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IMPACT User Experience

NASA Human Research Project (HRP) and Exploration Medical Capabilities (ExMC) team identified a need to implement a human-centered design approach for a computational tool that performs detailed trade space analysis and research prioritization, known as Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT). IMPACT processes numerous parameters such as space vehicle design, mission objectives, evacuation capability, medical events, and mission constraint, including but not limited to; duration, mass, volume, equipment, and medical capability, each with complex and interconnected relationships. The ability for users to navigate through these complexities and provide an intuitive report is critical to aiding stakeholders in the decision-making process of future missions. In this presentation we will discuss how the IMPACT team has applied human-centered design strategies to improve system usability by modelling human-system integration (i.e., task analysis) with the MagicDraw SysML modelling application and performing A/B testing of user interface prototypes.

S Ozbek↗

Derivation of the Most Influential Medical Conditions for An Extended Duration Artemis Mission

BACKGROUND: The risk of loss of mission due to medical conditions may be influenced by loss of crew life (LOCL), need for evacuation (RTDC; return to definitive care), and crew task time lost. Predicting what medical conditions are most likely to lead to crew morbidity and mortality may influence medical system design, clinical capability prioritization, and research strategies. NASA’s Informing Mission Planning via Analysis of Complex Tradespaces tool (IMPACT) applies Probabilistic Risk Assessment (PRA) methodology to assess these risks. OVERVIEW: A team of subject matter experts (SME) from a variety of medical disciplines developed a consensus-based process to determine 120 of the most clinically relevant medical conditions for long-duration exploration missions (LDEMs) . This IMPACT Condition List (ICL) expanded upon previous work done for Integrated Medical Model (IMM). For each condition a best-case and worst-case definition were derived. These definitions were used to identify probability of occurrence, proportion of cases that are best case vs. worst case, clinical phase duration, and risk of outcomes (task time loss [TTL], RTDC, and LOCL) for both treated and untreated states. These data were sources from existing spaceflight databases (e.g. Longitudinal Survey of Astronaut Health), relevant models (e.g. the ISS fire model), and/or terrestrial literature. Each condition was then tied to diagnostic and therapeutic resources and capabilities. IMPACT was then run for the LDLOLS DRM (see Abstract #2 for this panel). DISCUSSION: This abstract will present the process for generating the IMPACT condition list, the relevant data for each clinical condition, and present results for the ten most influential conditions impacting LOCL, RTDC, and TTL for a representative extended duration Artemis mission.

A Nelson↗

Comparison of Artemis 2 and Artemis 5 Model Outcomes Using the Impact Probabilistic Risk Assessment Tool

BACKGROUND The Artemis campaign is a Moon exploration program with a series of six planned missions, five of which will be crewed. These five crewed missions will contain a single mission segment (space flight), or multiple mission segments involving space flight (Orion), lunar landing (LTV) and/or space habitat (Gateway). Each crewed segment faces the risk of unique medical conditions, necessitating medical sets/kits tailored to those specificities. To support and enable a data-driven and evidence-based decision-making process through out a mission’s life cycle, a software tool called IMPACT was developed. Using probabilistic risk assessment (PRA) methodologies, IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) is a novel tool built for analyzing the possibility of encountering complex medical risks during space flight, and for identifying the medical resources and capabilities needed to treat those potential at-risk medical conditions. This presentation will seek to compare IMPACT’s computational results upon potential complex space medical conditions (e.g., sprain/strain back or sleep disturbance) using IMPACT’s risk metrics and the associated optimized medical sets/kits between two Artemis missions: single segment Artemis 2 and multi-segmented Artemis 5. OVERVIEW By identifying potential medical conditions in space using input criteria such as crew quantity and composition, certain crew physical characteristics, mission duration and mission activities, IMPACT can produce analyses on the type of medical resources and capabilities needed to produce an optimized medical set/kit to address those medical conditions. IMPACT achieves this by performing hundreds of thousands of Monte Carlo simulations of missions to build aggregate pictures of medical risk. IMPACT’s risk metrics include loss of crew life (LOCL) – a measure of crew mortality due to medical conditions in space, return to definitive care (RTDC) – the need to perform crew evacuation, and task time lost (TTL) – a measure of the inability to perform activities due to crew disability. These risk metrics are applied to every medical condition identified by IMPACT’s computation analyses for every segment of the mission. Medical sets/kits are optimized to address these medical conditions but must fit within the stated Artemis Design Reference Mission (DRM) request for mass and volume physical size constraints. ANTICIPATED ANALYSIS AND CONCLUSION Using two Artemis missions, Artemis 2 and Artemis 5, IMPACT will provide the analyses for comparison of medical set/kit contents based upon mass and/or volume requirements and identify the at-risk medical conditions within both missions. This paper serves as an initial exploration of probabilistic risk assessment (PRA) medical risk calculations between two crewed Artemis missions and is not intended to be deemed the official medical response for the Artemis campaign.

probabilistic risk assessment↗

Medical Database Accomplishments and Lessons Learned - 2021

The Medical Database (MD) is a virtual repository consisting of two software components: the Medical Item Database (MedID) and the Evidence Library (EL). MedID consists of engineering data and associated information for specific medical resource items (e.g., pharmaceutical, medical devices, and supporting components), while the EL is a tool which provides all of the medical evidence necessary. The Medical Database will serve as the single “source of truth” for the Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) tool suite for both medical evidence and medical resource engineering data. It will be used in conjunction with the IMPACT tool suite to inform research prioritizations and perform systematic trade study evaluations using probabilistic risk assessment and simulated human spaceflight missions to aid stakeholders in making informed decisions during Pre-Phase-A planning of human spaceflight missions. The IMPACT project is conducted under the Exploration Medical Capability (ExMC) element of the Human Research Program (HRP), within NASA’s Human Exploration and Operations Mission Directorate. Over the past year, the MedID software has been successfully merged with the Evidence Library into one cohesive Medical Database with two independent user interface experiences for modifying either clinical evidence or resource engineering data. As MD has evolved substantially over the past year, a number of challenges have been encountered and overcome along the way. A number of ‘lessons learned’ and practical/logistical realizations have emerged which will be detailed in the forthcoming Medical Database presentation.

Exploration Medical Capability↗

Exploring the Science Trade Space with the JPL Innovation Foundry A-Team

The JPL Innovation Foundry has established a new approach for exploring, developing, and evaluating early concepts with a group called the Architecture Team (A-Team). The A-Team combines innovative collaborative methods and facilitated sessions with subject matter experts and analysis tools to help mature mission concepts. Science, implementation, and programmatic elements are all considered during an ATeam study. In these studies, Concept Maturity Levels (CML) are used to group methods. These levels include idea generation and capture (CML 1), initial feasibility assessment (CML 2), and trade space exploration (CML 3). Methods used for exploring the science objectives, feasibility, and scope will be described including use of a new technique for understanding the most compelling science, called a Science Return Diagram (SRD). In the process of developing the SRD, gradients in the science trade space are uncovered along with their implications for implementation and mission architecture. Special attention is paid towards developing complete investigations, establishing a series of logical claims that lead to the natural selection of a measurement approach. Over 20 science-focused A-Team studies have used these techniques to help science teams refine their mission objectives, make implementation decisions and reveal the mission concept’s most compelling science. This paper will describe the A-Team process for exploring the mission concept's science trade space and the Science Return Diagram technique.In June of 2011 a new collaborative engineering approach forearly concept formulation began in the JPL InnovationFoundry [1], six months later becoming the “A-Team” [2].Responding to a need for exploring mission architecturelevel trades [3], the A-Team precedes Team X [4,5] in asequence of concurrent engineering teams at JPL that can beused to mature a concept from a “cocktail napkin” level ideato a complete mission point design. The A-Team efficientlyexplores the science, implementation, and programmatictrade space in early concept formulation. Small, facilitatedgroups of experts generate innovative ideas, quantitativelyassess feasibility, and discover key sensitivities in the tradespace through collaborative analysis and use of advancedmethods and tools. The A-Team process builds off theexperience within JPL and other recent approaches to earlyconcept formulation [6] including best practices of the JPLInnovation Foundry, Project Systems Engineering &Formulation Section, Team Eureka and the Rapid MissionArchitecture Team[7].The A-Team is a focal point for innovative formulationapproaches and people within JPL. It relies on a largebackground of study resources, creative thinkers and “greybeard” scrutinizers, advanced tools, and subject matterexperts with both breadth and depth in experience andexpertise that are all available at JPL. The A-Team isdesigned to be a rapid and efficient process takingapproximately 6 weeks (the entire process can be as short asjust a few days or as long as up to three months) and costingthe equivalent of a work-month of a full-time employee orless. Studies begin with detailed planning and client reviewfollowed by study sessions, analysis work, and reporting.The staffing on each study is customized to the study goalsand objectives, and it is addressed early in the A-Teamprocess. Sessions are generally half-day or whole-day eventsand conducted over a series of days with focused agendas thatare moderated by a trained facilitator. Preliminary results andknowledge capture are available within hours of each session,and a final report is generally available two weeks later.One of the biggest challenges facing early conceptdevelopment is understanding the gradient in science returnversus various available mission scenarios and payload options. Often times, major areas of scientific inquiry havealready been prioritized by science groups, including throughthe National Research Council’s Decadal Studies inAstronomy, Planetary, and Earth Science. Yet science teamscontinue to struggle, especially in competitive missionsolicitations, to capture the right amount of scope that’sachievable within the cost constraints of the opportunity.Often the desire to completely and comprehensively study ascience area in just one mission (after all, true missionopportunities are rare) drives teams to take on too much,providing requirements that are unachievable within theresources of the opportunity without inducing unacceptableimplementation risk. Alternatively, science teams can seekto reduce risk by using an established instrument, but havenot thought through the traceability and key aspects of thescience question to justify its use. Both scenarios lead to badassumptions at the beginning of the concept development thatcan then ripple through implementation option choices,potentially preventing what would have been a good scienceinvestigation from being selected.The purpose of this paper is first to provide some additionalbackground and summary of the A-Team process, tools,people, and facilities. We then focus on the A-Teammethodology for overcoming the barriers of defining thescience scope well at the early concept development stage.This includes understanding the science story andtraceability, and then examining the gradient in science returnversus key characteristics of observables, developing theright payload and mission requirement specification throughexamining the science and implementation trade space.

Ziemer, John K.↗

In-Depth Modeling and Simulation Analysis of Artemis Missions Using the Impact Probabilistic Risk Assessment Tool

BACKGROUND The Artemis campaign is a Moon exploration program with a series of six planned missions, five of which will be crewed. These five crewed missions will contain a single mission segment (space flight), or multiple mission segments involving space flight (Orion), lunar landing (LTV) and/or space habitat (Gateway). Each crewed segment faces the risk of unique medical conditions, necessitating medical sets/kits tailored to those specificities. To support and enable a data-driven and evidence-based decision-making process through out a mission’s life cycle, a software tool called IMPACT was developed. Using probabilistic risk assessment (PRA) methodologies, IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) is a novel tool built for analyzing the possibility of encountering complex medical risks during space flight, and for identifying the medical resources and capabilities needed to treat those potential at-risk medical conditions. IMPACT achieves this by performing hundreds of thousands of Monte Carlo simulations of missions to build aggregate pictures of medical risk. During an extended simulation modeling phase, IMPACT generated analytical results for medical risks, and the medical resources and capabilities to address those risks, for every segment of every crewed Artemis mission. This presentation will highlight the reliability, consistency and validity of IMPACT’s computational modeling techniques and will showcase the library of analytical outcomes generated for the Artemis missions. OVERVIEW During the early stages of IMPACT’s design, architecture and technical requirements collection, “scenarios” (use cases) - achievement goals required for acceptance testing, were identified by stakeholders. IMPACT successfully completed the scenario testing requirements and undertook an extensive operational run phase utilizing a wide range of input combinations with a goal of delivering a cohesive, trustworthy, reliable, vast, and diverse body of evidence. The intent of these modeling runs was to validate consistency in output, ensure solidity of executable operations and to streamline processes by identifying areas requiring efficiency improvements. Using the many missions of Artemis, IMPACT ran variations of operational runs to assess the output for acceptable, as well as unusual characteristics. This rigorous long-term “shakedown” analysis was implemented to help build a collective body of evidence to aid in securing a high level of confidence, reliability, and validity in the output, whether from the applicational components of IMPACT, or the entirety of the operational process. ANTICIPATED ANALYSIS AND CONCLUSION This presentation will discuss the various categories of input criteria; the comparisons in the application of these input criteria to various Artemis missions; the preparation and collection of the body of evidence, and reliability of the computational modeling techniques. This paper serves as an initial analytical overview of IMPACT’s probabilistic risk assessment (PRA) medical risk outputs covering Artemis missions and is not intended to be deemed the official medical response for the Artemis campaign.

Crew Composition↗

Harnessing Artificial Intelligence for Medical Diagnosis and Treatment During Space Exploration Missions

BACKGROUND The medical capabilities necessary for long-duration exploration missions (LDEMs) will differ tremendously from those currently available to crew medical officers (CMOs) on the International Space Station (ISS). Ground support will be more challenging due to distance-related communication delays and data transmission, and resource utilization must be optimized given limited ability for resupply. Clinical decision support systems (CDSSs) can help mitigate these limitations. The recent launch of generative artificial intelligence (AI) tools based upon large language models (LLM) support the creation of a smart assistant for onboard triage, diagnosis, and guided treatment of medical conditions during these missions. The Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) tool can help predict which clinical problems and outcomes are likely to occur for a design reference mission (DRM) and assist Medical Operations and systems engineering teams in creating a medical system that may optimally mitigate the predicted risks. The purpose of this study was to identify AI tools currently available or in development for the assistive diagnosis and care of medical conditions predicted for an extended duration Lunar mission. METHODS The 119 medical conditions currently built into the IMPACT suite were categorized into systems, and these diagnoses were used as keywords for our literature search. Using PubMed and Google Scholar, we performed a literature survey of AI tools applicable to these conditions. Article inclusion criteria included publication between the years 2017-2023, as the sentinel paper discussing the “selective attention” driving ChatGPT and other generative transformer models was published in June 2017. Where applicable, we reviewed only the top 1000 research articles (based on relevance) for each of the keywords/phrases. AI tools whose training sets were exclusive to a pediatric patient population were excluded. We also excluded any medical diagnostic tools (such as CT, MRI, mass spectrometry) or procedures (such as endoscopy, surgery) that are unlikely to be available during LDEMs due to mass and volume constraints, CMO knowledge, skills, and abilities, and/or inherent procedural risks. RESULTS Our survey highlighted several AI-driven tools for the triage, diagnosis, and management of those medical conditions highlighted by IMPACT. Selected publications for each medical condition were then screened for inclusion within ten systems-based categories including: general diagnostic tools (25), tools to diagnose and manage respiratory (40), dermatologic (34), neurologic (28), auditory and vestibular (30), ophthalmic (34), musculoskeletal (104), infection-associated (92), and gynecologic (19) conditions, as well as tools that could be deployed in the setting of trauma and emergency (34). CONCLUSIONS Numerous AI-driven tools were highlighted within this literature survey, ranging from chatbot assistants that triage knee pain to vision transformer models for diagnosis of ophthalmic conditions using ocular surface images captured with a mobile phone. Remaining challenges include optimizing connectivity and integration of existing and developing systems into the vehicles or habitats. Notably, findings from this survey could help guide the initial design of an all-encompassing, onboard medical AI assistant for use during future LDEMs.

R A Lacinski↗

IMPACTing Medical System Design with a Risk Analysis Tool [“IMPACT” sur la Conception du Système Médical avec un Outil d'Analyse des Risques]

Background: Following the success of Artemis I, NASA is preparing for human extended duration missions. Ongoing efforts are focused on mitigating mission-related risks, including those affecting crew health and performance. Communication latency, logistics of resupply and time frame of medical evacuation are barriers to provision of healthcare for these missions, especially with respect to constraints in mass, volume, and crew training. An in-depth assessment of medical risks, capabilities and resources for a specific mission design is necessary to determine an optimal balance that maximizes likelihood of mission success. Overview: IMPACT (Informed Mission Planning via Analysis of Complex Tradespaces) is a dynamic tool designed to estimate medical risk and outcomes for a specific mission design. In its current iteration, a list of medical conditions selected based on likelihood of occurrence and/or consequence was linked to a set of clinical capabilities and resources necessary for diagnosis and management. A probabilistic risk analysis tool was then used to identify and estimate the likelihood and consequence of risks through the following outcome metrics: loss of crew life (inflight mortality due to medical conditions), need for medical evacuation (return to definitive care), and crew disability (task time affected based on how medical conditions influence the ability to perform specific exploration mission crew tasks). Finally, the model’s optimization algorithm provides recommendations for medical capabilities that maximize risk mitigation relative to mass and volume constraints. In the Spring of 2023, IMPACT was utilized to estimate outcome metrics for a design reference mission that would be representative of an extended duration Artemis mission. Notional data generated were then used to determine a recommended set of medical capabilities and resources relative to user-defined mass and volume constraints. A multidisciplinary team has also been updating IMPACT to strengthen the model’s fidelity. Figure 1 shows how updates to outcome metric inputs for the conditions resulted in different capability and resource allocation recommendations. Discussion: This presentation will discuss the IMPACT tool and share the latest data generated for a representative extended duration Artemis mission. Efforts to improve the fidelity of data generated by the model’s algorithm will also be discussed.

K A Shair↗

IMPACTing Medical System Design with a Risk Analysis Tool

Background: Following the success of Artemis I, NASA is preparing for human extended duration missions. Ongoing efforts are focused on mitigating mission-related risks, including those affecting crew health and performance. Communication latency, logistics of resupply and time frame of medical evacuation are barriers to provision of healthcare for these missions, especially with respect to constraints in mass, volume, and crew training. An in-depth assessment of medical risks, capabilities and resources for a specific mission design is necessary to determine an optimal balance that maximizes likelihood of mission success. Overview: IMPACT (Informed Mission Planning via Analysis of Complex Tradespaces) is a dynamic tool designed to estimate medical risk and outcomes for a specific mission design. In its current iteration, a list of medical conditions selected based on likelihood of occurrence and/or consequence was linked to a set of clinical capabilities and resources necessary for diagnosis and management. A probabilistic risk analysis tool was then used to identify and estimate the likelihood and consequence of risks through the following outcome metrics: loss of crew life (inflight mortality due to medical conditions), need for medical evacuation (return to definitive care), and crew disability (task time affected based on how medical conditions influence the ability to perform specific exploration mission crew tasks). Finally, the model’s optimization algorithm provides recommendations for medical capabilities that maximize risk mitigation relative to mass and volume constraints. In the Spring of 2023, IMPACT was utilized to estimate outcome metrics for a design reference mission that would be representative of an extended duration Artemis mission. Notional data generated were then used to determine a recommended set of medical capabilities and resources relative to user-defined mass and volume constraints. A multidisciplinary team has also been updating IMPACT to strengthen the model’s fidelity. Figure 1 shows how updates to outcome metric inputs for the conditions resulted in different capability and resource allocation recommendations. Discussion: This presentation will discuss the IMPACT tool and share the latest data generated for a representative extended duration Artemis mission. Efforts to improve the fidelity of data generated by the model’s algorithm will also be discussed.

K A Shair↗

Model-Based Trade Space Exploration for Near-Earth Space Missions

We developed a capability for model-based trade space exploration to be used in the conceptual design of Earth-orbiting space missions. We have created a set of reusable software components to model various subsystems and aspects of space missions. Several example mission models were created to test the tools and process. This technique and toolset has demonstrated itself to be valuable for space mission architectural design.

space mission↗

Improving the Fidelity of Capability & Resource Weighting in A Probalistic Risk Assessment Model for Spaceflight

INTRODUCTION NASA’s Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) tool uses Probabilistic Risk Assessment (PRA) to provide an evidence-based, data-driven estimate of how medical system capabilities affect mission outcomes. IMPACT maps condition incidence to available resources thereby facilitating the calculation of outcome metrics that allow the estimation of mission medical risk. Conditions can be nominally categorized as either treated or untreated depending on the availability of necessary diagnostic and therapeutic capabilities. This categorization enables IMPACT to estimate the effect of various medical system configurations on mission outcomes such as crew mortality, disability, crew member down-time, return to duty/recovery, and need for evacuation. IMPACT currently employs an equal weighting, “partial credit” approach to define treatment in which each of the capabilities associated with a given condition contributes an equal amount to management of the condition. This feature enables IMPACT to report values in between “fully untreated” and “fully treated” based on the proportion of capabilities available within the model. However, as is normal in medical/clinical practice, not all individual capabilities contribute equally to medical care. For example, the ability to provide intramuscular epinephrine during an anaphylactic episode contributes more likelihood of overall management success than does the administration of oral diphenhydramine. We hypothesize that weighting the relative contribution of each capability to each specific condition will improve outcome prediction and therefore will better provide mission planners with more nuanced and accurate options when designing space medical systems. METHODS Using a five-point Fibonacci scaling sequence (1, 2, 3, 5, 8) subject matter experts from NASA’s Exploration Medical Capabilities (ExMC) element assigned relative contribution weighting values to each identified capability within IMPACT. Since the relative importance of each capability varies depending on the specific condition, the resulting “partial” weighting was completed for more than 1,600 individual weighting assignments for 666 capabilities across 121 conditions. Each assignment required three-physician concurrence based on the overall importance of the capability to the diagnosis and management of the condition being considered and the difficulty with which it could be improvised by the crew. Once complete, 100,000 IMPACT simulations were run for a 6-month Lunar mission with a 30-day surface stay to evaluate the effect of this modification of the model. RESULTS Partial weighting significantly decreased predicted task time loss (TTL), evacuation, and loss of crew life without causing significant changes to the recommended medical system design. CONCLUSIONS The paucity of real-world referent data to support long-duration space missions of this type limits the ability to judge one predictive analytics method as superior to another. However, since the proposed method significantly reduces and optimizes outcome risks—without changing the medical system design—incorporating a partial weighting methodology is likely to provide a more accurate and operationally-relevant representation of medical risk without compromising IMPACTs ability to inform overarching medical system requirements.

Steller JG↗