On-orbit prospective echocardiography on International Space Station crew.

Objectives: A prospective trial of echocardiography was conducted on six crew members onboard the International Space Station. The main objective was to determine the efficacy of remotely guided tele-echocardiography, including just-in-time e-training methods and determine what is "space normal" echocardiographic data.

Methods: Each crew member operator (n = 6) had 2-hour preflight training.

Sonography for determining the optic nerve sheath diameter with increasing intracranial pressure in a porcine model.

Objectives: This study investigated whether it is feasible to use sonography to monitor changes in the optic nerve sheath diameter in a porcine model.

Methods: A fiber-optic intracranial pressure transducer was surgically placed through the frontal sinus directly into the brain parenchyma of adult Yorkshire pigs (n = 5). A second bolt was placed on the contralateral side for intraparenchymal fluid infusion.

Ultrasonographic evaluation of sinusitis during microgravity in a novel animal model.

Objectives: To develop an animal model of rhinosinusitis in microgravity, to characterize the behavior of intracavitary fluid in microgravity, and to assess the accuracy of ultrasonographic (US) diagnosis in microgravity.

Design: An animal model of acute sinusitis was developed in anesthetized swine by creating a window into a frontal sinus to allow unilateral catheter placement and injection of fluid. We performed US examinations in normal and microgravity environments on control and sinusitis conditions and recorded these for later interpretation.

Ultrasound evaluation of sinus fluid levels in swine during microgravity conditions.

Background: Acute rhinosinusitis is a common problem that could occur in space secondary to absence of gravity-dependent drainage or odontogenic or external sources of infection. The purpose of this study was to determine the efficacy of ultrasound to determine sinus fluid distribution levels in swine and to assess the accuracy of ultrasound in the animal during normal and microgravity conditions.

Methods: Anesthetized swine had a catheter placed through a frontal bone window to allow aliquots of a viscous solution to be injected at 1 G (N = 4) or during brief microgravity parabolic flights (N = 4).

Autonomous medical care for exploration class space missions.

The US-based health care system of the International Space Station contains several subsystems, the Health Maintenance System, Environmental Health System and the Countermeasure System. These systems are designed to provide primary, secondary and tertiary medical prevention strategies. The medical system deployed in low Earth orbit for the International Space Station is designed to support a "stabilize and transport" concept of operations.

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.

Trauma sonography for use in microgravity.

Sonography is the only medical imaging modality aboard the ISS, and is likely to remain the leading imaging modality in future human spaceflight programs. While trauma sonography (TS) has been well recognized for terrestrial trauma settings, the technique had to be evaluated for suitability in spaceflight prior to adopting it as an operational capability. The authors found the following four-phased evaluative approach applicable to this task: 1) identifying standard or novel terrestrial techniques for potential use in space medicine; 2) developing and testing these techniques with suggested modifications on the ground (1 G) either in clinical settings or in animal models, as appropriate; 3) evaluating and refining the techniques in parabolic flight (0 G); and 4) validating and implementing for clinical use in space.

Percutaneous bladder catheterization in microgravity.

Introduction: Urinary obstruction (UO) or failure to void has been observed during several episodes of short-duration spaceflight, necessitating bladder catheterization. It should be considered a possible medical condition in long-duration space missions as well. Antiemetics used early in space flight add to the risk and severity of voiding problems, along with the sensory and psychological peculiarities of voiding without gravity and in the unusual setting of a spacecraft.

Battling fire and ice: remote guidance ultrasound to diagnose injury on the International Space Station and the ice rink.

Background: National Aeronautical and Space and Administration (NASA) researchers have optimized training methods that allow minimally trained, non-physician operators to obtain diagnostic ultrasound (US) images for medical diagnosis including musculoskeletal injury. We hypothesize that these techniques could be expanded to non-expert operators including National Hockey League (NHL) and Olympic athletic trainers to diagnose musculoskeletal injuries in athletes.

Methods: NHL and Olympic athletic trainers received a brief course on musculoskeletal US.

Diagnostic instrumentation aboard ISS: just-in-time training for non-physician crewmembers.

Introduction: The performance of complex tasks on the International Space Station (ISS) requires significant preflight crew training commitments and frequent skill and knowledge refreshment. This report documents a recently developed "just-in-time" training methodology, which integrates preflight hardware familiarization and procedure training with an on-orbit CD-ROM-based skill enhancement. This "just-in-time" concept was used to support real-time remote expert guidance to complete ultrasound examinations using the ISS Human Research Facility (HRF).

FAST at MACH 20: clinical ultrasound aboard the International Space Station.

Background: Focused assessment with sonography for trauma (FAST) examination has been proved accurate for diagnosing trauma when performed by nonradiologist physicians. Recent reports have suggested that nonphysicians also may be able to perform the FAST examination reliably. A multipurpose ultrasound system is installed on the International Space Station as a component of the Human Research Facility.

Evaluation of shoulder integrity in space: first report of musculoskeletal US on the International Space Station.

Investigative procedures were approved by Henry Ford Human Investigation Committee and NASA Johnson Space Center Committee for Protection of Human Subjects. Informed consent was obtained. Authors evaluated ability of nonphysician crewmember to obtain diagnostic-quality musculoskeletal ultrasonographic (US) data of the shoulder by following a just-in-time training algorithm and using real-time remote guidance aboard the International Space Station (ISS).

Sonographic detection of pneumothorax and hemothorax in microgravity.

Introduction: An intrathoracic injury may be disastrous to a crew-member aboard the International Space Station (ISS) if the diagnosis is missed or delayed. Symptomatic or clinically suspicious thoracic trauma is treated as a surgical emergency on Earth, usually with immediate stabilization and rapid transport to a facility that is able to deliver the appropriate medical care. A similar approach is planned for the ISS; however, an unnecessary evacuation would cause a significant mission impact and an exorbitant expense.

Focused Assessment with Sonography for Trauma in weightlessness: a feasibility study.

Background: The Focused Assessment with Sonography for Trauma (FAST) examines for fluid in gravitationally dependent regions. There is no prior experience with this technique in weightlessness, such as on the International Space Station, where sonography is currently the only diagnostic imaging tool.

Study Design: A ground-based (1 g) porcine model for sonography was developed.