Strategically, the HRP conducts research and technology development that: 1) enables the development or modification of Agency-level human health and performance standards by the Office of the Chief Health and Medical Officer (OCHMO) and 2) provides Human Exploration Operations Mission Directorate (HEOMD) with methods of meeting those standards in the design, development, and operation of mission systems.
HRP research focuses on reducing crew health and performance risks for exploration missions. In addition, HRP research gathers the data necessary to understand and mitigate the long-term health risks to the crew, to allow the update of specific crew health standards for each mission scenario, to support crew selection, and to address any rehabilitation requirements. The OCHMO owns and sets the standards upon which the HRP research efforts are based. The Transition to Medical Practice process defined by the OCHMO is used to review the HRP deliverable countermeasures and technologies prior to their operational use.
HRP technology development advances medical care and countermeasure systems for exploration and vehicle development programs’ missions. The HRP also develops and matures operational concepts to inform requirements for the design and operation of space vehicles and habitats needed for exploration. This includes requirements for displays and controls, internal environments, operations planning, habitability, and methodologies for maintaining crew physical and mental health as well as physical and cognitive capabilities.
The HRP is managed at the Johnson Space Center (JSC) and comprised of six research and technology development projects. These projects provide the program knowledge and capabilities to conduct research addressing the human health and performance risks as well as advancing the readiness levels of technology and countermeasures to the point of transfer to the customer programs and organizations. The six projects within the HRP are referred to as Program Elements throughout this document. Each Element is managed at the JSC with research and technology development expertise provided by JSC, Ames Research Center (ARC), Glenn Research Center (GRC), the Langley Research Center (LaRC), and the Kennedy Space Center (KSC), as well as other Agencies, institutions and organizations identified in the following Element descriptions. The six Elements are:
1) Space Radiation (SR) Element – The SR Element performs investigations to develop the scientific basis to accurately predict and mitigate health risks from the space radiation environment. This knowledge yields recommendations to permissible exposure limits, assessment/projection tools/models of crew risk from radiation exposure, and models/tools to assess vehicle design for radiation protection. The SR Element conducts research using accelerator-based simulation of space radiation. The SR Element explores and develops countermeasures to the deleterious effects of radiation on human health. The LaRC and ARC contribute to the SR Element.
2) Behavioral Health and Performance (BHP) Element – The BHP Element identifies and characterizes the behavioral and performance risks associated with training, living and working in space, and returning to Earth. The BHP Element develops strategies, tools, and technologies to mitigate these risks.
3) Exploration Medical Capability (ExMC) Element – The ExMC Element is responsible for defining requirements for crew health maintenance during exploration missions, developing treatment scenarios, extrapolating from the scenarios to health management modalities, and evaluating the feasibility of those modalities for use during exploration missions. The ExMC Element is also responsible for the technology and informatics development that will enable the availability of medical care and decision systems for exploration missions. GRC, LaRC and ARC contribute technology development and clinical care expertise to the ExMC Element.
4) Space Human Factors and Habitability (SHFH) Element – The SHFH Element is focused on the human system in space environments: how do humans interface with spacecraft systems, and what environmental and habitation factors are essential to maintain crew health and performance? The SHFH Element has three main focus areas: space human factors engineering, advanced environmental health, and advanced food technology. The ARC contributes to the SHFH Element.
5) Human Health Countermeasures (HHC) Element – The HHC Element is responsible for understanding the physiological effects of spaceflight and developing countermeasure strategies and procedures. The Element provides the biomedical expertise for the development and assessment of medical standards and vehicle and spacesuit requirements dictated by human physiological needs. In addition, the HHC Element develops a validated and integrated suite of countermeasures for exploration missions to ensure the maintenance of crew health during all mission phases. The ARC and GRC contribute to the HHC Element as well as international agencies cooperating on joint flight proposals, reduced gravity studies, and collaborative bed rest studies.
6) International Space Station Medical Projects (ISSMP) Element – The ISSMP Element is responsible for managing all ISS and ground analog human research activities, including those integrated with operational medical support of the crews, and to ensure research tasks are completed. The ISSMP is responsible for all planning, integration, and implementation services for HRP research tasks and evaluation activities requiring access to space or related flight resources on the ISS, Soyuz, Progress, Multi-Purpose Crew Vehicle (MPCV), commercial vehicles and ground-based spaceflight analogs. This includes support to related pre- and postflight activities. The ARC contributes to the ISSMP with technical support to experiment management, hardware development, and international partner integration. KSC provides support for baseline data collection requirements development for future crew vehicles.
The work performed within the six Elements is supported by numerous collaborative efforts with academia and international agencies. Relationships with the ISS Program, the National Space Biomedical Research Institute (NSBRI), the Brookhaven National Laboratory (BNL), and the University of Texas Medical Branch (UTMB) are critical to the HRP successfully meeting its objectives. The HRP also maintains collaborative relationships with the International Partners through various working groups. These relationships enhance the research capabilities and provide synergy between the research and technology efforts of different countries.
","programId":273,"responsibleMd":{"organizationId":9526,"organizationName":"Space Operations Mission Directorate","acronym":"SOMD","organizationType":"NASA_Mission_Directorate","canUserEdit":false,"locationEdit":false,"organizationRolePretty":"","organizationTypePretty":"NASA Mission Directorate"},"responsibleMdOffice":9526,"stockImageFileId":28253,"title":"Human Research Program","manageGaps":false,"acronymOrTitle":"HRP"},"description":"Introduction Imaging technologies are key to the diagnosis and treatment of medical conditions that astronauts on an exploration mission might encounter and to research activities that characterize and understand the adaptations to micro- and partial gravity environments. Key limitations of the currently available imaging capabilities include the complexity and operator dependency of the procedures to acquire high quality results. Currently, two imaging procedures critical to space medicine and research, ultrasound and optical coherence tomography (OCT), are performed on the International Space Station (ISS) by astronauts with the assistance of real-time communication with experts on the ground using a method called remote guidance. With this methodology astronauts have acquired diagnostic and research quality data that are central to our understanding of the physiological consequences of weightlessness, including altered cardiac function, muscle atrophy, and the spaceflight-associated neuro-ocular syndrome (SANS). However, with the time delay in communications that will be inherent in exploration missions while traveling great distances from Earth, remote guidance will no longer be practical, particularly when one-way transmissions may take up to 10 minutes or more. To fill this gap, we developed advanced audio-visual training modules, a form of just-in-time (JIT) training, to acquire medically necessary and research-relevant images. Building on our extensive experience with remote guidance of ISS astronauts and demonstrated success with just-in-time training, we employed an augmented reality (AR) system (Microsoft HoloLens) that included three-dimensional graphics of relevant anatomy, step-by-step audio instruction, reference images demonstrating adequate and inadequate quality, and troubleshooting guides. The ability of untrained subject-operators to acquire high-quality ultrasound and OCT images was evaluated by expert reviewers and compared to current JIT techniques for quality and time efficiency. Methods Tutorials to acquire ultrasound and OCT images were adapted for use as a PowerPoint presentation viewed either on a laptop computer or using an augmented reality platform with a heads-up display. Instructional material presented by the two different training modalities was identical, except that the augmented reality tutorial provided additional spatial guidance to complete the scanning protocols. Additional guidance included arrows superimposed on the ultrasound and OCT keyboards when specific controls were needed and virtual green dots superimposed on the body over the ultrasound targets' approximate locations to guide ultrasound probe placement. Twenty subjects attempted to acquire ultrasound and OCT images using the tutorials provided viewed on a laptop computer, and 20 subjects attempted the same diagnostic imaging procedures with instructions viewed using the AR system. No subject had prior experience performing these procedures or using this imaging hardware, and no subject participated in this study as a member of both groups. Subjects used guidance from the tutorials to acquire five ultrasound targets that constitute a subset of images in a trauma-induced injury assessment protocol (images of the heart, lungs, liver, kidney and spleen) and a single thirteen-line, vertical raster scan centered on the macula of the left eye using OCT. Time limits were imposed upon the subjects to acquire each of the ultrasound or OCT targets. This is not dissimilar to the environment on ISS or anticipated on future exploration missions in which communication windows or mission objectives can impact the available time to complete imaging procedures. After the data collection session, subjects completed a survey to capture their thought about the equipment, procedures, instructional material, and future improvements. Images were stored by the subjects and evaluated off-line in a blinded fashion by imaging professionals. Four radiologists from Vanderbilt University with training in ultrasound analyses evaluated the ultrasound images. Four trained evaluators at the Doheny Image Reading Center (University of California, Los Angeles), with previous experience using the grading techniques utilized in this study, evaluated the OCT images. Somers' D was used to assess the effect of the use of either laptop or HoloLens on the resulting image scores. Results and Discussion Nearly 70% of the ultrasound images and 53% of OCT scans that these previously untrained subjects acquired were considered to be diagnostically adequate. The quality scores for OCT images and 3 of the 5 ultrasound targets were not different between groups, but the laptop group performed better for the other 2 ultrasound targets. The time to acquire ultrasound images was, on average, shorter for the AR group (52 compared to 57 minutes). Interestingly, the survey results indicated that the AR group did not find the instructional material as helpful as the laptop group (p= 0.042), even though the content was the same for both. While it is evident that both the augmented reality and laptop groups struggled with the complexity of both ultrasound and OCT, there was a subset of subjects who appeared to embrace the technological challenge and performed well. This might be related to the education level, learning styles, or comfort level with technology, but these factors were not specifically evaluated. While some subjects embraced the technology, some were overwhelmed by the task of familiarizing themselves with a new technology (i.e., AR) while concurrently attempting complex, operator-dependent imaging which also was new to them. The inclusion of subjects not necessarily representative of the astronaut corps represents a limitation of the study. Additionally, the degree of familiarity with laptop computers and PowerPoint may have created a bias for the laptop group. ","benefits":"This study sought to evaluate a technique to help facilitate autonomous use of operator-dependent, non-invasive medical imaging devices in a subject population without prior ultrasound or optical coherence tomography (OCT) training. While the imaging protocols chosen for this study were based upon the health and medical risks identified as concerns for long-duration spaceflight, particularly exploration missions, these imaging protocols also are routinely used on Earth. Through this work we have developed and tested an augmented reality (AR) tutorial to guide inexperienced or untrained operators through complex, operator-dependent procedures for specific ultrasound and OCT applications. While originally developed for astronaut use beyond the range of timely communication with Earth, AR could enable more general uses in any remote or extreme environment lacking trained professionals. Ultrasound has been used in remote and extreme environments, including special forces military units in Afghanistan, Mount Everest expeditions, and rural locations without adequate medical expertise. Lessons learned from this project will facilitate the development of AR programs for similar applications. It should be noted that this type of training is not preferable to a study performed by a sonographer or other qualified medical professional trained in ultrasound. However, similar to defibrillators, if the equipment and adequate instruction is available, AR instruction could be used when equipment is available, but trained professionals are not. 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HRP research focuses on reducing crew health and performance risks for exploration missions. In addition, HRP research gathers the data necessary to understand and mitigate the long-term health risks to the crew, to allow the update of specific crew health standards for each mission scenario, to support crew selection, and to address any rehabilitation requirements. The OCHMO owns and sets the standards upon which the HRP research efforts are based. The Transition to Medical Practice process defined by the OCHMO is used to review the HRP deliverable countermeasures and technologies prior to their operational use.
HRP technology development advances medical care and countermeasure systems for exploration and vehicle development programs’ missions. The HRP also develops and matures operational concepts to inform requirements for the design and operation of space vehicles and habitats needed for exploration. This includes requirements for displays and controls, internal environments, operations planning, habitability, and methodologies for maintaining crew physical and mental health as well as physical and cognitive capabilities.
The HRP is managed at the Johnson Space Center (JSC) and comprised of six research and technology development projects. These projects provide the program knowledge and capabilities to conduct research addressing the human health and performance risks as well as advancing the readiness levels of technology and countermeasures to the point of transfer to the customer programs and organizations. The six projects within the HRP are referred to as Program Elements throughout this document. Each Element is managed at the JSC with research and technology development expertise provided by JSC, Ames Research Center (ARC), Glenn Research Center (GRC), the Langley Research Center (LaRC), and the Kennedy Space Center (KSC), as well as other Agencies, institutions and organizations identified in the following Element descriptions. The six Elements are:
1) Space Radiation (SR) Element – The SR Element performs investigations to develop the scientific basis to accurately predict and mitigate health risks from the space radiation environment. This knowledge yields recommendations to permissible exposure limits, assessment/projection tools/models of crew risk from radiation exposure, and models/tools to assess vehicle design for radiation protection. The SR Element conducts research using accelerator-based simulation of space radiation. The SR Element explores and develops countermeasures to the deleterious effects of radiation on human health. The LaRC and ARC contribute to the SR Element.
2) Behavioral Health and Performance (BHP) Element – The BHP Element identifies and characterizes the behavioral and performance risks associated with training, living and working in space, and returning to Earth. The BHP Element develops strategies, tools, and technologies to mitigate these risks.
3) Exploration Medical Capability (ExMC) Element – The ExMC Element is responsible for defining requirements for crew health maintenance during exploration missions, developing treatment scenarios, extrapolating from the scenarios to health management modalities, and evaluating the feasibility of those modalities for use during exploration missions. The ExMC Element is also responsible for the technology and informatics development that will enable the availability of medical care and decision systems for exploration missions. GRC, LaRC and ARC contribute technology development and clinical care expertise to the ExMC Element.
4) Space Human Factors and Habitability (SHFH) Element – The SHFH Element is focused on the human system in space environments: how do humans interface with spacecraft systems, and what environmental and habitation factors are essential to maintain crew health and performance? The SHFH Element has three main focus areas: space human factors engineering, advanced environmental health, and advanced food technology. The ARC contributes to the SHFH Element.
5) Human Health Countermeasures (HHC) Element – The HHC Element is responsible for understanding the physiological effects of spaceflight and developing countermeasure strategies and procedures. The Element provides the biomedical expertise for the development and assessment of medical standards and vehicle and spacesuit requirements dictated by human physiological needs. In addition, the HHC Element develops a validated and integrated suite of countermeasures for exploration missions to ensure the maintenance of crew health during all mission phases. The ARC and GRC contribute to the HHC Element as well as international agencies cooperating on joint flight proposals, reduced gravity studies, and collaborative bed rest studies.
6) International Space Station Medical Projects (ISSMP) Element – The ISSMP Element is responsible for managing all ISS and ground analog human research activities, including those integrated with operational medical support of the crews, and to ensure research tasks are completed. The ISSMP is responsible for all planning, integration, and implementation services for HRP research tasks and evaluation activities requiring access to space or related flight resources on the ISS, Soyuz, Progress, Multi-Purpose Crew Vehicle (MPCV), commercial vehicles and ground-based spaceflight analogs. This includes support to related pre- and postflight activities. The ARC contributes to the ISSMP with technical support to experiment management, hardware development, and international partner integration. KSC provides support for baseline data collection requirements development for future crew vehicles.
The work performed within the six Elements is supported by numerous collaborative efforts with academia and international agencies. Relationships with the ISS Program, the National Space Biomedical Research Institute (NSBRI), the Brookhaven National Laboratory (BNL), and the University of Texas Medical Branch (UTMB) are critical to the HRP successfully meeting its objectives. The HRP also maintains collaborative relationships with the International Partners through various working groups. These relationships enhance the research capabilities and provide synergy between the research and technology efforts of different countries.
","programId":273,"responsibleMd":{"organizationId":9526,"organizationName":"Space Operations Mission Directorate","acronym":"SOMD","organizationType":"NASA_Mission_Directorate","canUserEdit":false,"locationEdit":false,"organizationRolePretty":"","organizationTypePretty":"NASA Mission Directorate"},"responsibleMdOffice":9526,"stockImageFileId":28253,"title":"Human Research Program","manageGaps":false,"acronymOrTitle":"HRP"},"description":"Introduction Imaging technologies are key to the diagnosis and treatment of medical conditions that astronauts on an exploration mission might encounter and to research activities that characterize and understand the adaptations to micro- and partial gravity environments. Key limitations of the currently available imaging capabilities include the complexity and operator dependency of the procedures to acquire high quality results. Currently, two imaging procedures critical to space medicine and research, ultrasound and optical coherence tomography (OCT), are performed on the International Space Station (ISS) by astronauts with the assistance of real-time communication with experts on the ground using a method called remote guidance. With this methodology astronauts have acquired diagnostic and research quality data that are central to our understanding of the physiological consequences of weightlessness, including altered cardiac function, muscle atrophy, and the spaceflight-associated neuro-ocular syndrome (SANS). However, with the time delay in communications that will be inherent in exploration missions while traveling great distances from Earth, remote guidance will no longer be practical, particularly when one-way transmissions may take up to 10 minutes or more. To fill this gap, we developed advanced audio-visual training modules, a form of just-in-time (JIT) training, to acquire medically necessary and research-relevant images. Building on our extensive experience with remote guidance of ISS astronauts and demonstrated success with just-in-time training, we employed an augmented reality (AR) system (Microsoft HoloLens) that included three-dimensional graphics of relevant anatomy, step-by-step audio instruction, reference images demonstrating adequate and inadequate quality, and troubleshooting guides. The ability of untrained subject-operators to acquire high-quality ultrasound and OCT images was evaluated by expert reviewers and compared to current JIT techniques for quality and time efficiency. Methods Tutorials to acquire ultrasound and OCT images were adapted for use as a PowerPoint presentation viewed either on a laptop computer or using an augmented reality platform with a heads-up display. Instructional material presented by the two different training modalities was identical, except that the augmented reality tutorial provided additional spatial guidance to complete the scanning protocols. Additional guidance included arrows superimposed on the ultrasound and OCT keyboards when specific controls were needed and virtual green dots superimposed on the body over the ultrasound targets' approximate locations to guide ultrasound probe placement. Twenty subjects attempted to acquire ultrasound and OCT images using the tutorials provided viewed on a laptop computer, and 20 subjects attempted the same diagnostic imaging procedures with instructions viewed using the AR system. No subject had prior experience performing these procedures or using this imaging hardware, and no subject participated in this study as a member of both groups. Subjects used guidance from the tutorials to acquire five ultrasound targets that constitute a subset of images in a trauma-induced injury assessment protocol (images of the heart, lungs, liver, kidney and spleen) and a single thirteen-line, vertical raster scan centered on the macula of the left eye using OCT. Time limits were imposed upon the subjects to acquire each of the ultrasound or OCT targets. This is not dissimilar to the environment on ISS or anticipated on future exploration missions in which communication windows or mission objectives can impact the available time to complete imaging procedures. After the data collection session, subjects completed a survey to capture their thought about the equipment, procedures, instructional material, and future improvements. Images were stored by the subjects and evaluated off-line in a blinded fashion by imaging professionals. Four radiologists from Vanderbilt University with training in ultrasound analyses evaluated the ultrasound images. Four trained evaluators at the Doheny Image Reading Center (University of California, Los Angeles), with previous experience using the grading techniques utilized in this study, evaluated the OCT images. Somers' D was used to assess the effect of the use of either laptop or HoloLens on the resulting image scores. Results and Discussion Nearly 70% of the ultrasound images and 53% of OCT scans that these previously untrained subjects acquired were considered to be diagnostically adequate. The quality scores for OCT images and 3 of the 5 ultrasound targets were not different between groups, but the laptop group performed better for the other 2 ultrasound targets. The time to acquire ultrasound images was, on average, shorter for the AR group (52 compared to 57 minutes). Interestingly, the survey results indicated that the AR group did not find the instructional material as helpful as the laptop group (p= 0.042), even though the content was the same for both. While it is evident that both the augmented reality and laptop groups struggled with the complexity of both ultrasound and OCT, there was a subset of subjects who appeared to embrace the technological challenge and performed well. This might be related to the education level, learning styles, or comfort level with technology, but these factors were not specifically evaluated. While some subjects embraced the technology, some were overwhelmed by the task of familiarizing themselves with a new technology (i.e., AR) while concurrently attempting complex, operator-dependent imaging which also was new to them. The inclusion of subjects not necessarily representative of the astronaut corps represents a limitation of the study. Additionally, the degree of familiarity with laptop computers and PowerPoint may have created a bias for the laptop group. ","benefits":"This study sought to evaluate a technique to help facilitate autonomous use of operator-dependent, non-invasive medical imaging devices in a subject population without prior ultrasound or optical coherence tomography (OCT) training. While the imaging protocols chosen for this study were based upon the health and medical risks identified as concerns for long-duration spaceflight, particularly exploration missions, these imaging protocols also are routinely used on Earth. Through this work we have developed and tested an augmented reality (AR) tutorial to guide inexperienced or untrained operators through complex, operator-dependent procedures for specific ultrasound and OCT applications. While originally developed for astronaut use beyond the range of timely communication with Earth, AR could enable more general uses in any remote or extreme environment lacking trained professionals. Ultrasound has been used in remote and extreme environments, including special forces military units in Afghanistan, Mount Everest expeditions, and rural locations without adequate medical expertise. Lessons learned from this project will facilitate the development of AR programs for similar applications. It should be noted that this type of training is not preferable to a study performed by a sonographer or other qualified medical professional trained in ultrasound. However, similar to defibrillators, if the equipment and adequate instruction is available, AR instruction could be used when equipment is available, but trained professionals are not. ","releaseStatus":"Released","status":"Completed","destinationType":["Mars"],"trlBegin":4,"trlCurrent":6,"trlEnd":6,"favorited":false,"detailedFunding":false,"programContacts":[{"contactId":103847,"canUserEdit":false,"firstName":"David","lastName":"Baumann","fullName":"David K Baumann","fullNameInverted":"Baumann, David K","middleInitial":"K","email":"david.k.baumann@nasa.gov","receiveEmail":"Subscribed_User","programContactRole":"Program_Director","programContactId":181,"programId":273,"programContactRolePretty":"Program Director","projectContactRolePretty":""}],"endDateString":"May 2017","startDateString":"Jun 2016"},"technologyOutcomePartner":"Other","technologyOutcomeDate":"2017-05-31","infusion":"Other","technologyOutcomePath":"Closed_Out","technologyOutcomeRationale":"Other","details":"This research project did not receive formal funding until November, 2016. The entire project, from planning to initiation of testing to completion of data collection and analysis, was conducted using a compressed schedule of 6 months. 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