View of Japan Aerospace Exploration Agency astronaut Akihiko Hoshide, Expedition 33 flight engineer, performing a Sprint Ultrasound 2 Pre-Scan in the Columbus module on the International Space Station. (NASA)
View large image
Expedition 29 Commander Mike Fossum scans Japan Aerospace Exploration Agency crew member Satoshi Furukawa using the Ultrasound 2 on the International Space Station. The controller is approximately the size of a laptop computer. (NASA)
View large image An astronaut living on the International Space Station has to be a jack-of-all-trades, capable of running complex experiments, making intricate repairs and even monitoring the health of fellow crew members. But astronauts have limited equipment for performing medical checks. Tools at most doctors' disposal - like MRIs, CT scanners and even X-ray machines - are much too bulky to carry to space.
Astronauts need something simpler and easier. A doctor at the Henry Ford Hospital in Detroit had the solution. Scott Dulchavsky, M.D., Ph.D., chair of the Department of Surgery and Professor of Surgery, Molecular Biology and Genetics at Wayne State University School of Medicine in Detroit, taught them how to operate a portable ultrasound for use aboard the space station.
The technology originally designed to transmit ultrasound data quickly from the orbiting outpost to Earth is helping patients on the ground, too. From hospital rooms to the slopes of Mount Everest, a company called Mediphan of Ottawa, Ontario, Canada, can compress and transmit high-quality ultrasound images rapidly for doctors to examine at a distance. In April, the company's successful technology spinoff from space station research is being inducted into the 2013 Space Technology Hall of Fame. The Hall of Fame honors world class technology and those who transform technology originally developed for space exploration into products that help improve the quality of life on Earth.
"It's a great honor to receive this award on behalf of my entire team," said Dulchavsky. "This enabling technology development began with a space program need, was modified and improved by many astronauts and ground personnel and finally matured into a product that benefits not only NASA, but more importantly, medical care on the planet. The Hall of Fame induction of this technology provided wonderful and tangible recognition of the importance of space technology spinoffs to life on Earth."
With a goal to develop operational telemedicine capabilities, engineers at NASA's Johnson Space Center in Houston approached Dulchavsky in 2000 to develop medical ultrasound techniques that could be used by non-expert astronauts. Traditionally, ultrasound technicians undergo hundreds of hours of training, but Dulchavsky was able to instruct crew members from the ground in about four hours.
The use of remote expert guidance provides a significant advantage to other ultrasound technology. The crew first used these skills in orbit for the Advanced Diagnostic Ultrasound in Microgravity (ADUM) investigation, followed by the current Spinal Ultrasound study, which uses the updated Ultrasound 2 facility. These investigations help researchers advance telemedicine while investigating human health in microgravity.
As the principal investigator, Dulchavsky led the team that trained the International Space Station Expedition 9 crew to use remotely-guided ultrasound for the first time to obtain a wide variety of diagnostic-quality medical images. Satellite downlinks transmitted the images to experts on the ground, who were able to guide astronauts to specific targets. The team showed that ultrasound can be an effective method of diagnosing a host of medical issues.
"Communications between the space station and mission control have a huge pipeline, so it worked quite well," said Dulchavsky. "But being a doctor on the ground here, I saw that there might be some terrestrial uses for this."
Although many people are familiar with ultrasound because of its use in pregnancy, the technology has a wider range of medical diagnostics. Ultrasound transducers transmit very high frequency sound waves, inaudible to human ears, and the sound waves form a pattern as they bounce off objects in their paths. These returning signals are used to form an image, allowing physicians a window into the body. It can be an effective tool for examining muscles and internal organs.
"Prior to our experiments, ultrasound was not commonly used in diagnostics. Nobody would do an ultrasound to diagnose a collapsed lung or a broken leg; you would do an X-ray," Dulchavsky explained. "When we looked at novel ways to use ultrasound, we said 'Hey, that works pretty well.' Now that has expanded the use of ultrasound in trauma care and in developing countries."
To expand the technology's use, the ADUM team searched for existing technology that could enable fast, high-quality video transmission on Earth, but found it was difficult, expensive and required sophisticated equipment. The researchers started searching for new partners and came across an Ottawa-based firm called Epiphan, which developed technology for transmitting high-quality security video for airport monorail trains. Epiphan engineers shrunk their compression technology into a device the size of a wallet and commercialized two products:
DistanceDoc - an external video frame grabber that allows a remote ultrasound operator to transmit images securely over the Internet in real time and at near-original resolution; and
MedRecorder - a similar device that captures diagnostic-quality images and archives them for later reference.
Neither DistanceDoc nor MedRecorder requires special electronic wiring or cabling, both using USB connections. The video, which is streamed over the Internet, can be accessed on any device with a screen. "I can be sitting with my laptop in a coffee shop and watching this video feed from anywhere on the planet," Dulchavsky said.
Dulchavsky took the devices to the 2008 Olympic Games in Beijing, where he examined athletes. He even trained a Swedish mountain climber how to use it for an expedition to summit Mount Everest, and, on the mountainside, the climber performed a lung exam. Dulchavsky was able to view near real-time ultrasound video from his office in Detroit and diagnose pulmonary edema, or water on the lung, a complication related to altitude sickness.
DistanceDoc and MedRecorder are also being used in developing nations with limited access to health care, where physicians and volunteers are monitoring maternal health, traumatic injuries and infectious diseases. Even the software developed for the remote ultrasound training found a second life; the American College of Surgeons uses a modified version in their online ultrasound training courses for surgeons.
On Earth, as well as in space, ultrasound offers many benefits over technology like X-ray or MRI - patients are not exposed to any radiation and ultrasound machines can be very portable and lightweight.
"A portable X-ray machine weighs 500 lb; a portable ultrasound is 3 to 5 lb," Dulchavsky said. "You can carry it up Mount Everest, for crying out loud."
Dulchavsky said he has taught people from hockey players to lawmakers like U.S. Sen. Kay Bailey Hutchinson, and they were all able to use the Mediphan devices quickly and effectively. For a jack-of-all-trades like an astronaut, it's just one more tool to make life easier.