The Human Research Facility Ultrasound on the International Space Station (Ultrasound) hardware will use high resolution imaging to conduct ultrasound exams on crewmembers during ISS missions to help develop strategies for diagnostic telemedicine in both space and on Earth.Facility Manager(s)
Developer(s) Information PendingSponsoring Space Agency
National Aeronautics and Space Administration (NASA)Sponsoring Organization
Human Exploration and Operations Mission Directorate (HEOMD)ISS Expedition Duration
March 2001 - March 2010Expeditions Assigned
2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19/20,21/22Previous ISS Missions
Ultrasound has been operational on the ISS since expedition 2.Availability
Ultrasound is constrained to a maximum of four hours in a 24-hour period, and it is required to be run at least one time per increment. If imaging will take place during the session, private space-to-ground video downlink is required. The ISS crew must set up the ultrasound hardware (this consists primarily of the HRF laptop and the ultrasound keyboard, monitor, and probes) prior to Ultrasound usage.
During the spring of 2002, a permanent diagnostic ultrasound (U/S) imaging system was successfully established as a component of the Human Research Facility (HRF) in the Destiny Laboratory. Over the course of expedition 5, the space medical team and crew medical officers (CMOs) established an operational protocol for diagnostic retroperitoneal and pelvic U/S examination for the first time in spaceflight. Diagnostic ultrasound probes were selected and flown as add-on hardware for expedition 5. Crewmembers received a one-hour instruction and an approximately two-hour "hands-on" practice session prior to their flight. "Just-in-time" training was combined with real-time expert guidance to allow non-physician astronauts to perform complex ultrasound examinations onboard the ISS. U/S examinations performed by astronaut CMOs, with real-time ground support proved that ultrasound performs very well in space flight, and that diagnostic quality images could be obtained and successfully downlinked with ISS hardware and communication equipment.
During ISS Expedition 5, a focused assessment with sonography for trauma (FAST) examination utilizing the Ultrasound, including four standard abdominal windows, was completed in approximately 5.5 minutes onboard the ISS. Following commands from the Johnson Space Center - TeleScience Center (JSC-TSC) based expert, the crewmember acquired all target images without difficulty. The anatomic content and fidelity of the ultrasound video were excellent and would allow clinical decision making. It was concluded that it is possible to conduct a remotely guided FAST examination with excellent clinical results and speed, even with a significantly reduced video frame rate and a 2-second communication latency. A wider application of trauma ultrasound applications for remote medicine on Earth appears to be possible and warranted (Saragsyan et al 2004).
In 2005, athletic trainers for the National Hockey League (NHL) and the United States Olympic teams received a brief (less than 2 hours) hands-on course for musculoskeletal ultrasound techniques, from NASA scientists. Remotely guided musculoskeletal ultrasound examinations (knee, groin, ankle, elbow or shoulder) were obtained on 32 athletes by non-physician operators in less than 15 minutes each during the 2005 - 2006 NHL season and 2006 Winter Olympics. Digital images and video-streams were saved at intervals during the examinations and downloaded. All images and video-streams were considered adequate by professional musculoskeletal ultrasound radiologists. The use of the Ultrasound onboard ISS demonstrated that non-physician operators with limited ultrasound training can perform quality examinations with direction from remote-based professionals. Therefore, this experience suggests that remote ultrasound guidance can be expanded for use in locations without on-site expertise as demonstrated at the 2006 Winter Olympics and (Kwon et al 2006).
Given such risks that injury in space may increase due to the greater number of hours spent on orbit and the multitude of demanding tasks being performed, diagnostic capabilities onboard the ISS should be maximized both to prevent an unnecessary medical evacuation and to increase survival chances and recovery from serious injury if trauma is sustained. Sonography is the only means of medical imaging onboard the ISS, and is likely to remain the leading imaging modality in future human space flight programs. Although trauma sonography (TS) has been well recognized for use on Earth, the technique had to be evaluated for suitability in space flight prior to adopting it as an operational capability. Over a course of four phases, researchers conducted the following investigations: gathered literature reviews that supported the idea that TS was a potential screening tool for trauma in space; developed and tested animal models in ground studies; flight-tested animal models in the NASA KC-135 Reduced Gravity Laboratory; and addressed issues necessary to offer modified TS techniques for space use. Researchers believe that this four-phased approach provided an avenue to evaluating other future potential technologies for operational space medicine (Kirkpatrick et al 2007).
All U/S screenings were self-examinations with remote guidance by voice commands from a ground-based team consisting of a radiologist and an urologist/flight surgeon. Ultrasound of both kidneys for calculi, hydronephrosis and other irregularities showed no evidence, in these instances, of any abnormality. Renal arteries and veins were imaged with clarity, and a sample Doppler spectrum was acquired from a renal artery and the cortico-medullary junction without difficulty. The bladder, solid organs adjacent to the kidney, and the principal vascular structures of the abdominal cavity and and retroperitoneal space, were clearly identified. Power Doppler mode was used to demonstrate fluid mixing in the bladder, and thereby demonstrated "ureteral jets", which showed urine flowing into the bladder from each ureter. Images received through the video downlink in real-time were of sufficient quality to be considered adequate for clinical judgment, for a variety of potential genitourinary applications, including urinary tract survey for stones; signs of obstruction, masses, or cysts; screening for bladder distension or lesions; assessment of ureteral drainage into the bladder and bladder wall conditions. The HRF ultrasound system is now equipped with a reasonable array of ultrasound probes and supported by validated procedures and will significantly enhance the ability to timely diagnose, stage and monitor a wide variety of serious conditions. The outcome of a medical contingency may be changed drastically, and an unnecessary evacuation from the ISS may be prevented, if clinical decisions are supported by objective diagnostic information provided by remote U/S examinations (Jones et al. 2009).
Overall, results show that non-physician crewmembers, after minimal training, can perform complex U/S examinations and that ultrasound could be used in the management of the majority of potential medical problems, and serve as a powerful resource to reduce risks and safeguard crewmembers and missions. Reassured by the success of Advanced Ultrasound in Microgravity (ADUM) and in particular, autonomous data acquisition segments of the experiments, researchers are developing a new ultrasound imaging support system based on a digital catalog of existing sample images, complete with image recognition and acquisition logic and technique, and interactive multimedia reference tools, to further guide and support autonomous acquisition, and possibly interpretation, of images without real-time link with a human expert. In other words, researchers are attempting to replace, to the extent possible, expert human guidance with guidance from a digital information resource. Crewmember performed ultrasound provides additional medical onsite capability for the current space program, and could prove essential for future, exploration-class space flight lacking real-time guidance capability. This effort is supported by NASA as the agency plans to develop future human exploration programs beyond low Earth orbit that will require increased, and at some points, complete medical autonomy.
Kwon D, Bouffard JA, Sargsyan AE, van Holsbeeck M, Melton SL, Hamilton DR, Dulchavsky SA. Battling fire and ice: Remote guidance ultrasound to diagnose injury on the International Space Station and the ice rink. American Journal of Surgery. 2007; 193(3): 417-420. DOI: 10.1016/j.amjsurg.2006.11.009.
Sargsyan AE, Young J, Melton SL, Hamilton DR. The International Space Station Ultrasound Imaging Capability Overview for Prospective Users. NASA Technical Publication; 2006.
Kirkpatrick AW, Jones JA, Sargsyan AE, Melton SL, Hamilton DR, Dulchavsky SA, Beck G, Nicolau S, Campbell M. Trauma Sonography for Use in Microgravity. Aviation, Space, and Environmental Medicine. 2007; 78(4): A38-A42.
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.
Sargsyan AE, Garcia KM, Melton SL, Ebert D, Hamilton DR, Dulchavsky SA. Intuitive ultrasonography for autonomous medical care in limited-resource environments. Acta Astronautica. 2011; 68(9-10): 1595-1607. DOI: 10.1016/j.actaastro.2009.08.024.
Jones JA, Sargsyan AE, Barr YR, Melton SL, Hamilton DR, Dulchavsky SA, Whitson PA. Diagnostic Ultrasound at MACH 20: Retroperitoneal and Pelvic Imaging in Space. Ultrasound Medicine and Biology. 2009; 35(7): 1059-1067. DOI: 10.1016/j.ultrasmedbio.2009.01.002. PMID: 19427106.