Ultrasound in Space

Even as applications for sonography become increasingly diverse on Earth, ultrasound imaging is propagating skyward to advance the practice of medicine off the planet as well. With the help of ground-based experts, International Space Station (ISS) crew members with minimal training are obtaining diagnostic-quality images of structures of the cardiovascular system, the abdomen, facial structures, and the musculoskeletal system. Downlinked to sonologists on Earth, images acquired by these American and Russian astronauts may make possible the onboard diagnostic capabilities essential to astronaut safety on long-duration space expeditions of the future.

 

The only medical imaging modality on the ISS, ultrasound seems destined to play an important role in maintaining human safety in the remote environment of space. But providing ultrasound services on the ISS is no small feat. For one thing, limited equipment stowage means the monitor, keyboard, and ultrasound system must be separated, each piece stored in “racks” lining the walls of cramped ISS quarters. The monitor and keyboard are on articulated arms, connected to the ultrasound system only by cables. Subject positioning in microgravity poses another challenge to scanning in space; a system of restraints and foot straps is necessary to overcome subjects’ irksome tendencies to float away from the transducer.

 

Besides overcoming the physical challenges of off-planet scanning, astronauts must apply sufficient technical expertise to capture appropriate images. For crew members training to perform multiple complex research tasks, comprehensive sonography education is not feasible. Instead, NASA is investigating the effectiveness of limited technical training for astronauts as preparation for guided scanning with direction from a ground-based sonographer. Astronaut participants in NASA’s  Advanced Diagnostic Ultrasound in Medicine (ADUM) project received ultrasound instruction through a highly efficient “Just-in-Time” training program that delivered tightly focused instruction components just at the time when each would be most useful.

 

In one model, crew members received 3 hours of Just-in-Time sonography training. Several months before a scheduled scan, crew members completed a 2-hour session at Johnson Space Center in Houston. During this longest portion of the training program, astronauts became familiar with equipment setup and keyboard controls, and they learned basic exam-specific imaging techniques. Also, during this 2-hour session, crew members familiarized themselves with terms guidance experts would use to guide them as they scanned on the Space Station.

 

Several days before performing an exam, crew members participating in the ADUM project completed a 1-hour session with an On-Orbit interactive Proficiency Enhancement (OPE) CD-ROM. A bilingual (English and Russian) tool, the CD-ROM offered multimedia components to refresh crew member–users’ memories of ultrasound principles, equipment operation, and relevant anatomy.

 

Real-time guidance, with a strong partnership between astronaut and sonographer or other imaging specialist, is critical to the success of ISS scan experiments. As the crew member scans and downlinks images live to Mission Control, the ground expert views the images and by means of a real-time audio link guides the astronaut to adjust the transducer orientation and system setting controls. To facilitate communication, astronaut and sonographer refer to identical sets of “cue cards” that depict anatomic and control panel features. When the scan is complete, digitally saved images and cine loops are transmitted to on-ground sonologists for review in more detail.

 

Results of the project have been excellent. Images acquired on the ISS are of diagnostic quality, and with continued development of ultrasound’s application in space, experts believe sonography may prove to be a useful diagnostic tool for more than 250 medical conditions. Perhaps eventually a sonographer will become an astronaut and perform ultrasound exams “in person” on a space mission. But meanwhile, ground-based sonographers and nonsonographer astronauts are finding ways to collaborate to produce useful ultrasound studies. Together these teams are achieving fine work in our profession, solving problems, finding answers, and extending medical ser-vice boundaries beyond anything we might have imagined just a few short years ago. 

 

As sonography teams investigate inner space in outer space, I do hope one project on their agenda is follicle studies. After all, what factor could be more important to long-term human survival in the environment of space than its effect on our capacity to procreate? In microgravity, will we have triplets or will we struggle to ovulate? Anyone care to speculate?

 

Morphing at the speed of sound…

Sonography is morphing at the speed of sound. From static scanners to electronic arrays, from fuzzy mysterious shadows to images of stunning detail, the technology and its products advance.

 

In 1984, armed with a good education and impressive new ARDMS credentials, I joined the ranks of ultrasound pioneers, continuing the work begun by mid-20th century investigators whose perseverance and vision is reflected in our images. Twenty-three years later, new graduates join the profession as the next pioneers: 21st century sonographers, equipped with ever more dazzling technology. From static to real-time scanning to Doppler to 3D and beyond, just when the technological wave seems to be cresting, human curiosity, spirit, and ingenuity fuel ever larger, more powerful swells.

 

Of course, sonography is more than machines. What about the essence of the profession itself? With evolving technology and emerging applications, where will our challenges lie? How is the profession changing, and how do we prepare?

 

We sonographers are a diverse group. We are men, women, young singles, working parents, and grandparents. We scan in large medical institutions, in small rural offices, in remote villages, and on battlefields. We have associates, bachelors, and masters degrees, PhDs, and MDs. We arrived at this profession through systematic career research or quite by accident. But whomever we are, however we came to be here, we share in shaping the future of our profession, the modality, and, most importantly, human health and quality of life.

 

In this rich climate of medical evolution, our most critical tool will always be our initiative to stay informed. This column will serve as a forum in which we can look at our roots, share our accomplishments, examine our concerns, and explore our future. We’ve come a long way since water-filled horse troughs and motorized transducers. But however the profession morphs, whatever the future brings, together we can grow to meet the demands, to face the challenges, and to accept opportunities as they unfold.