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DOE OSTI2017

The medical science DMZ: a network design pattern for data-intensive medical science

Abstract Objective We describe a detailed solution for maintaining high-capacity, data-intensive network flows (eg, 10, 40, 100 Gbps+) in a scientific, medical context while still adhering to security and privacy laws and regulations. Materials and Methods High-end networking, packet-filter firewalls, network intrusion-detection systems. Results We describe a “Medical Science DMZ” concept as an option for secure, high-volume transport of large, sensitive datasets between research institutions over national research networks, and give 3 detailed descriptions of implemented Medical Science DMZs. Discussion The exponentially increasing amounts of “omics” data, high-quality imaging, and other rapidly growing clinical datasets have resulted in the rise of biomedical research “Big Data.” The storage, analysis, and network resources required to process these data and integrate them into patient diagnoses and treatments have grown to scales that strain the capabilities of academic health centers. Some data are not generated locally and cannot be sustained locally, and shared data repositories such as those provided by the National Library of Medicine, the National Cancer Institute, and international partners such as the European Bioinformatics Institute are rapidly growing. The ability to store and compute using these data must therefore be addressed by a combination of local, national, and industry resources that exchange large datasets. Maintaining data-intensive flows that comply with the Health Insurance Portability and Accountability Act (HIPAA) and other regulations presents a new challenge for biomedical research. We describe a strategy that marries performance and security by borrowing from and redefining the concept of a Science DMZ, a framework that is used in physical sciences and engineering research to manage high-capacity data flows. Conclusion By implementing a Medical Science DMZ architecture, biomedical researchers can leverage the scale provided by high-performance computer and cloud storage facilities and national high-speed research networks while preserving privacy and meeting regulatory requirements.

Peisert, Sean↗

NASA NTRS2023

Exploration Medical Capability IMPACT Medical Database – Medical Item Database (MedID) Content Development Methods

The Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) project encompasses a suite of computational tools that are used to inform systematic trade study evaluations and research prioritizations regarding the optimization of spaceflight medical systems, including the provision of risk assessment metrics, for a given design reference mission (DRM). The IMPACT Medical Database (IMPACT-MD) is the component that virtually houses the clinical and engineering data for medical conditions, capabilities, and resources used to support these analyses. In addition, IMPACT-MD also provides data to the associated SysML model to support the Level 2, Level 3, and Level 4 requirements development needed for IMPACT. IMPACT-MD contains an internal Evidence Library (EL) sub-component that hosts the clinical evidence, treatment and outcome metric data, and incidence data for each medical condition identified for exploration-class missions. Furthermore, a separate Medical Item Database (MedID) sub-component hosts the engineering data and physical attributes (e.g., mass, volume, power, etc.) associated with each medical resource item identified to address the requisite medical conditions. The IMPACT project is conducted under the Exploration Medical Capability (ExMC) element of the Human Research Program (HRP) within NASA's Space Operations Mission Directorate (SOMD). The reader is referred to the documents in Appendix A for a more complete overview of the IMPACT tool suite and functionality as well as further detail on any associated aspects of the project. The primary purpose of this document is to describe the methods utilized in the collection and verification of engineering data content during the project development phase for the MedID sub-component of the IMPACT-MD project. Engineering content data (both existing and new/future) will be stored in IMPACT-MD for use by the IMPACT project. This document will detail the content development and data credibility for the engineering data housed within the MedID subcomponent of IMPACT-MD, which is used to inform the IMPACT 1.0 project deliverables.

Exploration Medical Capability↗

DOE OSTI2014

WE-A-16A-01: International Medical Physics Symposium: Increasing Access to Medical Physics Education/Training and Research Excellence

In response to a world in which cancer is a growing global health challenge, there is now a greater need for US Medical Physicists and other Radiation Oncology professionals across institutions to work together and be more globally engaged in the fight against cancer. There are currently many opportunities for Medical Physicists to contribute to alleviating this pressing need, especially in helping enhance access to Medical Physics Education/training and Research Excellence across international boundaries, particularly for low and middle-income countries (LMIC), which suffer from a drastic shortage of accessible knowledge and quality training programs in radiotherapy. Many Medical Physicists are not aware of the range of opportunities that even with small effort could have a high impact. Faculty at the two CAMPEP-accredited Medical Physics Programs in New England: the University of Massachusetts Lowell and Harvard Medical School have developed a growing alliance to increase Access to Medical Physics Education/training and Research Excellence (AMPERE), and facilitate greater active involvement of U.S. Medical Physicists in helping the global fight against cancer and cancer disparities. In this symposium, AMPERE Alliance members and partners from Europe and Africa will present and discuss the growing global cancer challenge, the dearth of knowledge, research, and other barriers to providing life-saving radiotherapy in LMIC, mechanisms for meeting these challenges, the different opportunities for participation by Medical Physicists, including students and residents, and how participation can be facilitated to increase AMPERE for global health. Learning Objectives: To learn about the growing global cancer challenge, areas of greatest need and limitations to accessing knowledge and quality radiotherapy training programs, especially in LMIC; To learn about the range of opportunities for Medical Physicists, including students and residents, to work together in global health to help increase AMPERE and alleviate the growing global burden of cancer; To present and discuss a new model for harmonizing Medical Physics Training across countries and how this model (UMass and Heidelberg) could be extended to LMIC in collaboration with the IAEA; To highlight a new platform and program for facilitating contributions by Medical Physicists to increase AMPERE towards the elimination of global cancer disparities. Challenges in Cancer Control in Africa Twalib A. Ngoma, MD, Professor, Executive Director, Ocean Road Cancer Institute, Dar Es Salaam, Tanzania Cancer care in Africa is beset by lack of attention, political will, cancer registries, cancer plans, human resources, financial resources and treatment facilities.. As a result of this, cancer patients in Africa are far more likely to die of their disease than those in developed countries. According to data from the WHO 750,000 new cancer cases occur in Africa every year and this number is predicted to rise by 70% by 2020. To make matters worse, an estimated 75% of cancer patients in Africa have advanced or incurable cancers at diagnosis making palliative care the most realistic approach to their management. Furthermore, Cancer prevention is nearly nonexistent, cancer detection is rare and treatment usually comes too late and is inefficient. The overall mortality-to-incidence ratio for men with cancer in the Africa is 0.75 compared with 0.54 in the developed world while the ratios for women in Africa, is 0.65 compared with 0.45 for women in the developed world. There is also limited access to radiotherapy. According to the International Atomic Energy Agency (IAEA), whilst developed countries usually have one radiotherapy machine per 250,000 people, most African nations have only one machine per ten million people. The above numbers are alarming and speak for themselves. The only solution to improve this alarming situation is to address the major challenges which African countries face in provision of cancer services which include but not limited to lack of cancer registries, lack of funding, lack of human resources, lack of radiotherapy machines, lack of cancer drugs and lack of accessible and affordable cancer screening, early diagnosis, treatment or palliative care services. Since there are considerable differences among African countries, in my presentation I will share with the audience how we address cancer control challenges in Tanzania in general and specifically in radiation oncology. The African continent cancer plan 2013 2017 Folakemi Odedina, PhD, Professor and Director of Health Disparities, UF Health Cancer Center, University of Florida The burden of cancer is rising in Africa, in addition to current heavy burden of communicable, and other non-cancer related non—communicable diseases. Conquering cancer in Africa will require a comprehensive collaborative approach with cancer clinicians, scientists, patients, advocates, policy makers and community leaders working hand-in-hand at the local, state, national, and continent levels with the primary mission: To reduce the number of deaths from cancer and improve the quality of life of cancer patients, survivors and caregivers. Unfortunately, less than 40% of African countries have a credible cancer control policy and program. The African Organization for Research and Training in Cancer (AORTIC) decided to create an African Cancer Plan to provide cost-effective strategies that can be employed throughout the continent to fight cancer. Based on the African proverb that “It takes a village to raise a child”, the Cancer Plan provides specific strategies that can be used by individuals, employers, organizations and policy-makers to fight cancer. In addition, we have provided overarching strategies to address cancer in Africa and targeted 5-year plan for prostate, breast, cervix, lung and liver cancers. In developing this Cancer Plan, our primary goal is to decrease cancer incidence and mortality in Africa. This goal can only be achieved by stakeholders and dedicated individuals to lead and implement the strategies outlined in this plan. If you are interested in partnering with AORTIC to reduce the burden of cancer in Africa, please send an email to info@aortic-africa.org. Synergies in research and clinical care through international collaboration Thomas Bortfeld and David Gierga, Massachusetts General Hospital, Harvard Medical School, MA Medical Physics relies on high technology that is not distributed equally. The whole spectrum of Medical Physics technologies is not available at every hospital or research institute, and not even in every high income country. One example is heavy ion therapy equipment which is currently only available in Japan, Germany and Italy. There is also a large global variation in terms of research infrastructure and focus. A student of Medical physics cannot gain broad experience, certainly not hands-on experience, by staying at one place only. While it is debatable what a good trade-off between breadth and depth in Medical Physics education is, it is generally agreed upon that some breadth is necessary. Researchers in Medical Physics have to cross borders if they need specific technologies for their projects. Therefore it is self-evident that international programs in Medical Physics education and research make sense. Yet, very few programs of this type exist. In this presentation we will report on our own experience of pursuing an international career in Medical Physics, with international student programs, and with the international exchange of researchers. We will present new or planned opportunities such as the medical beamline at CERN in Geneva. We will also report on the synergies in clinical care through international collaborations between partners in high and low income countries. One example is the partnership of the MGH/Harvard Medical School community with the oncology community and government of Botswana to form the BOTSOGO (BOTSwana Oncology Global Outreach) initiative. This collaborative effort in oncology care was spurred by existing relationships in HIV/AIDS research and care delivery developed within the Botswana-Harvard AIDS Institute Partnership (BHP). The initial efforts of the BOTSOGO initiative have been organized as follows: 1) on-site visits to share expertise in clinical cancer care for capacity building purposes (e.g. cervical brachytherapy), 2) developing a forum for multi-disciplinary case discussions and education and 3) relationship building with local stakeholders for long-term sustainability and growth. An international system for the certification of medical physicists Raymond K. Wu, Chairman, IOMP Professional Relations Committee; Chairman, AAPM Exchange Scientist Program Subcommittee An international system for the certification of medical physicists is an important issue. The International Organization for Medical Physicists (IOMP) has in collaboration with a number of member countries established the International Medical Physics Certification Board (IMPCB) to address this issue, and to provide a mechanism to mark the milestone for the professional development of clinical medical physicists. Raymond Wu, PhD, is the CEO of IMPCB and the Chairman of the IOMP Professional Relations Committee. He is the invited speaker recommended by IOMP to give a talk on this important subject. He will give the latest update of the work of IMPCB, its near term goals, and pathways to the goals. He will also discuss the importance of such an International System of certification in the training/education of next generation Medical Physicists, including those in low and middle income countries (LMIC) where such training is crucial in the fight against cancer. Learning Objectives: Understand the certification program as described in the IOMP Policy Statements. Understand the plan of the IMPCB to establish the accreditation process of national certification programs. Understand the goals of this international collaborative effort and the potential impacts to the quality of clinical medical physics practice. Medical Physics Education Across Continents: The UMass Lowell and Heidelberg University Joint Coordination Effort Erno Sajo, Director of Medical Physics, University of Massachusetts at Lowell Medical Physics education has unique flavors across institutions within the US and shows significant differences across continents. In the latter, even the definition of Medical Physics may differ. Not only is there a difference in topical coverage, but often what is considered a cohesive topic in one institution, and taught as a single course, is fragmented among several other courses in the other institution due to a different philosophy. Because of the regulatory and certification requirements, these differences impact the mobility of medical physicists across continents. As a result, physicists who wish to practice in the US or Canada but have completed their education elsewhere often find that they have to take remedial courses or even obtain a new degree in Medical Physics despite the fact that they already have one. Outreach to developing countries, therefore, is even more difficult. The University of Massachusetts Lowell and Heidelberg University recently completed a joint coordination effort, in which they identified topics that are common versus complementary in their medical physics curricula. A student exchange program was developed that permits students to take any of the common topics at the other institution while taking complementary courses as electives, which count towards their degree requirements at their home institution. Thesis research is also mutually accepted. When properly documented, in this way CAMPEP recommendations can be met across the institutions. Therefore, students participating in this program satisfy both the American Board of Radiology (ABR) requirements and the European regulatory requirements. The framework on which this collaboration rests and the cross-comparison methods developed therein may be implemented in other exchange programs and thus a similar approach can be adopted in outreach programs with developing countries. IAEA PACT Program and opportunities for support and collaboration Susan Morgan, Program Coordinator, International Atomic Energy Agency, Vienna, Austria In response to the developing world's cancer crisis, the International Atomic Energy Agency (IAEA) established the Program of Action for Cancer Therapy (PACT) in 2004 to fully realize the public health impact obtained through global partnerships in cancer control and technology transfer in radiation medicine. PACT's vision strives for global partnerships to confront the cancer crisis in developing countries, notably with our sister United Nations agency, the World Health Organization (WHO), and our Joint Programme on Cancer Control established in 2009. The IAEA, through PACT, the WHO, the International Agency for Research on Cancer (IARC) and other cancer-related organizations work together to make a coordinated global response in supporting low and middle income (LMI) IAEA Member States in the implementation of comprehensive national cancer control programmes. PACT's goals are: To build global partnerships of cancer-related organizations committed to addressing the challenge of cancer in LMI Member States in all its aspects; To mobilize resources from charitable trusts, foundations, and others in public and private sectors sources to assist LMI Member States to develop and implement their radiation medicine capacities within a national cancer control programme (NCCP); and, To ensure the effective and sustainable transfer of radiation medicine technologies or knowledge to all LMI Member States where unmet needs exist. PACT work focuses on: imPACT: Assessing Cancer Burden PMDS: Developing Global Partnerships VUCCnet: Promoting Cancer Control Training AGaRT: Making Radiotherapy Accessible Facilitating increased participation and professional development of Medical Physicists and other Radiation Oncology professionals in global health Wilfred Ngwa, Harvard Medical School, University of Massachusetts Lowell, MA The 2014 World Health Organization (WHO) Cancer report highlights an alarming increase in the global burden of cancer. It also highlights what it terms “the cancer divide”, or disparities, evinced by a substantially higher cancer burden in low and middle income countries (LMIC) in Asia, Central/South America and Africa. The WHO even predicts a potential African cancer epidemic by 2020 if significant progress is not made in global cancer control efforts. Evidence that collaborative global health approaches have led to major progress in controlling infectious diseases including in LMIC suggests that similar approaches will be useful for non-communicable diseases like cancer. In consonance with this, leaders in cancer policy from the USA and 14 economically diverse countries recently concluded that successful campaigns to control cancers with existing methods and to improve current strategies will increasingly depend onconcerted multinational collaborations (Sci Transl Med 5, p. 175, 2013). Hence there is growing urgency for increasing collaborative global cancer Care Research and Education (CaRE), as well as support for greater effectiveness of already existing initiatives involving partners from different nations, diverse economic and cultural backgrounds. The good news is that there is a growing awareness of the importance of global health and growing interest including amongst Medical Physicists and other Radiation oncology (RadOnc) professionals to participate in global health. However, many are unaware of currently existing opportunities for participation that even with small effort could have a high impact. Over 50% of cancer patients in the developed world depend on RadOnc professionals for their treatment, and hence participation of RadOnc professionals in global health efforts in the global fight against cancer is crucial. It is also important that the next generation of RadOnc professionals (students, and residents) be trained with a global perspective, to be global health leaders in cancer CaRE. This presentation will highlight a novel platform for enhancing participation and professional development of Medical Physicists and other RadOnc professionals in global health. Ways in which this platform can facilitate contributions by Medical Physicists and other RadOnc Professionals, students and residents in global health towards the elimination of global cancer disparities will be discussed. This will be followed by a panel discussion by some of the pioneers/leaders in collaborative global cancer CaRE on the growing cancer burden, challenges and opportunities for greater active involvement and professional development.

60 APPLIED LIFE SCIENCES↗

NASA NTRSDate not supplied

An Automated Medical Inventory System (AMIS) to Enable Earth-Independent Medical Operations

BACKGROUND: Inventory of medical consumables and durables (medications, treatment aids, diagnostic equipment, etc.) aboard the International Space Station is a manual process whereby crewmembers reach out to their flight surgeon to relay when items are used. Performing a full medical system inventory is time intensive. However, as exploration progresses to long duration missions with little to no resupply or evacuation capabilities, maintaining an accurate account of inventory and location for medical systems across the mission will become increasingly critical. A new system must be developed for future exploration missions to meet the need for a crew-facing, real time method of managing medical inventory. OVERVIEW: NASA’s Exploration Medical Integrated Product Team (XMIPT) is funding the AMIS project to mature the technology readiness level and to conduct a flight demonstration of a medical inventory capability. AMIS will leverage lessons learned from a Medical Consumables Tracking project previously demonstrated aboard the ISS in 2016 and 2017. Key components of AMIS include a database, supporting hardware and software, and interfaces to power, communications, or other vehicle or medical systems. Some medical inventory capability may be provided by the vehicle inventory management system which relies upon RFID-based technology and can track larger items such as medical kits or medical hardware. AMIS will augment these capabilities to enable tracking of individual medical kit contents. Efforts are underway to characterize the optimal solution trade space by comparing system specifications (e.g. mass and volume, etc.) across maintenance and operational use cases (e.g. crew time saved, total inventory automated, etc). DISCUSSION: The contents of a Mars Medical System have not been fully defined which poses challenges to defining an inventory system and requires assumptions regarding medical kit contents and medical system design. Other important considerations include minimizing crew time required, avoiding access restrictions to medical inventory in the event of an emergency, and ensuring that data is accessible to other medical system elements to enable crew autonomy in provision of medical care.

Automated Medical Inventory System↗

DOE OSTI2016

WE-H-201-04: Models for Developing Medical Physics Educators and Education Programs in the Developing Countries and the Potential Role of US Universities and Individual Medical Physicists

The desperate need for radiotherapy in low and mid-income countries (LMICs) has been well documented. Roughly 60 % of the worldwide incidence of cancer occurs in these resource-limited settings and the international community alongside governmental and non-profit agencies have begun publishing reports and seeking help from qualified volunteers. However, the focus of several reports has been on how dire the situation is and the magnitude of the problem, leaving most to feel overwhelmed and unsure as to how to help and why to get involved. This session will help to explain the specific ways that Medical Physicists can uniquely assist in this grand effort to help bring radiotherapy to grossly-underserved areas. Not only can these experts fulfill an important purpose, they also can benefit professionally, academically, emotionally and socially from the endeavor. By assisting others worldwide with their skillset, Medical Physicists can end up helping themselves. Learning Objectives: Understand the need for radiotherapy in LMICs. Understand which agencies are seeking Medical Physicists for help in LMICs. Understand the potential research funding mechanisms are available to establish academic collaborations with LMIC researchers/physicians. Understand the potential social and emotional benefits for both the physicist and the LMIC partners when collaborations are made. Understand the potential for collaboration with other high-income scientists that can develop as the physicist partners with other large institutions to assist LMICs. Wil Ngwa - A recent United Nations Study reports that in developing countries more people have access to cell phones than toilets. In Africa, only 63% of the population has access to piped water, yet, 93% of Africans have cell phone service. Today, these cell phones, Skype, WhatsApp and other information and communication technologies (ICTs) connect us in unprecedented ways and are increasingly recognized as powerful, indispensable to global health. Thanks to ICTs, there are growing opportunities for Medical Physicists to reach out beyond the bunker and impact the world far beyond, without even having to travel. These growing opportunities in global health for Medical Physicists, powered by ICTs, will be highlighted in this presentation, illustrated by high impact examples/models across the globe that are improving patient safety and healthcare outcomes, saving lives. Learning Objectives: Published definitions of global health and the emerging field of global radiation oncology Learn about the transformative potential of ICTs in global radiation oncology care, research and education with focus on Medical Physics Learn about high impact examples of ICT-powered global radiation oncology and the increasing opportunities for participation by Medical Physicists. Yakov Pipman - The number and scope of volunteer Medical Physics activities in support of low-to-middle income countries has been increasing gradually. This happens through a variety of formal channels and to some extent through less formal but personal initiatives. A good deal of effort is dedicated by many, but many more could be recruited through a structured framework to volunteer. We will look into typical volunteer activities and how they fit with organizations already involved in advancing Medical Physics in LMIC. We will identify the range of these organizational activities and their scope to reveal areas of further need. We will point to a few key features of MPWB ( http://www.mpwb.org ) as a volunteering and collaborating structure and how members can get involved and contribute to these efforts at the grass roots level. The goal is that scarce resources can thus be channeled to complement rather than compete with those already in place. Learning Objectives: Understand the strengths and limitations of various organizations that support Medical Physics efforts in LMIC. Learn about ways to volunteer and contribute to Global Health through a grass roots organization focused on Medical Physics in LMIC. Perry Sprawls - With the growing capability and complexity of medical imaging methods in all countries of the world, the expanding role of medical physicists includes optimizing imaging procedures with respect to image quality, radiation dose, and other conflicting factors. With access to appropriate educational resources local medical physicists in all countries can provide direct clinical support and educational for other medical professionals. This is being supported through the process of Collaborative Teaching that combines the capabilities and experience of medical physicists in countries spanning the spectrum of economic, technological, and clinical development. The supporting resources are on the web at: http://www.sprawls.org/resources . Learning Objectives: Identify the medical physics educational needs to support effective and optimized medical imaging procedures. Use collaborative teaching resources to enhance the role of medical physicists in all countries of the world.

60 APPLIED LIFE SCIENCES↗

NASA NTRS2011

The Use of the Integrated Medical Model for Forecasting and Mitigating Medical Risks for a Near-Earth Asteroid Mission

Introduction The Integrated Medical Model (IMM) is a decision support tool that is useful to space flight mission managers and medical system designers in assessing risks and optimizing medical systems. The IMM employs an evidence-based, probabilistic risk assessment (PRA) approach within the operational constraints of space flight. Methods Stochastic computational methods are used to forecast probability distributions of medical events, crew health metrics, medical resource utilization, and probability estimates of medical evacuation and loss of crew life. The IMM can also optimize medical kits within the constraints of mass and volume for specified missions. The IMM was used to forecast medical evacuation and loss of crew life probabilities, as well as crew health metrics for a near-earth asteroid (NEA) mission. An optimized medical kit for this mission was proposed based on the IMM simulation. Discussion The IMM can provide information to the space program regarding medical risks, including crew medical impairment, medical evacuation and loss of crew life. This information is valuable to mission managers and the space medicine community in assessing risk and developing mitigation strategies. Exploration missions such as NEA missions will have significant mass and volume constraints applied to the medical system. Appropriate allocation of medical resources will be critical to mission success. The IMM capability of optimizing medical systems based on specific crew and mission profiles will be advantageous to medical system designers. Conclusion The IMM is a decision support tool that can provide estimates of the impact of medical events on human space flight missions, such as crew impairment, evacuation, and loss of crew life. It can be used to support the development of mitigation strategies and to propose optimized medical systems for specified space flight missions. Learning Objectives The audience will learn how an evidence-based decision support tool can be used to help assess risk, develop mitigation strategies, and optimize medical systems for exploration space flight missions.

Kerstman, Eric↗

NASA NTRS2020

Medical Data Architecture Platform and Recommended Requirements for a Medical Data System for Exploration Missions

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.

Krihak, M.↗

NASA NTRSDate not supplied

Baseline Medical System Translation for the Impact Medical Database

NASA has developed a new evidence-based data-driven probabilistic risk assessment and tradespace analysis tool as a successor to the Integrated Medical Model (IMM). This updated decision support tool is known as IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces). Whereas IMM focuses on the resources and risks associated with International Space Station (ISS) and Low Earth Orbit (LEO) missions, IMPACT estimates the frequency and consequences of medical conditions that might arise during exploration missions. One of the services offered by IMM is a series of generic or baseline medical systems associated with typical mission types or DRMs (Design Reference Missions), such that requestors may prioritize questions pertaining to the mission itself over the medical supplies indicated by the model outputs for that DRM. In a mission focused request, the appropriate baseline medical system is used in place of a prepared or optimized medical kit. In preparation, an effort was undertaken to create baseline systems of medical resources within IMPACT suitable for typical DRMs. Using an existing baseline medical system within IMM’s Integrated Medical Evidence Database (iMED) as a starting point, the resources found within the medical kit were compared to and substituted for equivalent resources available within the IMPACT MD (Medical Database). In consultation with clinicians with knowledge of IMPACT’s MD, each resource was matched as closely as possible to a similarly purposed resource in IMPACT, seeking to preserve the treatment capabilities and procedures offered by the IMM medical system while reconciling the differences in modeled resources and medical conditions between the models. To demonstrate the efficacy of this work, a prototype ISS medical system in IMPACT was translated from the baseline used in the IMM. The appropriate medical system was then run through its associated medical model to compare and validate the resultant risks and risk mitigation provided by each baseline ISS medical kit.

S Schwartz↗

NASA NTRS2009

The Integrated Medical Model - Optimizing In-flight Space Medical Systems to Reduce Crew Health Risk and Mission Impacts

The Integrated Medical Model (IMM) is a decision support tool used by medical system planners and designers as they prepare for exploration planning activities of the Constellation program (CxP). IMM provides an evidence-based approach to help optimize the allocation of in-flight medical resources for a specified level of risk within spacecraft operational constraints. Eighty medical conditions and associated resources are represented in IMM. Nine conditions are due to Space Adaptation Syndrome. The IMM helps answer fundamental medical mission planning questions such as What medical conditions can be expected? What type and quantity of medical resources are most likely to be used?", and "What is the probability of crew death or evacuation due to medical events?" For a specified mission and crew profile, the IMM effectively characterizes the sequence of events that could potentially occur should a medical condition happen. The mathematical relationships among mission and crew attributes, medical conditions and incidence data, in-flight medical resources, potential clinical and crew health end states are established to generate end state probabilities. A Monte Carlo computational method is used to determine the probable outcomes and requires up to 25,000 mission trials to reach convergence. For each mission trial, the pharmaceuticals and supplies required to diagnose and treat prevalent medical conditions are tracked and decremented. The uncertainty of patient response to treatment is bounded via a best-case, worst-case, untreated case algorithm. A Crew Health Index (CHI) metric, developed to account for functional impairment due to a medical condition, provides a quantified measure of risk and enables risk comparisons across mission scenarios. The use of historical in-flight medical data, terrestrial surrogate data as appropriate, and space medicine subject matter expertise has enabled the development of a probabilistic, stochastic decision support tool capable of optimizing in-flight medical systems based on crew and mission parameters. This presentation will illustrate how to apply quantitative risk assessment methods to optimize the mass and volume of space-based medical systems for a space flight mission given the level of crew health and mission risk.

Kerstman, Eric↗

NASA NTRS2020

Medical Data Architecture Platform and Recommended Requirements for A Medical Data System for Exploration Missions

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.

Krihak, M.↗

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↗

DOE OSTI2015

SU-A-210-00: AAPM Medical Physics Student Meeting: Medical Billing and Regulations: Everything You Always Wanted To Know, But Were Too Afraid To Ask

The purpose of this student annual meeting is to address topics that are becoming more relevant to medical physicists, but are not frequently addressed, especially for students and trainees just entering the field. The talk is divided into two parts: medical billing and regulations. Hsinshun Wu – Why should we learn radiation oncology billing? Many medical physicists do not like to be involved with medical billing or coding during their career. They believe billing is not their responsibility and sometimes they even refuse to participate in the billing process if given the chance. This presentation will talk about a physicist’s long career and share his own experience that knowing medical billing is not only important and necessary for every young medical physicist, but that good billing knowledge could provide a valuable contribution to his/her medical physics development. Learning Objectives: The audience will learn the basic definition of Current Procedural Terminology (CPT) codes performed in a Radiation Oncology Department. Understand the differences between hospital coding and physician-based or freestanding coding. Apply proper CPT coding for each Radiation Oncology procedure. Each procedure with its specific CPT code will be discussed in detail. The talk will focus on the process of care and use of actual workflow to understand each CPT code. Example coding of a typical Radiation Oncology procedure. Special procedure coding such as brachytherapy, proton therapy, radiosurgery, and SBRT. Maryann Abogunde – Medical physics opportunities at the Nuclear Regulatory Commission (NRC) The NRC’s responsibilities include the regulation of medical uses of byproduct (radioactive) materials and oversight of medical use end-users (licensees) through a combination of regulatory requirements, licensing, safety oversight including inspection and enforcement, operational experience evaluation, and regulatory support activities. This presentation will explore the career options for medical physicists in the NRC, how the NRC interacts with clinical medical physicists, and a physicist’s experience as a regulator. Learning Objectives: Explore non-clinical career pathways for medical physics students and trainees at the Nuclear Regulatory Commission. Overview of NRC medical applications and medical use regulations. Understand the skills needed for physicists as regulators. Abogunde is funded to attend the meeting by her employer, the NRC.

07 ISOTOPE AND RADIATION SOURCES↗

NASA NTRS2009

The Integrated Medical Model: A Risk Assessment and Decision Support Tool for Space Flight Medical Systems

The Integrated Medical Model (IMM) is a decision support tool that is useful to mission planners and medical system designers in assessing risks and designing medical systems for space flight missions. The IMM provides an evidence based approach for optimizing medical resources and minimizing risks within space flight operational constraints. The mathematical relationships among mission and crew profiles, medical condition incidence data, in-flight medical resources, potential crew functional impairments, and clinical end-states are established to determine probable mission outcomes. Stochastic computational methods are used to forecast probability distributions of crew health and medical resource utilization, as well as estimates of medical evacuation and loss of crew life. The IMM has been used in support of the International Space Station (ISS) medical kit redesign, the medical component of the ISS Probabilistic Risk Assessment, and the development of the Constellation Medical Conditions List. The IMM also will be used to refine medical requirements for the Constellation program. The IMM outputs for ISS and Constellation design reference missions will be presented to demonstrate the potential of the IMM in assessing risks, planning missions, and designing medical systems. The implementation of the IMM verification and validation plan will be reviewed. Additional planned capabilities of the IMM, including optimization techniques and the inclusion of a mission timeline, will be discussed. Given the space flight constraints of mass, volume, and crew medical training, the IMM is a valuable risk assessment and decision support tool for medical system design and mission planning.

Kerstman, Eric↗

NASA NTRS2021

Exploration Medical Capability Medical Scenarios

Medical systems supporting exploration class missions to cislunar space, the lunar surface, and the vicinity of Mars require an evolution in medical capability beyond that available for today’s low Earth orbit centric paradigm. Progress in developing more capable medical systems will be driven by the requirements of prolonged mission duration, increasing distance from Earth, and the realities of orbital mechanics, all necessitating a concomitant need for progressively Earth independent medical decision-making capabilities. These medical systems (which include the crewmembers) are expected to be capable of evaluating, diagnosing, treating and managing a defined list of medical conditions as well as addressing unanticipated medical conditions that may arise. The prioritized medical capabilities and associated resources needed to treat these medical conditions and support anticipated inflight medical events provide robust content that informs system designers and allows for a more complete evaluation of both medical and overall mission risk. Communication of these medical capabilities to system, vehicle, and mission designers can be enhanced using scenarios that characterize the system’s operations. Carefully considered scenarios provide the context needed to explore expected human and system interfaces, roles of ground and inflight crew (including periods of interrupted or delayed communications), identify training needs, assess data needs, etc. Mission-based scenario content varies dependent upon the needs, medical capabilities, conditions and context they are intended to illustrate. This document explicitly seeks to capture and codify those scenarios that have been useful to the Exploration Medical Capability Element of the Human Research Program in defining the enhanced medical systems required for future space exploration. It is expected that this document will continue to evolve through the refinement and characterization of current and future scenarios, respectively, as our knowledge grows, and requirements increasingly focus on Earth independent spaceflight operations.

Derek M Nusbaum↗

NASA NTRSDate not supplied

A Multi-Faceted Approach to Demonstrating Multi-Functional Integrated Medical Devices to Advance Earth-Independent Medical Operations

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.

B. E. Lewandowski↗

NASA NTRS2019

Medical System Concept of Operations for Mars Exploration Mission-11: Exploration Medical Capability (ExMC) Element - Human Research Program

NASA’s exploration missions to Mars will have durations of 2-3 years and will take humans farther away from Earth than ever before. This will result in a paradigm shift for mission planning, spacecraft design, human systems integration, and in-flight medical care. Constraints on real-time communication, resupply, and medical evacuation are major architectural drivers. These constraints require medical system development to be tightly integrated with mission and vehicle design to provide crew autonomy and enable mission success. This concept of operations provides a common vision of medical care for developing a medical system for Mars exploration missions. It documents an overview of the stakeholder needs and goals of a medical system and provides examples of the types of activities the system will be used for during the mission. Development of the concept of operations considers mission variables such as distance from Earth, duration of mission, time to definitive medical care, communication protocols between crewmembers and ground support, personnel capabilities and skill sets, medical hardware and software, and medical data management. The information provided in this document informs the ExMC Systems Engineering effort to define the functions to be provided by the medical system. In addition, this concept of operations will inform the subsequent systems engineering process of developing technical requirements, system architectures, interfaces, and verification and validation approaches for the medical system. This document supports the closure of ExMC Gap Med01: We do not have a concept of operations for medical care during exploration missions, corresponding to the ExMC-managed human system risk: Risk of Adverse Health Outcomes & Decrements in Performance due to Inflight Medical Conditions. This document is applicable to the ExMC Element Systems Engineering process and may be used for collaboration within the Human Research Program.

Urbina, Michelle↗

NASA NTRS2015

The Integrated Medical Model: A Probabilistic Simulation Model Predicting In-Flight Medical Risks

The Integrated Medical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The Integrated Medical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting mass and volume constraints.

Risk Analysis↗

NASA NTRS2015

The Integrated Medical Model: A Probabilistic Simulation Model for Predicting In-Flight Medical Risks

Risk Analysis↗