Butterfly Auto B-line Counter

Note: Depending on your platform, hardware, country, and membership type, certain presets, modes and features may not be available.

Overview

The Auto B-line Counter provides users with an automatic count of the number of B-lines present within a rib space when using the Lung preset. The Auto B-line Counter uses the Instant Percent method for calculating the maximum number of B-lines present within a single frame of a cine.  

Contraindications

Not for use in lung zones that contain a large pleural effusion. Not to be used with pediatric patient populations (people below 22 years of age). 

Compatibility

Auto B-line Counter is supported on all Butterfly iQ, iQ+, and iQ3 compatible iOS  and Android devices on supported OS versions. 

Accessing Auto B-line Counter

The Auto B-line Counter can be accessed in the Lung Preset while scanning in B-Mode.

1. On the Presets menu, select the “Lung” preset.
2. Tap Actions located at the bottom right corner of the screen.
3. The Lung actions screen will display. 
4. Select B-line Count from the Actions menu, under Tools.

NOTE: If this is your first time using the B-lines tool, a tooltip will display with instructions on how to use the tool.

5. The Auto B-line counter can be turned off by tapping X at the bottom of the screen while the tool is active or tapping the X in the Actions menu.

 

Calculating B-line Count

NOTE: For general tips about using the Auto B-line Counter, including information about proper probe positioning, tap the ? at the bottom right of the screen.

1. Select B-line Count from the Actions menu within the Lung preset.
2. Position the probe so that the intercostal space between the ribs and the pleural line is in the center of the screen.
   • A static, 30-degree sector intercostal space indicator is shown at the bottom of the screen that highlights the area of the image where the B-line count will be measured. 
   • Image gain can be adjusted by swiping left and right on the image. 
   • Image depth can be adjusted by swiping up and down on the image. The image depth cannot be adjusted to be less than 8 cm when using the Auto B-line Counter.
   • The locations of any detected B-lines are shown in real-time via blue lines overlaid on the image. A single blue line represents a discrete B-line and a blue bracket will highlight areas of confluent B-lines. 

NOTE: B-line location visualizations should not be used for clinical decision-making.

3. Select Count. 
   • A 6 second cine will be captured. A countdown timer will appear in the lower left hand side of the screen. Do not move the probe during the cine recording.
   • After capturing the cine, the device will prepare the cine and indicate whether automated B-line count is successful.
4. Auto B-line Counter successfully calculates B-line count
   • An automated B-line count is displayed at the bottom of the screen. 
     • The B-line count represents the maximum number of B-lines present within a single frame within the cine. The Auto B-Line Counter looks across all of the frames in the cine to determine this maximum count. (Note: multiple frames can have the maximum B-line count). 
     • The count displayed will be 0, 1, 2, 3, 4, or >5.
   • The cine above the B-line count displays the images and the B-lines that were identified.
     • The captured cine will play on a loop. The cine can be paused and frames manually reviewed by tapping the screen and using the playback controls on the screen.
     • Identified B-lines will be highlighted by blue lines on the corresponding captured cine. A single line represents a discrete B-line and a bracket will highlight areas of confluent B-lines. B-Line locations are provided as visualization to the user to show how B-Line counts were derived and should not be used for clinical decision-making
   • Please see the sections below for information on how to edit a B-line count, save the cine, or delete the cine.
5. Auto B-line Counter unsuccessfully calculates B-line count

The Auto B-line Counter has the capability of identifying cines that are not adequate for an automatic B-line calculation by the tool based on an internal quality check.

1. In this case, a prompt will display explaining that the tool was unable to obtain an automatic B-line count (see screenshot below). In addition, the automated B-line count will display as “N/A”. Pressing the Continue button will advance to the result screen where a count can be manually added via the Edit button.
2. To rescan/repeat the measurement, 
   • Press the “Rescan” button on the popup window
   • The device will return to the Auto B-line Counter home screen, where the “Calculating B-line Count” steps can be repeated including capturing a new cine.
3. To do any other action, including enter a manual B-line count, save the cine, or delete the cine, press the “Continue” button on the popup window

Editing the Automated B-line Count

The automated B-line counts for a captured cine can be manually edited by following the steps below.

1. Press the “Edit” button on the Estimated B-lines pop-up window
2. When prompted, select “Edit count”
3. Select the desired number of B-lines by using the number picker. The options for manual edits are 0, 1, 2, 3, 4, 5, and >5. 
4. If the B-line count is manually edited, 
   1. The count will be marked as a “Manual count” in the Estimated B-lines popup window
   2. Any blue lines indicating B-line locations will be removed
5. The result can be switched back to the automated count by pressing the Edit button again and selecting “Reset to auto count”

Saving or Deleting a Captured Cine

A captured cine and B-line count can be either saved to the cine reel or deleted. 

1. To save: 
   • Press the “Save” on the Estimated B-lines pop-up window
   • Once saved, a pop-up will display saying the cine has been saved to the exam reel
2. To delete: 
   • Press “Delete” at the top left hand side of the screen
   • The device will indicate that it is deleting the cine and then return to the Auto B-line Counter home screen

Using Auto B-line Counter With Lung Protocol

The Lung Protocol can be used with the Auto B-line Counter tool to help label the lung zones being scanned by the user. To turn on the Lung Protocol, click on “Lung Protocol” located above the blue “Count” button. Please refer to the “Using Protocols” section for more information on how to use the Lung Protocol.

User Tool Tips

Auto B-line Counter tool tips provide informational tabs with brief, static, standardized information on proper probe placement and how to use the tool. First time users of the Auto B-line Counter are automatically presented with tool tips when they select “B-line Count” from the Actions menu within the Lung preset. Tool tips can be accessed by any Auto B-line Counter user at any time by selecting the ? on the bottom right hand side of the screen when in the tool.

Document Reference: 980-23818-00 Rev A