Medical autonomy is required with deep space traveling
This blog post is the first in a mini-series of 4. Click here to read part 2, part 3 and part 4.
Medical autonomy, a prerequisite for deep space travel
In the near future, space flight will bring us further into the solar system and we will begin to stay away from Earth longer than our current expeditions to the International Space Station. Concerning the health of astronauts, the relationship that mission-control on Earth has with astronauts will need a change, very similar to the patient doctor relationship that we see changing in healthcare. In deep space, communication delays and the absence of specific medical equipment might pose a risk for astronaut health. Future missions will include physicians on their teams, but the physician can become ill and in need of medical treatment. Emergency evacuation is no longer an option in these situations. Medical autonomy is required on deep space exploration missions, but also on Earth in remote locations, like on Antarctica or Northern Canada. We can learn from remote and continuous monitoring efforts that we employ on Earth, but at the same time need to think of more sophisticated ways of treating astronauts on the go without remote help. A lot of the challenges the space community face are similar to the ones we see solutions for, be it in design or technology, in the healthcare innovation domain. In this article I will share more on these parallels.
We see healthcare moving towards a digital world and it is this change that is profound because it offers solutions that are smaller, cheaper and smarter. With the right technology and design, these digital solutions allow us to capture a more complete picture of a person’s health, both in space and on Earth.
Advancements in sensor technology has led to sensors that become so small they can be embedded in sophisticated small devices or even patches that stick to the skin to make continuous vital sign monitoring possible. Increasingly we can keep an eye on patients while they are not bothered by wires, not stuck to a particular area for connective reasons, or in other ways hindered in daily activities (like swimming!). Similarly, astronauts might not be wearing measurement devices everyday of their trip, but these technologies offer ways of monitoring them more often and more effectively, all while they can keep up with their working activities. A new monitoring shirt called Astroskin will be send up to the International Space Station in 2018. It sends measurements back to Earth, where doctors can monitor astronaut’s health.
Credit: Canadian Space Agency; The Astroskin of Hexoskin will fly to space in 2018.
New ways of interacting with computers are introduced by the advent of virtual humans. Over the last couple of years we have seen examples of human avatars developed to a point where it becomes hard to see differences with real human faces. These realistic avatars will provide a more natural way to engage with computer intelligences. Some of them have been co-created and tested with Australian national disability insurance scheme participants, aiming to eliminate filling in forms on websites and to provide new ways of navigating the internet. How would a directly accessible personal human-like assistant benefit an astronaut on its way to Mars or a patient in a rural area?
Credit: Soul Machines; Virtual humans might need a disclaimer: we are not real…
Next to these developments, technology to gain insight in our inner (physical) selfs, our genomes (and other ~omes) is decreasing exponentially in cost. This has resulted in consumer test kits becoming available to the general public for testing proneness to diseases or suggesting lifestyle changes according to your body’s response to diet, exercise and stress. In space, genomic sequencing has been tested since 2016 using a handheld sequencer called MinION. As far as I know, it was not yet tested to make the same kinds of health and lifestyle suggestions as consumer kits do, based on changes in gene expression in astronaut tissue samples…
From data to health
With healthcare becoming digital, valuable information is stored in the huge amount of data that is being collected with the above mentioned technologies. To analyze these huge streams of data, a lot of effort goes into development of algorithms that can find patterns that humans are no longer capable of detecting. On top of that, with health information being digital, healthcare can be delivered everywhere (on Earth and in space): more and more companies are taking parts of work traditionally being done in hospitals, universities or research institutes and try to improve on these tasks with artificial intelligence.
Next to analyzing data, decision making based on these analyses is something humans need help with too. Being able to compare a certain case against hundreds of thousands similar cases is where a computer could outperform even the most experienced human doctor. But not only doctors benefit: right now we see artificial intelligence agents that can perform triage for patients too, making on-demand and safe medical advice accessible to anyone carrying a smartphone. Decision aids can help doctors and patients with decision making on Earth, but will be essential for deep space traveling.
Coaching by AI
As we venture further into the solar system, one of the struggles of long-duration spaceflights will be the isolation of crews from friends and family (read: the rest of humanity). Other psychological stresses might arise from working in an extreme environment, confined to small spaces. New technologies like artificial intelligence (AI) are making tremendous progress to a point where they could possibly provide human-like companionship. Conversational AI services are actually being set-up and tested worldwide to play a role in psychological coaching for patients using ‘traditional’ Cognitive Behavioral Therapy methods. These AI agents can be used to chat about fears, about dealing with stress, or about coping with living with a disease (or even successfully help in the prevention of disease!).
Skipping a 40 minutes communication delay from Earth to Mars, potentially, AI could provide a solution to offer on-demand counseling with a skilled, but artificial psychologist. To add to that, the virtual humans that I described could deliver an even more realistic experience when speaking to such AIs.
Credits: Babylon Health
Real-time medical support
Astronauts can only be trained so much for potential medical events that arise up in space. Currently ground-based flight surgeons monitor and help out via a long-distance video call. The actual doing is up to astronauts themselves that for example learn how to draw their own blood (with tools floating away if not careful in weightlessness). With robots already capable of performing that task, what else can be automized?
Inspiration from fiction: In the television series Star Trek Voyager the doctor on board of the starship is a computer program: a hologram with all of humankind’s medical knowledge built-in that performed as the chief medical officer of the ship.
Even with the advent of virtual humans, we do not yet have virtual docs wondering around the International Space Station like the doctor on board the fictional USS Voyager. Making the right decision for treatment might come from similar decision support systems as the ones that are being developed on Earth for patients and doctors.
Reality check: VR, AR, MR?
Astronauts are relying on training for performing medical procedures and that training can greatly benefit from new technologies like Virtual Reality (VR). Startups are working on this for terrestrial healthcare, for example for surgery. Crews have already been using forms of VR for learning how to operate spacecraft and robot arms. It becomes interesting when virtual elements are added to real world scenario’s, called Augmented Reality (AR) or Mixed Reality (MR). When seen through glasses or a head-mounted display the inside of the space station can be blended with artificial layers adding relevant data like vitals or guidance while using complex medical equipment. Astronauts Scott Kelly and Tim Peake have been testing this on board the International Space Station. Also the European Space Agency is looking for ways to further develop VR, AR and MR for training in operational tasks. The future of medical training with Mixed Reality will benefit both doctors on Earth as well as astronauts on the ground and in space.
Credit: Astronaut Scott Kelly wearing a Microsoft Hololens on board the International Space Station (@StationCDRKelly)
What is reality?
In this article I have shared examples of technology and design that create opportunities for the future of healthcare on Earth and in space. Still, the absence of gravity and presence of radiation are challenges to be dealt with, but I believe that the space sector has lots to gain from the developments we see in modern healthcare here on earth, especially in ‘digital health’. Digital solutions ensure on-demand availability of care, focused on patients instead of centered around institutions. At the same time, terrestrial healthcare might benefit from solutions that are the result of designing for extreme environments. If we can do it in space, we can do it everywhere! Let’s combine forces and lead the way to a healthy world, up there and down below!
This is a translated and condensed version of the 4 part blog series posted on LinkedIn December 2017.
Written by Jules Lancee
In my work as a biomedical engineer at the Radboudumc REshape Center I focus on emerging technologies and their role in a changing world of healthcare. I explore how they will impact the care that we deliver to patients, but find it equally interesting to see how they will be able to benefit the future of long-term spaceflight. I think both questions are opportunities for collaboration and inspiration!