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Hamilton, Douglas R.

Publications and source records attributed to Hamilton, Douglas R..

At least 19 records
All sourcesNASA NTRSDOE OSTI
NASA NTRS2012

Quantification of Posterior Globe Flattening: Methodology Development and Validation

Microgravity exposure affects visual acuity in a subset of astronauts and mechanisms may include structural changes in the posterior globe and orbit. Particularly, posterior globe flattening has been implicated in the eyes of several astronauts. This phenomenon is known to affect some terrestrial patient populations and has been shown to be associated with intracranial hypertension. It is commonly assessed by magnetic resonance imaging (MRI), computed tomography (CT) or B-mode Ultrasound (US), without consistent objective criteria. NASA uses a semiquantitative scale of 0-3 as part of eye/orbit MRI and US analysis for occupational monitoring purposes. The goal of this study was ot initiate development of an objective quantification methodology to monitor small changes in posterior globe flattening.

Lumpkins, Sarah B.↗
NASA NTRS2011

Imaging Modalities Relevant to Intracranial Pressure Assessment in Astronauts

Learning Objectives of this slide presentation are: 1: To review the morphological changes in orbit structures caused by elevated Intracranial Pressure (ICP), and their imaging representation. 2: To learn about the similarities and differences between MRI and sonographic imaging of the eye and orbit. 3: To learn about the role of MRI and sonography in the noninvasive assessment of intracranial pressure in aerospace medicine, and the added benefits from their combined interpretation.

Sargsyan, Ashot E.↗
NASA NTRS2010

Imaging Modalities Relevant to Intracranial Pressure Assessment in Astronauts: A Case-Based Discussion

Introduction: Intracranial pressure (ICP) elevation has been inferred or documented in a number of space crewmembers. Recent advances in noninvasive imaging technology offer new possibilities for ICP assessment. Most International Space Station (ISS) partner agencies have adopted a battery of occupational health monitoring tests including magnetic resonance imaging (MRI) pre- and postflight, and high-resolution sonography of the orbital structures in all mission phases including during flight. We hypothesize that joint consideration of data from the two techniques has the potential to improve quality and continuity of crewmember monitoring and care. Methods: Specially designed MRI and sonographic protocols were used to image eyes and optic nerves (ON) including the meningeal sheaths. Specific crewmembers multi-modality imaging data were analyzed to identify points of mutual validation as well as unique features of complementary nature. Results and Conclusion: Magnetic resonance imaging (MRI) and high-resolution sonography are both tomographic methods, however images obtained by the two modalities are based on different physical phenomena and use different acquisition principles. Consideration of the images acquired by these two modalities allows cross-validating findings related to the volume and fluid content of the ON subarachnoid space, shape of the globe, and other anatomical features of the orbit. Each of the imaging modalities also has unique advantages, making them complementary techniques.

Sargsyan, Ashot E.↗
NASA NTRS2010

Noninvasive Techniques for Intracranial Pressure Assessment: A Review from Aerospace Medicine Perspective

Microgravity-induced changes in fluid distribution and other physiological factors due to space flight have been implicated as the cause of increased intracranial pressure (ICP) in a number of space crewmembers. The modest levels of ICP elevation and absence of severe symptoms in this group do not warrant invasive diagnostic interventions. However, the long-term trends and residual or consequential changes secondary to the observed ICP elevation in this group are not yet known. Therefore, close attention is needed to evaluate the potential techniques of noninvasively assessing ICP, including those feasible for in-flight use. Of particular interest is continuity between ground and in-flight testing, whereby data from the same or different techniques allow reasonably dependable estimation of ICP trends and responses. Methods: A thorough review of current literature, analysis of NASA data, and interviews with subject matter experts were conducted to construct a presentation that reflects the state of the art for noninvasive ICP measurement and monitoring. Results: Multiple imaging and non-imaging modalities are available to assess ICP in terrestrial clinical and experimental environments. Imaging alternatives include magnetic resonance imaging (MRI) and high-resolution sonography. Non-imaging techniques include transcranial Doppler, certain audiological methods, and venous ophthalmodynamometry, among others. Special functional techniques have been proposed recently that allow the use of advanced MRI methods to calculate ICP in addition to the acquisition of high-resolution images. Our data include many of these applications, with several cases of correlation with lumbar puncture, the invasive "gold standard" measurement of ICP.

Hamilton, Douglas R.↗
NASA NTRS2010

On-Orbit Prospective Echocardiography on International Space Station

A number of echocardiographic research projects and experiments have been flown on almost every space vehicle since 1970, but validation of standard methods and the determination of Space Normal cardiac function has not been reported to date. Advanced Diagnostics in Microgravity (ADUM) -remote guided echocardiographic technique provides a novel and effective approach to on-board assessment of cardiac physiology and structure using a just-in-time training algorithm and real-time remote guidance aboard the International Space Station (ISS). The validation of remotely guided echocardiographic techniques provides the procedures and protocols to perform scientific and clinical echocardiography on the ISS and the Moon. The objectives of this study were: 1.To confirm the ability of non-physician astronaut/cosmonaut crewmembers to perform clinically relevant remotely guided echocardiography using the Human Research Facility on board the ISS. 2.To compare the preflight, postflight and in-flight echocardiographic parameters commonly used in clinical medicine.

Hamilton, Douglas R.↗
NASA NTRS2010

Right Ventricular Tissue Doppler in Space Flight

The presentation slides review normal physiology of the right ventricle in space, general physiology of the right ventricle; difficulties in imaging the heart in space, imaging methods, tissue Doppler spectrum, right ventricle tissue Doppler, and Rt Tei Index.

Garcia, Kathleen M.↗
NASA NTRS2010

Atrial Fibrillation During an Exploration Class Mission

Background: A long-duration exploration class mission is fraught with numerous medical contingency plans. Herein, we explore the challenges of symptomatic atrial fibrillation (AF) occurring during an exploration class mission. The actions and resources required to ameliorate the situation, including the availability of appropriate pharmaceuticals, monitoring devices, treatment modalities, and communication protocols will be investigated. Challenges of Atrial Fibrillation during an Exploration Mission: Numerous etiologies are responsible for the initiation of AF. On Earth, we have the time and medical resources to evaluate and determine the causative situation for most cases of AF and initiate therapy accordingly. During a long-duration exploration class mission resources will be severely restricted. How is one to determine if new onset AF is due to recent myocardial infarction, pulmonary embolism, fluid overload, thyrotoxicosis, cardiac structural abnormalities, or CO poisoning? Which pharmaceutical therapy should be initiated and what potential side effects can be expected? Should anti-coagulation therapy be initiated? How would one monitor the therapeutic treatment of AF in microgravity? What training would medical officers require, and which communication strategies should be developed to enable the best, safest therapeutic options for treatment of AF during a long-duration exploration class mission? Summary: These questions will be investigated with expert opinion on disease elucidation, efficient pharmacology, therapeutic monitoring, telecommunication strategies, and mission cost parameters with emphasis on atrial fibrillation being just one illustration of the tremendous challenges that face a long-duration exploration mission. The limited crew training time, medical hardware, and drugs manifested to deal with such an event predicate that aggressive primary and secondary prevention strategies be developed to protect a multibillion-dollar asset like the International Space Station or a mission to the Moon or Mars. Learning Objectives: The audience will become familiar with the risks and challenges inherent to developing a therapeutic strategy for the treatment of atrial fibrillation during a long-term exploration class mission.

Lipset, Mark A.↗
NASA NTRS2010

On-Orbit Prospective Echocardiography on International Space Station Crew

Introduction A prospective trial of echocardiography was conducted on of six crewmembers onboard the International Space Station. The main objective was to determine the efficacy of remotely guided tele-echocardiography, including just-in-time e-training methods and determine what "space normal" echocardiographic data is. Methods Each crewmember operator (n=6) had 2-hour preflight training. Baseline echocardiographic data were collected 55 to 167days preflight. Similar equipment was used in each 60-minute in-flight session (mean microgravity exposure - 114 days (34 -- 190)). On Orbit ultrasound operators used an e-learning system within 24h of these sessions. Expert assistance was provided using ultrasound video downlink and two-way voice. Testing was repeated 5 to 16 days after landing. Separate ANOVA was used on each echocardiographic variable (n=33). Within each ANOVA, three tests were made: a) effect of mission phase (preflight, in-flight, post flight); b) effect of echo technician (two technicians independently analyzed the data); c) interaction between mission phase and technician. Results Nine rejections of the null hypothesis (mission phase or technician or both had no effect) were discovered and considered for follow up. Of these, six rejections were for significant technician effects, not as a result of space flight. Three rejections of the null hypothesis (Aortic Valve time velocity integral, Mitral E wave Velocity and heart rate) were attributable to space flight, however determined not to be clinically significant. No rejections were due to the interaction between technician and space flight. Conclusion No consistent clinically significant effects of long-duration space flight were seen in echocardiographic variables of the given group of subjects.

Hamilton, Douglas R.↗
NASA NTRS2010

Ultrasound Fracture Diagnosis in Space

Introduction: This ground-based investigation accumulated high-level clinical evidence on the sensitivity and specificity of point of care ultrasound performed by expert and novice users for the rapid diagnosis of musculoskeletal (MSK) injuries. We developed preliminary educational methodologies to provide just-in-time training of novice users by creating multi-media training tools and imaging procedures for non expert operators and evaluated the sensitivity and specificity of non-expert performed musculoskeletal ultrasound to diagnose acute injuries in a Level 1 Trauma Center. Methods: Patients with potential MSK injuries were identified in the emergency room. A focused MSK ultrasound was performed by expert operators and compared to standard radiographs. A repeat examination was performed by non-expert operators who received a short, just-in-time multimedia education aid. The sensitivity and specificity of the expert and novice ultrasound examinations were compared to gold standard radiography. Results: Over 800 patients were enrolled in this study. The sensitivity and specificity of expert performed ultrasound exceeded 98% for MSK injuries. Novice operators achieved 97% sensitivity and 99% specificity for targeted examinations with the greatest error in fractures involving the hand and foot. Conclusion: Point of care ultrasound is a sensitive and specific diagnostic test for MSK injury when performed by experts and just-in-time trained novice operators.

Dulchavsky, Scott A.↗
NASA NTRS2010

Ultrasound Imaging of Spine: State of the Art and Utility for Space Flight

Introduction: Ultrasound imaging (sonography) has been increasingly used for both primary diagnosis and monitoring of musculoskeletal injury, including fractures. In certain injuries, sonography has been shown to equal or surpass Magnetic Resonance Imaging in accuracy. Long-term exposure to reduced gravity may be expected to cause physiological and anatomical changes of the musculoskeletal system, which are not fully described or understood. In a limited-resource environment like space flight, sonography will likely remain the only imaging modality; therefore, further attention to its potential is warranted, including its ability to image anatomical deviations as well as irregularities of vertebrae and the spinal column. Methods: A thorough review of literature was conducted on the subject. A multipurpose ultrasound system was used to identify specific vertebrae, intervertebral disks, and other structures of the cervical spine in healthy volunteers, selected to represent various age, gender, and Body Mass Index (BMI) groups. Sonographic views were sought that would parallel radiographic views and signs used in the diagnosis of cervical spine injuries. Results: While using widely accepted radiographic signs of cervical spine injury, this sonographic protocol development effort resulted in successful identification of scanning planes and imaging protocols that could serve as alternatives for radiography. Some of these views are also applicable to diagnosing degenerative disk and bone disease, and other non-traumatic spine pathology. Strong, preliminary correlation has been demonstrated in a number of clinical cases between sonography and other imaging modalities. Conclusion: In the absence of radiography, sonography can be used to diagnose or rule out certain common types of cervical spine conditions including injury. Clinical validation of the findings appears to be realistic and would facilitate establishment of new sonographic protocols for special environments with lacking radiographic capability, such as human space flight.

Sargsyan, Ashot E.↗
NASA NTRS2009

Cardiac Atrophy and Diastolic Dysfunction During and After Long Duration Spaceflight: Functional Consequences for Orthostatic Intolerance, Exercise Capability and Risk for Cardiac Arrhythmias

Cardiac Atrophy and Diastolic Dysfunction During and After Long Duration Spaceflight: Functional Consequences for Orthostatic Intolerance, Exercise Capability and Risk for Cardiac Arrhythmias (Integrated Cardiovascular) will quantify the extent of long-duration space flightassociated cardiac atrophy (deterioration) on the International Space Station crewmembers.

Levine, Benjamin D.↗
NASA NTRS2009

Results of a Prospective Echocardiography Trial in International Space Station Crew

In the framework of an operationally oriented investigation, we conducted a prospective trial of a standard clinical echocardiography protocol in a cohort of long-duration crewmembers. The resulting primary and processed data appear to have no precedents. Our tele-echocardiography paradigm, including just-in-time e-training methods, was also assessed. A critical review of the imaging technique, equipment and setting limitations, and quality assurance is provided, as well as the analysis of "space normal" data.

Hamilton, Douglas R.↗
NASA NTRS2009

Acute Hemodynamic Effects of the Braslet-M Device on the International Space Station

The Braslet-M occlusion device is prescribed for cosmonauts as a countermeasure for early phases of spaceflight to temporarily alleviate symptoms associated with the cephalad fluid shift. Using a multipurpose ultrasound (US) device onboard, we assessed the acute hemodynamic effects of the Bracelet-M device on a long duration International Space Station (ISS) crewmember. Methods A combination of just-in-time training and real-time remote expert assistance was used to conduct the imaging procedures. An HDI-5000 imager (Philips, Bothell, WA) was used, provided by the ISS Human Research Facility. Superficial femoral artery (SFA), femoral vein (FV) flow spectra were obtained at mid-thigh level. Left ventricle was imaged through the apical 4-chamber view, with Color M-Mode to measure propagation velocity (V (p)). After 10 minutes of Bracelet-M use, data collection was repeated. All data were transmitted in DICOM format to ground for analysis. Results With Braslet-M, cardiac V(p) slope decreased (56ms to 42ms). A stagnation signature in the FV was seen suggesting impeded flow (rouleaux formation, too-low-to-measure velocity, and increase in diameter). Quadri-phasic flow in SFA was seen both before and after Braslet-M application. Velocities in the SFA decreased with Braslet-M (65cm/sec to 52cm/sec) and so did the time velocity integrals (16.97 to 12.4); the flow pattern spoke of resistivity increase in the vascular bed. Conclusion In the long duration ISS crewmember we observed effects of lower extremity venous occlusion through both central and peripheral indicators. A part of circulating volume transferred to peripheral potential vascular space. Impediment to venous outflow was demonstrated objectively, with a commensurate change in the flow pattern of the main feeding artery. Central volume reduction caused lower V(p). Additional studies are warranted to determine the time course of the changes and the dynamics in interstitial fluid sequestration, as well as the safe levels and duration of the compression forces.

Hamilton, Douglas R.↗
NASA NTRS2009

Medical Challenges of the First Canadian Long-Duration Space Mission: Lessons Learned

In 2008, Dr. Thirsk was assigned to the crew of Expedition 20/21. This Expedition represented a milestone for the Canadian Space Program since it was the first time that a Canadian would take part in a long-duration mission. Robert Thirsk had the privilege of expanding the boundaries of space exploration by living and working on board the International Space Station for six months. The launch took place on May 27, 2009 aboard a Soyuz rocket from the Cosmodrome in Baikonur, Kazakhstan. This abstract was written before Dr. Thirsk returned to Kazakhstan. Objective: To gather all medically relevant data needed to support the first Canadian long-duration mission in space, and process it to derive lessons learned for presentation and for public disclosure. Methods: Sources of data used for analysis for Expedition 20 on International Space Station included flight selection data, maintenance annual physicals, Flight Medicine Clinic visits, parabolic flight experiments, preflight exams and baseline data collections, daily in-flight exercise countermeasure and science payloads, weekly periodic fitness, nutrition, radiation and payload assessments, postflight medical exams, rehabilitation, and science activities.

Hamilton, Douglas R.↗
NASA NTRS2009

Right Ventricular Tissue Doppler in Space Flight

Tissue Doppler (TD) registers movement of a given sample of cardiac tissue throughout the cardiac cycle. TD spectra of the right ventricle (RV) were obtained from a long-duration ISS crewmember as a portion of an ongoing experiment ("Braslet" test objective). To our knowledge, this is the first report of RV TD conducted in space flight, and the data represent reproducibility and fidelity of this application in space and serve as the first "space normal" data set. Methods RV TD was performed by astronaut scientists remotely guided by an ultrasound expert from Mission Control Center, Houston, TX. In four of the subjects, RV TD was acquired from the free wall near the tricuspid annulus in two separate sessions 4 to 7 days apart. A fifth subject had only one session. All digital DICOM frames were exported for off-line analysis. Systolic (S ), early diastolic (E ) and late diastolic (A ) velocities were measured. RV Tei-index was calculated using diastolic and systolic time intervals as a combined measure of myocardial performance. Results and Discussion The mean values from the first 4 subjects (8 sessions) were used as the on-orbit reference data, and subject 5 was considered as a hypothetical patient for comparison (see Table). The greatest difference was in the early diastolic A (31 %) yet the standard deviation (a) for A amongst the reference subjects was 2.25 (mean = 16.02). Of interest is the Tei index, a simple and feasible indicator of overall ventricular function; it was similar amongst all the subjects. The late diastolic A seems to compensate for the variance in E . Normal Tei index for the RV is < 0.3, yet our data show all but one subject consistently above this level, notwithstanding their nominal responses to daily exercise in microgravity. These data remind us that the physiology of RV preload in altered gravity environments is still not completely understood.

Hamilton, Douglas R.↗
NASA NTRS2007

Diagnostic Imaging in the Medical Support of the Future Missions to the Moon

This viewgraph presentation is a course that reviews the diagnostic imaging techniques available for medical support on the future moon missions. The educational objectives of the course are to: 1) Update the audience on the curreultrasound imaging in space flight; 2) Discuss the unique aspects of conducting ultrasound imaging on ISS, interplanetary transit, ultrasound imaging on ISS, interplanetary transit, and lunar surface operations; and 3) Review preliminary data obtained in simulations of medical imaging in lunar surface operations.

Sargsyan, Ashot E.↗