The AR Show: John Black and Mina Fahim (MediView) on Giving Surgeons X-Ray Vision in the Operating Room

3:15AM Jun 8, 2021

Speakers:

Jason McDowall

Mina Fahim

John Black

Keywords:

technology

patient

space

ar

hololens

cleveland clinic

anatomy

headset

physician

mina

jason

put

company

clinician

john

visualization

procedure

imaging

solution

started

Welcome to the AR show right dive deep into augmented reality with a focus on the technology, the use cases and the people behind them. I'm your host Jason McDowall.

today's conversation is with john black and Mina Fahim, the CEO and CTO of MediView, a company working to give healthcare practitioners X ray vision in order to simplify minimally invasive procedures, enhance clinical workflow and improve patient outcomes using augmented reality. John black, MediView's co-founder and CEO, is a physiologist with an educational background in orthopedic sports medicine in cardiopulmonary physiology. He moved from allied health to the medical device industry early in his career. Prior to meta view, John was leading a sales organization as the Regional Vice President at Orthofix, a global medical device company. Mina Fahim, MediView's president and CTO, studied Biomedical Engineering and Technology Management as part of his career in medical device innovation. Prior to MediView, Mina spent four and a half years at Medtronic as a principal research development engineer. In this conversation, John and Mina discussed the unique challenges and opportunities for using AR during surgery here, Mina describes the vision for their solution.

So imagine, if the clinician could be sitting at his desk, pop his AR head mounted display on maybe in the future of Messina require an HMD. But they see the patient specific anatomy sitting at their desk, just like Iron Man, they can scroll through it, rotate it, expand it, just like Jarvis allows Iron Man to do and plan the trajectory, plan the optimal therapeutic site, save it, bring it along with him to the day of surgery, registered to the patient see under the skin in real time, and actually guide his instrument there. There's just a flow. And it is an intuition in that potential workflow that we're working towards, at the end of the day, to make the job of the clinician easier and more predictable, so that the outcomes for the patient are more durable, and more consistent. Regardless of whether you're practicing in downtown New York, or Duluth, Minnesota.

We go on to discuss the benefits and lessons learned from their partnership with the Cleveland Clinic, and how they see the landscape of immersive technology in the operating room. As a reminder, you can find the show notes for this and other episodes at our website, V AR show calm, let's dive in. John and Mina, what opens your eyes to the potential of AR in surgery?

So during my entire life, I always struggled with the left brain world didn't necessarily mean that I couldn't achieve things, it just means that I was a right brained individual trying to learn in a left brain world, in a rural Ohio community, which really, really emphasized that left brain in this. So you know, my entire life I was kind of brought up as you know, having to try a little bit harder to achieve, you know, kind of landing in that that not mediocre, but not extraordinary, despite the amount of effort you'd put into it. And as I got into my professional career, I found myself working in medical imaging, and orthopedic trauma. And so you'd have a lot of these two dimensional screens that would be put up in these, you know, very high pressure situations where decisions are made rapidly, and they have real consequences in a trauma setting. And when I found this, I was excelling at that. And there was a time that I recall, in a pediatric case where we were under pressure, you know, get the kid off anesthesia. And the physician had a really hard time visualizing where a piece of hardware had broken, it was lodged in the canal of the bone. And I'm standing there like, if you put your hand in here, and swivel this foot phlebotomy hook in a counterclockwise motion, you're going to hook the tip of that drill bit and just jiggle your hands, it'll fall right out. That's me standing 12 feet away, where now I had finally found this equalizer where you know, physicians being as brilliant as they are, tend to have more success when their left brain, it's really rare to find somebody who has that combination of both. So I found myself being a little bit of an asset and had a role that I played. And even though it was a very small role, I loved it. I wasn't Oh are junk. And, you know, despite that role you play, you always want the best for every patient and every kid or every adult that comes into the operating suite. And when I evaluated the technology in its raw state at the Cleveland Clinic in 2016, I knew that that was the ultimate equalizer that that this world of grainy, two dimensional world that you have to use to solve these highly three dimensional problems could finally end and I know that makes a disadvantage because now my role becomes less and my value proposition goes down but I think it's in the betterment of everything healthcare to embrace that and the visualization that you can achieve with augmentation. And just the deeper levels of understanding. So that was really what drew me to it and why I hung up everything I worked so hard to get to. And through the way in a second just for this, this technology,

it's amazing that we as humans are very much 3d creatures, that the way that we think about the world is very much about 3d. But here, physically, these surgeons are operating on a 3d environment, it's very difficult to capture that imagery, certainly, in real time. But regardless of whether it's before time, and you kind of rendering and modeling these sorts of things, so you can do this pre op sort of planning or whatever happens to be, we are 3d creatures. And so all of your right rein emphasis early on, it really comes to play in this trying to help the surgeons, I can imagine how this really helps the surgeons apply this sort of new technology in these novel ways that isn't quite as tied to the rote memorization exercises, maybe the doctors were had to excel apps in order to get to the position that they're in today. I mean, if you have any, any fun ones,

yeah, I mean, a fun story to share. And it's actually what got me into medical device I, early on, I had a friend actually whose dad died because of a aortic dissection, meaning that they didn't catch a cardiac problem early on in his life, which then all of a sudden become became emergent when he was having a cardiac, basically, scenario epidemic. And basically, they ended up ripping his aorta as they were trying to fix it. And this is really what got me interested in the medical device space. And, you know, wasn't on purpose, but ended up getting my first job and structural heart applications for performing procedures in a more minimally invasive way. So instead of having to crack open the chest and cut old things out and put new things in, you could put everything in just with a little catheter through your leg. And that's really what got me down this path. And, and that's on the professional side, I got on the personal side. And I always knew I wanted to do something that would even prevent one other person's dad, right, from having to suffer from that type of misdiagnosis that ended up resulting essentially, in in the loss of his life. And what's interesting, kind of on a more lighthearted note, is how I got introduced to AR, I was hanging out a friend at a friend's house. And he said, You got to come upstairs and check out this virtual reality. I was like, okay, it's just like an Xbox Kinect, or a Nintendo Wii, he's like, Nope, I'm gonna put you in a totally different universe. So we go upstairs, and he puts me an HTC Vive, he, you know, self built computer. And he knows that I'm afraid of heights. And he puts me at the top of Mount Fuji. And he's like, Hey, I'm gonna push you. And he gave me a little tap from behind. And it wasn't very strong. But I genuinely felt like I was falling off of the side of the cliff. And that's, you know, after getting over all of the sweating and panic and taking the headset off immediately, I really had a hard time sleeping the rest of the night. And I called my wife, you know, my friends places only, I don't know, eight minutes away from our place. But I couldn't wait to call my wife and be like I just saw the next technology is going to change healthcare. She's like a video game. And I was like, no, not a video game. It is a new way to visualize entire environments and immerse people in 3d. She goes, Okay, well, it sounds like Star Trek, I'll see you when I believe it. And that really started the journey down then, with my previous role starting an organic project that ended up growing legs in a fortune 50 Company, which is hard to do as it is. But that's really what started my journey down AR is being put on a on a mountainside and VR recognizing what it meant helping people experience content that way that immersively and really inspired me to say, Okay, well, how can we leverage a technology like this, similar to what john said, to alleviate some of the burdens that exist, and our long standing, you know, 20 3040 year problems in healthcare, because you get in a car, and you've got eight cameras, and 32 sensors all telling you where to go and where not to go and prevent you from crashing into the car next year, the median or the wall, or in my family's case, the garage door, which in that case, didn't help. But I think that was, you know, getting to realize that our normal day to day commute. Now we're at the point where you have autonomous vehicles, not only will they tell you, but they'll actually stop you or redirect you. And yet we perform surgery, essentially, on a grayscale, 2d flat image, where millimeters count. And in a world where there's solutions for only centimeters or inches count. There's really amazing solutions. So that was really my motivation of recognizing what it means to be in an immersive environment, experiencing content like that. And helping clinicians facilitate their job and kind of remove that cognitive burden from them was my motivation and medic, john Adam tapped me on the shoulder and the rest is 18 months worth of history.

Where were you just prior to this,

I was at Medtronic. So I was in the electrophysiology, atrial fibrillation division, helping develop solutions for people that have arrhythmias or irregular heartbeats. And in that specialty mapping and navigation 3d is huge. But it's still 3d that stuck on a 2d screen. So the depth perception of understanding where's my tool, or my instrument relative to my anatomy, while improved, still has a lot to be desired, I was lucky to be in that space and having been exposed to tight that type of surgical navigation because for me, it kind of all floated like, Okay, if we could peel this 3d content off the screen and put it in the real world, it's utilities and to go through the roof, being in the right place at the right time in a division where there was a portfolio gap that they were trying to fill, really is what got that project from zero off the ground to the point where we actually had a small team, working on it at an organic level, which again, is not common for a company that big, but Medtronic does a really nice job with those type of opportunities, but saw they didn't love it and love working there. But john and Adam, and many of you are going to bring this technology to the bedside faster and more efficiently, then the project I've been working on, and of course, the partnership with the Cleveland Clinic, right and getting that end user experience where offices across the hall from 50,000 practitioners, tough opportunity to pass off. So while I love working at Medtronic and truly starting that from grass roots, john and Adam had come across a technology that solved a really, really big gap that me and my colleagues at motronic had been working towards, but they're already been solved in a very elegant way, with a co inventors of the Medi view of technology.

And what was that gap that they had solved?

How do you take 3d content out of the computer and place it in the real world to millimeter level accuracy? That's not an easy thing to do. And without getting too far into the weeds, just when I noticed that they had the foresight, and the ability to understand, hey, these 3d holograms, while neat, until you can get someone the practitioner to believe in them will become limited in adoption. So when I saw the integrated use of live imaging, like live ultrasound, and live fluoroscopy, combined with augmented reality, it actually helped solve that gap of two things, one trust, how do I trust a technology like this, and having the foresight to realize, Hey, I'll use standard of care imaging, to help build the trust and a solution like this, and then extend that to then I'm going to use that standard of care to solve the what we call registration, or overlay or X ray vision problem of, hey, if I put a hologram on top of the patient's actual anatomy, it's going to be within a millimeter to have the real anatomy underneath the skin without having to open the patient up. That was really special. john adams said, Why don't you come and see? And I said, I don't believe you guys. They said, Okay, fine, we'll even pay for your ticket. Come on, just come check it out. I went out there and six weeks later found myself employed with many of you.

And john, where did you find the solution? What was that? What was the origin there?

I was functioning as the vice president of sales for the Mid Atlantic and northern region with a in the spine division of another company. So I saw the technology and evaluated initially from that position, brought it back and presented that technology to my president and CEO and got the standard big company answers that this technology while great and has a lot of promise, it's too early, we are too big, between legal marketing regulatory, we will find a way to kill this and bury it before it ever has a chance to succeed. So went through the process to make sure that I was able to engage that and essentially said, Hey, I'm leaving the company to pursue this. And that's how many who was founded, saw the technology was established. any pushback from that former

company,

I did get roped into staying a lot longer than what I thought I was. But the company was really excellent and their execution in their patient centric philosophies. It really was an outstanding organization. And it was hard to leave that group of people because they really made a home for me personally and professionally. But when I saw the technology, and then I got the endorsement of our other co founder Adam Wright straw, I knew that this was not just a pipe dream. This was the future and we wanted to be part of it.

And where is that future for you? specifically? How do you think about the vision For the company as you evolve it over the coming two years,

I hope and position every day that many of you will become the predominant leader in medical technologies involving augmented reality.

We're talking a little bit about this notion around holographic data visualization. For the purpose of meaning you're talking about this for the purpose of really enabling more precise navigation, an environment in which it's hard, maybe in a 2d environment to precisely understand where the target is and where the instrument is, and connecting those two things together without making any any unnecessary damage in the process. So it's really about this notion around how do you leverage AR, at least initially, around guidance and navigation? Is that fair? Yeah, I

would say it's very fair. I mean, and I think just taking us you know, a second to pause and credit, a lot of the groups in the space who have started out and you know, whether it's cae medical in the training and simulation space, you look at what dogmatics is doing in the spine space, and orthopedic space. You know, for us, the way we look at I agree with john, our vision is that we really become the leader in mixed reality guided surgical navigation, and guidance, but all ships ride with, you know, rise with the tide, right. And that's this space is going to require right a groundswell. And then there's going to have to be regulatory partnership as well, that gets this off the ground. And we're seeing some good success in the training and preoperative phase already, you look at universities like Duke and Maryland and Stanford and, and Case Western, right and right, our neighbors, right, and Dr. Mark Rosenwald, and all the great work he's been doing on hollow anatomy. And so starting with the education and training space, naturally, the clinicians who are being taught using these technologies today are going to come to expect them in their actual practice. If they're trained to this way, they're going to ask the question, why can't I practice this way? And that's really the threshold, we get this question all the time. So Oh, really cool. So you guys are doing a training tool? Well, no, we're actually using this intra operatively in real surgery, and doing our human evaluations this way. Yeah, you get, you can generate a trading tool as a result of that, which we definitely do from a preoperative planning perspective. But then, you know, I think you're spot on Jason is that as as the as the space grows, and, and being able to perform more and more precise surgical navigation help reduce error and improve outcomes. That's where many of us technology really, really shines.

Let's break it down for a surgeon throughout the course of the whole operation, the planning operation, whatever happens after the operation, as it relates maybe to this technology? How does it all fit

in is the ultimate tool in a perfect blue ocean of new technology. So the tool fits from a point of understanding, collaboration. Patient Education, I think is really overlooked in this and in helping those that are afflicted with these conditions really understand and have confidence that their treatment plan and their condition are well understood. And they have a pathway, that they feel confident moving forward. And this has a huge place in medicine in the future. And when I when I look at it, you know, just being part of it in being at the emergence of a brand new medical technology, it's very rare within the healthcare space, to have the opportunity to be at something when it's in the foundational stages, there is no clear brand champion, there is no definitive leader of all the companies that are emerging in this space. So to be part of this is something that's really incredible. And I see the place in healthcare as day to day procedure or procedure usage in the not so distant future.

And if I could Jason, just build on what john said, I mean, think back to your school days, right? I mean, how much would we all have given to get, you know, the final a week before the actual exam, and memorize the answers, and then just go regurgitate the answers and get 100%. I mean, we all would have loved that if it was fair, and it wasn't considered cheating. And all of the caveats behind morals that come with it. That's where many of you really provides the clinician this opportunity to bring their preoperative planning in a very unique way and bring it into the surgery with them. So it builds this level of confidence of, hey, I've seen this before. And I've seen it in a way that I resonate with and that I understand, and that's intuitive to me. Right, and I think one of the things to highlight is that clinicians across all specialties get trained in anatomy, physiology, and they all understand anatomy and physiology and 3d and their mechanics. But then how do you translate that and john was getting to this earlier on the right and left brain. There's, there's a there's a leap that you have to make of understanding anatomy in 3d and your training and then performing that On a modality that is, you know, is very specialized that takes a while to learn. And so imagine if the clinician could be sitting at his desk pop, his AR head mounted display on maybe in the future doesn't even require an HMD. But they see the patient's specific anatomy sitting at their desk, just like Iron Man, they can scroll through it, rotate it, expand it, just like Jarvis allows Iron Man to do, and plan that trajectory, plan the optimal therapeutic site, save it, bring it along with him to the day of surgery, register it to the patient see under the skin in real time, and actually guide his instrument there. There's just a flow and an ease and an intuition in that potential workflow that we're working towards, at the end of the day, to make the job of the clinician easier and more predictable, so that the outcomes for the patient are more durable, and more consistent. Regardless of whether you're practicing in downtown New York, or Duluth, Minnesota, right? Non people have probably never heard of Duluth. But that idea of democratizing access to clinical best practices is really what we're hoping this pre intra and post operative use of AR and allow,

where does the data come from, that they're using for visualization, whether it's in the preoperative planning, or during the surgery itself,

standard of care imaging today, right, CT, or MRI, and then we combine that with real time ultrasound, and that's the really special part about many of us techniques and capabilities. As you take that CT or MRI, you highlight the parts of the anatomy you want to represent, we have a unique way that of modeling those anatomies in 3d shells, that then they can visualize, but then we give them the opportunity. Those are static images CT or MRI, unless you're inside of a actual CT or MRI during the actual procedure, that's very expensive. It exposes the clinician and the patient to tremendous amounts of radiation, and which then actually creates contraindications or fluids, some patients from actually receiving therapy. So we bring that out of that room, we make it available to them in in a much more usable format. But then we confirm the morphology, the deformation, the position of the anatomy, using real time imaging, such as ultrasound, or fluoroscopy. So in summary, images that are captured from CT or MRI combined with real time imaging coming from ultrasound,

in your experience, both have been producing tools and solutions for surgeons for a number of years across your various job experiences various companies, what's the incremental benefit of being able to not only do that pre visualization and not only have the 3d visualization available, but to actually map that visualization directly over the anatomy? What does that extra incremental benefit come in

that sort of direct mapping, the physician confidence in the placement of the hologram is absolutely critical. And that was discovered after the first five inhuman procedures is that missing component, or that real time live combination of a preoperative image? With the verification of the real time imaging, it was critical to physician confidence in holography.

So that last piece was was critical. Otherwise, Is there even a utility for the headset, if you can visualize the value is primarily about the 3d visualization, I guess this kind of I'm getting out here. The value is primarily about the 3d visualization, then the mapping it directly to the human anatomy is not nearly as important, but what you've discovered is not just about 3d, it's also about the placement of that 3d and the direct alignment to the the actual anatomy.

Yeah, I think, you know, just to expand on what john mentioned, Jason is, it's visualization, but also confirmation, right? So today, the world of medical instrumentation and medical imaging are divorced. There's very few companies that and the ones that have done it have shown the value of doing it, the perspective of having an you know, the imaging, living on its own the surgical instrument living on its own and nothing talking between them creates a gap. So it's great right therapies are becoming more and more minimally invasive, meaning you don't have to open people up to perform procedures, well, that's great, but then that inherently creates a greater need for better and better visualization. And when you're, you know, traditional surgery, or you've got the person open, you're performing surgery, you have direct line of sight, you have your hands, you know exactly where your tools are, minimally invasive procedures are not like that. So extending the visualization to confirmation meaning now I'm creating a marriage between the actual imaging and the surgical instrument to give me real time feedback, on predictors of outcomes, right, so it's giving me acute or short term feedback while doing a procedure of metrics that are predictive of long term outcomes, 357 years out, you know, now you're bringing together the visualization with data confirmation. And that's a, that's a big deal on helping increase the success rates and long term durability of these procedures. So yes, visualization, but also confirmation.

I've been basically familiar with some some early attempts at mapping imagery to the physiology of a patient I, when I was going to school at Carnegie Mellon, I worked for a summer in the medical robotics lab, and they were doing computer assisted knee surgeries at the time. And, you know, it's a very common procedure, and not one that is nearly as complicated as as an open heart surgery or a heart surgery through some sort of minimally invasive procedure. But at the time, the lab was doing overlaying imagery on top of the patient, and they would have this semi transparent screen, they would have the medical imagery on it, and they'd be placed over the patient on some fancy arm. And on the patient, were all these giant 3d markers, like these, you know, metallic things that they screwed screw to the body in some way. I'm not sure how he physically attached him. I don't remember anymore. But but it was, it was an amazing, amazing bit of technology, which is now more than more than 20 years old. But but it was kind of back to this marker, you know, the camera, you got this marker, and the marker was kind of large, he had this challenge of how do you fix the marker to the body in such a way that it, it works reasonably well. And I don't even recall the level of accuracy that they were able to achieve at the time. But anyway, this is a long, long narrative around this notion of of trying to track the human body, the human anatomy, for the purpose of overlaying digital imagery has been around for a little while now, a couple decades, at least. What are you guys doing that is similar or different to kind of the techniques that have been around for quite some time?

Yeah, that's a really good question. And what's unique is that we're combining the variety of methods that each on their own have some success, but like you said, also have some inherent limitations when used by themselves. The credit to Mr. Jaffe and often Mr. Cornel West at the Cleveland Clinic, longtime imaging and navigation expertise in this space, having the realization that, for example, sensor based tracking alone, while has tremendous benefits has some drawbacks, and optical or camera based, while has some great benefits, while it has some drawbacks. And when you combine those with other datasets and an information piece of information that we're actually using in our registration to the human anatomy, is that we bring together sensors, imaging, camera based tracking, as well as physiological physiological metrics, such as respiration, or ECG, to help correct for some of those gaps where a single technology on its own doesn't do the job. But you use the complementary benefits of each on their own. And, you know, the sum of the parts is greater truly than their individual value were great technology and innovation in the surgical navigation space over the past, you know, call it 1520 years. Now that we're combining the various parts, we're starting to recognize the benefit of doing that, honestly, it's the only way. Now you add the AR component on top of that, it's the only way we can achieve the level of performance that we do is that we're not, you know, a single source of truth, we combine a couple sources of information and really coordinate across them to reap the benefits of the various technologies that make up our system.

And the other thing I would add to what Mina said is because he mentioned the CO inventors of the technology, is that the story of why the dedication and the need arose. That lab was established as the Dr. Greenberg lab, and they were building, the stent grafts and experimenting and cardiovascular structures and really pioneers in that space. And then that lab felt the painful touch of cancer, where their mentor Dr. Greenberg, died of brain cancer, his assistant has since passed away of cancer. And I believe another assistant that worked with him is suffering from cancer. And it is highly suspected that that was due to the large amount of radiation that we're using in those those centers. So that intense focus on all those other solutions to bring them together, as Mina mentioned, was the precursor to that.

Wow, that's a very Mary curry esque sort of story. you're sacrificing your body in the name of science unsuspectingly. So early on, as you think about the sensor fusion approach to a hole that's better, bigger than some of the parts sort of ability to accurately map this data visualization on top of the anatomy. How do you Measure the improvement in the outcomes, you know that part of it is about this longer term survival rate, morbidity rate or whatever it happens to be, but but is there a way that you can measure the impact in the short term in the course of the surgery or, or in the short follow up post op?

One way we're measuring it that I love that we're taking into consideration being a background in sales and marketing is the clinician workflow? How does many of you take a technology and not just make it better visualization? But how do you make the overall procedure faster, more efficient, more predictable? I've got to give full credit to Mina and his design team is that user centric approach has been a theme from day one. And so not just measuring the long term outcomes, but the clinical workflow, on how fast as a patient, enter into the room and leave the room. What efficiencies does that bring with treating more patients and getting more people care in a in a more efficient manner, I think is really important to that overall democratization of healthcare and how people receive treatment.

So time on the table is one metric. The goal is to do just as well, if not better, within less time. And I would say there's another point, right, is that if you look at the, you know, you know, today, Jason meadowview, is focused primarily as our first use case, while our platform truly is extensible, we've proven this in a variety of anatomies. The first use case that we're finding some great customer traction with is in the space of cancer tumor ablation, where you going and you're trying to kill a cancer rather than having to essentially resected What does that mean? Well, there's, you know, today, when someone thinks about cancer, what's the first thing they think of chemo, and chemo while and we're not saying we can replace chemo, that is not what I'm saying at all. But for a subset of patients who are receiving chemotherapy, think of the personal and social dynamics associated with that, right? Everything from hair loss to being quarantined, and just the overall quality of life, of having to struggle, you know, from a digestive perspective and immune perspective. And that's the standard of care. And you know, the next one after that is resection, meaning I gotta go in, open you up and cut cancer out, which has additional risks associated with it. So when you think of those two things, there's actually a subset of those patients who are good candidates for ablation or burning or freezing of the tissue to kill the cancer. But the reason they don't get referred down that pathway is a limitation of the number of clinicians who are comfortable performing. Basically, say, I'm gonna take a needle, I'm not going to open you up. And I'm going to try to position this needle within millimeters of your cancer, and I'm going to burn a freezer. So if you were to do that to share with you, Jason, only today, there's only about 20% of the indicated patients who actually receive this minimally invasive procedure. And the rate limiting factor is this comfort level with how do I take this needle? And how do I put it where I need to within millimeters to actually kill the cancer. So one of the impacts that many of you hopes to accomplish is, you take that and you start expanding the number of patients now that can receive this more minimally invasive procedure, which in the peer reviewed literature has shown to be non inferior, or just as good as resection, and in some cases, not all cases, even chemotherapy. So now, the patient's recovery time is shorter, their quality life is way better. And their likelihood of survival is as if not as good if not better, in some cases. So there's a social as well as a clinical dynamic to improving the life of the patient, that predictability, the access to this type of care where our solution you don't like you said, Yeah, there's a longitudinal 2357 year studies that will show outcomes. But there's a cute benefits to a system like ours, expanding access to less invasive care that leads to an improved quality of life.

So the four out of five patients who suggest that they could have the sort of minimally invasive procedure, but don't what is the reason that they don't,

it's truly a limitation of the type of tools and comfort level of the physician saying I feel comfortable using black and white 2d imaging, of placing this needle within millimeters of my target to kill the cancer. There's a very those sub specialized physicians are typically interventional radiologists. And there's only a handful of them. I mean, that's right. And so the number of practitioners there's actually a corollary in the space of cardiology, look at if you take for example, what happened in the cardiac space, only a cardiac surgeon for many, many years was able to perform perform a heart valve replacement, you know, and and it was a rate limiting factor to the number two When a patient could get therapy, when they could get the replacement, introduce transcatheter heart valves, meaning a heart valve that can be replaced through a straw through your leg, rather than having to crack open your chest. And the number of heart valve recipients that needed it started going up much, much faster, because now you can have a interventional cardiologist or even a cardiologist perform a heart complete heart valve replacement. And that's today, the data, you know, from 10 years ago, 12 years ago now, when these first valves were put in this way, this minimally invasive way, is that they're actually trying to be as good and in some cases, even better from a surgical outcomes perspective, because your risk of infection is down, the trauma to the patient goes down, and your complications are down. We believe the same corollary applies in our area where you go from the interventional radiologist, to a surgical oncologist to a diagnostic radiologist, maybe in the future to a surgeon, right, that they will be able to deliver this type of therapy to those four out of the five patients. And maybe to start with, we just increase by one more patient out of those five that gets this. But that's a huge benefit of read up on the worldwide skill when it comes to social dynamics, socio economics. You talk about quality of life, as it has a huge impact.

Yeah, there's really fires on all cylinders there, doesn't it profound potential improvement in the overall quality of health care? you'd mentioned early on that there was an ongoing relationship with the Cleveland Clinic? How did that come about? And what's the benefit for you as a company?

So the Cleveland Clinic is the birthplace of the technology itself, started in the Greenberg lab. And after his passing, that team that remained really changed their core focus to how do we reduce radiation. And that led to the discoveries that led to the intellectual property, and eventually many of you was formed for the sole purpose of commercializing that technology. And we have remained partners with Cleveland Clinic, we hit physicians who either walk in the lab at Cleveland Clinic or walk into our office multiple times every week, sometimes unannounced with ideas or new use cases to utilize AR technology in their specific clinical environment. And it's amazing to have 25,000 physicians or extended practitioners on site with you, you have the ability to rapidly deploy either in human or on benchtop, you have the ability to garner these key opinion leaders in a matter of hours, not months. And this environment is really a nice incubator for a startup medical technology. And so that relationship remains strong. And now we're realizing that not every hospital is like the Cleveland Clinic. So we're starting to branch out to hospitals that look more like a mid major or Regional Health Center. So we can really refine that use case for the broader, you know, population in the in the more common surgeon than than at the Cleveland Clinic.

And how does GE fit in the mix?

Ge has been a great partner. So let me start by saying this, right, the AR world is only as good as the inputs it receives. Right. So very humbly, we are not creating brand new medical imaging modalities like ultrasound, or CT or MRI, we are leveraging existing imaging and navigation to improve performance, accuracy and outcomes. Which goes back to what we're saying kind of that aggregation of multiple data sources together. Well, GE is the world leader in medical imaging. And outside it it only only second in the US when ultrasound but actually worldwide is first and an ultrasound as the number one ultrasound provider. So when you combine the image quality, and the scale of the GE ultrasound system, we actually were lucky and blessed enough to work and work out a strategic development agreement that was recently publicly announced between GE ultrasound and many of you. And what that affords us has direct access to their imaging data. And like I said before, when you have high quality inputs, you can do a lot of great things in AR, but again, they're only as good as the inputs they receive. So we consider ourselves having an excellent input that's coming in now that we can use in a way that's unique to us. And they allow us direct access to the to ultrasound in the future other imaging modalities. And there's actually even collaborative commercialization efforts where we actually are complementary on the sales side of things, because they see the value of what many of us doing, we value their partnership and having a great input into our system. So when you talk about strategic development and collaborative commercial opportunities, they've been an excellent partner in that space. So it's a It's both a technology enabler as well as a commercial scaler.

So many of us set up to have some amazing initial relationships both between GE on the commercial side Cleveland Clinic with the access to the originators of the IP, as well as this huge population of doctors who are eager to contribute. had an opportunity to iterate maybe three can go through this feedback cycle a bit more quickly. There may be some other companies who are on the outside looking in, what have you discovered, as you kind of have been iterating, over the last 1218 months on the product? What are some of these learnings that you're incorporating back in?

First and foremost is this is like going from a rotary phone to the to an iPhone, right. And first and foremost, you got to bring people along for the for the journey. And it's actually reflected in our product roadmap. So like john said, we, you know, we talked about full holographic immersive navigation. But one of our folks on our team, Greg Hart, who comes from actually a human usability, he actually started out at DreamWorks, where he worked on world scale international scale movies, like Shrek and then actually made his way into med device for the past 10 years. And he's like, I want to bring a little bit of magic into medicine. And he puts a strong emphasis on put things in front of users, and tell them what's good, and what's bad, and what needs to change. And we've learned that, hey, there's the holy grail of Ferrari that we're developing that we're, you know, come to market. But as we've exposed it to them, right, they realize, hey, you have a subset of features here, that constitute a product that could be deployed sooner. And so really, when we look at the end goal of where we're going with the full, holographic surgical navigation, as we bring people along for the ride, and incrementally expose them to AR, there's training wheels, and if you put those training wheels on, you'll become like, john, so kind of the first scalar, the first mover in this space to put these tools in the hands of clinicians today, at the point of care, even if it's with a subset of the full set of the four features that are possible, will help grow adoption. And that's what we've learned. And we're, and we're saying, so there's an adoption of AR, there's a subset of features that will help adoption grow. And we've actually tailored our go to market strategy and product development strategy, according we are starting to see the early fruits of that today.

JOHN, you want to add to that?

Yeah, absolutely. So what I really enjoy about our product and our technology that that I think is the feedback loop that we're understanding better is the training component. And not just the training component of how do you spend an hour or two with a clinician and teach them how to use your interface,

what you said is huge. And that just the ability to learn is different, right? at a startup at our stage, having direct access to the end user to influence and shape design so that we're not creating a technology push, but rather a market pull is something that we you know, we create multiple sessions of what we call formative usability, meaning you're truly forming the product definition with end users, not just the clinicians, while they are obviously one of the most important end users, but what about the administration? What about the insurance companies? How are you going to get reimbursed for this. So that ability to share our technology and story and vision with a variety of shareholders and stakeholders in this space is really what's helping us iterate. And again, purely just the access to those shareholders and stakeholders to help define and frame and form product definition is at our at our stages is critical to the success, you know of many of you, but of course in the broader AR and medicine space. So what I

like about the training component, and what this feedback loop that we're discovering from deploying an AR solution, not just the the amount of time it goes into teach somebody how to use the interface. But what I love about the meadow view product portfolio in what media was just describing, is the technology is really for everybody in the care spectrum. So our first technology really lends itself to the advanced practitioner, pa nurse practitioner working with a physician, and then it graduates. So you have a common core platform of augmented reality and how you interface with that tool that I think if many of you become successful in this arena, really has a shot at becoming the standard, so that it doesn't matter if it's your nurse who dons a headset, or the highly specialized physician, there is a common understanding of how you interface with that tool and how it's used. And that's the excitement of an emerging technology that we get to influence and help build out the right way.

It really is a gift to be able to to be that close. tied to this sort of feedback, and then take a very holistic approach to testing and understanding how it can benefit. As you noted, the broader population of potential beneficiaries beyond just the the expert surgeon, him or herself. Often, when young companies are encountered, you know, or discover something that the market values, it's really easy to spend a lot of time imagining what is the Ferrari mean, as you describe the Ferrari that you want to build? And oftentimes, startup will spend a lot of time focused just on that Ferrari without thinking about what's the Fiat, what's the 500 I can put to market first, or the you go or whatever. That early, barely functional vehicle is, but but it's more valuable than what the alternative, even though even the very nascent state, as entrepreneurs, how, how do you kind of separate this desire to build the most amazing thing you can build versus creating something that is useful? Even if it's in its most basic state? How do you balance those ambitions in your work?

Maybe you are trained under Clay Christensen, I'm not sure Jason, but you just basically spelled out right, the innovators dilemma and the innovator solution, right? I mean, that that's the definition of minimally viable product, right. And I think that's the difference. And I really want to just take a second and highlight the foundation of the company, right? And now you've got clinicians that are participating day in and day out, I mean, that very seriously, combined with commercial sales and marketing professionals with product development professionals. And we are looking beyond just the wow factor of augmented reality. Right? And that you've got to you know, you put you put anyone in an AR headset, and almost ubiquitously, right without fail. It's like, oh, my goodness, this is incredible. And then you wait five minutes, and you say, Okay, great, how's it going to be useful? Right? Really cool. But how am I going, how's this gonna make my life better the life of my patients better the life of my, my patients family better. And that's the approach that we took, and kind of what I was describing before is, you know, you've got, you've got the Ferrari, but as you expose people to it, you know, if you can truly humble your perspective and say, I'm going to listen to the person who's going to use these actual solutions, what are their pains today? Right? What is the job they're trying to do? So we've taken this approach from, you know, jobs to be done pains, gains, and rewards, and thought to ourselves, okay, we go in there, and we watch a case as it's done today. What are the main pain points? Where do people struggle? Why is there such a steep learning curve with the use of ultrasound, and you analyze those, and then you convert clinical needs into business opportunity? And then deploy technology solutions? In an entrepreneurship sometimes the opposite is the approach if you've mentioned is that amazing technology? Let me you know, we don't want to try to fit a, you know, a square peg into a circular hole. That's not that's, that's you, we don't want to force it. So helping give people the training wheels, which truly isn't the Ferrari, right? isn't the end embodiment right away? Knowing that it's gonna take a couple years to how do you even deploy a headset in a hospital institution? So that, you know, if it gets lost? How do you replace a what if it breaks? What about connectivity, right, there are infrastructure components to make the end goal successful that need to be solved. And in solving them come a feature set that creates benefit today, immediately, right and 2021, rather than, you know, 2022, or 2023. So and you start out their process of humbly listening to the end customer. And like john and i talked about you don't listen to everything the end customer says to last for the world. But you then deploy solutions that meet their immediate mid term and long term needs, you'll come to the realization of a success as a successful technology solution. Like in the AR space, we can go over the theory about a minimally viable products and their introductions for a very long time. I'll save that for another time.

So one of those pieces of infrastructure that you're relying on is the Microsoft HoloLens. Why that device over magically burn one of the other alternatives out there,

from the perspective of a world class, ar head mounted display, they've built the best ecosystem around their product. And what I mean by ecosystem is hardware software cloud. And we are at now we actually have no exclusivity with Microsoft that we can only deploy on their headset. But when you talk about familiarity, you talk about the readiness of a technology that can actually be deployed at scale as a product that you can count reliably on supply, which even that's even for the HoloLens is has some question marks next to it, which is we're accepting that risk for now. Our goal is to take the most advantage and benefit of these AR eight The technologies and to use them in a unique way from our core unique IP, rather than having to build an HMD. From the start, right? If we did that there would be many, many, many years of development that wouldn't be focused on how do I deploy a solution that's useful for the end user today, but would be pushed way out to the ever reliable Admiralty display. When you look at what they have accomplished. I don't mean to get into any political considerations here. But you look at what the Department of Defense putting $22 billion into potential development and acquisition of that that means that technology is not going away anytime soon. And they're really positioning themselves to be the leader in this space. So in summary, right, the predictability, we have a very close partnership in development with them, as well as the familiarity. And people will say, Well, you know, they have huge limitations for like, you know, this this technological perspective, true. But we don't actually, we're not subject to those limitations, because we only are relying on the cameras for a portion of what we do. But rather we deploy, like I said, unique sensors and algorithms that circumvent the limitations of the current HoloLens. And I don't think Microsoft would be concerned of me saying that they know that about the product themselves. So I would say all of the main reasons of predictability, partnership, current state of the art combined with our unique capability, john, yeah, I

would love to add just at a high level. From a founder standpoint, in my role, I am very comforted by the openly stated goal of Satya Nadella and Alex kipman. Both in the business model that allows not Microsoft to grow 17 new jobs, but their stand up infrastructure allowed many of you to build 17 new jobs. And that whole approach that is kind of an I don't know, pun intended, but refreshing, coming from the leadership at Microsoft is something that's very empowering, knowing that the openly stated commitment to continue to develop on that that product line and continue to refine it, knowing that it's not something that's going to get shelved. It's not something that's going to be neglected, but openly stated as a focus and priority for Microsoft, it empowers you that you don't need to build your own headset that you don't need to make that massive investment in components and you know, the supplier chain and design controls that go with that. Rather you can partner with somebody where it's a win win situation. And I think that's what we're in today.

There are other companies out there, we're also taking advantage of the work that Microsoft has done in applying it around similar sorts of use cases. How do we apply the HoloLens to improve intra operative surgery in the surgery itself? How do you describe how you are different than companies like sentier ar, or some of these others who are trying to also improve medical imaging using the HoloLens in surgery?

May I may I start with a bold statement, it will be five years before any of the companies that exist today are actually in competitive selling situations. Jason, I love the fact that we all get lumped into the same community, whether it's sente, ar og medics, or any of these companies that are emerging with an AR VR focus. The reality is, is this is a blue ocean of development. these use cases, although they seem very broad, when you say AR and anything medical, we tend to get lumped in together. The reality is many of you is focused on very specific problems with very specific value propositions. Some are global between every company but the problems that we solve are also very different compared to anybody working with either Microsoft HoloLens two, or any other augmented reality headset. And to me, that's exciting. Because you're going out you're you're part of this wave of changing healthcare for the betterment of every patient, and everybody is doing this from what I can see from the very right reasons. But we get lumped in together where there's very few if any competitive selling situations or competitive development situations that exist right now.

So blue ocean and you guys are so medical itself is such a large ocean. Yeah, that each of you has to pick your own swim lane and not run into each other. At least at this stage.

Correct. But I want to also Jason right answer your question. I agree with john right the like I said earlier right up all ships rise with the tide and it's a very good thing for us. And desert question what makes us different or unique? I'll go back to the we're kind of where we started as that sent tr. I know those folks over there really well. I love what they're doing in the space of electrophysiology with their command EP, great product. Medi ww is great training and education, Anatomy x, great product. I know they're starting to think about the space of navigation in real time. Use that And what is novel and, and we've been able to secure IP not just a provisional, but multiple non provisional, awarded and granted patents around this is this concept of, if I take a representation of anatomy, and I can peel it off of that screen from that CT or that MRI, and I can position it and reposition it and refine its position to the millimeter and in the future sub millimeter level, that is tremendously differentiating. And I will add, one thing that we haven't talked about actually, is specifically in the space of soft tissue, soft tissue moves, it deforms, it is unlike bone and not rigid. And our ability to combine these imaging modalities and sensors to account for the deformation of tissue, and help provide feedback with real time imaging, on top of our X ray vision for registration makes us really special in this space. Now, the other areas, right, there's other areas where others are ahead of us in some ways around, you know, whether you're talking about image processing, and I think we'll be complementary to each other in the like john said, in the three to five year span before we become competitive, but we do have very novel, like I said, registration and soft tissue capabilities,

as you have both in working around medical technology, and these hospital systems trying to push the standard of care forward using novel, novel technologies like this. What's your experience around why this particular industry has been so slow to adopt new sorts of technologies, because in some ways, the way that we're practicing surgery today is not very different than how we were practicing surgery 100 years ago, and I've heard that Justin Bryan of Oso, VR was talked a lot about this notion that from a training perspective, a lot of ways it's very, very similar. What is it about this industry that is so resistant to change,

I can start with what Jason said about the training component tends to lie on the physician. And I will alter that and speak from the industry side, it's risk. Companies that exist today have been merging or acquiring each other for some time, if you look at the overall environment of medical device, companies continue to get larger to this very day. So what used to be these little hubs of innovation have really kind of burnt out. And if you were to ask me, the question is now a good time to, to create a disruptive startup and a technology that is under adopted, I would tell you absolutely, because we're reaching a maturity point in medical technologies and medical device, where this innovation becomes rare and rare. And if you can find a good technology, and you can build a good team, and you can find the right thought leaders, there's opportunity for incredible potential, and achievement in that space that will drive adoption, where it otherwise doesn't exist.

As you look out from where you are today, given that you are one of those innovators outside of one of these large and increasingly growing existing medical device companies. But given where you are today, and as you look out over the next 1218 months, who are what makes you nervous,

I can give one very briefly, I had a concern. Up until a few weeks ago, I had a concern that depending on the adoption rate of the HoloLens two, that that that project could go the way of the Windows Phone. Now I can say that I love the Windows Phone, I was an that was my favorite phone. But that technology went away. And that left a gap for those that were adopting it. And I had a fundamental nightmare every day, that that would happen that one day that that HoloLens would not become a priority. And that fear recently went away with the the announced Department of Defense contract with Microsoft for 22 billion, I think we can definitively say that the current leader is not going to abandon that technology and in fact, will probably create an environment for others to paveway and new great headsets to come out that we look forward to seeing. But my fears right now I haven't found a new instance that has gone away.

Well, I'll share one with you, Jason. I mean, I think the end up john gave a nice perspective from a technology lens. And I'm going to give one from medic this goes back to your medic combines your last question about medicine and healthcare with what worries you know us me at least me I will speak on everybody else's behalf. If you look at what happens to a new technology space when one solution or player has a hiccup in the space, and this has actually happened a couple of times where the entire space gets brought into question. And on average, it'll take anywhere from four to 10 years to be given a second shot. And a space where this has happened is actually for hypertension right today. hypertension is primarily managed with medicine with pills. My wife is a pharmacist. So I'm not wishing anything happens to the space of pharmaceuticals. But we know that there's what's called renal renal denervation, meaning you can again, burn parts of the renal anatomy, and you can solve hybrid, solve for hypertension. And that patient ever has to take another pill in their life. However, back in 2000, and oh 11 or 12, there was a clinical study that actually showed an issue with this concept of renal denervation, there were four monsters playing. And even though the other three technologies seemed to be doing fine, this early solution ended up bringing the entire space down with it, and only in the past one or two years, has this concept of renal denervation being resurrected, and given a second chance. So this same thing is, and I think we're at as much if not greater risk, because we're not just introducing a new way of performing, you know, doing an existing therapy or new treatment, we're providing a whole new way of practicing. And if one and we're doing everything I've met up to make sure we're not that one. But it weren't, we're not immune to that, that if something happens in this space, with mixed reality, augmented reality based intra procedural use, it may still survive in the education and training space. But the burden to prove and resurrected intra operatively will become exponentially more difficult. So, you know, that's, I think the FDA is putting the right checks and balances in place, from a regulatory perspective, the obviously, of the new digital and data initiatives that there's standing up specific parts of the FDA for it to help mitigate that, and that's obviously their job. But, you know, that's one of the things that is concerning is that if a solution or player doesn't meet expectations, or actually underperforms or truly causes an issue, an actual health risk, the entire space could go down with it.

Yeah, I think we even even on the AR side, we've seen a recent example that as well, on the hardware side with Magic Leap, sucking up an incredible amount of investment dollars and enthusiasm and hype. And when they were not able to deliver against that promise initially. I my observation is that it really impacted the ability for other innovative hardware technology companies focused on this sort of technology to receive the sort of funding and support that they needed in order to deliver a product. But the large companies like Microsoft, have been investing even even in the face of magic leaps, stumbles. And you're right that, even if that even if the HoloLens was just a marketing spend for Azure Cloud, that it was money well spent, in securing us massive deal with the US government there. Yeah.

And I think one thing that we haven't touched on JSON doesn't mean the reality is in the next 10 years, this space will see tremendous amounts of consolidation, like all of the other advanced technology sectors that were especially from the hardware perspective, locate your cell phone, right? I mean, other than the US, right, we're Apple is the leader, Samsung is the leader globally, or at least Android, I should say Android more generally. And yeah, there are other players out there, whether it's Huawei or Nokia, etc. But there's been a tremendous amount of consolidation. So, you know, I'll put a I'll put a theoretical hypothesis out there. I won't be surprised if I wake up, you know, two years from now and see a headline that says Microsoft acquires magically, by IP, I mean, that the progress right we, whether you're talking about unreal, or Google Glass to or magically or HoloLens or meta, which, of course has already gone under, or look at, you know, Vario and what they're doing, they're doing some incredible work with true mixed reality. Over the next five to 10 years, there's going to be a tremendous amount of consolidation. Once we figure out what are the minimum requirements for these to be commonplace pieces in our day to day life?

Indeed, medic coming back, though, resurrected, and renamed as campfire,

I saw that I wonder if project Northstar from what was a Leap Motion at one point that was a really interesting project, build your own headset, 3d printed components. So it'll get there.

Yeah, let's wrap up with a few and lightning round questions. What commonly held belief about spatial computing? Do you disagree with that it

will never reach a point where it looks like my glasses.

You think there's a path? I think there's a path.

And I don't think it's dependent on purely on device hardware. I think it's gonna be a complementary solution between on device versus ancillary and accessory components. And because I said that I will take it even a step further, that someday I think you'll be able to perform these type of or do that, you know, do these type of projections and registrations without a head mounted display at all.

Can you expand on that a little bit? Sure.

I think that if once we understand that What is it about the optics, the field of view, the type of projectors that are needed to create this type of projection in front of your eyes, that those things can be solved using different light refraction and projection and laser technologies that we'll be able to do them even for just wear your normal glasses. Or if you don't wear glasses all the time, you don't wear glasses, Jason, but you and I will be able to look in the same space, whether it's mirrors, lasers, refraction, etc, that we'll be able to create this type of content in ambient air without hardware on your head. But it'll require like said, accessory ancillary devices. So that's my, my bold prediction.

Fun. Cool. JOHN, anything you want to add to that one or alternative answer,

the commonly held beliefs about spatial computing, the only thing I'll touch on is, with the new HoloLens two, we have not seen nausea or negative effects from wearing the headset. I think that was a problem with the way that the headset and some of the features with the earlier versions, but it's been nearly non existent versus our most recent rounds of usability and validation testing. So I do think that that gets better over time. And there's only a minuscule problem, that has been a major objection we've had to overcome.

Besides the one you're building, what tool or service Do you wish existed in this market?

I do have one that comes to mind that I think would have a lot of benefit for the way we treat patients. And Dr. Chuck Martin at the Cleveland Clinic has really started to pioneer this as well. And that is the the patient experience or understanding. So currently, a physician when explaining a condition is required to do that at about a sixth grade reading level. But a lot of physicians question on how much does that patient actually retained when they walk out of there. But if you were to hand the patient, a headset, and say I have a CT or an X ray or your imaging of your body, and I want to show you what we're facing from a standpoint. And, Jason, I look forward to the day where we can go from we consented the patient for a tumor ablation therapy, and we showed them where the cancer was at in their body. And we showed them how we are going to stick a needle in the center of it to deliver a therapy that would kill the cancer. And then I think for to the happier points, that the next follow up visit is when we get the opportunity to say, you know, here is what we did. And this is your imaging as it exists today. And based on the evidence I have in front of me today, I can tell you that we can consider your procedure a success. And I imagine the joy on that patient that they understood the whole time. They they truly had belief that their procedure was a success. And there's nobody on this planet that's going to convince me that that power of the mind and that situation and seeing is believing doesn't affect patient well being or outcomes

did

provide a slightly, I'll just very quickly say it I unless it already exists. And Jason, if you know about it, please send it to me, I'd love to see it, where the compute power is sufficient that you can run algorithms that can show holographic deformation of soft tissue in real time as you're performing procedures. That's, that's what I would love to see.

That's a hard one. You said if I got to pick? Yeah, no, that's great. You know, the thing that actually mean that comes to mind, I'm sure how real time it is. But there's a lot of work around fabric modeling the movement of clothing fabrics, which I imagine has some similarity to soft tissue, although maybe less bit less complexity. I'd love to send my way. I'd love to see it. Let me think on that a little bit. Maybe Maybe I can put in the right direction. Yes. And we will. Yeah. If you could sit down and have coffee with your 25 year old self. What advice would you share with 25 year old me now or 25? year old john?

Yeah, 25, I would say, listen, it's the culture of medigoo. Today, it's faith, family medigoo. Don't mix them up, don't get them out of balance. Because you will not be able to give yourself the very best of your company. And if those things get out of balance, bad things can happen. If I was sitting with my 25 year old self, I would say, john, do not sacrifice family over your work. Because what I didn't know at 25 was that I'd be burying a parent. In those times those minutes every second is precious parents, kids, you know that's something that you got to cherish and when you put your your very best into your your family life in your faith, the past in your work comes out.

I love that. All Sherif related thing actually, john I are actually very like minded in this space but live for more than yourself, is what I would tell my 25 year old self that if you live for others, your impact and significance is much in my at least from my standpoint is different than what people traditionally define as materialistic success and prioritize significance over success.

For more than yourself, excellent, a whole bunch of images you came to mind with that one, but I will, I will spare the commentary. And just say that was that was excellent. Any closing thoughts you'd like to share? Oh, sure, one,

I've been blessed and lucky to work on bleeding edge technologies in medicine. And to be alive in a time like this, to be able to have someone with your pedigree and background, Jason interested enough to create podcasts like this, invest in things like this and to see the world recognize the things that were once science fiction come to life is a pleasure and an honor. And this doesn't happen right? Every every year. And I really wanted to actually thank john who, you know, I get to talk to him on a daily basis. But to like he said, his first opening, he developed quite a reputation and a level of progress in his career to hang it up to see the benefits of this space and helped steer and, and I'll say, almost pioneer in the space as a, as it's great that there are people in the world, right, that are willing to do these things. And we're lucky to be living in a time like this, amongst so many negative things are happening across the globe, to be able to wake up and be like, I get to work with some incredible people to deliver on an incredible opportunity with incredible technology internally at media viewing collaboratively across the space as a pretty special thing to be able to say everyday.

Well, thank you, Mina, I gotta tell you, I am just very grateful, Jason for the time and the team. For many of you, I don't know if you're doing it right or doing it wrong, if you're filling my role. And you know, you're the most irrelevant person in the organization doing it, right, that means. But every day, I feel blessed, I get to work with some great minds, and I get to talk to some great people. And I'm just glad to be one small part of it. Yeah.

It's always been my perspective that as a leader, it's your job to make yourself as relevant as quickly as possible, because you have an amazing team and you set them out, set them up for success, give them the right, the right motivation, the right direction, and then get out of the way. Where can people go to learn more about you to and about your work there at MIT if you,

Cleveland, we welcome the visitors. Right now. I think this community is small enough that Jason if you if you find a desire to come to Cleveland and watch a clinical case, or Don the headset yourself, come on in, I do not recommend February in Ohio. But right now would be a good time to visit. I think we really have the the spirit of knowing that to build this technology. And to create this enthusiasm, we're going to have to put a lot of headsets on a lot of different people. And we would not turn anybody away.

And I'll give the John's invitation stands I'll give them more maybe obvious is go to our website itv.com. Send an email to info at medigoo comm or please reach out to us on LinkedIn. We were there job myself or anyone that works at many of you. We always welcome the opportunity to talk to technology, collaborators, clinical doctors, anyone in this space, even if you're a different industry. And maybe we have something that many of you that may be of benefit to right cross industry collaboration, as shown to be tremendously beneficial, which is another topic we can get into some other day, but feel free to reach

out. Awesome. Thank you both very much for this conversation. Thank you, Jason. Thank you, Jason.

The next new episode will be coming in September. I'm taking a break this summer to spend some time with my family away from home. I've already got several fantastic interviews lined up for when I returned, but until then, I'll be replaying a few highlights from last year. Please follow or subscribe to the podcast so you don't miss out on these new episodes. Enjoy your summer.