The Advanced Diagnostic Ultrasound in Microgravity (ADUM) experiment involves crewmembers conducting ultrasound exams on one another to determine the accuracy of ultrasound use to diagnose certain types of on-orbit injuries and illnesses, as well as to assess the feasibility of ultrasound for monitoring in-flight bone alterations.Principal Investigator(s)
Johnson Space Center, Human Research Program, Houston, TX, United States
National Aeronautics and Space Administration (NASA)Sponsoring Organization
Human Exploration and Operations Mission Directorate (HEOMD)Research Benefits
Information PendingISS Expedition Duration:
October 2003 - April 2006Expeditions Assigned
8,9,10,11,12Previous ISS Missions
ADUM is the first formal experiment to examine the use of ultrasound in microgravity. Crewmembers, however, did check out the ultrasound equipment during Increment 5.
ISS Science Challenge Selected Project
I chose to complete a PowerPoint presentation on the Advanced Diagnostic Ultrasound in Microgravity Experiment. I purposely chose an activity related to health because I find the human body fascinating, and I wanted to learn more about the effects of microgravity on it. This particular experiment appealed to me because I recently shadowed in the Radiology Unit at a hospital and saw many ultrasounds performed. I could relate my basic knowledge of what I learned to the performance of ultrasound in space. While completing this presentation, I learned a lot of new information about the uses and positive qualities of ultrasound diagnosis, as well as how drastically it could change our future. It also exposed me to the idea of telemedicine, which I had never heard of before.
- Smridhi, Grade 12, Health Careers High School, San Antonio, Texas
Advanced Diagnostic Ultrasound in Microgravity (ADUM) tests the accuracy of using ultrasound technology in the novel clinical situation of space flight. This investigation includes assessing health problems in the eyes and bones, as well as sinus infections and abdominal injuries. ADUM further tests the feasibility of in-flight ultrasound use to monitor bone density during long-duration space flights. Another objective of the experiment is to determine how well nonmedical crewmembers can learn to use an ultrasound device via CD ROM training manuals and remote guidance from Earth. The intent of the ADUM investigation is to develop methods by which a medically-untrained individual can use an ultrasound machine with remote diagnostician assistance to evaluate a vast array of medical problems.
Expedition crews use the International Space Station (ISS) Human Research Facility (HRF) ultrasound machine and four scan sets: the cardio/thoracic scan, which focuses on the heart, but also can scan the lungs; the abdominal/retroperitoneal scan, which focuses on the organs of the abdomen, including the liver, spleen, kidneys, and bladder; the dental scan, which can image the mouth, teeth, gums, facial bones and sinuses, and eyes; and the bone scan, which images bones and characterizes bone loss during flight. In addition to the ultrasound machine and probes, another key component of ADUM on ISS is the onboard proficiency enhancer, a software application the crew uses to train on the methods employed for each scan.
Aboard the ISS, there is not enough room for a fully functioning hospital or staff of doctors. It is also not feasible for a crewmember to return to Earth for a quick medical checkup. This experiment allows for efficient diagnosis of medical problems with minimal use of onboard resources. The ability of crewmembers to use an ultrasound machine with remote instruction, along with ground analysis, promotes timely treatment and averts unnecessary evacuation. Using a modification of this technology, crewmembers as far away as Mars could obtain remote examinations from doctors on Earth. This type of capability is essential for long-term space exploration.Earth Applications
The use of a relatively small piece of medical equipment to diagnose various health problems, in the absence of nearby specialized medical personnel, could save lives and reduce healthcare costs. Patients could transmit ultrasound information to doctors over great distances, resulting in efficient remote medical diagnosis and treatment to a high degree of confidence. This technology essentially allows anyone in the world the potential to access unique clinical imaging expertise remotely.
The current procedures for ADUM require two crewmembers to participate during each experimental scan. One person serves as a subject while the other operates the HRF ultrasound machine. For all scans, except the Bone scan, the experimental subject must anchor into the Medical Operations Crew Medical Restraint System. Instruction from the ground-based personnel during each scan requires two-way audio and a video downlink of the ultrasound images. Both audio and video links operate in the required private mode, which ensures crewmember privacy both during and after the experiment.Operational Protocols
ADUM investigator-developed Onboard Proficiency Enhancer (OPE) supplements the crewmembers’ ground training prior to each Increment. OPE sections are specific to each type of scan and crewmembers must view them within the week immediately before the respective scan.
The ISS crew must set up the ultrasound hardware on the day of each scan session. This equipment primarily consists of the HRF laptop and the ultrasound keyboard, monitor, and probes. Each scan lasts between 20 and 50 minutes. After the scan completes, the crew shuts down the ultrasound machine and stows the hardware. The total crew time required for each scan session is approximately 2 hours.
The ISS ADUM experiment (duration: Expedition 8 to 11) demonstrates that minimal training, along with audio guidance from a certified sonographer, can produce ultrasound imagery of diagnostic quality. The ISS crewmembers, act as operators and subjects, completing comprehensive scans of the cardiothoracic and abdominal organs, as well as limited scans of the dental, sinus, and eye structures. The experiment also includes multiple musculoskeletal exams, such as a detailed exam of the shoulder muscles. Analysis of ultrasound video downlinks to ground teams at the NASA Johnson Space Center (JSC) TeleScience Center shows excellent results. Many trauma centers around the world use ultrasound technology as a first-line diagnostic procedure to assess abdominal trauma. The use of ultrasound does not require performance by a radiologist for accurate results. Previous research studies cover this topic of expanding ultrasound technology use by nonradiologists in remote locations to provide diagnostic information on acute clinical conditions. The use of ultrasound technology as a diagnostic tool on ISS requires an onboard proficiency enhancement program, visual cue cards, procedures, and direction from ground-based trained radiological personnel. The high-fidelity image captures of the thoracic, cardiac, and vascular systems from the Expedition 8 crew demonstrate the capability of minimally trained, nonmedical personnel ultrasound operations. This investigation lays the groundwork for using ultrasound as a diagnostic tool, without an available physician, in microgravity and remote locations on Earth. There is a scientific paper discussing these results, which crewmembers sent directly from orbit (Foale et al. 2005).
Crewmembers' ultrasound images of the shoulder during Expedition 9 show the diagnostic quality of the ultrasound imagery for the evaluation of shoulder integrity. A example application of this technology is if a crewmember were to injure their shoulder during a strenuous extravehicular activity (EVA), these techniques enable evaluation and diagnosis of possible injuries (Fincke et al. 2005).
Following a traumatic event to the head or face, eye examination is a very important component of the physical examination. Significant orbital or facial swelling can complicate the examination. The Expedition 10 crew
Fincke EM, Sargsyan AE, Padalka G, Lee D, Melton SL, van Holsbeeck M, Hamilton DR, Dulchavsky SA, Martin DS, McFarlin K. Evaluation of Shoulder Integrity in Space: First Report of Musculoskeletal US on the International Space Station. Radiology. 2005; 234(2): 319-322.
Chiao LN, Sharipov S, Sargsyan AE, Melton SL, Hamilton DR, McFarlin K, Dulchavsky SA. Ocular examination for trauma; clinical ultrasound aboard the International Space Station. Journal of Trauma: Injury Infection and Critical Care. 2005; 58(5): 885-889.
Foale CM, Sargsyan AE, Kaleri AY, Melton SL, Hamilton DR, Martin DS, Dulchavsky SA. Diagnostic instrumentation aboard ISS: just in time training for non-physician crewmembers. Aviation, Space, and Environmental Medicine. 2005; 76: 594-598.
Jones JA, Sargsyan AE, Melton SL, Hamilton DR, Kirkpatrick AW, Dulchavsky SA, Whitson PA, Martin DS. FAST at MACH 20: Clinical Ultrasound Aboard the International Space Station. Journal of Trauma: Injury Infection and Critical Care. 2004; 58(1): 35-39. DOI: 10.1097/01.TA.0000145083.47032.78.
Hamilton DR, Sargsyan AE, Martin DS, Garcia KM, Melton SL, Feiveson AH, Dulchavsky SA. On-orbit prospective echocardiography on International Space Station crew. Echocardiography. 2011; 28(5): 491-501. DOI: 10.1111/j.1540-8175.2011.01385.x.
Sargsyan AE, Amponsah D, Melton SL, Marshall NE, Hamilton DR, Dulchavsky SA. Ultrasonic evaluation of pupillary light reflex. Critical UltraSound Journal. 2009. DOI: 10.1007/s13089-009-0012-9.