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At least 163 records · Page 9

Report on G4-Med, a Geant4 benchmarking system for medical physics applications developed by the Geant4 Medical Simulation Benchmarking Group

Geant4 is a Monte Carlo code extensively used in medical physics for a wide range of applications, such as dosimetry, micro- and nanodosimetry, imaging, radiation protection, and nuclear medicine. Geant4 is continuously evolving, so it is crucial to have a system that benchmarks this Monte Carlo code for medical physics against reference data and to perform regression testing. In this work, to respond to these needs, we developed G4-Med, a benchmarking and regression testing system of Geant4 for medical physics. G4-Med currently includes 18 tests. They range from the benchmarking of fundamental physics quantities to the testing of Monte Carlo simulation setups typical of medical physics applications. Both electromagnetic and hadronic physics processes and models within the prebuilt Geant4 physics lists are tested. The tests included in G4-Med are executed on the CERN computing infrastructure via the use of the geant-val web application, developed at CERN for Geant4 testing. The physical observables can be compared to reference data for benchmarking and to results of previous Geant4 versions for regression testing purposes. This paper describes the tests included in G4-Med and shows the results derived from the benchmarking of Geant4 10.5 against reference data.

60 APPLIED LIFE SCIENCES↗

Candidate Formulary Development for Exploration Missions

An interdisciplinary team of clinician, pharmacist, and system engineer subject matter experts (SMEs) collaborated to match pharmaceutical resources to the medical conditions anticipated to occur during exploration class missions. This effort began by using a SME generated Exploration Medical Conditions List and the associated medical system capabilities necessary to treat them. Using the systems engineering software MagicDraw™ and knowledge of pharmaceutical use and efficacy in spaceflight, the team traced appropriate medications to the medical conditions. These traces were used to pilot the process for generating a candidate formulary for level of care 4 and level of care 5 medical systems. This presentation will discuss the collaborative efforts of the team as they developed the content, detail the challenges of utilizing systems engineering software to describe clinical resources, and provide an overview of how the candidate medication formulary for exploration class missions was developed. It will also discuss how the lessons learned from this pilot effort can be applied to streamline future work.

S. Kurian↗

Crew Medical Officer Training and Role of Ground Support for International Space Station (ISS) Operations

Medical systems supporting exploration-class missions to the Moon and Mars will require greater inflight medical decision-making autonomy. An understanding of current ISS training regimens for Crew Medical Officers (CMOs) as well as the role of ground support personnel in medical operations is needed to identify the starting point from which exploration medical system design must evolve in order to achieve inflight medical autonomy.

Rachel Richardson↗

Supervisory Algorithm for Autonomous Hemodynamic Management Systems

Future military conflicts will require new solutions to manage combat casualties. The use of automated medical systems can potentially address this need by streamlining and augmenting the delivery of medical care in both emergency and combat trauma environments. However, in many situations, these systems may need to operate in conjunction with other autonomous and semi-autonomous devices. Management of complex patients may require multiple automated systems operating simultaneously and potentially competing with each other. Supervisory controllers capable of harmonizing multiple closed-loop systems are thus essential before multiple automated medical systems can be deployed in managing complex medical situations. The objective for this study was to develop a Supervisory Algorithm for Casualty Management (SACM) that manages decisions and interplay between two automated systems designed for management of hemorrhage control and resuscitation: an automatic extremity tourniquet system and an adaptive resuscitation controller. SACM monitors the required physiological inputs for both systems and synchronizes each respective system as needed. We present a series of trauma experiments carried out in a physiologically relevant benchtop circulatory system in which SACM must recognize extremity or internal hemorrhage, activate the corresponding algorithm to apply a tourniquet, and then resuscitate back to the target pressure setpoint. SACM continues monitoring after the initial stabilization so that additional medical changes can be quickly identified and addressed, essential to extending automation algorithms past initial trauma resuscitation into extended monitoring. Overall, SACM is an important step in transitioning automated medical systems into emergency and combat trauma situations. Future work will address further interplay between these systems and integrate additional medical systems.

42 ENGINEERING↗

Medical Research System

Based on Johnson Space Flight Center's development of a rotating bioreactor cell culture apparatus for Space Shuttle medical research, Johnson Space Flight Center engineers who worked on the original project formed a company called Synthecon, with the intention of commercializing the bioreactor technology. Synthecon grows three dimensional tissues in the bioreactor. These are superior to previous two-dimensional tissue samples in the study of human cell growth. A refined version of the Johnson Space Center technology, Synthecon's Rotary Cell Culture System includes a cell culture chamber that rotates around a horizontal axis. The cells establish an orbit that approximates free fall through the liquid medium in the chamber. The technology has significant applications for cancer research and treatment as well as AIDS research.

Source record↗

Design, installation and operating experience of 20 photovoltaic medical refrigerator systems on four continents

The NASA Lewis Research Center in cooperation with the World Health Organization, U.S.A. I.D., the Pan American Health Organization and national government agencies in some developing countries sponsored the installation of twenty photovoltaic powered medical vaccine storage refrigerator-freezer (R/F) systems. The Solar Power Corporation was selected as the contractor to perform the design, development and installation of these twenty units. Solar Power's experiences are described herein.

Hein, G. F.↗

Field-testing the new DECtalk PC system for medical applications

Synthesized human speech has now reached a new level of performance. With the introduction of DEC's new DECtalk PC, the small system developer will have a very powerful tool for creative design. It has been our privilege to be involved in the beta-testing of this new device and to add a medical dictionary which covers a wide range of medical terminology. With the inherent board level understanding of speech synthesis and the medical dictionary, it is now possible to provide full digital speech output for all medical files and terms. The application of these tools will cover a wide range of options for the future and allow a new dimension in dealing with the complex user interface experienced in medical practice.

NASA Discipline Data Analysis↗

Root Cause Analysis of the Data Refinement Process – Medical Conditions Capability Resource Tables

The medical system for spaceflight thus far has been designed to support missions in low earth orbit (LEO). Crew capabilities are limited and heavily dependent on the team of medical support staff at Mission Control Center (MCC) to guide diagnosis and management. However, missions to the Moon and Mars will suffer from several constraints that will make this ground support focused approach to care ineffective. In order to update and modify medical system design, NASA has relied on Probabilistic Risk Assessment (PRA) modeling to mitigate medical risk through trade space analysis. Specifically, capability resource tables (CRT’s) were developed to create a dataset of resources required to manage a list of accepted medical conditions significant in exploration spaceflight. With 120 conditions, this dataset contained hundreds of capabilities and thousands of resources with tens of thousands of cells of data. Initially these tables were built in excel for high throughput during development, but ultimately had to be transferred, managed, and modified into the Evidence Library database for modeling purposes. The process of collating and reviewing the Evidence Library revealed numerous errors in the dataset that had to be corrected through iterative changes. Several error types emerged during this process and can be broken into specific classifications defined as “input”, “transcription”, “structural”, “branching”, and “information”. In reviewing these error types through the root cause analysis (RCA) approach, we were able to identify the contributors to these errors which included single data review points, changing product end goals, limited software selection, time constraints and several others. By reviewing and evaluating the underlying causes we can provide possible system improvements that can be implemented for current and future data management in PRA model inputs.

A. Anderson↗

Association Between Dispatch Complaint and Critical Prehospital Time Intervals in Suspected Stroke 911 Activations in the National Emergency Medical Services Information System, 2012–2016

Emergency Medical Services can help improve stroke outcomes by recognizing stroke symptoms, establishing response priority for 911 calls, and minimizing prehospital delays. This study examines 911 stroke events and evaluates associations between events dispatched as stroke and critical EMS time intervals. Data from the National Emergency Medical Services Information System, 2012 to 2016, were analyzed. Activations from 911 calls with a primary or secondary provider impression of stroke were included for adult patients transported to a hospital destination. Three prehospital time intervals were evaluated: (1) response time (RT) ≤8 min, (2) on-scene time (OST) ≤15 min, and (3) transport time (TT) ≤12 min. Associations between stroke dispatch complaint and prehospital time intervals were assessed using multivariate regression to estimate adjusted risk ratios (ARR) and 95% confidence intervals (CIs). Approximately 37% of stroke dispatch complaints were identified by EMS as a suspected stroke. Compared to stroke events without a stroke dispatch complaint, median OST was shorter for events with a stroke dispatch (16 min vs. 14 min, respectively). In adjusted analyses, events dispatched as stroke were more likely to meet the EMS time benchmark for OST ≤15 min (OST, 1.20 [1.20–1.21]), but not RT or TT (RT, [1.00–1.01]; TT, 0.95 [0.94–0.95]). Furthermore, our results indicate that dispatcher recognition of stroke symptoms reduces the time spent on-scene by EMS personnel. These findings can inform future EMS stroke education and quality improvement efforts to emphasize dispatcher recognition of stroke signs and symptoms, as EMS dispatchers play a crucial role in optimizing the prehospital response.

59 BASIC BIOLOGICAL SCIENCES↗

Exploration Medical Cap Ability System Engineering Overview

Deep Space Gateway and Transport missions will change the way NASA currently practices medicine. The missions will require more autonomous capability compared to current low Earth orbit operations. For the medical system, lack of consumable resupply, evacuation opportunities, and real-time ground support are key drivers toward greater autonomy. Recognition of the limited mission and vehicle resources available to carry out exploration missions motivates the Exploration Medical Capability (ExMC) Element's approach to enabling the necessary autonomy. The ExMC Systems Engineering team's mission is to "Define, develop, validate, and manage the technical system design needed to implement exploration medical capabilities for Mars and test the design in a progression of proving grounds." The Element's work must integrate with the overall exploration mission and vehicle design efforts to successfully provide exploration medical capabilities. ExMC is using Model-Based System Engineering (MBSE) to accomplish its integrative goals. The MBSE approach to medical system design offers a paradigm shift toward greater integration between vehicle and the medical system, and directly supports the transition of Earth-reliant ISS operations to the Earth-independent operations envisioned for Mars. This talk will discuss how ExMC is using MBSE to define operational needs, decompose requirements and architecture, and identify medical capabilities needed to support human exploration. How MBSE is being used to integrate across disciplines and NASA Centers will also be described. The medical system being discussed in this talk is one system within larger habitat systems. Data generated within the medical system will be inputs to other systems and vice versa. This talk will also describe the next steps in model development that include: modeling the different systems that comprise the larger system and interact with the medical system, understanding how the various systems work together, and developing tools to support trade studies.

McGuire, K.↗

Improving Quantification of Medical Evacuation Risk for Human Spaceflight in the IMPACT Model

Traditionally, mission planners have used a heuristic and qualitative approach to design medical systems based on prior experience however this approach may result in high variability and implicit bias to design and could put missions and crewmembers at risk. The Informing Mission Planning through Analysis of Complex Tradespaces (IMPACT) tool is a probabilistic risk assessment tool designed by NASA to model medical risk in long duration missions outside of low earth orbit (LEO). This tool can quantify risk metrics such as risk of crewmember death, loss of crew task time, and the need for medical evacuation to better inform and augment the more traditional approach to medical system design. The risk metric of Return to Definitive Care (RTDC) represents the likelihood of requiring medical evacuation and has been difficult to quantify in a reliable and standardized manner. Initial development of the RTDC metric was constrained due to the complexity of a medical evacuation decision and the lack of prior spaceflight data and this presentation will discuss the review and improvement process used to increase model accuracy and fidelity.

Prashant Parmar↗

Exploration Medical Capability Science and Research Overview and Update

The mission of the Exploration Medical Capability (ExMC) Element is to advance medical system design and risk-informed decision making for exploration beyond low Earth orbit to promote human health and performance in space. In order to accomplish this mission, the Element takes a progressively Earth-independent approach to three main areas: - Answering key clinical and science research questions that will help to address the challenges of providing medical care in the extreme environment of space - Applying systems engineering processes to medical system design with the goal of developing robust requirements that can be fully integrated into future space exploration vehicle designs - Developing and demonstrating novel medical technologies that will improve future medical capabilities in space This presentation will focus on selected scientific and technical conceptual drivers for the Element, the current and future research risks and gaps, and provide an overview of the Element’s progress in 2022. In particular, it will address the ongoing effort for the IMPACT trade space analysis tool suite, the closeout work on a clinical decision support prototype, potential requirements for a long-duration lunar orbit and lunar surface medical system, and an International Space Station technology demonstration of a point-of-care laboratory analysis capability.

Kris Lehnhardt↗

From IMM to IMPACT: Enhanced Functionality for Exploration Missions

The Integrated Medical Model (IMM) is an evidence-based decision support tool used to assess medical risk and optimize medical systems for manned spaceflight missions. The IMM is baselined to the International Space Station (ISS) in terms of the spaceflight environment of low earth orbit and the ISS medical resource capability. IMPACT is the next generation evidence-based decision support tool currently under development by the Human Research Program to assess medical risk and optimize medical systems for future exploration missions to the moon and Mars. IMPACT is being designed to provide a comprehensive integrated suite of decision support tools for mission planners. This presentation will focus on the lessons learned from IMM and the enhanced functionalities of IMPACT.

E L Kerstman↗

Medical Automation System at the Marshall Space Flight Center

A computer system is reported for scheduling and coordinating physical examinations for groups of people who work with chemicals, lasers, X-rays, isotopic sources, toxic fuels, adhesives, and exotic metals. Complete medical data on the examined population are continuously updated for a broad medical master file. Statistical methods are employed to project progressive changes in the health status of these employees for possible clinical interventions.

Spraul, J. H.↗

Impact-Identified Medical Capabilities with Largest Effect on Medical Risk for an Extended Duration Artemis Mission

Historically, identifying resources to include in a medical system has been based on heuristically guided clinical subject matter expert assessment. Probabilistic risk assessment (PRA) and tradespace analysis have the power to simplify and increase the fidelity of this traditional approach by providing initial risk estimates and system design solutions that fit within the specified constraints. This will be especially important as the increased mission complexity, distance from Earth, and duration of LDEMs is likely to drive an increase in mission medical risk. NASA’s Informing Mission Planning via Analysis of Complex Tradespaces tool (IMPACT) is designed to do just that. IMPACT uses an evidence based medical database of conditions likely to affect LDEM outcomes and a PRA computational engine to estimate how medical conditions and included medical capabilities affect mission outcomes. We identified the 10 medical conditions with the largest effect on medical risks and determined what medical system capabilities affected risk reduction the greatest.

Anderson A↗

Risk of Adverse Health Outcomes and Decrements in Performance Due to In-flight Medical Conditions

The drive to undertake long-duration space exploration missions at greater distances from Earth gives rise to many challenges concerning human performance under extreme conditions. At NASA, the Human Research Program (HRP) has been established to investigate the specific risks to astronaut health and performance presented by space exploration, in addition to developing necessary countermeasures and technology to reduce risk and facilitate safer, more productive missions in space (NASA Human Research Program 2009). The HRP is divided into five subsections, covering behavioral health, space radiation, habitability, and other areas of interest. Within this structure is the ExMC Element, whose research contributes to the overall development of new technologies to overcome the challenges of expanding human exploration and habitation of space. The risk statement provided by the HRP to the ExMC Element states: "Given that medical conditions/events will occur during human spaceflight missions, there is a possibility of adverse health outcomes and decrements in performance in mission and for long term health" (NASA Human Research Program 2016). Within this risk context, the Exploration Medical Capabilities (ExMC) Element is specifically concerned with establishing evidenced-based methods of monitoring and maintaining astronaut health. Essential to completing this task is the advancement in techniques that identify, prevent, and treat any health threats that may occur during space missions. The ultimate goal of the ExMC Element is to develop and demonstrate a pathway for medical system integration into vehicle and mission design to mitigate the risk of medical issues. Integral to this effort is inclusion of an evidence-based medical and data handling system appropriate for long-duration, exploration-class missions. This requires a clear Concept of Operations, quantitative risk metrics or other tools to address changing risk throughout a mission, and system scoping and system engineering. Because of the novel nature of the risks involved in exploration missions, new and complex ethical challenges are likely to be encountered. This document describes the relevant background and evidence that informs the development of an exploration medical system.

Antonsen,Erik↗

Coupling apparatus for ultrasonic medical diagnostic system

An apparatus for the ultrasonic scanning of a breast or other tissue is reported that contains a cavity for receiving the breast, a vacuum for drawing the breast into intimate contact with the walls of the cavity, and transducers coupled through a fluid to the cavity to transmit sound waves through the breast. Each transducer lies at the end of a tapered chamber which has flexible walls and which is filled with fluid, so that the transducer can be moved in a raster pattern while the chamber walls flex accordingly, with sound transmission always occurring through the fluid.

Frazer, R. E.↗