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Butterfly iQ – A cheap handheld ultrasound tool with AI smarts inside
- madengr 9y agoIt 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 9y agoThat'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
- maxander 9y agoI’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.
- jazoom 9y agoI'm looking forward to having an inexpensive portable USS to help find veins. I doubt consumers will pay for one of these, except maybe for pregnancy.
- JshWright 9y agoYeah, this sort of thing is making quick inroads in prehospital care (this is far from the first portable ultrasound). Finding veins, FAST[1] scans, assessing the heart more directly during cardiac arrest, etc. [1]: https://en.wikipedia.org/wiki/Focused_assessment_with_sonography_for_trauma https://en.wikipedia.org/wiki/Focused_assessment_with_sonogr...
- jazoom 9y agoWe've been using portable USS machines for years but I suppose what I meant is one I can keep in my pocket and one that doesn't cost $150000.
- JshWright 9y agoThe GE Vscan has been around for years.
- jazoom 9y agoThat's interesting. I've not seen that before. Still seems to be far more expensive than what I'm thinking of, though. I'm looking forward to the day when every junior doctor can have one around their neck like every doctor has a stethoscope.
- JshWright 9y agoWhy? What gap do you think it fills in the routine assessment? I'm all for expanding access to US, but I'm very wary of throwing gadgets for the sake of gadgets at doctors...
- jazoom 9y agoPatients who need an IVC and have brittle veins and peripheral oedema. It comes up a lot. I never said anything about routine assessment.
- QAPereo 9y agoThe benefits of portable units at a non-devastating price have more implications for democratization of quality of care than anything else. WebMD and Google have already let the other genie well and truly out of the bottle. Edit: By the way years ago I read an article which talked about the price of ultrasound devices, and the bottleneck was the price of the transducers. Obviously that’s changed, but when did that change? Does anyone here know?
- tachydyne 9y agoI work for a competitor to Butterfly, and the main difference between this device and other ultrasound transducers is the use of a CMUT array instead of the typical piezoelectric crystal. CMUT arrays are MEMS devices, made in a semiconductor fab using the same processes as other ICs. This makes them cheaper to produce than traditional arrays where the elements have to individually sliced and wired to the electronics. CMUT isn't new, it's been being worked on for 20 years, but it isn't used because it is much less sensitive than the piezoelectric arrays. Either Butterfly has made a breakthrough and are choosing growth over profit margins, or they are trying to make up for worse performance with a much cheaper price. We won't know which until their device is actually on sale.
- QAPereo 9y agoIncredibly informative answer, thanks so much. One last thing, do you personally believe “breakthrough” or “discount” in this case?
- tachydyne 9y ago20 years of CMUT being the next big thing in ultrasound has left me a sceptic, but I know some really smart people at Butterfly. I don't think they would bring a device to market that they didn't think was competitive. My guess is that it'll be okay, not the best imaging handheld device on the market but better than several of our competitors.
- 9y ago
- adenadel 9y agoFor now, this isn't a consumer device [0] 0. https://twitter.com/matthewherper/status/923897406776889344 https://twitter.com/matthewherper/status/923897406776889344
- agumonkey 9y agoThis is a non issue IMO, it would probably self correct in a few months. Also you could still take advantage of that. The patient who made a few ultrasound videos along a period of time and still has pain worth seeing a doctor, can now spare the doctor some time by showing him a bit more data. Could be a data hell too I must admit, but somewhere somehow I'd hope people to learn a bit about biology and physics in the process and 1) know more 2) know when not to panic 3) know how to take care of their bodies
- tehlike 9y agoThats technology. At some point you can see remote doctor sessions being a thing, and robotic doctors carrying out some basic surgeries.
- mikenew 9y agoI’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 9y ago> 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 9y agoIs 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=homeopathy https://trends.google.com/trends/explore?date=all&q=homeopat...
- mschuster91 9y ago> 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#Bundesrepublik_Deutschland_ab_1990 https://de.wikipedia.org/wiki/Hom%C3%B6opathie#Bundesrepubli...). 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-measles-deaths-in-europe-80909 http://theconversation.com/whats-behind-the-sudden-rise-in-m...).
- averagewall 9y agoAre you saying proponents of quackery might misread somebody's home ultrasound or give misleading advice on how to read it? That doesn't sound any worse than what could happen with thermometers, stethoscopes, blood pressure meters, athlete wristbands, and inspecting the color of phlegm, poo, urine, skin, etc. Nobody would want to hide those things from people for their own safety.
- samfisher83 9y agoMaybe we can use machine learning to train a computer to identify these diseases. That would lot cheaper than a doctor and with enough data it could do a pretty good job.
- et2o 9y agoultrasound is pretty much the worst imaging modality to do this in all of medical imaging.
- jsight 9y agoI'm not convinced that the subset that would do that with an ultrasound device is really any different from the subset that does this kind of thing already.
- gotrecruit 9y agoeasy solution: charge per review of ultrasounds.
- err4nt 9y agoIf I can go get a device, and somebody qualified to read the images I produce can also inform me how and where to take pictures - I'd pay for that kind of a service. Seems like a business model to me :)
- giarc 9y agoProblem is that if you've ever had an ultrasound, it's not really something you can just tell someone how to do. They manipulate the transducer in real time, angling it just right, giving it just the right amount of pressure on the skin. Even if you did it in real time I can't imagine the frustration of a physician over the phone going "No move it to your right, now up, now back further, ok less pressure, now more pressure."
- serf 9y agoThat'll be a nice worry for doctors to have in reaction to the spread of consumer-available precision imagery equipment. Right now I think it's more valid to worry about the patients who can't receive care due to whatever host of valid economic/social/cultural reasons prevent them from doing so -- and one of the best ways to help that struggle seems to be the creation of cheaper and more available diagnostics and therapies. I don't know about this specific device -- but any competition in the medical diagnostics market that may drive device price down seems to be a benefit.
- philip1209 9y agoAnother great medical device that piggy-backs on an iPhone is the FDA-approved spirometer Wing: Http://mywing.io
- spydum 9y agoI know it's been studied extensively, but doesn't fda and others still advise caution about frivolous use?
- et2o 9y agoultrasound is pretty harmless. Consequences about frivolous use would mostly be due to unintended discoveries that might require further investigation, which can be dangerous.
- japhyr 9y agoCan 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 9y agoIn 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 9y agoCertainly 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 9y agoEven 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 9y agoEach 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/312169995 http://www.modernhealthcare.com/article/20141216/blog/312169... 2 = http://www.choosingwisely.org/patient-resources/echocardiograms-for-heart-valve-disease/ http://www.choosingwisely.org/patient-resources/echocardiogr...
- glangdale 9y agoThe 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 9y agoUltrasound 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 9y agoI'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.
- viraptor 9y ago> 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? This is likely healthcare system / country / training dependent, but yes, many local clinics will have ultrasound equipment. GPs do use it for things other than emergencies (simple pregnancy checkup, ultrasound guided injections, etc.) I know some that would find the "Can they be trained usefully" a silly/offensive question to be honest.
- sharpshadow 9y agoVery 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
- two2two 9y agoAs 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
- carbocation 9y agoIf the GP had the device, it would have taken them as long as the sonographer (or longer) to acquire the same high-quality images. In fact, it's so impractical for physicians in the US to routinely do their own ultrasounds that they hire sonographers to acquire those images. I don't think this device would have changed your experience, I'm sorry to say.
- two2two 9y agoIt appears there are courses just for physicians. [0] Also, the device itself may include a course of some sort. Without evidence, I find it hard to believe GPs aren't capable enough to use an ultrasound device. [0] https://sonosim.com/who-we-train/ https://sonosim.com/who-we-train/
- carbocation 9y agoIn my reply to you, I'm assuming that your GP is 100% capable of performing an ultrasound. Ultrasounds take a well-trained human being a long time to acquire.
- SkyPuncher 9y agoMy wife is in med school so I have a bit more familiarity with the subject than the average person. GP's being capable enough isn't the issue. It's much like blood draws. GP's are more than capable of drawing blood an sending it off to a lab, but that process requires significant support of outsides parties. It simply doesn't make sense for the GP to take care of it in house when they'll likely need to send it out to someone else. In the care of ultrasound, it also introduces an issue of "certifying" results. Taking an ultrasound isn't hard, but reading it can be difficult. Even if a GP can read an ultrasound with 90% accuracy, it's still much lower than someone who specializes in reading digital imagery. Of the 90% that a GP can read accurately, how many of those can a GP read confidently? Certainly not 90%. At that point, they might as well send you to someone who will get it right the first time.
- OkGoDoIt 9y agoSo 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-abortions-in-china/ http://www.havocscope.com/cost-for-illegal-ultrasound-and-ab...
- aaron695 9y agoAborting 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 9y agoIs 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 9y agoDime 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-daughters https://newrepublic.com/article/133845/truth-chinas-missing-...
- lancebeet 9y agoI don't understand the argument. Should the company not create this largely beneficial technology lest it be used for bad things in China? Should they be responsible for every case of people abusing the technology? Chinese companies hardly care about the fate of western blue-collar workers when they produce cheaper products for export. Nor should they, because this is not their responsibility. Similarly, the issue of illegal ultrasounds/abortions is the responsibility of Chinese society and the Chinese government, it has little to do with this product or the company developing this product.
- nerpderp83 9y agoI 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 9y agoThat 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 9y agoThey rely heavily on AI for processing the data, they absolutely could remove the ability for gender identification.
- pcl 9y agoThat 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.
- sumedh 9y agoNot sure why you are getting downvoted but if this device becomes popular in developing countries like India there will be a lot of aborted female babies.
- nbanks 9y agoI never understood the logic of this issue. If a fetus is human, then both male and female fetuses should be protected. If a fetus is not human, then this can't be a women's rights issue because women are human. If abortion is acceptable, parents should be able to choose to abort for whatever reason they want. Also if you withhold the sex of the baby in case some parents may abort due to gender, why allow screening for down syndrome since this is a much more common reason to abort?
- tynpeddler 9y ago>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 9y ago> 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.
- et2o 9y agoThere 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 9y agoYep, 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 9y agoGiven 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.
- russdill 9y agoWatch the video, this thing is mobile, but has the resolution of a full size device. But yes, thinking it will be an at home device is a bit of pipe dream.
- davycro 9y agoPerspective 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.
- JshWright 9y agoWhere do you see ultrasound being useful in the routine assessment? As a tool to rule in or out certain differentials, sure (like the examples you gave above), but I don't see the case for routine use in the GP's office. I think "pocket" ultrasound will be (and is being) adopted by EMS well before it makes inroads in primary care.
- raldi 9y agoThey 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.
- archeonkhan 9y agoWhat is the point of this, at all?
- imaginenore 9y agoOr you can get a vet ultrasound device for less than half that price on Amazon today.
- deleted 9y ago[deleted]
- marknadal 9y agoThere 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.
- itajaja 9y agoEngineer 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
- projektfu 9y agoThis 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.
- projektfu 9y agoThis 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.