[HN Gopher] How Ultrasound Became Ultra Small
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How Ultrasound Became Ultra Small
Author : CharlesW
Score : 133 points
Date : 2024-03-17 16:38 UTC (2 days ago)
(HTM) web link (spectrum.ieee.org)
(TXT) w3m dump (spectrum.ieee.org)
| polishdude20 wrote:
| This is wild. Also if this becomes cheap enough for regular folks
| to buy I can see a lot of self diagnosis coming in. Then again,
| maybe that'll be good
| phillc73 wrote:
| I'm not convinced self diagnosis will be a positive thing.
|
| What these small, portable machines will support is a lot of
| pre-hospital medics, working in remote or austere environments,
| to carry these devices and use them effectively.
|
| There are already courses available to teach exactly this:
|
| https://corom.org/apus/
| taion wrote:
| You're not allowed to buy these without an NPI number. And
| while ultrasound is relatively easy, it's still not really
| usable without some training. I think there have been some
| studies of training users to do ultrasound at home for a
| limited set of views, but it's not really a "pick it up and
| look around" sort of thing.
| _trampeltier wrote:
| A bit the same with infrared. About 10, 15 years ago, several
| startups came out with cheaper ir-cameras. Flir then came out
| with the first gen Lepton chip, lowered the price for a while,
| so they where cheeper than the competition, i think none of the
| startups survived. Now you pay again a much to high price for a
| thermal camera ..
| Cthulhu_ wrote:
| Good for what? How often do people need an ultrasound, and how
| much would it offload the existing medical whatnots? It would
| actually increase the load on the system, because people would
| be like "My ultrasound detected a thing, I need someone to look
| at it".
| engeljohnb wrote:
| I doubt it. How can you image an organ at home when you're not
| even 100% sure exactly where that organ is? Or what it looks
| like on an ultrasound? And that's not even getting into knowing
| whether you're looking at them from the right angle for the
| images to be diagnostically useful.
| leoedin wrote:
| Yeah - my experience of watching baby ultrasounds was that I
| had no idea what I was looking at until the technician told
| me. Maybe there's an occasional clear image of a head or nose
| or something, but the rest of the time it's just wobbling
| grey shapes. I can't imagine trying to do that myself - let
| alone looking at my own organs which are mostly just
| amorphous blobs, and trying to diagnose something.
|
| I suspect the main cost in running a diagnostic scan is
| labour rather than capital - and these low cost ultrasound
| devices will only have an impact in the developed world if
| they go hand in hand with AI.
|
| Obviously they'll make a huge difference in developing
| countries where labour is relatively cheap compared to
| equipment - but even then it'll still require trained
| professionals to operate.
| JPLeRouzic wrote:
| I remember a hot discussion here and only a few years ago where
| an "expert of the field" said small cheap portable ultrasounds
| were impossible, despite one or two commercial products available
| at the time.
| lend000 wrote:
| Couldn't find anything in the article about whether these still
| require gel (or if the gel is an absolute requirement for the
| conventional ones). Anyone know?
| taion wrote:
| Yes, they still require gel. That's just a matter of physics.
| Changing the transducer technology doesn't change that.
| ano-ther wrote:
| Yes. The gel aids the sound transmission so that it doesn't
| have to travel through air and is designed to have the same
| impedance as skin.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8774352
|
| https://www.animalultrasoundassociation.org/what-is-ultrasou...
|
| Secondary effect is that it lubricates the probe when you move
| it on the skin.
|
| And then it also gives you a good chill which is to notify your
| organs that they are about to be photographed.
| mnw21cam wrote:
| Some machines have a heated slot where the tube of gel is
| meant to be left so that it _isn 't_ cold when used.
| Foomf wrote:
| Laptop-sized ultrasound machines have been a thing for at least a
| decade at this point. It feels insincere to frame ultrasound
| machines as these big things lugged around on carts still.
| Hospitals still like those, but there's plenty of pre-hospital
| ultrasound machines that are compact. Not smartphone compact, but
| it feels weird for the article to completely omit them.
| hgomersall wrote:
| The article is a bit of a puff piece for Butterfly and Exo.
| MEMS address a problem, but not necessarily the hard one for
| portable ultrasound. There are plenty of handheld plain old PZT
| transducer based devices out there.
| Cthulhu_ wrote:
| The other thing to consider is that these machines cost money
| and have a write-off lifetime, I wouldn't be surprised if
| they're designed and purchased for a lifetime of 10, 15 years,
| with only some consumables like new probes and cables every
| once in a while.
| xattt wrote:
| GE had a handheld model that they featured in some feel-good
| "we are GE" ad in the late 2000s/2010s.
| nyrikki wrote:
| I was at Sonosite in the mid 2000s, that was that entire
| company. Custom analog ASIC based, but portable tablets.
| Foomf wrote:
| Me too! That's the only reason I know laptop-sized portable
| ultrasound machines exist. I had an internship there one
| summer where I wrote automation software for the M-Turbo.
| m3nu wrote:
| Aliexpress link to buy one?
| m3nu wrote:
| Found one. How useful is this at home? Is the main issue with
| interpretation?
|
| https://www.aliexpress.com/item/1005005664149090.html
| taion wrote:
| That one is not going to be particularly useful at all. It's
| a linear probe, which means it's really only for imaging
| things near the skin. It's one-third of a typical set of
| probes: https://stanfordmedicine25.stanford.edu/the25/ultraso
| und.htm...
|
| It's different from the MEMS-based devices this article talks
| about, which have the novelty of letting you do everything
| with a single probe. Though of course that comes with trade-
| offs.
| brtkdotse wrote:
| Sorely disappointed this wasn't about Gravis UltraSound
| BurnGpuBurn wrote:
| "handheld probes that send images to a phone"
|
| Great, even more of my private data being sucked up by big tech
| via my doctor's phone.
| Cthulhu_ wrote:
| This is why strict privacy regulation and pushback to big
| corporations is necessary, worldwide.
|
| Did you know that post-Brexit / post-being-subject-to-EU-
| privacy-laws, Amazon got NHS's
| data?https://www.theguardian.com/society/2019/dec/08/nhs-gives-
| am...
|
| While the article states that it did not include patient data,
| people living in the UK a few years before that had to opt out
| of their data being given to Amazon. Imagine that.
| choeger wrote:
| Now here's an application for "AI": have a ultrasound device the
| size of a medical tricorder from Star Trek in every household
| with children. If child gets one of the dozens of inevitable
| infections, use the device to check for the standard
| complications (otitis media, pneumonia ...) and allow a physician
| to replace 95% or more of the visits with a remote diagnostic.
| dhmallon wrote:
| Agree in principle with remote diagnostics in this way. But,
| the number of acute illnesses that can be diagnosed with US and
| can/should be treated at home is fairly small. Pneumonia cannot
| be detected by US unless it is up against the chest wall (or
| perhaps if it causes excess fluid in the pleural space). An
| otitis media diagnosis would not be possible with US.
| Appendicitis can be seen with US but it is very operator-
| dependent and asking parents to fish around for the appendix
| would be a big ask (even with some rather advanced AI
| assistance). You can certainly find enlarged lymph nodes but
| fingers are often just as good.
| Cthulhu_ wrote:
| There's already a "pandemic" of incorrect and/or hypochondriac
| "at home" diagnosis going on, along with quack pseudoscience to
| cure things, ranging from essential oils to bleach enemas; we
| don't need more of that.
|
| This is also an answer to a perceived problem, mixed with the
| XY problem; the problem isn't that there's not enough at-home
| diagnostic tools (a thermometer is enough for most households),
| the problem is access to health care, which has been messed
| with directly (cost of health care) and indirectly (people's
| physical health due to overconsumption, mental health due to
| _gestures everywhere vaguely_ ) by capitalism.
| RecycledEle wrote:
| > There's already a "pandemic" of incorrect and/or
| hypochondriac "at home" diagnosis going on, along with quack
| pseudoscience
|
| There is also a revolution in hone medical technology.
|
| It takes a long time for us lay people with cool medical
| gadgets we got off eBay to learn what the results mean, but
| we will get there.
|
| If fed.gov wants to help, they could test these devices, then
| offer training and certification so those who take advantage
| of the certification classes will know how to get reliable
| results and (more importantly) what the machines can not do.
| RecycledEle wrote:
| Of we can get AI to produce good quality images from ultrasound
| sensors and then to interpret the images, we can reduce the
| level of training required to use such devices.
|
| Imagine high school and junior high health classes teaching the
| use of these devices, getting the students certifications that
| require maybe 8 hours of coursework plus a 30-minute exam, then
| sending most of the clas home with a 21st century tricorder.
| verisimi wrote:
| I'm sure there's a time and a place for these things, but it
| cannot be said that something as innocuous sounding as
| 'ultrasound' is 100% safe. It has an effect, it can be used to
| break up kidney stones for example. I personally wouldn't use it
| for scanning pregnant women, despite this very common usage.
|
| Turning it into a small consumer level device sounds like it
| could lead to people causing themselves harm.
| dhmallon wrote:
| It is dose dependent. Use of low powered US for a short period
| is safe. If you increase power, you can cause damage - either
| to to break kidney stones as you say, or, when focussed
| properly, burn bits of the brain to treat tremors.
| verisimi wrote:
| It depends on one's definition of "safe". Yes, smaller doses
| will have less of an impact.
|
| I'm simply stating that ultrasound does impact the body.
| Despite the innocuous sounding name referencing 'sound', it
| is less like music and more like a microwave, capable of
| breaking kidney stones, burning tumors.
|
| Re the most common usage, I don't think lots of scans in
| pregnancy can be beneficial. Perhaps one or 2 scans are worth
| the risk in special circumstances. Present day scanning
| machines are way more powerful than historical ones; the dose
| is not getting safer.
| Cthulhu_ wrote:
| Capable of, but the ultrasound used for that is focused,
| higher intensity and in bursts.
|
| I mean if you want to fearmonger, there's plenty more
| examples of things that can cause damage if used in a
| different way, like water, air, electricity, light, etc.
|
| You seem to want to claim that _any_ use of ultrasound is
| dangerous, but you fail to provide evidence, you just bring
| in extreme cases and try to claim equivalence. I 'm sure
| there's a fancy sounding fallacy name for that.
| verisimi wrote:
| What I am saying that it is agreed that ultrasound does
| have an impact.
|
| The failure in the provision of evidence, is with those
| that claim it is safe. Its not for me to prove it is
| harmful.
|
| Ask yourself, how can a treatment that breaks kidney
| stones or burn tumours also be 'safe'? It may be that the
| impact is negligible, but that is not safe. In the womb
| especially, a slight impact may have a large effect on a
| growing foetus.
|
| Ask yourself too, what level of radiation is safe? How
| much microwaving? Is any?
|
| So am I fearmongering, or is this a valid concern? I
| think it is clearly a valid concern. I do not simply
| accept medical consensus over the reasoning of my own
| mind.
|
| I can see use cases where the information that is
| provided by ultrasound is useful and outweighs the risk.
| I think that casual, repeated usage of ultrasound for
| pregnant women, for the 'gender reveal'/colour scans or
| whatever, with powerful machines, is ill advised though.
| I don't recommend anyone undertake any unnecessary
| medical procedures.
|
| I also think that an adult that has awareness of the
| scope of a potential impact, can do what they want - its
| their choice to do as they want. I object to inflicting
| avoidable harm (albeit the harm might not be obvious) to
| individuals that cannot consent - eg infants, foetuses.
|
| FWIW, I do have kids, and - to my regret - I did scan
| them before they were born. I wouldn't do it now, knowing
| what I do.
| ceejayoz wrote:
| > Ask yourself, how can a treatment that breaks kidney
| stones or burn tumours also be 'safe'?
|
| The same way taking a bath can be safe, but a tsunami is
| not.
| fatnoah wrote:
| Or that there's a difference between a bath in 37C water
| and a bath in 100C wather.
| Loughla wrote:
| >FWIW, I do have kids, and - to my regret - I did scan
| them before they were born. I wouldn't do it now, knowing
| what I do.
|
| Why are you acting like you have scientific consensus
| behind what you're saying? There is literally zero proof
| of anything you're claiming.
|
| >So am I fearmongering, or is this a valid concern?
|
| You're fearmongering. That's it. Nothing else. It's the
| same kind of attitude that has led to such a self-
| important, 'I know better than doctors' attitude about
| vaccines.
| jasonjayr wrote:
| Sound waves have an impact. Too loud and it can
| permanently damage your hearing. What level of audio
| volume is safe?
|
| Water has an impact on your body. Drink too much and it
| can harm you. What amount of water is safe?
|
| etc., etc.
|
| The technology enables us to learn and prevent so many
| problems, that to write it off just because at extreme
| levels it can be harmful is foolish.
|
| And it's fearmongering to make that claim without
| evidence. See the summary here:
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262273/
|
| > The first mention that ultrasound could be used to
| produce images of the foetal head was probably in a
| lecture given by Ian Donald in 1959. Since that time, the
| use of ultrasound in obstetrics has grown rapidly, and
| has a generally accepted excellent safety record.
| However, it is impossible to prove zero risk, and the
| absence of evidence of harm should not be taken as
| evidence of absence of harm. The epidemiological evidence
| that exists is reassuring as to the safety of routine
| ultrasound scanning, but of necessity it only includes
| subjects who were imaged with devices that were state of
| the art at the time (mostly early 1980s). No pulsed
| Doppler or colour flow examinations are included, and the
| output from modern ultrasound scanners is considerably
| higher today than it was at that time. It is, therefore,
| essential to remain vigilant, and to assess new
| technologies and applications from a safety aspect as
| they arise.
|
| So TL;DR: Ultrasound is safe, the benefits outweigh the
| risks by a large margin, and we should always insist that
| Ultrasound, and any modern medical technology is held to
| rigorous scientific testing standards.
| callalex wrote:
| Listening to music on a little portable speaker is perfectly
| safe for your ears. Standing in front of the stack at a 500,000
| person concert is quite harmful. These devices are on the
| "portable speaker" end of that spectrum.
| niyyou wrote:
| Worth mentioning another nice initiative https://www.echopen.com/
| it's from Paris and it has been incubated by the hospitals of
| Paris themselves, first as an open-source project. Disclaimer: I
| was among the early contributors to the open-source project.
| panzi wrote:
| Just woke up an read: How Ultrasound Became Ultra Smell XD
| Cthulhu_ wrote:
| Smellovision; that said, there's people and/or dogs that can
| smell specific diseases, if they can figure out how that works
| they can incorporate it into an array of passive sensors to
| alert people of a possible problem.
| bearsnowstorm wrote:
| I own the 1st gen of the Butterfly - in my opinion, it wasn't
| great image-wise compared with the contemporary conventional
| crystal based probes (thinking of cart-based machines with less
| flexible, more expensive probes etc so perhaps an unfair
| comparison). Would be cool if the newest ones mentioned in the
| article are becoming comparable with the crystal based probes - I
| can't comment. But I can say image quality is absolutely key.
| There are lots of cool AI based applications coming out all the
| time (I know much more about echocardiography AI than the foetal
| ultrasound AI mentioned in the article, but this is a similar
| paper where some ultrasound novices had AI guidance and were able
| to obtain useful echo images
| https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.123.0155...).
| I get to use various machine vision based tools on echo images at
| work to automate various measurements - but at the moment, I find
| they fail badly if the imaging is anything but great quality,
| whereas humans can interpret them. Maybe future training sets
| will include more "technically difficult studies" (code for poor
| imaging) and AI tools will do better than they do now? Or there
| will be more augmentation of data sets with realistically
| degraded versions of images to add robustness? AI that worked on
| suboptimal images would be awesome, particularly in my setting
| (ICU).
| dotancohen wrote:
| Is there really room for AI in medical imaging?
|
| Medical imaging is not about getting the expected result as is
| typical in most bodies, rather, it is about getting the actual
| result as is found in this body.
| mikepurvis wrote:
| The applications I've seen are around analysis/alerting.
| Submit your raw data to a service and it screens for hundreds
| of rare conditions your doctor's never heard of.
|
| Similar to blood work maybe nothing comes back conclusive but
| it might be interesting enough to trigger follow on
| investigation.
|
| But the general theme is around augmenting the human decision
| maker rather than "preprocessing" the data in a way that
| might obscure or hallucinate important details.
| faeriechangling wrote:
| False positives on tests are a well understood source of
| illness and iatrogenic harm, as well as being a well known
| money printer for those administering the tests. Trying to
| screen for a whack of rare diseases with AI still sounds
| dubious to me unless you have good reason to suspect one
| beyond high levels of medical anxiety.
|
| I'm more interested in AIs ability to do things like read
| x-rays and identify illnesses with higher accuracy than a
| tired doctor on a 12 hour shift.
| adolph wrote:
| > Is there really room for AI in medical imaging?
|
| Sure, there are many applications and more coming. In your
| example of an actual result as is found in this body, the
| image segmentation [0] and recognition task is applicable.
|
| One of the bullet points in the above is "Intra-surgery
| navigation." Let's say there is a known position of a tumor
| within an organ based on previous imaging. The human body is
| squishy and interior organs may shift in position or shape
| when a procedure is performed. Deformable image registration
| [1] guides the surgeon (human or robot) to the tumor location
| with greater precision than what was possible before.
|
| 0. https://en.wikipedia.org/wiki/Image_segmentation
|
| 1. https://paperswithcode.com/paper/voxelmorph-a-learning-
| frame...
| aeonik wrote:
| I have a question:
|
| In radio we are seeing phased arrays and software defined systems
| becoming more popular.
|
| Why can't we expand the resolution and increase the bandwidth
| with ultrasound as well using the same ideas.
|
| Wouldn't we be able to get a more clear tomographic pictures if
| we used many receivers places around the body and layered
| different frequencies? I'm especially wondering why not use lower
| frequencies for deeper penetration, using phased arrays to offset
| the loss in resolution.
| dotancohen wrote:
| For what procedures are the current resolution limitations
| inadequate? What would be the cost difference towards a machine
| that provides adequate resolution?
| aeonik wrote:
| I'm envisioning something more like continuous monitoring
| electrodes. Low amplitude, high bandwidth, always on.
| natsucks wrote:
| A key advantage of US over other imaging modalities is
| portability. A key disadvantage is resolution with depth.
| Tomographic ultrasound systems exist, but if one is going to go
| with a bulky machine you might as well go with CT or MRI.
| gumby wrote:
| Last year I had arm surgery and in the recovery room I was in
| pain and agreed to a nerve block. The anesthesiologist put an
| iPad in my lap. Then with the ultrasound head in one hand and a
| syringe in the other he looked at the iPad until he found the
| nerves he wanted and zap!
|
| I was in a lot of pain and was a bit groggy but my one clear
| memory is being fascinated by this and watching the tablet
| closely.
|
| (The nerve block worked, but I don't know that I would ever get
| one again. It definitely freaked me out).
| fortran77 wrote:
| Having just had an ultrasound of my prostate, where the probe
| went up my ass, I welcome smaller ultrasounds!
|
| I was able to watch the procedure on the screen. The ultrasound
| image was overlayed on a prior MRI image, and it was used to
| guide the biopsy where 12 core samples were taken of the prostate
| with a needle. It sounded like a staple gun each time a sample
| was taken!
|
| Tiny Ultrasounds will be very useful for all sorts of biopsy
| procedures like this...
| Rinzler89 wrote:
| _> Having just had an ultrasound of my prostate, where the
| probe went up my ass, I welcome smaller ultrasounds! _
|
| Wait till you have to have a catheter inserted up your pp.
| doctoring wrote:
| Very interesting overview of the technological / materials
| breakthroughs to enable miniaturization.
|
| From a physician (specifically radiologist) perspective, I'm a
| big fan of handheld/point-of-care ultrasound and am excited about
| their potential at democratizing a very useful and low-cost/low-
| risk imaging technology. (I also own a Butterfly.)
|
| That being said, the "cart-based" ultrasounds will likely always
| have a place in a hospital; the size of the ultrasound probes is
| not why the cart is big/expensive/useful. The cart is a big
| floating screen and also an image/record management system. You
| (or at least, a trained ultrasound technician) can manipulate
| ultrasound parameters and annotate images (critical for
| ultrasound interpretation) way way faster on the cart's set of
| wonky keys/dials/trackball than on a smartphone.
|
| Also, with the rise of handheld/point-of-care ultrasound, we've
| noted with amusement in the radiology department the frequency
| with which patients get referred for additional imaging because
| the ED or primary doctor saw some pathology on their handheld
| ultrasound... and when we take a look it is just not there. I
| think this is probably more of a training issue, as ultrasound is
| truly quite challenging both to perform AND to interpret (and a
| major part of using an ultrasound probe is essentially real-time
| interpretation), which is even more challenging given the lower
| image quality and field-of-view of smaller probes.
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