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NASA NTRS2017

Radiation Impact on Pharmaceutical Stability: Retrospective Data Review

Historical studies performed by the JSC Pharmacotherapeutics Discipline suggest that exposure to spaceflight conditions may compromise the safety and efficacy of some medications. Follow-on studies have revealed that affected medications demonstrate reductions in active pharmaceutical ingredient (API) concentrations and altered release characteristics. It was hypothesized that the changes in API potency and release were from the medication's exposure to the harsh environmental conditions of spaceflight. Subsequent review of the spaceflight environmental control records from the time of these studies indicated that temperature and humidity levels aboard all spacecraft remained within United States Pharmacopeia (USP) recommended ranges to maintain optimal pharmaceutical stability. Therefore, space radiation was presumed to be the source of observed drug degradation. The Pharmacotherapeutics Discipline conducted a ground analog radiation experiment in 2006 at the NASA Space Radiation Laboratory (NSRL) at Brookhaven to validate this theory and to characterize the effects of high-energy radioactive particles on pharmaceutical stability. These data were never published. Recently, the Exploration Medical Capability (ExMC) Element finalized a research plan (RP) aimed at providing a safe and effective medication formulary for exploration spaceflight. As ExMC begins to design new flight and ground analog radiation studies, further analysis of the 2006 NSRL study data is essential for the characterization of the impact of radiation on medication potency and efficacy in the exploration spaceflight environment.

Daniels, V. R.↗
NASA NTRS2018

The Pathway to a Safe and Effective Spaceflight Medication Formulary: Expert Review Panel Recommendations

Exploration spaceflight poses several challenges to the provision of a comprehensive medication formulary. This formulary must accommodate the size and space limitations of the spacecraft, while addressing individual medication needs and preferences of the crew, consequences of a degrading inventory over time, the inability to resupply used or expired medications, and the need to forecast the best possible medication candidates to treat conditions that may occur. The Exploration Medical Capability (ExMC) Element's Pharmacy Project Team has developed a research plan (RP) that is focused on evidence-based models and theories as well as new diagnostic tools, treatments, or preventive measures aimed to ensure an available, safe, and effective pharmacy sufficient to manage potential medical threats during exploration spaceflight. Here, we will discuss the ways in which the ExMC Pharmacy Project Team pursued expert evaluation and guidance, and incorporated acquired insight into an achievable research pathway, reflected in the revised RP.

Daniels, V. R.↗
NASA NTRS2018

Defining Medical Capabilities for Exploration Missions

Exploration-class missions to the moon, Mars and beyond will require a significant change in medical capability from today's low earth orbit centric paradigm. Significant increases in autonomy will be required due to differences in duration, distance and orbital mechanics. Aerospace medicine and systems engineering teams are working together within ExMC to meet these challenges. Identifying exploration medical system needs requires accounting for planned and unplanned medical care as defined in the concept of operations. In 2017, the ExMC Clinicians group identified medical capabilities to feed into the Systems Engineering process, including: determining what and how to address planned and preventive medical care; defining an Accepted Medical Condition List (AMCL) of conditions that may occur and a subset of those that can be treated effectively within the exploration environment; and listing the medical capabilities needed to treat those conditions in the AMCL. This presentation will discuss the team's approach to addressing these issues, as well as how the outputs of the clinical process impact the systems engineering effort.

Hailey, M.↗
NASA NTRSDate not supplied

Developing A New Medical Condition List for Exploration Spaceflight

For the last decade, the National Aeronautics and Space Administration (NASA) has utilized a probabilistic risk analysis tool called the Integrated Medical Model (IMM), which contains 100 medical conditions, to conduct medical trade-space analyses and risk assessments for International Space Station (ISS) operations. Planning for future missions to the Moon and Mars will require updated tools and evidence that consider the unique features of exploration missions. To address this need, the Exploration Medical Capability (ExMC) Element of the NASA Human Research Program is developing an advanced trade-space analysis tool suite, IMPACT. As a part of this effort, ExMC has produced the IMPACT version 1 Condition List (ICL 1.0) which expands the scope and definition of medical conditions.

Amy Jean Kreykes↗
NASA NTRSDate not supplied

Exploration Medical Capability Science and Research Overview and Update

The mission of the Exploration Medical Capability (ExMC) Element is to advance medical system design and risk-informed decision making for exploration beyond Low Earth Orbit to promote human health and performance in space. To accomplish this mission, ExMC focuses on several key areas: • Investigating specific risks that are relevant for human exploration spaceflight, including in-flight medical conditions, degraded or toxic medications, and renal stones • Developing medical probabilistic risk analysis tools that are integrated with systems engineering processes to inform the medical system trade space and support the development of robust requirements • Demonstrating and defining requirements for a prototype clinical decision support system • Developing and demonstrating novel medical technologies that will improve future medical capabilities in space This presentation will focus on selected scientific and technical conceptual drivers for the Element and its current and future research risks and gaps while providing an overview of the Element’s progress in 2021 and areas of focus for 2022.

Benjamin Easter↗
NASA NTRSDate not supplied

Lessons Learned from Medical System Foundation Development for Long-Duration Lunar Orbit and Lunar Surface Missions

The Human Research Program (HRP) Exploration Medical Capability (ExMC) Element has been tasked with the development of Medical System Foundations for Level of Care IV for both short-duration lunar orbital missions and, subsequently, long-duration lunar orbital and surface operations missions. These Medical System Foundations serve as a framework to aid in early medical system design and mission planning. The content of both Foundation models is similar, consisting of a concept of operations, functional decomposition, clinical content (medical conditions, capabilities, and resources), technical requirements (interface, non-functional, and functional), and traces between these components and to the NASA standards documents and parent-level (Program- and Vehicle habitat system-level) requirements. Additionally, the development of both Foundations employed systems engineering principles and a model-based systems engineering (MBSE) approach. Throughout the development of these Foundations, ExMC has strived to improve the efficiency and robustness of its processes and to be more responsive to change (i.e., in design reference mission parameters and assumptions) and to stakeholders’ feedback. The most significant improvements made between the short- and long-duration Foundation models during this transformation process are the following: • Replacement of the traditional document-based ConOps with a model-based ConOps according to MBSE principles, which facilitated more efficient understanding of the material and the consolidation of all relevant information into a centralized location. • Utilization of an agile approach with tasks organized into sprints. This approach enabled solicitation of more frequent usability feedback from stakeholders, incorporation of more human factors reviews into the sprints, and more efficient tasking of team members. This presentation will discuss the journey of developing both Foundation models, as well as the lessons learned and resulting improvements made between the Short- and Long-Duration models.

M Kaetzer↗
NASA NTRSDate not supplied

Coordinated NASA Development of Medical Capabilities and Technologies for Deep Space Exploration

Building upon the success of the last two decades of human spaceflight medical operations onboard the International Space Station (ISS), NASA now must start to evolve to a deep space medical operations paradigm. This new paradigm will include myriad challenges including communication delays and blackouts, infrequent or unavailable resupply, potentially significant vehicle resource constraints, and delayed or non-existent evacuation options. To overcome these challenges, two separate but highly coordinated NASA groups are working together to develop and test solutions to these problems: the Exploration Medical Capability (ExMC) Element of the NASA Human Research Program and the Exploration Medical Integrated Product Team (XMIPT) of the Environmental Control and Life Support System – Crew Health and Performance Systems Capability Leadership Team. Although the work of these two groups is very complementary, ExMC generally focuses more on research and early technology development work while the XMIPT works on maturing and integrating new medical capabilities for exploration. During this panel, these two groups together will present details on how medical capability gaps are defined and addressed, a new work plan in development to increase medical autonomy in spaceflight, a technology maturation effort to generate intravenous fluids from potable water onboard a spacecraft, multiple new technology demonstrations of in-situ laboratory analysis capabilities, and new onboard tools to advance medical care for deep space missions.

Kris Lehnhardt↗
NASA NTRSDate not supplied

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↗
NASA NTRSDate not supplied

2023 Artemis Crew Health and Performance System Model Development

While the NASA Human Research Program (HRP) utilizes a Crew Health and Performance (CHP) System to represent all the Agency’s efforts to ensure the health and performance of NASA astronauts, there is no shared mental model of a CHP system at NASA. Some groups may consider a CHP system to be only a medical kit, while others may not be using the concept at all. To facilitate the integration of functions and capabilities to ensure astronaut health and performance during vehicle development, HRP has proposed a CHP Shared Mental Model derived from the NASA Human Health, Medical, and Performance Spaceflight Standards (NASA-STD-3001 Vol.1/Vol.2). [1] Even though many vehicle, ground, and communication systems as well as mission operations are modeled for the Artemis Campaigns, no mission level CHP system model was created to achieve the intent of the HRP CHP Shared Mental Model. The lack of this model renders it difficult to visualize and understand how the many programs work together to provide the necessary cross program functions and capabilities to ensure the health and performance of the crew throughout an Artemis mission. For this purpose, the Exploration Medical Capability (ExMC) element of HRP developed a CHP system model for the Artemis III and IV missions to provide a view of how each program contributes to and interacts with the overall CHP system. To develop the 2023 Artemis CHP system model, ExMC leveraged existing data and models from the Moon to Mars Program Office, the Office of the Chief Health and Medical Officer (OCHMO) and the Orion, Gateway, Extravehicular Activity and Human Surface Mobility (EHP) and Human Landing System (HLS) programs. By using a Model-Based Systems Engineering (MBSE) approach, existing requirements, functions, and concepts of operations were combined to create a single system model focused on representing CHP from the launch to the return to Earth segments of the Artemis III and IV missions. Additionally, by incorporating the HRP Systems Platform for Aggregating and Relating Capabilities, or SPARC tool, the data from the programs was also related back to the 2nd volume of the NASA Human Health, Medical, and Performance Spaceflight Standard (NASA-STD-3001, Vol.2) and the human system risks identified by the Human System Risk Board (HSRB). The first version of the 2023 Artemis CHP system model was baselined in Fall of 2023 after the model was demonstrated to be a potentially useful tool for systems engineers integrating CHP capabilities in vehicle development as well as members of the Health and Medical Technical Authority providing oversight of those programs. The model may also be useful to any stakeholder of astronaut health and performance by providing insights on how an Artemis mission satisfies the NASA Human Health, Medical, and Performance Spaceflight Standards as well as how they mitigate the HSRB Human System Risks. This presentation highlights how the model was developed and the possible benefits of the model. [1] NASA HRP (2022), Crew Health and Performance System Whitepaper

Systems engineering↗
NASA NTRSDate not supplied

Architectural Framework for Conceptualizing Exploration Class Medical Operations

Currently, discrete projects within NASA’s Human Research Program (HRP) take aim at providing future exploration missions with the capabilities necessary to operate within a progressively Earth-independent operative environment. Realizing an entire ecosystem that can accomplish these goals requires a clear visualization on how each project contributes to the overall objectives of Human Health and Performance (HH&P) in that context. The Exploration Medical Capability (ExMC) Element has developed an architectural framework for exploration class medical operations by utilizing a systems engineering approach using model-based systems engineering (MBSE). This model, a System of Systems Architecture (SoSA), captures a means of integrating various independent but related efforts into a comprehensive view associated with HRP’s goal of providing progressively Earth-Independent Medical Operations (EIMO). This level of visibility is realized by identifying interfaces between development efforts and existing programs that contribute to the overall mission of EIMO even if those extend past the traditional boundary of HRP. Potential interfaces that are considered important when constructing an architecture include program/project Needs, Goals, and Objectives (NGOs), capabilities, envisioned use cases/scenarios, and system/subsystem structure. This presentation will focus on the processes that were used to generate the SoSA along with a means to realize its utility amongst other MBSE products from ExMC. Evaluation of the best architecture moving forward can then be achieved that promotes cohesion between various functional areas of HH&P. Additionally, the SoSA is developed with a long-term vision for the dynamic integration of novel technological developments that may be implemented in the future. The SoSA is intended to enable Stakeholders the ability to view the broader interconnections that exist and begin to create avenues of communication between various efforts. The benefits of a SoSA provide an essential step towards addressing the unique challenges of attaining the goals of broader exploration class medical missions of the future.

Systems engineering↗
NASA NTRS2024

Architectural Framework for Conceptualizing Exploration Class Medical Operations

Currently, discrete projects within NASA’s Human Research Program (HRP) take aim at providing future exploration missions with the capabilities necessary to operate within a progressively Earth-independent operative environment. Realizing an entire ecosystem that can accomplish these goals requires a clear visualization on how each project contributes to the overall objectives of Human Health and Performance (HH&P) in that context. The Exploration Medical Capability (ExMC) Element has developed an architectural framework for exploration class medical operations by utilizing a systems engineering approach using model-based systems engineering (MBSE). This model, a System of Systems Architecture (SoSA), captures a means of integrating various independent but related efforts into a comprehensive view associated with HRP’s goal of providing progressively Earth-Independent Medical Operations (EIMO). This level of visibility is realized by identifying interfaces between development efforts and existing programs that contribute to the overall mission of EIMO even if those extend past the traditional boundary of HRP. Potential interfaces that are considered important when constructing an architecture include program/project Needs, Goals, and Objectives (NGOs), capabilities, envisioned use cases/scenarios, and system/subsystem structure. This presentation will focus on the processes that were used to generate the SoSA along with a means to realize its utility amongst other MBSE products from ExMC. Evaluation of the best architecture moving forward can then be achieved that promotes cohesion between various functional areas of HH&P. Additionally, the SoSA is developed with a long-term vision for the dynamic integration of novel technological developments that may be implemented in the future. The SoSA is intended to enable Stakeholders the ability to view the broader interconnections that exist and begin to create avenues of communication between various efforts. The benefits of a SoSA provide an essential step towards addressing the unique challenges of attaining the goals of broader exploration class medical missions of the future.

Systems engineering↗
NASA NTRS2024

2023 Artemis Crew Health and Performance (CHP) System Model Development

While the NASA Human Research Program (HRP) utilizes a Crew Health and Performance (CHP) System to represent all the Agency’s efforts to ensure the health and performance of NASA astronauts, there is no shared mental model of a CHP system at NASA. Some groups may consider a CHP system to be only a medical kit, while others may not be using the concept at all. To facilitate the integration of functions and capabilities to ensure astronaut health and performance during vehicle development, HRP has proposed a CHP Shared Mental Model derived from the NASA Human Health, Medical, and Performance Spaceflight Standards (NASA-STD-3001 Vol.1/Vol.2). [1] Even though many vehicle, ground, and communication systems as well as mission operations are modeled for the Artemis Campaigns, no mission level CHP system model was created to achieve the intent of the HRP CHP Shared Mental Model. The lack of this model renders it difficult to visualize and understand how the many programs work together to provide the necessary cross program functions and capabilities to ensure the health and performance of the crew throughout an Artemis mission. For this purpose, the Exploration Medical Capability (ExMC) element of HRP developed a CHP system model for the Artemis III and IV missions to provide a view of how each program contributes to and interacts with the overall CHP system. To develop the 2023 Artemis CHP system model, ExMC leveraged existing data and models from the Moon to Mars Program Office, the Office of the Chief Health and Medical Officer (OCHMO) and the Orion, Gateway, Extravehicular Activity and Human Surface Mobility (EHP) and Human Landing System (HLS) programs. By using a Model-Based Systems Engineering (MBSE) approach, existing requirements, functions, and concepts of operations were combined to create a single system model focused on representing CHP from the launch to the return to Earth segments of the Artemis III and IV missions. Additionally, by incorporating the HRP Systems Platform for Aggregating and Relating Capabilities, or SPARC tool, the data from the programs was also related back to the 2nd volume of the NASA Human Health, Medical, and Performance Spaceflight Standard (NASA-STD-3001, Vol.2) and the human system risks identified by the Human System Risk Board (HSRB). The first version of the 2023 Artemis CHP system model was baselined in Fall of 2023 after the model was demonstrated to be a potentially useful tool for systems engineers integrating CHP capabilities in vehicle development as well as members of the Health and Medical Technical Authority providing oversight of those programs. The model may also be useful to any stakeholder of astronaut health and performance by providing insights on how an Artemis mission satisfies the NASA Human Health, Medical, and Performance Spaceflight Standards as well as how they mitigate the HSRB Human System Risks. This presentation highlights how the model was developed and the possible benefits of the model. [1] NASA HRP (2022), Crew Health and Performance System Whitepaper

Systems engineering↗
NASA NTRSDate not supplied

Summary of Technical Interchange Meetings (TIMs) Designed to Enable Earth Independent Medical Operations (EIMO)

The Exploration Medical Capability Element (ExMC) in NASA’s Human Research Program hosted a series of TIMs in 2023-2024 designed to stimulate discussion around specific topics with the goal of enabling EIMO. In context of the thematic constituent elements of EIMO, namely pre-mission planning, acute/emergent/prolonged medical decision making, supply/resource management and task load management, subject matter experts from industry, academia and government (NASA and other Agencies) provided valuable and actionable guidance and recommendations. Earth-based medical experts will remain indispensable for pre-mission planning, however, management of acute/emergent medical contingencies will require a gradual transition of medical care and decision making from terrestrial to space-based assets to enable support of astronaut health and performance and reduce overall mission risk. Key to achieving these enhancements is providing an integrated data system platform capable of utilizing multiple data streams in concert with a variety of on-board databases and passive monitoring of video and wearable sensors to enable a multi-modal, agentic AI-based clinical decision support system (CDSS) to support crew medical officer (CMO) medical decision-making. The EIMO series of TIMs (I-V) have proven to be instructive and portend a significant paradigm shift will be necessary to maintain crew health and performance on exploration class missions. Importantly, since the expected paradigm shift will be significantly different from the methods of operation that have been employed for the majority of missions from the inception of human spaceflight to date, any proposed methods must be deployed in the setting of ongoing operations early and be “tested, reviewed and practiced” while reliable back-up is available to facilitate an Enterprise-wide level of comfort and acceptance. Serious constraints on data transmission coupled with a large and expanding universe of on-board medical informatics data streams will necessitate implementation of a CDSS to supplant the current reliance on support provided by ground-based SMEs. Establishment of trust in the system by CMO/crew and the ground-based medical support team will be essential. Co-development of a CDSS with industry partners will assure that state of the art tools can be employed, and industry efficiencies can be leveraged. Training regimens, materials and tools must evolve to be responsive (just-in-time training) and facilitate autonomous execution of procedures. Proficiency metrics should be established and be based on validated competencies or milestones as opposed to a prescribed number of training hours. Training should be prioritized for broad, translatable skills that have universal application across a variety of medical conditions. Repetition was deemed to be the key to achieving proficiency and emphasis should lie in procedural training which is known to extinguish more rapidly than diagnostic skills. Advanced tools, e.g., extended reality, can provide more realistic and effective training. Use of advanced probabilistic risk assessment tools will be essential to optimize the medical system capability while carefully balancing risk relative to mass/power/volume limitations. Importance of factoring use-life of medical supplies and maintaining awareness of redundancy and opportunity to re-purpose under off nominal situations was emphasized. Consideration of adopting optimized performance standards vs. “good-enough” performance thresholds is warranted. The use of legacy systems as opposed to creating new systems may be preferable. Managing task load and associated cognitive load will be essential to maintain operational safety and behavioral health. ExMC aspires to create a shared EIMO paradigm and strategic vision for advancing medical system design through novel technologies, training, protocols, and support capabilities, built upon the spirit of successful strategies and innovations over the past six decades of space medicine operations.

Jay Lemery↗
NASA NTRS2025

Evaluating the Viability of Compact and Portable X-Ray Systems for an Exploration Medical System in a Ground Demonstration

MOTIVATION FOR INCLUDING X-RAY CAPABILITIES For upcoming exploration missions, the need for enhanced medical care becomes critical due to extended mission durations, significant communication delays, and minimal evacuation opportunities. Previous evidence by our team has revealed that among the 119 medical conditions targeted for management during spaceflight within NASA Exploration Medical Capability’s IMPACT Condition List, at least 36 could benefit from radiography (XR). Utilizing XR for diagnosis and management is hypothesized to significantly improve management of crew health by enabling the immediate evaluation and confirmation of potential injuries or illnesses. Beyond clinical applications, XR also holds potential for non-destructive testing (NDT). This includes applications such as assessing the structural integrity of the spacecraft, analyzing surface and meteorite samples, and inspecting onboard electronics. THREE CANDIDATE X-RAY SYSTEMS CHOSEN FOR GROUND DEMONSTRATION The Exploration Medical Capability Element (ExMC) and the Exploration Medical Integrated Product Team (XMIPT) of the Mars Campaign Office initiated early background work for ground demonstrations. In FY21, ExMC published a Concept of Operations to guide requirements development. By FY23, XMIPT and yet2, a technology scouting and open innovation consulting firm, had completed a market survey and trade study to identify potential miniature XR systems. Selection criteria included commercial-off-the-shelf availability, low mass and volume, and regulatory compliance. The top three candidate devices—Remedi REMEX-KA6, MinXray Impact, and FujiFilm Xair—were acquired to characterize the requirements and capabilities of each device. To facilitate testing, phantoms, and radiographic personal protective equipment (PPE) were purchased, and a dedicated space was designated for XRS usage at Glenn Research Center. During this presentation, the mass, volume, and power requirements for each of the three piloted devices are revealed, as well as information regarding the detector, mA, and kV of the devices. GOAL AND OBJECTIVES OF A MINI XRS GROUND DEMONSTRATION The primary goal of ExMC/XMIPT technology demonstrations is to bridge the gap in available, flight-ready medical device technology by flight-testing diagnostic and treatment technologies essential for managing medical conditions during exploration missions. These technologies must adhere to vehicle constraints such as mass, volume, power, and data requirements, integrate seamlessly with medical decision-support tools, and support increasingly Earth-independent operations. There are three main objectives for the future ground demonstration of these three devices. First, we aim to determine the full capabilities of these three miniature XR systems within the context of the spaceflight environment. While medical applications are the primary focus for the miniature XR, a comprehensive exploration of non-medical uses has been initiated by an XMIPT-sponsored NASA SPARK campaign to identify collaborators. Second, we plan to establish criteria and to use insights gained from evaluating each miniature XR against those criteria to select the most suitable system among the three candidates. Third, we intend to evaluate their suitability for flight certification, which includes assessing its durability for launch, reentry, and exposure to high background radiation, as well as its compatibility with existing data architecture systems. Numerous subject matter experts from NASA and partner institutions will support these objectives.

C A Haddix↗
NASA NTRS2025

Limitations and Feasibility of Mini X-Ray Devices in Space Environments

LIMITATIONS AND FEASIBILITY OF MINI X-RAY DEVICES IN SPACE ENVIRONMENTS As space exploration advances toward long-duration missions, reliable medical diagnostic tools become increasingly critical. The miniature x-ray (XR) technology demonstrations by the Exploration Medical Capability (ExMC) and the Exploration Medical Integrated Product Team (XMIPT) aim to assess the feasibility and utility of miniature XR devices in spaceflight. This abstract explores the limitations of current miniature XR systems, the challenges of training crew members, the potential role of clinical decision support systems (CDSS), and the feasibility of ground-based image interpretation. We also propose the integration of miniature XR into other ExMC efforts aimed at identifying the capabilities and resources needed for future exploration class missions. One of the primary challenges with miniature XR devices is the ability to achieve specific anatomical views, particularly in the confined and weightless conditions of a spacecraft. Operators may struggle to acquire diagnostic-quality images when space is limited for proper patient positioning and the volume of the imaging device. Since space radiation and detector limitations may further impact image quality, the flexibility of the operating procedures of these devices will be critical for their success in space applications. CHALLENGES IN TRAINING CREW TO OPERATE IMAGING DEVICES Training in the skills necessary to acquire diagnostic-quality scans may be a barrier for non-clinician crewmembers. The curriculum developed for crew medical officers (CMOs) will require simplification and adaptation to fit into the highly truncated pre-flight training period. Therefore, hands-on familiarization and simulation, both pre-flight and just-in-time training during missions, will be crucial to ensuring the crew can operate the devices in real-life situations. The ability to adjust acquisition parameters must be simplified or made automatic through exam selections on equipment user interfaces, and subject and operator positioning should be assisted with laser guidance and pictorial guides. POTENTIAL FOR CDSS OR ARTIFICIAL INTELLIGENCE (AI)-ASSISTED CDSS CDSS and AI-assisted CDSS offer significant promise in assisting crew members with limited medical training. These systems could provide real-time feedback on image quality and interpretation, helping to mitigate the risks of human error during space missions. Integrating procedural guidance tools, such as virtual and augmented reality, will support crewmembers in accurately positioning patients and obtaining high-quality images. However, the success of such systems will depend on the development of robust training datasets, integration with spaceflight-rated hardware, and the medical decision-making capabilities of operators. FEASIBILITY OF GROUND INTERPRETATION AND DATA TRANSMISSION Reliance on ground-based interpretation may prove difficult for acute care during exploration class-missions due to delays in transmission with increasing distance from Earth or complete communication blackout periods. In such instances where immediate interpretation for clinical intervention is required, crew must be able to interpret the images independently or utilize AI-based assistance to do so. File sizes for XR exams can also be large if numerous images are acquired and bandwidth constraints may limit data transmissions for both radiography and ultrasound exams. FUTURE WORK AND INTEGRATION INTO THE EVIDENCE LIBRARY Future work proposes integrating miniature XR devices into NASA’s Evidence Library to address medical conditions identified as significant contributors to crew morbidity and mortality. The possibility of combining miniature XR with other imaging modalities, such as ultrasound devices, is also under investigation. In conclusion, while miniature XR technology holds potential for extraterrestrial medical systems, there are significant challenges to overcome. Training, integration of AI tools, dedicated exam protocols for microgravity, and improved data transmission systems will be key to realizing the full benefits of miniature XR technology in space.

A M Nelson↗
NASA NTRSDate not supplied

Earth-Independent Medical Operations (EIMO) Concept of Operations

In contrast to the current crew health paradigm for low-Earth orbit and Lunar missions, which depends on real-time communication with Mission Control, deep-space exploration missions will require a significant shift in medical operations. This shift is driven by the constraints of operating at a considerable distance from Earth, such as resource limitations—lack of resupply, restricted mass, power, volume, and data—as well as communication delays and the inability to evacuate back to Earth during emergencies. To move toward a more self-reliant medical model, a strategy is needed to gradually increase space-based crew autonomy and reduce risks to mission success in the challenging environment of deep space. This transformative change, known as "Earth-Independent Medical Operations" (EIMO), explores the gradual transfer of medical care and decision-making from Earth-based support to space-based systems. The goal of this transition is to enhance astronaut health and performance while minimizing mission risks. EIMO requires the development of a medical system that integrates seamlessly with mission planning, vehicle and spacesuit design, and data architecture. This integration is crucial for building a robust medical infrastructure that not only safeguards astronaut well-being but also ensures overall mission success. The Human Research Program (HRP) Exploration Medical Capability (ExMC) Element has revised the EIMO model-based Concept of Operations (ConOps) which outlines an initial vision for EIMO. The ConOps, which is built on the stakeholders’ need, system goals, and objectives (NGOs), presents an array of in-mission scenarios that span a wide range of medical conditions demonstrating the system’s capabilities from basic to complex events. Developed by a multidisciplinary team of systems engineers, scientists, and clinicians within ExMC, the ConOps revision includes two new scenarios(Barotrauma and Self-Medical Management and Behavioral Health and Chronic Medical Care), and implementation of findings from EIMO technical interchange meetings that focused on data and training. The envisioned EIMO Medical System (MS) operates as a system of systems, gathering data from various sources such as reference databases, real-time wearable sensors, point-of-care diagnostics, and environmental controls. The MS also incorporates advanced training tools to support autonomous medical care, assisting the Crew Medical Officer (CMO) during medical events where Ground Support is either unavailable or communication-delayed beyond practicality. Furthermore, MS functions and capabilities were decomposed from the scenarios to establish foundational requirements for EIMO and traced to the NASA Spaceflight Human-System Standard(NASA-STD-3001, Volumes 1 and 2). These traces were performed to gain insights on the alignment of EIMO requirements with the NASA standard. This work serves as an initial recommendation to increase crew autonomy gradually and safely for Mars missions and future deep-space exploration.

medical system↗
NASA NTRS2009

Biosensors for EVA: Muscle Oxygen and pH During Walking, Running and Simulated Reduced Gravity

During lunar excursions in the EVA suit, real-time measurement of metabolic rate is required to manage consumables and guide activities to ensure safe return to the base. Metabolic rate, or oxygen consumption (VO2), is normally measured from pulmonary parameters but cannot be determined with standard techniques in the oxygen-rich environment of a spacesuit. Our group developed novel near infrared spectroscopic (NIRS) methods to calculate muscle oxygen saturation (SmO2), hematocrit, and pH, and we recently demonstrated that we can use our NIRS sensor to measure VO2 on the leg during cycling. Our NSBRI-funded project is looking to extend this methodology to examine activities which more appropriately represent EVA activities, such as walking and running and to better understand factors that determine the metabolic cost of exercise in both normal and lunar gravity. Our 4 year project specifically addresses risk: ExMC 4.18: Lack of adequate biomedical monitoring capability for Constellation EVA Suits and EPSP risk: Risk of compromised EVA performance and crew health due to inadequate EVA suit systems.

Lee, S. M. C.↗
NASA NTRS2009

Human Research Program Requirements Document (Revision C)

The purpose of this document is to define, document, and allocate the Human Research Program (HRP) requirements to the HRP Program Elements. It establishes the flow-down of requirements from Exploration Systems Mission Directorate (ESMD) and Office of the Chief Health and Medical Officer (OCHMO) to the various Program Elements of the HRP to ensure that human research and technology countermeasure investments are made to insure the delivery of countermeasures and technologies that satisfy ESMD's and OCHMO's exploration mission requirements. Requirements driving the HRP work and deliverables are derived from the exploration architecture, as well as Agency standards regarding the maintenance of human health and performance. Agency human health and performance standards will define acceptable risk for each type and duration of exploration mission. It is critical to have the best available scientific and clinical evidence in setting and validating these standards. In addition, it is imperative that the best available evidence on preventing and mitigating human health and performance risks is incorporated into exploration mission and vehicle designs. These elements form the basis of the HRP research and technology development requirements and highlight the importance of HRP investments in enabling NASA's exploration missions. This PRD defines the requirements of the HRP which is comprised of the following major Program Elements: Behavioral Health and Performance (BHP), Exploration Medical Capability (ExMC), Human Health Countermeasures (HHC), ISS Medical Project (ISSMP), Space Human Factors and Habitability (SHFH), and Space Radiation (SR).

Vargas, Paul R.↗