NOTE: Extended to 10/31/2015 per NSSC information and D. Risin/JSC (Ed., 10/13/15)

NOTE: End date changed to 4/30/2015 per NSSC information (Ed., 12/16/14)

NOTE: Gap changes per IRP Rev E (Ed., 3/19/14)

NOTE: Extended to 12/15/2014 per NSSC information (Ed., 3/28/2013)

An increased height of astronauts is seen during microgravity; the exact mechanism is unclear. Relaxation of the postural muscles, combined with elongation of inter-vertebral disc spaces may be involved. Back pain is frequent during adaption to spaceflight; however, this has not resulted in changes to mission requirements or objectives. Neurologic sequelae have been seen with terrestrial spinal elongation; fortunately this has not occurred in astronaut crews.

This proposal will determine the accuracy of MSK ultrasound in characterizing the anatomy of the vertebral unit (disc, musculature, facets, ligaments) and develop just-in-time training methodologies to provide essential information to answer operationally relevant mandates with a team of experts to conduct ground, simulated microgravity, and in-flight experiments to answer the aims:

1. Determine the accuracy of MSK ultrasound in characterizing the normal and microgravity associated changes in the vertebral unit.

2. Investigate the human factors, level of experience, and training necessary to perform focused cervical and lumbar vertebral MSK ultrasound in microgravity with inexperienced ultrasound operators in parallel with expert operators.

3. Determine the anatomic changes in the vertebral unit during long duration spaceflight with astronaut performed vertebral ultrasound.

Design and Methods

I. GROUND BASED INVESTIGATIONS

Baseline evaluation of vertebral unit with MSK ultrasound: Expert sonologists at HFHS will perform magnetic resonance imaging (MRI) and vertebral unit MSK examinations on normal volunteers to assess anatomic accuracy, develop normalization tables, and optimize methodology.

Just in time training methodologies for non-expert users

A multi-media, just in time training program with reference cue cards will be developed for non-expert operators. The ability of non-expert operators to perform vertebral MSK examinations autonomously or with remote-expert guidance will be evaluated.

II. SIMULATED MICROGRAVITY INVESTIGATIONS

Human factors analysis of vertebral MSK ultrasound in a microgravity environment will be completed during parabolic flight to optimize subject and operator positioning and restraint.

III. FLIGHT INVESTIGATIONS

Pre-flight and Post-flight: The flight procedures will consist of a comprehensive vertebral MSK ultrasound and MRI evaluation of long duration crew-members. In-flight procedures will be conducted on the International Space Station (ISS) using the Human Research Facility (HRF) ultrasound at early, mid, and late mission time periods: a post-flight MSK ultrasound and MRI will also be done to assess microgravity anatomic effects and gravitational return to baseline.

Significance to NASA: This proposal will provide longitudinal, real time data regarding adaptation of the vertebral unit during long duration spaceflight to enhance mission completion, countermeasure development, and astronaut health. The ability to assess the crewmember musculoskeletal system is critical to guide countermeasures, provide functional data for high risk or impact activities, and assess acute injuries which may occur during exploration class spaceflight. Astronaut performed ultrasound examinations on the ISS have demonstrated that diagnostic quality images can be obtained with targeted training: the procedures developed and verified during this proposal will provide novel data and capabilities to enhance crew health for long duration space missions.

NOTE: Extended to 10/31/2015 per NSSC information and D. Risin/JSC (Ed., 10/13/15)

NOTE: End date changed to 4/30/2015 per NSSC information (Ed., 12/16/14)

NOTE: Gap changes per IRP Rev E (Ed., 3/19/14)

NOTE: Extended to 12/15/2014 per NSSC information (Ed., 3/28/2013)

An increased height of astronauts is seen during microgravity; the exact mechanism is unclear. Relaxation of the postural muscles, combined with elongation of inter-vertebral disc spaces may be involved. Back pain is frequent during adaption to spaceflight; however, this has not resulted in changes to mission requirements or objectives. Neurologic sequelae have been seen with terrestrial spinal elongation; fortunately this has not occurred in astronaut crews.

This proposal will determine the accuracy of MSK ultrasound in characterizing the anatomy of the vertebral unit (disc, musculature, facets, ligaments) and develop just-in-time training methodologies to provide essential information to answer operationally relevant mandates with a team of experts to conduct ground, simulated microgravity, and in-flight experiments to answer the aims:

1. Determine the accuracy of MSK ultrasound in characterizing the normal and microgravity associated changes in the vertebral unit.

2. Investigate the human factors, level of experience, and training necessary to perform focused cervical and lumbar vertebral MSK ultrasound in microgravity with inexperienced ultrasound operators in parallel with expert operators.

3. Determine the anatomic changes in the vertebral unit during long duration spaceflight with astronaut performed vertebral ultrasound.

Design and Methods

I. GROUND BASED INVESTIGATIONS

Baseline evaluation of vertebral unit with MSK ultrasound: Expert sonologists at HFHS will perform magnetic resonance imaging (MRI) and vertebral unit MSK examinations on normal volunteers to assess anatomic accuracy, develop normalization tables, and optimize methodology.

Just in time training methodologies for non-expert users

A multi-media, just in time training program with reference cue cards will be developed for non-expert operators. The ability of non-expert operators to perform vertebral MSK examinations autonomously or with remote-expert guidance will be evaluated.

II. SIMULATED MICROGRAVITY INVESTIGATIONS

Human factors analysis of vertebral MSK ultrasound in a microgravity environment will be completed during parabolic flight to optimize subject and operator positioning and restraint.

III. FLIGHT INVESTIGATIONS

Pre-flight and Post-flight: The flight procedures will consist of a comprehensive vertebral MSK ultrasound and MRI evaluation of long duration crew-members. In-flight procedures will be conducted on the International Space Station (ISS) using the Human Research Facility (HRF) ultrasound at early, mid, and late mission time periods: a post-flight MSK ultrasound and MRI will also be done to assess microgravity anatomic effects and gravitational return to baseline.

Significance to NASA: This proposal will provide longitudinal, real time data regarding adaptation of the vertebral unit during long duration spaceflight to enhance mission completion, countermeasure development, and astronaut health. The ability to assess the crewmember musculoskeletal system is critical to guide countermeasures, provide functional data for high risk or impact activities, and assess acute injuries which may occur during exploration class spaceflight. Astronaut performed ultrasound examinations on the ISS have demonstrated that diagnostic quality images can be obtained with targeted training: the procedures developed and verified during this proposal will provide novel data and capabilities to enhance crew health for long duration space missions.

We developed a computer based, experiment unique software to provide just in time training in spinal ultrasound for non-expert astronaut ultrasound operators. This software was successfully used, in tandem with brief, hands on training, to teach astronauts and cosmonauts (9 total) the technique of spinal ultrasound to be performed on the ISS.

We optimized an MRI protocol to provide high definition images of the lumbar and cervical spine for pre-flight and post-flight analysis against ultrasound.

We completed inflight ultrasound evaluations at early, mid, and late mission timepoints using remote expert guidance. All of the evaluations were successfully completed by the crewmembers with excellent image quality that formed the basis of a publication submitted electronically from space (Marshburn TH, Hadfield CA, Sargsyan AE, Garcia K, Ebert D, Dulchavsky SA. "New heights in ultrasound: first report of spinal ultrasound from the International Space Station." J Emerg Med. 2014 Jan;46(1):61-70. http://dx.doi.org/10.1016/j.jemermed.2013.08.001 ; reported in FY2014 Bibliography ). Crew preflight, post flight, and in flight imagery was compared to determine the effects of microgravity on the spine.

Brief conclusions are summarized; more extensive analysis is ongoing and is shown in the broader final report to NASA.

1. Non-expert operators can perform spinal ultrasound with just in time training and remote guidance.

2. Spinal ultrasound can provide useful morphologic information to evaluate disc height, disc health (dessication), and evaluate pathology (disk herniation, spur formation).

3. Astronaut crewmembers did not have appreciable changes in disc height during spaceflight.

4. Crewmembers did develop isolated pathology (disc alterations, spur formation) during spaceflight.

5. Alterations in the angulation/curvature of the spine occur during spaceflight.

NOTE: End date changed to 4/30/2015 per NSSC information (Ed., 12/16/14)

NOTE: Gap changes per IRP Rev E (Ed., 3/19/14)

NOTE: Extended to 12/15/2014 per NSSC information (Ed., 3/28/2013)

An increased height of astronauts is seen during microgravity; the exact mechanism is unclear. Relaxation of the postural muscles, combined with elongation of inter-vertebral disc spaces may be involved. Back pain is frequent during adaption to spaceflight; however, this has not resulted in changes to mission requirements or objectives. Neurologic sequelae have been seen with terrestrial spinal elongation; fortunately this has not occurred in astronaut crews.

This proposal will determine the accuracy of MSK ultrasound in characterizing the anatomy of the vertebral unit (disc, musculature, facets, ligaments) and develop just-in-time training methodologies to provide essential information to answer operationally relevant mandates with a team of experts to conduct ground, simulated microgravity, and in-flight experiments to answer the aims:

1. Determine the accuracy of MSK ultrasound in characterizing the normal and microgravity associated changes in the vertebral unit.

2. Investigate the human factors, level of experience, and training necessary to perform focused cervical and lumbar vertebral MSK ultrasound in microgravity with inexperienced ultrasound operators in parallel with expert operators.

3. Determine the anatomic changes in the vertebral unit during long duration spaceflight with astronaut performed vertebral ultrasound.

Design and Methods

I. GROUND BASED INVESTIGATIONS

Baseline evaluation of vertebral unit with MSK ultrasound: Expert sonologists at HFHS will perform magnetic resonance imaging (MRI) and vertebral unit MSK examinations on normal volunteers to assess anatomic accuracy, develop normalization tables, and optimize methodology.

Just in time training methodologies for non-expert users

A multi-media, just in time training program with reference cue cards will be developed for non-expert operators. The ability of non-expert operators to perform vertebral MSK examinations autonomously or with remote-expert guidance will be evaluated.

II. SIMULATED MICROGRAVITY INVESTIGATIONS

Human factors analysis of vertebral MSK ultrasound in a microgravity environment will be completed during parabolic flight to optimize subject and operator positioning and restraint.

III. FLIGHT INVESTIGATIONS

Pre-flight and Post-flight: The flight procedures will consist of a comprehensive vertebral MSK ultrasound and MRI evaluation of long duration crew-members. In-flight procedures will be conducted on the International Space Station (ISS) using the Human Research Facility (HRF) ultrasound at early, mid, and late mission time periods: a post-flight MSK ultrasound and MRI will also be done to assess microgravity anatomic effects and gravitational return to baseline.

Significance to NASA: This proposal will provide longitudinal, real time data regarding adaptation of the vertebral unit during long duration spaceflight to enhance mission completion, countermeasure development, and astronaut health. The ability to assess the crewmember musculoskeletal system is critical to guide countermeasures, provide functional data for high risk or impact activities, and assess acute injuries which may occur during exploration class spaceflight. Astronaut performed ultrasound examinations on the ISS have demonstrated that diagnostic quality images can be obtained with targeted training: the procedures developed and verified during this proposal will provide novel data and capabilities to enhance crew health for long duration space missions.

NOTE: Extended to 12/15/2014 per NSSC information (Ed., 3/28/2013)

An increased height of astronauts is seen during microgravity; the exact mechanism is unclear. Relaxation of the postural muscles, combined with elongation of inter-vertebral disc spaces may be involved. Back pain is a frequent during adaption to spaceflight; however, this has not resulted in changes to mission requirements or objectives. Neurologic sequelae have been seen with terrestrial spinal elongation; fortunately this has not occurred in astronaut crews.

This proposal will determine the accuracy of MSK ultrasound in characterizing the anatomy of the vertebral unit (disc, musculature, facets, ligaments) and develop just-in-time training methodologies to provide essential information to answer operationally relevant mandates with a team of experts to conduct ground, simulated microgravity, and in-flight experiments to answer the aims:

1. Determine the accuracy of MSK ultrasound in characterizing the normal and microgravity associated changes in the vertebral unit.

2. Investigate the human factors, level of experience, and training necessary to perform focused cervical and lumbar vertebral MSK ultrasound in microgravity with inexperienced ultrasound operators in parallel with expert operators.

3. Determine the anatomic changes in the vertebral unit during long duration spaceflight with astronaut performed vertebral ultrasound.

Design and Methods

I. GROUND BASED INVESTIGATIONS

Baseline evaluation of vertebral unit with MSK ultrasound: Expert sonologists at HFHS will perform MRI and vertebral unit MSK examinations on normal volunteers to assess anatomic accuracy, develop normalization tables, and optimize methodology.

Just in time training methodologies for non-expert users

A multi-media, just in time training program with reference cue cards will be developed for non-expert operators. The ability of non-expert operators to perform vertebral MSK examinations autonomously or with remote-expert guidance will be evaluated.

II. SIMULATED MICROGRAVITY INVESTIGATIONS

Human factors analysis of vertebral MSK ultrasound in a microgravity environment will be completed during parabolic flight to optimize subject and operator positioning and restraint.

III. FLIGHT INVESTIGATIONS

Pre-flight and Post-flight: The flight procedures will consist of a comprehensive vertebral MSK ultrasound and MRI evaluation of long duration crew-members. In-flight procedures will be conducted on the ISS using the HRF ultrasound at early, mid and late mission time periods: a post-flight MSK ultrasound and MRI also be done to assess microgravity anatomic effects and gravitational return to baseline.

Significance to NASA: This proposal will provide longitudinal, real time data regarding adaptation of the vertebral unit during long duration spaceflight to enhance mission completion, countermeasure development, and astronaut health. The ability to assess the crewmember musculoskeletal system is critical to guide countermeasures, provide functional data for high risk or impact activities, and assess acute injuries which may occur during exploration class spaceflight. Astronaut performed ultrasound examinations on the ISS have demonstrated that diagnostic quality images can be obtained with targeted training: the procedures developed and verified during this proposal will provide novel data and capabilities to enhance crew health for long duration space missions.

Annual Progress Report: Scott A. Dulchavsky M.D., Ph.D.

Period: 6/15/2012-6/15/2013

Henry Ford Health System, Department of Surgery, CFP-1, 2799 W. Grand Boulevard, Detroit, MI 48202

Grant #: NNX10AM34G

We have conducted preflight astronaut training and baseline data collection (MRI and Ultrasound) on 6 astronaut crewmembers. We have successfully manifested an experiment unique probe on the ISS as well as a computer based refresher training program on the ISS. We have conducted an inflight pre-study briefing with the Increment 34 crew, and have conducted 4 inflight data collection sessions. We have submitted an inflight publication electronically to the Journal of Emergency Medicine and await confirmation of the publication. We are analyzing data from the inflight sessions, and are timelined for post-flight data collection on the 2 enrolled subjects. We are also prepared for data collection on the next ISS crew.

NOTE: Extended to 12/15/2014 per NSSC information (Ed., 3/28/2013)

An increased height of astronauts is seen during microgravity; the exact mechanism is unclear. Relaxation of the postural muscles, combined with elongation of inter-vertebral disc spaces may be involved. Back pain is a frequent during adaption to spaceflight; however, this has not resulted in changes to mission requirements or objectives. Neurologic sequelae have been seen with terrestrial spinal elongation; fortunately this has not occurred in astronaut crews.

This proposal will determine the accuracy of MSK ultrasound in characterizing the anatomy of the vertebral unit (disc, musculature, facets, ligaments) and develop just-in-time training methodologies to provide essential information to answer operationally relevant mandates with a team of experts to conduct ground, simulated microgravity, and in-flight experiments to answer the aims:

1. Determine the accuracy of MSK ultrasound in characterizing the normal and microgravity associated changes in the vertebral unit.

2. Investigate the human factors, level of experience, and training necessary to perform focused cervical and lumbar vertebral MSK ultrasound in microgravity with inexperienced ultrasound operators in parallel with expert operators.

3. Determine the anatomic changes in the vertebral unit during long duration spaceflight with astronaut performed vertebral ultrasound.

Design and Methods

I. GROUND BASED INVESTIGATIONS

Baseline evaluation of vertebral unit with MSK ultrasound: Expert sonologists at HFHS will perform MRI and vertebral unit MSK examinations on normal volunteers to assess anatomic accuracy, develop normalization tables, and optimize methodology.

Just in time training methodologies for non-expert users

A multi-media, just in time training program with reference cue cards will be developed for non-expert operators. The ability of non-expert operators to perform vertebral MSK examinations autonomously or with remote-expert guidance will be evaluated.

II. SIMULATED MICROGRAVITY INVESTIGATIONS

Human factors analysis of vertebral MSK ultrasound in a microgravity environment will be completed during parabolic flight to optimize subject and operator positioning and restraint.

III. FLIGHT INVESTIGATIONS

Pre-flight and Post-flight: The flight procedures will consist of a comprehensive vertebral MSK ultrasound and MRI evaluation of long duration crew-members. In-flight procedures will be conducted on the ISS using the HRF ultrasound at early, mid and late mission time periods: a post-flight MSK ultrasound and MRI also be done to assess microgravity anatomic effects and gravitational return to baseline.

Significance To NASA: This proposal will provide longitudinal, real time data regarding adaptation of the vertebral unit during long duration spaceflight to enhance mission completion, countermeasure development, and astronaut health. The ability to assess the crewmember musculoskeletal system is critical to guide countermeasures, provide functional data for high risk or impact activities, and assess acute injuries which may occur during exploration class spaceflight. Astronaut performed ultrasound examinations on the ISS have demonstrated that diagnostic quality images can be obtained with targeted training: the procedures developed and verified during this proposal will provide novel data and capabilities to enhance crew health for long duration space missions.

We have developed a reproducible, ultrasound imaging methodology and are completing ultrasound imaging in the subject population for comparison against the MRI standards.

We have also completed investigations in patients with known spinal pathologies and have demonstrated strong concurrence between the MRI and ultrasound examinations. We have developed a computer based non-expert training program to allow astronauts to perform the vertebral ultrasound examinations with minimal training and guidance during long duration missions.

We have also developed didactic and hands on pre-flight training methodologies for non-expert astronaut crewmembers to learn spinal ultrasound rapidly. We have conducted 2 sessions with the Increment 34 crew members, and have consented these 2 astronauts to perform the examinations in space.

An increased height of astronauts is seen during microgravity; the exact mechanism is unclear. Relaxation of the postural muscles, combined with elongation of inter-vertebral disc spaces may be involved. Back pain is a frequent during adaption to spaceflight; however, this has not resulted in changes to mission requirements or objectives. Neurologic sequelae have been seen with terrestrial spinal elongation; fortunately this has not occurred in astronaut crews.

This proposal will determine the accuracy of MSK ultrasound in characterizing the anatomy of the vertebral unit (disc, musculature, facets, ligaments) and develop just-in-time training methodologies to provide essential information to answer operationally relevant mandates with a team of experts to conduct ground, simulated microgravity, and in-flight experiments to answer the aims:

1. Determine the accuracy of MSK ultrasound in characterizing the normal and microgravity associated changes in the vertebral unit.

2. Investigate the human factors, level of experience, and training necessary to perform focused cervical and lumbar vertebral MSK ultrasound in microgravity with inexperienced ultrasound operators in parallel with expert operators.

3. Determine the anatomic changes in the vertebral unit during long duration spaceflight with astronaut performed vertebral ultrasound.

Design and Methods

I. GROUND BASED INVESTIGATIONS

Baseline evaluation of vertebral unit with MSK ultrasound: Expert sonologists at HFHS will perform MRI and vertebral unit MSK examinations on normal volunteers to assess anatomic accuracy, develop normalization tables, and optimize methodology.

Just in time training methodologies for non-expert users

A multi-media, just in time training program with reference cue cards will be developed for non-expert operators. The ability of non-expert operators to perform vertebral MSK examinations autonomously or with remote-expert guidance will be evaluated.

II. SIMULATED MICROGRAVITY INVESTIGATIONS

Human factors analysis of vertebral MSK ultrasound in a microgravity environment will be completed during parabolic flight to optimize subject and operator positioning and restraint.

III. FLIGHT INVESTIGATIONS

Pre-flight and Post-flight: The flight procedures will consist of a comprehensive vertebral MSK ultrasound and MRI evaluation of long duration crew-members. In-flight procedures will be conducted on the ISS using the HRF ultrasound at early, mid and late mission time periods: a post-flight MSK ultrasound and MRI also be done to assess microgravity anatomic effects and gravitational return to baseline.

Significance To NASA: This proposal will provide longitudinal, real time data regarding adaptation of the vertebral unit during long duration spaceflight to enhance mission completion, countermeasure development, and astronaut health. The ability to assess the crewmember musculoskeletal system is critical to guide countermeasures, provide functional data for high risk or impact activities, and assess acute injuries which may occur during exploration class spaceflight. Astronaut performed ultrasound examinations on the ISS have demonstrated that diagnostic quality images can be obtained with targeted training: the procedures developed and verified during this proposal will provide novel data and capabilities to enhance crew health for long duration space missions.

Annual Progress Report Scott A. Dulchavsky M.D., Ph.D. Period: January 1, 2011. Henry Ford Health System Department of Surgery, CFP-1 2799 W. Grand Boulevard Detroit, MI 48202

Grant #: NNX10AM34G

Progress report: This is a brief progress report as this grant is active for only 3 months.

We have begun initial investigations regarding the ability of ultrasound to measure inter-vertebral disc space in normal, ground based volunteers. We have established optimal MRI specifications to allow wide viewing properties of the vertebral units of the cervical and lumbar spine. We have developed reproducible, anatomic landmarks for the examinations which allow rapid identification of the vertebral level and have initial measurements in 6 subject volunteers.

We have developed a reproducible, ultrasound imaging methodology and are completing ultrasound imaging in the subject population for comparison against the MRI standards.

We will increase the number of normal subjects and include volunteers with known spinal pathologies in the next evaluation period. We are also establishing a modeling program which will allow us to quantify alterations in the inter-vertebral discs and vertebral musculature/ligaments in long duration crew-members. We will also develop a non-expert training program to allow astronauts to perform the vertebral ultrasound examinations with minimal training and guidance during long duration missions.

An increased height of astronauts is seen during microgravity; the exact mechanism is unclear. Relaxation of the postural muscles, combined with elongation of inter-vertebral disc spaces may be involved. Back pain is a frequent during adaption to spaceflight; however, this has not resulted in changes to mission requirements or objectives. Neurologic sequelae have been seen with terrestrial spinal elongation; fortunately this has not occurred in astronaut crews.

This proposal will determine the accuracy of MSK ultrasound in characterizing the anatomy of the vertebral unit (disc, musculature, facets, ligaments) and develop just-in-time training methodologies to provide essential information to answer operationally relevant mandates with a team of experts to conduct ground, simulated microgravity, and in-flight experiments to answer the aims:

1. Determine the accuracy of MSK ultrasound in characterizing the normal and microgravity associated changes in the vertebral unit.

2. Investigate the human factors, level of experience, and training necessary to perform focused cervical and lumbar vertebral MSK ultrasound in microgravity with inexperienced ultrasound operators in parallel with expert operators.

3. Determine the anatomic changes in the vertebral unit during long duration spaceflight with astronaut performed vertebral ultrasound.

Design and Methods

I. GROUND BASED INVESTIGATIONS

Baseline evaluation of vertebral unit with MSK ultrasound: Expert sonologists at HFHS will perform MRI and vertebral unit MSK examinations on normal volunteers to assess anatomic accuracy, develop normalization tables, and optimize methodology.

Just in time training methodologies for non-expert users

A multi-media, just in time training program with reference cue cards will be developed for non-expert operators. The ability of non-expert operators to perform vertebral MSK examinations autonomously or with remote-expert guidance will be evaluated.

II. SIMULATED MICROGRAVITY INVESTIGATIONS

Human factors analysis of vertebral MSK ultrasound in a microgravity environment will be completed during parabolic flight to optimize subject and operator positioning and restraint.

III. FLIGHT INVESTIGATIONS

Pre-flight and Post-flight The flight procedures will consist of a comprehensive vertebral MSK ultrasound and MRI evaluation of long duration crew-members. In-flight procedures will be conducted on the ISS using the HRF ultrasound at early, mid and late mission time periods: a post-flight MSK ultrasound and MRI also be done to assess microgravity anatomic effects and gravitational return to baseline.

Significance To NASA This proposal will provide longitudinal, real time data regarding adaptation of the vertebral unit during long duration spaceflight to enhance mission completion, countermeasure development, and astronaut health. The ability to assess the crewmember musculoskeletal system is critical to guide countermeasures, provide functional data for high risk or impact activities, and assess acute injuries which may occur during exploration class spaceflight. Astronaut performed ultrasound examinations on the ISS have demonstrated that diagnostic quality images can be obtained with targeted training: the procedures developed and verified during this proposal will provide novel data and capabilities to enhance crew health for long duration space missions.