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Ultrasound in Space Medicine

This slide presentation reviews the use of ultrasound as a diagnostic tool in microgravity environments. The goals of research in ultrasound usage in space environments are: (1) Determine accuracy of ultrasound in novel clinical conditions. (2) Determine optimal training methodologies, (3) Determine microgravity associated changes and (4) Develop intuitive ultrasound catalog to enhance autonomous medical care. Also uses of Ultrasound technology in terrestrial applications are reviewed.

Dulchavsky, Scott A.↗

Split-screen display system and standardized methods for ultrasound image acquisition and multi-frame data processing

A standardized acquisition methodology assists operators to accurately replicate high resolution B-mode ultrasound images obtained over several spaced-apart examinations utilizing a split-screen display in which the arterial ultrasound image from an earlier examination is displayed on one side of the screen while a real-time "live" ultrasound image from a current examination is displayed next to the earlier image on the opposite side of the screen. By viewing both images, whether simultaneously or alternately, while manually adjusting the ultrasound transducer, an operator is able to bring into view the real-time image that best matches a selected image from the earlier ultrasound examination. Utilizing this methodology, dynamic material properties of arterial structures, such as IMT and diameter, are measured in a standard region over successive image frames. Each frame of the sequence has its echo edge boundaries automatically determined by using the immediately prior frame's true echo edge coordinates as initial boundary conditions. Computerized echo edge recognition and tracking over multiple successive image frames enhances measurement of arterial diameter and IMT and allows for improved vascular dimension measurements, including vascular stiffness and IMT determinations.

Selzer, Robert H.↗

Delivering New Ultrasound System to International Space Station

Ultrasound has been used for medical purposes and experiments. The previous ultrasound, HDI 5000, was delivered to the ISS in 2001 and had expected its service life in February, 2012. Due to on-orbit ultrasound failure in February 2011, the delivery date of new ultrasound was moved to July 8, 2011, which is 7 months earlier than original delivery date. This report shows how the Ultrasound 2 team including myself worked to make new delivery date. Four-step approach, (1) understanding the project (literature search), (2) learning different documents, (3) performing certification tests and (4) participating crew trainings, were used to succeed my internship at NASA JSC. In addition, the participation in Summer Institution and other contributions are explained. i

Sugita, Yoshino↗

Exploration Analysis of Carbon Dioxide Levels and Ultrasound Measures of the Eye During ISS Missions

Enhanced screening for the Visual Impairment/Intracranial Pressure (VIIP) Syndrome, including in-flight ultrasound, was implemented in 2010 to better characterize the changes in vision observed in some long-duration crewmembers. Suggested possible risk factors for VIIP include cardiovascular changes, diet, anatomical and genetic factors, and environmental conditions. As a potent vasodilator, carbon dioxide (CO (sub 2)), which is chronically elevated on the International Space Station (ISS) relative to typical indoor and outdoor ambient levels on Earth, seems a plausible contributor to VIIP. In an effort to understand the possible associations between CO (sub 2) and VIIP, this study analyzes the relationship between ambient CO (sub 2) levels on ISS and ultrasound measures of the eye obtained from ISS fliers. CO (sub 2) measurements will be pulled directly from Operational Data Reduction Complex for the Lab and Node 3 major constituent analyzers (MCAs) on ISS or from sensors located in the European Columbus module, as available. CO (sub 2) measures between ultrasound sessions will be summarized using standard time series class metrics in MATLAB including time-weighted means and variances. Cumulative CO (sub 2) exposure metrics will also be developed. Regression analyses will be used to quantify the relationships between the CO (sub 2) metrics and specific ultrasound measures. Generalized estimating equations will adjust for the repeated measures within individuals. Multiple imputation techniques will be used to adjust for any possible biases in missing data for either CO (sub 2) or ultrasound measures. These analyses will elucidate the possible relationship between CO (sub 2) and changes in vision and also inform future analysis of inflight VIIP data.

Young, M.↗

Determining Directions of Ultrasound in Solids

Ultrasound shadows cast by grooves. Improved method for determining direction of ultrasound in materials is shadow method using Scanning laser acoustic microscopy (SLAM). Direction of ultrasound calculated from dimensions of groove and portion of surface groove shields from ultrasound. Method has variety of applications in nontraditional quality-control applications.

Generazio, Edward R.↗

Ultrasound as a Noninvasive Method to Assess Changes of Intracranial Volume and Pressure During Simulated Microgravity

Headaches are commonly experienced by astronauts in microgravity and by subjects undergoing head-down tilt (simulated microgravity on Earth). Exposure to microgravity probably elevates blood pressure and flow in the head which may increase intracranial volume (ICV) and pressure (ICP) and in turn cause headache. Due to the slightly compliant nature of the cranial vault and the encasement of brain and its vasculature within this vault, any increase of ICV will increase ICP and slightly distend the cranium. Previous studies document perivascular edema and increased ICP in rhesus monkeys during head-down tilt. Elevated ICP has also been reported in humans during head-down tilt. ICP measurements in healthy humans are rare because of the invasiveness of currently-available measurement techniques. Therefore, we proposed a noninvasive ultrasound technique to assess changes of ICV and JCP. The ultrasound principle is based on compliance of the cranial vault. A 450 kHz ultrasound stimulus is transmitted through the cranium by a transducer every 7.5-10 msec. The ultrasound wave enters the brain tissue, reflects off the opposite side of the cranium and is received by the same transducer. The detected wave is compared for phase quadrature (90 deg.to transmitted wave). Because the electronic circuitry of the device maintains a 90 deg. phase (phi), any alterations in the detected wave caused by an increase of ICV and ICP will be reflected as a change in the wave frequency. Phase shift is directly proportional to path length of the wave, DELTA x, which is expressed as DELTA x = phi lambda/2 pi where lambda is wavelength. Elevated ICV and ICP expand the cranial vault and increase path length of the wave (a measure of intracranial distance). Increased path length equals reduced frequency of the detected wave. Reduced frequency is then related to elevated ICP. This technique has potential uses for ICP studies of astronauts in space and head trauma patients on Earth.

Murthy, G.↗

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↗

High-Frequency Focused Water-Coupled Ultrasound Used for Three-Dimensional Surface Depression Profiling

To interface with other solids, many surfaces are engineered via methods such as plating, coating, and machining to produce a functional surface ensuring successful end products. In addition, subsurface properties such as hardness, residual stress, deformation, chemical composition, and microstructure are often linked to surface characteristics. Surface topography, therefore, contains the signatures of the surface and possibly links to volumetric properties, and as a result serves as a vital link between surface design, manufacturing, and performance. Hence, surface topography can be used to diagnose, monitor, and control fabrication methods. At the NASA Glenn Research Center, the measurement of surface topography is important in developing high-temperature structural materials and for profiling the surface changes of materials during microgravity combustion experiments. A prior study demonstrated that focused air-coupled ultrasound at 1 MHz could profile surfaces with a 25-m depth resolution and a 400-m lateral resolution over a 1.4-mm depth range. In this work, we address the question of whether higher frequency focused water-coupled ultrasound can improve on these specifications. To this end, we employed 10- and 25-MHz focused ultrasonic transducers in the water-coupled mode. The surface profile results seen in this investigation for 25-MHz water-coupled ultrasound, in comparison to those for 1-MHz air-coupled ultrasound, represent an 8 times improvement in depth resolution (3 vs. 25 m seen in practice), an improvement of at least 2 times in lateral resolution (180 vs. 400 m calculated and observed in practice), and an improvement in vertical depth range of 4 times (calculated).

Roth, Don J.↗

Validation of On-Orbit Methodology for the Assessment of Cardiac Function and Changes in the Circulating Volume Using Ultrasound and "Braslet-M" Occlusion Cuffs

Recent advances in remotely guided imaging techniques on ISS allow the acquisition of high quality ultrasound data using crewmember operators with no medical background and minimal training. However, ongoing efforts are required to develop and validate methodology for complex imaging protocols to ensure their repeatability, efficiency, and suitability for use aboard the ISS. This Station Developmental Test Objective (SDTO) tests a cardiovascular evaluation methodology that takes advantage of the ISS Ultrasound capability, the Braslet-M device, and modified respiratory maneuvers (Valsalva and Mueller), to broaden the spectrum of anatomical and functional information on human cardiovascular system during long-duration space missions. The proposed methodology optimizes and combines new and previously demonstrated methods, and is expected to benefit medically indicated assessments, operational research protocols, and data collections for science. Braslet-M is a current Russian operational countermeasure that compresses the upper thigh to impede the venous return from lower extremities. The goal of the SDTO is to establish and validate a repeatable ultrasound-based methodology for the assessment of a number of cardiovascular criteria in microgravity. Braslet-M device is used as a means to acutely alter volume distribution while focused ultrasound measurements are performed. Modified respiratory maneuvers are done upon volume manipulations to record commensurate changes in anatomical and functional parameters. The overall cardiovascular effects of the Braslet-M device are not completely understood, and although not a primary objective of this SDTO, this effort will provide pilot data regarding the suitability of Braslet-M for its intended purpose, effects, and the indications for its use.

Bogomolov, V. V.↗

Ultrasound Evaluation of the Magnitude of Pneumothorax: A New Concept

Pneumothorax is commonly seen in trauma patients; the diagnosis is usually confirmed by radiography. Use of ultrasound for this purpose, in environments such as space flight and remote terrestrial areas where radiographic capabilities are absent, is being investigated by NASA. In this study, the ability of ultrasound to assess the magnitude of pneumothorax in a porcine model was evaluated. Sonography was performed on anesthetized pigs (avg. wt. 50 kg) in both ground-based laboratory (n = 5) and micro gravity conditions (0 g) aboard the KC-135 aircraft during parabolic flight (n = 4). Aliquots of air (50-1 OOcc) were introduced into the chest through a catheter to simulate pneumothorax. Results were video-recorded and digitized for later interpretation by radiologists. Several distinct sonographic patterns of partial lung sliding were noted, including the combination of a sliding zone with a still zone, and a "segmented" sliding zone. These "partial lung sliding" patterns exclude massive pneumothorax manifested by a complete separation of the lung from the parietal pleura. In 0 g, the sonographic picture was more diverse; 1 g differences between posterior and anterior aspects were diminished. CONCLUSIONS: Modest pneumothorax can be inferred by the ultrasound sign of "partial lung sliding". This finding, which increases the negative predictive value of thoracic ultrasound, may be attributed to intermittent pleural contact, small air spaces, or alterations in pleural lubricant. Further studies of these phenomena are warranted.

Sargsyan, Ashot E.↗

Modelflow Estimates of Stroke Volume Do Not Correlate With Doppler Ultrasound Estimates During Upright Posture

Orthostatic intolerance affects 60‐80% of astronauts returning from long‐duration missions, representing a significant risk to completing mission‐critical tasks. While likely multifactorial, a reduction in stroke volume (SV) represents one factor contributing to orthostatic intolerance during stand and head up tilt (HUT) tests. Current measures of SV during stand or HUT tests use Doppler ultrasound and require a trained operator and specialized equipment, restricting its use in the field. BeatScope (Finapres Medical Systems BV, The Netherlands) uses a modelflow algorithm to estimate SV from continuous blood pressure waveforms in supine subjects; however, evidence supporting the use of Modelflow to estimate SV in subjects completing stand or HUT tests remain scarce. Furthermore, because the blood pressure device is held extended at heart level during HUT tests, but allowed to rest at the side during stand tests, changes in the finger arterial pressure waveform resulting from arm positioning could alter modelflow estimated SV. The purpose of this project was to compare Doppler ultrasound and BeatScope estimations of SV to determine if BeatScope can be used during stand or HUT tests. Finger photoplethysmography was used to acquire arterial pressure waveforms corrected for hydrostatic finger‐to‐heart height using the Finometer (FM) and Portapres (PP) arterial pressure devices in 10 subjects (5 men and 5 women) during a stand test while simultaneous estimates of SV were collected using Doppler ultrasound. Measures were made after 5 minutes of supine rest and while subjects stood for 5 minutes. Next, SV estimates were reacquired while each arm was independently raised to heart level, a position similar to tilt testing. Supine SV estimates were not significantly different between all three devices (FM: 68+/-20, PP: 71+/-21, US: 73+/-21 ml/beat). Upon standing, the change in SV estimated by FM (‐18+/-8 ml) was not different from PP (‐21+/-12), but both were significantly less than US (‐37+/-16 ml, p<.05). Raising finger BP devices to heart level caused no significant change in SV measured with any of the devices (FM: 1.5+/-19, PP: 1.7+/-26, US: 0.5+/-6), although variability was 3‐6x greater as assessed by both blood pressure devices compared to US. Retrospective analysis of blood pressure data to assess SV in 11 supine subjects revealed significantly different estimates between methods (FM: 95+/-17, US: 75+/-32, p<.05), but the change in SV resulting from HUT was similar between methods (FM: ‐37+/-9, US: ‐40+/-18 ml). However, the correlation coefficient determined from pairs of SV estimated by US and FM was weak (r2=0.03). These data suggest Modelflow cannot be used in lieu of Doppler ultrasound to estimate SV during stand or HUT tests. Further investigation should focus on identifying factors contributing to differences between these measurement techniques in order to make use of a simple method for assessing beat‐by‐beat changes in SV during postural changes, especially during field testing.

Ferguson, Connor R.↗

Ultrasound Based Method and Apparatus for Stone Detection and to Facilitate Clearance Thereof

Described herein are methods and apparatus for detecting stones by ultrasound, in which the ultrasound reflections from a stone are preferentially selected and accentuated relative to the ultrasound reflections from blood or tissue. Also described herein are methods and apparatus for applying pushing ultrasound to in vivo stones or other objects, to facilitate the removal of such in vivo objects.

Bailey, Michael↗

Exploratory Analysis of Carbon Dioxide Levels, Ultrasound and Optical Coherence Tomography Measures of the Eye During ISS Missions

Enhanced screening for the Visual Impairment/Intracranial Pressure (VIIP) syndrome has been implemented to better characterize the ocular and vision changes observed in some long-duration crewmembers. This includes implementation of in-flight ultrasound in 2010 and optical coherence tomography (OCT) in 2013. Potential risk factors for VIIP include cardiovascular health, diet, anatomical and genetic factors, and environmental conditions. Carbon dioxide (CO2), a potent vasodilator, is chronically elevated on the International Space Station (ISS) relative to ambient levels on Earth, and is a plausible risk factor for VIIP. In an effort to understand the possible associations between CO2 and VIIP, this study explores the relationship of ambient CO2 levels on ISS compared to inflight ultrasound and OCT measures of the eye obtained from ISS crewmembers. CO2 measurements were aggregated from Operational Data Reduction Complex and Node 3 major constituent analyzers (MCAs) on ISS or from sensors located in the European Columbus module, as available. CO2 levels in the periods between each ultrasound and OCT session are summarized using timeseries metrics, including time-weighted means and variances. Partial least squares regression analyses are used to quantify the complex relationship between specific ultrasound and OCT measures and the CO2 metrics simulataneously. These analyses will enhance our understanding of the possible associations between CO2 levels and structural changes to the eye which will in turn inform future analysis of inflight VIIP data.

Schaefer, C.↗

Assessment of Ultrasound Devices to Protect the Health of Astronauts in the New Era of Space Exploration: A Literature Review

Microgravity and radiation of space create harsh physiological strains on astronauts with significant damaging effects on cardiovascular and musculoskeletal systems among others. It is necessary to utilize medical technologies that can effectively monitor chronic and acute alterations to astronauts’ health statuses on spacecrafts. Future missions to distant planetary bodies will result in longer exposure to damaging environmental factors and limit crew access to healthcare resources and maintenance devices; thus, even greater logistical and quality considerations must be made. Remarkable advancements in ultrasound technology have created new powerful portable imaging devices and a potential chip-based alternative to piezoelectric crystals that are used in nearly all ultrasound devices. This literature review will investigate new commercial and prototypal ultrasound medical devices on their potential effectiveness in austere environments such as space. The accuracy, versatility, and practicality of each device will be compared to each other as well as the current technological gold standards of health monitoring used in traditional healthcare settings. Assessment of new ultrasound technology in this literature review will provide guidance to future missions by space agencies regarding the most optimal medical devices to protect astronauts and, therefore, enable further exploration of distant planets and solar systems.

Parag Vyas↗

Applications of Doppler ultrasound in clinical vascular disease

Doppler ultrasound has become the most useful and versatile noninvasive technique for objective evaluation of clinical vascular disease. Commercially available continuous-wave instruments provide qualitative and quantitative assessment of venous and arterial disease. Pulsed Doppler ultrasound was developed to provide longitudinal and transverse cross-sectional images of the arterial lumen with a resolution approaching that of conventional X-ray techniques. Application of Doppler ultrasound in venous, peripheral arterial, and cerebrovascular diseases is reviewed.

Barnes, R. W.↗

Laser Sources for Generation of Ultrasound

Two laser systems have been built and used to demonstrate enhancements beyond current technology used for laser-based generation and detection of ultrasound. The first system consisted of ten Nd:YAG laser cavities coupled electronically and optically to permit sequential bursts of up to ten laser pulses directed either at a single point or configured into a phased array of sources. Significant enhancements in overall signal-to-noise ratio for laser ultrasound incorporating this new source system was demonstrated, using it first as a source of narrowband ultrasound and secondly as a phased array source producing large enhanced signal displacements. A second laser system was implemented using ultra fast optical pulses from a Ti:Sapphire laser to study a new method for making laser generated ultrasonic measurements of thin films with thicknesses on the order of hundreds of angstroms. Work by prior investigators showed that such measurements could be made based upon fluctuations in the reflectivity of thin films when they are stressed by an arriving elastic pulse. Research performed using equipment purchased under this program showed that a pulsed interferometric system could be used as well as a piezoreflective detection system to measure pulse arrivals even in thin films with very low piezoreflective coefficients.

Wagner, James W.↗

Ultrasound Techniques for Space Applications

Ultrasound has proven to be a safe non-invasive technique for imaging organs and measuring cardiovascular function. It has unique advantages for application to problems with man in space including evaluation of cardiovascular function both in serial studies and during critical operations. In addition, specialized instrumentation may be capable of detecting the onset of decompression sickness during EVA activities. A spatial location and three-dimensional reconstruction system is being developed to improve the accuracy and reproducibility for serial comparative ultrasound studies of cardiovascular function. The three-dimensional method permits the acquisition of ultrasonic images from many views that can be recombined into a single reconstruction of the heart or vasculature. In addition to conventional imaging and monitoring systems, it is sometimes necessary or desirable to develop instrumentation for special purposes. One example of this type of development is the design of a pulsed-Doppler system to monitor cerebral blood flow during critical operations such as re-entry. A second example is the design of a swept-frequency ultrasound system for the detection of bubbles in the circulatory system and/or soft tissues as an early indication of the onset of decompression sickness during EVA activities. This system exploits the resonant properties of bubbles and can detect both fundamental and second harmonic emissions from the insonified region.

Rooney, James A.↗

Measurement of Transcranial Distance During Head-Down Tilt Using Ultrasound

Exposure to microgravity probably elevates blood pressure and flow in the head which may increase intracranial volume (ICV) and pressure (ICP). Due to the slightly compliant nature of the cranium, any increase of ICP will increase ICV and transcranial distance. We used a noninvasive ultrasound technique to measure transcranial distance (frontal to occipital) during head-down tilt. Seven subjects (ages 26-53) underwent the following tilt angles: 90 deg. upright, 30 deg., 0 deg., -6 deg., -10 deg., -6 deg., 0 deg., 30 deg., and 90 deg. Each angle was maintained for 1 min. Ultrasound wave frequency was collected continuously and transcranial distance was calculated (Delta(x) = x(Delta)f/f, where x is path length and f is frequency of the wave) for each tilt angle. Frequency decreased from 503.687 kHz (90 deg. upright) to 502.619 kHz (-10 deg.). These frequencies translated to an increased transcranial distance of 0.403 mm. Although our data suggest a significant increase in transcranial distance during head-down tilt, this apparent increase may result, in part, from head-down tilt-induced subcutaneous edema or cutaneous blood volume elevation. In three subjects, when the above protocol was repeated with an ace bandage wrapped around the head to minimize such edema, the increased transcranial distance from 90 deg. to -10 deg. was reduced by 0.174 mm. Further development of the technique to quantify bone-to-bone expansion unconfounded by cutaneous fluid is necessary. Therefore, this ultrasound technique may provide measurements of changes in cranial dimensions during microgravity.

Torikoshi, Shigeyo↗