A Handheld X-Ray System: Interview with Evan Ruff and Gregory Kolovich, Co-Founders of OXOS Medical

OXOS Medical, a company derived from Georgia Tech medical technology, has created the Micro C, an FDA approved handheld X-ray system that is designed to image the distal extremities, from the shoulder to the hand and from the knee. up to the foot. The device is designed to prevent situations in which physicians have to manipulate and operate large machinery to take simple X-ray images of small bones in the extremities, and allows them to image directly at the point of care.

The device can be deployed during surgical procedures and allows surgeons to more easily capture images that might be difficult to obtain with large stationary equipment. The small size and portable nature of the system can also help increase access to medical images in remote and low-resource areas of the world.

OXOS reports that the device emits very low levels of radiation compared to traditional X-ray systems. This means that the Micro C can be used for dynamic digital radiography, which means it can produce ‘X-ray videos’, which allows physicians to perform guided injections or study moving bones.

Medgadget He had the opportunity to speak with OXOS Medical Co-Founders Evan Ruff, CEO, and Gregory Kolovich, Chief Medical Officer, about the technology.

Conn Hastings, Medgadget: Give us a quick overview of X-ray technology and how it has evolved since its inception.


Evan Ruff, OXOS Medical: X-rays are the first medical imaging modality dating back to Röntgen 1895. X-rays began to be used widely in medicine around World War I, with Marie Curie building a portable machine and taking diagnostic images in the fields of French battle. The digital C-arms and mini-C-arms seen in surgery today really started to evolve in the late 1990s, but then innovation stalled. Micro C is the first new radiographic imaging form factor in quite a few decades.

OXOS adopted technological advancements in other applications, such as advanced microcontrollers, computer vision, and sensor technologies. These technologies have enabled us to make fundamental advancements in the way we generate X-rays and in the size, weight, and security systems that enable the device to be deployed in so many different care settings.

Medgadget: What inspired you to develop a point-of-care x-ray system?


Gregory Kolovich, OXOS Medical: My inspiration for the Micro C really started while I was doing a pop-up replanting procedure at Mass General during my fellowship at Harvard. He was operating alone, trying to stabilize the anatomy as he struggled with this gigantic machine. My concentration is on my hand, so deploying an 800-pound device to image these small, intricate bones seemed counterintuitive. I have a background in electrical engineering so I started researching x-ray machines and components and felt there had to be a better way. That’s what led me to design the Micro C.

When we began to solve the regulatory, energy and safety challenges posed by the distal limb problem, we discovered that OXOS could apply those solutions to general radiography as well. With two-thirds of the world without access to medical imaging, OXOS has the opportunity to open up access to these life-saving technologies, changing the way we deliver healthcare around the world. As a surgeon, it is incredibly exciting.

Medgadget: What challenges did you encounter when developing a miniaturized X-ray system?

Evan Ruff: Oh yeah well … quite a few [hysterical laughing]. So there is a whole set of technical challenges around generating so much power in such a small space. The problem is how you generate a 60,000 volt pulse in someone’s hand and then manage to get all that heat out of there. Besides the highly volatile electrical pulses, there is radiation everywhere, so how do you protect the emission without the thing weighing 400 pounds? Those were tough, but then you have all the security and regulatory issues.

Essentially, you have built an ionizing radiation gun and you don’t want people to accidentally emit radiation everywhere. The challenge then is how do we ensure that the emission is safe and that the energy is used to create clinically relevant images. That’s when we came up with the idea for the positioning system. The positioning system is the core intellectual property of OXOS and describes how to ensure that the user can only emit radiation when the device is in a safe orientation. We do these calculations in less than a millisecond, allowing us to obtain live X-ray images, making the fluoroscopic approach obsolete.

Once OXOS tested the system with sub-millimeter precision, we began to develop the concept. What other safety and quality systems can we create with all this positioning information? This is how our team came up with the AI-powered, sensor-based dose determination engine, as well as new technologies created to improve image quality with less radiation. It is revolutionary in the radiographic space.

Medgadget: Please give us an overview of the Micro C system and its uses.

Gregory Kolovich: Micro is a six pound emitter paired with a 6 ”digital X-ray cassette. The device allows the distal extremity to be captured from the shoulder to the fingertips and the knees to the toes. I use the device both in surgery and in the clinic. In surgery, agility is great for difficult-to-capture views, and in the clinic, having the imaging device right there when I’m doing an exam is great. Micro C makes me a more efficient surgeon. Also, when you go to our satellite clinics, I will take you with me; that way, I know I’ll have the right modality as soon as I arrive.


A great benefit is our DDR images. Evan mentioned it, but as a doctor, this is very helpful. DDR is dynamic digital radiography. DDR works a bit like fluoroscopy, like a live radiograph, but with much more clarity. Due to our ultra-fast and low radiation X-ray tube, Micro C can create a live X-ray video, where each frame is a clinically relevant image. Micro C allows me to take a live DDR and then move through each frame to pin down the diagnosis. DDR also allows me to conduct guided injection and motion studies directly at my clinic. Is incredible.

Medgadget: Are there any radiation problems associated with the system? How does it compare to conventional X-ray systems in this context?

Evan Ruff: It is a very low dose device. The system produces 80% less radiation than existing systems. To put that in perspective, if an operator were to use the Micro C all day, every business day for a year, they would have been exposed to less radiation than on an international flight.

Suppose a user X-rays constantly with the Micro C during all business hours of each surgery and clinic day throughout the year. In that case, the operator would be exposed to the same amount of cumulative radiation as a single flight from New York to Japan.

Generally, radiation-emitting devices produce what is called a “scattering cloud,” which is defined by the area in space around the device that is exposed to any measurable amount of radiation. Standard C-arms and holders have a radiation scattering cloud radius of approximately 6 to 24 feet. Micro C’s radiation scattering cloud is only three feet away, so if you are more than three feet from Micro C, there is no measurable exposure.

Medgadget: Is Micro C used today? How have patients and doctors found the system?


Gregory Kolovich: Yes, the deployment of the system has been very, very strong. We have only been on the market since July and we are installing devices as quickly as possible. Until now, we’ve used the device everywhere from urgent care to orthopedic clinics, even outside of college and professional football. Viewing the anatomy is so important, and clinicians love using the device because it gives them so much control over their most used imaging modality.

Feedback from patients is even more exciting. As a doctor, I knew I would love to use a Micro C, but patients love the device. First, they don’t have to go to another area, wait again for the images, and then wait AGAIN to see me. I walk into the room and I can do the entire exam without interruptions, so they like it. The other thing they respond to is real-time collaboration with the doctor. When I use a Micro C and imagine a patient, we can instantly see the image, together. When I give them the diagnosis, show them their improvement in joint mobility or even give them an injection, they are involved in the care process, which builds more trust between the patient and the provider. It’s great.


Link: OXOS Medical Home Page …

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