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NASA NTRSDate not supplied

Comparison of Multispectral Imaging and Traditional Fundoscopy in the Detection of Terrestrial Retinal and Optic Nerve Pathologies like those Encountered During and/or Immediately Following Long-Duration Spaceflight

INTRODUCTION: The purpose of this investigation was to evaluate if MultiColor Imaging (MCI) can replace color fundus photography (CFP) as a diagnostic screening tool during spaceflight. MCI significantly reduces crew time (approx. 115 minutes/session, 36 hours/year) by eliminating nominal on-orbit fundoscopy sessions, while also providing the option to capture a larger field of view (55 vs. 35). METHODS: A comprehensive PubMed literature search was conducted using the following key words: multicolor, multispectral, imaging, retina, choroid, optic nerve, optic disc, and papilledema. Publications were filtered based on optic nerve and chorioretinal pathologies matching those seen during or immediately after spaceflight: optic disc edema (ODE), cotton wool spots (CWS), retinal hemorrhage, pigment epithelial detachment (PED), and serous chorioretinopathy (SCR). In a separate effort, 44 multicolor images (30 abnormal) of terrestrial patients were graded and compared to corresponding color fundus images acquired at the Doheny Eye Centers and UCLA. RESULTS: The search identified 340 articles; 9 describing MCI in relevant pathologies, 6 comparing MCI to CFP. MCI is superior in detecting CWS (1 paper), PED (2 papers), retinal hemorrhages (2 papers), and choroidal folds (1 paper), and can better delineate extent or boundaries of subretinal fluid and identify areas of RPE damage in SCR (2 papers). On MCI, ODE was described as a hyperreflective ring with a green shift and indistinct disc margins, with equaldetectability as using CFP (3 papers). Grading at Doheny Eye Institute confirmed these findings. DISCUSSION: MCI can effectively detect all retinal and optic nerve findings detectable by CFP during and immediately post-spaceflight and represents a suitable replacement as an on-orbit diagnostic screening tool. Additionally, by eliminating the nominal on-orbit fundoscopy sessions, dozens of crew hours are spared per year by utilizing MCI.

Jorge Nagel↗
NASA NTRSDate not supplied

Human Monitoring for Medical Operator Assistance

Measurement of multiple biologic and non-biologic signals can be exploited for the task of monitoring the physiological status of individuals - either as patients during and following illness or injury or as those engaged in operational activities. Assessing physiological status is accomplished by measuring vital signs and wellness measures that support clinical decision-making for physical optimization, illness/injury prevention and treatment, recovery progression, and general delivery of care, or monitoring an operator's moment-to-moment personal "readiness" state. Physiological measures are beneficial for monitoring the medical state of vehicle operators, for example, through the detection of incapacitation in the realm of transportation safety. Measuring physiological signals or control inputs can also be beneficial for monitoring operator state to optimize human-autonomy-teaming performance for safety and efficiency. Similarly, monitoring a health care provider during the performance of medical procedures could provide valuable feedback on optimizing human-robot interactions and human teaming with autonomous systems. In this sense, the provider can be seen as a "Medical Operator" in the same way other "operators" drive, aviate, or control vehicles by performing manual, attention-demanding tasks during safety-critical activities.

Neuroergonomics↗
NASA NTRSDate not supplied

Neuro-Vestibular Examination During and Following Spaceflight (Vestibular Health)

BACKGROUND Adaptation to microgravity during spaceflight causes neurological disturbances that are either directly or indirectly mediated by the vestibular system. These disturbances could include space motion sickness, spatial disorientation, and cognitive impairment, as well as changes in head-eye coordination, vestibulo-ocular reflexes, and control of posture and locomotion. Otolith-mediated reflex gains appear to adapt rapidly during spaceflight and after landing. However, animal studies have shown that structural modifications of the vestibular sensory apparatus develop during long-duration spaceflight. To date, no studies have characterized the severity of vestibular syndromes experienced by astronauts as a function of the duration of spaceflight or whether the effects are caused by changes at the peripheral end organs, midbrain, cerebellum, or vestibular cortex. OBJECTIVES We will investigate temporal vestibular changes in crewmembers of short, 6-month, and one-year missions to identify trends in adaptation of vestibular health and performance in orbit and after landing. We will also determine whether the vestibular organs and/or the central vestibular system undergo structural changes during long-duration exposure to microgravity, which could cause vestibular disorders when transitioning to a different gravitational environment. METHODS Recordings of eye, head, and body movements, as well as subjective reports of perception of motion, will be used to determine the presence of abnormal eye movements, dysmetria, motion sickness symptoms, and illusions of motion during head or body movements. This includes characterization of temporal trends in central compensation for vestibular (otolith) asymmetry. Pre-flight data will be collected 90 days before the flight. In-flight tests will be performed early in the mission and once every one or two months thereafter. Post-flight examinations will be performed on the following days after return (R) from the mission: R+0, R+4, R+9, and R+30. Ground-based control tests will be performed on healthy volunteers in the laboratory to estimate mean normative responses. CONTROL RESULTS Thirty-two healthy (non-astronaut) control subjects performed the same ground test procedures as planned for crewmembers. In addition to establishing a normative database, these data were used to calculate vestibular asymmetries from perceptual reports during unilateral centrifugation, oculomotor responses during visual-alignment tasks, vestibulo-ocular reflex gain during head-impulse tests, and body rotation during stepping tests. A significant correlation was observed between asymmetries of subjective visual vertical and verbal report during unilateral centrifugation. Another significant correlation was observed between the asymmetries of ocular alignment, vestibulo-ocular reflex gain, and body rotation. These findings in a healthy cohort may help us better understand changes in vestibular asymmetries in crewmembers during and following spaceflight. RELEVANCE If the observed symptoms in crewmembers are more deleterious after the year-long missions than those documented after 6-month missions, then relevant countermeasures will be required to maintain the health and operational performance of astronauts during longer missions. Depending on the etiology of the vestibular syndrome revealed by these tests, countermeasures will be proposed based on vestibular rehabilitation therapies currently used in patients with vestibular disorders, such as habituation, gaze stabilization, and/or balance training exercises. ACKNOWLEDGEMENT This work is supported by the NASA’s Human Research Program Human Health Countermeasures Element.

T R Macaulay↗
NASA NTRSDate not supplied

Rational Design of Nanoplasmonic Array Geometries for Biosensing

Background: Molecular diagnostics provide early and accurate diagnosis, which is essential for the prevention and treatment of infectious as well as chronic diseases. These tests are designed to detect disease-specific bioanalytes such as nucleic acid (DNA or RNA) or protein (antigens, antibodies) biomarkers. In the context of infectious disease diagnosis, nucleic acid-based detection methods are known to provide more specific and sensitive results. Here, the presence of a unique sequence belonging to the pathogenic genomic material is targeted to identify species, organism, genera and/or antimicrobial resistant gene markers. The majority of the common nucleic acid based diagnostic techniques require amplification (polymerase chain reaction, isothermal amplification etc.) of the pathogenic genetic material prior to detection impacting diagnostic speed, complexity, and cost thereby limiting ease of use. Thus, the development of simplified nucleic acid-based diagnostics that can be even used in resource-poor settings may hugely benefit patients across the globe. Nanopath is a molecular diagnostics company utilizing a solid-state nanosensor to enable sequence-specific detection of target nucleic acids without the need of amplification. These nanostructures enable ultra-sensitive biomarker detection using geometric, feature-dependent properties highly dependent on the local dielectric environment, allowing them to be sensitive to low concentration binding events. This paper describes an application of this approach to provide highly relevant clinical information within a single doctor’s office visit. Intro: The Nanopath team is in collaboration with NASA (National Aeronautics and Space Administration) and NIST (National Institute of Standards and Technology) to push the bounds of the fundamental physics associated with their biosensing platform. The ability of metals to support electromagnetic surface waves gives rise to surface plasmons when optically illuminated. This property, and its strong sensitivity to changes in the local refractive index, allows for the use of metal nanoparticles as ultra-sensitive transducers. In prior work by members of this team, ensembles of randomly oriented nanoparticles (i.e., colloidal nanorods dispersed on chip) were employed for sequence-specific nucleic acid sensing (1-3). While these particle sensors have the advantage of rapid fabrication, they suffer from low sensitivity and quality factor due to the random particle dispersity. In contrast, in this study we employ ordered array nanoparticle ensembles which can be used to improve sensor sensitivity and figure-of-merit. Study Methods Overview: In this talk, we detail the results of sensing experiments and computational simulations to outline a rational design of the structure of these plasmonic nanoparticle arrays for biomolecular sensing. Through simulation and experiment, we iteratively tailor nanostructure dimension to provide high quality signal and large resonance shifts upon modeled nucleic acid binding. In particular, full-wave electromagnetic simulations were conducted using Lumerical photonic simulation software in which periodic boundary conditions were applied in the x- and y- dimensions for each of the nanoplasmonic sensor geometries. To simulate the resonance response to changes in the bulk solution in contact with the sensor surface, the refractive index of the surrounding media was changed appropriately. Nucleic acid hybridization events were modeled using either using spherical structures approximating the relevant radius of genomic material as estimated by polymer models, or as conformal layers with the known refractive indices for nucleic acids. On the basis of initial simulations, nanosensors were fabricated using traditional electron-beam lithography protocols at NIST. To evaluate consensus between simulations and experiments, bulk sensing experiments were carried out in which the resonance peaks were obtained by submerging the sensors in refractive index standards. Key nanosensor characteristics including resonance peak locations, resonance peak shifts as a function of refractive index, and figure of merit (FOM) of extinction curves were examined between the experimental and simulation results prior to proceeding with simulations on additional geometries and more complex solution conditions, and further device fabrication. This iterative process is repeated toward a rational design of nanoplasmonic array geometries for biosensing optimizing response for targeted disease detection. In summary, this study puts forth a methodology for rational design and characterization of regularly spaced nanoparticle arrays for optics-based biosensing. The results of this study will allow for more informed design of nanostructure geometries towards sequence-specific nucleic acid detection. These improved designs have the potential to improve clinical sensitivity and limit-of-detection across disease indication.

sensor↗
NASA NTRSDate not supplied

Principles for Termination of Medical Care in Austere Analog Environments for Development of Spaceflight Protocols

INTRODUCTION: When compared to operations in low earth orbit, exploration class missions will have substantially limited resources and ground medical support while the risk of a significant medical event is projected to be higher. Termination of care (TOC) may need to be considered in certain instances. We aim to utilize data from earth-based analogs to identify common principles that can help develop future guidelines to this complex medical and ethical challenge. METHODS: A comprehensive literature review was conducted in medline, nasa.gov, Defense Technical Information Center(DTIC) and google scholar. Key search terms including “withdrawal of care, termination of care, termination of CPR, military medicine, wilderness medicine, futility, potentially inappropriate” and others were used to identify analog studies of relevance. These were qualitatively evaluated for recurring principles or themes that were reviewed and structured. RESULTS: Mission planning termination of care principles: definitions of clear medical goals, separate protocols for each relevant condition, protocols developed using best available evidence, crew involvement in development, protocols rehearsal pre-launch, and inclusion of palliative capabilities. In-mission termination of care principles: 1. Crew Medical Officer directed stabilization of the patient; 2. Consultation with mission control with standardized information exchange; 3. Multidisciplinary medical and ethical conference among the mission directors, flight surgeons and relevant specialist experts; 4. Multidisciplinary risk review examining both medical and mission risks for relevant options; 5. Provision of a transparent explanation of the process and decision to crew; 6. Allowing crew feedback and inquiry to review board; 7. Support of the crew in the enacted decision. DISCUSSION: By utilizing the best available evidence in conjunction with expert opinion we have identified common principles from earth-based analogs that could be used to help design future TOC protocols.

Samuel Stephenson↗
NASA NTRSDate not supplied

Conclusions of a Mini Technical Interchange Meeting on Mechanisms and Pathways Common Between Adverse Health Outcomes from Exposures to Space Radiation

To enable deep space exploration and sustained human presence in space, the NASA Human Research Program’s (HRP) Space Radiation Element (SRE) funds research to characterize and mitigate adverse health outcomes from exposure to space radiation that include risks of carcinogenesis, cardiovascular disease (CVD) and central nervous system (CNS) decrements. Over the past decade, a growing body of compelling experimental evidence suggests shared mechanisms and pathophysiological processes for CVD, neurodegenerative effects, and cancer development and progression, which are traditionally managed as separate disease processes. Additionally, epidemiological studies have identified cross-sectional and longitudinal associations between some specific types of cancer and CVD, and accumulating evidence indicates that the pathogenesis of neurodegenerative diseases such as Alzheimer’s disease may overlap with CVD and cancer pathogenesis. Identifying the mechanisms and pathways common to these important health decrements will not only accelerate development of effective countermeasures and improve management of spaceflight-induced risk, it will also help to develop new treatment strategies for patients on Earth. To identify common pathways and mechanisms of disease induction and progression from current SR-funded studies and to inform future work and solicitations, the SRE organizes themed sessions at annual HRP Investigators’ Workshops (IWS). These technical interchange meetings (TIMs) provide a venue for the scientific community to present ongoing work and engage in open discussion on results, limitations of current approaches, and incorporation of novel experimental strategies, model systems, and other innovative techniques. Here a summary and lessons learned from the SRE-sponsored mini-TIM titled “mechanisms and pathways common between adverse health outcomes” held at HRP IWS 2023 will be communicated. The 90-min TIM had 30-min dedicated to discussing and developing potential collaboration and tissue sharing opportunities among investigators. The SRE facilitated the discussion using a set of pressing questions and gaps in knowledge that need to be addressed by the scientific community. This poster presents the outcomes of the session along with proposed future workshops and other SRE initiatives.

Janapriya Saha↗
NASA NTRSDate not supplied

Conclusions of a Mini Technical Interchange Meeting on Mechanisms and Pathways Common Between Adverse Health Outcomes from Exposures to Space Radiation

To enable deep space exploration and sustained human presence in space, the NASA Human Research Program’s (HRP) Space Radiation Element (SRE) funds research to characterize and mitigate adverse health outcomes from exposure to space radiation that include risks of carcinogenesis, cardiovascular disease (CVD) and central nervous system (CNS) decrements. Over the past decade, a growing body of compelling experimental evidence suggests shared mechanisms and pathophysiological processes for CVD, neurodegenerative effects, and cancer development and progression, which are traditionally managed as separate disease processes. Additionally, epidemiological studies have identified cross-sectional and longitudinal associations between some specific types of cancer and CVD, and accumulating evidence indicates that the pathogenesis of neurodegenerative diseases such as Alzheimer’s disease may overlap with CVD and cancer pathogenesis. Identifying the mechanisms and pathways common to these important health decrements will not only accelerate development of effective countermeasures and improve management of spaceflight-induced risk, it will also help to develop new treatment strategies for patients on Earth. To identify common pathways and mechanisms of disease induction and progression from current SR-funded studies and to inform future work and solicitations, the SRE organizes themed sessions at annual HRP Investigators’ Workshops (IWS). These technical interchange meetings (TIMs) provide a venue for the scientific community to present ongoing work and engage in open discussion on results, limitations of current approaches, and incorporation of novel experimental strategies, model systems, and other innovative techniques. Here a summary and lessons learned from the SRE-sponsored mini-TIM titled “mechanisms and pathways common between adverse health outcomes” held at HRP IWS 2023 will be communicated. The 90-min TIM had 30-min dedicated to discussing and developing potential collaboration and tissue sharing opportunities among investigators. The SRE facilitated the discussion using a set of pressing questions and gaps in knowledge that need to be addressed by the scientific community. This poster presents the outcomes of the session along with proposed future workshops and other SRE initiatives.

Janapriya Saha↗
NASA NTRSDate not supplied

Oculometric Detection and Characterization of Sub-Clinical Visual/Visuomotor Impairment

It has long been known that qualitative abnormalities in eye movements can be used to diagnose overt brain pathologies (Diefendorf & Dodge, 1908; Fox & Holmes, 1926; Leigh & Zee, 2015). Here, we will examine the use of a set of quantitative measures of the human behavioral response (oculometrics) in a 5-minute radial ocular tracking task (Krukowski & Stone, 2005) with sufficient temporal, spatial, and directional uncertainty to minimize the contribution of a priori prediction or anticipation, and to emphasize the use of a posteriori visual processing of the stimulus trajectory (Liston & Stone, 2014). The derived oculometrics provide a largely independent, reliable set of metrics that are sensitive enough to detect mild sub-clinical impairment across a range of possible neural loci (Stone et al., 2019) with the pattern of impairment across the set providing specificity as to its nature (Tyson et al., 2023). We will review our earlier findings where oculometrics have been used to detect mild impairment due to traumatic brain injury, sleep loss, and low-dose alcohol (Liston et al., 2017; Stone et al., 2019; Tyson et al., 2021). We will also report on a recent clinical study of asymptomatic patients at risk of retinal pathology (Leung et al., 2022) and show that oculometrics can detect and characterize substantive loss of visual function in the absence of clinical indicators of pathology. We conclude that oculometric testing could be used as a routine non-invasive ophthalmological or neurological tool to aid in the early detection and diagnosis of neural injury, toxicity, or disease.

eye movements↗
NASA NTRSDate not supplied

Harnessing Artificial Intelligence for Medical Diagnosis and Treatment During Space Exploration Missions

BACKGROUND The medical capabilities necessary for long-duration exploration missions (LDEMs) will differ tremendously from those currently available to crew medical officers (CMOs) on the International Space Station (ISS). Ground support will be more challenging due to distance-related communication delays and data transmission, and resource utilization must be optimized given limited ability for resupply. Clinical decision support systems (CDSSs) can help mitigate these limitations. The recent launch of generative artificial intelligence (AI) tools based upon large language models (LLM) support the creation of a smart assistant for onboard triage, diagnosis, and guided treatment of medical conditions during these missions. The Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) tool can help predict which clinical problems and outcomes are likely to occur for a design reference mission (DRM) and assist Medical Operations and systems engineering teams in creating a medical system that may optimally mitigate the predicted risks. The purpose of this study was to identify AI tools currently available or in development for the assistive diagnosis and care of medical conditions predicted for an extended duration Lunar mission. METHODS The 119 medical conditions currently built into the IMPACT suite were categorized into systems, and these diagnoses were used as keywords for our literature search. Using PubMed and Google Scholar, we performed a literature survey of AI tools applicable to these conditions. Article inclusion criteria included publication between the years 2017-2023, as the sentinel paper discussing the “selective attention” driving ChatGPT and other generative transformer models was published in June 2017. Where applicable, we reviewed only the top 1000 research articles (based on relevance) for each of the keywords/phrases. AI tools whose training sets were exclusive to a pediatric patient population were excluded. We also excluded any medical diagnostic tools (such as CT, MRI, mass spectrometry) or procedures (such as endoscopy, surgery) that are unlikely to be available during LDEMs due to mass and volume constraints, CMO knowledge, skills, and abilities, and/or inherent procedural risks. RESULTS Our survey highlighted several AI-driven tools for the triage, diagnosis, and management of those medical conditions highlighted by IMPACT. Selected publications for each medical condition were then screened for inclusion within ten systems-based categories including: general diagnostic tools (25), tools to diagnose and manage respiratory (40), dermatologic (34), neurologic (28), auditory and vestibular (30), ophthalmic (34), musculoskeletal (104), infection-associated (92), and gynecologic (19) conditions, as well as tools that could be deployed in the setting of trauma and emergency (34). CONCLUSIONS Numerous AI-driven tools were highlighted within this literature survey, ranging from chatbot assistants that triage knee pain to vision transformer models for diagnosis of ophthalmic conditions using ocular surface images captured with a mobile phone. Remaining challenges include optimizing connectivity and integration of existing and developing systems into the vehicles or habitats. Notably, findings from this survey could help guide the initial design of an all-encompassing, onboard medical AI assistant for use during future LDEMs.

R A Lacinski↗
NASA NTRSDate not supplied

Neuro-Vestibular Examination During and Following Spaceflight (Vestibular Health)

BACKGROUND Adaptation to microgravity during spaceflight causes neurological disturbances that are either directly or indirectly mediated by the vestibular system. These disturbances can include space motion sickness, spatial disorientation, and cognitive impairment, as well as changes in head-eye coordination, vestibulo-ocular reflexes, and control of posture and locomotion. Otolith-mediated reflex gains appear to adapt rapidly during spaceflight and after landing. However, animal studies have shown that structural modifications of the vestibular sensory apparatus develop during long-duration spaceflight. To date, no studies have characterized the severity of vestibular syndromes experienced by astronauts as a function of the duration of spaceflight or whether the effects are caused by changes at the peripheral end organs, midbrain, cerebellum, or vestibular cortex. OBJECTIVES We will investigate temporal vestibular changes in crewmembers of short, 6-month, and one-year missions to identify trends in adaptation of vestibular health and performance in orbit and after landing. We will also determine whether the vestibular organs and/or the central vestibular system undergo structural changes during long-duration exposure to microgravity, which could cause vestibular disorders when transitioning to a different gravitational environment. METHODS Recordings of eye, head, and body movements, as well as subjective reports of perception of motion, will be used to determine the presence of abnormal eye movements, dysmetria, motion sickness symptoms, and illusions of motion during head or body movements. This includes characterization of temporal trends in central compensation for vestibular (otolith) asymmetry. Pre-flight data will be collected 90 days before launch. In-flight examinations will be performed early in the mission (Flight Days 1 and 30) and once every two or three months thereafter. Post-flight examinations will be performed on the following days after return (R) from the mission: R+0, R+4, R+9, and R+30. Ground-based control tests have been performed on healthy volunteers in the laboratory to estimate mean normative responses. RESULTS Data collection for this study is ongoing. Data processing techniques are being refined. Our eye tracking method for measuring three-dimensional eye movement takes advantage of modern computer vision software (OpenCV) and advances in the field of iris recognition to improve measurement of ocular-counterolling. RELEVANCE If the observed symptoms in crewmembers are more deleterious after the year-long missions than those documented after 6-month missions, then relevant countermeasures will be required to maintain the health and operational performance of astronauts during longer missions. Depending on the etiology of the vestibular syndrome revealed by these tests, countermeasures will be proposed based on vestibular rehabilitation therapies currently used in patients with vestibular disorders, such as habituation, gaze stabilization, and/or balance training exercises.

T R Macaulay↗
NASA NTRS2013

Electrical Impedance Tomography Technology: 2013 Center Innovation Fund Final Report

Electrical impedance tomography is a medical noninvasive imaging technology which has advantages over other medical imaging technologies for medically safe long term real time internal imaging monitoring applications in human patients. The technology is much more compact, portable, low power and potentially more low cost compared to other medical image technologies, making it very well suited for medical aerospace and spaceflight applications. EIT technology’s main drawback has been low image resolution, and consequently improving EIT resolution is the primary research goal, as well as increasing imaging speed for real time animation imaging. In a relatively short time the BERL group has brought together design plans, technical resources and has built and tested hardware with the purpose of improving EIT imaging technology. EIT prototype system development plans and system designs have been made to target needed EIT technical improvement in electronic and computer hardware as well as EIT software technology. New hardware design and fabrication resources and technologies have been brought together through resourceful use of existing equipment and software at BERL, and a significant advance has been made in custom electronic hardware prototyping capabilities in collaboration with EFAL, for mutual benefit for both NASA KSC laboratories. BERL has gained significant EIT software capability and tested EIT imaging algorithm code through collaboration with an internationally recognized EIT software development and research forum. A new custom workstation has been developed, built and tested using internal resources, equipment and expertise, that includes a new state-of-the-art massively parallel technology that is commercially available. Custom prototype hardware has been designed and tested, a high priority electronic design, key to improving electronic performance and image quality, has been researched and tested in four designs, with a summary of test results of the selected design illustrated here. The selected design performance exceeds the developed EIT design hardware specifications.

Michael R Lapointe↗
NASA NTRSDate not supplied

Crew Medical Training to Progressively Enable EIMO

Background. Onboard medical capabilities have greatly expanded over the history of the US space program. Newly identified space-related medical conditions, technological advances, and longer mission durations have led to an increasing need for on-demand medical expertise. Lengthy communications delays, lack of resupply and evacuation opportunities on exploration-class missions place an ever-increasing burden on the crew to provide medical care. Having adequate knowledge, skills, and abilities (KSA) available is an essential component of successful Earth Independent Medical Operations (EIMO). Without appropriate crew training and KSA, cutting-edge medical equipment has little value. Presumably, the crew will include a qualified physician; however, if the physician is incapacitated, a non-physician crew medical officer (CMO) will be needed. While more crew time is needed for medical training, there will be concomitant increases in preflight training demands for vehicle system management, operations, science, and contingencies. In truly independent operations, onboard resources such as just-in-time training, mixed reality, decision support tools, and AI-enabled chatbot “consultants” will be needed to augment KSA. Overview. Because of crew time constraints, topical priorities must be determined for preflight training. Curricula should be developed that emphasize management of conditions with relatively high incidence and morbidity/mortality. Defining the required KSA levels to treat each condition is essential, but all crewmembers should have basic lifesaving skills. Procedural and diagnostic training on live patients and simulators should be prioritized over classroom lectures. Crews must be trained with onboard equipment, resources, mixed reality, and AI-based decision support tools. Mission simulations should include medical problems with/without ground support and with appropriate communication delays. Certification guidelines for each level of KSA must be established. Skills rapidly decay for non-physician CMO’s; both pre-flight and in-flight refresher training will be needed. During spaceflight just-in-time training, simulations, and onboard CME with crew physician can help retain skills. Discussion. Medical technology, simulation design, mixed reality, and AI are advancing at a dizzying rate. Recognizing the severe constraints on crew time, it is critical that astronaut training is highly efficient and adapted to keep pace with new innovations both pre-flight and during exploration missions. These challenges will be discussed during this panel session.

Jay Lemery↗
NASA NTRSDate not supplied

Clinical Trials at NASA: What Makes A Clinical Trial & What Are the Requirements for International Partners?

ClinicalTrials.gov is a public registry designed to fulfill ethical obligations by providing information about clinical research studies to the general public, patients, medical practitioners and the research community. In the United States, recent revisions to human subject’s regulations have prompted new criteria for what constitutes a clinical trial along with requirements not typically requested for other types of human subject’s research. Identification of investigational clinical trials is the shared responsibility of NASA, the IRB, and the scientific investigators designing and conducting the research. This talk aims to educate attendees on the history of the development of Clinicaltrials.gov, discussion of why these requirements are important to both participants and researchers, and information on how to identify clinical trials research. In addition, we will provide information on the different requirements for clinical trials conducted at NASA or aboard the International Space Station.

Clinicaltrials.gov↗
NASA NTRS2024

Infrascope: Full-Spectrum Phonocardiography With Automated Signal Analysis Report

Physicians have used the stethoscope to listen to heart sounds for over 150 years. During this time the stethoscope has remained nearly unchanged. While the device is inexpensive, simple and easy to use, it has shortcomings as a diagnostic tool. It is dependent on human hearing to detect the complex sounds made by the heart, and human memory to analyze them. There also has been a significant decline in the use of stethoscope, at least in part because of the availability of technologies such as the echocardiogram, which can provide imaging and blood flow through the heart chambers. However, echocardiography can be complex, costly and time consuming and requires the need for a specialist, all of which delay the diagnosis and increase the cost of patient evaluation. Even with the availability of echocardiogram devices such as the handheld pocket ultrasound, diagnosing heart problems can still be difficult. The Infrascope is a new device that resembles a traditional stethoscope and is simple to use. In addition, the Infrascope offers greater sensitivity and a wider range of frequencies heard by the human ear, <20Hz than a traditional stethoscope can detect. Through automated analysis of the full spectrum of heart sounds, it has the potential to improve diagnostic accuracy while reducing the need for referrals, allowing primary care physicians to practice better medicine at the bedside.

Infrasounds↗
NASA NTRS2024

Uncrewed Aerial Systems for Emergency Medical First Response: A Market Research Report

This report presents the findings from market research conducted for NASA’s Aerial Aid Convergent Aeronautics Solutions (CAS) exploration project, which aims to assess the current state of the market and technological readiness for Uncrewed Aerial Systems (UAS) for medical emergency first response. The research reveals a robust and rapidly growing market for UAS, with a notable emerging sector for Drones as First Responders (DFR). Despite this growth, DFR applications are currently limited by regulatory, technical, and other challenges, which restrict their use primarily to manned remote video surveillance, and therefore are primarily employed by police units. To our knowledge, there is no evidence of UAS being utilized by medical first responders for scene assessment. Limited evidence exists for closely related applications; however, these are mostly confined to pilot programs for the delivery of medical supplies or equipment. Although there has been discussion around fully autonomous DFR applications for medical purposes such as UAS ambulances or patient transport drones, these applications are generally not yet operational in practice. The technology for full autonomy, especially in guidance and control, has seen significant advancements, and recent Federal Aviation Administration (FAA)regulations are likely to accelerate adoption. Computer vision algorithms for fully autonomous medical emergency response scene surveillance are primed for advancement and deployment. A notable gap likely exists between advancements in computer vision research and what is being integrated in the commercial DFR sector. This gap is primarily due to challenges such as quality assurance for autonomous systems, the availability of application-specific training datasets for computer vision algorithms, regulatory constraints, and public perception and privacy concerns.

Joshua M Fody↗
NASA NTRSDate not supplied

Objective Structured Clinical Evaluation (OSCE) of an Artificial Intelligence (AI) Clinical Decision Support System (CDSS) Tool

BACKGROUND Objective Structured Clinical Evaluations (OSCEs) have long been established as a robust methodology for summative assessment of clinical skills and decision-making during medical education. The recent integration of Artificial Intelligence (AI) into clinical decision-making processes has prompted the need for novel evaluation frameworks to assess the efficacy and reliability of AI clinical decision support system (CDSS) tools. This abstract outlines the process of quantitatively evaluating a novel CDSS (“Doc in a Box” Google 2024) trained on curated medical spaceflight data in the psychomotor domain as it interfaces with a human volunteer acting as the crew medical officer (CMO). PURPOSE The AI CDSS under review was developed as part of the Lunar Command and Control Interoperability (LuCCI) project, which is intended to address a gap in how Lunar Surface Systems (LSS) would interoperate across multiple programs, commercial partners, and international partners. The project objective is to define, prototype, integrate, and evaluate an interoperable lunar command, control, data, and software reference architecture to enable autonomy and informatics capability through common standards across LSS. A multi-modal AI-based CDSS compatible with Federated LSS will assist clinicians in diagnosing and managing complex medical conditions by providing evidence-based recommendations through predictive analytics. Given the critical role of decision-support as NASA continues to evolve its Earth-independent medical operations (EIMO), it is imperative to ensure that such AI tools perform reliably and align with clinical standards during progressive lunar and Martian exploration class missions. METHODS The OSCE framework, traditionally used for evaluating human clinicians, was adapted to assess the AI tool's decision-making capabilities in simulated clinical scenarios. In this adapted OSCE, the AI CDSS was tested across a series of structured clinical scenarios designed to mimic real-life spaceflight patient cases. These scenarios included a range of conditions and complexities, allowing for comprehensive assessment of the tool's performance. Key evaluation metrics included accuracy of diagnosis, timeliness of decision-making, and appropriate recommendations for therapies. The OSCE was scored by human physician evaluators who assessed the AI's recommendations in comparison with expert clinicians' medical decision making to ensure alignment with best practices and the standard of care. RESULTS Preliminary results indicate that the AI CDSS demonstrated high accuracy in diagnostic recommendations and decision support across various scenarios. However, certain limitations were noted, such as occasional discrepancies in handling complex or nuanced cases that required a more contextual understanding. Additionally, the tool scored higher on the diagnostic portion of the rubric, with lower scores in the therapeutic recommendations. These findings highlight the importance of continuous refinement and validation of AI tools through rigorous evaluation frameworks like the OSCE. The adaptation of OSCEs for AI tools presents several advantages, including a structured and reproducible approach to evaluation, the ability to test AI systems in diverse clinical scenarios, and the opportunity to benchmark AI performance against established clinical standards to permit charting of future progress as aerospace medicine evolves as a discipline. Remaining challenges include ensuring that these evaluations capture the full spectrum of clinical decision-making scenarios that will be confronted by CMOs during missions and adequately reflecting real-world variability of the austere spaceflight environment. CONCLUSION Employing OSCEs to evaluate AI clinical decision support tools offers a promising approach to validating their clinical utility and efficacy. This methodology not only provides insights into the tool's performance but also fosters ongoing improvement and alignment with standard of care practices. Future research should focus on refining these evaluation processes and addressing limitations to enhance the integration of AI tools in clinical spaceflight settings. REFERENCES Scott S, Hearns V, Barker MA. Testing Clinical Skills: A Look at the OSCE and USMLE Clinical Skills Exams. S D Med. 2019 Oct;72(10):451-453. Majumder MAA, Kumar A, Krishnamurthy K, Ojeh N, Adams OP, Sa B. An evaluative study of objective structured clinical examination (OSCE): students and examiners perspectives. Adv Med Educ Pract. 2019 Jun 5;10:387-397. Karam VY, Park YS, Tekian A, Youssef N. Evaluating the validity evidence of an OSCE: results from a new medical school. BMC Med Educ. 2018 Dec 20;18(1):313.

Ariana M Nelson↗
NASA NTRS2024

Combining Large Datasets - Cancer Moonshot Task Group Final Summary

In February 2022, President Biden re-ignited the Cancer Moonshot with bold new goals: to reduce the cancer death rate by half within 25 years and improve the lives of people with cancer and cancer survivors. To achieve these ambitious goals, the White House convened the first-ever Cancer Cabinet, bringing together departments and agencies from across the federal government to end cancer as we know it.The Cancer Cabinet convened three task forces and supporting task groups, including the Data and Innovation Task Force, which supported the Cancer Moonshot priority to “Deliver innovation to patients and communities.” In early 2023, the “Combining Large Datasets” (CoLD) Task Group was created within the Data and Innovation Task Force. The scope of the CoLD Task Group was how federal agencies combine large datasets for broad applications across cancer prevention and control, including nutrition, epidemiology, and military/Veteran health. Within this scope, the group sought to better leverage the immense potential of data and power of data tools to increase our understanding of cancer incidence, causes, mortality, treatments, prevention, outcomes, costs, and all other aspects of the burden of cancer.

data integration↗
NASA NTRSDate not supplied

Custom Integration of Multiple Medical Functionalities

INTRODUCTION: Previous spaceflight experience and results from probabilistic risk assessment of spaceflight medical risk have highlighted the need for vital sign measurements, medical scopes, and clinical imaging tools for managing medical conditions during spaceflight. The Human Research Program’s Exploration Medical Capability (ExMC) Element and the Mars Campaign Office’s Exploration Medical Integrated Product Team (XMIPT) have performed ground-based evaluations of two Commercial-off-the-Shelf (COTS) Multi-functional Integrated Medical (MIM) devices, which integrate various medical capabilities together in one device. The key findings from these evaluations are presented in a complementary presentation, leaving this presentation to focus on forward recommendations for customized integration of multiple medical functionalities. KEY COMPONENTS: The key features of a custom integration of multiple medical functionalities includes devices and capabilities that optimally reduce medical risk. The COTS MIM devices incorporated functionality for best supporting Earth-based, emergency, pre-hospital care. Our custom integration will use probabilistic risk assessment tools, such as the Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT), to determine the optimal functionality to include based on medical risk minimization. An additional feature of custom integration includes the ability to adapt to different requirements within different vehicles and/or missions. The COTS MIM devices store data in patient specific records, however, the format of the records is not modifiable, and data are not easily transferred from the MIM device to a central data architecture outside of the manufacturer’s established system. Our concept for custom integration will use devices that have an open application programming interface, which can easily connect to independent data architectures and third-party visualization software. The ultrasound capabilities included within the COTS MIM devices did not satisfy many of the Artemis Research and Operations Working Group’s ultrasound functional needs, and therefore, incorporation of higher quality ultrasound capabilities within a customized integration will be beneficial. The COTS MIM devices included minimal procedural guidance and clinical decision support tools. Supplemental tools of this type would need to be supplied along with the COTS MIM devices if they were to be used operationally, so another advantage of customization is the ability to integrate these support tools along with the medical functionality, for a more streamlined user experience. CONCLUSION: Investigation of a customized integration of medical functionality provides a method for further understanding the needs of a long-term exploration spaceflight medical system. The crew members of these exploration missions will need to operate more and more independently from Earth-based ground support. Therefore, having an optimized, streamlined medical system, which contains the functionality and supporting information needed, while remaining within mission and vehicle constraints, will help to maintain crew health and performance, which is necessary for achieving high levels of mission success.

B E Lewandowski↗