Systems and methods for calibrating and detecting poses of transesophageal echocardiography probe using force sensors

Abstract

Systems and methods for robotically controlling a transesophageal echocardiography imaging (TEE) system. Such systems and methods can control a TEE probe assembly having a catheter that is advanced through the mouth of a subject into the esophagus. The systems and methods disclosed herein can include calibration, pose determination, and force sensor inputs. For example, a system for controlling the TEE probe can include advancing the TEE probe to a prescribed position in an esophagus of a subject, calibrating the TEE probe, determining a pose of the TEE probe, moving the TEE probe relative to the prescribed position by a prescribed amount, and estimating a subject tissue resistance based on a measured force.

Description

LAZA.051WO PATENT SYSTEMS AND METHODS FOR CALIBRATING AND DETECTING POSES OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY PROBE USING FORCE SENSORSINCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATIONS

[0001] The present application claims priority to U. S. Provisional Patent Application No. 63 / 730,375, filed December 10, 2024, U. S. Provisional Patent Application No. 63 / 743,004, filed January 8, 2025, U. S. Provisional Patent Application No. 63 / 742,996, filed January 8, 2025, and U. S. Provisional Patent Application No. 63 / 742,754, filed January 7, 2025. The recited applications are hereby incorporated herein by reference in their entirety. Any and all applications for which a foreign or domestic priority claim is identified in the Application Data Sheet as filed with the present application are hereby incorporated by reference under 37 CFR 1.57.FIELD

[0002] The disclosure relates to robotic control of a catheter or probe, such as a transesophageal echocardiogram (TEE) probe, for medical imaging and modeling and for determining poses of TEE probes.BACKGROUND

[0003] Medical imaging has advanced significantly in recent years with the introduction of new imaging modalities and vast improvements in computing power. Transesophageal echocardiography (TEE) is one specialized application of the use of ultrasound for imaging anatomical bodies from within the esophagus. In some cases, a TEE probe can be used to analyze cardiac health of a subject (also referred to as a person or a patient) using a semi-invasive procedure. For example, the TEE probe is passed into the subject’s esophagus while an ultrasound transducer on the TEE probe obtains sensor information. The TEE probe may be manipulated in position and / or orientation within the esophagus to obtain specific cardiac views of interest to a medical professional.

[0004] TEE may be relied upon for relatively clear images of a subject’s heart as compared to other semi-invasive or non-invasive techniques (e.g., a transthoracic echocardiogram (TTE)). Additionally, and as known by those skilled in the art, TTE is limited by the available locations through the chest wall which allow for views of the subject’s heart. Clinicians widely use imaging tools such as TEE for diagnosis, assessment, treatment planning, intraoperative guidance, and more. Composite images are often used to create an anatomical map, such as with cardiac mapping systems.

[0005] While TEE provides technical benefits over other techniques, at present, existing imaging systems have significant limitations even with the recent advances. Echocardiography, for example, produces images which require a high degree of skill to interpret. According, the use of a TEE probe requires multiple specialized medical professionals. For example, a specialized medical professional may be required to control the TEE probe system while another specialized medical professional analyzes images. This necessitates tight coordination and communication between the interventionalist and echocardiographer and can lead to increased crowding, noise, and cost during cath-lab procedures. Additionally, many physicians will only work with select echocardiographers and will only schedule operations when these echocardiographers are available. This can lead to scheduling conflicts, delayed procedures, and other issues.

[0006] Furthermore, even skilled clinicians typically take considerable time to position the ultrasound transducer to enhance the images produced. Although the images can be in real-time, they are fixed inasmuch as the images are taken in a single location. The clinician must go through the tedious and difficult process of repositioning the transducer to image different anatomical structures or even different angles of the same structure. Accordingly, it may take substantial time to obtain clear images of specific cardiac views of interest. Furthermore, once a cardiac view is obtained, and the TEE probe subsequently moved, it may take substantial time to later adjust the TEE probe to again obtain images of the cardiac view.SUMMARY

[0007] The present disclosure describes systems and methods for robotically controlling a transesophageal echocardiography imaging (TEE) system. Such systems andmethods can control a TEE probe assembly having a catheter that is advanced through the mouth of a subject (e.g., a person or a patient) into the esophagus. The systems and methods disclosed herein can eliminate the need for a specialized echocardiographer thereby streamlining administrative burdens and mitigate technical hurdles. The systems and methods disclosed herein can include calibration, pose determination, and force sensor inputs.

[0008] In one aspect of the systems and methods disclosed herein, a method is described. The method includes advancing a TEE probe (e.g., an imaging element at a distal portion of the TEE probe assembly) into a subject. The distal portion of the TEE probe assembly can be placed at any location in the esophagus, e.g., at a prescribed position in an esophagus of a subject. The TEE probe assembly can be moved relative to the prescribed position by a prescribed amount, A subject tissue resistance can be estimated based on a load required for moving the TEE probe assembly by the prescribed amount.

[0009] In another aspect of the systems and methods disclosed herein, a robotic transesophageal echocardiography imaging apparatus is described. The apparatus includes a robotic support structure, a carriage movably mounted to the robotic support structure, and an actuator configured to provide for movement of the carriage. The apparatus also includes one or more hardware processors configured to move a TEE probe assembly within a subject relative to a prescribed position of an esophagus of a subject by a prescribed amount, estimate a subject tissue resistance based on a load required for moving the TEE probe assembly by the prescribed amount, and store a scaling factor based on the estimated subject tissue resistance.

[0010] In another aspect of the systems and methods disclosed herein, a system for robotic control of a TEE probe assembly is described. The system includes a mouthguard and a robotic transesophageal echocardiography imaging (TEE) system. The mouthguard includes a lateral member and a projection. The lateral member has a first side configured to overlay skin around a mouth of a subject and a second side opposite the first side. The projection has an internal wall defining a lumen. The mouthguard also has an arcuate support member disposed in the lumen, a radial support extending from the internal wall, and a visual fiducial. The radial support has a force sensor configured to generate a force signal related to forces applied to the arcuate support. The visual fiducial is disposed on the second side of the lateral member. The robotic TEE system includes an ultrasound probe including a catheter and a probe tip and a support arm assembly. The support arm assembly is configured to support the catheterbody of the ultrasound probe. The robotic TEE system also includes an actuator configured to adjust at least one degree of freedom of the probe tip by acting on or through the catheter body to relative to the support arm. The system for robotic control of the catheter can be configured to monitor the force signal while operating the actuator to control the acting on or through the catheter such that loads applied to the mouthguard are maintained below a threshold. The system for robotic control of the catheter can be configured to monitor the force signal while operating the actuator to control the acting on or through the catheter such that loads applied to the mouthguard are maintained above a threshold. The system for robotic control of the catheter can be configured to monitor the force signal while operating the actuator to control the acting on or through the catheter such that loads applied to the mouthguard are maintained above a first threshold and below a second threshold.

[0011] In another aspect of the systems and methods disclosed herein, a system for robotic control of a catheter having a probe tip is described. The system has a mouthguard and a robotic transesophageal echocardiography imaging (TEE) system. The mouthguard has a projection that has an internal wall that defines a lumen. The mouthguard also has a guide body disposed in the lumen and a force sensor coupled to the guide body. The guide body is configured to guide a catheter of an ultrasound probe through the mouthguard and into a mouth of a subject. The robotic TEE system has a support arm assembly and an actuator. The support arm assembly is configured to support the catheter of the ultrasound probe. The actuator is configured to adjust at least one degree of freedom of the probe tip by acting on or through the catheter. The force sensor is configured to generate a force signal related to forces applied between the guide body and the catheter as the catheter is moved through the mouthguard.

[0012] In another aspect of the systems and methods disclosed herein, a mouthguard for use in a transesophageal echocardiography imaging (TEE) procedure is described. The mouthguard has a projection that has an internal wall that defines a lumen. The mouthguard has a guide body disposed in the lumen and a force sensor coupled to the guide body. The guide body is configured to guide a catheter of an ultrasound probe through the mouthguard and into a mouth of a subject.

[0013] In another aspect of the systems and methods disclosed herein, a method of operating a robotic transesophageal echocardiography imaging (TEE) system to control a catheter and a probe tip of a TEE assembly is described. A catheter of a TEE probe assemblyis positioned in a mouthguard. The mouthguard is coupled to a mouth of a subject. The catheter of the TEE probe assembly positioned in the mouthguard is acted on or through to adjust at least one degree of freedom of the probe tip of the TEE probe assembly within an esophagus of the subject. A force signal generated by a force sensor disposed in the mouthguard is monitored while the catheter of the TEE probe assembly is acted on or through. A force level based on the force signal is compared to a threshold. The catheter of the TEE probe assembly is further acted on or through responsive to comparing the force level to the threshold.BRIEF DESCRIPTION OF THE DRAWINGS

[0014] Non-limiting features of some embodiments of the disclosed technology are set forth with particularity in the claims that follow. The following drawings are for illustrative purposes only and show non-limiting embodiments. Features from different figures may be combined in several embodiments. It should be understood that the figures are not necessarily drawn to scale. Distances, angles, etc. are merely illustrative and do not necessarily bear an exact relationship to actual dimensions and layout of the devices illustrated.

[0015] FIG. 1 illustrates a schematic illustration of a transesophageal echocardiography (TEE) imaging system and a heart.

[0016] FIG. 2 illustrates a perspective view of a procedure table configured to support a subject during a TEE imaging procedure.

[0017] FIG. 3 A illustrates an example robotic TEE imaging system.

[0018] FIG. 3B illustrates a robotic system configured to provide a kinematic connection with a procedure table.

[0019] FIG, 3C illustrates a side view of a robotic system configured to manipulate a TEE probe assembly and to be integrated into the system of FIG, 3B, the system providing for proximal control, a distal guide, and a buckling control system in an expanded state.

[0020] FIG. 3D illustrates an example TEE probe assembly having a handle capable of being manipulated manually to configure a distal portion thereof in many degrees of freedom.

[0021] FIG. 3E illustrates a perspective view of control knobs of the handle of FIG.

[0022] FIG. 4 illustrates the distal portion of the TEE probe assembly of FIG. 3D disposed at a mid-esophageal position for capturing a four-chamber view of the heart.

[0023] FIG. 5 illustrates a maneuver for in vivo calibration of translation control of the distal portion of the TEE probe assembly of FIG. 3D.

[0024] FIG. 6 illustrates a navigation of the distal portion of the TEE probe assembly of FIG. 3D, the navigation including translation of the distal portion within the esophagus.

[0025] FIG. 7 illustrates a maneuver for in vivo calibration of angulation control of the distal portion of the TEE probe assembly of FIG. 3D,

[0026] FIG. 8 illustrates a navigation of the distal portion of the TEE probe assembly of FIG 3D, the navigation including anterior flexing or angulation of the distal portion within the esophagus.

[0027] FIG, 9 illustrates a distal end of the TEE probe assembly of FIG. 3D with pose sensors.

[0028] FIG. 10 illustrates a flowchart of an example process for obtaining a pose of a tip or distal portion of a TEE probe assembly of FI G. 3D.

[0029] FIG. 11 illustrates a block diagram of an example automated inspection system in communication with a robotic TEE controller.

[0030] FIG. 12A illustrates an example illustration of forces associated with robotic insertion of a TEE probe assembly into a subject.

[0031] FIG. 12B illustrates an example force free body diagram associated with robotic retraction of the TEE probe assembly from a subject.

[0032] FIG. 12C illustrates an example force free body diagram associated with robotic insertion of the TEE probe assembly into a subject.

[0033] FIG. 13 illustrates a flowchart of an example process for adjusting operation of a robotic TEE controller based on estimated force.

[0034] FIG. 14A illustrates a block diagram of the example automated inspection system presenting a user interface based on estimated force.

[0035] FIG. 14B illustrates a block diagram of a force model.

[0036] FIG. 14C illustrates an example of a user interface reflecting estimated force which may be presented to a medical professional.

[0037] FIG. 14D illustrates another example of a user interface reflecting estimated force which may be presented to a medical professional.

[0038] FIG. 14E illustrates another example of a user interface reflecting estimated force which may be presented to a medical professional.

[0039] FIG. 15 illustrates a flowchart of an example process for performing calibration based on pose and estimated force.

[0040] FIG. 16A illustrates a side view of a distal portion of a robotic control system that includes a mouthguard and the robotic system of FIG, 3C.

[0041] FIG, 16B illustrates a catheter being advanced through the mouthguard of the system of FIG, 16 A.

[0042] FIG, 16C illustrates a perspective view of the mouthguard of the robotic control system of FIG. 16A,DETAWED DESCRIPTION

[0043] Reference will now be made in detail to the preferred embodiments of the disclosure, examples of which are illustrated in the accompanying drawings. While the disclosure will describe preferred embodiments, it will be understood that they are not intended to limit the disclosure to those embodiments. On the contrary, the disclosure is intended to cover alternatives, modifications, and equivalents, which may be included within the spirit and scope of the disclosed technology.

[0044] The present disclosure relates to a robotically controlled transesophageal echocardiography (TEE) probe which, in some embodiments, can calibrate a control input with a corresponding output and determine a pose of the TEE probe. The calibration and pose determination may use measurements from force sensors as inputs to determine the calibration and current pose. The force sensors may be positioned on the TEE probe assembly, robotic support structure, and / or a device worn by the subject. Additionally, the TEE probe assembly and / or the robotic support structure may be configured to transition between two or more states. The two or more states can allow the robotically controlled TEE probe to remain within a subject while accommodating other surgical equipment such as a C-arm. Accordingly, the present disclosure can streamline the safety and efficiency of using a robotically controlled TEE probe. For example, force sensors located on the support structure of the TEE probe, at the distal end of the TEE probe, and / or at an access opening (e.g., a mouthguard) of the subjectcan be used for calibration and pose determination while similarly ensuring that force applied on a subject doesn’t exceed a threshold.I. GENERAL ROBOTIC IMAGING SYSTEM FEATURES

[0045] FIG. 1 illustrates a system 100 for imaging a part of an anatomical structure 101 (e.g., a heart). The system 100 can include, for example, a catheter 102 and a console 104 having an optional display 105. The console 104 can have one or more hardware processors configured to implement various control methodologies as discussed further below. The console 104 is positioned outside the body and a probe 106 disposed on the end of a catheter 102 is positioned inside the body. The catheter 102 and the probe 106 can be configured for esophageal or for percutaneous insertion, for example.

[0046] The probe 106 may be one of a variety of imaging modalities. Examples include an ultrasound transducer. Such imaging probes may be known by one of skill m the art from the description herein including, but not limited to, probes used for transthoracic and / or TEE (e.g., 2D spatial + ID time = 3D and 3D spatial + ID time = 4D). In various embodiments, the probe 106 is a mini-TEE probe. In various embodiments, the probe 106 is miniaturized by including only the necessary number of signal lines and imaging elements. In some embodiments, the system can include a plurality of imaging modalities and can be configured to cycle through or combine different imaging modalities to acquire the necessary images (e.g., ultrasound probes and / or other imaging technologies such as fluoroscopy, CT, etc.).

[0047] The probe 106 can be electrically connected to the console 104. For example, signal lines can traverse the catheter 102. In some implementations, the signal lines can pass through a handle and a power wire structure that is coupled to the console 104. Processing the data collected by the probe 106 may be accomplished via electronics and software in the console 104. The console 104 may include, for example, various processors, power supplies, memory, firmware, and software configured to receive, store, and process data collected by the probe 106. Various types of probes may be used as would be understood by one skilled in the art.

[0048] In various embodiments, the catheter 102 can be controllable and automated, such as by robotic control. Examples of this are discussed in connection with FIGS.2-3D. The catheter 102, such as the distal end of the catheter 102, can be advanced and retractedaxially from or relative to the console 104. The probe 106 can be steerable in multiple degrees of freedom, as indicated by the arrows in FIG. 1. Robotic control of the catheter 102 can employ one or more robotic arms, linkages, or links. In various embodiments, the system 100 is configured to store and interpret data taken by the probe 106 in multiple locations in the time domain. In various embodiments, the system 100 uses the interpreted data to generate information for a clinician. For example, the system 100 may construct a 3D anatomical model based on image data taken from multiple locations. In another example, the system 100 generates image data based on composite data from multiple locations.

[0049] Because part of the system 100 is placed within the body and may be robotically controlled in various phases of operation, there are safety concerns with unintended or unexpected movements. These concerns are mitigated in the various systems discussed herein.II. ROBOTIC AND TEE PROBE ASSEMBLIES FOR CONTROLLING IMAGING COMPONENTS

[0050] FIG. 2 shows both the need for and some implementations providing a kinematic connection between a procedure table 120 and a robotic imaging system 140 (e.g., a robotic transesophageal echocardiography imaging (TEE) system). FIG. 2 depicts a schematic view of a system for coordinate positioning of a robotic ultrasound catheter and a procedure table 120. The procedure table 120 includes a support base 124 and a subject surface 128. The support base 124 can be a base firmly connected to a floor surface. The support base 124 can be mobile in some phases of operation, e.g., on lockable wheels. The subject surface 128 can be firmly affixed to the support base 124. In some applications, the subject surface 128 is able to move relative to the support base 124. The subject surface 128 can be configured to “float” when a brake system is disengaged. The brake system can include an electronic clutch that prevents movement of the subject surface 128 when engaged but allows motion of the subject surface relative to the support base 124 when disengaged. The brake system can be disengaged by pressing a button on a user interface of the procedure table 120, of the robotic imaging system 140 or on either one of the procedure table and the system, or on another console presenting control capabilities to the user.

[0051] The procedure table 120 can be moveable relative to the support base 124. The procedure table 120 can be configured to provide motion along a longitudinal direction (as indicated by the letter “L” in FIG. 2). The procedure table 120 can be configured to provide motion along a transverse direction (as indicated by the letter “T” in FIG. 2). Movement in the direction L and / or in the direction T can be after the brake system has been disengaged, as discussed above. The motion can be within a numerical range, e.g., up to system 50cm, 75cm, 100cm, 170 cm, 200cm, or any range of motion between the foregoing end points. The amount of longitudinal motion provided by the procedure table 120 can be to move a relevant part of the subject into the isocenter of imaging equipment (e.g., a C-arm). The movement in the transverse direction can be about + / -5cm, + / -10cm, + / -14cm, + / -15cm, about + / -20cm in either direction from a central longitudinal plane. In one example, movement along the transverse direction can be about 30cm in total.

[0052] The motion in one or both of the longitudinal direction and the transverse direction can be motorized. In this approach, disengaging a brake can be followed by engaging a motor to cause motion of the subject surface 128 to any position within the longitudinal range and the transverse range. The motion can be within a rectangular area defined by the motion extents in the longitudinal and transverse directions. If a motorized control is not provided, the subject surface 128 can be simply moved by hand or other mechanism so long as the brake system is disengaged.

[0053] In the case of inadvertent table motion, an amount of motion that can result can be modeled as follows. A user activates table travel of the subject surface 128 by pressing and holding a control button, e.g., to disengage a brake. In one case, the robotic imaging system 140 responds to initiating the movement of the subject surface 128 (e.g., by pressing and holding of the control button) to constrain a change in relative position between a support arm of a catheter portion of the robotic imaging system 140 and subject. The position of the subject corresponds to the subject surface 128. As discussed further below, constraining the change in relative position can be by detecting the initiation of movement (e.g., pressing or holding a control button) and by initiating a movement countermeasure. As discussed further below, a movement countermeasure can include issuing an alarm or warning to the user. The alarm can be issued on the console 104 for example. A movement countermeasure can include activating a robotic control routine. Other movement countermeasures are also possible.

[0054] If the robotic imaging system 140 detects the motion and produces an audible alarm alerting the user to stop (e.g., to release the control button), a certain amount of motion may have already occurred when the user stops the movement that has been initiated. The total travel motion in a motorized case can be expressed as:

[0055] L tabmot = L rob + L hum + L tabwhere:L rob is table motion that occurs up to the time that the robotic imaging system 140 emits the alarm;L hum is table motion occurring between the time the alarm is emitted until the user stops actuating the table control button (corresponding to human reaction time) I., tab is table motion occurring between the control button ceasing actuation and the tabletop stopping.

[0056] The distance L rob is a distance taken as an allocation to the Robotic System, This distance can be about 2 cm in some instances. This can correspond to encoder resolution in robotic joints of a setup arm (e.g., including jointed links as in FIG. 2), among other parameters.

[0057] The distance L hum can be estimated from detection of an auditory or visual signal up to (and including) finger actuation as a mean value of roughly 260 ms. In one study, the mean value had a standard deviation of about 20 ms. From this, a conservative estimate of reaction time for a wide population can be (based on a factor of safety of 2) applied to the mean value from the study can correspond to 520 ms. Assuming the maximum translation speed of 15 cm / s, the estimate of a human reaction distance of is L hum = 15 cm / s * 0.520 s = 7.8 cm.

[0058] The distance L tab, given conventional electromechanical components for table actuation (motors, gears, controllers, brakes), can provide an estimate of conservative stopping distance for the table of 2 cm.

[0059] The total estimate of longitudinal travel distance of the subject table for a safety-based motion contingency, given the above considerations, can be calculated as the:

[0060] L tabmot = L_rob + L hum + L tab = 2 + 7.8 + 2 = 11.8 cm

[0061] This is the amount of motion that the procedure table 120 could undergo when untimely moved by a user. This can be a basis for setting a single aspect-ratio expectedrange of motion for the table. To add further safety margin, a range of 30 cm by 30 cm (+ / '- 15 cm by + / - 15 cm) of expected table motion to be accommodated by the setup arm joints of robotic mechanism of the robotic imaging system 140. In other words, the setup arm is configured to move by that amount (e.g., by a safety based distance), which exceeds unwanted movement of the table to protect the subject from such movement. The setup arms of the robotic imaging system 140 can move with the table by this kinematic connection so that from the subject’s frame of reference there is no movement of the catheter portion of the imaging system of the robotic imaging system 140. In some embodiments, the safety based distance can be 300mm in the longitudinal direction. In some embodiments, the safety based distance can be 300mm in the transverse direction.

[0062] While the foregoing discussion of unwanted movement can be used to provide safety margin, expected movements of the table should also be accounted for. The overall motion of the procedure table 120 to provide for procedural steps provides for functionality-based table motion.

[0063] In order for the robotic imaging system 140 to support a wider range of procedures than those enabled by the baseline safety-based considerations discussed above, the longitudinal range of motion can be extended for targeted anatomical reach. A longitudinal range that is sufficient to move between groin and chest can be provided, for example. The following three reference anthropometric dimensions for a 95th percentile male (standing caudo-cranial distances from foot sole) can be provided:• crotch height: 92.5 cm• axilla height: 142.7 cm• suprasternale height: 154.0 cm

[0064] Then, reference longitudinal distances are as follows:• crotch to axilla (mid-chest): 50.2 cm• crotch to suprasternale (upper chest): 61.5 cm

[0065] These and the additional longitudinal ranges can provide for a variety of functionality-based movements of the procedure table 120. In order for the inserted catheter of the imaging system of the robotic imaging system 140 to move with the subject, the setup arm joints (linkages) can be equipped to travel by at least these amounts. The functionality based movements can correspond to a functionality based distance. In some embodiments, thefunctionality based distance can be a crotch to chest distance for an average subject of a subject sub-population. In some embodiments, the functionality based distance can be 500mm-600mm in the longitudinal direction. In some embodiments, the functionality based distance can be up to 1000mm in the longitudinal direction and up to 300mm in the transverse direction.

[0066] The movement of the setup arm joints can be provided by unfolding an arm with a plurality of linkages in one embodiment. In another embodiment, the movement of the setup arm joins can be provided by enabling a support device 144 of the robotic imaging system 140 to move with procedure table 120, e.g., by rolling in the same direction as the translation of the subject surface 128. The movement of the setup arm joins can be provided by enabling a support device 144 of the robotic imaging system 140 to move with the procedure table 120, e.g., by elevating as the subject surface 128 is elevated.

[0067] FIGS. 3A-3D depict a robotic transesophageal echocardiography (TEE) imaging system 300 and methods for operating the TEE imaging system 300, The TEE imaging system 300 can include a robotic support structure 302, an arcuate support 304, and a TEE probe assembly 306.

[0068] The robotic support structure 302 can include a support arm 308 and a carriage 310.

[0069] The support arm 308 may be a rigid body extending m a longitudinal direction of the TEE imaging system 300 from a first end to a second end. The support arm 308 can support one or more devices of the TEE imaging system 300. In some examples, the support arm 308 can support the arcuate support 304, the TEE probe assembly 306, and the carriage 310. In some examples, the support arm 308 can further support one or more actuators. For example, the support arm 308 may support a motor 312 and a pulley 314. The pulley 314 may be mounted at or coupled with a second end of the support arm 308, opposite the first end (see e.g., FIG. 16A). The motor 312 and the pulley 314 may be one of several actuators for moving the carnage 310.

[0070] The support arm 308 may be configured to be coupled to and / or supported on an imaging system support (e.g., a support surface). The support surface can be a ground surface, a table surface or an immovable portion of a robotic system. In some examples, the TEE imaging system 300 can be at least partially integrated into the robotic imaging system 140 (e.g., the support arm 308 of the TEE imaging system 300 can be coupled to and / or carriedby one or more of the linkages of the robotic imaging system 140). For example, the support surface can be the subject surface 128. The support surface can be a portion of a robotic arm of the robotic imaging system 140.

[0071] The carriage 310 can take many forms. In one case, the carriage 310 can include a first body portion 316 and a second body portion 318. The first body portion 316 can be referred to as a lid (e.g., a door) in that it is on top of the second body portion 318, which can be referred to as a base. The first body portion 316 can be closed over a portion of the TEE probe assembly 306 and secured by closure members. In some examples, the carriage 310 can include a cradle for interfacing with and coupling with a portion of the TEE probe assembly 306 or with auxiliary rolling cylinder component(s) coupled with the TEE probe assembly 306 for rolling motion on the cradle,

[0072] The carriage 310 can be coupled (e.g., movably mounted) to the robotic support structure 302. In some examples, the carriage 310 can be coupled to the support arm 308. For example, the carriage 310 can be mounted at or adjacent to a first end of the support arm 308. The carriage 310 can be configured to adjust at least one degree of freedom of the TEE probe assembly 306. For example, the carriage 310 may move linearly along the support arm 308. The carriage 310 can be operatively coupled with an actuator. For example, the carriage 310 may be coupled with the pulley 314. The motor 312 and the pulley 314 can be coupled by a transmission, e.g., a belt, chain, or other structure capable of responding to torque to move along a longitudinal axis of the support arm 308. The movement of the transmission is coupled with the carnage 310 to move the carriage 310 in a proximal-distal direction of the TEE imaging system 300. In some examples, the carnage 310 may be rotationally fixed. In other examples, the carriage 310 may be rotatable about an axis R-R. Accordingly, the carriage 310 can be a robotically controlled receptacle.

[0073] The arcuate support 304 can include a channel 320 configured to receive at least a portion of the TEE probe assembly 306. The channel 320 can be defined by a plurality of arcuate members that extend below the TEE probe assembly 306. The plurality of arcuate members can be telescoping members or can be spaced apart from each other. For example, with reference to FIG. 3C, the plurality of arcuate members are shown in an extended state. The plurality of arcuate members can include a first support element and a second support element. The first support element and the second support element can be slideably coupled toeach other, e.g., forming a telescoping assembly. The plurality of arcuate members can have substantially the same form. For example, the first support element can include a first tubular member (or tubular body) and a first probe support. The first probe support can include a first end coupled to the first tubular member and a second end opposite the first end. The second end can have a first probe portion interface. Similarly, the second support element can include a second tubular member (or tubular body) and a second probe support. The second probe support can include a first end coupled to the second tubular member and a second end opposite the first end. The second end can have a second probe portion interface,

[0074] In some cases, each of the plurality of arcuate members can be configured to axially receive an adjacent arcuate member and / or be axially inserted within an adjacent arcuate member (e.g., telescoping). For example, a first tubular member can be disposed distal to the second tubular member. The first tubular member can be retractable into and extendable from the second tubular member. The proximal mount can be positioned at the proximal most end of the arcuate support 304 and configured to receive the remaining support elements. The distal mount can be positioned at the distal most end of the arcuate support 304 and configured to be retracted into the remaining support elements. In some cases, the arcuate support 304 can include six support elements extendable and retractable from each other.

[0075] Each support element can include a probe support. The channel 320 can be formed by the probe supports. Each probe support can include an elongate body having a first end coupled to the tubular member or body and a second end opposite the first end. The second end of each probe support can include a probe portion interface. Each probe portion interface can include a C-shaped member. An internal surface of the C-shaped member can be configured to slideably support a probe portion to control buckling of the probe portion along the support element assembly. The C-shaped member can be disposed on one of a plurality of projections extending from a free end of the probe support. The projections can extend from a unitary proximal portion of the probe support. A slot can be disposed between the projections. The slotted configuration can allow some amount of deflection of the C-shaped member or the projections such that a body of the ultrasound probe can be inserted into the probe support. The C-shaped member can be one C-shaped member at the free end of one of the projections. An arcuate surface at an end of another projection can include a curved surface opposed to the C-shaped member. The curved surface and the C-shaped member can form the probe interface.An opening between the curved surface oppose to the C-shaped member can have a size that is less than the diameter of the body of the probe. The slotted configuration of the probe support can allow the probe body to be inserted into a passage through the probe support for retaining the probe body. For example, the slotted configuration allows the projections on opposite sides of the slot to deflect away from each other.

[0076] Accordingly, the plurality of arcuate members can comprise anti-buckling members and together can form an anti-buckling support for the TEE probe assembly 306. The arcuate support 304 and the channel 320 can be extendable and retractable as the carriage 310 moves toward and away from a probe guide 322 configured to at least partially define the trajectory of the TEE probe assembly 306. In some examples, the plurality of arcuate members can be a buckling control support. In one variation, the arcuate support 304 can be combined with the probe guide 322.

[0077] The arcuate support 304 can have an open end that faces the probe guide 322. The probe guide 322 can include a first end adjacent to the arcuate support 304 and a second end opposite the first end. The first end of the probe guide 322 can be coupled to a robotic support structure 302. The probe guide 322 can additionally include a retention surface. The probe guide 322 can have a fixed arcuate body and the curved guide structure comprises a curved guide surface defined by the fixed arcuate body disposed below the channel.

[0078] The probe guide 322 can be configured to redirect the distal portion 326 of FEE probe assembly 306. For example, the probe guide 322 can be configured to redirect the distal portion 326 of the TEE probe assembly 306 toward an opening in a subject, e.g., toward the mouth of the subject or toward a guide or a guard positioned at the opening in the subject. In some cases, the probe guide 322 can be referred to as a distal guide assembly. The probe guide 322 can have an arcuate configuration and / or be can be configured to have an arcuate configuration to redirect and guide a portion of a probe toward a target site. Accordingly, in some cases, the probe guide 322 can be referred to as an arcuate probe guide.

[0079] For example, the probe guide 322 can further include a curved guide structure, a probe channel, and a retention surface. The curved guide structure can provide the arcuate structure for guiding a probe. For example, the curved guide structure can provide a curved guide surface to support the probe. The curved guide structure can include a plurality of surfaces on separate members that can be pivotably connected to each other or otherwisejointed. The probe channel can provide an opening or path for the TEE probe assembly 306. For example, m some cases, the probe channel can be accessed via a serpentine access passage. The retention surface can be configured to provide support to keep the probe within the probe channel. In some cases, the retention surface can include one or more shoulders for securing a body of the TEE probe assembly 306 within the probe channel. The curved guide structure can be disposed below the probe channel and the retention surface. The retention surface can be configured to provide access to the probe channel defined between the retention surface and the curved guide structure.

[0080] The probe guide 322 can have a first end and a second end opposite the first end. In some cases, the probe guide 322 can have a first tangential axis extending tangentially from the first end of the probe guide 322 and a second tangential axis extending tangentially from the second end of the probe guide 322. In some cases, an angle between the first tangential axis and the second tangential axis can be between 45 and 30 degrees. The angle between the first tangential axis and the second tangential axis can be any angle between 30 degrees and 90 degrees or more, e.g., 30 degrees, 45 degrees, 60 degrees, 75 degrees, 80 degrees, or within a range including any of the foregoing values as end-points.

[0081] Accordingly, the probe guide 322 can be an arcuate probe guide having a first end configured to be coupled to a support device, a second end opposite to the first end, and a channel at least partially enclosed and extending between the first end and the second end.

[0082] In a first configuration, the retention surface can provide access to the channel 320. The probe guide 322 can have plurality of joints operatively coupled together. Each one of the plurality of joints can include a body having a proximal end and a distal end and an engagement surface. In such embodiments, the probe guide 322 can further include at least a portion of the retention surface that is coupled to at least one of the plurality of joints. The retention surface can be configured for loading the TEE probe assembly 306 transverse to a longitudinal axis of the ultrasound element. The probe guide 322 can further include an actuator operatively engaged with the engagement surface of each of the plurality of joints. An orientation of a distal portion of the probe guide 322 can be defined over a range of angles by movement of the actuator. In some cases, an orientation of a distal portion of the probe guide 322 can be defined over a range of angles by movement of the actuator.

[0083] In a second configuration, the channel 320 can be enclosed by the retention surface and an arcuate support opposite to the retention surface. The retention surface can allow insertion of the TEE probe assembly 306 into the channel 320 without requiring tools or actuating of clamping devices.

[0084] The probe guide 322 can have a first end configured to be coupled to the robotic support structure 302 and a second end opposite to the first end. The TEE probe assembly 306 can be disposed within and move along or within the channel 320 of the arcuate support 304. The TEE probe assembly 306 can be advanced toward and / or retracted away from the probe guide 322. The configuration of the probe guide 322 can cause the TEE probe assembly 306 to be advanced toward or into an access opening 324 (e.g., a subject’s mouth). In some embodiments, the TEE probe assembly 306 can be advanced through a subject’s mouth into the subject’s esophagus. In some cases, a mouthguard (also referred to as a mouthpiece or bite guard) can be used to protect the catheter of the TEE probe assembly 306 from being bitten by the subject and also to protect the subject from the catheter.

[0085] FIG. 3D illustrates an example TEE probe assembly 306 and a method for calibrating a movement of a distal portion 326 of the TEE probe assembly 306. The TEE probe assembly 306 can include a TEE probe 328 and a handle 330. The TEE probe 328 can include an imaging element. For example, the TEE probe assembly 306 can include an ultrasound imaging element at the distal tip of the TEE probe assembly 306 opposite the handle 330. The handle 330 of the TEE probe assembly 306 can include a plurality of control knobs (e.g., a first control knob 332 and a second control knob 334). The TEE probe assembly 306 can further include a catheter 336 and a power wire 354. A proximal end of the catheter 336 can be coupled with a first end of the handle 330. The power wire 354 can be coupled to a second end of the handle 330. The second end of the handle 330 can be opposite to the first end.

[0086] The handle 330 can be capable of manual interaction to move the distal portion 326 of the TEE probe assembly 306 (e.g., to move the TEE probe 328). The handle 330 of the TEE probe assembly 306 is configured to be manually manipulated to move the distal portion 326 of the TEE probe assembly 306 to a desired pose. FIG. 3E is an enlarged view of the plurality of control knobs of the TEE probe assembly 306. Each control knob can include an outer periphery configured to be manually rotated to control a distal portion 326 of the TEE probe assembly 306 to flex the TEE probe 328 at the tip of the TEE probe assembly306 relative to anatomy of a subject. The first control knob 332 can be used to flex the distal portion 326 of the TEE probe assembly 306 anteriorly and posteriorly (A-P). The second control knob 334 can be used to flex the distal portion 326 of the TEE probe assembly 306 in a first direction in a medial-lateral (M-L) plane and in a second direction in the medial lateral direction. The control knobs can have other functions. In other embodiments, the flexing direction controlled by the first control knob 332 and the second control knob 334 can be swapped. For example, the first control knob 332 can be used to flex (e.g., angulate) the distal portion 326 of the TEE probe assembly 306 in a first direction in a medial-lateral (M-L) plane and in a second direction in the medial lateral direction and the second knob 334 can be used to flex the distal portion 326 of the TEE probe assembly 306 anteriorly and posteriorly (A-P),

[0087] The control knobs (e g., the first control knob 332 and the second control knob 334) are sometimes referred to herein as j ust a knob (e.g., a first knob and a second knob). The first and second control knobs are sometimes referred to as the small and large (or big) knobs, respectively, in some contexts. A user interface input (e.g,, one of the control knobs or another button) or the handle 330 can be used to rotate (R) the distal portion 326. The distal portion 326 can be advanced distally or retracted proximally (D-P).

[0088] As further shown in FIG. 3E, in some embodiments, the handle 330 can include a pose lock 356 (e.g., a brake). The pose lock 356 can maintain a rotational position of the control knobs. The pose lock 356 can function to lock the position of the first control knob 332 and / or second control knob 334. When engaged, the pose lock 356 can prevent rotation of the first control knob 332 and / or second control knob 334, thereby locking the distal tip of the TEE probe assembly 306 in a fixed pose (e.g., the current pose with the current amount of flexion). When the pose lock 356 is disengaged, the first control knob 332 and / or the second control knob 334 can be rotated to change a pose of the distal tip of the TEE probe assembly 306.

[0089] Because the pose of the distal tip of the TEE probe assembly 306 can be adjusted and can be held in a flexed condition, it is important for subject safety that a robotic system for positioning be configured to mitigate the impact on the tip portion of the TEE probe assembly 306 when unintended impacts on the TEE imaging system 300 occur. Such mitigation has various forms.

[0090] As described above, the systems 100, 140, 300 can include one or more hardware processors. The one or more hardware processors can be associated with (e.g., mechanically coupled and / or electronically coupled with) the TEE probe assembly 306, the procedure table 120, the console 104, and / or any other components of the systems 140, 300. In other embodiments, the one or more hardware processors can be external or remotely located processors that are utilized by the systems 100, 140, 300. The one or more hardware processors can perform executable instructions (e.g., computer readable instructions) to control any of the functions of the systems 100, 140, 300 described above. For example, the one or more hardware processors can detect initiation of movement of the subject surface 128 and initiate a movement countermeasure in response to the detected initiation of movement. Detection of the initiation of movement can include detecting a pressing of the control button configured to cause the procedure table 120 to be moveable relative to the support base 124. The movement countermeasure can include a user alarm issued to one or more user interface devices. The movement countermeasure can cause a catheter 336 of the TEE probe assembly 306 to move by a corresponding amount and in a corresponding direction to the movement of the procedure table 120. In some embodiments, the one or more hardware processors can send a signal to an actuator of the systems 100, 140, 300 to cause the catheter 336 of the ultrasound probe to move by the corresponding amount and in the corresponding direction to the movement of the procedure table 120.

[0091] As described above, the TEE probe assembly 306 can be configured and capable of manual control. In some examples, the handle 330 of the TEE probe assembly 306 can be inserted into the carriage 310 and manipulated therein by an actuator, e.g., by the motor 312, pulley 314 and transmission as discussed above. The carriage 310 can also have actuators for manipulating the knobs 332, 334 and control buttons of the TEE probe assembly 306. Specifically, the handle 330 of the TEE probe assembly 306 can be inserted into a device interface of the carriage 310. The device interface can be configured to receive and engage the knobs 332, 334 of the handle 330 via an actuator (e.g., via a knob motor and transmission). The carriage 310 can include an actuator (e.g., a carriage rotation drive supported by a cradle) to rotate the handle 330 of the TEE probe assembly 306 within the carriage 310 about the axis R-R. In one embodiment, aspects of the mechanical positioning of pose of the tip portion of the TEE probe assembly 306 (sometimes referred to herein as the “pose”) can be controlled byactuators in or coupled with the carriage 310. Such control can be based on software code implemented on one or more hardware processors, e.g., on the console 104.

[0092] Accordingly, motion of the TEE probe assembly 306 can be caused by the carriage 310 positioned at the proximal end of the TEE probe assembly 306. For example, the carriage 310 can be advanced or retracted to move the TEE probe assembly 306 along the longitudinal axis thereof. Additionally, the carriage 310 can rotate or otherwise cause rotation of the TEE probe assembly 306 about a longitudinal axis thereof.

[0093] As shown in FIG. 3A, an applied force (Fapplied) can be applied by the carriage 310 to the TEE probe assembly 306 to advance or retract the TEE probe assembly 306 along the channel 320, As further shown in FIG. 3A, resistive forces from probe guide 322 (Fguide) and / or the subject’s body (Fsubjeot) can resist the applied force (Fapplied) and oppose directional movement of the TEE probe assembly 306 within the channel 320, The resistive forces of the probe guide 322 (Fguide) and / or the subject’s body (Fsubjeot) can include frictional forces and / or reaction forces resulting from the TEE probe assembly 306 moving along the channel 320 of the probe guide 322 and / or along the subject’s bodily tissue. These resistive forces can vary. For example, there can be variation in the configuration of the probe guide 322 that can affect the resistive forces of the probe guide 322 (Fguide). There can be variation in the responsiveness of the TEE probe assembly 306 to a motion input due to manufacturing variance and / or due to the amount a particular catheter body has been used. It is anticipated that the TEE probe assembly 306 may be used repeatedly after cleaning to minimize the cost to the healthcare system. Furthermore, the contribution of resistive forces of the subject’s body (Fsubject) can vary from subject-to-subject due to the makeup of the subject’s tissue, age and other factors. As will be described in more detail below, a variety of techniques can be used to assess and control these variabilities to enhance the performance of the TEE probe assembly 306 and / or the TEE imaging system 300.

[0094] Unwanted movement of a tip of the TEE probe assembly 306 within the subject is controlled within the TEE imaging system 300. For example, the arcuate support 304 and the probe guide 322 can be used to control unwanted movement. The probe guide 322 can have or be coupled to a support device 307. The support device 307 can be secured to a distal portion of the support arm 308. The probe guide 322 can direct the catheter 336 of a TEE probe assembly 306 from a direction of motion aligned with the axis R-R into the subject’s mouth.See FIG. 3A. The probe guide 322 can be aligned with a passage extending through the buckling control support of the arcuate support 304. The arcuate support 304 can extend between the carriage 310 and the probe guide 322. The arcuate support 304 can be telescoping to accommodate variation in the distance between the carriage 310 and the probe guide 322.

[0095] In some examples, the TEE imaging system 300 can be responsive to initiation of movement of the subject surface 128 by constraining a change in relative position of the support arm 308 relative to the subject surface 128. In some examples, a load sensor 1602 can be provided as part of a system for controlling unwanted movement of the TEE probe assembly 306 as described herein with reference to FIG, 16A. One or more hardware processors can be provided to process the signals of the load sensor 1602. The load sensor 1602 can include an accelerometer aligned with three axes, e.g., with the vertical axis, with a horizontal axis aligned with the direction of advancement of the carriage 310 (e.g., the axis R-R), and with an axis transverse to the support arm 308, FIG. 3B shows a kinetic connection mechanism 338 configured to cause the TEE imaging system 300 to follow at least to some extent the movement of the procedure table 120. The kinetic connection mechanism 338 can include a first link 340 and a second link 342. The first link 340 can be coupled to the procedure table 120. The second link 342 can be coupled to the support arm 308. The second link 342 can be coupled to the support arm 308 using a coupler 344. The coupler 344 can clamp rigidly onto the support arm 308. The coupler 344 can be configured to fix the orientation of the second link 342 in one configuration and can be configured to allow the second link 342 to move in at least one degree of freedom relative to the coupler 344 in another configuration. The coupler 344 could include a ball and socket joint configured to allow pivoting of the second link 342 relative to the coupler 344 but to retain the securement to the support arm 308 even while being allowed to rotate at the coupler 344. The first link 340 can be directly connected to the second link 342 at another joint, which can also be a ball and socket joint. The first link 340 can be coupled directly or indirectly to the procedure table 120. The connection between the procedure table 120 can be by a coupler similar to the coupler 344. The joints of the kinetic connection mechanism 338 can be placed in a locked configuration such that if the procedure table 120 moves the links 340, 343 do not change their relative position to the procedure table 120 or to the support arm 308 such that the support arm moves with the table. This causes the TEE probe assembly 306 to remain in the same position relative to the subject so that the TEEprobe assembly 306 is not adjusted in position (pulled out or pushed in) during inadvertent movement of the procedure table 120. The second link 342 can maintain its position relative to the first link 340 over the functionality based distance. The second link 342 can maintain its position relative to the first link 340 over the safety based distance. In some variations, the kinetic connection mechanism 338 is configured to allow some extension of the links 340, 342 but by an amount limiting position adjustment of the TEE probe assembly 306 relative to the subject.

[0096] The kinetic connection mechanism 338 can have a disengaged configuration that allows the procedure table 120 to move relative to the support arm 308. The disengaged configuration can involve a physical separation of two or more components of the kinetic connection mechanism 338 from each other, e.g., by a clutch or solenoid device. Such movement can be allowed when no subject is on the subject surface 128 or a subject is on the subject surface but the TEE probe assembly 306 is not inserted into the subject’s mouth. This can allow the support arm 308 to be separated from the procedure table 120 by a greater distance if space between the table and the TEE imaging system 300 is needed.

[0097] In a further variation, the support arm 308 can include a two (or more) link configuration where the kinetic connection mechanism 338 is coupled with one link and with the procedure table 120. Movement of the table and the kinetic connection mechanism 338 causes a more distal link to move relative to a more proximal link of the support arm 308. Such an arrangement could include at least one of telescoping proximal and distal links and multi¬ bar linkage that enable a distal portion of the TEE imaging system 300 coupled with the TEE probe assembly 306 to move in concert with the procedure table 120. Such muti-link support arms would be configured to extend by a distance corresponding to a safety- based motion feature. Such muti-link support arms would be configured to extend by a distance corresponding to a functionality-based table motion feature.

[0098] Although various physical connections can be implemented as kinetic connection mechanisms, in some cases a kinetic connection mechanism 338 is provided by the control of the carriage 310 in the TEE imaging system 300. This can be implemented by integrating a position sensor into one or both of the procedure table 120 and the robotic imaging system 140 (or the TEE imaging system 300). The position sensors in the procedure table 120 and / or the robotic imaging system 140 (or the TEE imaging system 300) can output a signal toa hardware processor in the console 104. The processor can analyze the signal to determine if any change in position of either of the procedure table 120 or the robotic imaging system 140 (or the TEE imaging system 300) is occurring. If the motion is within range of motion made possible by the actuators in the robotic imaging system 140 (or the TEE imaging system 300), the hardware processor can activate a corresponding motion. As one example, if the procedure table 120 is moved away from the base of the TEE imaging system 300 in a direction aligned with the axis of movement of the carriage 310 made possible by the motor 312 and the pulley 314, the processor can activate the motor 312 to move the carriage 310 in the same direction of movement as the procedure table 120, As a result, the base of the TEE imaging system 300 may maintain its position, but the carriage 310 will move with the procedure table 120 such that the TEE probe assembly 306 maintains its position relative to the subject surface 128 and the subject disposed thereon. More complex motion of the procedure table 120 can be countered by activating other actuators of the TEE imaging system 300 providing motion along other axes into which the more complex motion can be resolved.in. CALIBRATION OF TEE PROBE MOVEMENT

[0099] The TEE imaging system 300 may include a calibration method for mapping positions of the control knobs 332, 334 to a position and orientation of the distal tip of the TEE probe assembly 306. Calibrating the positions of the control knobs 332, 334 to the position and orientation of the distal tip of the TEE probe assembly 306 can increase confidence that the TEE probe is driven by the control knobs 332, 334 as expected.

[0100] A first ex vivo calibration technique can be provided to determine an amount of movement corresponding to an input on a control device. As shown in FIG. 3D, a grid is disposed behind the distal portion 326 of the TEE probe assembly 306. In a manual mode, an input can be provided to the handle 330 to move the distal portion 326 in any of the degrees of freedom shown in FIG. 3D. For example, an input can be provided to move the distal portion 326 in the distal or proximal direction. In some manual systems, distal and proximal movement are by advancing or retracting the handle 330. In other techniques the handle 330 is placed in the carriage 310 and distal and proximal movement can be by a linear actuator. The amount of movement expected based on the input can be compared to the actual movement by observing linear position change, e.g., by a distance that can be read from thegrid disposed behind the distal portion 326. If the amount of movement is less than expected, a correction factor can be applied in a control system to increase the amount of movement provided by the handle 330 or the linear actuator for an amount of movement that is input.

[0101] Other degrees of freedom can be confirmed by a similar calibration movement. The distal portion 326 can be flexed anteriorly and posteriorly (see A-P arrow). The actual movement can be determined by reference to the grid seen in FIG. 3D. A similar grid can be used to determine the actual movement in the medial-lateral plane for a given input (see M-L arrow). Rotation (R) of the distal portion 326 can be determined for calibration by comparing a change in rotational position of the distal portion 326 for a selected input. The amount of rotational movement could be by counting a number of graduation marks passing a perspective view as the distal portion 326 rotates. The perspective view can be from a camera positioned along the side of the distal portion 326 of the TEE probe assembly 306.

[0102] In addition to the ex vivo calibration of the TEE probe assembly 306, an in vivo calibration can be performed on the TEE probe assembly 306 as shown in FIGS. 4-8. In one method, a TEE probe 328 can be advanced into a subject to a prescribed position in an esophagus of a subject. The prescribed position can be a location that will serve as a home position for subsequent navigation. In one case, the distal portion 326 can be positioned at a mid-esophageal position. The mid-esophageal position can be one in which the imaging portion of the distal portion 326 is positioned to be directed toward the heart. FIG. 4 shows the distal portion 326 positioned in this manner. The distal portion 326 can be flexed toward the anterior side of the esophagus 402 to provide contact sufficient to obtain imaging information. When in the proper position, the distal portion 326 can generate imaging data to allow an ultrasound console coupled with the TEE probe assembly 306 to generate the image shown in the upper right corner of FIG 4. Once the position of the distal portion 326 of the TEE probe assembly 306 providing the image in the upper right corner has been established, a processor (e.g., a hardware processor) of the TEE imaging system 300 can cause a memory thereof to store the configuration of the apparatus for the location of the home position.

[0103] Once the prescribed position (e.g., home position) is found, the distal portion 326 of the TEE probe assembly 306 can be moved relative to the prescribed position by a prescribed amount. Such movement can be in any degree of freedom of the distal portion 326 of the TEE probe assembly 306. As seen in the upper right corner of FIG. 4, the movementby the prescribed amount can be linear translation in a distal and / or proximal direction (D-P), rotation (R), anterior-posterior angulation or flexing (A-P), movement (e.g., angulation) in a medial-lateral plane (M-L) of the subject. In the illustrated embodiment, the prescribed movement can be in a distal direction. The prescribed amount of movement can be in a proximal direction.

[0104] The amount of movement in the proximal direction can be less than the length of the esophagus proximal to the mid-esophageal location shown in FIG. 4. The amount of movement in the proximal direction can be less than the length of the esophagus from the mid-esophageal location shown in FIG. 4 to an upper esophageal view. The amount of movement in the proximal direction can be a standardized amount, e.g,, less than 30 cm, e.g., between 15 cm and 30 cm, between 7 and 15cm, 30cm, 25cm, 20cm, 15cm, 10cm, 5cm or a range including any of the foregoing end points as a range.

[0105] In some variants of an in vivo calibration, a movement can be provided in a distal direction. The amount of movement in the distal direction can be any distance up to the full length of the esophagus between a first anatomical location and a second anatomical location. The first anatomical location can be a location corresponding to the mid-esophageal view. The prescribed amount of movement can correspond to a distance between the mid-esophageal view and the stomach of the subject. The amount of movement can be a standardized amount, e.g., between 15cm and 30cm, between 7 and 15cm, 30cm, 25cm, 20cm, 15cm, 10cm, 5cm or a range including any of the foregoing end points as a range. Whether the movement is in a proximal or a distal direction, moving the TEE probe assembly 306 can comprise moving the distal portion 326 from the home position to an adjacent standardized imaging position distal to the home position or proximal to the home position.

[0106] As referenced above, the TEE probe assembly 306 can be moved by a prescribed amount relative to the prescribed position by rotating the TEE probe assembly 306 about a longitudinal axis thereof. The amount of rotation can be a standardized angular displacement. The TEE probe assembly 306 can be rotated while disposed at the home position of the navigation reference frame.

[0107] A calibration technique can also include estimating a subject tissue resistance during or following the movement by the prescribed amount. For example, the amount of movement can be determined by observing the movement of the distal portion 326of the TEE probe assembly 306. The amount of movement can be detected by a linear scale. A linear scale can be provided on the catheter 336 of the TEE probe assembly 306. The linear scale can show how much movement actually occurred during operation of the TEE probe assembly 306. The movement can be caused manually on the handle 330 or by the TEE imaging system 300. The subject tissue resistance can be determined by comparing the actual movement with a predicted movement based on monitoring the TEE probe assembly 306 or the TEE imaging system 300. For example, if the TEE imaging system 300 is used to move the distal portion 326 of the TEE probe assembly 306, the current used to drive the motor to achieve movement corresponding to the prescribed distance can be compared to an expected amount of current required to drive the motor to achieve the prescribed movement. In one approach, the expected amount of current could be based on how much current was used to achieve the same motion ex vivo. In another approach, the expected amount of current could be based on how much current was used to achieve the same motion in a typical (e.g., average or median) subject.

[0108] In some embodiments, pose sensors (e.g., pose sensors 902, 904 described with respect to FIG. 9) may supplement or replace the linear scale as a mechanism for determining actual movement during the calibration technique. Rather than relying solely on visual observation of graduation marks on the catheter 336, the controller may obtain pose information from the pose sensors that reflects orientation, and optionally translation, of the distal portion 326 within the subject. The process described with respect to FIG. 10 enables the controller to determine a precise pose by obtaining sensor measurements, determining a mid-point transformation, determining an offset, and obtaining the pose based on projection of the mid-point transformation through the offset. The resulting pose may indicate translation of the probe tip along any axis, enabling the controller to ascertain the actual distance traveled during a prescribed movement. The controller may compare this sensor-derived translation to the expected translation based on motor commands or control inputs, and any discrepancy may be attributed to subject tissue resistance. For example, if the controller commands a fifteen centimeter distal translation but the pose sensors 902, 904 indicate that the probe tip has translated only twelve centimeters, the controller may determine that the subject tissue resistance absorbed three centimeters of the commanded movement.

[0109] The pose sensors may provide advantages for estimating subject tissue resistance. For example, a linear scale may utilize observation of marks on the catheter 336 external to the subject, which may not account for compression or bowing of the catheter within the esophagus. In contrast, the pose sensors may be positioned at the distal portion 326 and be utilized to measure the pose of the probe tip relative to a fixed reference frame, such as a generator that produces a time-varying magnetic field. This direct measurement may capture the actual displacement of the probe tip regardless of intermediate catheter deflection. Additionally, the pose sensors may provide orientation information that enables the controller to detect rotational or angular deviations that occur during translation, which may further inform the calibration. In some embodiments, the controller may fuse information from the pose sensors with motor current measurements to generate a more complete characterization of subject tissue resistance, associating specific force levels with specific pose changes observed during the prescribed movement.

[0110] In one example (e.g., an example process or method), the distal portion 326 of the TEE probe assembly 306 is moved from a first position to a second position. The movement can be part of a navigation phase of operation, e.g., after calibration is performed. The movement can be from the mid-esophageal position to or toward the upper esophageal position. The movement can be from the mid-esophageal position to or toward the gastric or transgastric position. The movement can be from the upper esophageal position to or toward the mid-esophageal position. The movement can be from the gastric or transgastric position to or toward the mid-esophageal position. These movements can be provided by applying a load that is greater than the subject tissue resistance. The load can be determined by scaling a load based on an average subject tissue resistance by a calibration factor following the prescribed movement used in the calibration technique. The load can correspond to a distally or a proximally directed force. The load can be a current to be applied to a motor to generate a distally or a proximally directed force. The movement can be an anterior flexion (as in FIG. 8) or a posterior flexion. The movement can be a side-to-side movement, e g., in a medial-lateral plane of the subject.

[0111] In some cases, the scaling factor can be a number greater than or less than one such that the load can be larger or smaller than the load that would be applied to a typical subject. The scaling factor can be controlled to reduce the chance of an excessive force beingapplied to the esophagus of a subject during movement of the distal portion 326 of the TEE probe assembly 306. For example, the scaling up of the load can be limited on a percentage basis to not exceed, e.g., a 30 percent, 20 percent, 15 percent or 10 percent increase over the load applied to a typical subject.

[0112] Another form of safety factor can be position dependent. For example, a safety factor can include limiting or preventing scaling a load for a typical subject if the movement includes traversing the upper sphincter valve of the esophagus. A safety factor can include limiting or preventing scaling a load for a typical subject if the movement includes traversing the lower sphincter valve of the esophagus.

[0113] Given the possible use of a safety factor, the moving the distal portion 326 of the TEE probe assembly 306 from a first position to a second position can include applying a load exceeding the subject tissue resistance by less than a safety factor.

[0114] As discussed above, the prescribed position for calibration can include a home position of a navigation reference frame. The home position can be an internal position, e.g., within the home position is a position where significant anatomy can be imaged, e.g., a position capable of imaging a four-chamber view of a heart or the subject. The home position can be any position of the distal portion 326 of the TEE probe assembly 306 where an echocardiologist would position the distal portion 326 to obtain an image of significant anatomy.

[0115] After performing in vivo calibration, the TEE probe 328 can be moved relative to the prescribed position by a prescribed amount by moving the TEE probe 328 distally from a home position of a navigation reference frame.

[0116] As discussed above, one purpose of one or both of ex vivo and in vivo calibration is to enhance the process of navigating the distal portion 326 of the TEE probe assembly 306. The load to be applied by the TEE imaging system 300 to the TEE probe assembly 306 for a typical subject can be scaled. The scaling can include multiplying the load for the typical subject. The scaling can be provided by multiplying the load value by a factor, e.g., by 1.1 for a ten percent increase in the load. A first component of the scaling can be based on the ex vivo calibration. The scaling can take into account a greater or lesser stiffness or resistance to movement in one or more d egrees of freedom. A second component of the scaling can be based on the in vivo calibration. The scaling can take into account a greater or lesserstiffness or resistance to movement in the tissues of the subject. The scaling can result in the application of a navigation load adjusted by a factor based on the estimated subject tissue resistance.

[0117] In another way, the scaling can be provided by applying a factor to expected distance to be travelled. When the distal portion 326 of the TEE probe assembly 306 is being operated in relatively more resistant subject tissue, the distance that the actuator is driven to move the probe may result in less movement than anticipated. Accordingly, following calibration the actuator can be activated (e g., driven) to provide a greater amount of motion (or rotation, or flexion) than would be required in a lower resistance tissue subject. As a result, the amount the actuator is instructed to move may be scaled up to achieve the desired movement. The scaling up of motion may be limited by a safety factor, as discussed above. The safety factor can be, for example, a ten percent maximum scaling. The safety factor can be a lower maximum scaling, e.g., no scaling, for traversing a sphincter or other delicate anatomy,IV. POSE DETERMINATION BASED ON SENSOR ANALYSIS

[0118] The TEE imaging system 300 may perform a method for determining a pose of the control the distal tip of the TEE probe assembly 306. A pose may refer to the position and orientation of the distal tip of the TEE probe assembly 306. Determining the pose of the distal tip of the TEE probe assembly 306 can increase confidence that the TEE probe is positioned and oriented in an intended pose. The TEE imaging system 300 may both calibrate and determine poses of the TEE probe to more effectively control and to increase a confidence value in controlling the distal tip of the TEE probe assembly 306,

[0119] As described herein with reference to FIGS. 3A-3D, a TEE probe tool may be controlled by a TEE imaging system 300 in an automated or semi-automated fashion to reliably perform disparate TEE procedures. For example, a TEE tool, such as the TEE probe assembly 306, may be robotically controlled in a multitude of degrees of freedom while inserted into a subject. Example degrees of freedom may include translations, rotations of the TEE tool (also referred to herein as pose), electronic or mechanical rotations of an ultrasound sensor to adjust the 2-D echo plane, and so on. Thus, the TEE tool may be robotically controlledwithin a subject to obtain specific views. For example, the TEE tool may be controlled to obtain a four-chamber view.

[0120] While robotic control of the TEE tool may simplify operation of the TEE tool, the actual pose of the TEE probe (e.g., the probe tip) may be difficult to ascertain. For example, the degrees of freedom of the TEE probe assembly 306 may be adjusted via a controller, such as the carriage 310. As known by those skilled in the art, a TEE probe assembly 306 may have multiple dials (e.g., the knobs 332, 334) to adjust the degrees of freedom of the TEE probe assembly 306. Thus, as one example, the controller may adjust, or cause adjustment of the knobs 332, 334. As may be appreciated, the adjustment of the knobs 332, 334 may not map precisely to the actual pose of the TEE probe assembly 306, For example, the TEE probe tip may face resistance to movement due to the subject’s esophagus. As another example, it may be difficult to ascertain the pose from a zero or resting position. For example, as the TEE probe assembly 306 is inserted into a subject, the knobs 332, 334 may be adjusted as it moves within the subject. In this example, the movement of the knobs 332, 334 may be monitored but it may indicate a relative pose of the probe tip (e.g., relative to the movements performed) rather than a consistent global pose.

[0121] As will be described, in some embodiments a TEE probe assembly 306 may be provided with one or more sensors (referred to herein as pose sensors) at the tip or distal end of the TEE probe assembly 306. In some embodiments, two sensors may be used. In some embodiments, three or four sensors may be used. An example sensor described herein is an electromagnetic sensor which may be positioned at the tip or distal end of the TEE probe assembly 306. A generator, such as a generator with a threshold number of coils (e.g., 2, 4, and so on), may generate a magnetic field, such as a time-varying magnetic field, surrounding the electromagnetic sensor. In some embodiments, the generator may adjust the magnetic field, for example via exciting an individual coil at a time. The generator may also cause individual coils to generate magnetic fields which are associated with different frequencies.

[0122] With respect to the above, the pose sensors may include one or more coils such that voltages are induced based on the magnetic field. The voltages may be used to determine pose of the pose sensors. For example, a matrix may be determined which indicates a pose sensor’s pose in space. In this example, the matrix may reflect position (e.g., translation) and orientation of the pose sensor. In some embodiments, the matrix may be a 4x4 matrix. Insome embodiments, the matrix may be a 3x3 matrix. In some embodiments, the matrix may be of other dimensions.

[0123] As will be described, the matrix may be analyzed to determine pose associated with the pose sensors. In some embodiments in which two pose sensors are used, the pose may reflect a pose associated with a midpoint of the pose sensors. Additionally, the pose may be offset from a pose determined based on the sensors. As an example, an offset may enable a determination of a pose associated with a probe tip or specific portion of the probe tip. Thus, the sensors may be positioned where practicable on the tip of the TEE probe assembly 306, and the pose of a specific portion may be determined using an offset transformation or projection.

[0124] Pose may be used, for example, to address the above-described problems. For example, the pose determined using the pose sensors may be substantially global in the sense that it is with respect to a fixed reference frame (e.g., the generator). In this example, the precise movements of the probe tip may be monitored. For example, the controller may cause the probe tip to flex, or rotate, by a threshold amount. The controller may therefore determine whether the completed flexion, or rotation, corresponds to an expected pose.

[0125] Additionally, and as will be described, the pose may be used as part of a calibration technique. As described above, the controller may determine whether fine movements made to the dials of the probe result in corresponding adjustments of pose. Any deviation may be used to inform how to calibrate the controller. In some embodiments, force estimates may be determined for the probe tip (e.g., an estimate of force being applied to an internal surface of a subject). The system may therefore learn a mapping or association between force estimates and pose. For example, the controller may cause the probe tip to move 30 degrees. However, the resulting pose may indicate that the probe tip has moved 25 degrees. This distinction may be used to calibrate the controller. For example, the controller may learn that it is to increase the movement to account for resistance (e.g., estimated force) from the subject. In this way, the pose from the probe sensors may be used as a feedback technique to the controller.

[0126] Pose sensors (e.g., sensors 902, 904 described with respect to FIG. 9) may provide, or inform or adjust, the sensor measurements used in the calibration technique. A probe tip fixture (e.g., fixture 900) may surround or be fitted over the tip of the TEE probeassembly 306 and may include the pose sensors 902, 904 positioned at an offset from the ultrasound sensor such that they do not obstruct or interfere with ultrasound transmission. The pose sensors 902, 904 may be electromagnetic sensors that respond to a time- varying magnetic field generated by a fixed reference frame, such as a generator positioned external to the subject. When the controller causes the probe tip to move, such as by commanding thirty degrees of flexion via the knobs 332, 334, the pose sensors 902, 904 generate sensor measurements that the controller may process according to the flow described with respect to FIG. 10. The resulting pose may indicate that the probe tip has achieved only twenty-five degrees of flexion despite the thirty-degree command, and this discrepancy informs the calibration.

[0127] The force estimates used in the calibration technique may additionally be derived from, or otherwise informed from, the force modeling described with respect to FIGS.12A-12C. The force diagrams depicted in FIGS. 12B and 12C illustrate relationships between tension, friction, and applied force during retraction and insertion of the TEE probe assembly 306. During insertion, the TEE probe assembly 306 may experience compression as the carriage 310 moves toward the subject, and the distal portion 326 encounters frictional and resistive forces from the esophageal walls. The insertion force may be computed using relationships that account for the angle of the probe guide 322, the guide force measured by sensors on the guide, and the motor current used to drive translation. In some embodiments, the controller may use a regression model to process inputs including guide force, position, velocity, and motor current to generate an estimated insertion force, as described with respect to block 1304 of FIG. 13. The controller may correlate this estimated force with the pose deviation observed via the pose sensors 902, 904. For example, if the pose sensors indicate that a thirty-degree flexion command resulted in twenty-five degrees of actual movement, and the force estimate indicates elevated resistive force at the probe tip, the controller may learn that increased command magnitude is required to overcome the resistance and achieve the target pose.

[0128] The mouthguard 1604 described with respect to FIGS. 16A-16C may provide supplemental force information that enriches the calibration technique. The mouthguard 1604 may include a force sensor 1630 coupled to a guide body disposed within the mouthguard lumen. The force sensor 1630 may generate force signals related to forcesapplied between the guide body and the catheter 336 as the catheter traverses through the mouthguard 1604 into the subject’s mouth. During the calibration technique, the controller may monitor these mouthguard force signals alongside the pose information from the pose sensors 902, 904 and the estimated insertion force from the machine learning model. The mouthguard force signals may indicate resistance at the oral access point, which differs from resistance deeper within the esophagus. By distinguishing between these force sources, the controller may develop a more granular mapping or association between force estimates and pose. As one example, the controller may identify that a first portion of pose deviation results from resistance at the mouthguard 1604, while a second portion results from esophageal tissue resistance, and may calibrate command scaling factors for each source independently.

[0129] The load sensor 1602 described with respect to FIG. 16A may provide additional inputs for the calibration technique. The load sensor 1602 may be positioned at the distal end of the robotic support structure 302 and may include an accelerometer aligned with three axes. The load sensor 1602 may detect loads applied to the probe guide 322 as the TEE probe assembly 306 is advanced through the probe guide and into the subject. These load measurements may capture transient force events, such as sudden resistance during flexion or rotation maneuvers, that affect the correspondence between commanded movement and achieved pose. The controller may incorporate load sensor 1602 measurements into the calibration mapping alongside pose sensor data, mouthguard force signals, and estimated insertion force. In some embodiments, the controller may perform the calibration technique by iteratively commanding movements, collecting pose, force, and load data, and adjusting control parameters until commanded movements produce expected pose changes within a tolerance. The automated inspection system 1100 described with respect to FIG. 11 may coordinate this iterative calibration, receiving probe pose information 1108 from the pose sensors 902, 904, issuing control instructions 1106 to the robotic TEE controller 1102, and presenting calibration status via the user interface 1104.

[0130] Furthermore, the present disclosure describes techniques to estimate forces associated with control of the TEE probe. As an example described in more detail below, insertion force into a subject’s mouth may be estimated. This insertion force may be used to estimate, or otherwise determine, a force associated with the probe tip traversing through the subject. For example, a motor may be used to cause movement of the probe tip further into thesubject. In this example, the insertion force may be associated with the force experienced by an interior of the subject (e.g., a surface of the esophagus).

[0131] The estimated force, such as the insertion force, may be used by the controller to take certain actions. For example, the controller may cause movement or motion of the TEE probe to cease based on the estimated force. In this example, there may be a threshold force which causes movement of the probe to stop. In some embodiments, the controller may cause the TEE probe to relax or go limp and cause withdrawal, or backward movement, of the TEE probe. As another example, the controller may limit the current which the motor may use to cause movement of TEE probe. Thus, the controller may implement a force limiter in which the motor is unable to exceed a threshold force based on a limited current available to the motor,

[0132] Additionally, a user interface may present graphical representations of estimated force. As a medical professional uses the robotic TEE tool described herein, a user interface may depict an estimated force in substantially real-time. The user interface may additionally present information indicating that a force has been, or is about to be, exceeded. The user interface may additionally indicate that movement of the probe (e.g., forward movement) has stopped due to the estimated force.

[0133] The techniques described herein may additionally be used, in some embodiments, without robotic control. For example, pose may be determined even with control of the TEE probe by a medical professional. In this example, a user interface may present information identifying the pose (e.g., a graphical representation). The user interface may additionally present a three-dimensional model of a portion of a subject, such as a heart. In this way, the medical professional may easily determine the pose of the probe relative to the heart. Similarly, the user interface may present graphical representations associated with estimated force. In this way, the medical professional can ensure that they are not exceeding one or more force thresholds.

[0134] The TEE probe assemblies 306 can be electrically connected to the console 104. Processing of the data collected by the TEE probe assemblies 306 may be accomplished via electronics and software in the console. The console may include, for example, various processors, power supplies, memory, firmware, and software configured to receive, store, andprocess data collected by the TEE probe assemblies 306. Various types of TEE probe assemblies 306 may be used as would be understood by one of skilled in the art.

[0135] The computer-program instructions may include software including artificial intelligence and / or machine learning software. The software may include pre-trained classifiers. In some embodiments, the software may include instructions, that, when executed by the one or more processors, automatically classifies a present view of the imaging element and provides instructions to the control system to move the imaging element to a location that optimizes the desired view. The computer-program instructions may be further configured to apply a score to a present view of the imaging probe and / or catheter. In some examples, the computer-program instructions are further configured to provide instructions to the control system to move the imaging element until the score for the present view is above a target threshold. In other embodiments, the computer-program instructions are further configured to provide instructions to the control system to move the imaging element until the score for the present view is maximized,

[0136] In some cases, a software model can start with an initial 3D model of a heart based on a standard distribution of hearts. In some implementations, the distribution of hearts can be tailored to the subject’s age, sex, disease state, and demographic. In some embodiments, the standard distribution can exclude outliers (e.g., hearts with tumors, univentricular, and other rare cardiac disorders). In other embodiments, the 3D model can start with actual imaging of the subject’s heart instead of a standard distribution of hearts. For example, CT, MRI, or other high- definition imaging of the subject’s heart can be used by the model as a starting point.

[0137] In some cases, a physician (such as an interventionalist) can select or choose the type of view of the anatomy / procedure. This can include, for example, a 3D model of the target anatomy, 2D model of the target anatomy, color / black and white, cross-sectional views, etc. The physician can further select a procedure type from a procedure library and whether or not to include the tool / device that is being used in the model. This can be selected / chosen at the start of imaging. In another embodiment, the specific size of the device can be chosen by the user to be displayed / used by the system. In some embodiments, selecting the procedure type can automatically determine the optimal view type for that procedure. The system (e.g., the algorithms / artificial intelligence software) can then determine the position and / ororientation of the TEE probe assembly 306 (or other real-time imaging) relative to the target anatomy. This can be based, for example, on a procedure library that contains data from previous subjects and procedures. The TEE probe assembly 306 (or other imaging system) can acquire imaging data of the target anatomy. As the TEE probe assembly 306 acquires image slices of the target anatomy (e.g., the subject’s heart), the data can be stored in the historical imaging database and a historical cyclic model can be updated. Additionally, The 3D model of the target anatomy can be updated in real-time with the TEE images. Finally, the 3D model can be displayed to the physician.

[0138] With respect to the automated inspection system 1100 being proximate to a subject, the automated inspection system 1100 may execute software such as an application. The application may optionally be a mobile application which communicates with the TEE probe assembly 306. Thus, and as an example, a tablet may execute the mobile application to control the TEE probe assembly 306 and user interface 1104 via its touch-screen display,

[0139] In some embodiments, the automated inspection system 1100 may represent a cloud-based system or software executing on a cloud-based system. For example, the automated inspection system 1100 may be a web application (e.g., a dockerized application) which is in communication with a multitude of TEE tools. In this example, the TEE probe assembly 306 may be connected to a network (e.g., the internet, a private cloud or networked system) and controlled by the automated inspection system 1100. Similarly, an end-user device may be connected to the network and used to render user interface 1104. For example, the end-user device may execute an application, or web browser, which renders user interface 1104.

[0140] In some examples, the automated inspection system 1100 can provide control instructions 1106 to the TEE probe assembly 306. The robotic TEE controller 1102 may automatically adjust the TEE probe assembly 306 in a multitude of dimensions. For example, the robotic TEE controller 1102 may cause the TEE probe assembly 306 to extend along a dimension and be adjustable in two or more dimensions. In this example, the TEE controller 1102 may cause rotation of the TEE probe assembly 306 (e.g., via flexion, retroflexion, flexion tilts). The TEE controller 1102 may additionally cause rotation or adjustment of an ultrasound transducer (e.g., field of view), for example via beamforming techniques.

[0141] The control instructions 1106 may thus cause adjustment of the TEE probe assembly 306 within a subject. For example, the control instructions 1106 may cause the TEE probe assembly 306 to extend through the esophagus of the subject. In this example, the control instructions 1106 may be associated with station coordinates which describe the TEE probe assembly’s 306 values in the multitude of dimensions (e.g., values for a multitude of degrees of freedom). As described above, example values may reflect the TEE probe assembly’s 306 distance (e.g., from a consistent origin) into the subject, a pose or rotation of the TEE probe assembly 306, an electronic rotation, or other adjustment (e.g., focal distance), of the ultrasound sensor, and so on. Thus, the automated inspection system 1100 may accurately navigate the TEE probe assembly 306 to specific station coordinates via control instructions 1106.

[0142] In some embodiments, the automated inspection system 1100 may ensure that the TEE probe assembly 306 safely navigates through the esophagus of a subject. For example, the automated inspection system 1100 may determine a path from first station coordinates to second station coordinates. In this example, the first station coordinates may be associated with a first cardiac view and a medical professional may prefer to view images associated with a second cardiac view. The automated inspection system 1100 may determine control instructions 1106 which ensure that pressure applied to the interior of the esophagus is below a threshold. As an example, the automated inspection system 1100 may cause a straightening out of the TEE probe assembly 306 as it is translated towards the second station coordinates. In some embodiments, the automated inspection system 1100 may access a geometrical model indicative of the interior of the esophagus. In some embodiments, the model may represent an average or normal model of a person’s esophagus. In some embodiments, the average or normal model may be adjusted based on deviations detected through imaging or through movement of the probe (e.g., via a force sensor). The model may then be used to inform the specific path towards the second station coordinates (e.g., an automated navigation via the specific path). In some embodiments, the information may be presented as instructions or recommendations to a user who is controlling the TEE tool.

[0143] FIG. 9 illustrates example pose sensors 902, 904 on a TEE probe assembly 306. The TEE probe assembly 306 is an example of a probe with an ultrasound sensor (e.g., TEE probe 328) at the tip of the TEE probe assembly 306. The TEE probe assembly 306 maybe inserted into a subject, for example via the mouth, to obtain ultrasound images or information from within the subject. As one example, the ultrasound sensor may obtain ultrasound images or information of a heart or portion thereof.

[0144] In the illustrated example, the TEE probe assembly 306 includes a probe tip fixture 900 which surrounds, or otherwise fitted over or on top of, the tip of the TEE probe assembly 306. The probe tip fixture 900 may include one or more pose sensors, such as the pose sensors 902, 904. The pose sensors 902, 904 may be positioned at an offset from the ultrasound sensor such that they do not block, or otherwise interfere, with the ultrasound coming from the sensor. As described above, the pose sensors 902, 904 may represent electromagnetic sensors which are within a time-varying magnetic field. In some embodiments, the pose sensors 902, 904 may be Northern Digital Incorporated (NDI) sensors. As will be described below, with respect to FIG. 10, the pose of the tip of the TEE probe assembly 306 may be determined based on the pose sensors 902, 904. In some embodiments, the pose may reflect a pose associated with the offset ultrasound sensor.

[0145] In some embodiments, the TEE probe assembly 306 may be robotically controlled. For example, the TEE probe assembly 306 may be adjusted in a multitude of degrees of freedom, such as translation, flexion, rotation, and so on, by a robotic TEE controller (e.g., TEE imaging system 300). The pose sensors 902, 904 may be used as an accurate estimate of the pose in three-dimensional space of the tip of the TEE probe assembly 306.

[0146] As described herein with reference to FIGS. 3A-3D, the TEE probe assembly 306 may be robotically controlled to simplify performance of the TEE operation. For example, the TEE probe assembly 306 may be controlled to obtain ultrasound images or information from specific viewpoints.

[0147] The TEE imaging system 300 may therefore cause translation of the TEE probe assembly 306 further within the subject. The TEE imaging system 300 may additionally cause the probe tip to rotate, flex, and so on to enable viewing of the specific viewpoints. As described above, the pose of the tip of the TEE probe assembly 306 may be used to accurately ascertain the real-world pose of the TEE probe assembly 306. For example, the TEE imaging system 300 may adjust the knobs 332, 334 of the TEE probe assembly 306 to cause specific flexion or rotation. However, this adjustment may not precisely map to the real-world pose ofthe probe. Thus, the TEE imaging system 300 may use the determined pose to more accurately control the TEE probe assembly 306.

[0148] FIG. 10 is a flowchart of an example process 1000 for obtaining pose of a tip or distal portion of a TEE probe assembly 306. For convenience, the process 1000 will be described as being performed by a controller of one or more processors (e.g., the TEE imaging system 300).

[0149] At block 1002, the controller obtains sensor measurements associated with a probe tip of a probe (e.g., a TEE probe). As illustrated in FIG. 9, the probe may include one or more pose sensors at the tip or end of the probe. The obtained sensor measurements may reflect, for example, rotation information associated with the pose sensors along with position (e.g., translation).

[0150] At block 1004, the controller determines a mid-point transformation associated with the probe tip. In some embodiments, two pose sensors may be used. The controller may determine a pose associated with the mid-point between the pose sensors. For example, the controller may obtain the translation associated with each pose sensor, such as the x, y, and z values. The controller may then determine the average of the translation to indicate an x, y, z associated with the mid-point between the pose sensors.

[0151] Additionally, the controller may determine a direction vector associated with an axis, such as the z-axis. As an example, the controller may obtain a particular column from a matrix associated with the pose sensors and then average the information to obtain a mid-point associated with the z-axis. The controller may then determine a direction vector associated with a different axis, such as the x-axis. For example, this x-axis direction vector may be based on a difference between the translation of the two sensors. To determine the remaining direction vector, such as the y-axis, the controller may compute a cross product between the y-axis direction vector and z-axis direction vector.

[0152] At block 1006, the controller determines an offset associated with the pose. As illustrated in FIG. 9, the ultrasound sensor is offset from the pose sensors. Thus, in some embodiments the controller may adjust for this offset. As one example, the controller may generate a rotation matrix based on the above-described direction vectors. These direction vectors are associated with the mid-point between the two pose sensors. The controller may additionally determine a translation vector to shift between the mid-point to the final ultrasoundpose. In some embodiments, the translation vector may be defined by offset thresholds in one or more axes. For example, a z offset and a y offset may be used.

[0153] At block 1008, the controller obtains pose based on projection of the mid¬ point transformation through the offset. The controller may multiply the rotation matrix and translation vector by the rotation matrix that includes the above-described mid-point direction vectors.

[0154] FIG. 11 is a block diagram of an example automated inspection system 1100 in communication with a robotic TEE controller 1102. The robotic TEE controller 1102 may be the system 100 described herein with reference to FIG, 1 or the TEE imaging system 300 described herein with reference to FIGS, 3A-3D, The automated inspection system 1100 may represent a system of one or more processors or one or more computers. In some embodiments, the automated inspection system 1100 may be a computer system which is positioned proximate to a subject and the robotic TEE controller 1102, For example, the computer system may be a mobile device (e.g,, a tablet, a smart phone), a laptop, a computer, and so on. In these embodiments, the automated inspection system 1100 may be in wired or wireless communication with the TEE controller 1102, Additionally, the automated inspection system 1100 may be in wired or wireless communication with a display configured to present user interface 1104.

[0155] With respect to the automated inspection system 1100 being proximate to a subject, the automated inspection system 1100 may execute software such as an application. The application may optionally be a mobile application which communicates with the robotic TEE controller 1102. Thus, and as an example, a tablet may execute the mobile application to control the robotic TEE controller 1102 and present user interface 1104 via its touch-screen display.

[0156] In some embodiments, the automated inspection system 1100 may represent a cloud- based system or software executing on a cloud- based system. For example, the automated inspection system 1100 may be a web application (e.g., a dockerized application) which is in communication with a multitude of TEE tools. In this example, the TEE tool may be connected to a network (e.g., the internet, a private cloud or networked system) and controlled by the automated inspection system 1100. Similarly, an end-user device may beconnected to the network and used to render user interface 1104. For example, the end-user device may execute an application, or web browser, which renders user interface 1104.

[0157] In the illustrated example, the automated inspection system 1100 is providing control instructions 1106 to the robotic TEE controller 1102. The robotic TEE controller 1102 may automatically adjust the TEE probe assembly 306 in a multitude of dimensions. For example, the robotic TEE controller 1102 may cause the TEE probe assembly 306 to extend along a dimension and be adjustable in two or more dimensions. In this example, the robotic TEE controller 1102 may cause rotation of the TEE probe assembly 306 (e.g., via flexion, retroflexion, flexion tilts). The robotic TEE controller 1102 may additionally cause rotation or adjustment of an ultrasound transducer (e.g., field of view), for example via beamforming techniques. The control instructions 1106 may thus cause adjustment of the TEE probe assembly 306 within a subject. For example, the control instructions 1106 may cause the TEE probe assembly 306 to extend through the esophagus of the subject.

[0158] As described herein, the probe sensors 902, 904 may be used to determine probe pose information 1108 associated with the TEE probe assembly 306. For example, the probe pose information 1108 may reflect a probe associated with a particular portion of the tip of the probe (e.g., the ultrasound sensor).

[0159] FIG. 12A is an example illustration of forces associated with robotic insertion of a TEE probe assembly 306 into a subject. In the illustrated example, the insertion force is indicated as being the force associated with the subject’s mouth. To determine the estimated force, Fin (e.g., the force associated with pushing the probe in) and Fsensor (e.g., the force associated with a sensor or sensors that measure force where the probe is caused to angle downwards, such as the illustrated Fs) may be summed. An example angle may include 90 degrees, 45 degrees, and so on.

[0160] In some embodiments, to determine the insertion force a force model may be used as shown in FIGS. 12B and 12C. FIG. 12B illustrates a force model of a retraction force Ff in and FIG. 12C illustrates a force model of an insertion force Ff. As shown in FIGS.12B and 12C, the insertion force may be applied along a curve. The curve may represent the probe guide 322. The TEE probe assembly 306 may experience tension during retraction as the carriage 310 moves away from the subject and the distal portion of the TEE probe assembly306 experiences frictional and other resistive forces between the TEE probe assembly 306 and the esophagus of the subject. Retraction may include the following relationships:cos (0)Tj — — Fx— Fztan (0)1Ff — T-, — T2= — Fx- Fz(tan(0) - cos (0)eu~ '

[0161] By comparison, the TEE probe assembly 306 may experience compression during insertion as the carriage 310 moves toward the subject and the distal portion of the TEE probe assembly 306 experiences frictional or other resistive forces between the TEE probe assembly 306 and the esophagus of the subject. Insertion may include the following relationships:Ti = Fx+ Fztan(0)cos (0)

[0162] In some embodiments, a regression model may be used to estimate force. For example, inputs may include the sensor measurement associated with the probe being angled down, position information, velocity information, current associated with a motor used to push the probe, and so on. The regression model may then output an estimated force.

[0163] As may be appreciated, the estimated force may reflect an insertion force. This insertion force may be used to inform the force being applied to the subject, such as to an interior of the subject. Thus, as will be described this force may be used to take actions such as stopping of the insertion or limiting the motor current.

[0164] FIG. 13 is a flowchart of an example process 1300 for adjusting operation of a robotic TEE controller based on estimated force. For convenience, the process 1300 will be described as being performed by a controller of one or more processors (e g., the robotic TEE controller 1102).

[0165] At block 1302, the controller obtains inputs reflecting one or more of guide force, position, velocity, and motor current. As illustrated in FIG. 9, input information may be obtained from sensor(s) associated with guiding the probe downwards at an angle into a subject’s mouth. Fin may be estimated, in some embodiments, using the motor current.

[0166] At block 1304, the controller computes a forward pass through a machine learning model. As described above, the machine learning model may, in some embodiments, be a regression model. The regression model may use in the input information to determine an estimated force, such as an estimated insertion force.

[0167] At block 1306, the controller adjusts operation of the robotic TEE controller based on the estimated force. In some embodiments, the estimated force may be compared to one or more thresholds. The controller may stop movement of the probe based on the estimated force exceeding, or about to exceed, a threshold. The controller may additionally constrain the current which is available to the motor to enforce a threshold. For example, the Fin may be constrained based on the motor current. The controller may additionally lower the available motor current based on the force exceeding a threshold. In some embodiments, the controller may learn acceptable motor current ranges based on monitoring estimated force.

[0168] At block 1308, the controller causes update of a user interface. The controller, or the automated inspection system 1100 described in FIG. 11, may update a user interface based on the estimated force. As illustrated in FIGS. 14C-14E, example graphical representations of force may be presented. The user interface may additionally include alerts, or information, which inform a medical professional that estimated force has exceeded, or will exceed, a threshold.

[0169] FIG. 14A is a block diagram of the example automated inspection system 1100 presenting a user interface 1104 based on estimated force 1402. As described in FIGS.12-13, the estimated force 1402 may reflect a force associated with insertion of the probe into a subject. In response to the estimated force 1402, a user interface 1104 may be updated to inform the current force or forces being experienced by the subject. Example user interfaces are included in FIGS. 14C-14E.

[0170] FIG. 14B is a block diagram of an example force model. The example force model may represent a direct force limiter which uses the above-described guide sensor. Thecontroller may use this model, in some embodiments, to determine whether to stop motion of the probe based on a threshold being exceeded.

[0171] FIG. 14C is an example of a user interface reflecting estimated force which may be presented to a medical professional. In the illustrated example, different thresholds (Fl and F2) are presented. These thresholds may, in some embodiments, be definable by a medical professional using a user interface. In some embodiments, the controller or system may start with low threshold values and then increase them if they result in the probe not being able to move. For example, the probe may not be able to move due to exceeding a threshold or to lacking sufficient current.

[0172] The user interface may allow for a user, such as a medical professional, to ascertain the estimated force in substantially real-time. As described above, this may be presented via the user interface during robotic controller. Additionally, and as described above, this may be presented during manual control by the medical professional. Manual control may include, for example, manually controlling the robotic controller or manually manipulating the dials of the probe. The user interface includes a bar that may increase as the estimated force increases. Additionally, the force thresholds are specified such that the medical professional can easily determine how close to a threshold the estimated force currently is.

[0173] FIG. 14D is another example of a user interface reflecting estimated force which may be presented to a medical professional. The bar on the left is illustrated as being below a threshold (e.g., 100%) such that movement of the probe is possible. The bar on the right is illustrated as being above the threshold such that the probe has stopped movement. For example, the robotic controller may stop movement of the probe based on monitoring whether the estimated force has exceeded the threshold.

[0174] The user interfaces 1104 depicted in FIG. 14C and FIG. 14D present graphical representations of estimated force that inform a medical professional of forces applied to the interior of a subject during advancement of the TEE probe assembly 306. The estimated force reflected in these user interfaces may represent an insertion force associated with the probe tip traversing through the esophagus, rather than being limited to forces experienced at the mouthguard 1604 or oral cavity. In the illustrated embodiments, force thresholds such as Fl and F2 are presented as visual markers against which the current estimated force is compared in substantially real-time. The bar depicted in the user interface1104 may increase as the estimated force increases, thereby allowing the medical professional to ascertain proximity to a threshold before excessive force is applied to esophageal tissue. When the estimated force reaches or exceeds a threshold, the system may automatically halt probe motion to prevent injury, as reflected in the "insertion is stopped by the system" indicator shown in FIG. 14D. In some embodiments, the thresholds may be user-definable via the user interface 1104, enabling the medical professional to adjust sensitivity based on patient- specific factors or procedural requirements. The processor may additionally start with low threshold values and adaptively increase them if initial values prevent the probe from advancing due to threshold exceedance at low force levels, thereby balancing safety with procedural efficacy.

[0175] The estimated force presented in the user interfaces 1104 of FIG. 14C and FIG. 14D may be computed using the process described with respect to FIG. 13, At block 1302, the controller obtains inputs reflecting one or more of guide force, position, velocity, and motor current associated with the TEE probe assembly 306, At block 1304, the controller computes a forward pass through a machine learning model, such as a regression model, to generate an estimated force based on these inputs. The motor current may serve as a proxy for the force applied to translate the probe toward the subject, while the guide force may reflect measurements from sensors positioned on the probe guide 322 where the probe angles downward into the subject's mouth. By combining these inputs, the machine learning model may account for both the driving force applied by the motor and the resistive forces encountered along the probe path, thereby providing an estimate of the force experienced at the probe tip within the esophagus. At block 1306, the controller adjusts operation based on the estimated force, which may include stopping movement, constraining available motor current, or causing the probe to relax. At block 1308, the controller causes update of the user interface 1104, thereby presenting the graphical representations illustrated in FIGS. 14C-14E to the medical professional.

[0176] The system may integrate force information from multiple sensing modalities to provide comprehensive monitoring of forces applied to the subject. In some embodiments, the mouthguard 1604 described with respect to FIGS. 16A-16C may include a force sensor 1630 that generates force signals related to forces applied between the guide body and the catheter 336 as the catheter traverses through the mouthguard 1604. These mouthguard force signals may represent forces at the oral access point, which may differ from the estimatedinsertion force at the probe tip within the esophagus. The processor may present both force measurements via the user interface 1104, enabling the medical professional to distinguish between forces at the mouthguard and forces deeper within the anatomy. As one example, a first graphical indicator may reflect force at the mouthguard 1604, while a second graphical indicator may reflect estimated force at the probe tip derived from the machine learning model of FIG. 13. This multi-location force presentation may enhance situational awareness and enable targeted intervention when forces exceed acceptable levels at either location.

[0177] The load sensor 1602 described with respect to FIG. 16A may provide additional force information that supplements the estimated force computation. The load sensor 1602, which may include an accelerometer aligned with three axes, may be positioned at the distal end of the robotic support structure 302 to detect loads applied to the probe guide 322 as the TEE probe assembly 306 traverses into the mouth of the subject. Force signals from the load sensor 1602 may be provided to the processor and may serve as inputs to the machine learning model described in FIG, 13, thereby refining the estimated force computation. In some embodiments, the load sensor 1602 may detect transient force events, such as sudden resistance encountered during probe advancement, that supplement the guide force measurements. The processor may fuse information from the load sensor 1602, the force sensor 1630 of the mouthguard 1604, and the motor current to generate a more accurate estimate of force at the probe tip. The user interface 1104 may present this fused estimate as the primary force indicator, with optional supplemental indicators reflecting individual sensor readings for diagnostic purposes.

[0178] The pose sensors 902, 904 described with respect to FIG. 9 may provide spatial context that enhances interpretation of the estimated force presented in the user interfaces 1104. As described with respect to FIG. 10, the controller may determine a pose associated with the probe tip based on sensor measurements from the pose sensors 902, 904, including a mid-point transformation and an offset that accounts for the position of the ultrasound sensor relative to the pose sensors. In some embodiments, the processor may correlate the estimated force with the current pose to determine whether the force is consistent with the expected anatomical region. For example, higher resistive forces may be expected at certain depths or flexion angles within the esophagus, and the processor may adjust force thresholds dynamically based on pose information. The user interface 1104 may present thepose alongside the estimated force, enabling the medical professional to understand the spatial context of the force measurement. As one example, the user interface 1104 may display a graphical representation of the probe tip orientation within an anatomical model while simultaneously presenting the force bar and threshold indicators.

[0179] The calibration process described with respect to FIG. 15 may utilize the estimated force and pose information presented in the user interfaces 1104 to refine control of the TEE probe assembly 306. At block 1502, the controller controls the probe tip, including flexion and rotation maneuvers. At block 1504, the controller determines pose associated with the probe tip using the pose sensors 902, 904. At block 1506, the controller obtains estimated force, which may be the same estimated force presented in the user interfaces 1104 of FIGS.14C-14E. At block 1508, the controller performs calibration based on the pose and estimated force, which may include determining adjustments to control commands to achieve expected movement despite tissue resistance. The processor may identify that certain poses within the subject correspond to elevated force levels and may store this association for use during subsequent navigation. In this way, the calibration process creates a feedback loop between the force monitoring described in FIGS. 13-14 and the pose determination described in FIGS. 9- 10, enabling the robotic TEE controller to adapt to patient-specific anatomy.

[0180] The automated inspection system 1100 described with respect to FIG. 11 may coordinate the force monitoring, pose determination, and user interface presentation to provide an integrated control and feedback system. The automated inspection system 1100 provides control instructions 1106 to the robotic TEE controller 1102 and receives probe pose information 1108 from the probe sensors 902, 904. In some embodiments, the automated inspection system 1100 may additionally receive force signals from the mouthguard 1604, the load sensor 1602, and estimated force values computed via the machine learning model. The automated inspection system 1100 may present all relevant information via the user interface 1104, including graphical representations of estimated force with threshold indicators as shown in FIGS. 14C-14E, pose information, and alerts indicating that force limits have been reached. The automated inspection system 1100 may implement safety interlocks that prevent further probe advancement when any of the monitored force values exceeds a corresponding threshold, regardless of whether the force is detected at the mouthguard 1604, estimated at the probe tip, or measured by the load sensor 1602. This integrated approach enables the robotic TEE systemto maintain subject safety while providing comprehensive real-time feedback to the medical professional.

[0181] FIG. 14E is another example of a user interface reflecting estimated force which may be presented to a medical professional. In FIG. 14E, a warning is illustrated, “Force limit reached” along with a graphical representation of force. The graphical representation indicates force mapped against time (e.g., now to the last threshold number of seconds, such as 10 seconds). In this way, the medical professional may determine not only the estimated force but also the estimated force over a threshold number of seconds or time.

[0182] FIG 15 is a flowchart of an example process 1500 for performing calibration based on pose and estimated force. For convenience, the process 1500 will be described as being performed by a controller of one or more processors (e.g., the robotic TEE controller 1102).

[0183] At block 1502, the controller controls the probe tip, including flexion and / or rotation,

[0184] At block 1504, the controller determines pose associated with the probe tip. As described above, the controller may analyze sensor information from pose sensors to determine pose.

[0185] At block 1506, the controller obtains estimated force. As described above, the controller may determine a measure of force, such as insertion force, associated with the probe.

[0186] At block 1508, the controller performs calibration. The controller may determine adjustments to the control of the probe to cause expected movement of the probe based on the adjustments made to the dials of the probe. For example, the controller may determine that flexion is being restricted due to the force. In this example, the controller may identify that in certain locations within the subject, certain measures of force, and so on, may require additional adjustments to bring the pose to an expected pose.

[0187] The calibration process 1500 depicted in FIG. 15 may incorporate the pose sensor infrastructure described with respect to FIG 9 to enable precise pose determination at block 1504. At block 1502, the controller controls the probe tip by commanding flexion and rotation through adjustments to the knobs 332, 334 or through actuators within the carriage 310. The pose sensors 902, 904 positioned on the probe tip fixture 900 generateelectromagnetic sensor measurements in response to a time-varying magnetic field produced by an external generator. At block 1504, the controller processes these sensor measurements according to the technique described with respect to FIG. 10, determining a mid-point transformation by averaging translation values from the two pose sensors and computing direction vectors for the coordinate axes. The controller then determines an offset that accounts for the spatial separation between the mid-point of the pose sensors 902, 904 and the ultrasound sensor of the TEE probe 328, and obtains the final pose based on projection of the mid-point transformation through this offset. The resulting pose may indicate sub-millimeter position accuracy and sub-degree orientation accuracy for the probe tip within the subject. For example, at block 1506, the controller may obtain estimated force as described elsewhere herein. At block 1508, the controller may perform calibration by comparing the commanded flexion or rotation at block 1502 with the achieved pose determined at block 1504, using the estimated force to characterize resistance that caused any discrepancy. In this manner, the pose sensors 902, 904 enable the calibration process 1500 to achieve precise feedback- driven adjustment of control parameters.

[0188] In some embodiments, the estimated force obtained at block 1506 of the calibration process 1500 may be derived using the force relationships depicted in FIGS. 12A-12C. FIG. 12B illustrates a force free body diagram associated with robotic retraction of the TEE probe assembly 306 from a subject, depicting tension forces in the catheter 336, frictional forces at the probe guide 322, and resistive forces from the esophageal tissue. FIG. 12C illustrates a corresponding force free body diagram associated with robotic insertion of the TEE probe assembly 306 into a subject, showing how compression forces, guide friction, and tissue resistance interact during advancement of the catheter 336. The controller may apply these force relationships to measurements including motor current, guide force detected by sensors on the probe guide 322, and catheter position to compute an estimated force value at block 1506. During calibration at block 1508, the controller may distinguish between resistive forces attributable to tissue contact at the probe tip and mechanical friction within the probe guide 322 or along the catheter 336, enabling more targeted calibration adjustments. For example, if the force diagrams indicate that a significant portion of resistance originates from the angle of the probe guide 322 rather than from esophageal tissue, the controller may apply different scaling factors to translation commands versus flexion commands. The forcemodeling framework thereby enables the calibration process 1500 to develop nuanced control parameters that account for the distinct sources of resistance encountered during probe manipulation.

[0189] The regression model described with respect to FIG. 13 may generate the estimated insertion force used at block 1506 of the calibration process 1500. As described with respect to block 1304 of FIG. 13, the regression model receives inputs including guide force measured by sensors on the probe guide 322, catheter position within the channel 320, catheter velocity during advancement or retraction, and motor current used by the carriage 310, The regression model processes these inputs to produce an estimated insertion force that reflects the force experienced by the subject's esophageal tissue during probe manipulation. At block 1506, the controller obtains this estimated force and provides it to the calibration performed at block 1508. During calibration, the controller compares the estimated force with the pose deviation observed via the pose sensors 902, 904. If the regression model predicts a first force magnitude but the pose sensors indicate a deviation consistent with a different force magnitude, the controller may update parameters of the regression model itself to improve future force estimation accuracy. In some embodiments, the calibration process 1500 may include an adaptive learning component whereby successive calibration iterations refine the regression model weights based on accumulated pose and force observations. This adaptive approach may improve force estimation accuracy over multiple procedures performed on different subjects, enabling the system to generalize learned relationships between input features and actual tissue resistance.

[0190] The force sensor 1630 within the mouthguard 1604 described with respect to FIGS. 16A-16C may provide supplemental force information that enriches the estimated force obtained at block 1506 of the calibration process 1500. The mouthguard 1604 may be positioned within the subject's mouth and may include a guide body disposed within a lumen of the mouthguard through which the catheter 336 passes during insertion. The force sensor 1630 may be coupled to the guide body and may generate force signals related to forces applied between the guide body and the catheter 336 as the catheter traverses through the mouthguard 1604. During the calibration process 1500, the controller may obtain mouthguard force signals alongside the estimated insertion force derived from the regression model and the pose measurements from the pose sensors 902, 904. The mouthguard force signals may indicateresistance at the oral access point, which may differ in magnitude and character from resistance encountered deeper within the esophagus. By distinguishing between these force sources, the controller may develop separate calibration parameters for oral transit versus esophageal navigation at block 1508. As one example, the controller may identify that oral transit requires elevated motor current to overcome mouthguard friction while esophageal navigation requires graduated current scaling to avoid applying excessive force to mucosal tissue. The mouthguard 1604 force sensor thereby enables the calibration process 1500 to achieve region-specific calibration that reflects the distinct mechanical environments encountered during probe advancement.

[0191] The load sensor 1602 positioned at the distal end of the robotic support structure 302 may provide additional inputs for the calibration performed at block 1508 of the calibration process 1500, The load sensor 1602 may include an accelerometer aligned with three axes, including a vertical axis, a horizontal axis aligned with the direction of advancement of the carriage 310, and an axis transverse to the support arm 308. The load sensor 1602 may detect loads applied to the probe guide 322 as the TEE probe assembly 306 is advanced through the probe guide 322 and into the subject. These load measurements may capture transient force events, such as sudden resistance spikes when the catheter 336 encounters anatomical constrictions or when flexion commands cause the probe tip to contact esophageal walls. At block 1506, the controller may incorporate load sensor 1602 measurements into the estimated force alongside the regression model output and mouthguard force signals. At block 1508, the controller may correlate load sensor measurements with pose changes detected by the pose sensors 902, 904, enabling identification of mechanical compliance in the probe guide assembly that affects the relationship between commanded and achieved movement. For example, if the load sensor 1602 detects elevated vertical load concurrent with a pose deviation indicating insufficient downward translation, the controller may determine that the probe guide 322 is deflecting under load and may adjust translation commands to compensate for this deflection.

[0192] The user interfaces described with respect to FIGS. 14C-14E may present calibration status during the calibration process 1500 in addition to presenting estimated force. FIG. 14C illustrates a user interface presenting force thresholds and a bar indicator showing current estimated force relative to the thresholds. FIG. 14D illustrates a user interfaceindicating whether the estimated force exceeds a threshold causing movement to stop. FIG.14E illustrates a user interface presenting force mapped against time, enabling the medical professional to observe force trends. In some embodiments, these user interfaces may additionally present calibration progress during execution of the calibration process 1500. For example, the user interface may include graphical indicators showing the convergence between commanded flexion or rotation at block 1502 and achieved pose determined at block 1504, enabling the medical professional to monitor whether calibration is progressing toward acceptable tolerances. The user interface may present a pose deviation indicator that decreases as the calibration at block 1508 adjusts control parameters to reduce discrepancy between commanded and achieved movement, The user interface may present a calibration status message, such as a notification that calibration is complete when pose deviations fall within a threshold range. In this manner, the user interface enables the medical professional to observe the calibration process 1500 in substantially real-time and to intervene if calibration does not converge as expected,

[0193] The automated inspection system 1100 described with respect to FIG. 11 may orchestrate the calibration process 1500 depicted in FIG. 15. The automated inspection system 1100 may include or be in communication with the robotic TEE controller 1102 and may issue control instructions 1106 to the robotic TEE controller 1102 to execute probe tip control at block 1502. The control instructions 1106 may specify flexion angles, rotation angles, or translation distances to be commanded during calibration maneuvers. The automated inspection system 1100 may receive probe pose information 1108 from the pose sensors 902, 904, corresponding to the pose determination at block 1504. The automated inspection system 1100 may additionally receive estimated force information corresponding to block 1506, including estimated insertion force from the regression model, mouthguard force signals from the force sensor 1630, and load measurements from the load sensor 1602. At block 1508, the automated inspection system 1100 may perform calibration by analyzing the pose and force information and generating updated control parameters for the robotic TEE controller 1102. In some embodiments, the automated inspection system 1100 may iterate through the calibration process 1500 multiple times, issuing successive control instructions 1106, collecting corresponding pose and force feedback, and adjusting control parameters until commanded movements produce expected pose changes within a tolerance. The automated inspectionsystem 1100 thereby provides coordinated execution of the calibration process 1500 with closed-loop feedback from multiple sensor sources.

[0194] The linear scale described as being provided on the catheter 336 may be validated against measurements from the pose sensors 902, 904 during the calibration process 1500. The linear scale may show how much translation movement occurred during operation of the TEE probe assembly 306 by presenting graduation marks observable external to the subject. However, the linear scale measurements may be affected by compression, bowing, or deflection of the catheter 336 within the esophagus, causing the observed graduation marks to overstate or understate the actual displacement of the probe tip. The pose sensors 902, 904, positioned at the distal portion 326 on the probe tip fixture 900, directly measure the position of the probe tip relative to the fixed reference frame of the generator that produces the timevarying magnetic field. During the calibration process 1500, the controller may compare translation indicated by the linear scale with translation indicated by the pose sensors 902, 904, If the linear scale indicates a first translation distance but the pose sensors indicate a second translation distance that differs from the first, the controller may determine that catheter compression or bowing has occurred. The controller may use this comparison at block 1508 to generate a correction factor that adjusts future linear scale observations or to weight pose sensor measurements more heavily than linear scale observations for calibration purposes. This validation approach enables the calibration process 1500 to account for real-world catheter behavior that affects the accuracy of external observation methods.

[0195] The calibration process 1500 may specifically map positions of the knobs 332, 334 to achieved flexion and rotation angles detected by the pose sensors 902, 904. At block 1502, the controller causes actuators within the carriage 310 to adjust the first control knob 332 and the second control knob 334 by specified rotational increments. The first control knob 332 may control anterior-posterior flexion of the distal portion 326, while the second control knob 334 may control medial-lateral flexion. Each rotational increment of a knob corresponds to an expected angular change in the probe tip position. At block 1504, the controller determines the actual pose achieved by processing sensor measurements from the pose sensors 902, 904. The controller compares the expected angular change based on knob position with the achieved angular change based on pose sensor measurements. Discrepancies may result from mechanical hysteresis in the knob mechanisms, cable stretch within thecatheter 336, or tissue resistance at the probe tip. At block 1508, the controller performs calibration by generating a mapping table or transfer function that relates knob rotational positions to achieved probe tip angles under specific force conditions indicated by the estimated force at block 1506. The controller may store this mapping and apply it during subsequent navigation to compensate for the identified discrepancies, commanding adjusted knob movements to achieve target probe tip poses.

[0196] The calibration process 1500 may compare force baselines established during ex vivo calibration with force measurements obtained during m vivo calibration to quantify subject-specific tissue resistance. During ex vivo calibration performed prior to insertion of the TEE probe assembly 306 into the subject, the controller may command movements at block 1502, determine corresponding poses at block 1504, and obtain estimated forces at block 1506 in an environment without tissue resistance. The controller may store these ex vivo pose-to-force mappings as a baseline representing the mechanical characteristics of the specific TEE probe assembly 306 and robotic support structure 302 being used. Following insertion of the TEE probe assembly 306 into the subject, the controller performs in vivo calibration by repeating movements at block 1502 and obtaining corresponding pose and force measurements at blocks 1504 and 1506. At block 1508, the controller compares the in vivo force measurements with the ex vivo baseline. Forces exceeding the ex vivo baseline may be attributed to subject tissue resistance. The controller may compute a subject-specific scaling factor representing the ratio of in vivo force to ex vivo force for equivalent movements. This scaling factor may be applied during subsequent navigation to adjust commanded loads such that the TEE probe assembly 306 achieves desired movements despite subject-specific tissue resistance, while respecting safety limits that prevent application of excessive force to esophageal tissue.V. MOUTHGUARD CONFIGURED TO MEASURE LOADS FROM MOVEMENT OF A TEE PROBE

[0197] The TEE imaging system 300 may be equipped with a mouthguard 1604. In some examples, the mouthguard 1604 may be a smart mouthguard. For example, the mouthguard 1604 may include one or more electronic components for determining an applied force onto the mouthguard 1604. Accordingly, the TEE imaging system 300 may receivesignals from the mouthguard 1604 that can be used to help control one or more actuators that act on or through the catheter 336. In such cases, a TEE probe assembly 306 would be more safely and efficiently controlled if one or both ex vivo and in vivo calibration of movement loads commanded to actual movement achieved were taken into account.

[0198] In some cases, it may be beneficial to monitor the forces applied to the subject and / or to the TEE probe assembly 306. FIGS. 16A-16B illustrates a system 1600 implementing force detection at the distal end of the robotic support structure 302 and in a mouthguard 1604 of the subject. The system 1600 is configured for robotic control of the catheter 336 of the TEE probe assembly 306 having a probe tip. The catheter 336 is not shown in FIG. 16A for clarity, but it can be part of the TEE probe assembly 306. The system 1600 can include features of any of the systems described herein. In some examples, the system 1600 can further include a load sensor 1602 and / or a mouthguard 1604.

[0199] The load sensor 1602 can include an accelerometer aligned with three axes, e.g., with the vertical axis, with a horizontal axis aligned with the direction of advancement of the carriage 310 (e.g., the axis R-R), and with an axis transverse to the support arm 308. As shown in FIG. 16A, the load sensor 1602 may be positioned at a distal end of the robotic support structure 302. In some examples, the load sensor 1602 can be disposed between the probe guide 322 and the support arm 308. In some examples, the load sensor 1602 can be disposed between a support device 1606 and the support arm 308. In some cases, a spacer or shim 1608 may be provided to provide rigid connection between the probe guide 322 and the load sensor 1602 such that loads detected by the load sensor 1602 are more clearly a function of loads applied to the probe guide 322 as the TEE probe assembly 306 traverses the probe guide 322 into the mouth of the subject. One or more hardware processors can be provided to process the signals of the load sensor 1602.

[0200] The mouthguard 1604 can be configured to fit within an access opening of the subject and protect the access opening of the subject from the TEE probe assembly 306. In some examples, the mouthguard 1604 can be positioned within the subject’s mouth. The mouthguard 1604 can be supported against the subjects face by a strap.

[0201] FIG. 16A show’s a general spatial relationship between the TEE imaging system 300 and the mouthguard 1604. As seen in FIG. 16A, the probe guide 322 is disposedabove the subject and a trajectory through the probe guide 322 can direct the catheter 336 of a TEE probe assembly 306 into a mouth of a subject through the mouthguard 1604.

[0202] FIG. 16B shows that the catheter 336 of the TEE probe assembly 306 can be directed through the mouthguard 1604. There can be a space between an outside surface of the catheter 336 and a guide surface of the mouthguard 1604 such that additional resistance to motion is low. In one state, the catheter 336 may not even contact the probe guide 322 so that no forces are applied (or detected, as discussed below) in the no contact state. The contact can arise when the catheter 336 encounters resistance and begins to bow or buckle within the mouthguard 1604, For example, resistance may be caused by the catheter applying a force or pressure to an interior of a patient (e.g., the esophagus) or an additional resistance or bowing caused by the catheter. Then the side surface of the catheter 336 may contact (or press harder on) the guide structures, which can cause a force signal to be generated as discussed further below. A camera 1612 can be integrated into the system 1600. The camera 1612 can be mounted to the probe guide 322, the support arm 308 or another component of the TEE imaging system 300. The camera 1612 is directed to image a portion of the mouthguard 1604 with an orientation marker, as discussed further below.

[0203] FIG. 16C shows a number of distinct functional components of the mouthguard 1604. The mouthguard 1604 can include a lateral member 1614 and a projection 1616. The lateral member 1614 can include a first side 1618 and a second side 1620. The first side 1618 of the lateral member 1614 overlays skin around a mouth of a subject. The first side 1618 can rest on the skin in use. The second side 1620 faces away from the subject’s face and can be seen. The projection 1616 includes an internal wall 1622. The internal wall 1622 defines a lumen 1624 that extends from the second side 1620 through the elevation of the first side 1618 and to a distal end of the projection 1616. The lumen 1624 is sized to receive a catheter, such as the catheter 336. In some cases, the lumen 1624 is oversized such that the lumen can also house a guide body. In the illustrated embodiment, the guide body comprises an arcuate support member 1626 that is suspended in the lumen 1624. The arcuate support member 1626A can be supported in a cantilevered manner by a radial support 1628 A. The radial support 1628A can have a first end connected to the internal wall 1622 and a second end opposite to the first end. The radial support 1628A can also include or can be configured as a force sensor 1630. The illustrated embodiment also includes an arcuate support member 1626B that can besupported by a radial support 1628B. There can also be an arcuate support member 1626C that is supported by a radial support 1628C. The arcuate support member 1626A, the arcuate support member 1626B, and the arcuate support member 1626C can each have an arcuate form extending about 120 degrees about the center of the lumen 1624. Each of the arcuate support members can have a curvature that matches that of the catheter 336. The space between the arcuate support member 1626A, the arcuate support member 1626B, and the arcuate support member 1626C can be about equal to the diameter of the catheter 336 or can be larger so that an annular space can be provided between the catheter 336 and the members unless the catheter 336 bows out due to meeting resistance.

[0204] The force sensor 1630 can be configured to generate a force signal related to forces applied between the guide body (e.g., one or more of the arcuate support member 1626 A, the arcuate support member 1626B, and the arcuate support member 1626C) and the catheter 336 as the catheter 336 is moved through the mouthguard 1604. Embodiments could include any combination of strain-gauge (resistive), piezoelectric, capacitive, optical (IR or LED based), magnetic (Hall -effect), inductive, or MEMS force sensors. The force signals could be processed on the mouthguard 1604 or could be transmitted (by a wire or wirelessly) to a processor of the console 104 (or a similar console on one of the other systems).

[0205] In addition to the force sensors, the mouthguard 1604 can be equipped with an orientation signal generating device. For example, a visual fiducial 1632 can be disposed on the second side 1620. The visual fiducial 1632 can be an AruCo tag or an APRIL tag or any structural orienting discernable feature. The camera 1612 can capture an image of the mouthguard 1604 and of the visual fiducial 1632 and from the image determine an orientation of the mouthguard 1604 that can correspond to force signals that are generated by the mouthguard 1604. Other devices for generating orientation signals include IMUs and NDI sensors (magnetic sensors that can generate an output related to magnetic fields).

[0206] The one or more hardware processors can monitor or detect a force signal. The one or more hardware processors can control an actuator in response to monitoring of the force signal by maintaining a force level within, above, or below a threshold. The one or more hardware processors can generate an alarm in response to monitoring of the force signal by maintaining a force level within, above, or below a threshold. The forces can arise from anysource, including movement of the catheter 336 due to activating actuators of the TEE imaging system 300 and / or motion of the procedure table 120.

[0207] The one or more hardware processors can send a signal to the actuator to disengage (e.g., by clutch or solenoid) or to reduce the driving force of the actuator from the carriage 310 of the TEE imaging system 300. The carriage 310 can support the ultrasound probe, and disengaging the actuator from the carriage 310 can allow the carriage 310 to freely move along the support arm 308. The one or more hardware processors can send a signal to the actuator to engage the actuator with a carriage 310 of the TEE imaging system 300. Engaging the actuator can cause the carriage 310 to move in a direction corresponding to the direction of the movement of the procedure table 120. The movement countermeasure can cause at least a portion of the support arm 308 to move by a corresponding amount and in a corresponding direction to the movement of the procedure table 120. Movement of the support arm 308 relative to the procedure table 120 by the corresponding amount and in the corresponding direction can be a result of fixing a spatial arrangement of a linkage coupling the procedure table 120 to the support arm 308.

[0208] The system for coordinate positioning of a robotic ultrasound catheter and a procedure table 120 can be operated according to a method of operation. The method can include positioning a subject on a subject surface 128 of the procedure table 120. The method can include advancing a catheter 336 of the TEE probe assembly 306 into a mouth of the subject. The method can include supporting the TEE probe assembly 306 on a support arm 308. The method can include detecting initiation of movement of the subject surface 128 (e.g., movement of the subject surface 128 relative to the support arm 308). The method can include initiating a movement countermeasure in response to the detected initiation of movement of the subject surface 128 to constrain a change in relative position of the support arm 308 relative to the subject surface 128. The movement countermeasure can include issuing an alarm on a user interface directed to causing a user to cease the initiation of movement. The movement countermeasure can include engaging a kinetic connection between the support arm 308 and the subject surface 128.

[0209] The robotic TEE system can control a catheter 336 and a distal portion 326 of a TEE probe assembly 306 by way of force signals. The catheter 336 of the TEE probe assembly 306 can be positioned in the mouthguard 1604. The mouthguard 1604 can be coupledto a mouth of a subject, as seen in FIG. 3 A. The catheter 336 can be acted on or through while the catheter 336 is positioned in the mouthguard 1604. The action can be by an actuator of the support arm 308 or can be movement of the procedure table 120. The action can result in gross movement or a specific adjustment of at least one degree of freedom of the probe tip of the TEE probe assembly 306 within an esophagus of the subject.

[0210] A force signal, which can indicate zero force, can be generated by the force sensor 1630 disposed in the mouthguard 1604. The force signal can be generated w’hile an actuator of the support arm 308 is acting on or through the catheter 336 of the TEE probe assembly 306, The force signal can be generated while the procedure table 120 is moved relative to the support arm 308. A force level based on the force signal can be compared to a threshold. Based on the comparison, the actuator can allow for or provide further acting on or through the catheter 336 of the TEE probe assembly 306 responsive to comparing the force level to the threshold. The further acting can be at the same level, speed or magnitude, can be at a reduced level, speed or magnitude, or can be at an increased level, speed or magnitude. An orientation signal can be generated from the mouthguard 1604. This can be by a visual fiducial or other device as disclosed herein. A further acting on or through the catheter 336 of the TEE probe assembly 306 comprises further acting responsive to an orientation signal. The further acting can be based on the orientation of the mouthguard 1604 being within a threshold. The further acting can be based on the orientation of the mouthguard 1604 being above a threshold. The further acting can be based on the orientation of the mouthguard 1604 being below a threshold. The further acting can be at the same level, speed or magnitude, can be at a reduced level, speed or magnitude, or can be at an increased level, speed or magnitude.

[0211] In some embodiments, the system may correlate force signals from the mouthguard 1604 with pose information obtained from pose sensors (e.g., sensors 902, 904) to provide context-aware force thresholds. For example, the system may determine that certain poses of the probe tip correspond to anatomical regions where lower force thresholds are appropriate, such as when the distal portion 326 is flexed anteriorly toward the posterior wall of the esophagus. The system may automatically adjust the force thresholds applied to signals from the force sensor 1630 based on the current pose, thereby enabling more nuanced safety control. As one example, if the pose sensors 902, 904 indicate that the probe tip is oriented toward a transitional region of the esophagus, the processor may reduce the permissible forcetlireshold by a safety factor. This pose-correlated approach may provide enhanced subject safety compared to static force thresholds that do not account for probe orientation.

[0212] The load sensor 1602 and the force sensor 1630 of the mouthguard 1604 may be calibrated using pose information from the above-described pose sensors 902, 904 as a ground truth reference. During a calibration routine, the processor may cause translation of the TEE probe assembly 306 by a prescribed amount while simultaneously recording force signals from the load sensor 1602, force signals from the force sensor 1630, and pose changes from the pose sensors 902, 904, Discrepancies between commanded movement and actual pose change, as measured by the pose sensors 902, 904, may indicate tissue resistance, friction within the mouthguard lumen 1624, or mechanical compliance in the system. The processor may use these discrepancies to scale subsequent force estimates or to adjust control gams for the actuators. In this way, the pose sensors 902, 904 provide an independent measurement that validates or refines the force-based calibration described with respect to FIG. 15.

[0213] As described with respect to FIG. 9, adjustment of the knobs 332, 334 may not map precisely to the actual pose of the probe tip due to tissue resistance, cable slack, or hysteresis in the mechanical linkages. In some embodiments, the system 1600 may use the pose sensors 902, 904 to verify that commanded flexion or rotation has been achieved before proceeding with imaging or further navigation. For example, if the system instructs an anterior flexion via the control knobs, the pose sensors 902, 904 may confirm whether the probe tip has actually achieved that orientation. If the measured pose indicates a different degree of flexion, the system may issue additional commands to the actuators or may alert the medical professional via the user interface 1104 that the desired pose has not been reached. This closed- loop verification may be advantageous, as one example, when the catheter 336 is traversing the arcuate support members 1626A, 1626B, 1626C of the mouthguard 1604, where frictional forces may impede commanded movements.

[0214] In some embodiments, the system may use pose information from the pose sensors 902, 904 to guide navigation of the catheter 336 through the mouthguard 1604 and into the esophagus. As the catheter 336 advances through the lumen 1624 defined by the internal wall 1622, the pose sensors 902, 904 may provide real-time feedback regarding the orientation of the probe tip relative to the mouthguard 1604. The camera 1612 may capture images of the visual fiducial 1632 to establish the orientation of the mouthguard 1604 in a global referenceframe, and the system may transform the pose sensor measurements into this same reference frame. The system may then determine whether the probe tip is aligned with the lumen 1624 or whether corrective flexion is needed to avoid contact with the arcuate support members 1626A-1626C. This pose-guided navigation may reduce the forces applied to the mouthguard 1604 and to the subject's oral cavity.

[0215] A machine learning model, such as the model described above with respect to FIG. 13, may receive pose information as an additional input feature. In some embodiments, the model may receive not only the current pose from the pose sensors 902, 904 but also derivatives of the pose, such as angular velocity of the probe tip during flexion or rotation maneuvers. These pose deri vatives may improve the accuracy of the estimated force 1402 by accounting for dynamic effects that occur during rapid probe movements. For example, rapid anterior flexion may generate inertial forces that are distinct from the steady-state tissue resistance forces, and the model may learn to distinguish these contributions based on the pose derivative inputs. The enhanced force model may provide more accurate real-time feedback to the medical professional via the user interface 1104.

[0216] In some embodiments, the processor may record a time series of pose measurements from the pose sensors 902, 904 along with corresponding force measurements from the load sensor 1602 and the force sensor 1630. This combined dataset may be stored to create a spatial map of forces experienced throughout the procedure. The spatial map may indicate, for example, that higher forces were encountered at a particular depth and orientation within the esophagus. This information may be valuable for procedure documentation, for training purposes, or for refining force thresholds for subsequent procedures on the same subject. The user interface 1104 may present a graphical representation of the spatial force map overlaid on an anatomical model.

[0217] The pose sensors 902, 904 may serve as a redundant safety mechanism that operates independently of the force sensors. In some embodiments, the processor may monitor the rate of change of pose and may halt probe movement if the pose changes unexpectedly, even if the force sensors do not indicate an excessive force. For example, a sudden change in orientation detected by the pose sensors 902, 904 may indicate that the probe tip has encountered an obstruction or has slipped, and the processor may halt movement and alert the medical professional before damage occurs. This redundant monitoring may enhance theoverall safety of the robotic TEE system by providing multiple independent indicators of potentially hazardous conditions.VI. EXAMPLE IMPLEMENTATIONS

[0218] Examples of the implementations of the present disclosure can be described in view of the following example clauses. The features recited in the below example implementations can be combined with additional features disclosed herein. Furthermore, additional inventive combinations of features are disclosed herein, which are not specifically recited in the below example implementations, and which do not include the same features as the specific implementations below. For sake of brevity, the below example implementations do not identify every inventive aspect of this disclosure. The below example implementations are not intended to identify key features or essential features of any subject matter described herein. Any one or more features of one of the example clauses listed below can be combined by any of the one or more features of any one or more other example clauses listed below or any of the features described herein.

[0219] Clause 1. A method, comprising:advancing a TEE probe into a subject to a prescribed position in an esophagus of a subject;moving the TEE probe relative to the prescribed position by a prescribed amount; andestimating a subject tissue resistance based on a load required for moving the TEE probe by the prescribed amount.

[0220] Clause 2. The method of clause 1, further comprising moving the TEE probe from a first position to a second position by applying a load greater than the subject tissue resistance.

[0221] Clause 3. The method of any one of Clauses 1-2, further comprising moving the TEE probe from a first position to a second position by applying a load exceeding the subject tissue resistance by less than a safety factor.

[0222] Clause 4. The method of any one of Clauses 1-3, wherein the prescribed position comprises an internal home position of a navigation reference frame.

[0223] Clause 5. The method of any one of Clauses 1-4, wherein the prescribed position comprises a position capable of imaging a four-chamber view of a heart or the subject.

[0224] Clause 6. The method of any one of Clauses 1-5, wherein moving the TEE probe relative to the prescribed position by a prescribed amount comprises moving the TEE probe distally from a home position of a navigation reference frame.

[0225] Clause 7. The method of Clause 6, wherein moving the TEE probe distally comprises moving by a standardized distance.

[0226] Clause 8. The method of any one of Clauses 6-7, wherein moving the TEE probe distally comprises moving from the home position to an adjacent standardized imaging position.

[0227] Clause 9. The method of any one of Clauses 1-8, wherein moving the TEE probe relative to the prescribed position by a prescribed amount comprises moving the TEE probe proximally from a home position of a navigation reference frame by standardized distance.

[0228] Clause 10. The method of Clause 9, wherein moving the TEE probe proximally comprises moving by a standardized distance.

[0229] Clause 11. The method of any one of Clauses 9-10, wherein moving the TEE probe proximally comprises moving from the home position to an adjacent standardized imaging position.

[0230] Clause 12. The method of any one of Clauses 1-11, wherein moving the TEE probe relative to the prescribed position by a prescribed amount comprises rotating the IEE probe about a longitudinal axis thereof by a standardized angular displacement while an imaging element thereof is disposed at a home position of a navigation reference frame.

[0231] Clause 13. The method of any one of Clauses 1-12, wherein moving the IEE probe relative to the prescribed position by a prescribed amount comprises at least one of linearly translating, rotating, angulating anteriorly, angulating posteriorly, angulating in a first direction in a medial-lateral plane, and angulating in a second direction in a medial-lateral plane.

[0232] Clause 14. The method of any one of Clauses 1-13, further comprising navigating the TEE probe relative to the prescribed position by applying a load adjusted by a factor based on the estimated subject tissue resistance.

[0233] Clause 15. The method of any one of Clauses 1-14, further comprising navigating the TEE probe relative to the prescribed position by activating an actuator to move the TEE probe a distance adjusted by a factor based on the estimated subject tissue resistance.

[0234] Clause 16. A robotic transesophageal echocardiography imaging apparatus, comprising:a robotic support structure;a carriage movably mounted to the robotic support structure:an actuator configured to provide for movement of the carriage; and one or more hardware processors configured to:move a TEE probe within a subject relative to a prescribed position of an esophagus of a subject by a prescribed amount;estimate a subject tissue resistance based on a load required for moving the TEE probe by the prescribed amount; andstore a scaling factor based on the estimated subject tissue resistance.

[0235] Clause 17. A system comprising:a transesophageal echocardiogram (TEE) probe fixture configured to be positioned on a tip of a TEE probe, the TEE probe fixture having one or more pose sensors; anda TEE controller, the TEE controller configured to robotically control movement of the probe, wherein the TEE controller is configured to determine a pose associated with the TEE probe based on the one or more pose sensors.

[0236] Clause 18. The system of Clause 17, wherein the TEE controller is configured to adjust one or more dials of the TEE probe, the dials enabling adjustment of rotation and / or flexion of the TEE probe.

[0237] Clause 19. The system of any one of Clauses 17-18, wherein the TEE probe fixture includes two pose sensors.

[0238] Clause 20. The system of any one of Clauses 17-19, wherein the one or more pose sensors are electromagnetic sensors which respond to one or more changing magnetic fields.

[0239] Clause 21. The system of any one of Clauses 17-20, wherein the pose is configured for use in determining whether movements of the probe correspond to the determined pose.

[0240] Clause 22. The system of any one of Clauses 17-20, wherein the one or more pose sensors include two pose sensors, and wherein to determine the pose, the TEE controller is configured to:obtain, via the pose sensors, sensor measurements associated with the tip of the TEE probe;determine a mid-point transformation associated with the two pose sensors; determine an offset associated with the pose, the offset reflecting an offset from a mid-point of the two pose sensors to an ultrasound sensor of the TEE probe; and obtain the pose based on projection of the mid-point transformation through the offset.

[0241] Clause 23. The system of any one of Clauses 17-22, wherein the one or more pose sensors are configured for use in calibration of the TEE controller in response to measures of force reflecting insertion force of the TEE probe.

[0242] Clause 24. The system of any one of Clauses 17-23, wherein the TEE controller outputs information for inclusion in a user interface, and wherein the information includes the pose.

[0243] Clause 25. The system of Clause 24, wherein the user interface is configured to present a graphical representation of the pose and a graphical representation of a portion of a heart.

[0244] Clause 26. A method implemented by a robotic TEE controller, the method comprising:obtaining sensor information from one or more pose sensors included on a TEE probe fixture that’s positioned on a tip of a TEE probe; anddetermining pose associated with the pose sensors, wherein the TEE controller is configured to robotically control movement of the TEE probe.

[0245] Clause 27. The method of any one of Clauses 24-25, wherein the TEE controller is configured to adjust one or more dials of the TEE probe, the dials enabling adjustment of rotation and / or flexion of the TEE probe.Clause 28. The method of any one of Clauses 24-25 and 27, wherein the TEE probe fixture includes two pose sensors.

[0246] Clause 29. The method of any one of Clauses 24-25 and 27-28, wherein the one or more pose sensors are electromagnetic sensors which respond to one or more changing magnetic fields.

[0247] Clause 30. The method of any one of Clauses 24-25 and 27-29, wherein the pose is configured for use in determining whether movements of the probe correspond to the determined pose.

[0248] Clause 31. The method of any one of Clauses 24-25 and 27-30, wherein the one or more pose sensors include two pose sensors, and wherein determining the pose comprises:determining a mid-point transformation associated with the two pose sensors based on the sensor information;determining an offset associated with the pose, the offset reflecting an offset from a mid-point of the two pose sensors to an ultrasound sensor of the TEE probe; and obtaining the pose based on projection of the mid-point transformation through the offset.

[0249] Clause 32. The method of Clause 31, wherein the one or more pose sensors are configured for use in calibration of the TEE controller in response to measures of force reflecting insertion force of the TEE probe.

[0250] Clause 33. The method of any one of Clauses 24-25 and 27-30, wherein the TEE controller outputs information for inclusion in a user interface, and wherein the information includes the pose.

[0251] Clause 34. The method of Clause 33, wherein the user interface is configured to present a graphical representation of the pose and a graphical representation of a portion of a heart.

[0252] Clause 35. A system comprising:one or more pose sensors configured for to be positioned at an end of a transesophageal echocardiogram (TEE) probe; anda processor, the processor configured to robotically control movement of the probe, wherein the processor is configured to determine a pose associated with the TEE probe based on the one or more pose sensors.

[0253] Clause 36. A software controlled TEE probe with one or more pose sensors at an end of the TEE probe.

[0254] Clause 37, A system comprising:a transesophageal echocardiogram (TEE) controller, wherein the TEE controller is configured to robotically control movement of the probe, wherein the TEE controller is in communication with a motor that is configured to adjust translation of the probe; andat least one sensor positioned on a guide, the guide adjusting an angle of the TEE probe downwards towards a subject, and the at least one sensor measuring a guide force,wherein the TEE controller is configured to determine an estimated force associated with insertion of the probe into a mouth of the subject.

[0255] Clause 38. The system of Clause 37, wherein the TEE controller controls translation, flexion, and rotation of the probe.

[0256] Clause 39. The system of any one of Clauses 37-38, wherein the TEE controller determines the estimated force based on motor current associated with the motor as an estimate of force associated with translation of the probe towards the guide.

[0257] Clause 40. The system of any one of Clauses 37-39, wherein the TEE controller is configured to adjust operation based on the estimated force.

[0258] Clause 41. The system of Clause 40, wherein adjusting operation includes stopping movement of the probe.

[0259] Clause 42. The system of any one of Clauses 40-41, wherein adjusting operation includes causing the probe to go limp.

[0260] Clause 43. The system of any one of Clauses 40-42, wherein adjusting operation includes outputting an alert to a medical professional.

[0261] Clause 44. The system of any one of Clauses 37-43, wherein determining the estimated force is based on, at least, input of the guide force and motor current into a machine learning model.

[0262] Clause 45. The system of Clause 44, wherein determining the estimated force is further based on input of position and velocity associated with the probe.

[0263] Clause 46. The system of Clause 45, wherein position indicates pose of a tip of the probe.

[0264] Clause 47. The system of any one of Clauses 44-46, wherein the machine learning model is a regression model.

[0265] Clause 48. The system of any one of Clauses 37-47, wherein the TEE controller outputs information for inclusion in a user interface, and wherein the information includes a graphical representation associated with estimated force.

[0266] Clause 49. The system of Clause 48, wherein the graphical representation includes one or more markers indicative of force thresholds.

[0267] Clause 50. The system of any one of Clauses 48-49, wherein the TEE controller is configured to output an alert for inclusion in the user interface reflecting that the estimated force has exceeded a threshold.Clause 51. The system of any one of Claims 37-50, wherein the estimated force and one or more poses associated with a tip of the probe are used for calibration of the TEE controller.

[0268] Clause 52. A method implemented by a TEE controller of one or more processors, the method comprising:controlling movement of a TEE probe, wherein the TEE controller is in communication with a motor that is configured to adjust translation of the probe; and obtaining a measurement of guide force from at least one sensor positioned on a guide, the guide adjusting an angle of the TEE probe downwards towards a subject; anddetermining an estimated force associated with insertion of the probe into a mouth of the subject.

[0269] Clause 53. The method of Clause 52, wherein the TEE controller controls translation, flexion, and rotation of the probe.

[0270] Clause 54. The method of any one of Clauses 52-53, wherein the estimated force is based on a measure of motor current associated with the motor.

[0271] Clause 55. The method of any one of Clauses 52-54, further comprising adjusting operation based on the estimated force.

[0272] Clause 56. The method of Clause 55, wherein adjusting operation includes stopping movement of the probe.

[0273] Clause 57. The method of any one of Claims 55-56, wherein adjusting operation includes causing the probe to go limp.

[0274] Clause 58. The method of any one of Clauses 55-57, wherein adjusting operation includes outputting an alert to a medical professional.

[0275] Clause 59. The method of any one of Clauses 52-58, wherein determining the estimated force is based on, at least, input of the guide force and motor current into a machine learning model.

[0276] Clause 60. The method of Clause 59, wherein determining the estimated force is further based on input of position and velocity associated with the probe.

[0277] Clause 61. The method of Clause 60, wherein position indicates pose of a tip of the probe.

[0278] Clause 62. The method of any one of Clauses 59-61, wherein the machine learning model is a regression model.

[0279] Clause 63. The method of any one of Clauses 52-62, wherein the TEE controller outputs information for inclusion in a user interface, and wherein the information includes a graphical representation associated with estimated force.

[0280] Clause 64. The method of Clause 63, wherein the graphical representation includes one or more markers indicative of force thresholds.

[0281] Clause 65. The method of any one of Clauses 63-64, wherein the TEE controller is configured to output an alert for inclusion in the user interface that the estimated force has exceeded a threshold.

[0282] Clause 66. The method of any one of Clauses 52-64, w’herein the estimated force and one or more poses associated with a tip of the probe are used for calibration of the TEE controller.

[0283] Clause 67. A method implemented by a system of one or more processors, the system configured to control movement of a TEE probe and the method comprising:determining an estimate force associated with the TEE probe; and adjusting operation based on the estimated force.

[0284] Clause 68. The method of claim 67, wherein the estimated force is a force associated with insertion into a subject.

[0285] Clause 69. The method of any one of Clauses 67-68, wherein the force is indicative of force applied to an interior of a subject.

[0286] Clause 70. The method of any one of Clauses 67-69, wherein adjusting operation includes adjusting movement or stopping movement of the TEE probe.

[0287] Clause 71, The method of any one of Clauses 67-70, wherein the method further comprises causing presentation, via a user interface, of a graphical representation associated with the estimated force.

[0288] Clause 72. A system for robotic control of a TEE catheter having a probe tip, the system comprising:a mouthguard comprising a projection having an internal wall defining a lumen, a guide body disposed in the lumen, and a force sensor coupled to the guide body, the guide body configured to guide a catheter of an ultrasound probe through the mouthguard and into a mouth of a subject; anda robotic transesophageal echocardiography imaging ( TEE) system comprising: a support arm assembly configured to support the catheter of the ultrasound probe; andan actuator configured adjust at least one degree of freedom of the probe tip by acting on or through the catheter;wherein the force sensor configured to generate a force signal related to forces applied between the guide body and the catheter as the catheter is moved through the mouthguard.

[0289] Clause 73. The system of Clause 72, wherein the mouthguard comprises a lateral member having a first side configured to overlay skin around a mouth of a subject, a second side opposite the first side, and a visual fiducial disposed on the second side of the lateral member.

[0290] Clause 74. The system of Clause 73, further comprising a camera coupled with the robotic TEE system, the camera configured to capture images of the visual fiducial disposed on the second side of the lateral member of the mouthguard.

[0291] Clause 75. The system of Clause 74, wherein the camera is mounted to the support arm assembly of the robotic TEE system.

[0292] Clause 76. The system of Clause 73, wherein the visual fiducial compromises an APRIL tag.

[0293] Clause 77. The system of any one of Clauses 72-76, wherein the robotic TEE system is configured to monitor the force signal while operating the actuator to control the forces acting on or through the TEE catheter such that loads applied to the mouthguard are maintained below a threshold.

[0294] Clause 78. The system of any one of Clauses 72-77, wherein the system further comprises one or more hardware processors configured to:monitor the force signal; andcontrol the actuator or generate an alarm in response to monitoring of the force signal by maintaining a force level within a threshold.

[0295] Clause 79. The system of any one of Clauses 72-78, wherein the guide body comprises an arcuate support member.

[0296] Clause 80. The system of Clause 79, wherein the arcuate support member comprises a first arcuate support member spanning an arc of less than 360 degrees and further comprising a second arcuate support member spanning an arc of less than 360 degrees disposed adjacent to the first arcuate support member.

[0297] Clause 81. The system of Clause 80, further comprising a third arcuate support member, wherein each of the first arcuate support member, the second arcuate support member and the third arcuate support member spanning 120 degrees.

[0298] Clause 82. The system of Clause 81, wherein each of the first arcuate support member, the second arcuate support member and the third arcuate support member is coupled to the internal wall of the projection by a radial support extending from the internal wall, each radial support comprising a force sensor configured to generate a force signal related to forces applied to a corresponding arcuate support.

[0299] Clause 83. A mouthguard for use in a transesophageal echocardiography imaging (TEE) procedure, comprising a projection having an internal wall defining a lumen, a guide body disposed in the lumen, and a force sensor coupled to the guide body, the guide body configured to guide a catheter of an ultrasound probe through the mouthguard and into a mouth of a subject.

[0300] Clause 84. The mouthguard of Clause 83, wherein the guide body comprises an arcuate support member.

[0301] Clause 85, The mouthguard of Clause 84, wherein the arcuate support member comprises a first arcuate support member spanning an arc of less than 360 degrees and further comprising a second arcuate support member spanning an arc of less than 360 degrees disposed adjacent to the first arcuate support member.

[0302] Clause 86. The mouthguard of Clause 84, further comprising a third arcuate support member, wherein each of the first acute support member, the second arcuate support member, and the third arcuate support member spanning 120 degrees.

[0303] Clause 87. The mouthguard of Claim 86, wherein each of the first arcuate support member, the second arcuate support member and the third arcuate support member is coupled to the internal wall of the projection by a radial support extending from the internal wall, each radial support comprising a force sensor configured to generate a force signal related to forces applied to a corresponding arcuate support.

[0304] Clause 88. The mouthguard of any one of Clauses 83-87, further comprising a fiducial configured to indicate orientation of the mouthguard.

[0305] Clause 89. A method of operating a robotic transesophageal echocardiography imaging (TEE) system to control a catheter and a probe tip of a TEE assembly comprising:positioning a catheter of a TEE probe assembly in a mouthguard, the mouthguard coupled to a mouth of a subject;acting on or through the catheter of the TEE probe assembly positioned in the mouthguard to adjust at least one degree of freedom of the probe tip of the TEE probe assembly within an esophagus of the subject;monitoring a force signal (can be zero) generated by a force sensor disposed in the mouthguard while acting on or through the catheter of the TEE probe assembly;comparing a force level based on the force signal to a threshold; and further acting on or through the catheter of the TEE probe assembly responsive to comparing the force level to the threshold.

[0306] Clause 90. The method of Clause 89, wherein further acting on or through the catheter of the TEE probe assembly responsive to comparing the force level to the threshold comprises further acting on or through the catheter at a same level if the force level is below the threshold.

[0307] Clause 91, The method of any one of Clauses 89-90, wherein further acting on or through the catheter of the TEE probe assembly responsive to comparing the force level to the threshold comprises further acting on or through the catheter at a reduced level if the force level is at or above the threshold.

[0308] Clause 92. The method of any one of Clauses 89-91, wherein monitoring the force signal generated by a force sensor comprises monitoring a first force signal generated by a first force sensor and further comprising monitoring a second force signal from a second force sensor disposed in the mouthguard while acting on or through the catheter of the TEE probe assembly.

[0309] Clause 93. The method of any one of Clauses 89-92, further generating an orientation signal from the mouthguard and wherein further acting on or through the catheter of the TEE probe assembly comprises further acting responsive to an orientation signal.

[0310] Clause 94. The method of any one of Clauses 89-93, wherein the orientation signal is generated from an image of a visual fiducial taken by a camera of the robotic TEE system.

[0311] Clause 95. A system for robotic control of a TEE catheter, the system comprising:

[0312] a mouthguard comprising:a lateral member having a first side configured to overlay skin around a mouth of a subject and a second side opposite the first side;a projection having an internal wall defining a lumen, the mouthguard further comprising:an arcuate support member disposed in the lumen;a radial support extending from the internal wall, the radial support comprising a force sensor configured to generate a force signal related to forces applied to the arcuate support; anda visual fiducial disposed on the second side of the lateral member; and a robotic transesophageal echocardiography imaging (TEE) system comprising:an ultrasound probe comprising a catheter body and a probe tip;a support arm assembly configured to support the catheter body of the ultrasound probe; andan actuator configured adjust at least one degree of freedom of the probe tip by acting on or through the catheter body to relative to the support arm; wherein the robotic TEE system is configured to monitor the force signal while operating the actuator to control the acting on or through the catheter body such that loads applied to the mouthguard are maintained below a threshold.

[0313] Clause 96. The system of Clause 95, wherein the visual fiducial comprises an APRIL tag disposed on the second side of the lateral member and the system further comprises a camera configured to capture an image of the APRIL tag.

[0314] Clause 97. The system of Clause 96, wherein the camera is mounted to the support arm assembly of the robotic TEE system.

[0315] Clause 98. The system of any one of Clauses 95-97, wherein the arcuate support member comprises a first arcuate support member spanning an arc of less than 360 degrees and further comprising a second arcuate support member spanning an arc of less than 360 degrees disposed adjacent to the first arcuate support member.

[0316] Clause 99. The system of Clause 98, further comprising a third arcuate support member, wherein each of the first arcuate support member, the second arcuate support member and the third arcuate support member spanning 120 degrees.

[0317] Clause 100. The system of Clause 99, wherein each of the first arcuate support member, the second arcuate support member and the third arcuate support member is coupled to the internal wall of the projection by a radial support extending from the internal wall, each radial support comprising a force sensor configured to generate a force signal related to forces applied to the corresponding arcuate support.

[0318] Clause 101. A method for controlling a transesophageal echocardiography (TEE) probe, comprising:advancing a TEE probe through an esophagus of a subject to a prescribed position within the subject;moving the TEE probe relative to the prescribed position by a prescribed amount;measuring a load required to move the TEE probe by the prescribed amount; estimating a subject tissue resistance based on the measured load; and controlling a subsequent movement of the TEE probe based on the estimated subject tissue resistance.

[0319] Clause 102. The method of Clause 101, wherein controlling the subsequent movement comprises applying a scaling factor to a navigation command, wherein the scaling factor is based on the estimated subject tissue resistance.

[0320] Clause 103. The method of any one of Clauses 101-102, wherein the prescribed amount of movement comprises a standardized linear translation or a standardized angular rotation performed while an imaging element of the TEE probe is disposed at a home position.

[0321] Clause 104. The method of any one of Clauses 101-103, wherein moving the TEE probe relative to the prescribed position comprises moving the TEE probe from a mid-esophageal position toward a gastric position or an upper esophageal position.

[0322] Clause 105. The method of any one of Clauses 101-104, wherein measuring the load comprises monitoring an electrical current of a motor configured to drive the TEE probe or monitoring a signal from a force sensor coupled to the TEE probe.

[0323] Clause 106. The method of any one of Clauses 101-105, further comprising comparing the measured load to a safety threshold and ceasing movement if the measured load exceeds the safety threshold.

[0324] Clause 107. A robotic transesophageal echocardiography (TEE) imaging system, comprising:a robotic support structure;a carriage movably mounted to the robotic support structure and configured to couple with a handle of a TEE probe;an actuator configured to move the carriage; andone or more hardware processors configured to:cause the actuator to move the TEE probe through an esophagus of a subject to a prescribed position within the subject;cause the actuator to move the TEE probe relative to the prescribed position by a prescribed test amount;determine a resistance value based on a force required to achieve the prescribed test amount; andadjust a control parameter for subsequent navigation of the TEE probe based on the determined resistance value.

[0325] Clause 108. The system of Clause 107, wherein the one or more hardware processors are further configured to calculate the force required based on a current drawn by the actuator.

[0326] Clause 109, The system of any one of Clauses 107-108, further comprising a load sensor disposed on the robotic support structure, wherein the processor is configured to determine the resistance value based on input from the load sensor.

[0327] Clause 110. The system of any one of Clauses 107-109, wherein the carriage comprises a drive mechanism configured to rotate a control knob of the TEE probe, and wherein the actuator is further configured to actuate the drive mechanism.

[0328] Clause 111. The system of any one of Clauses 107-110, wherein the one or more hardware processors are further configured to detect an initiation of movement of a subject table and, in response, trigger a movement countermeasure to constrain relative motion between the robotic support structure and the subject table.

[0329] Clause 112. A mouthguard for use in a transesophageal echocardiography ( TEE) procedure, comprising:a main body having a projection configured to extend into a mouth of a subject; an internal wall within the projection defining a lumen sized to receive a catheter of a TEE probe;a guide body disposed within the lumen and configured to contact the catheter; anda force sensor coupled to the guide body and configured to generate a signal indicative of a force applied by the catheter against the guide body.

[0330] Clause 113. The mouthguard of Clause 112, wherein the guide body comprises at least one arcuate support member suspended within the lumen by a radial support.

[0331] Clause 114. The mouthguard of any one of Clauses 112-113, wherein the force sensor is disposed on the radial support.

[0332] Clause 115. The mouthguard of any one of Clauses 112-114, further comprising a visual fiducial disposed on an exterior surface of the main body, the visual fiducial configured to be readable by an optical camera to determine an orientation of the mouthguard.

[0333] Clause 116, The mouthguard of any one of Clauses 112-115, wherein the guide body comprises a plurality of independent support members, and wherein the force sensor comprises a plurality of sensors configured to detect force in multiple vectors.

[0334] Clause 117, A system for determining a pose of a transesophageal echocardiography (TEE) probe, comprising:a probe fixture configured to couple to a distal tip of a TEE probe, the fixture comprising a plurality of electromagnetic pose sensors; and a processor configured to:receive spatial data from the plurality of electromagnetic pose sensors; calculate a midpoint transformation based on the spatial data; apply an offset vector representing a distance between the midpoint transformation and an imaging element of the TEE probe; and determine a calculated pose of the imaging element based on the midpoint transformation and the offset vector.

[0335] Clause 118. The system of Clause 117, wherein the processor is further configured to compare the calculated pose of the imaging element to an expected pose based on a control input, and to calibrate a control mapping based on a difference between the calculated pose and the expected pose.

[0336] Clause 119. The system of any one of Clauses 117-118, wherein the processor is configured to generate a graphical user interface displaying a 3D model of the TEE probe within a subject anatomy based on the determined calculated pose.VII. OTHER VARIATIONS

[0337] While certain embodiments of the disclosed technology have been described, these embodiments have been presented by way of example only and are not intended to limit the scope of the disclosure. Indeed, the novel methods and systems described herein may be embodied in a variety of other forms. Furthermore, various omissions, substitutions and changes in the systems and methods described herein may be made without departing from the spirit of the disclosure. The accompanying claims and their equivalents are intended to cover such forms or modifications as would fall within the scope and spirit of the disclosure. Accordingly, the scope of the disclosed technology is defined only by reference to the appended claims and their equivalents.

[0338] Features, materials, characteristics, or groups described in conjunction with a particular aspect, embodiment, or example are to be understood to be applicable to any other aspect, embodiment or example described in this section or elsewhere in this specification unless incompatible therewith. All of the features disclosed in this specification (including any accompanying claims, abstract and drawings), and / or all of the steps of any method or process so disclosed, may be combined in any combination, except combinations where at least some of such features and / or steps are mutually exclusive. The protection is not restricted to the details of any foregoing embodiments. The protection extends to any novel one, or any novel combination, of the features disclosed in this specification (including any accompanying claims, abstract and drawings), or to any novel one, or any novel combination, of the steps of any method or process so disclosed.

[0339] Furthermore, certain features that are described in this disclosure in the context of separate implementations can also be implemented in combination m a single implementation. Conversely, various features that are described in the context of a single implementation can also be implemented in multiple implementations separately or in any suitable sub-combination. Moreover, although features may be described above as acting in certain combinations, one or more features from a claimed combination can, in some cases, be excised from the combination, and the combination may be claimed as a sub-combination or variation of a sub-combination.

[0340] Moreover, while operations may be depicted in the drawings or described in the specification in a particular order, such operations need not be performed in the particularorder shown or m sequential order, or that all operations be performed, to achieve desirable results. Other operations that are not depicted or described can be incorporated in the example methods and processes. For example, one or more additional operations can be performed before, after, simultaneously, or between any of the described operations. Further, the operations may be rearranged or reordered in other implementations. Those skilled in the art will appreciate that in some embodiments, the actual steps taken in the processes illustrated and / or disclosed may differ from those shown in the figures. Depending on the embodiment, certain of the steps described above may be removed, others may be added. Furthermore, the features and attributes of the specific embodiments disclosed above may be combined in different ways to form additional embodiments, all of which fall within the scope of the present disclosure. Also, the separation of various system components in the implementations described above should not be understood as requiring such separation in all implementations, and it should be understood that the described components and systems can generally be integrated together in a single product or packaged into multiple products.

[0341] For purposes of this disclosure, certain aspects, advantages, and novel features are described herein. Not necessarily all such advantages may be achieved in accordance with any particular embodiment. Thus, for example, those skilled in the art will recognize that the disclosure may be embodied or carried out in a manner that achieves one advantage or a group of advantages as taught herein without necessarily achieving other advantages as may be taught or suggested herein.

[0342] Conditional language, such as “can,” “could,” “might,” or “may,” unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that certain embodiments include, while other embodiments do not include, certain features, elements, and / or steps. Thus, such conditional language is not generally intended to imply that features, elements, and / or steps are in any way required for one or more embodiments or that one or more embodiments necessarily include logic for deciding, with or without user input or prompting, whether these features, elements, and / or steps are included or are to be performed in any particular embodiment.

[0343] Conjunctive language such as the phrase “at least one of X, Y, and Z,” unless specifically stated otherwise, is otherwise understood with the context as used in general to convey that an item, term, etc. may be either X, Y, or Z. Thus, such conjunctive language isnot generally intended to imply that certain embodiments require the presence of at least one of X, at least one of Y, and at least one of Z.

[0344] Language of degree used herein, such as the terms “approximately,” “about,” “generally,” and “substantially” as used herein represent a value, amount, or characteristic close to the stated value, amount, or characteristic that still performs a desired function or achieves a desired result. For example, the terms “approximately”, “about”, “generally,” and “substantially” may refer to an amount that is within less than 10% of, within less than 5% of, within less than 1% of, within less than 0.1% of, and within less than 0.01% of the stated amount. As another example, in certain embodiments, the terms “generally parallel” and “substantially parallel” refer to a value, amount, or characteristic that departs from exactly parallel by less than or equal to 15 degrees, 10 degrees, 5 degrees, 3 degrees, 1 degree, or 0.1 degree,

[0345] The scope of the present disclosure is not intended to be limited by the specific disclosures of preferred embodiments in this section or elsewhere in this specification and may be defined by claims as presented in this section or elsewhere in this specification or as presented in the future. The language of the claims is to be interpreted broadly based on the language employed in the claims and not limited to the examples described in the present specification or during the prosecution of the application, which examples are to be construed as non-exclusive.

[0346] Of course, the foregoing description is that of certain features, aspects, and advantages of the disclosed technology, to which various changes and modifications can be made wdthout departing from the spirit and scope of the disclosed technology. Moreover, the devices described herein need not feature all of the objects, advantages, features and aspects discussed above. Thus, for example, those of skill in the art will recognize that the disclosed technology can be embodied or carried out in a manner that achieves or optimizes one advantage or a group of advantages as taught herein without necessarily achieving other objects or advantages as may be taught or suggested herein. In addition, while a number of variations of the disclosed technology have been shown and described in detail, other modifications and methods of use, which are within the scope of the disclosed technology, will be readily apparent to those of skill in the art based upon this disclosure. It is contemplated that various combinations or sub-combinations of these specific features and aspects of embodiments maybe made and still fall within the scope of the disclosed technology. Accordingly, it should be understood that various features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the discussed apparatuses and methods.

Claims

WHAT IS CLAIMED IS:

1. A robotic transesophageal echocardiography (TEE) system comprising:a TEE probe assembly:a robotic support structure configured to support the TEE probe, the robotic support structure comprising:a memory configured to store instructions;a processor in electrical communication with the memory and configured to execute the instructions; anda load sensor positioned at a distal end of the robotic support structure and in electrical communication with the processor;a probe guide coupled to the load sensor and configured to support the TEE probe; anda mouthguard comprising an opening configured to receive the TEE probe assembly of the TEE probe and a force sensor coupled to the opening and in electrical communication with the processor;wherein the instructions are configured to:advance a TEE probe through an esophagus of a subject to a prescribed position within the subject;calibrate the TEE probe assembly;determine a pose of the TEE probe assembly;move the TEE probe assembly relative to the prescribed position by a prescribed amount; andestimate a subject tissue resistance based on a measured force.

2. The robotic TEE system of Claim 1, wherein the TEE probe assembly comprises:a handle comprising one or more control knobs;a catheter extending distally from the handle, wherein the catheter is configured to be controlled by the one or more control knobs; anda TEE probe located at a distal end of the catheter.

3. The robotic TEE system of any one of Claims 1 -2, wherein the robotic support structure further comprises a support arm and a carriage configured to translate along the support arm, wherein the carriage is configured to receive a portion of the TEE probe assembly.

4. The robotic TEE system of Claim 3, wherein the carriage is configured to rotate the TEE probe assembly.

5. The robotic TEE system of any one of Claims 1-4, wherein the TEE probe assembly comprises a sheath disposed around a TEE probe and one or more pose sensors disposed in the sheath.

6. The robotic TEE system of any one of Claims 1-5, wherein advancing the TEE probe assembly to the prescribed position in the esophagus of the subject comprises axially moving the TEE probe assembly toward the subject.

7. The robotic TEE system of any one of Claims 1-6, wherein calibrating the TEE probe assembly comprises:contacting the TEE probe assembly with an anterior side of the esophagus; generating an ultrasound image of a heart of the subject;storing a configuration of the TEE probe assembly in response to generating the ultrasound image of the heart of the subject;actuating the TEE probe assembly by a prescribed amount; and estimating a subject tissue resistance.

8. The robotic TEE system of any one of Claims 1-7, wherein determining a pose of the TEE probe comprises:obtaining sensor measurements associated with a tip of the TEE probe assembly;determining a mid-point transformation associated with the tip of the TEE probe assembly;determining an offset associated with the pose; andobtaining a pose based on projection of the mid-point transformation through the offset.

9. A method, comprising:advancing a robotic transesophageal echocardiography (TEE) probe to a prescribed position in an esophagus of a subject;calibrating the TEE probe;determining a pose of the TEE probe;moving the TEE probe relative to the prescribed position by a prescribed amount; andestimating a subject tissue resistance based on a measured force.

10. The method of Claim 9, wherein advancing the TEE probe to the prescribed position in the esophagus of the subject comprises axially moving the TEE probe toward the subject.

11. The method of any one of Claims 9-10, wherein the TEE probe comprises a handle disposed within a carriage movably disposed along a support arm, wherein the carriage is configured to axially translate and rotate the TEE probe.

12. The method of Claim 11, wherein advancing the TEE probe to the prescribed position in the esophagus of the subject comprises axially translating the carriage along the support arm.

13. The method of any one of Claims 9-12, wherein the prescribed position is a mid-esophageal position such that a distal portion of the TEE probe is directed toward a heart of the subject.

14. The method of Claim 9, w'herein calibrating the TEE probe comprises:contacting the TEE probe with an anterior side of the esophagus; generating an ultrasound image of a heart of the subject;storing a configuration of the TEE probe in response to generating the ultrasound image of the heart of the subject;actuating the TEE probe by a prescribed amount; andestimating a subject tissue resistance.

15. The method of Claim 14, wherein estimating the subject tissue resistance comprises observing a movement of the TEE probe.

16. The method of Claim 15, wherein the amount of movement can be detected by a linear scale provided on the TEE probe.

17. The method of Claim 14, wherein the subject tissue resistance can be determined by comparing an actual movement with a predicted movement based on monitoring the TEE probe.

18. The method of any one of Claims 9-17, wherein determining a pose of the TEE probe comprises:obtaining sensor measurements associated with a tip of the TEE probe; determining a mid-point transformation associated with the tip of the TEE probe;determining an offset associated with the pose; andobtaining a pose based on projection of the mid-point transformation through the offset.

19. A robotic transesophageal echocardiography (TEE) system comprising:a memory configured to store instructions, wherein the instructions are configured to:advance a TEE probe through an esophagus of a subject to a prescribed position within the subject;calibrate the TEE probe;determine a pose of the TEE probe;move the TEE probe relative to the prescribed position by a prescribed amount; andestimate a subject tissue resistance based on a measured force; and a processor in electrical communication with the memory and configured to execute the instructions.

20. The robotic TEE system of Claim 19, wherein advancing the TEE probe through the esophagus of a subject to the prescribed position within the subject comprises axially moving the TEE probe toward the subject.

21. The robotic TEE system of any one of Claims 19-20, wherein calibrating the TEE probe comprises:contacting the TEE probe with an anterior side of the esophagus; generating an ultrasound image of a heart of the subject;storing a configuration of the TEE probe in response to generating the ultrasound image of the heart of the subject;actuating the TEE probe by a prescribed amount; andestimating a subject tissue resistance.

22. The robotic TEE system of any one of Claims 19-21, wherein determining a pose of the TEE probe comprises:obtaining sensor measurements associated with a tip of the TEE probe; determining a mid-point transformation associated with the tip of the TEE probe;determining an offset associated with the pose; andobtaining a pose based on projection of the mid-point transformation through the offset.

23. The robotic TEE system of any one of Claims 19-22, further comprising the TEE probe.

24. The robotic TEE system of any one of Claims 19-23, further comprising a robotic support structure configured to support the TEE probe, wherein the robotic support structure comprises the memory and the processor,25. The robotic TEE system of Claim 24, wherein the robotic the robotic support structure further comprises a load sensor positioned at a distal end of the robotic support structure and in electrical communication with the processor.

26. The robotic TEE system of any one of Claims 19-25, further comprising a probe guide configured to support the TEE probe.

27. The robotic TEE system of any one of Claims 19-26, further comprising a mouthguard configured to receive the TEE probe, wherein the mouthguard comprises a force sensor in electrical communication with the processor, wherein the mouthguard is configured to detect a force applied to the mouthguard by the TEE probe.

28. A method, comprising:advancing a TEE probe into a patient to a prescribed position in an esophagus of a patient;moving the TEE probe relative to the prescribed position by a prescribed amount; andestimating a patient tissue resistance based on a load required for moving the TEE probe by the prescribed amount.

29. The method of Claim 28, further comprising moving the TEE probe from a first position to a second position by applying a load greater than the patient tissue resistance.

30. The method of any one of Claims 28-29, further comprising moving the TEE probe from a first position to a second position by applying a load exceeding the patient tissue resistance by less than a safety factor.

31. The method of any one of Claims 28-30, wherein the prescribed position comprises an internal home position of a navigation reference frame.

32. The method of any one of Claims 28-31, wherein the prescribed position comprises a position capable of imaging a four-chamber view of a heart or the patient.

33. The method of any one of Claims 28-32, wherein moving the TEE probe relative to the prescribed position by a prescribed amount comprises moving the TEE probe distally from a home position of a navigation reference frame.

34. The method of Claim 33, wherein moving the TEE probe distally comprises moving by a standardized distance.

35. The method of Claim 33, wherein moving the TEE probe distally comprises moving from the home position to an adjacent standardized imaging position.

36. The method of any one of Claim 28-35, wherein moving the TEE probe relative to the prescribed position by a prescribed amount comprises moving the TEE probe proximally from a home position of a navigation reference frame by standardized distance.

37. The method of Claim 36, wherein moving the TEE probe proximally comprises moving by a standardized distance.

38. The method of Claim 36, wherein moving the TEE probe proximally comprises moving from the home position to an adjacent standardized imaging position.

39. The method of any one of Claim 28-38, wherein moving the TEE probe relative to the prescribed position by a prescribed amount comprises rotating the TEE probe about a longitudinal axis thereof by a standardized angular displacement while an imaging element thereof is disposed at a home position of a navigation reference frame.

40. The method of any one of Claims 28-39, wherein moving the TEE probe relative to the prescribed position by a prescribed amount comprises at least one of linearly translating, rotating, angulating anteriorly, angulating posteriorly, angulating in a first direction in a medial-lateral plane, and angulating in a second direction in a medial-lateral plane.

41. The method of any one of Claims 28-40, further comprising navigating the TEE probe relative to the prescribed position by applying a load adjusted by a factor based on the estimated patient tissue resistance.

42. The method of any one of Claims 28-41, further comprising navigating the TEE probe relative to the prescribed position by activating an actuator to move the TEE probe a distance adjusted by a factor based on the estimated patient tissue resistance.

43. A robotic transesophageal echocardiography imaging apparatus, comprising:a robotic support structure;a carriage movably mounted to the robotic support structure;an actuator configured to provide for movement of the carriage; and one or more hardware processors configured to:move a TEE probe within a patient relative to a prescribed position of an esophagus of a patient by a prescribed amount;estimate a patient tissue resistance based on a load required for moving the TEE probe by the prescribed amount; andstore a scaling factor based on the estimated patient tissue resistance.

44. A system comprising:a transesophageal echocardiogram (TEE) probe fixture configured to be positioned on a tip of a TEE probe, the TEE probe fixture having one or more pose sensors; anda TEE controller, the TEE controller configured to robotically control movement of the probe, wherein the TEE controller is configured to determine a pose associated with the TEE probe based on the one or more pose sensors.

45. The system of Claim 44, wherein the TEE controller is configured to adjust one or more dials of the TEE probe, the dials enabling adjustment of rotation and / or flexion of the TEE probe.

46. The system of any one of Claims 44-45, wherein the TEE probe fixture includes two pose sensors.

47. The system of any one of Claims 44-46, wherein the one or more pose sensors are electromagnetic sensors which respond to one or more changing magnetic fields.

48. The system of any one of Claims 44-47, wherein the pose is configured for use in determining whether movements of the probe correspond to the determined pose.

49. The system of any one of Claims 44-48, wherein the one or more pose sensors include two pose sensors, and wherein to determine the pose, the TEE controller is configured to:obtain, via the pose sensors, sensor measurements associated with the tip of the TEE probe;determine a mid-point transformation associated with the two pose sensors; determine an offset associated with the pose, the offset reflecting an offset from a mid-point of the two pose sensors to an ultrasound sensor of the TEE probe; and obtain the pose based on projection of the mid-point transformation through the offset.

50. The system of any one of Claims 44-49, wherein the one or more pose sensors are configured for use in calibration of the TEE controller in response to measures of force reflecting insertion force of the TEE probe.

51. The system of any one of Claims 44-50, wherein the TEE controller outputs information for inclusion in a user interface, and wherein the information includes the pose.

52. The system of Claim 51, wherein the user interface is configured to present a graphical representation of the pose and a graphical representation of a portion of a heart.

53. A method implemented by a robotic TEE controller, the method comprising:obtaining sensor information from one or more pose sensors included on a TEE probe fixture that’s positioned on a tip of a TEE probe; anddetermining pose associated with the pose sensors, wherein the TEE controller is configured to robotically control movement of the TEE probe.

54. The method of Claim 53, wherein the TEE controller is configured to adjust one or more dials of the TEE probe, the dials enabling adjustment of rotation and / or flexion of the TEE probe.

55. The method of any one of Claims 53-54, wherein the TEE probe fixture includes two pose sensors.

56. The method of any one of Claim 53-55, w’herein the one or more pose sensors are electromagnetic sensors which respond to one or more changing magnetic fields.

57. The method of any one of Claims 53-56, wherein the pose is configured for use in determining whether movements of the probe correspond to the determined pose.

58. The method of any one of Claims 53-57, wherein the one or more pose sensors include two pose sensors, and wherein determining the pose comprises:determining a mid-point transformation associated with the two pose sensors based on the sensor information;determining an offset associated with the pose, the offset reflecting an offset from a mid-point of the two pose sensors to an ultrasound sensor of the TEE probe; and obtaining the pose based on projection of the mid-point transformation through the offset.

59. The method of Claim 58, wherein the one or more pose sensors are configured for use in calibration of the TEE controller in response to measures of force reflecting insertion force of the TEE probe.

60. The method of any one of Claims 53-57, wherein the TEE controller outputs information for inclusion in a user interface, and wherein the information includes the pose.

61. The method of Claim 60, wherein the user interface is configured to present a graphical representation of the pose and a graphical representation of a portion of a heart.

62. A system comprising:one or more pose sensors configured for to be positioned at an end of a transesophageal echocardiogram (TEE) probe; anda processor, the processor configured to robotically control movement of the probe, wherein the processor is configured to determine a pose associated with the TEE probe based on the one or more pose sensors.

63. A software controlled TEE probe with one or more pose sensors at an end of the TEE probe.

64. A system comprising:a transesophageal echocardiogram (TEE) controller, wherein the TEE controller is configured to robotically control movement of the probe, wherein the TEE controller is in communication with a motor that is configured to adjust translation of the probe; andat least one sensor positioned on a guide, the guide adjusting an angle of the TEE probe downwards towards a person, and the at least one sensor measuring a guide force,wherein the TEE controller is configured to determine an estimated force associated with insertion of the probe into a mouth of the person.

65. The system of Claim 64, wherein the TEE controller controls translation, flexion, and rotation of the probe.

66. The system of any one of Claims 64-65, wherein the TEE controller determines the estimated force based on motor current associated with the motor as an estimate of force associated with translation of the probe towards the guide.

67. The system of any one of Claims 64-66, wherein the TEE controller is configured to adjust operation based on the estimated force.

68. The system of Claim 67, wherein adjusting operation includes stopping movement of the probe.

69. The system of Claim 67, wherein adjusting operation includes causing the probe to go limp.

70. The system of Claim 67, wherein adjusting operation includes outputting an alert to a medical professional.

71. The system of any one of Claims 64-70, wherein determining the estimated force is based on, at least, input of the guide force and motor current into a machine learning model.

72. The system of Claim 71, wherein determining the estimated force is further based on input of position and velocity associated with the probe.

73. The system of Claim 72, wherein position indicates pose of a tip of the probe.

74. The system of Claim 71, wherein the machine learning model is a regression model.

75. The system of any one of Claims 64-74, wherein the TEE controller outputs information for inclusion in a user interface, and wherein the information includes a graphical representation associated with estimated force.

76. The system of Claim 75, wherein the graphical representation includes one or more markers indicative of force thresholds.

77. The system of Claim 75, wherein the TEE controller is configured to output an alert for inclusion in the user interface reflecting that the estimated force has exceeded a threshold.

78. The system of any one of Claims 64-77, wherein the estimated force and one or more poses associated with a tip of the probe are used for calibration of the TEE controller.

79. A method implemented by a TEE controller of one or more processors, the method comprising:controlling movement of a TEE probe, wherein the TEE controller is in communication with a motor that is configured to adjust translation of the probe; and obtaining a measurement of guide force from at least one sensor positioned on a guide, the guide adjusting an angle of the TEE probe downwards towards a person; anddetermining an estimated force associated with insertion of the probe into a m outh of the person,80. The method of Claim 79, wherein the TEE controller controls translation, flexion, and rotation of the probe.

81. The method of any one of Claims 79-80, wherein the estimated force is based on a measure of motor current associated with the motor.

82. The method of any one of Claims 79-81, further comprising adjusting operation based on the estimated force.

83. The method of Claim 82, wherein adjusting operation includes stopping movement of the probe.

84. The method of any one of Claims 82-83, wherein adjusting operation includes causing the probe to go limp.

85. The method of any one of Claims 82-84, wherein adjusting operation includes outputting an alert to a medical professional.

86. The method of Claim 85, wherein determining the estimated force is based on, at least, input of the guide force and motor current into a machine learning model.

87. The method of Claim 86, wherein determining the estimated force is further based on input of position and velocity associated with the probe.

88. The method of Claim 87, wherein position indicates pose of a tip of the probe.

89. The method of Claim 86, wherein the machine learning model is a regression model.

90. The method of any one of Claims 79-89, wherein the TEE controller outputs information for inclusion in a user interface, and wherein the information includes a graphical representation associated with estimated force.

91. The method of Claim 90, wherein the graphical representation includes one or more markers indicative of force thresholds.

92. The method of Claim 91, wherein the TEE controller is configured to output an alert for inclusion in the user interface that the estimated force has exceeded a threshold.

93. The method of any one of Claims 79-92, wherein the estimated force and one or more poses associated with a tip of the probe are used for calibration of the TEE controller.

94. A method implemented by a system of one or more processors, the system configured to control movement of a TEE probe and the method comprising:determining an estimate force associated with the TEE probe; and adjusting operation based on the estimated force.

95. The method of any one of Claim 94, wherein the estimated force is a force associated with insertion into a person.

96. The method of any one of Claims 94-95, wherein the force is indicative of force applied to an interior of a person.

97. The method of any one of Claims 94-96, wherein adjusting operation includes adjusting movement or stopping movement of the TEE probe.

98. The method of any one of Claims 94-97, wherein the method further comprises causing presentation, via a user interface, of a graphical representation associated with the estimated force.

99. A system for robotic control of a TEE catheter having a probe tip, the system comprising:a mouthguard comprising a projection having an internal wall defining a lumen, a guide body disposed in the lumen, and a force sensor coupled to the guide body, the guide body configured to guide a catheter of an ultrasound probe through the mouthguard and into a mouth of a patient; anda robotic transesophageal echocardiography imaging (TEE) system comprising:a support arm assembly configured to support the catheter of the ultrasound probe; andan actuator configured adjust at least one degree of freedom of the probe tip by acting on or through the catheter;wherein the force sensor configured to generate a force signal related to forces applied between the guide body and the catheter as the catheter is moved through the mouthguard.

100. The system of Claim 99, wherein the mouthguard comprises a lateral member having a first side configured to overlay skin around a mouth of a patient, a second side opposite the first side, and a visual fiducial disposed on the second side of the lateral member.

101. The system of Claim 100, further comprising a camera coupled with the robotic TEE system, the camera configured to capture images of the visual fiducial disposed on the second side of the lateral member of the mouthguard,102. The system of Claim 101, wherein the camera is mounted to the support arm assembly of the robotic TEE system.

103. The system of Claim 100, wherein the visual fiducial compromises an / XPRIL tag.

104. The system of any one of Claims 99-103, wherein the robotic TEE system is configured to monitor the force signal while operating the actuator to control the forces acting on or through the TEE catheter such that loads applied to the mouthguard are maintained below a threshold.

105. The system of any one of Claims 99- 104, wherein the system further comprises one or more hardware processors configured to:monitor the force signal; andcontrol the actuator or generate an alarm in response to monitoring of the force signal by maintaining a force level within a threshold.

106. The system of any one of Claims 99-105, wherein the guide body comprises an arcuate support member.

107. The system of Claim 106, wherein the arcuate support member comprises a first arcuate support member spanning an arc of less than 360 degrees and further comprising asecond arcuate support member spanning an arc of less than 360 degrees disposed adjacent to the first arcuate support member.

108. The system of Claim 107, further comprising a third arcuate support member, wherein each of the first arcuate support member, the second arcuate support member and the third arcuate support member spanning 120 degrees.

109. The system of Claim 108, wherein each of the first arcuate support member, the second arcuate support member and the third arcuate support member is coupled to the internal wall of the projection by a radial support extending from the internal wall, each radial support comprising a force sensor configured to generate a force signal related to forces applied to a corresponding arcuate support.

110. A mouthguard for use in a transesophageal echocardiography imaging (TEE) procedure, comprising a projection having an internal wall defining a lumen, a guide body disposed in the lumen, and a force sensor coupled to the guide body, the guide body configured to guide a catheter of an ultrasound probe through the mouthguard and into a mouth of a patient.

111. The mouthguard of Claim 110, wherein the guide body comprises an arcuate support member.

112. The mouthguard of Claim 111, wherein the arcuate support member comprises a first arcuate support member spanning an arc of less than 360 degrees and further comprising a second arcuate support member spanning an arc of less than 360 degrees disposed adjacent to the first arcuate support member.

113. The mouthguard of Claim 111, further comprising a third arcuate support member, wherein each of the first acute support member, the second arcuate support member, and the third arcuate support member spanning 120 degrees.

114. The mouthguard of Claim 113, wherein each of the first arcuate support member, the second arcuate support member and the third arcuate support member is coupled to the internal wall of the projection by a radial support extending from the internal wall, each radial support comprising a force sensor configured to generate a force signal related to forces applied to a corresponding arcuate support.

115. The mouthguard of Claim 110, further comprising a fiducial configured to indicate orientation of the mouthguard.

116. A method of operating a robotic transesophageal echocardiography imaging (TEE) system to control a catheter and a probe tip of a TEE assembly comprising:positioning a catheter of a TEE probe assembly in a mouthguard, the mouthguard coupled to a mouth of a patient;acting on or through the catheter of the TEE probe assembly positioned in the mouthguard to adjust at least one degree of freedom of the probe tip of the TEE probe assembly within an esophagus of the patient;monitoring a force signal (can be zero) generated by a force sensor disposed in the mouthguard while acting on or through the catheter of the TEE probe assembly;comparing a force level based on the force signal to a threshold; and further acting on or through the catheter of the TEE probe assembly responsive to comparing the force level to the threshold.

117. The method of Claim 116, wherein further acting on or through the catheter of the TEE probe assembly responsive to comparing the force level to the threshold comprises further acting on or through the catheter at a same level if the force level is below the threshold.

118. The method of any one of Claims 116-117, wherein further acting on or through the catheter of the TEE probe assembly responsive to comparing the force level to the threshold comprises further acting on or through the catheter at a reduced level if the force level is at or above the threshold.

119. The method of any one of Claims 116-118 wherein monitoring the force signal generated by a force sensor comprises monitoring a first force signal generated by a first force sensor and further comprising monitoring a second force signal from a second force sensor disposed in the mouthguard while acting on or through the catheter of the TEE probe assembly.

120. The method of any one of Claims 116-119, further generating an orientation signal from the mouthguard and wherein further acting on or through the catheter of the TEE probe assembly comprises further acting responsive to an orientation signal.

121. The method of any one of Claims 116-120, wherein the orientation signal is generated from an image of a visual fiducial taken by a camera of the robotic TEE system.

122. A system for robotic control of a TEE catheter, the system comprising:a mouthguard comprising:a lateral member having a first side configured to overlay skin around a mouth of a patient and a second side opposite the first side;a projection having an internal wall defining a lumen, the mouthguard further comprising:an arcuate support member disposed in the lumen;a radial support extending from the internal wall, the radial support comprising a force sensor configured to generate a force signal related to forces applied to the arcuate support; anda visual fiducial disposed on the second side of the lateral member; and a robotic transesophageal echocardiography imaging (TEE) system comprising:an ultrasound probe comprising a catheter body and a probe tip;a support arm assembly configured to support the catheter body of the ultrasound probe; andan actuator configured adjust at least one degree of freedom of the probe tip by acting on or through the catheter body to relative to the support arm; wherein the robotic TEE system is configured to monitor the force signal while operating the actuator to control the acting on or through the catheter body such that loads applied to the mouthguard are maintained below a threshold.

123. The system of Claim 122, wherein the visual fiducial comprises an APRIL tag disposed on the second side of the lateral member and the system further comprises a camera configured to capture an image of the APRIL tag.

124. The system of Claim 123, wherein the camera is mounted to the support arm assembly of the robotic TEE system.

125. The system of any one of Claims 122- 124, wherein the arcuate support member comprises a first arcuate support member spanning an arc of less than 360 degrees and further comprising a second arcuate support member spanning an arc of less than 360 degrees disposed adjacent to the first arcuate support member.

126. The system of Claim 125, further comprising a third arcuate support member, wherein each of the first arcuate support member, the second arcuate support member and the third arcuate support member spanning 120 degrees.

127. The system of Claim 126, wherein each of the first arcuate support member, the second arcuate support member and the third arcuate support member is coupled to the internal wall of the projection by a radial support extending from the internal wall, each radial support comprising a force sensor configured to generate a force signal related to forces applied to the corresponding arcuate support.

128. A system, device, and / or method as illustrated and / or described.

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