Not long ago, Nevada Sanchez, a Fellow of the Fannie and John Hertz Foundation, learned that Butterfly Network’s handheld ultrasound device—the Butterfly iQ+—had saved someone’s life. A physician diagnosed a patient in peri-arrest, the dangerous period just before or after a full cardiac arrest, and effectively treated him with inotropic drugs to increase the force of his heart contractions.
“That was a powerful moment for me,” says Sanchez. “Someone is alive today because I did this. “It’s incredibly rewarding and motivating to wake up every day and work on something that’s enormously fun and incredibly important for making the world a better place.”
Tales of lifesaving diagnoses using Butterfly Network’s handheld ultrasound abound: a physician who diagnosed his own metastatic throat cancer and another who diagnosed his father on the brink of a “widowmaker” cardiac event. Physicians in sub-Saharan Africa are using Butterfly’s device to diagnose children with treatable pneumonia, provide women glimpses of their developing fetuses, and determine whether masses are cancerous or benign.
“Our vision is that every doctor and nurse will have an ultrasound in their pocket, just as they now have a stethoscope, and not just in the developed world. Imaging will be accessible in the remotest parts of the world, including for the 4.7 billion people around the world lacking access to ultrasound,” Sanchez says.
Launched in late 2018, the low-cost, handheld scanner generates quality ultrasound images on a smartphone. Butterfly iQ+ can scan everything—a fetus, tumors, broken bones, pneumonia, kidney stones, and heart conditions. Ultrasounds are uploaded to a secure cloud, where any expert with permission can give second opinions or help analyze images. The platform was designed to be HIPAA compliant and ultra-secure: patient identifying information and the images are decoupled in such a way that provides maximum security.
Sanchez’s journey began a decade ago when Jonathan Rothberg—inventor of Ion Torrent System’s DNA-on-a-chip and a 2015 National Medal of Technology and Innovation award recipient—attended a talk on radio telescope technology by MIT physics professor Max Tegmark. Tegmark wanted to image the early universe using thousands of radio telescopes. To do this, Tegmark created a “butterfly network,” linking multiple computers into a high-speed network.
Rothberg was inspired by Tegmark’s research and wanted to find a way to revolutionize how we image the human body. Rothberg had asked the professor for his most brilliant students. Enter Sanchez, who had worked in Tegmark’s lab while earning degrees in electrical engineering, computer science, mathematics, and physics.
“This was a perfect fit for me,” Sanchez says. “When I met Jonathan, I realized that I had an opportunity that I couldn’t pass up. I could build a high-impact technology company, which was my life goal since I was a child.”
At 22, Sanchez deferred his doctorate and Hertz Fellowship and joined Rothberg. The start-up also hired Hertz Fellow Keith Fife, who had helped design the DNA-sequencing chips for Ion Torrent. Together, they achieved the near impossible: drastically reducing the size and cost of an ultrasound machine and powering it with a phone battery. “When we started Butterfly, we recognized that there were major challenges to making imaging ubiquitous,” Sanchez says.
The first problem was related to cost and accessibility. Traditional ultrasounds are large stationary machines that cost between $15,000 and $100,000 and take radiologists years to learn to use. They rely on thousands of lab-grown piezoelectric crystals attached to the front of a probe called a transducer. The crystals convert electrical signals into ultrasound waves. When the crystals are hit by reflected ultrasound waves, they begin to vibrate and produce electrical signals that are sent back to the ultrasound machine. There, the electrical signal is interpreted and translated into an image.
“We’ve taken an analog, old-school traditional process and made it small enough to fit in your pocket and run off of a battery,” Sanchez says. To do this, Sanchez and his team designed chips with about 9,000 silicon transducers—each not much bigger than the tip of a human hair—that can send out and receive sound waves and turn those waves into 3D ultrasound images. Each chip can conduct half a trillion operations per second to get an ultrasound signal in and a quality image out in real time.
Though Butterfly iQ is one of several portable handheld ultrasound devices on the market, it’s the first to replace the crystals with microchip technology, an effort that took five years and $100 million.
Another major barrier to the handheld ultrasound was usability. “So now that you have the device out there, how do you make it easy for people to acquire and interpret the image? Artificial intelligence (AI) was really the solution to both of these problems,” he says. Sanchez and team are developing AI algorithms to bring powerful capabilities to their device and to make it easy to use. Some of these algorithms, like automatic bladder volume measurement, are already FDA-approved and used by customers every day.
Others are still under development. For example, prototype algorithms have used AI to instruct users how to manipulate the probe to acquire good images, while others take in footage from the camera and detect the probe’s location in real time, directing users through arrows precisely where to position it. Another prototype AI system performs a quality check and a simple analysis on each image.
“AI can give the user feedback telling them whether they are doing a good job or aren’t quite there yet,” Sanchez says. “We are continuing to build deep learning tools so that users have software they need to self-train and to gain competence in using our device.”
Such software will be especially useful as the company expands into the consumer market. “There’s going to be a transition to bringing medical insights into the home,” Sanchez predicts. “The pandemic has really changed the landscape quite a bit where both the regulatory bodies and the industry are pushing medical insights and discoveries into the home rather than requiring people to go into doctors’ offices.”
At the end of January, Butterfly Network Inc. announced a business combination with Longview Acquisition Corp. and is now trading on New York Stock Exchange. This enabled Butterfly to raise the $540 million it needs to continue to grow its sales force and technology and expand to other markets, Sanchez says.
Though the United States is Butterfly’s primary market, the device can be purchased by healthcare practitioners in Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Ireland, Italy, the Netherlands, New Zealand, Norway, Poland, Portugal, Spain, Sweden, Switzerland, and the United Kingdom.
“This was a very technically demanding problem that drew upon everything I knew about mathematics, physics, software engineering, and electrical engineering. I had to get down to the fundamental issues,” Sanchez says. “On top of all that, it’s solving one of the most important problems that we have in the world today, which is global healthcare.”