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At least 19 records

The Portable Dynamic Fundus Instrument: Uses in telemedicine and research

For years ophthalmic photographs have been used to track the progression of many ocular diseases such as macular degeneration and glaucoma as well as the ocular manifestations of diabetes, hypertension, and hypoxia. In 1987 a project was initiated at the Johnson Space Center (JSC) to develop a means of monitoring retinal vascular caliber and intracranial pressure during space flight. To conduct telemedicine during space flight operations, retinal images would require real-time transmissions from space. Film-based images would not be useful during in-flight operations. Video technology is beneficial in flight because the images may be acquired, recorded, and transmitted to the ground for rapid computer digital image processing and analysis. The computer analysis techniques developed for this project detected vessel caliber changes as small as 3 percent. In the field of telemedicine, the Portable Dynamic Fundus Instrument demonstrates the concept and utility of a small, self-contained video funduscope. It was used to record retinal images during the Gulf War and to transmit retinal images from the Space Shuttle Columbia during STS-50. There are plans to utilize this device to provide a mobile ophthalmic screening service in rural Texas. In the fall of 1993 a medical team in Boulder, Colorado, will transmit real-time images of the retina during remote consultation and diagnosis. The research applications of this device include the capability of operating in remote locations or small, confined test areas. There has been interest shown utilizing retinal imaging during high-G centrifuge tests, high-altitude chamber tests, and aircraft flight tests. A new design plan has been developed to incorporate the video instrumentation into face-mounted goggle. This design would eliminate head restraint devices, thus allowing full maneuverability to the subjects. Further development of software programs will broaden the application of the Portable Dynamic Fundus Instrument in telemedicine and medical research.

Hunter, Norwood↗

Medicine on Mars: Remote medical care and the space exploration initiative

Mars exploration missions as described in the Synthesis Group report will involve extended exposures of crew members to remote, hazardous environments for up to 100 days. Maintenance of crew health and performance will be critical to ensure mission success. Because of the great distances between the Earth and Mars, round trip telecommunication will take from seven to forty minutes and immediate return to Earth will not be feasible: an autonomous medical care system that integrates preventive, occupational, and environmental aspects of health care and provides diagnostic and treatment capabilities will be necessary. Providing medical care for Mars explorers will pose some unique technical and engineering challenges. Medical care equipment will need to be designed to be modular and portable to ensure that it is interchangeable between vehicle and planetary surface elements. Miniaturization will be necessary to reduce mass and volume. Computerized systems that automatically acquire and manage medical information and provide medical references (literature), decision support, and automated medical record keeping will be a crucial part of a Martian medical care system. Medical care will also rely on remote consultation with Earth-based specialists. This presentation will provide an overview of the health and medical concerns associated with Mars exploration missions and will describe some specific concepts for Mars medical care systems.

Simmons, S. C.↗

Telemedicine: An Application in Search of Users

Telemedicine involves the use of telecommunication technologies as a medium for the provision of medical information and services to consumers at sites that are at a distance from the provider. The concept encompasses everything from the telephone system to high-speed, wide-bandwidth transmission with use of fiberoptics, satellites, or a combination of terrestrial and satellite-communication technologies. The peripheral software could be as simple as a typewriter used to type a letter requesting an opinion or as complex as high-capacity parallel processing computers and imaging devices. Although the definition includes telephone, facsimile, and distance learning, the term "Telemedicine" is currently used as a generic label for remote consultation and diagnosis. Telemedicine is not a medical subspecialty but a facilitator of all medical and surgical specialties.

Khandheria, Bijoy K.↗

Telemedicine and international disaster response: Medical consultation to Armenia and Russia via a telemedicine spacebridge

The Telemedicine Spacebridge, a satellite mediated audio-video-fax link between four U.S. and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. 209 patients were discussed, requiring expertise in 20 specialty areas. Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several U.S. medical centers was judged beneficial; quality of data transmission was judged excellent. These results suggest that interactive consultation by remote specialists can provide valuable assistance to onsite physicians and favorably influence clinical decisions in the aftermath of major disasters.

Houtchens, Bruce A.↗

Some considerations in low-cost image processing on a university main frame: The Penn State (ORSER) experience

The ORSER System as implemented on the Penn State University Computation Center's IBM main frame is an exceptionally useful mechanism for instructing the present and future remote sensing community in the theory and practice of automated analysis of digitized data. From its beginning, the system was used as the hands-on back-bone of a graduate level "Multispectral Remote Sensing" one-term course taught annually in the School of Forest Resources. It was also used at the end of a senior-level undergraduate "Introduction to Remote Sensing" course, and in teaching a variety of short courses, ranging in length from a few days for small groups of remote sensing consultants with specific application interests, to a 2-week course oganized by NASA for regional and urban planners who had little or no previous exposure to remote sensing. Because of its modular construction, the ORSER is suitable for all classes of remote sensing users. Although in a beginning course only 6 to 10 of the programs are generally used, the researcher has a set of about 35 programs available for his analyses.

Turner, B. J.↗

Quantitative 3-D imaging topogrammetry for telemedicine applications

The technology to reliably transmit high-resolution visual imagery over short to medium distances in real time has led to the serious considerations of the use of telemedicine, telepresence, and telerobotics in the delivery of health care. These concepts may involve, and evolve toward: consultation from remote expert teaching centers; diagnosis; triage; real-time remote advice to the surgeon; and real-time remote surgical instrument manipulation (telerobotics with virtual reality). Further extrapolation leads to teledesign and telereplication of spare surgical parts through quantitative teleimaging of 3-D surfaces tied to CAD/CAM devices and an artificially intelligent archival data base of 'normal' shapes. The ability to generate 'topogrames' or 3-D surface numerical tables of coordinate values capable of creating computer-generated virtual holographic-like displays, machine part replication, and statistical diagnostic shape assessment is critical to the progression of telemedicine. Any virtual reality simulation will remain in 'video-game' realm until realistic dimensional and spatial relational inputs from real measurements in vivo during surgeries are added to an ever-growing statistical data archive. The challenges of managing and interpreting this 3-D data base, which would include radiographic and surface quantitative data, are considerable. As technology drives toward dynamic and continuous 3-D surface measurements, presenting millions of X, Y, Z data points per second of flexing, stretching, moving human organs, the knowledge base and interpretive capabilities of 'brilliant robots' to work as a surgeon's tireless assistants becomes imaginable. The brilliant robot would 'see' what the surgeon sees--and more, for the robot could quantify its 3-D sensing and would 'see' in a wider spectral range than humans, and could zoom its 'eyes' from the macro world to long-distance microscopy. Unerring robot hands could rapidly perform machine-aided suturing with precision micro-sewing machines, splice neural connections with laser welds, micro-bore through constricted vessels, and computer combine ultrasound, microradiography, and 3-D mini-borescopes to quickly assess and trace vascular problems in situ. The spatial relationships between organs, robotic arms, and end-effector diagnostic, manipulative, and surgical instruments would be constantly monitored by the robot 'brain' using inputs from its multiple 3-D quantitative 'eyes' remote sensing, as well as by contact and proximity force measuring devices. Methods to create accurate and quantitative 3-D topograms at continuous video data rates are described.

Altschuler, Bruce R.↗

Medicine in long duration space exploration: the role of virtual reality and broad bandwidth telecommunications networks

Safety of astronauts during long-term space exploration is a priority for NASA. This paper describes efforts to produce Earth-based models for providing expert medical advice when unforeseen medical emergencies occur on spacecraft. These models are Virtual Collaborative Clinics that reach into remote sites using telecommunications and emerging stereo-imaging and sensor technologies. c 2001. Elsevier Science Ltd. All rights reserved.

Non-NASA Center↗

Internet technologies and requirements for telemedicine

Internet technologies are briefly introduced and those applicable for telemedicine are reviewed. Multicast internet technologies are described. The National Aeronautics and Space Administration (NASA) 'Telemedicine Space-bridge to Russia' project is described and used to derive requirements for internet telemedicine. Telemedicine privacy and Quality of Service (QoS) requirements are described.

Remote Consultation↗

The TERESA project: from space research to ground tele-echography

Ultrasound examinations represent one of the major diagnostic modalities of future healthcare. They are currently used to support medical space research but require a high skilled operator for both probe positioning on the patient's skin and image interpretation. TERESA is a tele-echography project that proposes a solution to bring astronauts and remotely located patients on ground quality ultrasound examinations despite the lack of a specialist at the location of the wanted medical act.

Space Flight/instrumentation↗

Internet-based transfer of cardiac ultrasound images

A drawback to large-scale multicentre studies is the time required for the centralized evaluation of diagnostic images. We evaluated the feasibility of digital transfer of echocardiographic images to a central laboratory for rapid and accurate interpretation. Ten patients undergoing trans-oesophageal echocardiographic scanning at three sites had representative single images and multiframe loops stored digitally. The images were analysed in the ordinary way. All images were then transferred via the Internet to a central laboratory and reanalysed by a different observer. The file sizes were 1.5-72 MByte and the transfer rates achieved were 0.6-4.8 Mbit/min. Quantitative measurements were similar between most on-site and central laboratory measurements (all P > 0.25), although measurements differed for left atrial width and pulmonary venous systolic velocities (both P < 0.05). Digital transfer of echocardiographic images and data to a central laboratory may be useful for multicentre trials.

NASA Discipline Cardiopulmonary↗

Real-Time Teleguidance of a Non-Surgeon Crew Medical Officer Performing Orthopedic Surgery at the Amundsen-Scott South Pole Station During Winter-Over

The Amundsen-Scott South Pole Research station located at the geographic South Pole, is the most isolated, permanently inhabited human outpost on Earth. Medical care is provided to station personnel by a non-surgeon crew medical officer (CMO). During the winter-over period from February to October, the station is isolated, with no incoming or outgoing flights due to severe weather conditions. In late June, four months after the station had closed for the austral winter, a 31 year old meteorologist suffered a complete rupture of his patellar tendon while sliding done an embankment. An evacuation was deemed to be too risky to aircrews due to the extreme cold and darkness. A panel of physicians from Massachusetts General Hospital, Johns Hopkins University and the University of Texas Medical Branch were able to assess the patient remotely via telemedicine and agreed that surgery was the only means to restore mobility and prevent long term disability. The lack of a surgical facility and a trained surgical team were overcome by conversion of the clinic treatment area, and intensive preparation of medical laypersons as surgical assistants. The non-surgeon CMO and CMO assistant at South Pole, were guided through the administration of spinal anesthetic, and the two-hour operative repair by medical consultants at Massachusetts General Hospital. Real-time video of the operative field, directions from the remote consultants and audio communication were provided by videoconferencing equipment, operative cameras, and high bandwidth satellite communications. In real-time, opening incision/exposure, tendon relocation, hemostatsis, and operative closure by the CMO was closely monitored and guided and by the remote consultants. The patient s subsequent physical rehabilitation over the ensuing months of isolation was also monitored remotely via telemedicine. This was the first time in South Pole s history that remote teleguidance had been used for surgery and represents a model for real-time guidance of CMO s working at remote duty stations.

Otto, Christian↗

Space Link Extension Protocol Emulation for High-Throughput, High-Latency Network Connections

New space missions require higher data rates and new protocols to meet these requirements. These high data rate space communication links push the limitations of not only the space communication links, but of the ground communication networks and protocols which forward user data to remote ground stations (GS) for transmission. The Consultative Committee for Space Data Systems, (CCSDS) Space Link Extension (SLE) standard protocol is one protocol that has been proposed for use by the NASA Space Network (SN) Ground Segment Sustainment (SGSS) program. New protocol implementations must be carefully tested to ensure that they provide the required functionality, especially because of the remote nature of spacecraft. The SLE protocol standard has been tested in the NASA Glenn Research Center's SCENIC Emulation Lab in order to observe its operation under realistic network delay conditions. More specifically, the delay between then NASA Integrated Services Network (NISN) and spacecraft has been emulated. The round trip time (RTT) delay for the continental NISN network has been shown to be up to 120ms; as such the SLE protocol was tested with network delays ranging from 0ms to 200ms. Both a base network condition and an SLE connection were tested with these RTT delays, and the reaction of both network tests to the delay conditions were recorded. Throughput for both of these links was set at 1.2Gbps. The results will show that, in the presence of realistic network delay, the SLE link throughput is significantly reduced while the base network throughput however remained at the 1.2Gbps specification. The decrease in SLE throughput has been attributed to the implementation's use of blocking calls. The decrease in throughput is not acceptable for high data rate links, as the link requires constant data a flow in order for spacecraft and ground radios to stay synchronized, unless significant data is queued a the ground station. In cases where queuing the data is not an option, such as during real time transmissions, the SLE implementation cannot support high data rate communication.

Computer Networking↗

Determining economic benefits of satellite data in short-range forecasting

The chances of enhanced short term weather predictions and economic benefits from the use of GOES satellite data were examined. Results for a meteorological consulting firm before and after the introduction of GOES data were chosen as the method, and monetary benefits were selected as the measure. Services were provided for use by road and street departments, commodities dealers, and marine clients of the consulting firm. The Man-computer Interactive Data Access Program (McIDAS) was employed to furnish 1/2 hour visual or IR imagery for remote access. The commodities clients reconnected the GOES real-time imagery once the study was completed, while the consulting firm, which was personnel and not equipment intensive, did not. Further development of the flexibility of access to the GOES data and improvements in the projected grids are indicated.

Suchman, D.↗

Application of future remote sensing systems to irrigation

Area estimates of irrigated crops and knowledge of crop type are required for modeling water consumption to assist farmers, rangers, and agricultural consultants in scheduling irrigation for distributed management of crop yields. Information on canopy physiology and soil moisture status on a spatial basis is potentially available from remote sensors, so the questions to be addressed relate to: (1) timing (data frequency, instantaneous and integrated measurement); and scheduling (widely distributed spatial demands); (2) spatial resolution; (3) radiometric and geometric accuracy and geoencoding; and (4) information/data distribution. This latter should be overnight, with no central storage, onsite capture, and low cost.

Miller, L. D.↗

A Concept of Operations (ConOps) of an In-time Aviation Safety Management System (IASMS) for Advanced Air Mobility (AAM)

The growth of new emerging operations involving Advanced Air Mobility (AAM) necessitates developing a perspective for an In-time Aviation Safety Management System (IASMS). This perspective advances from the National Academies report on IASMS and its recommendation for developing a Concept of Operations (ConOps) for IASMS. A ConOps has been developed for In-time System-Wide Safety Assurance (ISSA) from which the IASMS ConOps pivots to provide a robust scope commensurate with the broad vision defined by the National Academies. The IASMS ConOps focuses on emerging operations and spans innovations in Unmanned Aircraft System (UAS) and an increasingly complex ecosystem comprised of a widening mix of vehicles and technologies, Urban Air Mobility (UAM) with industry-federated services, traditional operations, as well as new supersonic aircraft and space launch systems.The challenge for the IASMS ConOps is to be broad to encompass innovations in the coming years and decades while agile to ensure levels of safety compatible with operational and certification requirements of the National Airspace System (NAS). The IASMS ConOps interweaves increasing complexity of operational safety capabilities and unlocking UAS Maturity Levels (UMLs). The relationships between increased complexity of automation and automated systems, fewer operators who are not as traditionally higher skilled, more complex operational environments, and aviation operations management with mixed aircraft and equipage pose a multi-dimensional space for IASMS capabilities essential for safety assurance and risk management. Instantiating IASMS capabilities and how they would be integral to AAM operations and increasing maturity of UAM could be accomplished through a series of Safety Demonstrators. These Safety Demonstrators could provide increased understanding and insight into use of controls for risk mitigation, means of compliance for certification, and operational experience with safety services such as in relation to contingency management. The IASMS capabilities can be viewed as initially residing with the vehicle, airspace, and Supplemental Data Service Provider (SDSP). For example, vehicle capabilities include communications including the command and control link, Remote Identification (ID), conflict advisory/alerting, and UAS system monitoring. These capabilities monitor and assess data such as battery health, aircraft state, and human performance. Complexity of ISAMS capabilities depends on a number of factors. These factors are intendedonly as a notional categorization with the purpose being to reflect the complexity of the AAM ecosystem that would drive up the complexity of ISSA capabilities including systems, sensors, models, standards, and controls. Factors could include the Vehicle Flight Management, Environment, Airspace, and Contingency Management. Each of these factors can be comprised of multiple sub-factors that contribute to increasing complexity. For example, Airspace at a lower level of complexity could be dedicated to UTM operations that are unmonitored, and at a higher level of complexity could involve mixed UTM and ATM operations. The IASMS concept includes safety services that provide data and information to different participants in AAM. The roles and responsibilities of participants can be defined using the Responsible-Accountable-Consulted-Informed (RACI) analysis. For example, for the safety service involving the Remote ID, the Operator would be accountable for providing the data, the Vehicle would be responsible for transmitting it, and the USS, SDSP, Vertiports, FIMS (FAA), and Public Entities such as safety services would be informed by receiving the data. The IASMS ConOps identifies the capabilities needed for risk mitigation and safety assurance in the increasingly complex national airspace. The ConOps serves as a pathway for engaging with industry to gain operational experience including through the Safety Demonstrator series, the RACI analysis, and operational complexity factors. The ConOps serves to integrate these different perspectives to build a cohesive and cogent approach to an AAM safety management system.

In-Time Aviation Safety Management System↗