Is a "normal" mammogram result enough to truly protect your health? What if your standard scan is missing crucial information that could predict your risk for both breast cancer and heart disease years in advance? This episode challenges the one-size-fits-all approach to medical imaging and explores the future of AI in radiology for personalized patient care. We uncover how machine learning is moving healthcare from a reactive model to a proactive one, where diseases are caught earlier and treatments are tailored to the individual, not the average.
In this installment of our Physician Innovators series, host Dr. Trevor Royce sits down with Dr. Sean Raj, a practicing radiologist and the Chief Innovation Officer and Chief Medical Officer at SimonMed Imaging. Dr. Raj breaks down how his team is pioneering this shift at one of the largest outpatient imaging practices in the nation. We dive deep into SimonMed's groundbreaking programs, which are redefining what patients can learn from a single imaging session. Dr. Raj explains the revolutionary "Mammogram Plus" program, which provides a highly personalized breast cancer screening by analyzing not just the image, but a patient's individual risk factors like breast density to provide actionable insights. We also explore the incredible innovation of detecting heart disease from mammograms—a capability that leverages the same scan to identify early signs of breast arterial calcifications, giving women a powerful two-for-one look at their health. The conversation also turns to the rising trend of proactive health screening with the whole body MRI for early detection. Dr. Raj details SimonMed's "simonONE" program, which utilizes advanced 3-Tesla MRI machines and AI to conduct comprehensive scans in as little as 30 minutes, finding silent diseases years before symptoms might appear. Throughout the discussion, Dr. Raj emphasizes the benefits of AI in medical imaging, from enhancing radiologist performance to making advanced diagnostics more affordable and accessible. This episode is a must-watch for anyone interested in the future of medicine, technology, and for aspiring physician innovators in health tech looking to make a scalable impact on patient outcomes.
Episode Resources:
Discover Mammogram Plus and Mammogram Plus Heart
Introduction
Dr. Trevor Royce: Welcome to Health Tech Remedy. This is the next installment of our bonus series on physician innovators, where we sit down with doctors who've stepped beyond the clinic to create new solutions, lead biotech and health tech, and shape the future of care delivery and bring those innovations back to the clinic. I'm Trevor Royce. Today, we are without my co-hosts, Paul Girard and Tim Showalter, so I'll be flying solo, but very excited about our guest today, who has done some really incredible work and look forward to hearing about it.
Again, in this series, we explore how physicians apply their medical knowledge in unconventional ways, from building companies and products to driving change as ecosystem leaders and implementing new technologies at scale. We'll be learning how these physician innovators navigate their pivots, what inspired them, what advice they have for others thinking about how to improve care for patients beyond the given clinical encounter. And so today, we're thrilled to continue the series with Dr. Sean Raj, a practicing radiologist and chief innovation officer at SimonMed.
A little bit about SimonMed. SimonMed Imaging is one of the largest outpatient medical imaging providers and largest physician radiology practices in the United States, with over 200 subspecialty-trained radiologists operating across 10 states with over 170 facilities, and they specialize in using the newest diagnostic imaging technologies, bringing them to the community in an affordable and accessible way. There's a particular emphasis on subspecialty work and technology in combination with that clinical expertise to provide the best care available to patients. And today, we have Dr. Sean Raj.
Dr. Trevor Royce: Dr. Raj serves as SimonMed's chief innovation officer, and in this role, he leads the evaluation, acquisition, integration, and implementation of new clinical technologies into SimonMed's infrastructure and practice. Dr. Raj directs the patient-centered research initiatives, focuses on incorporation of artificial intelligence technologies into the clinical practice.
Dr. Raj completed his breast imaging fellowship training at Harvard Medical School's Beth Israel Deaconess Medical Center, where I was for residency, so it's good to have you on the show, and was an associate professor of radiology and partner in a hybrid academic private practice in Texas where he developed a high-risk breast cancer screening and research program. So we look forward to hearing directly from Dr. Raj today, hearing about all of the interesting work you guys are doing, evaluating and implementing new technologies at scale, and again, bringing them to the bedside. Dr. Sean Raj, chief innovation officer and chief medical officer at SimonMed. Welcome to Health Tech Remedy. We're excited to have you.
Dr. Sean Raj: Such a pleasure, Trevor. I'm a huge fan of the podcast and really excited to chat with you today.
Dr. Raj's Journey: From Medicine to Health Tech Innovation
Dr. Trevor Royce: I'm pretty excited about our conversation. I guess we should probably start at the beginning, as all good stories do, and we'd love to hear how you got started down this path and even what led you into medicine to begin with.
Dr. Sean Raj: I've always been fascinated by the intersection of science, technology, and human impact. Medicine gave me this opportunity to combine my passion for science with purpose. In some ways, every single day, we make differences in patients' lives. And I think that specifically is what drew me to radiology. Because I thought it's a great avenue where patient care really meets technology.
And from there, innovation is just a natural extension of that wonderful dynamic. And I think that is what really got me thinking about what we could do better, how we can impact patients better, faster, more equitable. And from there, you just can't stop with the questions.
Dr. Trevor Royce: Absolutely. I think I've always been impressed by radiology in particular about how they've been taking a very practical approach to innovation and bringing innovative technologies directly to patients, certainly better than me. But in the last 20 years, the radiology modalities, technologies have just exploded. So I guess we'd love to hear from you a little bit, how you came to SimonMed and a little bit about your role and focus at SimonMed.
Dr. Sean Raj: I think it was really interesting because radiology specifically is so tech focused. We in radiology probably had one of the prime examples of early computer assisted detection technology and utilizing that technology to help identify breast cancers earlier. This technology, we saw it come about in the 2010s. That's right when I was finishing my residency and I thought that this was just super, super interesting.
And that is really what drove me to pursue a fellowship actually in breast imaging. And I had the fortunate chance to work with some of the pioneers of breast imaging in Boston at Harvard Medical School. And from there, I was able to take some of these great ideas from academia and have an opportunity to bring this to the community. I found a great practice in Dallas where I was able to take what normally we are able to do in academia, bring it to the community as far as developing high-risk breast programs. And that's what really drove the conversation to say, how can I do this beyond Dallas, beyond Dallas-Fort Worth?
Can I take these ideas I have and look for a more nationwide application to be able to impact the most lives? And I was very fortunate to meet Dr. Simon, who is the founder of SimonMed Imaging, one of the largest outpatient radiology practices in the United States. And he has built SimonMed on this wonderful idea that we would like to take the best technology and bring it to the community at affordable prices. I thought there couldn't be a better fit for taking the work I was focused on with innovating and high-risk breast cancer detection and taking that more broadly and thinking, what can we do at scale in all aspects of imaging to impact the most lives?
Mammogram Plus: Using AI for Personalized Breast and Heart Health Screening
Dr. Trevor Royce: That makes a lot of sense. I guess maybe as a way to illustrate those concepts, we could talk a little bit about the breast program. I would love to hear a little bit about how your early experience in advanced technology breast program, what that looked like, say 10 years ago, compared to what you guys are doing today and what exactly your breast AI program captures today.
Dr. Sean Raj: Great question. Historically, the field of breast imaging really focused purely on analyzing images, looking for subtle signs of change that could represent a possible breast cancer. And it was a one-size-fits-all approach. What's really dramatically changed, especially in more savvy practices, is that we are looking for a one-size-fits-one approach. So what does that mean?
Well, we know the population of women, every single person has a different risk of developing breast cancer. There are risks that we can stratify based on different algorithms like the Tyrer-Cuzick risk calculator. We can use something like image-based risk. We can use density, a patient's personalized breast density. We could take all of these different data points, synthesize it together, and provide patients personalized imaging reports now that combine the imaging with what's going on with the patient.
So most recently, we launched two programs in the breast stratosphere called Mammogram Plus and Mammogram Plus Heart. Both these programs are very personalized, focused on the individual. So in the Mammogram Plus program, we utilize artificial intelligence technology to help our radiologists elevate the performance of interpretation. We're finding cancers that are even sometimes beyond the scope of the human eye. We are also providing patients with personalization. So now patients, instead of receiving just a generic federally mandated letter, now we're providing patients with actionable insights about their density, about their risk, and the best part is what to do about it.
We have seen lives saved because patients are now educated about their health and empowered to make the best decisions for their lives. And the other program we have just launched is called Mammogram Plus Heart. Breast cancer and heart disease are two of the big causes of morbidity and mortality in women. And what we've learned is when we look for subtle changes in the arteries of the breasts, we can tell early that the patient may have early signs of heart disease. And that's what we're providing all from a mammogram.
So now a patient comes in for their mammogram, we can provide them not only information about their breast health as far as risk for developing breast cancer and what to do about that risk, we can also provide them insights about their risk for developing heart disease. And so what we believe now with these precision programs is patients are better off in their lives because now they have actionable steps. They can actually do something about the risk of breast cancer, about the risk of heart disease.
Dr. Trevor Royce: I guess just to play that thread out, what is an example of, say, an actionable insight that one might get from this advanced technology, from the patient perspective? What would happen next after their image?
Dr. Sean Raj: So we may have women who come in for their mammogram plus and, the radiologist plus the AI says there's no signs of breast cancer today. We know that, one, you may have dense breast tissue. And if you have dense breast tissue, we know the studies would support that you come back in for your breast ultrasound because breast ultrasound can find subtle signs of early breast cancer when cancer is most treatable, especially those findings that are hidden in dense breast tissue.
The other alternative here is that we may detect that this patient is higher risk for developing breast cancer. In fact, some studies show that one in seven women will have a greater than 20% lifetime risk. And we know that 98% of women that are high risk don't know they're high risk. But because of our program, we can help stratify patients based on their risk. And if they're elevated risk or high risk, we can suggest patients come back in for a breast MRI or a breast ultrasound. Again, the goal here is to find cancers when they're very small and very treatable.
Dr. Trevor Royce: That makes a lot of sense. For an advanced program like this, how do you know it's successful? Or, what are your metrics or measures for success? Or put another way, I guess, what are some of the levels of evidence that you need to say this is a program worth implementing that can help our patients? Can you reflect on that a little bit?
Dr. Sean Raj: It's a great question. And one that Dr. Simon and I have thought deeply about. I think we measure success in many ways, but, three ways really matter most to SimonMed. I'd say patient outcomes, patient experience, and scalability. Let's just say if AI finds cancers earlier, if patients say, well, that was easier, that was faster, and I feel safer. And if we can deploy it affordably across our hundreds of thousands of patients, then we know we have hit the mark.
Dr. Trevor Royce: That makes a lot of sense, particularly from the patient perspective. Let's look at the other side of the relationship from the physician perspective, from the radiologist perspective. You have this mammogram, it's been interpreted by this advanced technology, say AI interpretation on the diagnostic side of the mammogram. How does the radiologist interact with that tool? What's been the reception from the physician side for these tools? What's the uptake been like amongst your group? Can you reflect a little bit on that?
Dr. Sean Raj: Really good question. We touched on scalability. The main thing is how can you deploy AI technology at scale? It's very simple to do at a single center or a handful of centers. But what we've learned through experience is that we have to make deployments simple, straightforward, and just easy to implement from operations, from our clinical team, even back to our patients understanding.
And so from our physician standpoint, from the physician lens, we have been able to process with AI all images directly from the gantries, from the scanners themselves. As soon as that mammogram is done within seconds, we're having our AIs process looking for breast cancer. If the patient is coming in for a routine mammogram, a more advanced AI, if they signed up for the mammogram program, again, looking for breast cancer, and or, the breast arterial calcifications AI, if they signed up for Mammogram Plus Heart.
So the AI processes the images, again, within seconds of the images being acquired, there's the post-processing, and then the images come back marked up as an extra set of images for a radiologist to review. So not only do these AIs act like a second set of eyes, but the patients even have the ability to visualize these markings by the advanced AI.
It's a very nice balance of helping radiologists, but also helping patients and the providers gain more insights, because we know we have proven that when patients can see what their issues are, when they can understand what their issues are, they are much more likely to be better custodians of their own health and make meaningful, actionable changes in their lives.
Dr. Trevor Royce: Very interesting. So it sounds like a lot of the output from these advanced technologies and diagnostics are patient-facing. And so is it fair to say that they're getting a report that helps translate basically what has been detected to what they can act on or their level of risk?
Dr. Sean Raj: You nailed it. We are very focused at SimonMed on the patient. We believe that radiology is transforming from, if I may be very lay here, from a mill where patients come in, get their scan, and move on to a place where they get extreme value. They understand that they are in a healthcare facility where they are engaging with their care team. The radiologist is not just a technologist. The majority of patients today think a radiologist is the technologist doing the scan versus a physician behind the scan providing these clinical insights. And so we believe that every patient that comes to SimonMed should leave educated about their health and empowered to make better decisions.
Proactive Health Screening with the simonONE Whole Body MRI
Dr. Trevor Royce: Very interesting. I think it's a pretty powerful concept that you could come in for your mammogram, have this because the heart and the breasts are in close proximity to each other, have an evaluation done also of your coronary health and detect heart disease in addition to whatever your breast cancer risk is. And I think that ties in nicely with some of the other interesting technologies that I understand have been implemented in your program, including whole body MRIs. Could you tell us a little bit about the whole body MRI program? Who is using that technology? When's it indicated? How's it's been received? This is something that's been a part of the national narrative over the last couple of years, and we'd love to hear about it.
Dr. Sean Raj: Sure. We have a program called simonONE. I would say that simonONE is one of the most advanced whole body MRI scans on the market today. Simply put, we do all of our scans on very, very advanced MRI machines. What does that mean? Well, we do our simonONE scans on three Tesla magnets. So that means we have very, very powerful magnets. So that way we can visualize subtle changes earlier than those that do scans with older technology.
In addition, we use AI on our whole body scans as well, which is relatively unique. Again, SimonMed embraces using the best technology possible to get the most insights for our patients, possibly years earlier before other centers which may not be using the latest technology. And so that's where we really excel.
And then finally, we have a distinct advantage of, again, being a nationwide footprint. We are coast to coast. And we think that accessibility is critical and affordability. I would also say that when you're shopping for your whole body scans, these are the value sets. Where can I get the greatest value? Where can I have the best technology, the most advanced technology at the best price? And I think when you take all of these considerations together, our simonONE product stands alone. And we have impacted numerous lives and found disease, silent disease, years earlier before they presented themselves as something much more challenging for the patient.
Dr. Trevor Royce: And this is almost more for my own curiosity than anything, but curious, how long does a typical whole body MRI take?
Dr. Sean Raj: That's the beauty of the advanced three Tesla scanners. We have been able to get our scan time down to one of the quickest in the business. We can do some scans, depending on which package you choose, in as quick as 30 minutes. And that really impacts quite a few patients because I don't know if you've ever had an MRI before, but some patients can get quite claustrophobic. And to that point, we also make sure that when we buy magnets, when we buy these MRI machines, we make sure to get the most comfortable ones, meaning the wide bore, the extra wide bores, so patients have the most space in the machines as well.
Balancing Innovation, Affordability, and Patient Access
Dr. Trevor Royce: You're articulating some of the trade-offs that one could experience any time that you undergo medical imaging or any intervention, things like the time it takes. You could be uncomfortable if it's a small bore scanner, these sorts of things. Can you talk a little bit about how you prioritize patient access, affordability for these technologies? And I think part of that is tied into, obviously, the scale that you guys are aiming for. How do you get these to as many people as need it?
Dr. Sean Raj: There's always that tension between access and affordability, but pushing technology, which is expensive. And we know the technology can be amazing. We've seen great things. Part of our mission of developing the best technology, bringing the best technology at the most affordable price is true for every single thing we do. We, in fact, partner with many vendors and we help co-develop technology.
We have some very forward-thinking deals with vendors where we can essentially bring down the cost of technology substantially. So that way we can pass that savings right on to our patients. At SimonMed, we've built programs where AI and advanced imaging are even included at no extra cost to patients. We go back to talking about breast cancer screening. Our baseline mammogram, which is a 3D mammogram, we have AI included for all patients at no extra cost. And I think very few or a minority of practices are doing that today. So we believe it's all about democratizing innovation so that that single mom with a high deductible plan, which is all the rage right now, gets the same benefits as someone who's a president of a company, for example.
Enhancing Patient Understanding with Digital, Digestible Reports
Dr. Trevor Royce: That's terrific. Finding ways to increase access and bring these advanced technologies to larger swaths of the population is definitely a noble endeavor. I guess another tension that I would love to hear you reflect on a little bit is balancing all the information that you would get from some of these novel scans, your risk for heart disease versus just your simple mammogram. Or in the case of a whole body MRI, you might find incidental findings for the case, for example, for whole body MRI. How do you communicate those results to patients and make sure that it's understood what the scan is finding and how the scan results should be followed up on to avoid things like unnecessary procedures or findings that may be incidental and not cause harm for the patient?
Dr. Sean Raj: I think you're touching on two distinct areas. One is safety and privacy, and the other is report delivery, which is under the umbrella of safety and privacy. So first thing, and most importantly, at SimonMed, with AI, without AI, safety and privacy are non-negotiable. We have every technology that we implement, every tool, AI, full-body MRI, report delivery, everything must meet the highest standards. Is this HIPAA compliant? We ask ourselves, would I want my own family's data handled this way? That's the bar. And so we take safety and privacy extremely seriously.
And then when we talk about report delivery, we're doing some really, really innovative new technologies. When we're talking about report delivery, we have engaging reports. So what that means is we're taking the whole report experience, reporting experience, and going from 2D, just a piece of paper that has a lot of really high-level medical jargon that doesn't really mean much for the patient, and your providers also are, your referring providers are slammed with so many patients. The state of medical affairs right now is it's tough to give quality care, I would say, just the way medicine is right now. And so what we've been able to do is we, particularly for our simonONE programs and many of these AI programs that we've launched again in breast cancer detection and heart health, we have really focused on how can we make the report experience better for our patients.
And so we have created digital enhanced reports with our partner company, Cascaid Health, which uses almost like you're going through an Instagram reel, but you're getting your medical results through there in a very simple to understand, digestible reports, next steps, and really what you can do about your medical care. Your patient, your provider still gets their technical letter, but now the difference here is the patients are getting digestible reports. And we've seen a dramatic change in the trajectory of our patient's behavior, their psychology, as it comes to understanding the reports and making meaningful change. And we've seen the metrics, We've seen patients come back in for recommended scans on time. Because of that, we've caught disease earlier and earlier at SimonMed.
Dr. Trevor Royce: That's a great answer. In this era of open notes where things like radiology reports, pathology results, clinical encounter notes are released to the patients, often, now, sometimes, before the physician even sees them, it can create some anxiety or, there's a cyst on your kidney, which we find all the time. And interpreting that for the patient and the delay between when those results are returned and the physician conversation can increase anxiety. So, it sounds like approaches like yours are a great way to mitigate that risk and really communicate and translate these results to the patient.
The Future of Radiology: Towards Proactive and Hyper-Personalized Care
But just to shift gears a little bit as we are coming up on time, we'd love to hear future looking and forward thinking what some of the innovations that you and your team are excited about in the radiology world coming down the pipeline. What do some of the new technologies over the next five years look like for SimonMed and radiology practices across the U.S. broadly?
Dr. Sean Raj: I introduced the concept earlier about the one size fits one approach. And I think we've demonstrated now in breast cancer and more broadly women's health, we can execute this at scale and impact hundreds of thousands and hopefully millions of lives. But I believe, really believe that this personalization and prediction of disease will transcend beyond just women's health and breast cancer.
I think for every single aspect of imaging, there will be some technology that we can apply. Whether you're coming in for a suspected x-ray of a broken bone, you're coming in for an MRI of your prostate to look for possible prostate cancer because of your family history. I think every single scan and test we do will have some added value that we can personalize to the patient and provide patients more precise metrics and action steps. I think that the future of medicine is very, very personalized. And I think at SimonMed, we're leading the push in proactive healthcare.
Dr. Trevor Royce: That's great. As an oncologist, we talk about precision and personalized medicine oncology with biomarkers. And that's been a frequent topic on the show. And the idea of tailoring your images, scanning protocols and so forth for given history, that makes a lot of sense to me.
Advice for Aspiring Physician Innovators
One thing we like to cover on the show in the area of physician innovators, such as yourself is, thinking back to Dr. Raj in med school, what advice would you give your former self now that you are in this pathway of innovation and bringing innovative radiology techniques to the bedside, what kind of advice would you give for those early career docs that are thinking about pursuing similar career goals?
Dr. Sean Raj: Great question. What I tell myself, I would say one bit of advice I got early on and morphed into what I'm going to answer is start small. Don't wait for the perfect environment to occur for you to make some change. And then doubling down on that, I would say my advice would be very specifically, don't wait for permission. Innovation doesn't require a title of chief innovation officer. Again, bringing in that concept.
Start small, fix something in your workflow, measure it, iterate on it, share it, and figure out a way to get the stakeholders involved, the key stakeholders above you, around you. If you can show that you are making a meaningful impact on patient care, quality, you're going to find that people want to get behind you. We need to get to a state in medicine where people are willing to embrace that innovation mindset. And I think if you can be the inspiration to your peers and get that momentum, you're going to start seeing all around you. People are going to start thinking out of the box and looking for solutions and making meaningful change.
Dr. Trevor Royce: There you go. I love it. As we wrap up here, is there anything that we haven't covered today that our audience should hear about being a physician innovator in today's world?
Dr. Sean Raj: I would just close by saying being a physician innovator today is about combining these two worlds, the timeless values of medicine, with the disruptive potential of this technology. Patients want compassion. If you look at some recent survey, they say that patients are afraid of AI. But we're not talking about robots or machines taking care of patients. We're talking about the combination of human compassionate care, ingenuity, and the ideas of AI working all together synergistically for delivering the best care for the patient. We have the best tools that science has to offer now. And if we can bridge these worlds, well, that's where magic happens.
Dr. Trevor Royce: Fantastic. That's very well put. I think the modern clinical world is this delicate dance between advanced technologies, the patients, and the providers. And I think you've shared a lot of great examples of how those can impact outcomes and fulfill the promise of these technologies. So we really appreciate you coming on today and sharing your story.
Dr. Sean Raj: Trevor, thank you so much. It's such a pleasure.
Dr. Trevor Royce: Well, that'll do it for this episode of Health Tech Remedy presenting Physician Innovators. Be sure to subscribe and follow us on your favorite podcast platform. And if you know a physician innovator we should feature, please reach out. We'd love to hear their story. Dr. Raj, thanks for coming on the show.
Dr. Sean Raj: Thank you, Trevor.
