PROJECT SUMMARY Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already taken on a pandemic of epic proportions, affecting over 8 million humans in an estimated 100 countries. A global response to prepare health systems worldwide is of utmost importance. Respiratory symptoms are the primary manifestation of COVID-19, and the disease caused by SARS-CoV-2 can range from mild illness to severe, acute and fulminant respiratory distress. This varying severity in the face of a worldwide pandemic necessitates rapid diagnosis to provide the proper triage and disposition of patients. Diagnostic testing such as plain-film radiography (x-ray) and chest computed tomography (CT) are considered the mainstay of diagnostic imaging in the detection of lung-related disease. Lung ultrasound (LUS) has emerged as an alternative to x-ray and chest CT for rapid diagnosis of COVID-19 affected patients with major advantages include safety, absence of radiation, low cost, and its portability for ease of bedside diagnosis. Guidelines for LUS imaging in COVID-19 patients have been proposed. However, LUS imaging is highly operator dependent. In resource-limited areas, the accessibility is limited by the small number of physicians and sonographers who are properly trained in providing accurate diagnosis. Additionally, LUS imaging requires close physical proximity between the operator and patient, which could lead to an increased risk of COVID-19 transmission. Therefore, there is a unmet need to develop a more accessible LUS system for COVID-19 patients, whereby reducing physical contact between the operator and patient. In this proposal, we aim to develop a safe, low-cost, and easy-to-use robotic LUS platform to 1) maximize the accessibility in a resource-limited environment and 2) minimize the risk of COVID-19 transmission between patients and healthcare workers. This robotic platform will be designed to conduct LUS procedures following established diagnostic workflows, while ensuring adequate safety. The proposed gantry-based robot platform allows the operator to tele-operatively manipulate the ultrasound probe based on visual information from cameras. Thus, the operator is not required to be present with the patient, improving accessibility. An optimal tissue-probe contact pressure will be maintained by an electronics-free passive mechanical configuration to avoid excessive contact forces and ensure patient safety. The gantry system is structurally simple, low-cost, and easy to implement in a research-limited environment. Specifically, we propose to evaluate the robotic LUS platform with the active-passive hybrid control (Aim 1), demonstrate the safety and cross-validation in healthy volunteers (Aim 2), and demonstrate the system reliability and performance in COVID19 patients (Aim 3). This proposed robotic LUS platform (1) makes the LUS procedure more accessible in a resource-limited environment, (2) minimizes the risk of contagion between patients and healthcare workers and, (3) establishes standardized data collection of LUS to improve the efficacy. The proposed system has the potential to play a critical role in maximizing healthcare function via triaging of patients suspected to or have been diagnosed with COVID-19.

PROJECT NARRATIVE The proposed research aims to develop a safe robotic ultrasound platform making the lung ultrasound (LUS) procedure more accessible in a resource-limited environment and minimizing the risk of COVID- 19 transmission between patients and healthcare workers by virtually eliminating physical contact during the procedure. The developed system has the potential to play a critical role in maximizing healthcare delivery via triaging of patients suspected to or have been diagnosed with COVID-19. Thus, the proposed research is relevant to the mission of the Notice of Special Interest that pertains to the Coronavirus Disease 2019 (COVID-19), domestically or internationally.