Assessing the Added Value of Miniature X-Ray in the Setting of US in Spaceflight

INTRODUCTION:
Point-of-care ultrasound (POCUS) has become the standard of care for imaging diagnosis and management in lowEarth Orbit (LEO) spaceflight and it has long been hypothesized that POCUS will also be the standard of care for
exploration spaceflight. However, like the trajectory for which ultrasound became more portable and user-friendly,
the mass, volume, and power requirements of radiography devices for both diagnostic and therapeutic applications
have also been dramatically reduced. This study seeks to determine the clinical utility and added value of miniature
x-ray (XR) for the diagnosis and management of each of the 119 conditions within NASA Exploration Medical
Capability’s IMPACT Condition List (ICL) given that the medical system is presumed to already be carrying a
handheld portable POCUS device.
METHODS:
For each condition, a team of reviewers performed a rapid systematic literature review seeking sensitivity and
specificity data for both handheld portable ultrasound and miniature XR. When there was a paucity of data, subject
matter expertise and clinical experience was added to semi-quantitatively score the added value of miniature XR,
given an US was already available for both diagnosis and management. Diagnostic utility of a modality for a condition
was evaluated in the setting of both the best- and worst-case scenario definitions included and defined by the ICL.
Evidence tracing and quality of evidence scores were also recorded.
RESULTS/DISCUSSION:
Conditions for which it was determined that miniature XR added diagnostic or therapeutic value are provided in this
presentation. Previously presented work by our team has demonstrated that XR provides diagnostic and management
capabilities that are hypothesized to complement or surpass ultrasound for over one-third of medical conditions that
may arise during exploration spaceflight (i.e., diagnosis of injuries to the axial skeleton, teeth, and lungs as well as
management of orthopedic reductions, endotracheal tube placement, and drain placement confirmation). In the setting
of known inclusion of a handheld portable POCUS device, there remains significant added value of portable miniature
XR. Whether or not this added clinical benefit is worth the mass, volume, and power requirements of the radiography
system remains yet unknown and is the focus of future work.
LEARNING OBJECTIVES: 1) Understand the value of ultrasound and radiography in the diagnosis and
management of medical comorbidities that may arise in exploration spaceflight; 2) Understand the medical
conditions of highest concern on exploration class missions for which miniature x-ray may provide added value to
portable ultrasound.