June 13, 2022
reviewing the echonous kosmos ultrasound

Reviewing the EchoNous Kosmos Ultrasound

Disclaimer: EchoNous was kind enough to loan me a Kosmos ultrasound device during my deployment with the US Army. This review is a summary of that experience. There is no financial relationship between sports medicine review and EchoNous.

Introduction

EchoNous is a company founded in 2016 with the teams vision of “adding the emerging field of artificial intelligence (AI) with the extreme miniaturization of ultrasound to help solve common everyday problems in healthcare“. Per their website, EchoNous develops industry-leading, intelligent POCUS tools that help medical professionals solve common everyday problems in healthcare. Its flagship device, Kosmos, offers diagnostic-quality heart, lung, and abdominal scans in a handheld tool. The product offers ultrasound, ECG, color pulsed-wave and continuous-wave Doppler capabilities, acts as a digital stethoscope, and provides AI-guided cardiac scanning – an industry first in a single device.

I was fortunate enough to connect with their team months before deployment and they graciously loaned me one of their Kosmos units with both a linear and phased array probe. They arrived promptly and I was excited to open them and tinker a little before my deployment. 

All three transducers from right to left (phased array, linear and curvilinear) and the tablet (termed bridge)

The linear transducer plugged into the bridge.
The Kosmos ultrasound carrying case.

First Impression

The first thing I noticed was the interface was slick. I’ve used a lot of ultrasound devices and I would say the easy to navigate interface makes a good first impression. Moving among the different modes such as vascular, nerve and musculoskeletal are quick and easy. Saving images and videos is easy. Moving files off the device was a cinch. The tablet itself is light and easy to hold in one hand. Alternatively, it comes with a small and slightly clumsy stand that allows it to sit upright. 

I didn’t measure battery life, but I would say you can easily use it for 30-45 minutes on a full charge without any issues. The probes are light and the cable is long enough. I never really felt encumbered using the device or holding the transducer. Each probe also comes with a USB drive to easily move files off the device to your computer.

MSK Ultrasound

I spent a lot of time using the linear probe while deployed. Like in many resource limited clinical environments, it was very useful in theatre. I did not have immediate access to an xray machine, so the ultrasound became my default imaging modality for any musculoskeletal complaint that presented to the aid station. Above are a few basic rotator cuff sonograms to give you a sense of what the image looks like.

As standard with any ultrasound, you can quickly adjust both depth and gain. Although I didn’t save any images of nerves or vessels, the preset feature allows you to rapidly switch between modes depending on what you’re trying to accomplish.

Normal muscle: the anterior compartment of the leg in long axis.

Normal bone: anterior tibial cortex in short axis.

Normal subacromial space and bursa

Identifying normal pathology was easy. The linear probe provides a clear view of bone, muscle and tendon. The freeze image and video features were very easy to use.
Normal right pectoralis muscle.
Left pectoralis muscle tear in long axis. Note this particular soldier was very muscular which required me to increase the depth.

Large epidermoid cyst which was drained and excised on the base.

Patellar tendonitis seen in both long and short axis. The soldier was exquisitely tender on the inferior pole of the patella where you see this hypoechoic fluid in the substance of the proximal tendon.

Phased Array Probe

I didnt spend a ton of time using this probe while deployed. We practiced some FAST exams but I dont think I saved any images. However, this is where the artificial intelligence can really shine. I have a couple really cool images showing the power of the phased array probe with the artificial intelligence.

Demonstration of the artificial intelligence software calculating metrics for the echocardiogram
Demonstrating the bladder volume measurement using the artificial intelligence software. No calculations required!

Additional Thoughts

I did have a few concerns, all of which I think can be fixed. The first is that with the device they sent me, you can not charge the device and use the linear probe at the same time (they use the same port). However, you can charge the device and use the phased array probe at the same time. I imagine the engineers will change this at some point.

In the most recent software update, there was no doppler or color doppler on the linear probe. I’m told this feature is simply a matter of getting the coding and AI optimized before releasing it to the wild. I’m certain this will be added as it’s a must have for any physician using the linear probe for any purpose. I believe the phased array and/or phased array probes do have doppler for cardiovascular evaluation, but I did not test them for this purpose.

Summary

The Kosmos ultrasound is a fantastic device. It’s light, ergonomic and easy to use. I was able to acquire some high quality MSK images using the linear probe which is what I am looking for in a sports medicine/ orthopedic environment. I would have liked to use it for some procedures, but fortunately for us most members of the Armed Services do not need procedures! There are a few things that need to be tweaked or added to the software, which will inevitably happen. All in all, I would recommend this device to anyone looking for a light, portable ultrasound with strong software features and a team dedicated to bringing artificial intelligence to ultrasound.

 

Developer Update: Color is now available on the linear probe, doppler coming soon!