First Diagnostic X-Rays Captured in Space by Flight Crew

Sheyna Gifford, M.D., the lead researcher and assistant professor of aerospace medicine at Mayo Clinic in Rochester, Minnesota, stated, "It’s been a dream for aerospace medicine to have more than one imaging modality for diagnosing illnesses and injuries in space. X-rays are fast, easy and diagnostically valuable."

For over forty years, ultrasound has been the primary medical imaging tool used in spaceflights. As missions increase in duration, the limitations of ultrasound, which requires extensive operator training and relies on a sound wave-transmitting medium, have become more apparent.

Dr. Gifford explained the challenge of traditional X-ray machines: "They are very large, produce significant radiation, and can blur images with movement. Since everything in space is constantly moving, it was thought obtaining diagnostic images in orbit was too challenging."

However, advances in portable X-ray technology led Dr. Gifford's team to explore in-orbit X-ray capabilities. In 2022, the crew, with minimal medical training, successfully obtained a digital X-ray of a hand during a parabolic flight, using a portable X-ray machine.

The team collaborated with SpaceX to assess the feasibility of a commercial off-the-shelf portable radiography system during the Fram2 mission, which lasted 3.5 days in a polar orbit. Dr. Gifford noted, "Portable X-ray machines are used widely— at events like the Kentucky Derby and on the sidelines of the Super Bowl— because they operate on solar power and can be used by non-medical personnel."

In a prospective study leading up to the Fram2 flight, crew members used an ultraportable wireless digital X-ray generator to capture both anatomical and equipment images preflight and inflight. All images were evaluated by independent radiologists. Dr. Gifford emphasized that a spaceflight-ready radiography system would significantly impact not only crew health but also mission-critical nonmedical tasks.

Prior to the mission, three crew members received four hours of training on the radiography system, while SpaceX conducted compatibility and impact testing. The mission launched on March 31, 2025, using a SpaceX Falcon 9 rocket, reaching an orbit of 425 to 450 kilometers and returning to Earth on April 4, 2025. The X-ray generator sustained minor structural damage during landing, but the internal components were unharmed. Inflight images were successfully obtained without ground support.

Independent radiologists assessed all X-rays for image quality, spatial resolution, and contrast. The study found no significant differences in image quality between preflight and inflight X-rays, with inflight images achieving diagnostic standards despite slight positioning challenges with central body images.

Dr. Gifford concluded, "By capturing the first human and equipment X-rays in space, our study shows the feasibility of in-orbit radiography and expands diagnostic capabilities for crew health and hardware evaluation."

Crew members reported ease of use with the X-ray system and suggested enhancements for better mounting and clamping mechanisms. The estimated radiation exposure for crew members was comparable to regular clinical imaging on Earth.

Dr. Gifford called for more prospective studies to refine guidelines for imaging protocols. She expressed optimism that further miniaturization and ruggedness of portable imaging systems could lead to their inclusion in future missions. Potential applications for these systems go beyond medical imaging, including satellite analysis and improving public health with autonomous X-ray systems globally.

The study, titled "SpaceXray: Feasibility and Diagnostic Capabilities of On-Orbit Medical Radiography," included contributions from multiple researchers affiliated with Mayo Clinic and was edited by Suhny Abbara, M.D., at Mayo Clinic, Jacksonville, Florida.