Staff Writer

PARIS Robots may be seen as job-stealing contraptions elsewhere in France and bitterly resisted, but radiologists were lining up recently to hear how they can extend their practices using remote ultrasound exams with the Melody robotic system from Adechotech (Naveil, France).

And the system does not replace the ultrasound technician at the remote exam site. Au contraire, French radiologists were shown how the role of the technician is elevated and could well be expanded in remote medical centers thanks to the robot.

Since winning a CE mark approval for Melody in 2013, the French start-up has been ramping up its commercialization efforts and refining the touch-screen interface to remotely control a broad range of ultrasound systems (Medical Device Daily, January 14, 2013).

The company hit full stride for its ambitions in the domestic market at the French Radiology Congress (Journ es Fran aise de Radiologie) winning a frontline presentation slot from the Soci t Fran ais de Radiologie.

Key opinion leaders described the benefits for extending diagnostic exams to cover rural regions, prisons, oil platforms, or 5,000-passenger cruise ships in the Mediterranean. They held forth on the need to establish protocols, announced work already underway to set recommendations and guidelines.

In other words, no one was asking if the robot could play a role, but how it could be applied. And in a positive sign for the company, the discussion broke up with radiologists still kicking around their favorite topic of reimbursement.

Michel Claudon, a radiologist from the University Hospital in Nancy, presented colleagues with a review of published papers validating the remote examination approach in ultrasound.

The earliest efforts relied upon a record-and-upload model where an ultrasound technician would conduct the exam and a remote expert would review the file.

In an extreme example, Claudon cited a demonstration documented in a 2011 article in the Journal of Emergencies, Trauma, and Shock where a just-in-time, pleural and lung ultrasound exam was displayed for an expert evaluation on a smartphone using a portable ultrasound probe interfaced with a laptop computer with video-streaming over Skype.

The key distinguishing features of the approach enabled by Melody is that the examination is synchronous, performed in real-time, as opposed to asynchronous with the record and upload method.

It also provides a high quality exam, such that the remote expert cannot only be more confident in a diagnosis, but more importantly, formally and legally engage his responsibilities as a radiologist, unlike the jury-rigged technique using consumer electronics.

The Melody system is based on a robotic arm controlled by the ultrasound specialist.

Using the Melody Patient system, a trained operator at the patient s side in a secondary center placed a frame over the area of interest and applies gel to the targeted zone.

The robotic arm can accept any ultrasound probe and plug into any ultrasound platform for the exam, according to Nicolas Lefebvre, the general manager for Adechotech.

Connected by high-speed land line or satellite transmission, the Melody Expert system at a remote medical center controls the movement of the probe at the patient site, and it is marvelously sensitive and responsive, according to Claudon.

The ultrasound exam is viewed in real-time by the remote expert, who is simultaneously connected by video conferencing with the operator at the secondary center.

Newly developed touch screen software that can be loaded to any standard computer, according to Lefebvre, allows the ultrasound expert to adjust probe depth, the gain, switch on the Doppler function and otherwise operate the ultrasound platform at the patients side.

One megabyte per second for both uploading and downloading is sufficient capacity for the transmission of the exam and the video conferencing, according to CEO Eric Lefebvre, who also maintains his practice as a ultrasonographer.

The Melody system is shipped with a base price of 50,000 ($57,000), which includes video conferencing capabilities but does not include an ultrasound system. A system can run as high as 100,000, depending on customization and configurations.

In 2014, the company reported revenues of 200,000 ($227,000) but expects to reach 727,000 ($825,000) by the end of 2015.

The Lefebvre family continues to hold 75 percent of Adechotech that it founded in 2008, but in May, 2015 sold for 1 million ($1.14 million) a 25 percent share to Telespace Participation, the investment subsidiary of the French National Center for Space Studies (CNES; Paris), and Midi Capital (Toulouse, France).

CNES conceives and develops technologies, significantly Ariane rocket launchers, and plays a key role in European space programs, such as the comet landing of the Rosetta-Philae probe.

CNES has a 15-year history with the Melody ultrasound robot, encouraging and financing prototype versions developed by Professor Philippe Arbeille from the Trousseau Hospital (Chambray-l s-Tours, France).

A colleague through the University Hospital Center in Tours, France, Lefebvre saw the commercial potential and founded Adechotech.

In April, 2014, T-medrobotics (Scottsdale, Ariz.) became the distributor for the Melody system in the U.S,NULL, introducing the robot at the meeting of the American Telemedicine Association in Baltimore that year.

In September, Adechotech brought on export specialist Philippe Homsi, who will ramp up commercialization in the Middle East and Asia, as well as working with the American distributor.

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