The images in front of me on this Zoom call don't make much sense: There's a pie slice of noisy gray, punctuated by long, dark shadows that slide around laterally. And at the top sits a series of immobile, tightly packed layers. It's all gibberish to a layperson, but Dr. Mike Stone -- an emergency physician from Portland, Oregon -- can tell exactly what we’re looking at. It's a live ultrasound image of healthy lung tissue as seen through a ribcage. The thing is, he's not the one performing the ultrasound; instead, he's transmitting visual instructions through an app to a curly-haired Brooklynite pressing a wand to his chest.
Welcome to a new way to monitor COVID-19.
The microphone-sized wand in question is the Butterfly iQ, made by a company called Butterfly Network, and the New Yorker/good sport who peeled open his shirt on a Zoom call is Matt de Jonge, the company's VP of product. As de Jonge explained, this particular approach to medical imaging is nothing new; Butterfly Network has been squeezing its ultrasound-on-a-chip systems into $2,000 diagnostic wands that connect to iOS and Android devices for the better part of 18 months. They've gotten around, too -- in addition to being used in hospitals around the US (often by physicians who purchased the accessory personally), Butterfly iQs are also being used in over 20 countries, including a notable deployment in Uganda.
Historically, ultrasound machines have been unwieldy imaging devices that peered into the human body by beaming high-frequency sound waves into it. They also required trained medical professionals to operate them. With the fully handheld Butterfly iQ and this new, iOS-only teleguidance feature, neither of those things are strictly true anymore. And with COVID-19 reshaping the front lines of medicine, the company found itself fast-tracking its plans to help medical professionals more easily “see” patients, even from thousands of miles away.
Image credit: Butterfly Network
The beauty of Butterfly's approach to telemedicine is that you don't have to know a thing about ultrasound systems to use it. If a patient is given one to use, they can connect the iQ to their iPhones and have a professional guide them through the process, complete with on-screen cues to help them orient the probe correctly. (Thanks to a little augmented reality help, the doctor(s) on the other end of the call can see exactly which way the patient is holding the probe.) The same goes for nurses or orderlies in hospitals who don't necessarily have the training to use ultrasound equipment -- they can don their full PPE, meet with a patient, and help a physically remote physician or team of physicians find exactly what they're looking for.
"I thought initially I would use it in the ER getting images for teaching," said Dr. Stone, who also serves as Butterfly's director of education. "Now it's the only device I use. I carry with me the ability to not have to push a big cart into a room, and the ability to wipe it down immediately after use."
As the COVID-19 outbreak continues to flourish, the telltale signs doctors look for are areas of irregular opacity and thickness around the pleura, or the membranes that surround the lungs. If spotted, a doctor virtually instructing someone with a Butterfly wand can remotely control the probe's gain and depth to zero in on potential trouble spots, and record images and short video clips for further inspection. And just like that, a process that typically required multiple people in a room with a patient now requires just one, or even zero if the patient is wielding the wand while recovering at home.
The act of embracing telemedicine was always on Butterfly's roadmap, and the company quietly made its teleguidance feature available to users as a beta a few weeks ago. This new push to put Butterfly iQs into the hands of novices and into homes, however, was only possible because of new policy guidelines recently put into place by the US Food and Drug Administration to expand the "availability, functional capability, and portability of imaging systems” to help address these urgent public health concerns. Prior to this, the company's remote guidance tools were mostly being used for research, including one noteworthy partnership with a heart failure lab at NYU. That FDA guidance, however, has a time limit: These updated policies will only last until the COVID-19 outbreak is brought under control.
That (perhaps unfortunately) means there's a built-in expiration date for Butterfly's early efforts to make ultrasound available to neophytes. By then, though, Butterfly hopes it will have made its mark. There will always be a need for expensive, high-resolution ultrasound machines -- you wouldn't want to try and conduct a comprehensive cardiogram or search for subtle fetal anomalies with something that plugs into a phone.
Even in hospitals beset by COVID-19 patients, though, the normal business of tending to other maladies has to continue. Butterfly's teleguidance tools are meant to help with that, too, and the iQ produce results that the company says are on-par with a more traditional, mid-range $70,000 ultrasound machine. And with the right kind of remote guidance, it's not hard to imagine that a device like the Butterfly iQ could become a crucial part of a patient's prolonged, in-home care, be it for COVID-19 recovery or other illnesses.
That kind of case, where the ill can be sent home with a scanner and can regularly provide new diagnostic information to their medical practitioners, is a big area of focus for Butterfly Network. de Jonge said the company drew some inspiration from the glucose meter, a now-common bit of diagnostic tech that seemed equally unlikely to see personal use when the first model was introduced in 1971. (The biggest difference: Even with a $2,000 ultrasound wand at your disposal, you cannot and should not try to interpret your own results.) But that's the long game. For now, though, in an age where the thought of venturing to a hospital can be almost as fraught as the treatments involved, Butterfly's priority is helping doctors -- wherever they might be -- make sure patients get the right kind of treatment right now.
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