IP: 185.89.100.57 On: Fri, 21 Dec 2018 01:02:09 Copyright: Aerospace Medical Association Delivered by Ingenta 1034 AEROSPACE MEDICINE AND HUMAN PERFORMANCE Vol. 86, No. 12 December 2015 RESEARCH ARTICLE N umerous publications on ultrasound (US) imaging in actual and analogue spacefight environments report reliance on remote guidance (RG) of minimally trained caregivers or research operators with no professional expertise in US. 1,2,4 High-quality US images from multiple organ systems (e.g., cardiovascular, respiratory, musculoskeletal, genitouri- nary) have been obtained consistently, attesting to the general maturity of the remotely guided diagnostic US capability in orbital spacefight and in remote terrestrial settings with com- munication latency of up to 2 s. 7,8,14 However, increased latency in data fow and voice communication associated with greater distances is expected to impair the efectiveness of these tech- niques. Te actual communication delay that would render RG inefective has not been objectively established. Te two-way communication delay on missions to the Moon is expected to reach ;5-6 s and the delay on missions to Mars is expected to last 10 to 45 min. 3,5,13 A simulated Mars mission with a 15-min communication delay demonstrated successful use of US by a Concept of Operations Evaluation for Using Remote- Guidance Ultrasound for Exploration Spacefight Victor W. Hurst IV * ; Sean Peterson; Kathleen Garcia; Douglas Ebert; David Ham; David Amponsah; Scott Dulchavsky BACKGROUND: Remote-guidance (RG) techniques aboard the International Space Station (ISS) have enabled astronauts to collect diagnostic-level ultrasound (US) images. Exploration-class missions will likely require nonformally trained sonographers to operate with greater autonomy given longer communication delays ( . 6 s for missions beyond the Moon) and blackouts. Training requirements for autonomous collection of US images by non-US experts are being determined. METHODS: Novice US operators were randomly assigned to one of three groups to collect standardized US images while drawing expertise from A) RG only, B) a computer training tool only, or C) both RG and a computer training tool. Images were assessed for quality and examination duration. All operators were given a 10-min standardized generic training session in US scanning. The imaging task included: 1) bone fracture assessment in a phantom and 2) Focused Assessment with Sonography in Trauma (FAST) examination in a healthy volunteer. A human factors questionnaire was also completed. RESULTS: Mean time for group B during FAST was shorter (20.4 vs. 22.7 min) than time for the other groups. Image quality scoring was lower than in groups A or C, but all groups produced images of acceptable diagnostic quality. DISCUSSION: RG produces US images of higher quality than those produced with only computer-based instruction. Extended communication delays in exploration missions will eliminate the option of real-time guidance, thus requiring autono- mous operation. The computer program used appears efective and could be a model for future digital US expertise banks. Terrestrially, it also provides adequate self-training and mentoring mechanisms. KEYWORDS: spacefight, astronauts, ultrasound, telemedicine, remote guidance. Hurst VW IV, Peterson S, Garcia K, Ebert D, Ham D, Amponsah D, Dulchavsky S. Concept of operations evaluation for using remote-guidance ultrasound for exploration spacefight. Aerosp Med Hum Perform. 2015; 86(12):1034–1038. general physician with remote assistance to diagnose appendi- citis before surgery. 13 Anecdotal reports, however, are not suf- fcient to infuence the medical requirements for exploration missions of the future. To assess the efects of intermediate delays on a remotely guided collection of US images by nonexperts, a simulated explo- ration mission outpost was set up with the communication delay set at 5 s (a lunar mission scenario with additional satellite uplinks and ground segments). For longer delays without RG From Crew Health and Research, Wyle Science, Technology and Engineering, Houston, TX, the Canadian Space Agency, Saint-Hubert, Quebec, Canada, and the Department of Surgery, Henry Ford Hospital System, Detroit, MI Tis manuscript was received for review in November 2011. It was accepted for publication in August 2015. Address correspondence to: Scott Dulchavsky, M.D., Ph.D., Department of Surgery, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202; sdulcha1@hfs.org. Reprint & Copyright © by the Aerospace Medical Association, Alexandria, VA. DOI: 10.3357/AMHP.3244.2015 *Posthumously.