WEBVTT

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Welcome to the Behind the Shield podcast. As

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always, my name is James Geering, and this week

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it is my absolute honor to welcome on the show,

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Doctor of Radiology and the Medical Director

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of Primary Care Radiology at Pronuvo, Dr. Josef

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Czodekowicz. Now, in this conversation, we discuss

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a host of topics from his journey into the world

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of medicine, the scope of practice within radiology,

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innovations in modern day MRI, medical applications

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of ultrasound, the safety and efficacy of full

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-body preventative MRI scans, the application

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for the first responder professions, spine health,

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cancer detection, warning signs of potential

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aneurysms, and so much more. Now, as a side note,

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Pranuvo is offering you, the audience of the

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Behind the Shield podcast, 20 % off any scan

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through their Warrior program. And I will put

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the link to that on the show notes. Now, before

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we get to this incredibly powerful and important

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conversation, as I say every week, please just

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take a moment. Go to whichever app you listen

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to this on, subscribe to the show, leave feedback

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and leave a rating. Every single five -star rating

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truly does elevate this podcast, therefore making

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it easier for others to find. And this is a free

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library of almost 1 ,200 episodes now. So all

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I ask in return is that you help share these

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incredible men and women's stories so I can get

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them to every single person on planet Earth who

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needs to hear them. So with that being said,

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I introduce to you Dr. Yosef. Tredekowitz. Enjoy.

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Well, Dr. Sefi, I want to start by saying thank

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you so much for taking the time and coming on

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the Behind the Shield podcast today. Thanks,

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James. Thanks for having me. Glad to be here.

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So where on planet Earth are we finding you this

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afternoon? Well, I'm actually in California,

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in Palo Alto, which I can't complain about because

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I know most of the country now is under some

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severe weather. So I hope everyone is keeping

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as warm as possible and staying safe. Are you

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getting any edge of the band? We're going to

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get some cold weather starting tomorrow. For

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Florida, it's going to be quite cold. But what

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about California? This weekend was beautiful,

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actually, in my area, in Palo Alto, sunny skies.

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It wasn't particularly warm, but it wasn't particularly

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cold either. It just was out and about with family

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and kids, parks and birthday parties and things

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like that. Absolutely. All right. Well, then

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I would love to start at the very beginning of

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your timeline. So tell me where you were born

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and tell me a little bit about your family dynamic,

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what your parents did, how many siblings. So

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I was actually born in Los Angeles, California.

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And, you know, I would say an interesting multicultural

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household. So my father is Mexican. My mom is

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Cuban. My family household is Jewish. And I went

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to a Jewish school my whole life. And actually,

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my father is a neurosurgeon. So I have sort of

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medicine in sort of. I was always sort of around

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it, like medicine in the household. There was

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the idea that I would become a doctor early on,

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but I actually didn't end up going that pathway.

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I sort of wanted to carve out my own pathway.

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And in college, I studied philosophy, actually,

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and was not a pre -med student. And it was only

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sort of later on in life when I stopped getting

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parental advice on what to do with my life. I

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said, oh, you know, on second thought, I think

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I should go into medicine. So I learned a little

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bit of a lesson from that. Whatever I want my

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kids to go into, I will not tell them to do that.

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I'll let them figure it out on their own, and

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they'll probably come to it sooner than later.

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What kind of perspective did you get? Neurosurgeon

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is such an elite kind of sliver of the medical

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world. So what were some of the stories that

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you heard from your father of how his day at

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work was? Yeah, so it's interesting. I think

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my father being a neurosurgeon, had a big influence

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probably on a lot of my interests actually. And

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probably apple doesn't fall far from the tree.

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So even though I didn't pursue medicine directly

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right away, we had a similar shared interest

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in sort of kind of a philosophical approach to

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the body and biology. And in this case, the mind,

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the brain, et cetera. So he had a unique specialty

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where he would do functional neurosurgery and

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would basically implant deep brain stimulators,

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these electrical devices that would be able to

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rewire the circuitry of the brain and help people

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improve their function with movement disorders

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or disorders of pain, et cetera. And I was very

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fascinated by that aspect of medicine, more so

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than I was about the simple biology of medicine.

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And that's probably what led me towards the path

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of philosophy, actually. And even after, when

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I went back into medicine, I actually was gravitating

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towards the kind of the neurosciences, the brain

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sciences, the brain medicine fields. And I was

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debating going into neurosurgery myself or something

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with imaging. I ended up going into radiology.

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At one point, I was going to go into neuroradiology

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before I ended up going into body MRI and now

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whole body MRI. So the technology he was working

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with, would that be one of those examples we've

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seen the videos of? I believe it's people with

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pretty extreme Parkinson's and they've got the

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implants. And when they turn it on, they're able

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to kind of regain control of their body. That's

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right. That's one very well -known indication

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and application of that technology. So it's funny

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if you take a bigger historical view, bird's

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eye view. That technique with these brain stimulators

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was something that was developed probably in

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the early 90s, became much more mainstream in

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the late 90s and 2000s. But if you go back in

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time, they were doing different kinds of procedures

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for the same concept without the implantable

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electrical device, but with focal lesioning,

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often a technique called thalamotomy, where they

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basically cause a little micro lesion at a targeted

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region of the brain. that would rewire the circuits

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in a similar fashion. And the electrical stimulators

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would basically create like these pseudo lesions

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imitating that approach. Now, that was always

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something I was interested in. And when I was

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in medical school, there was another application

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that came out, which was called MRI guided focus

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ultrasound, which is essentially an imaging energy

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-based modality where you went back in time and

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did lesions with... ultrasound energy the same

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way they used to do with an open craniotomy and

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stick a probe in there and and kind of target

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that area of the brain that was misfiring we

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could now do that with radiologic based approaches

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under mri guidance watching in real time and

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then targeting ultrasonic energy to that same

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region of the brain and burning a small little

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hole with no incisions it's like magic magical

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incisionless brain surgery so that was an area

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that i wanted to go into through radiology and

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kind of came full circle towards um kind of like

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what I grew up hearing all about all the time,

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this kind of rewiring of the brain, philosophical

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neurosurgery in a way, and I was interested in

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doing that through radiology. So I actually went

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into a fellowship after residency to learn that,

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and I ended up going to Stanford University.

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The body MRI program had a big division in what's

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called minimally invasive MRI -guided interventional

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care. MIMRIC for short. And this was one of the

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leading centers that was basically driving this

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practice through radiology. Other centers were

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doing it through subspecialists like neurosurgery

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in the brain or in other areas like in the prostate

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through urology, et cetera. But here at Stanford,

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we were doing it all through radiology, including

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we were doing these thalamotomies in the brain

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with MRI guided focus ultrasound. Now, while

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I was in that fellowship, body MRI was also exposed

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to the whole body MRI. um as a as a screening

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exam for cancer screening and we were doing that

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in um not the same sort of patient population

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that we're doing a prenuva which is more broad

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for the general population but we were doing

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it there more limited to individuals with certain

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cancer predisposition syndromes that were at

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high risk for developing cancer so that was an

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area where i was exposed to whole body mri and

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found that extremely fascinating with a lot of

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kind of forward -looking applications um in the

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field of medicine because historically imaging

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is more relegated towards diagnosing a problem

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the cause of a problem once it's clinically pronounced

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itself you know patient goes to the doctor doc

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it hurts me here or doctor does a physical exam

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and palpates like there's a mass on examination

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i feel something in the abdomen i'm not normally

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feeling or there's an abnormal lab out and then

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they'll send it to the radiologist the patient

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of the radiology like figure out like what's

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the cause of that abnormality? Is this something

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that needs to be worked on or is this something

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that can be sort of watched and waited, et cetera?

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And as imaging had progressed and now we could

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do this whole body MRI, it was like a no -brainer

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that why don't we transform this modality towards

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the forefront of the patient encounter, the first

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point as part of a physical exam, essentially,

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and then we can rather than wait for the clinical

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symptoms to present themselves, get ahead of

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that curve and try to... be informative to the

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patient in an earlier state of kind of health

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status before disease progresses to a point where

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it's harder to treat and manage. So that was

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like the thinking that I had at that time. And

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then sort of I came to where I am now, Pernuvo,

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sort of, you know, by coincidence, we were, the

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company was just kind of emerging in The first

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clinic was in Canada, in Vancouver, and they

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were just opening their first clinic in the States,

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in California. And that's when I started getting

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involved with them at a very early stage. Basically,

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right after fellowship, these ideas were all

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kind of clicking together for me. So long story

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short, what I'm doing here now is, you know,

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a little bit forward looking in radiology, forward

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thinking. And I think of it more as like a new

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subspecialty in radiology, kind of like primary

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care radiology or another way of thinking about

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it, sort of. Radiology Enhanced Preventive Care.

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You mentioned using ultrasound in a kind of surgical

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way. It's funny because it's not funny at all.

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My dad just got diagnosed with a very horrendous

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cancer and it's not looking good. And the only

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surgical option is the Whipple, which is to fillet

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a human being, take everything out and kind of

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hope that you can stitch them back together again.

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But he's been looking at a technology, I think

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it was Hippotripsy. where they're using it on

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the liver to target, I think it's the solid organs

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that it's working with. What is the potential

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of that kind of technology when it comes to tumors

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and other parts of the body? Yeah, I mean, that's

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an area of, you know, very fascinating emerging

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field, basically this area of histotripsy is

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one effect that this focus ultrasound technique

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can have. So you might think of, ultrasound of

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this it's this mechanical um wave -based energy

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that can have all kinds of effects and we use

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an imaging all the time where we're not trying

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to affect the tissues we're trying to do it in

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a very low energy way and in order to get just

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images of the tissue but if you can concentrate

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ultrasound in a way where all that energy comes

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to a point you might have an analogy too if you've

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ever taken a magnifying glass and tried to kind

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of focus a beam from the sun onto a piece of

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paper and burn a little hole on the paper that's

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what you can do with ultrasound as well focus

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these beams create high energy and in one way

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you could do um thermal ablation which is what

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we were doing in the brain for thelamin but you

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can also do histotripsy which is where you're

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basically um creating such extreme vibrations

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that the tissue the cells themselves basically

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and they die in another way, not from heat, but

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from sort of just high energy vibrations. There

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is a lot of applications about those in the whole

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body, the liver being one of them. I was familiar

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with a trial that was being done for liver metastases

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using histotripsy to ablate those in a more minimally

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invasive fashion. That's a different... way of

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controlling those ultrasound beams than we were

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doing with a thermal ablation. And, you know,

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there's debates on like what the best way to

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do it is, but there's really a wide open field

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for really interventional radiology using ultrasound

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energy. In the brain, beyond like burning tissue,

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you can also use it to open up the blood brain

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barrier. And that has a lot of interesting applications

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to deliver drugs to the brain and target all

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kinds of disease that were kind of behind this

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wall where so in the brain is is it's a it's

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a unique organ where like a lot of the um uh

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molecules that circulate in our blood they don't

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have a way to get into the brain there's a special

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physiologic structure called the blood brain

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barrier which prevents things from going in and

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that's you know by evolution to protect the brain

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in a way but on the other hand it's an obstacle

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in medicine where A lot of the drugs you might

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want to use to treat, let's say, cancer, chemotherapies

00:14:02.259 --> 00:14:04.019
or whatnot, and they might go all over the body

00:14:04.019 --> 00:14:07.379
elsewhere. If there's a tumor in the brain, those

00:14:07.379 --> 00:14:09.299
same drugs can't get to the brain because the

00:14:09.299 --> 00:14:11.220
blood -brain barrier doesn't let them in. So

00:14:11.220 --> 00:14:13.240
with the same kind of idea with focused ultrasound,

00:14:13.379 --> 00:14:15.460
you can manipulate it in such a way where you

00:14:15.460 --> 00:14:19.779
basically massage open the structures that create

00:14:19.779 --> 00:14:22.879
the blood -brain barrier and it can create...

00:14:23.070 --> 00:14:24.710
make them to be leaky and then the drugs can

00:14:24.710 --> 00:14:26.889
leak in there. So all kinds of applications,

00:14:27.129 --> 00:14:28.929
whether it's in the liver or in the prostate,

00:14:29.210 --> 00:14:32.830
burning tumors or in the brain, doing functional

00:14:32.830 --> 00:14:38.149
neurosurgery or burning tumors or blood brain

00:14:38.149 --> 00:14:40.820
barrier opening, this is like a really This is

00:14:40.820 --> 00:14:42.820
different from prenuvo. This is nothing that

00:14:42.820 --> 00:14:44.519
we do at prenuvo, but that's a whole other area

00:14:44.519 --> 00:14:46.840
of medicine that, yeah, interesting that you

00:14:46.840 --> 00:14:48.899
have a similar, you know, you're aware of that

00:14:48.899 --> 00:14:50.980
and interested in it. That's an area that I trained

00:14:50.980 --> 00:14:53.240
in and was very fascinated in for a long time.

00:14:54.200 --> 00:14:56.100
Absolutely. Well, my dad was a veterinary surgeon,

00:14:56.179 --> 00:14:59.539
so he's a full -on, you know, science. Nerd is

00:14:59.539 --> 00:15:01.519
the wrong term, but he's obsessed with it. And

00:15:01.519 --> 00:15:04.820
so that's how he first came across it, was researching

00:15:04.820 --> 00:15:07.899
treatment options for himself. So immunotherapy

00:15:07.899 --> 00:15:09.600
is obviously another very exciting area, but

00:15:09.600 --> 00:15:12.019
it's not applicable in this particular cancer,

00:15:12.120 --> 00:15:17.539
sadly. When you talk about medical school, at

00:15:17.539 --> 00:15:19.039
the front door, it's very interesting because

00:15:19.039 --> 00:15:21.159
you went more recently than maybe some of the

00:15:21.159 --> 00:15:24.240
people who have been on here. With the whole

00:15:24.240 --> 00:15:26.159
cancer conversation, you've got some of these

00:15:26.159 --> 00:15:28.279
innovations in the treatment side, but obviously

00:15:28.279 --> 00:15:30.120
the other side of the conversation is, well,

00:15:30.200 --> 00:15:32.139
the prevention side. What are some of these things

00:15:32.139 --> 00:15:33.840
that are even creating more cancers in modern

00:15:33.840 --> 00:15:37.879
society? In the medical route that you went,

00:15:38.080 --> 00:15:41.659
how prevalent was training on nutrition, sleep,

00:15:41.980 --> 00:15:44.360
exercise, some of the kind of preventative holistic

00:15:44.360 --> 00:15:49.779
elements of medicine? I mean, that's not something

00:15:49.779 --> 00:15:52.779
I really focused on in my residency in radiology

00:15:52.779 --> 00:15:54.600
because we were usually focused on, obviously,

00:15:54.659 --> 00:15:57.679
in the imaging diagnosis. And a lot of that preventive

00:15:57.679 --> 00:16:00.539
management is something that would be sort of

00:16:00.539 --> 00:16:03.679
a different area of preventive care training.

00:16:03.879 --> 00:16:07.019
That being said, in medical school, I would say

00:16:07.019 --> 00:16:15.179
that the educational Those who determine what

00:16:15.179 --> 00:16:16.940
should be focused on in medical education at

00:16:16.940 --> 00:16:23.779
the time, the kind of curriculum planners, were

00:16:23.779 --> 00:16:25.559
starting to become aware of this. So we definitely

00:16:25.559 --> 00:16:28.860
had in medical school several lectures kind of

00:16:28.860 --> 00:16:31.179
peppered throughout training about nutrition

00:16:31.179 --> 00:16:37.190
and how to optimize. you know, preventive disease

00:16:37.190 --> 00:16:39.809
practices, as opposed to just treating the disease.

00:16:39.970 --> 00:16:42.690
It was still at that time, not yet as I think

00:16:42.690 --> 00:16:46.409
big, a mainstream focus as it is now. And that

00:16:46.409 --> 00:16:48.389
was, I was in medical school, you know, about

00:16:48.389 --> 00:16:54.090
10 years ago. And, or sorry, 10, 15 years ago,

00:16:54.110 --> 00:16:56.750
and like the five years of four years of medical

00:16:56.750 --> 00:16:58.029
school, I did research here for an extra year

00:16:58.029 --> 00:17:00.429
there. So it was just kind of beginning to get

00:17:00.429 --> 00:17:03.009
more an area of interest. I bet now if you go

00:17:03.009 --> 00:17:04.630
to medical schools, it's probably a much bigger

00:17:04.630 --> 00:17:08.849
focus. But yeah, at my time in medical school,

00:17:08.950 --> 00:17:10.589
it was starting to become an area where we were

00:17:10.589 --> 00:17:12.809
aware of this and it was important. We were having

00:17:12.809 --> 00:17:16.130
dedicated lectures about nutrition, preventive

00:17:16.130 --> 00:17:22.809
health, the metabolic effects on things like

00:17:22.809 --> 00:17:25.730
cancer development related to diabetes and whatnot.

00:17:26.869 --> 00:17:29.569
So yeah, this is not something new, but something

00:17:29.569 --> 00:17:32.150
that is becoming more and more an area of awareness

00:17:32.150 --> 00:17:37.049
and focus and investment in. these days brilliant

00:17:37.049 --> 00:17:39.670
well walk me through kind of the overview of

00:17:39.670 --> 00:17:42.309
the radiology track then as opposed to you know

00:17:42.309 --> 00:17:43.970
someone who might be a gp at the end of their

00:17:43.970 --> 00:17:49.730
their uh journey so uh you know radiology is

00:17:49.730 --> 00:17:53.549
um a field in medicine and i'm going to focus

00:17:53.549 --> 00:17:56.349
on diagnostic radiology first but basically it's

00:17:56.349 --> 00:17:59.869
the field of medicine that that leverages the

00:17:59.869 --> 00:18:05.240
kind of magic the magical abilities of you know,

00:18:05.259 --> 00:18:08.339
various different energy forms in physics to

00:18:08.339 --> 00:18:11.960
give you images of inside the body so you don't

00:18:11.960 --> 00:18:14.660
have to cut open the body to look at it. Historically,

00:18:14.740 --> 00:18:18.500
you might think that, not you might think historically

00:18:18.500 --> 00:18:21.940
to look, they used to do things like exploratory

00:18:21.940 --> 00:18:24.940
laparotomies, which, you know, may once in a

00:18:24.940 --> 00:18:26.900
while happen these days, but is not something

00:18:26.900 --> 00:18:30.119
that we normally do. So usually now if somebody's

00:18:31.309 --> 00:18:33.769
you know, has an abdominal, acute abdominal pain,

00:18:33.930 --> 00:18:36.369
they'll go to the emergency room or their outpatient

00:18:36.369 --> 00:18:38.450
doctor will order an imaging exam to give them

00:18:38.450 --> 00:18:40.329
the diagnosis. Is this appendicitis? Is this

00:18:40.329 --> 00:18:43.230
cholecystitis? Is this diverticulitis? It does

00:18:43.230 --> 00:18:46.029
not require having an open surgery to diagnose

00:18:46.029 --> 00:18:49.289
the problem in advance. So that's sort of a magic

00:18:49.289 --> 00:18:52.490
of radiology that's emerged from the beginning

00:18:52.490 --> 00:18:53.869
of time when they, not beginning of time, from

00:18:53.869 --> 00:18:56.009
the beginning of like the 1900s when they had

00:18:56.009 --> 00:18:59.349
the first x -ray acquired. And then you move

00:18:59.349 --> 00:19:02.119
forward into more advanced imaging, cross -sectional

00:19:02.119 --> 00:19:05.720
imaging like CT scans and MRI scans, which started

00:19:05.720 --> 00:19:07.740
emerging like the 1970s where you could actually

00:19:07.740 --> 00:19:10.539
get like a textbook picture, a slice of anatomy.

00:19:11.819 --> 00:19:13.500
Imagine like you look at a textbook of anatomy,

00:19:13.579 --> 00:19:15.099
you see like slices of the body. We could do

00:19:15.099 --> 00:19:18.460
that kind of imaging with those kind of new modalities.

00:19:19.000 --> 00:19:21.559
So that's what radiology kind of emerged of.

00:19:21.680 --> 00:19:24.720
Diagnostic radiology is, you know, give the diagnosis

00:19:24.720 --> 00:19:28.259
to avoid having a... a very invasive procedure

00:19:28.259 --> 00:19:30.519
medical procedure to get the diagnosis so that

00:19:30.519 --> 00:19:34.859
you can treat it and and um and that's what we

00:19:34.859 --> 00:19:37.059
basically you know we get trained on all the

00:19:37.059 --> 00:19:39.140
different modalities there's x -rays and there's

00:19:39.140 --> 00:19:41.079
live x -rays which is called fluoroscopy where

00:19:41.079 --> 00:19:43.319
you're dynamically imaging the patient in real

00:19:43.319 --> 00:19:46.380
time with giving let's say a contrast agent that

00:19:46.380 --> 00:19:48.880
you can see how it flows through the body Then

00:19:48.880 --> 00:19:52.319
there's ultrasound, there's MRI, there's CT scan.

00:19:52.579 --> 00:19:54.359
There's another field called nuclear medicine

00:19:54.359 --> 00:19:57.119
where we give a radio tracer that allows us to

00:19:57.119 --> 00:19:59.779
image physiologic properties of the body from

00:19:59.779 --> 00:20:03.759
the inside out. Now, a key feature of a lot of

00:20:03.759 --> 00:20:06.160
those modalities is while they're more benign

00:20:06.160 --> 00:20:08.880
in a sense than doing surgery to diagnose a problem,

00:20:09.119 --> 00:20:11.960
they involve usually some ionizing radiation,

00:20:12.279 --> 00:20:18.569
which is not a totally free lunch. in that if

00:20:18.569 --> 00:20:24.789
you give too much ionizing radiation to an individual

00:20:24.789 --> 00:20:27.549
at one time point, or those are not the doses

00:20:27.549 --> 00:20:29.329
we deal with in radiology, but let's say the

00:20:29.329 --> 00:20:32.069
small doses that we deal with, but you do that

00:20:32.069 --> 00:20:34.569
frequently over time, that can lead to long -term

00:20:34.569 --> 00:20:37.309
harm. So that radiation can actually cause mutations

00:20:37.309 --> 00:20:40.009
in DNA and lead to actually developing cancer

00:20:40.009 --> 00:20:41.990
in the long run, which is something we don't

00:20:41.990 --> 00:20:45.089
want to do in a preventive health context. Those

00:20:45.089 --> 00:20:48.319
are like historical modalities, the x -ray based

00:20:48.319 --> 00:20:50.240
modalities or the nuclear medicine based modalities

00:20:50.240 --> 00:20:52.079
that involve radiation. But there's a couple

00:20:52.079 --> 00:20:54.220
modalities, ultrasound being one of them and

00:20:54.220 --> 00:20:57.160
MRI being another one of them, which are unique

00:20:57.160 --> 00:20:59.680
in that they don't involve any ionizing radiation.

00:21:00.759 --> 00:21:06.440
And so this became an area of interest in terms

00:21:06.440 --> 00:21:10.500
of how can we apply those other modalities towards

00:21:10.500 --> 00:21:13.720
preventive health screening so that we can get

00:21:13.720 --> 00:21:17.359
sort of our cake and eat it too. How can we get

00:21:17.359 --> 00:21:20.059
sort of the power of radiology to diagnose disease

00:21:20.059 --> 00:21:24.039
in a setting where, in a symptomatic setting,

00:21:24.180 --> 00:21:26.400
you know, the pros of diagnosis usually outweigh

00:21:26.400 --> 00:21:28.279
the risks. You go one -time CT scan when you

00:21:28.279 --> 00:21:30.420
have an acute abdomen. It's not going to harm

00:21:30.420 --> 00:21:33.160
you while getting the benefit to treat a potentially

00:21:33.160 --> 00:21:37.519
high -risk condition will be benefited by getting

00:21:37.519 --> 00:21:39.720
that diagnosis early on. But you kind of lose

00:21:39.720 --> 00:21:42.279
that equation when you're like screening healthy

00:21:42.279 --> 00:21:45.849
people that are not symptomatic. use a modality

00:21:45.849 --> 00:21:48.730
that doesn't have ionizing radiation you kind

00:21:48.730 --> 00:21:51.369
of have a different you lose that that trade

00:21:51.369 --> 00:21:55.750
-off basically so for many years you couldn't

00:21:55.750 --> 00:21:59.509
effectively do that with with mri because it

00:21:59.509 --> 00:22:05.029
was a very very very very challenging complex

00:22:05.029 --> 00:22:08.849
modality it would take a long time to scan a

00:22:08.849 --> 00:22:11.349
patient for a small body part let alone for like

00:22:11.349 --> 00:22:14.210
screening the whole body It was extremely expensive.

00:22:14.549 --> 00:22:16.890
The exams would be intolerant to the patient.

00:22:16.950 --> 00:22:19.470
They have to lie there for many hours. But as

00:22:19.470 --> 00:22:23.569
technology progressed and it became more practically

00:22:23.569 --> 00:22:27.029
feasible, so that's where we started sort of

00:22:27.029 --> 00:22:29.450
thinking and sort of the prenuvo mindset of can

00:22:29.450 --> 00:22:35.029
we put this in the kind of routine, the routine

00:22:35.029 --> 00:22:38.289
apparatus, the toolbox of outpatient medicine.

00:22:38.390 --> 00:22:40.960
And that's kind of where we are today. The technology

00:22:40.960 --> 00:22:42.900
has accelerated to a level that you can do an

00:22:42.900 --> 00:22:45.599
effective whole body exam with high quality imaging,

00:22:45.940 --> 00:22:49.420
get a lot of information. It doesn't come at

00:22:49.420 --> 00:22:52.900
much. There's no ionizing radiation, so there's

00:22:52.900 --> 00:22:55.859
no sort of physiologic toxicity to the patient,

00:22:55.900 --> 00:22:58.019
but it's also tolerable from a comfort perspective.

00:22:58.180 --> 00:23:00.539
They can lie there for, you know, slightly under

00:23:00.539 --> 00:23:03.119
an hour on the table. In our case, we set it

00:23:03.119 --> 00:23:06.519
up with, you know, a way to be distracted. I'm

00:23:06.519 --> 00:23:08.640
not going to say it's like going. On vacation,

00:23:08.839 --> 00:23:10.259
it's not the most pleasurable experience. You're

00:23:10.259 --> 00:23:13.400
still lying on an MRI board for an hour, but

00:23:13.400 --> 00:23:15.640
they're relatively more comfortable than the

00:23:15.640 --> 00:23:18.240
older, more tighter MRIs. They're a little bit

00:23:18.240 --> 00:23:22.119
roomier. And the patients can watch a Netflix

00:23:22.119 --> 00:23:24.400
movie and be distracted during the time while

00:23:24.400 --> 00:23:27.619
they're in the scanner. So it becomes a degree

00:23:27.619 --> 00:23:30.539
much more convenient and comfortable. So putting

00:23:30.539 --> 00:23:34.190
all those things together, no radiation. No injections.

00:23:34.269 --> 00:23:37.410
We don't give a dye, any contrast agent and kind

00:23:37.410 --> 00:23:39.049
of the time. And then the expense keeps coming

00:23:39.049 --> 00:23:41.910
down. All these things are allowing us to put

00:23:41.910 --> 00:23:43.789
it sort of in this preventive healthcare context.

00:23:44.470 --> 00:23:49.150
So that is kind of taking this like historical

00:23:49.150 --> 00:23:52.910
view of what radiology was, this diagnostic,

00:23:53.390 --> 00:23:56.690
this diagnostic, especially based on getting

00:23:56.690 --> 00:23:59.509
images when there's already an established problem,

00:23:59.569 --> 00:24:02.789
but avoiding. an invasive diagnostic procedure,

00:24:03.390 --> 00:24:05.329
but doing that non -invasively, now we can do

00:24:05.329 --> 00:24:08.750
that same non -invasive magic, but, you know,

00:24:08.750 --> 00:24:12.210
go before the symptoms develop. Sort of a little

00:24:12.210 --> 00:24:14.730
bit of a historical course there and then toward

00:24:14.730 --> 00:24:17.509
the subspecialty that we do now. Yeah, I think

00:24:17.509 --> 00:24:19.150
it's important just to understand the background

00:24:19.150 --> 00:24:22.769
and, you know, the whys behind it. Total random

00:24:22.769 --> 00:24:25.190
question. What is it about the technology that

00:24:25.190 --> 00:24:27.549
makes it so loud, even with, you know, modern

00:24:27.549 --> 00:24:32.910
day science? So loud, I mean, for... Like literally

00:24:32.910 --> 00:24:34.390
when you're in the machine, the kind of grinding

00:24:34.390 --> 00:24:38.289
noise. Yeah, that's due to the physics of the

00:24:38.289 --> 00:24:42.250
machine itself and kind of the rapidly changing

00:24:42.250 --> 00:24:45.809
parameters. There's no way yet that I'm aware

00:24:45.809 --> 00:24:49.369
of to get rid of that noise factor. So even now,

00:24:49.410 --> 00:24:51.490
like, you know, you're watching in the Pernuba

00:24:51.490 --> 00:24:53.769
Clinic, let's say watching a movie and you're

00:24:53.769 --> 00:24:55.910
listening to the movie, you know, you'll still

00:24:55.910 --> 00:24:58.220
hear the noise to the headphones, but... We'd

00:24:58.220 --> 00:25:00.819
give people earplugs to start trying to dampen

00:25:00.819 --> 00:25:04.059
out the noise and then the headphones on top

00:25:04.059 --> 00:25:07.039
of those so they can hear a movie. That will

00:25:07.039 --> 00:25:08.779
help a little, but they'll still be pretty loud.

00:25:09.420 --> 00:25:10.880
You can't get away from that, unfortunately.

00:25:12.400 --> 00:25:15.720
Brilliant. What about where we are today? As

00:25:15.720 --> 00:25:18.720
we had this conversation in 2026 versus, as you

00:25:18.720 --> 00:25:20.720
mentioned, hours just to get a little sliver

00:25:20.720 --> 00:25:24.170
of the body a couple of decades ago. What can

00:25:24.170 --> 00:25:27.309
you see now with this head to toe scan that people

00:25:27.309 --> 00:25:32.109
will be hearing about? We can see a lot and we

00:25:32.109 --> 00:25:37.329
can get a sense basically of someone's general

00:25:37.329 --> 00:25:39.730
state of health by what we see on the MRI. It's

00:25:39.730 --> 00:25:41.549
not going to give us all the information. There's

00:25:41.549 --> 00:25:45.690
going to be a role for things like labs, you

00:25:45.690 --> 00:25:48.069
know, history, risk factors, et cetera. And that

00:25:48.069 --> 00:25:50.369
will put sort of a lot of our imaging observations

00:25:50.369 --> 00:25:53.170
in context as well as. fill in voids where we

00:25:53.170 --> 00:25:55.349
can't give complete information from the imaging

00:25:55.349 --> 00:25:57.569
alone. But all that put together allows us to

00:25:57.569 --> 00:26:00.009
get sort of an integrated approach to giving

00:26:00.009 --> 00:26:03.170
personalized sense of that patient's health and

00:26:03.170 --> 00:26:05.630
give them guidance to what they should plan for

00:26:05.630 --> 00:26:08.509
the next year, five years, 10 years, et cetera.

00:26:09.250 --> 00:26:11.910
Low -hanging fruit, I would say, is kind of the

00:26:11.910 --> 00:26:14.730
tumor screening. Obviously, that's an area of

00:26:14.730 --> 00:26:17.470
main interest for a lot of our patients and referring

00:26:17.470 --> 00:26:21.279
doctors. If you look at the current state of

00:26:21.279 --> 00:26:24.240
kind of recommended cancer screening, there's

00:26:24.240 --> 00:26:27.779
only about four specific cancers that are actively

00:26:27.779 --> 00:26:31.579
screened for in a targeted fashion. And it's

00:26:31.579 --> 00:26:34.500
limited to certain patients fit a demographic

00:26:34.500 --> 00:26:37.500
profile above a certain age with certain risk

00:26:37.500 --> 00:26:40.279
factors, which leaves a lot of people that maybe

00:26:40.279 --> 00:26:43.079
don't fit that demographic or that may be at

00:26:43.079 --> 00:26:44.819
risk for another cancer that's not one of those

00:26:44.819 --> 00:26:48.009
four cancers sort of. at some degree of risk

00:26:48.009 --> 00:26:52.809
for having a tumor develop that will go below

00:26:52.809 --> 00:26:55.289
the radar until it's kind of like later on in

00:26:55.289 --> 00:26:57.269
the stage of that tumor. Now, these might not

00:26:57.269 --> 00:26:59.329
be necessarily the most common tumors and they

00:26:59.329 --> 00:27:02.049
might not be individually very high risk, but

00:27:02.049 --> 00:27:05.410
when you take them as a kind of totality, they

00:27:05.410 --> 00:27:07.109
actually make up most of the cancers that are

00:27:07.109 --> 00:27:10.029
diagnosed. So actually only 14 % of cancers are

00:27:10.029 --> 00:27:13.150
diagnosed through screening in today's day and

00:27:13.150 --> 00:27:16.960
age. So this is sort of a... unmet need still,

00:27:17.039 --> 00:27:20.299
this sort of multi -cancer detection strategy.

00:27:20.660 --> 00:27:25.420
And so you can think of what one important void

00:27:25.420 --> 00:27:28.380
that something like the PNUVA scan fills is an

00:27:28.380 --> 00:27:31.180
imaging -based multi -cancer detection tool in

00:27:31.180 --> 00:27:33.940
a sense. It allows me as a radiologist to examine

00:27:33.940 --> 00:27:36.779
the body head to toe through images and anything

00:27:36.779 --> 00:27:40.640
that's basically forming a structural lesion,

00:27:40.640 --> 00:27:43.289
a mass -like lesion. Essentially, that could

00:27:43.289 --> 00:27:45.289
be a tumor that can further characterize this

00:27:45.289 --> 00:27:47.329
as an aggressive looking tumor. Is this something

00:27:47.329 --> 00:27:50.230
that looks benign? Maybe not even like something

00:27:50.230 --> 00:27:52.670
to worry about. I can characterize these into

00:27:52.670 --> 00:27:56.549
buckets of concern. Don't worry about it. This

00:27:56.549 --> 00:28:00.190
isn't intermediate. follow this up a little bit

00:28:00.190 --> 00:28:02.890
more actively and watch watchful waiting maybe

00:28:02.890 --> 00:28:04.309
see you again in six months maybe see you again

00:28:04.309 --> 00:28:06.950
in a year or maybe this is something that needs

00:28:06.950 --> 00:28:09.029
immediate you know attention and intervention

00:28:09.029 --> 00:28:12.849
prophylactically now so we can bucket these types

00:28:12.849 --> 00:28:15.509
of observations and that may be tumors into these

00:28:15.509 --> 00:28:18.289
different levels of concern and go do it you

00:28:18.289 --> 00:28:20.849
know head to toe so whereas you know traditionally

00:28:20.849 --> 00:28:23.509
there's only breast cancer that's green colon

00:28:23.509 --> 00:28:28.190
cancer that's screened um um cervical cancer

00:28:28.190 --> 00:28:30.490
that's screened in smokers that are of elevated

00:28:30.490 --> 00:28:32.710
risk beyond a certain age. We do low -dose chest

00:28:32.710 --> 00:28:36.950
CT screening. And even prostate screening has

00:28:36.950 --> 00:28:39.509
itself some controversy. It's usually done with

00:28:39.509 --> 00:28:42.490
PSA, a lab test. Some societies are for it. Some

00:28:42.490 --> 00:28:44.430
societies think it's a little bit diminishing

00:28:44.430 --> 00:28:47.170
returns. Those are the limited really cancers

00:28:47.170 --> 00:28:50.049
that are actively screened for. But for everything

00:28:50.049 --> 00:28:54.470
else, we're really sort of in the dark about

00:28:54.470 --> 00:28:59.549
when we should be informed of a diagnosis. And

00:28:59.549 --> 00:29:02.609
what you do about it is kind of tailored to a

00:29:02.609 --> 00:29:04.869
patient -specific context. So not everything

00:29:04.869 --> 00:29:09.910
needs an active emergency type alarm to it. A

00:29:09.910 --> 00:29:11.990
lot of findings that we encounter can be watched

00:29:11.990 --> 00:29:13.890
and waited. So that's important to realize as

00:29:13.890 --> 00:29:16.250
well. It's sort of a risk stratifying practice.

00:29:17.049 --> 00:29:18.630
That's from the tumor screening perspective,

00:29:18.869 --> 00:29:20.829
but separate from tumor screening, this is really

00:29:20.829 --> 00:29:22.089
not limited to tumor screening because we're

00:29:22.089 --> 00:29:24.390
doing the radiology, the cross -sectional imaging.

00:29:24.490 --> 00:29:26.210
So we get a lot more information beyond sort

00:29:26.210 --> 00:29:30.880
of a a cancer risk score in a way. So we include

00:29:30.880 --> 00:29:34.180
pretty high quality, high resolution imaging

00:29:34.180 --> 00:29:36.500
of the brain. And if there's concerns for things

00:29:36.500 --> 00:29:39.200
like demyelinating disorder, like multiple sclerosis,

00:29:39.359 --> 00:29:43.180
we can find patterns that would be concerning

00:29:43.180 --> 00:29:45.799
for that and then trigger appropriate follow

00:29:45.799 --> 00:29:48.299
-up for that kind of condition. We screen for,

00:29:48.400 --> 00:29:50.839
we do special sequences in the brain where we

00:29:50.839 --> 00:29:52.680
look at the brain arteries, actually, the flowing

00:29:52.680 --> 00:29:55.309
blood going into the brains. And this is done

00:29:55.309 --> 00:29:57.529
just by tweaking the parameters on MRI, no dye

00:29:57.529 --> 00:29:59.369
or anything like that. One of the magic things

00:29:59.369 --> 00:30:00.650
you could do with MRI that you can't really do

00:30:00.650 --> 00:30:03.950
with CT. And we use that very commonly to screen

00:30:03.950 --> 00:30:06.269
for aneurysms, so brain aneurysms. So we do see

00:30:06.269 --> 00:30:08.230
a good amount of aneurysms, actually. They're

00:30:08.230 --> 00:30:10.589
often small, low -risk aneurysms for which we

00:30:10.589 --> 00:30:13.190
don't recommend that every person needs to go.

00:30:13.869 --> 00:30:16.910
get that treated. But we like to follow them

00:30:16.910 --> 00:30:19.329
to see which are the aneurysms that are starting

00:30:19.329 --> 00:30:22.730
off small, which one is going to stay around

00:30:22.730 --> 00:30:24.849
stable and not going to grow and pose any risk

00:30:24.849 --> 00:30:26.569
to somebody versus ones that are progressively

00:30:26.569 --> 00:30:30.289
dilating. Those ones will trigger a prophylactic

00:30:30.289 --> 00:30:35.730
consultation probably with endovascular neurosurgical

00:30:35.730 --> 00:30:37.250
specialists or something like that. And many

00:30:37.250 --> 00:30:39.470
of those will probably get treated because we

00:30:39.470 --> 00:30:42.470
want to avoid a catastrophic event like a ruptured

00:30:42.470 --> 00:30:45.180
brain aneurysm, which is can be basically a sudden

00:30:45.180 --> 00:30:47.779
death type episode or if you survive that you

00:30:47.779 --> 00:30:49.859
know can cause significant morbidity and cost

00:30:49.859 --> 00:30:54.019
over over someone's life lifetime so brain aneurysms

00:30:54.019 --> 00:30:56.240
that's another sort of high yield area that we

00:30:56.240 --> 00:30:59.599
screen for um brain neurological disorders in

00:30:59.599 --> 00:31:02.880
general and then in the body all kinds of metabolic

00:31:02.880 --> 00:31:06.240
disorders we focus a lot on the liver um things

00:31:06.240 --> 00:31:09.480
like fatty liver or hepatic steatosis, something

00:31:09.480 --> 00:31:11.440
that a lot of people in America these days are

00:31:11.440 --> 00:31:13.180
walking around with and don't even know about

00:31:13.180 --> 00:31:15.119
it. It can be related to diet, can be related

00:31:15.119 --> 00:31:18.660
to genetics. And we can see that very well with

00:31:18.660 --> 00:31:20.940
MRI and quantify it and say, this is a mild level,

00:31:20.960 --> 00:31:22.579
this is a moderate level, this is a severe level.

00:31:22.700 --> 00:31:26.819
And if that goes sort of undetected and unmanaged,

00:31:26.859 --> 00:31:30.720
it can lead to things like liver disease, inflammation

00:31:30.720 --> 00:31:33.900
in the liver, even in the long run, fibrosis

00:31:33.900 --> 00:31:37.730
and cirrhosis. So getting ahead of that in advance,

00:31:37.869 --> 00:31:40.150
you can manage that with lifestyle changes, improve

00:31:40.150 --> 00:31:41.869
your diet. And we can see again, how's the fatty

00:31:41.869 --> 00:31:44.930
liver changing? If there's elevated liver enzymes,

00:31:45.109 --> 00:31:48.650
you might need to go for, you know, more targeted

00:31:48.650 --> 00:31:50.869
attention to like a hepatologist that might want

00:31:50.869 --> 00:31:53.690
to treat the inflammation associated with, with,

00:31:53.769 --> 00:31:58.009
you know, fatty liver. Are there sort of liver

00:31:58.009 --> 00:32:01.089
toxins that you're ingesting or, you know, change

00:32:01.089 --> 00:32:05.829
your drinking habits and things like that. kind

00:32:05.829 --> 00:32:07.990
of impetus to a patient that may not be thinking

00:32:07.990 --> 00:32:11.630
about these in advance to like want to act on

00:32:11.630 --> 00:32:14.069
it. So in a way, a picture speaks also a thousand

00:32:14.069 --> 00:32:16.710
words. And we've seen this anecdotally in our

00:32:16.710 --> 00:32:19.049
practice, like patients will know that they need

00:32:19.049 --> 00:32:21.289
to kind of improve their diet or kind of cut

00:32:21.289 --> 00:32:23.289
back on their drinking, but they've not done

00:32:23.289 --> 00:32:24.869
it. And then we show them like, look, this is

00:32:24.869 --> 00:32:27.730
your liver and this looks really fat. This is

00:32:27.730 --> 00:32:30.049
going to keep getting worse. And they'll use

00:32:30.049 --> 00:32:32.509
that as, oh, wow, now I really am motivated to

00:32:32.509 --> 00:32:35.980
improve that because I can see that myself. So

00:32:35.980 --> 00:32:39.099
tumors, aneurysms, as I mentioned, metabolic

00:32:39.099 --> 00:32:43.220
disorders like fatty liver, these are sort of

00:32:43.220 --> 00:32:45.559
examples of the wide spectrum of conditions that

00:32:45.559 --> 00:32:49.839
we can assess for on a whole body MRI examination.

00:32:50.039 --> 00:32:51.980
And it's really a risk stratifying approach.

00:32:53.160 --> 00:32:54.859
It's information that we can provide that can

00:32:54.859 --> 00:32:57.460
then be put in context and inform next steps

00:32:57.460 --> 00:32:59.220
on how to optimize health in the short term or

00:32:59.220 --> 00:33:03.630
long term. So you guys were kind enough to allow

00:33:03.630 --> 00:33:07.670
me to come and do an MRI myself. And I was incredibly

00:33:07.670 --> 00:33:10.549
impressed by the depth of the family history

00:33:10.549 --> 00:33:12.849
questionnaire prior and my own personal history.

00:33:13.509 --> 00:33:15.410
Very, very impressed. And for everyone listening,

00:33:15.529 --> 00:33:16.970
I haven't been paid to say any of this stuff

00:33:16.970 --> 00:33:20.750
by the actual. clinic itself, the place where,

00:33:20.769 --> 00:33:23.529
you know, where we did the MRI, um, really, really

00:33:23.529 --> 00:33:25.569
great experience, very thorough. Like you said,

00:33:25.589 --> 00:33:27.910
it's the most encapsulating MRI I've ever done.

00:33:27.990 --> 00:33:30.490
And I've had MRIs on my back on my knees after

00:33:30.490 --> 00:33:34.789
injuries. Um, and then after, you know, the consultation,

00:33:35.089 --> 00:33:36.910
so you get, you know, the results and it was

00:33:36.910 --> 00:33:39.269
very, very quickly as well, but it was, I think

00:33:39.269 --> 00:33:41.829
we talked for an hour in the end and went head

00:33:41.829 --> 00:33:44.410
to toe, all the different, you know, um, systems

00:33:44.410 --> 00:33:47.890
and organs and, you know, the, the musculoskeletal

00:33:47.890 --> 00:33:52.150
system. And it was so incredibly thorough. And

00:33:52.150 --> 00:33:55.109
when I think the application of the fire service

00:33:55.109 --> 00:33:58.329
or the first responders listening, it in itself

00:33:58.329 --> 00:34:00.869
is incredibly powerful. But if you have a baseline,

00:34:01.130 --> 00:34:04.089
whether it's the first day firefighter, cop,

00:34:04.289 --> 00:34:07.369
whoever it is, or whether it's now someone's

00:34:07.369 --> 00:34:09.449
25 years into the fire service, which is their

00:34:09.449 --> 00:34:14.369
first one, the ability to scan and detect, God

00:34:14.369 --> 00:34:17.530
forbid, abnormality in a blood vessel or some

00:34:17.530 --> 00:34:20.599
sort of tumor. in itself is incredibly powerful

00:34:20.599 --> 00:34:22.219
because as you said normally we're not going

00:34:22.219 --> 00:34:25.440
to hone in on it unless um really unless there's

00:34:25.440 --> 00:34:27.920
symptoms because most departments don't have

00:34:27.920 --> 00:34:30.059
thorough blood work either they're very kind

00:34:30.059 --> 00:34:33.340
of surface level but where i see the superpower

00:34:33.340 --> 00:34:35.920
of this is you've had your baseline and in medicine

00:34:35.920 --> 00:34:38.920
obviously trending is is the biggest thing is

00:34:38.920 --> 00:34:41.630
the second scan There's a couple of places where

00:34:41.630 --> 00:34:43.949
I had a blood vessel and it's probably just thickening

00:34:43.949 --> 00:34:46.090
genetically, but it's something that I'm going

00:34:46.090 --> 00:34:48.329
to look. And when I get it done a year or two

00:34:48.329 --> 00:34:52.369
later, now I'm going to be able to compare 2026

00:34:52.369 --> 00:34:55.929
and 2028. And I think that's where there's incredible

00:34:55.929 --> 00:34:58.070
value because now, as you said, you can see,

00:34:58.090 --> 00:35:01.829
was this a benign genetic non -abnormality? It's

00:35:01.829 --> 00:35:05.550
just I'm abnormal in my anatomy. Or is this a

00:35:05.550 --> 00:35:07.429
growth or a weakening of an artery that I need

00:35:07.429 --> 00:35:10.289
to be worried about? Yeah, that's a really important

00:35:10.289 --> 00:35:16.289
point. So the idea, the highest value for an

00:35:16.289 --> 00:35:19.050
individual will come from using something like

00:35:19.050 --> 00:35:25.369
the whole body MRI as a longitudinal surveillance

00:35:25.369 --> 00:35:29.250
tool. And it allows the individual then to basically

00:35:29.250 --> 00:35:31.969
serve as their own reference control. You get

00:35:31.969 --> 00:35:34.590
the baseline in hopefully a healthy state. Hopefully

00:35:34.590 --> 00:35:36.550
on the first scan, we don't find anything that...

00:35:37.269 --> 00:35:39.130
it's particularly radiologically concerning.

00:35:39.289 --> 00:35:42.010
Like we'll see a lot of benign, nobody has a

00:35:42.010 --> 00:35:44.090
completely normal whole body MRI. That really

00:35:44.090 --> 00:35:48.010
doesn't, that's sort of like a paradox in a way

00:35:48.010 --> 00:35:50.530
that doesn't exist. Like everybody has dots all

00:35:50.530 --> 00:35:52.170
over the body. You might think of it as an analogy

00:35:52.170 --> 00:35:53.989
to like, look at everyone's skin. Like everyone

00:35:53.989 --> 00:35:56.550
has freckles somewhere. You don't go to the dermatologist

00:35:56.550 --> 00:35:58.650
and they biopsy every freckle for possible melanoma,

00:35:58.690 --> 00:36:01.989
but they can recognize the ones that maybe are

00:36:01.989 --> 00:36:03.349
more concerned that need watchful waiting or

00:36:03.349 --> 00:36:05.929
the ones that need a biopsy on the spot. So you

00:36:05.929 --> 00:36:08.639
now, go deeper into the body and everyone will

00:36:08.639 --> 00:36:10.679
have things like, you know, little dots and little

00:36:10.679 --> 00:36:12.960
cysts and, you know, say the kidneys or the liver,

00:36:13.099 --> 00:36:16.559
things like that. Those are sort of leave alone,

00:36:16.699 --> 00:36:18.380
but we can document that the baseline. And then

00:36:18.380 --> 00:36:22.940
serving as someone's own control, what is normal

00:36:22.940 --> 00:36:26.320
for them is basically what are the expected age

00:36:26.320 --> 00:36:28.760
appropriate changes that that person might develop

00:36:28.760 --> 00:36:31.719
within a year or two. There are things that from

00:36:31.719 --> 00:36:35.079
seeing so many healthy whole body MRIs, we can

00:36:35.079 --> 00:36:37.300
have a sense of, This is within the spectrum

00:36:37.300 --> 00:36:40.099
of normal versus this is outside the spectrum

00:36:40.099 --> 00:36:42.659
of normal. And this requires some tailoring,

00:36:42.699 --> 00:36:45.980
targeted attention in that specific patient.

00:36:46.039 --> 00:36:48.179
It's not all just about tumors and aneurysms.

00:36:48.239 --> 00:36:50.500
It could be, you mentioned, you know, spine imaging

00:36:50.500 --> 00:36:52.679
could even be something about spine health. So,

00:36:52.679 --> 00:36:56.139
you know, there's a lot of wear and tear that

00:36:56.139 --> 00:36:58.239
we all get on our spine. No one's going to escape.

00:36:58.480 --> 00:37:02.059
You know, the radiology term we use is degenerative

00:37:02.059 --> 00:37:03.920
change of the spine. That really means, you know,

00:37:03.940 --> 00:37:07.019
wear and tear. Now, you can be somebody in their

00:37:07.019 --> 00:37:10.460
50s who has the spine of a 50 -year -old. That's

00:37:10.460 --> 00:37:11.920
maybe age appropriate. You can be someone in

00:37:11.920 --> 00:37:14.679
their 20s and has the spine of a 50 -year -old.

00:37:14.860 --> 00:37:17.400
And you might not have any back pain issues right

00:37:17.400 --> 00:37:19.119
now, but you might want to be alerted to that

00:37:19.119 --> 00:37:22.800
so you can practice good spine health, good posture.

00:37:23.760 --> 00:37:26.380
If you work at a desk, maybe get ergonomic type

00:37:26.380 --> 00:37:28.880
desk setup, standing desk, good chair, et cetera.

00:37:29.679 --> 00:37:31.800
Do appropriate exercise and manage your weight

00:37:31.800 --> 00:37:35.119
to avoid the accelerated deterioration of the

00:37:35.119 --> 00:37:38.239
spine so that when you're in middle age, you

00:37:38.239 --> 00:37:39.820
don't have the spine of somebody who's like in

00:37:39.820 --> 00:37:41.820
advanced age. And maybe when we all get to advanced

00:37:41.820 --> 00:37:44.179
age, maybe on the other hand, we have, if we

00:37:44.179 --> 00:37:48.260
can be mindful enough of our physical mechanics

00:37:48.260 --> 00:37:51.710
better. We might be in our 70s and have the spine

00:37:51.710 --> 00:37:53.550
of a 50 -year -old. So that is sort of the idea.

00:37:53.570 --> 00:37:56.489
Getting this imaging information is a motivating

00:37:56.489 --> 00:37:59.090
factor towards optimizing long -term health.

00:37:59.349 --> 00:38:02.690
Now, tumors, obviously, those are important because

00:38:02.690 --> 00:38:12.489
we will often see a smaller, locally, like a

00:38:12.489 --> 00:38:15.150
local tumor that will never have pronounced itself

00:38:15.150 --> 00:38:17.960
until... diagnosed for another reason once it's

00:38:17.960 --> 00:38:19.539
much bigger and harder to treat. But when you

00:38:19.539 --> 00:38:21.480
see with imaging at the earliest stages, where

00:38:21.480 --> 00:38:23.860
it's just a small, it's a nodule in an organ,

00:38:23.960 --> 00:38:26.760
and it's new from, let's say, last year, and

00:38:26.760 --> 00:38:29.139
it doesn't look like the benign picture of a

00:38:29.139 --> 00:38:32.940
cyst or some other typical benign thing like

00:38:32.940 --> 00:38:35.119
a hemangioma that we often see in different organs,

00:38:35.360 --> 00:38:39.960
then this is basically an alert to early action.

00:38:40.099 --> 00:38:43.500
And many times those... don't need to be aggressively

00:38:43.500 --> 00:38:46.619
treated with a major surgery, let's say, but

00:38:46.619 --> 00:38:51.139
we have the tools to observe them minimally invasively,

00:38:51.199 --> 00:38:54.760
either with more imaging or to even intervene

00:38:54.760 --> 00:38:57.400
on them without having the morbidity and risk

00:38:57.400 --> 00:39:00.320
associated with big open surgery. So an organ

00:39:00.320 --> 00:39:03.559
that I'm particularly excited by in my case is

00:39:03.559 --> 00:39:07.400
kidneys. Kidneys, we actually see a good number

00:39:07.400 --> 00:39:11.380
of early renal cell carcinomas. And there's probably

00:39:11.380 --> 00:39:13.539
some controversy about those. Like maybe we're

00:39:13.539 --> 00:39:15.940
detecting a lot more renal cell carcinomas that

00:39:15.940 --> 00:39:19.119
really would never have hurt the patients had

00:39:19.119 --> 00:39:21.300
they not been like detected with imaging. Maybe

00:39:21.300 --> 00:39:23.239
they'd be slow growing, relatively indolent,

00:39:23.260 --> 00:39:24.719
and a patient might die from some other cause

00:39:24.719 --> 00:39:26.679
in like 10 years and better they didn't know

00:39:26.679 --> 00:39:28.360
about it, but rather than know about it. However,

00:39:28.599 --> 00:39:31.280
that's sort of based on, I think, incomplete

00:39:31.280 --> 00:39:35.940
assumptions because not every small tumor needs

00:39:35.940 --> 00:39:37.760
to have a major surgery and take out the whole

00:39:37.760 --> 00:39:40.059
kidney. So nowadays we can minimally invasively

00:39:40.059 --> 00:39:42.639
with imaging, you know, put a needle into that

00:39:42.639 --> 00:39:45.599
tumor and ablate that like we were talking about

00:39:45.599 --> 00:39:47.920
earlier with focused ultrasound in the brain.

00:39:49.199 --> 00:39:51.639
Similarly, you could do, whether it's with not

00:39:51.639 --> 00:39:53.440
so much these days with an ultrasound, but maybe

00:39:53.440 --> 00:39:55.260
in the future with something like histotripsy

00:39:55.260 --> 00:39:57.260
or another ultrasound too. But these days we

00:39:57.260 --> 00:40:00.260
usually do it with like a needle -based ablation

00:40:00.260 --> 00:40:02.679
with radiofrequency or microwave ablation. And

00:40:02.679 --> 00:40:04.579
you could leave the whole kidney intact. You

00:40:04.579 --> 00:40:09.110
just burn. the tumor, and that's just the disease

00:40:09.110 --> 00:40:12.889
tissue is removed. And the benefits are that

00:40:12.889 --> 00:40:16.170
you kind of get the benefit of early detection

00:40:16.170 --> 00:40:21.090
without the cost or the trade -off of the unintended

00:40:21.090 --> 00:40:24.590
consequences of the high risk and highly costly

00:40:24.590 --> 00:40:27.070
treatments that would go along with that. So

00:40:27.070 --> 00:40:29.829
the technologies are kind of emerging in parallel,

00:40:29.909 --> 00:40:32.369
medicine from the interventional side, as well

00:40:32.369 --> 00:40:34.900
as medicine from the... diagnostic as well as

00:40:34.900 --> 00:40:37.940
medicine from the pre -diagnostic but early detection

00:40:37.940 --> 00:40:43.519
side. So the baseline really enables you to use

00:40:43.519 --> 00:40:48.079
your own self, your own data as that control.

00:40:48.280 --> 00:40:51.940
Because if I see a new lesion, small, maybe looks

00:40:51.940 --> 00:40:54.139
low risk at the first baseline without the prior

00:40:54.139 --> 00:40:57.019
baseline, I might not be able to tell you, oh,

00:40:57.039 --> 00:40:59.000
this is more concerning because I want to see

00:40:59.000 --> 00:41:01.360
another time point. But if I already had an earlier

00:41:01.360 --> 00:41:04.780
time point, where I can see it wasn't there and

00:41:04.780 --> 00:41:07.880
now there's a new tumor there. That means I can

00:41:07.880 --> 00:41:10.820
give you a trajectory of like sort of this is

00:41:10.820 --> 00:41:13.039
number one new. What's the growth rate? What's

00:41:13.039 --> 00:41:15.539
the doubling time? This has more concerning for

00:41:15.539 --> 00:41:17.619
something more progressive versus something stable.

00:41:17.639 --> 00:41:19.840
Now, if I see it for the first time and I see

00:41:19.840 --> 00:41:21.380
you again in three months or six months and I

00:41:21.380 --> 00:41:23.380
can demonstrate, well, look, it hasn't grown

00:41:23.380 --> 00:41:26.539
actually. It's stable. We don't have to really

00:41:26.539 --> 00:41:29.460
worry too much about it so we can afford to watch

00:41:29.460 --> 00:41:31.980
and wait it. So those longitudinal data points

00:41:31.980 --> 00:41:37.440
are more additional information that people forget

00:41:37.440 --> 00:41:39.659
about. Like that value is really in that longitudinal

00:41:39.659 --> 00:41:42.159
follow -up goes beyond just the baseline alone.

00:41:42.480 --> 00:41:45.960
And the ability to do that without ionizing radiation

00:41:45.960 --> 00:41:50.480
means that we don't have to worry about the concept

00:41:50.480 --> 00:41:53.840
of overdosing people with the trade -offs that

00:41:53.840 --> 00:41:56.199
we would get in other radiology contexts that

00:41:56.199 --> 00:41:59.389
would also, you know, In theory, be able to do

00:41:59.389 --> 00:42:02.929
the same thing, but come at that radiation cost.

00:42:05.130 --> 00:42:08.690
I had a guest on for a second time, Josh Clemente,

00:42:08.690 --> 00:42:11.230
who's the man behind Levels. And he made a really

00:42:11.230 --> 00:42:15.530
powerful kind of point. He said, and he was obviously

00:42:15.530 --> 00:42:18.050
generalizing, but he said doctors were never

00:42:18.050 --> 00:42:21.610
meant to be treating chronic disease. He said

00:42:21.610 --> 00:42:24.329
doctors were originally created for trauma and,

00:42:24.349 --> 00:42:26.639
you know. childbirth and some of these other

00:42:26.639 --> 00:42:28.940
areas where you need this medical professional

00:42:28.940 --> 00:42:33.099
with this medical expertise. And with this AI

00:42:33.099 --> 00:42:37.039
and with the much better blood work now and technology

00:42:37.039 --> 00:42:42.059
like preventative MRIs, his point was we're putting

00:42:42.059 --> 00:42:44.199
the power back in the hands of the patient. Now

00:42:44.199 --> 00:42:47.480
we're asking medical professionals to interpret

00:42:47.480 --> 00:42:51.039
this data for us. But now you can say, okay,

00:42:51.159 --> 00:42:53.800
I'm starting to get slightly fatty liver disease.

00:42:54.400 --> 00:42:56.639
Before I ever would have walked in, because now

00:42:56.639 --> 00:42:58.599
I'm bright yellow and asking my doctor what's

00:42:58.599 --> 00:43:01.440
wrong, now I'm so far ahead of it that I can

00:43:01.440 --> 00:43:03.980
look at all these things and say, as James Gearing,

00:43:04.119 --> 00:43:07.659
as my own advocate, what am I going to do to

00:43:07.659 --> 00:43:10.000
get ahead of this? And we don't really have that

00:43:10.000 --> 00:43:12.159
in a lot of modern medicine. People go when they're

00:43:12.159 --> 00:43:13.880
already feeling bad or they're already hurt.

00:43:14.519 --> 00:43:16.460
And I'll give you a good example. When I had

00:43:16.460 --> 00:43:20.300
my MRI, and I wish I could remember your colleague's

00:43:20.300 --> 00:43:22.380
name that was the one that was walking me through

00:43:22.380 --> 00:43:25.539
it. But she was saying how good my spine looked.

00:43:27.900 --> 00:43:32.320
And what was interesting is I had a near career

00:43:32.320 --> 00:43:35.820
ending back injury about 10 years ago. And even

00:43:35.820 --> 00:43:38.119
though I was told to take meds and probably go

00:43:38.119 --> 00:43:40.980
down the surgical route, I refused and did chiropractic

00:43:40.980 --> 00:43:45.139
and specific movement practice that is amazing

00:43:45.139 --> 00:43:48.699
for back health. And my back looks great, even

00:43:48.699 --> 00:43:51.340
like the actual disc, the bulging of the discs.

00:43:52.010 --> 00:43:53.989
gone down and i hadn't really had an mri on my

00:43:53.989 --> 00:43:55.889
back since i originally heard it which at that

00:43:55.889 --> 00:43:57.989
point there was multiple protruding discs and

00:43:57.989 --> 00:44:01.809
one of my vertebrae was turning the wrong way

00:44:01.809 --> 00:44:06.500
so again it goes to show that now you have this

00:44:06.500 --> 00:44:08.239
kind of imaging proof, like, okay, you're not

00:44:08.239 --> 00:44:10.079
going to go back to having an 18 year old back.

00:44:10.199 --> 00:44:12.340
But yeah, in that particular case, movement practice

00:44:12.340 --> 00:44:14.880
helped my back without any surgery. You know,

00:44:14.880 --> 00:44:18.280
you reverse some areas in the body by changing

00:44:18.280 --> 00:44:20.079
your exercise routine and your sleep routine

00:44:20.079 --> 00:44:23.900
and your nutrition. So what I love about this

00:44:23.900 --> 00:44:26.099
is not only obviously the screening itself, but

00:44:26.099 --> 00:44:28.699
it's putting the power of the patient, you know,

00:44:28.699 --> 00:44:30.599
back in their own hands, which is the whole point.

00:44:30.619 --> 00:44:32.280
They're the only person really, apart from their

00:44:32.280 --> 00:44:35.639
family, that's affected by this health. So the

00:44:35.639 --> 00:44:37.980
more we can empower them with this modern technology,

00:44:38.159 --> 00:44:41.539
the more they can understand this whole issue,

00:44:41.659 --> 00:44:43.880
the more empowered they are to make their own

00:44:43.880 --> 00:44:46.800
decisions. And then most importantly, that proactive

00:44:46.800 --> 00:44:49.320
preventative health becomes a lot more powerful

00:44:49.320 --> 00:44:55.840
now. Totally. So in a way, it democratizes the

00:44:55.840 --> 00:44:59.400
medical data and makes it accessible to the...

00:44:59.800 --> 00:45:01.760
the patient direct, and it's not limited to,

00:45:01.800 --> 00:45:03.820
you know, the whole body MRI and prenuvo scan

00:45:03.820 --> 00:45:06.840
alone. Like nowadays patients have access to

00:45:06.840 --> 00:45:09.980
their own medical records relatively generally.

00:45:10.099 --> 00:45:14.000
Right. The challenge is a patient may also be

00:45:14.000 --> 00:45:17.960
overwhelmed with all that data without sort of

00:45:17.960 --> 00:45:22.059
kind of, like you said, like originally medicine

00:45:22.059 --> 00:45:24.860
emerged as sort of a way to treat acute disease,

00:45:25.039 --> 00:45:30.269
but at the same time, even outside the acute

00:45:30.269 --> 00:45:34.849
setting you kind of need an expert coach to kind

00:45:34.849 --> 00:45:37.429
of make sense of all this data for you that's

00:45:37.429 --> 00:45:40.389
often can be very technical or maybe you might

00:45:40.389 --> 00:45:42.969
be you know well versed and so one area of it

00:45:42.969 --> 00:45:45.349
but you don't understand how it inter integrates

00:45:45.349 --> 00:45:48.730
with another area of like how does imaging relate

00:45:48.730 --> 00:45:53.409
to labs etc and so kind of having a medical expertise

00:45:53.409 --> 00:45:56.679
to holistically integrate this and counsel you

00:45:56.679 --> 00:45:58.679
so counseling i think is going to be very important

00:45:58.679 --> 00:46:01.260
nonetheless i don't think i don't think it will

00:46:01.260 --> 00:46:07.480
be any one individual can be assumed to um it

00:46:07.480 --> 00:46:10.139
would be sort of irresponsible i think of doctors

00:46:10.139 --> 00:46:12.219
to sort of say here's your data and go figure

00:46:12.219 --> 00:46:15.780
it out but it is our job to educate counsel and

00:46:15.780 --> 00:46:19.559
provide guidance on on um on how to use that

00:46:19.559 --> 00:46:21.280
information but the patient then once they have

00:46:21.280 --> 00:46:27.269
that that framing is then armed to take care

00:46:27.269 --> 00:46:30.429
of their own health in a way that is not behind

00:46:30.429 --> 00:46:34.070
sort of the gates of medicine. You don't have

00:46:34.070 --> 00:46:41.949
to go to any one center or doctor who's sort

00:46:41.949 --> 00:46:44.030
of controlling all the data and then having them,

00:46:44.110 --> 00:46:46.130
the doctors talk to the other doctor to share

00:46:46.130 --> 00:46:47.809
the opinions of the day. They can all be centralized

00:46:47.809 --> 00:46:50.869
in really the patient as the concentrating point

00:46:50.869 --> 00:46:53.559
for their own. their own data and healthcare.

00:46:53.699 --> 00:46:55.380
And that's something that we've done at Prenuva

00:46:55.380 --> 00:46:57.480
specifically. We had that in mind. And so every

00:46:57.480 --> 00:46:59.840
patient through like the Prenuva app will get

00:46:59.840 --> 00:47:04.579
the full set of, you know, the whole, the radiology

00:47:04.579 --> 00:47:07.559
report for sure. They'll also get sort of direct

00:47:07.559 --> 00:47:09.820
embedded links to sort of educational materials

00:47:09.820 --> 00:47:12.500
for any one of those conditions that we may be

00:47:12.500 --> 00:47:15.440
observing, whether it's the fatty liver or the

00:47:15.440 --> 00:47:18.940
liver cysts or hemangiomas, et cetera. be able

00:47:18.940 --> 00:47:21.059
to put that in their own context in addition

00:47:21.059 --> 00:47:23.900
to having the medical consultation that you experienced,

00:47:24.300 --> 00:47:28.340
but then also have the images themselves downloadable

00:47:28.340 --> 00:47:30.300
through the app that they can then share directly

00:47:30.300 --> 00:47:32.760
with the specialist that they go to. So they

00:47:32.760 --> 00:47:34.739
can go to, let's say, the liver doctor, and the

00:47:34.739 --> 00:47:37.619
liver doctor can download the images and look

00:47:37.619 --> 00:47:40.159
at them directly themselves and then have...

00:47:41.039 --> 00:47:45.800
the maximal exposure to the pure data and it

00:47:45.800 --> 00:47:47.820
not having to be filtered through, you know,

00:47:47.840 --> 00:47:51.179
multiple kind of plain telephone in a way. And

00:47:51.179 --> 00:47:52.679
the patient takes ownership of their own care

00:47:52.679 --> 00:47:54.699
because they could choose their provider. They

00:47:54.699 --> 00:47:56.800
can connect the data directly to the provider.

00:47:56.880 --> 00:47:58.440
And I think that's been very well received and

00:47:58.440 --> 00:48:03.980
very, very useful. Nobody is more of an advocate

00:48:03.980 --> 00:48:09.289
for their own health than themselves. Having

00:48:09.289 --> 00:48:12.230
been in the medical environment as a patient

00:48:12.230 --> 00:48:15.090
myself and for my wife when she was delivering

00:48:15.090 --> 00:48:18.250
our kids, everybody needs to be able to advocate

00:48:18.250 --> 00:48:20.130
for themselves. And the more knowledge that you

00:48:20.130 --> 00:48:22.230
have and information you have at your disposal,

00:48:22.230 --> 00:48:24.909
the more it arms you to do so. Especially as

00:48:24.909 --> 00:48:27.489
the system gets bigger and bigger and bigger

00:48:27.489 --> 00:48:32.130
and it's hard to sort of, we lose a lot of that

00:48:32.130 --> 00:48:37.000
personalization that is... important to the tradition

00:48:37.000 --> 00:48:39.579
of medicine, that patient -doctor relationship.

00:48:40.159 --> 00:48:46.079
I think this new development of democratizing

00:48:46.079 --> 00:48:47.960
medical data and making it directly available

00:48:47.960 --> 00:48:50.420
to patients and arming them with that information

00:48:50.420 --> 00:48:54.019
is important, especially as we just keep making

00:48:54.019 --> 00:48:56.940
it more accessible to the larger masses. People

00:48:56.940 --> 00:48:58.519
need to be able to advocate for themselves and

00:48:58.519 --> 00:49:03.719
have that direct touch on their information.

00:49:06.119 --> 00:49:08.280
Another application that I'm thinking of in my

00:49:08.280 --> 00:49:11.500
mind, just as you're talking, even at my level,

00:49:11.519 --> 00:49:14.639
at the bachelor's level in the paramedic school,

00:49:14.739 --> 00:49:18.239
when we're taught medicine, it's organ system

00:49:18.239 --> 00:49:20.579
by organ system. Okay, this chapter is a renal.

00:49:20.659 --> 00:49:22.659
And then I would imagine as you go through medical

00:49:22.659 --> 00:49:25.519
school, if you have a residency and a specialty,

00:49:25.639 --> 00:49:28.199
and now you become a renal specialist, there's

00:49:28.199 --> 00:49:31.579
a danger of becoming myopic in that one area.

00:49:32.929 --> 00:49:35.630
When you have the ability to then have all these

00:49:35.630 --> 00:49:38.030
images, though, from a full body MRI and you

00:49:38.030 --> 00:49:40.650
think this issue is coming from the kidneys,

00:49:40.789 --> 00:49:42.130
but you're like, well, I wonder if it's coming

00:49:42.130 --> 00:49:44.170
from this other area. Now you're able to look

00:49:44.170 --> 00:49:46.369
at the whole body and say, well, was there an

00:49:46.369 --> 00:49:50.869
issue with the liver? Or was there some cardiovascular

00:49:50.869 --> 00:49:53.070
issues in the lower legs? Whatever it is that

00:49:53.070 --> 00:49:54.369
you're looking for. And I can tell I'm just making

00:49:54.369 --> 00:49:57.349
that part up because I'm not a doctor. But getting

00:49:57.349 --> 00:50:00.170
that macro perspective of the whole person again,

00:50:00.230 --> 00:50:03.070
I could see there was value. um when trying to

00:50:03.070 --> 00:50:05.010
even diagnose something when you have gone to

00:50:05.010 --> 00:50:09.610
that specialist yeah and um even in radiology

00:50:09.610 --> 00:50:11.349
it's it takes some wrapping your head around

00:50:11.349 --> 00:50:14.329
because in radiology usually we would outside

00:50:14.329 --> 00:50:16.869
the whole body screening context usually you'd

00:50:16.869 --> 00:50:19.889
get like a brain mri or a prostate mri you know

00:50:19.889 --> 00:50:22.610
these are totally separate organs they don't

00:50:22.610 --> 00:50:25.750
like interact with each other. They're not diagnostically

00:50:25.750 --> 00:50:27.150
related, but it's not really true because they're

00:50:27.150 --> 00:50:30.030
all part of the organism, the whole body entity.

00:50:31.449 --> 00:50:34.610
And a lot of these conditions and pathologies

00:50:34.610 --> 00:50:39.269
and organisms, they interrelate with each other.

00:50:39.389 --> 00:50:44.650
So obviously, when we talk about the heart, the

00:50:44.650 --> 00:50:50.409
kidneys, the lungs, the liver, these are all...

00:50:50.590 --> 00:50:53.050
physiologically related with each other. And

00:50:53.050 --> 00:51:00.630
you can have fluid dynamics and physiology that

00:51:00.630 --> 00:51:04.050
affects all those organs or systemic conditions

00:51:04.050 --> 00:51:06.570
like inflammation or even cancer that you might

00:51:06.570 --> 00:51:09.329
have a tumor in a certain organ. Then you have

00:51:09.329 --> 00:51:13.469
metastases spread elsewhere. Until you take the

00:51:13.469 --> 00:51:16.010
whole body approach, number one, you can sort

00:51:16.010 --> 00:51:20.199
of characterize distinct processes that are separated

00:51:20.199 --> 00:51:23.199
in anatomic space in a way. But a lot of times

00:51:23.199 --> 00:51:26.320
they do interrelate. So when you see somebody

00:51:26.320 --> 00:51:29.360
with, let's say, a picture of metabolic syndrome,

00:51:29.719 --> 00:51:33.320
you know, they have enlarged visceral fat. So

00:51:33.320 --> 00:51:34.800
when I talk about visceral fat, I mean, there's

00:51:34.800 --> 00:51:36.820
like two general categories of fat. There's like

00:51:36.820 --> 00:51:38.940
subcutaneous fat, the fat below the skin, which

00:51:38.940 --> 00:51:42.039
is, you know, maybe aesthetically not, you know,

00:51:42.039 --> 00:51:43.900
the type of fat that we want to have. But from

00:51:43.900 --> 00:51:45.739
a metabolic perspective, it's not like the bad

00:51:45.739 --> 00:51:49.679
metabolically. you know, dysfunctional type of

00:51:49.679 --> 00:51:52.019
fat as much as visceral fat. Visceral fat is

00:51:52.019 --> 00:51:55.000
like the deep fat, usually within the abdomen,

00:51:55.079 --> 00:51:57.639
but also can be, you know, in the chest, the

00:51:57.639 --> 00:52:00.539
thoracic, pericardiac fat. But these are the

00:52:00.539 --> 00:52:03.559
kinds of fat that will go along with things like

00:52:03.559 --> 00:52:07.300
sugar, dysregulation, diabetes, and things like

00:52:07.300 --> 00:52:09.179
that. They'll often be part of a manifestation

00:52:09.179 --> 00:52:12.920
of a metabolic syndrome and fatty liver, and

00:52:12.920 --> 00:52:17.139
can also relate to all kinds of chronic vascular

00:52:18.730 --> 00:52:21.449
disorders. So, you know, diabetes can cause,

00:52:21.530 --> 00:52:25.969
you know, small vessel disease. So in the brain,

00:52:26.130 --> 00:52:28.090
we might see small vessel ischemia, a little,

00:52:28.190 --> 00:52:30.409
you know, what we call non -specific white spots,

00:52:30.510 --> 00:52:33.469
but it's often a kind of small vessel ischemia

00:52:33.469 --> 00:52:36.710
from long -term sort of narrowing of those end

00:52:36.710 --> 00:52:40.050
small blood vessels. And you can grade it in

00:52:40.050 --> 00:52:41.530
terms of mild, moderate, severe. And as you can

00:52:41.530 --> 00:52:44.349
see, get a more general whole body picture of

00:52:44.349 --> 00:52:47.860
not just This organ is diseased, but how does

00:52:47.860 --> 00:52:50.820
this organ manifest in a sort of whole body system

00:52:50.820 --> 00:52:53.559
with integrated systems and get a sense of this?

00:52:53.619 --> 00:52:55.659
So we might say, oh, well, you might want to

00:52:55.659 --> 00:52:57.940
get more aggressive management of your cardiovascular

00:52:57.940 --> 00:53:00.000
risk factors because, look, you're on the verge

00:53:00.000 --> 00:53:03.099
of showing signs of metabolic syndrome. You have

00:53:03.099 --> 00:53:04.980
increased liver fat. You have increased visceral

00:53:04.980 --> 00:53:07.880
fat. You have end organ, ischemic change in the

00:53:07.880 --> 00:53:12.460
brain, et cetera. You're in your 40s. Let's think

00:53:12.460 --> 00:53:14.679
about this so that when you're in your 60s, you

00:53:14.679 --> 00:53:18.079
don't have. increased risk for cardiovascular

00:53:18.079 --> 00:53:23.860
acute events or even brain health like vascular

00:53:23.860 --> 00:53:26.960
dementia, which can lead to over time of one

00:53:26.960 --> 00:53:31.500
kind of dementia from just brain small vessel

00:53:31.500 --> 00:53:34.780
ischemia that just goes unchecked and keeps progressing.

00:53:35.219 --> 00:53:37.380
Now, it's not going to be a magic bullet. These

00:53:37.380 --> 00:53:41.389
are informational findings that will... Give

00:53:41.389 --> 00:53:44.110
a patient sort of impetus and maybe give them

00:53:44.110 --> 00:53:46.349
a benchmark from which they can compare future

00:53:46.349 --> 00:53:49.909
changes over time. And as long as things are

00:53:49.909 --> 00:53:52.230
improving without getting worse, that's probably

00:53:52.230 --> 00:53:54.289
in many cases the best that we can hope for.

00:53:54.369 --> 00:53:56.510
But there are targets like the liver fat that

00:53:56.510 --> 00:53:58.889
we can actually, we can see, you know, you're

00:53:58.889 --> 00:54:01.269
taking fat off the liver or visceral fat. The

00:54:01.269 --> 00:54:04.230
visceral fat is decreasing. And so your general

00:54:04.230 --> 00:54:12.480
trajectory might be improving. So, in another

00:54:12.480 --> 00:54:15.840
sense, another kind of interesting application

00:54:15.840 --> 00:54:19.119
to make it easy is from a tumor screening perspective,

00:54:20.039 --> 00:54:22.800
cancer screening is often like binary tests.

00:54:23.019 --> 00:54:25.559
Is there cancer? Is there not cancer? And it

00:54:25.559 --> 00:54:28.400
might be in an organ -limited fashion, like with

00:54:28.400 --> 00:54:31.380
the PSA, we're looking for prostate cancer, or

00:54:31.380 --> 00:54:34.639
in breast, another imaging modality. targeted

00:54:34.639 --> 00:54:36.639
just for breast is mammography which on a side

00:54:36.639 --> 00:54:38.059
note i just want to clarify you know when we

00:54:38.059 --> 00:54:40.460
talk about these multi -cancer detection technologies

00:54:40.460 --> 00:54:42.739
these usually are not intended to replace any

00:54:42.739 --> 00:54:44.780
one single cancer screening approach because

00:54:44.780 --> 00:54:48.159
those are evidence -based to be high ceo for

00:54:48.159 --> 00:54:50.260
patients of certain risk factors for that kind

00:54:50.260 --> 00:54:53.019
of cancer they complement each other but that

00:54:53.019 --> 00:54:54.760
being said usually they'll be focused for is

00:54:54.760 --> 00:54:57.639
there concern for cancer in that one organ binary

00:54:57.639 --> 00:55:00.619
and then a patient will have to go undergo other

00:55:00.619 --> 00:55:04.519
examinations to, let's say, cancer is proven,

00:55:04.880 --> 00:55:07.699
what's the sort of burden of disease? How big

00:55:07.699 --> 00:55:09.940
is the tumor? Where is the tumor located? Is

00:55:09.940 --> 00:55:15.179
it, you know, which organ of origin is it from?

00:55:15.300 --> 00:55:17.559
Is it on the right side? Is it on the left side?

00:55:17.719 --> 00:55:21.159
Is there evidence of local invasion or distant

00:55:21.159 --> 00:55:23.440
metastatic disease? So those sort of staging

00:55:23.440 --> 00:55:26.300
evaluations are often, you know, additional exams

00:55:26.300 --> 00:55:29.409
after the fact. We'll have a role still, no doubt,

00:55:29.570 --> 00:55:31.969
after, let's say, screening detection with whole

00:55:31.969 --> 00:55:34.969
body MRI. But you can imagine we will also get

00:55:34.969 --> 00:55:36.690
at the time of screening, the same encounter,

00:55:36.929 --> 00:55:40.269
the detection, but also an estimation of disease

00:55:40.269 --> 00:55:41.650
burden because we're getting that whole body

00:55:41.650 --> 00:55:44.030
view. So I might be able to say, oh, there's

00:55:44.030 --> 00:55:46.989
a prostate lesion. But by the way, there's, and

00:55:46.989 --> 00:55:49.449
that's very concerning for prostate cancer. It

00:55:49.449 --> 00:55:51.920
looks like. you know, you know, we grade it on

00:55:51.920 --> 00:55:53.900
sort of, you know, MRI features and say, this

00:55:53.900 --> 00:55:55.599
looks like cancer to proven otherwise needs a

00:55:55.599 --> 00:55:57.539
biopsy. But by the way, there's also all these

00:55:57.539 --> 00:55:59.920
bone lesions and those look like prostate metastases.

00:56:00.960 --> 00:56:03.639
This might be considered high, you know, late

00:56:03.639 --> 00:56:05.619
stage cancer to proven otherwise, which changes

00:56:05.619 --> 00:56:07.599
sort of maybe the aggressiveness with which you

00:56:07.599 --> 00:56:09.699
work it up and treat it or the treatment options

00:56:09.699 --> 00:56:11.980
or sort of the goals of care. And you can get

00:56:11.980 --> 00:56:14.059
that at the same time point of screening that

00:56:14.059 --> 00:56:18.079
you wouldn't get with other kind of non -holistic

00:56:18.079 --> 00:56:20.900
approaches to the whole body. Almost all diseases

00:56:20.900 --> 00:56:24.820
that we are concerned about will progress towards

00:56:24.820 --> 00:56:27.480
sort of systemic manifestations. But our goal

00:56:27.480 --> 00:56:32.840
with early detection is to detect them at a local

00:56:32.840 --> 00:56:36.099
stage. But if there is evidence of systemic manifestations,

00:56:36.860 --> 00:56:39.739
be able to... get a sense of that as well. So

00:56:39.739 --> 00:56:41.780
it's kind of like a lot of bang for your buck

00:56:41.780 --> 00:56:44.420
in the early detection space because we get that

00:56:44.420 --> 00:56:47.019
systemic view at the same time as a byproduct

00:56:47.019 --> 00:56:51.659
really of the early targeted detection. What

00:56:51.659 --> 00:56:54.059
about the skeleton? You're able to see bone density

00:56:54.059 --> 00:56:59.179
or potential fractures, et cetera? So that's

00:56:59.179 --> 00:57:02.449
an interesting area. I would say that's... Talking

00:57:02.449 --> 00:57:05.469
about bone density, not something today that

00:57:05.469 --> 00:57:07.610
we are doing. I wouldn't hang my hat on that.

00:57:07.730 --> 00:57:12.630
But there is research that MRI, at some point,

00:57:12.650 --> 00:57:16.289
should be able to get developed and become clinically

00:57:16.289 --> 00:57:18.510
mainstream enough to be able to do some form

00:57:18.510 --> 00:57:23.050
of bone mineral density assessment. Now, that's

00:57:23.050 --> 00:57:25.429
not where we are today. So you come to Pernuvo,

00:57:25.590 --> 00:57:27.710
you would not get sort of an osteoporosis screening.

00:57:28.170 --> 00:57:31.159
But there are... So individuals, researchers

00:57:31.159 --> 00:57:34.460
looking into being able to do that sort of opportunistic

00:57:34.460 --> 00:57:37.460
sort of detection with MRI as well. So it would

00:57:37.460 --> 00:57:39.659
put kind of bone mineral density aside. If someone,

00:57:39.760 --> 00:57:42.820
let's say, usually females over a certain age

00:57:42.820 --> 00:57:44.480
that are at risk for osteoporosis, they should

00:57:44.480 --> 00:57:47.219
probably still go for this usual DEXA -based

00:57:47.219 --> 00:57:50.699
screening, which allows to measure the bone density

00:57:50.699 --> 00:57:54.139
relative to age -matched controls and see if

00:57:54.139 --> 00:57:57.619
they're more at risk for getting a fracture.

00:57:59.079 --> 00:58:01.079
So we definitely don't want someone to replace

00:58:01.079 --> 00:58:04.199
that practice with anything we're doing with

00:58:04.199 --> 00:58:07.260
whole body MRI today, but there would be potentially

00:58:07.260 --> 00:58:10.219
some applications in the future. So put that

00:58:10.219 --> 00:58:13.199
aside, the bone mineral density for now, but

00:58:13.199 --> 00:58:16.239
talking about, let's say, fractures, if someone

00:58:16.239 --> 00:58:19.280
had a trauma, they fell something or they have

00:58:19.280 --> 00:58:22.780
an unexplained pain in a bone or joint, I don't

00:58:22.780 --> 00:58:25.519
want them to come to Prenuascan to diagnose that

00:58:25.519 --> 00:58:27.989
because it'll be a... A more directed diagnostic

00:58:27.989 --> 00:58:30.730
modality in that setting. But if somebody has

00:58:30.730 --> 00:58:34.469
a history of a fracture and they didn't even

00:58:34.469 --> 00:58:36.889
know about it, it's chronic at this point. Let's

00:58:36.889 --> 00:58:39.309
say in the spine, they previously had trauma

00:58:39.309 --> 00:58:41.429
and they know about it or they don't know about

00:58:41.429 --> 00:58:43.329
it and there was compression fractures or they

00:58:43.329 --> 00:58:45.829
have osteoporosis and there's compression fractures

00:58:45.829 --> 00:58:48.510
and maybe they didn't know about it. We can see

00:58:48.510 --> 00:58:50.980
manifestations of... what looks like chronic

00:58:50.980 --> 00:58:53.039
compression fractures, we might say that there's

00:58:53.039 --> 00:58:55.800
no evidence for acute findings. There's no, you

00:58:55.800 --> 00:58:57.579
know, there's no edema. There's no spinal canal

00:58:57.579 --> 00:58:59.579
stenosis or cord compression or anything like

00:58:59.579 --> 00:59:01.059
that. But usually these would be chronic, but

00:59:01.059 --> 00:59:03.380
we can give a sense of they are there present.

00:59:04.300 --> 00:59:06.699
So that would be something we could comment on,

00:59:06.760 --> 00:59:08.840
but I wouldn't recommend that that's something

00:59:08.840 --> 00:59:11.440
to come to Prenuva for because usually those

00:59:11.440 --> 00:59:14.280
are things that would be diagnosed routinely

00:59:14.280 --> 00:59:18.380
in more acute settings. or with a bone mineral

00:59:18.380 --> 00:59:20.260
density in sort of the standard screening context.

00:59:22.159 --> 00:59:24.340
I want to go to some of the success stories that

00:59:24.340 --> 00:59:27.800
you heard, but just before we do, my profession

00:59:27.800 --> 00:59:31.260
is known, sadly, cancer is a big thing in our

00:59:31.260 --> 00:59:35.000
profession. We have carcinogens in the fires

00:59:35.000 --> 00:59:36.900
we respond to and a lot of the other hazards.

00:59:36.920 --> 00:59:39.420
We have carcinogens in our gear, like PFAS. It's

00:59:39.420 --> 00:59:41.320
actually in there because of the manufacturer.

00:59:42.380 --> 00:59:45.019
We also know that sleep deprivation is carcinogenic,

00:59:45.239 --> 00:59:48.659
which is a more recent revelation, let's put

00:59:48.659 --> 00:59:51.800
it that way. We have the heart disease, and again,

00:59:51.880 --> 00:59:54.820
from the stress to the body composition. But

00:59:54.820 --> 00:59:56.860
one of the ones that's been alarming recently

00:59:56.860 --> 00:59:59.860
is a lot of young firefighters getting strokes,

01:00:00.079 --> 01:00:03.559
and a lot of them are hemorrhagic strokes. With

01:00:03.559 --> 01:00:06.219
obviously your father and then now yourself,

01:00:06.619 --> 01:00:10.679
what, if any, have you... seen read about as

01:00:10.679 --> 01:00:13.380
far as a correlation between shift work chronic

01:00:13.380 --> 01:00:17.119
sleep deprivation and that kind of disease process

01:00:17.119 --> 01:00:23.980
in younger men so i want to not over say what

01:00:23.980 --> 01:00:27.420
i'm not an expert on um so i'm not necessarily

01:00:27.420 --> 01:00:31.099
specifically informed on the firefighter specific

01:00:31.099 --> 01:00:34.539
risk factors for developing stroke and young

01:00:34.539 --> 01:00:36.480
men for developing stroke. That being said, all

01:00:36.480 --> 01:00:38.440
the things that you mentioned, these are known

01:00:38.440 --> 01:00:44.760
risk factors for all kinds of significant disease,

01:00:44.880 --> 01:00:47.219
including cardiovascular disease and stroke risk.

01:00:47.980 --> 01:00:52.480
So I'm not surprised that firefighters as a group

01:00:52.480 --> 01:00:54.860
would be at elevated risk for developing things

01:00:54.860 --> 01:00:58.980
like stroke, in addition to their risk for developing

01:00:58.980 --> 01:01:01.739
all kinds of tumors that are... at higher risk

01:01:01.739 --> 01:01:05.599
than the standard population. But as a matter

01:01:05.599 --> 01:01:07.679
of, can I say, do I know more about like, this

01:01:07.679 --> 01:01:10.380
causes them to be at more risk, this particular

01:01:10.380 --> 01:01:14.019
practice or this material that they're exposed

01:01:14.019 --> 01:01:16.360
to, or, you know, in their gear, that is not

01:01:16.360 --> 01:01:19.719
an area that I'm particularly informed on. But

01:01:19.719 --> 01:01:21.980
I will say that I have a good amount of experience

01:01:21.980 --> 01:01:24.579
doing whole body MRI in firefighters. We see

01:01:24.579 --> 01:01:27.780
a lot of firefighters at Pernuba, a lot of departments

01:01:27.780 --> 01:01:31.519
are actually referring their their members to

01:01:31.519 --> 01:01:35.059
us for advanced screening. Oftentimes, the first

01:01:35.059 --> 01:01:37.119
thing that I'm aware of that they're interested

01:01:37.119 --> 01:01:39.559
in is the cancer screening. I actually was less

01:01:39.559 --> 01:01:43.400
aware about the cardiovascular concerns. That

01:01:43.400 --> 01:01:46.760
being said, we can provide a lot of information

01:01:46.760 --> 01:01:50.460
that would inform risk assessments towards that.

01:01:50.599 --> 01:01:55.639
So if I see examples of prior strokes that may

01:01:55.639 --> 01:01:58.139
have been subclinical stroke we we can give that

01:01:58.139 --> 01:02:01.500
information on the whole body scan if i see evidence

01:02:01.500 --> 01:02:04.719
of risk factors like small vessel ischemia like

01:02:04.719 --> 01:02:08.019
white matter disease and whatnot even if no like

01:02:08.019 --> 01:02:11.159
large vessel occlusion or territorial vascular

01:02:11.159 --> 01:02:15.059
territory stroke had occurred this is an one

01:02:15.059 --> 01:02:18.280
data point that says this patient is a vasculopath

01:02:18.280 --> 01:02:23.300
and probably should get into some a preventive

01:02:23.300 --> 01:02:25.739
care program to minimize their ongoing risk,

01:02:25.820 --> 01:02:28.179
not just for brain, but for cardiovascular events

01:02:28.179 --> 01:02:32.199
as well. The two will go hand in hand. If I see

01:02:32.199 --> 01:02:33.780
things in the brain, you mentioned hemorrhagic

01:02:33.780 --> 01:02:35.400
stroke, that could be various different kinds

01:02:35.400 --> 01:02:39.159
of stroke. If it's a hemorrhagic stroke, meaning

01:02:39.159 --> 01:02:42.500
maybe one type being from a ruptured aneurysm,

01:02:42.500 --> 01:02:47.059
we would see manifestations of aneurysms pretty

01:02:47.059 --> 01:02:51.019
well, probably as good as one would hope for.

01:02:51.400 --> 01:02:56.699
in a pre -acute scenario, which allows you an

01:02:56.699 --> 01:02:59.400
opportunity. You want to do surveillance on that

01:02:59.400 --> 01:03:02.559
or even prophylactically intervene on it if it's

01:03:02.559 --> 01:03:04.340
beyond a certain size. You have risk factors,

01:03:04.619 --> 01:03:07.280
familial concerns, et cetera. Those patients

01:03:07.280 --> 01:03:10.539
might go for an early, hopefully relatively minimally

01:03:10.539 --> 01:03:13.400
invasive intervention as well. Now, those would

01:03:13.400 --> 01:03:16.360
be like subarachnoid hemorrhage from an aneurysm,

01:03:16.380 --> 01:03:18.860
but there could be other types of hemorrhagic

01:03:18.860 --> 01:03:21.460
stroke. It could be from hypertension or other

01:03:21.460 --> 01:03:25.340
ideologies. I'm not going to be probably able

01:03:25.340 --> 01:03:27.699
to predict a hypertensive stroke because that

01:03:27.699 --> 01:03:31.219
is going to be acute and shown probably from

01:03:31.219 --> 01:03:33.079
a history of hypertension. But again, those are

01:03:33.079 --> 01:03:35.119
data points that will go together. If a patient

01:03:35.119 --> 01:03:37.619
knows they have high blood pressure and maybe

01:03:37.619 --> 01:03:39.659
that wasn't itself like something that motivated

01:03:39.659 --> 01:03:45.099
them to get into a blood pressure control improvement

01:03:45.099 --> 01:03:47.940
plan. but I show them all these other data points.

01:03:48.019 --> 01:03:49.460
Oh, look, you also have small vessel ischemia.

01:03:49.519 --> 01:03:51.920
That's also related to hypertension, plus minus

01:03:51.920 --> 01:03:55.519
diabetes, or you have these metabolic disorders

01:03:55.519 --> 01:03:59.539
with visceral fat and fatty liver, et cetera.

01:03:59.719 --> 01:04:02.119
The picture is not looking like it's going in

01:04:02.119 --> 01:04:04.199
the right direction. The picture speaks a thousand

01:04:04.199 --> 01:04:06.119
words and has been very helpful for those patients.

01:04:06.659 --> 01:04:09.780
We can also see if there's, I want to soften

01:04:09.780 --> 01:04:15.590
this a little bit, sort of like significant atherosclerotic

01:04:15.590 --> 01:04:17.550
disease in the intracranial arteries, if there's

01:04:17.550 --> 01:04:21.269
like high -grade stenosis, usually this is not

01:04:21.269 --> 01:04:23.789
the first line approach for kind of screening

01:04:23.789 --> 01:04:26.230
for atherosclerosis. But if I see sort of irregularities

01:04:26.230 --> 01:04:28.650
in the brain arteries, and this could be suggestive

01:04:28.650 --> 01:04:33.090
of atherosclerosis and high risk for developing

01:04:33.090 --> 01:04:37.030
future strokes, I might comment on that. But

01:04:37.030 --> 01:04:39.449
usually that's not the first way we look at that.

01:04:39.510 --> 01:04:40.750
So I don't want someone to think that they can

01:04:40.750 --> 01:04:44.400
get a prenuvo scan. and have sort of no comment

01:04:44.400 --> 01:04:48.239
on like atherosclerosis or narrowing of the brain

01:04:48.239 --> 01:04:49.840
arteries and think that that means they're risk

01:04:49.840 --> 01:04:52.800
-free. But we might comment on that opportunistically

01:04:52.800 --> 01:04:55.340
if we see that. Similarly for like dissections,

01:04:55.340 --> 01:04:57.119
which can be a cause of stroke as well. We see

01:04:57.119 --> 01:05:00.460
sort of weakenings in the blood vessel wall where

01:05:00.460 --> 01:05:04.019
it's now starting to... kind of tear off some

01:05:04.019 --> 01:05:06.280
of the inner lining of the blood vessel often

01:05:06.280 --> 01:05:08.380
from hypertension or from some let's say neck

01:05:08.380 --> 01:05:11.280
manipulation we see that once in a while as well

01:05:11.280 --> 01:05:13.039
we might say oh there's concern for dissection

01:05:13.039 --> 01:05:15.280
we need to further evaluate this and see somebody

01:05:15.280 --> 01:05:17.420
uh to evaluate if there's any risk for stroke

01:05:17.420 --> 01:05:20.639
or symptoms and then treat the risk factors that

01:05:20.639 --> 01:05:23.500
may go along with that so it it can heal basically

01:05:23.500 --> 01:05:26.880
not have an acute event so these are things that

01:05:26.880 --> 01:05:29.860
are like But the main thing that we screen for

01:05:29.860 --> 01:05:32.679
kind of neurovascular wise would be brain aneurysms.

01:05:33.639 --> 01:05:36.179
And one way we didn't really touch on was the

01:05:36.179 --> 01:05:38.360
heart specifically. What are you able to see

01:05:38.360 --> 01:05:44.460
with the heart? So in this kind of basic, the

01:05:44.460 --> 01:05:46.559
current iteration of the printable scan, and

01:05:46.559 --> 01:05:48.340
I emphasize current iteration because this is

01:05:48.340 --> 01:05:54.119
always an improving exam, improving technique.

01:05:55.260 --> 01:05:57.440
We will hopefully improve our heart evaluation

01:05:57.440 --> 01:05:59.800
over time. But right now, because the heart is

01:05:59.800 --> 01:06:02.199
a moving structure, it's beating, there's some

01:06:02.199 --> 01:06:05.219
blurring of that organ relative to the static

01:06:05.219 --> 01:06:07.559
organs that are not in motion. You might think,

01:06:07.579 --> 01:06:09.139
obviously, if you're taking a picture of somebody

01:06:09.139 --> 01:06:11.280
and they're running around, they might be blurred.

01:06:11.420 --> 01:06:13.719
So the same kind of logic applies by analogy

01:06:13.719 --> 01:06:17.000
in kind of medical imaging. So because the heart

01:06:17.000 --> 01:06:19.619
is beating in motion and we didn't do any special

01:06:19.619 --> 01:06:22.340
tricks on the prenuvo scan that you might have

01:06:22.340 --> 01:06:24.730
in like a cardiac MRI where you're doing. kind

01:06:24.730 --> 01:06:27.070
of cardiac gating where you're timing the imaging

01:06:27.070 --> 01:06:29.690
to a certain point of the cardiac cycle where

01:06:29.690 --> 01:06:32.429
you can control for that motion. It has the state

01:06:32.429 --> 01:06:34.650
of contraction of the heart as well. We're not

01:06:34.650 --> 01:06:36.989
doing that in our screening context right now.

01:06:37.210 --> 01:06:39.409
So the heart will have some relative limitations.

01:06:39.590 --> 01:06:41.469
So it's not going to be an exam that can really

01:06:41.469 --> 01:06:46.829
tell you much about heart function or the kind

01:06:46.829 --> 01:06:51.130
of coronary arteries or many of the relevant

01:06:51.130 --> 01:06:55.239
important... structures that you'd want to know

01:06:55.239 --> 01:06:57.500
about from a more complete evaluation from a

01:06:57.500 --> 01:07:02.019
preventive mindset about heart health. That being

01:07:02.019 --> 01:07:04.760
said, if there's a big abnormality like a mass

01:07:04.760 --> 01:07:07.340
around the heart or a lot of fluid around the

01:07:07.340 --> 01:07:10.980
heart or a gross enlargement of the heart, we

01:07:10.980 --> 01:07:13.900
would comment on that. If I see related not to

01:07:13.900 --> 01:07:15.340
the heart itself, but let's say to the vessels

01:07:15.340 --> 01:07:17.179
coming out of the heart, the aorta, if I see

01:07:17.179 --> 01:07:20.699
the aorta is dilated, I might comment on. dilation

01:07:20.699 --> 01:07:23.179
of the aorta and risk for aneurysm. That goes

01:07:23.179 --> 01:07:25.699
for the thoracic aorta in the chest, as well

01:07:25.699 --> 01:07:28.219
as for the abdominal aorta in the abdomen. So

01:07:28.219 --> 01:07:31.420
those major cardiovascular structures, we can

01:07:31.420 --> 01:07:34.739
provide some comment on, but as much as like

01:07:34.739 --> 01:07:37.000
a detailed evaluation of the heart, this will

01:07:37.000 --> 01:07:39.000
not be the first line for that. So for let's

01:07:39.000 --> 01:07:42.699
say coronary artery evaluation, there's better

01:07:42.699 --> 01:07:45.409
techniques for that right now. And if someone

01:07:45.409 --> 01:07:48.650
is interested in sort of heart function and looking

01:07:48.650 --> 01:07:51.269
at the heart valves and looking at the ejection

01:07:51.269 --> 01:07:52.929
fraction of the heart, how much it's pumping

01:07:52.929 --> 01:07:55.789
out, then something like an echocardiogram is

01:07:55.789 --> 01:07:58.670
going to be more standard and more informative

01:07:58.670 --> 01:08:02.210
from that perspective than what we can currently

01:08:02.210 --> 01:08:07.179
do with the Pernua scan today. So the chief of

01:08:07.179 --> 01:08:10.639
Boynton Beach Fire Department, Hugh Bruder, not

01:08:10.639 --> 01:08:13.920
only was part of the movement to move them to

01:08:13.920 --> 01:08:16.020
a healthier work week in the fire service, 24

01:08:16.020 --> 01:08:18.939
-72 we call it, which is a 42 -hour work week.

01:08:19.359 --> 01:08:22.319
They also use you guys. I think it's every two

01:08:22.319 --> 01:08:25.899
years they do a scan. And he was singing from

01:08:25.899 --> 01:08:28.720
the rooftops about how incredible it was. And

01:08:28.720 --> 01:08:31.039
he talked of several lives that were potentially

01:08:31.039 --> 01:08:33.699
saved through this technology. we don't have

01:08:33.699 --> 01:08:35.260
to talk about that particular department, but

01:08:35.260 --> 01:08:37.539
in general, talk to me about some of the incredible

01:08:37.539 --> 01:08:39.779
success stories you've had with this preventive

01:08:39.779 --> 01:08:45.500
medicine. So hard to talk about specific individual

01:08:45.500 --> 01:08:48.319
stories without risking sort of, you know, talking

01:08:48.319 --> 01:08:50.600
about and violating kind of patient confidentiality.

01:08:50.640 --> 01:08:53.720
But I can tell you like a big picture. We've

01:08:53.720 --> 01:08:55.899
had a lot of positive feedback, similarly from

01:08:55.899 --> 01:08:57.640
the firefighting community. We have a program,

01:08:57.760 --> 01:09:04.130
we call it the Warriors program that, kind of

01:09:04.130 --> 01:09:10.310
acknowledges sort of the additional risk and

01:09:10.310 --> 01:09:15.149
appreciation. So the risk that firefighters and

01:09:15.149 --> 01:09:17.670
other first responders and veterans kind of put

01:09:17.670 --> 01:09:20.170
themselves at for the benefit of basically everyone

01:09:20.170 --> 01:09:24.409
else in society and acknowledges that and appreciates,

01:09:24.409 --> 01:09:26.869
wants to demonstrate that we want to deliver

01:09:26.869 --> 01:09:29.720
this kind of service to those that... need it

01:09:29.720 --> 01:09:32.239
most potentially and appreciate them for everything

01:09:32.239 --> 01:09:34.399
that they sacrifice. So we have a program like

01:09:34.399 --> 01:09:36.300
the Warriors program that allows it to make it

01:09:36.300 --> 01:09:38.920
easier for firefighter communities to come and

01:09:38.920 --> 01:09:40.319
get scanned with us. And we've had a lot of very

01:09:40.319 --> 01:09:42.640
positive feedback, whether it's an early detection

01:09:42.640 --> 01:09:46.819
of a tumor. whether like a bladder cancer or

01:09:46.819 --> 01:09:49.239
a brain tumor. We've seen these examples, frequently

01:09:49.239 --> 01:09:51.640
early detection of an aneurysm. We've seen these

01:09:51.640 --> 01:09:54.979
stories come back to us with gratitude saying,

01:09:55.220 --> 01:09:58.319
wow, if it wasn't for this, I would be at extreme

01:09:58.319 --> 01:10:03.159
risk and put my team at risk. If I had a ruptured

01:10:03.159 --> 01:10:04.920
brain aneurysm in the field or my family at risk,

01:10:05.039 --> 01:10:07.939
et cetera. So this is something that I think

01:10:07.939 --> 01:10:12.319
affects firefighters. at least as much as our

01:10:12.319 --> 01:10:14.319
regular patients, even more so because of the

01:10:14.319 --> 01:10:16.359
added responsibility that they carry and the

01:10:16.359 --> 01:10:20.800
risks that they put themselves at. We're collaborating

01:10:20.800 --> 01:10:24.159
in a, that's the warrior spring, but we're collaborating

01:10:24.159 --> 01:10:26.880
in a firefighter cancer screening study as well.

01:10:26.920 --> 01:10:28.399
So we're not the only ones interested in this,

01:10:28.439 --> 01:10:31.439
but we have partners in the community that are

01:10:31.439 --> 01:10:34.800
clinicians in this particular study based out

01:10:34.800 --> 01:10:37.779
of kind of the Maryland area that they're running

01:10:37.779 --> 01:10:39.640
a firefighter cancer screening study looking

01:10:39.640 --> 01:10:42.130
at. can we offer actual benefit to firefighters

01:10:42.130 --> 01:10:44.609
with early cancer detection going beyond sort

01:10:44.609 --> 01:10:46.630
of like the n of one like we know we can affect

01:10:46.630 --> 01:10:49.529
individualized but does this affect with benefits

01:10:49.529 --> 01:10:52.170
sort of like the group level can we justify this

01:10:52.170 --> 01:10:56.029
from a broader active screening perspective so

01:10:56.029 --> 01:10:59.869
we have a very you know active uh program that

01:10:59.869 --> 01:11:01.569
we're collaborating on over there out of the

01:11:01.569 --> 01:11:04.510
maryland area with the innova health system uh

01:11:04.510 --> 01:11:06.970
and that's ongoing so i don't have like results

01:11:06.970 --> 01:11:08.989
that i can share about it but you know these

01:11:08.989 --> 01:11:14.050
are Definitely, we start off with the anecdotal

01:11:14.050 --> 01:11:17.029
stories, and then that gives us reason to want

01:11:17.029 --> 01:11:19.689
to investigate things more robustly in a scientific

01:11:19.689 --> 01:11:22.369
context. So that's where we're kind of moving

01:11:22.369 --> 01:11:24.909
towards right now, establishing more scientific

01:11:24.909 --> 01:11:28.810
methods to study the benefit to groups like firefighters,

01:11:29.010 --> 01:11:33.289
especially. Well, going back to that one department,

01:11:33.449 --> 01:11:36.750
you take your work week to a healthier work week.

01:11:36.810 --> 01:11:38.470
So now your men and women are getting more rest

01:11:38.470 --> 01:11:42.619
and recovery. ideally from day one, a baseline,

01:11:42.899 --> 01:11:45.479
you know, full body MRI. And then, you know,

01:11:45.479 --> 01:11:47.960
every year, two years, whatever it is, you're

01:11:47.960 --> 01:11:49.979
putting that in as well. And you have comprehensive

01:11:49.979 --> 01:11:52.920
blood work. And I know your colleague was talking

01:11:52.920 --> 01:11:54.840
to me about the potential of even doing an ultrasound

01:11:54.840 --> 01:11:57.979
as well as part of the overall test to hit some

01:11:57.979 --> 01:12:01.300
of the areas that, you know, that. that they

01:12:01.300 --> 01:12:04.079
are better at hitting than the MRI. And now you've

01:12:04.079 --> 01:12:06.359
got the ability to get ahead of so many of these

01:12:06.359 --> 01:12:08.979
issues way before they become acute, you know,

01:12:08.979 --> 01:12:10.479
potentially. Of course, you know, there's always

01:12:10.479 --> 01:12:13.579
those anomalies. But to me, this technology seems

01:12:13.579 --> 01:12:17.220
like if it was interwoven into the fire service,

01:12:17.300 --> 01:12:19.500
I mean, firstly, you'd save so much money catching

01:12:19.500 --> 01:12:22.619
these before they became, God forbid, some, you

01:12:22.619 --> 01:12:24.479
know, hundreds of thousands of dollars chemo

01:12:24.479 --> 01:12:28.779
treatment or, you know, neurosurgery. But also,

01:12:28.979 --> 01:12:31.060
more importantly, you're empowering the firefighter

01:12:31.060 --> 01:12:32.819
to stay ahead. And then, as you mentioned, even

01:12:32.819 --> 01:12:35.159
with body composition, you know, when you start

01:12:35.159 --> 01:12:38.819
to see that fat is actually very visceral, you

01:12:38.819 --> 01:12:40.800
can show the pictures to the firefighter and

01:12:40.800 --> 01:12:43.869
then that will definitely help. hopefully motivate

01:12:43.869 --> 01:12:46.369
them to start curbing the way they eat and exercising

01:12:46.369 --> 01:12:49.329
more and that kind of thing. So I see so many

01:12:49.329 --> 01:12:51.609
different applications from a prevention point

01:12:51.609 --> 01:12:54.409
of view, rather than what we normally see, which

01:12:54.409 --> 01:12:56.430
is reactive. Our whole profession, that's the

01:12:56.430 --> 01:12:58.590
nature of the beast is someone calls 911 and

01:12:58.590 --> 01:13:01.729
we react to whatever we go to. Well, the other

01:13:01.729 --> 01:13:04.069
side of the equation is how do we stop people's

01:13:04.069 --> 01:13:05.689
homes burning in the first place, people having

01:13:05.689 --> 01:13:08.970
heart attacks in the first place. And this gives

01:13:08.970 --> 01:13:11.289
us the potential to do that same thing to our

01:13:11.289 --> 01:13:15.720
own health. Yeah, I'll add on to that. I think,

01:13:15.739 --> 01:13:19.420
and it may not be surprising, but from what I've

01:13:19.420 --> 01:13:22.539
seen, the firefighting community that I see at

01:13:22.539 --> 01:13:26.720
Pernuvo, they seem to be a relatively, not relatively,

01:13:26.779 --> 01:13:31.119
I think an objectively stoic bunch. I mean, you

01:13:31.119 --> 01:13:35.340
guys are tough. And so a lot of times the kind

01:13:35.340 --> 01:13:38.779
of observations that I see in firefighters, I'm

01:13:38.779 --> 01:13:40.720
like, surprise, wow, how are they not complaining

01:13:40.720 --> 01:13:44.720
of this? And being symptomatic, like whether

01:13:44.720 --> 01:13:49.199
it's like a musculoskeletal injury, like a muscle

01:13:49.199 --> 01:13:54.640
tear or a, you know, degenerative spine issue,

01:13:54.739 --> 01:13:59.760
like very tough guys kind of suppressing a lot

01:13:59.760 --> 01:14:04.020
of the physiologic symptoms of stress on the

01:14:04.020 --> 01:14:07.239
body to get the job done. But it puts their own

01:14:07.239 --> 01:14:09.840
well -being on the side because it's, you know.

01:14:10.989 --> 01:14:13.109
hard to focus on that when you're running into

01:14:13.109 --> 01:14:15.909
buildings and doing whatever you have to do to

01:14:15.909 --> 01:14:19.010
lift somebody out of that state of danger. And

01:14:19.010 --> 01:14:24.989
at the same time, you're overcoming the sensations

01:14:24.989 --> 01:14:29.050
of pain or something in that body part that is

01:14:29.050 --> 01:14:33.229
telling you, oh, don't lean on that knee or something

01:14:33.229 --> 01:14:37.029
like that. You just ignore that. And then the

01:14:37.029 --> 01:14:40.670
acute pains subsides. And then It goes back to

01:14:40.670 --> 01:14:42.289
normal, but that doesn't mean the body has totally

01:14:42.289 --> 01:14:45.130
healed. So we see this all the time in imaging.

01:14:45.250 --> 01:14:48.409
And I talked to some of my referring colleagues

01:14:48.409 --> 01:14:49.970
who tend to refer us to these firefighters. I'm

01:14:49.970 --> 01:14:52.449
like, wow, these guys are stoic, right? I don't

01:14:52.449 --> 01:14:54.090
understand how this is even in the screening

01:14:54.090 --> 01:14:56.869
context a lot of the time. This is stuff that

01:14:56.869 --> 01:15:01.069
if my body looked like that, I feel like I'd

01:15:01.069 --> 01:15:02.890
be in the doctor complaining like a little baby

01:15:02.890 --> 01:15:07.689
myself. So the view into the body, it gives.

01:15:08.380 --> 01:15:11.380
kind of like the those of us that are tougher

01:15:11.380 --> 01:15:15.319
than others from like our um our body is still

01:15:15.319 --> 01:15:18.319
not foolproof even though we may be able to mentally

01:15:18.319 --> 01:15:21.000
overcome the pain in the short term and it allows

01:15:21.000 --> 01:15:23.699
you when you're not dealing with that emergency

01:15:23.699 --> 01:15:27.180
situation and having to you know take someone

01:15:27.180 --> 01:15:29.300
out of the burning building to like refocus on

01:15:29.300 --> 01:15:31.619
yourself and say oh yeah i gotta really work

01:15:31.619 --> 01:15:34.260
on that pt for that knee injury that i had or

01:15:34.260 --> 01:15:38.220
you know my my my back that It does kind of ache

01:15:38.220 --> 01:15:40.060
me a little bit, but, you know, I can like brush

01:15:40.060 --> 01:15:42.779
it aside that then I point out, oh, no, look

01:15:42.779 --> 01:15:44.319
at that big disc herniation over there. Maybe

01:15:44.319 --> 01:15:47.659
you got to do some more active, you know, take

01:15:47.659 --> 01:15:50.520
it easy. Don't don't do some physical therapy.

01:15:51.279 --> 01:15:53.979
Let's let things go back to the way they're more

01:15:53.979 --> 01:15:56.739
physiologic. So I think the imaging information

01:15:56.739 --> 01:16:01.159
arms, especially people like probably firefighters

01:16:01.159 --> 01:16:04.539
that have to suppress a lot of those internal

01:16:04.539 --> 01:16:07.399
triggers. Those cues that there's something to,

01:16:07.479 --> 01:16:10.159
you know, pain is good. It tells our body, like,

01:16:10.220 --> 01:16:11.880
take it easy on that part of the body, allow

01:16:11.880 --> 01:16:15.640
it to heal. And some of us aren't as in an environment

01:16:15.640 --> 01:16:17.840
that allows us to do that routinely, while some

01:16:17.840 --> 01:16:20.260
of us are. So I think firefighters are a unique

01:16:20.260 --> 01:16:23.340
group that could benefit from this proactive

01:16:23.340 --> 01:16:25.800
health information, body information that is

01:16:25.800 --> 01:16:32.140
not really accountable in a routine preventive

01:16:32.140 --> 01:16:36.260
health care context. In the mental health conversation,

01:16:36.479 --> 01:16:38.500
it's been interesting because my mind has shifted

01:16:38.500 --> 01:16:42.479
from nine, 10 years ago, which was, man, you

01:16:42.479 --> 01:16:44.800
know, we keep taking our own lives. This is addiction

01:16:44.800 --> 01:16:48.140
crisis. You know, we're air quotes broken. How

01:16:48.140 --> 01:16:51.319
do we fix us? And then over the years, from the

01:16:51.319 --> 01:16:54.560
resistance through the conversations to understanding

01:16:54.560 --> 01:16:58.710
what. psychology looks like in high performers

01:16:58.710 --> 01:17:01.430
you realize that really the conversation we should

01:17:01.430 --> 01:17:03.489
be having is actually performance because if

01:17:03.489 --> 01:17:05.670
you do the things that forge mental performance

01:17:05.670 --> 01:17:08.149
you are simultaneously addressing the issues

01:17:08.149 --> 01:17:11.010
that affect you know negative mental health and

01:17:11.010 --> 01:17:13.010
i think this is the other part of this conversation

01:17:13.010 --> 01:17:18.989
is if you if you have um first responders who

01:17:19.550 --> 01:17:22.149
are proactively staying on top of their health

01:17:22.149 --> 01:17:26.510
and the injury prevention and these other areas,

01:17:26.710 --> 01:17:29.550
you will perform at a much higher level. As someone

01:17:29.550 --> 01:17:32.770
who has nursed many injuries through my career

01:17:32.770 --> 01:17:35.770
before they were addressed, you are operating

01:17:35.770 --> 01:17:38.609
at a lower percentage. You cannot deny that.

01:17:38.810 --> 01:17:41.189
So I think from a performance point of view,

01:17:41.229 --> 01:17:43.149
where do we take the fire service? Where do we

01:17:43.149 --> 01:17:45.920
take law enforcement ultimately? This kind of

01:17:45.920 --> 01:17:48.460
proactive preventative screening allows you to

01:17:48.460 --> 01:17:50.279
get ahead of all the things that are going to

01:17:50.279 --> 01:17:52.840
hold you back, address them early so that you

01:17:52.840 --> 01:17:56.199
can carry on performing at a high level. Yeah,

01:17:56.220 --> 01:17:58.100
I know. I think that also makes a lot of sense.

01:17:58.239 --> 01:18:02.939
It's not just for the firefighter, the individual

01:18:02.939 --> 01:18:07.220
themselves, but the team, the society benefits

01:18:07.220 --> 01:18:11.430
from maintaining the optimal health. performance

01:18:11.430 --> 01:18:14.909
health of the individuals on the team. So it's

01:18:14.909 --> 01:18:20.869
mutually important to value this perspective

01:18:20.869 --> 01:18:24.069
of preventive health. The team is only as strong

01:18:24.069 --> 01:18:25.750
as the individuals that make it up, right? So

01:18:25.750 --> 01:18:29.750
if not everyone is performing at 100 % because

01:18:29.750 --> 01:18:32.369
they're nursing an injury or they're struggling

01:18:32.369 --> 01:18:36.449
with a mental health issue, this needs to be

01:18:36.449 --> 01:18:39.100
addressed. sooner rather than later when they

01:18:39.100 --> 01:18:42.680
are actually more addressable and you can change

01:18:42.680 --> 01:18:47.960
the trajectory of the course of that limited

01:18:47.960 --> 01:18:51.420
condition, but also that how it affects the individual

01:18:51.420 --> 01:18:53.819
holistically and then by extension affects the

01:18:53.819 --> 01:18:56.939
team. So it's really multifactorial, totally.

01:18:58.220 --> 01:19:01.100
Absolutely. Well, for people listening, I'm sure

01:19:01.100 --> 01:19:03.560
they would love to learn more, you know, just

01:19:03.560 --> 01:19:06.699
be able to schedule a consultation, maybe even

01:19:06.699 --> 01:19:08.699
approach you as far as getting screens for their

01:19:08.699 --> 01:19:11.000
entire department. Where are the best places

01:19:11.000 --> 01:19:15.439
online to do that? Oh, well, number one, they

01:19:15.439 --> 01:19:20.079
could go to the Prenuva website. There's like

01:19:20.079 --> 01:19:23.460
a direct platform there where they can. see what

01:19:23.460 --> 01:19:25.260
the availability is at whatever clinic they are.

01:19:25.340 --> 01:19:26.979
And we have like, I forget the number now, how

01:19:26.979 --> 01:19:29.600
many clinics, 25 or so clinics across the US

01:19:29.600 --> 01:19:32.220
and basically in the major cities in different

01:19:32.220 --> 01:19:35.420
states. And they can directly book an opening.

01:19:36.239 --> 01:19:38.920
They can see the calendar or they can call in

01:19:38.920 --> 01:19:41.539
and have someone on our team going to assist

01:19:41.539 --> 01:19:44.399
them to book an appointment. That's at the one,

01:19:44.500 --> 01:19:47.560
you know, single person level. But if their department

01:19:47.560 --> 01:19:52.920
has already sort of somewhat of a program where

01:19:52.920 --> 01:19:55.840
they're referring out or even helping fund some

01:19:55.840 --> 01:19:59.000
of these exams for their members. They might

01:19:59.000 --> 01:20:01.060
want to reach out and see if that exists. And

01:20:01.060 --> 01:20:04.000
then there's often like a special pathway that's

01:20:04.000 --> 01:20:06.140
already pre -established for those kind of partner

01:20:06.140 --> 01:20:09.149
departments already. And if their department

01:20:09.149 --> 01:20:10.710
is interested in that, but hasn't yet established

01:20:10.710 --> 01:20:12.390
that, that might be also something, a conversation

01:20:12.390 --> 01:20:15.250
they could bring up and reach out to our teams

01:20:15.250 --> 01:20:17.710
and see if a pathway could be established for

01:20:17.710 --> 01:20:19.970
that. In the meantime, anyone is able on their

01:20:19.970 --> 01:20:22.130
own to go to the website and book an appointment

01:20:22.130 --> 01:20:25.050
or call in to our team. I don't have the number

01:20:25.050 --> 01:20:27.649
offhand, but we can get that for you after the

01:20:27.649 --> 01:20:31.729
call. Brilliant. And then 25 at the moment, what

01:20:31.729 --> 01:20:38.039
is your goal to be in all 50 states? I think

01:20:38.039 --> 01:20:41.159
so. It's not really the area that I'm actively

01:20:41.159 --> 01:20:43.859
involved in, in the kind of like company planning.

01:20:44.300 --> 01:20:48.279
But yeah, no, I think the goal is to make proactive

01:20:48.279 --> 01:20:52.100
care informed by radiology or whole body MRI

01:20:52.100 --> 01:20:55.500
at its foundational level accessible to everybody,

01:20:55.539 --> 01:20:59.260
both in terms of location and also in terms of

01:20:59.260 --> 01:21:04.789
cost as well. So we're always trying to. make

01:21:04.789 --> 01:21:06.729
it faster, make it less expensive and make it

01:21:06.729 --> 01:21:10.590
more widely available. So probably if it can

01:21:10.590 --> 01:21:13.770
be in every state, that'd be the ideal in every

01:21:13.770 --> 01:21:15.869
major city, the ideal to work towards. Right

01:21:15.869 --> 01:21:18.109
now we're at 25. I don't know what the sort of

01:21:18.109 --> 01:21:21.369
the timeline is to get towards the ideal state,

01:21:21.489 --> 01:21:24.090
but that is sort of the goal we're working towards.

01:21:24.670 --> 01:21:27.470
If you look back over the last few years, you

01:21:27.470 --> 01:21:28.869
know, when I started at Adventure and Pernuvo

01:21:28.869 --> 01:21:32.109
about five years ago. We had one clinic and then

01:21:32.109 --> 01:21:34.949
we accelerated to now 25 clinics, most of them

01:21:34.949 --> 01:21:37.569
open in the last, you know, I think one to two

01:21:37.569 --> 01:21:41.649
years. So pretty good stage of growth right now.

01:21:41.710 --> 01:21:45.270
And hopefully soon we'll be more accessible to

01:21:45.270 --> 01:21:49.770
mostly everybody. Brilliant. Well, I want to

01:21:49.770 --> 01:21:51.329
thank you so much. It's been such an amazing

01:21:51.329 --> 01:21:54.130
conversation. I've genuinely, people know now

01:21:54.130 --> 01:21:55.569
if they've listened to this podcast for nine

01:21:55.569 --> 01:21:57.649
years, I will not stand behind anything I don't

01:21:57.649 --> 01:21:59.350
believe in. The sponsors that come on the show

01:21:59.350 --> 01:22:01.050
are all products that I've used in the past,

01:22:01.090 --> 01:22:05.199
for example. But I was genuinely so impressed,

01:22:05.319 --> 01:22:07.920
not just by the actual imaging itself, but the

01:22:07.920 --> 01:22:10.739
medical history before, the consultation after.

01:22:10.819 --> 01:22:12.600
And as someone who's been in the wellness space,

01:22:12.779 --> 01:22:15.920
I'm no expert by any means, but I've got a pretty

01:22:15.920 --> 01:22:17.899
good barometer on what I think is going to be

01:22:17.899 --> 01:22:20.159
important for this profession. And this is hands

01:22:20.159 --> 01:22:23.920
down one of them. So before I let you go, if

01:22:23.920 --> 01:22:25.899
people want to reach out to you and learn more

01:22:25.899 --> 01:22:27.699
about you, are there any other places online

01:22:27.699 --> 01:22:31.090
to do that? Oh, yeah, I have a LinkedIn page,

01:22:31.350 --> 01:22:34.109
which, you know, it's my name right here. I have

01:22:34.109 --> 01:22:37.289
my Pernuvo email. I'm not always the best at

01:22:37.289 --> 01:22:39.609
responding to direct emails to me. But if they

01:22:39.609 --> 01:22:42.050
want, anybody wants to learn more about our firefighter

01:22:42.050 --> 01:22:45.170
program or talk to me as a sort of one of the

01:22:45.170 --> 01:22:47.550
radiologists and get more information, it's Yosef,

01:22:47.550 --> 01:22:51.289
Y -O -S -E -F at Pernuvo .com. And at least maybe

01:22:51.289 --> 01:22:53.369
I can point them in the right direction if I

01:22:53.369 --> 01:22:56.869
can't answer the question directly. And otherwise.

01:22:58.390 --> 01:23:01.789
Just call anyone in the company if there's a

01:23:01.789 --> 01:23:03.909
special interest to reach out to me directly

01:23:03.909 --> 01:23:08.550
about research projects, collaborations, radiology,

01:23:08.729 --> 01:23:11.810
this idea of primary care radiology. They can

01:23:11.810 --> 01:23:14.189
call the company or email me directly and I'm

01:23:14.189 --> 01:23:17.819
happy to be connected with them. Beautiful. Well,

01:23:17.840 --> 01:23:19.760
again, I want to thank you so much for being

01:23:19.760 --> 01:23:21.859
not only so generous with your time, but also

01:23:21.859 --> 01:23:24.239
just educating us on a bunch of areas that is

01:23:24.239 --> 01:23:27.979
very, very new technology and coming on the Behind

01:23:27.979 --> 01:23:30.539
the Shield podcast. So thank you so much. Thanks

01:23:30.539 --> 01:23:30.979
for having me.