Technical Report
Life Support Telerobot for Aerospace Medicine and Surgery
by Dr Vini G. Khurana
[Published on-line here by CNS Aerospace, 16 January, 2022, as a global OPEN SOURCE effort]
Acknowledgements: This manuscript was delivered as an oral presentation at the 2021 Annual Meeting of the Australasian Society of Aerospace Medicine, Australia [Viewable PDF is at the bottom of this Webpage]. The author would like to thank Mr Prashant Singh, Mr Vikrant Singh and Ms Cathy Zhou for their technical, research and administrative assistance, and Ms Ayesha Ali (Figure 1) and Mr Ben Mitchell (Cartoons in B&W, upper right of this page, and in colour, lower right of this page) for their artwork. A provisional patent application (2020903976; “Life Support Tele-Robot”, LISTER, CNS Aerospace Pty Limited) was lodged by FB Rice with IP Australia/Australian Government on 2 November, 2020. LISTER idea incept: Dr Vini Khurana, 24 August, 2019 (see "POC" sketch below right). There are no conflicts of interest.
Short title: Aerospace Medical Telerobot
Abstract: Designing a realistic and effective medical telerobot needs to incorporate a number of fundamental elements. These include systems for mobility/propulsion, bidirectional communication (including haptics), environment sampling/interaction, useful equipment/payload, and data processing. For a successful medical or surgical intervention in deep space, however, added complexities such as communication latency and disruption, and transport and supply (logistic) constraints, need to be accounted for. This necessitates the development of autonomous intelligence (e.g., for subject location/retrieval, accurate diagnostics, procedure planning) and precise technical action (intervention, trouble-shooting) capabilities for remote mechanical assets such as medical telerobots. Further, for humans working with and overseeing such assets in remote locations, basic medical and surgical knowledge, and the provision of suitable medical equipment and clinical training are required. This paper describes and illustrates the key design features of a unique, dedicated medical robot that also has an integrated drone (LIfe Support TEleRobot; LISTER; patent pending). One particular clinical scenario, involving an extravehicular astronaut’s medical incapacitation, followed by drone reconnaissance and robot medical intervention, is described. It is hoped that this work will contribute towards the refinement of both telerobotic technology and human intervention in the context of medical (including surgical) emergency management in deep space.
Keywords: Aerospace; Life support; Space surgery; Robotics; Telemedicine
Introduction
Modern metropolitan operating theatres are complex environments. They are typically comprised of surgeons and anaesthetists supported by numerous highly trained staff. There are a myriad of surgical instruments, technologies and devices, well-rehearsed workflows, and ready access to required resources. This is not the situation in remote areas on Earth and, at least initially, will not be the situation during the expected colonization of our Moon, Mars, and beyond(16) As a result, from a medical and surgical perspective, innovative, practical, reliable and serviceable technologies will need to be developed and deployed for the successful management of inevitable health emergencies.(10,12,18) In this regard, tremendous strides have been made since early conceptualizations11 and the first successful telesurgery using a Zeus robot in 2001.(3) There have been recent demonstrations of the utility of telemedical resources to assist in astronaut medical conditions on the International Space Station (ISS).(2) These include the use of intelligent clothing for astronauts (e.g., Astroskin) with multi-parameter biometric telemonitoring capabilities, and the deployment of a few space robots such as the crew interactive mobile companion (CIMON), an intelligent and communicative floating ‘robo-head’ on the ISS, as well as Robonaut, an anchored talking humanoid with dexterous manipulation ability.(2) Further, a comprehensive description of a tele-operated biosurgical system designed for aerospace medicine (Space Biosurgeon) has recently been published, including console, controls, platform, table, camera and arms, with attention to kinematic motion simulation.(7)
Practical limitations of telerobotics and telesurgery, particularly in deep space environments, have been well discussed by a variety of authors.(3,10,19) These include communication delays/latency,(15,19) accuracy of haptic feedback,(15) operator experience,(15) effects of low gravity on restraint of personnel, equipment and biological tissues,(19) and a lack of availability of physical products even with local 3D-printing.(19) The expected deficit of human back-up and evacuation options may necessitate mission crew members needing to be trained as, for example, both pilot and surgeon or anaesthetist.(13) Autonomous intelligence (AI) of medical robotic systems will probably effectively address this particular deficit one day.(15,18,19) The present technical paper describes the design of a “LIfe Support TEleRobot” (LISTER; provisional patent application 2020903976) whose overriding purpose is medical beneficence. This mobile telerobot is conceived to have multisensorial and multimodal environmental analysis and action capabilities, as well as an integrated reconnaissance and interventional drone. It is envisaged that the robot design described here, with telehealth functions(2,3) and potential for autonomous capability,(3,17) may one day assist in the delivery of urgent medical care to crews beyond Earth. To facilitate its visual conceptualization, a small-scale rudimentary prototype of LISTER, complete with central processing unit (CPU), working manipulating arm, tank-tread mechanical propulsion and maneuverability, light emitting diode (LED) lighting, two-way mobile audiovisual (AV) communication, battery power supply, medical kit, and a mounted propeller-driven launchable drone with its own camera and LED light, was recently constructed by CNS Aerospace and demonstrated at the Annual Meeting of the Australasian Society of Aerospace Medicine (11 September 2021; video available at https://www.cnsaerospace.com.au). The author believes LISTER’s design is unique among current medical telerobotic systems owing to its combination of propulsion options, comprehensive multimodal biomedical analytical systems, and integrated active arms, holographic projector, and reconnaissance drone (Figure 1). Its proposed technical specifications (Table 1) are based on current rover-type technologies,(4) arm and hand devices,(2,4,9) intelligent integrated systems,(2,17) and special instruments,(1,3,4) as well as anticipated technological developments,(6,14,20) including miniaturization.
Figure 1
Envisaged features of the proposed life support telerobot (LISTER). AED, automated external defibrillator; AI, autonomous intelligence; AV, audiovisual; CPU, central processing unit; D/N, day/night; Echo, echocardiography; EPIRB, emergency position indicating radio beacon; LED, light emitting diode; Spec, spectroscopy.
Basic System Components
LISTER (Figures 1 & 2) is comprised of a mobile robot and a telecommunications system for wireless communication(3,4) between a remote physician and the affected subject or other individual in the vicinity of the mobile robot. Communication frequencies would be the same as those used by current Mars rovers which utilise ultra high frequency (UHF) and K- and X-band super high frequency (SHF), reserving very high frequency (VHF) for short distance, unobstructed/line-of-sight communication. It has a system for collecting data corresponding to biometric identifiers of the subject and their environment,(2,8) as well as a CPU to receive and analyze signals and biological samples, and to transmit relevant data to actuate a medical response by the telerobot and/or the telepresent physician, or both. It includes articulating kinematic multi-axial arms,(2,4) each with five articulated fingers, similar to Honda’s advanced step in innovative mobility (ASIMO)(9) robot, and NASA’s Robonaut.(2) It is therefore capable of grasping, pushing, lifting and placing, and administering, for example, direct current in the setting of cardiac defibrillation. Each finger can grasp 2.5 lbs of weight, with a bimanual maximum payload of 25 lbs, around two-thirds of floor-planted Robonaut.(2) LISTER includes a means of deriving and generating power, for example, via batteries,(6) biofuel cells(6) and/or solar panels.(4) This is different to NASA’s larger, much slower (0.1 mph) and heavier (2260 lbs)(4) Perseverance rover currently on Mars, which uses a plutonium-based multi-mission radioisotope thermoelectric generator (MMRTG)(4) as its power source, given the multi-year duration of its mission. LISTER has a modular propulsion unit to provide ground(4) and/or air (atmospheric) propulsion,(6,14,20) via a combination of, for example, all-terrain wheels,(4) tank tread/caterpillar track, propellers,(4) and propulsive turbofan or turbojet/’jetpack’ nozzles(4,6) that can provide vectored thrust for ‘hopper’-style guided manoeuvres. It bears numerous LED and camera units(4) for local environment illumination, and also a holographic projector for more realistic and intuitive broadcast of medical directions, including instructions on available tools and techniques.(5) The system has its own navigation capability and emergency position indicating radio beacon (EPIRB). Unlike any of the current aerospace, mining and defence rover-type robots, LISTER carries essential medical supplies including oxygen, an airway pressure respirator/ventilator, and other first aid equipment, in addition to food and physiological fluids. A rotor drone(4,17) is mounted on the robot and deployable from it (Figure 1). LISTER has a modular design such that its components/modules are configured to be independently detached, interchanged, upgradable and mission-customizable (Table 1).
Multimodal Analytical Systems
LISTER (Figures 1 & 3) carries biological and environmental analytical systems that include a variety of compact and portable measuring instruments, sensors, and biomedical imaging devices.(1,4) The sampling systems may include spectrometers (such as a mass spectrometer, an ion-mobility spectrometer, or an optical spectrometer), instruments suitable for spectroscopy (such as ultraviolet-visible spectroscopy, infrared spectroscopy, Raman spectroscopy, photoemission spectroscopy, or circular dichroism spectroscopy),(4) heart rate monitors, blood pressure monitors, thermometers, a pulse oximeter, electroencephalogram (EEG) monitor, electrocardiogram (ECG), transthoracic echocardiogram (TTE) monitor, and breath and blood sample analysers.(1,2,8) There can be a microphone-stethoscope and a high-fidelity ultrasound scanner. Included can be an auscultation device incorporating a microphone for capturing body sounds, a variety of cameras and projectors for multi-way AV communication,(4) equipment for allergy skin tests (such as a skin prick test) and/or in vitro diagnostic devices. Integrated compact imaging systems (such as ultrasound/echo,1 thermal, X-ray, or magnetic field-based imaging systems)(3) can be used to collect biometric data related to anatomical, physiological and/or behavioural characteristics of the subject.(2,8) Examples of anatomical and physiological characteristics include information based on brain and heart signals,(2,8) information related to body and limb geometry and position, a finger or palm print, face recognition, retinal scan, and odour/scent and breath. Examples of behavioural characteristics(2,9) include information related to patterns of behaviour, such as gait, vocal pitch, and integrity of language/communication that can be compromised for example by concussion, hypoxia or environmental toxins. Samples and data collected from the astronaut and local environment can be transferred to an on-board environmental analysis system where they are measured by, for example, mass and infrared spectrometers.(4) They can be used to investigate if a characteristic of the local environment has caused the emergency, for example a toxic chemical or an asphyxiant gas, and to facilitate a tailored response.(8)
LISTER may be configured such that the step of analysing multiple and potentially complex data by the CPU involves a remote medical physician or team. Alternatively, the processing can be performed semi-autonomously or fully-autonomously(3,17) by the robotic system. The robot and its modular analytical and therapeutic instruments on gantries can be vertically raised or lowered. For example, the mobile robot might include a lift or vertical extender module. The mobile robot can also adapt to include a lateral extender to allow the robotic system to extend laterally. Its manipulative arms are also extendable to facilitate utility in sampling and intervention (Figure 1).(2,4,9)
Drone
A remote-controlled launchable drone(4) is mounted in or on the robot (Figure 1). The drone can perform, for example, surveillance, communication, and/or object delivery/retrieval tasks. It can collect and transmit biometric data from a subject, and can be deployed to areas that are difficult for the robot itself to access or quickly reach.(17) The drone has its own LED illumination, compact cameras, navigation and rotary propulsion system.(4) It can also carry basic medical and nutritional supplies for remote delivery as needed (Figure 1 and Table 1). In this context, the flying drone concept has recently been successfully tested by NASA on Mars via their Ingenuity helicopter, a device which is dual (counter) rotor-propelled, solar-power battery-driven (for short flights at present), weighs around 4 lbs, flies at a maximum speed of 22 mph, and is equipped with a 13-megapixel digital camera.(4)
Off-Earth Medical Emergency Scenario
Consider the remote emergency circumstance of an astronaut becoming medically incapacitated while carrying out an extravehicular activity(8) some distance away from a main base on Mars. Loss of normal or expected communications between the astronaut and mission base would lead to search and rescue protocol activation. This would include deployment of the mobile medical telerobot, either from the base itself or from a transport vehicle closer to where the astronaut was working. The robot’s flying drone could be launched early in order to expeditiously navigate to the disabled astronaut based on his/her positional beacon or last known location.(17) The drone has its cameras for day and night vision, as well as lighting and access to telemetry data that can be acquired locally from the astronaut/Astroskin.(2,8) Once the subject is located, the local environment and medical subject are surveilled by the drone for various relevant parameters communicated in real-time to the robot and mission base.(4,17) Once the robot arrives, it can illuminate the local site and injured astronaut, while its AV system can be used to establish communication with mission medical and rescue crew.(3) Whenever possible, time-critical treatment instructions can be accordingly conveyed to the medical subject, with clarity augmented by holographic projection.(5) The robot has biomedical imaging (e.g., ultrasound, mass spectrometer, thermal imaging and x-ray)(1,2,4) and sampling equipment that together can aid diagnostics with regard to the medical subject’s cardiovascular, neurological, and anatomical condition, and also his/her potentially noxious environment (soil composition, atmospheric gases, local radioactivity).(2,8) The robot carries a variety of medical and nutritional supplies including supplemental oxygen supply, optimised food and fluids, a ventilator and defibrillator. It can establish physical, including intravenous (IV), access via designated ports in the space suit, its ultrasound and manipulation arms’ digits.(2,9) It can take and analyse blood and breath samples as well as provide IV and oral fluids and medications. While there is potential for cardiac defibrillation via pre-designated pads embedded in the Astroskin or equivalent,(2) and accessible to the robot, this intervention will likely first require retrieval and transport of the incapacitated astronaut to a local enclosed vehicle in order that the main space suit can be removed.
Conclusion
A dedicated mobile aerospace medical robot with AI will probably be of substantial benefit to human crews in off-Earth missions. The modular design proposed herein incorporates key medical features including biomedical imaging systems, manipulation/intervention-capable arms, biodata telemetry, potential integration with space suits (and, for example, Astroskin), tissue sampling systems, environmental threat analysis, physical and behavioural analysis, holographic projection, and an integrated flying drone. The successful development and deployment of such robots during remote aerospace missions is dependent upon an ability to overcome any relevant environmental, logistic, technological and operational limitations. In time, it is anticipated that such robots will be an integral and beneficial part of off-Earth missions and colonies.
