What happens when a crew hundreds of miles up needs an answer that usually requires a hospital wing? The four astronauts who flew back early from the International Space Station in January reported on a small device that went some way towards filling this gap: a portable ultrasound device that, according to Mike Fincke, was “super handy” when a medical issue arose. The astronauts did not specify which of them required medical attention or what the problem was that led to their early return, and NASA has maintained medical confidentiality. What the astronauts did provide was a telling portrait of how uncertainty is managed in contemporary space travel.
Fincke explained that the ultrasound was already a regular part of the crew’s routine, used to monitor the body’s changes during long periods of weightlessness. This familiarity proved important. When a health issue arose on Jan. 7, one day before a scheduled spacewalk that was canceled at the last minute, the ultrasound changed from a research and monitoring tool to a quick diagnostic tool. Fincke said it should be included on all future space missions. “It really helped,” he said.
The use of ultrasound is, however, no accident or recent development. NASA has been working for years to make ultrasound a “go-to” imaging modality in orbit because it has been able to fit significant diagnostic power into small mass, low power, and few consumables. This was formalized through the Advanced Diagnostic Ultrasound in Microgravity (ADUM) program, which taught astronauts to image crew members while receiving direction from experts on the ground. This is one of the most extreme examples of telemedicine, in which the crew takes the images, and experts on the ground interpret them and direct follow-up actions. This has been extended to extreme environments on Earth as well.
Cardman, who commanded the return flight to SpaceX, spoke of a station culture that is health-cautious when it comes to matters of health. “Our timing of this departure is unexpected,” she said before the return flight, “but what was not surprising to me was how well this crew came together as a family to help each other and just take care of each other.” Cardman also agreed that NASA had made the right decision to scrub the spacewalk due to health reasons, especially since a spacewalk is a very challenging and precisely timed activity.
The beat of predictable problems in space medicine helps to explain the significance of a single imaging device. A systematic review quoted in NASA’s exploration health resources reported that space-related skin conditions occur at a rate 25 times higher than on Earth, exacerbated by low humidity and the absence of opportunities for personal hygiene. Fluid shift to the head can cause “space sniffles,” congestion, and headaches, particularly in the early phases of space travel. Sleep can be disrupted by the station’s 90-minute orbit cycle 16 sunrises and sunsets in a day and the ambient hum of the equipment. At the same time, the daily countermeasure to protect against loss of strength and bone two hours of exercise is also hazardous, with musculoskeletal injuries documented over flight days in NASA research.
Ultrasound is relevant to many of these realities because it has the ability to assess soft tissue, help guide the assessment of pain or swelling, and help with monitoring without radiation. It has also been proven to be useful in unexpected ways. NASA has recorded a situation where a blood clot was identified during a routine research ultrasound, which led to a long treatment plan that was conducted remotely from orbit. This situation highlighted the fact that important conditions are not always dramatic, and symptoms do not always announce themselves early.
NASA is still evaluating new ultrasound technologies with the aim of going beyond low Earth orbit, including a technology demonstration of the Butterfly IQ Ultrasound and mobile computing. The aim is simple: to enhance image quality and manageability while still being compact enough to fit into a spacecraft and useful enough when the emergency room is a planet away. In this case, the value of the tool had less to do with its futuristic potential and more to do with its immediate usability. As Japanese astronaut Kimiya Yui said, “We can handle any kind of difficult situation.” On a space station designed for science, the value of the tool was shown to lie not in its ability to perform some complex function, but in its ability to assist the crew in making decisions quickly, thoughtfully, and as clearly as possible through a small screen.
