1. Spinal Ultrasound Training Strategy Team (TST) Joyce Schultz Crew Training Coordinator 281-218-3051 joyce.e.schultz@lmco.com 1

2. Agenda Introduction Experiment Description Experiment Points of Contact Planned On-Orbit Activities Experiment Start Planned Crew Training Session Training Example Proposed Training Milestone Schedule Training Schedule Considerations Notes, Issues, & Concerns 2

3. Experiment Description 3 Experiment Title: Sonographic Astronaut Vertebral Examination Op Nom: Spinal Ultrasound Principal Investigator: Scott Dulchavsky, MD, Henry Ford Hospital, Detroit, MI Co-Investigators (all at JSC): Vicky Byrne, Kathleen Garcia, Doug Ebert, Ashot Sargsyan, David Ham Description: Significant changes in the cervical and lumbosacral spinal unit occur during prolonged exposure to microgravity. Comprehensive cervical and lumbar ultrasound examinations will be completed on and by ISS crewmembers at early, mid, and late flight periods using on-orbit software and remote expert guidance methodologies. Pre- and postflight magnetic resonance imaging (MRI) and ultrasound examinations will also be completed.

4. Experiment/Increment Points of Contact Susan Torney – Experiment Systems Manager for Spinal Ultrasound Laura Sarmiento – Project Lead, Instructor Laura Sarmiento – (acting) Experiment Support Scientist (ESS) Marty Bost – Hardware Engineer (Ultrasound), (acting) ESS Wes Tarkington – (acting) ESS Ashot Sargsyan – Instructor/ Remote Guider Kathleen Garcia – Instructor/Remote Guider Kristen Kinder – Increment Manager for 33 - 34 Gina Miller – Increment Lead for 33 - 34 Joyce Schultz –Training Coordinator Robert Strahan – Procedures 4

5. Planned On-orbit Activities Operator will review on-orbit software prior to scanning Operator/subject will configure Ultrasound 2 for scanning and set up cabin video Subject will wear ECG electrodes and cable that connects to Ultrasound 2 Subject will be secured supine using the Crew Medical Restraint System (CMRS) Operator will secure him/herself using restraint (crew preference) Operator will perform cervical and lumbar scanning with assistance from remote sonographer Preferred that activity be scheduled early in day prior to exercise and heavy meal Three in-flight sessions will be scheduled across increment: early, mid, and late 5

6. Spinal Ultrasound Training  Session Title: P HRF Spinal USND Ov/Task 31168  Prerequisite: P HRF USND 2 Ov/Task 31168 for operator  Crew Prerequisite: Signed consent for subject  Session Duration: 1 hr for crew operator and 1 hr for crew subject*  Session Scheduling: between L-6 and L-3 months  Location: J9 PDL  Session Synopsis: Crewmember will be provided an overview of the on-orbit operations and training session objectives. Software will be demonstrated as well as spinal and lumbar scanning techniques. The crewmember operator will practice scanning the crew-member subject while being remotely guided by an expert sonographer via simulated air/ground communications. Ultrasound images and cabin video will be sent to consoles outside the PDL via a secure loop.  Crew Clothing Note: Subjects should wear a loose T-shirt for ultrasound probe access from two front locations. * Soyuz A operators should scan 4 month Soyuz B subject(s). Soyuz B operators should scan each other and 4 month Soyuz A subject. Therefore total training time for operator-only is 1 or 2 hrs and for a subject/operator is 2 hrs (see graphic on following page). 6

7. Chris Hadfield (Hd) (USOS – 33S) Tom Marshburn (Mb) (USOS – 33S) Kevin Ford (Fd) (USOS – 32S) E. Tarekin (RS – 32S) Inc 34 Soyuz 32 & 33 crews Inc 36 Soyuz 34 & 35 crews Chris Cassidy (Cs) (USOS – 34S)) A. Misurkin (RS – 34S) P. Vinogradov (RS – 34S) Inc 34 – 4 months Inc 35 – 2 months O Novitskiy (RS – 32S) R. Romanenko (RS – 33S) 2012 33S Dec. 5, 2012 34S Apr 2, 2013 32S Rtn 33S Rtn Mar 19, 2013 31S Rtn Nov 12 2013 ISS Inc. 34/35/36 Training Examples A and B pairing crewmembers who are together for 4 months Inc 36 – 4 months Inc 35 Soyuz 33 & 34 crews Luca Parmitano (Pm) (USOS – 35S)) Karen Nyberg (Nb) (USOS – 35S)) F. Yurchikin (RS – 35S)) May 16, 2013 34S Rtn 35S May 29, 2013 Sept. 16, 2013 Training Example A: 3 opr. & 2 subj Ford is operator only; in training he scans a surrogate for 1 hr total Hadfield is subj/operator; in training he scans Mb and is a subject for Mb for 2 hrs total. Marshburn is subj/operator; in training he scans Hd and is a subject for Hd for 2 hrs total. Cassidy is subj/operator; in training he scans Pm and is a subject for Nb for 2 hrs total Parmitano is subj/operator; in training he scans Nb and is a subject for Cs for 2 hrs total. Nyberg is subj/operator; in training she scans Cs and is a subject for Pm for 2 hrs total. Total Training Hours: 5 Training Example B: 3 opr. & 3 subj Total Training Hours: 6 7

8. Spinal Ultrasound Training Instructors:  Ashot Sargsyan, remote sonographer  Kathleen Garcia, remote sonographer  Laura Sarmiento, session overview/hardware/software Location: J9 PDL Hardware: Uses existing flown hardware except for 1 new probe. See attached lesson plan for complete list.  8C-RS Probe (new)  HRF Training Rack  HRF Ultrasound 2  Video Power Converter  4C-RS Probe  12L-RS Probe  ECG Cable  Ethernet and Data Video Cables  USB and HRF 28 V Common Power Cables 8

9. Experiment Start: Increment 34 Key Launch Dates  32S launch: Sept. 26, 2012 – NASA CDR, RSA FE, RSA FE  31S return: Nov.11, 2012  33S launch: Nov.26, 2012 – CSA CDR, NASA FE, RSA FE  32S return: Mar. 19, 2013 Prime Crewmembers  American- Kevin Ford (31S FE)  Russian- O. Novitskiy (31S CDR)  Russian- E. Tarelkin (31S FE)  Canadian- Chris Hadfield (32S FE)  American- Tom Marshburn (32S FE)  Russian- R. Romanenko (32S CDR) 9 Kevin Ford Chris HadfieldTom Marshburn First Operator  American - Kevin Ford (Fd, 31S FE) First Subjects/Operators  Canadian- Chris Hadfield (Hd, 32S FE)  American- Tom Marshburn (Mb, 32S FE) Delta Informed Consent Briefing  Planned for March 16 for Hd and Mb

10. 10 ActivityStartComplete Committee for the Protection of Human Subjects (CPHS) approval 1/09/12 Preliminary lesson plan 1/30/12 Op nom for experiment and probe 1/30/122/28/12 Spinal USND Sw submitted/approved by PDRT2/6/12 Draft Crew Procedures2/10/12 J9 Training Readiness Review package2/13/12 Training Strategy Team (TST) meeting2/28/12 Ops assessment with crew officeTBD Crew office approval of software3/5/12 Delta Informed Consent Briefing (ICB)4/3/12 Internal Training Dry Run (ITDR)4/25/12 Revise Initial Lesson Plan & Courseware4/30/12 Payload Training Dry Run (PTDR)5/10/12 Signed consent forms received5/25/12 Crew training session ready/scheduled for July training rotation Training Milestone Schedule

11. Training Schedule Considerations wk of July 9 & 16 – P/L training weeks (32S crew); last US rotation for 32S crew wk of July 30-- P/L training week (33S crew) wk of Sept. 17 – P/L training week, last US rotation for 33S crew 11 Exp 33: CSA: Marius Ochisor; ESA: Norbert Illmer; JAXA: Maria Nakamura; NASA: Natasha Niemann; Russia: Alexei Kirillov TEMPLATE AGREED TO THROUGH MAY 15, 2012 2012 MayJuneJulyAugustSeptemberOctoberNovember 714212841118252916233061320273101724181522295121926 Nov (32S)R30SAARRERRRA A ARRRRRRRRRR L 32S NET 10/15/12 Tar (32S)R30SAARRRRRRA A ARRRRRRRRRR L 32S NET 10/15/12 Fd (32S)R30SAARRJJ A/V AAA AAEA A/R RRRRR L 32S NET 10/15/12 Exp 34: CSA: Edward Tabarah; ESA: Norbert Illmer; JAXA: Maria Nakamura; NASA: Alicia Simpson; Russia: Konstantin Ponomarev TEMPLATE AGREED TO THROUGH MAY 15, 2012 2012 2013 MayJuneJulyAugustSeptemberOctoberNovemberDecemberJanuary '13 7142128411182529162330613202731017241815222951219263101724317142128 Rom (33S)RRRRRRRRR31SR AA RRREAAARRRRRRRRRR L 33S NET 12/05/12 Hd (33S)AA E RRRRRR31SA AA RRRJAA A AV E RRRRRRR L 33S NET 12/05/12 Mb (33S)AAV E RRRRR31SA AA RR R/J JAA A AAAV E RRRRR L 33S NET 12/05/12 ITIWG Crew Training Template

12. Inc. 33/34 Notes, Issues, & Concerns This experiment is coming into the flow late for Inc. 33/34; however, the goal is to be prepared to train the 33/34 crewmembers in their July rotation. Nevertheless, Exp. 34 crewmembers could be scheduled in Sept. May not know if 33S crewmembers consent to be subjects until April or May. Would like to reserve training time. 12

13. Acronyms and Abbreviations CMRSCrew Medical Restraint System CPHSCommittee for the Protection of Human Subjects CsCassidy, Chris ECGElectrocardiogram ESSExperiment Support Scientist FdFord, Kevin HdHadfield, Chris Hrhour HRFHuman Research Facility ICBInformed Consent Briefing ITDRInternal Training Dry Run LLaunch MbMarshburn, Tom MRIMagnetic Resonance Imaging NbNyberg, Karen Op NomOperations Nomenclature OprOperator OvOverview PDLPayload Development Lab P/LPayload PmParmitano, Luca PTDRPayload Training Dry Run RSRussian Segment RtnReturn SSoyuz SubjSubject swSoftware TSTTraining Strategy Team USBUniversal Serial Bus USNDUltrasound USOSUS Operating Segment Vvolt 13