Digital radiography in space.

With the permanent habitation of the International Space Station, the planning of longer duration exploration missions, and the possibility of space tourism, it is likely that digital radiography will be needed in the future to support medical care in space. Ultrasound is currently the medical imaging modality of choice for spaceflight. Digital radiography in space is limited because of prohibitive launch costs (in the region of $20,000/kg) that severely restrict the volume, weight, and power requirements of medical care hardware. Technological increases in radiography, a predicted ten-fold decrease in future launch costs, and an increasing clinical need for definitive medical care in space will drive efforts to expand the ability to provide medical care in space including diagnostic imaging. Normal physiological responses to microgravity, in conjunction with the high-risk environment of spaceflight, increase the risk of injury and could imply an extended recovery period for common injuries. The advantages of gravity on Earth, such as the stabilization of patients undergoing radiography and the drainage of fluids, which provide radiographic contrast, are unavailable in space. This creates significant difficulties in patient immobilization and radiographic positioning. Gravity-dependent radiological signs, such as lipohemarthrosis in knee and shoulder trauma, air or fluid levels in pneumoperitoneum, pleural effusion, or bowel obstruction, and the apical pleural edge in pneumothorax become unavailable. Impaired healing processes such as delayed callus formation following fracture will have implications on imaging, and recovery time lines are unknown. The confined nature of spacecraft and the economic impossibility of launching lead-based personal protective equipment present significant challenges to crew radiation safety. A modified, free-floating radiographic C-arm device equipped with a digital detector and utilizing teleradiology support is proposed as a theoretical solution to help overcome many of these difficulties.