Handheld ultrasound + AI

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On September 28th, the US handheld ultrasound equipment manufacturer Butterfly Network announced the completion of the $250 million D round of financing, with a post-mortem valuation of $1.25 billion, becoming the new unicorn in the digital health care field.

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Who is Butterfly? Why are investors so optimistic? What is the current status of the entire handheld ultrasound market? Is there a company in China that is comparable to Butterfly? China first launched the first hand-held ultrasound manufacturer that obtained the Chinese registration certificate CFDA. It is located in Huisheng Technology of Chengdu, trying to solve these problems one by one by deepening the industry.

Founded in 2011, American Butterfly is one of the world's leading R&D companies for handheld ultrasound imaging. It is committed to the decentralization of medical imaging through the development and application of “Palm Ultrasound+AI”. Its Butterfly iQ ultrasound product is the world's first FDA-approved personal ultrasound device and the world's first single-needle universal ultrasound imaging device.

Butterfly iQ relies on an ultrasound transducer system integrated on a single chip, which can be directly connected to a smart phone, and combined with cloud technology, artificial intelligence, deep learning, etc., to achieve a single handheld ultrasound probe through a variety of inspection modes, respectively Complete the operation of multiple parts of the body, a variety of clinical applications. It is reported that Butterfly iQ has covered 13 indications including abdominal, cardiovascular, fetal, gynecological, urinary, musculoskeletal and so on.

At the same time, with the help of smart phone application and Internet technology, Butterfly iQ has the functions of remote mutual assistance, which enables seamless real-time cooperation and communication between ordinary users and industry experts, primary medical institutions and large hospitals.

Dr. Jonathan M. Rothberg, founder of Butterfly, believes that Butterfly iQ represents "the birth of a new industry," which is using on-chip ultrasound to change existing medical models.

Pocket ultrasound is a challenge for traditional ultrasound?

This new industry is the subdivision of "Palm Ultrasound + AI".

Pocket ultrasound, also known as hand-held ultrasound, is a mobile-sized ultrasound device that can perform inspections that require large hospital B-ultrasounds. This small handheld ultrasound instrument has many unique advantages over traditional large instruments:

Traditional large-scale ultrasonic instruments have the disadvantages of being bulky, cumbersome, incapable of moving, and expensive. For hospitals, the purchase of large-scale ultrasound equipment is expensive, and it is also necessary to train professional doctors; for patients, the use of the scene is limited, must go to a special department to check, generally have to make an appointment in advance or wait in line, the procedure is relatively cumbersome.

Portable ultrasound equipment can just make up for these weaknesses. First of all, the ease of portability and ease of operation of handheld ultrasound can greatly improve the diagnostic efficiency, facilitate access to the clinical department, and sink to the grassroots; secondly, in terms of price, handheld ultrasound also has great advantages.

The director of the Department of Ultrasound at Shanghai Ruijin Hospital said, “The price of large-scale ultrasound is more than 1 million, and the cost of handheld ultrasound is extremely low, which is conducive to popularization in grassroots and clinical departments. In the future, it can become a doctor's helper like a stethoscope. At the same time, handheld ultrasound can reach A large amount, large ultrasound usually only about 20 hospitals in the top three hospitals, small ultrasound clinical departments can be equipped with each group of doctors. If the primary medical institutions can not afford high-end instruments, you can use handheld ultrasound to achieve the purpose of ultrasound screening, but also the following In the community and the countryside, the application scenarios are very extensive. In addition, the handheld ultrasound in the military field is also very useful, and the demand for field operations is very large."

Wide range of applications

Specifically, there are three main application scenarios for handheld ultrasound: hospital clinical departments, including bedside testing and ICU emergency services; primary medical market; and emergency out-of-hospital disasters. This is an incremental market that traditional large-scale ultrasound is difficult to reach.

First, with the miniaturization of ultrasound equipment, ultrasound technology has stepped out of the ultrasound department, entered the clinical department, assisted clinicians in bedside testing, and even entered the emergency department and ICU to save lives. For example, anesthesia before surgery, the doctor can accurately apply the needle under ultrasound guidance, which can reduce the number of needle insertions during anesthesia.

Second, the sinking of medical resources and the rise of primary medical care. The demand for ultrasound examination in China's vast primary health care market is enormous. However, due to the fact that the primary doctors do not use or understand ultrasound, the popularity of ultrasound examination is limited. In order to allow more grassroots doctors to use ultrasound extensively, "Palm Ultrasound + AI" will play a major role. By relying on an integrated artificial intelligence system, the ultrasound device can automatically prompt, such as whether the lesion may be malignant, can greatly reduce the pressure on the primary doctor.

Third, portable handheld ultrasound equipment is particularly useful at disaster relief sites, especially in remote mountainous areas. It can help doctors to accurately diagnose patients' injuries on the spot, and conveniently give timely treatment plans to determine which patients need on-site first aid and which need to be transferred immediately.

Fourth, POC bedside ultrasound (POINT OF CARE ULTRASOUND SYSTEM)

In addition, there is another application scenario for handheld ultrasound that is home health care. As the population ages, family doctors and nurses can perform routine routine vital signs tests for patients. At present, handheld ultrasound is more popular among American family doctors.
 

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Low price

In terms of price, handheld ultrasound equipment is also much cheaper than traditional large ultrasound instruments.

According to Cost Owl, most new ultrasound devices range in price from $20,000 to $75,000. GE's high-end ultrasound systems sell for more than six figures. The price of the Butterfly iQ ultrasound device is only $2,000, which is 10 times lower.

Butterfly's chief medical officer, John Martin, even said that once the company expands its production scale, the price of the equipment may be even lower, as low as $500. Butterfly hopes that handheld ultrasound devices can become a standing tool for doctors, such as "stethoscopes."

Wu Yifang, president and CEO of Fosun Pharma, commented: "Butterfly has brought about a revolution in medical imaging, making ultrasound imaging technology more popular, more convenient, and more affordable."

As for the future, with the further popularization of handheld ultrasound, whether it will incite the status of traditional ultrasound equipment, or even replace it, is still uncertain. But it is predictable that handheld ultrasound will definitely become the strongest increase in the ultrasound market. Perhaps, handheld ultrasound is not a substitute but a supplement to traditional ultrasound.

The demand for handheld ultrasound is large, and the market is huge.

We live in a world of uneven distribution of medical resources and technology. In this world, about two-thirds of people in the world do not have access to medical imaging services. Even in developed countries, the lack of cost and expertise limits the popularity of medical imaging. .

Butterfly has been trying to popularize ultrasound imaging, removing cost barriers through advanced technology and meeting the needs of ultrasound for 4.7 billion people worldwide. There are 9.2 million doctors and nurses, midwives and other health care providers in the world. Therefore, the market for high-efficiency, portable, and inexpensive handheld ultrasound equipment is quite large.

According to research by Probe Capital and Signify Research, the global market for ultrasound imaging equipment was $7.5 billion in 2015. The global market is expected to reach $10.5 billion in 2021, with an average annual growth rate of 7%. Among them, the portable ultrasound segment has grown by 40% from 2016 to 2017. As performance and availability increase, the market is expected to grow at a rate of 20% per year from 2017 to 2022.

Simon Harris, principal analyst at Signify Research, said: "The latest handheld ultrasound devices have been greatly improved in performance, such as image quality and power management and availability, are widely recognized in bedside diagnostics, and in radiology, urology More traditional departments such as cardiovascular and feminine health have a smaller degree of application."

Blue ocean market, technology is king

So, is the handheld ultrasound market Red Sea or Blue Ocean? To get into the home and the individual, you need to link the smartphone through the wireless or USB interface. The handheld ultrasound of the tablet is not the shrinking of the traditional ultrasound, then the market is very large, so a big toon, this meaning There are only a handful of global players on the handheld ultrasound. It can be seen that the handheld ultrasound market is still a blue ocean, and there is still much room for development in the future.

From a global perspective, the traditional medical device giants led by GPS are gradually joining the handheld ultrasound market, and the earliest layout has begun in 2009. When GE's first-generation handheld ultrasound VSCAN 1.0 was launched in the US, it caused a sensation. It was named "50 Best Inventions in 2009" and "2010" by Time magazine and the well-known science magazine "New Technology Times". 100 best scientific and technological achievements of the year."

However, most of the world's handheld ultrasound manufacturers are mainly start-ups, Chinese companies and foreign companies are basically synchronized, and most of them are the first handheld ultrasound certification in 2016-2017. At present, GE, Philips, Clarius, Healcerion and Butterfly have obtained FDA certification. The Australian company Signostics has obtained approval from the Australian, Canadian, Japanese, New and European regulatory authorities, but has not entered China. Domestic Huisheng is the first company to obtain CFDA certification. Its products can be connected to mobile phones, computers and tablets. It is no longer that some manufacturers simply reduce the traditional ultrasound, followed by Sonostar and Suzhou Scott.

In addition, from a technical point of view, there are some differences between domestic and foreign companies. The imaging quality of ultrasound equipment is closely related to two aspects: one is the number of physical channels on the hardware, and the other is the level of algorithm chip implementation. The former can be compared to the body of ultrasound performance, the latter can be understood as the soul of ultrasound performance.

In terms of the number of physical channels, generally speaking, the more the number of physical channels, the more signal data is collected, and the higher the resolution of the image obtained by the operation. At present, the main manufacturers of handheld ultrasound are mostly 8 channels or 24 channels, in which the handheld sound device can achieve 32 physical channels at the start. And the company said its next step is to open 128 physical channels. This will become the number of physical channels used in large-scale color ultrasound equipment in the domestic low-end market.

In terms of algorithm chips, excellent ultrasound core algorithms and chip implementations allow ultrasound devices to perform at performance levels well beyond existing hardware levels. At present, many well-known domestic ultrasonic brands are completely comparable to imported brands at the hardware level, but there is still a big gap between the research and development of algorithm chip technology and imported brands.

Butterfly in the United States is the first company to re-imagine ultrasound from the ground up. Its Butterfly iQ ultrasound device is no longer just a reduction of traditional ultrasound equipment, but fundamentally changes the design of ultrasound.

Conventional ultrasound equipment relies on the vibration of a quartz crystal sensor to send pulses to the body, which then convert the returned pulses into an image. The Butterfly iQ replaces these crystals with ASIC chips embedded with 9,000 metal sensors, each of which is smaller than the tip of a human hair. Compared with general-purpose chips such as GPUs and CPUs, ASIC chips are more powerful and cost-effective. At the same time, it can also encapsulate the AI ​​algorithm, so that all functions of ultrasonic testing are concentrated in the front section, the data collection efficiency is greatly improved, and the overall computing power is strengthened.

The arterial network found that there are currently only four handheld ultrasound manufacturers equipped with AI on the products, namely, Australia Signostics, American Butterfly, and China Langsheng Technology and Stoco. Stoco is the only ultrasonic testing equipment manufacturer in China that can package the underlying platform algorithms and artificial intelligence algorithms into ASIC chips. At present, such artificial intelligence assisted demand is biased towards delineating organ structures and delineating lesions.

In China, local handheld ultrasound companies have an advantage

Focusing on China, the market for ultrasonic diagnostic equipment in China has reached 6.9 billion yuan in 2014. It is estimated that in 2019, the market size of medical ultrasonic diagnostic equipment in China will exceed 9.1 billion yuan, with an average annual compound growth rate of 5.7%.

In the field of handheld ultrasound segmentation, with the improvement of China's medical technology research and development capabilities, there are more and more domestic companies that can compete with Butterfly, such as Huisheng Technology and Chaoxin. As local companies, they are enjoying the benefits of technology, policy and market environment.

First of all, with the development of technology and the cost reduction brought by scale, handheld ultrasound equipment is expected to replace the stethoscope, the most common clinical detection instrument, in bedside detection, etc., so the market prospects brought by it are very broad.

In the field of ultrasound imaging, handheld ultrasound equipment is also accepted by clinical doctors because of its wide application fields and portable operation. It can enter the clinical department and gradually sink the primary care. It is expected to become the strongest growth in the ultrasound imaging market. power.

According to the survey, the emergency department, anesthesia, maternity, heart, endocrine and other departments of the top three hospitals in China also have a large demand for it, and the market can reach about 28 billion US dollars in the future.

Secondly, primary medical care has gradually emerged, and hospital outpatient clinics have begun to shift to primary care. The grassroots has become one of the main use scenarios for small non-invasive diagnostic devices.

Finally, the national policy is beneficial to the development of the domestic handheld ultrasound industry. In recent years, the state has introduced a series of policies to encourage medical device innovation.

For example, in 2017, the “Opinions on Deepening the Reform of Examination and Approval System and Encouraging Innovation in Pharmaceutical Medical Devices” was encouraged to encourage domestic medical device innovation; in 2016, the National “13th Five-Year Plan” major research and development project issued by the Ministry of Science and Technology, handheld ultrasound equipment was listed among them. The government's primary health care projects, such as “doctors on horseback”, are pursuing the purchase of small non-invasive diagnostic equipment, and the demand is increasing.

This series of policies and market factors have made domestic mobile ultrasound companies such as Huisheng Technology more advantageous in foreign markets than foreign companies such as GE, Philips and Butterfly. Moreover, as far as the current situation is concerned, there is no foreign wireless portable ultrasound in the domestic market. Siemens wireless equipment is sold abroad, but the price is too high, not sold in the country; Philips is a wired device, ready to enter China sales; GE is a mobile phone, but the traditional ultrasound equipment is reduced, mainly in the clinical department of the big hospital .

Therefore, this is a great opportunity for the development of China's domestic handheld ultrasound industry.

Who will take the lead in achieving a corner overtaking?

Then, in such a good environment, those companies with excellent independent research and development strength will most likely bend over and take the lead in realizing the commercialization of handheld ultrasound equipment.

Among several domestic handheld ultrasound equipment companies, Huisheng Technology is the most promising leader in domestic handheld ultrasound.

First, a team with a strong technical background makes the voice different from other companies in the ultrasound field. Huisheng's core team has deep technical knowledge and rich experience in ultrasonic research and production. Sino-Dutch Capital, which is preparing to invest in Huisheng Technology, also evaluates the handheld ultrasound of Huisheng Technology. They are the few teams in China with the integrated software and hardware design and development capabilities of the underlying technology platform.

The company also has its own original imaging platform, as well as a number of key technologies such as original elastic imaging technology and 3D Doppler spectrum imaging. Huisheng Technology's original ultrasound imaging platform not only enabled 32 physical channels (8 channels or 24 channels in the same class), but also independently developed the GUP Open CL architecture for image data processing. It should be noted that GPU-based image data processing technology generally appears in the international first-line manufacturers, such as GE, Siemens, France, and other new high-end ultrasound products. Domestic large-scale medical ultrasound products mostly use CPU arithmetic processing, which is behind the GPU algorithm.

Huisheng Technology has a number of small ultrasound-based non-invasive diagnostic products that can be used in a variety of settings such as intraoperative, anesthesia, puncture, etc., and can be used for liver disease diagnosis, cervical vascular and thyroid screening. In the future, image fusion navigation can also be used for interventional instruction.

In the field of handheld ultrasound, we see that Butterfly has developed into an industry unicorn with its subversive technical strength. It will improve the quality of care for half of the world's population, while also allowing its investors to get a good return in the process.

Like Butterfly, Hunyin Technology also encapsulates the underlying platform algorithm and artificial intelligence algorithm onto the chip. With the intelligent diagnostic module, the conventional use scene of ultrasound is moved out of the single imaging department and into the clinical departments, greatly expanding the use of the scene. The size of the market makes the diagnosis more precise and minimizes the need for high-level expert experience, which is conducive to promotion to the grassroots.

Therefore, with strong technical strength, will Healson Acoustic Technology be China's Butterfly? Even with the advantage of Chinese local enterprises, under the impetus of national policies and markets, to achieve cornering overtaking, leading the entire handheld ultrasound industry? We will wait and see.

Future

There is an old saying: "Sell to the rich, live with the poor; sell to the poor, live with the rich." From a perceptual point of view, selling to the poor seems to be more favorable. In other words, technologies and products that improve the quality of life of the poor will be more likely to be sustainable. Pocket ultrasound meets the medical needs of more people at a lower price, which is in line with this concept, and the future development prospects are expected.

Now, more and more doctors are aware of the potential of handheld ultrasound. In the next five to ten years, a large number of clinicians, general practitioners and other medical staff will have a personal ultrasound device that can be placed in a pocket. Pocket ultrasound may be the next stethoscope.

2019/05/06 11:18
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