Butterfly takes flight: Hand-held ultrasound pushed to the limits to test its use for space missions

Editor's Note: This story was updated to clarify the new-generation Butterfly expected to be on the next Polaris Dawn mission is a second-generation Butterfly iQ+. The new expected launch date of the mission is now summer 2023, not March.

In June 2021, more than 7,300 pounds of science and crew supplies journeyed to the International Space Station (ISS) on the SpaceX Dragon as part of the 22nd cargo resupply mission. Also catching the flight was a hand-held whole-body ultrasound scanner that would soon be used in its first user demo in space.

The Butterfly iQ is a single-probe whole-body ultrasound system using semiconductor technology that connects to a tablet or smartphone to scan any part of the body within minutes. Meant to be an inexpensive, portable alternative to other scanners on the market, it had already been deployed in rural African villages years before. But for its maker, Butterfly Network, the sky was not the limit.

“If your device is able to handle Mount Everest, it sure as heck will be able to handle the hills down below,” John Martin, M.D., Butterfly Network’s chief medical officer, told Fierce Healthcare.

In space missions, saving room on board is critical. The lower the mass, the faster the acceleration of a rocket. And if an astronaut gets sick, there has to be a way to find out why. 

An imaging capability would greatly aid future missions.“Whenever we don’t know exactly what’s wrong with you, those diagnostic dilemmas are solved by medical imaging," Martin said. Ultrasounds in particular can be more accurate and quicker than an X-ray—and Butterfly’s operator assistance and automation tools reduce user training time, the company claims. 

The Butterfly is currently only approved for use by trained healthcare professionals, though it is in clinical trials to be used without experts. But going to space to test it out with nonexpert users is quicker, according to Martin.

Before the Butterfly could take flight, NASA’s medical authority and safety boards had to approve the device. Butterfly Network was tasked with finding a new battery that could withstand rigorous tests, like having nails driven through it, which took months to find. 


Handheld ultrasound developer Butterfly Network stretches wings to 35% annual sales growth

Once in space on the ISS, astronauts tested the Butterfly on several organ types, transmitting the images to Earth for review through the cloud communication network on board. In September 2021, the Butterfly joined SpaceX’s Inspiration4, the first all-civilian flight to orbit Earth, where several experiments using the device were also conducted. 

The device is still being evaluated for its feasibility in various future missions. While the Butterfly has automated some scanning procedures, most still require real-time communication with experts in the control room for guidance, explained Ashot Sargsyan, M.D., a physician scientist at KBR GS who supports various aspects of human space flight.

With exploration and lunar missions, communication will be delayed, so just-in-time instructions for crews will be needed. But in tests so far, the device has been successful. 

“The beauty of this technology is it’s very digital, it’s very software-based and every time the software is improved, the update is provided to the device without the user even knowing it,” Sargsyan said. “The younger the technology, the longer in the future it will still make a difference.” 

As a physician in Soviet Armenia, Sargsyan learned to make the most of technology in a limited-resource environment, where only one CT scan machine was available for an entire population. Ultrasound devices eventually revolutionized medicine there, and, today, Sargsyan sees their potential in space as much as in developing countries. Like anywhere under-resourced, there is a great need for imaging in spaceflights where there is also limited expertise. 

Results related to the Butterfly ISS demos remain under review. While the Butterfly ultrasound device is technically available to any user, Sargsyan said, there are still barriers to its full integration into the ISS data infrastructure. 

The second-generation probe, Butterfly iQ+, is expected to be on board the next Polaris Dawn mission, targeting a summer launch, and is now part of the medical kit on SpaceX’s Crew Dragon. The devices are also used on the ground by NASA in operational settings such as crew landings and hazardous astronaut training, according to Sargsyan. 

A highly scientific approach is needed to ultimately be able to recommend the Butterfly for the ISS: “This is a big decision to make. And we cannot be cavalier about it,” Sargsyan concluded.