Space to clinic: How TRISH helped advance ultrasound simulation with Level Ex

Supporting human health during long-duration space exploration requires new approaches to training, diagnostics, and decision-making. In space, where access to specialists and infrastructure is limited, medical technologies must be intuitive, portable and capable of supporting independent care. These same challenges exist on Earth in rural clinics, emergency settings and resource-constrained environments.

With support from TRISH, Level Ex developed one of the most advanced real-time ultrasound simulation platforms in medicine. What began as a solution for astronaut training in space-constrained environments has evolved into a widely deployed training tool across terrestrial healthcare.

By funding early development and helping refine the technology for operational use, TRISH was a catalyst in bringing this advancement from concept to real-world application.

“TRISH was proud to serve as an early catalyst for this technology,” said Jimmy Wu, deputy director and chief engineer at TRISH. “What began as an effort to support medical training and decision-making in space has evolved into a platform with the potential to improve care for millions of patients on Earth. That’s exactly the kind of dual-purpose innovation we aim to support, advancing the capabilities needed for human exploration while delivering tangible benefits to healthcare systems today.”

Building a new standard for ultrasound training

Now, the Level Ex ultrasound simulator is fully built and in active use. It already has trained tens of thousands of healthcare professionals across the country. Through commercial partnerships, including a major deployment with Philips for intravascular ultrasound (IVUS), the platform is expanding into neurosurgery, obstetrics, emergency medicine and primary care.

The system uses GPU-accelerated physics modeling to render ultrasound images in real time. Rather than relying on pre-recorded visuals, it simulates how sound waves move through tissue, producing artifacts like speckle and acoustic shadowing as natural outcomes of wave propagation. This allows clinicians to train with realistic, dynamic scenarios based on both simulated and patient-derived anatomy.
Unlike traditional simulation tools, the platform also incorporates game-based learning. The interactive challenges help build pattern recognition and clinical intuition, allowing users to learn faster and retain skills across specialties.

As the technology scales, its impact across healthcare continues to grow:
Intraoperative neurosurgery: Training surgeons to use cranial ultrasound during brain tumor resections can reduce reliance on intraoperative MRI, potentially saving significant operating room time and improving outcomes for thousands of patients each year.
Maternal and rural health: With millions of pregnancy-related ultrasounds performed annually, expanding access to training can help close gaps in rural and underserved areas where equipment is available, but trained providers are limited.
Emergency and primary care: Point-of-care ultrasound is already used in millions of ER visits annually, with further growth constrained largely by training. Expanding adoption enables faster, safer diagnoses at the frontlines of care.
Broad clinical education: As a general ultrasound curriculum is developed, the platform has the potential to support care for tens of millions of patients annually by improving provider proficiency across disciplines.

This shift reflects a broader trend: training, not hardware, is often the limiting factor in expanding access to advanced diagnostics. By lowering that barrier, the Level Ex platform is helping bring high-quality care closer to patients.

From space operations to everyday medicine

TRISH support also enabled Level Ex to build a real-time clinical data visualizer designed to help astronauts interpret longitudinal health data and make informed medical decisions during missions.

That same system is now being used on Earth by pharmaceutical companies, including Novartis, to help clinicians interpret complex clinical trial data at the point of care. These downstream applications are reaching hundreds of thousands of medical professionals, improving how data informs treatment decisions.

TRISH: The Milky Way’s healthcare advancement catalyst and innovator

As exploration efforts look toward establishing a sustained human presence on the moon and, eventually, missions to Mars, the need for autonomous medical capability will only increase. Astronauts will need to diagnose, monitor and treat conditions without immediate support from Earth.

Technologies like Level Ex’s simulator directly contribute to this vision. By enabling faster, more effective training and supporting decision-making in constrained environments, they help lay the foundation for independent medical operations in space.

At the same time, these innovations are reshaping healthcare delivery on Earth. From operating rooms to rural clinics, the ability to train providers at scale and deliver actionable clinical insight at the point of care is improving outcomes, expanding access, and strengthening health systems.

By Madison Hever, senior communications associate for the Center for Space Medicine