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Ultrasound-guided percutaneous needle insertion is a standard procedure employed in both biopsy and ablation in clinical practices. However, due to the complex interaction between tissue and instrument, the needle may deviate from the in-plane view, resulting in a lack of close monitoring of the percutaneous needle. To address this challenge, we introduce a robot-assisted ultrasound (US) imaging system designed to seamlessly monitor the insertion process and autonomously restore the visibility of the inserted instrument when misalignment happens. To this end, the adversarial structure is presented to encourage the generation of segmentation masks that align consistently with the ground truth in high-order space. This study also systematically investigates the effects on segmentation performance by exploring various training loss functions and their combinations. When misalignment between the probe and the percutaneous needle is detected, the robot is triggered to perform transverse searching to optimize the positional and rotational adjustment to restore needle visibility. The experimental results on ex-vivo porcine samples demonstrate that the proposed method can precisely segment the percutaneous needle (with a tip error of $0.37\pm0.29mm$ and an angle error of $1.19\pm 0.29^{\circ}$). Furthermore, the needle appearance can be successfully restored under the repositioned probe pose in all 45 trials, with repositioning errors of $1.51\pm0.95mm$ and $1.25\pm0.79^{\circ}$. from latex to text with math symbols, Comment: accepted by IEEE TIM. code: https://github.com/noseefood/NeedleSegmentation-GAN; video: https://youtu.be/4WuEP9PACs0

Ultrasound imaging has been widely used in clinical examinations owing to the advantages of being portable, real-time, and radiation-free. Considering the potential of extensive deployment of autonomous examination systems in hospitals, robotic US imaging has attracted increased attention. However, due to the inter-patient variations, it is still challenging to have an optimal path for each patient, particularly for thoracic applications with limited acoustic windows, e.g., intercostal liver imaging. To address this problem, a class-aware cartilage bone segmentation network with geometry-constraint post-processing is presented to capture patient-specific rib skeletons. Then, a dense skeleton graph-based non-rigid registration is presented to map the intercostal scanning path from a generic template to individual patients. By explicitly considering the high-acoustic impedance bone structures, the transferred scanning path can be precisely located in the intercostal space, enhancing the visibility of internal organs by reducing the acoustic shadow. To evaluate the proposed approach, the final path mapping performance is validated on five distinct CTs and two volunteer US data, resulting in ten pairs of CT-US combinations. Results demonstrate that the proposed graph-based registration method can robustly and precisely map the path from CT template to individual patients (Euclidean error: $2.21\pm1.11~mm$).

Automatic report generation has arisen as a significant research area in computer-aided diagnosis, aiming to alleviate the burden on clinicians by generating reports automatically based on medical images. In this work, we propose a novel framework for automatic ultrasound report generation, leveraging a combination of unsupervised and supervised learning methods to aid the report generation process. Our framework incorporates unsupervised learning methods to extract potential knowledge from ultrasound text reports, serving as the prior information to guide the model in aligning visual and textual features, thereby addressing the challenge of feature discrepancy. Additionally, we design a global semantic comparison mechanism to enhance the performance of generating more comprehensive and accurate medical reports. To enable the implementation of ultrasound report generation, we constructed three large-scale ultrasound image-text datasets from different organs for training and validation purposes. Extensive evaluations with other state-of-the-art approaches exhibit its superior performance across all three datasets. Code and dataset are valuable at this link.

Ultrasound (US) has been widely used in daily clinical practice for screening internal organs and guiding interventions. However, due to the acoustic shadow cast by the subcutaneous rib cage, the US examination for thoracic application is still challenging. To fully cover and reconstruct the region of interest in US for diagnosis, an intercostal scanning path is necessary. To tackle this challenge, we present a reinforcement learning (RL) approach for planning scanning paths between ribs to monitor changes in lesions on internal organs, such as the liver and heart, which are covered by rib cages. Structured anatomical information of the human skeleton is crucial for planning these intercostal paths. To obtain such anatomical insight, an RL agent is trained in a virtual environment constructed using computational tomography (CT) templates with randomly initialized tumors of various shapes and locations. In addition, task-specific state representation and reward functions are introduced to ensure the convergence of the training process while minimizing the effects of acoustic attenuation and shadows during scanning. To validate the effectiveness of the proposed approach, experiments have been carried out on unseen CTs with randomly defined single or multiple scanning targets. The results demonstrate the efficiency of the proposed RL framework in planning non-shadowed US scanning trajectories in areas with limited acoustic access.

In clinical applications that involve ultrasound-guided intervention, the visibility of the needle can be severely impeded due to steep insertion and strong distractors such as speckle noise and anatomical occlusion. To address this challenge, we propose VibNet, a learning-based framework tailored to enhance the robustness and accuracy of needle detection in ultrasound images, even when the target becomes invisible to the naked eye. Inspired by Eulerian Video Magnification techniques, we utilize an external step motor to induce low-amplitude periodic motion on the needle. These subtle vibrations offer the potential to generate robust frequency features for detecting the motion patterns around the needle. To robustly and precisely detect the needle leveraging these vibrations, VibNet integrates learning-based Short-Time-Fourier-Transform and Hough-Transform modules to achieve successive sub-goals, including motion feature extraction in the spatiotemporal space, frequency feature aggregation, and needle detection in the Hough space. Based on the results obtained on distinct ex vivo porcine and bovine tissue samples, the proposed algorithm exhibits superior detection performance with efficient computation and generalization capability.

Deep Venous Thrombosis (DVT) is a common vascular disease with blood clots inside deep veins, which may block blood flow or even cause a life-threatening pulmonary embolism. A typical exam for DVT using ultrasound (US) imaging is by pressing the target vein until its lumen is fully compressed. However, the compression exam is highly operator-dependent. To alleviate intra- and inter-variations, we present a robotic US system with a novel hybrid force motion control scheme ensuring position and force tracking accuracy, and soft landing of the probe onto the target surface. In addition, a path-based virtual fixture is proposed to realize easy human-robot interaction for repeat compression operation at the lesion location. To ensure the biometric measurements obtained in different examinations are comparable, the 6D scanning path is determined in a coarse-to-fine manner using both an external RGBD camera and US images. The RGBD camera is first used to extract a rough scanning path on the object. Then, the segmented vascular lumen from US images are used to optimize the scanning path to ensure the visibility of the target object. To generate a continuous scan path for developing virtual fixtures, an arc-length based path fitting model considering both position and orientation is proposed. Finally, the whole system is evaluated on a human-like arm phantom with an uneven surface., Comment: Accepted Paper IEEE T-ASE

This article reviews the recent advances in intelligent robotic ultrasound (US) imaging systems. We commence by presenting the commonly employed robotic mechanisms and control techniques in robotic US imaging, along with their clinical applications. Subsequently, we focus on the deployment of machine learning techniques in the development of robotic sonographers, emphasizing crucial developments aimed at enhancing the intelligence of these systems. The methods for achieving autonomous action reasoning are categorized into two sets of approaches: those relying on implicit environmental data interpretation and those using explicit interpretation. Throughout this exploration, we also discuss practical challenges, including those related to the scarcity of medical data, the need for a deeper understanding of the physical aspects involved, and effective data representation approaches. Moreover, we conclude by highlighting the open problems in the field and analyzing different possible perspectives on how the community could move forward in this research area., Comment: Accepted by Annual Review of Control, Robotics, and Autonomous Systems

The recovery of morphologically accurate anatomical images from deformed ones is challenging in ultrasound (US) image acquisition, but crucial to accurate and consistent diagnosis, particularly in the emerging field of computer-assisted diagnosis. This article presents a novel anatomy-aware deformation correction approach based on a coarse-to-fine, multi-scale deep neural network (DefCor-Net). To achieve pixel-wise performance, DefCor-Net incorporates biomedical knowledge by estimating pixel-wise stiffness online using a U-shaped feature extractor. The deformation field is then computed using polynomial regression by integrating the measured force applied by the US probe. Based on real-time estimation of pixel-by-pixel tissue properties, the learning-based approach enables the potential for anatomy-aware deformation correction. To demonstrate the effectiveness of the proposed DefCor-Net, images recorded at multiple locations on forearms and upper arms of six volunteers are used to train and validate DefCor-Net. The results demonstrate that DefCor-Net can significantly improve the accuracy of deformation correction to recover the original geometry (Dice Coefficient: from $14.3\pm20.9$ to $82.6\pm12.1$ when the force is $6N$)., Comment: Accepted by MedIA. code is available

Ultrasound (US) is one of the most widely used modalities for clinical intervention and diagnosis due to the merits of providing non-invasive, radiation-free, and real-time images. However, free-hand US examinations are highly operator-dependent. Robotic US System (RUSS) aims at overcoming this shortcoming by offering reproducibility, while also aiming at improving dexterity, and intelligent anatomy and disease-aware imaging. In addition to enhancing diagnostic outcomes, RUSS also holds the potential to provide medical interventions for populations suffering from the shortage of experienced sonographers. In this paper, we categorize RUSS as teleoperated or autonomous. Regarding teleoperated RUSS, we summarize their technical developments, and clinical evaluations, respectively. This survey then focuses on the review of recent work on autonomous robotic US imaging. We demonstrate that machine learning and artificial intelligence present the key techniques, which enable intelligent patient and process-specific, motion and deformation-aware robotic image acquisition. We also show that the research on artificial intelligence for autonomous RUSS has directed the research community toward understanding and modeling expert sonographers' semantic reasoning and action. Here, we call this process, the recovery of the "language of sonography". This side result of research on autonomous robotic US acquisitions could be considered as valuable and essential as the progress made in the robotic US examination itself. This article will provide both engineers and clinicians with a comprehensive understanding of RUSS by surveying underlying techniques., Comment: Accepted by Medical Image Analysis

Autonomous ultrasound (US) imaging has gained increased interest recently, and it has been seen as a potential solution to overcome the limitations of free-hand US examinations, such as inter-operator variations. However, it is still challenging to accurately map planned paths from a generic atlas to individual patients, particularly for thoracic applications with high acoustic-impedance bone structures under the skin. To address this challenge, a graph-based non-rigid registration is proposed to enable transferring planned paths from the atlas to the current setup by explicitly considering subcutaneous bone surface features instead of the skin surface. To this end, the sternum and cartilage branches are segmented using a template matching to assist coarse alignment of US and CT point clouds. Afterward, a directed graph is generated based on the CT template. Then, the self-organizing map using geographical distance is successively performed twice to extract the optimal graph representations for CT and US point clouds, individually. To evaluate the proposed approach, five cartilage point clouds from distinct patients are employed. The results demonstrate that the proposed graph-based registration can effectively map trajectories from CT to the current setup for displaying US views through limited intercostal space. The non-rigid registration results in terms of Hausdorff distance (Mean$\pm$SD) is 9.48$\pm$0.27 mm and the path transferring error in terms of Euclidean distance is 2.21$\pm$1.11 mm., Comment: Accepted by IROS23

Ultrasound (US) imaging is widely used for biometric measurement and diagnosis of internal organs due to the advantages of being real-time and radiation-free. However, due to high inter-operator variability, resulting images highly depend on operators' experience. In this work, an intelligent robotic sonographer is proposed to autonomously "explore" target anatomies and navigate a US probe to a relevant 2D plane by learning from expert. The underlying high-level physiological knowledge from experts is inferred by a neural reward function, using a ranked pairwise image comparisons approach in a self-supervised fashion. This process can be referred to as understanding the "language of sonography". Considering the generalization capability to overcome inter-patient variations, mutual information is estimated by a network to explicitly extract the task-related and domain features in latent space. Besides, a Gaussian distribution-based filter is developed to automatically evaluate and take the quality of the expert's demonstrations into account. The robotic localization is carried out in coarse-to-fine mode based on the predicted reward associated to B-mode images. To demonstrate the performance of the proposed approach, representative experiments for the "line" target and "point" target are performed on vascular phantom and two ex-vivo animal organ phantoms (chicken heart and lamb kidney), respectively. The results demonstrated that the proposed advanced framework can robustly work on different kinds of known and unseen phantoms.

Ultrasound (US) imaging is widely used for diagnosing and monitoring arterial diseases, mainly due to the advantages of being non-invasive, radiation-free, and real-time. In order to provide additional information to assist clinicians in diagnosis, the tubular structures are often segmented from US images. To improve the artery segmentation accuracy and stability during scans, this work presents a novel pulsation-assisted segmentation neural network (PAS-NN) by explicitly taking advantage of the cardiac-induced motions. Motion magnification techniques are employed to amplify the subtle motion within the frequency band of interest to extract the pulsation signals from sequential US images. The extracted real-time pulsation information can help to locate the arteries on cross-section US images; therefore, we explicitly integrated the pulsation into the proposed PAS-NN as attention guidance. Notably, a robotic arm is necessary to provide stable movement during US imaging since magnifying the target motions from the US images captured along a scan path is not manually feasible due to the hand tremor. To validate the proposed robotic US system for imaging arteries, experiments are carried out on volunteers' carotid and radial arteries. The results demonstrated that the PAS-NN could achieve comparable results as state-of-the-art on carotid and can effectively improve the segmentation performance for small vessels (radial artery)., Comment: Accepted Paper IROS 2023

Medical ultrasound (US) is widely used to evaluate and stage vascular diseases, in particular for the preliminary screening program, due to the advantage of being radiation-free. However, automatic segmentation of small tubular structures (e.g., the ulnar artery) from cross-sectional US images is still challenging. To address this challenge, this paper proposes the DopUS-Net and a vessel re-identification module that leverage the Doppler effect to enhance the final segmentation result. Firstly, the DopUS-Net combines the Doppler images with B-mode images to increase the segmentation accuracy and robustness of small blood vessels. It incorporates two encoders to exploit the maximum potential of the Doppler signal and recurrent neural network modules to preserve sequential information. Input to the first encoder is a two-channel duplex image representing the combination of the grey-scale Doppler and B-mode images to ensure anatomical spatial correctness. The second encoder operates on the pure Doppler images to provide a region proposal. Secondly, benefiting from the Doppler signal, this work first introduces an online artery re-identification module to qualitatively evaluate the real-time segmentation results and automatically optimize the probe pose for enhanced Doppler images. This quality-aware module enables the closed-loop control of robotic screening to further improve the confidence and robustness of image segmentation. The experimental results demonstrate that the proposed approach with the re-identification process can significantly improve the accuracy and robustness of the segmentation results (dice score: from 0:54 to 0:86; intersection over union: from 0:47 to 0:78)., Comment: video: https://www.youtube.com/watch?v=ZH7K63GngdA; code: https://github.com/Felixduelmer/DopUs

Autonomous ultrasound (US) scanning has attracted increased attention, and it has been seen as a potential solution to overcome the limitations of conventional US examinations, such as inter-operator variations. However, it is still challenging to autonomously and accurately transfer a planned scan trajectory on a generic atlas to the current setup for different patients, particularly for thorax applications with limited acoustic windows. To address this challenge, we proposed a skeleton graph-based non-rigid registration to adapt patient-specific properties using subcutaneous bone surface features rather than the skin surface. To this end, the self-organization mapping is successively used twice to unify the input point cloud and extract the key points, respectively. Afterward, the minimal spanning tree is employed to generate a tree graph to connect all extracted key points. To appropriately characterize the rib cartilage outline to match the source and target point cloud, the path extracted from the tree graph is optimized by maximally maintaining continuity throughout each rib. To validate the proposed approach, we manually extract the US cartilage point cloud from one volunteer and seven CT cartilage point clouds from different patients. The results demonstrate that the proposed graph-based registration is more effective and robust in adapting to the inter-patient variations than the ICP (distance error mean/SD: 5.0/1.9 mm vs 8.6/6.7 mm on seven CTs)., Comment: online video: https://www.youtube.com/watch?v=LkSHL7FJ8eU

Generalization capabilities of learning-based medical image segmentation across domains are currently limited by the performance degradation caused by the domain shift, particularly for ultrasound (US) imaging. The quality of US images heavily relies on carefully tuned acoustic parameters, which vary across sonographers, machines, and settings. To improve the generalizability on US images across domains, we propose MI-SegNet, a novel mutual information (MI) based framework to explicitly disentangle the anatomical and domain feature representations; therefore, robust domain-independent segmentation can be expected. Two encoders are employed to extract the relevant features for the disentanglement. The segmentation only uses the anatomical feature map for its prediction. In order to force the encoders to learn meaningful feature representations a cross-reconstruction method is used during training. Transformations, specific to either domain or anatomy are applied to guide the encoders in their respective feature extraction task. Additionally, any MI present in both feature maps is punished to further promote separate feature spaces. We validate the generalizability of the proposed domain-independent segmentation approach on several datasets with varying parameters and machines. Furthermore, we demonstrate the effectiveness of the proposed MI-SegNet serving as a pre-trained model by comparing it with state-of-the-art networks.

Robotic ultrasound (US) imaging aims at overcoming some of the limitations of free-hand US examinations, e.g. difficulty in guaranteeing intra- and inter-operator repeatability. However, due to anatomical and physiological variations between patients and relative movement of anatomical substructures, it is challenging to robustly generate optimal trajectories to examine the anatomies of interest, in particular, when they comprise articulated joints. To address this challenge, this paper proposes a vision-based approach allowing autonomous robotic US limb scanning. To this end, an atlas MRI template of a human arm with annotated vascular structures is used to generate trajectories and register and project them onto patients' skin surfaces for robotic US acquisition. To effectively segment and accurately reconstruct the targeted 3D vessel, we make use of spatial continuity in consecutive US frames by incorporating channel attention modules into a U-Net-type neural network. The automatic trajectory generation method is evaluated on six volunteers with various articulated joint angles. In all cases, the system can successfully acquire the planned vascular structure on volunteers' limbs. For one volunteer the MRI scan was also available, which allows the evaluation of the average radius of the scanned artery from US images, resulting in a radius estimation ($1.2\pm0.05~mm$) comparable to the MRI ground truth ($1.2\pm0.04~mm$)., Comment: Directly accepted by IEEE RAL after the first round of review. will present at IROS2022. Video: https://www.youtube.com/watch?v=OlBwmqLGf7w; Codes: https://github.com/jiang96998/AutoLimbUSscan

Robotic ultrasound (US) imaging has been seen as a promising solution to overcome the limitations of free-hand US examinations, i.e., inter-operator variability. However, the fact that robotic US systems cannot react to subject movements during scans limits their clinical acceptance. Regarding human sonographers, they often react to patient movements by repositioning the probe or even restarting the acquisition, in particular for the scans of anatomies with long structures like limb arteries. To realize this characteristic, we proposed a vision-based system to monitor the subject's movement and automatically update the scan trajectory thus seamlessly obtaining a complete 3D image of the target anatomy. The motion monitoring module is developed using the segmented object masks from RGB images. Once the subject is moved, the robot will stop and recompute a suitable trajectory by registering the surface point clouds of the object obtained before and after the movement using the iterative closest point algorithm. Afterward, to ensure optimal contact conditions after repositioning US probe, a confidence-based fine-tuning process is used to avoid potential gaps between the probe and contact surface. Finally, the whole system is validated on a human-like arm phantom with an uneven surface, while the object segmentation network is also validated on volunteers. The results demonstrate that the presented system can react to object movements and reliably provide accurate 3D images., Comment: The paper has been accepted by IEEE TIM. Video: https://www.youtube.com/watch?v=MUtgSXS7EZI

Ultrasound (US) is one of the most common medical imaging modalities since it is radiation-free, low-cost, and real-time. In freehand US examinations, sonographers often navigate a US probe to visualize standard examination planes with rich diagnostic information. However, reproducibility and stability of the resulting images often suffer from intra- and inter-operator variation. Reinforcement learning (RL), as an interaction-based learning method, has demonstrated its effectiveness in visual navigating tasks; however, RL is limited in terms of generalization. To address this challenge, we propose a simulation-based RL framework for real-world navigation of US probes towards the standard longitudinal views of vessels. A UNet is used to provide binary masks from US images; thereby, the RL agent trained on simulated binary vessel images can be applied in real scenarios without further training. To accurately characterize actual states, a multi-modality state representation structure is introduced to facilitate the understanding of environments. Moreover, considering the characteristics of vessels, a novel standard view recognition approach based on the minimum bounding rectangle is proposed to terminate the searching process. To evaluate the effectiveness of the proposed method, the trained policy is validated virtually on 3D volumes of a volunteer's in-vivo carotid artery, and physically on custom-designed gel phantoms using robotic US. The results demonstrate that proposed approach can effectively and accurately navigate the probe towards the longitudinal view of vessels., Comment: Directly accepted by IEEE RAL after the first round of review. Video: https://www.youtube.com/watch?v=bzCO07Hquj8 Codes: https://github.com/yuan-12138/VesNet-RL

Tissue deformation in ultrasound (US) imaging leads to geometrical errors when measuring tissues due to the pressure exerted by probes. Such deformation has an even larger effect on 3D US volumes as the correct compounding is limited by the inconsistent location and geometry. This work proposes a patient-specified stiffness-based method to correct the tissue deformations in robotic 3D US acquisitions. To obtain the patient-specified model, robotic palpation is performed at sampling positions on the tissue. The contact force, US images and the probe poses of the palpation procedure are recorded. The contact force and the probe poses are used to estimate the nonlinear tissue stiffness. The images are fed to an optical flow algorithm to compute the pixel displacement. Then the pixel-wise tissue deformation under different forces is characterized by a coupled quadratic regression. To correct the deformation at unseen positions on the trajectory for building 3D volumes, an interpolation is performed based on the stiffness values computed at the sampling positions. With the stiffness and recorded force, the tissue displacement could be corrected. The method was validated on two blood vessel phantoms with different stiffness. The results demonstrate that the method can effectively correct the force-induced deformation and finally generate 3D tissue geometries, Comment: Accepted for publication in IEEE Robotics and Automation Letters; Video: https://www.youtube.com/watch?v=MlZtugQ2cvQ

Robotic three-dimensional (3D) ultrasound (US) imaging has been employed to overcome the drawbacks of traditional US examinations, such as high inter-operator variability and lack of repeatability. However, object movement remains a challenge as unexpected motion decreases the quality of the 3D compounding. Furthermore, attempted adjustment of objects, e.g., adjusting limbs to display the entire limb artery tree, is not allowed for conventional robotic US systems. To address this challenge, we propose a vision-based robotic US system that can monitor the object's motion and automatically update the sweep trajectory to provide 3D compounded images of the target anatomy seamlessly. To achieve these functions, a depth camera is employed to extract the manually planned sweep trajectory after which the normal direction of the object is estimated using the extracted 3D trajectory. Subsequently, to monitor the movement and further compensate for this motion to accurately follow the trajectory, the position of firmly attached passive markers is tracked in real-time. Finally, a step-wise compounding was performed. The experiments on a gel phantom demonstrate that the system can resume a sweep when the object is not stationary during scanning., Comment: Accepted to ICRA2021

Ultrasound (US) imaging is widely employed for diagnosis and staging of peripheral vascular diseases (PVD), mainly due to its high availability and the fact it does not emit radiation. However, high inter-operator variability and a lack of repeatability of US image acquisition hinder the implementation of extensive screening programs. To address this challenge, we propose an end-to-end workflow for automatic robotic US screening of tubular structures using only the real-time US imaging feedback. We first train a U-Net for real-time segmentation of the vascular structure from cross-sectional US images. Then, we represent the detected vascular structure as a 3D point cloud and use it to estimate the longitudinal axis of the target tubular structure and its mean radius by solving a constrained non-linear optimization problem. Iterating the previous processes, the US probe is automatically aligned to the orientation normal to the target tubular tissue and adjusted online to center the tracked tissue based on the spatial calibration. The real-time segmentation result is evaluated both on a phantom and in-vivo on brachial arteries of volunteers. In addition, the whole process is validated both in simulation and physical phantoms. The mean absolute radius error and orientation error ($\pm$ SD) in the simulation are $1.16\pm0.1~mm$ and $2.7\pm3.3^{\circ}$, respectively. On a gel phantom, these errors are $1.95\pm2.02~mm$ and $3.3\pm2.4^{\circ}$. This shows that the method is able to automatically screen tubular tissues with an optimal probe orientation (i.e. normal to the vessel) and at the same to accurately estimate the mean radius, both in real-time., Comment: Accepted for publication in IEEE Transactions on Industrial Electronics Video: https://www.youtube.com/watch?v=VAaNZL0I5ik

Drilling is one of the hardest parts of pedicle screw fixation, and it is one of the most dangerous operations because inaccurate screw placement would injury vital tissues, particularly when the vertebra is not stationary. Here we demonstrate the drilling state recognition method for moving tissue by compensating the displacement based on a simplified motion predication model of a vertebra with respect to the tidal volume. To adapt it to different patients, the prediction model was built based on the physiological data recorded from subjects themselves. In addition, the spindle speed of the drilling tool was investigated to find a suitable speed for the robotic-assisted system. To ensure patient safety, a monitoring system was built based on the thrusting force and tracked position information. Finally, experiments were carried out on a fresh porcine lamellar bone fixed on a 3-PRS parallel robot used to simulate the vertebra displacement. The success rate of the robotic-assisted drilling procedure reached 95% when the moving bone was compensated.