So what is so special about the Butterfly IQ? Why am I spending a whole article to review a single device? To be fair, the Butterfly is one of multiple small portable POCUS devices on the market now (see also Clarius and Lumify). Its unique technology and approach to marketplace, however, represents a novel approach to the practice of medicine that also encompasses humanitarianism, crowdsourcing, and optimal team practice. As a practicing physician assistant myself, the benefits of team collaboration to optimize patient care is an attractive attribute when seen manifested in a technology.
To speak to the technology components, typical ultrasounds use a piezoelectric or single crystal transducer to generate and receive a pulse, converting electrical energy to ultrasonic energy and back to electrical energy, thereafter producing an image reflective of the anatomy to which the energy has been applied. As remarkable as this technology is, limitations in size, weight, cost, energy requirements, and image resolution make it difficult to obtain adequate results in an ultraportable platform robust enough for the wilderness environment. The folks at Butterfly Network, however, developed an imbedded microchip in the transducer probe that hosts 9,000 tiny metal transducers to produce tremendous anatomical imagery transmitted to your smartphone/ tablet. Looking at other technical specifications, the device weighs in at 309 grams (.68lbs). For comparison, a Nalgene bottle full of water weighs in at nearly 1200 grams (2.6lbs). The built-in battery is 2600mAh and will perform more than two hours of continuous scanning. Recharging is performed wirelessly through the included wireless (Qi) charging cradle. Of note are the limited specs of operating temperature. Coupled with an iPhone which Apple recommends using between the ambient temperature of 32 and 95 degrees Fahrenheit, the Butterfly IQ has a reported operational bandwidth between 41 and 109 degrees Fahrenheit. In practice, the few times I have deployed this device in an alpine environment, storage options with a chemical heat warmer or against my core have facilitated at least temporary functionality towards image acquisition. Other components of its design reveal 4-foot drop testing resilience, IP67 water/ dust resistance, and robust but replaceable components (eg, cord).
Looking at the Butterfly Network company’s approach to business is as uniquely novel as the technology of their product. Embedded within their website are a host of training resources. While nothing replaces regular usage in front country medical practice, dedicated ultrasound fellowships or formal ultrasound CME opportunities, their website resources to support the product are quite robust. One might ask, “But what if I work in orthopedics and I’m trying to use ultrasound for evaluation of a possible pneumothorax?” In addition to their training resources online, the company has built in a HIPAA compliant data network to send images back to another collaborator such as an attending physician, radiologist, or colleague to further optimize team practice and care - a process they call “teleguidance”. This model of image collaboration and training has already been demonstrated in the EMS literature where paramedic crews were trained and deputized to implement field based ultrasound in order to facilitate care. Of course, in the wilderness medicine environment, such collaboration would be dependent upon reliable transmission of data which might not always be possible.
Giving attention to this issue, another probing question comes forward, “can you see it now?” While cellular based collaboration may have been a required resource before, it might not be as important as previously considered. As another approach to marketplace and utilization, Butterfly’s IQ+ has embedded an educational/ training resource into their ultrasound app interface allowing users to save “how-to” applications of POCUS and literally coach you into successful image acquisition. Combined with other artificial intelligence integrations, the device and its platform are a real game changer both for the front country and wilderness medicine provider.
Still, despite all of these great integrations, the use of any POCUS, Butterfly IQ included, requires a certain amount of maintenance. Not limited to charging the device and performing decontamination between patients, the skill set and knowledge base required to maintain proficiency is a perishable group of resources. Just like rehearsing your knots and rope rescue systems, practicing your echo windows and measuring things like optic nerve sheath diameter requires vigilant attention and dedication of time. Scanning the horizon of future technology with wilderness application has been an exciting endeavor but for now, I think I’m going to spend more time practicing the images at hand.