X-Ray and Ultrasound for Human Spaceflight Using the NASA IMPACT Conditions List

INTRODUCTION: Imaging is central to modern clinical medicine and advancing the level of care on exploration-class missions will require imaging capabilities to reduce medical risk. The NASA Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) tool suite was designed for exploration-class mission probabilistic risk assessment and trade space analysis. The associated IMPACT Conditions List includes 119 in-flight medical conditions of high likelihood and/or consequence as established by flight and terrestrial data, as well as expert opinion. This study evaluates the utility of ultrasound (US) and radiography (XR) for these conditions. METHODS: For each condition, two reviewers performed a rapid review of professional society guidelines and scientific literature, supplemented with subject-matter expertise, to semiquantitatively score the utility of US and XR for both diagnosis and management. RESULTS: XR was diagnostically highly useful in 36 conditions and US in 38 conditions. Conversely, for 63 (52.9%) conditions, neither XR nor US had any diagnostic utility. For management, XR was highly useful for 24 conditions, while US was highly useful for 21. DISCUSSION: In over one-third of conditions, XR possesses unique capabilities either complementary or superior to US. XR possesses superior diagnostic utility for bony injuries, dental conditions, and some pulmonary conditions, and superior management capability for orthopedic reductions and device placement confirmation. This analysis suggests future missions may consider augmenting the medical system with portable radiography if resource constraints allow, and future work should quantify the risk reduction provided by this capability. Boyle MJ, Pohlen M, Lehnhardt K, Parmar P, Easter B. X-ray and ultrasound for human spaceflight using the NASA IMPACT conditions list. Aerosp Med Hum Perform. 2026; 97(3):176-184.