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Medicine Open Source Technology

Cheap, 3D-Printed Stethoscope Challenges Top-of-the-Line Model 179

mask.of.sanity writes: Tarek Loubani, an emergency physician working in the Gaza strip, has 3D-printed a 30-cent stethoscope that beats the world's best $200 equivalent as part of a project to bottom-out the cost of medical devices. Loubani together with a team of medical and technology specialists designed the stethoscope and tested it against global standard benchmarks, finding it out performed the gold-standard Littmann Cardiology 3. They now intend to make a range of ultra-low cost medical devices for the developing world.

It cost about US$10,000 to develop, and has been released as an open source model for anyone to use. Loubani says the project is following the footsteps of the free software movement and aims to replace expensive proprietary solutions. He hopes that within 25 years the devices will be common-place in the Third World, and be the "Apache of the medical world."
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Cheap, 3D-Printed Stethoscope Challenges Top-of-the-Line Model

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  • My doctor doesn't, he uses an electronic device. Not sure what it is called.
    • Re: (Score:2, Insightful)

      by Anonymous Coward

      Yes they do. Particularly when they're doctors in poor or war-torn areas that cannot afford access to the electronic device whose name you are unsure of.

    • Re: (Score:2, Informative)

      by Maxo-Texas ( 864189 )

      Just so you know.. those devices are unreliable unless calculated weekly.

      Two doctor visits ago, I showed a 175/110. I panicked... they panicked. They got a stethoscope and I was 122/78.

      Last doctor visit, they were no longer using the electronic devices and had gone back to stethoscopes.

      • by jhol13 ( 1087781 ) on Friday August 14, 2015 @09:49AM (#50316237)

        Reminds me of my electronic tyre pressure gauge. It was extremely good - as a random number generator. Moved back to analog.

      • by thaylin ( 555395 )

        How did they use it to measure blood pressure? Typically that is the sphygmomanometer

        • A stethoscope is used in conjunction with a sphygmomanometer. The stethoscope is used for the doctor or nurse to hear a "knocking sound [practicalc...skills.com]" when the blood flow changes.
      • TIL that you take blood pressure with a stethoscope (rather than a sphygmomanometer)

      • I may be stating the obvious, but not everyone knows, or realizes, that the stethoscope/sphygmanometer method is also not always reproducable. It relies on the clinician to hear the knocking sound your blood makes in relation to the restriction placed on the arm by the sphygmanometer at the correct time. If the nurse/doctor/clinician has any sort of reduced hearing capabilities (most commonly due to advanced age), then they may not hear it correctly.

        I've personally experienced this when comparing blood pr

        • " comparing blood pressure readings from my GP (an older man) versus that of the younger nurse." I totally agree, my blood pressure often goes up too when the old man doctor leaves and a younger, far more attractive nurse comes in.
      • The problem you experienced was not with the electronic "stethoscope". the problem was with the electronic sphygmomanomter.
    • Does your doctor also use a fancy electronic device to listen to your breathing through your back/front?

  • Will the patients see any of this reduced cost?
    Or will it go straight to higher profits?

    • Re:Profits. (Score:5, Insightful)

      by gstoddart ( 321705 ) on Friday August 14, 2015 @09:39AM (#50316171) Homepage

      In America, higher profits.

      In developing nations, better medical care.

    • Re:Profits. (Score:4, Insightful)

      by njvack ( 646524 ) <njvack@wisc.edu> on Friday August 14, 2015 @10:37AM (#50316573)

      In the US? No, because the costs of healthcare here aren't driven by the costs of stethoscopes. They cost a couple hundred dollars and last for a very long time; high healthcare costs are much more likely to come from "Oh, my exam showed a possible irregularity; to be safe, we should send you in for an echocardiogram (or cardiac MRI if the system has one)." And in the vast majority of cases, you get an expensive procedure to learn things are basically OK.

      It's really easy to prescribe that, because hey, we have the machine and it seems a lot better to run a test when it's not needed than skip one that could have caught something serious. And since insurance covers most of it, it's not that expensive for an individual patient...

      What this could help with is availability of basic healthcare where a $200 stethoscope is a really big deal -- especially if you're in an environment where equipment is likely to get damaged or stolen.

      • by jfengel ( 409917 )

        Also... don't most health care providers buy their own stethoscopes? I got the impression that they're rather personal choices, and since they go in your ears, it's not like you'd want to check one out of the equipment supply. You buy it, and it's yours.

        It might well improve the lives of the lowest paid health care providers, but I don't think they're a major cost driver for first-world companies.

        • The expensive ones are status symbols. Availability of cheep stethoscopes is old news. Injection molded, so 1/10 the price of printed ones and stronger.

      • This is the real reason why medical costs are so high here in the USA, and it's odd that no politician as made this a talking point yet. For most of the 20th century, the US was the leader in medical devices, new surgeries, new medicines, etc. With time and the sharing of information, that tech has spread out quite a bit now. Yet for a long time the US was the #1 medical research system. And since we're a capitalist society, someone has to pay for all that and those costs have been amortized down into ev
        • No, completely wrong. The high cost of medical care in the USA has nothing to do with cost, it's because prices are set based on ability to pay and the USA is a very wealthy country.
  • if you ignore the amortized cost of the 3-d printer, the wages to the 3-d printer operator, the electricity to run the 3-d printer, the lease for the building where the 3-d printer resides, and all sorts of other overhead.
    • You forgot the cost of testing/certification/insurance that drives that drives the cost of medical equipment through the roof

      • Right, because an organization providing medical care to refugees and people in dirt poor countries are concerned about those things.

        And, really ...

        He is so confident of the device that he expects the peer-review process to be a "cake walk".

        The device was tested using a the standard practice of pressing it against a balloon filled with water - a test dubbed the Hello Kitty protocol given the availability of cat-branded balloons at the time.

        If the actual standard test involves a Hello Kitty balloon, it's pro

        • But but but ... quality medical devices! FDA approval sticker! Triple certified !

          Because, we have to make sure they can't fail in a life or death situation!

      • Re:30 cents... (Score:4, Insightful)

        by ColdWetDog ( 752185 ) on Friday August 14, 2015 @10:22AM (#50316471) Homepage

        Stethoscopes don't need to be 'tested' much. You hear stuff or not. They're not FDA approved.

        We've have cheap stethoscopes that work pretty well for ages. The big deal with the Littman Cardiology scopes is that they are built like tanks and you can get replacement bits for them. MRIs use plastic stethoscopes in the MRI suite because metal ones have this annoying tendency to get rocketed into the 1 Tesla magnet at inopportune times. They cost a couple of bucks.

        I'm glad they've solved their problem with a 3D printer. They could have just as well solved it with knowing a good Chinese supplier.

        And pulse oximeters / EKGs - good luck with that. First off you can buy a good pulse ox for about $15, retail. I'll bet you can get them for half price in bulk. And you can buy a used, serviceable EKG for $50-100 - the big costs being the thermal paper they use.

        Geez, next big thing will be a 3D printed gizmo connected to the Internet....

        • by n1ywb ( 555767 )
          I have a Chinese pulse oximeter. It's completely worthless as a pulse oximeter although it has a very nice OLED display. I can hold my breath for a minute and get tunnel vision without it showing any drop in my blood O2 concentration. I know this is crap because I've shared a hospital room overnight with a guy with really bad sleep apnea who was setting off his O2 alarm every 30 minutes as he entered a deep sleep phase, stopped breathing for 20 seconds, and his O2 dropped to 80%. That was a long night.
    • That's my main gripe with 3-D printing. The comparisons are always pure material costs vs. retail sale price for the manufactured equivalent. In the medical device world, that manufactured equivalent probably gone through FDA- approval.
      • Fortunately for the Third World, FDA approval isn't required there.

        Also do note that a 3D Printer can make other things. So the question is "is it better to buy a 3D printer, and use it more or less constantly making assorted stuff, or to buy (possibly) better product(s) as needed?"

        Alas, I don't know the answer. I doubt you do either, when you frame things in terms of FDA approval for countries other than the USA....

    • That there will exist 3d printers is fairly obvious. That people will have a cost recovery model where they'll charge you for materials and time is also pretty likely.

      So you print a few hundred of the damned things, have Medicine Sans Frontiers ship them in and distribute them, and voila ... you've got stethoscopes where they were too expensive to have. At 30 cents a piece, print a few thousand and give to anybody who comes even close to patient care.

      Hell, design enough stuff which can be printed, and org

      • If the design is possible to be injection moulded, just mass-produce the things for a few pennies apiece. But it's possible this is not the case - 3D printing can produce shapes that are impossible to injection-mould.

        I had a cheap 10 stethoscope that I got from a nursing supplies store, was designed like a Russian military surplus device but my colleagues were forever asking to borrow it because they liked it's sound output better than their fancy £50 Littmanns.

        I never saw anything special about the L

        • As someone who will never use a stethoscope professionally ... I will restrict my enthusiasm purely to the fact that doctors in poor countries can have one, instead of simply putting their ear to someone's chest.

          This strikes me as one of those things where you get far more gain by ensuring anybody who needs one can have it.

          I mean, is there an actual downside to these things being easy to get? Well, aside from the sudden spike in safe cracking and eavesdropping I guess.

    • " 3-d printer operator" I'm guessing you haven't used a 3-d printer. It doesn't take some specialized, months long training. Their not designing a car or a building. It's filling the material bin, pushing a button, and waiting. "the building"? Really, are you saying the printer is some huge machine that takes up a whole building? Like some material-producing ENIAC? 3-D printers are the same size (or actually smaller) than most workgroup laser printers, and use less electricity.
  • Because it was 3D printed.
  • by LaurenCates ( 3410445 ) on Friday August 14, 2015 @09:55AM (#50316299)

    I'm not a doctor, I don't know any, at least any that would be interested in trying (there's no way any doctor in my area would verify on his or her own that this works), but I'm still willing to try out this project myself. You know, for grins.

    That having been said, people seem to be developing projects left and right and bending over backwards to make 3D printing a thing.

    I can't say whether or not it will be, but it's a lot of fun trying to figure it out.

    • The Maker Event Horizon is an economic theory that draws a correlation between the level of economic (and emotional) depression of a society and the number of Hackerspaces the society has.

      The theory is summarized as such: as a society sinks into depression, the people of the society need to cheer themselves up by making things. This is usually done with CNC routers, laser cutters and 3D printers. As more money is spent on these tools, more Makerspaces are built, and the quality of the maker tools begins to

  • by Snotnose ( 212196 ) on Friday August 14, 2015 @10:11AM (#50316401)
    I suspect that $0.30 cost is just the materials used in making it. Add in design costs, buying the machine, hiring people to watch over the machines, HR, accounting, sales, and support, that stethoscope can easily cost a full $3.00.
    • I suspect that $0.30 cost is just the materials used in making it. Add in design costs, buying the machine, hiring people to watch over the machines, HR, accounting, sales, and support, that stethoscope can easily cost a full $3.00.

      And will only be usable in countries that don't give a crap about medical standards and thusly have no governing body like the FDA which must approve the device.

      • by gstoddart ( 321705 ) on Friday August 14, 2015 @10:32AM (#50316543) Homepage

        And by "give a crap about medical standards" you mean "barely have any medical care available now".

        Let's be perfectly clear on this ... in a poor country in which there are no stethoscopes, and the doctor puts his ear to your chest, anything is better than nothing.

        In a lot of ways, a stethoscope is about as sophisticated as putting a glass against a door to listen into the room. I had a toy one from Fisher Price when I was a kid.

        If I was a doctor in a poor country who couldn't afford to buy a damned stethoscope, this would literally be a game changer. Which is why they did it in the first place.

        • So how does this doctor in a poor country who can't afford a stethoscope get a 3D printer?
          • He probably doesn't. But he goes to the local charity place, and tells them that he needs basic medical tools, and instead of pulling out pre-packaged ones that have been flown in, they tell him to come back tomorrow, and start printing.

          • Gee, I don't know ... maybe the poor doctor isn't going to get a 3d printer ... but maybe a super awesome organization like, say, Doctors Without Borders does what they can to ensure they get spread around because they're suddenly cheap as hell.

            That's kind of what Doctors Without Borders does. Not to mention various UN aid agencies, and who knows what else.

            And I bet if you gave them 100 or so free stethoscopes and said "if you find a doctor without a stethoscope, give him one", they'd all say "hell yeah".

    • $2.85 [ebay.com] on ebay.
    • If it's anything like military hardware, the expense isn't in the manufacturing, it's in the testing. Those $100 hammers you hear about? They're not $100 because the contractor is trying to rip off the military. They're $100 because some military brass decided the hammer should be capable of pounding 2 inch nails into a dozen different types of hardwood 2x4s in 3 hits by an average 20 yo male, endure 1000 hours of such use, do those things in climates ranging from -40 F to +130 F, withstand heating to 25
    • I suspect that $0.30 cost is just the materials used in making it. Add in design costs, buying the machine, hiring people to watch over the machines, HR, accounting, sales, and support, that stethoscope can easily cost a full $3.00.

      Did you RTFS? It says right there that he spent $10,000 in design costs and that he is going to open source the design. This means that you just need someone with a 3D printer and the $0.30 in material to do the printing. What the cost comes out to be will depend on quality and availability of the printer required to make it.

  • The reason a littmann is made of thick heavy materials is because hearing the subject is a whole lot easier than keeping outside noise out. I'd imagine a plastic head would be subject to a lot of outside noise.
  • One advantage to 3D printing and modelling is that the device can be optimized. They can dynamically change things such as the shape and thickness of materials and inner chamber and then determine whether it made a difference or not. And, they can do it cheaply. I wonder, can they reuse the plastic from earlier models?

    More power to them for doing this. As I haven't had time to read the article, are they publishing their design as open source?

    • More power to them for doing this. As I haven't had time to read the article, are they publishing their design as open source?

      Or apparently the summary itself (RTFS? RTFB -- blurb?): "It cost about US$10,000 to develop, and has been released as an open source [github.com] model for anyone to use."

      To be fair, I myself haven't RTFA, but I did do a really good partial skim of the summary.

  • My wife is a veterinarian (graduated UC Davis) and has found that expensive stethoscopes are not as helpful as having significant experience with your stethoscope. She has used an inexpensive device to pick up very faint heart murmurs and other issues that others were not able to detect with their expensive devices. I would suggest that consistency is the most important aspect of creating these stethoscopes, so that if a physician develops a significant amount of experience with one, they could switch to an
    • This is true with just about *any* tool. It's the hands running it that make it great...

      Put a hand saw in the hands of an experienced carpenter and it will give you great results... Hand it to me and get results similar to what a hatchet could produce.

    • "Your hardware is only as good as your wetware." Shadowrun axiom.
  • The cost of medical care really does threaten to burst the US economy and the solutions are complex rather than simple. Here we have a great example of a medical device being created really inexpensively. It is a precursor of what must follow. If we can make all of the medical equipment much more inexpensively we can have more hospitals and clinics without the need for enormous funding, loans, etc.. If we follow that path we may be able to create medical schools which are not expensive to attend su
    • We in the US are the ones paying for the research and development of such tech like this. Some doctor in Africa might now get a .30 printed scope, but the path to get that scope in the first place is paid for by the US. The US developed most modern operating procedures, drugs, devices, etc. We are still paying for all that via our higher costs. If we could actually spread out those costs better, everyone's cost across the world would increase while ours here in the US decrease. That's why drugs cost so
  • I am surprised that the git appears to only offer molds for making silicone ear pieces. I am not going to deny that the silicone earpiece is likely superior both for comfort and for ambient noise elimination. It seems like having additions options available would be important.

    If these are being printed in a resource poor area a set of ear tubes that have ball ends built directly onto them so added material resources of liquid silicone is not necessary would seem to be an essential! Of course several diam

    • Decent quality disposable injection molded plastic stethoscopes are available for less than $1, packaged sterile, make part of the need here difficult to accept. I am sure the sound quality on a disposable stethoscope is not even similar to a Littmann cardio III.

  • Personally, I buy hand tools for their durability and not necessarily their technical details. I want stuff that will last for decades and give reasonable results because I don't want to waste my time running out to the store to replace a broken tool.

    If the $200 stethoscope lasts forever under normal use and the $0.30 version is easily broken in your pocket, give me the $200 version. If there is a $50 version that is nearly the best but works for my application and won't break on me every few weeks, I'll t

    • Except you're comparing apples to spaceships, and the issue is affordability.

      If the doctor in question doesn't earn enough to be able to pay for the $200 version (or the $50 version, or the $10 version), and currently hasn't got one at all ... talking about someone who can afford the $200 version is pointless. It's completely missing the point.

      Sometimes cheap also means that people who would never have been able to afford to buy one can be given one.

      Hell, I'd personally pay for $100 worth of 30 cent stetho

  • The medical device space is ripe for Uberization. A high-end hearing aid contains perhaps a hundred dollars worth of electronics, but in the US market sells for $4000 and more because it's a sacred "medical device" that manufacturers have special legal rights to force Americans to pay the highest prices in the world for. Introduce medical electronics priced relative to real cost in the BRIC countries, and the market will explode to such an extent that US healthcare will have no choice but to let them in ev

  • by ThatsNotPudding ( 1045640 ) on Friday August 14, 2015 @12:11PM (#50317263)
    I'm betting some top-secret clauses in the Transatlantic Trade and Investment Partnership will make such noble endeavors outright criminal.
  • One property of a metal stethoscope that a printed plastic one may have trouble replicating: the specific heat of metal. It is unlikely that the experience of a properly chilled metal 'scope can be replicated using plastic.

  • $10k to develop this thing. Give me a Littman stethoscope, a $10 Harbor Freight digital caliper, and some free CAD software (DesignSpark Mechanical) and I'll have a copy rolling off my printer in about an hour. OK, maybe 3 hours if I have to modify the design a little and print a few test pieces.

    The $10K probably included the cost of buying a 3D printer, a Solidworks license, and paid training for both.

    • Yes, you don't understand and know it. Half the battle.

      You realize that printed plastic has different material properties than metal? Perhaps the design will have to be altered, walls made thicker etc.

  • So many of these articles that proclaim how inexpensive it is to produce things with 3-D printing technology completely misrepresent the true cost.

    That 30 cents figure is probably just for the materials. It doesn't consider the development cost (which in this case may be donated, but in many cases must be amortized across every piece produced), the cost of production equipment (also to be amortized), employment of production labor, distribution costs, marketing, overhead, and any number of other real busine

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