A team of crew members aboard a commercial spaceflight acquired the first diagnostic X-rays during an orbital flight, according to results published on July 14 in Radiology, a journal of the Radiological Society of North America.
For more than forty years, ultrasound has been the only reliable medical imaging modality used in spaceflight. As missions grow longer and venture farther from Earth, there is increased risk for adverse medical events, making ultrasound's limitations less acceptable. Ultrasound requires significant operator training and relies on a sound wave transmitting medium.
"Traditional X-ray machines are very large, produce a lot of radiation, and have a tendency to produce a blurred image if there's movement," Dr. Gifford said. "Because everything in space is constantly moving, the conceit has been that obtaining a diagnostic image in orbit was too technically challenging."
The introduction of small portable X-ray machines allowed Dr. Gifford's team to test their use in orbit. In 2022, crew with minimal medical training took such a machine on a parabolic flight and successfully obtained an X-ray image of a hand under microgravity conditions.
Dr. Gifford's team partnered with SpaceX to investigate using an off-the-shelf portable radiography system during Fram2, a 3.5-day polar orbital flight. "Portable X-ray machines are in use everywhere—at the Kentucky Derby, on the sidelines of the Super Bowl and around the globe in low-resource areas—because they can run on solar power and can be operated by individuals with no medical expertise," she said.
During Fram2's mission from March 31 to April 4, 2025—launched aboard SpaceX Falcon 9—the crew acquired preflight images after four hours' training and inflight images without ground support using an ultraportable wireless digital generator. All images were evaluated by independent radiologists for quality parameters including spatial resolution and contrast resolution.
The researchers found no differences between preflight and inflight image quality or resolution; all inflight images achieved diagnostic levels despite lower positioning scores for some central body scans like chest or abdomen images.
"By acquiring the first human and equipment X-rays in space, our study demonstrates the feasibility of in-orbit radiography and expanded diagnostic capabilities for crew health and hardware evaluation," Dr. Gifford said. "Acquiring diagnostically useful X-rays in space is something that anyone can do." Crew feedback indicated ease of use but suggested improvements such as better mounting mechanisms for equipment safety.
Dr. Gifford said more studies are needed to establish guidelines for indications, interpretation, and baselines: "It's my hope that we can further reduce the size of portable imaging systems... so they can be included in future missions." She also pointed out potential uses beyond astronaut health—including satellite diagnostics or lunar surface analysis—and added: "Disseminating autonomous miniature X-ray systems around the globe could also change the game in public health... The sky is not the limit when it comes to X-rays."
