Ultrasound: Portable technology in hands of Temple medical students

BUTTERFLY DEVICES

PORTABLE ULTRASOUND TECHNOLOGY IN HANDS OF TEMPLE MEDICAL STUDENTS

By David A. Kostival, Contributing Writer

When it comes to training students in the practice of medicine, keeping up with the latest technology often goes hand-in-hand with clinical skills.

Temple University recognized this earlier this year when it made a groundbreaking gift to all first- and second-year students in the Lewis Katz School of Medicine.

Because of what the university called a “generous donation” by Dr. Ronald Salvitti, MD, ’63, the Katz School gave handheld, portable Butterfly iQ+ ultrasound devices to every member of the class of 2025 in August and to the members of the class of 2024 in October.

Temple became the first school on the East Coast to make such a gift. According to university officials, there are only two other medical schools, both on the West Coast, that gave its students the devices.

Six imaging modes

The Butterfly iQ+ brings point-of-care ultrasound to the next level. The probe is plugged into a mobile device, which then connects to the Butterfly iQ+ iOS or Android app. The device has access to six imaging modes, offering visualization of nearly every bodily structure.

In a press release, Jason Wingard, president of Temple University, said this was a path-breaking gift for medical students.

“It allows us to introduce them to advanced medical imaging on the very first day that they begin their coursework, creating a solid foundation for them to become future leaders and innovators in the field of medicine,” Wingard said in a statement.

Dr. Amy Goldberg, interim dean and professor of surgery at the Lewis Katz School of Medicine at Temple University, said the technology involved has been around for decades. But what is new is that the portable units can easily bring ultrasonography to a patient’s bedside.

“This is cutting-edge with regard to education,” Goldberg said. “This is like a high-powered stethoscope. But where with a stethoscope you listen, the ultrasound sees.

“If seeing a patient with abdominal pain, you will take this out of your pocket, plug it into your phone and take a look to see how the gall bladder looks,” she said.

Goldberg said that is why it is so critically important to give a unit such as this to students.

The technology “is cutting-edge with regard to education,” said Dr. Amy Goldberg, interim dean and professor of surgery at the Lewis Katz School of Medicine at Temple University. “This is like a high-powered stethoscope. But where with a stethoscope you listen, the ultrasound sees.”

First-year Temple medical students receive hand-held ultrasound units as part of the white coat ceremony in August. Courtesy of Ryan Brandenberg, Temple University

The Butterfly iQ+ is three-probes-in-one. Point-of-care ultrasound technology began with emergency medicine out of a need in 24-hour emergency rooms, said Dr. Ryan Gibbons, associate professor of emergency medicine, director of the Emergency Ultrasound Fellowship and associate director of the Division of Emergency Ultrasound in the Department of Emergency Medicine, and director of Ultrasound in Medical Education at the Lewis Katz School of Medicine at Temple University.

‘Train to use it’

“We have to learn how to adapt to new technology, but this enables the students to have it at a time while in medical school where they can train to use it,” Goldberg said. “Specifically, we’ve created ultrasound sessions to allow the students to become familiar with ultrasound and learn how to use it.”

Goldberg said the students are ecstatic.

“They understand this is an incredible resource that has been given to them, and they are proud that they are on the cutting edge of technology,” she said.

“Clayton Christensen (an academic consultant who developed the theory of disruptive innovation) wrote about innovation years ago and how certain things, which are innovative, are disrupters,” Goldberg said. “Ultrasonography was one of those, and there are a host of different specialties in medicine that utilize ultrasound.”

Quinn Harrigan, a second-year medical student, said she was surprised by the versatility of the device.

“Typically, ultrasounds have different probes for different types of examination, such as a curvilinear probe for the abdomen, phased-array probe for the heart and a linear probe for vascular assessment.” Harrigan said. “The Butterfly is three-probes-in-one. It lets us examine more than one organ system without carrying around multiple probes.”

Harrigan said she and her fellow students are using the devices during workshops.

“We are in a gastrointestinal block, and we used the devices to practice looking for the gall bladder and the portal triad during a practice session,” she said. “This type of work will enable us to be more comfortable assessing the gall bladder in future clinical settings. Being able to integrate clinical skills into our didactic-based first two years in this way facilitates an easier and more effective transition to the clinical third and fourth years.”

Second-year Temple medical students receive ultrasound devices. Courtesy of Joe Labolito, Temple University

Combine transducers

While handheld devices have been around a while, the Butterfly iQ has been able to combine all transducers into one unit, according to Dr. Ryan Gibbons.

Gibbons is associate professor of emergency medicine, director of the Emergency Ultrasound Fellowship and associate director of the Division of Emergency Ultrasound in the Department of Emergency Medicine. He is also director of Ultrasound in Medical Education at the Lewis Katz School of Medicine at Temple University.

“Typically, you need a cardiatric probe: something for the stomach and another for the vascular system,” Gibbons said. “What Butterfly has done is to put all of this into one probe and manage to put it in a handheld device. It is revolutionary: We are not seeing this from any other company.”

Gibbons said the advantage to students is that it can be used in any field of medicine.

“By introducing it in the first year, they have something that they will grow with throughout their careers,” Gibbons said. “From a patient-care perspective, it doesn’t get any better.”

Gibbons said point-of-care ultrasound technology began with emergency medicine out of a need in 24-hour emergency rooms.

“This has been expanding into internal medicine,” he said. “This is something over the next couple of years that will be popping up throughout all fields of practice.”

Gibbons said there are numerous medical schools that are teaching point-of-care ultrasound, but have not been able to give the students the hand-held devices to use routinely.

“Along with the schools on the West Coast, we will be leading in this effort,” he said. “We have had other schools reaching out to us. This will be commonplace, eventually.”

Beginning of careers

William Mills Worrilow, another second-year medical student, said the opportunity will introduce students to relatively new technology at the beginning of their careers.

“Point-of-care ultrasound is being utilized at most academic centers in the emergency departments across the country as well as other departments,” Worrilow said. “Rather than starting our clinical rotations without any prior exposure to these devices, we will now have knowledge, familiarization and hands-on experience.”

Worrilow said there are so many ways in which the devices can be used.

“We will be able to look at the heart real time to look for cardiac function and for the presence of a pericardial effusion,” he said. “We will be able to evaluate the lungs for fluid. We can look at the aorta for the presence of an aneurysm. We can look for the presence of fluid in the abdomen for our trauma patients. We would be able to look at the eye to assess for retinal detachments. We can look at the gall bladder to assess for cholecystitis and the kidney for stones.”

Worrilow serves as one of the co-presidents of the Point of Care ultrasound interest group at the Lewis Katz School, and has helped to organize hands-on skill-based sessions for the first- and second-year students.

“The fact that the device is portable and easy to use will be an incentive for me to use it more often,” Worrilow said. “I feel quite fortunate that the Katz School of Medicine has provided this amazing tool for our use.” •

David A. Kostival is a contributing writer to Philadelphia Medicine.