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NASA NTRS2004

Visualizing ultrasound through computational modeling

The Doppler Ultrasound Hematocrit Project (DHP) hopes to find non-invasive methods of determining a person s blood characteristics. Because of the limits of microgravity and the space travel environment, it is important to find non-invasive methods of evaluating the health of persons in space. Presently, there is no well developed method of determining blood composition non-invasively. This projects hopes to use ultrasound and Doppler signals to evaluate the characteristic of hematocrit, the percentage by volume of red blood cells within whole blood. These non-invasive techniques may also be developed to be used on earth for trauma patients where invasive measure might be detrimental. Computational modeling is a useful tool for collecting preliminary information and predictions for the laboratory research. We hope to find and develop a computer program that will be able to simulate the ultrasound signals the project will work with. Simulated models of test conditions will more easily show what might be expected from laboratory results thus help the research group make informed decisions before and during experimentation. There are several existing Matlab based computer programs available, designed to interpret and simulate ultrasound signals. These programs will be evaluated to find which is best suited for the project needs. The criteria of evaluation that will be used are 1) the program must be able to specify transducer properties and specify transmitting and receiving signals, 2) the program must be able to simulate ultrasound signals through different attenuating mediums, 3) the program must be able to process moving targets in order to simulate the Doppler effects that are associated with blood flow, 4) the program should be user friendly and adaptable to various models. After a computer program is chosen, two simulation models will be constructed. These models will simulate and interpret an RF data signal and a Doppler signal.

Guo, Theresa W.↗

NASA NTRS2001

Microarthroscopy System With Image Processing Technology Developed for Minimally Invasive Surgery

In a joint effort, NASA, Micro Medical Devices, and the Cleveland Clinic have developed a microarthroscopy system with digital image processing. This system consists of a disposable endoscope the size of a needle that is aimed at expanding the use of minimally invasive surgery on the knee, ankle, and other small joints. This device not only allows surgeons to make smaller incisions (by improving the clarity and brightness of images), but it gives them a better view of the injured area to make more accurate diagnoses. Because of its small size, the endoscope helps reduce physical trauma and speeds patient recovery. The faster recovery rate also makes the system cost effective for patients. The digital image processing software used with the device was originally developed by the NASA Glenn Research Center to conduct computer simulations of satellite positioning in space. It was later modified to reflect lessons learned in enhancing photographic images in support of the Center's microgravity program. Glenn's Photovoltaic Branch and Graphics and Visualization Lab (G-VIS) computer programmers and software developers enhanced and speed up graphic imaging for this application. Mary Vickerman at Glenn developed algorithms that enabled Micro Medical Devices to eliminate interference and improve the images.

Steele, Gynelle C.↗

NASA NTRS2006

Stress, and pathogen response gene expression in modeled microgravity

Purpose: Immune suppression in microgravity has been well documented. With the advent of human exploration and long-term space travel, the immune system of the astronaut must be optimally maintained. It is important to investigate the expression patterns of cytokine genes, because they are directly related to immune response. Heat shock proteins (HSPs), also called stress proteins, are a group of proteins that are present in the cells of every life form. These proteins are induced when a cell responds to stressors such as heat, cold and oxygen deprivation. Microgravity is another stressor that may regulate HSPs. Heat shock proteins trigger immune response through activities that occur both inside the cell (intracellular) and outside the cell (extracellular). Knowledge about these two gene groups could lead to establishment of a blueprint of the immune response and adaptation-related genes in the microgravity environment. Methods: Human peripheral blood cells were cultured in 1g (T flask) and modeled microgravity (MMG, rotating-wall vessel) for 24 and 72 hours. Cell samples were collected and subjected to gene array analysis using the Affymetrix HG_U95 array. Data was collected and subjected to a two-way analysis of variance. The genes related to immune and stress responses were analyzed. Results and Conclusions: HSP70 was up-regulated by more than two fold in microgravity culture, while HSP90 was significantly down-regulated. HSP70 is not typically expressed in all kinds of cells, but it is expressed at high levels in stress conditions. HSP70 participates in translation, protein translocation, proteolysis and protein folding, suppressing aggregation and reactivating denatured proteins. Increased serum HSP70 levels correlate with a better outcome for heat-stroke or severe trauma patients. At the same time, elevated serum levels of HSP70 have been detected in patients with peripheral or renal vascular disease. HSP90 has been identified in the cytosol, nucleus and endoplasmic reticulum, and exists in many tissue types. HSP90 associates with actin filaments in certain conditions and aids cell motility. The down-regulation of HSP90 could lead to deleterious effects in the lymphocytes, thereby contributing to suppressed immune function in microgravity. Interleukins such as IL 1 alpha, IL11 receptor chain alpha, IL7R, and IL4R were significantly down regulated in modeled microgravity. Further analysis of the genes involved in immune response at the protein level may provide a basis for prophylactic and countermeasure strategies to augment the human immune system for space exploration.

Sundaresan, Alamelu↗

NASA NTRS2006

Biomedical Aspects of Lunar and Mars Exploration Missions

Recent long-range planning for exploration-class missions has emphasized the need for anticipating the medical and human factors aspects of such expeditions. Missions returning Americans to the moon for stays of up to 6 months at a time will provide the opportunity to demonstrate the means to function safely and efficiently on another planet. Details of mission architectures are still under study, but a typical Mars design reference mission comprises a six-month transit from Earth to Mars, eighteen months in residence on Mars, and a six-month transit back to Earth. Physiological stresses will come from environmental factors such as prolonged exposure to radiation, weightlessness en route to Mars and then back to Earth, and low gravity and a toxic atmosphere while on Mars. Psychological stressors will include remoteness from Earth, confinement, and potential interpersonal conflicts, all complicated by circadian alterations. Medical risks including trauma must be considered. The role of such risk-modifying influences as artificial gravity and improved propulsion technologies to shorten round-trip time will also be discussed. Results of planning for assuring human health and performance will be presented.

Charles, John B.↗

NASA NTRS2007

Bisphosphonate Treatment: Risk Management in Long Duration Spaceflight

Bisphosphonates are a class of pharmaceuticals used to treat diverse bone disorders such as osteoporosis, Paget's disease, and multiple myeloma. They constitute a class of drugs which adhere to bony surfaces and interfere with the resorptive activity of osteoclasts. They also represent a potential countermeasure towards the loss of bone mass experienced by astronauts during spaceflight. Recently, the medical literature has revealed cases of osteonecrosis of the jaw in individuals receiving intravenous bisphosphonate therapy with a smaller number of cases occurring in individuals receiving the oral form of the medication. Risk management for long duration missions requires consideration of mission success and lifetime health care of astronauts. We performed MEDLINE and PubMed searches (1966 December 2006) using the following keywords: osteonecrosis, jaw, bisphosphonates. Additional references were obtained from the citations of the retrieved articles. Injectable bisphosphonates such as pamidronate and zoledronic acid have been highlighted recently in the literature due to a possible link with osteonecrosis of the jaw. The mechanism of action remains unclear but may be linked to physiologic microdamage in the jawbones resulting from suppression of bone metabolism. The most predisposing factors appear to be the type and dose of bisphosphonate used, a history of dental surgery, trauma, and/or dental infection. In addition, patients diagnosed with a malignancy such as breast cancer or multiple myeloma, who have been on intravenous bisphosphonate therapy for several months seem to be at increased risk. The use of oral bisphosphonates appears to place patients more at risk from acute events such as gastrointestinal tract injury or perforation. Although some studies report little to no increase in GI events compared to placebo, we must remember that in microgravity, astronauts may be unable to comply with medication instructions. They may have difficulty remaining upright for the required 30-45 minutes post-ingestion. We are currently unaware if this inability to comply with instructions on the package insert may lead to an increased risk for GI events. There is a potential long-term complication that resides with both forms of bisphosphonate therapy. In order to repair normally occurring physiologic microdamage to bone, both osteoclastic resorption and osteoblastic bone deposition must be functional. Controversy exists in the literature regarding whether prolonged use of bisphosphonates may lead to the suppression of bone turnover and accumulation of microdamage. Bisphosphonates are a powerful class of drugs that suppress bone turnover, but may cause serious adverse clinical events such as gastrointestinal tract injury or osteonecrosis of the jaw. Unfortunately, little to no data exists currently which may help us provide answers regarding the risks of their use in a healthy astronaut cohort. While controversy exists in the literature regarding their mechanism and long-term consequences, the potential mission impact or lifetime health care impact of an adverse clinical event resulting from bisphosphonate therapy must be considered.

Fogarty, Jennifer A.↗

NASA NTRS2007

Artificial Gravity as a Multi-System Countermeasure: Effects on Cognitive Function

The Space Flight Cognitive Assessment Tool for Windows (WinSCAT) is a medical requirement on the International Space Station, and its purpose is to evaluate cognitive functioning after physical insult (e.g., head trauma, decompression sickness, exposure to toxic gases, medication side effects). The current objective is to assess cognitive functioning in a long duration space mission analog environment where Artificial Gravity is being applied as a countermeasure in a Bed Rest study. Methods: Fifteen male subjects (8 treatment and 7 control) who participated in 21 days of -6 degree head-down bed rest were assessed. Three practice and three baseline WinSCAT test sessions were administered during the pre-bed rest phase of study participation. During the bed rest phase, the WinSCAT test was scheduled every other day, following the centrifuge, for a total of 10 test sessions. (The treatment group received 60 minutes of centrifugation each day during the 21 days of bed rest. The control subjects were strapped to the centrifuge for the same length of time as the treatment group but were not spun.) During the post-bed rest (reconditioning) phase, the test was administered 4 times. Results: Individual differences were found both within and between the treatment and control groups. After controlling for the number of subjects in each group, the treatment group accounted for more off-nominal WinSCAT scores than the control group. Conclusions:There is some preliminary evidence that centrifuge spinning might negatively impact cognitive functioning. However, due to sample size limitations, it cannot be ascertained whether there were significant differences in cognitive performance between the treatment and control groups. If centrifugation had a negative effect on cognitive functioning, consistent decrements would be expected to be found with all treatment subjects across time. Individual differences in underlying cognitive ability and motivation level are other possible explanations for the results found in this study.

Sipes, Walter E.↗

NASA NTRS2003

Cell separation using electric fields

The present invention involves methods and devices which enable discrete objects having a conducting inner core, surrounded by a dielectric membrane to be selectively inactivated by electric fields via irreversible breakdown of their dielectric membrane. One important application of the invention is in the selection, purification, and/or purging of desired or undesired biological cells from cell suspensions. According to the invention, electric fields can be utilized to selectively inactivate and render non-viable particular subpopulations of cells in a suspension, while not adversely affecting other desired subpopulations. According to the inventive methods, the cells can be selected on the basis of intrinsic or induced differences in a characteristic electroporation threshold, which can depend, for example, on a difference in cell size and/or critical dielectric membrane breakdown voltage. The invention enables effective cell separation without the need to employ undesirable exogenous agents, such as toxins or antibodies. The inventive method also enables relatively rapid cell separation involving a relatively low degree of trauma or modification to the selected, desired cells. The inventive method has a variety of potential applications in clinical medicine, research, etc., with two of the more important foreseeable applications being stem cell enrichment/isolation, and cancer cell purging.

Mangano, Joseph A.↗

NASA NTRS2008

Health and Safety Benefits of Small Pressurized Suitport Rovers as EVA Surface Support Vehicles

Pressurized safe-haven providing SPE protection and decompression sickness (DCS) treatment capabilities within 20 mins at all times. Up to 50% reduction in time spent in EVA suits (vs. Unpressurized Rovers) for equal or greater Boots-on-Surface EVA exploration time. Reduces suit-induced trauma and provides improved options for nutrition, hydration, and waste-management. Time spent inside SPR during long translations may be spent performing resistive and cardiovascular exercise. Multiple shorter EVAs versus single 8 hr EVAs increases DCS safety and decreases prebreathe requirements. SPRs also offer many potential operational, engineering and exploration benefits not addressed here.

Gernhardt, Michael L.↗

NASA NTRS2009

Cell separation using electric fields

Mangano, Joseph↗

NASA NTRS2000

Human Health and Performance Aspects of the Mars Design Reference Mission

This paper will describe the current planning for exploration-class missions, emphasizing the medical, and human factors aspects of such expeditions. The details of mission architecture are still under study, but a typical Mars design reference mission comprises a six-month transit from Earth to Mar, eighteen months in residence on Mars, and a six-month transit back to Earth. Physiological stressors will include environmental factors such as prolonged exposure to radiation, weightlessness in transit, and hypogravity and a toxic atmosphere while on Mars. Psychological stressors will include remoteness from Earth, confinement, and potential interpersonal conflicts, all complicated by circadian alterations. Medical risks including trauma must also be considered. Results of planning for assuring human health and performance will be presented.

Charles, John B.↗

NASA NTRS2002

Rapid Diagnosis of an Ulnar Fracture with Portable Hand-Held Ultrasound

Orthopedic fractures are a common injury in operational activities, injuries that often occur in isolated or hostile environments. Clinical ultrasound devices have become more user friendly and lighter allowing them to be easily transported with forward medical teams. The bone-soft tissue interface has a very large acoustic impedance, with a high reflectance that can be used to visualize breaks in contour including fractures. Herein reported is a case of an ulnar fracture that was quickly visualized in the early phase of a multi-system trauma resuscitation with a hand-held ultrasound device. The implications for operational medicine are discussed.

Kirkpatrick, Andrew W.↗

NASA NTRS2010

Smart Ultrasound Remote Guidance Experiment (SURGE)- Concept of Operations Evaluation for Using Remote Guidance Ultrasound for Planetary Space Flight

Introduction Use of remote guidance (RG) techniques aboard the International Space Station (ISS) has enabled astronauts to collect diagnostic-level ultrasound images. Exploration class missions will require this cohort of (typically) non-formally trained sonographers to operate with greater autonomy given the longer communication delays (2 seconds for ISS vs. >6 seconds for missions beyond the Moon) and communication blackouts. To determine the feasibility and training requirements for autonomous ultrasound image collection by non-expert ultrasound operators, ultrasound images were collected from a similar cohort using three different image collection protocols: RG only, RG with a computer-based learning tool (LT), and autonomous image collection with LT. The groups were assessed for both image quality and time to collect the images. Methods Subjects were randomized into three groups: RG only, RG with LT, and autonomous with LT. Each subject received 10 minutes of standardized training before the experiment. The subjects were tasked with making the following ultrasound assessments: 1) bone fracture and 2) focused assessment with sonography in trauma (FAST) to assess a patient s abdomen. Human factors-related questionnaire data were collected immediately after the assessments. Results The autonomous group did not out-perform the two groups that received RG. The mean time for the autonomous group to collect images was less than the RG groups, however the mean image quality for the autonomous group was less compared to both RG groups. Discussion Remote guidance continues to produce higher quality ultrasound images than autonomous ultrasound operation. This is likely due to near-instant feedback on image quality from the remote guider. Expansion in communication time delays, however, diminishes the capability to provide this feedback, thus requiring more autonomous ultrasound operation. The LT has the potential to be an excellent training and coaching component for autonomous ultrasound image collection during exploration missions.

Hurst, Victor, IV↗

NASA NTRS2000

Ultrasound Evaluation of the Magnitude of Pneumothorax: A New Concept

Pneumothorax is commonly seen in trauma patients; the diagnosis is usually confirmed by radiography. Use of ultrasound for this purpose, in environments such as space flight and remote terrestrial areas where radiographic capabilities are absent, is being investigated by NASA. In this study, the ability of ultrasound to assess the magnitude of pneumothorax in a porcine model was evaluated. Sonography was performed on anesthetized pigs (avg. wt. 50 kg) in both ground-based laboratory (n = 5) and micro gravity conditions (0 g) aboard the KC-135 aircraft during parabolic flight (n = 4). Aliquots of air (50-1 OOcc) were introduced into the chest through a catheter to simulate pneumothorax. Results were video-recorded and digitized for later interpretation by radiologists. Several distinct sonographic patterns of partial lung sliding were noted, including the combination of a sliding zone with a still zone, and a "segmented" sliding zone. These "partial lung sliding" patterns exclude massive pneumothorax manifested by a complete separation of the lung from the parietal pleura. In 0 g, the sonographic picture was more diverse; 1 g differences between posterior and anterior aspects were diminished. CONCLUSIONS: Modest pneumothorax can be inferred by the ultrasound sign of "partial lung sliding". This finding, which increases the negative predictive value of thoracic ultrasound, may be attributed to intermittent pleural contact, small air spaces, or alterations in pleural lubricant. Further studies of these phenomena are warranted.

Sargsyan, Ashot E.↗

NASA NTRS2010

Ultrasound Fracture Diagnosis in Space

Introduction: This ground-based investigation accumulated high-level clinical evidence on the sensitivity and specificity of point of care ultrasound performed by expert and novice users for the rapid diagnosis of musculoskeletal (MSK) injuries. We developed preliminary educational methodologies to provide just-in-time training of novice users by creating multi-media training tools and imaging procedures for non expert operators and evaluated the sensitivity and specificity of non-expert performed musculoskeletal ultrasound to diagnose acute injuries in a Level 1 Trauma Center. Methods: Patients with potential MSK injuries were identified in the emergency room. A focused MSK ultrasound was performed by expert operators and compared to standard radiographs. A repeat examination was performed by non-expert operators who received a short, just-in-time multimedia education aid. The sensitivity and specificity of the expert and novice ultrasound examinations were compared to gold standard radiography. Results: Over 800 patients were enrolled in this study. The sensitivity and specificity of expert performed ultrasound exceeded 98% for MSK injuries. Novice operators achieved 97% sensitivity and 99% specificity for targeted examinations with the greatest error in fractures involving the hand and foot. Conclusion: Point of care ultrasound is a sensitive and specific diagnostic test for MSK injury when performed by experts and just-in-time trained novice operators.

Dulchavsky, Scott A.↗

NASA NTRS2004

Extraterrestrial Hemorrhage Control: Terrestrial Developments in Technique, Technology, and Philosophy with Applicability to Traumatic Hemorrhage in Space

Managing injury and illness during long duration space flight limits efforts to explore beyond low earths orbit. Traumatic injury may be expected to occur in space and is a frequent cause of preventable deaths, often related to uncontrolled or ongoing hemorrhage (H). Such bleeding causes 40% of terrestrial injury mortality. Current guidelines emphasize early control of H compared to intravenous infusions. Recent advances in surgical and critical care may be applicable to trauma care in space, with appropriate considerations of the extreme logistical and personnel limitations. Methods: Recent developments in technique, resuscitation fluids, hemoglobin (Hb) substitutes, hemostatic agents, interventional angiography, damage control principles, and concepts related to suspended animation were reviewed. Results: H associated with instability frequently requires definitive intervention. Direct pressure should be applied to all compressible bleeding, but novel approaches are required for intracavitary noncompressible bleeding. Intravenous hemostatic agents such as recombinant Factor VII may facilitate hemostasis especially when combined with a controlled hypotension approach. Both open and laparoscopic techniques could be used in weightlessness, but require technical expertise not likely to be available. Specific rehearsed invasive techniques such as laparotomy with packing, or arterial catherterization with with robotic intravascular embolization might be considered . Hemodynamic support, thermal manipulation, or pharmacologic induction of a state of metabolic down regulation for whole body preservation may be appropriate. Hypertonic saline, with or without dextran, may temporize vascular support and decrease reperfusion injury, with less mass than other solutions. Hb substitutes have other theoretical advantages. Conclusions: Terrestrial developments suggest potential novel strategies to control H in space, but will required a coordinated program of evaluation and training to evaluate.

Kirkpatrick, Andrew↗

NASA NTRS2004

Neuropsychological Testing of Astronauts

The Spaceflight Cognitive Assessment Tool for Windows (WinSCAT) is a computer program that administers a battery of five timed neuro-cognitive tests. WinSCAT was developed to give astronauts an objective and automated means of assessing their cognitive functioning during space flight, as compared with their own baseline performances measured during similar prior testing on the ground. WinSCAT is also intended for use by flight surgeons to assess cognitive impairment after exposure of astronauts to such cognitive assaults as head trauma, decompression sickness, and exposure to toxic gas. The tests were selected from among a group of tests, denoted the Automated Neuropsychological Assessment Metrics, that were created by the United States Navy and Army for use in evaluating the cognitive impairment of military personnel who have been subjected to medication or are suspected to have sustained brain injuries. These tests have been validated in a variety of clinical settings and are now in the public domain. The tests are presented in a Microsoft Windows shell that facilitates administration and enables immediate reporting of test scores in numerical and graphical forms.

Flynn, Christopher↗

NASA NTRS2012

Benefits of a Single-Person Spacecraft for Weightless Operations

Historically, less than 20 percent of crew time related to extravehicular activity (EVA) is spent on productive external work.1 A single-person spacecraft with 90 percent efficiency provides productive new capabilities for maintaining the International Space Station (ISS), exploring asteroids, and servicing telescopes or satellites. With suits, going outside to inspect, service or repair a spacecraft is time-consuming, requiring pre-breathe time, donning a fitted space suit, and pumping down an airlock. For ISS, this is between 12.5 and 16 hours for each EVA, not including translation and work-site set up. The work is physically demanding requiring a day of rest between EVAs and often results in suit-induced trauma with frequent injury to astronauts fingers2. For maximum mobility, suits use a low pressure, pure oxygen atmosphere. This represents a fire hazard and requires pre-breathing to reduce the risk of decompression sickness (bends). With virtually no gravity, humans exploring asteroids cannot use legs for walking. The Manned Maneuvering Unit offers a propulsive alternative however it is no longer in NASA s flight inventory. FlexCraft is a single person spacecraft operating at the same cabin atmosphere as its host so there is no risk of the bends and no pre-breathing. This allows rapid, any-time access to space for repeated short or long EVAs by different astronauts. Integrated propulsion eliminates hand-over-hand translation or having another crew member operate the robotic arm. The one-size-fits-all FlexCraft interior eliminates the suit part inventory and crew time required to fit all astronauts. With a shirtsleeve cockpit, conventional displays and controls are used and because the work is not strenuous no rest days are required. Furthermore, there is no need for hand tools because manipulators are equipped with force multiplying end-effectors that can deliver the precise torque for the job.

Griffin, Brand N.↗

NASA NTRS2012

Mega-Impacts on Mars: Implications for the Late Heavy Bombardment in the Inner Solar System, and the Early Evolution of the Earth and Mars

There are about 30 very large impact basins on Mars, > 1000 km in diameter, most of which are revealed by their topographic and/or crustal thickness signatures. Crater retention ages and model absolute ages suggest these all formed in a relatively short time (100-200 million years?), perhaps during a "Late Heavy Bombardment" (LHB) caused by the evolution of the orbits of the giant planets. This so-called "Nice Model" of planetary formation may explain the LHB on the Moon at about 3.9 billion years ago and would have produced a similar bombardment throughout the inner solar system. The formation of 30 very large impact basins would have had catastrophic environmental consequences for Mars, which were further complicated by the demise of the global magnetic field at about the same time. If there are no very large basins on Mars older than the 30 we see and the LHB really lasted everywhere only a short time, there may have been a relatively longer time (~400 million years?) during which Mars and the Earth suffered no major impact trauma and during which conditions on both worlds may have been far more habitable than during the LHB. However, if the formation of the Mars crustal dichotomy was due to an even larger giant impact that predated the very large basins, all record of this earlier and possibly more clement time on Mars may have been erased. Ages of the smaller but still very large basins can be used to approximately date the giant impact (if it occurred). Even the very large basins appear to have reset the crater retention ages of the entire crust of Mars and may have by themselves erased any record of an earlier time.

Frey, Herbert↗