Ultrasound to go: versatile partner on hospital rounds

The University Hospital Bonn has recently introduced an ultrasound device that's small enough to fit in your coat pocket. It's ready to use once you have connected it to a tablet or smartphone. The portable system makes bedside physical exams possible. The device primarily benefits students as it allows them to combine basic knowledge and clinical application.

In this MEDICA-tradefair.com interview, Dr. Florian Recker talks about the new ultrasound device, explains why it will make various transducers obsolete in the future and describes the role artificial intelligence plays in this setting.

Dr. Recker, you recently introduced a new ultrasound system. What makes it so unique?

Dr. Florian Recker: The Butterfly iQ imaging device was developed in the U.S. What's new and unique is its size. It's small enough to fit in your white coat pocket and can be connected to Android or iOS devices. While there are similar devices by other manufacturers, this device is special because it no longer has piezoelectric crystals. The company has developed a silicon chip that vibrates to send ultrasonic waves. The benefit here is that this single transducer can emulate any type of frequency and wave patterns and therefore any type of transducer. In the past, you needed multiple transducers, including linear, curved or phased transducers. Today you only need a single transducer that emulates all three.

What are the technical requirements to use the device?

Recker: Besides the actual device – the transducer – you need a tablet or smartphone as a monitor. The system was originally only available for iOS, limiting its application to Apple devices such as an iPad and iPhone. As of earlier this year, it is also available for Android devices. Users can also add the Butterfly Cloud service for a fee, which is GDPR-compliant. You can upload patient data to the Butterfly Cloud and have access to an education platform with instructional videos for specific exam methods or AI-based programs. This allows you to perform an automated interpretation to compute the ejection fraction or conduct a calculation of bladder volume without the need for prior measurements using only the probe. You don’t need any other equipment apart from the Cloud service and the tablet or smartphone.

How do you use the device for an exam?

Recker: The physicians always has the device in his/her pocket when he/she makes hospital rounds. No matter the issue - pleural effusions, ascites or size of ascites – we simply connect the transducer to the tablet or smartphone and find out right away. You no longer need a separate room with a large ultrasound machine. The exams take place right at the bedside, facilitating a point-of-care ultrasound.

Why do you specifically use this system for teaching purposes?

Recker: We have teamed up with our Chief of Rheumatology, PD Dr. Valentin Schäfer, and use the system as a didactic model. The cost of the device was a big advantage as one device costs around 2,000 euros, enabling us to buy several of them. Our goal is to give students a fundamental and comprehensive ultrasound education that is currently only an option as such at a handful of German universities. The devices should be used on the patient during block rotation and medical internships. The idea is that students should not only practice diagnostic medical sonography on each other - this has already been done in a peer-assisted format -, but also perform a bedside ultrasound examination and make a direct link to pathology. Until now, the bedside physical exam comprised auscultating of the heart or respiratory system with the stethoscope. Bedside ultrasound can now become another exam component. This hopefully gives students an additional tool for patient exams in the future and ensure faster and better patient care.

What are some future applications of the system?

Recker: Apart from using the device in a teaching context, you can also use it in clinical practice. Right now, device use is being studied for musculoskeletal exams, for example as it pertains to rheumatic diseases and conditions. It is also helpful to check the presentation of a fetus in the delivery room. We also reviewed the device with our radiologists. It can be used for simple urologic evaluations and applications in oncology and internal medicine. In the United States, the device is used in emergency medical services both at the hospital and in ambulances or helicopters. Since it is a pocket-sized ultrasound device that can make direct calculations, its use is particularly relevant to emergency medicine.

How will new technologies like this one shape the future of medicine?

Recker: Digital tools combined with artificial intelligence or virtual and augmented reality will see increased usage in medicine in years to come. Miniaturization and lower prices for these types of technology will make them more widely available. AI also improves diagnostic processes, making them faster and less prone to errors. This is already apparent in the world of medical imaging where AI supports findings and helps radiologists. Digitization is gradually changing medicine and will unquestionably transform clinical practices.