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At least 19 records

Transmission ultrasonography

Review of the results of the application of an advanced signal-processing technique, called time delay spectrometry, in obtaining soft tissue transmission images by transmission ultrasonography, both in vivo and in vitro. The presented results include amplitude ultrasound pictures and phase ultrasound pictures obtained by this technique. While amplitude ultrasonographs of tissue are closely analogous to X-ray pictures in that differential absorption is imaged, phase ultrasonographs represent an entirely new source of information based on differential time of propagation. Thus, a new source of information is made available for detailed analysis.

Heyser, R. C.

Characterization of Jugular Venous Blood Flow During Acute Fluid Shifts

INTRODUCTION Exposure to weightlessness induces a headward fluid shift and redistribution of fluids, resulting in increased internal jugular vein (IJV) cross-sectional area and altered IJV blood flow dynamics including stasis and retrograde flow. These findings may contribute to various risks of spaceflight, including thrombosis or other risks affected by cerebral venous blood flow. To date, our understanding of the cerebral venous outflow dynamics is limited to the left IJV assessed ~45and ~150days into spaceflight. Therefore, it is unknown how quickly the alterations in venous blood flow dynamics change as a result of weightlessness. The purpose of this study is to determine 1) if venous stasis is an immediate effect of weightlessness, and therefore a risk for short-duration missions, and 2) the effect of weightlessness on brachiocephalic venous flow. METHODS In this study, we will determine the effects of acute weightlessness during parabolic flight on right and left IJV cross-sectional area, as well as blood flow dynamics through the IJV and brachiocephalic veins in 12 healthy subjects. Baseline ultrasound images will be obtained on the ground prior to the parabolic flight in the seated and supine postures to determine normal changes in blood flow with posture-induced fluid shifts in a 1genvironment. Subjects will then undergo parabolic flight withrepeated,~20 second exposure to 0g. Each data collection session will include 2D ultrasonography to quantify IJV cross-sectional area and Doppler ultrasonography to characterize venous blood flow patterns in the IJV and brachiocephalic veins. RESULTS Data collection for this study is planned to take place in October, 2021.CONCLUSIONS This study will characterize the immediate venous response in the left and right IJV and brachiocephalic veins upon entry into weightlessness. The results from this parabolic flight study will be compared with previous data from International Space Station crewmembers collectedafter~45 and ~150 days into spaceflight to provide a more complete understanding of the temporal profile of changes in venous blood flow dynamics during weightlessness and whether these findings develop in veins other than the left IJV. Supported by the NASA Human Research Program.

K Marshall-Bowman

Characterization of Jugular Venous Blood Flow During Acute Fluid Shifts

INTRODUCTION Exposure to weightlessness induces a headward fluid shift and redistribution of fluids, resulting in increased internal jugular vein (IJV) cross-sectional area and altered IJV blood flow dynamics, including stasis and retrograde flow. These findings may contribute to various risks of spaceflight, including thrombosis or other risks affected by cerebral venous blood flow. To date, our understanding of the cerebral venous outflow dynamics in weightlessness is limited to the left IJV assessed ~45 and ~150 days into spaceflight. Therefore, it is unknown how quickly the alterations in venous blood flow dynamics change as a result of weightlessness. The purpose of this study is to determine 1) if venous stasis is an immediate effect of weightlessness and therefore a risk for short-duration missions and 2) the effect of weightlessness on brachiocephalic venous flow. METHODS In this study, we investigated the effects of acute weightlessness during parabolic flight on the right and left IJV in 12 healthy subjects. Baseline ultrasound images were obtained on the ground (1g) in the seated and supine postures and during 0g parabolic flight. Each data collection session included 2D ultrasonography to quantify IJV cross-sectional area and Doppler ultrasonography to characterize venous blood flow patterns in the bilateral IJVs. RESULTS There was a similar pattern of response in the left and right IJV area across postures and g-levels. IJV area increased from seated to supine by 0.74 mm2 (95% CI: 0.56 to 0.91 mm2, p<.001) and increased further during weightlessness by 0.29 mm2 (95% CI: 0.11 to 0.47 mm2, p=.0015). IJV Doppler images revealed stagnant flow in the left IJV in one subject during 0g exposure that was not present during any imaging on the ground; the right IJV continued to show pulsatile, nominal flow patterns in both 0g and 1g. CONCLUSIONS This study characterized the immediate effect of the weightlessness-induced headward fluid shift on venous parameters in the left and right IJV. The left IJV appears to be more susceptible to flow alterations, including stagnant flow, during both short and long-duration exposure to weightlessness that may contribute to the risk of thrombosis inflight.

K Marshall-Goebel

Localization of needle tip with color doppler during pericardiocentesis: In vitro validation and initial clinical application

This study evaluates a new device that uses color Doppler ultrasonography to enable real-time image guidance of the aspirating needle, which has not been possible until now. The ColorMark device (EchoCath Inc, Princeton, NJ) induces high-frequency, low-amplitude vibrations in the needle to enable localization with color Doppler. We studied this technique in 25 consecutive patients undergoing pericardiocentesis, and in vitro, in a urethane phantom with which the accuracy of color Doppler localization of the needle tip was compared with that obtained by direct measurement. Tip localization was excellent in vitro; errors axial to the ultrasound beam (velocity Doppler -0.13 +/- 0.90 mm, power Doppler -0.05 +/- 1.7 mm) were less than lateral errors (velocity -0.36 +/- 1.8 mm, power -0.02 +/- 2.8 mm). In 18 of 25 patients, the needle was identified and guided into the pericardial space with the ColorMark technique, and it allowed successful, uncomplicated drainage of fluid. Initial failures were the result of incorrect settings on the echocardiographic machine and inappropriate combinations of the needle puncture site and imaging window. This study demonstrates a novel color Doppler technique that is highly accurate at localizing a needle tip. The technique is feasible for guiding pericardiocentesis. Further clinical validation of this technique is required.

NASA Discipline Cardiopulmonary

Cerebral blood flow velocity and cranial fluid volume decrease during +Gz acceleration

Cerebral blood flow (CBF) velocity and cranial fluid volume, which is defined as the total volume of intra- and extracranial fluid, were measured using transcranial Doppler ultrasonography and rheoencephalography, respectively, in humans during graded increase of +Gz acceleration (onset rate: 0.1 G/s) without straining maneuvers. Gz acceleration was terminated when subjects' vision decreased to an angle of less than or equal to 60 degrees, which was defined as the physiological end point. In five subjects, mean CBF velocity decreased 48% from a baseline value of 59.4 +/- 11.2 cm/s to 31.0 +/- 5.6 cm/s (p<0.01) with initial loss of peripheral vision at 5.7 +/- 0.9 Gz. On the other hand, systolic CBF velocity did not change significantly during increasing +Gz acceleration. Cranial impedance, which is proportional to loss of cranial fluid volume, increased by 2.0 +/- 0.8% above the baseline value at the physiological end point (p<0.05). Both the decrease of CBF velocity and the increase of cranial impedance correlated significantly with Gz. These results suggest that +Gz acceleration without straining maneuvers decreases CBF velocity to half normal and probably causes a caudal fluid shift from both intra- and extracranial tissues.

NASA Discipline Cardiopulmonary

Cardiovascular Imaging and Image Processing: Theory and Practice - 1975

Ultrasonography was examined in regard to the developmental highlights and present applicatons of cardiac ultrasound. Doppler ultrasonic techniques and the technology of miniature acoustic element arrays were reported. X-ray angiography was discussed with special considerations on quantitative three dimensional dynamic imaging of structure and function of the cardiopulmonary and circulatory systems in all regions of the body. Nuclear cardiography and scintigraphy, three--dimensional imaging of the myocardium with isotopes, and the commercialization of the echocardioscope were studied.

Harrison, Donald C.

Cardiovascular imaging and image processing: Theory and practice - 1975; Proceedings of the Conference, Stanford University, Stanford, Calif., July 10-12, 1975

The present collection of papers outlines advances in ultrasonography, scintigraphy, and commercialization of medical technology as applied to cardiovascular diagnosis in research and clinical practice. Particular attention is given to instrumentation, image processing and display. As necessary concomitants to mathematical analysis, recently improved magnetic recording methods using tape or disks and high-speed computers of large capacity are coming into use. Major topics include Doppler ultrasonic techniques, high-speed cineradiography, three-dimensional imaging of the myocardium with isotopes, sector-scanning echocardiography, and commercialization of the echocardioscope. Individual items are announced in this issue.

Harrison, D. C.

Leg muscle volume during 30-day 6-degree head-down bed rest with isotonic and isokinetic exercise training

Magnetic resonance imaging (MRI) was used to compare the effect of two modes of lower-extremity exercise training on the mass (volume) of posterior leg group (PLG) muscles (soleus, flexor hallucis longus, tibialis posterior, lateral and medial gastrocnemius, and flexor digitorum longus) on 19 men (ages 32-42 years) subjected to intense dynamic-isotonic (ITE, cycle ergometer, number of subjects (N) = 7), isokinetic (IKE, torque egrometer, N = 7), and no exercise (NOE, N = 5) training for 60 min/day during head-down bed rest (HDBR). Total volume of the PLG muscles decreased (p less than 0.05) similarly: ITE = 4.3 +/- SE 1.6%, IKE = 7.7 +/- 1.6%, and NOE = 6.3 +/- 0.8%; combined volume (N = 19) loss was 6.1 +/- 0.9%. Ranges of volume changes were 2.6% to -9.0% (ITE), -2.1% to -14.9% (IKE), and -3.4% to -8/1% (NOE). Correlation coefficients (r) of muscle volume versus thickness measured with ultrasonography were: ITE r + 0.79 (p less than 0.05), IKE r = 0.27 (not significant (NS)), and NOE r = 0.63 (NS). Leg-muscle volume and thickness were highly correlated (r = 0.79) when plasma volume was maintained during HDBR with ITE. Thus, neither intensive lower extremity ITE nor IKE training influence the normal non-exercised posterior leg muscle atrophy during HDBR. The relationship of muscle volume and thickness may depend on the mode of exercise training associated with the maintenance of plasma volume.

Greenleaf, J. E.

Lower Extremity Muscle Thickness During 30-Day 6 degrees Head-Down Bed Rest with Isotonic and Isokinetic Exercise Training

Muscle thickness was measured in 19 Bed-Rested (BR) men (32-42 year) subjected to IsoTonic (ITE, cycle orgometer) and IsoKi- netic (IKE, torque orgometer) lower extremity exercise training, and NO Exercise (NOE) training. Thickness was measured with ultrasonography in anterior thigh-Rectus Femoris (RF) and Vastus Intermadius (VI), and combined posterior log-soleus, flexor ballucis longus, and tibialis posterior (S + FHL +TP) - muscles. Compared with ambulatory control values, thickness of the (S + FHL + TP) decreased by 90%-12% (p less than 0.05) In all three test groups. The (RF) thickness was unchanged in the two exercise groups, but decreased by 10% (p less than 0.05) in the NOE. The (VI) thickness was unchanged In the ITE group, but decreased by 12%-l6% (p less than 0.05) in the IKE and NOE groups. Thus, intensive, alternating, isotonic cycle ergometer exercise training is as effective as intensive, intermittent, isokinetic exercise training for maintaining thicknesses of rectus femoris and vastus lntermedius anterior thigh muscles, but not posterior log muscles, during prolonged BR deconditioning.

Ellis, S.

Focused Assessment with Sonography for Trauma in weightlessness: a feasibility study

BACKGROUND: The Focused Assessment with Sonography for Trauma (FAST) examines for fluid in gravitationally dependent regions. There is no prior experience with this technique in weightlessness, such as on the International Space Station, where sonography is currently the only diagnostic imaging tool. STUDY DESIGN: A ground-based (1 g) porcine model for sonography was developed. We examined both the feasibility and the comparative performance of the FAST examination in parabolic flight. Sonographic detection and fluid behavior were evaluated in four animals during alternating weightlessness (0 g) and hypergravity (1.8 g) periods. During flight, boluses of fluid were incrementally introduced into the peritoneal cavity. Standardized sonographic windows were recorded. Postflight, the video recordings were divided into 169 20-second segments for subsequent interpretation by 12 blinded ultrasonography experts. Reviewers first decided whether a video segment was of sufficient diagnostic quality to analyze (determinate). Determinate segments were then analyzed as containing or not containing fluid. A probit regression model compared the probability of a positive fluid diagnosis to actual fluid levels (0 to 500 mL) under both 0-g and 1.8-g conditions. RESULTS: The in-flight sonographers found real-time scanning and interpretation technically similar to that of terrestrial conditions, as long as restraint was maintained. On blinded review, 80% of the recorded ultrasound segments were considered determinate. The best sensitivity for diagnosis in 0 g was found to be from the subhepatic space, with probability of a positive fluid diagnosis ranging from 9% (no fluid) to 51% (500 mL fluid). CONCLUSIONS: The FAST examination is technically feasible in weightlessness, and merits operational consideration for clinical contingencies in space.

NASA Discipline Life Sciences Technologies

Effect of perturbations and a meal on superior mesenteric artery flow in patients with orthostatic hypotension

Our aims were to evaluate to role of superior mesenteric blood flow in the pathophysiology of orthostatic hypotension in patients with generalized autonomic failure. METHODS: Twelve patients with symptomatic neurogenic orthostatic hypotension and 12 healthy controls underwent superior mesenteric artery flow measurements using Doppler ultrasonography during head-up tilt and tilt plus meal ingestion. Autonomic failure was assessed using standard tests of the function of the sympathetic adrenergic, cardiovagal and postganglionic sympathetic sudomotor function. RESULTS: Superior mesenteric flow volume and time-averaged velocity were similar in patients and controls at supine rest; however, responses to cold pressor test and upright tilt were attenuated (p < 0.05) in patients compared to controls. Head-up tilt after the meal evoked a profound fall of blood pressure and mesenteric blood flow in the patients; the reduction of mesenteric blood flow correlated (r = 0.89) with the fall of blood pressure in these patients, providing another manifestation of failed baroreflexes. We make the novel finding that the severity of postprandial orthostatic hypotension regressed negatively with the postprandial increase in mesenteric flow in patients with orthostatic hypotension. CONCLUSION: Mesenteric flow is under baroreflex control, which when defective, results in, or worsens orthostatic hypotension. Its large size and baroreflexivity renders it quantitatively important in the maintenance of postural normotension. The effects of orthostatic stress can be significantly attenuated by reducing the splanchnic-mesenteric volume increase in response to food. Evaluation of mesenteric flow in response to eating and head-up tilt provide important information on intra-abdominal sympathetic adrenergic function, and the ability of the patient to cope with orthostatic stress.

Non-NASA Center

Height increase, neuromuscular function, and back pain during 6 degrees head-down tilt with traction

BACKGROUND: Spinal lengthening and back pain are commonly experienced by astronauts exposed to microgravity. METHODS: To develop a ground-based simulation for spinal adaptation to microgravity, we investigated height increase, neuromuscular function and back pain in 6 subjects all of whom underwent two forms of bed rest for 3 d. One form consisted of 6 degrees of head-down tilt (HDT) with balanced traction, while the other was horizontal bed rest (HBR). Subjects had a 2-week recovery period in between the studies. RESULTS: Total body and spinal length increased significantly more and the subjects had significantly more back pain during HDT with balanced traction compared to HBR. The distance between the lower endplate of L4 and upper endplate of S1, as measured by ultrasonography, increased significantly in both treatments to the same degree. Intramuscular pressures in the erector spinae muscles and ankle torque measurements during plantarflexion and dorsiflexion did not change significantly during either treatment. CONCLUSION: Compared to HBR, HDT with balanced traction may be a better method to simulate changes of total body and spinal lengths, as well as back pain seen in microgravity.

NASA Discipline Number 26-10

Ocular examination for trauma; clinical ultrasound aboard the International Space Station

BACKGROUND: Ultrasound imaging is a successful modality in a broad variety of diagnostic applications including trauma. Ultrasound has been shown to be accurate when performed by non-radiologist physicians; recent reports have suggested that non-physicians can perform limited ultrasound examinations. A multipurpose ultrasound system is installed on the International Space Station (ISS) as a component of the Human Research Facility (HRF). This report documents the first ocular ultrasound examination conducted in space, which demonstrated the capability to assess physiologic alterations or pathology including trauma during long-duration space flight. METHODS: An ISS crewmember with minimal sonography training was remotely guided by an imaging expert from Mission Control Center (MCC) through a comprehensive ultrasound examination of the eye. A multipurpose ultrasound imager was used in conjunction with a space-to-ground video downlink and two-way audio. Reference cards with topological reference points, hardware controls, and target images were used to facilitate the examination. Multiple views of the eye structures were obtained through a closed eyelid. Pupillary response to light was demonstrated by modifying the light exposure of the contralateral eye. RESULTS: A crewmember on the ISS was able to complete a comprehensive ocular examination using B- and M-mode ultrasonography with remote guidance from an expert in the MCC. Multiple anteroposterior, oblique, and coronal views of the eye clearly demonstrated the anatomic structures of both segments of the globe. The iris and pupil were readily visualized with probe manipulation. Pupillary diameter was assessed in real time in B- and M-mode displays. The anatomic detail and fidelity of ultrasound video were excellent and could be used to answer a variety of clinical and space physiologic questions. CONCLUSIONS: A comprehensive, high-quality ultrasound examination of the eye was performed with a multipurpose imager aboard the ISS by a non-expert operator using remote guidance. Ocular ultrasound images were of diagnostic quality despite the 2-second communication latency and the unconventional setting of a weightless spacecraft environment. The remote guidance techniques developed to facilitate this successful NASA research experiment will support wider applications of ultrasound for remote medicine on Earth including the assessment of pupillary reactions in patients with severe craniofacial trauma and swelling.

Clinical Trial

Smart Ultrasound Remote Guidance Experiment (SURGE) Preliminary Findings

To date, diagnostic quality ultrasound images were obtained aboard the International Space Station (ISS) using the ultrasound of the Human Research Facility (HRF) rack in the Laboratory module. Through the Advanced Diagnostic Ultrasound in Microgravity (ADUM) and the Braslet-M Occlusion Cuffs (BRASLET SDTO) studies, non-expert ultrasound operators aboard the ISS have performed cardiac, thoracic, abdominal, vascular, ocular, and musculoskeletal ultrasound assessments using remote guidance from ground-based ultrasound experts. With exploration class missions to the lunar and Martian surfaces on the horizon, crew medical officers will necessarily need to operate with greater autonomy given communication delays (round trip times of up to 5 seconds for the Moon and 90 minutes for Mars) and longer periods of communication blackouts (due to orbital constraints of communication assets). The SURGE project explored the feasibility and training requirements of having non-expert ultrasound operators perform autonomous ultrasound assessments in a simulated exploration mission outpost. The project aimed to identify experience, training, and human factors requirements for crew medical officers to perform autonomous ultrasonography. All of these aims pertained to the following risks from the NASA Bioastronautics Road Map: 1) Risk 18: Major Illness and Trauna; 2) Risk 20) Ambulatory Care; 3) Risk 22: Medical Informatics, Technologies, and Support Systems; and 4) Risk 23: Medical Skill Training and Maintenance.

Hurst, Victor

Optic Nerve Sheath Diameter: Translating a Terrestrial Focused Technique Into a Clinical Monitoring Tool for Space Flight

Emergency medicine physicians recently adopted the use of ultrasonography to quickly measure optic nerve sheath diameter (ONSD) as concomitant with increased intracranial pressure. NASA Space and Clinical Operations Division has been using ground and on-orbit ultrasound capabilities since 2009 to consider this anatomical measure as a proxy for intracranial pressure in the microgravity environment. In the terrestrial emergency room population, an ONSD greater than 0.59 cm is considered highly predictive of elevated intracranial pressure. However, this cut-off limit is not applicable to the spaceflight setting since over 50% of US Operating Segment (USOS) astronauts have an ONSD greater than 0.60 cm even before missions. Crew Surgeon clinical decision-making is complicated by the fact that many astronauts have history of previous spaceflights. Data will be presented characterizing the distribution of baseline ONSD in the astronaut corps, longitudinal trends in-flight, and the predictive power of this measure related to increased intracranial pressure outcomes.

Mason, Sara S.

Evidence Based Medicine in Space Flight: Evaluation of Inflight Vision Data for Operational Decision-Making

Due to recently identified vision changes associated with space flight, JSC Space and Clinical Operations (SCO) implemented broad mission‐related vision testing starting in 2009. Optical Coherence Tomography (OCT), 3 Tesla Brain and Orbit MRIs, Optical Biometry were implemented terrestrially for clinical monitoring. While no inflight vision testing was in place, already available onorbit technology was leveraged to facilitate in‐flight clinical monitoring, including visual acuity, Amsler grid, tonometry, and ultrasonography. In 2013, on‐orbit testing capabilities were expanded to include contrast sensitivity testing and OCT. As these additional testing capabilities have been added, resource prioritization, particularly crew time, is under evaluation.

Van Baalen, Mary

Optic Nerve Sheath Diameter: Translating a Terrestrial Focused Technique into a Clinical Monitoring Tool for Spaceflight

Ultrasonography is increasingly used to quickly measure optic nerve sheath diameter (ONSD) when increased intracranial pressure (ICP) is suspected. NASA Space and Clinical Operations Division has been using ground and on‐orbit ultrasound since 2009 as a proxy for ICP in non‐acute monitoring for space medicine purposes. In the terrestrial emergency room population, an ONSD greater than 0.59 cm is considered highly predictive of elevated intracranial pressure. However, this cut‐off limit is not applicable to the spaceflight setting since over 50% of US Operating Segment (USOS) astronauts have an ONSD greater than 0.60 cm even before launch. Crew Surgeon clinical decision‐making is complicated by the fact that many astronauts have history of previous spaceflights. Our data characterize the distribution of baseline ONSD in the astronaut corps, its longitudinal trends in long‐duration spaceflight, and the predictive power of this measure related to increased ICP outcomes.

Mason, Sara

Expanding Biological Repository Data Available for Sharing and Knowledge Discovery

Biology has developed next-generation data science and alternative analytical approaches with methodologies which require principal investigator (PI) experimental assay data be re-used. This new approach involves mining multiple datasets at once from various hierarchical organizations of biological complexity, while concurrently evaluating how experimental factors affect endpoints of standard assays. The purpose of the NASA Ames Life Sciences Data Archive (ALSDA) is to collect, curate, and make findable, accessible, interoperable, and reusable (FAIR) all non-human space-relevant biological data. These data include mission metadata, subject metadata, assay metadata (parameters), raw and processed assay data, assay imagery, and subject-experienced telemetry (radiation, temperature, humidity, acoustics, vibrations). ALSDA has transformed to bring current biological repository data and all future collected data into this new scientific data mining reality. It has integrated into the ‘NASA Open Science’ group of projects to facilitate a suite of new tools and workflows to improve data accessibility and reusability by implementing data management plans, automating data submission agreements, and adopting the single-point-of-entry data submission portal, originally developed by NASA GeneLab. These systems required ALSDA to develop science assay configurations for the submission portal, capturing essential assay parameters according to established norms in each sub-field within biology. The submission portal expedites data collection by enhancing ease of PI data submission, providing a user interface and specificity for which data is to be submitted. ALSDA datasets are curated to maintain rich metadata, accuracy of datasets, data transparency, provenance, and additionally ensure data are machine-readable (e.g., R and Python languages). ALSDA integration with GeneLab and its analysis portals enable higher-order physiological-level datasets be mined in conjunction with -omics datasets. As ALSDA physiological-level datasets are published (micro-computed tomography, histology, intraocular pressure, hormonal assays, immunostaining, ultrasonography), the merging of hierarchical organizations of biological complexity from spaceflight will enable new knowledge discovery approaches.

Ryan T Scott