Expeditionary interventional radiology for human spaceflight: A framework for procedural autonomy beyond Earth

Long-duration human spaceflight will require medical systems capable of managing illness and injury without rapid evacuation or real-time assistance from Earth. Microgravity physiology, engineering limits, and communication delays reduce the feasibility of conventional surgery and favor imaging-based, minimally invasive approaches. Expeditionary interventional radiology can be defined as a practice model emphasizing image-guided, minimally invasive procedures delivered with compact equipment by small, cross-trained teams in resource-constrained environments. Research shows that astronauts and other non-specialists can obtain diagnostic-quality ultrasound images in microgravity, and analog studies demonstrate that individuals with little experience can learn key ultrasound-guided tasks after focused instruction. These findings support the feasibility of image-guided drainage, decompression, and vascular access as candidate strategies for managing acute conditions encountered during exploration missions. Remaining challenges include procedural ergonomics, equipment design, sterility, fluid containment, and development of autonomous guidance tools. This narrative review outlines a streamlined approach for adapting interventional radiology to spaceflight and highlights research needs for achieving procedural autonomy beyond Earth.