President and CEO Randy AuCoin discusses the company’s game changing micro-ultrasound platform, lessons learned from raising over $45 million as a first-time fundraiser, and more.

One of the toughest questions politicians face today is how to fix overburdened healthcare systems that never really recovered from the pandemic. While government policy will certainly play a key role, solutions can also be found in the private sector—in particular, from innovative medtech businesses. Exact Imaging, a startup that creates high-res micro-ultrasound systems, is one such gamechanger.

Exact Imaging, headquartered in Markham, Ontario, produces world-leading micro-ultrasound systems that allow for real-time, highly accurate imaging during biopsies to diagnose prostate cancer.

Randy AuCoin, president and CEO of Exact Imaging, says the company honed in on urology (which deals with diseases of the male and female urinary tract) as its focus because of their technology’s ability to make a significant change in the field. “Urology is the perfect fit for our tech, because there’s a lot of anatomy you can get next to with either a trans rectal probe or small parts probe that can really benefit from using high-frequency ultrasound,” he says.

Ok, but what does “micro-ultrasound” actually mean?

“When people hear micro ultrasound, the first thing they think is that the device itself must be micro,” says AuCoin. “But it’s not that the device is small; it’s that it sees small things. Normally human ultrasound is in the frequency range of one to 15 megahertz and, in the case of urology, one to nine megahertz, which sees a certain amount of resolution. We go well beyond that in terms of higher frequency and, as a result, higher resolution.”

He says their tech boasts a 300 per cent improvement over normal ultrasound use in urology and “that makes all the difference when it comes to telling what’s normal versus what’s suspicious inside the prostate.”

Micro-ultrasound tech undoubtedly has applications outside of urology, from helping with radial artery imaging to guiding hand surgery. AuCoin also says it could play a major role in risk-stratifying other cancer cases. However, Exact Imaging has made a business decision to remain steadfastly focused on urology, which is rather expansive in and of itself.

“The healthcare space is huge and there’s so much going on, it’s impossible to focus on everything,” says AuCoin. “So the question for us isn’t, ‘what else can we do outside of urology?’ The question is, ‘what else can we do within urology?’”

Exact Imaging’s technology has the potential to go beyond targeted prostate biopsies, into areas like screening, guiding treatment, and planning surgeries. It could also be used for testicular imaging and determining whether bladder cancer is muscle-invasive or not.

Using AI to combat doctor burnout

While technological advances in the healthcare space improve diagnostic capabilities, they also bolster the resilience and efficiency of healthcare workers. Doctors and nurses report record rates of overwork and burnout, which can have downstream impacts on patients. In 2019, Exact Imaging partnered with Cambridge Consultants to explore how artificial intelligence (AI) could improve their products. They continue to explore possibilities with other groups, including UCLA, Stanford, and the University of British Columbia.

“The beautiful thing is our technology enables us to see the prostate in so much detail, that AI has enough information to work with. There are enough high-quality samples that eventually we’re going to be able to work with these and other partners on developing an algorithm that will allow you to scan the prostate and push a button. Then, in 30 seconds, the machine can point out areas it believes look suspicious for further examination,” says AuCoin.

“Sometimes healthcare isn’t the same at the end of the day as it is at the beginning of the day… AI could help make sure nothing is missed.”

The goal is to make sure no cancer cases fall through the cracks. “Sometimes, healthcare isn’t the same at the end of the day as it is at the beginning of the day,” says AuCoin. “At the beginning of the day, when we’re not behind schedule and everybody’s fresh, you might take more time to look at something. At the end of the day, when everyone’s tired, things are behind schedule, and patients have been waiting a long time, there might be a tendency to rush. But the machine’s never going to get tired, even if the people using it are. AI could help make sure nothing is missed.”

While there’s still a lot of work to do before this becomes a reality, AuCoin says early work by Exact Imaging and its research partners is “really, really promising.”

A passion for early-stage medical device companies

AuCoin co-founded Exact Imaging in 2012 with Sam Ifergan (iGan Partners). The Company began operating in early 2013 with AuCoin as the Company’s President and CEO. His core focus is leading the global commercialization of the company’s ExactVu micro-ultrasound platform while driving strategy and fundraising. To date, he’s raised over $45 million in financing for Exact Imaging.

While no startup’s journey is a cakewalk, medtech comes with its own specific challenges—ones AuCoin thrives on. Early in his career, he discovered a passion for early-stage medical device companies, which he now specializes in.

“I started out my career a long time ago as a software developer in 1990. At that time, I was the seventh person hired in an electrophysiology company, which dealt with electrical signals within the heart, and two things happened: I fell in love with early-stage companies and I fell in love with medical devices,” says AuCoin. He’s worked in the space ever since.

“Quite frankly, there’s probably easier ways to make money. I like the work that goes into figuring out how to take something from an idea to standard of care, which is really difficult and challenging, but figuring out how we can take technology and solve a problem for physicians has become a passion of mine.”

He also likes the “chaos” of young companies and the ability to wear many hats within them. Much like Exact Imaging’s laser focus on urology, AuCoin has his own laser focus—a novel admission in an age where many startups and burgeoning leaders (and some experienced ones, too) attempt to be too many things, all at once.

“Once it gets to more than 100 or 200 people, everybody starts to have their silo and speciality they need to focus on, “ AuCoin says. “It becomes a little narrow for me at that point, so I’m the person that’s good from one to 100 people and a certain level of revenue. Then there are others better at scaling a startup to a $500 million company and tickling out that last bit of profit.”

“I used to think the hardest thing was to get the product done. Turns out, it isn’t. Commercialization is by far the hardest step.”

After decades in the field, AuCoin is able to impart some valuable lessons to others entering the medtech space. “At the start of my career, I was in product development, writing code, managing projects, and things like that. I used to think the hardest thing was to get the product done. Turns out, it isn’t,” he says. “Commercialization is, by far, the hardest step. Unfortunately, we have a huge number of great products invented in Canada, even just in Ontario and the Greater Toronto Area (GTA) that sit on shelves, not developed into their potential.”

A great idea, or even product, is just the beginning. To become successful, medtech companies must see their devices through adoption, establish workflow pathways, change existing habits, and get their tool to be what physicians reach for every day. “That’s the part where companies succeed or fail,” says AuCoin.

Raising $45 million and counting

AuCoin has led an undeniably successful fundraising drive for Exact Imaging, so it may surprise some to know he’s not only a first-time CEO, but entirely new to raising money. Other than surrounding oneself with experienced people who can provide advice, he says the most important part of fundraising is perseverance.

“You just need to be ready for it to be difficult. It’s always difficult,” he says. “I’ve been lucky enough to raise money through good times and bad times. When we started, it wasn’t good times—and that was actually a good thing. Because then, when good times come along, you can recognize that they’re good times and not the norm.”

He explains he always leads with the belief they’ll be successful, and then it’s just a question of making the process to get there. “For example, it might take us reaching out to 100 different groups and a certain percentage of those groups will say they want to learn more, and then a certain amount of those will take a meeting, then an even smaller percentage will dig into the data room, and a certain smaller amount will write cheques.”

“Because I’m always set up for a process and having to do the work, I never had too many high highs or low lows. If something wasn’t going right, it was because I hadn’t finished the work yet,” AuCoin says.

He recommends always having a next meeting in your calendar, even if you don’t think you’ll need it. That way, if you have a bad result, at least “ then you always have hope for tomorrow.”

AuCoin also praises Exact Imaging’s relationship with RBCx, which he says “is like a one-stop shop with a whole variety of services that an early-stage company needs.”

“If we have a question, our Director of Finance can jump on the phone or send an email and get a response very quickly for an issue that may be time-sensitive, like foreign exchange when someone wants to buy your device in a new country,” he says. “You’d think it’s going to take seven days to get an answer like that from a big bank, but RBCx manages to have a small bank feel that’s very personal.”

“That’s very valuable because, of course, we want to spend time solving clinical problems, not doing banking.”

To learn more about Exact Imaging, visit ExactImaging.com.

RBCx backs some of Canada’s most daring tech companies and idea generators. We turn our experience, networks, and capital into your competitive advantage to help drive lasting change. Speak with a RBCx Advisor to learn more about how we can help your business grow.

This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While the information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by Royal Bank of Canada or its affiliates

This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While the information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by Royal Bank of Canada or its affiliates.

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