## 1 Introduction
### Medical Screening and Certification Prior to Space Travel
Resistance: 3x/wk & \\  sit-ups in 2 min; maximum & & (60 min) Aerobic: 3x/wk & \\  pull-ups; handgrip strength & & (30 min) & \\  with dynamometer & & \\ \hline \multirow{8}{*}{Cardiovascular} & Coronary artery calcium (CAC) & \multirow{8}{*}{Cardiovascular} & \multirow{8}{*}{Cardiovascular} \\  & score every 5 years & & \\  Echocardiogram annually & & & \\  VO2 max cycle test annually & & & \\  Fasting lipid panel & & & \\  High Sensitivity C-Reactive & & & \\  Peptide (HS-CRP) & Quarterly VO2 max cycle testing & & Echocardiogram \\  Carotid Intima-Media & Quarterly vascular US & & \\  Thickness (CIMT) annually & Monthly health surveillance & & \\ \cline{1-1}  & & exam with blood & \\  Individuals with & pressure measurement & & \\  cardiovascular disease history & & & \\ (e.g., compensated heart & & & \\  failure, asymptomatic CAD, & & & \\  arrhythmias) are not currently & & & \\  eligible for either long- or & & & \\  short-term space travel & & & \\ \hline \multirow{8}{*}{Pulmonology} & Pulmonary function & \multirow{8}{*}{None} & \multirow{8}{*}{Pulmonary function testing} \\  & testing annually & & \\ \cline{1-1}  & & & \\ \cline{1-1 \begin{table}
\begin{tabular}{c c c c} \hline \hline
**Scheme** & **Pre-Flight** & **In-Flight** & **Post-Flight** \\ \hline \hline \multirow{8}{*}{Ophthalmology} & SANS-surveillance, to include & & \\  & baseline testing of: & & \\  & Visual acuity & & \\  & OCT & & \\  & US & & \\  & MRI orbits & & \\  & Tomonetry & & \\  & Ophthalmology & Ophthalmologic examination & See attached chart for inflight & \\  & Color vision & scheduling details & \\  & Phoria testing & & \\  & Ophthalmologic screening for & & \\  & ocular health and visual status & & \\  & (e.g., testing for refractive & & \\  & errors or cataracts) & & \\  & is recommended & & \\ \hline \multirow{2}{*}{Otorhinolaryngology} & Screening audiometry & Quarterly On Orbit Hearing &
\begin{tabular}{c} Hearing questionnaire and \\ pure-tone audiometry \\ testing (annually) \\ \end{tabular} \\  & Tympanography & Assessment (OOHA) & & \\ \hline \multirow{2}{*}{Hematology} & Complete Blood Count (CBC) & & \\  & with differential & CBC every 60 days & CBC, CMP (annually) \\  & Iron studies & & \\ \hline \multirow{4}{*}{Immunology} & Administration of vaccines & & NASA has recommended \\  & (e.g., Shingrix) for prevention & & post-flight quarantine and \\  & of inflight VZV reactivation & & immune status monitoring \\  & Immunoglobulins (annually) & & (i.e., immune-boosting \\  & TB screening with PPD, & & protocol) to mitigate the risk \\  & Quantiferon Gold & & of infection \\ \hline \multirow{2}{*}{Gastroenterology} & Age appropriate colon & & Lifetime Surveillance of \\  & cancer screening & None & Astronaut Health (LSAH) \\ \hline \multirow{4}{*}{Musculoskeletal} & Annual DNA for osteoporosis & & \\  & screening for postmenopausal & & Post-flight DNA for BMD \\  & females and males \(>\)50 years old & & Spine MRI \\  & Cervical and thoracic spine MRI & & \\ \hline \multirow{4}{*}{Dermatology} & \multirow{4}{*}{Annual skin examination} & & Visual exam of the skin with \\  & & & photo documentation of any \\  & & & abnormalities, particularly for \\  & & & melanoma and \\  & & & non-melanoma skin cancers \\  & & (R+0/1 day and annually) \\ \hline \multirow{4}{*}{Genitourinary} & PSA in males & & \\  & Annual urinalysis, 24-h urine collection & & \\  & urine collection & & 24-h urine collection \\ \hline \multirow{2}{*}{Neurology} & MRI brain & & \\  & Neurovestibular platform test & None & Neurovvestibular platform test \\ \hline \multirow{2}{*}{Endocrine} & TSH, free T4 & & \\  & Thyroid US & None & Annual TSH, free T4 \\ \hline \multirow{2}{*}{Dental} & Annual dental examinations & & \\  & Orthopantomogram X-rays & None & Post-flight dental examination \\ \hline \multirow{4}{*}{Onocology} & Age-appropriate pap smear & & \\  & and mammogram in females & & \\ \cline{1-1}  & Age-appropriate colon & & \\ \cline{1-1}  & cancer screening & & \\ \hline \hline \end{tabular}
\end{table}