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Exploration-class missions lead to longer communication delays with mission control. May not always have communication capability to stream real-time ultrasound images. SURGE explores use of a "just-in-time" learning tool, called OPEL = On-Board Proficiency Enhancer Light as an aid to a hypothetical crew medical officer working autonomously.
OVERVIEW A NASA Flight Medicine optometrist teamed with a human factors specialist to develop an electronic questionnaire for crewmembers to record their visual acuity test scores and perceived vision assessment. It will be implemented on the International Space Station (ISS) and administered as part of a suite of tools for early detection of potential vision changes. The goal of this effort was to rapidly develop a set of questions to help in early detection of visual (e.g. blurred vision) and/or non-visual (e.g. headaches) symptoms by allowing the ISS crewmembers to think about their own current vision during their spaceflight missions. PROCESS An iterative process began with a Space Shuttle one-page paper questionnaire generated by the optometrist that was updated by applying human factors design principles. It was used as a baseline to establish an electronic questionnaire for ISS missions. Additional questions needed for the ISS missions were included and the information was organized to take advantage of the computer-based file format available. Human factors heuristics were applied to the prototype and then they were reviewed by the optometrist and procedures specialists with rapid-turn around updates that lead to the final questionnaire. CONCLUSIONS With about only a month lead time, a usable tool to collect crewmember assessments was developed through this cross-discipline collaboration. With only a little expenditure of energy, the potential payoff is great. ISS crewmembers will complete the questionnaire at 30 days into the mission, 100 days into the mission and 30 days prior to return to Earth. The systematic layout may also facilitate physicians later data extraction for quick interpretation of the data. The data collected along with other measures (e.g. retinal and ultrasound imaging) at regular intervals could potentially lead to early detection and treatment of related vision problems than using the other measures alone.
A package of software computes the time-dependent propagation of a narrow laser beam in an arbitrary three- dimensional (3D) medium with absorption and scattering, using the transient-discrete-ordinates method and a direct integration method. Unlike prior software that utilizes a Monte Carlo method, this software enables simulation at very small signal-to-noise ratios. The ability to simulate propagation of a narrow laser beam in a 3D medium is an improvement over other discrete-ordinate software. Unlike other direct-integration software, this software is not limited to simulation of propagation of thermal radiation with broad angular spread in three dimensions or of a laser pulse with narrow angular spread in two dimensions. Uses for this software include (1) computing scattering of a pulsed laser beam on a material having given elastic scattering and absorption profiles, and (2) evaluating concepts for laser-based instruments for sensing oceanic turbulence and related measurements of oceanic mixed-layer depths. With suitable augmentation, this software could be used to compute radiative transfer in ultrasound imaging in biological tissues, radiative transfer in the upper Earth crust for oil exploration, and propagation of laser pulses in telecommunication applications.
The Medical Data Architecture (MDA) project supports the Exploration Medical Capability (ExMC) risk to minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the ExMC MDA project addresses the technical limitations identified in ExMC Gap Med 07: We do not have the capability to comprehensively process medically- relevant information to support medical operations during exploration missions. This gap identifies that the current in-flight medical data management includes a combination of data collection and distribution methods that are minimally integrated with on-board medical devices and systems. Furthermore, there are a variety of data sources and methods of data collection. For an exploration mission, the seamless management of such data will enable a more medically autonomous crew than the current paradigm of medical data management on the International Space Station. ExMC has recognized that in order to make informed decisions about a medical data architecture framework, current methods for medical data management must not only be understood, but an architecture must also be identified that provides the crew with actionable insight to medical conditions. This medical data architecture will provide the necessary functionality to address the challenges of executing a self-contained medical system that approaches crew health care delivery without assistance from ground support. Hence, the products derived from the third MDA prototype development will directly inform exploration medical system requirements for Level of Care IV in Gateway missions. In fiscal year 2019, the MDA project developed Test Bed 3, the third iteration in a series of prototypes, that featured integrations with cognition tool data, ultrasound image analytics and core Flight Software (cFS). Maintaining a layered architecture design, the framework implemented a plug-in, modular approach in the integration of these external data sources. An early version of MDA Test Bed 3 software was deployed and operated in a simulated analog environment that was part of the Next Space Technologies for Exploration Partnerships (NextSTEP) Gateway tests of multiple habitat prototypes. In addition, the MDA team participated in the Gateway Test and Verification Demonstration, where the MDA cFS applications was integrated with Gateway-in-a-Box software to send and receive medically relevant data over a simulated vehicle network. This software demonstration was given to ExMC and Gateway Program stakeholders at the NASA Johnson Space Center Integrated Power, Avionics and Software (iPAS) facility. Also, the integrated prototypes served as a vehicle to provide Level 5 requirements for the Crew Health and Performance Habitat Data System for Gateway Missions (Medical Level of Care IV). In the upcoming fiscal year, the MDA project will continue to provide systems engineering and vertical prototypes to refine requirements for medical Level of Care IV and inform requirements for Level of Care V.
Minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the ExMC MDA project addresses the technical limitations identified in ExMC Gap Med 07: We do not have the capability to comprehensively process medically relevant information to support medical operations during exploration missions. This gap identifies that the current in-flight medical data management includes a combination of data collection and distribution methods that are minimally integrated with on-board medical devices and systems. Furthermore, there are a variety of data sources and methods of data collection. For an exploration mission, the seamless management of such data will enable a more medically autonomous crew than the current paradigm of medical data management on the International Space Station. ExMC has recognized that in order to make informed decisions about a medical data architecture framework, current methods for medical data management must not only be understood, but an architecture must also be identified that provides the crew with actionable insight to medical conditions. This medical data architecture will provide the necessary functionality to address the challenges of executing a self-contained medical system that approaches crew health care delivery without assistance from ground support. Hence, the products derived from the third MDA prototype development will directly inform exploration medical system requirements for Level of Care IV in Gateway missions.In fiscal year 2019, the MDA project developed Test Bed 3, the third iteration in a series of prototypes, that featured integrations with cognition tool data, ultrasound image analytics and core Flight Software (cFS). Maintaining a layered architecture design, the framework implemented a plug-in, modular approach in the integration of these external data sources. An early version of MDA Test Bed 3 software was deployed and operated in a simulated analog environment that was part of the Next Space Technologies for Exploration Partnerships (NextSTEP) Gateway tests of multiple habitat prototypes. In addition, the MDA team participated in the Gateway Test and Verification Demonstration, where the MDA cFS applications was integrated with Gateway-in-a-Box software to send and receive medically relevant data over a simulated vehicle network. This software demonstration was given to ExMC and Gateway Program stakeholders at the NASA Johnson Space Center Integrated Power, Avionics and Software (iPAS) facility. Also, the integrated prototypes served as a vehicle to provide Level 5 requirements for the Crew Health and Performance Habitat Data System for Gateway Missions (Medical Level of Care IV). In the upcoming fiscal year, the MDA project will continue to provide systems engineering and vertical prototypes to refine requirements for medical Level of Care IV and inform requirements for Level of Care V.
INTRODUCTION Exposure to weightlessness induces a headward fluid shift and redistribution of fluids, resulting in increased internal jugular vein (IJV) cross-sectional area and altered IJV blood flow dynamics including stasis and retrograde flow. These findings may contribute to various risks of spaceflight, including thrombosis or other risks affected by cerebral venous blood flow. To date, our understanding of the cerebral venous outflow dynamics is limited to the left IJV assessed ~45and ~150days into spaceflight. Therefore, it is unknown how quickly the alterations in venous blood flow dynamics change as a result of weightlessness. The purpose of this study is to determine 1) if venous stasis is an immediate effect of weightlessness, and therefore a risk for short-duration missions, and 2) the effect of weightlessness on brachiocephalic venous flow. METHODS In this study, we will determine the effects of acute weightlessness during parabolic flight on right and left IJV cross-sectional area, as well as blood flow dynamics through the IJV and brachiocephalic veins in 12 healthy subjects. Baseline ultrasound images will be obtained on the ground prior to the parabolic flight in the seated and supine postures to determine normal changes in blood flow with posture-induced fluid shifts in a 1genvironment. Subjects will then undergo parabolic flight withrepeated,~20 second exposure to 0g. Each data collection session will include 2D ultrasonography to quantify IJV cross-sectional area and Doppler ultrasonography to characterize venous blood flow patterns in the IJV and brachiocephalic veins. RESULTS Data collection for this study is planned to take place in October, 2021.CONCLUSIONS This study will characterize the immediate venous response in the left and right IJV and brachiocephalic veins upon entry into weightlessness. The results from this parabolic flight study will be compared with previous data from International Space Station crewmembers collectedafter~45 and ~150 days into spaceflight to provide a more complete understanding of the temporal profile of changes in venous blood flow dynamics during weightlessness and whether these findings develop in veins other than the left IJV. Supported by the NASA Human Research Program.
INTRODUCTION Exposure to weightlessness induces a headward fluid shift and redistribution of fluids, resulting in increased internal jugular vein (IJV) cross-sectional area and altered IJV blood flow dynamics, including stasis and retrograde flow. These findings may contribute to various risks of spaceflight, including thrombosis or other risks affected by cerebral venous blood flow. To date, our understanding of the cerebral venous outflow dynamics in weightlessness is limited to the left IJV assessed ~45 and ~150 days into spaceflight. Therefore, it is unknown how quickly the alterations in venous blood flow dynamics change as a result of weightlessness. The purpose of this study is to determine 1) if venous stasis is an immediate effect of weightlessness and therefore a risk for short-duration missions and 2) the effect of weightlessness on brachiocephalic venous flow. METHODS In this study, we investigated the effects of acute weightlessness during parabolic flight on the right and left IJV in 12 healthy subjects. Baseline ultrasound images were obtained on the ground (1g) in the seated and supine postures and during 0g parabolic flight. Each data collection session included 2D ultrasonography to quantify IJV cross-sectional area and Doppler ultrasonography to characterize venous blood flow patterns in the bilateral IJVs. RESULTS There was a similar pattern of response in the left and right IJV area across postures and g-levels. IJV area increased from seated to supine by 0.74 mm2 (95% CI: 0.56 to 0.91 mm2, p<.001) and increased further during weightlessness by 0.29 mm2 (95% CI: 0.11 to 0.47 mm2, p=.0015). IJV Doppler images revealed stagnant flow in the left IJV in one subject during 0g exposure that was not present during any imaging on the ground; the right IJV continued to show pulsatile, nominal flow patterns in both 0g and 1g. CONCLUSIONS This study characterized the immediate effect of the weightlessness-induced headward fluid shift on venous parameters in the left and right IJV. The left IJV appears to be more susceptible to flow alterations, including stagnant flow, during both short and long-duration exposure to weightlessness that may contribute to the risk of thrombosis inflight.
INTRODUCTION TO MIM DEVICES Multi-functional Integrated Medical (MIM) devices conveniently incorporate multiple medical system capabilities within one device. The NASA Exploration Medical Integrated Product Team (XM-IPT) sponsored a market survey and trade study which identified the Tempus ProTM and the LifeBot 10® as the MIM devices that best met the evaluation criteria of the trade study. The Tempus ProTM (Remote Diagnostic Technologies, Ltd., Philips Corp., Farnborough, UK) and LifeBot 10® (LifeBot Health, Chicago, IL) both provide vital sign measurements such as blood pressure, electrocardiograms, heart rate, end tidal CO2, respiration rate, pulse oximetry and temperature along with ultrasound imaging. A video laryngoscopy capability is unique to the Tempus ProTM, while the LifeBot 10® supports connectivity with a digital stethoscope, otoscope, eye exam camera, and dermatoscope. Both devices include procedural guidance capabilities and have various data transmission and report generation features. TECHNOLOGY DEMONSTRATIONS NASA’s exploration-class missions will have severe resource constraints, long return trip durations, significant communication delays, and limited resupply opportunities. The medical systems of these missions will need to fit within an Earth-Independent Medical Operations (EIMO) construct. 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. Evaluations are underway to determine if it will be beneficial to include MIM devices within exploration medical systems by conducting a series of planned technical demonstrations. Exploration Atmosphere Chamber studies are being performed to determine MIM functionality in a high oxygen concentration atmosphere. A side-by-side comparison of the Tempus ProTM and LifeBot 10® will be performed during ground-based demonstrations. Use of the MIM devices within an EIMO medical scenario simulation will be practiced during ground-based demonstrations in preparation for International Space Station (ISS) demonstrations of the MIM device. These various demonstrations are designed to gather evidence for or against the inclusion of MIM devices within an EIMO medical system. EXPECTED DEMONSTRATION OUTCOMES Information will be gained about the feasibility, benefits, and challenges of using a multifunctional, all-in-one, medical device for medical diagnosis. Information will also be collected about performance differences as available ground support decreases. Gaining this understanding will allow for further development of exploration medical system capabilities, which take the EIMO construct into consideration.
In FY21, Argonne National Laboratory (ANL) with researchers at Texas A&M University (TAMU) designed and engineered a prototypical device for accounting types of irradiated pebbles (for example with different 235U enrichments or pure graphite) in Pebble-Fueled Reactors (PFRs). Through engagements with reactor designers, a need arose to assist in identifying and categorizing types of pebbles as a complementary nuclear material control method that would synergize with designers’ use of fuel burnup measurements for material accountancy needs. As part of an overall nuclear material control approach, a concept of pebble batch accounting was investigated using extrinsic non-radiological features to identify intrinsic characteristics. This concept of batch accounting led to the ability of identifying types of pebbles based on characteristics such as initial 235U enrichment of pebble batches or dates of introduction into the reactor core. Identification was achieved by embedding the 5-mm thick graphite periphery of pebbles with 2-mm diameter inert Yttria-Stabilized Zirconia (YSZ) microspheres to achieve an averaged volumetric density (i.e., common spacing between microspheres) unique to that type of pebble. With an ultrasound imaging system in proximity with each pebble, the YSZ microspheres in the pebble proved visible and their spacing became the unique feature upon which pebble type categorization could occur. At the culmination of FY21, ANL intended on delivering and installing the prototype at TAMU for initial testing but, due to the on-going pandemic, this was postponed until FY22.
We have initiated an experimental program to develop an ultrasound system for non-intrusively imaging the thermal field in opaque fluids under an externally imposed temperature gradient. Many industrial processes involve opaque fluids, such as molten metals, semiconductors, and polymers, often in situations in which thermal gradients are important. For example, one may wish to understand semiconductor crystal growth dynamics in a Bridgman apparatus. Destructive testing of the crystal after the process is completed gives only indirect information about the fluid dynamics of the formation process. Knowledge of the coupled thermal and velocity fields during the growth process is then essential. Most techniques for non-intrusive velocity and temperature measurement in fluids are optical in nature, and hence the fluids studied must be transparent. In some cases (for example, LDV (laser Doppler velocimetry) and PIV (particle imaging velocimetry)) the velocities of small neutrally buoyant seed particles suspended in the fluid, are measured. Without particle seeding one can use the variation of the index of refraction of the fluid with temperature to visualize, through interferometric, Schlieren or shadowgraph techniques, the thermal field. The thermal field in turn gives a picture of the pattern existing in the fluid. If the object of study is opaque, non-optical techniques must be used. In this project we focus on the use of ultrasound, which propagates easily through opaque liquids and solids. To date ultrasound measurements have almost exclusively relied on the detection of sound scattered from density discontinuities inside the opaque material of interest. In most cases it has been used to visualize structural properties, but more recently the ultrasound Doppler velocimeter has become available. As in the optical case, it relies on seed particles that scatter Doppler shifted sound back to the detector. Doppler ultrasound techniques are, however, not useful for studying convective fluid flow in crystal growth, because particle seeding is unacceptable and flow velocities are typically too low to be resolved, and may be even lower in microgravity conditions where buoyancy forces are negligible. We will investigate a different use of ultrasound to probe the flows of opaque fluids non-intrusively and without the use of seed particles: our goal is to ultrasonically visualize the thermal field of opaque fluids with relatively high spatial resolution. The proposed technique relies upon the variation of sound speed with temperature of the fluid. A high frequency ultra-sound pulse passing through a fluid-filled chamber will traverse the chamber in a time determined by the relevant chamber dimension and the temperature of the fluid through which the pulse passes. With high time-resolution instrumentation that compares the excitation signal with the received pulse we can detect the influence of the fluid temperature on the pulse travel time. This is effectively an interferometric system, which in its optical form is an extremely sensitive approach to measuring thermal fields in fluids. Moreover, the temperature dependence of sound velocity in liquid metals is comparable to the temperature dependence of the speed of light required for accurate interferometric thermal images in transparent fluids. With an array of transducers scanned electronically a map of the thermal field over the chamber could be produced. An alternative approach would be to use the ultrasound analog of the shadowgraph technique. In the optical version, collimated light passes through the fluid, where it is focused or defocused locally by temperature field induced variations of the index of refraction. The resulting image reveals the thermal field through the spatial pattern of light intensity variations. By analogy, an ultrasound plane wave traversing an opaque fluid sample would be also locally focused or defocused depending on the speed of sound variations, giving rise to spatial variations in sound intensity that will reveal the thermal field pattern. These approaches could be applied to any situation in which temperature differences are expected to occur, and will rapidly provide information about the flow that simply cannot be obtained by any current intrusive or non-intrusive diagnostic technique. As materials processing in microgravity matures it will become increasingly important to have available simple and versatile diagnostic tools, such as we will develop, for studying the flows of opaque fluids under thermal forcing.
Medical imaging-based triage is a critical tool for emergency medicine in both civilian and military settings. Ultrasound imaging can be used to rapidly identify free fluid in abdominal and thoracic cavities which could necessitate immediate surgical intervention. However, proper ultrasound image capture requires a skilled ultrasonography technician who is likely unavailable at the point of injury where resources are limited. Instead, robotics and computer vision technology can simplify image acquisition. As a first step towards this larger goal, here, we focus on the development of prototypes for ultrasound probe securement using a robotics platform. The ability of four probe adapter technologies to precisely capture images at anatomical locations, repeatedly, and with different ultrasound transducer types were evaluated across more than five scoring criteria. Testing demonstrated two of the adapters outperformed the traditional robot gripper and manual image capture, with a compact, rotating design compatible with wireless imaging technology being most suitable for use at the point of injury. Next steps will integrate the robotic platform with computer vision and deep learning image interpretation models to automate image capture and diagnosis. This will lower the skill threshold needed for medical imaging-based triage, enabling this procedure to be available at or near the point of injury.
Reinforced concrete is a critical structural material used to construct nuclear power plants (NPPs). As such, its safety and performance must be thoroughly examined throughout the life cycle of the NPP infrastructure system. Ultrasonic measurements have been an industry standard for both surface and subsurface inspections. To support the development of these techniques, Oak Ridge National Laboratory (ORNL) has researched and developed advanced image reconstruction algorithms to capture internal damage. The results and discussion presented herein summarize the current state of the ultrasonic model–based iterative reconstruction (U-MBIR) algorithm developed at ORNL. In the work documented in this report, the U-MBIR methodology was applied to four sets of ultrasonic data collected from concrete specimens. The results demonstrate that the U-MBIR algorithm can successfully detect defects within the four concrete samples. The reconstruction images help identify the specimen thickness, regions of delamination, and location of rebar embedded within the concrete. The reconstruction images allow engineers and technicians to characterize the internal defects within concrete specimens and structural members. Ultimately, this knowledge can guide engineers in making informed decisions regarding the performance, safety, and reliability of structural materials (i.e., reinforced concrete) throughout the life cycle of NPPs.
A new method of forming a visual image by ultrasound is described. A shadowgraphic transmission image similar to an X-ray radiograph is produced by the application of a technique known as Time Delay Spectrometry. The system uses a repetitive frequency sweep with a linear relationship between frequency and time and the transmitting and receiving crystal are scanned in raster fashion about the subject. By electronic processing, an image may be built up which represents the energy transmitted through the specimen with a given time delay. An intensity modulated picture encompassing the full shades-of-gray capability of the recording system can be produced. A second type of image showing transmission time through the specimen may also be formed. Brightness changes in the displayed image in this case correspond to changes in the ultrasonic transmission time through the specimen.
Ultrasound tomography imaging methods for imaging a tissue medium with one or more ultrasound transducer arrays comprising a plurality of transducers, wherein said transducers comprise source transducers, receiving transducers. The methods include assigning a phase value or time delay to source transducers, exciting the transducers and calculating a search direction based on data relating to the excited transducers.
At NASA's Jet Propulsion Laboratory (JPL), NASA-developed Video Imaging Communication and Retrieval (VICAR) software laid the groundwork for analyzing images of all kinds. A project seeking to use imaging technology for health care diagnosis began when the imaging team considered using the VICAR software to analyze X-ray images of soft tissue. With marginal success using X-rays, the team applied the same methodology to ultrasound imagery, which was already digitally formatted. The new approach proved successful for assessing amounts of plaque build-up and arterial wall thickness, direct predictors of heart disease, and the result was a noninvasive diagnostic system with the ability to accurately predict heart health. Medical Technologies International Inc. (MTI) further developed and then submitted the technology to a vigorous review process at the FDA, which cleared the software for public use. The software, patented under the name Prowin, is being used in MTI's patented ArterioVision, a carotid intima-media thickness (CIMT) test that uses ultrasound image-capturing and analysis software to noninvasively identify the risk for the major cause of heart attack and strokes: atherosclerosis. ArterioVision provides a direct measurement of atherosclerosis by safely and painlessly measuring the thickness of the first two layers of the carotid artery wall using an ultrasound procedure and advanced image-analysis software. The technology is now in use in all 50 states and in many countries throughout the world.
Abstract Hypertensive pregnancy disorders (HPDs), such as pre-eclampsia, are leading sources of both maternal and fetal morbidity in pregnancy. Noninvasive imaging, such as ultrasound (US) and magnetic resonance imaging (MRI), is an important tool for predicting and monitoring these high risk pregnancies. While imaging can measure hemodynamic parameters, such as uterine artery pulsatility and resistivity indices (PI and RI), the interpretation of such metrics for disease assessment relies on ad hoc standards, which provide limited insight to the physical mechanisms underlying the emergence of hypertensive pregnancy disorders. To provide meaningful interpretation of measured hemodynamic data in patients, advances in computational fluid dynamics can be brought to bear. In this work, we develop a patient-specific computational framework that combines Bayesian inference with a reduced-order fluid dynamics model to infer parameters, such as vascular resistance, compliance, and vessel cross-sectional area, known to be related to the development of hypertension. The proposed framework enables the prediction of hemodynamic quantities of interest, such as pressure and velocity, directly from sparse and noisy MRI measurements. We illustrate the effectiveness of this approach in two systemic arterial network geometries: an aorta with branching carotid artery and a maternal pelvic arterial network. For both cases, the model can reconstruct the provided measurements and infer parameters of interest. In the case of the maternal pelvic arteries, the model can make a distinction between the pregnancies destined to develop hypertension and those that remain normotensive, expressed through the value range of the predicted absolute pressure.
An ultrasound technique has been developed to non-intrusively image temperature fields in small-scale systems of opaque fluids undergoing convection. Fluids such as molten metals, semiconductors, and polymers are central to many industrial processes, and are often found in situations where natural convection occurs, or where thermal gradients are otherwise important. However, typical thermal and velocimetric diagnostic techniques rely upon transparency of the fluid and container, or require the addition of seed particles, or require mounting probes inside the fluid, all of which either fail altogether in opaque fluids, or necessitate significant invasion of the flow and/or modification of the walls of the container to allow access to the fluid. The idea behind our work is to use the temperature dependence of sound velocity, and the ease of propagation of ultrasound through fluids and solids, to probe the thermal fields of convecting opaque fluids non-intrusively and without the use of seed particles. The technique involves the timing of the return echoes from ultrasound pulses, a variation on an approach used previously in large-scale systems.
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