Space Ultrasound: A Proposal for Competency-based Ultrasound Training for In-flight Space Medicine.

Space travel has transformed in the past several years. Given the burgeoning market for space tourism, in-flight medical emergencies are likely to be expected. Ultrasound is one of the few diagnostic and therapeutic modalities available for astronauts in space. However, while point-of-care ultrasound (POCUS) is available, there is no current standard of training for astronaut preparation. We suggest an organized and structured methodology by which astronauts should best prepare for space with the medical equipment available on board. As technology continues to evolve, the assistance of other artificial intelligence and augmented reality systems are likely to facilitate training and dynamic real-time needs during space emergencies. Summary: As space tourism continues to evolve, an organized methodology for POCUS use is advised to best prepare astronauts for space.

Spacesuit Center of Gravity Assessments for Partial Gravity EVA Simulation in an Underwater Environment.

OBJECTIVE: The objective is to analytically determine the expected CG and build hardware to measure and verify the suited subject's CG for lunar extravehicular activity (EVA) training in an underwater environment. BACKGROUND: For lunar EVAs, it is necessary for astronauts to train with a spacesuit in a simulated partial gravity environment. NASA's Neutral Buoyancy Laboratory (NBL) can provide these conditions by producing negative buoyancy for a submerged suited subject. However, it is critical that the center of gravity (CG) for the human-spacesuit system to be accurate for conditions expected during planetary EVAs. METHODS: An underwater force-transducer system and individualized human-spacesuit model was created to provide real-time measurement of CG, including recommendations for weight placement locations and quantity of weight needed on the spacesuit to achieve a realistic lunar spacesuit CG. This method was tested with four suited subjects. RESULTS: Across tested weighout configurations, it was observed that an aft and high CG location will have large postural differences when compared to low and fore CG locations, highlighting the importance of having a proper CG. The system had an accuracy of ±5lbs of the total lunar weight and within ± 15 cm for fore-aft and left-right CG directions of the model predictions. CONCLUSION: The developed method offers analytical verification of the suited subject's CG and improves simulation quality of lunar EVAs. Future suit design can also benefit by recommending hardware changes to create ideal CG locations that improve balance and mobility. APPLICATION: The developed methodology can be used to verify a proper CG location in future planetary EVA simulations such as different reduced gravity training analogs (e.g. active cable offloading systems).

Medical Event Management for Future Deep Space Exploration Missions to Mars.

BACKGROUND: Long-duration exploration missions (LDEMs), such as voyages to Mars, will present unique medical challenges for astronaut crews, including communication delays and the inability to return to Earth early. Medical events threaten crewmember lives and increase the risk of mission failure. Managing a range of potential medical events will require excellent technical and nontechnical skills (NTSs). We sought to identify medical events with potential for rescue, range them according to the potential impact on crew health and mission success during LDEMs, and develop a list of NTSs to train for management of in-flight medical events. MATERIALS AND METHODS: Twenty-eight subject matter experts with specializations in surgery, medicine, trauma, spaceflight operations, NTS training, simulation, human factors, and organizational psychology completed online surveys followed by a 2-d in-person workshop. They identified and rated medical events for survivability, mission impact, and impact of crewmember NTSs on outcomes in space. RESULTS: Sudden cardiac arrest, smoke inhalation, toxic exposure, seizure, and penetrating eye injury emerged as events with the highest potential mission impact, greatest potential for survival, and that required excellent NTS for successful management. Key NTS identified to target in training included information exchange, supporting behavior, communication delivery, and team leadership/followership. CONCLUSIONS: With a planned Mars mission on the horizon, training countermeasures need to be developed in the next 3-5 y. These results may inform policy, selection, medical system design, and training scenarios for astronauts to manage in-flight medical events on LDEMs. Findings may extend to surgical and medical care in any rural and remote location.

Practicing for space underwater: inventing neutral buoyancy training, 1963-1968.

Neutral buoyancy's value was far from obvious when human spaceflight began in 1961. Starting in 1964, Environmental Research Associates, a tiny company in the suburbs of Baltimore, developed the key innovations in an obscure research project funded by NASA's Langley Research Center. The new Houston center dismissed it until a mid-1966 EVA crisis, after which it rapidly took over. In parallel, NASA Marshall Space Flight Center developed many of the same techniques, as did many large aerospace corporations, yet the long-run technological impact of corporate activity was near zero. Because ERA and Marshall's pioneering activities led to the two long-running NASA training centers at Houston and Huntsville, those two organizations deserve primary credit for the construction of the neutral buoyancy technological system.

[Research activities of cosmonauts in long-duration orbital missions].

The paper presents the view of space medicine and human factor experts on the problems of cosmonaut's research activities. Readiness of ISS crewmembers for conducting experiments and research equipment handling depends on the pre-flight training quality and course of adaptation to the flight conditions, the latter of particular criticality for participation in human use tests as an object.

Virtual guidance as a tool to obtain diagnostic ultrasound for spaceflight and remote environments.

INTRODUCTION: With missions planned to travel greater distances from Earth at ranges that make real-time two-way communication impractical, astronauts will be required to perform autonomous medical diagnostic procedures during future exploration missions. Virtual guidance is a form of just-in-time training developed to allow novice ultrasound operators to acquire diagnostically-adequate images of clinically relevant anatomical structures using a prerecorded audio/visual tutorial viewed in real-time. METHODS: Individuals without previous experience in ultrasound were recruited to perform carotid artery (N = 10) and ophthalmic (N = 9) ultrasound examinations using virtual guidance as their only training tool. In the carotid group, each untrained operator acquired two-dimensional, pulsed and color Doppler of the carotid artery. In the ophthalmic group, operators acquired representative images of the anterior chamber of the eye, retina, optic nerve, and nerve sheath. Ultrasound image quality was evaluated by independent imaging experts. RESULTS: Of the studies, 8 of the 10 carotid and 17 of 18 of the ophthalmic images (2 images collected per study) were judged to be diagnostically adequate. The quality of all but one of the ophthalmic images ranged from adequate to excellent. DISCUSSION: Diagnostically-adequate carotid and ophthalmic ultrasound examinations can be obtained by previously untrained operators with assistance from only an audio/video tutorial viewed in real time while scanning. This form of just-in-time training, which can be applied to other examinations, represents an opportunity to acquire important information for NASA flight surgeons and researchers when trained medical personnel are not available or when remote guidance is impractical.

Production of finely graded forces in humans: effects of simulated weightlessness by water immersion.

We have shown before that subjects exposed to a changed gravitoinertial environment produce exaggerated manual forces. From the observed pattern of findings, we argued that initial forces were exaggerated because of abnormal vestibular activity and peak forces because of degraded proprioceptive feedback. If so, only peak but not initial forces should be affected by water immersion, an environment that influences proprioceptive feedback but not vestibular activity. The present study was undertaken to scrutinize this prediction. Twelve subjects sat in a chair once immersed in water and once on dry land, while producing pre-trained isometric forces with a joystick. In a control experiment, subjects performed a four-choice reaction-time task. During the joystick task, produced initial forces were comparable in water and on land, while peak (+24%) and end forces (+22%) were significantly higher in water, as was their reaction time (+6%). During the control task, reaction time was comparable in water and on land. Our findings corroborate the above notion that initial forces increase when the vestibular system is stimulated (gravitoinertial change, visual field motion, but not water immersion), while peak forces increase when proprioceptive feedback is degraded (probably all three scenarios) and are not corrected until response end. Our findings further confirm the absence of cognitive slowing in simple-choice reaction tasks under shallow-water immersion conditions.

Tolerance to extended galvanic vestibular stimulation: optimal exposure for astronaut training.

BACKGROUND: We have developed an analogue of postflight sensorimotor dysfunction in astronauts using pseudorandom galvanic vestibular stimulation (GVS). To date there has been no study of the effects of extended GVS on human subjects and our aim was to determine optimal exposure for astronaut training based on tolerance to intermittent and continuous galvanic stimulation. METHODS: There were 60 subjects who were exposed to a total of 10.5 min of intermittent GVS at a peak current of 3.5 mA or 5 mA. A subset of 24 subjects who tolerated the intermittent stimulus were subsequently exposed to 20-min continuous stimulation at 3.5 mA or 5 mA. RESULTS: During intermittent GVS the large majority of subjects (78.3%) reported no or at most mild motion sickness symptoms, 13.3% reported moderate symptoms, and 8.3% experienced severe nausea and requested termination of the stimulus. During 20-min continuous exposure, 83.3% of subjects reported no or at most mild motion sickness symptoms and 16.7% (all in the 5-mA group) experienced severe nausea. CONCLUSION: Based on these results, we propose two basic modes of GVS application to minimize the incidence of motion sickness: intermittent high (5 mA) amplitude, suited to simulation of intensive operator tasks requiring a high-fidelity analogue of postflight sensorimotor dysfunction such as landing or docking maneuvers; and continuous low (3.5 mA) amplitude stimulation, for longer simulation scenarios such as extra vehicular activity. Our results suggest that neither mode of stimulation would induce motion sickness in the large majority of subjects for up to 20 min exposure.

Determining spherical lens correction for astronaut training underwater.

PURPOSE: To develop a model that will accurately predict the distance spherical lens correction needed to be worn by National Aeronautics and Space Administration astronauts while training underwater. The replica space suit's helmet contains curved visors that induce refractive power when submersed in water. METHODS: Anterior surface powers and thicknesses were measured for the helmet's protective and inside visors. The impact of each visor on the helmet's refractive power in water was analyzed using thick lens calculations and Zemax optical design software. Using geometrical optics approximations, a model was developed to determine the optimal distance spherical power needed to be worn underwater based on the helmet's total induced spherical power underwater and the astronaut's manifest spectacle plane correction in air. The validity of the model was tested using data from both eyes of 10 astronauts who trained underwater. RESULTS: The helmet's visors induced a total power of -2.737 D when placed underwater. The required underwater spherical correction (FW) was linearly related to the spectacle plane spherical correction in air (FAir): FW = FAir + 2.356 D. The mean magnitude of the difference between the actual correction worn underwater and the calculated underwater correction was 0.20 ± 0.11 D. The actual and calculated values were highly correlated (r = 0.971) with 70% of eyes having a difference in magnitude of <0.25 D between values. CONCLUSIONS: We devised a model to calculate the spherical spectacle lens correction needed to be worn underwater by National Aeronautics and Space Administration astronauts. The model accurately predicts the actual values worn underwater and can be applied (more generally) to determine a suitable spectacle lens correction to be worn behind other types of masks when submerged underwater.

Emergency medical support system for extravehicular activity training held at weightless environment test building (WETS) of the Japan Aerospace Exploration Agency (JAXA) : future prospects and a look back over the past decade.

The Japan Aerospace Exploration Agency (JAXA) provides extravehicular activity (EVA) training to astronauts in a weightless environment test building (WETS) located in Tsukuba City. For EVA training, Tsukuba Medial Center Hospital (TMCH) has established an emergency medical support system, serving as operations coordinator. Taking the perspective of emergency physicians, this paper provides an overview of the medical support system and examines its activities over the past decade as well as future issues. Fortunately, no major accident has occurred during the past 10 years of NBS. Minor complaints (external otitis, acute otitis media, transient dizziness, conjunctival inflammation, upper respiratory inflammation, dermatitis, abraded wounds, etc.) among the support divers have been addressed onsite by attending emergency physicians. Operations related to the medical support system at the WETS have proceeded smoothly for the former NASDA and continue to proceed without event for JAXA, providing safe, high-quality emergency medical services. If an accident occurs at the WETS, transporting the patient by helicopter following initial treatment by emergency physicians can actually exacerbate symptoms, since the procedure exposes a patient who was recently within a hyperbaric environment to the low-pressure environment involved in air transportation. If a helicopter is used, the flight altitude should be kept as low as possible by taking routes over the river.

Ultrasound detection of simulated intra-ocular foreign bodies by minimally trained personnel.

PURPOSE: To test the ability of non-expert ultrasound operators of divergent backgrounds to detect the presence, size, location, and composition of foreign bodies in an ocular model. METHODS: High school students (N = 10) and NASA astronauts (N = 4) completed a brief ultrasound training session which focused on basic ultrasound principles and the detection of foreign bodies. The operators used portable ultrasound devices to detect foreign objects of varying location, size (0.5-2 mm), and material (glass, plastic, metal) in a gelatinous ocular model. Operator findings were compared to known foreign object parameters and ultrasound experts (N = 2) to determine accuracy across and between groups. RESULTS: Ultrasound had high sensitivity (astronauts 85%, students 87%, and experts 100%) and specificity (astronauts 81%, students 83%, and experts 95%) for the detection of foreign bodies. All user groups were able to accurately detect the presence of foreign bodies in this model (astronauts 84%, students 81%, and experts 97%). Astronaut and student sensitivity results for material (64% vs. 48%), size (60% vs. 46%), and position (77% vs. 64%) were not statistically different. Experts' results for material (85%), size (90%), and position (98%) were higher; however, the small sample size precluded statistical conclusions. CONCLUSIONS: Ultrasound can be used by operators with varying training to detect the presence, location, and composition of intraocular foreign bodies with high sensitivity, specificity, and accuracy.

Virtual reality laparoscopic skill assessment in microgravity.

BACKGROUND: The objective of the study was to assess if performance of basic laparoscopic skills on a virtual reality (VR) simulator is impaired in microgravity relative to normal gravitational influences. MATERIALS AND METHODS: Fourteen subjects with various educational backgrounds underwent basic laparoscopy skill training for five consecutive days on the ground before flying aboard NASA's KC-135 zero-gravity laboratory. The participants performed basic laparoscopic exercises (clip applying, grasping, cutting, and suturing) on a VR laparoscopy simulator, both on the ground and during 25-s microgravity windows in parabolic flight. Skill levels after ground training were compared with skill levels in performing the same tasks in microgravity. Blinded reviewers measured the number of tasks successfully completed, tissue damage number, left and right hand path lengths during task execution, and percentage of task attempts that resulted in successful completion. RESULTS: A significant increase in tissue injury (t test, P < 0.05) and task erosion were seen in clip applying, cutting, and grasping in microgravity (45%, 20% and 57% decrease in task attempts that resulted in a successful completion, respectively). However, there was no significant difference in the left and right hand path lengths, and the total number of tasks successfully completed on the ground versus in microgravity, for any of the four laparoscopic exercises (t test, P > 0.05). CONCLUSION: This study demonstrates decreased efficiency and increased injury to the simulated tissues in performing laparoscopic skills during microgravity as compared to performing these skills in standard gravitational influence. Additional experiments are indicated to further develop and validate VR microgravity surgical simulation.

Columbus: ready for the International Space Station.

One of the key contributions to the development and operation of the International Space Station (ISS) is ESA's Columbus Laboratory Module. It will be transported to the ISS, together with its payload complement, on Space Shuttle Assembly Flight 1E in 2006. Columbus's readiness for launch requires the availability not only of the Module itself, but also three other major elements being provided by ESA, namely: the Ground Segment, consisting of the Columbus Control Centre and the User Support and Operations Centres (USOCs), the Operations products, and the Crew Training.

[Malfunction simulation by spaceflight training simulator].

OBJECTIVE: To implement malfunction simulation in spaceflight training simulator. METHOD: The principle of malfunction simulation was defined according to spacecraft malfunction predict and its countermeasures. The malfunction patterns were classified, and malfunction type was confirmed. A malfunction simulation model was established, and the malfunction simulation was realized by math simulation. RESULT: According to the requirement of astronaut training, a spacecraft subsystem malfunction simulation model was established and realized, such as environment control and life support, GNC, push, power supply, heat control, data management, measure control and communication, structure and so on. CONCLUSION: The malfunction simulation function implemented in the spaceflight training simulator satisfied the requirements for astronaut training.