
New Startup Raises $100M for Portable Ultrasound - chriskanan
http://www.technologyreview.com/news/532166/with-100-million-entrepreneur-sees-path-to-disrupt-medical-imaging/
======
new299
Rothberg is something of a character.

His two DNA sequencing companies (454 and Ion torrent) have both had what I
would consider successful exits (solid to Roche and Life technologies
respectively). But more importantly both products made their way into the
hands of consumers (which is actually rare for DNA sequencing startups).
However after acquisition both products failed to gain significant traction
(Roche has just shelved 454).

He also engages in a certain amount of showmanship [1], which has as gained
him some ridicule. I think he has to be respected to successfully executing in
a market where most startups fizzle out though.

I hope this pans out though, it sounds awesome. I really hope this (and other
research/medical device) technology makes its way into the hands of normal
consumers (not just research labs/medical institutes).

[1] Oh and he has a scale model of Stonehenge in his back yard.
[http://clonehenge.com/2009/01/17/circle-of-life-
connecticuts...](http://clonehenge.com/2009/01/17/circle-of-life-connecticuts-
stonehenge/)

~~~
sitkack
My only experience with Roche is that they buy promising new technologies and
shutter them. First they purchase the product, then they invest, then they
purchase the company then they shut it down.

~~~
new299
This is really interesting. They certainly have a reputation for killing 454.
What other companies have they done this with?

~~~
refurb
I wouldn't say Roche "killed" 454\. Illumina is absolutely dominating the
sequencing market. I would say killing something that isn't profitable is a
good business decision.

~~~
new299
You might not, I might not. But they do have somewhat of a reputation for not
executing well on the 454 technology. It has been said that they failed to
scale out what was a fundamentally sound platform. That they didn't really
push on density to the increase device throughput as much as they could have.

The truth maybe that the technology just has fundamental limitations. But I'd
would say that's not objectively clear.

The Illumina (Solexa) platform also had significant limitations, it took a lot
of platform development to get it where it is today. In contrast Illumina have
executed quite well, providing systematic improvements to the Solexa platform.

------
tricky
Some researchers at wash u engineering built a cheap, phone based ultrasound
in 2009:

[http://news.wustl.edu/news/Pages/13928.aspx](http://news.wustl.edu/news/Pages/13928.aspx)

I did various forms of cardiac ultrasound research for 10 years at the med
school. So, I know a little bit about it. It's easy to find your heart or a
baby, but knowing enough to make any sort of diagnosis takes a lot of
practice. No matter how smart you think you are, you won't be able to order
one of these on Amazon Prime and find a leaky valve or a problem with your
gallbladder. The images are noisy. Positioning the probe to get a clear view
of the structure you want to see is an art. If you're obese, forget about it.

I'm all for disrupting the imaging industry with cheap hardware, but this
article and a lot of the comments here show the general lack of knowledge
about medicine. Have a look at the comments in the heart attack thread. Some
people think they can just buy an ECG and self-diagnose a heart attack. If
anyone spent twenty minutes looking at ECG's (or ultrasounds) with a
knowledgable tech they'd cringe at how stupid they sounded. Ultrasound is the
exact same thing.

Finally, ultrasounds are regulated medical devices. As far as I know, it's
illegal to own one.

On a happier note, 3D ultrasound is kind of awesome. If you get a probe that
can rotate 180 degrees, it is really easy to make a 3D model of the
structures. I did it for a work-study job in 1998 on an old SGI indigo. Sadly,
you can get much better pictures in MRI or CT so 3D ultrasound is not really
used in the clinic (it's gaining some traction in cardiology, though)

------
juretriglav
I guess what's new here is the capacitive micro-machined ultrasound
transducers (CMUT), ultrasound emitters directly on a semi-conductor wafer.
Though I would like to see what we can do with this technology without
limitations of mobile/portable.

In terms of portable ultrasound, there are a few existing solutions on the
market:

This looks pretty portable (connected to an iPhone too):
[http://www.mobisante.com/](http://www.mobisante.com/)

GE's portable ultrasound seems pretty portable too:
[http://www3.gehealthcare.com/en/Products/Categories/Ultrasou...](http://www3.gehealthcare.com/en/Products/Categories/Ultrasound/Vscan_Family/Vscan#tabs/tab034ECFD4634747698D1F9B59CE785D9F)

Best of luck to Rothberg et al., I believe there's a huge consumer market for
a portable ultrasound done right! The pregnancy market alone is vast, e.g.
[https://www.bellabeat.com/](https://www.bellabeat.com/)

~~~
seren
The difference with GE Vscan seems to be the 3D reconstruction capabilities.
However I am not sure if the 3D is really needed. I always understood the 3D
ultrasound reconstruction as a gimmick (at least in obstetrics) to show parent
the head of their future baby.

~~~
pak
Most of the ultrasound-using doctors that I've talked to in med school seem to
agree with you; if there's a real need for 3D imaging today, doctors (in 1st
world countries at least) send the patient for a CT. The cost/benefit for 3D
ultrasound doesn't compare favorably to CT because it is a much noisier
imaging process and it takes just about as long as a CT.

That's why if you Google image search for "3D ultrasound", you get mostly
pictures of fetus faces and very few medical conditions.

So, I see this product mostly benefitting the 3rd world, unless they vastly
improve image quality and lowered the technical hurdles compared to existing
ultrasound equipment. (Which would be awesome, but is a _hard_ problem.)

Disclaimer: have used the Vscan as a student, but am no means an expert in
ultrasound.

~~~
sjg007
good luck trying to ct scan a pregnant woman!

~~~
pak
True, but you've just emphasized my (and the GP's) point: 3D ultrasound is
probably most relevant for pregnant women and 3rd world situations.

Incidentally, besides the abdomen and pelvis, you can safely CT just about any
other part of a pregnant woman.

------
avighnay
On the darker side, a dangerous social impact that this device would have is
an increase female foeticide

[http://en.wikipedia.org/wiki/Sex-
selective_abortion](http://en.wikipedia.org/wiki/Sex-selective_abortion)

Though there is a lot being done against this social evil, it is still very
prevalent.

~~~
adventured
A few questions.

Why would a cheaper technology lead to an increase in abortions? Don't they
just kill the fetus anyway upon realization of the sex if it's undesirable?

Wouldn't it ultimately be safer for the mother, to perform a very early term
abortion if that's what she wants, rather than waiting?

If a mother wants to abort at 60 days pregnant (assuming the new tech enables
earlier sex identification), why shouldn't she be allowed to for any reason
she deems worthy?

~~~
ig1
Because in countries where this is a problem it's common to have extreme
restrictions on use of ultrasound machines. For example requiring two doctors
to be present to use it and banning gender identification uses.

If this device is cheap/small enough that illegal clinics could have it, it
would make gender identification much more widely available then it is now.

Selective abortion can be dangerous population-wise because even a small
gender skew can be hugely problematic.

~~~
hayksaakian
On a micro level I sympathize with freedom of choice.

On a macro level, population skew is certainly a problem.

Tough call.

~~~
rglullis
Not to start a flamewar, but it really isn't a tough call at all. It's just
that you got trapped in this debate-framing message that abortions are about
freedom.

You know another problem with legalized abortions? Women that sell them in
exchange of suing for child support. [0]

[0]: [https://blogs.law.harvard.edu/philg/2014/10/30/who-knows-
abo...](https://blogs.law.harvard.edu/philg/2014/10/30/who-knows-about-
divorce-laws-in-countries-other-than-the-u-s/)

------
dgreensp
I have an ultrasound that we bought on eBay when my wife was pregnant.

The reason more individuals don't own them is that it's illegal! No company
that makes ultrasound machines will sell them to a non-doctor, because of some
kind of regulations. I believe they don't want people to think they can
diagnose themselves when it actually takes a doctor. Whatever the reason,
that's why more people don't own sub-$10k ultrasound machines, and omitting
that fact to make the story one purely about the march of technological
progress is poor journalism.

~~~
maratd
> I believe they don't want people to think they can diagnose themselves when
> it actually takes a doctor.

That is not the only reason. Long-term effects of ultrasound are unknown.
Short-term effects are increases in temperature of the tissue being scanned.
Improper use _can_ lead to harm.

Not saying they should be illegal to own or purchase by consumers, but you
really shouldn't be scanning things for shits and giggles. Remember, not that
long ago, x-rays were considered routine and harmless.

------
ck2
Hope they destroy the industry.

10 minutes of ultrasound to diagnose a serious illness can cost several
hundred dollars in the USA

Maybe in a decade it can even be built into smartphones like a tricorder.

This device already looks like it can plug into a smartphone
[http://www.mobisante.com/products/product-
overview/](http://www.mobisante.com/products/product-overview/)

~~~
jepper
An you can feed a software consultant on 1 dollar a day.

The price in medicine is mostly not the hardware but the required expertise to
analyse the data. Ultrasound imaging is not easy. The american health system
is very expensive though, a ultrasound is around 50 euro's here.

That said, 3D ultrasound can have tons of other applications not just in
diagnostic medicine. Real time surgcial feedback in soft tissue, yes please!

~~~
Otik
This is the sort of tool that will find loads of uses in different areas if
it's cheap, portable and flexible.

I can imagine engineers using it to examine materials, plant scientists
looking at plant growth or builders using it to find out where different
things are located in walls.

------
saileshc
Exciting development from R&D perspective for sure. Love the infusion of
capital and the media buzz.

We have been tackling the opportunity of point-of-care ultrasound with a phone
and tablet solution for a few years now (www.mobisante.com). There are
interesting nuances related to business model, education, and market adoption
even within US, and non-trivial complexity in purchasing dynamics and politics
when it comes to emerging markets. These are just as important to break
through as cost and complexity barriers – which we have already done to some
extent.

That said, we would love to source these transducers when commercially
available and cleared by the FDA, and integrate them in our solution offering!

Sailesh Chutani, CEO Mobisante

------
kanzure
GE has a $9k version (Vscan), and Rothberg says he wants to make this for $6k
("1000 times cheaper [than a $6M MRI machine]" is $6k). Is that really a
significant improvement? I guess any price competition is good, but I was
hoping for a <$1k version. Everyone should have one of these next to their
toothbrush.

Here's some reports from someone who has been using GE's portable ultrasound
machine:

[http://whyisamericanhealthcaresoexpensive.blogspot.com/2014/...](http://whyisamericanhealthcaresoexpensive.blogspot.com/2014/04/pocket-
ultrasound-machines-why-doesnt.html)

[http://whyisamericanhealthcaresoexpensive.blogspot.com/2013/...](http://whyisamericanhealthcaresoexpensive.blogspot.com/2013/02/how-
to-make-your-own-ultrasound-gel.html)

" _It was an unexpected and welcome bonus that my patients and their families
loved it. I would share the moving ultrasound pictures with them, often having
them hold the machine so I could point out how beautiful their internal organs
were and what we could see that helped give us a clue about their disease
process. Many of these same patients also got full, detailed ultrasounds or
other imaging by radiology technicians, but since the technicians aren 't
supposed to discuss findings with the patients and often they couldn't see the
screen, it wasn't nearly as gratifying._"

" _When I see a patient now, instead of taking their pulse and placing my
stethoscope on their chest and back, hearing the vague taps and clunks and
bubbles and whooshes of the internal organs I have come to trust are in there,
I open the ultrasound machine that lives in my white coat, squeeze a little
gel from a tube I keep warm in my pocket...._ "

" _The most common comment I get from patients is, "Wow, that's really cool!"
"I agree!" I answer. Then they will ask, "Why doesn't everyone have one of
these things?" That is kind of a difficult question. "They're pretty
expensive," I usually say. They are. At least for now. The little machines
(Vscan, by GE) retail for over $8000, though you can buy them cheaper used or
overseas. Physicians balk at spending this amount of money on a piece of
equipment. Most of the expensive gadgets we use are owned by hospitals or by
our group practices. Musicians, however, who make a fraction of what we do,
buy their own musical instruments which often cost in excess of $10,000. I'm
not sure the cost ought to be a serious consideration._"

I think in parts this can get down to way under $1k. Right now the bottleneck
is the ultrasound transducer probe tips/fronts/arrays, which are apparently
quite laborious to make. The image processing techniques are pretty standard
and appear as open source software in at least one of TI's development kits.

edit: And as another commenter points out, yeah it's illegal to sell these
machines or something (blame the Federal Death Administration).

~~~
nomnombunty
The price should be in the hundreds. According to re/code, "Butterfly’s goal
is to launch the device in as soon as 18 months — pending development and
regulatory approval — with a price tag of hundreds of dollars, Rothberg said"

[https://recode.net/2014/11/02/butterfly-network-
raises-100-m...](https://recode.net/2014/11/02/butterfly-network-
raises-100-million-to-bring-deep-learning-to-medical-imaging/)

------
agrman
Butterfly Network, one of the companies mentioned in the article, has a panel
discussion next week in NYC on artificial intelligence. Panel includes David
Ferrucci (one of the creators of IBM’s Watson) and Max Tegmark (who
hypothesizes that consciousness is a state of matter that can be
mathematically described). More info here: [https://4combinator-speaker-
series.eventbrite.com](https://4combinator-speaker-series.eventbrite.com)

------
sjg007
I think a network of sensors is an interesting, like what you see in Extant. A
lot of the ultrasound technicians job is to move the wand around to get images
and adjust the frequency to see different things. They do also push down a
lot. When we had our babies, I never understood why they just didn't drape a
bunch of sensors over and run a single scan that calculates everything.

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iamjoday
Best of luck to Rothberg! Amazing!

