Blog | Thursday, December 20, 2018

More disruption of handheld ultrasound


A few years ago I wrote a wistful piece about the potential for hand held ultrasound devices to displace the stethoscope from its totemic perch at the meeting of patient and doctor. That has not happened yet, but another new device might bring us closer.

I recently learned about a new hand held ultrasound device, the Butterfly.

The obvious distinction between this and earlier machines is that it is an extension of the already ubiquitous technology of the iPhone. It also integrates the probe and phone with a cloud-based storage site where, the company promises, images may be securely stored and shared among appropriately credentialed users. As the company's website suggests, all you need to do is “Sign into the Butterfly iQ mobile app using your Butterfly Cloud credentials, attach the probe to your phone, and start scanning.” And in case you thought this was all about making cardiac auscultation obsolete, the butterfly is designed to accommodate a full range of ultrasound exams, including abdominal, vascular, soft tissue, and obstetric. It is priced “starting at under $2K.”

I can't help but remember my days on-call as a cardiology fellow when, if an emergency echocardiogram was indicated, I would have to push a very heavy, very large ultrasound “cart” to the patient's room, complete with (and here I certainly date myself) a VHS tape recorder, a dedicated cardiac ultrasound machine that cost hundreds of thousands of dollars, and a large (not flat!) TV screen. I bet the whole contraption weighed more than I did.

The real story here, however, is not just about the technology getting smaller and cheaper. It is that the technology is now smaller, cheaper and more capable enough to imagine it being used in completely new and different ways. What happens when the device is a few hundred dollars and linked with cloud-based neural network based artificial intelligence that not only records images but interprets them?

I canrecord my ECG with my watch today. What if, in the near future, I could do an echocardiogram any time I choose and obtain an immediate “machine read” of my left ventricular function? What if a pregnant woman could do her obstetrical ultrasound at home? What if the parent of a teenager with right lower quadrant pain could rule out appendicitis without interacting with a physician?

I think we are entering a very different era, characterized by distributed “smart” technology that will empower patients, and profoundly change how patients and physicians interact. We've been driving an old Buick and are about to step into a self-driving “transportation pod.”

What do you think?

Ira S. Nash, MD, FACP, is the senior vice president and executive director of Northwell Health Physician Partners, and a professor of cardiology and professor of occupational medicine, epidemiology, and prevention at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He is board certified in internal medicine and cardiovascular diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining Northwell Health. He is married with two daughters and enjoys cars, reading biographies, and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.