title: Medical qualification of a commercial spaceflight participant: not your average astronaut.
abstract: BACKGROUND
  Candidates for commercial spaceflight may be older than the typical astronaut and more likely to have medical problems that place them at risk during flight. Since the effects of microgravity on many medical conditions are unknown, physicians have little guidance when evaluating and certifying commercial spaceflight participants. This dynamic new era in space exploration may provide important data for evaluating medical conditions, creating appropriate medical standards, and optimizing treatment alternatives for long-duration spaceflight.
  
  
  METHODS
  A 57-yr-old spaceflight participant for an ISS mission presented with medical conditions that included moderately severe bullous emphysema, previous spontaneous pneumothorax with talc pleurodesis, a lung parenchymal mass, and ventricular and atrial ectopy. The medical evaluation required for certification was extensive and included medical studies and monitoring conducted in analogue spaceflight environments including altitude chambers, high altitude mixed-gas simulation, zero-G aircraft, and high-G centrifuge. To prevent recurrence of pneumothorax, we performed video-assisted thoracoscopic pleurodesis, and to assess lung masses, several percutaneous or direct biopsies. The candidate's 10-d mission was without incident.
  
  
  CONCLUSIONS
  Non-career astronauts applying for commercial suborbital and orbital spaceflight will, at least in the near future, challenge aerospace physicians with unknowns regarding safety during training and flight, and highlight important ethical and risk-assessment problems. The information obtained from this new group of space travelers will provide important data for the evaluation and in-flight treatment of medical problems that space programs have not yet addressed systematically, and may improve the medical preparedness of exploration-class missions.
authors.affiliation: Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-1150, USA. rjenning@utmb.edu
authors.forename: Richard T
authors.initials: RT
authors.lastname: Jennings
authors.forename: David M F
authors.initials: DM
authors.lastname: Murphy
authors.forename: David L
authors.initials: DL
authors.lastname: Ware
authors.forename: Serena M
authors.initials: SM
authors.lastname: Aunon
authors.forename: Richard E
authors.initials: RE
authors.lastname: Moon
authors.forename: Valery V
authors.initials: VV
authors.lastname: Bogomolov
authors.forename: Valeri V
authors.initials: VV
authors.lastname: Morgun
authors.forename: Yuri I
authors.initials: YI
authors.lastname: Voronkov
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Fife
authors.forename: Michael C
authors.initials: MC
authors.lastname: Boyars
authors.forename: Randy D
authors.initials: RD
authors.lastname: Ernst
mesh_terms: D000337:Aerospace Medicine / Q000592:standards*; D003560:Cysts / Q000175:diagnosis; D005080:Exercise Test; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis; D017563:Lung Diseases, Interstitial / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D010808:Physical Examination; D018700:Pleurodesis; D011030:Pneumothorax / Q000175:diagnosis / Q000628:therapy; D001261:Pulmonary Atelectasis / Q000175:diagnosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis; D011656:Pulmonary Emphysema / Q000175:diagnosis; D012129:Respiratory Function Tests; D013026:Space Flight / Q000592:standards*; D020775:Thoracic Surgery, Video-Assisted; D018879:Ventricular Premature Complexes / Q000175:diagnosis