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.
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.
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.
I'm not kidding, it's very real: http://forever-yours.us/3d-4d-ultrasounds-2/
Our first child came very late, and in those last weeks we downloaded a "baby heart monitor" on our iphone - it simply used the microphone with some isolation / amplification. We pressed the microphone end of the phone into the abdomen wall, and when it works we heard an amplified heartbeat out the speakers - very reassuring. But when it didn't work - when we couldn't find the heartbeat - we worried. Is it a false negative? Or should we rush to the hospital?
You could hear baby heart and also blood rushing to placenta. And those have distinct sounds and places you could check.
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.
[1] http://www.nbcnews.com/id/10309963/ns/health-womens_health/t...
I think "pocket" ultrasound will be (and is being) adopted by EMS well before it makes inroads in primary care.
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?
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.
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. :-/
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.
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).
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.
> More education and
> empowerment is the answer,
> not less
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.
0. https://twitter.com/matthewherper/status/923897406776889344
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?
[1]: https://en.wikipedia.org/wiki/Focused_assessment_with_sonogr...
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
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
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.
We're constantly led to believe that the revolution is coming where you can snap a photo of your arm, send it to the health service and get a diganosis. That's not happening for a long time, I think.
> “And saving those images is required to bill for the scan,” he notes.
If that throwaway comment doesn't worry people, then I don't know what does. I can understand low resolution, health risks, but a principle barrier to the hospital is that they can't charge you for using it? Fuck that system, quite frankly.
But the good news is that it's rooted in the hopefully-soon-to-be-obsolete pricing model. If ultrasound devices really can get down into the $2000 price range, then the good doctors will buy them as a cost of doing business, and just not bill for the ultrasound readings. Wait a decade or so, and that'll percolate from the good doctors to the rest of the field.
Yes, there are perverse incentives etc. etc., but I know a number of doctors who are in it for the love of medicine and helping people. The bureaucracy changes course slowly, but those leaders can and do make a difference over time.
A few caveats. One, telepresence. You can have the specialist basically be there with you as you operate the probe. Everything gets done in office and the patient doesn't have to travel which can be a big deal in rural communities. I find most urban GPs don't even have a second thought about sending patients off for a scan at some other office.
Following that would be very remote doctors, those that might be labeled as a GP, but basically have to have a ton of specialist knowledge because of the wide range of things they might need to do.
And of course vets, especially large animal vets. Who are already using cool devices such as head mounted displays to view the ultrasound as they generally have their arm all the all the way up an animals rear end.
One of the main health issue is waiting to fix an issue. Cost and exam delay are both factors into letting things sink deeper.
Also, lots of medical tech is IMO (feel free to take me down on this one) stuck into analog electronics and physics of the past[1]. Namely one way information live flow. Today we may be able to compensate through software logic. Think super resolution algorithms used in space exploration. Now just think how neat it would be to make use of these smartphone GPUs for once .
[1] don't get me wrong, they did breathtaking thinking most of the time, but it's a difficult art and not necessarily the best solution today.
timely :)
Is this as good as it seems, or are there features this lacks which prevents it from being that useful in the hospital setting?
$150k machines come with a high price tag because they also come with a reputation (and even financial guarantees) of accuracy. This minimizes risk to the hospital.
This is a new device, from a new manufacturer, based on a new technology. Health systems will be extremely hesitant about adopting this until it has some real world experience. They'll want to make sure that they if their are risks with the device and if the manufacturer looks to be around in the long run.
I could see this being somewhat popular when the decision is the alternative is no ultrasound at all. If the health system has a proven system, they'll like look to use that before this device.
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.
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?
Resolution is driven by the number of piezoes. Previous low cost ultrasound sensors skimped on the number in the array, which limited effective resolution. Aside from the piezos themselves, you need enough real time inputs to process them.
It seems like this one does better, though details are scant.
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?
http://www.nytimes.com/2005/11/25/opinion/missing-50-million...
http://shanghaiist.com/2017/07/12/ultrasound-van.php
http://www.havocscope.com/cost-for-illegal-ultrasound-and-ab...
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.
0 - https://www.absolutemed.com/picts/products/tnw800-GE-Voluson...
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.
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.
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.
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.
Given the size and cost of a conventional cart-based machine, I think the pocket one is more well suited.
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.
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.
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.
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.
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.
Http://mywing.io
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.
[1] https://lu.mu
