November 8, 2021 Conn Hastings Exclusive, Plastic Surgery, Radiology

OXOS Medical, a medical technology spin-off company of the Georgia Institute of Technology, created Micro C, an FDA-approved handheld X-ray system designed to image the distal end from shoulder to hand, knee to foot. The device is designed to prevent clinicians from having to handle and operate large machinery to perform simple X-ray imaging of small bones in the limbs and allow them to perform imaging at the point of care.

The device can be deployed during surgical procedures and allows surgeons to more easily capture images that are difficult to obtain with large fixed devices. The small size and portability of the system may also help increase access to medical imaging in resource-poor and remote areas of the world.

OXOS reports that the level of radiation emitted by the device is very low compared to traditional X-ray systems. This means that Micro C can be used for dynamic digital radiography, which means it can generate "X-ray video", enabling clinicians to conduct guided injections or study bones in motion.

Medgadget had the opportunity to talk with OXOS Medical co-founder and CEO Evan Ruff and chief medical officer Gregory Kolovich about the technology.

Conn Hastings of Medgadget: Please briefly introduce X-ray technology and its development since its inception.

Evan Ruff of OXOS Medical: X-ray is the first medical imaging method that dates back to Roentgen in 1895. X-rays began to be widely used in medicine during the First World War. Marie Curie built a portable machine and took diagnostic images on the French battlefield. The digital C-arm and mini C-shaped you see in surgery today Arms really started to develop in the late 1990s, but then innovation stagnated. Micro C is the first new radiographic form factor in decades.

OXOS has adopted technological advancements in other applications, such as advanced microcontrollers, computer vision, and sensor technology. These technologies have allowed us to make fundamental advances in the way X-rays are generated, as well as in size, weight, and safety systems, enabling the equipment to be deployed in many different care scenarios.

Medgadget: What inspired you to develop a bedside X-ray system?

Gregory Kolovich of OXOS Medical: My inspiration for Micro C really started when I was undergoing emergency replantation surgery at Mass General during my scholarship at Harvard University. I was performing the operation alone, and I was fighting with this huge machine while trying to stabilize the anatomy. My focus is on my hands, so it seems counterintuitive to deploy an 800-pound device to image these small and complex bones. I have a background in electrical engineering, so I started to study X-ray machines and components, and felt that there must be a better way. This is why I designed Micro C.

When we started to address the power, safety, and regulatory challenges caused by distal limb problems, we discovered that OXOS can also apply these solutions to general radiology. Since medical images are not available in two-thirds of the world, OXOS has the opportunity to open up these life-saving technologies and change the way we provide medical services on a global scale. As a surgeon, this is very exciting.

Medgadget: What challenges did you face when developing a miniature X-ray system?

Evan Ruff: Oh, yes, um... a lot. Therefore, generating so much energy in such a small space presents a set of technical challenges. The question is, how do you generate a 60,000 volt pulse in someone's hand and then manage to dissipate all the heat. Except for highly variable electrical pulses, radiation is everywhere, so how to shield radiation without something weighing 400 pounds. Those are difficult, but you will encounter all the safety and regulatory issues.

Essentially, you have built an ionizing radiation gun, and you don't want people to accidentally emit radiation everywhere. The challenge then becomes how to ensure that the launch is safe and how to use energy to create clinically relevant images. That was when we came up with the idea of ​​a positioning system. The positioning system is the core intellectual property of OXOS. It describes how to ensure that users can only emit radiation when the device is in a safe direction. We complete these calculations in less than a millisecond, allowing us to perform real-time X-ray imaging, making fluoroscopy methods obsolete.

Once OXOS tested the system to sub-millimeter accuracy, we started to build this concept. What other safety and quality systems can we use all this positioning information to create? This is how our team proposes a sensor-based, artificial intelligence-driven dose determination engine, and a new technology built around improving image quality to reduce radiation. It is revolutionary in the field of radiography.

Medgadget: Please tell us about the Micro C system and its uses.

Gregory Kolovich: The Micro is a 6-pound transmitter with a digital 6-inch X-ray cassette. The device allows capturing distal limbs from shoulders to fingertips and knees to toes. I use this device in surgery and clinics. In surgery, agility is great for difficult-to-capture views, and in the clinic, it's great to put the imaging equipment there when I do the examination. Micro C makes me a more efficient surgeon. In addition, when I go to our satellite clinic, I will take it with me; this way, I know that I will have the right way as soon as I arrive.

A huge benefit is our DDR imaging. Evan mentioned it a bit, but as a clinician, it is very useful. DDR is dynamic digital radiography. DDR works a bit like fluoroscopy, like real-time X-rays, but with much higher clarity. Thanks to our low-radiation and ultra-fast X-ray tube, Micro C can create real-time X-ray video, where each frame is a clinically relevant image. Micro C allows me to perform real-time DDR and then use each frame to determine the diagnosis. DDR also allows me to conduct exercise research and guided injections directly in my clinic. It's incredible.

Medgadget: Are there any radiation issues related to the system? In this case, how does it compare to traditional X-ray systems?

Evan Ruff: This is a very low-dose device. This system generates 80% less radiation than existing systems. From another perspective, if operators use Micro C for a whole day every working day of the year, they will receive less radiation than international flights.

Generally, devices that emit radiation produce so-called "scattering clouds", which are defined as areas in the space surrounding the device that are exposed to any measurable amount of radiation. The radius of the radiation scattering cloud for the standard C-arm and the incumbent is approximately 6-24 feet. The radiation scattering cloud from Micro C is only three feet, so if you are more than three feet away from Micro C, there is no measurable exposure.

Medgadget: Is Micro C in use now? How did patients and clinicians find the system?

Gregory Kolovich: Yes, the launch of the system is very, very powerful. We have only entered the market since July and are installing the equipment as soon as possible. So far, we have used the device everywhere, from emergency care to orthopedic clinics, and even on the sidelines of college and professional football games. Seeing the anatomy is very important, and doctors like to use this device because it allows them to have so much control over the most commonly used imaging methods.

The feedback from patients is even more exciting. As a doctor, I know I would like to use Micro C, but patients like the device. First, they don't have to go to another area, wait for the image again, and then wait to see me again. I walked into the room and could finish the whole exam without interruption, so they liked it. Another thing they responded to was real-time collaboration with doctors. When I use Micro C to image the patient, we can see the image immediately. When I diagnosed them, showed them the improvement in joint mobility, and even gave them injections, they were all involved in the care process, thus building more trust between the patient and the provider. it's great.

Conn Hastings received his Ph.D. from the Royal College of Surgeons in Ireland for his work in drug delivery, and studied injectable hydrogels in the treatment of cancer and cardiovascular diseases to deliver cells, drugs and nano The potential of particles. After earning his PhD and completing a year of postdoctoral research, Conn began his career in academic publishing and then became a full-time science writer and editor, combining his experience in the field of biomedical sciences with a passion for written communication.

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