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As a specialty registrar in acute internal medicine, I have been using cart-based ultrasound machines for several years but I have had a particular interest in POCUS since beginning the formal accreditation process approximately 18 months ago.

It’s now become an essential part of my practice and I’ve earned accreditation in thoracic, abdominal, vascular and cardiac POCUS through the Society for Acute Medicine and the Intensive Care Society. I achieved all this using cart-based machines and, for a long time, they were my preference, mostly because of familiarity.

It’s now become an essential part of my practice and I’ve earned accreditation in thoracic, abdominal, vascular and cardiac POCUS through the Society for Acute Medicine and the Intensive Care Society. I achieved all this using cart-based machines and, for a long time, they were my preference, mostly because of familiarity.

However, like many clinicians – I’d long-been frustrated by the limitations of cart-based machines, namely the need to:

• Track one down when I need it and wheel it to the patient’s bedside
• Navigate narrow bedspaces, often having to rearrange them to make room for the cart
• Justify the time spent doing all this to colleagues cynical about the benefits of POCUS

The image quality from our cart-based machines was always more than adequate to meet my needs. By contrast, I was skeptical about the pictures produced by handheld devices, mostly because I hadn’t had much exposure to the technology.
I didn’t see the need to make a change — that is, until I started using the Butterfly iQ3.

Transforming workflows and reducing inefficiencies

I previously navigated near-constant workflow challenges with cart-based ultrasound. At almost every hospital I’ve worked at, team WhatsApp groups were regularly flooded with messages asking where the cart-based ultrasound machine was. It seemed like the machine was always unavailable when it was needed most urgently.

Those challenges disappeared overnight once I had a Butterfly probe. Wherever I am in the hospital, I can instantly plug the device into my phone. Without having to leave the bedside to track down a machine, I can scan the patient in a matter of seconds. The convenience allows me to use POCUS in settings I would not otherwise use it – for example, when attending an emergency call in one of our lower-acuity wards, which are often several corridors and stairwells away from the nearest cart.

Since I realized how efficiently I could scan patients and get the images I needed — without the inconvenience of a bulky cart-based machine — I haven’t looked back.

Enhancing clinical versatility with on-demand imaging

As a physician with a special interest in postgraduate medical education, I’m eager for my juniors to pick up ultrasound as a simple but powerful tool that can make a meaningful difference to the care we offer patients. The Butterfly iQ3 probe is a major step in that direction.
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The intuitive interface makes it easy to plug in and start scanning without having to waste time learning complex controls. Once you’ve learned to use the probe, it’s incredibly versatile. It becomes a simple part of your clinical examination, which adds no more than a minute to your assessment.

Within seconds, Butterfly iQ3 helps clinicians answer yes-or-no questions like:

• Is there increased lung water?
• Is the heart function severely impaired?
• Is there evidence of a blood clot?
• Is there fluid building up in the lungs or abdomen?
• Is there a vein here if I need to gain intravenous access?

I currently work in an NHS ambulatory care unit that’s always under enormous pressure. If I want to answer a pressing clinical question with ultrasound, I need to be able to do so at speed. If I’m seeing someone with unexplained breathing difficulties and want to rule out water on the lung or severe heart failure, I can do so in the time it would take me to listen to their chest with a stethoscope.

Time is a vital currency for us. The time I gain by using a handheld POCUS device is time I can use, not only to see more patients, but to enhance the care I’m offering the patients I’m seeing.

When I need a second opinion from a colleague, Butterfly also allows on-demand image sharing. To share an image from a cart-based machine, I would need to either:

• Put it on a USB and email it to someone, which is unwieldy and time-consuming or
• Film the screen, losing image quality in the process

Both of these raise significant information governance concerns.

The iQ3 uploads images to the Cloud, where I can then instantly copy a link and send anonymized images for another clinician to review. The Butterfly app also gives me central access to anonymous images that I can use to train and teach other doctors.

Improving patient care and experience

In addition to enhancing efficiency, handheld ultrasound devices can make a genuine difference to patient care. For example, I had a patient who had been to see her general practitioner and the Emergency Department several times with non-specific symptoms. It took me just 30 seconds to scan her with the Butterfly iQ3.

As a result, I discovered a worrying abnormality I would not otherwise have found, leading to a new cancer diagnosis. Without the Butterfly iQ3, we might not have made that discovery, as her non-specific symptoms wouldn’t necessarily have justified the time it would take to borrow a cart-based machine from another department.

Making the most of the investment in ultrasound

By the numbers, a cart-based machine is substantially more expensive than a Butterfly device. What’s more, an entire team of doctors might only use 10% of its functionality for POCUS, as cart-based machines have been designed for the more extensive departmental scans offered by sonographers and radiologists.

A department could buy 6 or 7 Butterfly probes for the cost of that cart-based machine. In my opinion, the probes are a much better investment as it means multiple doctors can access a device at once. With the app's regular updates, those probes are always cutting edge. For those reasons, I believe Butterfly devices are the best option if we want to encourage trainees to take up ultrasound.

Capturing quality images to meet patient and clinician needs

People may be skeptical about the image quality that handheld POCUS devices offer, but the images we capture from Butterfly iQ3 are more than sufficient to the most important clinical questions we have in acute care.

If a clinician is looking for fluid, performing a gross assessment of cardiac function or trying to gain intravenous access in a challenging patient, Butterfly iQ3 gives you all the functionality you need. Higher resolution images may be possible using a cart-based machine but in my experience, crisper images do not change patient management. The POCUS-savvy clinician needs to answer questions at speed. A Butterfly iQ3 should be their tool of choice.

Elevating the standard of care with Butterfly

Chip-based ultrasound technology is already impressive, and it’s only going to explode in the years to come. In ten years, the technology clinicians use for POCUS will be unrecognizable by today’s standards. Now is the time to introduce a tool that’s only going to improve.