With crowded hospitals and a nationwide shortage of general practitioners, can this new technology help triage our struggling healthcare system?
This is the world’s first low-cost, fully-portable ultrasound scanner. I first saw it demonstrated in May at Apple Park, the tech giant’s headquarters in Cupertino, California. Now, the Butterfly IQ is about to go on sale in New Zealand and priced at less than $3,000, promises to make examinations via ultrasound for everything from pregnancy scans to heart examinations.
The device follows a well-beaten path in the world of tech – miniaturising and redesigning sophisticated equipment to fit on a silicon chip and using the processing power of a device that sits in the pocket of millions, the smartphone.
Ultrasound on a chip
Ultrasound works by sending out high-frequency sound waves directed at the part of the body being examined and recording the reflected sound or echoes to create an image.
“For the last 50-plus years, all ultrasound has been predicated on piezoelectric crystals,” says Butterfly Network’s head of growth, Darius Shahida.
The delicate crystals are wired up and tuned to produce three types of ultrasonic waves: linear, curved and phased. But ultrasound machines are typically bulky and expensive, costing upwards of US$50,000.
“For the first time ever, we actually engineered a fundamentally new technology by putting ultrasound on a semiconductor chip,” says Shahida.
The computer chip in the Butterfly IQ carries thousands of sensors, like a grid of tiny drums, that wobble to produce all three of the ultrasonic wave patterns doctors need to view inside different parts of the body at different depths.
As such, it allows highly accurate scans to be taken at a patient’s bedside or in a GP’s clinic, avoiding the usual route of booking appointments on ultrasound machines, which are usually in high demand in hospitals.
“The difficulty, historically, has been, if I want to answer a question with an image, that's a destination. I send you for an X-ray, I send you for an ultrasound,” says Dr John Martin, Butterfly Network’s chief medical officer.
“I wait for you to come back to initiate therapy. The time delay in instituting therapy becomes a critical factor in inaction. The sooner we make a diagnosis, the sooner I can institute therapy, the sooner people get better.”
From genetics to ultrasounds
The effort to put ultrasound on a chip was driven by Butterfly Network founder, Dr Jonathan Rothberg, a US biotech entrepreneur who pioneered next-generation genetic sequencing through two companies, 454 Life Sciences and Ion Torrent, which were sold in sizeable deals that gave Rothberg the cash to put into Butterfly Network.
Rothberg had used computer chips to reinvent genetic sequencing technology, which he now applied to ultrasound, motivated by his own personal experience; his daughter was diagnosed with a form of tuberous sclerosis and developed tumours and cysts on her kidneys.
She had to make regular visits to doctors offices for different types of ultrasound scans. Rothberg thought there must be a better method and went to work fusing the underlying ultrasound technology with silicon chips.
It may turn out to be his biggest success. In September, Butterfly Network raised US$250 million in capital from investors, including the Gates Foundation, giving it a valuation north of US$1 billion.
The IQ device has received tens of thousands of orders since it was granted 13 different device clearances from the US Food and Drug Administration – crucial endorsement that it could perform as well as existing ultrasound devices on the market.
“There are different questions that you can answer with a $50,000 or $60,000 system, but for typical questions we want to answer at the point of care at the bedside, this device meets that standard of having the image quality that physicians demand to make the kind of clinical decisions that we need to make,” says Martin.
While the chip in the Butterfly IQ produces the images, the device also harnesses the Core ML feature in newer models of iPhones and iPads. This machine learning framework allows sophisticated processing of information and imagery on the mobile device.
In Cupertino, that manifested itself as an augmented reality overlay on the ultrasound images coming from the Butterfly IQ device itself. It allowed the operator to navigate and make sense of the imagery and is available as an app download from Apple’s App Store for a monthly subscription (US$420 for a single licence).
In New Zealand, where the Butterfly IQ went on sale today, Martin sees it being used both in hospitals to speed up ultrasound testing as well as in GP practices. Butterfly Network is hiring a team to support customers using the gadget and will initially support New Zealand customers from Australia.
But there may also be a role for the Butterfly IQ in the home as well.
“The obvious one for us is congestive heart failure, where people actually have a problem with do with build-up [of fluid] in their lungs,” says Martin.
Use at home
Users could scan themselves using the Butterfly IQ and an iPhone and send their images to their doctor to examine. Patients suffering a bladder condition that required them to insert a catheter into their bladder could also benefit from a handheld ultrasound device, scanning themselves to check when the catheter needed to be inserted.
“Right now, that is actually done arbitrarily, by the clock, rather than what actually physiologically needs to be done when your bladder is full,” says Martin. Trials involving home use of the device were underway in the US.
Ultimately, the Butterfly IQ device may have its greatest impact in the developing world, where ultrasound equipment is in limited supply in many cities and towns.
In Uganda, the device is being used by healthcare workers to detect paediatric pneumonia replacing X-ray where no imaging is available. In Kenya, clinic workers are using the Butterfly IQ to assess pregnant women, who typically wouldn’t have regular access to scans during their pregnancy.
The Butterfly IQ is one of a growing range of medical devices designed to work with smartphones to tackle health issues that are expensive and time-consuming to treat. New Zealand company oDocs has developed an attachment for an iPhone that allows doctors to easily detect macular degeneration, which can lead to blindness in developing countries where eye care is unavailable to millions.
Healthcare on the phone
The Triton Sponge is an iPad app used in medical operating rooms to quickly calculate and keep track of blood loss collected by surgical sponges and suction canisters. The app uses iOS technologies like Core Image and camera Depth Map to detect sponges, as well as Core ML and machine learning to perform complex blood loss calculations to improve patient care.
Another iOS-based app also utilises the Apple Watch. The Dexcom G5 Mobile is a real-time continuous glucose monitoring system approved for adults and children 2 years and older. Using Bluetooth technology that is built into the transmitter, Dexcom G5 Mobile allows for complete remote viewing of glucose levels, trends and data from compatible smart devices.