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AURORA-SPINA/Deep dive/In design

AURORA-SPINA is an open, federated software stack for the multidisciplinary team caring for a patient with spina bifida.

Spina bifida is the most common congenital defect of the central nervous system. AURORA-SPINA spans embryonic origin to adult life, with explicit support for prenatal surgical repair and continence/mobility outcomes.

What it is
A software substrate. 6 subsystems on one federated runtime, installed inside the hospital — not a cloud service, not a black box.
What it does
AURORA-SPINA is an open stack for the most common neural-tube defect compatible with life. Six subsystems span origin biology, the prenatal-window decision, surgical closure, lifelong protection, life-trajectory modelling and a discovery lane for new hypotheses.
Who uses it
The fetal medicine · paediatric neuro · urology · pm&r MDT at pilot partner institutions today. Open to any hospital under MIT at public alpha (Q4 2026).
Why it exists
So a spina bifida case at any hospital benefits from the substrate the top centres already have. Same code, same model cards, same audit story everywhere.
Subsystems
6
all spec-frozen
Pilot sites
Fetal-medicine partners in early conversation
scoping → live
Working papers
6
drafts in flight
Latency
target <120ms
median per case
License
MIT
@ public alpha
Stage
Soon
public alpha Q4 2026
I · The clinical surface

What clinicians actually see.

A non-functional preview of the AURORA-SPINA surface. Composable panels, logged overrides, explainable end-to-end. Pilot sites tune this to their own workflow.

FidelityPixel-accurate mock — no live data.
SubstrateReact 18 · CSS custom properties · no framework lock-in.
ScopeVocabulary for all AURORA-* surfaces.

MRN-201418 · MMC L4 · 23+5 weeks

plannedpilot · UCL Fetal Medicine override · 1
Stage
Pre-decision MDT
Subsystems
6/6 ready
Latency
target <120ms
Audit log
on
Fetal MRI · sagittal T2 · GA 23+5 · lesion overlayupdated 2s ago
10 mm
lesion 18×9 mm·ventricular atrium 12.4 mm
lesion segmentation
MoMS eligibility band
Subsystem signalsupdated 2s ago
SPINA-ORIGIN   Origin & Embryology72%
SB-PRENATAL   Prenatal Window91%
SB-REPAIR   Surgical Repair66%
SB-PROTECT   Neuro-Protection58%
Prenatal profile · SB-PRENATALsigned report
Lesion type
MMC
conf 0.96
Upper boundary
L4
conf 0.91
Ventricles
atrium 12.4 mm
conf 0.94
Chiari II
moderate herniation
conf 0.88
MoMS eligible
yes · 8/8 criteria
conf 0.99
AFP / AChE
elevated · positive
conf 0.97
Lesion-level concordance
92.4%
Mobility @ 30mo (est.)
indep · 68%
II · The clinical case

Why an open module for spina bifida.

AURORA-SPINA is an open stack for the most common neural-tube defect compatible with life. Six subsystems span origin biology, the prenatal-window decision, surgical closure, lifelong protection, life-trajectory modelling and a discovery lane for new hypotheses.

Spina bifida is the most common neural-tube defect compatible with life. Outcomes pivot on timing — the prenatal window for closure, the postnatal CSF-diversion question, and the long arc of continence, ambulation and cognition. Fragmented systems track each chapter separately; AURORA-SPINA puts that whole timeline on one substrate.

The clinical evidence base is unusually rich. The MoMS randomised trial established prenatal repair as the standard of care for eligible patients, and its 30-month follow-up clarified the shunt-rate and motor benefits. Fetoscopic alternatives continue to mature. The questions in front of teams today are not whether to operate, but who, when and how — and how to support patients through decades of care.

AURORA-SPINA does not replace clinical judgement; it removes the substrate cost. Imaging, registry data and outcomes flow through one federated runtime. Decisions are explainable, overrides are logged, and patient data never leaves the institution.

We are not building a product around Spina Bifida. We are seeding an infrastructure — so that any hospital with the will to use it can.
SPINA · INTERVENTION WINDOWS

Four windows. One continuous spec.

AURORA-SPINA treats neural-tube closure as a single continuous trajectory with four intervention windows. Each window has its own subsystem; they share the same patient identity, the same audit log, the same consent metadata.

−4w
FOLATE · PRECONCEPTION
SPINA-ORIGIN
20–26w
PRENATAL REPAIR · MOMS WINDOW
SB-PRENATAL
0–72h
POSTNATAL CLOSURE
SB-REPAIR
6mo → 30y+
LIFELONG PROTECTION
SB-PROTECT · SB-LIFE
conception20wbirth5y30y
One identity · the patient's record predates them; their first AURORA event is folate, not surgery.
One spec · MoMS-aligned outcomes carry into the lifelong window unchanged.
One audit · every override in any window is visible in every other window.
III · The stack

6 subsystems. Each one independently useful.

Every AURORA-SPINA subsystem can be adopted alone or as part of the bundle. Each ships with its own model cards, eval results and a one-command install.

SPINA · 01 planned

Origin & Embryology

SPINA-ORIGIN

Neural tube closure simulator with folate-axis perturbations.

Neural-tube closure simulator with folate-axis perturbations. Foundational priors that other SPINA subsystems consume.

SPINA · 02 planned

Prenatal Window

SB-PRENATAL

Imaging, lesion-level and timing decisions for in-utero repair.

Imaging and lesion-level analysis for the prenatal window. Produces a structured decision packet for the fetal-medicine team.

SPINA · 03 planned

Surgical Repair

SB-REPAIR

MOMS-aligned planning for open and fetoscopic closures.

MOMS-aligned planning for open and fetoscopic closures, including approach selection and risk-adjusted timing.

SPINA · 04 planned

Neuro-Protection

SB-PROTECT

Long-term shunt, cord and skin protection over the lifespan.

Lifelong shunt, cord and skin protection — a longitudinal companion that does not let the case fall off the radar.

SPINA · 05 planned

Life Trajectory

SB-LIFE

Continence, ambulation, cognition and quality-of-life modelling.

Continence, ambulation, cognition and quality-of-life modelling, with explicit uncertainty bands.

SPINA · 06 planned

Discovery Lane

SB-DISCOVER

Open hypotheses, registry signals and replication tracker.

Open hypothesis tracker, registry signals and replication watch — where new SPINA research is announced first.

IV · The product, in detail

What AURORA-SPINA produces, end-to-end.

Inputs the module reads from your existing systems, outputs it returns to them, the protocols it speaks, and the lifecycle of one case as it moves through AURORA-SPINA.

01Inputs8 types
Prenatal imaging
Targeted anatomy ultrasound at ≥18w plus fetal MRI (T2 HASTE, T1, DWI). The module reads lemon/banana signs, ventricular atrium width, hindbrain-herniation grade and lesion segmentation — not just a single Boolean.
DICOM 3.0 · linear/curvilinear US · 1.5T MRI
Amniotic biochemistry
AFP and acetylcholinesterase from amniocentesis when available. AURORA-SPINA reads ranges relative to the lab's published normal curves, not raw numbers — site-to-site drift never reaches the prediction.
HL7v2 ORU · FHIR Observation · lab-curve registry
Genetic
Karyotype, microarray and NIPT screen results. Used to gate prenatal-repair eligibility and to flag syndromic associations (VANGL1/2, MTHFR variants, T18, T13).
FHIR Observation · NGS report PDF
Postnatal records
Birth weight + Apgar, neonatal exam, head circumference trajectory, motor exam at discharge, neuro-urological assessment at 6w.
FHIR Procedure + Observation
Urodynamic studies
Cystometrogram traces and pressure-flow data per follow-up. SB-LIFE clusters urodynamic phenotype; raw waveforms are stored for re-analysis when the cluster changes.
DICOM Encapsulated PDF + JSON traces
Orthopaedic + PM&R
Hoffer ambulation level at each visit, scoliosis Cobb angle, hip stability score, lower-limb tone scores. Caregiver-reported function rolls into the same trajectory band.
FHIR Observation · structured forms
Family + caregiver
Family-reported outcomes (FROMs), school placement, transition-to-adult-care readiness scores. Family-facing surfaces are opt-in per cohort policy.
FHIR QuestionnaireResponse
Audit seed
Cohort consent metadata, prior override log if migrating from another platform. MoMS-derived priors carry an explicit attribution chain back to the trial-arm definitions.
AURORA audit (NDJSON)
02Outputs8 artefacts
Prenatal decision packet
Structured packet for the fetal-medicine MDT: lesion level + uncertainty, MoMS eligibility check, projected motor and continence trajectories with bands. A plain-language family version ships alongside the clinician version.
Signed PDF (clinician + family) + JSON
MoMS eligibility report
Per-criterion eligibility (lesion upper boundary T1-S1, GA 19–25+6 weeks, BMI < 35, singleton, normal karyotype, no fetal anomalies, etc.) with the exact data point that drove each decision. Missing data is shown as 'unknown', never silently treated as a fail.
Signed PDF + JSON
Repair-plan draft
Open hysterotomy vs fetoscopic comparison with patient-specific risk envelopes (premature rupture of membranes, preterm birth, dehiscence). Surgical team finalises; AURORA never sets the date.
JSON + DICOM SR
Shunt-risk forecast
12-month and 30-month CSF-diversion risk with calibrated Brier-aligned bands, conditioned on the chosen repair pathway and post-op imaging at one week.
JSON + FHIR Observation
Urodynamic phenotype
Cluster assignment from SB-LIFE with confidence; informs continence pathway choice (clean intermittent catheterisation, anticholinergics, Mitrofanoff candidacy).
JSON + DICOM SR
Trajectory dashboard
Continence, ambulation, cognition and quality-of-life bands across 30mo / 5y / 10y / 20y horizons. Updated after every clinic visit; the case never expires.
FHIR Observation stream + on-demand signed PDF
Family communication packet
Plain-language version of every clinician-facing output, reviewed by the patient-advocate council before each release. Available in the family's language where the site supports it.
Signed PDF · WCAG 2.2 AA web view
Audit envelope
Hash chain back through imaging, genetic, surgical, follow-up. Every prediction is re-runnable; the chain is signed by the site's federation key.
AURORA audit (NDJSON + Sigstore)
03Case lifecycle9 steps · median target <120ms
  1. 01
    Prenatal flag (≤1s)
    Anomaly scan or fetal MRI lands on PACS. AURORA-SPINA binds the case by accession + maternal MRN, checks the cohort consent policy, and pulls AFP / AChE + genetic results if present.
  2. 02
    Lesion-level pass (4–7s)
    SB-PRENATAL segments the lesion on fetal MRI and identifies the upper anatomical boundary. Confidence is reported per vertebral level (T11, T12, L1…S1), never as a single label.
  3. 03
    MoMS eligibility (<1s)
    Each MoMS criterion is checked against the available data. Missing items are reported as 'unknown' and surface for the team to fill; nothing fails silently.
  4. 04
    Trajectory bands (3–5s)
    SB-LIFE produces projected motor, continence and cognitive bands at 30mo, 5y and 10y. Bands widen explicitly when input is sparse; SB-LIFE refuses a confident estimate when it shouldn't have one.
  5. 05
    Family packet generation (2s)
    Plain-language family packet is generated alongside the clinician packet. The patient-advocate council reviews the template language at each release — not the per-case copy.
  6. 06
    MDT review
    Fetal-medicine + paediatric-neurosurgery + maternal-fetal-anaesthesia MDT reviews on the AURORA surface. Every override carries a reason; the audit log writes durably before the next render.
  7. 07
    Repair planning (if proceed)
    SB-REPAIR drafts approach-specific plans (open hysterotomy vs single-port fetoscopic vs two-port fetoscopic) with patient-specific risk envelopes. Surgical team finalises; AURORA never sets the date or the approach.
  8. 08
    Postnatal handoff
    From day 0, records flow into SB-PROTECT. The case is in lifelong-watch mode; no manual re-enrolment is required between paediatric and adult services.
  9. 09
    Lifelong surveillance
    Each clinic visit (urology, ortho, PM&R, neurosurgery) updates the trajectory dashboard and refreshes the shunt-failure forecast. The case never falls off the radar; the audit chain extends with each visit.
04Integrations the module speaks9 endpoints
PACS / Imaging
DICOM C-STORE for ultrasound + fetal MRI + postnatal MRI · STOW-RS for derived series · SR attachment on signed reports.
EHR / FHIR
FHIR R4 — DiagnosticReport, Condition, Procedure, Observation, QuestionnaireResponse, Subscription. OAuth2 client credentials; SMART scopes accepted.
Genetic feeds
HL7v2 ORU for legacy karyotype + microarray; FHIR Observation for NIPT and trio NGS. Both shapes ingested without site-side mapping.
Urodynamics
Direct connectors for Laborie, MMS and Medtronic urodynamic stations; raw cystometrogram traces are stored for re-analysis when the cluster assignment changes.
Registries
Federated links to the National Spina Bifida Patient Registry (US), the UK IFOPA registry, EUROCAT and equivalents. Data stays at the registry; AURORA-SPINA reads signed aggregate updates.
Family-facing
Parent app issues plain-language summaries and reminders. Accessibility-first (WCAG 2.2 AA); offered in the family's language where the site supports it.
Auth
OIDC — Microsoft AD FS, Okta, Keycloak. Per-clinician identity in every override log entry; family identity for caregiver-facing surfaces; role mapping per RFC.
Provenance
Sigstore-signed weights and container digests · per-site federation key in Vault, KMS or HSM · audit log is signed before the next render.
Air-gap
OCI tarball + offline Helm chart. Identical outputs to networked deployments on identical inputs — important for the LMIC sites where most spina bifida cases live.
05Per-subsystem, in detail6 units · independently installable
SPINA-ORIGIN
Origin & Embryology
planned

Neural-tube closure simulator. Encodes folate-axis perturbations, hyperthermia, anticonvulsant exposure (valproate, carbamazepine) and genetic associations (VANGL1/2, PAX3, MTHFR variants). Not patient-facing on its own; supplies priors that condition every other SPINA subsystem.

Producesprior tensors (.aurora.prior) + origin-evidence index
SB-PRENATAL
Prenatal Window
planned

Imaging + biochemical synthesis for the prenatal window. Reads targeted ultrasound, fetal MRI and AFP / AChE; outputs lesion type and upper boundary, ventricular atrium width, hindbrain-herniation grade, and a MoMS eligibility check. The output is a packet, not a recommendation — the team and the family decide.

Producesprenatal packet (signed PDF + JSON) + DICOM SEG (lesion segmentation)
SB-REPAIR
Surgical Repair
planned

Surgical-repair planner. MoMS-aligned for open hysterotomy; current-evidence-aligned for fetoscopic (single-port and two-port). Produces approach-specific risk envelopes — premature rupture of membranes, preterm birth, dehiscence, oligohydramnios — and explicitly flags where the evidence is thin or single-site.

Producesapproach comparison (JSON) + DICOM SR (operative checklist)
SB-PROTECT
Neuro-Protection
planned

Lifelong protection module. Shunt-failure forecast (12 / 30 / 60 month), tethered-cord recurrence watch, skin-breakdown risk from pressure-mapping data, and latex-allergy exposure log. Designed to be the case's longitudinal home — the place where the patient does not fall through the cracks between paediatric and adult services.

Producesshunt-failure forecast (JSON) + longitudinal alerts (FHIR Subscription)
SB-LIFE
Life Trajectory
planned

Trajectory model. Joint multi-output regression over ambulation (Hoffer scale 1–5), continence (urodynamic phenotype + caregiver-reported), cognition (PIQ / VIQ, BRIEF executive function) and quality of life (PedsQL spina bifida module). Uncertainty bands widen honestly when input is sparse.

Producestrajectory bands (NDJSON) + family-facing summary PDF
SB-DISCOVER
Discovery Lane
planned

Open hypothesis tracker. Surfaces emerging registry signals, replication attempts and disagreements between cohorts. RFCs against any SB-* subsystem must cite SB-DISCOVER entries before changing endpoints, thresholds or eligibility logic.

Produceshypothesis ledger (JSON-LD) + replication watch feed
Reversibility
Nothing the module installs is destructive. Uninstall removes containers + audit pointer; underlying records are untouched.
Determinism
Pinned commit + container digest + weights hash + dataset hash. Every AURORA-SPINA run is re-runnable and re-attributable.
Air-gap parity
Air-gapped deployments produce byte-identical outputs to networked deployments on identical inputs. No silent telemetry, ever.
Override SLO
Every clinician override is logged ≤ 200ms after the action; the log is durable before the next prediction renders.
VI · Endpoints we will track

The metrics that matter over a lifetime.

These are the endpoints AURORA-SPINA is built to measure across pilot deployments. The targets below are pilot goals, not retrospective results.

+11%
target
Independent ambulation at 30 months

Across registered prenatal-repair cohorts (target lift).

−22%
target
Shunt placement

Reduction in CSF diversion under aligned in-utero repair.

92%
target
Lesion-level concordance

Auto-staged vs. expert fetal-medicine consensus.

+18%
target
Continence outcomes at 5y

Composite urodynamic + caregiver-reported score.

100%
target
Auditable override rate

Every override logged with reason.

−40%
target
Time to integrated prenatal decision

From scan to family-ready packet.

⚠ PILOT TARGETS · NOT RETROSPECTIVE RESULTS · TO BE VALIDATED AT PUBLIC ALPHA
VII · Install AURORA-SPINA

From pip install to a hospital deploy in one afternoon.

Available to pilot partners today on private registries. At public alpha (Q4 2026) the same images, weights and signatures ship under MIT on public registries. For the full per-product download grid, see the unified download page.

step 1 of 3
# 1 · install
pip install aurora-spina             # just AURORA-SPINA
# or
pip install aurora-neuro[peds]       # paediatric bundle (SPINA included)
step 2 of 3
# 2 · verify
aurora doctor spina
# → AURORA-SPINA  ✓ python  ✓ models  ✓ datasets
# → six subsystems loaded
# → ready in target ≤120ms
step 3 of 3
# 3 · try a public case
from aurora.spina import load_case
case = load_case("bench/spina/case-0021")
print(case.lesion_level)     # → "L4"
print(case.repair_window)    # → "prenatal (24+1)"
print(case.urodynamic_band)  # → "moderate · σ 0.18"
Hardware
CPU · NVIDIA · AMD · Apple silicon
OS
Linux · macOS · Windows · WSL
Deploys
Cloud · On-prem · Air-gapped · Edge
Telemetry
Opt-in · Off by default

Hardware footprint, in practice

AURORA-SPINA is designed to run on hardware that already exists inside hospital networks. CPU-only inference is supported for the lighter subsystems; the heavier ones benefit from a recent GPU but do not require one. A single modern workstation handles routine cases under the latency target.

Networking and consent

Federated deploys do not require open inbound ports. The runtime opens an outbound mTLS connection to the federation control plane; model updates are signed, audited and pulled. Patient data never traverses the federation. Consent metadata is a first-class object — subsystems with an explicit consent dependency refuse to run on records that lack the appropriate cohort policy.

Migration paths

Most pilot sites land on AURORA-SPINA with an existing system in place. The recommended path is: install alongside, compare outputs on a held-out cohort for one quarter, then move read-only surfaces to AURORA, and decide on the rest. Reversibility is a design goal — nothing in the install creates lock-in.

Download grid

For the full per-product, per-platform download buttons (macOS / Windows / Linux installers + pip / docker / helm / rust commands), see the unified download page. Each subsystem of AURORA-SPINA is independently downloadable there.

VIII · Questions

The honest questions on AURORA-SPINA.

Eight diseases is the beginning.

AURORA is in private pilot today and opens to the world at public alpha in Q4 2026 under MIT. If you carry the weight of these diseases — as a clinician, scientist, builder, patient or advocate — there is a seat at the table.

Changelogv0.6.0