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A Handheld X-Ray System: Interview With Evan Ruff And Gregory Kolovich, Co-Founders Of OXOS Medical

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  1. The Good Doctor

    The Good Doctor Golden Member

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    OXOS Medical, a medtech spin-off out of Georgia Tech, has created the Micro C, an FDA cleared handheld X-ray system that is designed to image the distal extremities, from the shoulder to the hand and from the knee to the foot. The device is intended to prevent situations in which clinicians have to handle and operate large machinery to perform simple X-ray imaging of small bones in the extremities, and allows them to conduct imaging right at the point of care.

    The device can be deployed during surgical procedures, and allows surgeons to more easily capture images that could be difficult to obtain using large, fixed equipment. The small size and portable nature of the system may also help to increase access to medical imaging in low-resource and remote areas of the world.

    OXOS reports that the device emits very low levels of radiation compared with traditional X-ray systems. This means that the Micro C can be used for dynamic digital radiography, meaning that it can produce ‘X-ray videos’, allowing clinicians to perform guided injections or study bones in motion.

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    Medgadget had the opportunity to speak with the OXOS Medical co-founders, Evan Ruff, CEO, and Gregory Kolovich, Chief Medical Officer, about the technology.

    Conn Hastings, Medgadget: Please give us a quick overview of X-ray technology and how it has evolved since inception.

    Evan Ruff, OXOS Medical: X-Ray is the first medical imaging modality going all the way back to Röntgen 1895. X-Rays started being widely used in medicine around WWI, with Marie Curie building a portable machine and taking diagnostic images on French battlefields. The digital C-Arms and Mini C-Arms that you see in surgery today really started evolving in the late 1990s, but then innovation stagnated. Micro C is the first new radiographic imaging form factor in quite a few decades.

    OXOS adopted technological advancements in other applications, such as advanced microcontrollers, computer vision, and sensor technologies. These technologies have allowed us to make fundamental advances in the way we generate x-rays and the size, weight, and safety systems that allow the device to be deployed to so many different care scenarios.

    Medgadget: What inspired you to develop a point of care X-ray system?

    Gregory Kolovich, OXOS Medical: My inspiration for the Micro C really started while I was doing an emergent replant procedure at Mass General during my fellowship at Harvard. I was operating by myself, trying to stabilize the anatomy while wrestling this gigantic machine. My concentration is in hand, so deploying an 800 lbs device to image these small, intricate bones seemed counterintuitive. I have a background in electrical engineering, so I started researching x-ray machines and the components and felt there had to be a better way. That’s what led to my design for the Micro C.

    As we started solving the power, safety, and regulatory challenges presented by the distal extremity problem, we discovered that OXOS could also apply those solutions to general radiography. With two thirds of the world lacking access to medical imaging, OXOS has an opportunity to open access to these life-saving technologies, changing the way we deliver medical care across the globe. As a surgeon, it’s incredibly exciting.

    Medgadget: What challenges did you encounter while developing a miniaturized X-ray system?

    Evan Ruff: Oh, yeah, well… quite a few. So, there’s an entire technical set of challenges around generating that much energy in such a small space. The problem is, how do you make a 60,000-volt pulse in someone’s hand and then manage to get all that heat out of there. In addition to the highly volatile electrical pulses, you’ve got radiation going everywhere, so how do you shield the emission without the thing weighing 400 lbs. Those were hard, but then, you’ve got all the safety and regulatory issues.

    Essentially, you’ve built an ionizing radiation gun, and you don’t want people accidentally emitting radiation all over the place. The challenge then becomes how do we make sure the emission is safe and that the energy is used to create clinically relevant images. That’s when we came up with the idea of the positioning system. The positioning system is the core OXOS intellectual property, and it describes how to make sure the user can only emit radiation when the device is in a safe orientation. We do these computations in less than a millisecond, allowing us to do live x-ray imaging, making the fluoroscopic approach obsolete.

    Once OXOS tested the system to sub-millimeter accuracy, we started building on the concept. What other safety and quality systems can we create with all that positioning information? That’s how our team came up with the sensor-based, AI-powered dose determination engine, as well as new technologies built around improving image quality for less radiation. It’s revolutionary in the radiographic space.

    Medgadget: Please give us an overview of the Micro C system and its uses.

    Gregory Kolovich: Micro is a six-pound emitter paired with a digital 6” x-ray cassette. The device allows for capturing the distal extremity from the shoulder to fingertips and knees to toes. I use the device in both surgery and the clinic. In surgery, the agility is excellent for the hard-to-capture views, and in the clinic, having the imaging device right there when I’m doing an exam is terrific. Micro C makes me a more efficient surgeon. Also, when I’m going to our satellite clinics, I’ll take it with me; that way, I know I’ll have the right modality as soon as I arrive.

    One huge benefit is our DDR imaging. Evan sort of mentioned it, but as a clinician, this is so useful. DDR is dynamic digital radiography. DDR works a bit like fluoroscopy, like a live x-ray, but with much higher clarity. Because of our low radiation and super-fast x-ray tube, Micro C can create a live x-ray video, where every frame is a clinically relevant image. Micro C allows me to take a live DDR and then move through each frame to nail the diagnosis. DDR also lets me do motion studies and guided injections right in my clinic. It’s incredible.

    Medgadget: Are there any radiation concerns associated with the system? How does it compare with conventional X-ray systems in this context?

    Evan Ruff: It’s a very low-dose device. The system produces 80% less radiation than existing systems. To put that in perspective, if an operator used the Micro C all day, every working day for a year, they would have exposed themselves to less radiation than an international flight.

    Generally, radiation-emitting devices produce what’s called a “scatter cloud,” which is defined by the area in space around the device that is exposed to any measurable quantity of radiation. Standard C-arms and incumbents have radiation scatter cloud radius of about 6–24 feet. The radiation scatter cloud from the Micro C is only three feet, so if you’re more than three away from the Micro C, there is no measurable exposure.

    Medgadget: Is the Micro C in use at present? How have patients and clinicians found the system?

    Gregory Kolovich: Yes, the rollout of the system has been very, very strong. We have only been in the market since July and are installing devices as fast as we can. So far, we’ve had the device used everywhere, from urgent care to ortho clinics, even on the sidelines of both college and professional football. Seeing the anatomy is just so important, and doctors love using the device because it gives them so much control over their most used imaging modality.

    The feedback from patients is even more exciting. As a physician, I knew that I would love using a Micro C, but patients love the device. First, they don’t have to go to another area, wait again for images, and then wait AGAIN to see me. I come into the room and can do the entire exam without interruption, so they like that. The other thing they respond to is having that real-time collaboration with the doctor. When I use a Micro C and image a patient, we can see the image instantly, together. When I give them the diagnosis, show them their improvement in joint mobility, or even do an injection, they’re involved in the care process, which creates more trust between the patient and provider. It’s great.

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