ISS Technology Demonstrations for Future Spaceflight Medical Systems
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Kelly Gilkey↗
Engineering topics
Beth Lewandowski
Publications and source records attributed to Beth Lewandowski.
Development of A Crew Health and Performance System Probabilistic Risk Assessment Tool: Proof-of-Concept Approach
The crew health and performance (CHP) system represents the span of technological interventions and tested processes and procedures that in combination address the human risk to space flight. The Human Research Program (HRP) mental model of the CHP system breaks the capabilities needed to meet NASA human flight systems standards into specific categories (i.e., countermeasures, behavioral health, medical intervention). These categories are further broken down into specific sub-groups generally associated with the human system risks that these capabilities seek to mitigate. Like the approach used to develop the Integrated Medical Model (IMM) and the Medical Extensible Dynamic Probabilistic Risk Analysis Tool (MEDPRAT), HRP tasked NASA GRC’s Cross-Cutting Computational Modeling Project with developing a CHP probabilistic risk assessment tool, the CHP-PRA. The CHP-PRA model seeks to quantify and relatively assess the human risk state within the crew health and performance domain, using a combination of knowledge about human system risks and technology and practices likely to be applied during space flight missions. This modeling system will incorporate customer and stakeholder feedback and be flexible enough to address multiple different questions about important low-level mission-specific parameters. This presentation will introduce the initial concept and development timeline for this tool and demonstrate proof-of-concept through an application addressing a specific human risk question posed within the Artemis program.
Risk analysis↗
Preparation for an Earth Independent Medical Operations Demonstration using the Tempus ALS™ Medical Device
NASA’s exploration-class missions have severe resource constraints, long return trip durations, significant communication delays and limited resupply opportunities. Validation on the International Space Station (ISS) of medical devices that fit within Earth-Independent Medical Operations (EIMO) systems is a necessary preparation step. Key features of an EIMO medical system include: 1) technologies that support the prevention, diagnosis, and treatment of spaceflight medical events; 2) components that meet mass, volume, power and crew time/training constraints; 3) consideration of the medical skill level of the astronaut caregiver; 4) collection, storage and analysis of medical data within a central data architecture; and 5) incorporation of appropriate guidance and support tools that allow crew autonomy. The Human Research Program’s (HRP) Exploration Medical Capability (ExMC) Element and the Exploration Medical Integrated Product Team (XM-IPT) are planning an ISS technology demonstration to determine the feasibility of including a multifunctional medical device into an EIMO medical system. Demonstration Preparations: The Tempus ALS (Remote Diagnostic Technologies, Ltd., Philips Corp., Farnborough, UK) is a commercial-off-the-shelf medical device, with United States Food and Drug Administration clearance and is Conformité Européene marked in Europe. Several thousand units have been sold and are successfully operating in pre-hospital and in remote settings, such as by European Space Agency (ESA) flight surgeons and some of NASA’s commercial partners during post-flight medical operations. The Tempus ALS provides vital sign measurements such as blood pressure, electrocardiograms, heart rate, end tidal CO2, respiration rate, pulse oximetry and temperature. The device has ultrasound imaging and video laryngoscopy capabilities and has automatic or manual defibrillation modes for treating cardiac arrhythmias. It includes procedural guidance capabilities to assist in the collection of the vital sign measurements and it has various data transmission and report generation features. NASA’s HRP ExMC and XM-IPT are partnering with the ESA to demonstrate the Tempus ALS on ISS, with ESA manifesting the Tempus ALS and its accessories. ESA will compare performance of periodic health status exams and medical contingency drills performed nominally and with the Tempus ALS. NASA’s EIMO demonstration will include the use of Tempus ALS to diagnose a complaint of abdominal pain under increasingly independent circumstances. The caregiver must assess the present illness, collect vital sign measurements, and perform an abdominal ultrasound, under one of three communication situations, including real-time, with a several second delay and with a delay on the order of minutes. Expected Outcomes: Information will be gained about the feasibility, benefits, and challenges of using a multifunctional, all-in-one, medical device for medical diagnosis instead of separate devices with singular functionalities. Information will also be collected about performance differences as communication delays increase and available ground support decreases. Gaining this understanding will allow for further development of exploration medical system capabilities which takes the EIMO construct into consideration.
Beth Lewandowski↗
Crew Health and Performance System Probabilistic Risk Assessment (CHP-PRA): Proof-of-Concept Approach
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Jerry Myers↗
Assessing Long-Term Health (LTH) Outcomes in Astronauts
NASA has linked potential Long-Term Health (LTH) risks of astronauts to their spaceflight experience, including the effects of space radiation, microgravity, and stressors such as isolation, sleep deprivation, and stress. Therefore, assessing the LTH outcomes for astronauts exposed to these hazards becomes a critical investigation in ensuring any deleterious effects are minimal. Prior research conducted into LTH outcomes of astronauts has not revealed increases in non-accidental mortality rates when compared to the U.S. general population, analog healthy cohorts, and professional athletes. One study did report an increased incidence of non-fatal cardiovascular disease events (Hazard Ratio=2.41, 95% Confidence Interval 1.26 to 4.63). Additional evidence indicates that astronauts may have increases in incidences of melanoma, prostate, and hematologic cancers, though the former is consistent with rates observed among aircraft pilots and the latter two are likely caused by detection bias due to increased screening on former astronauts.
long term health↗
Strategy for Risk Quantification of Spaceflight Crew Health and Performance Using Dynamic Probabilistic Risk Assessment
At NASA, the Crew Health and Performance (CHP) system represents the span of countermeasures, capabilities, interventions, and tested processes and procedures that in combination work to mitigate the human component of spaceflight mission risk. Across the varying NASA mental models of the CHP system, the different functionalities needed to meet human flight systems standards can be broken down into specific categories (i.e. medical capability, environmental health, behavioral health). These categories can be further broken down into specific subgroups generally associated with the CHP functionalities meant to mitigate or buy down individual human system risks. Taking a similar development approach we seek to leverage dynamic probabilistic risk assessment as a means to quantify and relatively assess the human risk state within the crew health and performance domain. By utilizing existing tools as integrators, we propose a rapid development strategy for incorporating research and operational data that represent the influence of the CHP system functionalities, in order to provide order of magnitudes estimates of the influence on most human system risks outcomes. The model system utilizes a modest cumulative risk approach and that limits the scope to primary paths of influence between the CHP functionalities and human system risks, thus enabling quick prototypes of the integrative effects of CHP functional combinations to solicit valuable feedback from stakeholders and customers on the data, relationship, and structure of the integration.
Drayton Munster↗
Proof-of-Concept for a Long-Term Health Metric to Quantify End of Mission Health Status in Astronauts
NASA has long used Probabilistic Risk Assessment (PRA) when high-stakes decisions need to be made about complex systems. For spaceflight medical risk, the Human Research Program’s Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) is a significant step towards robustly quantifying the risk to crew health during exploration missions. However, there remains a significant gap in the ability to comprehensively characterize and assess risk across the disparate functionalities and capabilities which comprise the entire Crew Health and Performance (CHP) system. To fill this gap, the Crew Health and Performance – Probabilistic Risk Assessment (CHP-PRA) project aims to perform risk characterization for the CHP system by assessing performance risk in addition to medical risk. This effort also includes quantifying Long-Term Health (LTH) risk in addition to in-mission risk outcomes within the CHP-PRA results. LTH risk encompasses the timeframe from immediately post-flight, through the rest of an astronaut’s career, through retirement, and until death. A proof-of-concept LTH risk metric is based on medical condition end-state, as defined by the Evidence Library, capturing the spaceflight specific medical impacts persisting into post-flight[1]. Condition outcomes in the Evidence Library progress through three Clinical Phases (CP): the diagnostic phase (CP1), the treatment/convalescent phase (CP2), and the end-state phase (CP3) which represents the detrimental effects of the condition after the crew member has recovered to the maximal extent. Each CP has an associated Task Impairment (TI), defined as the degree of crew incapacity due to experiencing the condition, and is quantified with a 0-1 range. Conditions with an associated CP3 (e.g. Sepsis, Traumatic Hypovolemic Shock, Sudden Cardiac Arrest, etc.) typically have serious consequences that can cause an astronaut to be fully or partially debilitated throughout the remainder of the mission. Consequently, the Cumulative CP3 TI End-of-Mission Health Status Metric is developed by CHP-PRA to quantify the cumulative effects of all conditions which progressed to the CP3 state throughout the entirety of the mission. Hence, this End-of-Mission Health Status Metric attempts to serve as an indicator of an astronaut’s health state at the time of landing. The severity of the lingering effects of in-mission medical events are dependent on mission activities and the level of available in-mission medical care. This allows the associated cumulative TI metric to be used in comparison with the crew’s end of mission health status for different levels of in-mission resources. This presentation provides the strategy for using CP3 as an LTH metric component, as well as a proof-of-concept demonstration of LTH risk characterization using this component.
long term health↗
Long-Term Health Risk Quantification
Astronauts face hazards during spaceflight, including space radiation exposure, isolation and confinement, traveling far distances from Earth, reduced gravity levels, and closed and hostile environments. These hazards drive the definition of human health and performance risks associated with spaceflight. NASA’s Human System Risk Board maintains the human spaceflight risk posture for in-mission risks, as well as post-flight, Long-Term Health (LTH)risks potentially occurring later in the astronaut’s life. LTH risk encompasses the timeframe from immediately post-flight, through the rest of an astronaut’s career, through retirement, and until death. Possible LTH risk outcomes include the time and interventions needed for the astronaut to return to preflight physiological states after experiencing spaceflight hazards and recovery from any in-mission medical events that persist into the post-flight timeframe. It includes chronic complications that may arise due to experiencing in-flight medical conditions or injuries and medical conditions that occur later in life with a higher probability of occurrence or with more severity because of their spaceflight exposure. Finally, LTH risk outcomes can also include a reduction in life expectancy due to spaceflight exposures. There have been 144 medical conditions identified by NASA’s Lifetime Surveillance of Astronaut Health team to be associated with LTH risk. Epidemiological studies have been performed for some of these conditions to determine if astronauts suffer from an increased prevalence or severity of the condition due to their spaceflight experience compared to a comparable cohort .Differences in astronaut mortality or morbidity due to spaceflight experience were not detected in several of these studies. There were two cases where a modest increase in the incidence rate of astronaut LTH outcomes was detected. The first suggested an increase in the incidence of melanoma cases in astronauts, where the number of cases in astronauts were similar to the elevated number of cases observed in airplane pilots. The second provided some evidence of elevated numbers of cardiovascular disease events in astronauts compared to an appropriate healthy comparator cohort, which may warrant additional investigation. The lack of detection of LTH risk outcomes should not ease concerns about astronaut LTH. The studies highlighted here constitute only a small portion of the potential LTH conditions that could occur. Once epidemiological studies are performed on all conditions, significant findings may be detected. The analysis of astronaut LTH also suffers from limited numbers of data points because of the limited numbers of astronauts overall and the even fewer who have reached an age where LTH outcomes may begin to manifest. As shuttle and ISS astronauts begin to age and increase the feasibility of analysis, LTH outcomes may be detected. An application of risk quantification is the use of risk metrics within trade studies for resource prioritization and decision making. Trade studies regarding countermeasures to LTH risk outcomes would benefit from a quantification of LTH risk. NASA has ground-based processes in place such as astronaut screening and access to continuous medical monitoring and care during and after their astronaut career which are the main methods for mitigating LTH risk. In-mission countermeasures, such as acceptable levels of medical care and available countermeasures to counter spaceflight related physiological decrements, can mitigate a poor health and performance status immediately post-flight. Identifying appropriate risk metrics, obtaining valid quantities for them, and tying them to LTH countermeasures are necessary steps for realizing their use in trade studies. This presentation will highlight the challenges associated with the identification, quantification, and utilization of LTH risk metrics
Beth Lewandowski↗
Sensorimotor Application of Proposed Methods to Combine the Effects of Multiple Countermeasures for PRisM
Risk associated with human systems is challenging to quantify but is critical for the mission planning and decision making required to enable future Lunar and Martian missions. To address this gap, the Crew Health and Performance-Probabilistic Risk Assessment (CHP-PRA) project is developing an integrated computational model for CHP mission risk. Much like how MEDPRAT is designed to allow medical resource trades informed by medical risk, CHP-PRA will enable analogous trades in human system risks across multiple CHP functions and capabilities. Human performance is one component of the risk intended to be captured by CHP-PRA through the Performance Risk Model (PRisM). The sensorimotor risk area provides a good frame of reference for investigating the structure of a performance model because most tasks that astronauts are expected to perform require input from the sensory system and/or movement/motor control. Additionally, sensorimotor countermeasures are an area of particular concern for NASA’s Human Research Program because of the increased sensorimotor risk associated with surface operations in Lunar and Martian missions. Thus, a tool that can quickly compare risk reductions of potential countermeasures would be beneficial in guiding research and development of effective countermeasures. In this proof of concept, we present a systematic way to combine multiple performance data sets for humans subjected to different countermeasures such that we can predict the countermeasure(s) that optimize astronaut performance on relevant tasks. PRisM assumes that both the tests that are used to measure countermeasure effectiveness (input data) and the tasks we use to represent astronaut performance, can be broken down and represented as a function/vector of the human systems required to perform that test/task. Through mathematical combination, test data are used to predict performance on astronaut tasks that use similar systems. We propose that when combining countermeasures evaluated using the same test, that only one value should be used to represent their combined effectiveness. We start our analysis with the assumption that two countermeasures together will perform better than each countermeasure individually. Our initial implementation of this framework compares various space motion sickness countermeasures and the most up to date analysis will be demonstrated at the IWS.
Caroline R Austin↗
Performance Risk Model (PRisM) Proof-of-Concept: An Operational Decision Support Tool to Predict Crew Performance in Space from Available Performance Tests
The Crew Health and Performance-Probabilistic Risk Assessment (CHP-PRA) team at NASA Glenn Research Center has developed a range of tools to evaluate astronaut health during spaceflight and to optimize the medical set required for missions. Among these, the Performance Risk Model (PRisM) represents a novel advancement, extending CHP-PRA’s focus beyond medical systems into the domain of human performance. Such tool could be pivotal in optimizing astronaut capabilities during space travel, thereby enhancing overall mission success. PRisM leverages data from well-established performance assessments conducted during previous crewed space missions and Earth analogs to strategically predict outcomes for planned tasks, even when direct performance testing has not been conducted for those specific tasks. To evaluate performance, PRisM references the various metrics outlined in NASA-STD-3001 and employs a methodology to integrate different performance scales. This framework analyzes the contribution of various human system task categories (HSTCs) to task execution and compares these contributions to the HSTCs’ involvement in other known tests. The model further employs a Monte Carlo simulation to sample performance scores from their distribution in operationally relevant tests such as those in Mulavara et al. (2018) and, by leveraging similarities in HSTC involvement, transfers this knowledge to actual mission tasks, such as those outlined in the "Human Exploration of Mars: Preliminary List of Crew Tasks”. The current PRisM proof-of-concept includes analyses of the impact of exercise and specific medications on astronauts’ performance, with provisions to incorporate additional countermeasures as data becomes available. Furthermore, the tool is customizable to include any system necessary to fully encompass the domain of human systems and can be adapted to evaluate performance for any spaceflight activities as requested by operational stakeholders. PRisM has the potential to assist the Human Research Program in exploring the capabilities trade space for optimized crew performance.
performance modeling↗