Robotic-assisted percutaneous coronary intervention (PCI) holds considerable promise for elevating precision and safety in cardiovascular procedures. Nevertheless, current systems heavily depend on human operators, resulting in variability and the potential for human error. To tackle these challenges, Sim4EndoR, an innovative reinforcement learning (RL) based simulation environment, is first introduced to bolster task-level autonomy in PCI. This platform offers a comprehensive and risk-free environment for the development, evaluation, and refinement of potential autonomous systems, enhancing data collection efficiency and minimizing the need for costly hardware trials. A notable aspect of the groundbreaking Sim4EndoR is its reward function, which takes into account the anatomical constraints of the vascular environment, utilizing the geometric characteristics of vessels to steer the learning process. By seamlessly integrating advanced physical simulations with neural network-driven policy learning, Sim4EndoR fosters efficient sim-to-real translation, paving the way for safer, more consistent robotic interventions in clinical practice, ultimately improving patient outcomes.

Accurate three-dimensional (3D) reconstruction of guidewire shapes is crucial for precise navigation in robot-assisted endovascular interventions. Conventional 2D Digital Subtraction Angiography (DSA) is limited by the absence of depth information, leading to spatial ambiguities that hinder reliable guidewire shape sensing. This paper introduces a novel multimodal framework for real-time 3D guidewire reconstruction, combining preoperative 3D Computed Tomography Angiography (CTA) with intraoperative 2D DSA images. The method utilizes robust feature extraction to address noise and distortion in 2D DSA data, followed by deformable image registration to align the 2D projections with the 3D CTA model. Subsequently, the inverse projection algorithm reconstructs the 3D guidewire shape, providing real-time, accurate spatial information. This framework significantly enhances spatial awareness for robotic-assisted endovascular procedures, effectively bridging the gap between preoperative planning and intraoperative execution. The system demonstrates notable improvements in real-time processing speed, reconstruction accuracy, and computational efficiency. The proposed method achieves a projection error of 1.76±0.08 pixels and a length deviation of 2.93±0.15%, with a frame rate of 39.3 1.5 frames per second (FPS). These advancements have the ±potential to optimize robotic performance and increase the precision of complex endovascular interventions, ultimately contributing to better clinical outcomes.

Over the past decade, significant advancements have been made in the research and industrialization of robotic systems for endovascular procedures, yet their clinical application remains relatively limited. Physicians commonly report that these robots lack certain intelligent assistive capabilities during procedures. There has been increasing interest and attempts to apply learning-centered algorithms to the training and enhancement of surgical robot skills. This paper proposes an autonomous navigation algorithm for interventional guidewires that is initially trained solely in a virtual simulation environment and subsequently deployed to a real-world robot. Experimental results demonstrate the feasibility of this approach for real-world applications. The proposed approach can help physicians reduce the learning curve for guidewire manipulation and elevate the robot to a higher level of autonomous operation, thereby breaking through the current bottleneck in the level of intelligence for clinical applications of interventional robots. It also holds promise for bringing intelligent transformation to future interventional procedures. Note to Practitioners—This work is motivated by the emerging need to increase the level of autonomy in robotic-assisted endovascular procedures, which has the potential to improve procedural efficiency, standardize procedures, and broaden the adoption of robotic systems in clinical practice. The proposed simulation-based reinforcement learning provides a safe and efficient method for training robotic systems, enabling them to master complex tasks in simulation environments prior to real-world application. The successful deployment of models trained in simulation onto physical robotic platforms demonstrates the feasibility of this method for real-world applications. The proposed simulation-based reinforcement learning method offers a promising and viable pathway for enhancing skill acquisition in endovascular interventional robots.