A Space Mission For Health

Hundreds, thousands of kilometers from Earth, there are no hospitals or doctors. But astronauts still need access to care. The limitations in space spark innovations in telemedicine, robotics, and AI that often help patients on Earth. Together with Arnaud Runge, Medical Engineer from the European Space Research and Technology Centre (European Space Agency, ESA), let’s explore how healthcare benefits from space flights, satellites, and the “failure is not an option” approach.

The success of space missions also relies on astronauts’ health. So how do people living in a small space craft get medical care?

The primary tool to access healthcare in space is the astronaut him or herself—each person is trained to cope with medical emergencies to a certain extent. For future exploration-class missions, one of the crew members will likely have an emergency medicine background to cope with health-related issues.

Nevertheless, the crew is always supported by various technologies tailored to the mission. For instance, the astronauts working and living in the International Space Station (ISS), orbiting 400 to 500 km above the Earth, receive care through telemedicine. Data from local sensors are transmitted via a secure satellite connection, so doctors in a space health center on Earth can perform regular health checks.

We are working on new solutions to improve remote care. For example, we are developing a technology demonstrator for a compact monitoring system that can acquire and stream physiological data. Similar solutions are already used in ambulances. Previously, we worked on a robotic system to perform ultrasound scans that could support both clinical or scientific cases. Ultrasound examinations and image reading can be very complex and require a high level of expertise, which the crew does not necessarily possess.

This is now. And what about the future missions?

For missions that will be further away from the Earth, the approach to telemedicine will have to be reshaped—due to the distance between the health expert and the astronauts, no real-time operations are possible.

Telemedicine will still be possible, but in a somewhat asynchronous way to provide a second opinion or feedback. When radio waves need minutes or hours to travel from the space craft to Earth, we can’t reply in teleconference-like consultations.

The technologies we are currently investigating to support future missions focus on making the crew as autonomous as possible. It requires developing artificial intelligence and machine learning solutions and automating the care processes. Astronauts will need new knowledge and skills, while robots will assist in decision-making and performing medical interventions.

We have to think about onboard technologies—their volume and mass are strictly limited. It is an exciting job requiring us to think ahead. The constraints and requirements for space missions are different, but the objective is similar to the care provided on Earth.

When you say that, I start thinking about a “Star Trek” sci-fi movie. The Enterprise crew has what they call a tricorder – a small scanner that quickly collects patient data. Is this an inspiration or just pure science-fiction?

We are actually working on compact Point of Care devices (POC). Using a small blood sample, ideally just one drop, they will indeed analyze several biological parameters. However, we are pretty far from the scanners from sci-fi movies… (laugh)

Space technologies are among the most advanced innovations. Can you outline how they are developed to ensure that the final mission will be successful?

You probably know the famous sentence: “Failure is not an option.” Indeed, we can’t afford failures in the space domain. And this is also true for space medicine—nobody wants that a health problem becomes the reason to abort a mission.

This is why space engineering is based on a robust approach where safety and quality are at the forefront. The development of space technologies is guided by a set of standards and requirements which have proven their value across time, leaving minimal space for risk.

Space engineering and medical technologies have many similarities—both space and medical products have designs that prevent single points of failure and privileging redundancy. They require a lot of strict testing and certifications. So you can imagine that space-qualified medical products will have to be pretty robust.

There is one more approach that bridges space and med tech. In the past, the development of space technologies took a very long time. We needed years to reach the readiness for a launch of a mission. Nowadays, we aim to speed up development phases while maintaining the same safety and performance levels. In practice, this means shortening the time needed for product certification. We have also seen an analogy during the COVID-19 pandemic when we couldn’t afford the previous approach to vaccine development but had to ensure the same safety standards. Healthcare systems and space agencies can learn a lot from each other.

What healthcare challenges are space technologies already helping to address?

Broadly speaking, space technologies include the technology developed for space exploration and human space flights, communication via satellites, Global Navigation Satellite System (GNSS) technologies, and Earth observation data. All of these play a crucial role in healthcare. Sometimes as an enabler—without the contribution of the space technology, the product or the service is not possible; sometimes as a differentiator—thanks to space technologies, the product or service has a competitive advantage over similar solutions.

Let me give you an example: the physiological monitoring system TEMPUS PRO we have been working on. The system offers features similar to other equivalent devices. However, each includes a positioning chip that helps track the utilization team or the asset itself. In addition, it has been designed to work over satellite for sending data remotely—our competitors don’t have these features.

Thanks to space technologies, our product can target specific utilization cases. Remote connectivity makes it possible to reach a doctor in another location. With access to the data, healthcare professionals can help the patient and the paramedic on site. The device can now be found onboard airplanes and air ambulances.

Another example is a technology developed to perform ultrasound examinations of astronauts remotely. Ultrasound is a beneficial imaging technique in space—it is compact, non-invasive, and non-ionizing. But the major drawback is the very high operator dependence and skills required to perform a good ultrasound scan. Thus, ESA has been working on the concept of a robotic tele-ultrasound system where a medical expert remotely manipulates the ultrasonic probe to get the right images.

This could find direct application in health care. Patients don’t have to travel to a medical center located far away from their homes. The technology can also limit the impact of the uneven healthcare infrastructure or even lack of it.

Observation and positioning data contribute to building epidemiological maps, which help sanitary authorities decide what measures are required to manage the spread of diseases. They were applied during the COVID-19 pandemic, but also during the Ebola epidemic in Africa and other outbreaks of vector-borne diseases.

European Space Agency also runs programs supporting the transfer of space technologies initially developed to explore space and monitor our planet Earth to healthcare…

Indeed. For example, we have a technology transfer initiative aimed at reusing software developed for astronomy in the development of a medical imaging device.

Another scheme, called business applications and space solutions, financially supports companies that want to develop space-based products and services for terrestrial locations.

ESA plays the role of “gap filler” in terms of medical technology development. Sometimes we need to invent some solutions, either because what is available on the market doesn’t meet our requirements or because there is no solution on the market—due to the high technological challenge or low priority, meaning low profitability.

Can you give an example?

One of the most exciting fields is highly portable and compact devices that can be used on Earth in small healthcare centers in remote areas. We are currently working on a small x-ray medical imaging system that could be used in any doctor’s office.

Another example is the set of biomechanical countermeasure systems to protect the astronauts from the harmful effects of microgravity, such as decreasing muscle mass and bone density. Some of these technologies can potentially be applied in rehabilitation programs on Earth.

Many benefits come from life sciences research—observations and examinations performed on the space station let us understand the mechanisms of proprioception and osteoporosis. We hope it will contribute to developing new treatments in the future.

ESA, the UK Space Agency, and UK NHS are funding a new project aiming at creating a “hospital of the future.” What do you expect from the initiative?

We want to demonstrate how space tech could contribute to shaping the hospital of tomorrow and play a key role in developing new services or solutions. The project applies not only to medical devices —we want to approach anything that revolves around the functioning of a hospital.

Let me list some examples: drones to improve logistics, smart shuttles to avoid congestion in hospital parking lots and facilitate access to the premises for patients and hospital staff, sanitation technologies to keep the hospital environment clean, and many more.

By improving prevention and teleconsultation solutions, some inventions—paradoxically—could help shift care from hospital to home. Each selected project will first go through a short feasibility study and then, if completed successfully, be followed by a demonstration project to prove the benefits of the proposed service.

This is not the first project of this type. A few years ago, for the 70th anniversary of the NHS, the three agencies partnered and allocated £4 million to support projects in different sectors such as cancer detection, support for mental care, and improving access to healthcare. Following the positive achievements of this initiative, we decided to continue the collaboration.

What is the driver of ESA’s contribution to healthcare?

Although ESA is not a healthcare solutions developer, we see our role as an enabler and a facilitator of healthcare innovation. Through our programs, we support companies with the expertise, talent, and knowledge of the commercial market in the health sector.

As an international organization, ESA cooperates with other stakeholders, such as the World Health Organization and governmental partners. We have enormous internal expertise, know-how, and what’s most important—innovation-oriented culture. Therefore, every initiative, research outcome, or new technology can collectively lead to a snowball effect and contribute to a more considerable transformation. This is the way ESA addresses current and future health challenges on Earth.

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