A mission to make medical x-rays cheaper and quicker
X-rays are taken for granted in the western world, but the World Health Organization believes that close to two-thirds of the world’s population do not have reliable access to diagnostic imaging. The cost of equipment alone is prohibitive in many developing nations, as well as the cost of maintaining and powering hardware, which can amount to several million dollars. Nanox claims that its “digital” X-ray system, the Star Trek-inspired biobed called the Nanox Arc, is cheaper to use, easier to maintain and does not require installation in a heavy hospital facility.
The company gave its first live technology demonstration earlier this week. The presentation came from its Israel HQ, transmitted at the annual conference of the Radiological Society of North America (Online-Only, thanks to COVID). During the broadcast, CEO Ran Poliakine took his X-ray with a device carrying the company’s custom hardware. He then showed the beds that scanned the lamb’s leg and some medical dummies for examination.
During the presentation, a pair of “independent” radiologists praised Nanox’s work. They commented on the speed and accuracy of the images taken, particularly when analysing the 3D image of the chest X-ray. The pair said that the larger number of tubes—the Nanox Arc has six separate X-ray tubes that can be used at various amplitudes—could make it easier to detect small lesions and tumours.
These tubes are the centre of invention for Nanox; 10-centimeter cylinders that use the “cold cathode” process. A sextet of these tubes sits inside the ring, while a mechanical bed draws patients through it, allowing the system to scan their entire body. Nanox says the device will deliver skeletal X-rays as well as computerised tomography (CT) scans at the same time. After a minute of processing, the data is used to create a scrollable 3D model of the body of a human, enabling professionals to see both soft tissue and skeleton.
Nanox’s tale starts in the wreckage of Sony’s doomed project Field Emission Show, which began in 1998. Sony was trying to create higher-definition TVs that avoided (then common problems with dead pixels, flickering and burn-in that came with LCD and Plasma Screen TVs. Its approach was focused on the basic principle of the old Cathode Ray TV—an electron gun shot at a phosphorescent display—and modified it. Instead of firing a single electron gun on the projector, Sony designed a MEMS chip that packed millions of tiny electron guns into a silicone wafer.
Early demos of technology that provided high definition and reduced risk of dead pixels were promising. But Sony’s costly but theoretically superior technology has been usurped by advancements in more and more cheaply) LCD/LED TVs. In 2009, Sony killed the project, having reportedly spent nearly a billion dollars on R&D, and then sold the technology (and the team) to Japanese businessman Hitoshi Masuya. He recruited the founder of Powermat, Poliakine, to join and run the company that was working on the adaptation of technology for medical imaging.
The standard hot cathode” X-ray works by passing an electrical current through a filament that heats up. The filament, stuck in a vacuum, shoots electrons towards an anode, and when they meet high-energy photons (X-rays) are published. The tube itself is lined with lead, apart from a single opening, and this is how these photons are guided at an individual. Some areas of the human body are more permeable to X-rays than others so documenting what’s going on in a photographic film enables a radiographer to see what’s going on inside an individual. One downside is that it takes a lot of energy and time to heat the filament, and the tube needs to be replaced periodically.
The development of a “cold cathode” device without the need for heating has been a target for a number of companies for years. Researchers have recently tried to create cold cathodes with carbon-nanotube-based field emitters acting like an electron cannon. But no company has yet to bring these systems to market—we find a 2019 press release from a company named Meiden, but then the trail ends cold. This is where Sony’s “billion-dollar” Field Emission Display system comes in, depending on existing technology. It already functions as a simple electron gun, and can be triggered and deactivated by a switch without the need for heating.
Not everybody is as excited about the organisation as some of the outspoken cheerleaders are right now. After the company’s decision to make its Initial Public Offering (IPO) back in August, analyst and short-selling specialist Andrew Left took part. The figure behind Citron Research, also a long-standing critic of Tesla, said that Nanox was a “compleat farce.” Left added that the company was another Theranos and that its alleged customer list was “fake.”
Poliakine characterised Left’s statements as “bullshit” and a lie,” adding that his attention was on producing the finished product. It is obvious, however that a demonstration of the technology in front of a group of influential radiologists would help to refute these arguments. It will not be until Nanox’s hardware is used or at least tested in the real world by independent assessors, that we will have a good picture of its effectiveness and reliability.
Nanox is not trying to enter hospitals and major healthcare firms, but is aiming to bring its products to under-served regions. The business model is a little different, too. It’s not going to charge for beds, which Poliakine says cost only $14,000 to build and ship, compared to around $300,000 for a standard CT scanner. Instead they’re going to be loaned to remote hospitals, in the same way you can borrow an office printer from a large company, and charge $14 for any scan you take. This fee will also include cloud storage and the prospect of using the AI medical research programme. A variety of companies are working on AI to help doctors identify anomalies in X-ray scans.
Nanox is now turning its focus to the first hardware roll-out scheduled for the beginning of 2021. The company expects to instal a handful of beds in the first few months, but plans to hit a target of 15,000 units in the next few years. When clinics have measured the value of the technology, we can see whether or not the target of Nanox is optimistic.