Think transistors instead of tubes. PCs instead of mainframes. Or iPods instead of Walkmans.
Now think of a radiologist’s lab with banks of computers and monitors, as well as suites of sophisticated software—all costing hundreds of thousands of dollars—to decode, decipher, and analyze two-dimensional, grey-scale images from CT scans, MRIs, ultrasounds, or any other medical imaging system being used today.
“Radiological products out there now are unbelievably hard to use,” says Curt Carlson, president and CEO of Visual Medical Solutions LLC. “You’ve got to have a pilot’s license to run half of these things.”
Carlson wants to make medical imaging as simple as child’s play, and he and his principals—Iowa State mechanical engineers Eliot Winer and James Oliver—think they have the “toys” to do just that. And though radiology jet jockeys might sneer at the Xbox controller Carlson uses, his simulated flight through the human body is no video game but instead a potential game changer for the medical community.
Exploratory surgery done virtually
BodyViz is a software package that can render any medical imaging done in the Digital Imaging and Communications in Medicine (DICOM) protocol—x-rays, CT scans, PET scans, MRIs, ultrasounds, and others—into detailed, 3-D representations of the human body that can be traversed, sectioned, penetrated, or otherwise manipulated using little more than a laptop computer and an Xbox video game controller. Moreover, the basic software package sells for only a tiny fraction of the price of the equipment and software typically found in radiology suites.
BodyViz isn’t intended to replace all of that high-priced gear but instead offers surgeons a means to better visualize the inside of their patients’ bodies and map out detailed strategies before operating. Where formerly surgeons might spend hours poring over series of 2-D grey-scale scans to sketch out approaches to excising a tumor or replacing a joint, BodyViz lets them plot surgeries down to the smallest detail using accurate 3-D models. Manipulating the controller, they can zoom in on a tumor, circle it, and closely examine its extension, irregularities, and involvement with organs and body systems. In effect, surgeons can virtually conduct exploratory surgery or rehearse procedures inside accurate models of their patients’ actual bodies.
And that’s a big deal. After all, there’s a reason people like BodyViz cofounder and medical consultant Dr. Thom Lobe of Blank Children’s Hospital in Des Moines are in such high demand. He’s one of a small number of surgeons—5 to 10%, according to Oliver—who can examine a battery of 2-D grey-scale CT or MRI segments, mentally aggregate them, and then accurately visualize the interior geography of their patient’s body.
With BodyViz, though, any surgeon can envision on his laptop computer almost instantly what colleagues like Lobe can simply intuit, saving considerable time and money—and maybe even lives. In a word, Winer and Oliver’s invention has the potential to disrupt business as usual in the operating theater with a tool that effectively elevates the game of any medical practitioner who uses it.
Disrupting a market model
Oliver has read Clayton Christensen’s 1997 classic, The Innovator’s Dilemma. And, as one of the leaders of the explosive growth of Engineering Animation, Inc., in the late 1990s, he knows a little something about “disruptive” technologies.
“We think BodyViz has the potential to be a disruptive technology,” Oliver says, “in that we’re essentially letting lots of other potential users at this data that has been the province of just the radiologists for years.”
“It’s not just getting people to think our product is good,” Winer adds, extending Oliver’s remarks, “it’s getting them to understand that the way we want them to image—the way we want them to interact with their data—is completely different from what they’ve done before.”
Wider accessibility is only part of Christensen’s definition for a disruptive technology, though. “Generally,” the author says, “disruptive innovations were technologically straightforward, consisting of off-the-shelf components put together in a product architecture that was often simpler than prior approaches. They offered less of what customers in established markets wanted and so could rarely be initially employed there. They offered a different package of attributes valued only in emerging markets remote from, and unimportant to, the mainstream” (The Innovator’s Dilemma, p. 13).
Winer and Oliver’s BodyViz software meets all of these criteria—with one significant exception.
First, when you use an Xbox video game controller to fly through the human body, yes, you’re using “off-the-shelf” technology. However, years of experience at Iowa State’s Virtual Reality Applications Center (VRAC), which Oliver directs, give the two engineers an advantage in adapting simple interfaces to complex tasks.
Next, there is no argument that BodyViz is “simpler” than the approaches used by radiologists—just as there is little chance those same radiologists will toss their pricey gear in exchange for a laptop loaded with a few hundred dollars’ worth of BodyViz software.
However, while the BodyViz team is exploring markets well beyond the orbit of the radiology lab and operating theater, the surgeons and other practitioners who comprise the software’s initial target market can hardly be considered “remote from, and unimportant to,” the radiological “mainstream” whose primary clients they in fact are. Rather, BodyViz represents a downstream application on the clinical continuum that complements rather than challenges existing technologies—there is no techno-insurgency here.
Success not inevitable
If BodyViz is a “disruptive” technology, then it’s a welcome disruption for surgeons, nurses, and OR technicians. Still, as compelling as BodyViz might seem as a technology, as a business proposition its destiny is anything but assured. The initial enthusiasm of surgeons notwithstanding, as with any other goods or services, BodyViz must be aggressively marketed if it is to succeed—especially because of its potential to “disrupt” business as usual between radiologists and the physicians they work with.
The job of commercializing BodyViz falls largely to Carlson, a 1985 Iowa State graduate in management information systems who, after an initial stint with Ford Motor Company, helped shepherd University Systems Technology through its start-up phase and sale to telemarketing firm RuffaloCODY, a division of McLeodUSA. More recently, he was instrumental in launching iSeek, a start-up marketing a “geometric search engine” developed by former Iowa State mechanical engineering faculty members Abir Qamhiyah and Don Flugrad.
While it may be inevitable that physicians will one day routinely prep for surgery using 3-D imaging, Carlson says, it’s not inevitable they’ll do so with BodyViz. There are both active and potential competitors in the 3-D imaging market, though none yet who can match BodyViz’s price-to-performance level. Still, running any small tech start-up, Carlson suggests, is nothing so much as whistling past the graveyard of great ideas.
“You’re lucky if one in ten of these start-ups is a hit,” Carlson says. “A lot of entrepreneurs bring technology out—maybe the original founders—and they fail to realize that the hardest part of this whole thing is selling and marketing the product—and making sure you have a big enough market to go after.”
Carlson cites the “total U.S. addressable market” as the lead factor in attracting either small “angel” investors or, eventually, larger sums from venture capitalists who may demand controlling interest in the enterprise. The existing market for their product, Carlson says—largely the 100,000 or so general surgeons practicing in the United States—is of limited interest to such investors. The total addressable market, however, is another story.
A $4 billion market
Oliver notes a recent study claiming that one of the top reasons tech start-ups fail is because they neglect to “validate” that addressable market before going after outside funding. Validation, he says, is a gradual process of discovery that can unfold in directions the business does not anticipate.
“You always think you’re going to sell it in one direction, and it’s always some slight deviation from that,” says Oliver. “Or it could be a major deviation. In our case, we had no idea the education market would be as fruitful as it is. But it seems we’re getting a lot of traction in education.”
If the development team had narrowly focused on medicine after initial consumer reaction (“the surgeons went batty over the software,” Winer says of his first presentation of BodyViz at a medical conference), the total addressable market for the software would have been fairly limited. Yet that narrow focus on surgical planning expanded dramatically after beta testing of the product at Des Moines University, a large and progressive teaching hospital for osteopathic medicine.
“That’s when we began to realize, wow, these are the education people,” Oliver recalls. “They might find it more useful as a supplement to anatomy books. Cadavers are expensive, and there are few of them. If you can get further along that learning curve with virtual technologies, you can learn a lot more about the body and anomalies and that sort of thing.”
From there it soon became apparent that, beyond medical schools, BodyViz could be a valuable teaching tool for universities, community colleges, and even high schools. Along with the functionality Winer and Oliver say they can easily add to the software to make it useful for virtually any medical specialty, as well as routine patient consultations, that “total addressable market” for BodyViz is substantial.
“We’ve calculated the total addressable market for BodyViz at about $4 billion,” Carlson offers. “Surgeons, residents, nurses, education—that’s a very large market space.”
Establishing a beachhead
Capturing even a fraction of that market would make BodyViz a runaway success—and its principals wealthy men. But as with the relatively short life spans of most technological innovations, time is of the essence.
“We’re establishing our market presence as quickly as possible, which is what you have to do in this business,” Oliver remarks. “There’s a technology window and a market opportunity that intersect, and we’re the first ones in it. But that means we have to establish momentum and be the market leader.”
Carlson is employing an array of tactics to push the BodyViz brand. First, the company has established a marketing “beachhead” of sorts by enlisting what Winer calls a major “reference client” in Methodist Hospital in Houston, Texas, whose surgery department purchased an installation for BodyViz in conjunction with Mechdyne Corporation, an Iowa-based VRAC spin-off specializing in large-scale visualization applications.
Next, Carlson has entered into agreements with about half a dozen resellers that specialize in marketing medical equipment, firms whose sales reps will include BodyViz in the portfolio of products they sell to clinics, hospitals, and private medical practices.
“This is key,” Carlson says. “If you can get the product into a larger distribution network—people out there who already have relationships with surgeons or educators—you’re going to move product much faster than you will developing a direct sales force.”
Generating the buzz
One critical way to get the BodyViz brand in the public consciousness, of course, is through media exposure. Needless to say, small tech start-ups don’t have multimillion-dollar marketing budgets, and, at least for the present, BodyViz isn’t a consumer product in any event.
Still, there exists a very real need to create “buzz” for a product regardless of its ultimate market, and Carlson and company have taken advantage of every opportunity for free publicity that has come their way. The product has been featured in newspaper articles in Des Moines and television news reports in Houston, among other media. It has been covered by CNBC’s Business of Innovation program. And in January BodyViz even made its “reality TV” debut in a brief appearance on NBC’s The Biggest Loser Couples.
That’s hardly surprising, says Carlson, given the tremendous visual appeal of BodyViz to laypersons with limited understanding of the medical implications of the software package. “We get great press because there’s the mix of, ‘yes, I’d like to see my own 3-D MRI or CT on a PC,’ right?” Carlson offers. “And then you throw the Xbox controller on top of that and it’s that simple: it’s the one elevator pitch or tagline that draws a picture in just a few words.”
Beyond mass media, though, there lies the expanding profile of so-called “social media” over the past decade that, in addition to its individual consumers, has increasingly been adopted by commercial interests to promote their products and services at little or no cost. BodyViz has been quick to take advantage of every available medium in this regard, including Facebook, Twitter, and YouTube, where a clip of the software in action has generated thousands of hits since posting last year.
Once those contacts have been made, though, it remains for Carlson and his small staff to turn prospects into customers. And while some “walk-in” business may come through the company’s web site, any prospective sale must include a “high touch” component to negotiate the high tech.
“With this type of product, there’s got to be human interaction of some sort,” Carlson stresses. “Someone has to go out and do a demo and show it to them, or you’re doing an online demo with WebEx, so there’s interaction there and a relationship develops.”
Every sale a victory
As the young start-up lands more clients, its commercial prospects will make it attractive to the angel investors whose backing can help BodyViz expand into that larger market space beyond the surgical suite. And with the company’s sales and distribution partners coming online, that’s beginning to happen: hospitals, medical schools, and private practices in Texas, Iowa, and California are using the software today, and, Carlson says, more are in the pipeline.
Also, as the economy slowly recovers from the worst recession of the post-war period, investors are beginning to look for new opportunities beyond the high-risk environs of Wall Street. There are identifiable pools of potential investors in medical technologies, Winer notes, with doctors themselves representing an obviously well-heeled group of “angel” candidates. Adds Carlson, “We have people come in just off our web site and say they’re interested.”
Certainly, success for the young enterprise has the potential to disrupt not just current medical practice but the lives of the engineers themselves. But, Oliver jokes, that may be a good thing, and he cites Clayton Christensen’s recent book on new trends that bid to “disrupt” traditional education models.
“We are vulnerable because we’re the incumbents here at Iowa State,” Oliver notes with a laugh. “I want to read that one next!
“But the business is going good,” he adds. ”It’s hand-to-mouth at this stage of a start-up—we’re two years old. Every step is hard fought, but every sale is a victory. It’s exciting.”