US acquisitions in general
applications (see Fig. 4 (g)). An RGB-D camera is attached
to the manipulator to obtain depth and color information of
the patient. The region of interest is automatically segmented
from the RGB image and a scanning path is planned to cover
of the region. Two force sensors attached to the probe are used
to measure the contact force during the scan, and a 3D volume
of the target is reconstructed after the scan. This system can
complete autonomous 3D-US acquisitions for different tissues,
but the orientation of the probe is fixed. In an advanced version
of the system [66], a 6-DoF robotic arm is used and the
orientation of the probe is adjusted to be perpendicular to the
tissue surface, which can extend the application range of the
system (see Fig. 4 (h)). Experiments on phantoms of different
tissues (i.e., thyroid, breast, lumbar) and a real human forearm
were conducted to demonstrate the effectiveness of the system
to perform autonomous 3D-US imaging for general purposes.
Kaminski et al. [70] developed a robotic system to scan the
thyroid following a manually planned trajectory. As shown in
Fig. 4 (i), 3D perception of the patient is conducted using
an RGB-D camera attached at the end-effector of the robot
before acquisition, and the current observations is registrated
with a template model for transfer of the preplanned trajectory
in the horizontal plane. Then the robotic arm controls the 3-
DoF translation of the probe to scan along the scanning path
while exerting a constant force in the vertical direction, and a
3D-US volume is compounded using the collected data after
acquisition.
C. Evaluation Metrics
Due to the different purposes and requirements of existing
autonomous US acquisition systems, the evaluation metrics
used in these systems are usually application-specific. We
summarize the evaluation criteria used in the reported systems
as follows.
1) Visibility of Target Anatomy: In the systems for diagnos-
tic purposes, the evaluation is usually based on the visibility of
the target anatomy in the acquired images. In [54], the robotic
acquisition is judged as successful or not according to whether
a clear image of the intima is obtained. In [56], the system is
manually evaluated according to the diagnosability and clarity
of the image and the completeness of the scanning trajectory.
Other methods also qualitatively assess the visibility of the
target tissue or features in the image by manual evaluation
[57][67][65][66].
2) Accuracy of Biometric Measurements: In the systems for
biometric measurement applications, the evaluation metrics are
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based on the accuracy of the measurement results using the
robotically acquired US images. Some systems use manual
measurements in standard expert-operated US scans as the
reference to evaluate the accuracy of robotically acquired 3D-
US volumes [59] and [64]. In [58], the measurement results
using robotically acquired 3D-US volumes are compared with
the computer-aided design (CAD) files used for prototyping
the phantoms and the computed tomography angiography
(CTA). In addition, [65] uses phantoms with regularly sized
and spaced features to evaluate the accuracy of measurements
in the acquired images.
3) Accuracy of Executing Pre-interventional Plans: The
systems that perform US acquisitions for interventional sup-
port usually pay more attention to the agreement between the
actual US acquisition and the pre-interventional plans. In [61],
the system is quantitatively evaluated based on the coverage
of pre-defined volumes of interest in the CT image. In [60],
registration errors between the acquired 3D-US volume and the
preoperative MRI data are used for evaluation of the system
accuracy to follow the pre-interventional plan.
4) Quality of US Images: In some of the reported works,
the system performance is also evaluated based on the general
US image quality. Some methods qualitatively evaluate the US
image quality based on the presence of shadowing artifacts
[67][63], and [63] also quantitatively assesses the image qual-
ity based on the US intensity in the image during acquisition.
In [68] and [59], the image quality is evaluated by calculating
the confidence value in the region of interest based on the
ultrasound confidence map [80], which can estimate the per-
pixel uncertainty in attenuated or shadow regions in the US
image.
5) Repeatability of Acquisitions: In [70], the repeatability
of the 2D-US scans are evaluated by measuring the cross-
correlation value between frames acquired in subsequent US
scans. In [64], the standard deviation of thyroid size mea-
surements performed in robotically acquired images are used
to indirectly assess the repeatability of image acquisitions.
As [69] focuses on overcoming the tissue motion during
the autonomous acquisition, the similarity between the US
images acquired at the same position in the prescence of
tissue deformation is measured based on the normalized cross
correlation to evaluate the system performance.
IV. T OPICS AND M ETHODS
In the aforementioned robotic systems for autonomous US
acquisitions, some common research topics are involved and
different methods have been proposed with particular con-
cerns. Three main topics, namely, the scanning path planning,
contact force control and image quality optimization, are
summarized in Table III and discussed in this section.
A. Scanning Path Planning
Scanning path planning is defined as the planning of a set of
waypoints that specify the desired position and orientation of
the US probe during the autonomous robotic US acquisitions.
In order to efficiently and accurately acquire US images of
the target anatomy with autonomous robotic systems, it is a
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prerequisite to plan the scanning path before acquisition based
on the specific requirement of the target application, such as
finding a desired imaging plane or covering a selected ROI.
Generally, the scanning path planning methods in existing
systems are based on the global information of the target tissue
obtained from preoperative medical images (e.g., MRI or CT)
or the surface information obtained from external sensors (e.g.,
RGB-D camera), or directly based on the real-time US images
acquired by the robot.
In some reviewed systems, the scanning path is manually
specified in the robot workspace by the human operator before
the robotic acquisition [57][58]. Since the predefined trajectory
does not consider real-time tissue information and may limit
the flexibility of the acquisition, online probe adjustment based
on the US feedback is incorporated in [58] to improve the
imaging results, which will be discussed in Section IV-C.
Some attempts have been made to plan the scanning path
in a semi-autonomous manner, by automatically adjusting the
manually planned path to fit the tissue surface. In [67], the
manually specified scanning path in the horizontal plane is
automatically adjusted to follow the abdominal surface using
a delicately designed passive mechanism, which assumes the
shape of the abdomen as an oval hemisphere. In [68], the
authors proposed to reconstruct the tissue surface using pre-
interventional MRI scans (CAD file of a phantom was actually
used in their experiments), and transfer the predefined path
onto the surface. Similarly, [69][64] project the predefined
2D scanning path to the 3D surface of the patient extracted
using RGB-D cameras. In [60], the scanning path is manually
planned in the pre-interventional MRI data of the patient, and
automatically transferred to the robot workspace based on the
surface registration between pre-interventional MRI and real-
time RGB-D image of the patient. In [59], the preplanned
path in a generic MRI atlas is transferred to the live RGB-
D image of the patient based on a deformable registration.
Similarly, in [70], the scanning path is planned on a template
thyroid model and tranferred to the robot workspace based
on registration between the model and the real-time RGB-D
images. Compared with [60], the methods in [59] and [70] are
more versatile as they utilize statistical or template anatomical
images and do not require individual tomographic data.
There are also a number of methods that can realize
automatic planning of the scanning path to cover a manually
selected ROI. In these methods, since the user only needs
to select an ROI without giving a specific path, the ease of
use is further improved. In [61], after a volume of interest
is manually selected in a preoperative tomographic image of
the patient, it can be transferred into the RGB-D image of
the patient by surface registration, and the scanning path can
be automatically planned to cover the volume of interest. The
same planning method is also used in [62], where the region
of interest is directly selected in the RGB-D image of the
patient. In addition to covering a selected region of interest,
[63] can also automatically plan the scanning path to optimize
the image quality. Given a target point inside the human
body, the method can find the probe pose with the optimal
acoustic window (i.e., anatomical structure on the travelling
path of the US wave) based on the pre-interventional CT image
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TABLE III
T OPICS AND M ETHODS IN AUTONOMOUS ROBOTIC US ACQUISITIONS

Topic Method References

Manually plan the scanning path in the robot workspace [57][58]

Manually plan the scanning path and automatically adjust it to the tissue surface with a passive mechanism [67]
Manually plan the scanning path and automatically adjust it to the tissue surface based on preoperative images [68]
Manually plan the scanning path and automatically adjust it to the tissue surface based on RGB-D images [69][64]
Scanning path
Manually plan the scanning path in preoperative images, and automatically tranfer it to the robot workspace based on RGB-D images [59][60][70]
planning
Manually select a region of interest in preoperative images or RGB-D images, and automatically plan to cover the selected region [61][62]
Manually select a region of interest in preoperative images, and automatically plan to cover the region and optimize the acoustic window [63]
Automatically plan the scanning path based on RGB-D images [56][65][66]
Automatically plan the scanning path based on real-time US images [54]

Use a six-axis force sensor mounted at the tip of the robotic manipulator, and apply a constant force on the patient [56][58]
Use two force sensors mounted at the front face of the probe; keep the two force measurements in a range [65][66]
Contact force
Use built-in force sensors in the robotic manipulator; apply a constant force on the patient [60][61][62][63][64][70]
control
Use built-in force sensors in the robotic manipulator; apply a patient-specific optimal contact force on the patient [59]
Not use force sensors; apply a constant force on the patient with a passive constant-force spring [67]

Before acquisition; plan the scanning path to optimize the acoustic window based on preoperative images [63]
During acquisition; online update of the scanning path based on tissue motion estimation from RGB-D images [69]
Image quality
During acquisition; online update of the scanning path based on registration between the acquired US images and preoperative images [60]
optimization
During acquisition; online probe adjustment based on US image features [56][54][58]
During acquisition; online probe adjustment base on the ultrasound confidence map [80] [68][59]

of the organ, by modelling both the geometric and physical
constraints of the US acquisition. First, the probe poses that
can guarantee the coverage of the target point are selected
as candidates based on the geometrical constraints. Then an
acoustic transmission model based on the tomographic data is
established to estimate the US attenuation, and the probe pose
that maximizes the image quality is finally chosen. Although
this approach is limited in high computational cost, it opens
the way for integrating the image quality optimization into the
planning stage, which will also be discussed in Section IV-C.
Only a few systems allow fully automatic planning of the
scanning path. In [56], [65] and [66], the region of interest is
automatically extracted from the RGB-D image of the patient
surface using image processing techniques. In [56], the human
umbilicus and mammary papillae are detected from RGB
images as landmarks to locate the liver region to determine
the scanning initial position. Then a scanning protocal is
implemented to mimic the standard acquisition steps in the
general clinical US imaging of the liver. Although a clear
path is not given by this method, it provides a general idea for
automatically planning the scanning path to mimic the clinical
procedures. In [65] and [66], color features are used to segment
the region of interest from the RGB-D image, and the scanning
path is automatically planned to cover the region of interest
through a number of sweeps and follow the tissue surface.
In [54], the scanning path is incrementally planned based on
the real-time US images, in order to search for the desired
view of the carotid artery. The authors developed real-time
image processing algorithms to detect the carotid landmarks,
and delicately designed an automatic path planning workflow
to plan the probe motion accordingly. Since the future motion
of the probe is planned in real time based on the US feedback,
the method has the inherent advantage to compensate for
patient motion. However, since the hand-crafted image features
and well-engineered scanning strategies are designed for the
specific imaging purposes, this method may be difficult to
generalize to other organs.
Among the aforementioned planning methods, [69] and [60]
also support online update of the planned path based on the
real-time tissue information obtained using RGB-D cameras or
the acquired US images to account for tissue motion during
acquisition, which will also be discussed in Section IV-C.
B. Contact Force Control
During the acquisition process, it is essential to maintain
proper contact between the US probe and the patient to
improve image quality and ensure patient safety. Excessive
contact force may cause deformation of the target anatomy
and even hurt the patient, while insufficient force cannot ensure
good acoustic coupling and would result in poor image quality.
Therefore, contact force control during the acquisition process
is implemented in most of the reviewed systems.
In [56][58], a six-axis force sensor is attached to the tip
of the manipulator to detect the contact force between the
probe and the patient, and a constant force is applied in the
normal direction of the patient surface. In [65][66], two force
sensors are mounted at the front face of the US probe, and the
pose of the robot is automatically adjusted to ensure both the
force measurements fall into the range of [1N, 8N]. While this
contact force control method can help maintain proper contact
between the probe and the skin surface, the attachment of force
sensors to the front face of the probe will inevitably introduce
small shadow artifacts in the acquired images. Many systems
use the built-in force-torque sensors in the robotic manipulator
to estimate the Cartesian force acting on the end-effector, and
apply a constant contact force along the direction of the probe
[59][60][61][62][63][64][70].
Different from the above methods that actively apply a
contact force on the patient with actuators, [67] does not

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implement force sensing and feedback control, but uses a
passive mechanism that adopts a constant-force spring of 1.0
kgf to generate a constant force in the vertical direction to
avoid exerting excessive force onto the patient by accident,
thereby improving patient safety in fetal US scans.
In the majority of the reported methods, the desired contact
force applied on the patient is manually parameterized based
on experience. In view of a clinical integration, however, the
parameterization of the contact force needs to be tailored to
the individual characteristics and specific target applications
to satisfy the safety requirements and improve image quality.
In [67], the optimal contact force is determined according
to clinical survey data in fetal US imaging. In [59], the
optimal contact force is estimated in a patient-specific manner
before acquisition based on the ultrasound confidence map
[80] in order to optimize the image quality (which will also
be discussed in Section IV-C). This adaptive force estimation
can make it easier for the robotic system to cope with diverse
patient populations.
C. Image Quality Optimization
In the past few decades, the imaging quality of clinical US
devices has greatly improved due to advances in transducer
design [81] and image enhancement techniques [82]. However,
since the acoustic propagation is easily affected by the prop-
erty of the medium, it is important to correctly position the US
probe with respect to the patient to ensure good image quality
in extracorporeal US imaging tasks. For instance, since US
waves cannot penetrate the air and the bones, the probe should
be in close contact with the skin and the acoustic window
should be appropriately selected to avoid strong reflectors such
as the ribs. Therefore, methods to quantitatively evaluate and
optimize the image quality during the acquisition are needed.
Currently, there is no uniform standard to assess the quality
of US images. In general, existing methods for US image
quality evaluation can be divided into two categories. One
is to predict US image quality based on prior knowledge
of the target anatomy, which is usually obtained from the
tomographic data of the patient, such as CT and MRI. A
number of methods have been proposed to synthesize US
images from tomographic data [83][84][85]. Since the 3D
tomographic image of the target organ can provide information
about its spatial anatomy, including the location of strong
reflectors such as bones and gases, this information can be
combined with the physical model of ultrasonic propagation
to predict the quality of US images.
The other category directly processes the acquired US
images to evaluate the US image quality. Several groups have
investigated the automatic quality assessment of US images for
specific applications, such as breast US imaging [86], fetal
biometric measurement [87][88][89], and knee arthroscopy
[90]. These studies mainly use the correlation between the
content of obtained images and the target image to represent
the image quality (e.g., whether the obtained image contains
the target anatomical structures). The quality assessment can
then be used to assist in the specific image analysis tasks.
Based on the physical properties of US propagation, some
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methods have been proposed for more generic US image
quality assessment that are applicable to a broader range of
US imaging applications. For instance, the ultrasonic atten-
uation is estimated in the obtained images in some studies
[91][92][93][94]. Karamalis et al. [80] proposed the ultra-
sound confidence map, which is a general approach to estimate
the pixel-wise uncertainty in US images using the random
walks framework [95]. This method utilizes the propagation
properties of US in soft tissues to evaluate the image quality,
and can provide a spatial map of the relative confidence in
real time. A variant of the ultrasound confidence map was
presented in [96].
In some of the reported autonomous US acquisition systems,
the optimization of image quality is conducted before acqui-
sition (i.e., in the scanning path planning phase) or during
acquisition (i.e., by online update of the scanning path or
probe adjustment), corresponding to the above two types of
image quality evaluation methods. In [63], based on the US
attenuation model introduced in [84], the authors used pre-
interventional tomographic data of the target organ to plan
the scanning path that optimizes the acoustic window. Using
the relationship between X-ray attenuation coefficient and
the ultrasonic propagation physics, the US intensity at the
selected point inside the patient body can be predicted before
performing the actual acquisition, and the optimal probe pose
on the tissue surface can be selected to minimize the US
attenuation. Therefore, the planned scanning path can avoid
strong reflectors such as the ribs based on the prior knowledge
of the target organ, thereby optimizing the US image quality
in the planning phase.
Other systems optimize the US image quality during the
acquisition process by updating the scanning path or adjusting
the probe pose in real time. In [69][60], the preplanned scan-
ning path is updated online based on the real-time estimation
of tissue motion. In [69], the scanning path is updated to
adapt to the tissue surface in real time by estimating a rigid
transformation of the tissue from RGB-D images captured
by an endoscopic stereo camera. The US image quality is
optimized during acquisition as the tissue tracking method
helps maintain proper contact between the probe and the
tissue. [60] updates the planned path based on multi-modality
registration between the real-time US image and preoperative
MRI to overcome patient movement. Since the above methods
can account for motion compensation, the pre-interventional
plan can be executed more stably and accurately to obtain
images of the selected target in the precense of tissue motion,
which is crutial in interventional applications. Some systems
adjust the probe pose in real time based on the US feedback
to optimize image quality. In [56][54], the brightness of the
B-mode images is used to detect the shadow artifacts caused
by improper contact with the patient, and the probe orientation
is adjusted accordingly to improve the image quality. In [58],
since the system is aimed at recontructing a 3D-US image of
the lower limb artery, the probe position is adjusted in real
time to maintain the artery at the center of the B-mode image
based on the segmentation of the artery lumen using a fast-
marching method. In [68][59], the image quality is estimated
in real time by computing the average confidence value in
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the region of interest using the ultrasound confidence map
[80]. A visual servoing approach is used in [68] to control
the in-plane rotation and the height of the probe to keep
the probe in contact with the breast and optimize the image
quality, while [59] adjusts the out-of-plane rotation of the
probe in real time based on the confidence change compared
with previous frames. In addition, the system in [59] also
estimates the optimal contact force for each individual based
on the confidence map to optimize the image quality. Besides,
the systems that incorporate contact force control (which are
discussed in Section IV-B) can inherently maintain contact
between the probe and the tissue, thereby implicitly optimizing
the image quality.
The optimization of US image quality have also been
studied in many semi-autonomous robotic US imaging sys-
tems to improve ease of use and reduce user-dependency.
Abolmaesumi et al. [43][44][45] proposed several feature
extraction algorithms to track the carotid artery in real-time US
images, and used a visual servoing controller to automatically
adjust the in-plane motions of the probe during remote US
examinations. Since the US image servoing can automatically
maintain the carotid artery in the image center, unwanted
patient motions can be compensated during the teleoperation.
More visual features have been explored in US-based visual
servoing to consider more complex shaped objects in robot-
assisted target tracking tasks [97][98][51][99]. Şen et al. [47]
proposed a registration-based method to dynamically update
the desired probe position in the cooperative system based
on the difference between the real-time US image and a
reference US image. Chatelain et al. [100] incorporated the
ultrasound confidence map in a visual servoing framework
to control the in-plane rotation of the probe in robotic tele-
echography tasks. This work was further extended to full
control of the probe [52], which integrates the force, position
and confidence control of the probe in a redundant framework
for tele-echography and target tracking tasks. Besides, Jiang
et al. [101] used the ultrasound confidence map and force
feedback to estimate the optimal orientation of the probe at
the point of contact, thereby improving the image quality
at a given position. Although proposed for different target
applications, we believe that the ideas in these methods are
general and can be integrated into current autonomous systems
to achieve better imaging results.
V. C HALLENGES AND F UTURE D IRECTIONS
A. Challenges of the Increased Autonomy
Abundant research has demonstrated the feasibility of using
autonomous robotic systems as an alternative to the stan-
dard handheld technique in extracorporeal US acquisitions.
Compared with the non-autonomous and semi-autonomous
systems, the autonomous systems do not need an on-site or off-
site human operator to directly manipulate the probe, which
can significantly simplify the workflow, reduce operator work-
load and improve the reproducibility of the acquisition. Also,
the operation of the autonomous systems does not require
the patient site to have remote communication capabilities.
However, according to our standardization in Section II, the
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majority of existing autonomous systems are still at level 2,
which rely on a human-in-the-loop to manually plan the acqui-
sition. Therefore, the imaging results of these systems are still
operator-dependent. Only four systems (i.e., [54][56][65][66])
have been developed at level 3, but their clinical effectiveness
needs to be further investigated and compared with the semi-
autonomous systems.
Besides, as the level of autonomy increases, the task of
robotic acquisition becomes more complex and sophisticated,
which requires the system to have better perception and
decision-making capabilities. Several limitations have been re-
ported in existing autonomous systems, including the inability
to adapt to large tissue motions [66] and suboptimal image
quality [56][60]. To this end, better algorithms need to be
developed and incorporated in current systems to respond to
various sensor data and make corresponding decisions, in order
to replicate the skills of an expert sonographer.
Moreover, safety is a paramount issue for the autonomous
US acquisition systems to improve clinical acceptance of
this technology. Compared with the systems under continuous
control of a human operator, the increased autonomy in the
autonomous systems may bring a higher risk of patient injury
due to malfunction [31]. Although most existing autonomous
systems have incorporated force sensing to improve patient
safety, excessive force may be accidentally exerted onto the
patient due to sensor or controller failure [67][68]. Using more
sensors to monitor the system may improve the safety and
reliability of the acquisition, but it would also increase the
burden of data processing. Future studies should pay more
attention to these issues, and conduct more clinical trials to
certify the safety and reliability of the autonomous systems.
B. Expansion of the Application Paradigms
Autonomous robotic systems have been developed for US
acquisition in a broad range of medical applications, as
demonstrated in Section III. Their target anatomies include
the thyroid, carotid artery, breast, liver, cervix, fetus, lumbar,
forearm, lower limb arteries, and abdominal aortic aneurysms.
All existing works use general-purpose US probes in their
systems, probably because of the low cost. Future studies are
expected to explore the applications of autonomous robotic
systems for US imaging of other organs, such as the lung,
heart, kidneys, urinary tract and gastrointestinal (GI) tract.
For these new applications, the autonomous robotic acquisition
will face different difficulties and challenges due to the diverse
transducer types and imaging requirements. Therefore, it is
of great practical relevance to identify the clinical needs and
develop dedicated systems for specific target applications.
Besides, intracorporeal US acquisition such as intravascular
and intracardiac ultrasonography [102] is another promising
application for autonomous robotic systems, which has differ-
ent challenges from extracorporeal US acquisitions, as the task
involves inserting a specialty transducer into the body to obtain
images of the internal organs. This topic is outside the scope of
this review, however, the basic ideas of scanning path planning,
contact force control and image quality optimization addressed
in existing extracorporeal systems may be transferred and
applied in the intracorporeal applications.
 This is the author's version of an article that has been published in this journal. Changes were made to this version by the publisher prior to publication.
The final version of record is available at
JOURNAL OF LATEX CLASS FILES, VOL. 14, NO. 8, AUGUST 2015
C. Hardware Design
Existing autonomous US acquisition systems usually use
rigid robots and conventional mechanical actuators, which
are often expensive [64] and contain large and bulky ma-
chinery which may result in potential damage to the patient
[67][103]. To this end, future improvements can be made in
the hardware design to make the robotic system more compact,
more portable, less expensive, and safer for human-robot
interaction. Novel actuation methods for the robotic US system
can be investigated, such as pneumatic [103], fluidic [104] and
magnetic actuation [105]. Recent developments in soft robotics
have demonstrated the capability of soft robots in performing
dexterous and high-level tasks in a wide range of medical
applications [106]. In [103], a portable and wearable soft
robotic system with soft pneumatic actuators was developed
for US probe steering applications, which can allow more
compliant human-robot interaction during the acquisition.
Similarly, soft robotic end-effectors have been developed for
teleoperated fetal US imaging [104] and US-guided interven-
tions [107]. Compared with rigid robots, soft robots have
inherent advantages of smaller size, lighter weight, simpler
control methods, higher flexibility, and better compatibility
with human tissues. Combined with these advances in soft
robotics, we can anticipate that the safety, practicability and
clinical acceptance of future robotic systems for autonomous
US acquisitions could be significantly improved.
Besides, only one of the autonomous systems utilized the
clinical survey data in the hardware design of the robotic
system [67]. Future studies are suggested to improve the safety
and comfort of the robot design by taking into consideration
the clinical acceptance by the patients. To this end, more clin-
ical statistical data from diverse patient populations should be
collected in clinical US imaging to find the optimal solutions.
D. Tissue Motion Compensation
Most of the existing robotic systems for autonomous US
acquisitions require the patients to remain still during the
scan. However, this setup may cause discomfort to the pa-
tient; furthermore, the system may fail to work properly if
the patient unintentionally moves during the examination.
Therefore, active compensation for patient movement and
tissue deformation can help improve the robustness and pa-
tient comfort during the robotic acquisition, especially in
intraoperative imaging applications [69]. A large number of
visual servoing methods have been proposed to control the
US probe in real time to compensate for undesired tissue
motions in applications such as teleoperated sonography [45],
target tracking [108] and surgical navigation [109]. Various
features have been used for tissue tracking in the US image,
such as speckle information [98][50], image moments [51] and
intensity [99]. These methods can be integrated into existing
autonomous US acquisition systems to further improve the
imaging performance under tissue motions.
E. Contact Force Optimization
In order to ensure proper contact with the patient, most
of existing methods apply a constant contact force onto the
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11
patient. However, since the soft tissues of the human body
are highly deformable, the contact force should achieve a
balance between maintaining good acoustic coupling and
avoiding excessive deformation of the tissue, which remains
an important yet challenging task. Large tissue deformation
in the acquired images will strongly impair the quality of 3D
reconstruction [78] and the accuracy of subsequent diagnosis
and measurements. Also, the optimal contact force for different
patients should depend on individual characteristics, such as
tissue stiffness [67][59]. To this end, future researchers are
suggested to take into account patient-specific characteristics
in the design of contact force control strategies, as well as
estimate and overcome the tissue deformation caused by the
external pressure [110] to achieve more adaptive control of the
contact force.
F. Real-time US image Interpretation
Another direction for future research is to combine the
interpretation of US images with the autonomous control
of the US probe to make the robotic US acquisition more
intelligent. With the rapid development in artificial intelligence
and computer vision, various data-driven algorithms have been
proposed and applied in US image analysis, yielding fron-
tier results in the classification, detection, and segmentation
tasks for different anatomical structures [111]. Recently, a
growing number of machine learning approaches have been
developed for image-based probe guidance in simulated US
acquisitions for fetal [112] and spinal imaging [113]. Li et
al. [114] proposed a deep reinforcement learning solution to
autonomous control of a US probe towards the desired imaging
plane based on real-time US image feedback. In future studies,
these methods are expected to be integrated into real robotic
systems to automatically interpret the US images and guide
the movement of the probe in real time, thereby mimicking
the visual search and navigation strategies of sonographers.
G. Evaluation Criteria
Currently, there is no uniform evaluation criteria for the
autonomous US acquisition systems, and many existing studies
only qualitatively validate the effectiveness of their methods.
Also, there is a lack of uniform standards regarding the reading
techniques of the reconstructed 3D-US volumes, making it
difficult to quantitatively evaluate the robotic US imaging
results [24]. Future studies should investigate more standard-
ized evaluation metrics to validate the systems based on their
clinical applications and requirements.
Furthermore, none of the reported systems include the
patient satisfaction in the evaluation criteria. In order to further
justify the clinical acceptance of this technology, the perfor-
mance of the systems need to be assessed in terms of patient
safety, comfort and satisfaction. For instance, feedback from
the patients can be included in the system evaluation [115].
In addition, more studies are needed to compare the results
of the robotic acquisitions with the standard expert-operated
acquisitions to demonstrate the feasibility and effectiveness of
their methods.
 This is the author's version of an article that has been published in this journal. Changes were made to this version by the publisher prior to publication.
The final version of record is available at
JOURNAL OF LATEX CLASS FILES, VOL. 14, NO. 8, AUGUST 2015
VI. C ONCLUSIONS
Combining the advantages of robotic manipulators and
US imaging, an increasing number of robotic systems have
been developed to automatize extracorporeal US acquisitions
in a broad range of medical applications. We present an
overview of literature on this subject of research, covering
the state-of-the-art systems and techniques on autonomous
robotic US acquisitions for various clinical applications. The
standardization of autonomy levels in robotic ultrasonography
is discussed based on the level of computer assistance provided
by the robotic systems. The important features of existing
autonomous systems are described and compared, and related
research topics and methods are summarized and discussed.
The development of autonomous robotic US acquisitions has
demonstrated the potential of using robots to autonomously
obtain reproducible and diagnosable imaging results without
the operation of specialized personnel.
We strongly believe that the presented efforts in autonomous
robotic US acquisitions are important to pave the way for a
promising future of US-based medical care. This technology
is expected to be incorporated with advances in other fields
such as soft robotics and AI-powered US image analysis, and
will hopefully benefit a broad spectrum of clinical procedures
in the medical domain.
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Max Q.-H. Meng received the Ph.D. degree in elec-
trical and computer engineering from the University
of Victoria, Victoria, BC, Canada, in 1992.
He was with the Department of Electrical and
Computer Engineering, University of Alberta, Ed-
monton, AB, Canada, where he served as the Di-
rector of the Advanced Robotics and Teleoperation
Laboratory, holding the positions of Assistant Pro-
fessor, Associate Professor, and Professor in 1994,
1998, and 2000, respectively. In 2001, he joined
The Chinese University of Hong Kong, where he
served as the Chairman of the Department of Electronic Engineering, holding
the position of Professor. He is affiliated with the State Key Laboratory of
Robotics and Systems, Harbin Institute of Technology, and is the Honorary
Dean of the School of Control Science and Engineering, Shandong University,
China. He is currently with the Department of Electronic and Electrical
Engineering, Southern University of Science and Technology, on leave from
the Department of Electronic Engineering, The Chinese University of Hong
Kong, Hong Kong SAR, China, and also with the Shenzhen Research Institute
of the Chinese University of Hong Kong, Shenzhen, China. His research
interests include robotics, medical robotics and devices, perception, and
scenario intelligence. He has published about 600 journal and conference
papers and led more than 50 funded research projects to completion as PI.
Dr. Meng is an elected member of the Administrative Committee (AdCom)
of the IEEE Robotics and Automation Society. He is a recipient of the IEEE
Millennium Medal, a fellow of the Canadian Academy of Engineering, and a
fellow of HKIE. He has served as an editor for several journals and also as
the General and Program Chair for many conferences, including the General
Chair of IROS 2005 and the General Chair of ICRA 2021 to be held in Xi’an,
China.

Keyu Li received the B.Eng. degree in communi-

cation engineering from Harbin Institute of Tech-
nology, Weihai, China, in 2019. She is currently
pursuing the Ph.D. degree in the Department of
Electronic Engineering, The Chinese University of
Hong Kong (CUHK), Hong Kong.
Her research focuses on artificial intelligence and
its application in medical robotic systems, super-
vised by Prof. Max Q.-H, Meng.

Yangxin Xu received the B.Eng. degree in electrical

engineering and its automation from Harbin Institute
of Technology, Weihai, China, in 2017. He is cur-
rently pursuing the Ph.D. degree in the Department
of Electronic Engineering, The Chinese University
of Hong Kong (CUHK), Hong Kong.
His research focuses on magnetic actuation and
localization methods and hardware implementation
for wireless robotic capsule endoscopy, supervised
by Prof. Max Q.-H, Meng.
Mr. Xu received the Best Conference Paper from
the 2018 IEEE International Conference on Robotics and Biomimetics (RO-
BIO), Kuala Lumpur, Malaysiain, in 2018.

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