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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↗

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↗

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↗

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↗

NASA NTRS2020

Medics: Medical Decision Support System for Long-Duration Space Exploration

The Autonomous Medical Operations (AMO) group at NASA Ames is developing a “medical decision support system” to enable astronauts on long-duration exploration missions to operate autonomously. The system will support clinical actions by providing medical interpretation advice and procedural recommendations during emergent care and clinical work performed by crew. The current state of development of the system, called MedICS (Medical Interpretation Classification and Segmentation) includes two separate aspects: a set of machine learning diagnostic models trained to analyze organ images and patient health records, and an interface to ultrasound diagnostic hardware and to medical repositories. Three sets of images of different organs and medical records were utilized for training machine learning models for various analyses, as follows: 1. Pneumothorax condition (collapsed lung). The trained model provides a positive or negative diagnosis of the condition. 2. Carotid artery occlusion. The trained model produces a diagnosis of 5 different occlusion levels (including “normal”). 3. Ocular retinal images. The model extracts optic disc pixels (image segmentation). This is a precursor step for advanced autonomous fundus clinical evaluation algorithms to be implemented in FY20. 4. Medical health records. The model produces a differential diagnosis for any particular individual, based on symptoms and other health and demographic information. A probability is calculated for each of 25 most common conditions. The same model provides the likelihood of survival. All results are provided with a confidence level. Item 1 images were provided by the US Army and were part of a data set for the clinical treatment of injured battlefield soldiers. This condition is relevant to possible space mishaps, due to pressure management issues. Item 2 images were provided by Houston Methodist Hospital, and item 3 health records were acquired from the MIT laboratory of computational physiology. The machine learning technology utilized is deep multilayer networks (Deep Learning), and new models will continue to be produced, as relevant data is made available and specific health needs of astronaut crews are identified. The interfacing aspects of the system include a GUI for running the different models, and retrieving and storing data, as well as support for integration with an augmented reality (AR) system deployed at JSC by Tietronix Software Inc. (HoloLens). The AR system provides guidance for the placement of an ultrasound transducer that captures images to be sent to the MedICS system for diagnosis. The image captured and the associated diagnosis appear in the technician’s AR visual display.

Colombano, Silvano↗

NASA NTRSDate not supplied

Crowd Sourcing Medical Data Collection Using Medical Students

OBJECTIVE We undertook an upgrade of the Evidence Library database of NASA HRP’s Integrated Medical Model, assessing 120 medical conditions which integrate with a novel probabilistic risk assessment (IMPACT) tool of medical risk and resource utilization for long duration exploration human spaceflight. This data collection process included a selection of these conditions crowd sourced over one year via three 4-week medical student electives at the University of Colorado School of Medicine (IDPT 8059 Space Medicine: Human Spaceflight Factors & Medical Risk Assessment). Students undertook a rapid systematic review of each medical condition, under close preceptors with backgrounds in clinical medicine, library science, epidemiology, biostatistics, and evidence-based medicine. As part of the elective, students also received instruction in core space medicine concepts, evidence based medicine and problem based learning sessions as a flight surgeon supporting a simulated Mars mission. METHODS The list of 120 medical conditions includes both common, terrestrial illness/injury (epistaxis, diverticulitis) as well as spaceflight-specific ones (space adaptation conditions, EVA-related injuries). A rapid systematic review process was developed that would allow students to find the data for determining disease incidence/prevalence, return to definitive care (often a surrogate such as hospitalization rates), loss of crew life, and treatment duration. Each data point required a tailored, specialized search process using different databases and corresponding specialized search filters. Databases were selected on their ability to provide high quality literature in an efficient manner and prioritized by their ability to provide graded evidence via a set rubrics specific to human spaceflight. Students were responsible for performing all literature searches and identifying the highest quality available evidence for each data point. Completed student data sheets underwent initial review by faculty preceptors followed by a secondary editing review by the ExMC Clinical Science Team. RESULTS Over the course of three electives, approximately 105 medical conditions were researched by students using spreadsheets with pre-crafted search strategies. Overall, this process was successful in allowing students to perform the preponderance of work to update incidence, treatment duration, return to definitive care, and loss of crew life data points. Students were successful in running searches, identifying the necessary data points within the literature, and determining the types of terrestrial data that most aligns with the astronaut population for successful completion of their tasks. Limitations included variable student experience with search methodologies [PubMed], differing values of evidence grading [best practice evidence based medicine vs. relevant to spaceflight], and students’ unfamiliarity with spaceflight specific conditions. CONCLUSION Finding the relevant literature for medical conditions in spaceflight within terrestrial databases in a systematic method is time consuming and not intuitive. However, the stepwise process that balanced sensitivity with specificity allowed for students to be highly successful in a short amount of time. Additionally, as the process was refined over the course of three electives, preceptors were better able to anticipate where students were likely to encounter barriers, which allowed the course to be adjusted to account for certain data points needing more time for completion. This replicable process may be an efficient way to accomplish rapid systematic reviews for a large volume of data in a short amount of time.

J Lemery↗

NASA NTRSDate not supplied

Exploration Medical Capability - Advancing Medical System Design and Risk-Informed Decision Making for Deep Space Exploration

BACKGROUND: Within NASA’s Human Research Program, the Exploration Medical Capability (ExMC) Element has three primary focus areas: clinical and scientific research, systems engineering and trade space analysis, and technology development and demonstrations. These focus areas feed into the overarching goal of enabling progressively Earth-Independent Medical Operations (EIMO), a new paradigm that will be necessary for future Artemis and Mars medical and vehicle systems. This EIMO end state aligns with NASA’s Moon to Mars Objectives, which clearly outline the need for NASA deep space exploration missions to reduce their reliance upon Earth and become increasingly autonomous, in preparation for the first human Mars mission. OVERVIEW: To advance exploration medical systems and ultimately, integrated crew health and performance systems, ExMC’s portfolio includes: funding ground development & testing of novel medical capabilities; creation of new approaches for the development of medical protocols and procedures; deployment of innovative technologies into analog environments; technology demonstrations in spaceflight; and eventual transition to operations of new capabilities for deep space exploration missions. The portfolio also includes: pharmaceutical research targeting stability, pharmacokinetics, and pharmacodynamics; integrated data architectures and clinical decision support tools; and systems engineering and trade space analysis tools to assist NASA in the development of future medical system models as well as the medical system requirements that can serve as a foundation for deep space exploration missions. All of these investments are done in a collaborative and coordinated fashion with other NASA stakeholders, such as the Environmental Control and Life Support Systems – Crew Health and Performance System Capability Leadership Team and the Health and Medical Technical Authority. DISCUSSION: In this presentation, ExMC will provide an overview of our work from across our portfolio, all of which will inform future EIMO efforts at NASA. ExMC’s research and development investments are targeted to reduce the human system risks associated with deep space exploration to the Moon and Mars.

Kris Lehnhardt↗

NASA NTRS2018

Validation of the Nasa Integrated Medical Model: a Space Flight Medical Risk Prediction Tool

The Human Research Program funded the development of the Integrated Medical Model (IMM) to quantify the medical component of overall mission risk. The IMM uses Monte Carlo simulation methodology, incorporating space flight and ground medical data, to estimate the probability of mission medical outcomes and resource utilization. To determine the credibility of IMM output, the IMM project team completed two validation studies that compared IMM predicted output to observed medical events from a selection of Shuttle Transportation System (STS) and International Space Station (ISS) missions. The validation study results showed that the IMM underpredicted the occurrence of ~10% of the modeled medical conditions for the STS missions and overpredicted ~20% of the modeled medical conditions for the ISS missions. These findings imply that the strength of IMM predictions to inform decisions depends on simulated mission specifications including length. This discrepancy could result from medical recording differences between ISS and STS that possibly influence observed incidence rates, IMM combining all "mission type" data as constant occurrence rate or fixed proportion across both mission types, misspecification of symptoms to conditions, and gaps in the literature informing the model. Some of these issues will be alleviated by updating the IMM source data through incorporation of the observed validation data.

medical equipment↗