In African Villages, Phones Can Become Ultrasound Scanners | Hacker News Reader

In African Villages, Phones Can Become Ultrasound Scanners

nytimes.com

176 pointsyodaiken54 comments

This is beautiful. As a developer this is the kind of app I would like to work on, that has a direct good impact on people's life.

I know there are all kinds of lists on github.

Is there a list of companies that are inherently good (I know it's subjective) and are hiring developers?

As an engineer working in non-profit health, just remember the grass is always greener.

Does this mean you feel that your work is not altruistic?

Would you mind elaborating on that? Some days I feel like I’d rather work for a non-profit than where I am.

Having worked in a government organization (military) for 10 years, i will guess.

I think the point is not that one is not better than the other, simply that they are different. Each coin has two sides, and double edged swords cut both ways.

If youre flush with cash, you might feel void of meaning. If youre helping children, you feel fulfilled but frustrated by what little it would take to accomplish so much more.

Reminds me of the Japanese idea of 'Ikigai' [1]. Basically what you describe - most careers end up fulfilling you in one way, but leave you devoid in another.

[1]http://theviewinside.me/what-is-your-ikigai/

There's actually a great list provided by the folks at Fast Forward, specifically focused on tech forward non-profits https://www.ffwd.org/tech-nonprofit-jobs/opportunities/?_sft...

I run Nafundi (https://nafundi.com) and we work exclusively on open source software (https://opendatakit.org) that improves the lives on the underserved. We are bootstrapped, remote-only, and always hiring.

Amazing work! Just curious -- what's your revenue model?

A combination of professional services and grants. The mix varies from year to year.

Hi guys, Butterfly is growing and we are hiring senior engineers on a variety of teams! Check out some openings here https://careers.smartrecruiters.com/4Catalyzer/butterfly-net... Also, feel free to send me an email or send your application directly to my email maria@butterflynetinc.com

For even more context here: they're part of a biotech incubator called 4Catalyzer. The other companies are also working on potentially life-changing products too, including cancer drugs and seizure detection.

Lots of possible roles, take a look!

Goodbye to India's hopes to control ultrasound scanning of pregnant women to prevent gender selection. :(

I am glad people are using butterfly in remote areas rather than just in hospitals where they already have the ultrasound tech.

https://news.ycombinator.com/item?id=14869138

2 years ago build somebody a simple ultrasonic scanner with a Raspberry Pi.

Anyway it's great. A lot of such tech is just expensive .. because it is since ever and customer pay the price.

This is the kind of investment in technology I think Bill & Melinda Gates should be remembered by, as well as their investment in vaccines and contraception. Great stuff ( and well done to the inventor)

At a tech meetup a while back, I chatted with someone who had just finished reading a book about Disney. They were lit up and enthused. Walt was a saint; Disney Corporation is a distillation of sunlight and laughter; its motivation and impact on the world is bringing joy to children. I wasn't sure what to say. Perhaps I mumbled something like "I always worry when I haven't seen nuance, that I've noticed only one face of something".

Jonathan Rothberg should have enough money to invest of his own. He is behind several dna sequencing companies.

I had similar thoughts, but then I started realizing that investing in fighting malaria or cheap ultrasound scanners will matter little if in 30-50 years much of our planet becomes uninhabitable, which is now nearly certain unless we take immediate action.

These days I think almost all resources should be thrown into inventing and developing carbon capture technologies.

I don't mean to belittle the achievement or sound harsh, but when thinking of priorities one has to consider what will happen if something is not done.

All these things need to be done. My thoughts center around how do you provide a decent sustainable existence for the other 2-3 billion people on earth[1]. There are a lot of things that need to be done to make that happen. Really affordable basic healthcare is one of those things.

[1] Hint we can't do this via the raw growth and exploitation used to lift the first billion people out of poverty.

Yes, all these things need to be done. But, again, most of these things will matter little if in 30-50 years much of our planet becomes uninhabitable, which is now nearly certain unless we take immediate action.

Those 2-3 billion people on earth you mentioned? Most of those live in the tropical zones and if we do not concentrate on fighting climate change NOW, will not have a place to live. Healthcare will be a secondary issue.

You can walk and chew gum at the same time...

And here I think our highest priority should be stopping the heat death of the universe. Makes global warming seems really small in comparison, no use spending energy on it.

Fun fact - Tim O'Reilly tweeted that this tool came about from a discussion at one of his FOO Camps.

I don't understand why this ultrasound scanner needs a user license except for exploitative reasons. It's what crooks would do.

Ultrasound systems are medical devices. There are limits on power levels for patient safety and to ensure efficacy. To my knowledge, licensing here is an attempt to protect patient safety.

Phony argument. An electronic thermometer and blood pressure monitor ensure safety too and they never need a license. Do x-ray machines need a license? This ulrasound device by definition doesn't even emit radiation. This company is conning its users.

Thermometers and blood pressure monitors are passive devices. Ultrasound systems do emit radiation, in the form of ultrasound vibrations from a transducer of some kind. In the ultrasound industry, there are two measurements, mechanical index (MI) and thermal index (TI) used to characterize the power being transmitted into human tissue. Clinical ultrasound manufacturers usually have a lab (AP&I "Acoustic Power and Intensity") to measure these parameters to stay within what are thought to be safe limits.

You can believe they are conning their users, but if you want to manufacturer and sell ultrasound systems, you generally have to comply with many different regulations.

If you actually read the FAQ on the website (https://www.butterflynetwork.com/pricing) you'll see that you don't need a license to continue using the product:

> Your Butterfly iQ will remain functional even without a subscription. You can continue to scan in all 19 applications, but will not be able to upload new images. You will have full access to all images in the cloud that were previously saved.

They're forcibly charging for the first year of cloud subscription, and this still makes it a con.

Only works with Apple products? That's rather out of touch.

Guess if you can afford a $2000 scanner you can afford a $200 used iPhone.

Not really. The thing with Apple devices is that you can be relatively sure it will work and you only have to test against a couple devices. For Android handsets? Different and vastly larger beast.

There's so much that may or may not work: the USB port must support OTG/Host on the hardware side, which is already a hit-and-miss. The port must be able to supply the power required for the ultrasound. Then the Android stack must support USB OTG - and that must have been properly tested during manufacturing. And then the vendor must have compiled the Linux kernel below Android with support for uvcvideo (which is not standard enabled in cheap phones). Then the CPU and video unit must be powerful enough to run the software with video playback.

android is currently under development

I too doubt iPhone is the cheapest capable smartphone and the most cost-effective way to do whatever it can do.

It has nothing to do with the phone or the software it's the device, which if you could get down to a hundred $ or so it could be used by farmers of livestock.

This could be a revolution, but the Ultrasound Scanners need to be in the hands of low income farmers then imagine how quickly the dam ecosystem would develop across to humans.

I've been looking to get a cheap one from China, but you can't, I'm not sure why, but perhaps it needs a certain chip that is not made cheaply yet. There are DIY's around but seem immature.

If you want to change the world, get the price down for use on animals.

This is a good first step, but while the medical community is in change it'll move at a snail pace which means a lot of people will die.

I guess it's hard to make a decent one. You can get scanners from about $600 up from china. Apparently you need an array of transducers which cost a bit.

I'm not sure why the Africans need a $2000+ butterfly scanner rather than this kind of thing https://www.aliexpress.com/item/Veterinary-ultrasound-machin... ?

I presume the Chinese one isn't as good. The images do look a bit blurry.

I'm not sure you can mass market it. You need medical knowledge to make sense of ultrasound images. Unless you plan to use it for something else than medical

A lot of farmers have a surprising amount of medical knowledge. It is common for farmers to do a lot of simple medical procedures on their animals. Large farmers in the US already have ultrasound machines for their cows - they don't need to know everything about how to read them to know signs that mean call in help (thus saving a lot of money)

Knowledge of animal anatomy or certain medical procedures are no help in trying to decipher an ultrasound image. I don't think you can just plop an ultrasound scanner into a farmer's hands and have them to do anything truly useful with it, to justify the investment. Not without training.

One option would probably be to have a doctor remotely in a "command center" just looking at these as they are uploaded from the field, and relaying the diagnosis back to the farmer.

How much training do you need though: A one day class can cover "this is is normal, this is where you need help". Of course these are animals: farmers are willing to make economic decisions here. The risk/cost of a rare disease going undetected vs time to learn how to accurately diagnose it (or pay someone who has the training) is something that can be talked about.

> A one day class can cover

...probably not much more than a 1 day C++ course would offer a random person. :)

That's nowhere near what a farmer needs to read much into an ultrasound. It takes a medical student years of learning (medicine) topped by a lot of practice and experience in imaging until they are useful in actually reading an image. And even a 1-2 day course costs thousands of dollars.

It would be a massive expense for very little real life benefit. I'm guessing AI and a remote doctor would do better. I kept reading a lot of good news recently about AI helping with diagnostics in medical imaging so I guess we can't be too far.

Over the weekend I had a veterinarian tell me that he wasn’t capable of properly interpreting an ultrasound! He did an x-ray and saw something concerning, but being Easter weekend there were no ultrasound techs in the office. I had to take my cat to a different clinic, where a pro successfully figured out what was going on.

I agree fully that a 1-day course isn’t going to be enough here. Radiologists go to school for a while to get good at both the imaging part and the interpretation part.

In the article, the dr uploads the scan for confirmation. I agree the average person shouldn’t be trying to self diagnose from a scan, but anyone could upload a scan to a dr they couldn’t travel to.

Ultrasound is actually something that requires training and The imaging quality is very operator dependent. This physician is definitely reading the scans himself and acting upon them; uploading might just be for some kind of confirmation and formal quantification.

You can't just hand someone a probe and expect them to produce meaningful images. Especially in this kind of context where presumably they are getting used in dozens of different contexts; it really does require some medical reasoning and anatomical knowledge.

The price of a portable ultrasound has little to do with the electronics as far as I understand it. Production of the probe's ceramic transducer is expensive.

Yes you are right, except for the fact that this probe uses a silicon chip instead of a piezoeletric ceramic transducer, and that's exactly the reason why it costs 2000 dollars.

Right, but that is what the parent is hinting/asking: can we make whatever expensive parts more cheaply? Can we find alternative measurement setups?

Regarding the price of piezoelectric transducers, the typical buzzers (i.e. the flat round piezo discs) are very cheap.

===

Idea 1: Using piezo buzzer elements (the piezo disks):

The piezo discs are ridiculously cheap, but large monolithic transducers. There is a trick to partition them into multiple transducers:

The piezo disc transducers are essentially: a steel membrane, onto which a thin layer of piezoelectric material is deposited, onto which a very thin and weak layer of metal is vaporized, onto which leads can be soldered (at low temperature).

The steel membrane defines the resonance frequency in its monolithic configuration, and can be thickened to make it less flexible, say by electrodeposition of copper in a copper sulfate bath, in order to make the steel membrane a more rigid base (since we are interested in the local pressures and not the global pressure which deforms the disc).

The thinnest metallic layer on top can be easily patterned even mechanically, see for example:

https://web.archive.org/web/20071214032759/http://www.geocit...

Here the single disc transducer is patterned into 4 independently transducing quadrants. For context on the motivation of that page, it is for actuating a scanning tip for a Scanning Tunneling electron Microscope (STM).

Essentially they just use a ruler and a fine blade to cut the metal layer, and then clean up any remains with a pencil eraser to clean the surface for soldering and eliminate any conductive burrs after the cut to prevent shorts between the quadrants. It's pretty genius.

For context on why they want the 4 quadrants for the STM see: https://web.archive.org/web/20121114015437/http://www.geocit...

So in theory you could lay out a grid of piezo sensors this way, and then solder afterwards, or alternatively pattern the thin metal layer in such a way with traces such that between the top pads of each new subtransducer there are thin traces going to the edge of the piezo disc...

The patterning could happen mechanically or perhaps more sanely lithographically: spin coat (on a CPU fan) some photoresist, pattern with minification (don't need 5nm resolution) then etch the metal layer away... This seems to be within financial reach of top universities of even the poorest nations...

The cheapest buzzer element on DigiKey (helpfully without leads presoldered): https://www.digikey.com/product-detail/en/murata-electronics...

$ 0.19827 @ 8k pieces

(Cheapest in the naive sense of sorting by price, ideally you'd go through the list of 107 active products and inspect the price as a function of quantity)

The largest buzzer element on DigiKey (larger to allow more sub transducers to be defined):

https://www.digikey.com/product-detail/en/pui-audio-inc/AB65...

$ 2.67 @ single piece $ 1.4 @ 1000 pieces

(Largest in the naive sense of sorting by diameter, ideally you'd again go through the list of 107 active parts, and check the datasheets or images to estimate the actual piezo area diameter as opposed to the metal base diameter)

For the full list of active (currently buyable) DigiKey piezo elements: https://www.digikey.com/products/en/audio-products/buzzer-el...

For patterning one could use an analog camera, and focus it on a high resolution monitor, try and develop a couple of times to find the best setting for final resolution. then place the piezo with photoresist in place of the film...(probably irreversibly modify the analog camera a bit). Photoresist should be relatively cheap if its consumption is properly planned.

===

Idea 2: Using pressure sensitive paints, and optical readout.

Wikipedia https://en.wikipedia.org/wiki/Pressure-sensitive_paint

Pressure sensitive paints work by sensing the local oxygen concentration, which may be problematic in aquous conditions, perhaps it could still work on dissolved oxygen? Perhaps variations on oxygen-based PSP could be designed for liquids (better impedance matching with human body).

Perhaps a layer of PSP can be cured/dried in a flexible foamed state (with trapped air bubbles). Such that it can be brought in contact with water but still retain trapped air?

===

Idea 3: Using "schlieren photography": I am unable to find it back, but years ago I saw a video (I believe from some israeli university/college) where they somehow used Schlieren photography in water (which is rather incompressible) to visualize the beam quality and spot size of the transducer & accoustic lens / ...

If Schlieren imaging was used to characterize the quality of the ultrasonic beam, it suggests that perhaps Schlieren imaging could be used directly, if properly miniaturized etc...

One can easily find papers on the subject of using Schlieren imaging for characterizing hydrophones etc...

First time that I see that something can be connected to an IPhone. I wonder if you need special privileges from Apple, or there is an API available that can do some data (serial ?) transfer.

what do you mean? You can connect an FLIR to an iPhone to get thermo reading. You can connect a payment terminal to an iPhone for credit card processing. There's the 1inch DXO camera etc.

I don’t think there is any public API for this: you probably have to be in the MFI program to send data through the Lightning port.

"iOS app developers do not need to join the MFi Program. Everything app developers need is in the External Accessory Framework" https://developer.apple.com/documentation/externalaccessory/...

Technically there is a serial cable you can buy for hobbyist/personal/internal use but "Under current Apple policy this cable may not be used with apps sold on the App Store." https://redpark.myshopify.com/products/serial-cable-l2-db9v

I thought the hardware manufacturer needed to get MFI approval allow for developers to distribute apps that rely on ExternalAccessory?

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