A robotic simulation platform for fluoroscopy-guided catheter navigation in transcatheter tricuspid valve intervention: system development and proof-of-concept applications.

Robot-assisted transcatheter tricuspid valve intervention requires operators to manipulate a flexible catheter through a robotic interface while interpreting two-dimensional fluoroscopic images. However, accessible platforms for robotic catheter training and image-guided control evaluation remain limited. This study presents a virtual-physical robotic simulation platform integrating a physically manipulated catheter, optical shape tracking, patient-specific cardiac anatomy, CT-derived virtual fluoroscopic projection rendering, and image-space anatomical augmentation. A client-server architecture was developed to separate robot control from computationally intensive image generation while providing continuous virtual fluoroscopic feedback. Two proof-of-concept applications were demonstrated to evaluate the capabilities of the platform. First, a paired operator study demonstrated that the platform could support measurable robotic catheter manipulation tasks under both raw and augmented virtual fluoroscopy. Second, an image-space catheter control experiment demonstrated that the same platform could support the repeatable implementation and evaluation of closed-loop robotic control using a physical catheter. These results demonstrate the technical feasibility of the proposed platform as an intermediate environment for robotic catheter operation studies, training-system development, and image-guided control evaluation before testing in a clinical catheterization laboratory.