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Orthopedic evaluation

The clinical performance of the Lixiscope in orthopedics was compared with routine radiography. Portability and size were the major advantages of the Lixiscope. The main disadvantage at this point in time was the Lixiscope's inability to study large areas.

Walden, T.

Ku-band electron linac for battery-powered hand-portable 2-MeV X-ray generator

X-ray generators, producing radiation in MeV range, are a critical tool for radiography, non-destructive testing and security applications. Field operation of such source requires them to be hand-portable, autonomous and allow parameter adjustability. RF linear accelerators can serve as a flexible, reliable, and robust radiation generator alternative to dangerous radioisotopes and bulky betatrons that are currently used for field radiography if their size, weight, cost, and imaging performance are matched to these sources. Here, in this paper, we present the design and test results of a 2 MeV Ku-band electron linac for a hand-portable X-ray generator system for field radiography being developed by RadiaBeam. The dramatic scale of miniaturization and cost-reduction is achieved thanks to the implementation of innovative technologies such as air-cooled Ku-band air-traffic control magnetrons, a split accelerating structure fabrication technique, and solid-state Marx modulators. This paper presents the design of the first prototype of the accelerator, its operation from Li-Ion batteries, as well as high-power and beam measurements.

43 PARTICLE ACCELERATORS

Using Digital Radiography To Image Liquid Nitrogen in Voids

Digital radiography by use of (1) a field-portable x-ray tube that emits low-energy x rays and (2) an electronic imaging x-ray detector has been found to be an effective technique for detecting liquid nitrogen inside voids in thermal-insulation panels. The technique was conceived as a means of investigating cryopumping (including cryoingestion) as a potential cause of loss of thermal insulation foam from space-shuttle external fuel tanks. The technique could just as well be used to investigate cryopumping and cryoingestion in other settings. In images formed by use of low-energy x-rays, one can clearly distinguish between voids filled with liquid nitrogen and those filled with gaseous nitrogen or other gases. Conventional film radiography is of some value, but yields only non-real-time still images that do not show time dependences of levels of liquids in voids. In contrast, the present digital radiographic technique yields a succession of images in real time at a rate of about 10 frames per second. The digitized images can be saved for subsequent analysis to extract data on time dependencies of levels of liquids and, hence, of flow paths and rates of filling and draining. The succession of images also amounts to a real-time motion picture that can be used as a guide to adjustment of test conditions.

Cox, Dwight

Assessing the Added Value of Miniature X-Ray in the Setting of Portable Ultrasound in Spaceflight

INTRODUCTION: Point-of-care ultrasound (POCUS) has become the standard of care for imaging diagnosis and management in low-Earth Orbit (LEO) spaceflight and it has long been hypothesized that POCUS will also be the standard of care for exploration spaceflight. However, like the trajectory for which ultrasound became more portable and user-friendly, the mass, volume, and power requirements of radiography devices for both diagnostic and therapeutic applications have also been dramatically reduced. This study seeks to determine the clinical utility and added value of miniature x-ray (XR) for the diagnosis and management of each of the 119 conditions within NASA Exploration Medical Capability’s IMPACT Condition List (ICL) given that the medical system is presumed to already be carrying a handheld portable POCUS device. METHODS: For each condition, a team of reviewers performed a rapid systematic literature review seeking sensitivity and specificity data for both handheld portable ultrasound and miniature XR. When there was a paucity of data, subject matter expertise and clinical experience was added to semi-quantitatively score the added value of miniature XR, given an US was already available for both diagnosis and management. Diagnostic utility of a modality for a condition was evaluated in the setting of both the best- and worst-case scenario definitions included and defined by the ICL. Evidence tracing and quality of evidence scores were also recorded. RESULTS/DISCUSSION: Conditions for which it was determined that miniature XR added diagnostic or therapeutic value are provided in this presentation. Previously presented work by our team has demonstrated that XR provides diagnostic and management capabilities that are hypothesized to complement or surpass ultrasound for over one-third of medical conditions that may arise during exploration spaceflight (i.e., diagnosis of injuries to the axial skeleton, teeth, and lungs as well as management of orthopedic reductions, endotracheal tube placement, and drain placement confirmation). In the setting of known inclusion of a handheld portable POCUS device, there remains significant added value of portable miniature XR. Whether or not this added clinical benefit is worth the mass, volume, and power requirements of the radiography system remains yet unknown and is the focus of future work. LEARNING OBJECTIVES: 1) Understand the value of ultrasound and radiography in the diagnosis and management of medical comorbidities that may arise in exploration spaceflight; 2) Understand the medical conditions of highest concern on exploration class missions for which miniature x-ray may provide added value to portable ultrasound.

J G Steller

Assessing the Added Value of Miniature X-Ray in the Setting of US in Spaceflight

INTRODUCTION: Point-of-care ultrasound (POCUS) has become the standard of care for imaging diagnosis and management in lowEarth Orbit (LEO) spaceflight and it has long been hypothesized that POCUS will also be the standard of care for exploration spaceflight. However, like the trajectory for which ultrasound became more portable and user-friendly, the mass, volume, and power requirements of radiography devices for both diagnostic and therapeutic applications have also been dramatically reduced. This study seeks to determine the clinical utility and added value of miniature x-ray (XR) for the diagnosis and management of each of the 119 conditions within NASA Exploration Medical Capability’s IMPACT Condition List (ICL) given that the medical system is presumed to already be carrying a handheld portable POCUS device. METHODS: For each condition, a team of reviewers performed a rapid systematic literature review seeking sensitivity and specificity data for both handheld portable ultrasound and miniature XR. When there was a paucity of data, subject matter expertise and clinical experience was added to semi-quantitatively score the added value of miniature XR, given an US was already available for both diagnosis and management. Diagnostic utility of a modality for a condition was evaluated in the setting of both the best- and worst-case scenario definitions included and defined by the ICL. Evidence tracing and quality of evidence scores were also recorded. RESULTS/DISCUSSION: Conditions for which it was determined that miniature XR added diagnostic or therapeutic value are provided in this presentation. Previously presented work by our team has demonstrated that XR provides diagnostic and management capabilities that are hypothesized to complement or surpass ultrasound for over one-third of medical conditions that may arise during exploration spaceflight (i.e., diagnosis of injuries to the axial skeleton, teeth, and lungs as well as management of orthopedic reductions, endotracheal tube placement, and drain placement confirmation). In the setting of known inclusion of a handheld portable POCUS device, there remains significant added value of portable miniature XR. Whether or not this added clinical benefit is worth the mass, volume, and power requirements of the radiography system remains yet unknown and is the focus of future work. LEARNING OBJECTIVES: 1) Understand the value of ultrasound and radiography in the diagnosis and management of medical comorbidities that may arise in exploration spaceflight; 2) Understand the medical conditions of highest concern on exploration class missions for which miniature x-ray may provide added value to portable ultrasound.

Jon Steller

Advanced Ultrasonic Diagnosis of Extremity Trauma: The Faster Exam

Ultrasound is of prO)len accuracy in abdominal and thoracic trauma and may be useful to diagnose extremity injury in situations where radiography is not available such as military and space applications. We prospectively evaluated the utility of extremity , ultrasound performed by trained, non-physician personnel in patients with extremity trauma, to simulate remote aerospace or military applications . Methods: Patients with extremity trauma were identified by history, physical examination, and radiographic studies. Ultrasound examination was performed bilaterally by nonphysician personnel with a portable ultrasound device using a 10-5 MHz linear probe, Images were video-recorded for later analysis against radiography by Fisher's exact test. The average time of examination was 4 minutes. Ultrasound accurately diagnosed extremity, injury in 94% of patients with no false positive exams; accuracy was greater in mid-shaft locations and least in the metacarpa/metatarsals. Soft tissue/tendon injury was readily visualized . Extremity ultrasound can be performed quickly and accurately by nonphysician personnel with excellent accuracy. Blinded verification of the utility of ultrasound in patients with extremity injury should be done to determine if Extremity and Respiratory evaluation should be added to the FAST examination (the FASTER exam) and verify the technique in remote locations such as military and aerospace applications.

Dulchavsky, S. A.

Low-intensity x-ray and gamma-ray imaging device

Low-dosage, low-power X-ray system can be made completely self-contained, allowing fluoroscopy and radiography to be carried out in field and remote locations. New device, known as "lixiscope," can be used with conventional X-ray machine turned down to low level, or, it can be operated with radioisotope source for hand-held portable applications. Originally developed for X-ray astronomy, lixiscope obtains high sensitivity by using intermediate stages of photoelectron conversion and electron amplification to generate image suitable for direct viewing or for recording on film.

Yin, L. I.

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

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

C A Haddix

Mission Implementation Constraints on Planetary Muon Radiography

Cost: Use heritage hardware, especially use a tested landing system to reduce cost (Phoenix or MSL EDL stage). The sky crane technology delivers higher mass to the surface and enables reaching targets at higher elevation, but at a higher mission cost. Rover vs. Stationary Lander: Rover-mounted instrument enables tomography, but the increased weight of the rover reduces the allowable payload weight. Mass is the critical design constraint for an instrument for a planetary mission. Many factors that are minor factors or do not enter into design considerations for terrestrial operation are important for a planetary application. (Landing site, diurnal temperature variation, instrument portability, shock/vibration)

entry, descent, and landing (EDL)

Goal-directed ultrasound in the detection of long-bone fractures

BACKGROUND: New portable ultrasound (US) systems are capable of detecting fractures in the remote setting. However, the accuracy of ultrasound by physicians with minimal ultrasound training is unknown. METHODS: After one hour of standardized training, physicians with minimal US experience clinically evaluated patients presenting with pain and trauma to the upper arm or leg. The investigators then performed a long-bone US evaluation, recording their impression of fracture presence or absence. Results of the examination were compared with routine plain or computer aided radiography (CT). RESULTS: 58 patients were examined. The sensitivity and specificity of US were 92.9% and 83.3%, and of the physical examination were 78.6% and 90.0%, respectively. US provided improved sensitivity with less specificity compared with physical examination in the detection of fractures in long bones. CONCLUSION: Ultrasound scans by minimally trained clinicians may be used to rule out a long-bone fracture in patients with a medium to low probability of fracture.

Validation Studies

Development of Inspection for Friction Stir Welds for Rocket Fuel Tanks

During development of the Ares I weld processes nondestructive and destructive testing were used to identify and characterize defects that occurred. These defects were named and character noted. This catalogue of defects and characteristics was then used to develop inspection methods for Self Reacting Friction Stir Welds (SR ]FSW) and Conventional Friction Stir Welds (C ]FSW). Dye penetrant, eddy current, x ]radiography, single element ultrasonic, and phased array ultrasonic (PAUT) inspection procedures were developed to target the expected defects. Once the method procedure was developed a comparison was performed to allow for selection of the best inspection method. Tests of the effectiveness of the inspection were performed on purposely fabricated flawed specimens and electrodischarge machined notches. The initial test results prompted a revisit of the PAUT procedure and a redesign of the inspection. Subsequent testing showed that a multi ]angle PAUT inspection resulted in better detection capability. A discussion of the most effective orientations of the PAUT transducer will be presented. Also, the implementation of the inspection on production hardware will be presented. In some cases the weld tool is used as the transducer manipulator and in some cases a portable scanner is used

Russell, Samuel S.