SpaceXray: Feasibility and Diagnostic Capabilities of On-Orbit Medical Radiography

Background To support crew health during spaceflight, in-flight imaging must extend beyond the capabilities of portable ultrasound (US). Digital radiography may provide improved diagnostic quality and enable equipment monitoring through nondestructive testing. Purpose To demonstrate the feasibility of a commercial-off-the-shelf (COTS) radiography system for on-orbit imaging applications. Materials and Methods In a prospective study, a portable, digital, COTS radiography system was evaluated during the 3.5-day Fram2 polar orbital flight. Anatomic and equipment radiographs were obtained preflight and in-flight by crew participants with 4 hours of training. Radiographs were evaluated by independent radiologists on overall image quality, spatial resolution, contrast resolution, and positioning (Likert scores of 1-5). Preflight radiographs were compared with in-flight radiographs using the Wilcoxon rank sum test. Hardware testing and crew surveys were conducted postflight; survey responses were thematically analyzed due to small sample size. Results Three crewmembers participated (mean age, 42.8 years ± 13.9 [SD]; two women). In-flight and preflight anatomic radiographs (seven each) demonstrated no evidence of differences in overall image quality (mean score, 4.86 ± 0.26 vs 5.0 ± 0, respectively; P > .99), spatial resolution (mean score, 4.86 ± 0.26 vs 5.00 ± 0; P = .46), or contrast resolution (mean score, 4.86 ± 0.26 vs 5.00 ± 0; P = .46). However, for central radiographs (chest, abdomen, pelvis; 12 of 14 images), image positioning was worse in-flight than preflight (mean score, 4.07 ± 0.72 vs 4.95 ± 0.13, respectively; P = .02). In-flight nondestructive testing enabled visualization of internal equipment components to the submillimeter scale. The radiography system functioned nominally postflight despite minor re-entry damage. Crew surveys rated equipment and protocols easy to use. Conclusion By acquiring the first human radiographs in space, this study demonstrated the feasibility of on-orbit radiography, expanded diagnostic capabilities for crew health and equipment evaluation, and identified operational standardization gaps and image-aligned challenges in microgravity. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Abbara and McMillan in this issue.