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  • Rewriting Life

    This Doctor Diagnosed His Own Cancer with an iPhone Ultrasound

    Can a smartphone-enabled ultrasound machine become medicine’s next stethoscope?

    • by Antonio Regalado
    • October 27, 2017
    • “To look at this as just an ultrasound device is like looking at an iPhone and saying it’s just a phone.”

    Every marketer wants the perfect story to tell. But if you’re in medicine, you don’t want it to be about yourself.

    Earlier this year, vascular surgeon John Martin was testing a pocket-sized ultrasound device developed by Butterfly Network, a startup based in Guilford, Connecticut, that he’d just joined as chief medical officer.

    He’d been having an uncomfortable feeling of thickness on his throat. So he oozed out some gel and ran the probe, which is the size and shape of an electric razor, along his neck.

    On his smartphone, to which the device is connected, black-and gray images quickly appeared. Martin is not a cancer specialist. But he knew that the dark, three-centimeter mass he saw did not belong there. “I was enough of a doctor to know I was in trouble,” he says. It was squamous-cell cancer.

    The device he used, called the Butterfly IQ, is the first solid-state ultrasound machine to reach the market in the U.S. Ultrasound works by shooting sound into the body and capturing the echoes. Usually, the sound waves are generated by a vibrating crystal. But Butterfly’s machine instead uses 9,000 tiny drums etched onto a semiconductor chip.

    The Butterfly IQ is the first solid-state ultrasound machine to reach the market in the U.S.

    Making ultrasound devices in a semiconductor manufacturing plant, the company says, makes the technology cheaper and more versatile. It says its machine will go on sale this year for $1,999—far less than any other model on the market.

    “Now we think it’s an individual purchase,” says Martin. “This gives you the ability to do everything at the bedside: you can pull it out of your pocket and scan the whole body.”

    Ultrasound—once practiced only by technicians—has already been spreading among medical specialties as a more routine type of exam. In emergency rooms, doctors use it to quickly look inside a patient’s heart, lungs, and stomach without x-rays. But there’s resistance. Hospitals create revenue by using big, costly machines run by specialists. 

    Butterfly was started in 2011 by Jonathan Rothberg, an entrepreneur who specializes in adapting semiconductor technology to biology. He previously invented a method of sequencing DNA on a chip.

    It took eight years for Rothberg to move the idea for the ultrasound device from concept to market. Instead of vibrating crystals, it uses “capacitive micro-machined ultrasound transducers,” or CMUTs, tiny ultrasonic emitters layered on a semiconductor chip a little larger than a postage stamp.

    The mass Dr. Martin discovered with his Butterfly IQ turned out to be cancer.

    The company, which has raised more than $100 million so far, is entering a market already crowded with an earlier generation of portable ultrasound scanners like Philips’s Lumify, which costs around $6,000 and uses the older crystal technology. The lower cost of the new device means it will have to sell a lot of them to make a profit. “It seems like they’ll need to drive the volume of ultrasound scanners far beyond what it is now,” says Richard Przybyla, cofounder of Chirp Microsystems. 

    John Kendall, ultrasound director at the emergency department of Denver Health Medical Center, who is one of the company’s advisors, says the images the device creates aren’t as detailed as those produced by high-end ultrasound machines rolled around on carts. But, he says, “the question is whether I can get to a diagnostic answer better.” Considering the device’s cost and the way he can fit it into the top pocket of his scrubs, “it’s not even a fair comparison,” he concludes. “It’s infinitely portable. It’s not even the same genre of machine.”

    The company says it hopes to combine the instrument with artificial-intelligence software that could help a novice position the probe, collect the right images, and interpret them. By next year, it believes, its software will let users automatically calculate how much blood a heart is pumping, or detect problems like aortic aneurisms. Work in that direction is described in a video released by the company.

    Automating interpretation of fuzzy ultrasound images could eventually turn the technology into something easily used by ambulance crews, in remote regions, or even at home. “The ability to acquire an image and know what you are seeing—I think it’s coming,” says Kendall.

    An ultrasound of a beating heart.
    4CATALYZER

    Martin, who since diagnosing his cancer has undergone a five-and-a-half-hour surgery and radiation treatment, believes the devices can take on new shapes, like a patch that could be sent home with patients. Perhaps before too long a parent might diagnose a kid’s fracture at home.

    “To look at this as just an ultrasound device is like looking at an iPhone and saying it’s just a phone,” he says. “If you have a window into the body where anyone can afford it, everyone can use it, and everyone can interpret it, it becomes a heck of a lot more than an ultrasound device.”

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