Revolutionizing Cancer Detection Full Body Scans with Emi Gal of Ezra

Episode Overview

Episode Topic:

In this episode of The Skeleton Crew, host Jen Callahan sits down with Emi Gal, the founder and CEO of Ezra, to explore groundbreaking advancements in cancer detection technology. Ezra has developed an innovative approach to early cancer screening using full-body MRI scans, providing a comprehensive way to detect cancer in its early stages. This episode dives deep into how these scans work, the technology behind them, and their potential to revolutionize the way we approach cancer detection and prevention. With a focus on making these scans both affordable and accessible, Emi discusses the future plans of Ezra and how they aim to bring this life-saving technology to more people around the world.

Lessons You’ll Learn:

Listeners will gain insight into the critical importance of early cancer detection and how new technologies, like Ezra’s full-body MRI scans, are changing the landscape of healthcare. Emi Gal shares his personal motivation behind creating Ezra, driven by his family’s experience with cancer, and his commitment to preventing late-stage cancer diagnoses. Learn about the innovative AI technology Ezra employs to enhance scan accuracy and reduce costs, making early detection more accessible. The episode also highlights practical information on how listeners can assess their own cancer risk and take proactive steps toward early screening and prevention.

About Our Guests:

Emi Gal is the founder and CEO of Ezra, a company pioneering the use of full-body MRI scans for early cancer detection. Originally from Romania, Emi’s personal experience with cancer in his family fueled his dedication to finding a better way to screen for cancer early. With a background in applied mathematics and computer science, Emi previously led a successful company in the advertising technology sector before turning his focus to healthcare innovation. Under his leadership, Ezra has developed cutting-edge AI technologies that make cancer screening faster, more accurate, and more affordable, aiming to prevent late-stage cancer diagnoses and improve survival rates worldwide.

Topics Covered:

This episode covers a range of topics related to cancer detection and healthcare innovation. Emi Gal explains the science behind Ezra’s full-body MRI scans, which screen for cancer across 13 different organs, and discusses the benefits of using MRI technology over traditional methods. The conversation also touches on the challenges of making advanced medical screening affordable and the role of insurance in expanding access. Listeners will learn about the different types of scans offered by Ezra, the impact of early detection on survival rates, and the future developments in AI technology that could further enhance the speed and affordability of full-body scans. Emi also shares success stories from individuals who have benefited from Ezra’s early detection services.

Our Guest: Emi Gal

Episode Transcript

Jen Callahan: Hey, everybody, welcome back to another episode of The Skeleton Crew. My name is Jen Callahan, and today I have a great guest with me. His name is Emi Gal. He is the founder and CEO of a company called Ezra. And they’re doing some pretty really important work right now, and something that I personally have never heard of before, where it’s offered for you to have pre screening done. I mean, I guess there are some stuff out there, but this is for a full body scan to check to see if you have cancer. So Emi’s going to give us the full background of what his company is doing. And you know what they’re going to continue to be doing moving into the future. So Emi, thanks for being with me today.

Emi Gal: Thanks for having me, Jen. It’s great to be here.

Jen Callahan: All right. So I just gave a brief introduction of yourself. So why don’t you give us a background of you, and then maybe how you’ve led into the company of Ezra?

Emi Gal: Absolutely. So I’m originally from Romania. You might pick up an accent. I studied applied mathematics in computer science at school. And actually started a company in a very different space before Ezra and the advertising technology space. That company did quite well. It was acquired by a big advertising group in New York, and that’s how I ended up in New York City. And I became very interested in cancer because I’m personally at high risk for cancer, for melanoma, and I’ve had cancer in my family. Sadly, my mother passed away from cancer because she found cancer late. And so I have a very personal interest in helping people find cancer early, because I really believe that had my mother found cancer early, she would still be alive today. And so when I started looking at the cancer space, I realized that really the main reason why people die is because they find cancer late. And the main reason we find cancer late is because there’s no way to screen for cancer ever in the body. That’s fast, accurate and affordable. And so that’s what we’re trying to solve at Ezra.

Jen Callahan: , I’m very sorry about your mom. Thank you. I personally hate cancer, and I’m sure that a lot of people feel that way. Yes.

Jen Callahan: So early detection, like you said, is key. And I mean, I definitely agree with the statement that you said that most cancers are deadly, you know, because they’re caught too late, that by the time that you’re actually exhibiting symptoms, it’s because you’re probably progressing so far through what, maybe stage three, possibly stage four cancer. And there’s really no coming back from that. Absolutely. Yeah.

Emi Gal: So if you look at the, , at the data, you know, look at the American Cancer Society data, uh, early stage cancer has an 80, 90, 99% five year survival rate. If you look at breast cancer, if you look at prostate cancer, we’re talking about high 90s, uh, survival rate, uh, late stage cancer survival has a less than 20% five year survival rate. And if you take something like pancreatic cancer, you have like a 4 or 5% five year survival rate at late stage. And so the key to survival is finding cancer early. So what we’ve done at is we’ve created this full body MRI that screens for cancer in all of the organs. You cannot currently screen for cancer. And so, you know, there are 4 or 5 organs in the body right now that have well established screening guidelines. You have mammogram for breast, you have colonoscopy for colon, you have PSA for prostate, pap smear for uterus. Maybe some people do skin checks. I certainly do for for melanoma and skin cancer. That’s pretty much it. If you’re unlucky enough to get a brain tor or pancreatic cancer or liver cancer or gallbladder cancer and so on, you’ll find out when you’re symptomatic, which will be too late. So what we’ve done is we’ve created this full body scan that finds cancer in all of these organs. You cannot currently screen for cancer in. And uniquely, what we’ve been able to accomplish at Astra is we’ve made full body MRI affordable or most affordable. Scan is 30 minutes, full body MRI cost just over $1,000. And we think over the next couple of years we’ll be able to offer a $500.

Jen Callahan: Is that something that you’re going to attempt? I mean, I don’t know how insurance companies go about actually deciding that they’re going to give reimbursement back for a scan like this, but you would think that it would be in their benefit for them to pay out this money so that later, you know, cancer is caught.

Emi Gal: Absolutely.

Jen Callahan: So it’s not paying out for for more treatments, you know.

Emi Gal: Yes. So cancers , payers already pay for screening procedures. So like they’ll pay they pay for mammograms, they pay for colonoscopies. They they pay for skin checks sometimes, etc.. The key is having a test that’s high sensitivity, relatively good specificity and low cost. And so MRI has very high sensitivity like we’re talking 9,798% sensitivity catches everything. It has reasonably good specificity around 90%. So equivalent to a mammogram. The only challenge of MRI is that it’s a very expensive modality. You know you work in healthcare. So you know that like getting an MRI of the knee can cost you 2500 dollars. And so the key to making MRI is modality for cancer screening is making it affordable. And so at Azure we’ve developed a nber of eyes that enable us to offer what’s essentially the fastest, most accurate scan on the market.

Jen Callahan: Now I mean I’m not sure if you knew this answer. Or is MRI considered possibly the most expensive one because of the amount of time that is required to do the scan. You know, time is money basically. , so they’re charging more because of the amount of time that it, you know, it takes.

Emi Gal: Yeah. So there are two reasons why it’s expensive. One, the scan itself is expensive. The scan is expensive because it takes time, like an MRI takes, you know, the order of 30, 45 minutes an hour, unlike a CT that can be done in, like a couple of minutes. And two MRIs are actually more complicated to read by radiologists, so they take longer. And so what we’ve done at Astra is we’ve built an AI called Azure Flash that enables us to enhance the quality of MRI images. So what that enables us to do is accelerate the MRI imaging by increasing the acceleration factor on the scan, and then that results in noisier images that maybe have some aliasing artifacts. And what we do is we eliminate the noise and we reduce the artifacts using AI. So that enables us to go from, you know, 2.5 hour full body scan to one hour full body scan, and now more recently, to a 30 minute full body scan. That’s nber one. Nber two is once the scan has been done, it gets read by radiologists. Radiologists need to often do all sorts of measurements on the scan in order to be able to indicate to the patient the extent of the problem. We’ve built AIS that enable us to automate a lot of those things in order to support radiologists to be faster and so faster scan, faster radiology report. And more recently, we’ve built an AI that helps convert radiology reports into plain English. You know, in a radiology, reports are quite technical oftentimes. And so we have this I call this reporter that will take any radiology report and convert it into plain English. And so we’ve stacked these three A’s together. Now in order to offer this kind of super affordable, fast full body scan. And that’s how we’ve been able to deliver such an affordable scan.

Jen Callahan: And so the full body scan entails, uh, what, up to 13 organs, do all the scans, or are there different levels of scans that you can have done?

Emi Gal: Yeah. So we have three scans. We have our full body flash, which is our cancer focused 30 minute scan. It covers all 13 organs. We then have ourEzra full body without flash at the end, full body that also includes some non-cancerous areas or areas where we look for non-cancerous findings. So this is spine and hips where we look for bone degeneration like disc herniations and so on. That’s our full body. And then we have our full body plus, which is our full body MRI, plus a low dose chest CT for lung cancer screening and coronary calci score. Mri is not great for lung cancer screening because you’re using the protons in the water and the body to create internal images of the body. Hopefully you don’t have much water in your lungs, you know. That would be a problem. And so low dose chest CT is kind of a better modality for lung cancer screening. And so we’ve incorporated that into our protocol.

Jen Callahan: Okay. And could you just go over the 13 organs that you’re scanning.

Emi Gal: Yeah. So if we go from the top we start with brain at the top of the body we follow with neck. And so in the neck we look at the thyroid. We, as I mentioned, include spine in the kind of full body standard full body we do lung if you’re doing a low dose chest CT and then we do all of the organs in the abdomen that are relevant. So liver, gallbladder, pancreas, spleen kidney, adrenal glands. And then in the pelvis we do bladder ovaries uterus and prostate. So pretty much all the major organs that do not currently have a screening procedure.

Jen Callahan:  Okay. All right30 minutes. That’s great. before we started recording, I had said that to Emi, that, I mean, I feel like a normal MRI, just of one body part could take 30 to 40 minutes, and you’re doing a body scan in 30 minutes. That’s, you know, and even that you were able to cut down that initially it was an hour. And, you know, with the eye that you’re using to enhance it, you’ve cut it down to 30 minutes is great.

Emi Gal: You know. And, you know, an important thing to note is that our vision atEzra is that we have this super fast, super affordable scan that’s covered by insurance. And so we started at an hour. We brought it down to 30 minutes. We’re going to build more eyes to bring it down to 15 minutes. And at 15 minutes we can probably offer it for $5,600. And at $5,600, it becomes interesting for payers to start reimbursing the scan. Yeah.

Jen Callahan: I mean, if you think about investing into yourself and I mean, I mean, money is tight. Money is tight in the United States. I mean, you’re in New York, right?

Emi Gal: I’m in New York. Yeah.

Jen Callahan: So I mean, I’m sure you feel the squeeze there. Definitely, because you know, life in general, even for, you know, our current economical situation. Not to get into that, but, you know, it was like to live there already.

Emi Gal: Yeah.

Jen Callahan: So I mean, you know, everyone’s counting their pennies at this day and age. I feel like I, I feel like even if you’re, you know, have, you know, better finances and say the next person next to you, you’re still, you know, counting it. And I mean, my mom actually said to me, we were talking this is kind of sidebar, but has to go into spending money on yourself that my mom wanted to get a new mattress, and she said, I don’t want to spend that kind of money. You know, I said, but mom, you sleep on this bed every single night. Like, why would you not spend the money so that you could sleep properly? The bed that you currently have is like 20 years old. You just need to get rid of it. But she didn’t want to invest the money in herself because it just sounded like too much. So part of what I’m saying is that, you know, you have your scan that currently right now, you said it’s around $1,000 or so. And, you know, to everyone, you know, not to everyone, but even someone myself like wow, $1,000 sounds like a lot of money, but if you could possibly catch some type of cancer that could potentially kill you, isn’t it worth it?

Emi Gal: And and you know, it’s the outcome, right? You find cancer early, but it’s also the peace of mind that you get with a scan. Like, you know, like there are three outcomes from one of our scans. You we either give you a clean bill of health, you get a report that’s all green, nothing to be concerned about. And so then you get a lot of peace of mind knowing that, you know, you don’t have something lingering in the body that can kill you. Two we find cancer before it’s symptomatic, which means it’s the best time to find it because it’s when it’s most curable. And so that two is peace of mind, because you can now do something about it with a very high probability of survival or three, we find something that’s not cancer that could impact your health in the future. A fatty liver disease, disc herniations, aneurysms, endometriosis, PCOS, all sorts of like 500 other conditions that can really impact your health, that you could do something about today so that they don’t affect you in the future. And so we think it’s kind of a small price to pay for, for that peace of mind. And on top of that, the scan is a bit of $1,000. If you are to find cancer late, you’re going to spend many, many, many more thousands of dollars in the US getting treated even with insurance, because that’s how the system works. And so if you have a bit of disposable income, we think that it is like a super important scan to get, especially for people over 40. And then finally, on this point, what we try to do to make it affordable is we have monthly installment plans so people can pay as as little as $60 a month for a couple of years to to cover the scan. We have HSA and FSA dollars, so you can use kind of pretax dollars in order to pay for it, which reduces the overall cost. And so we’re constantly trying to make it as affordable as possible for our members.

Emi Gal: That’s great. That’s great.

Jen Callahan: So on the website, Amy and I again were talking before we started recording, and I had told him that he had caught me while I was in the middle of going through my risk assessment questionnaire form. Can you share with us what you know, what I’m speaking about, and you know how you use that, you know, to determine, I guess, really, if having this type of scan is beneficial for you.

Emi Gal: Absolutely. So we have a calculator on our website. It’s free to use where people can go. They can answer 30 questions. , generally about lifestyle, family, history of cancer, uh, age kind of demographic and so on. And based on that, we calculate your risk for cancer or risk to develop cancer in all of the organs in the body. So essentially the report tells you, hey, because of your family history or your lifestyle and so on, you are at risk for cancer in these organs. And then you can use that calculator to make informed decisions about your health in order to potentially decide to get screened And maybe important to note, that calculator was built based on a study that was done by the Harvard Medical School on screening. And so they took a lot of factors that influence one’s risk. And then they built this model, and we took the model and we essentially wrapped the beautiful interface around it. So astro.com know your risk.

Jen Callahan: So like I said, I don’t even think I was more than halfway through it. , but one of the questions that I found interesting was in the beginning it had asked, you know, what? Do you know what your birth weight is? You know, were you 8.5 pounds or over or 8.5 pounds or under? If you don’t know it, that’s totally okay. But do you know how that goes into your potential risk?

Emi Gal: Yeah, I’d have to look in the into the Harvard study that on on why they included that factor. It probably has to do with some propensity for weight depending on your weight at birth. And because weight is a factor that’s tightly correlated with increased risk for cancer. So people who are overweight have a 60% higher chance of developing cancer. And so kind of weight has a big is a big component. I prese that that question has a little bit to do with that.

Jen Callahan: Right? That’s really interesting. I don’t I don’t think I realized that weight I mean, weight affects things overall in your body, you know, just moving in general. But I didn’t realize that it was that big of a risk factor. So talking about the the scanner itself, you guys have multiple locations throughout the country at this point. So you’re not just like one location. How many different cities are you on at this point?

Emi Gal: Yeah. So the really unique thing about Ezra is that we’ve built a nber of software and AIS that enable our scan, and then we partner with existing imaging networks in order to deliver the scan. And we’ve partnered with Radnet, with Reyes, with Simon Med, with Hackensack Imaging, with a lot of the large imaging networks in the country. And through these partnerships, we are in 14 cities, about 60 facilities. So and by the end of the year, we’ll probably be in like 2025 cities. So kind of most major metros in the US will have at least a few extra facilities, partner facilities where you can get scanned. And so the typical process is you go on Xcom, you book a scan, you pay, you select which facility you want to go to, you visit a facility, you get a scan there. Uh, when you get the scan, there’s a bit of an experience. You get like a personalized pajama and like a little welcome bag and so on. And then about five business days after the scan, you receive a report. The report tells you everything we have found, and you have the option to book a video call to speak with one of our doctors. And we have a team of doctors on staff who jp on video calls and kind of communicate the results to members.

Jen Callahan: I really enjoy the fact that you said that you get the Ezra pajamas because, I mean, there was a facility that I had worked at, and they were very trying to think of what the best word is. They were just very much like, you have to get changed. You have to put on put on a gown. It doesn’t matter what you’re wearing, whether you can swear up and down that, you know, for certain that there is no metal in it. They need to get changed no matter what. And you’re putting on a gown. And, you know, generally most health facilities are rather chilly. So, you know, you’re waiting in the room, you’re waiting in the waiting room in this like gown, and you feel naked already because you are underneath of it. Yep. And then you get brought into this room and yeah, you’re having to lay on an MRI bed for 30 minutes or more. And again, you’re probably freezing. So it’s just nice that you’re offered pajamas and you can be comfortable.

Emi Gal: Yes. We wanted to make the experience. Obviously people are going in for preventative cancer screening, right? They don’t have an issue. They’re not like, uh, investigating some problem. And so we wanted to make the experience as comfortable, as premi, as enjoyable as possible. And, uh, they’re really nice pajamas and you can keep them. And actually, one of our, uh, radiologists wears his pajamas all the time at home. And like, when he flies and stuff, he just loves them. And we send him a new pair every quarter.

Emi Gal: It was funny.

Jen Callahan: Oh, God. That’s great. Yeah. So your list that you have for the different cities that you, that you’re coming into in the next year seems, you know, is quite extensive. Philadelphia is one of them. , I’m in the Philadelphia region. Do you know or are you allowed to say, do you know who you’ll be partnering with in the Philadelphia region?

Emi Gal: We haven’t announced it yet. So, you know, it’s signed, but we haven’t announced it. And so, like, we’ll wait. We’ll wait to announce it together with our partner there.

Jen Callahan: I’m excited, I wonder I mean, there’s about three big names in the area, so I’m sure. I wonder, I wonder if the help facility that I work at is one of them, so.

Emi Gal: Well, you know, more and more on that in Q4.

Jen Callahan: Yeah, I’ll find out. So the different AI technology that that you have is incorporated obviously into all the scans. And then how did you decide that, you know, you have to just keep making it better and better and like, how is the I mean, I guess to say, how is the AI technology developed? This is probably way more extensive than what we need to hear. But just the ideas that you have of and you know, to to put them into motion.

Emi Gal: Absolutely. So the the great thing about MRIs is that you use the protons in the water to create images of the body. Therefore they don’t use radiation, ionizing radiation, which means they’re a perfect modality for screening because you’re not exposing the body to any kind of harmful radiation. And so that’s a positive. That’s why we chose MRI. The negative of MRI is that you’re using this magnetic resonance environment, which means that it’s inherently a very noisy environment. So in a noisy environment, the way you get signal is by doing a scan multiple times and then averaging out the noise. Now the problem is that if you do the scan multiple times, that adds to scan time, and so that adds to cost, etc.. And so what we realized kind of as technologists is that you could actually do the scan fewer times and teach an AI I what noise looks like. And not only that, but you could accelerate how much data you acquire on the scan in one go, and that results in even more noise, these artifacts and so on. It’s called parallel imaging. So dialing up parallel imaging leads to faster images, but it leads to noisier images. And we realized that we could train AIS to remove that noise too. And maybe important to note that our chief scientist is Doctor Dan Dixon from NYU, who invented parallel imaging and compressed sensing. And so in the mid 90s kind of made him world famous for that. And he is our chief scientist part time and is the chief of innovations at NYU part time. And so we know a lot about MRI image acquisition and how to accelerate it, and what the kind of MRI physics of that look like in order to be able to build these eyes. And so our vision is to continue deploying AIS that enable us to push the boundary of how quickly we can acquire an MRI scan to the point where we do a full body scan in 10 to 15 minutes, and that’s how we think we can get to significant scale.

Jen Callahan: I mean, it sounds pretty in-depth and obviously it is. Which leads me to the question about technologists who are doing these scans. Do they have to receive like special training to perform the scans?

Emi Gal: A little bit, yeah. So it’s a it’s a very specific type of scan because we’ve developed it to optimize every single parameter and every single sequence for our objective, which is to find cancer. And so there’s a full body localizer, there’s like multiple coils. There’s like a very specific playlist of sequences that needs to be done in the sequence that we provided. It’s like not a straightforward knee exam, you know, it’s a more complicated scan, but generally we do 1 or 2 sessions with technologists and they get it and then they can just scan with our protocol. We also have a continuous education kind of program where technologists can get credits for doing our certification and so on. So kind of we’ve created a whole system to make sure that our partner facilities technologists know how to do the scan.

Jen Callahan: So lots of great stuff going on with you guys. I’m sure that there’s more in development. Where do you see the company like moving forward in the next few years, hoping to just branch out more or to to further develop the software even further?

Emi Gal: Yeah.

Emi Gal: So we we have thus far scanned tens of thousands of people. We’ve helped about 6% of our members find possible cancer. And so kind of quite a significant nber. Many of these members was confirmed cancer. They got treated. They’re now cancer free. We get emails almost every week from folks who got laser scanned, were asymptomatic and found cancer. It was early, they got treated. And they’re now happy and well. And so in a few years, I would hope that we’re screening hundreds of thousands, maybe millions of people with this kind of super fast, full body scan in order to help our members find cancer early and give them a better shot at survival.

Jen Callahan: Speaking of which, you said, you know, different emails that you receive. I was reading through the different testimonials and it’s crazy. How so? You know, so many people had said that, you know, early detection. It caught it. One one guy had a brain tor. And basically if it wasn’t addressed, he probably would have died from it. , but to another man who did not have cancer but had caught something heart related from the calcification score. , I guess that would have been through the city.

Emi Gal: Yeah.

Emi Gal: And, you know, the crazy thing is that many of the people for whom we find cancer are on the younger side. You know, we’re talking 30 to 35, 40, 40, 43, like people who buy the kind of current guidelines, they wouldn’t have gotten screened with anything and they would have found cancer in their kind of 40s or late 40s, when they would have been super symptomatic and kind of would have had no shot at survival. And so the fact that we’re having this kind of scan that’s safe, that’s relatively affordable, that people can just sign up and do, is making a difference in people’s lives. And we just want to make it as available as possible. Yeah.

Jen Callahan: I really think this is just a phenomenal thing that you have going on that you’ve put together for the world. , or at least for the United States at this point.

Emi Gal: , thank you John.

Jen Callahan: Question to lead into do you think possibly you might branch out into other countries or continents with.

Emi Gal: Ezra.

Emi Gal: For sure. Yeah. I mean, our focus is currently very much on the US because we think there’s a huge opportunity here to help people to expand. We’re just staying very focused. But in the near future, I think we’ll we’ll expand in Europe, Asia, you know, we want to be a global company. Ultimately for now though, we’re staying very, very focused on being within a few short miles of anyone in the US. Yeah.

Jen Callahan: So everyone, this is Emi Gao with us today talking about early detection of cancer. , if you’re listening to this, go to Ezra. Com and check out Take the risk question assessment to see if possibly you should be scanned. Check out their website. In general, lots of great information. And like I said, the testimonials. I mean very just to have your life saved and not even know that you needed it saved. And it’s just, I don’t know, I can’t even find words for it. So early detection 100%. Everyone should go check it out. Thank you so much for being with me today. I really appreciate it.

Emi Gal: Thanks for having me, Jen. I really enjoyed it.

Jen Callahan: Alright guys, we’ll see you next week. Have a great week. You’ve been watching The Skeleton Crew, brought to you by X-ray Tech. Org. On the next episode, join us to explore the present and the future of the Rad Tech career in the field of radiology.