National Aeronautics and Space Administration Crew Health, Medical, and Safety: Human Research Program
Briefing to the National Research Council Committee on Human Spaceflight Technical Panel March 27, 2013
Steve Davison • NASA Headquarters Spaceflight: Human Health History
“Extending the spatial and temporal boundaries of human space flight is an important goal for the nation and for NASA” (National Academies, IOM, 2006) ………….Human Health and Performance Research Foundational Discipline Based Risk-based Knowledge Risk-based Human Response Physiological Bases of µg Applied Survival Characterization responses Research
ApolloApollo GeminiGemini SkylabSkylab Shuttle/SpacelabShuttle/Spacelab Shuttle/Shuttle/MirMir ISSISS Mercur y 1960 1970 1980 1990 2000 Exploration Fundamental Human Human Adaptation Medicine & Research Endurance Technology 2 ………….Research Capacity ISS is Our Space Biomedical Laboratory and Gateway to Mars
Primary orbiting laboratory that enables space biomedical research involving crewmembers
Only facility capable of providing long-term exposure to the reduced-gravity environment of space
Equipped as a space biomedical research platform
ISS One-year Mission - Launch in March 2015
Scott Kelly STS-103, Mikhail Kornienko STS-118, ISS 25/26 ISS 23/24 ISS Research –Critical to mitigating human exploration risks
On-Orbit Research Facilities Biomedical Research
Nutritional Requirements
Physiological Changes and Exercise Countermeasures
Human Research Rack-1 Human Research Rack-2
Immunological Changes
Exercise Facilities Crew Sleep and Performance Research
Space Radiation Research ISS Research –Critical to mitigating human exploration risks
Biomedical Capabilities International Research Development Collaborations
Lightweight Trauma Module
Portable Medical Imaging CSA Cardiovascular Function Experiment ESA Muscle Physiology Facility
Integrated heath care system JAXA Bone Loss Countermeasure IV Fluid Generation Experiment Russian Fluid Shift Countermeasure Experiment Human Response to Spaceflight
Astronauts experience a spectrum of adaptations/stressors in flight and post-flight • Sensorimotor
• Cardiovascular
• Bone and Muscle
• Food/Nutrition
Balance Disorders • Behavior/Performance Fluid Shifts Cardiovascular Deconditioning • Space Radiation Decreased Immune Function Muscle Atrophy • Ocular Impairment Bone Loss Radiation Exposure Sleep Disturbances • Immunology Isolation and Confinement
Health and Performance Risks
“Human space flight remains an endeavor with substantial risks, and these risks must be identified, managed, and mitigated appropriately to achieve the nation’s goals in space.” (A Risk Reduction Strategy for Human Exploration of Space, National Academies, Institute of Medicine, 2006)
• Humans have limits which drive mission and vehicle design - Exposure to micro-gravity, G-tolerance, Radiation exposure, Closed environment, Psychological and Behavioral, Habitation & Life Support (air, nutrition, etc.) • Highest health risks associated with exploration missions have been identified, documented, reviewed, and are actively managed • Health Risk Framework and Research underpinnings have been established by the National Academies • Research Roadmap: http://humanresearchroadmap.nasa.gov/
7 Crew Health, Medical, and Safety
• Policy, Operations, and Research are integrated through a Human Health Risk Framework - Office of the Chief Health and Medical Officer (OCHMO) • Medical Policy, Health and Performance Standards, and Bioethics (IRB, ACUC, Risk Threshold) - Crew Health and Safety (CHS) • Medical Operations and Occupational Health (career health care/post career monitoring) - NASA Human Research Program (HRP) • Human health & performance research in support of space exploration - Perform research necessary to understand & reduce health & performance risks - Develop and validate technologies to characterize and reduce medical risks - Enable development of human spaceflight medical and performance standards
8 Crew Health, Medical, and Safety
• Standards are the first step in risk mitigation and acknowledging accepted risk - Standards based on best available scientific/clinical evidence & expert recommendations (research findings, lessons learned from previous space missions and analogue environments, current standards of medical practice, risk management data)
• Four sets of health and medical standards have been identified & approved by NASA - Astronaut selection/retention – Space Flight Health Standards - Human Factors/Environmental – Levels of medical care
• Space Flight Health Standards - Fitness for Duty (FFD – e.g. cardiovascular): Minimum measurable capability or capacity for a given physiological or behavioral parameter that allows successful performance of all required duties. - Permissible Exposure Limits (PEL – e.g. radiation): Quantifiable limit of exposure to a space flight factor over a given length of time (e.g. life time radiation exposure). - Permissible Outcome Limits (POL – e.g. limit bone loss): POLs delineate an acceptable maximum decrement or change in a physiological or behavioral parameter, as the result of exposure to the space environment.
9 Crew Health, Medical, and Safety: Space Flight Health Standards
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10 Exercise: solution for many of the space health issues
• Physical fitness benefits – Cardiovascular system – Aerobic capacity – Muscle mass and Bone strength
• Psychological Benefits – Antidepressant, Relieves stress, Better sleep
Lack of gravity requires exercise hardware to maintain baseline physical fitness
11 Human Research Program
• Science Management & Program Integration Office – Peer Review, Task/Risk Management, Data Archive – Program planning, integration & control
• Elements – Behavioral Health and Performance • Individual, sleep, and interpersonal – Human Health and Countermeasures • Physiology, ocular impairment – ISS Medical Project • Infrastructure for flight experiments – Exploration Medical Capability • Medical care for missions beyond low Earth orbit – Space Human Factors and Habitability • Interfaces between humans and vehicles/habitatss – Space Radiation • Radiation exposure and biological effects
• National Space Biomedical Research Institute – Cooperative agreement to pursue research that complements the HRP portfolio 12 External Research Community
A Risk Reduction • Strategic Planning Strategy for Human – National Academies (IOM, NRC) Exploration of Space • Risk Reduction Strategy for Human Exploration of Space • Review of HRP Evidence Base and Merit Review Process – National Council on Radiation Protection (NCRP) – NASA Advisory Committee (NAC) – Annual Standing Review Panels (SRP)
• Science Planning – Research and Clinical Advisory Panel for Visual Impairment, Papilledema & VIIP Summits National Council on – Telemedicine Summit, Osteoporosis & Bone Summits Radiation Protection & Measurement – Atmospheric Dust Toxicity Assessment Group – Decompression Risk Review, Dental Working Group – Acute Risk: Radiation Workshop, CNS Research Panel, NRC Report on NASA – Habitable Volume Workshop Cancer Risk Models
• Research Implementation IOM Review of – National Research Solicitations NASA’s Human • Crew Health and Performance NRA, Space Radiobiology NRA Research Program – Graduate Student and Post-Doctoral Programs Evidence Books 13 Interfaces/Collaborationsns Human Research Program FY 2012 Tasks/Principal Investigators by State
WA ) )* 5/4
MN MA 25/21 OR 3/3 2/2 ID WI 1/1 1/1 NY MI 15/12 5/4 IA PA 1/1 OH 12/6 IN 7/7 CO 1/1 DC 2/2 CA MD 13/12 8/7 KS ' , 30/28 VA NJ 2/2 1/1 KY 5/4 1/1 $ NC TN 4/3 AZ 1/1 1/1 SC )* 1/1 # GA 3/3 TX 61/50 # ' FL 1/1 214 Tasks 182 PIs in 28 states )* Source for data, as of 05/29/2012 NASA Task Book 4 ) http:// ' taskbook.nasaprs.co m/Publication/ welcome.cfm ' )* ! " ! " 6 &'5 ' # 6 7-+D7-
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14 Research & Technology Deliverables
Portable Medical Imaging Physiological Monitoring Systems Updated Space Radiation Codes
ISS instrumented harness study In-situ-Intravenous (IV) Fluid Generation Remote Medical Capability: Diagnostic technology guide to assist with ultrasound imaging
Technology for astronaut health Spinal Elongation Study Dust Permissible Exposure Limit monitoring 15 Flight and Ground Facilities
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Human Health and Performance Risks
• 47 Human Space Flight Health and Performance Risks – Crew Health and Safety Risks (Medical Operations): current crew and space mission – Human Research Program Risks: require active research program to mitigate the risk for future long-duration missions – All human health and performance risks are managed and assessed by the NASA Human System Risk Board (Mission Operations and Research)
Crew Health and Safety Risks (Medical Operations) Risk of Toxic Exposure Risk of Common Medical Events Risk of Hearing Loss Related to Spaceflight Risk of Injury from Sunlight Exposure Risk of Urinary Retention Risk of Space Adaptation Back Pain Risk of Probability of mild Acute Mountain Sickness (AMS) in astronauts resulting in reduced crew performance prior to adaptation to a mild hypoxia. Risk of Inability to Certify Environment for Flight Risk of Acute and Chronic Carbon Dioxide Exposure Risk of Adverse Behavioral Conditions Risk of Psychiatric Disorders Risk of Compromised EVA Performance & Health Due to Inadequate EVA Suit Systems (MOD) Risk of Compromised EVA Performance & Crew Health Due to Inadequate EVA Suit Systems Risk of Exceeding Career Radiation Exposure Limits
Risk of Limited Crew Selection Due to Radiation Exposure Limits 18 Human Research Program Risks By Element: Reviewed by the National Academies’ Institute of Medicine
Space Human Factors & Habitability Risks Exploration Medical Capability Risks Risk of Performance Decrement and Crew Illness Due to Risk of Unacceptable Health and Mission Outcomes Due to an Inadequate Food System Limitations of In-flight Medical Capabilities Risk of Inadequate Human-Computer Interaction Risk of Performance Errors Due to Training Deficiencies Risk of Inadequate Design of Human and Automation/ Human Health Countermeasures Risks Robotic Integration Risk of Orthostatic Intolerance During Re-Exposure to Gravity Risk of Inadequate Critical Task Design Risk of Early Onset Osteoporosis Due to Spaceflight Risk of Adverse Health Effects of Exposure to Dust and Risk Factor of Inadequate Nutrition Volatiles During Exploration of Celestial Bodies Risk of Compromised EVA Performance and Crew Health Due to Risk of an Incompatible Vehicle/Habitat Design Inadequate EVA Suit Systems Risk of Adverse Health Effects Due to Alterations in Host- Risk of Impaired Performance Due to Reduced Muscle Mass, Microorganism Interactions Strength and Endurance Behavior Health & Performance Risks Risk of Renal Stone Formation Risk of Adverse Behavioral Conditions and Psychiatric Risk of Bone Fracture Disorders Risk of Intervertebral Disc Damage Risk of Performance Errors Due to Fatigue Resulting from Risk of Cardiac Rhythm Problems Sleep Loss, Circadian Desynchronization, Extended Risk of Reduced Physical Performance Capabilities Due to Wakefulness, and Work Overload Reduced Aerobic Capacity Risk of Performance Decrements due to Inadequate Risk of Crew Adverse Health Event Due to Altered Immune Cooperation, Coordination, Communication, and Response Psychosocial Adaptation within a Team Risk of Impaired Control of Spacecraft, Associated Systems and Immediate Vehicle Egress due to Vestibular / Sensorimotor Space Radiation Risks Alterations Associated with Space Flight Risk of Radiation Carcinogenesis Risk of Clinically Relevant Unpredicted Effects of Medication Risk of Acute Radiation Syndromes Due to Solar Particle Risk of Spaceflight-Induced Intracranial Hypertension/Vision Events Alterations Risk of Acute or Late Central Nervous System Effects from Risk of Decompression Sickness Radiation Exposure Risk of Injury from Dynamic Loads Risk of Degenerative Tissue or other Health Effects from Radiation Exposure 19
Architecture: Evidence « Risks « Gaps « Tasks « Deliverables
Evidence Base – Reviewed by IOM Reviewed by Standing Flight and Ground Review Panels • Science • Clinical Risks Gaps Prioritization & • Operational Implementation Approach experience HSRB Reviews/Refines Risk Posture Constrained by • Customer need dates • Budgets Exploration • Research platform Missions & availability Architectures Utilize HSRB to review NASA Spaceflight Human System and refine risk posture Standards Integrated Research Plan/ Human Research Roadmap Results and Deliverables • Mitigate Risks • Update Standards Solicitations • Countermeasures & Directed • Medical Technologies Research • Results ©New Gaps Customer Review Peer Review 20 " , - H "
* * 2 ) Transitionon to Deliverabless Operations
Tasks $ G- HF ! I % Gaps G A< ! * ) 5 ' G ' • F $)* $ $ Risks • AF & & • )=$* '$ ! A! :F & & ! %& ) 0F %& GF 21 International Coordination: Exploration Biomedical Challenges
Not mission Not Potentially Mission limiting, but Human Health and Performance Risks mission Mission increased limiting limiting Coordinated with all International Partners ISS NEA Mars risk 6 mo (1yr) (3yr) Long-term health risk of Early Onset Osteoporosis; Musculoskeletal Mission risk of reduced muscle strength and aerobic capacity
Sensorimotor Mission risk of sensory changes/dysfunctions
Mission and long-term health risk of Microgravity-Induced Visual U U Ocular Impairment Impairment and/or elevated Intracranial Pressure (VIIP) Mission risk of behavioral and nutritional health due to inability to Nutrition provide appropriate quantity, quality and variety of food Mission health risk due to inability to provide adequate medical care Autonomous Medical Care throughout the mission (Includes onboard training, diagnosis, treatment, and presence/absence of onboard physician) Behavioral Health and Mission and long-term behavioral health risk. Performance Long-term risk of carcinogenesis and degenerative tissue disease Space Radiation due to radiation exposure Mission risk of exposure to a toxic environment without adequate Toxicity monitoring, warning systems or understanding of potential toxicity (dust, chemicals, infectious agents) Medical risks due to life support system failure and other Autonomous Emergency emergencies (fire, depressurization, toxic atmosphere, etc.), crew Response rescue scenarios Long-term risk associated with adaptation during IVA and EVA on U Hypogravity asteroids and Mars (vestibular and performance dysfunctions) and post-flight rehabilitation 22 HRP Well-aligned with the NASA Exploration Mission • Enhance crew health and safety by using a systematic approach to reduce the exploration mission risks • Fully utilize ISS as a space biomedical research platform • Ensure content/approach are vetted by National Academies and independent review boards Astronauts and Education- NASA’s Mission X: Train Like An • Engage the U.S. research communities using open, peer Astronaut fitness challenge built reviewed research announcements to produce off the natural admiration toward innovative solutions astronauts to challenge young students to get in shape and eat • Collaborate with the National and International agencies right. In partnership with the to leverage funding, unique capabilities, and enhance White House’s Let's Move Initiative, over 20 countries and scientific exchange thousands of students focused on addressing the urgent issue of • Coordinate research with other NASA programs to gain childhood obesity while getting efficiencies students excited about space, exploration, and a healthy • Contribute NASA innovation to broader national needs lifestyle. by capitalizing on R&T advancements that return benefits to the economy, health care, & STEM education • Revitalize excitement for space exploration in young people across the nation through education and outreach projects like Mission-X
2323 Backup Charts
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25 Space Radiation Environments
• Galactic cosmic rays (GCR) penetrating 100 Fluence (F) Dose = F x LET protons and heavy nuclei - a biological Dose Eq = Dose x QF science challenge 10
– shielding is not effective 1
– large biological uncertainties limits ability 0.1
to evaluate risks and effectiveness of % Contribution mitigations 0.01
0.001 0 5 10 15 20 25 30 • Solar Particle Events (SPE) largely GCR Charge Number
medium energy protons – a shielding, GCR a continuum of ionizing radiation types operational, and risk assessment challenge – shielding is effective; optimization needed to reduce weight – improved understanding of radiobiology needed to perform optimization – accurate event alert and responses is essential for crew safety
Solar particle events and the 11-yr solar cycle26 The Space Radiation Problem
• Space radiation is comprised of high-energy protons and heavy ions (HZE’s) and secondary protons, neutrons, and heavy ions produced in shielding
• Unique damage to biomolecules, cells, and tissues occurs from HZE ions that is qualitatively distinct from X-rays and gamma-rays on Earth
• No human data to estimate risk from heavy ions
• Animal models must be applied or developed to estimate cancer, CNS risks, and other risks
• Shielding has excessive costs and will not eliminate Single HZE ions in cells Single HZE ions in photo-emulsions galactic cosmic rays (GCR) Cucinotta and Durante, Lancet Oncology (2006) And DNA breaks Leaving visible images
27 Space Radiation Shielding is Well Understood
• NASA has invested in shielding Radiation Shielding Materials are technologies for many years not effective against GCR’s and understanding is nearly complete 10000 – Over 1,000 research publications GCR L. Hydrogen GCR Polyethylene since 1980 GCR Graphite GCR Aluminum – Solar events can be shielded GCR Regolith 1000 SPE Graphite SPE Regolith – GCR requires enormous mass to SPE L. Hydrogen shield because of high energies and secondary radiation 100 • Highly accurate predictive cSv codes exist with +15% errors for organ exposure projections 10 – Transport codes Dose Equivalent, rem/yr – Environmental models 1 – Optimal materials 0 5 10 15 20 25 30 35 – Topology Design methods Shielding Depth, g/cm2 • Knowledge missing is accurate August 1972 SPE and GCR Solar Min understanding of radiobiology for Exposure to Risk conversion 28 Categories of Radiation Risk
• Cancer (morbidity and mortality risk)
• Acute and Late Central Nervous System (CNS) risks
immediate or late functional changes
• Chronic & Degenerative Tissue Risks Lens changes in cataracts (E. Blakely) cataracts, heart-disease, etc.
• Acute Radiation Sickness Prodromal risks Differences in biological damage of heavy nuclei in space with x-rays, limits Earth-based data on health effects of heavy ions – New biological knowledge on risks First experiments for leukemia induction with GCR (R. Ullrich) must be obtained 29 Space Safety Requirements
• Congress has chartered the National Council on Radiation Protection (NCRP) to guide Federal agencies on radiation limits and procedures
• Crew safety – limit of 3% fatal cancer risk – NASA limits the 3% risk at a 95% confidence level to protect against uncertainties in risk projections – prevent radiation sickness during mission – new exploration requirements limit central DNA damage and tissue controls (M. Wang/NASA) nervous system (CNS) and heart disease risks from space radiation Sham TGFβ
• Mission and Vehicle Requirements – shielding, dosimetry, and countermeasures γ γ +TGFβ
• NASA programs must follow the ALARA principle to ensure astronauts do not approach dose limits Fe Fe+TGFβ
Space Radiation in breast cancer formation (M.30 Barcellos-Hoff)/NYU) ISS Mission Nominal Fatal Cancer Risk
31 31
NASA Space Radiation Laboratory at the Brookhaven National Laboratory (BNL)
• Within a year of creation of NASA in •Beam Line 1958, it was realized that cosmic rays •Target Area •Dosimetry are substantial threat to human •Staging Area space missions and a need for •Liaison Scientist particle accelerator simulation was NSRL identified
• The NASA Space Radiation Laboratory (NSRL) at BNL is critical to enabling deep space missions – It is the only place in the USA and one of the few places in the world that can simulate the harsh cosmic (heavy ion) and solar radiation environment found in space
• New research results are impacting risk estimates for ISS and deep space missions
• NSRL is operated under a DOE/NASA MOU 32 NASA Space Radiation Cancer Risk Model
• NASA has updated its Space Radiation Cancer Risk Model based on recent research results and epidemiological studies – The National Academy of Sciences, National Research Council completed its Evaluation of Space Radiation Cancer Risk Model: Report published March 2012 – Model will be used to project the cancer risk for current ISS crews and future explorations missions.
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Curiosity's First Radiation Measurements on Mars: 3.5-hour observation on August 7 with a time resolution of one minute. For reference, the average radiation dose observed during Cruise has been included to show that Deep Space Radiation levels are higher than those on Mars.
Surface: .7mSv/day Cruise: 1.9 mSv/day
Coronal Mass Ejection registered by the Advanced Composition Explorer (ACE) Spacecraft (Sun-Earth Lagrange Point 1, 1.5 Million Kilometers from Earth). MSL was significantly further away from the Sun and from Earth at that point, explaining why RAD detected the increased particle flux later than ACE. The graph shows that MSL's hull was able to provide significant shielding from the impinging radiation. AG " % • G% < % 8' 8 ' % 'H % % G 8 % • % 6 " 6 ! , • : :6 " , Normal bone • H = %% ' Osteoporitic bone ( H % ) • '8%81% 21! 266Q$@A976 DA@47@A 6 E$9 )$7%`Rbe!76$T576A0 6#A773a – ) ,)%& # * H$ 9@A7)$A! "3A789$U(1)0A!76$#$6@1AHR 79$$&$"BE$$G$9"1@$0 9#F 9$V$./W ) ( 2, ' *) 0 @@1)61'" 6A4H9$#D"$!76$47@@ 6# 5D@"4$ A9780HR1D99$6A@AD#1$@Q – & ' L) " ** 21@807@8076 A$@V80 95 "$DB" 4WP97 V6DA91B76 4W
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