title: Technique for Performing Lumbar Puncture in Microgravity Using Portable Radiography.
abstract: BACKGROUND
  Visual Impairment and Intracranial Pressure Syndrome (VIIP) has caused symptomatology during and after long duration missions on the International Space Station (ISS). Only indirect measurements of intracranial pressure (ICP), such as ultrasound, have been performed on ISS. Discussion and interest has happened at NASA about performing lumbar puncture (LP) in microgravity. Only the "blind" palpation approach and the ultrasound-assisted approach have been discussed. This article, as proof of concept, discusses the possibility of portable radiography to assist lumbar punctures in microgravity.
  
  
  METHODS
  An anthropomorphic radiological phantom of an adult lumbar spine was made containing a fluid-filled space in the spinal canal with a latex membrane which simulated the dural sac and cerebrospinal fluid. A portable direct-digital radiography system with wireless transmitting image receptor and screen was used to perform image-guided lumbar puncture. Using the same equipment and technique, this procedure was then performed on a cadaver for final proof of concept.
  
  
  RESULTS
  Technical success was achieved in all approaches on the first try without needle redirection. There was no difference between the cadaver model and the phantom model in terms of difficulty in reaching the fluid space or visually confirming needle location.
  
  
  CONCLUSIONS
  Portable radiography via proof of concept has the potential to guide lumbar puncture while minimizing volume and mass of equipment. This could be ideal for assisting in performing lumbar puncture in microgravity, as this is the standard of care on Earth for difficult or failed "blind" lumbar punctures. Lerner DJ, Parmet AJ, Don S, Shimony JS, Goyal MS. Technique for performing lumbar puncture in microgravity using portable radiography. Aerosp Med Hum Perform. 2016; 87(8):745-747.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St Louis, MO, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lerner
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Parmet
authors.forename: Steven
authors.initials: S
authors.lastname: Don
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Shimony
authors.forename: Manu S
authors.initials: MS
authors.lastname: Goyal
mesh_terms: D000328:Adult; D002102:Cadaver; D006801:Humans; D008161:Lumbosacral Region / Q000000981:diagnostic imaging*; D019047:Phantoms, Imaging; D011859:Radiography / Q000295:instrumentation; D013129:Spinal Puncture / Q000379:methods*; D014893:Weightlessness