## 1 Introduction
### Future Directions for Precision Space Health with AI  
In this new era of space travel and exploration, 'future' tools and novel applications are needed in order to prepare deep space missions, particularly pertaining to strategies for mitigating extraterrestrial environmental factors, including both exogenous and endogenous processes. Such 'future' tools could help assist and ensure a safe travel to deep space, and more importantly, help bring space travelers and astronauts back to Earth. These tools and methods may initially be'remotely' controlled, or have its data sent back to Earth for analysis. Primarily efforts should be focused on analyzing data in situ, and on site during the mission itself, both for the purpose of efficiency, and for the progressive purpose of slowly weaning off a dependency on Earth. AI is an emerging tool in the big data era and AI is considered a critical aspect of 'fu-ture' tools within the healthcare and life science fields. A combination of AI and big data can be used for the purposes of decision making, data analysis and outcome prediction. Just recently, there have been encourage in advancements in AI and space technologies. To date, AI has been employed by astronauts for the purpose of space exploration; however, we may just be scratching the surface of AI's potential. In the area of medical research, AI technology can be leveraged for the enhancement of telehealth delivery, improvement of predictive accuracy and mitigation of health risks, and performance of diagnostic and interventional tasks [273]. The AI model can then be trained and have its inference leveraged through cloud computing or Edge TPU or NVIDIA Jetson Nano located on space stations. (Tables 3 and S4) Figure 3 demonstrates potential AI applications in space. As described previously, the capability to provide telemedicine beyond LEO is primarily limited by the inability to effectively communicate between space and Earth in real-time [274]. However, AI integration may be able to bridge the gap and advance communication capabilities within the space environment [275; 276]. One study demonstrated a potential mechanism for AI incorporation in which an AI-generated predictive algorithm displayed the projected motion of surgical tools to adjust for excess communication lag-time [277]. This discovery could potentially enable AI-enhanced robotics to complete repetitive, procedural tasks in space without human inputs (e.g., vascular access) [278]. Figure 3: Potential AI applications in space. Today, procedures performed with robotic assistance are not yet fully autonomous (they still require at least one human expert). It is possible with future iterations that an AI integration could be created with the ability to fully replicate the necessary human steps to make terrestrial procedures (e.g., percutaneous coronary intervention, incision and drainage [103], telecholecystectomy [105, 106], etc.) feasible in space [275, 279]. The seventh NEEMO mission previously demonstrated that robotic surgery controlled by a remote physician is feasible within the environment of a submarine, but it remains to be seen whether this can be expanded to the space environment [280]. On space stations, Edge TPU-accelerated AI inference could be used to generate accurate risk prediction models based on data obtained from simulated environments (e.g., NASA AI Risk Prediction Challenge) [281]. For example, AI could potentially utilize data (e.g., -omics) obtained from research conducted both on Earth and in simulated environments (e.g., NASA GCR Simulator) to predict an astronaut's risk of developing cancer due to high-LET radiation exposure (cytogenetic damage, mitochondrial dysregulation, epigenetic alterations, etc.) [63, 78, 79, 282, 283, 284]. Another potential area for AI application is through integration with wearable technology to assist in the monitoring and treatment of a variety of medical conditions.