Menu

 

The NASA Task Book
Advanced Search     

Project Title:  Sonographic Astronaut Vertebral Examination Reduce
Fiscal Year: FY 2016 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 06/16/2010  
End Date: 10/31/2015  
Task Last Updated: 12/18/2015 
Download report in PDF pdf
Principal Investigator/Affiliation:   Dulchavsky, Scott A. M.D., Ph.D. / Henry Ford Health System 
Address:  Surgery 
2799 W. Grand Boulevard, CFP-1 
Detroit , MI 48202-2608 
Email: sdulcha1@hfhs.org 
Phone: 313 916 9306  
Congressional District: 13 
Web:  
Organization Type: PUBLIC SERVICE 
Organization Name: Henry Ford Health System 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Ebert, Douglas  Wyle Laboratories, Inc. 
Garcia, Kathleen  Self 
Hamilton, Douglas  Wyle Laboratories, Inc. 
Sargsyan, Ashot  Wyle Laboratories, Inc. 
Soltanian-Zadeh, Hamid  Henry Ford Health System 
Peck, Donald  Henry Ford Health System 
van Holsbeeck, Marnix  Henry Ford Health System 
Key Personnel Changes / Previous PI: None
Project Information: Grant/Contract No. NNX10AM34G 
Responsible Center: NASA JSC 
Grant Monitor: Ploeger, Stephanne  
Center Contact:  
stephanne.l.ploeger22@nasa.gov 
Solicitation / Funding Source: 2009 Crew Health NNJ09ZSA002N 
Grant/Contract No.: NNX10AM34G 
Project Type: FLIGHT 
Flight Program: ISS 
TechPort: No 
No. of Post Docs:
No. of PhD Candidates:
No. of Master's Candidates:
No. of Bachelor's Candidates:
No. of PhD Degrees:
No. of Master's Degrees:
No. of Bachelor's Degrees:
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) ExMC:Risk of Unacceptable Health and Mission Outcomes Due to Limitations of In-flight Medical Capabilities (IRP Rev E)
(2) IVD:Concern of Intervertebral Disc Damage upon and immediately after re-exposure to Gravity (IRP Rev F)
(3) Occupant Protection:Risk of Injury from Dynamic Loads (Risk move from HHC to SHFH per IRP Rev F)
Human Research Program Gaps: (1) ExMC 4.08:We do not have the capability to optimally treat musculoskeletal injuries during exploration missions (IRP Rev E)
(2) IVD1:Determine whether post-flight back pain and/or injury are caused by changes to the vertebral body in-flight (IRP Rev E)
(3) OP05:We do not know the extent to which spaceflight deconditioning decreases injury tolerance for dynamic loads (IRP Rev F)
Flight Assignment/Project Notes: ISS

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)

Task Description: This proposal responds to NASA Research Announcement (NRA) NNJ09ZSA002N and teams world experts in musculoskeletal (MSK) ultrasound at Henry Ford Health System (HFHS) and space medical experts at Wyle Integrated Science and Engineering to evaluate the ability of ultrasound to characterize acute microgravity associated changes in lumbar and cervical spine to provide operationally relevant data to optimize crew health and guide countermeasure development.

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.

Research Impact/Earth Benefits: MRI is the gold standard of spine and intervertebral disk imaging. In many regions of the world there is no access to MRI. Ultrasound is an available and affordable medical imaging option for many areas of the body. However, ultrasound is an unproven imaging modality for the spinal and intervertebral disks (IVD). In this project we are seeking answers to the possibility of using simple off-the-shelf ultrasound to characterize the spine and IVD. The changing spinal dynamics in the microgravity environment allow us an opportunity to prove what is possible for this imaging technique. Additionally, constraints in crew training and the austere environment of the International Space Station allow us to merit this technique in the hands of novice operators using remote guidance as a substitute to intense crew training and just-in-time computer training tools. This research proposal will verify the ability of ultrasound to be used to evaluate changes to the spine of astronauts during spaceflight and patients without access to a CT (computerized tomography) scan or MRI. We are developing new methodologies and training materials to allow non-expert operators to use ultrasound to obtain images which would allow distant experts to determine if a significant change or disease process is occurring relative to the cervical or lumbar spine. This information is important in spaceflight; however, spinal disease conditions are widespread on the Earth. This proposal will provide inexpensive, portable diagnostic tools to allow non-physicians to extend medical care capabilities in underserved or geographically isolated areas worldwide.

Task Progress & Bibliography Information FY2016 
Task Progress: This proposal successfully taught astronauts to perform cervical and lumbosacral spinal ultrasound examinations on the ISS. Ultrasound correlated well with preflight and post flight MRI examinations. Analysis of the data is ongoing; however, we demonstrated that ultrasound has the potential to be an accurate tool to assess acute and chronic changes to the spine during flight. We showed changes in the curvature of long duration crewmembers, and some changes to the intervertebral disks and bodies that may lead to a higher change of spinal injury. These findings, if confirmed, may provide significant spinoff opportunities for point of care ultrasound to provide critical clinical information where CT or MRI is not available.

Bibliography Type: Description: (Last Updated: 03/02/2022) 

Show Cumulative Bibliography Listing
 
Articles in Peer-reviewed Journals Garcia KM, Harrison MF, Sargsyan AE, Ebert D, Dulchavsky SA. "Real-time ultrasound assessment of astronaut spinal anatomy and disorders on the International Space Station." J Ultrasound Med. 2018 Apr;37(4):987-99. Epub 2017 Sep 29. https://doi.org/10.1002/jum.14438 ; PubMed PMID: 28960477 , Apr-2018
Articles in Peer-reviewed Journals Harrison MF, Garcia KM, Sargsyan AE, Ebert D, Riascos-Castaneda RF, Dulchavsky SA. "Preflight, in-flight, and postflight imaging of the cervical and lumbar spine in astronauts. " Aerosp Med Hum Perform. 2018 Jan;89(1):32-40. https://doi.org/10.3357/AMHP.4878.2018 ; PubMed PMID: 29233242 , Jan-2018
Project Title:  Sonographic Astronaut Vertebral Examination Reduce
Fiscal Year: FY 2015 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 06/16/2010  
End Date: 10/31/2015  
Task Last Updated: 10/13/2015 
Download report in PDF pdf
Principal Investigator/Affiliation:   Dulchavsky, Scott A. M.D., Ph.D. / Henry Ford Health System 
Address:  Surgery 
2799 W. Grand Boulevard, CFP-1 
Detroit , MI 48202-2608 
Email: sdulcha1@hfhs.org 
Phone: 313 916 9306  
Congressional District: 13 
Web:  
Organization Type: PUBLIC SERVICE 
Organization Name: Henry Ford Health System 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Ebert, Douglas  Wyle Laboratories, Inc. 
Garcia, Kathleen  Self 
Hamilton, Douglas  Wyle Laboratories, Inc. 
Sargsyan, Ashot  Wyle Laboratories, Inc. 
Soltanian-Zadeh, Hamid  Henry Ford Health System 
Peck, Donald  Henry Ford Health System 
van Holsbeeck, Marnix  Henry Ford Health System 
Key Personnel Changes / Previous PI: None
Project Information: Grant/Contract No. NNX10AM34G 
Responsible Center: NASA JSC 
Grant Monitor: Gilbert, Charlene  
Center Contact:  
charlene.e.gilbert@nasa.gov 
Solicitation / Funding Source: 2009 Crew Health NNJ09ZSA002N 
Grant/Contract No.: NNX10AM34G 
Project Type: FLIGHT 
Flight Program: ISS 
TechPort: No 
No. of Post Docs:
No. of PhD Candidates:
No. of Master's Candidates:
No. of Bachelor's Candidates:
No. of PhD Degrees:
No. of Master's Degrees:
No. of Bachelor's Degrees:
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) ExMC:Risk of Unacceptable Health and Mission Outcomes Due to Limitations of In-flight Medical Capabilities (IRP Rev E)
(2) IVD:Concern of Intervertebral Disc Damage upon and immediately after re-exposure to Gravity (IRP Rev F)
(3) Occupant Protection:Risk of Injury from Dynamic Loads (Risk move from HHC to SHFH per IRP Rev F)
Human Research Program Gaps: (1) ExMC 4.08:We do not have the capability to optimally treat musculoskeletal injuries during exploration missions (IRP Rev E)
(2) IVD1:Determine whether post-flight back pain and/or injury are caused by changes to the vertebral body in-flight (IRP Rev E)
(3) OP05:We do not know the extent to which spaceflight deconditioning decreases injury tolerance for dynamic loads (IRP Rev F)
Flight Assignment/Project Notes: ISS

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)

Task Description: This proposal responds to NASA Research Announcement (NRA) NNJ09ZSA002N and teams world experts in musculoskeletal (MSK) ultrasound at Henry Ford Health System (HFHS) and space medical experts at Wyle Integrated Science and Engineering to evaluate the ability of ultrasound to characterize acute microgravity associated changes in lumbar and cervical spine to provide operationally relevant data to optimize crew health and guide countermeasure development.

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.

Research Impact/Earth Benefits: MRI is the gold standard of spine and intervertebral disk imaging. In many regions of the world there is no access to MRI. Ultrasound is an available and affordable medical imaging option for many areas of the body. However, ultrasound is an unproven imaging modality for the spinal and intervertebral disks (IVD). In this project we are seeking answers to the possibility of using simple off-the-shelf ultrasound to characterize the spine and IVD. The changing spinal dynamics in the microgravity environment allow us an opportunity to prove what is possible for this imaging technique. Additionally, constraints in crew training and the austere environment of the International Space Station allow us to merit this technique in the hands of novice operators using remote guidance as a substitute to intense crew training and just-in-time computer training tools. This research proposal will verify the ability of ultrasound to be used to evaluate changes to the spine of astronauts during spaceflight and patients without access to a CT (computerized tomography) scan or MRI. We are developing new methodologies and training materials to allow non-expert operators to use ultrasound to obtain images which would allow distant experts to determine if a significant change or disease process is occurring relative to the cervical or lumbar spine. This information is important in spaceflight; however, spinal disease conditions are widespread on the Earth. This proposal will provide inexpensive, portable diagnostic tools to allow non-physicians to extend medical care capabilities in underserved or geographically isolated areas worldwide.

Task Progress & Bibliography Information FY2015 
Task Progress: We completed a comprehensive analysis of point of care ultrasound for evaluation of the cervical and lumbar spine. Our team demonstrated that expert performed ultrasound was able to rapidly and reproducibly evaluate the cervical spine (C7-C3) and the lumbar spine (S1-L2) for pathology, disc morphology, and inter vertebral spacing. The technique was also expanded to allow the paraspinous musculature to be quantitatively evaluated.

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.

Bibliography Type: Description: (Last Updated: 03/02/2022) 

Show Cumulative Bibliography Listing
 
Articles in Peer-reviewed Journals Vollman A, Hulen R, Dulchavsky S, Pinchcofsky H, Amponsah D, Jacobsen G, Dulchavsky A, van Holsbeeck M. "Educational benefits of fusing magnetic resonance imaging with sonograms." J Clin Ultrasound. 2014 Jun;42(5):257-63. Epub 2014 Jan 22. http://dx.doi.org/10.1002/jcu.22136 ; PubMed PMID: 24449415 , Jun-2014
Project Title:  Sonographic Astronaut Vertebral Examination Reduce
Fiscal Year: FY 2014 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 06/16/2010  
End Date: 04/30/2015  
Task Last Updated: 04/14/2014 
Download report in PDF pdf
Principal Investigator/Affiliation:   Dulchavsky, Scott A. M.D., Ph.D. / Henry Ford Health System 
Address:  Surgery 
2799 W. Grand Boulevard, CFP-1 
Detroit , MI 48202-2608 
Email: sdulcha1@hfhs.org 
Phone: 313 916 9306  
Congressional District: 13 
Web:  
Organization Type: PUBLIC SERVICE 
Organization Name: Henry Ford Health System 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Ebert, Douglas  Wyle Laboratories, Inc. 
Garcia, Kathleen  Self 
Hamilton, Douglas  Wyle Laboratories, Inc. 
Sargsyan, Ashot  Wyle Laboratories, Inc. 
Soltanian-Zadeh, Hamid  Henry Ford Health System 
Peck, Donald  Henry Ford Health System 
van Holsbeeck, Marnix  Henry Ford Health System 
Key Personnel Changes / Previous PI: None
Project Information: Grant/Contract No. NNX10AM34G 
Responsible Center: NASA JSC 
Grant Monitor: Gilbert, Charlene  
Center Contact:  
charlene.e.gilbert@nasa.gov 
Solicitation / Funding Source: 2009 Crew Health NNJ09ZSA002N 
Grant/Contract No.: NNX10AM34G 
Project Type: FLIGHT 
Flight Program: ISS 
TechPort: No 
No. of Post Docs:
No. of PhD Candidates:
No. of Master's Candidates:
No. of Bachelor's Candidates:
No. of PhD Degrees:
No. of Master's Degrees:
No. of Bachelor's Degrees:
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) ExMC:Risk of Unacceptable Health and Mission Outcomes Due to Limitations of In-flight Medical Capabilities (IRP Rev E)
(2) IVD:Concern of Intervertebral Disc Damage upon and immediately after re-exposure to Gravity (IRP Rev F)
(3) Occupant Protection:Risk of Injury from Dynamic Loads (Risk move from HHC to SHFH per IRP Rev F)
Human Research Program Gaps: (1) ExMC 4.08:We do not have the capability to optimally treat musculoskeletal injuries during exploration missions (IRP Rev E)
(2) IVD1:Determine whether post-flight back pain and/or injury are caused by changes to the vertebral body in-flight (IRP Rev E)
(3) OP05:We do not know the extent to which spaceflight deconditioning decreases injury tolerance for dynamic loads (IRP Rev F)
Flight Assignment/Project Notes: ISS

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)

Task Description: This proposal responds to NASA Research Announcement (NRA) NNJ09ZSA002N and teams world experts in musculoskeletal (MSK) ultrasound at Henry Ford Health System (HFHS) and space medical experts at Wyle Integrated Science and Engineering to evaluate the ability of ultrasound to characterize acute microgravity associated changes in lumbar and cervical spine to provide operationally relevant data to optimize crew health and guide countermeasure development.

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.

Research Impact/Earth Benefits: MRI is the gold standard of spine and intervertebral disk imaging. In many regions of the world there is no access to MRI. Ultrasound is an available and affordable medical imaging option for many areas of the body. However, ultrasound is an unproven imaging modality for the spinal and intervertebral disks (IVD). In this project we are seeking answers to the possibility of using simple off-the-shelf ultrasound to characterize the spine and IVD. The changing spinal dynamics in the microgravity environment allow us an opportunity to prove what is possible for this imaging technique. Additionally, constraints in crew training and the austere environment of the International Space Station allow us to merit this technique in the hands of novice operators using remote guidance as a substitute to intense crew training and just-in-time computer training tools. This research proposal will verify the ability of ultrasound to be used to evaluate changes to the spine of astronauts during spaceflight and patients without access to a CT (computerized tomography) scan or MRI. We are developing new methodologies and training materials to allow non-expert operators to use ultrasound to obtain images which would allow distant experts to determine if a significant change or disease process is occurring relative to the cervical or lumbar spine. This information is important in spaceflight; however, spinal disease conditions are widespread on the Earth. This proposal will provide inexpensive, portable diagnostic tools to allow non-physicians to extend medical care capabilities in underserved or geographically isolated areas worldwide.

Task Progress & Bibliography Information FY2014 
Task Progress: As of this report, the team is preparing for the final on-orbit data session and the final post flight data collection. We have completed 90% of the data collection. There is a significant amount of data analysis to complete.

Bibliography Type: Description: (Last Updated: 03/02/2022) 

Show Cumulative Bibliography Listing
 
Articles in Peer-reviewed Journals 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. Epub 2013 Oct 15. http://dx.doi.org/10.1016/j.jemermed.2013.08.001 ; PubMed PMID: 24135505 , Jan-2014
Articles in Peer-reviewed Journals Kufta JM, Dulchavsky SA. "Medical care in outer space: a useful paradigm for underserved regions on the planet." Surgery. 2013 Nov;154(5):943-5. Review. http://dx.doi.org/10.1016/j.surg.2013.06.003 ; PubMed PMID: 24139489 , Nov-2013
Project Title:  Sonographic Astronaut Vertebral Examination Reduce
Fiscal Year: FY 2013 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 06/16/2010  
End Date: 12/15/2014  
Task Last Updated: 04/26/2013 
Download report in PDF pdf
Principal Investigator/Affiliation:   Dulchavsky, Scott A. M.D., Ph.D. / Henry Ford Health System 
Address:  Surgery 
2799 W. Grand Boulevard, CFP-1 
Detroit , MI 48202-2608 
Email: sdulcha1@hfhs.org 
Phone: 313 916 9306  
Congressional District: 13 
Web:  
Organization Type: PUBLIC SERVICE 
Organization Name: Henry Ford Health System 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Ebert, Douglas  Wyle Laboratories, Inc. 
Garcia, Kathleen  Self 
Hamilton, Douglas  Wyle Laboratories, Inc. 
Sargsyan, Ashot  Wyle Laboratories, Inc. 
Soltanian-Zadeh, Hamid  Henry Ford Health System 
Peck, Donald  Henry Ford Health System 
van Holsbeeck, Marnix  Henry Ford Health System 
Key Personnel Changes / Previous PI: None
Project Information: Grant/Contract No. NNX10AM34G 
Responsible Center: NASA JSC 
Grant Monitor: Maher, Jacilyn  
Center Contact:  
jacilyn.maher56@nasa.gov 
Solicitation / Funding Source: 2009 Crew Health NNJ09ZSA002N 
Grant/Contract No.: NNX10AM34G 
Project Type: FLIGHT 
Flight Program: ISS 
TechPort: No 
No. of Post Docs:
No. of PhD Candidates:
No. of Master's Candidates:
No. of Bachelor's Candidates:
No. of PhD Degrees:
No. of Master's Degrees:
No. of Bachelor's Degrees:
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) ExMC:Risk of Unacceptable Health and Mission Outcomes Due to Limitations of In-flight Medical Capabilities (IRP Rev E)
(2) IVD:Concern of Intervertebral Disc Damage upon and immediately after re-exposure to Gravity (IRP Rev F)
(3) Occupant Protection:Risk of Injury from Dynamic Loads (Risk move from HHC to SHFH per IRP Rev F)
Human Research Program Gaps: (1) ExMC 4.08:We do not have the capability to optimally treat musculoskeletal injuries during exploration missions (IRP Rev E)
(2) IVD1:Determine whether post-flight back pain and/or injury are caused by changes to the vertebral body in-flight (IRP Rev E)
(3) OP05:We do not know the extent to which spaceflight deconditioning decreases injury tolerance for dynamic loads (IRP Rev F)
Flight Assignment/Project Notes: ISS

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

Task Description: This proposal responds to NRA NNJ09ZSA002N and teams world experts in musculoskeletal (MSK) ultrasound at Henry Ford Health System (HFHS) and space medical experts at Wyle Integrated Science and Engineering to evaluate the ability of ultrasound to characterize acute microgravity associated changes in lumbar and cervical spine to provide operationally relevant data to optimize crew health and guide countermeasure development.

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.

Research Impact/Earth Benefits: This research proposal will verify the ability of ultrasound to be used to evaluate changes to the spine of astronaut during spaceflight and patients without access to a CT scan or MRI. We are developing new methodologies and training materials to allow non-expert operators to use ultrasound to obtain images which would allow distant experts to determine if a significant change or disease process is occurring relative to the cervical or lumbar spine. This information is important in spaceflight, however, spinal disease conditions are widespread on the Earth. This proposal will provide inexpensive, portable diagnostic tools to allow non-physicians to extend medical care capabilities in underserved or geographically isolated areas worldwide.

Task Progress & Bibliography Information FY2013 
Task Progress: SONOGRAPHIC ASTRONAUT VERTEBRAL EXAMINATION

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.

Bibliography Type: Description: (Last Updated: 03/02/2022) 

Show Cumulative Bibliography Listing
 
 None in FY 2013
Project Title:  Sonographic Astronaut Vertebral Examination Reduce
Fiscal Year: FY 2012 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 06/16/2010  
End Date: 12/15/2014  
Task Last Updated: 06/11/2012 
Download report in PDF pdf
Principal Investigator/Affiliation:   Dulchavsky, Scott A. M.D., Ph.D. / Henry Ford Health System 
Address:  Surgery 
2799 W. Grand Boulevard, CFP-1 
Detroit , MI 48202-2608 
Email: sdulcha1@hfhs.org 
Phone: 313 916 9306  
Congressional District: 13 
Web:  
Organization Type: PUBLIC SERVICE 
Organization Name: Henry Ford Health System 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Ebert, Douglas  Wyle Laboratories, Inc. 
Garcia, Kathleen  Self 
Hamilton, Douglas  Wyle Laboratories, Inc. 
Sargsyan, Ashot  Wyle Laboratories, Inc. 
Soltanian-Zadeh, Hamid  Henry Ford Health System 
Peck, Donald  Henry Ford Health System 
van Holsbeeck, Marnix  Henry Ford Health System 
Key Personnel Changes / Previous PI: None
Project Information: Grant/Contract No. NNX10AM34G 
Responsible Center: NASA JSC 
Grant Monitor: Maher, Jacilyn  
Center Contact:  
jacilyn.maher56@nasa.gov 
Solicitation / Funding Source: 2009 Crew Health NNJ09ZSA002N 
Grant/Contract No.: NNX10AM34G 
Project Type: FLIGHT 
Flight Program: ISS 
TechPort: No 
No. of Post Docs:
No. of PhD Candidates:
No. of Master's Candidates:
No. of Bachelor's Candidates:
No. of PhD Degrees:
No. of Master's Degrees:
No. of Bachelor's Degrees:
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) ExMC:Risk of Unacceptable Health and Mission Outcomes Due to Limitations of In-flight Medical Capabilities (IRP Rev E)
(2) IVD:Concern of Intervertebral Disc Damage upon and immediately after re-exposure to Gravity (IRP Rev F)
(3) Occupant Protection:Risk of Injury from Dynamic Loads (Risk move from HHC to SHFH per IRP Rev F)
Human Research Program Gaps: (1) ExMC 4.08:We do not have the capability to optimally treat musculoskeletal injuries during exploration missions (IRP Rev E)
(2) IVD1:Determine whether post-flight back pain and/or injury are caused by changes to the vertebral body in-flight (IRP Rev E)
(3) OP05:We do not know the extent to which spaceflight deconditioning decreases injury tolerance for dynamic loads (IRP Rev F)
Flight Assignment/Project Notes: ISS

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

Task Description: This proposal responds to NRA NNJ09ZSA002N and teams world experts in musculoskeletal (MSK) ultrasound at Henry Ford Health System (HFHS) and space medical experts at Wyle Integrated Science and Engineering to evaluate the ability of ultrasound to characterize acute microgravity associated changes in lumbar and cervical spine to provide operationally relevant data to optimize crew health and guide countermeasure development.

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.

Research Impact/Earth Benefits: This research proposal will verify the ability of ultrasound to be used to evaluate changes to the spine of astronaut during spaceflight and patients without access to a CT scan or MRI. We are developing new methodologies and training materials to allow non-expert operators to use ultrasound to obtain images which would allow distant experts to determine if a significant change or disease process is occurring relative to the cervical or lumbar spine. This information is important in spaceflight, however, spinal disease conditions are widespread on the Earth. This proposal will provide inexpensive, portable diagnostic tools to allow non-physicians to extend medical care capabilities in underserved or geographically isolated areas worldwide.

Task Progress & Bibliography Information FY2012 
Task Progress: We have completed 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 that allow rapid identification of the vertebral level and have measurements in 20 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 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.

Bibliography Type: Description: (Last Updated: 03/02/2022) 

Show Cumulative Bibliography Listing
 
 None in FY 2012
Project Title:  Sonographic Astronaut Vertebral Examination Reduce
Fiscal Year: FY 2011 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 06/16/2010  
End Date: 06/15/2013  
Task Last Updated: 03/18/2011 
Download report in PDF pdf
Principal Investigator/Affiliation:   Dulchavsky, Scott A. M.D., Ph.D. / Henry Ford Health System 
Address:  Surgery 
2799 W. Grand Boulevard, CFP-1 
Detroit , MI 48202-2608 
Email: sdulcha1@hfhs.org 
Phone: 313 916 9306  
Congressional District: 13 
Web:  
Organization Type: PUBLIC SERVICE 
Organization Name: Henry Ford Health System 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Ebert, Douglas  Wyle Laboratories, Inc. 
Garcia, Kathleen  Self 
Hamilton, Douglas  Wyle Laboratories, Inc. 
Sargsyan, Ashot  Wyle Laboratories, Inc. 
Soltanian-Zadeh, Hamid  Henry Ford Health System 
Peck, Donald  Henry Ford Health System 
van Holsbeeck, Marnix  Henry Ford Health System 
Key Personnel Changes / Previous PI: None
Project Information: Grant/Contract No. NNX10AM34G 
Responsible Center: NASA JSC 
Grant Monitor: Baumann, David  
Center Contact:  
david.k.baumann@nasa.gov 
Solicitation / Funding Source: 2009 Crew Health NNJ09ZSA002N 
Grant/Contract No.: NNX10AM34G 
Project Type: FLIGHT 
Flight Program: ISS 
TechPort: No 
No. of Post Docs:
No. of PhD Candidates:
No. of Master's Candidates:
No. of Bachelor's Candidates:
No. of PhD Degrees:
No. of Master's Degrees:
No. of Bachelor's Degrees:
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) ExMC:Risk of Unacceptable Health and Mission Outcomes Due to Limitations of In-flight Medical Capabilities (IRP Rev E)
(2) IVD:Concern of Intervertebral Disc Damage upon and immediately after re-exposure to Gravity (IRP Rev F)
(3) Occupant Protection:Risk of Injury from Dynamic Loads (Risk move from HHC to SHFH per IRP Rev F)
Human Research Program Gaps: (1) ExMC 4.08:We do not have the capability to optimally treat musculoskeletal injuries during exploration missions (IRP Rev E)
(2) IVD1:Determine whether post-flight back pain and/or injury are caused by changes to the vertebral body in-flight (IRP Rev E)
(3) OP05:We do not know the extent to which spaceflight deconditioning decreases injury tolerance for dynamic loads (IRP Rev F)
Flight Assignment/Project Notes: ISS

Task Description: This proposal responds to NRA NNJ09ZSA002N and teams world experts in musculoskeletal (MSK) ultrasound at Henry Ford Health System (HFHS) and space medical experts at Wyle Integrated Science and Engineering to evaluate the ability of ultrasound to characterize acute microgravity associated changes in lumbar and cervical spine to provide operationally relevant data to optimize crew health and guide countermeasure development.

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.

Research Impact/Earth Benefits: This research proposal will verify the ability of ultrasound to be used to evaluate changes to the spine of astronaut during spaceflight and patients without access to a CT scan or MRI. We are developing new methodologies and training materials to allow non-expert operators to use ultrasound to obtain images which would allow distant experts to determine if a significant change or disease process is occurring relative to the cervical or lumbar spine. This information is important in spaceflight, however, spinal disease conditions are widespread on the Earth. This proposal will provide inexpensive, portable diagnostic tools to allow non-physicians to extend medical care capabilities in underserved or geographically isolated areas worldwide.

Task Progress & Bibliography Information FY2011 
Task Progress: SONOGRAPHIC ASTRONAUT VERTEBRAL EXAMINATION

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.

Bibliography Type: Description: (Last Updated: 03/02/2022) 

Show Cumulative Bibliography Listing
 
 None in FY 2011
Project Title:  Sonographic Astronaut Vertebral Examination Reduce
Fiscal Year: FY 2010 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 06/16/2010  
End Date: 06/15/2013  
Task Last Updated: 08/31/2010 
Download report in PDF pdf
Principal Investigator/Affiliation:   Dulchavsky, Scott A. M.D., Ph.D. / Henry Ford Health System 
Address:  Surgery 
2799 W. Grand Boulevard, CFP-1 
Detroit , MI 48202-2608 
Email: sdulcha1@hfhs.org 
Phone: 313 916 9306  
Congressional District: 13 
Web:  
Organization Type: PUBLIC SERVICE 
Organization Name: Henry Ford Health System 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Ebert, Douglas  Wyle Laboratories, Inc. 
Garcia, Kathleen  Self 
Hamilton, Douglas  Wyle Laboratories, Inc. 
Sargsyan, Ashot  Wyle Laboratories, Inc. 
Soltanian-Zadeh, Hamid  Henry Ford Health System 
Peck, Donald  Henry Ford Health System 
van Holsbeeck, Marnix  Henry Ford Health System 
Project Information: Grant/Contract No. NNX10AM34G 
Responsible Center: NASA JSC 
Grant Monitor: Norsk, Peter  
Center Contact:  
Peter.norsk@nasa.gov 
Solicitation / Funding Source: 2009 Crew Health NNJ09ZSA002N 
Grant/Contract No.: NNX10AM34G 
Project Type: FLIGHT 
Flight Program: ISS 
TechPort: No 
No. of Post Docs:  
No. of PhD Candidates:  
No. of Master's Candidates:  
No. of Bachelor's Candidates:  
No. of PhD Degrees:  
No. of Master's Degrees:  
No. of Bachelor's Degrees:  
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) ExMC:Risk of Unacceptable Health and Mission Outcomes Due to Limitations of In-flight Medical Capabilities (IRP Rev E)
(2) IVD:Concern of Intervertebral Disc Damage upon and immediately after re-exposure to Gravity (IRP Rev F)
(3) Occupant Protection:Risk of Injury from Dynamic Loads (Risk move from HHC to SHFH per IRP Rev F)
Human Research Program Gaps: (1) ExMC 4.08:We do not have the capability to optimally treat musculoskeletal injuries during exploration missions (IRP Rev E)
(2) IVD1:Determine whether post-flight back pain and/or injury are caused by changes to the vertebral body in-flight (IRP Rev E)
(3) OP05:We do not know the extent to which spaceflight deconditioning decreases injury tolerance for dynamic loads (IRP Rev F)
Flight Assignment/Project Notes: ISS

Task Description: This proposal responds to NRA NNJ09ZSA002N and teams world experts in musculoskeletal (MSK) ultrasound at Henry Ford Health System (HFHS) and space medical experts at Wyle Integrated Science and Engineering to evaluate the ability of ultrasound to characterize acute microgravity associated changes in lumbar and cervical spine to provide operationally relevant data to optimize crew health and guide countermeasure development.

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.

Research Impact/Earth Benefits: 0

Task Progress & Bibliography Information FY2010 
Task Progress: New project for FY2010.

Bibliography Type: Description: (Last Updated: 03/02/2022) 

Show Cumulative Bibliography Listing
 
 None in FY 2010