# RMP-PREV-003 Flight-surgeon-ordered surveillance scans (such as kidney and bladder ultrasound): reminder, checked kit fetch, display holding and clip labelling with a crew-held probe (diagnostic only) # Version 0.2 (Draft). CONCEPTUAL. NOT FOR CLINICAL USE. # Space Medicine Foundation robot-readable protocol library. Format: https://spacemedicinefoundation.org/robotic-medicine/protocols/schema/ # Every threshold marked must be set by the named owner (see the schema) before any use. schema_version: '0.3' version: '0.2' status: draft conceptual: true not_for_clinical_use: true max_autonomy: 2 missions: - leo - commercial - moon - mars updated: '2026-10-21' review: state: reviewed-ai-assisted requested: '2026-10-21' reviewed: '2026-10-21' human_clinician_review: false text: >- AI-assisted clinical and source review by the Medical Research Assistant, Oct 21, 2026 (batch 11 review: 10 required corrections, R1 to R10; 9 optional suggestions not applied in this version); all required corrections that apply to this protocol are applied in this version (see Corrections). No named human clinician has reviewed it. Not for clinical use. fixed_rules: flight_surgeon_is_medical_authority: true cmo_acts_under_delegated_care: true human_starts_and_restarts_robot: true robot_never_diagnoses: true no_drug_or_fluid_advice_by_robot: true safe_state_on_fault_or_no_response: true lost_link_pause_then_cmo_decides: true robot_lockouts: diagnosis: true drug_or_fluid_advice: true starting_stopping_or_adjusting_oxygen_or_any_medicine: true self_start_or_self_restart: true changing_own_protocol_thresholds_or_limits: true handing_over_a_mismatched_item_as_verified: true id: RMP-PREV-003 slug: rmp-prev-003 title: >- Flight-surgeon-ordered surveillance scans (such as kidney and bladder ultrasound): reminder, checked kit fetch, display holding and clip labelling with a crew-held probe (diagnostic only) category: prev tier: 2 rung_note: >- Max rung 2 for the scheduled prompt, supervised fetching of the ultrasound kit, holding the display and the scan checklist, and labelling and relaying clips, as in RMP-GI-001 and RMP-RESP-004. The CMO holds the probe: "Contact with the crewmember: not allowed". result_language: use: - clip recorded - image not obtained - non-diagnostic, for human review - sent to flight surgeon - as stated by the crewmember never: - normal - no problem found - all clear - negative - any diagnosis or cause - normal - abnormal - clear - no fluid - fluid - nothing seen - looks fine - reassuring - stone - no stone - blockage - hydronephrosis - residual - full bladder - empty bladder - safe - mild - minor scope: summary: >- Only when the flight surgeon has loaded a scan order for this crewmember (for example a kidney and bladder surveillance scan), the robot prompts the crewmember at the ordered time; the scan starts only when the crewmember or the CMO accepts. The robot brings the ultrasound kit by a checked kit fetch, holds the display and the scan checklist where the CMO can see them, relays live images and voice to the ground imaging expert when the link allows, and labels each clip with the side, view and clock time. The CMO holds the probe. Every image is "non-diagnostic, for human review": the robot never reads an image or says what it shows. Any symptom moves to the matching care protocol. why: >- NASA screens astronauts' kidneys by ultrasound for mineralized material that can become stones; after 282 studies in 73 people there was no change from before to after flight, so routine screening was reduced to selection, the first annual exam and before and after flight (Reyes 2023, abstract). Renal ultrasound before and after flight is standard, ultrasound helps if a stone is suspected in flight, and NASA has tested guided ultrasound for non-physician astronauts (OCHMO-MTB-003); clinical ultrasound has been done on the ISS by crew with remote guidance (Sargsyan 2005). In-flight surveillance scans are not routine: the robot runs this protocol only when the flight surgeon has loaded a scan order for this crewmember, and how often is the flight surgeon's decision; the robot's role (prompt, fetch, display, label) is design judgment and follows RMP-GI-001 and RMP-RESP-004. covers: - >- Kidney and bladder ultrasound ordered by the flight surgeon for this crewmember, with a crew-held probe - Other scheduled surveillance scans the flight surgeon names, with the same display-and-label role - >- Symptoms: flank pain RMP-RENAL-001; cannot pass urine RMP-RENAL-002; urinary symptoms RMP-RENAL-003; abdominal pain scans RMP-GI-001 locked_out: - Diagnosis or naming a cause - Any medicine, fluid or oxygen advice; starting, stopping or adjusting oxygen - Touching the crewmember - >- Handing over any medicine outside RMP-PHARM-001, or after a MISMATCH or CANNOT VERIFY (the item stays quarantined; only the CMO can ask for it, through the RMP-PHARM-001 logged two-step override) - Holding, moving or pressing the probe, or touching the skin - Reading or measuring an image, or saying what an image shows or does not show - Changing the scan preset, the schedule or the scan list - >- Scanning over an open wound or broken skin, unless the flight surgeon directs it with a sterile cover - >- Showing a clip on a shared display, or using clips for robot or AI training, research or outreach without separate written consent related: - RMP-GI-001 - RMP-RESP-004 - RMP-RENAL-001 - RMP-RENAL-002 - RMP-RENAL-003 - RMP-INF-002 - RMP-PREV-002 roles: medical_authority: Flight surgeon (ground). Holds medical authority for every run. onboard_lead: >- Crew medical officer (CMO), acting under delegated care; uses the pre-approved onboard checklist when there is no link. others: - 'Second trained CMO: receives every alert and takes over if the CMO is the patient' - 'Vehicle commander: leads any cabin emergency procedure' - 'Other crew: help as the CMO or commander directs' robot_may: - Prompt the crewmember at the time on the flight surgeon's scan order - Bring the ultrasound kit by a checked kit fetch (or an emergency fetch) - Hold the display and the scan checklist without contact - Relay live images and voice to the ground imaging expert - Label, store and send clips robot_may_not: - Hold or move the probe, or touch anyone - Say what an image shows - Change the preset, the schedule or the scan list - Start a scheduled scan without a human accepting the prompt commercial: >- On commercial flights, 'flight surgeon' and 'CMO' mean the operator's designated medical authority and trained onboard responder. If no trained responder is aboard, this protocol is not used. (NASA-STD-3001 requires two CMOs per vehicle for NASA programs [V1 3006]; FAA rules set no medical standards for spaceflight participants.) preconditions: - id: PRE-1 text: >- The scan starts only when the crewmember (or the CMO) accepts the on-screen prompt; a loaded schedule alone never starts it. An unaccepted prompt is logged "not accepted" and the CMO is told. A crewmember or the CMO can also start it by command. check: human_start == true refs: - V2 10174 - id: PRE-2 text: Robot self-test passed; kit stowage locations known. refs: - V2 10161 - V2 7059 - id: PRE-3 text: Robot and supplies restrained when not moving. refs: - V2 7046 - id: PRE-4 text: Link status known. The crew never wait for the robot before acting. check: link_state in [live, delayed, down] consent: standard: >- The crewmember agrees to the scan and to clips being recorded and sent to the flight surgeon and the ground imaging expert. Clips go only to the people the flight surgeon names. emergency: >- If the crewmember cannot agree, this is not a scheduled scan: the robot sends an URGENT alert and a crewmember checks in person (X7). withdrawal: The crewmember can stop the scan at any time; the flight surgeon decides on clips already taken. inputs: - id: IN-1 name: The flight surgeon's scan list (organs, sides and views), schedule and the unit preset to use source: Flight surgeon required: true if_missing: The robot shows "scan list not loaded" and runs only on a human command. - id: IN-2 name: >- Symptoms in the crewmember's words (flank or back pain, pain or trouble passing urine, blood in the urine, fever) source: Crewmember required: false if_missing: Log "no response"; D3 applies. - id: IN-3 name: Ultrasound clips, each with the side and view the CMO names source: Ultrasound unit required: false if_missing: Log "image not obtained" (never a reassuring value) and continue. - id: IN-4 name: Link status and delay source: Communications system required: true if_missing: Treat as link down; clips are stored and forwarded. steps: - id: S1 actor: robot rung: 2 action: >- Only when the flight surgeon has loaded a scan order for this crewmember, and at the ordered time, show the crewmember an on-screen prompt that a surveillance scan is due, and tell the flight surgeon and the CMO (URGENT if any red flag is stated). The scan starts only when the crewmember or the CMO accepts the prompt; an unaccepted prompt is logged "not accepted" and the CMO is told. Show the symptom prompt first and log answers word for word. Every URGENT alert goes to the CMO and the flight surgeon at the same time (queued for the flight surgeon if the link is down). If the CMO is the patient, is busy treating, or does not answer, the alert goes to the second trained CMO, or the crewmember named before flight [V1 3006]. An URGENT alert that is not acknowledged within seconds is repeated and sent to the next named crewmember. success: Prompt accepted, or "not accepted" logged and sent; answers logged. refs: - V2 10174 - V1 3003 - V1 3006 - id: S2 actor: robot rung: 2 action: >- On the CMO's command, run a checked kit fetch of the ultrasound medical kit (unit, sealed gel and probe-cover pack): check the kit ID and seal before hand-over, and quarantine a kit whose ID or seal does not match (no hand-over; the CMO is told). Any medicine goes only through RMP-PHARM-001. If an URGENT red flag has fired or a human states an emergency, bring it instead as an emergency fetch: This is an emergency fetch on a human command (CMO): no barcode check runs before hand-over and nothing waits for one. The robot reads the kit's own label and seal status only if that adds no delay, says "EMERGENCY FETCH – NOT VERIFIED (CMO command)", and "seal not intact" if so, and hands the kit over anyway. The fetch is logged as an override: time, who asked, the reason as stated, kit ID and seal status. It never says "verified". success: Kit within reach after a matched ID and seal, or quarantined, or emergency fetch logged. limit: refs: - V2 7046 - V2 7059 - id: S3 actor: crew action: >- The crewmember and the CMO are restrained for scanning; the crewmember empties or does not empty the bladder as the scan list states. The probe and gel are never placed on an open wound or broken skin unless the flight surgeon directs it with a sterile cover. success: Ready to scan. refs: - V2 7046 - id: S4 actor: robot rung: 2 action: >- Hold the ultrasound display and the scan checklist where the CMO can see them, no closer than the set display distance, and relay live images and voice to the ground imaging expert when the link allows. When the link is down, show the onboard scan checklist and store the clips for forwarding. success: Display held; relay running or clips stored. limit: refs: - V1 6003 - id: S5 actor: crew action: >- The CMO holds the probe and scans the sides and views on the scan list or as the ground expert guides; the crewmember can stop at any time. success: Scan done or stopped. refs: - V1 3003 - id: S6 actor: robot rung: 2 action: >- Label and store each clip with the side and view the CMO names and the clock time, and mark every clip "non-diagnostic, for human review". A device image-quality prompt is passed on to the CMO as displayed; the robot never judges an image. success: Clips labelled, or "image not obtained". refs: - V1 7001 - id: S7 actor: crew action: >- After the scan, the crew clean the probe and any shared surface under RMP-INF-002; a probe on intact skin is noncritical equipment, and a probe cover never allows a lower level of cleaning. A probe that touched broken skin is semicritical equipment: the crew tag it "not for use" under RMP-INF-002 until it has had high-level disinfection. success: Cleaning recorded as stated under RMP-INF-002. refs: - V2 7046 - id: S8 actor: robot rung: 2 action: >- After any URGENT alert: After an URGENT alert the robot does not leave on its own: it stays at its rest position in the module, with its screen and voice link available, until a human has taken over or tells it to go. It never follows, blocks or touches anyone. It keeps time-stamping what humans say they did, and repeats the alert if it is not acknowledged. success: Robot at rest in the module until a human releases it; alert acknowledged or escalated. refs: - V2 10173 - V1 3006 - id: S9 actor: ground action: >- The flight surgeon with the ground imaging expert (or the CMO under the onboard checklist when there is no link) reviews the clips and decides on any follow-up, care or the next scan. success: Decision logged. refs: - V1 3003 - id: S10 actor: robot rung: 2 action: >- Only after the CMO or flight surgeon has placed an order, run RMP-PHARM-001 for the ordered item (fetch, barcode match to every order field, recipient check). This protocol adds nothing to that check, never suggests an order, and never hands anything over outside RMP-PHARM-001. success: RMP-PHARM-001 run logged with its result, or none ordered. refs: - V2 7059 - id: S11 actor: robot rung: 2 action: >- When the CMO says the event is over, run RMP-PHARM-001 reconciliation on each kit fetched: record the items the CMO or crew state were used, the remaining contents against the kit list, seal status and expiry, labelled "inventory reconciliation after emergency use – not a check before use". Flag the override to the flight surgeon and the pharmacy lead, and show each kit as "opened – not restocked" until a human restocks and reseals it. success: Kit reconciled or shown as "opened – not restocked". refs: - V2 7059 - id: S12 actor: robot rung: 2 action: >- Send the flight surgeon one package: answers as stated, labelled clips, times, alerts and decisions; clips go only to the people the flight surgeon names. success: Package delivered or queued. refs: - V1 6003 - V1 7003 decisions: - id: D1 after: S2 decided_by: robot question: Which kit fetch was it, and what did the checked kit fetch show? branches: - if: EMERGENCY FETCH (an URGENT red flag had fired, or a crewmember or the CMO stated an emergency) then: >- Hand-over already done as an emergency fetch, logged as an override; reconciled afterwards (not a check before use). - if: KIT ID AND SEAL MATCH then: >- Hand the kit over closed; log "KIT ID AND SEAL MATCH. Not a check of the contents." and the clock time. - if: MISMATCH, seal not intact or CANNOT VERIFY then: >- Shown with the reason. No hand-over under this protocol: the kit stays sealed in quarantine (the RMP-PHARM-001 default), and the robot never hands it over unprompted or to anyone but the CMO. The robot does not offer or suggest an override. Only if the CMO explicitly makes the two-step override request inside RMP-PHARM-001 can the kit go to the CMO, logged there as an override with the reason, and flagged to the flight surgeon. If the need becomes an emergency, a crewmember or the CMO states it and the emergency fetch applies. handoff: none - id: D2 after: S6 decided_by: robot question: >- Checked after every answer and at any point in the run (even mid-question or mid-step): does any answer, reading or observation meet a red flag? branches: - if: 'Yes' then: >- Stop the current question or step at once and apply the action listed for each matching red flag (URGENT alert, flag, or stop), with the answer or reading itself, never a cause. Every URGENT alert goes to the CMO and the flight surgeon at the same time (queued for the flight surgeon if the link is down). If the CMO is the patient, is busy treating, or does not answer, the alert goes to the second trained CMO, or the crewmember named before flight [V1 3006]. An URGENT alert that is not acknowledged within seconds is repeated and sent to the next named crewmember. - if: 'No' then: Continue. - id: D3 after: S1 decided_by: robot question: Did the crewmember answer the symptom prompt, or say they want to skip it? branches: - if: 'Yes' then: Continue. - if: Declined explicitly (the crewmember says no to a question) then: Log "declined" for that question only; the alert already sent stands. - if: No response, or the answer does not make sense then: >- URGENT: log "no response" (never "declined"); the CMO, or the second trained CMO if the CMO is the patient, checks the crewmember in person at once. - id: D4 after: S9 decided_by: ground question: What follow-up, care or next scan applies? branches: - if: Link live then: Flight surgeon decides; robot logs. - if: Link down or delay too long then: >- The CMO decides under the pre-approved onboard checklist; the flight surgeon reviews the log at the next contact. - id: D5 after: S10 decided_by: robot question: What did RMP-PHARM-001 show for the ordered item? branches: - if: MATCH TO ORDER then: >- RMP-PHARM-001 completes its own recipient check and hand-over; this protocol only logs "MATCH TO ORDER. Not a dose, interaction or allergy review." and the clock time. - if: MISMATCH or CANNOT VERIFY on any field, or a failed scan or recipient check then: >- MISMATCH or CANNOT VERIFY shown with the fields named. No hand-over under this protocol: the item stays sealed in the NOT VERIFIED bag in quarantine (the RMP-PHARM-001 default), and the robot never hands it over unprompted or to anyone but the CMO. The robot does not offer or suggest an override. Only if the CMO explicitly makes the two-step override request inside RMP-PHARM-001 can the item go to the CMO, logged there as an override with the reason and the mismatched fields, and flagged to the flight surgeon. handoff: none stop_rules: - id: X1 trigger: The patient (or the crewmember being examined) says stop, or withdraws consent action: >- Robot stops all motion at once, backs away to its rest position and tells the CMO. Recording stops unless the patient agrees to keep it running. level: stop refs: - V2 10165 - id: X2 trigger: Any crewmember presses stop or takes over control action: Protective stop; robot holds its stopped position; only a human may restart it. level: safe-state refs: - V2 10165 - V2 10168 - V2 10174 - id: X3 trigger: Robot fault, sensor fault, or a force, speed or reach limit is reached action: Protective stop and hand control to the CMO; log the fault. level: safe-state refs: - V2 10172 - V2 10168 - id: X4 trigger: CMO is asked to take over and does not respond (for example, the CMO is the patient) action: Robot stays stopped; the next named crewmember is called. level: safe-state refs: - V2 10173 - V2 7045 - id: X5 trigger: Loss of link, or delay longer than the limit for live guidance action: >- Only the robot pauses: before it holds, it moves to a position clear of a hatch route or a crewmember's route (it never pauses in one), and tells the CMO. This pauses robot movement only: crew scanning already under way and all other care continue under the onboard checklist and never wait for the link or the robot. The CMO decides whether the robot continues offline under the pre-approved onboard checklist; it resumes only on the CMO's confirmation. level: pause refs: - V2 10172 - V2 10173 - id: X6 trigger: An URGENT alert is not acknowledged within the set time action: >- Robot repeats the alert and sends it to the next named crewmember (the second trained CMO first if the CMO is the patient), and keeps repeating at the set interval. It stays where it is: it does not leave on its own. level: urgent refs: - V1 3006 - V2 10173 - id: X7 trigger: The crewmember stops responding, or seems confused or drowsy, at any point action: >- URGENT alert at once, even mid-question or mid-step; the robot stops its current task, stays at its rest position and does not continue the run; a crewmember checks in person. level: urgent - id: X8 trigger: A crewmember asks the robot what is wrong, or for medicine, fluid or treatment advice action: >- Robot declines, says it cannot assess or advise, and routes the question to the CMO or flight surgeon. level: stop - id: X9 trigger: The crewmember says the probe causes pain, or asks to stop action: Robot tells the CMO at once and holds the display; the CMO decides whether to stop the scan. level: stop - id: X10 trigger: Someone needs the space or route the robot is in action: Robot moves clear at once without contact and holds; it never pauses in a hatch route. level: safe-state refs: - V2 10172 red_flags: - id: RF1 sign: Flank or back pain, or pain spreading to the groin, as stated threshold: any action: URGENT alert; see RMP-RENAL-001 source: renal24 - id: RF2 sign: Cannot pass urine, or passing only small amounts with a feeling of a full bladder, as stated threshold: any action: URGENT alert; see RMP-RENAL-002 source: stepaniak - id: RF3 sign: Fever or shaking chills threshold: >- degrees (shared parameter FEVER_ALERT_C: body temperature in degrees Celsius, the same value in RMP-GI-003, RMP-ENT-002, RMP-SKIN-002 and RMP-RENAL-004) or higher, or any shaking chills action: URGENT alert; see RMP-INF-001 and RMP-RENAL-003 source: ng253 - id: RF4 sign: Pain or burning on passing urine, passing urine more often, or blood in the urine, as stated threshold: any action: Flag to the flight surgeon; see RMP-RENAL-003 source: ukhsauti - id: RF5 sign: Unresponsive, or not breathing normally threshold: any action: URGENT alert; start RMP-CARD-001 now source: aha2025bls safety_limits: - id: L1 name: Contact with the crewmember value: not allowed enforced: Keep-out zone in the robot controller refs: - V2 10172 - id: L2 name: Probe holding or movement by the robot value: not allowed enforced: No probe task is loaded; the robot holds only the display and reference card - id: L3 name: Robot speed near the crewmember value: enforced: Hard limit in the controller refs: - V2 10172 - id: L4 name: Display distance from the crewmember value: enforced: Hard limit in the controller refs: - V2 10172 logs: - id: LOG-1 text: Every input, robot action, decision (with who made it) and hand-off, time-stamped to the second. refs: - V2 10163 - V2 10164 - id: LOG-2 text: Mode changes and safety-limit events are announced to the operator as they happen and logged. refs: - V2 10162 - V2 10172 - id: LOG-3 text: >- Records are stored and sent as private medical data, encrypted, with access limited to the medical team. refs: - V1 6003 - V1 7003 - id: LOG-4 text: Results are kept in a permanent, retrievable format so the flight surgeon can see trends. refs: - V1 7001 - id: LOG-5 text: >- Prompt and acceptance; answers as stated; each clip with side, view and time; images not obtained; who viewed the clips. - id: LOG-6 text: >- Each URGENT alert, who received it, the time it was acknowledged (or the escalation to the next named crewmember), and the time a human released the robot. refs: - V2 10163 - id: LOG-7 text: >- Each emergency fetch as an override (time, who asked, reason as stated, kit ID, seal status) and the later inventory reconciliation, labelled "not a check before use". refs: - V2 7059 - id: LOG-8 text: >- Each RMP-PHARM-001 run started from this protocol: order ID, result (MATCH TO ORDER, MISMATCH or CANNOT VERIFY with the fields), quarantine, and any CMO override logged by RMP-PHARM-001 (reason and mismatched fields), at clock time. No running counter of doses. refs: - V2 7059 - id: LOG-9 text: >- Each checked kit fetch: time, who asked, kit ID, seal status and result (KIT ID AND SEAL MATCH, MISMATCH, seal not intact or CANNOT VERIFY), and any quarantine. refs: - V2 7059 requirements: - id: V1 3003 use: >- In-mission preventive health care and monitoring; the flight surgeon schedules any surveillance scan. - id: V1 3006 use: >- Two trained CMOs per vehicle for NASA programs; the second trained CMO receives alerts when the CMO is the patient (see the commercial-flight note). - id: V1 6003 use: Logs and alerts sent to the ground are private medical communications. - id: V1 7001 use: Records kept so the flight surgeon can see trends. - id: V1 7003 use: Secure handling of medical records. - id: V2 7045 use: Usable by non-physician crew, including when the CMO is the patient. - id: V2 7046 use: Patient, caregiver and supplies restrained. - id: V2 7059 use: >- Kit inventory and seal status are tracked; after an emergency fetch the robot reconciles the kit through RMP-PHARM-001 as an inventory record (never a check before use) and shows it as "opened – not restocked" until resealed. - id: V2 10161 use: Robot shows its status and health. - id: V2 10162 use: Mode changes are announced to the operator. - id: V2 10163 use: Robot records and shares its data. - id: V2 10164 use: Shows whether the human or the robot is expected to act. - id: V2 10165 use: Human can override and shut down the robot. - id: V2 10168 use: Human can take over. - id: V2 10172 use: Protective stop when a limit is exceeded. - id: V2 10173 use: Robot stays stopped if no one takes over. - id: V2 10174 use: Only a human starts or restarts the robot. validation: - stage: simulation what: >- Scripted scans with an unaccepted prompt, a kit seal mismatch, flank pain stated mid-scan, CMO as patient, lost link. pass: Zero contact; zero image interpretation; every red flag raised. - stage: training model what: Scan drill on an ultrasound training model with remote guidance. pass: Every clip labelled with side, view and time. - stage: parabolic or station demonstration what: Display holding and kit fetch in weightlessness. pass: Display distance and keep-out held. - stage: flight use under flight surgeon supervision what: First scheduled scan. pass: No safety or privacy events. signoff: protocol: - Clinical lead for the specialty (sets every clinical threshold marked ) - Flight surgeon, as medical authority - Robotics and medical-device safety board - Program approval for the mission restart_after_stop: >- Human only. After any emergency or protective stop, a crewmember must restart the robot; the robot never restarts itself. each_run: >- Scheduled by the flight surgeon and accepted by the crewmember or CMO, or started by command. The CMO holds the probe; the flight surgeon and the imaging expert read every image. change_control: - Every change gets a new version number and a written reason; earlier versions are kept. - >- Any change to steps, thresholds, limits or software that touches the patient repeats validation from the simulation stage before use. - >- Software and learned-skill updates follow a pre-agreed change plan (what may change, how it is tested, how to roll back), modeled on the FDA predetermined change control plan approach. - >- If a new version misbehaves, the robot rolls back to the last validated version and the event is reviewed by the flight surgeon and safety board. - The robot never changes its own protocol, thresholds or limits. comms: live: 'Low Earth orbit: the ground imaging expert guides live when the link allows.' loss_of_signal: - >- Only the robot pauses non-essential motion, at a position clear of hatch routes and crew routes, and tells the CMO; it resumes offline only on the CMO's confirmation. - >- Crew scanning already under way and all other care continue under the onboard checklist and never wait for the link or the robot. - The scan follows the onboard checklist; clips are stored and forwarded. mars_delay: - 'Mars: no live guidance; the CMO follows the onboard checklist and clips are reviewed with delay.' sources: - key: reyes2023 text: >- Reyes D, Sargsyan A, Everson A, Navarro C, Locke J. Update to NASA's clinical practice guideline for renal stone surveillance in U.S. astronauts (abstract; NASA Technical Reports Server 20230015727, 2023). url: https://ntrs.nasa.gov/citations/20230015727 supports: >- Abstract only: for 9 years all NASA astronauts had specialized renal ultrasound screening for mineralized renal material (MRM, a precursor of stones); as of April 2023 (73 individuals, 282 studies) there was no change in MRM from before to after flight, and screening was reduced to selection, the first annual exam, and before and after flight. Read Oct 21, 2026 (saved copy in src/b11). - key: mtb003 text: NASA OCHMO. Urinary Health. Medical Technical Brief OCHMO-MTB-003 Rev A (2025). url: https://www.nasa.gov/wp-content/uploads/2025/01/ochmo-mtb-003-urinary-health.pdf supports: >- Renal ultrasound before and after flight is standard; if stones are suspected in flight, ultrasound and limited laboratory work help; NASA tested guided ultrasound software for non-physician astronauts; urine left in the bladder after voiding is not retention but can lead to urinary infection and retention. Kidney stone is the second most likely reason for an emergency medical evacuation from the ISS in NASA's Integrated Medical Model. Read Oct 21, 2026 (saved copy in src/b11). - key: sargsyan2005 text: >- Sargsyan AE, Hamilton DR, Jones JA, et al. FAST at MACH 20: clinical ultrasound aboard the International Space Station. J Trauma. 2005;58(1):35-39. url: https://doi.org/10.1097/01.ta.0000145083.47032.78 doi: 10.1097/01.ta.0000145083.47032.78 pmid: '15674147' supports: >- An ISS crewmember with minimal sonography training was remotely guided from Mission Control through a FAST (focused assessment with sonography for trauma) examination of four abdominal windows in about 5.5 minutes, with a 2-second delay, private two-way audio and video downlink, and identical reference cards for crew and ground expert. Abstract read. - key: renal24 text: 'NASA Human Research Program. Evidence Report: Risk of Renal Stone Formation (2024).' url: https://humanresearchroadmap.nasa.gov/evidence/other/2024%20Renal%20Evidence%20Report_Final.pdf - key: stepaniak text: >- Stepaniak PC, Ramchandani SR, Jones JA. Acute urinary retention among astronauts. Aviat Space Environ Med. 2007;78(4 Suppl):A5-A8. url: https://pubmed.ncbi.nlm.nih.gov/17511293/ pmid: '17511293' supports: >- Case report: an astronaut who took promethazine and scopolamine before launch developed acute urinary retention on reaching orbit, had intermittent catheterization for the first 3 days with a single balloon-tipped catheter, which, because iodine solution was lacking on board and duties could not be interrupted, was left in place for a total of 4 days; voiding returned after day 7, retention returned on day 10 (1 day before landing), and recurred for the first 24 hours of the next mission; obstructive, medicine-related, psychogenic and nerve-related causes are discussed. - key: ukhsauti text: >- UK Health Security Agency. Diagnosis of urinary tract infections: quick reference tools for primary care (updated 2025). url: >- https://www.gov.uk/government/publications/urinary-tract-infection-diagnosis/diagnosis-of-urinary-tract-infections-quick-reference-tools-for-primary-care supports: >- Follow the dipstick manufacturer's guidance, including test timing. Women under 65: positive nitrite, or both positive leukocyte and blood, means a UTI (urinary tract infection) is likely. Men: use dipsticks to rule in infection, not to rule it out; urinary symptoms with fever or systemic symptoms strongly suggest prostate or kidney involvement. Check for signs of kidney infection (pyelonephritis): kidney pain or tenderness in the back under the ribs, flu-like illness, shaking chills (rigors) or a temperature of 37.9 °C or above, nausea or vomiting. Earth primary-care context for the flight surgeon. Read Oct 21, 2026 (saved copy in src/b9). - key: ng253 text: >- National Institute for Health and Care Excellence. Suspected sepsis in people aged 16 or over: recognition, assessment and early management. NICE guideline NG253 (2025, last updated Sept 23, 2026). url: https://www.nice.org.uk/guidance/ng253/chapter/Face-to-face-assessment supports: >- People with sepsis may feel very unwell and may not have a high temperature; do not rely on fever alone; a rise in temperature can be a physiological response; assess temperature, heart rate, breathing rate, blood pressure, level of consciousness and oxygen saturation; look for mottled or ashen skin, blue skin, lips or tongue, a non-blanching rash, and breaks in the skin; ask how often the person passed urine in the past 18 hours and about fever or shaking chills (rigors); pay attention to new changes in behavior and to concerns raised by others. - key: aha2025bls text: >- Kleinman ME, Buick JE, Huber N, et al. Part 7: Adult Basic Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16_suppl_2):S448-S478. url: https://doi.org/10.1161/CIR.0000000000001369 doi: 10.1161/CIR.0000000000001369 pmid: '41122888' supports: >- Adult basic life support: initial recognition of cardiac arrest, activation of the emergency response, high-quality CPR and use of an automated external defibrillator; also respiratory arrest and foreign-body airway obstruction. Earth guidance; the onboard checklist leads. Abstract read via PubMed Oct 21, 2026; full text not read. - key: cdcdis text: >- U.S. Centers for Disease Control and Prevention. Guideline for Disinfection and Sterilization in Healthcare Facilities (2008): summary of recommendations. url: https://www.cdc.gov/infection-control/hcp/disinfection-sterilization/summary-recommendations.html supports: >- 3.b: at least high-level disinfection for semicritical equipment that touches mucous membranes or non-intact skin; 3.c: low-level disinfection for noncritical surfaces and equipment that touch intact skin; 4.b: follow the disinfectant label's safety precautions and use directions, including contact time; 4.c: disinfect noncritical devices when visibly soiled and on a regular basis. Content read through the web search index on Oct 21, 2026 (the CDC site returned HTTP 403 to automated fetch); copy in src/b7/cdc_summary_searchindex.txt. - key: v1 text: 'NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023).' url: https://www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-rev-c-with-signature.pdf supports: 'NASA-STD-3001 Vol 1 Rev C: V1 3003, V1 3006, V1 6003, V1 7001, V1 7003.' - key: v2 text: >- NASA. NASA-STD-3001, Volume 2: Human Factors, Habitability, and Environmental Health (Rev F, 2026), including Section 10.6 Automated and Robotic Systems. url: https://standards.nasa.gov/standard/NASA/NASA-STD-3001_VOL_2 supports: Requirement IDs beginning V2. - key: tb044 text: NASA OCHMO. Medical Operations. Technical Brief OCHMO-TB-044 (2025). url: https://www.nasa.gov/wp-content/uploads/2025/08/ochmo-tb-044-medical-operations.pdf supports: >- The crew surgeon keeps medical authority when care is delegated; crew medical officers train on the JSC 48522 medical checklist. - key: marsdelay text: >- NASA. Mars communications disruption and delay (fact sheet, 2023 Moon to Mars Architecture Concept Review). url: https://www.nasa.gov/wp-content/uploads/2024/01/mars-communications-disruption-and-delay.pdf supports: >- One-way Earth-Mars delay up to about 21-23 minutes, plus blackouts of about 2-3 weeks near solar conjunction. - key: pccp text: >- U.S. Food and Drug Administration. Marketing submission recommendations for a predetermined change control plan for artificial intelligence-enabled device software functions (guidance). url: >- https://www.fda.gov/regulatory-information/search-fda-guidance-documents/marketing-submission-recommendations-predetermined-change-control-plan-artificial-intelligence supports: A model for planning, validating and rolling back software updates. - key: faa460 text: 'U.S. Code of Federal Regulations, Title 14, Part 460: Human space flight requirements.' url: https://www.ecfr.gov/current/title-14/chapter-III/subchapter-C/part-460 supports: >- Federal rules for crew and spaceflight participants on licensed commercial flights; they set no medical standards for spaceflight participants. corrections: - date: '2026-10-21' version: '0.2' source: Batch 11 AI-assisted clinical review (Medical Research Assistant), Oct 21, 2026 items: - >- R1: retitled "Flight-surgeon-ordered surveillance scans"; the protocol runs only when the flight surgeon has loaded a scan order for this crewmember (summary, S1, covers and robot role). The why says routine screening is selection, the first annual exam and before and after flight, and in-flight scans are not routine (Reyes 2023, abstract; OCHMO-MTB-003). - >- Batch 11 protocols now record the review as AI-assisted (Medical Research Assistant, Oct 21, 2026); no named human clinician.