EchoNous KOSMOS 3-in-1 Ultrasound, Electronic Stethoscope, and ECG Helps with COVID-19

EchoNous, a developer of novel ultrasounds, has discovered a solution to leverage a number of vital scientific applied sciences inside a single machine. The result’s KOSMOS, a handheld 3-in-1 machine consisting of an ultrasound, digital stethoscope, and an ECG, all linked through synthetic expertise.

When COVID-19 was hitting NYC earlier this yr, EchoNous was ready to make use of KOSMOS to assist diagnose COVID sufferers and to tell on therapy methods. We had a stunning chat with Dr. Richard Hoppmann, a key member of EchoNous, Scientific Professor of Inside Medication on the College of South Carolina, and the Director of the Ultrasound Institute.

Alice Ferng, Medgadget: Are you able to inform me a bit about your self and how you bought concerned about ultrasound applied sciences that led to your involvement with EchoNous? 

Dr. Richard Hoppmann, innovator at EchoNous: I’m an internist/rheumatologist by coaching and have been with College of South Carolina Faculty of Medication since 1990. My profession right here has included Directorship of the Division of Rheumatology, Chief of Medical Service on the Dorn VA Hospital, Chair of the Division of Inside Medication, Affiliate Dean of Medical Training, Dean of the Faculty of Medication, and Director of the Ultrasound Institute.

In 2006, whereas Affiliate Dean of Medical Training, we initiated the first-in-the-nation built-in ultrasound curriculum for medical college students throughout all 4 years of medical college. We subsequently based the primary skilled group devoted to ultrasound in medical training – the Society of Ultrasound in Medical Training (SUSME) – and hosted the primary World Congress on Ultrasound in Medical Training in 2011. There have been six different world congresses since then with the newest being on the College of California-Irvine. The 2020 Congress needed to be rescheduled as a result of COVID and is now scheduled at Wayne State College Faculty of Medication in Detroit in August of 2021. We’ve expanded our ultrasound program over the previous 15 years to incorporate coaching residents, doctor assistants, practising physicians, and others. Further info on our packages may be supplied.

Our focus has been totally on creating ultrasound as a studying device and as a frontline healthcare supplier scientific apply device. We’ve accomplished this by creating academic materials for our medical college students in addition to offering it to others through open entry on our Ultrasound Institute web site. Our Youtube video channel on ultrasound scanning has had over 1.3 million views worldwide. We’ve hosted many conferences and have been working with many medical faculties nationally and internationally to develop ultrasound curricula. We’ve additionally partnered with nationwide and worldwide organizations to advance ultrasound training such because the American Institute of Ultrasound in Medication (AIUM) and the World Interactive Community Centered on Vital Ultrasound (WINFOCUS).

Roughly 12 years in the past we started searching for modern methods to reinforce ultrasound as a educating device and began working with our mental property workplace on patents. We now have 4 patents which have been issued and have seven patents which can be pending.

One among our early patents was combining stethoscope sounds (auscultation) and ultrasound in real-time. The addition of sound to ultrasound was rapidly acknowledged as a terrific educating device, particularly for understanding and assessing the center. Our group on the College of South Carolina Faculty of Medication Ultrasound Institute has additionally been concerned about synthetic intelligence (AI) and the way it is likely to be utilized in each medical training and medical apply.

Thus, we have been delighted in 2016, when Kevin Goodwin and Niko Pagoulatos from EchoNous approached us concerning the stethoscope sound-ultrasound patent. They’d already conceived of the three-signal strategy of ultrasound, auscultation, and ECG mixture augmented with AI.

Medgadget: Let’s discuss extra concerning the KOSMOS machine. What was the inspiration and reasoning behind incorporating ultrasound, stethoscope auscultation, and ECG in a single machine? What sort of info does this present the doctor?

Dr. Hoppmann: From the mix of stethoscope sounds and ultrasound perspective, I distinctly bear in mind being in my workplace one night and pondering, “I wonder what it would be like to listen to my heart with a stethoscope as I scan it with ultrasound”. So, I obtained my stethoscope and a transportable ultrasound system and did simply that. After I had the stethoscope and ultrasound probe in place over my coronary heart and regarded on the ultrasound display I stated one thing like “Wow, I can both see and hear my heart and how the closure of the heart valves are creating the heart sounds”.

I’ve all the time been a instructor and I knew at that second that college students would love this strategy and it might give them an understanding of the center and coronary heart sounds that had by no means earlier than been doable. So, I started working with Shaun Riffle, an extremely gifted media knowledgeable, and we deliberate a session to concurrently document the ultrasound of the center and the stethoscope coronary heart sounds. We recorded the center sounds by reducing the tubing of an outdated stethoscope and slipping a lavalier microphone down the remaining tubing and sealed it off. Once we captured our first ultrasound-heart sounds recording, we knew we had one thing distinctive. We submitted a patent on the mix and started exploring different modern approaches to medical training and scientific apply, particularly these associated to ultrasound.  

For us, AI is about combining the ability of massive knowledge with the advances in laptop processing to investigate with algorithms and neural networks large quantities of knowledge to considerably enhance training and the apply of drugs.  Kosmos is ready to enhance the acquisition and the accuracy of interpretation of the three indicators of ultrasound, auscultation, and ECG’s individually and then together to supply necessary scientific info that’s higher than the sum of the separate indicators. This may also help us perceive illness processes and enhance affected person care generally in addition to for the person affected person. It permits for a extra customized or precision drugs strategy to the care of the affected person. As an additional advantage, utilizing a single machine with AI is extra environment friendly than the normal strategy of performing and analyzing these three indicators separately. This effectivity saves time that may then be utilized by the busy healthcare supplier for direct private communication with the affected person which is crucial in really caring for the affected person and addressing his/her healthcare considerations.

To understand the potential magnitude of this multi-signal AI strategy, one can consider Kosmos because the good stethoscope for the 21st century. If everybody who presently makes use of a stethoscope at the moment – physicians, nurses, nurse practitioners, doctor assistants, medics, and others – had entry to a sensible machine like Kosmos with the ability to seize and analyze three of probably the most elementary well being evaluation indicators in drugs with AI help, the world of healthcare would change dramatically. One want solely mirror on how good telephones have basically modified our each day lives to get a way of the potential of Kosmos to alter medical training and healthcare throughout the globe.

Medgadget: What sort of knowledge can you acquire with KOSMOS that the normal applied sciences alone didn’t present? 

Dr. Hoppmann: Right here’s a few of what Kosmos is ready to do:

  • Actual-time auto-labeling of the constructions being scanned corresponding to figuring out the proper and left atria and ventricles of the center. This can significantly improve self-directed studying of ultrasound and additionally studying cardiac anatomy.
  • Actual-time auto-grading of the standard of picture obtained on a scale from 1 to 5. This can speed up the learner’s means to seize high quality photos and additionally present a regular of picture high quality so learners can finally grade the standard of their very own photos in addition to photos of others. Acquiring high quality photos is crucial to precisely figuring out physiological features such because the ejection fraction of the center.
  • Auto-guidance within the type of probe directions corresponding to “rotate the probe clockwise” are  displayed in real-time on the display  thus permitting even the novice ultrasound consumer to rapidly study to seize high quality photos – one other assist in self-directed studying.
  • Automated calculations of necessary physiological measures of operate such because the ejection fraction or % of blood ejected from the center with every beat. The ejection fraction is a superb evaluation of coronary heart operate.
  • Additionally included is coronary heart fee and sooner or later it can embrace ECG interpretation and coronary heart sound interpretation.

Medgadget: How does AI play into this? Are you able to discuss extra particularly about how AI amplifies every of the three applied sciences, in addition to the way it works to convey them collectively for a hybrid output that gives physicians a novel approach of knowledge? How are you coaching or creating the algorithms?

Dr. Hoppmann: The founders of EchoNous are pioneers in point-of-care ultrasound and have introduced intensive experience and success to Kosmos. As well as, they’ve employed specialists with superior levels in AI, together with picture recognition. Additionally they have a broad array of skilled ultrasound consultants together with emergency drugs physicians, cardiologists, obstetricians, internists, and sonographers that present extra ultrasound and scientific experience in addition to help within the improvement of AI algorithms and coaching / testing on massive populations of sufferers.

Coaching and testing of AI on massive datasets enhances the diagnostic accuracy of the person elements of the three indicators and the mix of knowledge from the three indicators additional enhances diagnostic accuracy. This permits all customers to acquire correct photos and scientific measurements that lead to improved prognosis and therapy for his or her sufferers.

Mixtures of those indicators permit calculation and show of necessary physiological measures of coronary heart features corresponding to stroke quantity, ejection fraction, coronary heart fee and cardiac output.   

Cardiac Calculation Show: EF=ejection fraction or the proportion of blood ejected from the ventricle with every contraction, SV=stroke quantity or the amount of blood ejected with every contraction or stroke of the center, CO=cardiac output or the amount of blood pumped by the center per minute, and HR=coronary heart fee or beats per minute. Quantity calculations are primarily based on modifications in left ventricular quantity when it’s at its largest, the top diastolic quantity (EDV), and at its smallest, after it has contracted and ejected blood, the top systolic quantity (ESV).

Beneath are two scientific situations during which analyzing three simultaneous indicators can improve prognosis and administration of sufferers by practitioners – from those that are extremely skilled to these new to ultrasound and scientific apply.

  • Ultrasound alone can detect left ventricular hypertrophy (LVH) which is thickening of the center muscle wall and is mostly attributable to persistent hypertension. Early detection of LVH and ample administration of the hypertension can forestall the development of coronary heart wall thickening to coronary heart failure. Average to extreme LVH can normally be appreciated and measured with ultrasound in most sufferers however in hard-to-scan sufferers and sufferers with gentle illness, it may be a problem to determine even for skilled ultrasound customers. Nonetheless, the thickened ventricular wall may also be detected within the ECG sign (elevated voltage) and it may possibly produce a further coronary heart sound (S4) detected on auscultation as a result of decreased compliance of the ventricle. An evaluation of those three mixed indicators may end up in a extra correct identification of LVH and permit the healthcare supplier to implement the suitable degree of hypertensive administration to forestall additional development of the center illness and even lead to regression of the LVH.
  • Coronary heart valve illness is a typical cardiac drawback and can have a marked impression on cardiac operate. Early illness of a coronary heart valve corresponding to valvular insufficiency leading to backflow and not ahead circulate of blood when the center beats can at instances be tough to determine with ultrasound alone, particularly with a restricted point-of-care examination within the setting of the time constraints of a busy scientific apply.  

Including digital auscultation that may detect a murmur of valvular dysfunction and an ECG to determine the timing of the murmur within the cardiac cycle (systole or diastole) will alert the clinician to a possible valvular abnormality and assist classify the kind of murmur. This could then be adopted by a better have a look at the valves and consideration of extra ultrasound analysis corresponding to Doppler or referral of the affected person for a extra complete cardiac examination. Early detection in these instances can result in higher administration of the affected person’s valvular situation and delay or forestall additional issues corresponding to development of the illness requiring valve alternative or the event of coronary heart failure.

Medgadget: It’s superb that KOSMOS was accessible on the proper time as an current product to check for COVID-19 when NYC was the epicenter of the pandemic. How have been you capable of assist check for COVID-19 at the moment once we nonetheless knew so little concerning the illness? What metrics did you search for that urged somebody might have COVID-19 (temperature, HRV modifications, respiratory, and so forth.)? Had been modifications being made week to week to accommodate the brand new findings as we discovered extra about SARS-Cov-2 over time? And the way is the machine presently getting used to diagnose and deal with COVID-19 sufferers?

Dr. Hoppmann: Lung ultrasound is a comparatively new ultrasound software and its worth in diagnosing and managing pneumonia was not broadly appreciated previous to the COVID-19 pandemic. Nonetheless, there was a substantial physique of literature on lung ultrasound accessible describing the ultrasound traits of each bacterial and viral (COVID-19) pneumonias. Thus, although our understanding of the specifics of COVID-19 an infection have been evolving in the course of the course of this pandemic, we did have a superb understanding of viral pneumonia and its ultrasound findings that might instantly be utilized to COVID and have confirmed to be of giant profit in the course of the pandemic. 

Healthcare suppliers on the frontlines have been ready to make use of Kosmos and different hand-held ultrasound units to rapidly look at sufferers for proof of pneumonia and make presumptive diagnoses of COVID-19 if findings of viral pneumonia have been current on lung ultrasound, particularly in sufferers with signs corresponding to fever or cough. This strategy has been notably helpful in locations the place emergency rooms, hospitals, and clinics have been overwhelmed with the variety of sufferers being seen. Moreover, lung ultrasound has been vital in settings with restricted entry to different imaging modalities corresponding to CT in addition to for services experiencing unavailability of COVID-19 nasal swab and different testing or having vital delays in reporting of outcomes.

In the course of the pandemic transportable ultrasound has allowed health-care suppliers to make better-informed medical selections, corresponding to triaging sufferers on presentation, safely discharging sufferers to residence with applicable directions on follow-up if indicated, isolating sufferers when needed, and managing workflow and utilization of scare sources corresponding to intensive care unit beds and ventilators. Making fast, knowledgeable selections primarily based on point-of-care ultrasound exams has additionally decreased publicity of workers and non-COVID sufferers to sufferers with COVID-19. Level-of-care ultrasound has considerably decreased the necessity to transport COVID sufferers by means of the hospital to get extra testing corresponding to CT exams, additional enhancing security for all.

As extra expertise was gained with COVID-19, it turned clear this isn’t only a pneumonia and illness of the lungs however is a multi-organ illness that may have an effect on the center, blood vessels, kidney, mind, and different organ programs. Thus, clinicians turned rather more vigilant about assessing for different COVID manifestations. Transportable ultrasound has confirmed to be a really great tool to diagnose and handle many of those manifestations, a few of that are life threatening corresponding to coronary heart failure and thrombosis with pulmonary embolism.  

As a result of these COVID manifestations can evolve over time, hand-held ultrasound has additionally supplied the chance to re-examine sufferers as steadily as wanted to determine development of lung illness or improvement of significant issues. These may then be addressed in a well timed style bettering outcomes and saving lives.

Hand-held ultrasound units are additionally a lot simpler and faster to decontaminate after use making them safer to make use of than different imaging expertise corresponding to CT scanners in addition to the bigger laptop computer sized ultrasound units. Fast decontamination additionally saves valuable time within the setting of a heavy affected person care workload disaster. Hand-held units may even be left in particular person intensive care unit rooms and used solely on the one affected person within the room additional enhancing effectivity and security for sufferers and workers.  

We proceed to study from the COVID expertise concerning the benefits and general advantages of getting access to transportable ultrasound.  There have been quite a few temporary reviews within the literature in the course of the pandemic and there are a variety of extra complete research underway throughout the globe that may assist additional make clear the function of ultrasound with respect to greatest practices, standardization of protocols, and areas needing additional analysis.

Nonetheless, even at this level, most would agree that that bedside ultrasound has performed a big function on this pandemic and has improved outcomes for hundreds of sufferers and has enhanced security for all sufferers and their healthcare suppliers world-wide. Classes discovered with Kosmos and different hand-held units in the course of the pandemic will little question higher put together us for a future that will embrace comparable international well being crises.

Medgadget: What are some issues that KOSMOS can’t be anticipated to do, and maybe presently falls quick on (and are these gaps and points issues sooner or later plans for this machine)? Are there limitations corresponding to battery life, visible vary re: depth of tissue, or extra correlations that aren’t but accessible? 

Dr. Hoppmann: At current, Kosmos makes use of a low frequency ultrasound probe that offers wonderful photos of intermediate to deep constructions within the physique corresponding to the center, liver, and aorta however has restricted capability in imaging extra superficial constructions nearer to the physique floor. Nonetheless, improvement is already underway for including a excessive frequency probe to Kosmos that may seize top quality photos of superficial constructions corresponding to bones, vessels, and thyroid gland.

At current Kosmos operates with a high-tech straightforward to function companion pill. This offers the consumer excellent photos, nice performance, and ease of use. This mix of probe and pill is a perfect transportable system for high-tech, skilled specialised customers in addition to new and intermediate degree customers. Nonetheless, for some customers the pill is just too massive and considerably inconvenient for his or her wants.

Additionally in improvement is the choice to make use of Kosmos with an off-the-shelf pill or a sensible cellphone as a substitute of the corporate pill. This makes utilizing Kosmos extra handy and cell, particularly for customers concerned in affected person care throughout a number of areas of a hospital or clinic and even totally different apply websites. The off-the-shelf pill and good cellphone choices will even be cheaper which is able to make it extra inexpensive for these with restricted budgets corresponding to these in coaching and establishments needing many programs for lots of of scholars. It is going to even be enticing for these solely concerned in training and not producing income by billing for ultrasound companies.  

Medgadget: What are the plans for KOSMOS long-term? 

Dr. Hoppmann: The Kosmos platform will supply a complete bundle of transportable ultrasound performance together with imaging modalities not but accessible on any handheld machine (ie steady wave and pulsed wave Doppler expertise) and even laptop computer ultrasound programs (steady wave expertise). Kosmos will supply complete, safe, ultrasound performance and knowledge administration augmented with synthetic intelligence. This can symbolize a brand new mannequin for ultrasound platforms and different digital expertise for training, scientific apply, and analysis. The cloud-based platform will even permit customers to wirelessly improve new features and capabilities of the system as they grow to be accessible.

Product web page: Kosmos…

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