Space Research Gives Birth To New Ultrasound Tools For Health Care İn Orbit, On Earth

The remoteness and resource limitations of spaceflight pose a serious challenge to astronaut health care. One solution is ultrasound. Scientists with the National Space Biomedical Research Institute (NSBRI) have developed tools that expand the use of ultrasound during spaceflight and on Earth, especially in rural and underserved locations. These tools include techniques that streamline training and help remote experts guide non-physician astronauts to perform ultrasound exams. Ultrasound can be used to assess numerous conditions – fractured bones, collapsed lungs, kidney stones, organ damage and other ailments – in space and on Earth. With an NSBRI grant, they also created a catalog, or atlas, of "space-normal" imagery of the human body, setting the stage for astronauts to provide care without consulting a physician on Earth. This atlas was handed over to NASA earlier this year.

Dr. Scott A. Dulchavsky, the Roy D. McClure Chairman of Surgery and Surgeon-in-Chief at the Henry Ford Hospital in Detroit, is the principal investigator of these projects and is a member of the NSBRI Smart Medical Systems and Technology Team. "The ultrasound imagery techniques came from space program constraints of not having a trained radiologist on orbit or having a CAT scan or an MRI available, forcing us to use ultrasound for things in which we would not normally use it," he said. "Also, time limitations forced us to put some tight brackets around what is absolutely required for training to be able to obtain a high-quality ultrasound image and to make some sense out of the image."

Dulchavsky and colleagues from NSBRI, NASA, Henry Ford and Wyle Integrated Science and Engineering Group began their first ultrasound experiment -- Advanced Diagnostic Ultrasound in Microgravity (ADUM) -- by developing exam techniques for use on the International Space Station (ISS). The goal was for ISS crewmembers to collect high-quality ultrasound images to send to the Mission Control Center for analysis. The ADUM research was split into two projects: NSBRI funded the ground portion of the research, while NASA supported the flight portion.

The researchers conducted 80 hours of ultrasound examinations on the ISS and then sifted through approximately 20,000 images and many hours of video collected during ISS Expeditions 8 through 12 to create the "space-normal" atlas. The researchers developed the intuitive ultrasound guide to give astronauts broader use of ultrasound in additional organ systems and medical problems that were not part of the ISS experiment. Dulchavsky said, "ADUM initially utilized telemedicine and tele-ultrasound operations in which the astronauts were interacting with researchers and flight controllers on the ground during the examinations. The ultrasound intuitive guide allows astronauts to conduct exams when quick communication with an expert is not available due to distance from Earth or other reasons."

One of the first to be trained and to conduct an ultrasound exam in space was former NASA Astronaut and ISS Expedition 10 Commander Dr. Leroy Chiao. "We demonstrated on the International Space Station that even non-physicians can produce diagnostic-quality ultrasound images using remote guidance," said Chiao who is chairman of the NSBRI User Panel and a member of Baylor College of Medicine's Center for Space Medicine. "These ultrasound exam techniques and atlas will be increasingly important as we venture farther and longer into space. Telemedicine using ultrasound will be an invaluable medical diagnostic tool."

The level of skill needed to accurately analyze ultrasound exam results will vary based on the exam's goal. "To diagnose a broken bone is relatively straight-forward. When we were trialing this at my hospital, we trained the custodial personnel to conduct exams. After about five minutes, they had a diagnostic accuracy in the high 90s," Dulchavsky said. "Alternatively, if you are trying to look at subtle changes in how the heart functions in zero-gravity after six months, that takes considerably more expertise, and may take hours or even days of evaluation to do."

As in space, low costs and reduced-resource consumption make ultrasound an attractive option on Earth, but until recently, the lack of trained personnel has been an issue. Based on their research for NSBRI, Dulchavsky and his colleagues have spun off the techniques for terrestrial use and published "The ICU Ultrasound Pocket Book" – a reference guide for conducting examinations.

"The American College of Surgeons, which is charged with continuing education of surgeons in our country, saw the methods we developed for space and has now incorporated these techniques in its ultrasound training courses for all of the surgeons in the United States," Dulchavsky said. "Similarly, medical schools are starting to incorporate this training for all medical students, not just surgeons."