Make It Smaller, Cheaper, Better:

Democratizing Ultrasound  


By   Shlomo Maital

     Take a useful product. Make it smaller, cheaper. MUCH smaller and cheaper. In doing so you make it accessible to those in poorer countries.

     A lot of world-changing innovation works that way.   Take for instance Butterfly (New York Times, front page, April 18 2019).   “Hope in the palm of a hand”.   Butterfly Network is a Connecticut company that makes a hand-held ultrasound scanner called the Butterfly iQ.   It is about the size of an electric shaver. It is battery-powered, and is based not on piezoelectric crystals (used in nearly all ultrasound devices) but instead on microchips, far more durable. Butterly iQ won’t break if dropped. The target market: doctors and nurses who can afford a $2,000 device that “fits in a coat pocket and is as portable as a stethoscope”.

     The NYT article, by Donald McNeil Jr. and Esther Ruth Mbabazi, shows how this device has vast potential in Africa, Asia and Latin America, where conventional X-ray machines are miles and miles away and are often inaccessible. The article shows how Dr. Michael Cherniak counselled Rodgers Ssekawoko Muhumuza, a Ugandan clinical officer he was training, in using the device, to diagnose early-stage pneumonia in a six-year-old.   Rodgers prescribed antibiotics, and Dr. Cherniak approved.

       I was privileged to work with GE Ultrasound, in Haifa Israel, which began as an Israeli startup acquired by GE.   The entrepreneurs initially developed a PC-based ultrasound device, cheaper and smaller by far than the existing device.    They did this based on faith, that PC computing power would ultimately be sufficient – and it was. The key was image-processing software, that sharpened the ultrasound image a lot, developed by a genius software engineer.   Next, the development team converted the device to work on a laptop.   And now, in the US, Butterfly has slimmed it all down to the size of a mobile phone.

         Innovation is often not just about new inventions, but about making existing inventions accessible to those with low income, and low accessibility to urban medical care and devices. Almost by definition, things that are smaller are often also cheaper, and of course easier to transport.

     Kudos to Butterfly and founder   Jonathan Rothberg. He pursued the goal initially, because one of his daughters had kidney cysts that required regular ultrasound scans. One of his backers was the Bill and Melinda Gates Foundation.   “Two-thirds of the world gets no imaging at all,” Rothberg noted. “When you put something on a chip, the price goes down and you democratize it.”