Cricothyrotomy is a life-saving emergency intervention that secures an alternate airway route after a neck injury or obstruction. The procedure starts with identifying the correct location (the cricothyroid membrane) for creating an incision to insert an endotracheal tube. This location is determined using a combination of visual and palpation cues. Enabling robot-assisted remote cricothyrotomy may extend this life-saving procedure to injured soldiers or patients who may not be readily accessible for on-site intervention during search-and-rescue scenarios. As a first step towards achieving this goal, this paper explores the feasibility of palpation-assisted landmark identification for cricothyrotomy. Using a cricothyrotomy training simulator, we explore several alternatives for in-situ remote localization of the cricothyroid membrane. These alternatives include a) unaided telemanipulation, b) telemanipulation with direct force feedback, c) telemanipulation with superimposed motion excitation for on-line stiffness estimation and display, and d) fully autonomous palpation scan initialized based on the user’s understanding of key anatomical landmarks. Using the manually digitized cricothyroid membrane location as ground truth, we compare these four methods for accuracy and repeatability of identifying the landmark for cricothyrotomy, time of completion, and ease of use. These preliminary results suggest that the accuracy of remote cricothyrotomy landmark identification is improved when the user is aided with visual and force cues. They also show that, with proper user initialization, landmark identification using remote palpation is feasible - therefore satisfying a key prerequisite for future robotic solutions for remote cricothyrotomy.

In this work, we develop an approach for guiding robots to automatically localize and find the shapes of tumors and other stiff inclusions present in the anatomy. Our approach uses Gaussian processes to model the stiffness distribution and active learning to direct the palpation path of the robot. The palpation paths are chosen such that they maximize an acquisition function provided by an active learning algorithm. Our approach provides the flexibility to avoid obstacles in the robot's path, incorporate uncertainties in robot position and sensor measurements, include prior information about location of stiff inclusions while respecting the robot-kinematics. To the best of our knowledge this is the first work in literature that considers all the above conditions while localizing tumors. The proposed framework is evaluated via simulation and experimentation on three different robot platforms: 6-DoF industrial arm, da Vinci Research Kit (dVRK), and the Insertable Robotic Effector Platform (IREP). Results show that our approach can accurately estimate the locations and boundaries of the stiff inclusions while reducing exploration time.