Procedure table and robotic transesophageal echocardiography imaging systems with kinematic connection

Abstract

A system for coordinate positioning of an ultrasound probe relative to a patient surface of a procedure table is provided. The system includes a robotic transesophageal echocardiography imaging (TEE) system. The robotic TEE system includes a support arm and an actuator. The support arm is coupled to an imaging system support. The support arm is configured to support the ultrasound probe. The actuator is configured to adjust at least one degree of freedom of the ultrasound probe relative to the support arm. The robotic TEE system is responsive to initiation of movement of the patient surface by constraining a change in relative position of the support arm relative to the patient surface.

Description

LAZA.052WO PATENT PROCEDURE TABLE AND ROBOTIC TRANSESOPHAGEAL ECHOCARDIOGRAPHY IMAGING SYSTEMS WITH KINEMATIC CONNECTIONINCORPORATION BY REFERENCE

[0001] This application claims priority to U. S. Provisional Application No.63 / 742,352 tiled January 6, 2025 and titled “PROCEDURE. TABLE AND ROBOTIC TRANSESOPHAGEAL ECHOCARDIOGRAPHY IMAGING SYSTEMS WITH KINEMATIC CONNECTION,” the disclosure of which is hereby incorporated herein by reference m its entirety.BACKGROUNDField

[0002] The disclosure relates to systems and methods for control of a catheter or probe, such as a probe for medical imaging and modeling.Description of the Related Art

[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. 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.

[0004] However, 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. Moreover, 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.

[0005] Many interventionalist procedures performed on cardiac anatomy require the presence of highly skilled echocardiographers, which necessitates tight coordination and communication between the interventionalist and echocardiographer. This can lead to increased crowding, noise, and cost during catli-lab procedures. Furthermore, 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.SUMMARY

[0006] Robotic control of a transesophageal echocardiography imaging (TEE) system is needed. Such a system controls a TEE probe assembly with a catheter that is advanced through the mouth of a patient into the esophagus. In the procedure the patient is placed on a patient surface of a procedure table. The table can move during a procedure. Some movements are planned and desirable. Some are inadvertent and undesirable. In either case, movement of the catheter of the TEE probe assembly relative to the mouth of the patient caused by movement of the patient surface is undesirable. At the least, these motions do not aid in the imaging procedure and may have to be countered by subsequent movement. At worst, such movements could cause injury

[0007] In one embodiment, a system for coordinate positioning of a robotic ultrasound catheter and a procedure table is provided. The system includes a procedure table and a robotic transesophageal echocardiography imaging (TEE) system. The procedure table has a patient surface configured to support a patient during a procedure and a support base. The procedure table is moveable in a longitudinal direction and a transverse direction thereof relative to the support base. The robotic TEE system includes an ultrasound probe, a support arm, and an actuator. The support arm is coupled to an imaging system support. The support arm is configured to support the ultrasound probe. The actuator is configured to adjust at least one degree of freedom of the ultrasound probe relative to the support arm. The robotic TEE system is responsive to initiation of movement of the patient surface by constraining a change in relative position of the support arm relative to the patient surface.

[0008] In one embodiment, a system for coordinate positioning of a robotic ultrasound catheter and a procedure table having a patient surface is provided. The system includes a robotic transesophageal echocardiography imaging (TEE) system. The robotic TEEsystem includes an ultrasound probe, a support arm, and an actuator. The support arm is coupled to an imaging system support. The support arm is configured to support the ultrasound probe. The actuator is configured to adjust at least one degree of freedom of the ultrasound probe relative to the support arm. The robotic TEE system is responsive to initiation of movement of the patient surface by constraining a change in relative position of the support arm relative to the patient surface.

[0009] In another embodiment, a method is provided in which a patient is positioned on a patient surface of a procedure table. A catheter of a TEE probe assembly is advanced into a mouth of the patient. The TEE probe assembly is supported on a robotic support arm. Initiation of movement of the patient surface relative to the robotic support arm is detected, A movement countermeasure is initiated in response to the detected initiation of movement of the patient surface to constrain a change in relative position of the support arm relative to the patient surface.

[0010] In another embodiment, a system for coordinate positioning of an ultrasound probe relative to a patient surface of a procedure table is provided. The system includes: a robotic transesophageal echocardiography imaging (TEE) system including: a support arm coupled to an imaging system support, the support arm configured to support the ultrasound probe; and an actuator configured to adjust at least one degree of freedom of the ultrasound probe relative to the support arm; wherein the robotic TEE system is responsive to initiation of movement of the patient surface by constraining a change in relative position of the support arm relative to the patient surface.

[0011] In some embodiments, the robotic TEE system includes a kinetic connection mechanism including a first link configured to be coupled to the procedure table and a second link configured to be coupled to the support arm, wherein the second link is configured to maintain its position relative to the first link over a functionality based distance.

[0012] In some embodiments, the functionality based distance includes a crotch to chest distance for an average patient of a patient sub-population.

[0013] In some embodiments, the functionality based distance includes 500mm-600mm in a longitudinal direction.

[0014] In some embodiments, the functionality based distance includes up to 1000mm in a longitudinal direction and up to 300mm in a transverse direction.

[0015] In some embodiments, the robotic TEE system includes a kinetic connection mechanism including a first link configured to be coupled to the procedure table and a second link configured to be coupled to the support arm, wherein the second link is configured to maintain its position relative to the first link over a safety based distance.

[0016] In some embodiments, the safety' based distance includes 300mm in a longitudinal direction.

[0017] In some embodiments, the safety' based distance includes 300mm in a transverse direction.

[0018] In some embodiments, the system further includes one or more hardware processors configured to: detect initiation of movement of the patient surface of the procedure table; and initiate a movement countermeasure in response to the detected initiation of movement,

[0019] In some embodiments, detecting the initiation of movement includes detecting a pressing of a control button configured to cause the patient surface to be moveable relative to a support base of the procedure table.

[0020] In some embodiments, the movement countermeasure includes a user alarm configured to be issued on one or more user interface devices.

[0021] In some embodiments, the movement countermeasure causes the ultrasound probe to move by a corresponding amount and m a corresponding direction to the movement of the procedure table.

[0022] In some embodiments, the one or more hardware processors is configured to send a signal to the actuator to cause the ultrasound probe to move by the corresponding amount and in the corresponding direction to the movement of the procedure table.

[0023] In some embodiments, the one or more hardware processors is configured to send a signal to the actuator to disengage the actuator from a carriage assembly of the robotic TEE system, the carriage assembly supporting the ultrasound probe, wherein disengaging the actuator from the carriage assembly allows the carriage assembly to freely move along the support arm.

[0024] In some embodiments, the one or more hardware processors is configured to send a signal to the actuator to engage the actuator with a carriage assembly of the robotic TEE system, the carriage assembly supporting the ultrasound probe, wherein engaging theactuator causes the carriage assembly to move in a direction corresponding to the direction of the movement of the procedure table.

[0025] In some embodiments, the movement countermeasure causes at least a portion of the support arm to move by a corresponding amount and in a corresponding direction to the movement of the procedure table.

[0026] In some embodiments, wherein the robotic TEE system is configured to initiate a movement countermeasure in response to the initiation of movement of the patient surface, wherein the movement countermeasure causes at least a portion of the support arm to move by a corresponding amount and in a corresponding direction to the movement of the procedure table, wherein movement of the support arm relative to the procedure table by the corresponding amount and in the corresponding direction is a result of fixing a spatial arrangement of a linkage coupling the procedure table to the support arm.

[0027] In another embodiment, a method is provided. The method includes: supporting a TEE probe assembly on a robotic support arm; advancing a catheter of the TEE probe assembly into a mouth of a patient, wherein the patient is positioned on a patient surface of a procedure table; and constraining a change in relative position of the robotic support arm relative to the patient surface, wherein constraining a change in relative position comprises: initiating a movement countermeasure in response to movement of the patient surface relative to the robotic support arm.

[0028] In some embodiments, the movement countermeasure includes issuing an alarm on a user interface directed to causing a user to cease the initiation of movement.

[0029] In some embodiments, the movement countermeasure includes engaging a kinetic connection between the robotic support arm and the patient surface.

[0030] In some embodiments, the kinetic connection mechanism can enable the robotic TEE system to passively constrain a change in position of the support arm relative to the patient surface. In some embodiments, the robotic TEE system may only passively constrain the relative movement (e.g., via the kinetic connection mechanism) without any active countermeasures (e.g., without one or more hardware processors and / or motors that detect movement of the patient surface and actively move the support arm or other portion of the robotic TEE system to counteract movement of the patient surface).

[0031] In some embodiments, the robotic TEE system may only actively constrain the relative movement (e.g., via the one or more hardware processors and / or motors that detect movement of the patient surface and actively move the support arm or other portion of the robotic TEE system to counteract movement of the patient surface) without passively constraining the relative movement (e.g., without the kinetic connection mechanism or similar passive dampening devices).BRIEF DESCRIPTION OF THE DRAWINGS

[0032] Non-limiting features of some embodiments of the inventions 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.

[0033] FIG. 1 is a schematic illustration of a transesophageal echocardiography (TEE) imaging system and a heart.

[0034] FIG. 2 is a perspective view of a procedure table configured to support a patient during a TEE imaging procedure.

[0035] FIG. 3A shows a robotic system configured to provide a kinematic connection with a procedure table.

[0036] FIG. 3B shows a side view of a robotic system configured to manipulate a TEE probe assembly and to be integrated into the system of FIG. 3 A, the system providing for proximal control, a distal guide, and a buckling control system m an expanded state.

[0037] FIG. 3C is a side view of the distal portion of the robotic system of FIG.3B.

[0038] FIG. 4 A is a schematic view of a TEE probe assembly capable of manual control and of being integrated into the robotic systems of FIGS. 1, 2, and 3A-3C.

[0039] FIG. 4B is a detail view of certain controls of the TEE probe assembly of FIG. 4A.

[0040] FIG. 5 is a flowchart of an example process for coordinating the positioning of a robotic ultrasound catheter.DETAILED DESCRIPTION

[0041] 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 invention as defined by the appended claims.

[0042] This application is directed to robotic imaging systems that can account for and manage procedure table movements while enhancing or maintaining patient safety. The systems can provide a kinematic connection between the imaging and robotic components and a procedure table such that relative movements among these components can be managed to avoid safety concerns for the patient, FIG. 1 shows a robotic imaging system that is configured to perform cardiac imaging. FIG. 2 shows one implementation of the robotic imaging system and a procedure table upon which a patient can be placed during a cardiac imaging procedure. FIGS. 3A-3B show a robotic imaging system that is fixed to a supporting surface (e.g., a support arm and a procedure table) and where the system is configured to respond to possible disruptive movements in its environment. FIGS. 4A-4B show details of embodiments of TEE probe assemblies that can be capable of manual or robotic control.i. GENERAL ROBOTIC IMAGING SYSTEM FEATURES

[0043] FIG. 1 shows 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 and probe can be configured for esophageal or for percutaneous insertion, for example.

[0044] The probe may be one of a variety' of imaging modalities. Examples include an ultrasound transducer. Such imaging probes may be known by one of skill in 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 is a mini-TEE probe. In various embodiments, the probe is miniaturized by includingonly 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.).

[0045] 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. Some of these structures are discussed in connection with FIGS, 4 A and 4B below. Processing the data collected by the probe may be accomplished via electronics and software in the console 104. The console 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.

[0046] In various embodiments, the catheter 102 can be controllable and automated, such as by robotic control. Examples of this are discussed m connection with FIGS.2-3B. The catheter 102, such as the distal end of the catheter, can be advanced and retracted axially from or relative to the console. 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 is configured to store and interpret data taken by the probe in multiple locations in the time domain. In various embodiments, the system uses the interpreted data to generate information for a clinician. For example, the system may construct a 3D anatomical model based on image data taken from multiple locations. In another example, the system generates image data based on composite data from multiple locations.

[0047] 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. TEE PROBE ASSEMBLIES FOR CONTROLLING IMAGING COMPONENTS

[0048] 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 200 for coordinate positioning of a robotic ultrasound catheter and a procedure table 120. The system 200 can include one or more of the systems described below’ (e.g., the procedure table 120, the robotic imaging system 140, a robotic imaging system 300, a kinetic connection mechanism 320, and / or a TEE probe assembly 400). The procedure table 120 includes a support base 124 and a patient 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 patient surface 128 can be firmly affixed to the support base 124, In some applications, the patient surface 128 is able to move relative to the support base 124. The patient 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 patient surface 128 when engaged but allows motion of the patient 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 system 140 or on either one of the procedure table and the system 200, or on another console presenting control capabilities to the user.

[0049] 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 longitudinal direction L and / or in the transverse 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 patient 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.

[0050] 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 patient surface 128 to any position within the longitudinal rangeand 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 patient surface 128 can be simply moved by hand or other mechanism so long as the brake system is disengaged.

[0051] 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 patient surface 128 by pressing and holding a control button, e.g., to disengage a brake. In one case, the system 140 responds to initiating the movement of the patient surface 128 (e.g., by pressing and holding of the control buton) to constrain a change in relative position between a support arm of a catheter portion of the system 140 and patient. The position of the patient corresponds to the patient 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.

[0052] For example, if the system 140 detects the motion and initiates a movement countermeasure (e.g., 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:

[0053] L tabmot = L rob + L hum + L tab

[0054] where:

[0055] L rob is table motion that occurs up to the time that the system 140 emits the alarm;

[0056] 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)

[0057] L tab is table motion occurring between the control buton ceasing actuation and the tabletop stopping.

[0058] 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.

[0059] 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.

[0060] 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.

[0061] The total estimate of longitudinal travel distance of the patient table for a safety-based motion contingency, given the above considerations, can be calculated as the:

[0062] L_tabmot = L_rob + L_hum + L_tab = 2 + 7.8 + 2 = 11.8 cm

[0063] 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 expected range 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 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 patient from such movement. The setup arms of the system 140 can move with the table by this kinematic connection so that from the patient’s frame of reference there is no movement of the catheter portion of the imaging system of the 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.

[0064] While the foregoing discussion of unwanted movement can be used to provide safety margin, expected movements of the table should also be accounted for. Theoverall motion of the procedure table 120 to provide for procedural steps provides for functionality-based table motion.

[0065] In order for the 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

[0066] Then, reference longitudinal distances are as follows:• crotch to axilla (mid-chest): 50.2 cm• crotch to suprasternale (upper chest): 61.5 cm

[0067] 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 system 140 to move with the patient, 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, the functionality based distance can be a crotch to chest distance for an average patient of a patient 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.

[0068] 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 joints can be provided by enabling a support device 144 of the system 140 to move with procedure table 120, e.g., by rolling in the same direction as the translation of the patient surface 128, The movement of the setup arm joints can be provided by enabling a supportdevice 144 of the system 140 to move with the procedure table 120, e.g., by elevating as the patient surface 128 is elevated.

[0069] FIG. 3A-3C show additional details of a robotic imaging system 300 (e.g., a robotic transesophageal echocardiography imaging (TEE) system). The system 300 can include one or more components or features of the system 140. In one example, the system 300 can be at least partially integrated into the system 140 (e.g., a support arm 302 of the system 300 can be coupled to and / or carried by one or more of the linkages of the system 140). The system 300 can be responsive to initiation of movement of the patient surface 128 by constraining a change in relative position of the support arm 302 relative to the patient surface 128. The system 300 can include one or more of an ultrasound probe (e g., a probe of the TEE probe assembly 400), a support arm 302, and / or an actuator. The system 300 can include a robotically controlled receptacle (e.g., a carriage or carriage assembly 304). The support arm 302 can support the carriage assembly 304. The support arm 302 is 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. The support surface can be the patient surface 128. The support surface can be a portion of a robotic arm of the system 140. The carriage assembly 304 can be one device configured to adjust at least one degree of freedom of an ultrasound probe, e.g., a tip portion 404 of a TEE probe assembly 400 discussed below. The support arm 302 can support a motor 308 that is one of several actuators for moving the carriage assembly 304. The carriage assembly 304 mounted at or adjacent to a first end of the support arm 302 and can be coupled with a pulley 309 mounted at or coupled with a second end of the support arm 302, opposite the first end. The motor 308 and the pulley 309 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 302. The movement of the transmission is coupled with the carriage assembly 304 to move the carriage assembly in a proximal-distal direction of the system 300.

[0070] The carriage assembly 304 is configured to be coupled with a TEE probe assembly. In some embodiments, the carriage assembly 304 can include a cradle for interfacing with and coupling with the TEE probe assembly or with auxiliary rolling cylinder component(s) coupled with the TEE probe assembly for rolling motion on the cradle. In one embodiment, the TEE probe assembly can be configured as discussed in connection with FIGS.4A-4B. The TEE probe assembly can be capable of manual control as discussed below. The TEE probe assembly can be inserted into the carriage assembly 304 and manipulated therein by an actuator, e.g., by the motor 308, pulley 309 and transmission as discussed above. The carriage assembly 304 can also have actuators for manipulating control knobs and control buttons of the TEE probe assembly as discussed below. Specifically, a handle of the TEE probe assembly can be inserted into a device interface of the carriage assembly 304. The device interface can be configured to receive and engage control knobs of the handle via the actuator (e.g., via a knob motor and transmission). The carriage assembly 304 can include an actuator (e.g., a carriage rotation drive supported by a cradle) to rotate a handle portion of the TEE probe assembly within the carriage assembly 304 about the axis R-R. In one embodiment, aspects of the mechanical positioning of pose of the tip portion of the TEE probe assembly (sometimes referred to herein as the “pose”) can be controlled by actuators in or coupled with the carriage assembly 304. Such control can be based on software code implemented on one or more hardware processors, e.g., on the console 104.

[0071] The carriage assembly 304 can take many forms. In one case as shown in FIG. 3B, the carriage assembly 304 includes a first body portion 310 and a second body portion 312. The first body portion 310 can be referred to as a lid (e.g., a door) in that it is on top of the second body portion 312, which can be referred to as a base. The first body portion 310 can be closed over a TEE probe assembly and secured by closure members. The carriage assembly 304 moves linearly but is fixed rotationally. In other embodiments, the carriage assembly 304 is itself rotatable about the axis R-R.

[0072] Unwanted movement of a tip of the TEE probe assembly within the patient is controlled within the system 300. With reference to FIGS. 3A-3C, the system 300 can include a guide 306 and a buckling control support 314, for example, to control unwanted movement. The guide 306 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 302. The guide 306 can direct a catheter 412 of a TEE probe assembly 400 from a direction of motion aligned with the axis R-R into the patient’s mouth. See FIG. 3 A. The guide 306 can take several different forms, as discussed in the Appendix. The guide 306 can be aligned with a passage extending through the buckling control support 314. The buckling control support 314 can extend between the carriage assembly 304 and the guide 306. The buckling control support 314 can be telescopingto accommodate variation in the distance between the carriage assembly 304 and the guide 306.

[0073] As shown in FIG. 3C, a load sensor 316 can be provided as part of a system for controlling unwanted movement of the catheter 412. The load sensor 316 can be disposed between the guide 306 and the support arm 302. The load sensor 316 can be disposed between the support device 307 and the support arm 302. In some cases, a spacer or shim may be provided to provide rigid connection between the guide 306 and the load sensor 316 such that loads detected by the load sensor 316 are more clearly a function of loads applied to the guide 306 as the catheter 412 traverses the guide 306 into mouth of the patient.

[0074] One or more hardware processors can be provided to process the signal of the load sensor 316. The load sensor 316 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 assembly 304 (e.g., the axis R-R), and with an axis transverse to the support arm 302.

[0075] FIG. 3A shows a kinetic connection mechanism 320 configured to cause the system 300 to follow at least to some extent the movement of the procedure table 120. The kinetic connection mechanism 320 can include a first link 324 and a second link 328. In some embodiments, the kinetic connection mechanism 320 may include one or more additional links between the first link 324 and the second link 328. The first link 324 can be coupled to the procedure table 120. The second link 328 can be coupled to the support arm 302. The second link 328 can be coupled to the support arm 302 using a coupler 332. The coupler 332 can clamp rigidly onto the support arm 302. The coupler 332 can be configured to fix the orientation of the second link 328 in one configuration and can be configured to allow the second link 328 to move in at least one degree of freedom relative to the coupler 332 in another configuration. The coupler 332 could include a ball and socket joint configured to allow pivoting of the second link 328 relative to the coupler 332 but to retain the securement to the support arm 302 even while being allowed to rotate at the coupler 332. The first link 324 can be directly connected to the second link 328 at another joint, which can also be a ball and socket joint. The first link 324 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 332 or any other suitable fixation interface as described below in more detail. The joints of the kinetic connectionmechanism 320 can be placed in a locked configuration such that if the procedure table 120 moves the links 324, 328 do not change their relative position to the procedure table 120 or to the support arm 302 such that the support arm moves with the table. This causes the catheter 412 to remain in the same position relative to the patient so that the catheter is not adjusted in position (pulled out or pushed in) during inadvertent movement of the procedure table 120. The second link can maintain its position relative to the first link over the functionality based distance. The second link can maintain its position relative to the first link over the safety based distance. In some variations, the kinetic connection mechanism 320 is configured to allow some extension of the links 324, 328 but by an amount limiting position adjustment of the catheter 412 relative to the patient. In some embodiments, with the joints of the kinetic connection mechanism 320 in the locked configuration movement of the procedure table can be transferred to the support arm (e.g., to one or more joints of the support arm 302), thereby forcing movement of the support arm 302 (e.g., articulation of the support arm joints). This resulting movement of the support arm 302 can correspond to the movement of the procedure table 120 to maintain the position of the catheter 412 relative to the patient.

[0076] To facilitate rapid setup and emergency decoupling, the coupler 332 connecting the second link 328 to the support arm 302 can comprise a quick-release mechanism. This mechanism may include an over-center latch, a spring- loaded jaw, or a cam lever configured to allow a user to instantly disengage the kinetic connection mechanism 320 from the robotic system 300 without tools. Regarding the connection to the procedure table 120, the first link 324 can be coupled via various fixation interfaces. In one embodiment, the coupling comprises a rail clamp configured to rigidly engage a standard medical accessory rail (e.g., a DIN rail) of the procedure table 120. The rail clamp may feature a cam-lock mechanism for rapid manual attachment. In another embodiment, particularly for tables lacking side rails, the coupling comprises a substantially flat, rigid blade configured to be inserted between a mattress of the patient surface 128 and a structural frame of the procedure table 120. To prevent lateral disengagement, the blade may further comprise a latching mechanism, such as a hook or adjustable jaw, disposed at a proximal end of the blade to securely grasp an edge of the procedure table frame or mattress.

[0077] The kinetic connection mechanism 320 can have a disengaged configuration that allows the procedure table 120 to move relative to the support arm 302. Suchmovement can be allowed when no patient is on the patient surface 128 or a patient is on the patient surface but the catheter 412 is not inserted into the patient’s mouth. This can allow the support arm 302 to be separated from the procedure table 120 by a greater distance if space between the table and the system 300 is needed.

[0078] In a further variation, the support arm 302 can include a two (or more) link configuration where the kinetic connection mechanism 320 is coupled with one link and with the procedure table 120. Movement of the table and the kinetic connection mechanism 320 causes a more distal link to move relative to a more proximal link of the support arm 302. Such an arrangement could include at least one of telescoping proximal and distal links and multibar linkage that enable a distal portion of the system 300 coupled with the catheter 412 to move in concert with the procedure table 120. Such multi-link support arms would be configured to extend by a distance corresponding to a safety-based motion feature. Such multi-link support arms would be configured to extend by a distance corresponding to a functionality-based table motion feature.

[0079] Although various physical connections can be implemented as kinetic connection mechanisms, in some cases a kinetic connection mechanism is provided by the control of the carriage assembly 304 in the system 300. This can be implemented by integrating a position sensor into one or both of the procedure table 120 and the system 140 (or the system 300). The position sensors in the procedure table 120 and / or the system 140 (or the system 300) can output a signal to a 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 system 140 (or the system 300) is occurring. If the motion is within range of motion made possible by the actuators in the system 140 (or the 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 system 300 in a direction aligned with the axis of movement of the carriage assembly 304 made possible by the motor 308 and the pulley 309, the processor can activate the motor to move the carriage assembly 304 in the same direction of movement as the procedure table 120. As a result, the base of the system 300 may maintain its position, but the carriage assembly 304 will move with the procedure table 120 such that the catheter 412 maintains its position relative to the patient surface 128 and the patient disposed thereon. More complex motion of the procedure table 120 can be countered by activating other actuators oftlie system 300 providing motion along other axes into which the more complex motion can be resolved.

[0080] FIG. 4A illustrates an example of a TEE probe assembly 400 capable of being operated manually or in a robotic system (as in FIGS. 1-3B) to provide degrees of freedom of movement of a tip portion 404 of the probe assembly.

[0080] As shown in FIG. 4A, the TEE probe assembly 400 can include an ultrasound imaging element at the tip portion 404 and a handle 408. The TEE probe assembly 400 can include a catheter 412 and a power wire 416. A proximal end of the catheter 412 can be coupled with a first end of the handle 408. The power wire 416 can be coupled to a second end of the handle 408. The second end of the handle can be opposite to the first end. The handle of the TEE probe assembly is configured to be manually manipulated to move the distal portion of the probe assembly to a desired pose. The handle of the TEE probe assembly can include a plurality of control knobs (e.g., a first control knob 420 and a second control knob 424).

[0081] FIG. 4B is an enlarged view of the plurality of control knobs of the standard TEE probe of FIG. 4A. Each control knob can include an outer periphery configured to be manually rotated to control a distal portion of the probe assembly to flex the probe tip relative to anatomy of a patient. The first control knob can be used to flex the distal portion of the probe assembly anteriorly and posteriorly (A-P) The second control knob can be used to flex the distal portion of the probe assembly in a first direction in a medial -lateral (M-L) plane and in a second direction in the medial lateral direction. In other embodiments, the flexing direction controlled by the first and second control knobs can be swapped. The control knob (e.g., the first control knob and the second control knob) is sometimes referred to herein as just 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 TEE probe handle can be used to rotate (R) the distal portion. The distal portion can be advanced distally or retracted proximally (D-P).

[0082] As shown in FIG. 4B, in some embodiments, the TEE probe handle can include a pose lock (e g., a brake) 428. The pose lock can maintain a rotational position of the control knob. The pose lock can function to lock the position of the first control knob and / or second control knob. When engaged, the pose lock can prevent rotation of the first controlknob and / or second control knob, thereby locking the distal tip of the TEE probe assembly in a fixed pose (e.g., the current pose with the current amount of flexion). When the pose lock is disengaged, the first control knob and / or the second control knob can be rotated to change a pose of the distal tip of the TEE probe assembly.

[0083] Because the pose of the distal tip of the TEE probe assembly can be adjusted and can be held in a flexed condition, it is important for patient safety that a robotic system for positioning be configured to mitigate the impact on the tip portion of the TEE probe assembly when unintended impacts on the robotic system occur. Such mitigation has various forms, as discussed below.

[0084] As described above, the robotic imaging 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 400, 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 patient 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 412 of the ultrasound probe 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 412 of the ultrasound probe to move by the corresponding amount and in the corresponding direction to the movement of the procedure table 120.

[0085] The one or more hardware processors can send a signal to the actuator to disengage the actuator from the carriage assembly 304 of the system 300. The carriage assembly 304 can support the ultrasound probe, and disengaging the actuator from the carriageassembly 304 can allow the carriage assembly 304 to freely move along the support arm 302. The one or more hardware processors can send a signal to the actuator to engage the actuator with a carriage assembly 304 of the system 300. Engaging the actuator can cause the carriage assembly 304 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 302 to move by a corresponding amount and in a corresponding direction to the movement of the procedure table 120. Movement of the support arm 302 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 (e.g,, the kinetic connection mechanism 320) coupling the procedure table 120 to the support arm 302.

[0086] FIG. 5 is a flowchart of an example process 500 for coordinating the positioning of a robotic ultrasound catheter. For convenience, the process 500 will be described as being performed by a system (e.g., the system 200 for coordinate positioning of a robotic ultrasound catheter and a procedure table 120).

[0087] At block 502, the system 200 supports the TEE probe assembly 400 on the robotic support arm 302.

[0088] At block 504, a catheter 412 of the TEE probe assembly 400 of the system 200 is advanced into a mouth of the patient. For example, the catheter 412 may be advanced robotically by the system 200. The patient can be positioned on the patient surface 128 of the procedure table 120 (See e.g., FIG. 2).

[0089] At block 506, the system 200 constrains a change in relative position of the robotic support arm 302 relative to the patient surface 128.

[0090] As one example of block 208, the one or more hardware processors can detect initiation of movement of the patient surface 128. 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. Detection of the initiation of movement can additionally or alternatively be performed by the load sensor 316 and / or position sensor that sends one or more signals to the one or more hardware processors indicating a movement of the support arm 302 and / or the patient surface 128. The processor can analyze the signal to determine if any change in position of either of the procedure table 120 or the system 140 (or the system 300) is occurring. In response to detecting initiation ofmovement of the patient surface 128, the one or more processors can initiate a movement countermeasure. The movement countermeasure can include a user alarm issued to one or more user interface devices to cause a user to cease the initiation of movement. The movement countermeasure can cause the catheter 412 of the ultrasound probe and / or the support arm 302 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 412 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 another example of block 508, the kinetic connection mechanism 320 can constrain a change in relative position of the robotic support arm 302 relative to the patient surface 128. A movement countermeasure can include engaging a kinetic connection between the robotic support arm 302 and the patient surface 128 via the kinetic connection mechanism 320. The kinetic connection mechanism 320 can cause the support arm 302 to follow at least to some extent the movement of the procedure table 120. As described above, the joints of the kinetic connection mechanism 320 can be placed in a locked configuration such that if the procedure table 120 moves the links 324, 328 do not change their relative position to the procedure table 120 or to the support arm 302.

[0092] As another example of block 508, the system 200 can constrain a change in relative position of the robotic support arm 302 relative to the patient surface 128 via a combination of the one or more processors and the kinetic connection mechanism 320. In some embodiments, the process 500 can include only one or more of the blocks 502, 504, 506 performed in any order.

[0093] While certain embodiments of the inventions 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 present inventions is defined only by reference to the appended claims and their equivalents.

[0094] 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 m 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.

[0095] Furthermore, certain features that are described in this disclosure in the context of separate implementations can also be implemented in combination in 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.

[0096] 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 particular order 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, thefeatures 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.

[0097] 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.

[0098] 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.

[0099] 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 is not 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.

[0100] 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.

[0101] 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.

[0102] Of course, the foregoing description is that of certain features, aspects, and advantages of the present invention, to which various changes and modifications can be made without departing from the spirit and scope of the present invention. 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 invention 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 invention have been shown and described in detail, other modifications and methods of use, which are within the scope of this invention, will be readily apparent to those of skill in the art based upon this disclosure. It is contemplated that various combinations or sub- com binations of these specific features and aspects of embodiments may be made and still fall within the scope of the invention. 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 system for coordinate positioning of an ultrasound probe relative to a patient surface of a procedure table, the system comprising:a robotic transesophageal echocardiography imaging (TEE) system comprising:a support arm coupled to an imaging system support, the support ami configured to support the ultrasound probe; andan actuator configured to adjust at least one degree of freedom of the ultrasound probe relative to the support arm;wherein the robotic TEE system is responsive to initiation of movement of the patient surface by constraining a change in relative position of the support arm relative to the patient surface.

2. The system of Claim 1, wherein the robotic TEE system comprises a kinetic connection mechanism comprising a first link configured to be coupled to the procedure table and a second link configured to be coupled to the support arm, wherein the second link is configured to maintain its position relative to the first link over a functionality based distance.

3. The system of Claim 2, wherein the functionality based distance comprises a crotch to chest distance for an average patient of a patient sub-population.

4. The system of Claim 2 or 3, wherein the functionality based distance comprises 500mm-600mm in a longitudinal direction.

5. The system of any one of Claims 2 to 4, wherein the functionality based distance comprises up to 1000mm in a longitudinal direction and up to 300mm in a transverse direction.

6. The system of any one of Claims 1 to 5, wherein the robotic TEE system comprises a kinetic connection mechanism comprising a first link configured to be coupled to the procedure table and a second link configured to be coupled to the support arm, wherein the second link is configured to maintain its position relative to the first link over a safety based distance.

7. The system of Claim 6, wherein the safety based distance comprises 300mm in a longitudinal direction.

8. The system of Claim 6 or 7, wherein the safety based distance comprises 300mm in a transverse direction.

9. The system of any one of Claims 1 to 8, wherein the system further comprises one or more hardware processors configured to:detect initiation of movement of the patient surface of the procedure table; and initiate a movement countermeasure in response to the detected initiation of movement.

10. The system of Claim 9, wherein detecting the initiation of movement comprises detecting a pressing of a control button configured to cause the patient surface to be moveable relative to a support base of the procedure table.

11. The system of Claim 9 or 10, wherein the movement countermeasure comprises a user alarm configured to be issued on one or more user interface devices.

12. The system of any one of Claims 9 to 11, wherein the movement countermeasure causes the ultrasound probe to move by a corresponding amount and in a corresponding direction to the movement of the procedure table.

13. The system of Claim 12, wherein the one or more hardware processors is configured to send a signal to the actuator to cause the ultrasound probe to move by the corresponding amount and in the corresponding direction to the movement of the procedure table.

14. The system of Claim 13, wherein the one or more hardware processors is configured to send a signal to the actuator to disengage the actuator from a carriage assembly of the robotic TEE system, the carriage assembly supporting the ultrasound probe, wherein disengaging the actuator from the carriage assembly allows the carriage assembly to freely move along the support arm.

15. The system of Claim 13 or 14, wherein the one or more hardware processors is configured to send a signal to the actuator to engage the actuator with a carriage assembly of the robotic TEE system, the carriage assembly supporting the ultrasound probe, wherein engaging the actuator causes the carriage assembly to move in a direction corresponding to the direction of the movement of the procedure table.

16. The system of any one of Claims 9 to 15, w’herein the movement countermeasure causes at least a portion of the support arm to move by a corresponding amount and m a corresponding direction to the movement of the procedure table.

17. The system of any one of Claims 1 to 16, wherein the robotic TEE system is configured to initiate a movement countermeasure in response to the initiation of movement of the patient surface, wherein the movement countermeasure causes at least a portion of the support arm to move by a corresponding amount and in a corresponding direction to the movement of the procedure table, wherein movement of the support arm relative to the procedure table by the corresponding amount and in the corresponding direction is a result of fixing a spatial arrangement of a linkage coupling the procedure table to the support arm.

18. A method comprising:supporting a TEE probe assembly on a robotic support arm;advancing a catheter of the TEE probe assembly into a mouth of a patient, wherein the patient is positioned on a patient surface of a procedure table; and constraining a change in relative position of the robotic support arm relative to the patient surface, wherein constraining a change in relative position comprises:initiating a movement countermeasure in response to movement of the patient surface relative to the robotic support arm.

19. The method of Claim 18, wherein the movement countermeasure comprises issuing an alarm on a user interface directed to causing a user to cease the initiation of movement.

20. The method of Claim 18 or 19, wherein the movement countermeasure comprises engaging a kinetic connection between the robotic support arm and the patient surface.

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