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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 enou

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.

JshWright 9y ago
Where 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.
- davycro 9y ago
  Agreed, it’s better for acute complaints instead of routine physical exams. If a patient with COPD or CHF comes into your primary care office with a little cough, then you could enhance your bedside workup with a quick cardiac and pulmonary ultrasound. You could see if they have pleural effusions, pulmonary edema, consolidations, and make an informal assessment of their ejection fraction. This info takes about two minutes to acquire, and helps you rule-out dangerous diagnosis.
jbandela1 9y ago
I agree with your assessment. In my experience, ultrasound has revolutionized trauma care - basically getting rid of the invasive Diagnostic Peritoneal Lavage (where they put a needle in the abdomen, inject liquid, suck it out, and then see if it has blood in it). Other examples where it can be used in a primary care setting: 1. Carotid stenosis (narrowing) - we know that this can be a cause of stroke and listening by stethoscope is likely useless (the really narrowed arteries don't produce much noise). Having ultrasound that is cheap and accessible might help catch more of these cases in a primary care setting 2. Heart defects resulting in athlete sudden deaths. Having a primary care doctor evaluate an athlete's heart during a sports physical with ultrasound might help catch some of these cases. 3. Outpatient evaluation of deep vein thrombosis in sedentary populations. This is important because this can help stop blood clots to the lungs. However, as with your examples, these use cases all involve a medically trained operator. Like you, I am not seeing a lot of potential consumer use cases.
haimez 9y ago
Counter point to your whole argument: medical professionals without the funding to acquire "proper" hardware. This isn't a DIY solution for hypochondriacs, it's access to technology that might not otherwise be able to afford it. Maybe veterinarians too.
- ndh2 9y ago
  That's not a counter point at all. It said "Many comments ask if non-medical persons would use ultrasound should it become affordable. I think not."
- photojosh 9y ago
  Yup! I'm halfway through the comments, and yet to see a mention of how cheap ultrasound machines would be a massive boon for healthcare in developing countries.
  - nbanks 9y ago
    This is the first thing that came to mind. The second is giving med students more hands on time with ultrasounds. The price is low enough that students could practice on each other in class.
Waterluvian 9y ago
I saw ultrasounds live for the first time last year due to a worry about my son's nose bone. My thought was that sonogram interpretation is an impressive skill to develop. I've done remote sensed imagery interpretation for a few years in university and it felt like just that. To a normal person it's just blurry blobs but to an expert it's a map.
woolvalley 9y ago
How about using an ultrasound for body composition? http://intelametrix.com/FullSite/ http://intelametrix.com/FullSite/ BodyMetrix has been around for a while and has about the same price of $2000
- rsingla 9y ago
  Great point - the difference between portable ultrasound machines like the one presented here and the Butterfly Network one is the mode of operation. The BodyMetrix system uses A-mode (Amplitude Modulation) which essentially uses one signal or pulse and plots the amplitude change over depth. The changes in amplitude correspond to differences in tissue. [I conclude they use A-mode from the abstracts of the papers linked in their Science and Validation section] The Butterfly Network system is a B-mode (Brightness Modulation) one. These have traditionally had many signals and are used to create the greyscale images commonly seen when referring to ultrasound. B-mode imaging has traditionally required a fair amount more in terms of hardware, software, and thus cost.
crdb 9y ago
> 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.
- viraptor 9y ago
  > with "complications" mid-pregnancy because... That's terrible :-( I know many GPs in Australia would love to do the ultrasound for them + bill for it, but it would be pretty affordable. This case is literally the reason mentioned at GP conferences for why you could buy an ultrasound - to make pregnant women happy because they see the pictures.
- CobrastanJorji 9y ago
  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/
  - deleted 9y ago
    [deleted]
  - goldenkey 9y ago
    Thats actually really affordable considering how often people have children. The teddy bear thing is a really cool idea.
  - 9y ago
narrator 9y ago
The possibilities with deep learning are ridiculous. A doctor could point it at someone's heart or stomach and it could tell if it was normal heart or there was a problem with it and possibly what kind of problem.
- viraptor 9y ago
  In reality, we can't even get good results from ECG readings, and that's "pure data". Ultrasound results would be way harder (depending on position, orientation, person's body)
TeMPOraL 9y ago
I wonder what about industrial use? Wouldn't USG be useful e.g. as a cheaper alternative to x-rays in searching for hidden structural damages in materials?
- robryk 9y ago
  The reason you need a gel between the USG head and the body is to bridge the gap with something of a similar speed of sound. Barriers between materials of significantly different speed of sound reflect large part of sound waves; having such a strong barrier at the skin would make the SNR much worse. Speed of sound in metals is much larger than speed of sound in water or air. I'm unaware of liquids that could be used in place of USG gel for examining metal objects (maybe mercury? but that would be bad from the environmental and health/safety POV).
robryk 9y ago
> 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. Out of curiosity's sake: IIUC blood thinners help a patient with an ischaemic stroke, but are harmful for patients with hemorrhagic stroke. Am I right? If so, how do people usually quickly rule out hemorrhagic stroke?
- Gatsky 9y ago
  Head scan. CT or MRI.
  - davycro 9y ago
    Correct. We do a non-contrast head ct and ct angiogram of the head/neck before giving tPA. In this case we may have found the carotid dissection on the ct angiogram.
wildlogic 9y ago
I have chronic kidney stones (over 100 at age 30) and would absolutely pay $2000 for a personal ultrasound. Often it is difficult for me to tell whether it is just a rough passage (extremely painful but not a medical emergency), or a large stone obstructing my ureter causing hydronephrosis (medical emergency). With a personal ultrasound, I would be able to look at my bladder and see urine flowing from the kidneys to rule out blockage and prevent a trip to the ER. Granted, I'd probably still have to go to the ER because it is difficult in the states (in my experience) to get access to adequate pain control in a non-emergency setting.
- oceanghost 9y ago
  Hi, off topic but-- my father had these, several a year for two decades. Some mornings we would wake to a note on the counter that said something like "Kidney stone, at the hospital." That being said-- the trick for him turned out to be stopping soda, and keeping a water bottle by his bed and drinking a gulp of water everytime he woke up-- basically staying hydrated during the evening, and at all other times. Just wanted to mention this in case it was of any use. Also, keep an eye on RCC. :-/
  - wildlogic 9y ago
    Appreciate the reply, thanks!
  - Balgair 9y ago
    While on the subject: https://www.webmd.com/kidney-stones/extracorporeal-shock-wave-lithotripsy-eswl-for-kidney-stones https://www.webmd.com/kidney-stones/extracorporeal-shock-wav...
crankylinuxuser 9y ago
I'm glad you responded. Ive had ultrasounds, and CAT, PET, and MRI before. Never knew you could glean so much information off of an ultrasound. Now, for the hacker/maker community - maybe you won't know this offhand. But are there applications for ultrasound outside of medical? Would it be good for 3d scanning internal structures of a certain size? Can it find/detect cracks inside substrates, like how Xrays is used in weld defect detection? Im just as curious at the non-medical as the medical. And it'd be damn nice to be able to ultrasound myself and go, "that dont look right". Im not a doc, but I live with my body 24/7.
- detaro 9y ago
  Ultrasound is used to detect faults in materials (cracks in metal etc), yes. I think also for some measurements in fluids.
  - deleted 9y ago
    [deleted]

JshWright 9y ago

Where 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.

davycro 9y ago
Agreed, it’s better for acute complaints instead of routine physical exams. If a patient with COPD or CHF comes into your primary care office with a little cough, then you could enhance your bedside workup with a quick cardiac and pulmonary ultrasound. You could see if they have pleural effusions, pulmonary edema, consolidations, and make an informal assessment of their ejection fraction. This info takes about two minutes to acquire, and helps you rule-out dangerous diagnosis.

jbandela1 9y ago

I agree with your assessment. In my experience, ultrasound has revolutionized trauma care - basically getting rid of the invasive Diagnostic Peritoneal Lavage (where they put a needle in the abdomen, inject liquid, suck it out, and then see if it has blood in it). Other examples where it can be used in a primary care setting: 1. Carotid stenosis (narrowing) - we know that this can be a cause of stroke and listening by stethoscope is likely useless (the really narrowed arteries don't produce much noise). Having ultrasound that is cheap and accessible might help catch more of these cases in a primary care setting 2. Heart defects resulting in athlete sudden deaths. Having a primary care doctor evaluate an athlete's heart during a sports physical with ultrasound might help catch some of these cases. 3. Outpatient evaluation of deep vein thrombosis in sedentary populations. This is important because this can help stop blood clots to the lungs. However, as with your examples, these use cases all involve a medically trained operator. Like you, I am not seeing a lot of potential consumer use cases.

haimez 9y ago

Counter point to your whole argument: medical professionals without the funding to acquire "proper" hardware. This isn't a DIY solution for hypochondriacs, it's access to technology that might not otherwise be able to afford it. Maybe veterinarians too.

ndh2 9y ago
That's not a counter point at all. It said "Many comments ask if non-medical persons would use ultrasound should it become affordable. I think not."
photojosh 9y ago
Yup! I'm halfway through the comments, and yet to see a mention of how cheap ultrasound machines would be a massive boon for healthcare in developing countries.
- nbanks 9y ago
  This is the first thing that came to mind. The second is giving med students more hands on time with ultrasounds. The price is low enough that students could practice on each other in class.

Waterluvian 9y ago

I saw ultrasounds live for the first time last year due to a worry about my son's nose bone. My thought was that sonogram interpretation is an impressive skill to develop. I've done remote sensed imagery interpretation for a few years in university and it felt like just that. To a normal person it's just blurry blobs but to an expert it's a map.

woolvalley 9y ago

How about using an ultrasound for body composition? http://intelametrix.com/FullSite/ http://intelametrix.com/FullSite/ BodyMetrix has been around for a while and has about the same price of $2000

rsingla 9y ago
Great point - the difference between portable ultrasound machines like the one presented here and the Butterfly Network one is the mode of operation. The BodyMetrix system uses A-mode (Amplitude Modulation) which essentially uses one signal or pulse and plots the amplitude change over depth. The changes in amplitude correspond to differences in tissue. [I conclude they use A-mode from the abstracts of the papers linked in their Science and Validation section] The Butterfly Network system is a B-mode (Brightness Modulation) one. These have traditionally had many signals and are used to create the greyscale images commonly seen when referring to ultrasound. B-mode imaging has traditionally required a fair amount more in terms of hardware, software, and thus cost.

crdb 9y ago

> 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.

viraptor 9y ago
> with "complications" mid-pregnancy because... That's terrible :-( I know many GPs in Australia would love to do the ultrasound for them + bill for it, but it would be pretty affordable. This case is literally the reason mentioned at GP conferences for why you could buy an ultrasound - to make pregnant women happy because they see the pictures.
CobrastanJorji 9y ago
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/
- deleted 9y ago
  [deleted]
- goldenkey 9y ago
  Thats actually really affordable considering how often people have children. The teddy bear thing is a really cool idea.
- 9y ago

narrator 9y ago

The possibilities with deep learning are ridiculous. A doctor could point it at someone's heart or stomach and it could tell if it was normal heart or there was a problem with it and possibly what kind of problem.

viraptor 9y ago
In reality, we can't even get good results from ECG readings, and that's "pure data". Ultrasound results would be way harder (depending on position, orientation, person's body)

TeMPOraL 9y ago

I wonder what about industrial use? Wouldn't USG be useful e.g. as a cheaper alternative to x-rays in searching for hidden structural damages in materials?

robryk 9y ago
The reason you need a gel between the USG head and the body is to bridge the gap with something of a similar speed of sound. Barriers between materials of significantly different speed of sound reflect large part of sound waves; having such a strong barrier at the skin would make the SNR much worse. Speed of sound in metals is much larger than speed of sound in water or air. I'm unaware of liquids that could be used in place of USG gel for examining metal objects (maybe mercury? but that would be bad from the environmental and health/safety POV).

robryk 9y ago

> 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. Out of curiosity's sake: IIUC blood thinners help a patient with an ischaemic stroke, but are harmful for patients with hemorrhagic stroke. Am I right? If so, how do people usually quickly rule out hemorrhagic stroke?

Gatsky 9y ago
Head scan. CT or MRI.
- davycro 9y ago
  Correct. We do a non-contrast head ct and ct angiogram of the head/neck before giving tPA. In this case we may have found the carotid dissection on the ct angiogram.

wildlogic 9y ago

I have chronic kidney stones (over 100 at age 30) and would absolutely pay $2000 for a personal ultrasound. Often it is difficult for me to tell whether it is just a rough passage (extremely painful but not a medical emergency), or a large stone obstructing my ureter causing hydronephrosis (medical emergency). With a personal ultrasound, I would be able to look at my bladder and see urine flowing from the kidneys to rule out blockage and prevent a trip to the ER. Granted, I'd probably still have to go to the ER because it is difficult in the states (in my experience) to get access to adequate pain control in a non-emergency setting.

oceanghost 9y ago
Hi, off topic but-- my father had these, several a year for two decades. Some mornings we would wake to a note on the counter that said something like "Kidney stone, at the hospital." That being said-- the trick for him turned out to be stopping soda, and keeping a water bottle by his bed and drinking a gulp of water everytime he woke up-- basically staying hydrated during the evening, and at all other times. Just wanted to mention this in case it was of any use. Also, keep an eye on RCC. :-/
- wildlogic 9y ago
  Appreciate the reply, thanks!
- Balgair 9y ago
  While on the subject: https://www.webmd.com/kidney-stones/extracorporeal-shock-wave-lithotripsy-eswl-for-kidney-stones https://www.webmd.com/kidney-stones/extracorporeal-shock-wav...

crankylinuxuser 9y ago

I'm glad you responded. Ive had ultrasounds, and CAT, PET, and MRI before. Never knew you could glean so much information off of an ultrasound. Now, for the hacker/maker community - maybe you won't know this offhand. But are there applications for ultrasound outside of medical? Would it be good for 3d scanning internal structures of a certain size? Can it find/detect cracks inside substrates, like how Xrays is used in weld defect detection? Im just as curious at the non-medical as the medical. And it'd be damn nice to be able to ultrasound myself and go, "that dont look right". Im not a doc, but I live with my body 24/7.

detaro 9y ago
Ultrasound is used to detect faults in materials (cracks in metal etc), yes. I think also for some measurements in fluids.
- deleted 9y ago
  [deleted]