Sound concept: medical spin-off from ISS technology

Spending long periods of time in space can put a huge strain on the human body, so astronauts need to be carefully monitored for signs of ill health.

But the International Space Station is a long way from the nearest hospital, so researchers have had to develop imaging technologies that can be operated from Earth, to allow specialists to keep a careful eye on the astronauts during their time in orbit.

Now this remote imaging technology is being used to help give people on Earth better access to specialist medical scans.

The technology, known as tele-ultrasound, was originally developed in a series of projects by the European Space Agency (ESA), according to Arnaud Runge, a biomedical engineer at the agency.

“Upcoming long-duration ISS stays and future manned exploration missions will require the use of different medical tools in order to diagnose potential crews’ health problems,” said Runge.

Consisting of a remotely-controlled ultrasound probe, the system was also designed to image astronauts’ hearts as part of ESA’s research into the effects of microgravity on the cardiovascular system.

The heart can undergo changes to its structure and performance during prolonged periods in microgravity, since it does not have to work as hard. Over time, this may lead to deconditioning and a decrease in the size of the heart, according to the US’ National Space Biomedical Research Institute.

“Ultrasonography provides medical experts with real-time access to anatomical and functional information about the patient while being non-invasive and harmless,” said Runge. “However, its main drawback remains its operator dependence, as skilled personnel are required to capture and interpret dynamic images,” he said.

So the TESSA - or Tele-Echography for ESA - system was designed to allow a team of experts on the ground to operate an ultrasound scanner on the ISS or a spacecraft, which can then beam back images of the astronauts’ hearts to Earth.

But it is not just astronauts who find themselves a long way from the nearest doctor.

In countries with a large rural population, such as France or Canada for example, patients can be forced to travel tens or even hundreds of miles to reach the nearest medical centre with a specialist radiologist, according to Nicolas Lefebvre, managing director of AdEchoTech based in Vendôme in central France, which has worked with ESA on the technology’s development.

“France, like many countries, is suffering from medical ‘desertification’ issues, meaning we have some small cities and many Department (counties), without any radiologists,” said Lefebvre. “This means people are forced to drive 50-100 kilometres to find the nearest radiologist.”

This may simply be an inconvenience for routine scans, but it could be potentially life-threatening in an emergency.

So the company, founded in 2008 by Lefebvre’s father, Dr Eric Lefebvre, has developed a terrestrial version of the tele-ultrasound system, which they have dubbed Melody.

The system allows a specialist radiologist at a large central hospital, for example, to perform remote ultrasound scans on patients at smaller regional medical centres hundreds or even thousands of miles away.

“The Melody system can be used for emergency cases where an ultrasound is needed, for example for carrying out abdominal, pelvic, obstetric, or gynaecological scans,” said Lefebvre.

At the patient site, the technology consists of three components: the ultrasound machine, which works in the same way as a conventional device; the Melody system itself, in the form of an ultrasound probe attached to a robotic arm; and a video conferencing system.

This video conferencing system is then linked via an internet connection to the radiologist’s location. “On the expert’s site you will find the same video conferencing system, to allow the radiologist to see and speak to their patient, and also to speak to the technician holding the robotic system over the patient’s body,” said Lefebvre.

This technician could be a nurse or other member of the medical team, as the system is designed to be guided by someone without specialist radiology skills, he said.

Also at the radiologist’s location is a computer interface to allow them to view the ultrasound images in real-time, and to remotely operate the Melody system. The radiologist can control all of the settings on the system, allowing them to change parameters such as the frequency of the ultrasound, for example, to improve the amount of detail in the image, said Lefebvre.

Lastly, a joystick with three degrees of freedom, which was designed by radiologists to very closely resemble the probes used to carry out a conventional ultrasound, allows the specialist to move the robotic arm over the patient’s body.

A patient requiring an ultrasound scan of their unborn baby, for example, would lie on the hospital bed, with the nurse or other technician positioning the robotic arm over their body. The patient can discuss their concerns with the remote radiologist via the video conferencing link, and the specialist would then use the joystick to move the ultrasound probe attached to the robotic arm over their body.

The company has already sold the system to more than 15 hospitals and health institutes in France and elsewhere, with other centres taking part in trials.

It could be used in any remote location, including prisons, islands, and ships, or to provide medical assistance following a natural disaster, using either an internet or satellite link.

ESA also recently completed a trial of the technology with four European defence ministries, making it available to military garrisons based in Lebanon and Afghanistan.

The technology has also been tested successfully on oil platforms off the coast of West Africa, and at inland medical clinics in French Guiana.

To develop the system further, AdEchoTech and ESA are also working together on a new generation of the technology, for both space and terrestrial applications, said Lefebvre.

“We are working on a third generation system for echocardiography in space,” he said. “The idea is to reduce the size and weight (of the robotic arm) using new technology, but to have the same specifications.”

If successful, the new system could make it even easier for specialists to monitor the health of astronauts, and those of us on Earth, even from thousands of kilometres away.