nView Medical’s Fast 3D Intraoperative Imaging With Less Radiation: Interview With CEO Cristian Atri

Fluoroscopy is used in surgical procedures to visualize structures and tools in real-time, allowing surgeons to monitor the movement of a device, instrument, or body part. However, fluoroscopy is a 2D technology that can lead to surgical inaccuracies. Alternative 3D imaging systems provide higher accuracy, but they sometimes require pausing the surgery and exposing patients to significant radiation.

nView medical Inc. is developing an intraoperative imaging system that is better than traditional fluoroscopy. The company’s flagship product, the nView s1, utilizes AI to accurately and quickly construct images with less radiation. This allows surgeons to visualize structures without interrupting the surgical workflow.

We asked CEO Cristian Atria about nView medical and the nView s1 imaging system.

Cici Zhou, Medgadget: Tell me about the founding of nView medical. What was the inspiration behind the idea and product?


Cristian Atria, nView medical: Before founding nView medical I used to develop surgical navigation products. Imagine a surgeon: he is operating on a patient through a small incision. He doesn’t have direct visualization to the bone he is drilling into, or where he is placing an implant. Instead, he looks at a 3D image on a screen to see where in the bone he is drilling, or where he is placing that implant. That’s surgical navigation. It’s very cool technology.

Navigation started in the 90s, and yet, the majority of orthopedic and spine procedures are still not navigated. I asked myself why, and the answer was obvious: technology was not simple enough. The patient needed an additional scan before the operation to have the 3D image; the surgeon had to have special instrumentation for it to be tracked and recognized by the navigation system; the image overlay had to be adjusted for it to accurately represent the actual position of the tracked instrument through a tedious process called registration. Layers of technology had piled up… something had to be rethought for navigation to work in a simple and reliable manner. We identified imaging as being the weak link in this chain of technologies, and took the bold approach to conceive the right imaging system from scratch.

Medgadget: What makes nView medical stand out compared to traditional intra-operative imaging? How does the nView s1 use AI to achieve a lower radiation dose?

Atria: Traditional intra-operative imaging in orthopedics is fluoroscopy, which is basically fast x-ray imaging used at key steps in the procedure. The challenge with fluoroscopy is that it is 2D imaging, and it is well accepted that this leads to surgical errors, like misplaced implants. In the thoracic spine for example, the rate of misplaced implants can be as high as 18%.


Having 3D imaging in surgery is key. nView s1 is a breakthrough imaging system because it provides 3D images in just a few seconds, without interrupting the surgical workflow. This allows imaging to be used throughout the procedure, and removes the adoption barriers that traditional 3D technologies are associated with.

Creating 3D images can require a lot of x-ray radiation and it can take a lot of time. Our approach was to minimize the data we gather during imaging, to speed-up data acquisition time and to reduce radiation dose. The challenge is that you don’t have all the data you would need to create a good image. Here is where AI comes into play, by filling the gaps of missing data to provide good images quickly and with minimum amounts of radiation.

Medgadget: At what stage is the company today? (Number of team members, stage of development and use, investment funding, etc.)

Atria: Despite having received FDA 510(k) clearance for nView s1 last year, we are still an early stage company. We are a team of 12, and have developed everything from concept to pilot production with less than $6M. Our backers include granting agencies like the National Science Foundation, the National Institutes of Health, the State of Utah (where we are based) and private funding from Fusion Fund (an early stage VC) – and sophisticated angels (a prominent neurosurgeon and executives from Medtronic, Johnsons & Johnson and GE Healthcare). We are now raising our series A to go commercial.

Medgadget: What are some of the biggest challenges facing the team, whether it’s on the technology or business side?

Atria: Our biggest challenge is to evolve from being a technology development start-up to being a customer development company. For the last 6 years, we have focused on developing technology in our labs. We did it with a massive amount of customer input — we have done around 100 demos and more than 200 customer interviews — but our DNA is technology and now we feel the need to build stronger relationships with our customers. We started that process this year, with the hiring of our first full-time customer facing team members, and we will continue this transformation by starting partnerships with our first customers. We will need to gain this new dimension without losing our ability to bring similarly innovative products to market.

Medgadget: Looking to the next 5 years, what are the biggest goals for nView medical?

Atria: In the short term our goal is to make nView s1 the leading imaging solution in pediatric orthopedic surgery. Our low-dose performance is key for our pediatric customers and we know we can deliver what they need. We will of course move our technology beyond pediatrics, but what excites me the most is the potential to integrate our breakthrough imaging with other technologies in the operating room. We want to integrate our imaging with navigation — this is where everything started — providing imaging data to AI systems that can help surgeons make better decisions and enable autonomous surgical robotics. Everything is geared towards fulfilling our mission to make surgeries safer, faster and consistently accurate.

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