Results for “Medical System” — Page 12

NASA NTRS2015

Prioritizing Medical Resources for Exploration Missions

Long duration missions beyond low Earth orbit introduce new constraints to the medical system. Factors such as the inability to evacuate to Earth in a timely manner, communication delay, limitations in available medical equipment, and the clinical background of the crew will all have an impact on the assessment and treatment of medical conditions. The Exploration Medical Capability (ExMC) Element of NASAs Human Research Program seeks to improve the way the element derives its mitigation strategies for the risk of "Unacceptable Health and Mission Outcomes Due to Limitation of In‐flight Medical Capabilities."

Shah, R. V.↗

NASA NTRS1991

Landsat Legacy

The Landsat resources survey system spawned a number of companies engaged in commercial applications of remote sensing, among them International Imaging Systems (I2S). With initial NASA assistance, I2S has provided remote sensing hardware and software to several foreign countries, developed meteorological analysis systems, medical diagnostic software and scanning equipment for government and commercial use. Latest product is an advanced image-based photogrammetric system employing digital technology - not optical or mechanical systems - to generate terrain elevation data and other processing functions. Called PRI2SM, it compensates automatically for topographic relief displacement, is cheaper, faster, and easier to use and maintain. Company product line includes four major areas: image processing equipment for Earth Resources Management; meteorological analysis systems; satellite ground processing systems; and digital photogrammetric mapping systems.

Source record↗

NASA NTRSDate not supplied

Leveraging Nurse Informaticists for Development of the Impact Tool

The American Nurses Association (ANA) defines nursing informatics as the integration of “nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice. [1]” In additional to nursing education and clinical experience, this field requires additional education in areas of data analysis, database management, and clinical information systems. Nursing informaticists help bridge the communication gap between clinical and technical stakeholders which help align common goals. NASA is currently developing a new medical system trade analysis and decision support tool called IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces). The development team is comprised of multiple specialties including but not limited to clinicians (pharmacists, physicians, and nurse informaticists), software and program developers, human factors experts, and engineers. The nurse informaticists play a significant role in the development, operation, and results interpretation of IMPACT. Their expert knowledge and skills in both clinical nursing, information science, and database management place them in a unique position to collaborate and integrate with the clinical, engineering, and software development members of the team to achieve a cohesive, functional, and user-friendly model.

Lynn Boley↗

NASA NTRS2006

Development and Testing of an Axial Halbach Magnetic Bearing

The NASA Glenn Research Center has developed and tested a revolutionary Axial Halbach Magnetic Bearing. The objective of this work is to develop a viable non-contact magnetic thrust bearing utilizing Halbach arrays for all-electric flight, and many other applications. This concept will help to reduce harmful emissions, reduce the Nation s dependence on fossil fuels and mitigate many of the concerns and limitations encountered in conventional axial bearings such as bearing wear, leaks, seals and friction loss. The Axial Halbach Magnetic Bearing is inherently stable and requires no active feedback control system or superconductivity as required in many magnetic bearing designs. The Axial Halbach Magnetic Bearing is useful for very high speed applications including turbines, instrumentation, medical systems, computer memory systems, and space power systems such as flywheels. Magnetic fields suspend and support a rotor assembly within a stator. Advanced technologies developed for particle accelerators, and currently under development for maglev trains and rocket launchers, served as the basis for this application. Experimental hardware was successfully designed and developed to validate the basic principles and analyses. The report concludes that the implementation of Axial Halbach Magnetic Bearings can provide significant improvements in rotational system performance and reliability.

Eichenberg, Dennis J.↗

NASA NTRSDate not supplied

Implementation of a SysML Model-Based Concept of Operations for Level of Care IV: Long-Duration Lunar Orbital and Surface Operations

One goal of the Human Research Program (HRP) Exploration Medical Capability (ExMC) Element Systems Engineering (SE) team is to define the technical system needed to support crew medical system capabilities for future exploration missions, including orbital and surface operations for long duration lunar missions. This is accomplished through the development of a Medical System Foundation, which communicates medical system requirements, capabilities, conditions, and resources that define a starting point for a medical system that meets the specification for design reference missions and associated Levels of Care (as defined by NASA-STD-3001). The starting point for creating this Medical System Foundation Model is the development of a Concept of Operations (ConOps) that describes the operation of the system from the point of view of the users. It includes a comprehensive and thoroughly vetted list of the users, their specific needs, the goals of the system, key assumptions about the system, and definitions of the system’s operational environments. The use case scenarios included in the ConOps illustrate required medical system capabilities for Level of Care IV and enable the ExMC SE team to develop integrated medical system requirements and identify capabilities required to meet those requirements. For this “Long Duration” Medical System Foundation development effort, ExMC replaced the traditional document-based ConOps with a model-based ConOps using model-based systems engineering. This approach has several advantages, including the facilitation of more efficient understanding of the material through information-dense images with less opportunity for misinterpretation than text alone, the roll-out of changes to the ConOps to stakeholders in real-time as they are approved, and the consolidation of all salient information into one centralized location. This discussion will focus on both how the model represents the ConOps content and how the SE team utilized lessons learned in an agile environment to improve the way this information was created and presented to stakeholders.

M Kaetzer↗

NASA NTRSDate not supplied

Implementation of a SysML Model-Based Concept of Operations for Level of Care IV: Long-Duration Lunar Orbital and Surface Operations

One goal of the Human Research Program (HRP) Exploration Medical Capability (ExMC) Element Systems Engineering (SE) team is to define the technical system needed to support crew medical system capabilities for future exploration missions, including orbital and surface operations for long duration lunar missions. This is accomplished through the development of a Medical System Foundation, which communicates medical system requirements, capabilities, conditions, and resources that define a starting point for a medical system that meets the specification for design reference missions and associated Levels of Care (as defined by NASA-STD-3001). The starting point for creating this Medical System Foundation Model is the development of a Concept of Operations (ConOps) that describes the operation of the system from the point of view of the users. It includes a comprehensive and thoroughly vetted list of the users, their specific needs, the goals of the system, key assumptions about the system, and definitions of the system’s operational environments. The use case scenarios included in the ConOps illustrate required medical system capabilities for Level of Care IV and enable the ExMC SE team to develop integrated medical system requirements and identify capabilities required to meet those requirements. For this “Long Duration” Medical System Foundation development effort, ExMC replaced the traditional document-based ConOps with a model-based ConOps using model-based systems engineering. This approach has several advantages, including the facilitation of more efficient understanding of the material through information-dense images with less opportunity for misinterpretation than text alone, the roll-out of changes to the ConOps to stakeholders in real-time as they are approved, and the consolidation of all salient information into one centralized location. This discussion will focus on both how the model represents the ConOps content and how the SE team utilized lessons learned in an agile environment to improve the way this information was created and presented to stakeholders.

Mary Susan Kaetzer↗

NASA NTRSDate not supplied

Exploration Atmosphere Demonstration of A Multi-Functional Integrated Medical Device (Tempus Pro)

INTRODUCTION The Exploration Medical Capability (ExMC) element within the Human Research Program and the Exploration Medical Integrated Product Team (XMIPT) within the Mars Campaign Office seek to advance medical system design and risk-informed decision-making for exploration missions. This includes assessment of candidate devices and their compatibility within a variety of increasingly Earth-independent medical scenarios. The Tempus Pro (Remote Diagnostic Technologies, Ltd., Philips Corp., Farnborough, UK) is a commercial-off-the-shelf (COTS), multi-functional integrated medical device capable of vital signs monitoring, with built-in procedure support (iAssist), patient record and telemedicine communication features, and medical imaging (e.g., camera, laryngoscope, ultrasound) that meets multiple exploration medical capability needs. One of several hypobaric atmospheres being considered for exploration vehicles is 8.2 psi with 34% oxygen. To assess the useability of the Tempus Pro in such environments by individuals without formal medical training, the unit was tested in May and June of 2023 at the Johnson Space Center 20-Foot Exploration Atmosphere Chamber in conjunction with the Exploration Atmospheres-2 (EA-2) study. TECHNOLOGY DEMONSTRATION Eight subjects in the EA-2 study were assigned roles as the caregiver or patient – or both in the case of a self-exam – and caregivers were asked to place sensors for 3-Lead ECG, non-invasive blood pressure (NIBP), pulse oximetry (SpO2), and temperature using Tempus Pro’s iAssist. Depending on the procedure, additional tasks included an oropharyngeal exam of the throat with the laryngoscope and capturing ultrasound images of a cardiac subxiphoid view or of the user’s choice from a pre-specified list. Scenarios ranged from remote-guided to fully autonomous operations and surveyed the effectiveness of support, amount of support desired, and importance of support by type (e.g., written crew procedures, iAssist and device guidance, remote console guidance, etc.). Feedback from the subjects and the support personnel was also gathered to inform future designs for training and support and to determine what operations are plausible given different levels of each. An unweighted NASA task load index (TLX) was used to profile the demands of using the device, however the sample size does not support statistics. The research was exploratory in nature and qualitative information was the main goal. Calibration checks on the Tempus Pro were conducted before and after chamber testing to ensure the device was in useable condition. RESULTS All subjects performed their tasks successfully and found the Tempus Pro easy to use with the support provided. The calibration checks outside the chamber showed that the Tempus Pro remained unchanged and measurements inside the chamber were within normal values. Caregivers taking the NASA TLX reported mean scores ≤ 41/100 showing the tasks to be undemanding and less demanding with repeated use (~20/100). Novice users were able to easily connect sensors and take vital signs with the guidance from Tempus Pro’s iAssist feature. For more complex tasks, such as the oropharyngeal exam and ultrasound image acquisition, guidance beyond iAssist was needed, primarily from a supporting physician. Feedback on the importance of support types varied by person and scenario but greater than 50% of the support used by each was non-native to the device. Overall opinions were positive, but the ultrasound users expressed a lack of confidence in their results and 3 out of 4 desired more time, training, or support. Subjects found the sensors to be comfortable and comparable to prior experiences with such devices, except for the blood pressure cuff, which squeezed too tightly for uncomfortably long periods. Many observations provoked discussion, especially regarding ultrasound, that will aide decisions about future demonstrations.

R. S. Miller↗

NASA NTRS2018

International Space Station Multilateral Medical Policy Board Transitions in Space Medicine 25 Years in Photos

This collection of photographic highlights covers the past 25 years of international collaboration in human spaceflight. Beginning in 1993, the international community came together to develop the medical systems for an international space station. Initially, this collaboration was bilateral in support of the Shuttle / Mir Space Station (Phase 1). However, the framework that was established to serve as the medical authority structure provided a foundation for the multilateral boards and panel, which were codified in the memoranda of understanding.

Doarn, Charles R.↗

NASA NTRS2019

International Space Station Multilateral Medical Policy Board Transitions in Space Medicine: 25 Years in Photos

This collection of photographic highlights covers the past 25 years of international collaboration in human space flight. Beginning in 1993, the international community came together to develop the medical systems for an international space station. Initially, this collaboration was bilateral in support of the Shuttle / Mir Space Station (Phase 1). However, the framework that was established to serve as the medical authority structure provided a foundation for the multilateral boards and panel, which were codified in the memoranda of understanding. The Multilateral Medical Policy Board, the Multilateral Space Medicine Board, and the Multilateral Medical Operations Panel were developed in a collegial and mutually beneficial environment by the men and women of the space agencies of Canada, Europe, Japan, Russia, and the United States. This collection of photographs from official and personal collections captures the spirit and collegiality to which we have grown accustomed. They are also presented to commemorate the integrity, professionalism, tenacity, and dedication to human space exploration consistently demonstrated by individuals involved in this amazing effort.

photographs↗

NASA NTRSDate not supplied

Predictive Modeling to Assess and Address Challenges and Limitations Associated with Clinical Care and Decision Support in Deep Space

Probabilistic risk assessment (PRA) is a method for assessing and integrating the risk of failure in a multivariate system. While it is often applied by engineers designing complex machines, it could also be applied to humans to assess the probability of a health “failure” treating diseases as the multiple “variables” and the human as the “complex machine.” The Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) was developed to apply PRA to assess medical risk for exploration spaceflight and inform the design of medical systems for space flight. The NASA engineering community utilizes event-driven and fault tree probabilistic techniques to classify risk in the space flight environment by leveraging the inherent knowledge of complex space flight system design and testing to quantify risk. However, in harmonizing the risk of human space flight, answering the question of “How do we balance astronaut health, performance and resource risks with other engineering risks on exploration space missions?” remains a profoundly challenging and largely qualitative practice. The Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) is one aspect of the Human Research Program’s efforts to represent space fight human health and performance risks quantitatively.

L Mcintyre↗

NASA NTRS2014

Estimating the Risk of Renal Stone Events During Long-Duration Spaceflight

Introduction: Given the bone loss and increased urinary calcium excretion in the microgravity environment, persons participating in long-duration spaceflight may have an increased risk for renal stone formation. Renal stones are often an incidental finding of abdominal imaging studies done for other reasons. Thus, some crewmembers may have undiscovered, asymptomatic stones prior to their mission. Methods: An extensive literature search was conducted concerning the natural history of asymptomatic renal stones. For comparison, simulations were done using the Integrated Medical Model (IMM). The IMM is an evidence-based decision support tool that provides risk analysis and has the capability to optimize medical systems for missions by minimizing the occurrence of adverse mission outcomes such as evacuation and loss of crew life within specified mass and volume constraints. Results: The literature of the natural history of asymptomatic renal stones in the general medical population shows that the probability of symptomatic event is 8% to 34% at 1 to 3 years for stones < 7 mm. Extrapolated to a 6-month mission, for stones < 5 to 7 mm, the risk for any stone event is about 4 to 6%, with a 0.7% to 4% risk for intervention, respectively. IMM simulations compare favorably with risk estimates garnered from the terrestrial literature. The IMM forecasts that symptomatic renal stones may be one of the top drivers for medical evacuation of an International Space Station (ISS) mission. Discussion: Although the likelihood of a stone event is low, the consequences could be severe due to limitations of current ISS medical capabilities. Therefore, these risks need to be quantified to aid planning, limit crew morbidity and mitigate mission impacts. This will be especially critical for missions beyond earth orbit, where evacuation may not be an option.

Reyes, David↗

NASA NTRS2014

Estimating the Risk of Renal Stone Events during Long-Duration Spaceflight

Introduction: Given the bone loss and increased urinary calcium excretion in the microgravity environment, persons participating in long-duration spaceflight may have an increased risk for renal stone formation. Renal stones are often an incidental finding of abdominal imaging studies done for other reasons. Thus, some crewmembers may have undiscovered, asymptomatic stones prior to their mission. Methods: An extensive literature search was conducted concerning the natural history of asymptomatic renal stones. For comparison, simulations were done using the Integrated Medical Model (IMM). The IMM is an evidence-based decision support tool that provides risk analysis and has the capability to optimize medical systems for missions by minimizing the occurrence of adverse mission outcomes such as evacuation and loss of crew life within specified mass and volume constraints. Results: The literature of the natural history of asymptomatic renal stones in the general medical population shows that the probability of symptomatic event is 8% to 34% at 1 to 3 years for stones < 7 mm. Extrapolated to a 6-month mission, for stones < 5 to 7 mm, the risk for any stone event is about 4 to 6%, with a 0.7% to 4% risk for intervention, respectively. IMM simulations compare favorably with risk estimates garnered from the terrestrial literature. The IMM forecasts that symptomatic renal stones may be one of the top drivers for medical evacuation of an International Space Station (ISS) mission. Discussion: Although the likelihood of a stone event is low, the consequences could be severe due to limitations of current ISS medical capabilities. Therefore, these risks need to be quantified to aid planning, limit crew morbidity and mitigate mission impacts. This will be especially critical for missions beyond earth orbit, where evacuation may not be an option.

Reyes, David↗

NASA NTRS2011

Designing Medical Support for a Near-Earth Asteroid Mission

This panel will discuss the design of medical support for a mission to a near-Earth asteroid (NEA) from a variety of perspectives. The panelists will discuss the proposed parameters for a NEA mission, the NEA medical condition list, recommendations from the NASA telemedicine workshop, an overview of the Exploration Medical System Demonstration planned for the International Space Station, use of predictive models for mission planning, and mission-related concerns for behavioral health and performance. This panel is intended to make the audience aware of the multitude of factors influencing medical support during a NEA mission.

Watkins, S. D.↗

NASA NTRSDate not supplied

Derivation of the Most Influential Medical Conditions for An Extended Duration Artemis Mission

BACKGROUND: The risk of loss of mission due to medical conditions may be influenced by loss of crew life (LOCL), need for evacuation (RTDC; return to definitive care), and crew task time lost. Predicting what medical conditions are most likely to lead to crew morbidity and mortality may influence medical system design, clinical capability prioritization, and research strategies. NASA’s Informing Mission Planning via Analysis of Complex Tradespaces tool (IMPACT) applies Probabilistic Risk Assessment (PRA) methodology to assess these risks. OVERVIEW: A team of subject matter experts (SME) from a variety of medical disciplines developed a consensus-based process to determine 120 of the most clinically relevant medical conditions for long-duration exploration missions (LDEMs) . This IMPACT Condition List (ICL) expanded upon previous work done for Integrated Medical Model (IMM). For each condition a best-case and worst-case definition were derived. These definitions were used to identify probability of occurrence, proportion of cases that are best case vs. worst case, clinical phase duration, and risk of outcomes (task time loss [TTL], RTDC, and LOCL) for both treated and untreated states. These data were sources from existing spaceflight databases (e.g. Longitudinal Survey of Astronaut Health), relevant models (e.g. the ISS fire model), and/or terrestrial literature. Each condition was then tied to diagnostic and therapeutic resources and capabilities. IMPACT was then run for the LDLOLS DRM (see Abstract #2 for this panel). DISCUSSION: This abstract will present the process for generating the IMPACT condition list, the relevant data for each clinical condition, and present results for the ten most influential conditions impacting LOCL, RTDC, and TTL for a representative extended duration Artemis mission.

A Nelson↗

NASA NTRSDate not supplied

Performance Risk Model (PRisM) Proof-of-Concept: An Operational Decision Support Tool to Predict Crew Performance in Space from Available Performance Tests

The Crew Health and Performance-Probabilistic Risk Assessment (CHP-PRA) team at NASA Glenn Research Center has developed a range of tools to evaluate astronaut health during spaceflight and to optimize the medical set required for missions. Among these, the Performance Risk Model (PRisM) represents a novel advancement, extending CHP-PRA’s focus beyond medical systems into the domain of human performance. Such tool could be pivotal in optimizing astronaut capabilities during space travel, thereby enhancing overall mission success. PRisM leverages data from well-established performance assessments conducted during previous crewed space missions and Earth analogs to strategically predict outcomes for planned tasks, even when direct performance testing has not been conducted for those specific tasks. To evaluate performance, PRisM references the various metrics outlined in NASA-STD-3001 and employs a methodology to integrate different performance scales. This framework analyzes the contribution of various human system task categories (HSTCs) to task execution and compares these contributions to the HSTCs’ involvement in other known tests. The model further employs a Monte Carlo simulation to sample performance scores from their distribution in operationally relevant tests such as those in Mulavara et al. (2018) and, by leveraging similarities in HSTC involvement, transfers this knowledge to actual mission tasks, such as those outlined in the "Human Exploration of Mars: Preliminary List of Crew Tasks”. The current PRisM proof-of-concept includes analyses of the impact of exercise and specific medications on astronauts’ performance, with provisions to incorporate additional countermeasures as data becomes available. Furthermore, the tool is customizable to include any system necessary to fully encompass the domain of human systems and can be adapted to evaluate performance for any spaceflight activities as requested by operational stakeholders. PRisM has the potential to assist the Human Research Program in exploring the capabilities trade space for optimized crew performance.

performance modeling↗

NASA NTRS2025

Innovative Drug Selection, Storage, and Shelf-Life Strategies for Exploration Spaceflight

Medications have been a part of space travel dating back to the Apollo missions. A safe and effective medication formulary is essential to maintaining crew health and performance during long-duration spaceflight outside of low Earth orbit (LEO). Distance from Earth creates four key operational changes that increase medical risks, including communication, resupply, crewmember health, and evacuation. The current spaceflight pharmaceutical formulary consists of medications indicated to treat a variety of anticipated medical events and healthcare needs during spaceflight, but depends on a robust consumables resupply chain, which may be strained for a Lunar, and possibly non-existent for a Mars mission. The specific medications selections for the formulary may change to optimally align with the mission, crew compliment, and spacecraft design. Medical support at long-duration exploration missions will differ from LEO missions due to mission duration, lack of consumables resupply, prolonged exposure to space radiation, and the absence of emergency medical return capability. Loss of medication resupply limits or removes the ability to replace medications that have been exhausted or degraded, potentially exacerbating the medical risk posture. To address these anticipated risks, long-duration missions must consider use of novel medical technologies, treatment modalities, and smart medical systems that offer greater crew autonomy, such as physiologically based pharmacokinetic modeling, drug repurposing, on demand drug synthesis, or wearable drug delivery / monitoring devices. Once an ideal formulary for exploration space is determined, it is essential to establish the chemical and physical stability of each medication compound, as well as its safety by identifying its degradation profiles and products. Although few studies have been conducted to provide evidence on the physicochemical stability of pharmaceuticals during space missions, the data suggests that the spaceflight environment may promote degradation in some pharmaceuticals. Formulary drug purity and efficacy should be verified by pharmaceutical stability assessments, and can be realized non-destructively, and accessed in remote environments. Non-destructive pharmaceutical analysis and statistical modelling techniques could optimize exploration spaceflight medical care by enabling early detection of suboptimal therapeutics. Likewise, novel packaging, storage strategies, and dosage form innovations are promising countermeasures to optimize pharmaceutical shelf life, purity, and quality of exploration spaceflight medications. As we prepare for more distant exploration missions, risk management planning for astronaut healthcare should include the assembly of a medication formulary that is comprehensive enough to prevent or treat anticipated medical events, remains safe and chemically stable, and retains sufficient potency to last for the duration of the mission. Following extensive review of the literature, we will present innovative formulary optimization strategies, pharmaceutical stability assessment techniques, and storage and packaging solutions that could enhance drug safety and efficacy for future exploration spaceflight missions.

Vernie R Daniels↗

NASA NTRSDate not supplied

Novel Approach to Simulating Diagnostic Capabilities in Medical Resource Risk Assessment

Diagnostics represent a key subset of medical resources considered for helping mitigate and control spaceflight medical risk. Historically, when modeling the medical risk domain for spaceflight, diagnostic resources have been handled like any other medical resource used for treatment. That is to say, the resource being unavailable will result in the related condition having suboptimal treatment outcomes. However in the real world, should a diagnostic resource be unavailable, a more analogous effect would be that the condition might be misdiagnosed, and thus inappropriate treatment applied. This talk presents an alternative means of representing diagnostic resources within the Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) that can simulate the effect both in risk, resource consumption, and competition for resources of a missing or depleted diagnostic. The scenario where a differential diagnosis may not be possible for abdominal conditions that use an ultrasound machine as a diagnostic tool is considered. Two approaches for modeling the effect of not having a diagnostic capability on the medical system are demonstrated. In the “simple” approach, it is assumed that any abdominal condition requiring the ultrasound machine for diagnosis is mis-diagnosed and treated as an appendicitis. This is represented by replacing the treatment for the affected conditions with the treatment for appendicitis, thereby changing the optimized medical set available for treatment for the remainder of the mission. In the “complex” approach, MEDPRAT treatment clusters are utilized to capture and represent overlapping treatment between the misdiagnosed condition and appendicitis. This elicits both the effect that inappropriate treatment is applied, resulting in wasted resource consumption, and that treatment which was truly needed for the misdiagnosed condition was not applied, which reduces the treatment effectiveness. In this talk, results comparing the simple and complex diagnostic capability approach to a baseline where the diagnostic is treated as a traditional resource is presented. Either approach provides an option for a more analogous representation of diagnostic resources and provides insight into how the modeled spaceflight medical resources and outcomes change when that diagnostic is unavailable.

C. M. Gasiewski↗

NASA NTRS2025

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↗