Endovascular robots have been actively developed in both academia and industry. However, progress toward autonomous catheterization is often hampered by the widespread use of closed-source simulators and physical phantoms. Additionally, the acquisition of large-scale datasets for training machine learning algorithms with endovascular robots is usually infeasible due to expensive medical procedures. In this chapter, we introduce CathSim, the first open-source simulator for endovascular intervention to address these limitations. CathSim emphasizes real-time performance to enable rapid development and testing of learning algorithms. We validate CathSim against the real robot and show that our simulator can successfully mimic the behavior of the real robot. Based on CathSim, we develop a multimodal expert navigation network and demonstrate its effectiveness in downstream endovascular navigation tasks. The intensive experimental results suggest that CathSim has the potential to significantly accelerate research in the autonomous catheterization field. Our project is publicly available at https://github.com/airvlab/cathsim. Endovascular interventions are commonly performed for the diagnosis and treatment of vascular diseases. This intervention involves the utilization of flexible tools, namely guidewires, and catheters. These instruments are introduced into the body via small incisions and manually navigated to specific body regions through the vascular system [69]. Endovascular tool navigation takes approximately 70% of the intervention time and is utilized for a plethora of vascular-related conditions such as peripheral artery disease, aneurysms, and stenosis [49].

Autonomous robots in endovascular operations have the potential to navigate circulatory systems safely and reliably while decreasing the susceptibility to human errors. However, there are numerous challenges involved with the process of training such robots, such as long training duration and safety issues arising from the interaction between the catheter and the aorta. Recently, endovascular simulators have been employed for medical training but generally do not conform to autonomous catheterization. Furthermore, most current simulators are closed-source, which hinders the collaborative development of safe and reliable autonomous systems. In this work, we introduce CathSim, an open-source simulation environment that accelerates the development of machine learning algorithms for autonomous endovascular navigation. We first simulate the high-fidelity catheter and aorta with a state-of-the-art endovascular robot. We then provide the capability of real-time force sensing between the catheter and the aorta in simulation. Furthermore, we validate our simulator by conducting two different catheterization tasks using two popular reinforcement learning algorithms. The experimental results show that our open-source simulator can mimic the behaviour of real-world endovascular robots and facilitate the development of different autonomous catheterization tasks. Our simulator is publicly available at https://github.com/robotvisionlabs/cathsim.