The video head impulse test (vHIT) is an advanced diagnostic tool that provides objective, quantitative assessment of vestibulo-ocular reflex function across all six semicircular canals (SCCs). Its relevance in the aerospace domain is particularly notable, as the test operates within the 1–5 Hz frequency range—closely matching natural human head movements—and enables independent evaluation of vertical SCCs, which are sensitive to gravitational forces. This review introduces the principles of vHIT and explores its utility in quantifying vestibular function among fighter pilots.The integration of vHIT into aerospace medicine offers a practical and evidencebased approach to evaluating vestibular function and has its potential in monitoring physiological adaptation to high-speed, high-G flight conditions.

This issue of the Korean Journal of Aerospace and Environmental Medicine (Vol.36, No. 1) presents five articles addressing emerging topics in aerospace medicine, aeromedical evaluation, and space medicine policy. An original article proposes a neuro-adaptive cockpit communication support system integrating artificial intelligence and neurophysiological monitoring to reduce pilot cognitive workload and enhance situational awareness. Another original study examines the prevalence and aeromedical implications of cardiac conduction abnormalities among Korean Air Force pilots, providing evidence for risk-based surveillance strategies in aeromedical screening. A review article discusses the clinical value of the video head impulse test for quantitative assessment of vestibular function in pilots exposed to high-acceleration flight environments. Another review revisits the historical development and current relevance of the “1% rule,” a widely used framework for aeromedical risk assessment in aviation safety. Finally, a brief communication summarizes a panel discussion on the future development of space medicine in Korea, emphasizing interdisciplinary collaboration and national research governance.

Purpose: Communication between air traffic control and pilots is the cornerstone of aviation safety. However, the increasing complexity of flight environments often leads to cognitive overload, particularly during critical flight phases. This study proposes the Neuro-Adaptive Aerospace Support System (NAASS) Core to enhance situational awareness and manage pilot workload through real-time neurophysiological feedback. Methods: This paper is a concept validation study that proposes a system architecture and evaluates its feasibility based on existing neuro-physiological benchmarks. The system integrates an automatic speech recognition module fine-tuned from OpenAI’s Whisper-Large-v3 model and a neural-informed large language model. It utilizes functional near-infrared spectroscopy and Electroencephalography (EEG) to monitor the pilot’s cognitive state. Based on these inputs, an adaptive display system is designed to dynamically adjust information presentation levels. Results: The NAASS Core design evaluation indicates that cognitive workload is projected to decrease by 32.5%, and situation awareness is expected to improve by 28.4%. Conclusion The proposed neuro-adaptive framework is designed to address the “Automation Paradox” by keeping the pilot in the decision-making loop while providing necessary cognitive support. This research proposes a robust safety assurance strategy aligned with aviation standards for future intelligent cockpit designs.

In the Fall Conference of the Korean Microgravity Society, the panel talk of space medicine was held on November 5th, 2025. Six medical experts participated, and they discussed the achievements and strategies of domestic research in space medicine, space technology development, space medicine governance, and the role of government and research institutions. The discussion reviewed the current status of infrastructure development for space medicine research across various fields and examined the subsequent research activities; based on these insights, it delineated a strategic direction for establishing a national space medicine framework. Furthermore, the discussion highlighted the complexities and critical nature of establishing governance through cross-border institutional collaborations. This underscored the imperative for a unified, inter-ministerial governance framework to effectively facilitate international cooperation. Specifically, the proposal identified several critical tasks: developing independent research and development (R&D) frameworks for space medicine-related ministries, eliminating research redundancies, and securing a legal foundation for management systems to adapt to the volatile research landscape. The discussion concluded that laying these foundational pillars is a prerequisite for a ‘K-Space Medicine’ system, emphasizing the vital role of cross-disciplinary synergy, national governance, and technologies that bridge clinical and extraterrestrial environments.

Purpose: Cardiac conduction abnormalities detected on electrocardiography are often asymptomatic and considered benign. However, in aviation medicine, they required careful evaluation because of the potential risk of sudden in-flight incapacitation. Data on their clinical significance among military aircrew are limited. Methods: We conducted a retrospective study of 2,827 Korean Air Force aircrew who underwent checkup between 2021 and 2022. Conduction abnormalities—including complete right bundle branch block, left anterior fascicular block, left posterior fascicular block, and bifascicular block—were identified on 12-lead electrocardiography.Clinical, metabolic, echocardiographic, and exercise test data were analyzed. Logistic regression assessed factors associated with conduction abnormalities. Results: Conduction abnormality was identified in 27 participants (1.0%), with left anterior fascicular block being the most common (0.5%). Participants with conduction abnormalities demonstrated normal findings on echocardiography and treadmill test. Complete separation was observed between conduction abnormalities and echocardiographic abnormalities. In univariate analysis, metabolic syndrome was associated with the presence of conduction abnormalities (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.01–6.32), while age, smoking, and other metabolic parameters were not. In multivariable analysis adjusting for age, the association with metabolic syndrome remained of borderline statistical significance (adjusted OR 2.50, 95% CI 0.98–6.35). Conclusion Among military aircrew undergoing checkup, cardiac conduction abnormalities were uncommon and were not accompanied by structural or exerciseinduced cardiac abnormalities. These findings indicate that isolated, asymptomatic conduction abnormalities may occur without detectable structural heart disease in this highly selected population. Further longitudinal studies are required to clarify their long-term clinical and aeromedical significance.

The 1% rule has been introduced as a practical model for aeromedical risk acceptance to airworthiness risk. It has been incorporated into European Joint Aviation Authorities’ guidance, then endorsed by International Civil Aviation Organization as threshold of decision. Although it has served as an important benchmark in aeromedical judgment, the underlying assumptions for initial setting have changed, making it necessary to revise the 1% rule. Specifically, the risk of heart disease has been excessively emphasized, which could lead to unintended losses of experienced older pilots. On the other hand, as pilots are now working to older ages, issues such as brain diseases are becoming more relevant, making additional tests for asymptomatic cerebral infarctions necessary. Maintaining strict standards alone does not necessarily contribute to aviation safety. More flexible criteria are needed depending on the working environment in aviation, and for example, standards such as the 2% or 5% rule could be introduced.

This issue features six papers in aerospace medicine and safety, including four original articles and two reviews, focusing on pilot health, safety management, aerospace education, cardiovascular research in space, and artificial intelligence (AI) guidelines in aviation safety. Two studies analyze aviation medical examinations, highlighting rising pilot disqualification rates primarily due to neurological, cancer-related, and mental health disorders, emphasizing the need for targeted health management strategies. Another paper proposes enhancing the Line Operations Safety Audit methodology to systematically capture positive crew behaviors, competencies, and proactive threat management. A research article explores relationships between selfefficacy, team-member exchange, and academic performance in aviation service students, recommending customized training programs. Additionally, a review discusses cardiovascular therapeutics using microgravity and cosmic radiation environments, revealing potential terrestrial applications for cardiac regeneration and drug development. Finally, guidelines for AI development in aviation safety stress reliable governance, ethics, and transparency. Future research expanding practical implementation and deepening interdisciplinary collaboration in aerospace medicine and safety is anticipated.

In recent years, artificial intelligence (AI), a collection of core technologies leading the 4th Industrial Revolution, is playing an important role in national innovation. AI is not just a new technology, but an innovative technology that brings about widespread changes in industrial and social structures and is a key driving force that will lead to strengthening the quality of life and national competitiveness of the people. The aviation safety sector also expects AI technology to be used as an error prevention and risk management tool in aircraft design and operation, aircraft production and maintenance, environmental problems, and airport operation. The national strategies of advanced countries for AI include securing professional manpower, securing their own AI technology, establishing an ecosystem and establishing ethics for human-centered AI development. However, most AI-related strategic plans and operational guidelines in the public sectors, including aviation, are focused on technology development and services, so they do not consider essential items such as reliability and ethics when developing and applying AI in the public sector. Therefore, this study aims to present guidelines that should be considered and applied when developing and introducing systems using the latest AI technology in the aviation safety and public sector.

As research on the unique effects of space environment, especially microgravity and cosmic radiation, on the cardiovascular system is being conducted, research on the development of cardiovascular therapeutics using the space environment is attracting attention. This review comprehensively analyzes the current status and prospects of cardiovascular therapeutics development research utilizing space environment.Microgravity environment has been shown to have a positive effect on the proliferation and differentiation of cardiac progenitor cells and induced pluripotent stem cell-derived cardio myocytes. Cardiac tissue culture and organoid technology have enabled more effective drug screening and disease modeling than on the ground, and changes in gene expression such as Aquaporin-4 have been found to play an important role in cardiac function. Cosmic radiation can cause myocardial remodeling, fibrosis, and vascular endothelial dysfunction, and the underlying mechanisms of these effects include increased oxidative stress, promotion of inflammatory responses, deoxyribo nucleic acid damage, and cell death. Currently, the development of drugs that can prevent or treat cardiovascular damage caused by the space environment is in the early stages, and future research is expected to focus on developing personalized treatments and exploring the potential applications of space medicine research results to terrestrial medicine.

Purpose: The physical and mental fitness of pilots is important for aviation safety. This study analyzes the causes of disqualification among class 1 pilots who underwent aviation medical examinations in South Korea from 2022 to 2024. Methods: A retrospective analysis was conducted using data from class 1 pilots who underwent disqualification between 2022 and 2024. The disqualifying conditions were categorized into major groups (e.g., neurological, cancer, mental health, car diovascular). Results: Among the 26 disqualified pilots, 92.3% (n=24) were men, and the mean age was 49.4 years old (standard deviation, ±6.9). Neurological conditions were the leading cause (27.0%), followed by cancer-related conditions (23.1%) and mental health disorders (15.4%). Cardiovascular diseases accounted for 11.5%, while falsification of medical records, ophthalmologic issues, musculoskeletal problems, and hearing impairments made up the remaining cases. Conclusion These findings emphasize the importance of rigorous medical standards, robust follow-up protocols, and effective management of both chronic and emergent medical conditions in aviation.