Founded in 2015, Exo has raised more than $100 million in funding to date and is proceeding in its vision to modernize medical imaging. The company’s investors include Action Potential Venture Capital (a GlaxoSmithKline venture fund), Applied Ventures, Bold Capital, Creative Ventures, Fiscus Ventures and Reimagined Ventures – Magnetar Capital affiliates, Innovative Growth Fund, Intel Capital, Longevity Vision Fund, Nautilus Venture Partners, OSF Healthcare, Rising Tide Fund, Solasta Ventures, TDK Ventures, and Wanxiang Healthcare Investments. We recently spoke with Dr. Janusz Bryzek, Exo’s Co-Founder and Executive Chairman, about his vision for the company, current marketplace dynamics, as well as technology and business roadmap. Dr. Bryzek also shared his main lessons for entrepreneurs in the sensors and MEMS ecosystem, and a few interesting startup companies he has been tracking.
MEMS Journal: What’s the brief history of Exo? Why did you decide to start the company?
Janusz Bryzek: Exo was born based on the information from the World Health Organization that 75% of the world doesn’t have access to medical imaging. Shortly after I learned about this, I received encouragement from Professor Richard Popp who pioneered using ultrasound imaging for cardiac applications at Stanford. Shortly thereafter, Sandeep Akkaraju, who was my partner at a previous startup, Jyve, got encouragement from Apple. We both coincidentally received recommendations to develop a low cost, easy-to-use handheld ultrasound device. We then partnered with John Kokulis and Yusuf Haque, and Exo was born. Professor Popp became the Chair of our Medical Advisory Board.
MEMS Journal: What’s your vision for Exo? How do you see the company in 3-5 years?
Janusz Bryzek: We are introducing a high performance, low-cost ultrasound device supported by a workflow solution. Our initial users are medical professionals, but over time, we envision applications that will enable consumers to use the ultrasound device as well. We are reimagining the stethoscope for the 21st century.
MEMS Journal: What’s the main technological challenge that Exo’s team has had to overcome?
Janusz Bryzek: The initial challenge we faced was selecting an ultrasound transducer that could enable low-cost, high-performance imaging. We started exploring CMUTs, as we had deep experience with capacitive sensors from previous startups. However, we found several disadvantages of CMUTs in comparison to legacy PZT transducers and switched to PMUTs.
Our PMUT technology combines advantages of CMUTs and traditional PZT transducers, such as low cost, high acoustic power, stable and linear operation, broadband operation, and also adds a low operating voltage as an additional benefit.
Developing a breakthrough integrated manufacturable PMUT based transducer, the first for medical imaging, was the biggest technological challenge to date.
MEMS Journal: What were your main technological milestones in 2020?
Janusz Bryzek: Exo’s technology is designed to be affordable and enable best-in-class medical imaging to be carried in the pocket of every caregiver and clinician worldwide. This will require widespread distribution supported by a world-class supply chain. In 2020 our team accomplished the goal of developing a capable global supply chain.
MEMS Journal: What’s on your roadmap for 2021?
Janusz Bryzek: In 2021, we will be working to receive FDA clearance on our handheld ultrasound device and have plans to launch in the US. Additionally, we are in the process of releasing Exo Works, an intelligent and intuitive point-of-care ultrasound workflow solution designed for the entire healthcare system. The goal of Exo Works is to solve the chronic workflow issues within hospitals and clinics.
MEMS Journal: Who are your main competitors and how do you compare?
Janusz Bryzek: Overall, it’s an exciting time for handheld ultrasound. There are a lot of good products, but most are lacking in image quality and functionality such as image transfer, full ultrasound capabilities, full cardiac packages, and full OB packages.
Butterfly Network has been an evangelist in the handheld ultrasound market. They have a similar goal to Exo’s, which is to democratize medical imaging. However, our ultrasound technology is built on proprietary PMUT technology -- the only technology of its kind -- and aims to deliver superior image quality. We also will pair our device with Exo Works which transforms billing, documentation, and the patient record process, making Exo work seamlessly in the emergency room or clinic environment. Not only that, but Exo Works will quite literally work with any point-of-care ultrasound device.
MEMS Journal: Which applications are you pursuing first and why those applications?
Janusz Bryzek: The beauty of silicon broadband ultrasound transducers is the ability to replace multiple traditional probes with one. This enables the imager to be useful for many applications.
MEMS Journal: In addition to Exo, which of your career accomplishments are most significant and why?
Janusz Bryzek: Starting ten MEMS companies in Silicon Valley is among my most significant accomplishments. This involved me participating in developing disruptive MEMS technologies impacting the world and shaping the future of MEMS.
Another one of my noteworthy achievements was my work on the development of the world’s first disposable blood pressure sensor used during open heart surgery. My company reached about 60% market share, shipping about 30 million sensors per year, which contributed to helping save about 30 million lives annually.
MEMS Journal: Aside from the ultrasound technology which you have been developing, which emerging sensors and MEMS technologies do you think are most promising in the next few years?
Janusz Bryzek: Through the TSensors initiative, we discovered the following applications with the potential growth of supporting sensors into the trillions: personal health monitoring, including ultrasound imagers; food and ag-tech, optimizing production and conservation of food; sustainable solutions for global environment, including monitoring chemical, biological and other pollutants; monitoring of global natural, manmade, and infrastructure disasters; energy generation and conservation.
In my experiences, I have discovered that in the path to a trillion nodes, the cost for these technologies must drop significantly. The only technology capable to support trillions of nodes without breaking the GDP is printed electronics and sensors.
MEMS Journal: What are the main mistakes that entrepreneurs make in the sensors and MEMS industry?
Janusz Bryzek: Entrepreneurs' errors are not unique to the sensors and MEMS industry. Some major mistakes include: falling in love with his/her invention and trying to bring it to market, wherein the market is very small; underestimating the time it takes to commercialize a bleeding edge technology; underfunding manufacturing infrastructure development; not knowing the target market and developing a product that does not solve your customers’ problems; under-appreciating the value of marketing, believing that the product will sell itself; avoiding sharing equity with employees and investors, believing that 100% equity with zero-value is better than 10% equity worth millions.
MEMS Journal: What types of sensors and MEMS companies are most ripe for M&A and consolidation?
Janusz Bryzek: Artificial intelligence is invading every aspect of our lives, transforming existing markets and creating new ones. I would envision sensor-based products with embedded AI as a likely target for M&A. The healthcare market is hot, with tele-health usage significantly accelerating due to COVID-19. Sensor companies enabling large system markets will likely be the targets for acquisition.
Several industries are undergoing transformation. For example, self-driving vehicles with novel sensors, such as LIDAR, are being developed by approximately 100 startups. As such, consolidation and M&A activity may be expected.
MEMS Journal: Which 3-4 sensors and MEMS startup companies are most interesting to you right now and why?
Janusz Bryzek: Here are a few and I am also tracking selected nano-startups.
Injectsense, a sensor-enabled digital health company with an injectable sensor and actuation platform for multiple medical domains, including ophthalmology, cardiovascular, urology, gastroenterology, and neurology. The company is building upon pressure sensor technology developed in one of my startups.
AiDx Medical, a company developing portable AI-based diagnostic microscopes enabling quick parasite detection, with a first focus on malaria. One of the founder’s brothers died of malaria in Nigeria, which motivated him to get his Ph.D. at Delft University, where he focused on malaria detection. His thesis advisor and company co-founder helped me develop the optical switch in one of my startups.
Sidhu Laboratories, a company revolutionizing solid-state batteries. The founder is the son of my former co-worker, and he works there as well.
Zhittya Genesis Medicine, a company developing a revolutionary group of drugs which trigger the human body’s natural regeneration process, targeting the healing of diseases such as Parkinson’s, Alzheimer’s, Multiple Sclerosis and others. The founder envisions his new drug will help heal my walking problem, which I developed in recent years.
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This article is a part of MEMS Journal's ongoing market research project in the area of medical MEMS devices and applications. If you would like to receive our comprehensive market research report on this topic, please contact Dr. Mike Pinelis at [email protected] for more information about rates and report contents.
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