A startup that makes a new iPhone ultrasound device ...

A startup that makes a new iPhone ultrasound device, whose chief medical officer used it to diagnose his own cancer, just raised $250 million

Charlotte Hu, Business Insider US

September 29, 2018





Picture a bulky, wired-up ultrasound machine, condensed to the size of an electric razor that can plug in to your phone, and fit into your pocket.

And better yet, it costs only $2,000.

The ultrasound-on-chip is the invention of Butterfly Network, founded by Jonathan Rothberg, who also had a hand in creating Next Generation DNA-sequencing, which made the then-exclusive DNA sequencing technology a standard part of most medical practices and clinics.

The new device, named Butterfly iQ, was inspired by Rothberg’s own personal experiences. His daughter was born with a disease called tubular sclerosis, which creates tiny tumors all over the body. The treatment procedure for this requires the use of a high-frequency ultrasound and MRI-imaging.

Through this ordeal, Rothberg became frustrated with the limited amount of ultrasound machines available in a hospital and the hassle of waiting for hours for a machine to become available. Rothberg wanted to democratize the access to these machines, which can cost up to $70,000 on average. By sizing the machine down and making it more versatile, Butterfly Network hopes to enable a wider range of doctors and healthcare workers to make more precise diagnoses out in the field, at in-office checkups, and in emergency rooms and ambulances.

On Thursday, the company announced that it has raised $250 million in a series D fundraising round and is expecting to ship out starting this week, with investments from Fidelity, Fosun Pharma, and the Bill and Melinda Gates Foundation.

It was only a year ago that the Butterfly device was first unveiled at an American College of Emergency Physicians conference. Now, it’s gearing up to ship out its product to key industry leaders, institutions, and private healthcare providers.

Globally there are currently 40 million healthcare practitioners who Butterfly is trying to serve.

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Ultrasound is the safest and most widely used medical imaging equipment. It is used for medical imaging inside the body and can detect the presence of anything from blood flow, to tumors, to unborn babies.

Charlotte Hu / Business Insider

“In almost every single disease state, there’s a role for ultrasound. It has incredible versatility,” chief medical officer Dr. John Martin told Business Insider. It’s been in use since the 1950s, but cost has made the equipment extremely prohibitive.

Initially, these machines ran up to a price tag of over $100,000. Now, the average ultrasound costs about $60,000-$80,000. Add that to the fact that you needed medical specialists with the expertise to capture and interpret the image.

“We wanted to make it cheaper, easier to capture the image, easier to interpret the image so it can become available, not only to every healthcare provider in this country, but to address the issue that two-thirds of the world right now has no access to medical imaging,” Martin said.

The only way to make the ultrasound cater to their needs was to in a sense, reinvent the wheel. Traditional ultrasound uses something called piezoelectric crystals (there’s 128 crystals in a standard device), which emit different frequencies that translate to ultrasound when an electric charge is applied. There are three different probes for low, middle and high frequency ranges, and these can have different configurations.

Butterfly iQ translates that technology onto a tiny silicone chip, which contains 9,000 tiny drum-like mechanisms that can receive and emit sound.

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“Getting an ultrasound done used to be a destination,” Martin said. There was a lot of waiting around for results, for technology, for the technicians and doctors to come proctor and administer these tests.

Charlotte Hu / Business Insider

“It’s time for the physical examination to change,” Martin said.

Increasingly, medical schools and graduate medical education programs are incorporating ultrasound interpretation and proctoring into their curriculum. 

More healthcare providers are learning how to administer an ultrasound. These include nurses, nurse practitioners, EMTs, and other healthcare providers. Making a critical diagnosis out in the field or at remote locations ahead of entering the hospital can help providers on the ground anticipate what resources are needed for the patient ahead of time. 

The device has 13+ settings that can look at musculoskeletal, abdominal, aorta, bladder, cardiac, and pediatric abdomen. These indications are all FDA approved.

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This device is not meant to completely phase out existing ultrasound machines, at least not as of now.

Charlotte Hu / Business Insider

Martin said that they’re to give healthcare providers a quick look at the significant issues such as general heart function or presence of a blood clot, so it can screen out people who don’t need more complex tests.

“This is incredibly good for yes-no answers. Do you have an aneurysm or not?” Martin said. It’s perfect as a bedside tool and as a portable device in developing countries with limited resources he added.

In fact, last year, Martin used the device to diagnose his own cancer.

As far as image resolutions go, the team said that in side-by-side comparisons with $60,000-$80,000 machines in the market right now, the difference is indiscernible.

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Darius Shahida, chief of staff at Butterfly, demonstrates the function of the cardiac setting of the ultrasound by imaging his own heart in real-time.

Charlotte Hu / Business Insider

“You can see the valves and the contractility of the heart, so if someone comes in to the emergency room and I’m worried if their heart is functioning well or not,” Martin said. “I can very quickly, with a very simple scan, within seconds, answer that question.”

In conditions like pericardial effusion, where fluid gathers around the heart, a quick diagnosis can mean the difference between life or death. And sometimes there’s not enough time to send for a technician, lug the heavy machinery to where the patient is. These are instances where a quick diagnosis and discharge for surgery can really make a medical difference.

The app also has advanced functionality like viewing the ultrasound with color doppler, which can visualize blood flow.

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Shahida then showed us the ultrasound on the setting for viewing the carotid artery. Viewing the carotid artery is important, especially since plaque buildup in this area of the body is one of the most common causes of strokes.

Charlotte Hu / Business Insider

The ultrasound can also help guide the insertion of an IV in the central vein, which is often done blindly or with the help of a cardiac visualization technician. “We used to joke that when you were putting a central line in someone, the thing that took the longest was finding the ultrasound machine. Now it’s in my pocket,” said Martin.

In addition to viewing the ultrasound, the app also lets you annotate and record your scan. You can then save that or send it to a doctor for interpretation.

The data is stored in the cloud after it becomes de-identified. The app is HIPAA compliant, and you can share your data across the globe or across different medical and academic institutions.

Looking forward, the company is working to incorporate parts of the app with electronic medical records, and maybe even bring in artificial intelligence to analyze the ultrasound and tele-diagnose patients for simple maladies.

https://www.businessinsider.my/butterfly-network-iphone-compatible-ultrasound-raised-250-million-2018-9/

4 Must-Have Heart Tests - MUST READ

Heart disease is tricky. Like other “silent” conditions, such as high blood pressure and kidney disease, you may not know that you have it until you’re doubled over from a heart attack.

HEALTHWISE

Published

 

June 1, 2015

 

Publication

 

Bottom Line Health

 

Source

Joel K. Kahn, MD, Wayne State University School of Medicine

THEY TRULY ARE LIFESAVING…

Heart disease is tricky. Like other “silent” conditions, such as high blood pressure and kidney disease, you may not know that you have it until you’re doubled over from a heart attack.

That’s because traditional methods of assessing patients for heart disease, such as cholesterol tests and blood pressure measurements, along with questions about smoking and other lifestyle factors, don’t always tell a patient’s whole story.

Shocking finding: In a recent study, doctors followed nearly 6,000 men and women (ages 55 to 88) who had been deemed healthy by standard heart tests for three years and then gave them basic imaging tests (see below).Result: 60% were found to have atherosclerosis. These study participants were eight times more likely to suffer a heart attack or stroke, compared with subjects without this fatty buildup (plaque) in the arteries.

THE MUST-HAVE TESTS

Below are four simple tests that can catch arterial damage at the earliest possible stage—when it can still be reversed and before it has a chance to cause a heart attack or stroke. My advice: Even though doctors don’t routinely order these tests, everyone over age 50 should have them at least once—and sometimes more often, depending on the findings. Smokers and people with diabetes, very high cholesterol levels (more than 300 mg/dL) and/or a family history of heart disease should have these tests before age 50. Having these tests can literally save your life…

For more on this topic, see our
Guide to Surprising Things 
That Help—or Harm—Your Heart

• Coronary calcium computed tomography (CT) scan. This imaging test checks for calcium deposits in the arteries—a telltale sign of atherosclerosis. People who have little or no calcium in the arteries (a score of zero) have less than a 5% risk of having a heart attack over the next three to five years. The risk is twice as high in people with a score of one to 10…andmore than nine times higher in those with scores above 400.

While the American College of Cardiology recommends this test for people who haven’t been diagnosed with heart disease but have known risk factors, such as high blood pressure and/or a family history of heart disease, I advise everyone to have this test at about age 50.* The test takes only 10 to 15 minutes and doesn’t require the injection of a contrast agent.

Cost: $99 and up, which may be covered by insurance. 

I use the calcium score as a onetime test. Unless they abandon their healthy habits, people who have a score of zero are unlikely to develop arterial calcification later in life. Those who do have deposits will know what they have to do—exercise, eat a more healthful diet, manage cholesterol and blood pressure, etc.

One drawback, however, is radiation exposure. Even though the dose is low (much less than you’d get during cardiac catheterization, for example), you should always limit your exposure.

My advice: Choose an imaging center with the fastest CT machine. A faster machine (a 256-slice CT, for example) gives less radiation exposure than, say, a 64-slice machine.

• Carotid intima-media thickness (CIMT). The intima and media are the innermost linings of blood vessels. Their combined thickness in the carotid arteries in the neck is affected by how much plaque is present. Thickening of these arteries can indicate increased risk for stroke and heart attack.

The beauty of this test is that it’s performed with ultrasound. There’s no radiation, it’s fast (10 minutes) and it’s painless. I often recommend it as a follow-up to the coronary calcium test or as an alternative for people who want to avoid the radiation of the coronary calcium CT.

The good news is that you can reduce CIMT—with a more healthful diet, more exercise and the use of statin medications. Pomegranate—the whole fruit, juice or a supplement—can reduce carotid plaque, too. In addition, research has found Kyolic “aged” garlic (the product brand studied) and vitamin K-2 to also be effective.

Cost: $250 to $350. It may not be covered by insurance.

• Advanced lipid test. Traditional cholesterol tests are less helpful than experts once thought—particularly because more than 50% of heart attacks occur in patients with normal LDL “bad” cholesterol levels.

Experts have now identified a number of cholesterol subtypes that aren’t measured by standard tests. The advanced lipid test (also known as an expanded test) still measures total cholesterol and LDL but also looks at the amounts and sizes of different types of cholesterol.

Suppose that you have a normal LDL reading of 100 mg/dL. You still might have an elevated risk for a heart attack if you happen to have a high number of small, dense LDL particles (found in an advanced LDL particle test), since they can more easily enter the arterial wall.

My advice: Get the advanced lipid test at least once after age 50. It usually costs $39 and up and may be covered by insurance.

If your readings look good, you can switch to a standard cholesterol test every few years. If the numbers are less than ideal, talk to your doctor about treatment options, which might include statins or niacin, along with lifestyle changes. Helpful supplements include omega-3 fatty acids, vitamin E and plant sterols.

• High-sensitivity C-reactive protein (hs-CRP). This simple blood test has been available for years, but it’s not used as often as it should be. Elevated C–reactive protein indicates inflammation in the body, including in the blood vessels. Data from the Physicians’ Health Study found that people with elevated CRP were about three times more likely to have a heart attack than those with normal levels.

If you test low (less than 1 mg/L) or average (1 mg/L to 3 mg/L), you can repeat the test every few years. If your CRP is high (above 3 mg/L), I recommend repeating the test at least once a year. It’s a good way to measure any progress you may be making from taking medications (such as statins, which reduce inflammation), improving your diet and getting more exercise.

Cost: About $50. It’s usually covered by insurance.

* People already diagnosed with heart disease and/or who have had a stent or bypass surgery do not need the coronary calcium CT.

Source: Joel K. Kahn, MD, a clinical professor of medicine at Wayne State University School of Medicine and director of Cardiac Wellness at Michigan Healthcare Professionals, both in Detroit. He is also a founding member of the International Society of Integrative, Metabolic and Functional Cardiovascular Medicine and the author of The Whole Heart Solution.

http://bottomlinehealth.com/4-must-have-heart-tests