Diagnostic Remote Guidance on Mars (Abstract)

Despite rigorous health screening in astronaut crews, there are a number of conditions that may occur during long duration, exploration class spaceflight.  The risk of abdominal conditions requiring surgical intervention is not clear, yet submarine and polar base experiences suggest contingency planning is warranted.  While radio communication time delay is only 2 seconds to the international space station (ISS), a potential Mars mission would necessitate time delays of about 15 minutes.  We sought to demonstrate the feasibility of remote expert guidance of diagnostic ultrasound followed by laparoscopic appendectomy in a simulated Mars environment.

Research was deemed exempt by the institutional review board.  A simulated Mars research environment was utilized on Devon Island in the Canadian Arctic.  Electronic communications including audio and video were established between the Arctic base and Henry Ford Hospital serving as Mission Control and incorporated the 15-minute communications lag into all communication.  Ultrasound and laparoscopic capabilities were integrated into communications for remote guidance.  Remote guidance methods and technology utilized has been previously published in communication with the international space station.

A simulated scenario involving a young female astronaut developing right lower quadrant pain was developed and utilized for this demonstration.  An anatomical appendectomy model was utilized for the ultrasound and laparoscopic portions.  Reference aids describing background technical aspects were developed.  A set of confirmation milestones was used to generate a hard stop and mandated remote review.

We report a successful remote guidance demonstration from a simulated mars environment with clinical control from a terrestrial base utilizing appropriate delay and consistent bandwidth and technology.  Reference aids were appropriate for non-surgical personnel and hard stops for milestones with remote approval and go ahead were shown to be feasible.  The appendicitis was appropriately diagnosed utilizing remote guidance of ultrasonography and the appendix removed laparoscopically using stapled technique with remote guidance as well.

Terminology Used in Remote Guidance

Medical and technical terminologies, as well as a combination of both, are used often in the field of remote guidance. Here are some terms that are commonly found in remote guidance literature:

Ultrasound:
Also known as diagnostic sonography, medical sonography, and medical ultrasonography, ultrasound is a diagnostic medical imaging technique used to visualize muscles, tendons, and many internal organs, their size, structure and any pathological lesions with real time tomographic images. It is also used to visualize a fetus during routine and emergency prenatal care. Ultrasound scans are performed by medical health care professionals called sonographers. Obstetric sonography is commonly used during pregnancy. Source.

Laparoscopy:
Also referred to by the medical term laparoscopic surgery, or the less medical terms minimally invasive surgery (MIS), bandaid surgery, keyhole surgery, and pinhole surgery. Laparoscopy is the process of surgery using a telescopic rod lens system connected to a camera to perform operations in the abdomen through small incisions, using the camera/lens system as a guide. Source.

VGA:
VGA stands for Video Graphics Array and is the most common connector for analog video on computer equipment and various electronics with an analog video output. VGA carries a RGB (red-green-blue) signal and is also referred to as D-Sub due to its’ 15-pin connector. Source.

DVI:
DVI stands for Digital Visual Interface and is a digital video format used on most modern computer monitors. It is forward compatible with HDMI video in digital mode and fully compatible with VGA video in analog mode.

The DVI connector carries both a digital and analog video signal. It is of rectangular form and comes in a variety of flavors dependant on its pin layout. Source.