NASA - National Aeronautics and Space Administration

Overview | Description | Applications | Operations | Results | Publications | Images

Experiment/Payload Overview

Brief Summary

Crew will conduct ultrasound exams on one another to help develop strategies for diagnostic telemedicine in both space and on Earth.

Principal Investigator

Scott A. Dulchavsky, M.D., Ph.D., Henry Ford Health System, Detroit, MI

Co-Investigator(s)/Collaborator(s)

Shannon Melton, Wyle Laboratories, Houston, TX

Douglas Hamilton, M.D., Ph.D., Wyle Laboratories, Houston, TX

Ashot Sargsyan, M.D., Wyle Laboratories, Houston, TX

Payload Developer

Johnson Space Center, Human Research Program, Houston, TX

Sponsoring Agency

National Aeronautics and Space Administration (NASA)

Expeditions Assigned

|8|9|10|11|12|

Previous ISS Missions

Nothing like ADUM has previously been conducted in space. However, the ultrasound equipment was checked out during Increment 5; this is the first formal experiment to examine the use of ultrasound in microgravity.

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Experiment/Payload Description

Research Summary

• The ultrasound is the only medical imaging device currently available on ISS. Ultrasound may have direct application for the evaluation and diagnosis of 250 medical conditions of interest for treating exploration crews.



• This experiment will demonstrate the diagnostic accuracy of ultrasound in medical contingencies in space and determine the ability of minimally trained crewmembers to perform ultrasound examinations with remote guidance from the ground.



• The telemedicine strategies investigated by this experiment will be needed for astronaut crews traveling beyond low earth orbit and could have widespread application on Earth in emergency and rural care situations.

Description

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 using an in-flight ultrasound to monitor bone density during long-duration space flights. Another objective of the experiment is determining how well nonmedical crewmembers can learn to use an ultrasound device with CD ROM training manuals and remote guidance from Earth. The intent of the ADUM investigation is to develop methods by which an individual who is untrained in medicine can use an ultrasound machine with remote diagnostician assistance to evaluate a vast array of medical problems.

Expedition crews used the ISS 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 station is the on-board proficiency enhancer, a software application that is used to train crewmembers on the methods employed for each scan.

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Applications

Space Applications

There is not room for a fully functioning hospital and staff of doctors aboard the ISS, nor is it feasible for a crewmember to return to Earth for a quick medical checkup. This experiment can lead to efficient diagnosing of medical problems with minimal use of on-board resources. Ability of crew members to use an ultrasound machine with remote instruction, sending information to the ground for analysis, can assist in timely treatment as well as avert unnecessary evacuation. Crew members as far away as Mars could be remotely examined by doctors on Earth using a modification of this technology. 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 without specialized medical expertise nearby could save lives as well as health care costs. Doctors could receive transmitted ultrasound information from great distances and assist with remote medical diagnosis and treatment, with a high degree of confidence and efficiency. This technology essentially allows anyone in the world access to unique clinical imaging expertise.

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Operations

Operational Requirements

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 but the Bone scan, the experimental subject must be anchored in the Medical Operations Crew Medical Restraint System. During every scan, two-way audio and a video downlink of the ultrasound image are required to allow instruction for the crew from the ground-based investigators. Both audio and video links are operated in private mode, which is required to ensure privacy of the crewmembers both during and after the experiment.

Operational Protocols

On-board Proficiency Enhancer (OPE) software was developed by ADUM investigators to supplement the ground training given to participating crewmembers before each Increment. Sections of OPE are specific to each type of scan and must be viewed by the crew within the week immediately before the respective scan.

The day of the each scan session the ISS crew must set up the ultrasound hardware (this consists primarily of the HRF laptop and the ultrasound keyboard, monitor, and probes). Each scan lasts between 20 and 50 minutes. After the scan is complete the crew shuts down the ultrasound machine and puts away the hardware. The total crew time required for each scan session is approximately two hours.

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Results/More Information

The ISS crews, which began their work with ADUM on Expedition 8 and completed it during Expedition 11, have demonstrated that minimal training along with audio guidance from a certified sonographer can produce ultrasound imagery of diagnostic quality. The ISS crewmembers, acting as operators and subjects, have completed comprehensive scans of the cardiothoracic and abdominal organs as well as limited scans of the dental, sinus, and eye structures. They also have completed multiple musculoskeletal exams, including a detailed exam of the shoulder muscles. To date, analysis of ultrasound video downlinked to ground teams at the NASA Johnson Space Center TeleScience Center has yielded excellent results that are beginning to appear in the scientific literature.

Ultrasound technology is now used in many trauma centers around the world as a first-line diagnostic procedure with which to assess abdominal trauma and has been accurate when performed by non-radiologists. Expanding ultrasound technology use by non-radiologists in remote locations to provide diagnostic information on acute clinical conditions has been investigated by many researchers. The use of ultrasound technology as a diagnostic tool on station required an on-board proficiency enhancement program, visual cue cards, procedures, and direction from ground-based trained radiological personnel. The Expedition 8 crew was able to capture high-fidelity images of the thoracic, cardiac, and vascular systems with minimally trained nonmedical personnel. This investigation has laid the groundwork for using ultrasound as a diagnostic tool in microgravity and remote locations on Earth when a physician is not readily available. A scientific paper discussing these results was submitted by the crewmembers directly from orbit (Foale et al. 2005).

Ultrasound images of the shoulder during Expedition 9 showed that ultrasound performed by crewmembers obtained diagnostic-quality imagery for evaluation of shoulder integrity. An application of this technology would be if a crewmember were to injure his/her shoulder during a strenuous extravehicular activity (EVA, or spacewalk), these techniques would allow 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. This examination may be difficult due to significant orbital or facial swelling. The Expedition 10 crew used ultrasound technology to examine the eye though a closed eyelid. This examination could determine a number of problems with the eye that are signs of other more significant trauma of the head (Chiao et al. 2005).

In addition to the importance of establishing ultrasound techniques for examination and diagnosis on ISS, this study is establishing ultrasound as a key tool for clinical medicine on future vehicles, the moon, and eventually Mars. The success of ADUM may also lead to additional applications of ultrasound on Earth. The remote guidance paradigm can be adapted on Earth for patients in rural/remote areas, disaster relief, and the military. Using existing communication systems, a person (e.g., nurse, physician's assistant, military medic) who is minimally trained in ultrasound could perform an ultrasound exam on a patient with guidance from an expert at a medical facility hundreds or thousands of miles away. This would expand the tools for the rural medical community, provide the ability to triage a mass casualty, and help in the decisions to conduct medical transport of patients.

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Related Web Sites

Science @ NASA

CNN News, Space and Science

International Space Station Medical Project (ISSMP)

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Publications

Results Publications

• Sargsyan AE, Hamilton DR, Melton SL, Amponsah D, Marshall NE, Dulchavsky SA. Ultrasonic evaluation of pupillary light reflex. Critical UltraSound Journal. 2009.
• Foale CM, Kaleri AY, Sargsyan AE, Hamilton DR, Melton S, Margin D, Dulchavsky SA. Diagnostic instrumentation aboard ISS: just in time training for non-physician crewmembers. Aviation, Space and Environmental Medicine 2005 ;76:594-598.
• Chiao L, Sharipov S, Sargsyan AE, Melton S, Hamilton DR, McFarlin K, Dulchavsky SA. Ocular examination for trauma; clinical ultrasound aboard the International Space Station. Journal of Trauma. 2005 ;58(5):885-889.
• Fincke EM, Padalka G, Lee D, van Holsbeeck M, Sargsyan AE, Hamilton DR, Martin D, Melton SL, McFarlin K, Dulchavsky SA. Evaluation of Shoulder Integrity in Space: First Report of Musculoskeletal US on the International Space Station. Radiology. 2005 ;234(2):319-322.

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Related Publications

• Sargsyan AE, Hamilton DR, Jones JA, Melton S, Whitson PA, Kirkpatrick AW, Martin D, Dulchavsky SA. FAST at MACH 20: Clinical Ultrasound Aboard the International Space Station. The Journal of Trauma, Injury, Infection, and Critical Care. ;58(1):35-39. 2004

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Images

Video Screen Shot of ISS Science Officer, Michael Foale, performing a cardiac ultrasound exam on fellow crew member Alexander Kaleri. The ultrasound image is easily seen by Foale and the controls are being adjusted with his left hand while he holds the probe in his right hand. Alexander Kaleri is being held to the Crew Medical Restraint System using only the waist and shoulder straps. Foale is interacting with ground based experts in the Johnson Space Center - TeleScience Center using a voice activated communications headset. Image courtesy of NASA, Johnson Space Center.
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NASA Image: ISS009E17466 - Increment 9 Commander Gennady Padalka and Flight Engineer Mike Fincke prepare for the ADUM Bone Scan.
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NASA Image: ISS009E17439 - Increment 9 Commander Gennady Padalka and Flight Engineer Mike Fincke perform the ADUM Bone Scan.
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NASA Image: ISS010E05720 - Increment 10 Commander Leroy Chiao performs the ADUM Bone Scan on the knee of Flight Engineer Salizhan Sharipov.
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NASA Image: ISS010E05727 - Increment 10 Commander Leroy Chiao performs the ADUM Bone Scan on the elbow of Flight Engineer Salizhan Sharipov.
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Information Provided and Updated by the ISS Program Scientist's Office