Lifting Off
By Jessica Zimmer
Radiology Today
Vol. 26 No. 5 P. 12
Medical images from space boldly go where no X-ray imaging has gone before.
In April, the first medical-grade radiographs taken in space came back accurate and clear, showing that X-ray imaging technologies can successfully be utilized in space. The finding was accomplished through an in-flight study by the Fram2 crew, a four-person civilian flight team aboard a spacecraft led by entrepreneur Chun Wang. The group spearheading this imaging project is SpaceXray, a 12-person consortium of space doctors, radiologists, and X-ray technology experts.
SpaceXray physicians developed the research protocols, and members of KA Imaging and MinXray provided equipment and financial support. As a group, the SpaceXray team trained Fram2’s crew prior to the flight. Members are now writing up the study results for a forthcoming journal manuscript.
The project’s success means astronauts and civilians on space flights can add DR with dedicated bone and soft tissue imaging abilities to their toolkit. Until this point, crews only had access to ultrasound technology. The shift would improve diagnosis and treatment for short- and long-term space trips. Use of DR technology sets the stage to monitor bone density loss in space.
The project is significant because it demonstrates that current ultraportable medical imaging equipment can be utilized successfully in space. It also shows that nonmedical professionals can take X-rays in space. As it is more technically challenging to take X-ray images in space than in any other known environment, the project is proof that almost anyone, in any location, can take X-rays with the equipment and training used in the project. Because the equipment utilized in the experiment was low cost and durable, potential customers are not likely to see it as too fragile or expensive for use in developing nations.
The project reveals the potential of a battery-powered portable system to redefine care in sites from nursing homes to sports fields. With such a system, caregivers can easily take medical images and quickly answer important questions, such as whether a large stone is present in a kidney. This enables prioritization of care by everyone from emergency medical technicians (EMTs) to sports medicine physicians.
Portable X-rays taken on-site could facilitate the treatment of sudden traumatic injuries and long-term conditions such as lung disease, heart disease, and osteoarthritis. The capabilities of KA Imaging’s detector to generate images similar to dual X-ray absorptiometry (DEXA) scans also allow for the identification of signs of osteoporosis.
If health care providers and countries work together to establish distributed diagnostic centers equipped with portable battery-powered systems, caregivers such as EMTs could engage in more extensive triage before patients come to hospitals. This would reduce the financial liability and care burden on hospitals in countries from the United States to Kenya.
“X-ray technology works almost immediately to help a care provider determine whether a concern like a swollen ankle on a soccer field is broken or sprained. Imagine how EMTs could use X-rays to transform medical care to be more accurate and responsive. That’s the power of the team effort in which SpaceXray engaged,” says Sheyna Gifford, MD, MPH, MBA, MS, MA, principal investigator of SpaceXray and an assistant professor of aerospace medicine physician at Mayo Clinic in Rochester, Minnesota.
How It Works
The first major component of the Fram2 X-ray project was KA Imaging’s Reveal 35C, a flat-panel detector that captures DR, bone, and soft tissue images in a single exposure. The second was MinXray’s Impact Wireless, a portable, rechargeable lithium-ion battery-powered X-ray generator and accompanying image acquisition software.
SpaceXray estimated the images would be accurate based on successful use of the equipment in 2022 in a simulated microgravity environment of parabolic flight. Parabolic flight is defined as a reduced-gravity environment in a fixed-wing aircraft.
KA’s detector and MinXray’s generator and software did not require adjustments or modifications to be operable in space, say Karim S. Karim, PhD, founder and chief technology officer of KA Imaging, and Michael Cairnie, director of global and government sales for MinXray. The keys to ensuring that a medical image taken in space will be clear are a fast exposure to capture the image, the functionality and correct use of tethering equipment, and the development of a strategy to stabilize the equipment. In space, an object that is not tethered has an equal tendency to move in any direction.
“All of the components of taking an X-ray are constantly moving: the X-ray machine, the person taking the image, and the person whose image is being taken,” Gifford says. “If movement of all the pieces is not restricted, the image comes out blurry.”
Prior to the mission, SpaceXray was curious whether cosmic radiation, the background radiation that is always present in space, would negatively affect the detector, the generator, or both. Members were also worried that radiation from the X-ray would affect the craft and crew. Neither issue presented concerns.
“Making sure those batteries are well-protected (shielded from radiation) and able to handle space flight was a big piece for us,” Karim says.
Cairnie adds that, with luck, the equipment used in the study, or future iterations, could be utilized on long-term missions to Mars.
Currently, the Reveal 35C can compute bone density measurements because of the spectral data it captures. The data has not yet been cleared by the FDA. Until KA Imaging obtains clearance, analysis of bone density measurements in space remains a research project.
On Earth, MinXray has AI-integrated software that is available for use with its equipment. The AI-powered software can detect signs of fractures and lung conditions. The company deploys such software often, benefiting remote communities such as rural villages with limited access to qualified medical staff.
The equipment that recently traveled into space did not have software integrated with AI. Future long-term space missions are likely to utilize AI-integrated software. This could empower astronauts to make medical decisions when they are far from Earth and have limited contact with on-the-ground medical teams.
Crew Maintenance
X-rays can also be used to investigate materials and devices without disassembling them, according to Lonnie G. Petersen, MD, PhD. Petersen is a professor of aeronautics and astronautics at the Massachusetts Institute of Technology (MIT) and a member of the SpaceXray team.
“This technique of nondestructive hardware testing is something we have used for decades in aviation and now have also demonstrated in space. X-rays represent a new tool we have not previously had access to in space. As a physician, I am excited for the applications for our crew, and as an engineer, I am equally excited for the increased capability for hardware diagnostics,” Petersen says.
Crew members could potentially take X-rays of a component of a tool used outside the spacecraft to fully visualize damage, such as holes caused by impacts with micrometeorites. In addition, the crew could take X-rays to collect data from experimental animals brought on board.
For astronauts and civilians, medical images assist researchers in developing treatments for acute and chronic concerns related to space travel. Imaging aids in the development of countermeasures, defined as exercises and practices that keep crews healthy. The lungs, spine, heart, teeth, and bones are all negatively affected by space flight. The chest is the most likely initial area of focus for medical imaging.
“If the astronauts were going on a long space flight or stepping out into space, there’s a chance that these astronauts might inhale space dust. Space dust may cause things like fibrosis in the lungs. X-rays would be a way to track that exposure,” Karim says. “If there was some kind of accident in space, this type of imaging would be good at picking up pneumothorax (collapsed lung) and fractures.”
Fractures are more likely to occur on long-duration missions, due to bone loss in microgravity. Astronauts typically lose 1% to 2% of the density in their hip and spine per month.
During space flight, blood and fluid are redistributed more evenly inside the body. The absence of gravitational stress can lead to changes in the way that the body works, particularly in the renal and hormonal systems.
“The longer you spend in space, the more the body adapts to this environment. During long-duration missions, astronauts must follow a rigorous exercise program to prevent muscle atrophy and bone demineralization,” Petersen says.
Ultimately, time in space leads to a reduction in performance. Prior to the Fram2 mission, Petersen’s research team at MIT had been recording bone demineralization in astronauts by taking images before and after space flights. Since flights were short, the team could not study the process of bone demineralization directly. They are preparing to study the process on longer missions in the near future.
“With this technology, we now have a great research tool that will allow us to connect the dots and be able to quantify bone loss in-flight. This will help us bridge some of the current knowledge gaps,” Petersen says.
Broader Use
It is a goal for practitioners in space medicine to provide the highest possible quality of medical care for astronauts. The idea is to bring as many of the capabilities that exist in hospitals on Earth to space. Karim says a redesign of medical care with the addition of more portable X-ray systems could also assist patients in everyday environments on Earth, such as the Canadian suburbs.
“In Canada, there are not as many CT scan machines as there are in the US. More use of portable X-ray systems by EMTs and the like would reduce the wait time for CTs overall,” Karim says. “Spectral X-rays like those taken by the Reveal 35C are more detailed than your grandfather’s X-ray. One of the studies KA Imaging did shows this detector reduced the need for follow-up chest CT in the ICU by up to 37%.”
A wider use of portable X-ray systems could enable sports medicine clinics to monitor how healing is occurring for elite athletes. It would allow the set-up of an on-site fracture clinic for intense sports like rugby.
“Portable X-ray systems could also be a regular part of care in nursing homes. An elderly patient could be scanned in their room rather than have to travel to a hospital and wait,” Karim says.
Simplifying Training
SpaceXray was formed in 2021, initially calling itself the Digital Ultra Portable X-Ray for Space (DUXS) team. The group changed its name to SpaceXray in 2024, when KA Imaging joined as a research partner. Creating training for the civilian Fram2 crew required that members “go back to the basics” and find creative ways to identify where the operator, imaged person, and equipment should be placed.
“It can be challenging to position patients correctly. If the image is of their chest, you need to give them breathing protocols to take the best images,” says Michael Pohlen, MD, an assistant professor of clinical radiology at the University of California, San Diego, and a member of SpaceXray.
Over time, SpaceXray drastically simplified the training to make communication of protocols as clear as possible. “Our work involved creating a customized, step-by-step manual that explained what images we needed to capture,” Cairnie says. “We also developed an order to take images, making sure the most important images would be taken first and the least important images on the back end.”
SpaceXray will review the medical images, return the equipment to KA Imaging and MinXray, and allow those companies to analyze how the equipment performed and how it is currently operating. During imaging review, the X-rays are read blindly by a radiologist who does not know they are from a space flight. This allows for an unbiased comparison in quality between images captured in space and on Earth.
SpaceXray will use the information it retrieves to find ways to reduce the weight of the battery-powered digital X-ray system. This will minimize its addition to a space mission’s payload.
“We’re also exploring making the device into a rollable form factor, so that it is really compact and doesn’t occupy such a large surface area,” Karim says. It is a challenge to shrink the size of the system and make it durable enough for a space mission.
“The equipment also has to be easy enough to use for whoever is on board,” says Adam Wang, PhD, an assistant professor of radiology and, by courtesy, of electrical engineering at Stanford University, and a member of SpaceXray.
Capturing Images and Attention
The medical imaging project was one of 22 experiments that the Fram2 crew performed while onboard. It received widespread attention from CNN, Space. com, and numerous other media outlets.
“The optics of conducting medical imaging experiments has started a conversation about the accessibility of medical imaging technologies. No matter where a person lives, they shouldn’t be in the dark about whether they have a condition like a vitamin D deficiency,” Gifford says.
Increasing access to diagnostics in low- to middle-income countries underserved by medical imaging technologies has long been a goal for MinXray. “A centralized body is needed to grow support. For example, in Kenya, one of the biggest challenges is the upfront cost, the acquisition of the technologies. Banks are hesitant to give loans. The backend partners are not ready,” Cairnie says.
Historians in radiology are taking note of the importance of SpaceXray’s work.
“It (the Fram2 project) is certainly interesting and shows how rapidly medical imaging continues to advance. The American Society of Radiologic Technologists (ASRT) Museum and Archives will do some research on the project to determine if it will include information in the museum in the future,” says William Brennan, executive director of the ASRT Museum and Archives in Santa Fe.
— Jessica Zimmer is a freelance writer living in northern California. She specializes in covering AI and legal matters.