Handheld Point-of-Care Ultrasonography for Gynecology: Insights Into Space Travel Through Parabolic Flight.

In the current proof-of-concept project, a parabolic flight at the National Research Council in Ottawa, Ontario, Canada, was conducted to assess the feasibility of performing a self-gynecologic ultrasonography under weightlessness, simulating a space environment. A modified Falcon 20 aircraft was used to create a microgravity environment through parabolic flight. This specially modified business jet flew parabolic arcs to produce about 18–20 seconds of nearly 0-G acceleration force (weightlessness) per parabola. This parabolic maneuver is initiated and terminated with a pull-up and pullout of about 2 G (Fig. 1 ), and the test flight consisted of nine parabolas (Fig. 1 and Video 1 ). The flight crew members consisted of scientists conducting experiments, a flight test engineer, and pilots. During the hypergravity phase (about 2 G) of the parabola, the Butterfly iQ3 POCUS device was connected to the cell phone application, which was set to airplane mode. A participant performed a transabdominal self-scan of her lower abdomen during the microgravity phases (weightlessness) of a parabolic flight (Figs. 2 and 3 ). The protocol involved applying gel to the suprapubic area with a full bladder. The probe was positioned so that the bladder was captured at its widest dimensions and was centered on the screen. An automated pointer in the screen guided the operator to center the bladder for optimal measurement. The auto bladder volume tool detected a bladder volume of 638 mL within the 20 seconds of microgravity during one parabola ( Video 2 ). The preflight bladder volume was not measured because of the time gap between the preflight and the first parabola. After completion of the bladder scan, during a separate parabola, the ultrasound probe was repositioned to obtain sagittal and transverse views of the uterus. The participant successfully completed a self-scan of the uterus within 20 seconds of entering microgravity, obtaining clear images of the uterus, fundus, myometrium, endometrial lining, and cervix (Fig. 4 and Video 3 ). The ultrasound probe rotated 90° counterclockwise for a transverse view while also viewing the adnexa. Toward the end of the microgravity phase of the parabola, the postparabola pullout hypergravity phase began. During this phase, imaging became challenging, and the participant experienced nausea, preventing the adnexa from being adequately visualized within the microgravity window. The experiment assessed ease of use, privacy, time required for image acquisition, and image quality during the microgravity phases of flight. The data were captured and stored in the software application without an internet connection because the personal cell phone was in airplane mode. The quality of the images was sufficient to exclude the presence of macroscopic masses such as leiomyomas and to delineate the borders of the endometrial lining. During the scan, images were obtained, clicked to save, and automatically saved to the cell phone software application. During the study, the participant needed to adapt to spatial orientation and coordination under weightlessness and to manage the physiologic cardiovascular responses to altered gravity. Mathyk. Handheld POC Ultrasonography for Gynecology. Obstet Gynecol 2025 . Video 1. Parabolic flight operations. KIAS, knots indicated airspeed. National Research Council Canada. Used with permission. 1_epgvdqav Kaltura Parabolic flight operations. KIAS, knots indicated airspeed. National Research Council Canada. Used with permission. Mathyk. Handheld POC Ultrasonography for Gynecology. Obstet Gynecol 2025 . Mathyk. Handheld POC Ultrasonography for Gynecology. Obstet Gynecol 2025 . Video 2. Bladder imaging and sonogram under weightlessness. Artist & Graphic Designer: Urban Koi. Used with permission. 1_tqb8yzrx Kaltura Bladder imaging and sonogram under weightlessness. Artist & Graphic Designer: Urban Koi. Used with permission. Mathyk. Handheld POC Ultrasonography for Gynecology. Obstet Gynecol 2025 . Video 3. Portable point-of-care ultrasound use during weightlessness. Artist & Graphic Designer: Urban Koi. Used with permission. 1_7eg5h4rq Kaltura Portable point-of-care ultrasound use during weightlessness. Artist & Graphic Designer: Urban Koi. Used with permission.

This article reports gynecologic imaging during weightlessness in the microgravity phase of a parabolic flight. Our study was designed as a proof of concept to assess the feasibility of using a portable POCUS for gynecologic imaging in microgravity. Our experience has further shown that patient privacy is not an obstacle when transabdominal gynecologic imaging is used as the primary imaging modality. Furthermore, the participant experienced differences in her spatial orientation, including hand–eye coordination, during the scan because gravitational changes can affect these sensations differently as a result of vestibular system adaptation and cardiovascular changes. This was the participant’s first parabolic flight experience. Thus, the study was limited by the inability to complete the full gynecologic scan, including visualization of the adnexa, because of the participant's nausea and the timing of the scan, which was conducted after exposure to multiple parabolas. In the future, the participant plans to repeat the test at the beginning of the flight, potentially with the use of premedication. In addition, it will be important to test the portable POCUS with less experienced ultrasound users and to develop algorithms to guide users for correct imaging. Gynecologic emergencies are a leading cause of hospital admissions on Earth and could present significant risks in austere environments, including space travel, where emergencies need to be managed autonomously. Because participation of women in spaceflights to date has been significantly lower compared with men and with no woman having yet set foot on the moon, it remains unknown how frequently gynecologic emergencies may ultimately arise. However, the prevalence of gynecologic emergencies in earthbound medical settings suggests that planning for their management in space should be a serious consideration. Notably, upcoming missions aim to increase female participation in space exploration, including all-female astronaut crews and the first female astronaut to fly to the moon as part of the Artemis program. Given these developments, it is crucial for space missions, particularly those of longer durations, to establish well-defined protocols for addressing potential gynecologic emergencies. This includes ensuring that medical personnel are adequately trained and equipped to manage such conditions within the unique environment of space. Access to diagnostic tools such as portable POCUS is critical for ensuring timely evaluation and intervention. Curriculum development for POCUS has been conducted in air flights and helicopter emergency medical services for extended focused assessment with ultrasonography in trauma 16 ; however, there is a need to focus on gynecologic conditions. Current literature on the use of POCUS in obstetrics and gynecology primarily emphasizes its application in pregnancy. Portable POCUS has demonstrated utility in a variety of clinical applications, including the confirmation of early pregnancies, detection of abnormal pregnancies, and identification of gynecologic conditions such as ovarian cysts and pelvic free fluid. 7 , 10 The Pedersen et al 7 study demonstrated that in the first trimester the use of a portable POCUS device had a sensitivity of 73% for detecting fetal heart tones, and the positive predictive value for identifying abnormal pregnancies was 100%. Notably, these results were achieved by practitioners with limited training and without a subspecialty license in gynecology, demonstrating the practicality of the technology and its potential for broader applications in diverse and austere environments. The implications of portable POCUS are crucial from a gynecology standpoint, including the assessment of early pregnancy and its complications (ie, confirming intrauterine pregnancy, ectopic pregnancy, and miscarriage); diagnosis and monitoring of acute and chronic gynecologic conditions such as ovarian torsion, hemorrhagic cysts, tubo-ovarian abscesses, leiomyomas, and benign or malignant adnexal masses; and follow-up of interventions (ie, intrauterine device malposition). During space travel, access to comprehensive medical facilities has been almost universally limited, necessitating adaptation of existing diagnostic tools for use under these conditions. In addition, in the setting of communication delay (ie, Mars missions one-way 20-minute delay) 12 or communication network failure (eg, natural disasters on Earth), independent self-evaluation of medical conditions and emergencies is crucial. Future tools, including artificial intelligence–guided image capturing and augmented reality, should be developed to assist and guide less experienced users in managing emergencies in such settings. Such innovations would be invaluable in austere environments, including spaceflight, in which access to advanced health care and specialist care is limited.

This proof-of-concept project has successfully demonstrated the feasibility of using portable POCUS to image the female reproductive tract during microgravity phase of a parabolic flight (weightlessness). The participant performed a self-transabdominal scan within the 20-second microgravity phase of a parabolic flight, obtaining clear sagittal images of the uterus, fundus, myometrium, endometrial lining, and cervix. There were no concerns about privacy during the gynecologic ultrasonography with the transabdominal probe, even in the presence of other crew members on the aircraft. Participants also subjectively self-assessed the use of the handheld probe under weightlessness, noting challenges related to movement during gravitational changes and physiologic responses experienced during the parabolic flight. The human body experiences significant physiologic changes during gravitational transitions, with the cardiovascular system being particularly affected by alterations in G-forces during flight. During the ultrasound scan, the participant noted cardiovascular changes, including a sensation of fluid shifting from the lower extremities to the upper body and an increased sense of pressure. During the hypergravity phase, the participant felt pressed down into the seat, with pooling of blood in the lower extremities. Simultaneously, the movement of the upper extremities and the ultrasound probe felt heavier, adding to the challenges of imaging during this phase. In the microgravity phase, the participant experienced weightlessness and fluid shifts in the body and began a whole-body float. It is recommended to minimize head movement during gravity changes to stabilize the vestibular system and to mitigate vertigo, nausea, and dizziness. Minimizing head movement helped and reduced the risk of sensations such as dizziness or pressure changes in the head and neck; thus, the participant experienced better transition between gravitational forces and completed the uterine scan.