OXOS Medical, a company derived from Georgia Tech’s medical technology, has created the Micro C, an FDA-approved portable X-ray system that is designed for imaging the distal limbs, from the shoulder to the hand, and from the knee to the foot. The device is designed to prevent situations where doctors have to handle and operate large machinery to perform simple X-ray images of small bones on the limbs, and allows them to take images right at the point of care.
The device can be deployed during surgical procedures and allows surgeons to more easily capture images that might be difficult to obtain with large, fixed equipment. The small size and portable nature of the system can also help increase access to medical imaging in remote and under-resourced areas of the world.
OXOS reports that the device emits very low levels of radiation compared to traditional X-ray systems. This means that the Micro C can be used for dynamic digital radiography, meaning it can produce “X-ray videos”, which it allows doctors to perform guided injections or study moving bones.
Medgadget had the opportunity to speak with OXOS Medical co-founders Evan Ruff, general manager, 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 the beginning.
Evan Ruff, OXOS Medical: X-rays are the first form of medical imaging dating back to Röntgen 1895. X-rays began to be widely used in medicine around World War I, with Marie Curie building a portable machine and making diagnostic images in the world. French battlefields. The digital C-arms and mini-C-arms you see today in surgery really started to evolve in the late 1990s, but then innovation stalled. Micro C is the first new radiographic imaging form factor in a few decades.
OXOS adopted technological advances 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 in the size, weight and security systems that allow us to deploy the device in so many different care settings.
Medgadget: What inspired you to develop a point-of-care X-ray system?
Gregory Kolovich, OXOS Medical: My inspiration for Micro C really started while doing an emerging replanting procedure at Mass General during my Harvard fellowship. I was operating on my own, trying to stabilize the anatomy while struggling with this giant machine. My concentration is at hand, so deploying an 800-pound device to imagine these small, complex bones seemed counterintuitive. I have training in electrical engineering, so I started researching X-ray machines and components and I thought there had to be a better way. This is what led to my design for the Micro C.
When we began to address the power, safety, and regulation challenges posed by the distal limb problem, we discovered that OXOS could also apply these solutions to general radiography. With two-thirds of the world without access to medical imaging, OXOS has the opportunity to open up access to these life-saving technologies, changing the way we provide medical care worldwide. As a surgeon, it’s incredibly exciting.
Medgadget: What challenges did you encounter during the development of a miniaturized X-ray system?
Evan Ruff: Oh yeah, well … a few [hysterical laughing]. So there’s a whole technical set of challenges around generating so 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 have radiation everywhere, so how do you protect the emission without the thing weighing 400 pounds. They were difficult, but then you have all the security and regulation issues.
Essentially, you’ve built an ionizing radiation gun and you don’t want people to accidentally emit radiation everywhere. The challenge, then, is how to ensure that the emission is safe and that the energy is used to create clinically relevant images. That’s when the idea of the positioning system came to us. The positioning system is the basic intellectual property of OXOS and describes how to ensure that the user can only emit radiation when the device is in a safe orientation. We do these calculations in less than a millisecond, which allows us to take live X-ray images, making the fluoroscopic approach obsolete.
Once OXOS tested the system with submillimeter accuracy, we started building the concept. What other safety and quality systems can we create with all this positioning information? That’s how our team devised the sensor-based, AI-driven dose determination engine, as well as new technologies built to improve image quality for less radiation. He is revolutionary in the radiographic space.
Medgadget: Give us an overview of the Micro C system and its uses.
Gregori Kolovich: Micro is a six-pound transmitter combined with a 6-inch digital X-ray cassette. The device allows you to capture the distal limb from the shoulder to the tip of the toes and knees to the toes. I use the device in both surgery and the clinic. In surgery, agility is great for hard-to-capture views, and in the clinic, having the imaging device right there when I’m doing an exam is fantastic. Micro C makes me a more efficient surgeon. Also, when I go to our satellite clinics, I’ll take it with me; that way, I know I’ll have the right modality as soon as I get there.
A big benefit is our DDR image. Evan mentioned it, but as a doctor, this is very helpful. DDR is a dynamic digital x-ray. DDR works a bit like fluoroscopy, like a live x-ray, but with a much higher clarity. Due to our low radiation and our super fast X-ray tube, Micro C can create a live X-ray video, where each frame is a clinically relevant image. Micro C allows me to do a live DDR and then go through each frame to make the diagnosis. DDR also allows me to do motion studies and guided injections directly at my clinic. It’s incredible.
Medgadget: Are there any radiation issues associated with the system? How does it compare to conventional X-ray systems in this context?
Evan Ruff: It is a very low dose device. The system produces 80% less radiation than existing systems. To put it in perspective, if an operator used the Micro C all day, every working day for a year, it would have been exposed to less radiation than an international flight.
Suppose a user was constantly x-rayed with the Micro C throughout business hours for each day of surgery and clinic throughout the year. In this case, the operator would be exposed to the same amount of accumulated radiation as a single flight from New York to Japan.
In general, radiation-emitting devices produce what is called a “scattering cloud,” which is defined by the area of space around the device that is exposed to any measurable amount of radiation. Standard C-arms and holders have a radiation scattering cloud radius of about 6-24 feet. The radiation scattering cloud of the Micro C is only three feet, so if you are more than three feet away from the Micro C, there is no measurable exposure.
Medgadget: Is the Micro C currently in use? How have patients and doctors found the system?
Gregori Kolovich: Yes, the deployment 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 used the device everywhere, from urgent care to orthopedic clinics, even outside of college and professional football. Seeing the anatomy is very important, and doctors love to use the device because it gives them a lot of control over their most commonly used imaging modality.
Patient feedback is even more exciting. As a doctor, I knew I would like to use a Micro C, but patients love the device. First, they don’t have to go to another area, wait for the pictures again, and then wait to see me again. I walk into the classroom and I can do the whole exam without interruption, so they like it. The other thing they respond to is having this collaboration in real time with the doctor. When I use a Micro C and imagine a patient, we can see the image instantly, together. When I diagnose them, show them improved joint mobility, or even give them an injection, they are involved in the care process, which creates more trust between the patient and the provider. It is great.
Link: OXOS Medical Home …
