
Butterfly iQ – A cheap handheld ultrasound tool with AI smarts inside - taion
https://spectrum.ieee.org/the-human-os/biomedical/imaging/new-ultrasound-on-a-chip-tool-could-revolutionize-medical-imaging
======
davycro
Perspective from an emergency doctor. Many comments ask if non-medical persons
would use ultrasound should it become affordable. I think not.

There aren’t enough common medical conditions that you would monitor with a
personal ultrasound[1]. Also it’s a tough skill to learn without a solid
background in anatomy. This would deter many.

Primary care doctors (eg family, internal, and emergency medicine) will
benefit most from affordable ultrasound. We are learning that it’s a powerful
diagnostic tool when used along side the physical exam. Some zealots have
equated bedside ultrasound to be the biggest advancement to medicine since
antibiotics. This notion I feel is exaggerated, but— it taps into the
underlying excitement in the medical community for bedside ultrasound.

Here are some sample cases.

Patient came in with all the symptoms and findings of a stroke— altered mental
status, inability to move their left arm. Before giving the treatment for a
stroke, a potent blood thinner called tPA, the doctor decided to do an
informal ultrasound of the patients heart. He found the patient had a massive
dissection of their aorta. The patient wasn’t getting adequate blood flow to
their arm or brain. Had the patient been given tPA they most likely would have
died. A quick bedside ultrasound revealed a difficult diagnosis and saved the
patients life.

Another case- a young female came in unresponsive and without a pulse. Her
husband said she had complained of belly pain for the past several days but
nothing else. While doing cpr we placed an ultrasound on her abdomen and saw a
massive amount of blood in her belly. A pelvic binder was applied and we
immediately started massive transfusion for presumed ruptured ectopic
pregnancy. In this case the easy access to ultrasound gave us a diagnosis in
under a minute.

Both of these cases occurred in the emergency department. Of all specialties I
think emergency medicine has been quickest to adopt bedside ultrasound. Other
fields however could benefit too. Ultrasound is underutilized in family
medicine and internal medicine clinics. Making it affordable, say close in
price to a stethoscope, should encourage its use in these specialties and lead
to more discoveries of its use as a diagnostic aide.

1\. patients with an abdominal aneurysm may wish to monitor its size with a
personal ultrasound. This seems extreme.

~~~
crdb
> Many comments ask if non-medical persons would use ultrasound should it
> become affordable. I think not.

I immediately thought of a non-medical use case.

A pregnancy and birth in Singapore costs $5-20k, so an extra $2k is not that
much to be able to see your baby move and grow whenever you like as opposed to
having to wait for your monthly appointment (and perhaps post photos on
Instagram). It's a bit much for me but I might have bought one for $100.

Some redditors working in US ER departments complained of mothers turning up
with "complications" mid-pregnancy because of the mandatory ultrasound that
follows, allowing them to see their child, at which point their symptoms
mysteriously vanish and they head home smiling.

~~~
CobrastanJorji
Luxury ultrasound is a growing business in the US. Wanna know the gender at 14
weeks? No problem, $40 in the mall. Want a DVD with a recording of the baby's
heartbeat and a 20 minute video of it squiring around in 3D? $100. Want to
stick that baby heartbeat into a teddy bear? Dude, you are kind of
weird....$30. Sign up for our monthly "checking in on baby" package ultrasound
discount.

I'm not kidding, it's very real: [http://forever-
yours.us/3d-4d-ultrasounds-2/](http://forever-yours.us/3d-4d-ultrasounds-2/)

~~~
giarc
Where there's money to be had, there's someone willing to exploit it.

[http://www.ctvnews.ca/health/ultrasound-clinic-blames-
identi...](http://www.ctvnews.ca/health/ultrasound-clinic-blames-identical-
baby-images-on-computer-glitch-1.2906974)

~~~
goldenkey
And when you get caught, shout "IT WAS A VIRUS!!!! CLONING IMAGES!!"

I dont think I have ever encountered a virus that cloned images. The only way
I can even imagine it true is if a malfunctioning root kit was somehow
installed and affected file writes....but in 30 years..haven't seen it. Likely
they were just lazy so they kept handing out the same image figuring no one
would know.

------
maxander
I’m sure doctors are looking forward to ultrasound scanners being common
household devices, and getting 50 emails a day from panicked people convinced
that their gallbladder is a tumor.

~~~
mikenew
I’m not saying that wouldn’t happen, but we need to get away from the idea
that non-professionals shouldn’t have access to their own medical information.
More education and empowerment is the answer, not less.

~~~
mschuster91
> More education and empowerment is the answer, not less.

The crux lies in determining the boundary between education and quackery. The
resurgence of antivaxxers, homeopathy believers and friends doesn't exactly
help the case for deregulation here.

~~~
staunch
Is there any evidence anti-vaccine and homeopathy movements are bigger than
they were in the past?

Google Trends suggests homeopathy is up a bit recently, but way down from its
pre-internet peak.

[https://trends.google.com/trends/explore?date=all&q=homeopat...](https://trends.google.com/trends/explore?date=all&q=homeopathy)

~~~
mschuster91
> Is there any evidence anti-vaccine and homeopathy movements are bigger than
> they were in the past?

I'm talking about Germany here as I can't really speak for the US, where from
2011 to 2013 prescriptions rose 3.8% and OTC sales went up 23%
([https://de.wikipedia.org/wiki/Hom%C3%B6opathie#Bundesrepubli...](https://de.wikipedia.org/wiki/Hom%C3%B6opathie#Bundesrepublik_Deutschland_ab_1990)).

As for antivaxers, Europe as a whole has a _huge_ measles problem which has
risen in the last years ([http://theconversation.com/whats-behind-the-sudden-
rise-in-m...](http://theconversation.com/whats-behind-the-sudden-rise-in-
measles-deaths-in-europe-80909)).

------
itajaja
Engineer at Butterfly Network here, very excited to see interest on HN. As you
can imagine, we are hiring, there are a lot of very interesting open
opportunities
[https://careers.smartrecruiters.com/4Catalyzer](https://careers.smartrecruiters.com/4Catalyzer)

------
two2two
As someone who just had an ultrasound, I think this is the right direction. I
had to goto a diagnostics center where they specialize in scanned imagery. I
go in, paperwork, wait, wait some more, get scanned, and leave. The technician
just had me hold my breath while she put some jelly on my abdomen and moved
the device around. Once in a while she would take ultrasound pictures. Snap,
snap, move, breath, snap.

My GP had me go in order to troubleshoot a blood test. Now, if the GP had this
device it would have saved me some time and effort, not to mention the
external factors such as gas, taking up space on the road, and an appointment.

So yeah, please, GPs everywhere, load yourself with these devices as they
become cheaper and cheaper.

edit: GP's to GPs

~~~
gozur88
>The technician just had me hold my breath while she put some jelly on my
abdomen and moved the device around. Once in a while she would take ultrasound
pictures. Snap, snap, move, breath, snap.

Well, yes, and she probably went to school for quite some time to know exactly
what gets a picture and what doesn't.

This is like saying "I had an appendectomy, and all the surgeon did was make
some cuts an sew me up." You're not going to a surgeon because he owns a
scalpel.

~~~
mlrtime
The GP surely has the skills to take and read the scan.

~~~
giarc
But it's not efficient use of their time.

Ultrasound techs do the imaging/take the photos, and the physician reviews
them. Ultrasound techs make less money than physicians, that's why physicians
are taken out of that part of the process.

It's like saying "The dentist should also clean my teeth". Well their time is
better spent on procedures, leave the cleaning to the hygienist.

~~~
pjwMD
In the outpatient setting it might take days or a week or more to get an
appointment for a formal US, then more time for the radiologist to read it,
then more time for the GP to get the results and consider treatment changes
then more time to get in touch With the patient. But if I as a physician
perform and interpret the ultrasound in real time I can immediately begin
appropriate therapy. This is the major benefit of point-of-care US as opposed
to conventional US.

------
tynpeddler
>He also ran into difficulties with transmitting the images to the hospital’s
database for storage. “And saving those images is required to bill for the
scan,” he notes.

I think this guy is missing the point. Seems like the goal is to make giving
an ultrasound so easy that it would be silly to charge for it. Just like the
doctor doesn't (or at least shouldn't) have a special charge to listening to
your chest with a stethoscope.

~~~
mschuster91
> Seems like the goal is to make giving an ultrasound so easy that it would be
> silly to charge for it.

A literal ape can do an ultrasound scan if trained well enough - you still
need years of training to actually _interpret_ the data you gather with an
ultrasound image or by listening to a chest. This is what you pay for.

------
japhyr
Can someone with a better understanding of the medical industry comment about
the quality of this device? It seems like a small portable ultrasound device
would be a great thing for diagnosis. But I understand there are all kinds of
issues that might not be obvious to people without a strong medical
background.

Is this as good as it seems, or are there features this lacks which prevents
it from being that useful in the hospital setting?

~~~
JshWright
In a hospital setting this isn't terribly useful. An ultrasound is not that
big, and easily moved around on a small cart.

Small portable ultrasounds like this are gaining popularity in prehospital
care (in ambulances, etc).

This isn't really a new concept though. Things like the GE Vscan have been
around for years.

~~~
leggomylibro
Certainly in a well-funded hospital, but might $2K also not look more
appealing than $20K-$200K for a small clinic in a one-horse town?

Caveat, I have no idea how much a commercial ultrasound machine costs. But
it's _one_ machine Michael, what could it cost? Ten thousand dollars?

~~~
kraig
Even for a well funded hospital this should mean that the procedure now
becomes less expensive. Especially important for pets where you can be out of
pocket for half the price of one of these.

~~~
carbocation
Each of the machines at my (large academic) hospital is used for 8-12
transthoracic echocardiograms every weekday, or ~2,500 times per year. An
average ultrasound machine cost $140,000 in 2016 (per [1]). If we assume that
the machines last 3 years (so far I can tell you that they last at least 5
years, but let's be conservative), then the hospital gets ~7,500 ultrasounds
for $140,000, so just under $20 of the cost is attributable to the machine.
According to Choosing Wisely[2], the average cost of a TTE is ~$1,000. So,
only 2% of the bill seems to be attributable to the price of the ultrasound
machine. So, at least at major academic medical centers, the device itself
probably won't make a huge change.

I could imagine the standard of care changing, however, and that might make a
difference. If cheap ultrasounds become ubiquitous and more physicians are
trained in their use, the use of ultrasound among generalists might increase,
freeing up specialists to take a more narrow focus. I could see this
technology being particularly useful in emergency and critical care settings.

1 =
[http://www.modernhealthcare.com/article/20141216/blog/312169...](http://www.modernhealthcare.com/article/20141216/blog/312169995)

2 = [http://www.choosingwisely.org/patient-
resources/echocardiogr...](http://www.choosingwisely.org/patient-
resources/echocardiograms-for-heart-valve-disease/)

~~~
jacquesm
The mark-up in western hospitals notwithstanding I can see a large market for
cheaper devices in countries that are not so rich.

~~~
carbocation
Absolutely. This price point -- apparently 70x cheaper than the prevailing
standard -- could definitely bring the technology to places where $140,000 is
prohibitive.

------
OkGoDoIt
So how to stop people from taking this discreet, inexpensive ultrasound device
to China where parents will pay a lot of money for a black-market ultrasound
to be told the gender of their fetus?

[http://shanghaiist.com/2017/07/12/ultrasound-
van.php](http://shanghaiist.com/2017/07/12/ultrasound-van.php)

[http://www.havocscope.com/cost-for-illegal-ultrasound-and-
ab...](http://www.havocscope.com/cost-for-illegal-ultrasound-and-abortions-in-
china/)

~~~
aaron695
Aborting girls in China is exaggerated and you're certainly over playing it.

What about the girls lives saved by cheap medical technology?

Certainly one theory on the gender imbalance is girls tend to get less medical
care due to costs and as such die at higher rates.

~~~
jbarham
Is 100 million "killed, aborted or neglected" girls exaggerated? Or do you
have better sources than the Economist:
[http://www.economist.com/node/15606229](http://www.economist.com/node/15606229)
(Note that article is from 2010, there have been many more since.)

~~~
aaron695
Dime a dozen that dispute that figure but my biggest issue is with this
comment is -

> to China where parents will pay a lot of money for a black-market ultrasound

No, normal parents don't abort girls, normal parents don't infanticide girls.
The Chinese are not some sort of subhuman race that on mass do awful things to
their children.

Not a fan of the New Republic but it talks about the issue (and the racism
behind it)

[https://newrepublic.com/article/133845/truth-chinas-
missing-...](https://newrepublic.com/article/133845/truth-chinas-missing-
daughters)

------
projektfu
This is absolutely interesting to veterinarians. Many veterinarians would use
this as an adjunct to the physical exam. In human med, the follow up of
conditions like mitral valve insufficiency is covered by insurance but in vet
med, it gets expensive going to the recommended cardiology visits paying out
of pocket. Plus, we can use ultrasound for a lot of routine and emergency
procedures. I signed up right away.

------
et2o
There are already a number of mobile ultrasound devices, including ones that
plug into phones and tablets.

As someone who's actually done a few ultrasound courses, depending upon what
you're trying to image it's not easy. It's not just about having the device,
years of medical training come into play.

Also, the mobile devices have significantly lower resolution and don't seem to
be super important in the hospital.

~~~
pen2l
Yep, I've been playing with the Lumify
([https://www.lumify.philips.com/web/](https://www.lumify.philips.com/web/))
for a few years. I think my hospital has had it for about 5 years.

From what I can gather, this new device's selling point is the price. I'm not
sure how much the Lumify is, but I had the impression that it was a few
thousand dollars. And there's some talk about new AI technology packed inside
the new device, what that is I am not sure.

~~~
rsingla
Given the regulatory process, I would envision AI along the lines of "region
proposal". That is software to highlight or draw one's attention to a certain
portion of the image that "may" have X or something interesting. That's in
contrast to diagnosis software where it'd say this portion "is" X.

I should add there are several hand-held portable ultrasound machines, like
from SonoSite and Clarius, and would agree that the selling point here is the
price point. To the best of my knowledge, the cost of ultrasound machines has
gone down by two orders of magnitude with somewhat comparable resolutions. I
believe the top-tier machines with the best image quality or resolution are
still on the order of >$100k (Philips Epiq for example).

The cloud software offered by Butterfly should also be interesting if done
well.

------
glangdale
The interesting question is who/what does the diagnosis. I've had my kids fall
over a bunch of times (with a couple broken bones in there - _never_
ambiguous, sadly) and broken a couple bones in my life too (as well as done
stuff that convinced me that _something_ must be broken in there, when nothing
was).

So I think there were essentially zero times when a cheap-hand-held ultrasound
in that home would have added information. The question is really whether this
could be enormously helpful to a GP? Can they be trained usefully to take over
some of the role of an ultrasound technician and do first-line diagnosis? It'd
be great to not have to do the standard schlep over to the diagnosis place,
wait around, get the thing done, and wait to get the results back to the GP or
specialist.

I imagine there's also a fair bit of computer "vision" work on this stuff too
- I would presume people are working feverishly away on ways of reconstructing
3D imagery and actual diagnoses of an image via computer, as opposed to
squinting at these mysterious pictures.

~~~
JshWright
Ultrasound is not terribly useful in the diagnosis of fractures. It can detect
certain types of fractures in kids under 12 or so, but can't rule out a
fracture.

There are absolutely things a GP could use ultrasound for to rule in or out
various diagnosis. A GP doesn't really need a "pocket" ultrasound though. A
"normal" ultrasound would work just fine.

~~~
rsingla
I'd be curious as to what the payment model for a GP to own a conventional
ultrasound machine would look like in Canada, the US, and the UK. It's my
understanding that the pocket ultrasound at it's price point would essentially
pay itself earlier on while serving a purpose of being a triage tool.

Given the size and cost of a conventional cart-based machine, I think the
pocket one is more well suited.

------
projektfu
This is absolutely interesting to veterinarians. Many veterinarians would use
this as an adjunct to the physical exam. In human med, the follow up of
conditions like mitral valve insufficiency is covered by insurance but in vet
med, it gets expensive going to the recommended cardiology visits paying out
of pocket. Plus, we can use ultrasound for a lot of routine and emergency
procedures.

------
nerpderp83
I saw no mention if they removed the ability for it to sex a fetus, if they
haven't it will be a tool for aborting female babies.

~~~
guelo
That seems like an impossible feature for an imaging device. I guess you could
train a neural network to recognize fetus gender and blur out the crotch area
on the image.

~~~
nerpderp83
They rely heavily on AI for processing the data, they absolutely could remove
the ability for gender identification.

~~~
pcl
That depends on how they're applying their "AI technology." Maybe it's to
improve the SNR for a given pixel? Maybe it's to interpolate additional
resolution between pixels / lines? It seems possible, but not necessarily
likely, that they're doing whole-image post-processing / analysis.

------
raldi
They should sell these at a huge discount in exchange for an agreement to
share imaging data and eventual diagnosis back to the company, as training
data for their AI. An AI that could identify medical issues on an ultrasound
with greater accuracy than a doctor would be worth a fortune -- and genuinely
make the world a better place.

------
spydum
I know it's been studied extensively, but doesn't fda and others still advise
caution about frivolous use?

~~~
et2o
ultrasound is pretty harmless. Consequences about frivolous use would mostly
be due to unintended discoveries that might require further investigation,
which can be dangerous.

------
philip1209
Another great medical device that piggy-backs on an iPhone is the FDA-approved
spirometer Wing:

Http://mywing.io

------
marknadal
There is a lot of hate in these comments for this being a surprisingly cheap
and potentially disruptive technology.

I was just having a lengthy discussion with an ultrasound technician last
week. He himself admitted that:

1) The classes he found for free on YouTube were just as good as his technical
training and certification.

2) These new smaller devices are actually superior to the older/larger
machines because the signal is processed locally rather than remotely (on the
machine through the cable). He said he regularly has to deal with
interference/noise from the cable itself.

The $2K price point is half anything else I have seen on the market. But I
also suspect they'll be able to get this 10X cheaper within 4 years.

If nobody bothered doing this, this was going to be on my bucketlist of
companies to start. It has massive potential, I'm glad somebody else is paving
the way though.

Finally, medical imaging like this has already been proven to be a sweet spot
and a hotbed for the modern day AI wave (even if we have another winter, it is
the right tech for the right time). Similar fields, such as skin conditions,
etc. has seen AI expertise trained and accurate well beyond even first world
doctors.

This is a game changer for sure.

------
sharpshadow
Very good! I'm looking forward to this high-end gadget future. Also stumbled
today over Lumu Power[1] which I will probably acquire.

[1] [https://lu.mu](https://lu.mu)

------
archeonkhan
What is the point of this, at all?

------
madengr
It won’t do a damn thing in the USA since it “can’t” be used for diagnosis.
The incumbent industry will make sure it is not approved.

~~~
rcdmd
That's not how FDA approval works. It's actually easier for device approval
when others entered the space first thanks to the "substantially equivalent"
510(k) process. Here's a link to Butterfly's premarket approval:
[https://www.accessdata.fda.gov/cdrh_docs/pdf16/K163510.pdf](https://www.accessdata.fda.gov/cdrh_docs/pdf16/K163510.pdf)

