A robot, operated by health workers in Brisbane, is scanning patients’ hearts more than 1,000 kilometres away in the Queensland outback.
Sonographers sitting in a tiny room at the Royal Brisbane and Women’s Hospital (RBWH) operate a handheld controller — like those used to play computer games — to manipulate the robot on patients at Longreach, in the state’s remote central west.
The Queensland-designed remote-controlled robot, hailed as a world-first, is expected to help alleviate the tyranny of distance faced by patients living in remote, rural, and regional areas.
It’s hoped the technology will eventually eliminate the need for many outback Queenslanders to travel hundreds of kilometres to a major centre, or wait months for an outreach team, to access a — potentially lifesaving — heart ultrasound, known medically as an echocardiogram.
Echocardiography is a key diagnostic test for heart specialists, giving them images of the structural components of the heart. It enables them to diagnose conditions such as heart failure and rheumatic heart disease.
Longreach bank manager Mai Cameron had a defibrillator implanted, in Brisbane in November 2022, after heart monitoring detected a dangerously low heart rate which put her at risk of a stroke.
The defibrillator detects and corrects abnormal heart rhythms but she still requires regular heart scans to monitor the condition.
Ms Cameron said the robot meant she wouldn’t have to leave Longreach for her scans, saving her at least three days of travel and the corresponding costs.
It means she can continue caring for her dogs, Millie and Benson, rather than worrying about them while she’s away having a scan.
“Having it in Longreach, literally, I can do it on my lunch break,” she said.
“If there’s nothing that needs doing, happy days, go back to work and continue on.
“But if there is something they find, they can act so quickly.
“[The ultrasound] is being live fed to Brisbane — they’re already looking at it while you’re having it done — so if there’s anything untoward, or anything they’re not sure of, they can bring in experts then and there.”
Longreach Hospital health workers prepare the robot, place gel on the ultrasound probe and manoeuvre patients into position so a sonographer in Brisbane can perform the scan.
Hopes to close gap between regions and city
RBWH’s director of cardiac sciences, Adam Scott, established start-up company Remote Medical Innovations (RMI) Oceania in 2019 to develop and commercialise the ultrasound robot.
“There’s a tendency to keep doing what we’ve always done,” Dr Scott said.
“Change can be very hard for some people but, if we keep doing what we’ve always done, we’ll keep getting the same result.
“We need to test new models of care.”
Queensland Health has partnered with RMI Oceania in a 12-month pilot study to validate and test the new technology.
A robot is being trialled at Longreach Hospital and another one will be located at Cloncurry Hospital, about 500km north-west of Longreach.
Dr Scott said it would allow much faster diagnosis for cardiac patients in rural, remote, and regional areas, describing the images it produced as “incredibly high quality”.
“This has not been able to have been done anywhere in the world,” he said.
The adjunct professor at QUT’s School of Public Health and Social Work said rural Queenslanders lived, on average, seven years less than people in metropolitan areas.
“We see a 25 per cent higher morbidity and mortality [rate] in rural locations due to reduced access to specialist care,” Dr Scott said.
“In detecting their disease earlier, we’re going to be able to treat [regional patients] faster and support them and therefore, prolong their life span.”
Rural Doctors Association of Queensland president Alex Dunn said innovations like the robotic ultrasound, where medical care could be delivered closer to home, made a patient’s health journey “a much more comfortable one and less intimidating”.
“I think someone having to travel to Brisbane or to Rocky (Rockhampton), which can be hours and hours away, can be really daunting for many of these patients,” Dr Dunn said.
“For some, they’ll just choose not to go and not get the care that they need and deserve.
“If the pilot proves to be successful, which we sincerely hope it does, I think projects like this getting rolled out across the state would be a great step forward.”
New technologies help medical staff
However, Dr Dunn said it was also important to maintain outreach programs in rural and regional areas so that medical specialists continued to build relationships with remote patients.
In 2016, Dr Scott and his team at the RBWH started a tele-cardiac investigations program to fast-track cardiac care for remote Queenslanders.
Working in Brisbane, they conduct remote cardiac stress testing, electrocardiograms (ECG) and Holter monitoring on patients at 24 health facilities across Queensland, with help through trained local hospital workers.
“We’ve been able to save 460,000km in patient travel over the last eight years, which is about 11 and a half times around the world,” Dr Scott said.
Providing a remote-controlled robotic heart ultrasound was the next step.
Queensland Health data from the patient travel subsidy scheme (PTSS) shows that last financial year, the scheme supported almost 70 million kilometres of motor vehicle travel by public patients and their escorts.
That figure does not include travel by air or rail.
Dr Scott expects the remote-controlled ultrasound robot – dubbed COBOT for collaborative robot — will further cut the number of kilometres outback patients need to travel for health care.
He’s hopeful COBOT can be used for other types of ultrasounds, beyond heart echocardiographs, including obstetric scans, abdominal and musculoskeletal scans, and in paediatric medicine.
The robots have the potential to benefit sonographers as well as patients and their families.
Dr Scott said the injury burden on sonographers performing manual scans was “huge”, with some leaving the profession as a result.
Conducting manual scans can be physically demanding on sonographers, particularly those involving larger patients. Sonographers need to maintain pressure on the ultrasound probe for significant periods of time, putting strain on their shoulders.
The COBOT is expected to reduce that injury risk, with the robotic arm applying the pressure.
Dr Scott said being able to conduct scans remotely would also allow more flexibility for sonographers, such as women on maternity leave or those with young children, to work from home.