Studying vs. Experiencing Entrepreneurship - Shortening Your Learning Curve
Amit Vohra is the Founder and CEO of Promaxo, a medical technology company that is commercializing an office-based MRI system. In this episode he shares why entrepreneurs need a support system around them, how culture is really built in a company, identifying good start-up team members, why everyone needs to be a salesperson, working with advisors, the balance between being flexible and holding true to what you believe, and what Promaxo does and why the technology is a game changer.
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Episode Transcript
This transcript was generated using an automated transcription service and is minimally edited. Please forgive the mistakes contained within it.
Patrick Kothe 00:31
Welcome! The entrepreneurial journey is unique to everyone who's chosen to take it. But you'll learn lessons along the way that generally increase the probability of success of your next venture. And certainly help you maintain your sanity. Through the chaos of startup world. Our guest today has lived the life of the entrepreneur been successful at it. And he's here to share his insights on building a successful company. Amit Vohra is the founder and CEO of Promaxo, a medical technology company that's commercializing an office based MRI system. And it's completely different than what you imagine when I say the word MRI. Amit was a co founder and president of Navya Biomedical Technologies VP of strategy and operations at Eigen, and co founder and CEO of Convergent Life Sciences. He is also an active advisor, consultant, and angel investor, which we'll talk about. In our conversation, we discuss why entrepreneurs need a support system around them. How culture is really built in startup companies, identifying good startup team members, why everyone needs to be a salesperson, working with advisors, the balance between being flexible, and holding true to what you believe in the direction that you think the company needs to go in, and what Promax does, and why the technology is a game changer. Here's our conversation. Amit, thanks so much for joining us today.
Amit Vohra 02:25
So thank you for inviting me on the podcast.
Patrick Kothe 02:28
So your career path, I find it to be really pretty unique, kind of starting with your education. I see that you earned a mechanical engineering degree from the University of Florida, but you also earned a doctorate in philosophy not not a lot of us have that. Uh, can you briefly explain kind of your career progression? And, and kind of what, what's interested you through the years?
Amit Vohra 02:53
No, absolutely. I'm an engineer by training, like you saw, I did a doctorate actually in mechanical engineering. But most of my work was focused on biomed. And on the med tech side, and actually, this was 2001 when I started. So there was this big anthrax scare that happened. So a lot of my project focused on looking at indoor air disinfection. The project was funded by US Army and DOD at that point, to look at new applications that you could come out with, to counter indoor air contamination and stuff. So it was pretty fascinating, expose me to things that I wasn't sure I could do as a mechanical engineer. And then even during my PhD defense, a lot of the conversations were about how do you justify this being something related to engineering, because it was so different. But you know, what it allowed me to do is I completed my doctorate and then ended up working as a scientist for a couple of years, and then got into the startup world in early 2008, became an entrepreneur, thanks a lot due to my wife would push me into that pathway to some extent, and then over the years, been fortunate to have had products that are being used on patients and having commercialized technologies as well.
Patrick Kothe 04:09
So the types of technologies that you've been working with in the past, what have they been,
Amit Vohra 04:14
the first thing I worked on as an entrepreneur was an imaging product where we were mapping MRI onto ultrasound, and then using a semi robotic device to buy prostate biopsies. So what that would allow us to do is use the high sensitivity and specificity of MRI, but then bring it into a more affordable imaging modality like ultrasound, and use that to perform more targeted interventions like biopsies. So we launched this product into the nine 2010 timeframe. And we beat Philips to the market who was also working on a competitive technology called your on app. And this somehow became the standard of care over the last 10 to 12 years. So it was exciting to be part of that. up, our company grew to over 300 million in enterprise value, I was second in command there. And then, you know, we use Hitachi Aloka were brought in as a partner to commercialize the product in the US market, after that company, you know, started another startup, which was looking at kidneys and prostate cancers and looking at Laser Ablation as a treatment modality. And again, using multiple imaging sources to see if we could do more targeted treatment. So that was an interesting project as well. And then after that, took a break was working on my executive MBA review, and was advising high intensity focus on some company called Sona blade, and then was doing some consulting work for Philips as well. And then I chanced upon the underlying technology for our current startup Promax. So, which is a single sided low field, MRI, was funded by NIH and NSF. At that point, when I saw it in North Carolina at a biotech center event, we wanted to always position it as a platform platform in outpatient setting to guide interventions not purely as an imaging play. So that's been pretty exciting. We received a clearance last year starting to generate revenues, we've already done over 7 million in sales well, so it's been an exciting last seven months or so.
Patrick Kothe 06:20
We're gonna get pretty deep into Promax in a couple minutes. But let me kind of ask about imaging, it seems like imaging is something that you've been involved with, for a great part of your career. Why is that? What's what's drawn you to it?
Amit Vohra 06:37
I think it's not been like a specific reason why I came into imaging as I got into devices and got into medicine, a lot of it was dependent on providing more data driven medicine. And imaging enables that by providing image guided procedures rather than blinded procedures, how a lot of the procedures were being done till about a decade or two decades ago. And then what then it enables you to do is can you make this imaging more accessible, and can you bring it on make it more flexible and adaptable that physicians can use it in the setting that they're doing procedures. So a lot of the focus has been on imaging, but making imaging as a navigation source or a guidance source rather than pure imaging.
Patrick Kothe 07:20
Got it. So a little bit more on the interventional side, as opposed to the diagnostic side, many of us find our way into into the device field and different in different ways, whether it's relative who has a has an issue or an interest in that or want to be a physician first, or, you know, a lot of different ways, what brought you into into the device field.
Amit Vohra 07:44
You know, I mean, all of us have had, like personal experiences, whether you look at, you know, we're working with prostate cancer, you know, our families have been afflicted, my granddad had prostate issues. But that wasn't the only reason I think what fascinated me about the industry was more about that you could impact patient lives directly. You could also see everybody around you, where this thing could be utilized. And something that really makes an impact beyond making money and generating profits. So I think that's still our end goal. When we develop products, we want them to be utilized on patients, we want them to make an impact in the management of the disease. And then once you can do that, in some ways, I think, you know, there's, of course, these personal stories that each one of us has, where we can correlate to it and see how this is going to make an impact to our family members, or our friends and relatives as well. But for me, it was more like, you know, getting exposed to it during my doctorate days. And then once I got exposed to it, then it was all about seeing you know how we could work more on it. Also, I would like to say, the family around me, especially my wife's family had always been in pharmaceuticals and biotech products and everything. So there was that drive as well to start doing something in that space. And I was fortunate enough to have opportunities available to me in the device sector where some really innovative work was happening as well.
Patrick Kothe 09:11
So you mentioned that your wife was a driver and moving you into the entrepreneurial space. How many years did you work? Not as an entrepreneur within a company before you moved into being an entrepreneur?
Amit Vohra 09:26
Yes. I mean, for about slightly over two years, I was a scientist at the L key which is a large industrial medical gas company, global company. So and then I moved into a startup in early 2008. And I started dating my wife, like about a year prior to that. So you know, as we started working together and talking about stuff together, you know, was always this drive to do something on our own and having moved into a startup and then seeing how these things could play out. By idea was why don't we do something on our own. And she coming from an entrepreneurial family on our own, always knew that journey and that pathway. So once she exposed me to it, and I had my own personal experiences around it, I think the natural drive was, hey, why don't we do something that can really create a product that can make impact. And everything tends to work together, I would never say like, startups are easy or anything, it's you always need support around you. We always need to have the right kind of support system that protects you as well, while you're doing all these things. So I think that was also very important having her and having her gone through this process with a family knowing the whole process that helped me as well.
Patrick Kothe 10:47
I think the other thing is, being an entrepreneur is not an easy path. Not everybody is successful all the time you have issues or cashflow things, there's stress, there's all kinds of different things that that you're going to run to run into as an entrepreneur. I can empathize with your experiences, as well as my experiences as an entrepreneur, unless you've got a spouse that is fully bought in to the entrepreneurial journey. You could have some some problems, because it's not a paycheck. Every week, it's not the, you know, the benefits. It's not the you know, the career path that all goes it's, it's it's a little messy sometimes. So having that spouse I think is one of the most important things in being an entrepreneur is is to have that, that spouse and understands that and that buys into that. Does that kind of your experience as well?
Amit Vohra 11:47
You're absolutely correct. I mean, like, it's, it's not easy being an entrepreneur, for sure. So you need somebody around you completely believes in it, and believes in it, sometimes more than you, right. So because you will have days of crests and troughs, and you need to be stable and have somebody who's around you somewhat, you know, staying the course as well. So made Assad easy. That's why most of the people prefer going the stable route, the, you know, the route that allows them to have a paycheck every couple of weeks or every month, this motivate as well, I think it's not just like the stability that provides somebody but also to be able to work through the ups and downs that happened in that journey as well. So to be able to kind of work through it, of course, you're gonna have success someday, but there's so many failures that happen along the way as well, and be able to persevere through it, you absolutely need the support system. And that's where, you know, having a supportive spouse or somebody who knows that journey more than you do, or along with you on that journey is absolutely paramount.
Patrick Kothe 12:52
So you've been an entrepreneur since what you said 2008?
Amit Vohra 12:55
Pretty much yeah, to go the nine for sure. 2009.
Patrick Kothe 12:59
And you've built different teams. So let's let's talk about that for a second. Because we were talking about it from our own standpoint, and you know, making the making the move to be become an entrepreneur, but you're building teams, and building teams, of other people that are walking into startup companies is also different. Because now you're you're bringing people in and you've got responsibility, but they're taking risks, risks, as well. Let's discuss a little bit about the type of people that that you select to be part of the team. And what what what do they have going for them? Or what are you looking for in them to know that they're going to be a good fit for a startup culture?
Amit Vohra 13:45
Yeah, I mean, we're fortunate that we are in San Francisco and Silicon Valley and everything. So there's a lot of people who get exposed to startups very early in their careers. So it does help them. But going, taking a step back and looking at who do you want in your leadership team. And then who do you want in your rest of the team. You want people who can provide complementary skill sets to you and your leadership team. You don't want people who are going to be listening just to you. I mean, you could have a great vision and everything, but you need people who can execute on that vision. So diversity of opinion is great. Also people with skill sets that you don't own yourself, potentially you don't want to be the smartest person in the room, because that's not going to be a good starting point, the end point. Also people who come into your startup, whether in the leadership position or any other role, need to believe in the startup itself, and need to believe in the vision as much as you do, and need to believe in the product and the impact it can make that you're building. Once you have that people do self select themselves from the startup culture. It's a lot harder at times there are days when you're putting in a lot more hours, but also the reward is there as well. So if you're able to succeed, those people that you bring in the first reading first 50 should also be able to get the reward for all the hard work they put out. So if you can provide that, I think you do find people who, like I said earlier, self select themselves to a start up culture, and are able to see that and go, and then able to execute and get there, whichever way, whether it takes 12 hours of work today, or whether it takes three days of preparing for, you know, either a regulatory clearance, or whatever it might end up being. I think that's important. And we've been fortunate over the years, having built multiple teams, we've seen people who, who have been, like, amazing at what they do, and, and some of them stick together like this couple of people who I've worked with across multiple startups. And then, you know, once you believe in somebody, and you know, that they can execute, and they believe in you, then yeah, you can, you can do good things together.
Patrick Kothe 15:57
And the first startup scenarios that I've been part of, I really didn't spend a lot of time consciously building culture. What what's your experience been? In terms of, have you consciously started early on to say, hey, I want to build a culture this way? And, or have you just kind of let it evolve through?
Amit Vohra 16:20
Yeah, that's a very, very good point, I think a startup culture or a specific culture that you want within your entity is important. But what we've seen in my career, what I've seen is, you can impose your culture on the first 20, maybe up to 50 people, but then it starts becoming very hard to do that, after that. And after that, you know, people have to buy into a certain, you know, ecosystem or a certain, you know, belief that exists within that company. And, you know, we go to MBAs and we get taught all this, in a way, you know, we're building this cult, when you go to an MBA and those cards, I mean, could have positive negative connotations, and could work either way, but you're putting everybody together into this specific belief and working towards it. I think what we've done is like, because we know the first 10, or 20, folks that we bring in, we can work together, you know, you can build that camaraderie between them when they're more like friends and family rather than just coworkers. And that seems to work very well up to a certain point. After that, again, you know, the culture can be imposed. And you need to have like these leaders at various positions, and you know, this conversation about different definitions of leaders and our servant leaders and all that. I don't know how much can you impose the on a certain point, I think it becomes hard. But up to a certain point, yes, it does make sense that you have people who believe in the overall vision, and then they are with you, and you're with them, more like friends and family.
Patrick Kothe 17:53
And those initial hires are just so important. Because if you want, as you said, there's the people in your organization, you may be able to influence the culture on on the first, you know, first line management in the second line management, but then the people that you're bringing in their first line, their second line, they have to be taking on the leadership role and the culture role as well. So those first initial hires are just so important, that they reinforce what you want that culture to be
Amit Vohra 18:26
the absolutely, right, I mean, you can have a top line management that absolutely believes that you could even have your managers below that, who believe in it. But to have that keeps resonating and having leaders at every, you know, every step along the organization's org chart is critical. And they should all be working towards a common goal. That's another important thing. You need to have a cohesive vision and a common goal. And people need to have some measurable tasks around those common goals. So as long as they believe in it, and they're able to execute on it, and they see progress for themselves as well for the company. I think that culture seems to propagate or tends to propagate a lot easier than when you have people running in opposite directions, trying to do their own thing, even though they might be working very hard. It's just not getting to where you want to go.
Patrick Kothe 19:20
And entrepreneurship is an interesting word. And it can be a very trendy word. In different areas of the country. As you said, you're out in the bay area. It's a very common thing to be to be an entrepreneur in other areas. It's not as as common. But it's it as I said, it becomes a very trendy thing. And I get a lot of people that come to me in a startup and say, Hey, I you know, I'm graduating college, I want to I want to be in the startup world. I want to be an entrepreneur, and I am torn there. Because I came up I worked for the big companies before I did that I learned how to attend a meeting to be a team mate to do goals and objectives to talk to customers, I got training on this. But if you come directly into the entrepreneurial world from a degree, you're missing that. So you're, you're building it on the fly, so to speak. That's my experience. And and I will generally tell somebody, Hey, you know, spend a couple of years in a larger company and get, you know, find out a little bit about what work is like and get some good habits and some good training before you jump into that. What's your experience? And and you're in a different culture out there in San Francisco. What's your experience with that?
Amit Vohra 20:45
Well, I think that's a, that's a very good point you're making but I look at it slightly differently. I think the bigger concern I have is, the programs that they're going into further undergrad are not preparing them to be an entrepreneur at all. So and there aren't many programs in this country that can prepare you to be an entrepreneur, even though they might try. So an easier thing is for these, you know, we were having a conversation, there were like four of us entrepreneurs having a conversation with some teenagers, actually, last Sunday, where all these questions were being posed, what should we do, you know, these are seniors, juniors in high school, and they're entering college. So I think the biggest way to learn anything is to get exposed to as many groups as you can, and as an undergraduate setting, see if he can work with people on an entrepreneurial project. And then even if you fail, if you've started something, it's I mean, the burden is not as much because you're still young enough, you're gonna learn through the process, and you have the chance to do that. Now, I think it depends on the company you go to and work for, I wouldn't say every company will train you or even prepare you to be an entrepreneur, you might work in opposite, it might work oppositely for you. So I wouldn't say like just having that experience out. But they need to have some experience that has exposed them to an entrepreneurial culture, whether it's through groups and you know, associations and organizations in the undergraduate framework, or having tried to do something, right, during a senior year, maybe your senior year project is something you want to see if you can pitch to somebody and see what gets out. Also, another important thing is, and you know, this, and I know this and all entrepreneurs know, this is not only about how great your product is question is, can you sell your product, you need to be a salesperson, and that's something you can learn, you can learn along your growth of being a student or, or even like an employee or a company, can you learn how to sell your projects to your counterparts or to your boss, or to your executive team? If you can do that, I think you've probably learned how to create a nice pitch deck that you can then send to investors. And a few things you can always learn is listening to the customers and, and listening, how much do you want to listen, and you know what points you want to take from your customers. So when we think about it, I mean, I've not been to Stanford, but I know people will be into Stanford Biodesign, where all these, you know, students have kids in college are exposed to a clinical setting where they're brought into it, and they're told, Hey, view some procedures and see what's going wrong there. And maybe that can expose you to creating a solution that's out of the box. So you do want that, if you can get to that kind of exposure early enough in your career, I think it does help you to prepare yourself. And one thing I also want to stress upon is you want people to not be in the safe zone all the time and their comfort zone all the time. They need to be thrown out of it somehow, for at least six months or two semesters or a term where they're told to do something where something is contingent upon doing that. And if they're able to do that, that's a good learning experience to be an entrepreneur if they really wanted to be that otherwise, yeah, it's and we all boats here. And all of us see, and people do create companies, but they don't stick with it. They give up on it pretty easily as well, because it's not easy to continue to get rejected by the investor community.
Patrick Kothe 24:20
Commitment is a double edged sword to I'm committed to that idea. I'm so committed to that idea that I'm going to stay with it beyond the point of time where I should have given up on it. So that's, that's always a fun thing to try and look back at and I've had that happen to me, where I had a director on my board say, hey, Pat, you know, do I do I need to take you out and take you out of your Medus misery here. You've tried everything and it's not working? Is it time for me to help you make that transition? Because we're all so invested in our ideas and sometimes they just don't work.
Amit Vohra 24:59
Yeah, that's where you need people around you who are going to give you not a group thing, you know, mentality. You need people around you either on your advisory board or on your board of directors or even in your management team or your employees. We're not feeding you, what do you want to hear? If, if it's not working, and the customers are not being receptive, you either need to pivot, which is probably the best way to do it. Because when I talk to investors and our friends who are investors, and we ourselves, like both my spouse and I, my wife and I have been investors, and our investors, we believe in people, not as much and at the end of the day, and I mean, of course, we believe in technologies and certain innovative stuff, but the team is the most critical, what are they willing to pay? What are they willing to move to get to an end product, or a product that could be used for the customers, I think those are critical, you can be that bias towards your own idea that you're just going after it, whether the market is giving you any traction or not. I mean, that's happened to all of us, like, I don't think any company that started with an idea ends up five years or 10 years out with the same concept they had five years ago, that doesn't happen, never happens. And if you are still trying to do that two years into an equation where you haven't raised anything, and you're not moving anywhere, you better either shut it down, or, or do something else.
Patrick Kothe 26:29
So you've seen things, this ability to be coachable, you've seen it from the entrepreneurs standpoint, and also from the investor standpoint. And that's a critical place. Because sometimes you get investors who say here, this is the idea, this is my idea, you should implement it. And as an entrepreneur, you've got to keep your your hand on the tiller to say, you know, this is not the direction that we're going in, I have the most knowledge in this space, and I appreciate the input. But this is the direction we need to go. That can be seen by an investor as being somebody who's not coachable. And that's not necessarily the case. So talk to me a little bit about that type of a situation, both from the entrepreneur standpoint, and from the investor standpoint, because it sounds like the ability to be coachable and learn things and pivot is something that you're looking at as being an important thing from an investor standpoint.
Amit Vohra 27:33
Yeah, no, I think it's a very, very good point you're bringing up right, it's, we need to have like common goals at the end of the day, whether it's, you know, you're pivoting to an end goal that leads leads you to an inflection point, that is understandable to both the entrepreneur as well as the investor. So a classic example could be what's happening in the current scenarios right now, where people are being told to cut down costs and let go of people and, and do this and do that. I mean, there are various ways you can do it, right? Doesn't mean you have to let go of the most important people you have, just because your board wants you to let go 40% or 50% of your staff, you know, you can cut down on certain things. But still, what you can come back with is, hey, let me go the way I'm going. And I'm able to execute on this and show you this in three months or six months. And that's the negotiation that you need to play. So it's not just pivoting for the sake of pivoting and completely giving up on your passion and your vision. It's within your vision, creating a product that will get to market a lot faster, even though it might not have the bells and whistles every bell and whistle you want it. But then from there on, once you reach that standpoint, you know that you've executed the investors have seen and, you know, your next group of investors have seen that he could, you know, do something which made sense to everyone. I don't think there's any board where you don't have these kinds of discussions. But I mean, you know, you need a board that kind of forces you to think outside the box as well, and allows you to, but they should also come up with some constructive work, not just for the sake of it, say, hey, like how you said, Let's not do this at all, that's not going to help anyone. So I think there is a thin line between right also there is a thin line between being confident and being arrogant. So you know, you need to know that thin line and you need people who can kind of keep you keep you honest. So that's why it's so important to be surrounded by people who are not only thinking about you are not only thinking about themselves, but thinking on a global level, how this could impact, you know, the overall company's goals. So I think it's, it's a good point, it's just depends on the independent situation, how you can handle the people around you, and sometimes you just don't have an option. So at that point, I think it's, you know, there's no real good way of dealing with things but more often than not, you should be able to We'll deal with it way before it ends that leads to that, you know, final step.
Patrick Kothe 30:07
I think what you described was being a humble leader, being confident, but also being humble enough to know that there's opinions out there that you should consider. And you should thoughtfully consider them, you can still make the decision that you feel was the right way, right one in the first place. But being humble enough to know that, hey, maybe I don't know everything. The people that I've brought in to support me are going to challenge me. And it just allows me to think through the scenarios a little bit differently.
Amit Vohra 30:43
Yeah, I mean, you're correct, you're absolutely correct. It's also good to talk to other entrepreneurs around you, because they are facing similar challenges. So if you're able to talk to them in your industry, maybe outside your industry, and they're facing similar challenges, then you can kind of also brainstorm or coming up with certain solutions, like this whole economic situation, and the COVID times and everything, we've all had challenges. And companies have spoken to each other. I mean, you need a group of advisors, which could be on your, on your deck or not on your dime. And you can still talk to them. And, you know, they give you honest advice on how these things could play out. And nobody has a crystal ball at the end of the day. So it's not like they can tell you, Hey, this is how this is gonna play out. They could be the biggest banker in the world, or they could be the most famous entrepreneur routes down multiple exits, everything is unique, and everything is different. So but at the end of the day, if you can get those data points, then you probably can make a slightly more educated decision than just listening to either two people on your board or just going, you know, this is how I feel that I'm going to do it.
Patrick Kothe 31:52
The word mentorship is something that people use a lot. And I look at it as some people describe it, as I've got one or two mentors that are the Oracles that I go to and think and talk through things. The other way to look at it is that there's a number of different people that I go to and keep in touch with that I talked to, and bounce ideas off of to help me manage through situations and manage manage through my career as well. How do you view mentorship?
Amit Vohra 32:22
Yes, I mean, I have a few people around me I talk to a lot like I mean, unfortunately, my wife is an entrepreneur as well. And we talk a lot and, and that helps us at least have the first line of discussion, then I also have my team that's worked across with me or with me across multiple startups. And I trust them a fair bit. So I do have conversations with them as well. But then, you know, I don't stop at that circle itself. You know, how I would look at it is, is talking to a lot of our network beyond us, depending on the situations where so not everything has the same vintage, as you know, the earlier people I mentioned, I would of course, give it more weight, age or entire team on board. Of course, I've worked with them for years and years. And before that, of course, my own wife and my own family, I would give a lot of ways to all of those things before I go to the other people, but then there are these advisors who are either on our cap table or beyond our cap table, that kid might have had an experience that is very similar to ours in their careers, or they might have something to say which we haven't thought of. So I think it's good to talk to those people if there's a very unique, you know, challenge that you're facing. And then it gives you an idea, then I'll give you an example of our own. You know, we were working with FDA and we'd send our product to FDA as a submission and FDA came back first time around and said no, you know, we need to sit with you and talk this is not going to work the way you think it's going to work on the clearance site. Now there's different ways you could react to that right I mean, you could try to formulate a plan which we have to the first thing was go back to each one of our key critical investors and tell them Hey guys, this is going to take a lot longer than what you thought you know, it's not gonna get cleared next month. But more importantly also not just wait on that and because some of these news don't get better with time you need to have that conversation early enough and you need to have a plan from there on as well. You can't just say hey, oh man, this happened What do I do? No, we we came back with a plan and we said this is what we're gonna do and this is how this thing is gonna play out and then we will go talk to more people and come up with a plan and then we go back and said, will there be it work in that so in a way, you know, getting a buy in from your own industry base, your own team, and then also getting the support from everybody around you. I still remember when that happened. You know, my my wife was supporting me and then my friends were supporting me and then from there on, like, you know, our board supported us and Everything happened in a way where, you know, the communication channels were not blocked in any way. And there was like a lot of good communication happening and, and then we came up with a plan that we executed upon. So it's a way that seems to work relatively okay for most people in most situations, if you can communicate and not try to, you know, hide information or try to assume that things will or will not work out, because I think more data and more time tends to lead to better educated decisions.
Patrick Kothe 35:33
So let's, let's talk about Promag. So and what you're what you're doing there, you mentioned early on that it's, it's a Mr. Technology, explain to, to us what exactly the technology is all about, and what the product is all about.
Amit Vohra 35:50
So what we're doing at promap. So is we have a compact, single sided, low field MRI that can be placed in an office or outpatient setting. And we're using it currently for prostate interventions. So what that means is you're doing prostate biopsies and treatment of prostate cancer in outpatient office using the server, we also have a couple of other products in pipeline, we have our own Mr. Compatible robot that will building as well, that allows us to do robotic interventions. And then we are doing a fair bit of work on artificial intelligence that allows us to go into tissue characterization, Computer Aided diagnostics and adaptive treatment planning someday, as well. So the main goal is now that we have this small, compact scanner, we can make it adaptable, we can make it flexible to do procedures, and the physicians can now use it and in their office on their ASCs. And they can still build for it. But more importantly, they can provide faster and better care to patients. Under image guided procedures,
Patrick Kothe 36:57
we've got an audio medium here. So let's try and get get people to get a good mental picture of what's going on here. The old MRIs, whatever it was used to is a great big wall with a hole in it. And you go inside that hole. And and and there's imaging that occurs, magnetic resonance imaging that occurs inside that, that room that wall that that you're going in. I've had it before many people have had it before. I didn't know that I was claustrophobic until I went inside of that thing. If you could explain what how your product is different, and and visually explain what it looks like. Oh, absolutely.
Amit Vohra 37:42
I mean, that's the most important point, right. So when you look at conventional MRIs, and you think of conventional MRI, you're talking about a 50,000 pound system, you have the whole room and infrastructure built around it, you know, you go into this big uniform bore. And the idea to go inside it is because magnetic fields by nature are non uniform and nonlinear. So what Mr. Companies do in the conventional sense is they build these big boards to have a uniform field in there, that allows you to have a nice image because the mathematics to solve that equation is a linear Fourier equation, and you're able to solve it and get a nice pretty image, it allows you to see what's wrong. For the specific body part or anatomy that you're looking at. What we're doing is is very different. We're actually if a conventional MRI is 1.5 Tesla three Tesla field strength, our field strength is about 65 millimeters. So it's almost, you know, like 100 times, lower fields, or 50 times lower fields, and then commercial MRIs. So we're able to make it a lot more compact. So we required more shielding in the room, we can go through a regular elevator, see if you can think of visualizing a four feet by 30 inches by 20 inches, you know, some kind of a cuboid. That's how big it is. But also you don't go inside our MRI, we're doing single sided imaging, so you lie down next to it or you sit next to it to image and we image from the face of the magnet. So more like it's not like X ray in its imaging, modality sense, but from form factors. And just like how an x ray is brought next to you, and you create an image of your bones, were able to get the patient next to this MRI and we project animals six inches long or longer with the gradient and we're able to get that. So it's a compact limited field of use. We only use it for the body part that we are imaging. But what it also allows you to do by keeping patient on one side of the scanner, there's no claustrophobia. There's no loud knocking noises because it's very low field. And then we can bring a robot from the other side as well. Because it's low field. It's compatible with robotics, and it's easier to do procedures under it as well which are almost impossible to do with Conventional MRIs, because one thing is putting a patient into that claustrophobic board. The second thing is, how do you put tools, it's almost impossible to bring tools into that equation as well. So I think a lot of it is about removing operational constraints of a conventional Mr by bringing this compact small MRI, and then we can put it in a 10 foot by 10 foot office by just plugging it into 230 volts, we don't really need anything. So the whole installation process for a provider or a practice is within half a day, rather than taking months to build the whole infrastructure around getting an MRI. So I think making that flexibility and making that ergonomic ease of use for the end user, who in this case for us, as your audiologist and radiation oncologist right now also creates a big value proposition which is unique to us as well.
Patrick Kothe 40:51
Right Is it a portable situation is on a cart, so to speak,
Amit Vohra 40:56
it is on a board and it has wheels, but we are careful about calling it absolutely portable, because it's an MRI. So, you have to be somewhat careful, especially with people who have pacemakers or you know, they have maybe hearing aids that could be magnetically activated or deactivated. So, we want to be able to control the movement word, but it is on wheels, and it can be moved around if needed. But within a room or in an ESC or a wall, we can move the system around wherever we want.
Patrick Kothe 41:23
So a conventional M, Mr. Machine is strictly for imaging strictly for obtaining information to diagnose something, your system will do that, as well as be used for interventions. Talk about that a little bit.
Amit Vohra 41:44
Yeah, exactly. I mean, at the National MRI can be used for interventions is just a very convoluted and complicated procedure. And it's just hard to do. So people have tried it, and people still do it. But it's not done on a mass scale or anything which ever will be adopted by your community. So what we're allowing them to do is do that. So yes, we can image like a conventional MRI can but our image is different than what a conventional MRI will look like. Because you're looking at a localized field of view right now. So let's say if you're looking at the prostate, we're just looking at the prostate and the surrounding tissue, when a conventional MRI could do a whole abdominal scan or a whole body scan. So that's one big difference where we're not competing with them as such. But what we are able to do is we can now do a prostate biopsy directly under RMR. We can also do treatments that are RMR. And we can also do some confirmation scans just imaging itself post procedures using our MRI as well. So in a way, what we are trying to do is make an MRI as a live intraoperative tool as well, which is currently not available with the vessel scans.
Patrick Kothe 42:52
With conventional scanners, basically scan the body you could do at any part of the body. You are honing in on prostate at this point. Why? Why go after one specific spot? Why why is it different than a traditional MRI scan? Where where it could be utilized in all parts of the body?
Amit Vohra 43:14
No, I think we can go out to different body parts as well. So that's a good point. The reason why we went with prostate is such lowfield to do imaging of prostate has never been done before. So I think it was hard to go to fda when we first went to FDA, you like okay, we can do different body parts. But FDA was like start with something right. So we started with prostate, we see a big need here. I think the current pathway for doing ultrasound guided post high PSA does not seem to work. We know that. So we know the challenges in the current prostate cancer management pathway. So it fits in well there. But we're already looking at the MRI to go beyond prostate. We're looking at female urology OBGYN indications. We will be looking at breast oncology. We also want to look at sports medicine. So it's for us an incremental process because we're doing something very innovative. It low field. So the burden of proof for FDA as well as for us. There's a lot
Patrick Kothe 44:17
that's interesting, because FDA probably wouldn't go to I don't know who's making scanners he says GE or Philips and and say Hey, y'all, we want you to we want you to go after a body. One particular thing. Your technology is a little bit different. So you're getting some guidance to say look at one particular particular aspect. Yeah, I
Amit Vohra 44:38
mean, so we again, like you know, started out by looking at one as well because we wanted to focus on one where we can make the biggest impact. And, you know, urology and prostate seem like one. But as we talk about interventions and procedures. oncology is a big field. So if we can go after oncological interventions and prostate cancer being one or a variant or for that matter, you know, breast oncology indications, I think there is a lot you can do with the procedural side. And that's where our focus is right now. And also this way, we don't really truly compete with the traditional scanners, either they can do what they're doing, we are bringing procedures to them that they never had access to earlier.
Patrick Kothe 45:24
So with the prostate, what's the current situation? What's the current technology do and what is yours do differently?
Amit Vohra 45:33
Yeah, so the current pathway of looking at prostate cancer is today, you know, you have PSA, which is a biomarker, I PSA mandates, a prostate biopsy. Now this is either done transparently using an ultrasound, where a trans rectal probe is inserted of the rectum and you shoot well, needles, you're looking at a 2d image, so it's somewhat blinded. So more often than not, after a high PSA, your yield of prostate cancer on our axon guided biopsy is going to be less than 50%. So more often than not, people go through multiple rounds of very invasive procedures, which are, you know, these transcriptional procedures, you're shooting needles of the rectum, and you're not really finding cancer. So what we had done 10 years ago, 12 years ago was create MRI or some fusion, which was you take an MRI, you can go to destroy it, map it onto an ultrasound, and then use a device to potentially look at both. Because you have an annotated, previously annotated MRI that shows something suspicious, you're now putting it on top for live ultrasound, and then you're using the ultrasound using a fusion device to guide biopsies or procedures. It seems to work, okay. And this is what became somewhat the standard of care over the last 10 years, the problem still exists, you're still using a transcript a lot sound. So you don't have additional reimbursement, you're still moving the class moving this transfer control. So you're losing all co registration. And it's still a very, very invasive procedure that patients don't like. So you know, the idea was, can we bring an MRI directly into a practice. And if we could do that, we could just do everything under them, or we don't have to bring the ultrasound into the equation at all. We could still use a conventional MRI, I feel, get that information one time. But then from there on, we could guide the whole patient management pathway on a rock scan, whether it's doing an image guiding a biopsy, post biopsy, guiding a treatment, post treatment, managing the patient as well. So that was where it absolutely revolutionizes how prostate cancer is going to be managed with any kind of cancer for that matter in outpatient setting. So we got a lot of tailwinds. The payers like it, because they don't like class rectal procedures, it causes infections called hospitalization. They don't like you know, somebody going through multiple rounds of biopsies is lot of cost associated with it. And they don't like anything being done in hospital setting, if it could be done in outpatient or office. Absolutely perfect. So by doing all of those, but still creating revenue streams for physicians, where they can serve well, for this, while helping patients so much, I think, you know, we touch every stakeholder in that equation. So that's why we started with this as our beachhead market. And then of course, there are markets which go beyond this as well. Let's test on quality and, and potentially even like some sports medicine applications and practice settings. So we're excited, it's a big enough market for us that we can start here and create a nice value proposition and then we can start looking at other indications.
Patrick Kothe 48:36
X ray, you take an x ray, it's a picture you do fluoro, and it's a moving picture. The ultrasound can be a moving picture, is your system a picture? Or is it a movie,
Amit Vohra 48:48
so we create a full 3d image, not just a single 2d picture, right? somewhat of a challenge with MRIs or the temporal resolution is not as high as let's say you would have with without some x ray doesn't have it that is either. So you know, with with ultrasound, you're always like, you're always 2d, you never have 3d image. So with MRI, you have a 3d you know, with this, you take every slice, but then it takes slightly longer, it takes a couple of minutes, the minutes to get the whole 3d model. So what we are able to do is once we reconstruct the full 3d image, we can do image to image coregistration by doing it pretty fast. So we know if something has moved on anything and that creates a pretty life interoperated scan. You know, real time is a misnomer. What does real time mean? Is it milliseconds is it seconds is it minutes, but what it does allow you to do is have a live 3d imaging modality available to you that you could use and that's what you know, doesn't exist without the sound even though it can give you a booty live image and doesn't exist with floral pressure.
Patrick Kothe 49:52
So where did the idea come from?
Amit Vohra 49:54
It came out of a incubator in Maryland. The couple of inventors or CTO is one of them. The other inventor is a radiologist and physicist, Erwin Weinberg, who came up with this idea of a low field, you know, portable scanner. But over the last 10 to 20 years, there's been a resurgence in low field scanners, because of the availability of technology to process a lot more data. And to be able to also solve nonlinear equations, which is what we're doing. Like I mentioned earlier, we don't really do it how conventional MRI is to was uniform linear scans, were able to deal with nonlinear equations, by leveraging what crypto industry does and gaming industry does by taking everything on two GPUs and processing a lot more data. And having an image that could be corrected for measurements and artificial intelligence that will take on RFG P zero, b one maps. So there's a lot of technology that goes into doing what we're doing. And there's a lot of intellectual property around it as well. But you know why it's feasible today and not maybe 20 years ago, is also because of the computing power available on GPUs.
Patrick Kothe 51:02
Some development projects are quite complex, some of them are pretty straightforward. And if you have the idea, and you kind of move it through, but others have a lot of learning and a lot of issues that come up during development, how would you describe your development process in terms of, of bringing the technology from where you started to a finished product,
Amit Vohra 51:29
I mean, it's one of the most challenging r&d projects that have been other ever undertaken to do a single sided low field, MRI that nobody has tried before. And then also do create a hole in the middle, right, where your imaging to bring your robot through. People laughed at us that six years ago, when they said it's not even feasible. But you know, the physics was there, but it's so hard to execute on doing something like this. So it took like months and months and years and years of r&d, before this came into functional prototype, and then to go through FDA and do all the validation tests and use it on humans and get the clinical studies going. And that to see data that it's, it's bypassing and surpassing or surpassing the standard of care and getting higher yields. And cancer reduction is absolutely astonishing, for even us because it's taken a long time to get to where it is, it's taken over 10 years of research to get to a product that works in humans. And so when people ask us, Hey, how Aren't you scared, people are going to copy this, I mean, innovation will always get copied, and people will keep improving upon it. But this is not an easy project to undertake. Even for the GES or the Philips of the world, we've been working on it for decades.
Patrick Kothe 52:49
When you have a when you're swinging for the homerun, this is this is certainly a homerun that you're swinging for at the beginning. There's so much that you don't know. But you're asking people to invest in a dream. What was that like early on, when you had the idea, but you didn't have the pathway? And you knew that there was going to be a lot of difficulties getting there?
Amit Vohra 53:12
Yeah, no, I think that's exactly we joke about it all the time. And we remember it when we were first raising capital in 2016. You know, we have a debt. And we had a very, very early prototype, which was nothing like how it's supposed to be. And we will be able to use that. I think there are some advantages, like having grant money in meant that NIH had done some due diligence. So at least, you know, what resonated with investors was that it's a very innovative technology. So that's one thing that people do like to invest in, because they are also going for a homerun or grand slam at that point. And at least that part is validated. And there was a lot of IP around it as well. But second thing, which was more important than all of that was to get early buy in from customers. So our early seed round was mostly funded by urologist, and radiologists and radiation oncologists who had known about us or who liked what this could do for them in their clinical setting and in their clinical workflow. So that part of it getting that validation was kind of a soft market validation for us. And that's how we were able to bring our seed round and which allowed us to get to some inflection point, which was getting an early prototype ready and doing something. The second thing was which when we went to Series A, we got a big corporate strategic on board very early MicroPort scientific cooperation from Asia. So getting their buy in on series A meant that there was a global impact this technology could create once you bring it to a product. So that was great to have, but then we did a fair bit of primary market research on our side as well and we invested we invested 150,000 and another 100 grand in showing that there is a willingness to purchase this car out from the market that we're going after. But then also, even ideas and pairs of sunk cost of owning MRIs were open to buying our system, because they could run procedures and outpatient, which is not what they could do. So once we got all these small steps, you know, you start creating a story. And then you know, the story starts having some meat to it. And, you know, and then you start executing on those different servers, then you get your first image and you start working on that image, then you start looking at how this could create everything. And you know, it's like, you know, everything is incremental, you have this big vision, and you're executing on small steps to get to that vision. And now that we've used this on patients, and we're selling this and everything, it's, it's getting close to being a reality.
Patrick Kothe 55:50
So you talked about pivots, and being open to learning things. 10 years ago, when you wrote the original business plan, or you had the original deck, and you did the financial projections, that everything, how different does it look today than what it looked like back then?
Amit Vohra 56:12
So I think, you know, that's a good question, right? It's always a good question. When you first create a business plan, you want to have an MRI, that could do all these things, and more. But, you know, when we went to FDA, we had to kind of temper our expectations into having, let's go with prostate first, right? Because early on, like what we talked about, you know, we wanted to go after every body part and have an MRI that could do a limited field of view of everybody. But as we went to FDA, as we looked at what we could do, you know, it was nice to at least start with one get your foot in the door. And then we ourselves could use, you know, Promax Yamaha as a predicate for the next indication. So I think you learn that along the way, and you pivot. So I wouldn't say it's like a major pivot. But you know, you don't try to keep going after the Grand Slam at that point, right. And you say, Okay, I'm gonna go with basic, this is a big base here, it's gonna allow me to load my bases, do everything I want to do. And then, you know, in a couple of years, we can go and expand that wherever we want. That was one big one. Also, the robot itself. You know, we wanted to build the whole thing together, and then we made the decision to do it sequentially, have them are out first, start getting data, start generating revenues, and have the robot come in right after. So I think there's always things that you design along the way and think along the way. And we hadn't even thought of doing everything on the artificial intelligence side, which is what we're doing today. So in some ways, it expanded the horizon of everything we could do. So I think there's some advantages to doing that. And I don't think looking back at 2016, or 2015, people are going to complain what we showed them to where we are today. But things of course, always pivot
Patrick Kothe 58:02
around. didn't meet your expectations.
Amit Vohra 58:07
So I'm super excited right now. I mean, the day that was used on patients for the first time, and we did biopsies, and then we got our biopsy results back and, and I can tell you on the first 36 patients that we did biopsy on, we found cancer and nine of them that transrectal ultrasound did not find even after we had found them, well, that's made. I know it's only you know, in statistics terms, you can say, oh, it's nine out of 36 last year, or beginning of this year, but what it is every patient life, you're impacting, you're impacting their entire families, and you're finding cancer, it's critical to be able to get to those, you know, small wins and helping patients because then you know, your product can do something. So I think that's what is the most exciting thing about it.
Patrick Kothe 58:56
So we started this conversation talking about entrepreneurship, and really appreciate hearing your story coming through Promax zone and and the flexibility that you have with the drive that that you had as well. If you're talking to somebody who's thinking about taking the entrepreneurial journey and going through it, what words of advice would you have for someone?
Amit Vohra 59:21
I mean, they've got to be perseverance. They gotta persevere. And they've got to have that trait from day one. But they also need to be realistic. Get as much input as you can upfront, learn as much as you can. I don't think anybody can learn being an entrepreneur. So you have to go through the process, and then have the right support structure around your family that believes in you friends that believe in you. And like everything we mentioned earlier, having that around you and having the right advisors around you and then believing in yourself and sticking with it.
Patrick Kothe 59:56
There is just so much to take away from this conversation. Ahmed is an experienced and very thoughtful person, which means that he not only recognizes when he has success, but more importantly, he understands the why behind his success, which makes it reproducible in the next venture. A few of my takeaways, first week, when we discuss setting culture, I thought it was really interesting that he talked about being able to influence the first 10 to 20 people. And then you have to rely on those managers to continue to either build and reinforce the culture that you're trying to build or not. It really depends on who that person is. So the importance of hiring the right people, we always talk about it, but specific to culture. If you don't have the right person that matches your values, the culture that you're trying to build in building the company is not going to happen. The second thing is, I really liked a very simple thing that he said, he said, cohesive vision, cohesive goals with accountability. Again, it's very simple thing to say, but it's very powerful, a cohesive vision, it takes time to really come to that cohesive vision. And then you have to have cohesive goals. And I think the key word in here is cohesive, because it needs to fit within your general company goals. And all of these things need to work and reinforce each other. And the last thing, accountability, we can never discount the importance of accountability. When we're building companies. The last thing that we discussed his support system. And the way he started off why he became an entrepreneur is he got good words of advice from his spouse about taking that jump. He moved into that and relied on his spouse for support throughout the journey, and he still does, but he also built his network of friends, other entrepreneurs, advisors, investors, board members, and the criteria that I was looking for there is people who will tell you that real truth, not what you want to hear. Thank you for listening. Make sure you get episodes downloaded your device automatically by liking or subscribing to the mastering medical device podcast wherever you get your podcasts. Also, please spread the word and tell a friend or two to listen to the mastering medical device podcast as interviews like today's can help you become a more effective medical device leader. Work hard. Be kind
