CASOG: Conservative Actor-critic with SmOoth Gradient for Skill Learning in Robot-Assisted Intervention

Coronary artery disease is the most common cardiovascular diseases and kills millions every year [1]. Percutaneous coronary intervention (PCI) is a widely used treatment for coronary artery disease. In PCI, physicians use X-ray fluoroscopy for guidance and deliver guidewires, catheters, and other instruments to the target vessel for treatments such as stenting and drugs. Due to X-ray fluoroscopy guidance, physicians are exposed to radiation and wear heavy lead-lined garments for radiation protection, which leads to radiation-associated hazards [2] and orthopedic strain injuries [3]. Vascular robotic systems with the master-slave control mode [4, 5] have been developed to reduce the risks mentioned above. Robot-assisted intervention has shown numerous benefits in clinical trials, including X-ray exposure reduction, control precision improvement, and procedural duration decrease. In robot-assisted intervention, instruments are shaped as flexible wires. Physicians manipulate the proximal tip of instruments outside the patient body to deliver the distal tip to the target in vessels. The relationship between manipulations and distal motion is non-linear, making instrument deliveries challenging.