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Autonomous Medical Operations

Description:

Scope Title:

Autonomous Medical Operations

Scope Description:

Current medical operations on the International Space Station (ISS) rely on real-time communication with NASA's Mission Control Center (MCC), leveraging telemedicine technologies to monitor and enable the optimization of Crew Health and Performance (CHP) measures. Near real-time communications allow MCC staff (Flight Surgeons, Flight Controllers, etc.) to intervene when a given medical scenario exceeds the crew's knowledge, skills, or abilities. This MCC subject matter expertise pool extends crew capabilities, allowing them to respond to larger and more complex sets of medically relevant events as they arise. Further, well before launch, crewmembers are trained to operate essential medical assets onboard the ISS and employ detailed, MCC-led procedures to respond to various planned and unplanned events. Importantly, all crewmembers receive pre-mission training on medically centric procedures in preparation for assigned spaceflight. Despite selecting a specific astronaut who receives additional medical training and is the designated “Crew Medical Officer,” onboard medical capabilities are understandably limited by experience, logistics, and communications. Consequently, crewmembers are not fully vested with the resources to adequately address the breadth of medical situations that will require more robust medical (and non-medical) decision support and may arise in exploration-class spaceflight operations.

In contrast to ISS missions where MCC can work with a crewmember to “troubleshoot” medical anomalies in real-time, exploration-class missions (and their more burdensome requirements for increasing autonomy) will necessarily evolve and come to dominate NASA’s efforts. Mars missions, understandably, will not have real-time communications with MCC, nor will they have a rapid return capability. Round trip communications between the surface of Mars and Earth is approximately 40 minutes, and the return trip for the spacecraft and crew will be months, which significantly complicates NASA's current medical operations paradigm. Communication bandwidth considerations may also limit data transmission between the crew and MCC, even in high acuity medical situations. More specifically, a variety of existing ISS medical operations require the spaceflight team to "Contact MCC" or "Notify Surgeon" for additional instructions, a capability significantly delayed, reduced, or unavailable for early and future Mars surface operations. In the more near term, Artemis missions in lunar orbit and on the surface of the Moon will also require a commensurate increase in remote operations. Artemis crews, faced with communications latencies that will make instantaneous procedural guidance impossible, medical evacuation times of up to 2 weeks because of the near rectilinear halo orbit, and limitations on crew training for medical operations, will need to address and resolve medical problem sets independently farther and farther afield, specifically in the domains of clinical decision support, medical decision making, and diagnostic/procedural execution. Independent medical decision-making activities can be achieved through autonomous crew decision support technologies combined with integrated systems that permit assessment, treatment, stabilization, or the resolution of problems in progressively Earth-independent fashion. Therefore, it is likely that some in-flight events will exceed the crew's and MCC's ability to medically respond to preserve CHP during exploration-class spaceflight missions. Unmanageable in-flight medical circumstances would otherwise require the astronauts to resort to providing inadequate or relatively ineffective medical care or would make a rapid, unplanned return to Earth (medical evacuation) necessary to seek definitive medical care for their affected crewmember. If mission planners, engineers, scientists, and policymakers do not explore, define, develop, select, test, and integrate autonomous medical support systems into future spaceflight systems, these scenarios become more likely.

NASA requires highly functional and easy-to-use novel autonomous medical support technologies that will reduce resource footprint, tools, and training while enabling greater autonomy and self-reliance for the crew. These technologies will allow astronauts to operate in a progressively Earth-independent manner by fomenting the integration and leveraging of highly transferable technologies to buy down risk. Enhanced clinical decision support tools focused on exploration-class spaceflight operations will nominally enable MCC, at baseline, to accurately monitor and even predict potentially adverse conditions when communications are robust while enhancing and facilitating crew decision support technologies and autonomous crew decision-making capability when MCC-Crew communication is suboptimal or absent.

Optimally, integrated solutions should add minimal mass, volume, power, and crew time, or even, where possible, result in savings of these resources. Examples of technology developments can include but are not limited to: advanced just-in-time training modalities; enhanced procedure execution technologies (augmented reality); autonomous physiologic monitoring and trend prediction, integrated clinical decision making support technologies, tools, and systems; automated in situ diagnostic and image interpretation capabilities; multipurpose medical supplies, devices, and technologies (e.g., 3D printing, etc.); and surface operations medical autonomy systems (e.g., casualty assessment/extraction/in situ evacuation, etc.).

This subtopic will advance NASA’s long-term priority for maturation of Earth-independent medical operations, but will also support near-term medical capabilities for the Artemis program, specifically in high-risk, critical path solutions for Artemis Phase I, by boosting "best in class" commercial-off-the-shelf (COTS) or near-term translational technologic solutions to the NASA-specific exploration-class spaceflight problem sets and requirements that will augment operational clinical decision support, medical decision making and diagnostic/procedural execution. Clear deliverables to these ends entail innovations to: (1) maximize crew autonomy and self-reliance across a wide range of medical operations, (2) demonstrate how technology could be leveraged to prevent adverse medical conditions and provide prolonged in situ medical capabilities, (3) extend the amount of time needed before (or eliminate) MCC intervention is required, (4) minimize or reduce the occurrence of medically oriented operational scenarios that could negatively impact mission success, and (5) simultaneously reduce resource costs in terms of up and down mass, power, and volume through novel application of combination technologies, material solutions, or "cross-over" or "cross-domain" multiuse systems that optimize resource allocation/dedication. The subtopic will not only address the near-term needs of Artemis, but also provide a solid platform for maturation of technologies to support Artemis sustaining missions as well as deep space Earth-independent medical operations.

Expected TRL or TRL Range at completion of the Project: 5 to 7

Primary Technology Taxonomy:

  • Level 1 06 Human Health, Life Support, and Habitation Systems
  • Level 2 06.3 Human Health and Performance

Desired Deliverables of Phase I and Phase II:

  • Prototype
  • Hardware
  • Software

Desired Deliverables Description:

Desired Deliverables Description (provide deliverable description for both Phase I & Phase II)

Autonomous medical systems technologies that minimize mass, volume, and material waste, that increase crew ability to make sound and timely decisions independent of terrestrial mission control across a wide range of medical operational scenarios, and optimize crew health and performance on long-duration spaceflight operations.

Desired Deliverables Description

Phase I Deliverable—Candidate autonomous medical support technology prototypes. Documentation of analytical/experimental results validating predictions of key parameters, critical function and/or characteristic proof of concept.  Examples may include component and/or breadboard validation in a relevant laboratory environment and documented test performance demonstrating agreement with analytical predictions.

Phase II Deliverable—System prototypes successfully demonstrated in analog and space environments.  Documentation of test performance demonstrating agreement with analytical predictions as well as clarifying definition of scaling requirements. Examples may include system/sub-system model or prototype demonstration in an operational environment.

State of the Art and Critical Gaps:

Current space-relevant autonomous systems comprise software, sensors, and other various technologies applied predominantly to spacecraft operational systems, habitats, and propellant loading systems. Two NASA testbeds evaluate autonomous systems technology: The 2nd Generation Deep Space Habitat (Johnson Space Center, Houston, TX) and the Cryogenic Test Bed Laboratory (Kennedy Space Center, FL). Additionally, the ISS is essentially remotely and autonomously controlled by a large team of experts located at the NASA MCC (Houston, TX). The commercial industry is experiencing a significant paradigm shift regarding its adoption of autonomous systems enabled by multisensory industrial scale "Internet of Things" tracking, low-emission public transport utilization, factory production line optimization, sustainable agricultural practice implementations, and self-governing power grid solutions. Machine learning, artificial intelligence, and digital transformation are currently laying the groundwork to create new employment opportunities across the public sector that will be enhanced or wholly facilitated by autonomous systems. Recent and upcoming advances secondary to the high speeds and low latency of 5G cellular and space-based internet systems (e.g., Starlink™) will supplement deployment and dissemination of the seeds of a future system of systems comprising interacting robots, sensors, and humans in the workforce. Future missions to the lunar surface and beyond to Mars will have significant delays in communication.  Despite speed-of-light communication capabilities, future astronauts will experience delays of up to 22 minutes each way—requiring the development of synergistic and cross-cutting autonomous system technologies that assist astronauts in critical, timely decision making supported by integrated sensors, systems management tools, and "human in the loop" devices and software systems that automatically alert, detect, and assist in the diagnosis of ailing crewmembers as well as to alert the crew to potentially dangerous environmental conditions onboard their spacecraft.

Relevance / Science Traceability:

This subtopic seeks technology development that benefits the Exploration Medical Capability (ExMC) Element of the NASA Human Research Program (HRP) as well as the Exploration Medical Integrated Product Team (XMIPT), part of the Environmental Control and Life Support System (ECLSS)-CHP Systems Capability Leadership Team. Autonomous medical systems technologies are needed to address the following assigned risks mappings:

"Risk of Adverse Health Outcomes and Decrements in Performance Due to Medical Conditions that occur in Mission, as well as Long Term Health Outcomes Due to Mission Exposures" (ExMC)

“Risk of Adverse Outcome Due to Inadequate Human Systems Integration Architecture” (Human Factors and Behavioral Performance [HFBP])

Supports the following identified HRP Gaps:


Medical-701: We need to increase in-flight medical capabilities and identify new capabilities that (a) maximize benefit and (b) reduce “costs” on the human system/mission/vehicle resources.

HSIA-501: We need to determine how Human Systems Integration (HSI) will be used to develop dynamic and adaptive mission procedures and processes, to mitigate individual and team performance decrements during increasingly Earth-independent, future exploration missions (including in-mission and at landing).

And assigned Task Book entries:

-Assisted Medical Procedures (Status: Completed; Responsible HRP Element: ExMC)

-Medical Training Methods for Exploration Missions (Status: Completed; Responsible HRP Element: ExMC)

-Medical Proficiency Training (Status: Completed; Responsible HRP Element: Space Human Factors and Habitability; Collaborating Organization: ExMC)

-Adaptive Stress Training for Hazardous Conditions (Status: Active; Responsible Element: HFBP)

-ExMC Support of Medical Scenarios for the Autonomous Mission Operation (AMO) Test (Status: Completed; Responsible HRP Element: ExMC)

 

This topic also supports the following entries on the Exploration Medical IPT roadmap:

  1. Medical Imaging, Diagnostics, and Treatment Technology
  2. Operational Medical Decision Support and Informatics
  3. CHP-Integrated Data Architecture

References:

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  • Holden, K., Russi-Vigoya, N., Adelstein, B. D., & Munson, B. (2019b) Human capabilities assessment for autonomous missions (HCAAM) phase I: Human performance standards and guidelines final report [Unpublished Report]. NASA Johnson Space Center.
  • Johnson, M., Bradshaw, J., Feltovich, P., Jonker, C., van Riemsdijk, B., & Sierhuis, M. (2011) The fundamental principles of coactive design: Interdependence must shape autonomy. In M. de Vos, N. Fornara, J. Pitt, & G. Vouros (Eds.), Coordination, organizations, institutions, and norms in agent systems VI, 6541, pp. 172-191. The Institute for Human & Machine Cognition. http://www.ihmc.us/users/mjohnson/papers/Johnson_2010_COIN_FundamentalPrincipleofCoactiveDesign.pdf
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