NASA - National Aeronautics and Space Administration

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Experiment/Payload Overview

Brief Summary

The Advanced Diagnostic Ultrasound in Microgravity (ADUM) experiment involves crewmembers conducting ultrasound exams on one another to determine the accuracy of ultrasound use to diagnose certain types of on-orbit injuries and illnesses, as well as to assess the feasibility of ultrasound for monitoring in-flight bone alterations.

Principal Investigator

Scott A. Dulchavsky, M.D., Ph.D., Henry Ford Health System, Detroit, MI

Co-Investigator(s)/Collaborator(s)

Shannon Melton, Wyle Laboratories, Houston, TX

Douglas Hamilton, M.D., Ph.D., Wyle Laboratories, Houston, TX

Ashot Sargsyan, M.D., Wyle Laboratories, Houston, TX

Payload Developer

Johnson Space Center, Human Research Program, Houston, TX

Sponsoring Space Agency

National Aeronautics and Space Administration (NASA)

Supporting Organization:

Exploration Systems Mission Directorate (ESMD)

Expeditions Assigned

|8|9|10|11|12|

ISS Duration:
October 20, 2003 - April 08, 2006

Previous ISS Missions

ADUM is the first formal experiment to examine the use of ultrasound in microgravity. Crewmembers, however, did check out the ultrasound equipment during Increment 5.

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Experiment/Payload Description

Research Summary

• The ultrasound is the only medical imaging device currently available on the International Space Station (ISS). Ultrasound may have direct application for the evaluation and diagnosis of 250 medical conditions of interest for treating exploration crews.



• This experiment demonstrates the diagnostic accuracy of ultrasound in medical contingencies in space, determining the ability of minimally-trained crewmembers to perform ultrasound examinations with remote guidance from the ground.



• Crews traveling beyond Low Earth Orbit (LEO) need the telemedicine strategies this experiment investigates, should injury or illness occur in space. There are also widespread Earth applications for emergencies and rural care situations.

Description

Advanced Diagnostic Ultrasound in Microgravity (ADUM) tests the accuracy of using ultrasound technology in the novel clinical situation of space flight. This investigation includes assessing health problems in the eyes and bones, as well as sinus infections and abdominal injuries. ADUM further tests the feasibility of in-flight ultrasound use to monitor bone density during long-duration space flights. Another objective of the experiment is to determine how well nonmedical crewmembers can learn to use an ultrasound device via CD ROM training manuals and remote guidance from Earth. The intent of the ADUM investigation is to develop methods by which a medically-untrained individual can use an ultrasound machine with remote diagnostician assistance to evaluate a vast array of medical problems.

Expedition crews use the International Space Station (ISS) Human Research Facility (HRF) ultrasound machine and four scan sets: the cardio/thoracic scan, which focuses on the heart, but also can scan the lungs; the abdominal/retroperitoneal scan, which focuses on the organs of the abdomen, including the liver, spleen, kidneys, and bladder; the dental scan, which can image the mouth, teeth, gums, facial bones and sinuses, and eyes; and the bone scan, which images bones and characterizes bone loss during flight. In addition to the ultrasound machine and probes, another key component of ADUM on ISS is the onboard proficiency enhancer, a software application the crew uses to train on the methods employed for each scan.

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Applications

Space Applications

Aboard the ISS, there is not enough room for a fully functioning hospital or staff of doctors. It is also not feasible for a crewmember to return to Earth for a quick medical checkup. This experiment allows for efficient diagnosis of medical problems with minimal use of onboard resources. The ability of crewmembers to use an ultrasound machine with remote instruction, along with ground analysis, promotes timely treatment and averts unnecessary evacuation. Using a modification of this technology, crewmembers as far away as Mars could obtain remote examinations from doctors on Earth. This type of capability is essential for long-term space exploration.

Earth Applications

The use of a relatively small piece of medical equipment to diagnose various health problems, in the absence of nearby specialized medical personnel, could save lives and reduce healthcare costs. Patients could transmit ultrasound information to doctors over great distances, resulting in efficient remote medical diagnosis and treatment to a high degree of confidence. This technology essentially allows anyone in the world the potential to access unique clinical imaging expertise remotely.

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Operations

Operational Requirements

The current procedures for ADUM require two crewmembers to participate during each experimental scan. One person serves as a subject while the other operates the HRF ultrasound machine. For all scans, except the Bone scan, the experimental subject must anchor into the Medical Operations Crew Medical Restraint System. Instruction from the ground-based personnel during each scan requires two-way audio and a video downlink of the ultrasound images. Both audio and video links operate in the required private mode, which ensures crewmember privacy both during and after the experiment.

Operational Protocols

ADUM investigator-developed Onboard Proficiency Enhancer (OPE) supplements the crewmembers? ground training prior to each Increment. OPE sections are specific to each type of scan and crewmembers must view them within the week immediately before the respective scan.

The ISS crew must set up the ultrasound hardware on the day of each scan session. This equipment primarily consists of the HRF laptop and the ultrasound keyboard, monitor, and probes. Each scan lasts between 20 and 50 minutes. After the scan completes, the crew shuts down the ultrasound machine and stows the hardware. The total crew time required for each scan session is approximately 2 hours.

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Results/More Information

The ISS ADUM experiment (duration: Expedition 8 to 11) demonstrates that minimal training, along with audio guidance from a certified sonographer, can produce ultrasound imagery of diagnostic quality. The ISS crewmembers, act as operators and subjects, completing comprehensive scans of the cardiothoracic and abdominal organs, as well as limited scans of the dental, sinus, and eye structures. The experiment also includes multiple musculoskeletal exams, such as a detailed exam of the shoulder muscles. Analysis of ultrasound video downlinks to ground teams at the NASA Johnson Space Center (JSC) TeleScience Center shows excellent results. Many trauma centers around the world use ultrasound technology as a first-line diagnostic procedure to assess abdominal trauma. The use of ultrasound does not require performance by a radiologist for accurate results. Previous research studies cover this topic of expanding ultrasound technology use by nonradiologists in remote locations to provide diagnostic information on acute clinical conditions. The use of ultrasound technology as a diagnostic tool on ISS requires an onboard proficiency enhancement program, visual cue cards, procedures, and direction from ground-based trained radiological personnel. The high-fidelity image captures of the thoracic, cardiac, and vascular systems from the Expedition 8 crew demonstrate the capability of minimally trained, nonmedical personnel ultrasound operations. This investigation lays the groundwork for using ultrasound as a diagnostic tool, without an available physician, in microgravity and remote locations on Earth. There is a scientific paper discussing these results, which crewmembers sent directly from orbit (Foale et al. 2005). Crewmembers? ultrasound images of the shoulder during Expedition 9 show the diagnostic quality of the ultrasound imagery for the evaluation of shoulder integrity. A example application of this technology is if a crewmember were to injure their shoulder during a strenuous extravehicular activity (EVA), these techniques enable evaluation and diagnosis of possible injuries (Fincke et al. 2005). Following a traumatic event to the head or face, eye examination is a very important component of the physical examination. Significant orbital or facial swelling can complicate the examination. The Expedition 10 crew?s examination of the eye through a closed eyelid using ultrasound addresses this issue. This examination can determine a number of problems with the eye that are signs of other more significant trauma of the head (Chiao et al. 2005). In addition to the importance of establishing ultrasound techniques for examination and diagnosis on ISS, this study establishes ultrasound as a key tool for clinical medicine on future vehicles, the Moon, and eventually Mars. The success of ADUM may also lead to additional applications of ultrasound on Earth, as users adapt the remote guidance paradigm for patients in rural/remote areas, disaster relief, and the military. Using existing communication systems, a minimally trained person (e.g., nurse, physicians assistant, military medic, etc.) could perform an ultrasound exam on a patient with guidance from an expert at a medical facility hundreds or thousands of miles away. This would expand the tools for the rural medical community, provide the ability to triage a mass casualty, and help in the decisions to conduct medical transport of patients. For example, at Olympic Training Facilities, trainers from a National Hockey League have training on ultrasound use, similarly to the ISS crewmembers. This enables them to take images of various locations (e.g., groin, knee, elbow, etc.) from athletes and transmit them for diagnostic interpretation by remotely located experts (Kwon et al, 2007).

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Related Web Sites

Science @ NASA

CNN News, Space and Science

International Space Station Medical Project (ISSMP)

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Publications

Results Publications

• Fincke EM, Padalka G, Lee D, van Holsbeeck M, Sargsyan AE, Hamilton DR, Martin D, Melton SL, McFarlin K, Dulchavsky SA. Evaluation of Shoulder Integrity in Space: First Report of Musculoskeletal US on the International Space Station. Radiology. 2005 ;234(2):319-322.
• Chiao L, Sharipov S, Sargsyan AE, Melton S, Hamilton DR, McFarlin K, Dulchavsky SA. Ocular examination for trauma; clinical ultrasound aboard the International Space Station. Journal of Trauma. 2005 ;58(5):885-889.
• Foale CM, Kaleri AY, Sargsyan AE, Hamilton DR, Melton S, Margin D, Dulchavsky SA. Diagnostic instrumentation aboard ISS: just in time training for non-physician crewmembers. Aviation, Space and Environmental Medicine 2005 ;76:594-598.

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Ground Based Results Publications

• Sargsyan AE, Hamilton DR, Melton SL, Amponsah D, Marshall NE, Dulchavsky SA. Ultrasonic evaluation of pupillary light reflex. Critical UltraSound Journal. 2009.

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ISS Patent Publications

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ISS Spinoffs Publications

• Image-Capture Devices Extend Medicine?s Reach. Scientific and Technical Inforamtion. 2009

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Related Publications

• Sargsyan AE, Hamilton DR, Jones JA, Melton S, Whitson PA, Kirkpatrick AW, Martin D, Dulchavsky SA. FAST at MACH 20: Clinical Ultrasound Aboard the International Space Station. The Journal of Trauma, Injury, Infection, and Critical Care. ;58(1):35-39. 2004

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Images

Video Screen Shot of ISS Science Officer, Michael Foale, performing a cardiac ultrasound exam on fellow crew member Alexander Kaleri. Foale can easily see the ultrasound image, as he adjusts the controls with his left hand and holds the probe in his right hand. The Crew Medical Restraint System holds Alexander Kaleri, using only the waist and shoulder straps. Foale interacts with ground-based experts in the Johnson Space Center - TeleScience Center, using a voice-activated communications headset. Image courtesy of NASA, Johnson Space Center.
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NASA Image: ISS009E17466 - Increment 9 Commander Gennady Padalka and Flight Engineer Mike Fincke prepare for the ADUM Bone Scan.
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NASA Image: ISS009E17439 - Increment 9 Commander Gennady Padalka and Flight Engineer Mike Fincke perform the ADUM Bone Scan.
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NASA Image: ISS010E05720 - Increment 10 Commander Leroy Chiao performs the ADUM Bone Scan on the knee of Flight Engineer Salizhan Sharipov.
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NASA Image: ISS010E05727 - Increment 10 Commander Leroy Chiao performs the ADUM Bone Scan on the elbow of Flight Engineer Salizhan Sharipov.
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NASA Image: ISS010E18770 - Using the ADUM protocols, ISS Expedition Commander Leroy Chiao performs an ultrasound examination of the eye on Flight Engineer Salizhan Sharipov.
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The educational program and remote expert guidance concepts developed for Advanced Diagnostic Ultrasound in Microgravity (ADUM) on the ISS was modified for terrestrial use. There are a great number of medically under-served regions on the Earth. For example, high altitude climbers are at risk of serious lung problems, due to the thin air at heights. This photo shows a Swedish climber performing a comprehensive chest ultrasound examination at Advanced Base Camp on Mt Everest. The climber operator had never seen an ultrasound before and was remotely guided to perform the examination over the Internet on OoVoo via a satellite phone and a solar panel charged portable ultrasound device. The exam was completed in 10 minutes and showed increased lung fluid due to exposure to high altitudes. Image provided courtesy of Scott A. Dulchavsky, M.D., Ph.D., Henry Ford Health System, Detroit, MI.
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The educational program and remote expert guidance concepts developed for Advanced Diagnostic Ultrasound in Microgravity (ADUM) on the ISS have expanded to sporting venues on the Earth. Initially ultrasound training and remote guidance were provided to nonphysician, athletic trainers for the Detroit Red Wings, Tigers, and Lions; these diagnostic capabilities were extended for use in the Olympic Games. Hundreds of musculoskeletal ultrasound scans on injured athletes in the U.S. Olympic Training Facilities in California, Colorado Springs, and Lake Placid supported the Olympic Games in Turino, Beijing, and most recently in Vancouver. A nonphysician athletic trainer was remotely guided to perform a point of care scan on a woman skier with an injured leg. The scan confirmed that she could continue to compete and she won a gold medal 3 days later. Image provided courtesy of Scott A. Dulchavsky, M.D., Ph.D., Henry Ford Health System, Detroit, MI.
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The techniques established by the Advanced Diagnostic Ultrasound in Microgravity (ADUM) research on the ISS can rapidly and economically improve medical care in underserved areas. This photo shows an obstetrical examination conducted on an Inuit mother in the high arctic circle. A just-in-time training program developed for the astronauts was modified to allow novice operators to perform ultrasound to determine the status of pregnant women. This technique will provide important guidance as to whether the delivery will be safe in her village or whether potential complications will require the mother to travel, seeking additional attention from a higher level of care. Image provided courtesy of Scott A. Dulchavsky, M.D., Ph.D., Henry Ford Health System, Detroit, MI.
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Information provided by the investigation team to the ISS Program Scientist's Office