Brain MRI Revolution Unveiled! With Edmond Knopp, M.D.

Hi, thanks for tuning in to episode #108 of the Doctor Podcast, Sicard File Show, and I'm your host, Doctor Robert Sicard. As usual today we have a great guest, which I'll tell you about in a moment. But first, please subscribe and follow Doctor Podcast. And also, please like, share and repost this episode so that we can get more great guests like we have today. And by the way, Dr. Podcasts is now on multiple social media platforms. So wherever you like to watch your social media and wherever you like to watch video podcasts, please tune in and watch.

We'd really appreciate it. Now today we have a great guest and we're talking about an important topic in the field of medicine, which is rapidly evolving and progressing. And we have one of the world's leading experts today on MRI technology. As you probably know, MRI is a scan that's done to see the internal parts of the body, and it has been a major breakthrough in medicine. Today we have one of the top radiologists and neuroradiologists on the planet who's an expert in MRI. Our guest today is Doctor Edmund Nopp.

Dr. Nopp is a distinguished physician and neuroradiologist and he's the Chief Medical Officer of a company called Hyperfine Incorporated, which is a pioneering revolutionizing MRI technology with its portable point of care SWOOP system. Doctor Knopp has served as Co investigator and Principal investigator on multiple NIH funded studies focusing on advanced MRI techniques and technologies. He's authored over 80 peer reviewed publications with a focus on neuroimaging, brain tumors, perfusion MRI and has established himself as a thought leader in the application of MRI for neurologic disorders.

His work has advanced the understanding and diagnosis of complex conditions, with a particular emphasis on integrating cutting edge MRI technologies into clinical practice. As Chief Medical Officer of Hyperfine Company, Doctor Knopp leads the development and clinical application of the SWOOP portable Mr. imaging system, which we'll talk about in detail. It's the world's first FDA cleared portable MRI designed to deliver accessible, cost effective and patient centric imaging at the point of care.

So Doctor Knobs, thanks very much for taking time from your busy day, doing all the things you do to explain what MRI is to us and what your company's special swoop system is all about. Like to start from the beginning? How did you become interested in radiology and in medical school and then specifically neuroradiology? Sure. Well, thank you very much for having me and it is my sincere pleasure to be here. So the story actually doesn't start with radiology or neuroradiology back in the day. Actually back in high school, junior high school, I was very interested in surgery, in particular cardiac surgery, as you may or may not know, at my alma mater, one of your current academic institutions.

I was involved in the cardiac research program at New York University and I was going down that road and following medical school obtained A surgical residency and was going to go on to do cardiac surgical fellowship. However, life is always more rosy in the training phase than it is in reality. And I realized it wasn't for me, but back in that day, 30 some odd years ago, at least for surgery and I think probably for most clinical specialties. Don't know about ophthalmology. The day started and ended in radiology and I realized the integral importance that radiology played to the clinician.

So when I realized that I was going to make a transition out of surgery and cardiac surgery into something else, I picked radiology. Wow, that's interesting. So did you do internship and residency and surgery before you decided to do radiology? So I did 2 years of general surgery. In fact, I kind of made this decision and you'll be able to relate to this the end of July of my second year of surgery. So I had an entire year ahead of me but decided I was going to stick it out. I didn't want any undue burden on my Co Co residence and was able to move into a radiology program at the end of that two year period, at which point I was interested in it was general diagnostic radiology.

But in during training I was fascinated by neuro and there was a neuro radiology attending kind of took me under his wing and said why don't you do some research projects and whatnot. I got phenomenally interested and then went to pursue a fellowship. Neuro radiology at that point required two additional years following four years of diagnostic radiology and ended back at my old alma mater at New York University where I did my fellowship and then stayed for some 25 years in as my academic career.

Right at the NYU Grossman School of Medicine and NYU Langone Medical Center, where. It wasn't called that back then, but nonetheless, that's what it is now. Right. That's an amazing story. So that two years of surgery background, however, gave you lots of insight into the pathologies and diseases that patients have and probably was very helpful in your radiology experience, right? Absolutely. And in addition, I think it gave me a surgical mindset, right. So instead of what maybe some radiologist radiologist do him and Haw, I went right to the point, right to the decision and came up with very specific things as surgeons typically do as you know yourself.

And it only took it eight years. Yeah, well, it was to +4678, you're right. Only eight years. Yeah, well, you got a break because I've had a few cardiac surgeons on the show and they tell me they trained about 10 or 11 years. So by switching careers midstream, you saved yourself an. Extra a little time. Not some. Gray hairs, but I saved a little time. Right. That's a, that's a great story. Can you explain what MRI is to the general public, people who don't really understand what it is, how it works, and also how's it different from ACT scan or a CAT scan and its advantages and certain types of diseases and pathologies and abnormalities that patients have?

Sure. So let me just kind of take a little step back and talk about radiology in general. Radiology, it enables us to look inside the body without opening up the body. And there are various ways to do that, basic cruder ways using radiation and the plain X-ray. I'm sure most people can relate to an X-ray for a fractured arm and the like with more sophistication. As the years went on, computers were applied to some of these techniques in order to generate more precise imaging that wasn't necessarily just a flat image of a body part, but rather a reconstructed image from a three-dimensional picture itself.

That's in fact what CAT scan is. CAT scan. It's not a CAT that goes, meows and scans you, but rather stands for computerized Axial Tomography. Computerized. There are computers used to generate this. Axial is the plane and orientation of a slice. Typically it cuts across your chest or your body, almost like a salami slice at the belly counter. And tomography means that you can get individual slices and pictures from a 3D volume of information. Now computerized tomography CAT scan involves the use of radiation just like a regular X-ray for a fractured arm and uses the difference differences in density of tissues to distinguish between the lung which is filled with air versus the heart, which is filled with blood, a bone which is basically calcium.

And that's all that it's kind of showing us to supplement that contrast, iodine containing contrast, which is dense to be injected to kind of discriminate different tissue types. CAT scan was discovered and widely used and still remains to be used in this, you know, currently, however, probably in the late 60s, early 70s, another methodology was used and that's MRI, which stands for magnetic resonance imaging. So it's using different technology, it's not utilizing radiation. So it's safer for the patient and it's giving us images of the body and tissue contrast, not reliant upon density of tissue, but rather the actual composition of that tissue itself.

MRI started as most advanced imaging starts with the brain and the and the nervous system. Why? Because unlike your lungs and your chest and your heart, the brain doesn't move that much, so it's easier to image. So MRI is a technology that uses typically very, very strong magnets so that the tissue that's placed in there is aligned in a certain direction. And then we can use changing magnetic fields to Orient that and alter that to give us this different signal tissue contrast to make determinations as to what's going on.

Classically, MRI uses magnetic strength, it feels known as Tesla, unrelated to the car but related to the inventor Nikola Tesla that are about 20 to 30 times that of the magnetic field of the earth itself. And as the technology developed, everyone was kind of in the American McDonald's era super sized me, bigger is better, stronger and stronger and stronger magnets. So much so when I was in training, our typical magnetics field started with one is .5 Tesla, half a Tesla. Then we got one Tesla, 1.5 Tesla, three Tesla, and we were fortunate at NYU to have the 1st clinical 7 Tesla magnet.

These magnets were so strong, anything near them would be sucked in and would put people potentially at high risk. But recently what's come into vogue within the last 10 to 12 years is that you don't necessarily need that very, very strong magnetic field in order to generate an image and in order to answer specific clinical questions. And that's what we have with Hyperfine and the hyperfine swoop system. So unlike the conventional MRI system that you may have used 1.5 Tesla or three Tesla, our strength is 0.064 Tesla orders of magnitude lower.

That's even lower than the first Mris that you had years ago. Much in order of magnitude lower than those as well. And you may ask, well, how can this be done? And it's through advanced technology, both advanced magnet technology that actually create the magnetic field, but more importantly, advanced processing, generating that picture, what we call an image. And that's used there artificial intelligence technologies that are employed in order to generate an image that a can be interpreted and B is almost similar to the standard 1.5 Tesla magnets themselves.

The advantage then of a scanner like this is you're not afraid of the strong magnetic field pulling things in. It can go wherever you need it to go and image patients wherever they need to be who would would would not be possible to image on conventional systems. Maybe they're too unstable. Maybe they have an implanted catheter, Schwann Ganz catheter. Maybe they're utilizing devices to maintain their life system. Respirators, extracorporeal membrane oxygenation, ECMO, all are now compatible. When you can bring the scanner, as you said earlier, to the point of care, bring it to that patient, whether they're in the ICU, whether they're in a remote area in Africa, obviously not on ECMO in low and middle income countries, wherever they are.

The goal of the company when it first started out was to democratize healthcare, give, bring Mr. to the masses. There are sites in Africa where the Mr. magnet runs off of a generator. There's a site in Africa where the Mr. scanner is running off of solar panels. There is no electricity. Really. Wow. And. And that's your company's hyperfine swoop. And that's exactly that's the company, the Hyperfine Swoop Mr. It's been FDA cleared for commercial and clinical use in the United States for over 4 years, in addition to other parts of the world, be it Canada, Australia and the European Union.

Wow that's amazing. Now just explain what the magnetic field does inside your body so that you can visualize this with software. Is it changing the orientation of of molecules inside your body? It actually is, and I think some people who are going to listen to this are going to be scared when they hear what I have to say. But most of our body, for the most part, is made-up of water molecules. Right. And water molecules contain protons. And what the MRI does in the magnetic field does is it lines up all of the protons in your body in One Direction.

You don't know this when you're in the magnet, you don't feel anything. But what happens is if we then send the radio wave into your body, we can tilt that proton and the time it takes and the way that proton returns to normal, since it's still in the magnetic field, gives us a picture of what it looks like inside. It gives us certain imaging characteristics. Water will look one way, fat will look another way, intermediate tissues will look separately. And that's exactly what MRI does. It lines all the protons in your body up in One Direction.

It depends on how the magnet is designed. And then it tilts them and then lets them come back to normal and obtains a signal. So the MRI is like radio transmitter and radio receiver, all within a strong magnet. Wow, that's amazing. And your protons don't mind that at all. It's it's I'm. Sure, you've been scanned. I've been scanned and we seem to look the same and feel the same. Right. And we've had this technology now for 40 years or more. About that, pretty close. Right. And there is no radiation like.

Cat, there's absolutely no radiation, so it's safe for repeated use. It's safe for family members, caregivers to also be in the room, whatever that is with the patient, unlike CAT scan or other radiation. Right where you have to step out. That's that's pretty amazing. The people who invented this or the person were were pretty much geniuses to think of that. And then no question about it. Right now, can you share your your journey into neuroradiology, which is the radiology of the brain and the head, and what sparked your interest in advancing MRI technology specifically for brain imaging?

I know you were at NYU many years doing neuroradiology. Why'd you decide to get into this area? So again, I got into neuro radiology because of radiology attending I had during my training who sparked my interest and got me involved in the research projects. When we were at NYU, it was in the very beginning. So in the early 90s, it was a transition period for neurosurgery and a new neurosurgery chairman was coming in, whose area of interest was neuroncology and tumors using advanced techniques at that time in terms of guiding his surgical approach based on imaging.

So I was fascinated by that. Again, with a surgical background, I lined right up with the neurosurgeons themselves and we developed sophisticated methodologies to incorporate his navigation systems into imaging and developed additional techniques to try to give us some insight into the tumors that he was going to undertake resection on. To give us some sense, is this tumor worse than this other tumor and to guide, well, maybe this one is really bad. We're not going to be able to be concerned about taking it all out, rather get a piece so that we can treat the patient with chemotherapy back then or this tumor isn't behaving that orally.

Let's try to take the whole thing out. And that's kind of how it started with something you had mentioned before called perfusion weighted imaging. It gives us an insight into the functional side of architecture, of what's going on in the brain itself. Really amazing. Now you mentioned earlier about the magnet in, in the traditional, traditional MRI suites, patients have to be sure they're not carrying any magnetic material. Otherwise the MRI magnet can pull it out of their body or out of their pocket.

And is is the hyperfine swoop system have so much less magnetic field energy that you can have metallic instruments or other devices nearby and and not have to worry about it? That's absolutely correct. So when we talk about MRI, we talk about the magnetic pull and the strength of that magnetic field. That's what's known as A5 gauss line in the standard Mr. That's the room itself. So anyone who goes into that room, including the patient, has to be assured they have no external metallic substances or devices on them at all.

For our system, you can probably see over my shoulder the magnet itself and these orange rings that is our five gauss line. It only extends about 2 1/2 feet from the tip of your nose outwards. Anything outside of that will not feel a magnetic pull whatsoever. So patients can have what we call static metallic devices, something that doesn't actively do anything. It's implanted in your body, an aneurysm clip, a cardiac stent played in your skull, a bullet without any effect at all. Likewise, one of the other safety issues for MRI and some people may have noticed this is something we call SAR specific absorption ratio because of the radio frequency waves that are being beamed into the patient.

Think like a microwave, the body is heated up and some of you who may have had body MRI come out very warm and a little sweaty. That's because you're actually being slightly cooked and slightly heated up, but because of. Not in a harmful way, not in a. Harmful way, just maybe slightly uncomfortable, but because of the strength of our magnet and the frequency with which it operates on, that's not an issue and not a problem. So certain devices and items can go into that magnet that couldn't go into a high field scanner like various catheter devices and electrodes and the like.

There is however a caveat and it's not 100%. So if you have an implanted device that interacts and is active, as we say, depending on the device and where it is, it may not be compatible. Such both typically would be an implanted cardiac pacemaker because why they tend to be just below your clavicle and that's just at the fringe field. So we like to play it safe and not scan pacemakers that are not compatible with MRI. Whereas other devices that are more typical, such as stimulators for a back pain, pain medication pumps, insulin pumps, glucose monitors, they have no issue whatsoever because they're far enough away that have no effect.

Wow. And there can be other people in the room where. Absolutely. I think that's a big advantage. And if we talk about, we kind of intimated this earlier, if we take the Magnet up to an intensive care unit, those patients are very sick. They have one to one nursing. The nurse can stay in the room with the patient without fear of any untoward harm. Whereas if a CAT scan were to go up to that patient, the nurse would have to leave because of the radiation. Likewise, if you have an older patient who's maybe a little confused or a child, their caregiver can be with them.

Some of you have may have had Mrs. before and realized how loud the banging is. This matched it while it still bangs, is not loud at all, does not require hearing protection and you can talk to the patient and vice versa during the image procedure itself. Does it take as long? Now I know the MRI scan sometimes take 20 minutes, 25 minutes. Does this take as long to get the image that you need? So for each sequence, so basically for each flavor of imaging that we're performing, it takes a little longer than it does on a regular scanner itself.

The total scan time would be about 25 minutes. Whereas on some very strong magnets you can get you you can image within a minute or two, but the patient has to go down to that magnet has to become a more compatible. So this is weird. Yeah, sorry. Go ahead. This magnet, it's not a replacement for the high field magnet, but rather an adjunct to answer specific questions when it's too difficult. It's not impossible to get those questions answered. Right. So this is ideal for a patient in the ICU who's too risky to bring to the Mr. room, which might be several floors down and or across the street in the hospital, or patients in the emergency room or who are in critical condition because of some injury or trauma, or even in rural hospitals that don't have the traditional type of MRI scanners.

Is that right? Absolutely no question about it. And that tends to be our primary use case, at least clearly in the United States and in industrial nations. It's that unstable critical care patient. But as you mentioned in other parts of the world in low middle income countries that don't have the resources because unlike a high field scanner, the electrical requirements and the siding requirements are next to nothing. It uses as much electricity as the coffee pot that we all use this morning to make our cup of coffee really not required.

You can. You can just plug it into the wall. You plug it in to a 15 amp circuit, be it 110 or 220 depending where you are on the wall. In 2 minutes it's ready to scan. It doesn't have the overhead or the requirements for refrigeration and liquid nitrogen and liquid helium because it's a permanent magnet. The strength to give someone the sense, the strength of the magnet is very similar to the magnet that people have on their refrigerators holding up the kids home. It's no stronger than that. Wow.

That's amazing. Can you share a specific case that comes to mind or or study or example where the swoop system made a significant difference in patient care, particularly in time sensitive or resource limited settings as you mentioned? Sure, absolutely. So last year from one of our clinical sites, there was a highly unstable patient in septic shock. So because of infection throughout their body, they can't maintain their blood pressure, their respiration and their neurologic status was totally unknown.

Didn't know if there was actual infection or not. The patient could not, because of all the support mechanisms needed, get a high field MRI. And this patient had the hyperfine swoop scan come up to the ICU and were able to diagnose multiple areas of infarct or basically dead brain kind of throughout the brain. So it enables the physician to get a prognostic indication as to the potential outcome. But in addition, we're able to see that one of those areas was different. One of those areas showed it was actually an Abscess because of the infection whose treatment is entirely different than an infarct and requires drainage.

And that allowed the physicians to make those changes. And that's I think a good example in a high industrial environment. Yet one of our earliest uses for the system was in Blantyre, Malawi. So in sub-Saharan Africa at a hospital sponsored by Madonna purchased the system where they were studying children with malaria and they had a CAT scan that was there. And they were using this to get a sense of how well the children are progressing and if they have to be more aggressive with the medication.

But the CAT scan broke, and no one could fix it. So Madonna purchased the system. And using this system in that environment where electricity was up and down, Internet was up and down, they were able to get established, look at what the children's brains were with and without malaria infection in their brain and treat them more appropriately. And to this day, they're still doing that. Wow, you should change the name of this to the Madonna system. Well, that was just one system. There now 165 other systems.

All right, So you have 165 of these out in the field? Globally, yeah, throughout the world, with about 100 in the United States for clinical research. That's great. I think Madonna adopted some children from Malawi. Exactly. And that's why she set up this hospital there and this whole program. Wow, that's amazing. Now you mentioned cost. How expensive is this? The Swoop compared to traditional Mris in in hospitals or radiology suites. Right. So I like to think of it in a simplistic fashion. It's just easier that for every one Tesla of magnet strength, it's approximately to purchase $1 million.

Wow. But however, that magnet, as you're aware and as most people may be aware, has to be placed in a certain place. And the cost of that could be in excess of two to $3,000,000, depending where it is. If it's on the 4th floor of a hospital, it's got to get up there. You need cranes, you have to close the street, you got to take part of the wall out. So the cost of siding a new system could be upwards of $4 million or so, whereas this magnet does not have any siding cost whatsoever. And the cost of the system is less than half, $1,000,000 currently.

Wow. So that's a huge savings. With all the debate going on now about the expensive healthcare system, this should be something that is very valuable to many hospitals and medical centers and reduces costs. No, absolutely no question about it. Yeah, we like to talk to the sales people like to about return on investment. The return on investment for this is very short as compared to a high field scanner. Right. And it looks like from the image next to you there looks like it's on wheels is is that correct?

So you can actually move it around. Right. It's on wheels, it's portable and point of care. So you have to get to that point of care. So it drives and you can kind of see it over my shoulder here like an electric wheelchair does with a little joystick. And it's capable of moving throughout the hospital or from one ICU bed to another. This is clearly the tortoise and not the hair. It moves slowly because it weighs 1400 lbs, but that adds to the utility of the system. It goes to the patient, whether it's patient one, patient two, wherever they are in the hospital, and it's designed.

The size and configuration is such that it fits through standard hospital doorways and standard visitor elevators, not even patient elevators. Really give us an idea how. How wide is it? So it is 5 feet tall and about 3 feet wide and weighs 1400 lbs. Wow, so it can get through typical doorways? Right. No question. We brought it in to demonstrate it into conference rooms and physicians offices, narrow doorways it can go through. Amazing. Now how user friendly is it? Because I know in the hospital when you have an MRI, you've got several technicians, you've got nurses, you've got radiologists.

Does this require also that many people to operate it or is it simpler and easier? So it's much simpler and easier. If I go back to what I said earlier about the motivation behind us to democratize healthcare, you wanted to make it able to be run by anyone. So it doesn't have the sophisticated need to have an in depth understanding of MRI. It basically runs. You mentioned Spotify, like a Spotify playlist. You set up what you want to do, push play and it runs it so much. So within the last six months, the accrediting agencies for MRI and radiology have acknowledged the fact that it does not require any sophisticated level of training in order to run.

It requires a medical professional. Let's say, let's say you wanted to put it in your office. You could have one of your medical assistants run the scanner and be reimbursed for that system as well. Does not require that MRI technologist who's making all sorts of adjustments and tweaking the system. So it's it's simplified, highly accessible, that's great. So nurses in in the emergency room or in the ICU could could use this with. Training in the United States. What we see is there are some centers, probably more because of union contracts that require MRI technologists to run it.

Other centers are using regular X-ray technologists and portable X-ray technologists who are used to going through the hospital and aren't afraid of the ICU environment. There's one center that's using the clinical staff. They're using their ICU staff, whether it's the residents, the fellows, the attendings, or their advanced practice practitioners, nurse practitioners and P as to actually run it because it works best for their workflow. It's whatever works for the site that wants to have the system itself.

Now it seems like it's also not claustrophobic because many of my patients tell me they get claustrophobic when they're in the MRI and some of them can't do it because they go kind of crazy after a few minutes and and they can't complete the scan. This seems like there wouldn't be a claustrophobia issue. Is that right? There really is not at all because in the standard MRI, you're basically the device is about 5 feet long and you're going into the middle of that and it's a circular tube, you know, kind of like a paper towel tube.

With this device, you can see, it's open, you can see out of it and well, there's a top and a bottom. It's not claustrophobic inducing whatsoever. And if you are concerned and a little anxious and nervous, you can have a loved one next to you rubbing your belly, rubbing your chest, talking to you through it. Whereas maybe they can go into the scan room and maybe they can touch your toe if you're going into the magnet at best, right? That you've mentioned the sophisticated hardware evolution that's allowed your company to create the swoop system.

What about the software that reads the images or creates the images? I should say is. Is that also advanced? So that's the key. It's not the hardware that's advanced, but rather the software that's advanced and the change in software and computer power and calculation. So the software over the past 4 1/2 years I've been associated with the company has dramatically improved image quality through the use of what we call deep learning and artificial intelligence technology, employing more and more sophisticated graphical processing computers like NVIDIA and the like.

And it just takes things to the next level and we're not unique in that regard. All imaging technique, all advanced imaging technologies and more from different companies as well as CAT scan are using these methods because they afford increased image quality improvement, increased resolution and a decrease in time to scan. I think we take it to the next level because we've gone from, in all honesty, 4 years ago, images that were kind of so, so at best to now images that are on par with high field scanners, enabling people to make specific pinpoint diagnosis and effect significant change in patient care.

Now is the actual computer and screen that that you look at built into that machine so you can see the results right away? So in a regular Mr. as you're kind of intimated, it's in the basement, there's a control room and all these computers. There's a whole computer room that patients never even say. Our computer room is right here where it says hyper fine. All the graphical array processors are underneath and the control interface is an iPad, just like iPads you use everyday. It's very simple, it's sophisticated.

The image appears immediately on the iPad or, and more more often, both. It can go into whatever information system exists in the facility, in the hospital, in an office, wherever it happens to be. So if there's a physician doing the scan in the ICU, let's say, they can see the image right away and if they're experienced enough, they can read the image and and see what it shows. Or you can transmit it to, let's say, the radiology suite, which is on a different floor in the hospital. Absolutely. And get.

Done. And that's done over over the institutional Wi-Fi. Wow. Pretty neat it. Doesn't have to be plugged in to transmit. It needs electricity to power, but it's designed to move around, so you don't want to be fixed by Ethernet cords, right? Are there other companies with with similar products and and how is Hyperfine's Swoop different than those if they exist? So Hyperfine Swoop was developed about 11-12 years ago and the 1st and actually the first FDA cleared system 4 1/2 years ago. There are now as with everything, imitation is the best form of compliment.

There are now other systems starting to come on the market, but they don't have that breadth of experience, that breadth of being able to generate images. And I think there's only one without actually an actual scanner. They just had a prototype that has some sort of preliminary FDA clearance. I would say in the next 5 years, what's happening is people are realizing the value of not having a strong magnet, having a very low magnet, and are starting to copy and imitate the system. So basically any, even major medical centers need one or more of these for their patients who can't get to the MRI radiology suite.

Right, exactly. And if you think the MRI radiology imaging is a very limited resource, so how many times or how long does a patient have to wait? And I had to deal with this all the time and get calls. Well, I need to get this Mr. before I can discharge my patient. And the patient's waiting 123 days. And why is that? The sick complicated patients take a lot longer to scan an image. So if I'm taking a patient from the ICU, they're saying Mr. Jones is coming down, he's very unstable for his Mr. I'm going to stop scanning.

So the second he gets to radiology, he can go on that magnet because I don't want this unstable patient there. So an exam that on the high field scanner may take 15 minutes is actually going to take 90 minutes because the scanner is sitting, not being used because I don't want it occupied when he comes down. But if we can image him on the floor, then I now have 90 minutes to scan four additional patients and decrease the backlog in exams and theoretically decrease what we call the length of stay of a patient, whether it's in the ICU, in a step down unit or even in the hospital or the emergency room for that matter.

Huge cost savings in addition to the accessibility and as you said, democratizing MRI scans and diagnosis. Right. If you think about cost savings, what does it take to bring a highly unstable patient down to Mr. It takes a respiratory therapist. It takes a nurse, maybe it takes a physician. It takes a transporter. Plus everything connected to them has to be switched out, longer tubing and everything else so it can be compatible with the Mr. The cost is crazy. Yeah. And this addresses disparities in access to healthcare and and imaging all over the world, as you gave the example in Africa.

Now as chief medical officer at Hyperfine, what, what's your vision for the role of portable MRI and in the future of global healthcare? It sounds like this is just kind of in its infancy, even though it's incredible. Where do you think this is headed in the next three to five years? I think we're going to see proliferation of these systems both in the highly industrial nations and in the tertiary care referral centers. But also if we think about hospital networks, everybody's aware the hospital networks, NYU has got 50 million hospitals, but they don't put their high end resources all over the place.

But we can use this as what we like to call spoken hub, scan a patient in the spoke at a lower cost to make a determination. Yes, this patient needs to come to the mother, the mothership, to the big hospital. In some places that could cost an inordinate amount of money. In fact, we have a site that's in Canada, in the Ontario province, where there is a magnet way north in a province called Nineveh. Those patients didn't have that ability before, so they would get sent all the way down to look to Hamilton, ON in order to be imaged.

Sometimes it was negative, sometimes it was positive. Now you can save that transport cost during the winter. Maybe that was a plane, maybe it was an ambulance. You're talking about 10s of thousands of dollars that you can eliminate and save those costs by being able to disperse it. In addition, I think look at the physician's office, right? You take an orthopedist, they have X-ray in their office because it's convenient and easy. Now we're starting to look at placing these systems in neurology offices.

Not necessarily maybe a solo practitioner, it might not be cost effective, but a neurology group that has two or three neurologists, if they can get a scan and answer the patient's question right there, right? You go into the neurologist office, you have this horrible headache. What do you think's going on? You think you have a tumor? Wouldn't it be great? The neurologist says OK, come in here, you don't have a tumor. And all of a sudden, the headache probably goes away too. Right from the anxiety.

Well, that's that's very interesting because my patients always complain that they have headaches or other issues. They went to see a neurologist and the MRI scan is scheduled 3 weeks later. I mean, exactly, They don't know what's going on. So instead of waiting three weeks, you can wait 3 minutes. Exactly. And you know the anxiety is going to build over those three weeks. And so this is great for telemedicine because if you're in some very northern province in Canada or elsewhere where there's no radiologists around for 100 or 200 miles, you can get the image and then transmit it to the major hospital and get it read quickly.

Exactly, exactly. And that's what was done in that case. That's amazing. When are you creating a a pocket MRI so I can carry one with me 'cause things are are shrinking all the time? You never know, right? We can go to Star Trek in the tricorder. Right. I remember that it was the size of a smartphone. That's pretty amazing. Now currently you're just imaging brain, is that right? At the current time, it is brain only. Who knows what the future will bring. If we want to concentrate and take our brain imaging to the absolute best level that we can and then see within the confines and configuration of the system, what else may be possible, right?

As a neuroradiologist, I think it's great because for me it's the brain. Right, but you know, the spine is connected to the brain and. No question. People have spine tumors or some sort of compression and that would be helpful as well. I I guess you need to just adjust the hardware and technology. That would require a a different design and footprint for the magnet. Right now for healthcare providers like neurologists you mentioned who are considering adopting the the Swoop system, what advice would you give them about integrating this technology into their practice?

You mentioned probably for a single practitioner neurologist not really cost effective, but how many doctors in the group would you say are needed to make this cost I? Think it's going to depend on the area of specialization for the neurologist. And more importantly, what we look at is the number of MRI brains without intravenous contrast that they refer out on a weekly or monthly basis and how many of those can they capture internally for themselves. Now, is this covered by Medicare and other insurance companies at this point?

So interestingly enough, the reimbursement and the billing is based on CPT code as I know you're aware. And the CPT code for this exam is identical to whether you're getting a 1.5 Tesla, A3 Tesla or A7 Tesla. The reimbursement rates are negotiated by the site, but there's no difference whatsoever provided the exam is completed and the report is generated. So it's it's basically covered by all insurance companies that cover the standard type of MRI. Provided the facilities accredited and most facilities are and the company can help them with that sort of thing.

Now what about the maintenance of this long term is, is the maintenance complicated? Do you need somebody from hyper Fine coming out frequently or is this so well established and evolved that there is very little maintenance? Exactly the latter. There's very little maintenance, unlike a high field scanner that has all sorts of sophisticated scanning techniques, cooling requirements, electrical requirements and moving parts. The only thing here that moves is the scanner itself. It's basically think of it as a super laptop on wheels.

So the maintenance is almost non existent. We perform preventive maintenance just to check everything is working fine on an annual basis. But as you had indicated earlier, it's all about software. So if there's a software issue, we can connect in remotely, take a look at it, update the software when new software becomes available. Just like your phone, it can download when you want it to and automatically update the system. So the maintenance costs are negligible because you don't have these refrigeration systems and everything else with the scanner.

That's amazing. Now, you mentioned earlier that the software involves AI and and machine learning and all these new technologies. AI is rapidly advancing as you know where, Where do you think that's that's headed in the future? How is AI going to interface with radiology and neuroradiology and all these new devices and hardware? So right now there, I think I like to look at it from two different aspects. 1 is the image acquisition and image quality improvement, which is what we're doing. And then AI is also being used not to replace, but rather to guide whoever's interpreting the images, the radiologist, whoever to say, look, we think maybe something is wrong here, maybe there's not.

Take a look in this regard. Even more importantly, and we see this in clinical radiology, the radiologists are reading an untoward number of studies, and they just populated in a list, first in, first out. But you have no idea. The first patient that you're going to read the case and it's going to take time may be perfectly fine. But patient #10 May be in dire need of acute care. You can use AI to pre screen that and say don't read #2 I want you to read #10 next. Because I think there may be a problem.

Maybe there is and maybe there isn't, but at least the prioritization occurs. Wow that's that's awesome. So AI can actually screen and figure out which scans you need to read first, rather than. And all of these, and there are a large number of companies that do this and all of this AI artificial intelligence is trained, it's taught based on images. So it looks at it. It's looks at all these normal images. So it knows what normal is. It looks at images with a tumor and now knows what a tumor is.

And it can make that comparison by itself. Wow that's incredible, I didn't think of that. It's a great screening tool and will save lives. And where it's typically used extensively almost throughout the United States, is in mammography and breast imaging, whereas it'll highlight areas of the mammogram for the mammographic radiologist to look to give a second look and make sure yay or nay, it's not making that decision. The radiologist is, but it's targeting their view a little more precisely. Well.

So again, makes it more cost effective and less likely that there would be an error in diagnosis. Exactly, exactly right. That's incredible. Technology's moving fast. Oh no point. Who would have known? When we first met what, 30 some odd years ago, this was totally unheard of and now look where we are. Right. Everything we're seeing now used to be science fiction years ago. Right now it's science fact. Right. So I want to thank you again for taking the time to explain to us all this important information about MRI and especially the Hyper Fine Swoop system, which looks like it's the next step in MRI technology.

So my pleasure and I think it is no question. Thank you very much. You're very welcome. Thank you. Thank you everyone.

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