Butterfly IQ - image quality?

MechEDoc · May 7, 2019

Question for people experienced with the Butterfly IQ ultrasound. I am looking at purchasing a unit to allow for easier access than using the department X-porte. How does image quality compare? My most common uses are central and peripheral line placement, DVT, FAST, RUSH, basic cardiac, pulmonary, IVC, abscesses and biliary. I would like to expand to using it for nerve blocks and more MSK indications.

Thoughts? Is this device ready for prime time? I have previously used Sonosite X-Porte, M-Turbo, and Edge II and the Philips Lumify and found them to be acceptable.

Groove · May 7, 2019

I like my Butterfly. However, the image quality is not as good as my Sonosite SII but I didn't really expect it to be. It's no slouch though and could totally be useable in all the applications you mentioned. It's good for line placement and decent to good for all the applications you mentioned. It's not great at cardiac.

My main gripe is that there's nowhere to really place your phone during sterile procedures. You have to basically just drop the phone somewhere outside your sterile field or have an assistant hold it. It's not a huge deal but there's something to be said for an ultrasound on a stand. I find myself peering over to the phone while I'm doing a procedure and it's just a little bit unwieldy. That's the price of portability though.

My other grip is that there are no preset calculations in any of the modes. OB would be a great example, no BPD, no CRL, nothing. You basically just have to measure everything from scratch and calculate. I thought that was a big oversight and hopefully something they correct with the next software update.

Minor gripe is that the footprint on your screen does not translate to the physical footprint of the probe. So, when you are doing lines, you have to get a feel for when the needle actually shows up on your screen and where that approximately is located on the probe footprint. It's a minor thing and you get used to it after a couple of procedures.

Second minor gripe. I wish they sent it with a fanny pack or something. I don't wear a white coat but I'd totally sport a fanny pack for this thing. It's too big to carry around in your pocket IMO.

Otherwise, I think the device is very cool. It's incredible that something that only costs about 2K could totally function as your sole ultrasound if you didn't have anything else. I'm happy with the purchase but I didn't have unrealistic expectations.

southerndoc · May 7, 2019

Why do they charge $420/yr to use their app?

Apollyon · May 7, 2019

southerndoc said:
Why do they charge $420/yr to use their app?

Maybe they're high?

TooMuchResearch · May 7, 2019

LOL.
Because subscription models are the wave of the future.

Arcan57 · May 7, 2019

If you can turn a product into a service then profits increase significantly. EA and video games are a good example, as is John Deere and making their tractors unserviceable without proprietary cables and software. Or selling a $2000 bike then charging studio level fees to use it.

southerndoc · May 7, 2019

Arcan57 said:
If you can turn a product into a service then profits increase significantly. EA and video games are a good example, as is John Deere and making their tractors unserviceable without proprietary cables and software. Or selling a $2000 bike then charging studio level fees to use it.

That $2000 bike (a Peloton I'm presume) has a subscription fee because of streaming new content.

What new content is given by the ButterflyIQ? Do they provide overreads for you if needed?

People will always pay a fee for something because they want the latest/greatest. Unless that fee includes insurance to replace your probe if dropped/damaged, then it's a waste of money.

I hate how we seem to have given into the subscription model (Office 365, Adobe Creative Cloud, etc.) when it's not really needed. It ends up costing more and business know this. They make more profits from us suckers that are immune to overcharges.

TooMuchResearch · May 7, 2019

southerndoc said:
That $2000 bike (a Peloton I'm presume) has a subscription fee because of streaming new content.

What new content is given by the ButterflyIQ? Do they provide overreads for you if needed?

People will always pay a fee for something because they want the latest/greatest. Unless that fee includes insurance to replace your probe if dropped/damaged, then it's a waste of money.

I hate how we seem to have given into the subscription model (Office 365, Adobe Creative Cloud, etc.) when it's not really needed. It ends up costing more and business know this. They make more profits from us suckers that are immune to overcharges.

I still use office/PPT/Excel 2007... never giving up those discs.

thegenius · May 7, 2019

I think the subscription service allows you to securely upload your US still shots and videos to a secure cloud-based service. If you plan on billing for your ultrasounds, one of the requirements is that the images you take be saved on a secure server for up to (I believe) 5 years.

southerndoc · May 7, 2019

thegenius said:
I think the subscription service allows you to securely upload your US still shots and videos to a secure cloud-based service. If you plan on billing for your ultrasounds, one of the requirements is that the images you take be saved on a secure server for up to (I believe) 5 years.

So that is the service that you get for $400/year. I asked and nobody told me what service you were getting for it. That explains it, and yes, I agree that storing it somewhere is required.

What happens when Apple ditches the Firewire cable and goes to USB-C? Will they exchange probes or will they have an adapter available?

thegenius · May 7, 2019

southerndoc said:
So that is the service that you get for $400/year. I asked and nobody told me what service you were getting for it. That explains it, and yes, I agree that storing it somewhere is required.

What happens when Apple ditches the Firewire cable and goes to USB-C? Will they exchange probes or will they have an adapter available?

I believe that is the service, one of our ER docs got that butterfly US probe and he pays like $30-40/month to store images on their cloud.

There is already a converter between Firewire and USB-C:
Firewire to USB-C

indianadan · May 29, 2019

Groove said:
I like my Butterfly. However, the image quality is not as good as my Sonosite SII but I didn't really expect it to be. It's no slouch though and could totally be useable in all the applications you mentioned. It's good for line placement and decent to good for all the applications you mentioned. It's not great at cardiac.

My main gripe is that there's nowhere to really place your phone during sterile procedures. You have to basically just drop the phone somewhere outside your sterile field or have an assistant hold it. It's not a huge deal but there's something to be said for an ultrasound on a stand. I find myself peering over to the phone while I'm doing a procedure and it's just a little bit unwieldy. That's the price of portability though.

My other grip is that there are no preset calculations in any of the modes. OB would be a great example, no BPD, no CRL, nothing. You basically just have to measure everything from scratch and calculate. I thought that was a big oversight and hopefully something they correct with the next software update.

Minor gripe is that the footprint on your screen does not translate to the physical footprint of the probe. So, when you are doing lines, you have to get a feel for when the needle actually shows up on your screen and where that approximately is located on the probe footprint. It's a minor thing and you get used to it after a couple of procedures.

Second minor gripe. I wish they sent it with a fanny pack or something. I don't wear a white coat but I'd totally sport a fanny pack for this thing. It's too big to carry around in your pocket IMO.

Otherwise, I think the device is very cool. It's incredible that something that only costs about 2K could totally function as your sole ultrasound if you didn't have anything else. I'm happy with the purchase but I didn't have unrealistic expectations.

I've used the IQ to put in peripheral IV'. The procedures went smoothly. Once you center the vein on the screen the blue guidelines on the probe indicate where you place your IV. The butterflynetwork.com website has a 2 min tutorial on peripheral line insertion you might look there.
On another note:
I've been able to see gallstones and GB wall thickening and pericholecystic fluid:
Butterfly Cloud (look at the 4th image)

Also saw rib fractures
Butterfly Cloud (1st image).

checking the IVC for collapse (for fluid status)and measuring it with M-MODE and a PLAX cine with EPSS (for EF estimation):