Few days ago we visited a company that makes avionics for small private planes. I looked at the hardware, a simple touch screen and tiny linux computer with usual sensor connections. I thought I could build this myself in a weekend for may be $300 tops which is an order of magnitude lower than their sell price. However what I learned was that the thing is expensive is not because hardware or software is expensive but the QA and certification process. There are regulations that avionics needs to work in all kind of weather at wide range of temperatures and pressures while still being accurate and have million hour of run time testing without any crashes and survive extreme shocks, vibrations and G-forces. Someone is after all betting their lives on your device. Now suddenly you have to care about strength of every soldering joint, specs of every transistor and reliability of every screw. Add on to this the customer support, marketing, warranties, legal expenses, returns and other typical overhead of production. If I'd to make device that is compliant of all these, it wouldn't come cheap. Making a hobby device for demo to school kids is quite different than making device that would help people make life and death decisions.
A company I worked for had a new website built (their big customer facing domain). It was just a Drupal theme, responsive, absolutely nothing fancy.
An old friend of mine guessed $20k, maybe $30k tops if you were being crazy, and I thought even that was high. Back in our consulting days we probably would have quoted lower.
They brought on a company for $1 mil, ended up 6 months late and $1.6 mil.
Gotta love those project managers and "status update meetings" to burn the cash.
This realization you had is precisely one of the reasons for which I was very vocal in a recent thread [1] about a startup that wants to (watch out, projectile vomiting coming) make manufacturing "orders of magnitude" better.
The problem with a lot of these ideas is ignorance of what real product development and manufacturing entails in the context of real-life applications, regulatory constraints, liability and more.. They think that because you can iterate code fast while sipping a latte at Starbucks the same "logic" can be applied to manufacturing and, voilà, "orders of magnitude" better manufacturing.
Reality, as you have come to realize, is often far more complex that machining a few pieces of metal, throwing together a microprocessor board and writing code over a weekend. And every industry is different.
> Add on to this the customer support, marketing, warranties, legal expenses, returns and other typical overhead of production.
This is often why startups and SMEs can sell at lower cost too. The overheads are lower. I work for a medical devices company and our main competitor is more expensive than us and keeps having layoffs (or so it is rumoured). It's hard for them to cut prices for similar products when they have 10x the staff.
Business love regulation. Really keeps the upstarts out of the game if they need to have twenty different certifications to get their product to compete.
> A computer that can run a MHz frequency transducer is easy and cheap these days, e.g. a raspberry pi’s GPIO pins can run that frequency.
This is ridiculous. Transmitting needs a good amount of energy for a high number of channels (several dozen, and quite often > 100), and at a high frequency. And if you are driving a 10MHz transducer, you will for ex drive it with a 80MHz numeric signal (at least when using a low number of levels, which you often wants to in order to keep an high efficiency for the relatively high power TX)... Citing a raspberry GPIO pin to do that shows that guy does not know what he is talking about.
Reception is also not trivial at all, if you want a decent quality. You also sample at a rate > to the centre frequency.
Of course you might be able to construct an amateur toy low-end ultrasound machine, but it would be of no clinical value (and of limited value for a lot of other purposes too). Also without extensive measurements, you should not use your resulting machine on any living thing...
Power isn't a problem, because at that frequency any kind of amplifier can be used. Overall IO speed usually is for the simple fact that very few chips are specifically designed for that kind of thing, but it isn't impossible. AM335, FPGA and many DSP chips will handle that level of processing for <$20. The Raspberry Pi can't be used, but you could use a Beaglebone black if you tried hard enough (although it is also a poor choice). Regardless direct sampling ADC at 80 MHz or less is far from an impossible task.
In the end I would say the writer is right and you are wrong. He is painting with an extremely broad brush but his guesses are dead on the money. You should look at the links he provides at the bottom, there are exceptionally good DIY and open source ultrasonic machines.
Making the transducer is very, very difficult but he doesn't pretend it isn't.
> Citing a raspberry GPIO pin to do that shows that guy does not know what he is talking about.
Agreed, but I wouldn't rule out the possibility that a crazy individual with sufficient hardware and software signal processing experience could make it work, where "work" allows for a significant tradeoff or two compared to a modern commercial machine.
DAC is probably the easy part -- use a LFSR and maybe some jellybean filters to get spectral content where you need it. 10MHz is slow enough that you could probably phase it in software if you handwrote everything in bare-metal assembly, paid attention to interrupts and DRAM, etc, etc. At first I thought you'd need a coprocessor (and in that case it might as well be a proper Spartan 6) but perhaps it can be done with a dedicated core. ADC is the probably the harder part. You can't kick the can down the road anymore. Both cost and value are tightly coupled to 2^(bit depth)*(sample rate). If you try to make a shitty ADC out of GPIO pins, you just wind up with a shitty ADC, you can't really hide the flaws and play up the strengths like you did with the DAC.
Or maybe I had it backwards and you could use a good DAC and some sort of sigma-delta like trick to make the shitty GPIO - ADC work.
Fun stuff to think about, but I suspect the real innovation will happen when someone in hardware realizes that DAC/ADC/FPGA technology has slowly and surely advanced far enough that they can do to the ultrasound market what the DS1054Z did to the oscilloscope market.
> You also sample at a rate > to the centre frequency
To be clear, a sampling rate that is only greater than the center frequency isn't very useful. You need the well known nyquist rate, twice the maximum frequency to avoid aliasing
I think you do something like using a BeagleBone with its PRUs to handle moving all the data somewhere fast enough in combination with a cheap FPGA to drive the transducer(s) and do a little initial signal processibg to reduce the data rate a little.
This is a little more complex but the cost is going to be of the same order of magnitiude as a Pi
Wouldn't you normally mix down on the receive side for better SNR? Doppler should be pretty negligible, so if your LO tracks the output the receive side could probably be an audio ADC.
Power on the output side is the big one for sure, however. Also I'm not sure the transducers cited are anywhere near big enough.
I like free software as much as the next guy, but saying, "If there were free software for this project, the cost would come down." ignores that developing that software is expensive and someone needs to pay for it.
From an economic perspective (and this article is about economics), companies release software when they hope that the cost of the freeloaders is outweighed by the number of benefit additional contributors will provide. (Or that broad adoption of the software has some other benefit to the opening company.)
Generally, the more broadly useful the software is, the more economic sense it makes to open the source.
I see no evidence that there would be any economic benefit for any company opening the source of their very specialized, very expensive software here.
So yeah, if it were free, it would cost less. OK then.
There's also the fact that most (all?) free software licenses explicitly lack a warranty and (to the extent they can) disavow any liability for problems in the product. This is a good thing (you'd be crazy to contribute to a free software project if it weren't the case), but it doesn't fly in the world of medical devices. Nobody will use a product if there's not a liability chain they can point to if it breaks and kills somebody.
Free software is used in medical devices where it makes sense. Sometimes it saves money.
The cost often really isn't from the writing of software, but from the regulatory, QA and hardware development typically. Which is all dwarfed by validation if you need to do a PMA, but typically devices like this will be a 510k. Software development directly is a bit more expensive that some areas, mostly because you really need to follow engineering practices (e.g. traceable V&V, full documentation, test & review practices, etc.). Usually that isn't the dominant cost of bringing a device to market.
> developing that software is expensive and someone needs to pay for it.
or, you know, someone donates some of their time to write it. that's usually how OS works.
think about how much research the person writing the article has done. if you could buy a $25 transducer off ebay, they could have put that time into writing the software.
>I see no evidence that there would be any economic benefit for any company opening the source of their very specialized, very expensive software here.
Hmm maybe if you can find a way to lock-in users so they have to always come to you for the hardware. So, one way to do that is on a project that sees a lot of source code churn, you can tightly couple it with your services/hardware. Any competition that's downstream will find it hard to keep up with your commits in addition to having to patch in support for different hardware/services.
There's a lot of nitpicking about the details going on in this thread, and it's very interesting to read.
But I think the gist of the post is that the hardware cost of a high end ultrasound unit is rapidly decreasing due to advances in ADC technology and the general trend of moving more and more functionality into DSP that used to require specialized analog circuitry.
For example, I recently bought a 20MHz spectrum analyzer and oscilloscope with built-in tracking generator for $145. Gear of similar quality would have cost tens of thousands of dollars just a decade ago.
That's really nifty, I've got a Serious Business(DSOX-3014A) scope but could never justify a spectrum analyzer. I've got the signal gen so I've though about rigging up their API to do a simple sweep but never got around to it.
I do synthetic aperture radar signal processing for a living. I make the SAR pictures you see (or use for your research). I think a big part of the cost is the signal processing. You need fast A/D converters too. The software though to make a steerable ultrasound beam is not trivial by any means. Also, you have multiple sound speeds to account for in layered media where you dont know the layers occur or what their sound speed is. Another really hard problem.
TL;DR there isn't enough demand for specialty materials fab (PZT thin films for mHz range transducers) to benefit from economies of scale.
Other stuff (software, controllers) is also expensive, but it's probably a fraction of the transducer cost so buyers tolerate it in order to get manufacturer support/service contracts
One piece missing from the TL;DR: cost of compliance. Any medical device carries huge liabilities, and can easily bring a company down if it malfunctions. Probably the only other field that comes close to it is avionics.
The reasons ultrasound machines are expensive are not technical, it's mostly low volume and high overhead to comply with all rules and regulations.
You can make a useful ultrasound machine with just one transducer (e.g., to measure blood flow through the heart using Doppler, or using mechanical scanning).
You don't need fast CPU for processing, just downconvert to audio range and then 80286 is fast enough.
Source: wrote embedded software for one of those machines back in the day. 16 kB for everything, from keypad debouncing to GUI.
I've been researching diagnostic medical equipment a lot recently, and it seems like the biggest barrier to homebrew medical diagnostic equipment is attitudinal. Discussion about building your own equipment are almost immediately sidetracked by FUD about how dangerous it is.
Proper medical devices have loads of safety features! They have isolated power supplies! They are tested in harsh environments! They fail in a predictable manner! There are regulations that need to be followed! New devices are still expensive because they are better!
Yes, electricity can kill you.
Yes, improper medical advice can kill you.
Yes, malfunctioning diagnostic equipment can lead to an incorrect diagnosis, which, yes, can kill you.
Yes, medical regulations exist and protect us from harm.
While a homebrew machine would not be able to compete with the latest and greatest, I'd hazard that even rudimentary diagnostic equipment could save thousands of lives a year in the developing world. These technologies are not new -- the medical ultrasound has been around for more than 60 years, and the EKG has been around for nearly 100. It seems insane that cost is still such a barrier for the machines used for medical diagnostics, when the price of other technologies has fallen so much in the same period of time.
I bought myself a Rigol DS1054Z, and I realized that I paid $400 for an oscilloscope that would have cost millions of dollars 30 years ago. I thought about the experiments I had done on neurons using the 50 year old oscilloscopes as part of my degree, and I realized that an ECG/EKG can be replicated pretty easily with an oscilloscope. It turns out, building an ECG is pretty trivial. It's not a 12-lead ECG, but it's also something I built out of parts I had on hand.
I don't see why other medical technology should be any different. Yes, unregulated medical technology is dangerous, but the risk doesn't seem to outweigh the potential benefit. If the parts to build these devices is cheaper and more accessible than they ever have been, and the equipment needed to build, test and calibrate the devices is cheaper and more accessible than ever, it seems like the devices themselves should be cheaper and more accessible than ever. I think there is a place for a $20k ultrasound, but when you live hours or days from an ultrasound, a cheaper option could save lives, even if the primary purpose is directing people to get a follow-up with the more capable machine.
I think one of the problems of "but this is just a small engineering project" is precision, reliability, quality-- whatever you want to call it.
There is interpretation that goes into reading an EKG, an xray, lab results. If there's any unreliability whatsoever, that will impact treatment and outcomes.
If there's any unreliability in your EKG readout, that's can be the different between diagnosing a minor heart attack versus chest pain.
The same goes for diagnosing a cancerous tumor from a benign one. There's already ambiguity and interpretation; if there's any imprecision in the measuring device, that's going to lead to bad outcomes-- both overtreatment and undertreatment.
From a quick look on eBay, you can pick up a vetinary ultrasound machine for between £800 and £2000. Are these materially different to medical ones, or is the cost difference down to certification?
Good point. I used to work at a mobile startup that subsequently got acquired and burned - the run rate for a company of ~140 people was astronomical.
Radio engineers are expensive and rare, scopes and even faraday cages are expensive, specialist software is expensive, handsets were a fortune when you had to buy hundreds of them.
We got sold for (I think) about $330 million, then you look at social media startups that go for a couple of billion. Nobody wants to do stuff that changes the world for a reason.
I would hope that this type of hardware can be offset by the fact that these devices don't suffer obsolescence the same way other digital devices do, which need to be replaced because there's no longer 802.11b networks around etc.
The FDA process is also extremely expensive. Not saying it justifies cost, but it is a significant upfront investment of time. Additionally, updates to the device over time have to go through approvals again.
One of the responses to the question is a respectful, reasonable post; the other responds with the typical protectionist FUD that permeates this area. The second asks about the costs of misdiagnosis by people using it inappropriately, but ignores the lost rewards of appropriate uses that are curtailed, and the costs of overpayment due to lack of competition to determine what level of training and payment is actually appropriate.
The original article might be naive about some of the technological challenges associated with an ultrasound machine, but I think that's missing the point.
When a response to "why can't anyone buy an ultrasound machine" is to disingenuously reply "because you have to have the FDA ensure that it's working correctly and people aren't running around killing each other with it," it puts huge constraints on innovation and growth in this area. I can go buy a crowbar and kill people with it, so why can't I buy an ultrasound and use it to study muscle movement, or for education, like the author of the posted article is noting?
Plenty of technically sophisticated open-source efforts exist, and they can't happen if there's arbitrary and unnecessary prohibitions on them happening. Maybe if the FDA said "hey, go to it" people would realize it's too hard, but maybe they wouldn't. We'll never know as long as there's unnecessary restrictions in the way.
I'm going to be a cardiology fellow at Stanford in July, we use ultrasound often for both bedside informal exams as well as diagnostic echocardiogram. I've used handheld devices like the Lumify and Vscan, as well as the large tractor sized epiq machines. Similar to what is written in the article, my impression is that the actual hardware, specifically the transducer, is quite expensive to manufacture. The software and processing power continues to get cheaper but to have to best quality pictures, require expensive transducers. I've actually been very very impressed by the Lumify and I think it is getting near if not better than the quality of the gigantic epiq machines, primarily by having a very high quality transducer. This is indeed a hot area and knowing people who are actively doing development in the field, there are poeple trying things like having a giant paralleled transducers over the entire chest for continuous 3D images and other interesting ideas that are limited more by hardware than processsing power or imagination.
If you want to improve ultrasound, combine it with the positioning sensors of a VR system so the position of the sensor is known. Then you can do full tomography and build up a 3D model as the sensor is run over the body. For extra points, have alignment sticker targets you can attach to the body to track the patient if they move. Veterinarians would go for that.
It's probably worth mentioning that relatively low-cost and mobile ultrasound machines exist. One company just recently received FDA approval for a wireless ultrasound machine. Target price seems to be ~7k to ~10k
I think there are low end Chinese transducers that plug into a laptop that are $1500.
That said the idea that an ultrasound machine is expensive is just laughable from a commercial/industrial cost perspective. Ok a mid range ultrasound machine costs $50,000.
$50,000!!!! Oh the agony!!! Oh please, a taxi costs $30,000 and I can get a taxi ride downtown for $8.
What's expensive is US medical pricing. Where they charge $700 for an ultrasound. When the machine itself has a capital cost of about $600/mo.
When cheap unregulated Chinese clones start coming out of ultrasounds like this one: http://intelametrix.com/FullSite/ thats when you know ultrasounds can be cheap.
Aside from the technical issues with the machine, ultrasound imaging is harder to perform (in terms of scanning technique) and very difficult to interpret compared to a high-resolution MRI or even simple X-ray. It takes significant training to even find specific organs, and distinguishing between, eg, a gas bubble in the small intestine vs a potentially dangerous foreign object or even a tumor takes a lot of education and experience.
What I find missing from this discussion is the safety aspect of wholesale ultrasound. Yes, we've been told they're perfectly safe. That was once said of x-rays as well and physicians were routinely x-raying fetuses in the uertus up until the 1970's. That was before the evidence of birth defects from exposure to x-rays became so overwhelming that the practice finally stopped.
See http://sarahbuckley.com/ultrasound-scans-cause-for-concern and references quoted therein for a good overview of the current discussions on side effects of routine ultrasound screening, including tissue damage due to cavitation and hearing loss in fetuses.
The regulatory burden is not so high that it can be attributed to the cost of most USS machines - thats just a mirage created by the large corporates who want to defend their place in the market. This isn't just seen in medical ultrasound, but across healthcare.
The regulatory and evidence burden is hard - but its not insurmountable and it certainly shouldn't stop change.
I don't have experience with medical ultrasound, but I have built a few basic ultrasonic systems around a PC or a single board computer for structural testing applications. If you're not doing phased array ultrasonics you can build a system for under $1000USD, possibly less if you can use PVDF instead of PZT. The expensive part is the software.
[+] [-] sytelus|9 years ago|reply
[+] [-] grecy|9 years ago|reply
A company I worked for had a new website built (their big customer facing domain). It was just a Drupal theme, responsive, absolutely nothing fancy.
An old friend of mine guessed $20k, maybe $30k tops if you were being crazy, and I thought even that was high. Back in our consulting days we probably would have quoted lower.
They brought on a company for $1 mil, ended up 6 months late and $1.6 mil.
Gotta love those project managers and "status update meetings" to burn the cash.
[+] [-] rebootthesystem|9 years ago|reply
This realization you had is precisely one of the reasons for which I was very vocal in a recent thread [1] about a startup that wants to (watch out, projectile vomiting coming) make manufacturing "orders of magnitude" better.
The problem with a lot of these ideas is ignorance of what real product development and manufacturing entails in the context of real-life applications, regulatory constraints, liability and more.. They think that because you can iterate code fast while sipping a latte at Starbucks the same "logic" can be applied to manufacturing and, voilà, "orders of magnitude" better manufacturing.
Reality, as you have come to realize, is often far more complex that machining a few pieces of metal, throwing together a microprocessor board and writing code over a weekend. And every industry is different.
[1] https://news.ycombinator.com/item?id=13177786
[+] [-] tomw2005|9 years ago|reply
This is often why startups and SMEs can sell at lower cost too. The overheads are lower. I work for a medical devices company and our main competitor is more expensive than us and keeps having layoffs (or so it is rumoured). It's hard for them to cut prices for similar products when they have 10x the staff.
[+] [-] monk_e_boy|9 years ago|reply
[+] [-] knz|9 years ago|reply
[+] [-] temac|9 years ago|reply
This is ridiculous. Transmitting needs a good amount of energy for a high number of channels (several dozen, and quite often > 100), and at a high frequency. And if you are driving a 10MHz transducer, you will for ex drive it with a 80MHz numeric signal (at least when using a low number of levels, which you often wants to in order to keep an high efficiency for the relatively high power TX)... Citing a raspberry GPIO pin to do that shows that guy does not know what he is talking about.
Reception is also not trivial at all, if you want a decent quality. You also sample at a rate > to the centre frequency.
Of course you might be able to construct an amateur toy low-end ultrasound machine, but it would be of no clinical value (and of limited value for a lot of other purposes too). Also without extensive measurements, you should not use your resulting machine on any living thing...
[+] [-] hwillis|9 years ago|reply
In the end I would say the writer is right and you are wrong. He is painting with an extremely broad brush but his guesses are dead on the money. You should look at the links he provides at the bottom, there are exceptionally good DIY and open source ultrasonic machines.
Making the transducer is very, very difficult but he doesn't pretend it isn't.
[+] [-] jjoonathan|9 years ago|reply
Agreed, but I wouldn't rule out the possibility that a crazy individual with sufficient hardware and software signal processing experience could make it work, where "work" allows for a significant tradeoff or two compared to a modern commercial machine.
DAC is probably the easy part -- use a LFSR and maybe some jellybean filters to get spectral content where you need it. 10MHz is slow enough that you could probably phase it in software if you handwrote everything in bare-metal assembly, paid attention to interrupts and DRAM, etc, etc. At first I thought you'd need a coprocessor (and in that case it might as well be a proper Spartan 6) but perhaps it can be done with a dedicated core. ADC is the probably the harder part. You can't kick the can down the road anymore. Both cost and value are tightly coupled to 2^(bit depth)*(sample rate). If you try to make a shitty ADC out of GPIO pins, you just wind up with a shitty ADC, you can't really hide the flaws and play up the strengths like you did with the DAC.
Or maybe I had it backwards and you could use a good DAC and some sort of sigma-delta like trick to make the shitty GPIO - ADC work.
Fun stuff to think about, but I suspect the real innovation will happen when someone in hardware realizes that DAC/ADC/FPGA technology has slowly and surely advanced far enough that they can do to the ultrasound market what the DS1054Z did to the oscilloscope market.
[+] [-] IshKebab|9 years ago|reply
Nope, they basically use a series of pulses at 10 MHz and rely on the frequency response of the transducer to turn it into a nice wave packet.
Source (look at pulseShape):
http://www.ultrasonix.com/wikisonix/index.php/Texo_Parameter...
[+] [-] zild3d|9 years ago|reply
To be clear, a sampling rate that is only greater than the center frequency isn't very useful. You need the well known nyquist rate, twice the maximum frequency to avoid aliasing
https://en.wikipedia.org/wiki/Nyquist%E2%80%93Shannon_sampli...
[+] [-] titanomachy|9 years ago|reply
I think it's pretty clear that he doesn't, but it's not like he's claiming to be an expert.
[+] [-] Taniwha|9 years ago|reply
This is a little more complex but the cost is going to be of the same order of magnitiude as a Pi
[+] [-] highd|9 years ago|reply
Power on the output side is the big one for sure, however. Also I'm not sure the transducers cited are anywhere near big enough.
[+] [-] compiler-guy|9 years ago|reply
From an economic perspective (and this article is about economics), companies release software when they hope that the cost of the freeloaders is outweighed by the number of benefit additional contributors will provide. (Or that broad adoption of the software has some other benefit to the opening company.)
Generally, the more broadly useful the software is, the more economic sense it makes to open the source.
I see no evidence that there would be any economic benefit for any company opening the source of their very specialized, very expensive software here.
So yeah, if it were free, it would cost less. OK then.
[+] [-] Analemma_|9 years ago|reply
[+] [-] ska|9 years ago|reply
The cost often really isn't from the writing of software, but from the regulatory, QA and hardware development typically. Which is all dwarfed by validation if you need to do a PMA, but typically devices like this will be a 510k. Software development directly is a bit more expensive that some areas, mostly because you really need to follow engineering practices (e.g. traceable V&V, full documentation, test & review practices, etc.). Usually that isn't the dominant cost of bringing a device to market.
[+] [-] guitarbill|9 years ago|reply
or, you know, someone donates some of their time to write it. that's usually how OS works.
think about how much research the person writing the article has done. if you could buy a $25 transducer off ebay, they could have put that time into writing the software.
[+] [-] ksk|9 years ago|reply
Hmm maybe if you can find a way to lock-in users so they have to always come to you for the hardware. So, one way to do that is on a project that sees a lot of source code churn, you can tightly couple it with your services/hardware. Any competition that's downstream will find it hard to keep up with your commits in addition to having to patch in support for different hardware/services.
[+] [-] dublinben|9 years ago|reply
[+] [-] grandalf|9 years ago|reply
But I think the gist of the post is that the hardware cost of a high end ultrasound unit is rapidly decreasing due to advances in ADC technology and the general trend of moving more and more functionality into DSP that used to require specialized analog circuitry.
For example, I recently bought a 20MHz spectrum analyzer and oscilloscope with built-in tracking generator for $145. Gear of similar quality would have cost tens of thousands of dollars just a decade ago.
https://www.amazon.com/gp/product/B018XD6Z5O/ref=oh_aui_sear...
[+] [-] vvanders|9 years ago|reply
For filter work that'd be near perfect.
[+] [-] pjc50|9 years ago|reply
Maybe I should get one of those and a USB DJ controller for input.
[+] [-] amelius|9 years ago|reply
Nice. Does it work under Linux too?
[+] [-] ipunchghosts|9 years ago|reply
[+] [-] xkcd-sucks|9 years ago|reply
Other stuff (software, controllers) is also expensive, but it's probably a fraction of the transducer cost so buyers tolerate it in order to get manufacturer support/service contracts
[+] [-] ucaetano|9 years ago|reply
[+] [-] melling|9 years ago|reply
http://tricorder.xprize.org
[+] [-] pps43|9 years ago|reply
You can make a useful ultrasound machine with just one transducer (e.g., to measure blood flow through the heart using Doppler, or using mechanical scanning).
You don't need fast CPU for processing, just downconvert to audio range and then 80286 is fast enough.
Source: wrote embedded software for one of those machines back in the day. 16 kB for everything, from keypad debouncing to GUI.
[+] [-] Declanomous|9 years ago|reply
Proper medical devices have loads of safety features! They have isolated power supplies! They are tested in harsh environments! They fail in a predictable manner! There are regulations that need to be followed! New devices are still expensive because they are better!
Yes, electricity can kill you.
Yes, improper medical advice can kill you.
Yes, malfunctioning diagnostic equipment can lead to an incorrect diagnosis, which, yes, can kill you.
Yes, medical regulations exist and protect us from harm.
While a homebrew machine would not be able to compete with the latest and greatest, I'd hazard that even rudimentary diagnostic equipment could save thousands of lives a year in the developing world. These technologies are not new -- the medical ultrasound has been around for more than 60 years, and the EKG has been around for nearly 100. It seems insane that cost is still such a barrier for the machines used for medical diagnostics, when the price of other technologies has fallen so much in the same period of time.
I bought myself a Rigol DS1054Z, and I realized that I paid $400 for an oscilloscope that would have cost millions of dollars 30 years ago. I thought about the experiments I had done on neurons using the 50 year old oscilloscopes as part of my degree, and I realized that an ECG/EKG can be replicated pretty easily with an oscilloscope. It turns out, building an ECG is pretty trivial. It's not a 12-lead ECG, but it's also something I built out of parts I had on hand.
I don't see why other medical technology should be any different. Yes, unregulated medical technology is dangerous, but the risk doesn't seem to outweigh the potential benefit. If the parts to build these devices is cheaper and more accessible than they ever have been, and the equipment needed to build, test and calibrate the devices is cheaper and more accessible than ever, it seems like the devices themselves should be cheaper and more accessible than ever. I think there is a place for a $20k ultrasound, but when you live hours or days from an ultrasound, a cheaper option could save lives, even if the primary purpose is directing people to get a follow-up with the more capable machine.
[+] [-] lawpoop|9 years ago|reply
There is interpretation that goes into reading an EKG, an xray, lab results. If there's any unreliability whatsoever, that will impact treatment and outcomes.
If there's any unreliability in your EKG readout, that's can be the different between diagnosing a minor heart attack versus chest pain.
The same goes for diagnosing a cancerous tumor from a benign one. There's already ambiguity and interpretation; if there's any imprecision in the measuring device, that's going to lead to bad outcomes-- both overtreatment and undertreatment.
[+] [-] mpettitt|9 years ago|reply
[+] [-] vvanders|9 years ago|reply
You just don't see the volume that makes economies of scale kick in over your NRE(non-recurring engineering) costs.
[+] [-] sofaofthedamned|9 years ago|reply
Radio engineers are expensive and rare, scopes and even faraday cages are expensive, specialist software is expensive, handsets were a fortune when you had to buy hundreds of them.
We got sold for (I think) about $330 million, then you look at social media startups that go for a couple of billion. Nobody wants to do stuff that changes the world for a reason.
[+] [-] matt_wulfeck|9 years ago|reply
[+] [-] outworlder|9 years ago|reply
[+] [-] rasz_pl|9 years ago|reply
[+] [-] Justin_K|9 years ago|reply
[+] [-] kem|9 years ago|reply
https://www.quora.com/Why-is-the-Philips-Lumify-ultrasound-f...
One of the responses to the question is a respectful, reasonable post; the other responds with the typical protectionist FUD that permeates this area. The second asks about the costs of misdiagnosis by people using it inappropriately, but ignores the lost rewards of appropriate uses that are curtailed, and the costs of overpayment due to lack of competition to determine what level of training and payment is actually appropriate.
The original article might be naive about some of the technological challenges associated with an ultrasound machine, but I think that's missing the point.
When a response to "why can't anyone buy an ultrasound machine" is to disingenuously reply "because you have to have the FDA ensure that it's working correctly and people aren't running around killing each other with it," it puts huge constraints on innovation and growth in this area. I can go buy a crowbar and kill people with it, so why can't I buy an ultrasound and use it to study muscle movement, or for education, like the author of the posted article is noting?
Plenty of technically sophisticated open-source efforts exist, and they can't happen if there's arbitrary and unnecessary prohibitions on them happening. Maybe if the FDA said "hey, go to it" people would realize it's too hard, but maybe they wouldn't. We'll never know as long as there's unnecessary restrictions in the way.
[+] [-] alphaoverlord|9 years ago|reply
[+] [-] Animats|9 years ago|reply
[+] [-] rsingla|9 years ago|reply
See news here: http://www.mobihealthnews.com/content/clarius-mobile-health-...
See company website here: http://www.clarius.me/
[+] [-] Gibbon1|9 years ago|reply
That said the idea that an ultrasound machine is expensive is just laughable from a commercial/industrial cost perspective. Ok a mid range ultrasound machine costs $50,000. $50,000!!!! Oh the agony!!! Oh please, a taxi costs $30,000 and I can get a taxi ride downtown for $8.
What's expensive is US medical pricing. Where they charge $700 for an ultrasound. When the machine itself has a capital cost of about $600/mo.
[+] [-] mahyarm|9 years ago|reply
[+] [-] bkeroack|9 years ago|reply
[+] [-] wolframarnold|9 years ago|reply
See http://sarahbuckley.com/ultrasound-scans-cause-for-concern and references quoted therein for a good overview of the current discussions on side effects of routine ultrasound screening, including tissue damage due to cavitation and hearing loss in fetuses.
[+] [-] riphay|9 years ago|reply
https://news.ycombinator.com/item?id=11156288
[+] [-] christophmccann|9 years ago|reply
The regulatory and evidence burden is hard - but its not insurmountable and it certainly shouldn't stop change.
[+] [-] LurkerAbove|9 years ago|reply
[+] [-] beambot|9 years ago|reply