Innovation From the Outside In: Olivia Ho Cheng, CEO of Aurora

Olivia Ho Cheng, CEOOlivia Ho Cheng, CEO of Aurora Imaging Technology Inc, North Andover, Massachusetts, was recently appointed to the international advisory board for the Britton Chance Center for Biomedical Photonics (BC CBMP), the first research laboratory focused on medical-imaging technology research and development in China. ImagingBiz spoke with her about the outside-in approach to research and development and the unique aspects of the Chinese marketplace that could make it a fertile breeding ground for new breakthroughs in diagnostic imaging.ImagingBiz: Congratulations on being appointed to the international advisory board for the BC CBMP. You are among distinguished company that includes a Nobel laureate. What is the right time to bring a business perspective into a research institute? From your perspective, is it ever too soon? Cheng: What we have found is that typically, a research laboratory or large university will take the inside-out approach: The researchers will conceptualize a product that has the potential to be very helpful, develop the product, and then try to find companies to commercialize it. On the other hand, at Aurora, we have taken the outside-in approach. As a company that has been in the breast-imaging industry for a while, we understand the importance of continued research and development, but we also realize the heavy cost that often accompanies such efforts. We saw that we could bring our projects to the university or national laboratory and combine our vision with that of their researchers, resulting in products that are more viable for the marketplace. We felt that approach could be very effective. ImagingBiz: China appears to have made medical-imaging research a significant priority with the founding of the BC CBMP. As the CEO of a dedicated breast MRI company, what do you see as the potential impact of biomedical photonics on medical imaging (in general) and on breast imaging (specifically)? Why is there a focus on photonics in China? Cheng: I firmly believe that in the past 50 years, the medical quality system has improved drastically, and one contributor is imaging. If you can see a disease or abnormality, you can treat it better, so medical imaging has been critical. Breast cancer, specifically, can be elusive, but once you can see it, you can develop a better plan to target treatment. We want to tap into the think tank of the world to see if we can bring breast imaging to the next level. We’re very happy with what we have done so far, but if we could identify breast-cancer markers, and if we can use imaging to identify the disease much earlier or more precisely, it will reduce suffering from the disease. We look to see which entities have the kind of research ability to help us reach this goal, and we want to align ourselves with them. Radiography has a dosage issue; MRI is currently the most benign screening technology because it’s a magnet, and then there’s ultrasound, a little lower on the technology bar because its depth is limited. You need all kinds of imaging technology for different needs, and a laboratory focused on optical imaging may be helpful in furthering this development.ImagingBiz: Beginning with the role of the institute’s namesake (photonics researcher Britton Chance, from the University of Pennsylvania), China appears to have made a concerted effort to build an international team, both through its board and through cooperative research with other countries. What is the significance of this global focus? Does it represent a departure for Chinese research? Cheng: China is playing catch-up now. It wants to catch up with the Western world, and it has the world’s largest population, so it has a reason to want to use its experts to shorten the learning curve. That’s a very smart approach. Experts worldwide also see the large market there and know that if they can help out, we all benefit. It’s a win–win situation.ImagingBiz: What is the incidence of breast cancer in China, and why is dedicated breast MRI particularly well suited for this demographic? Cheng: There are several reasons that breast MRI is well suited for the Asian population. In the United States, among women 40 years and older, only 35% to 50% of women have dense breasts. In Asia, it’s 85% of women who have more dense breast tissue and less fat. Mammography is less effective for these patients. In addition, in Asian women, breasts tend to be smaller, and because the breasts are smaller, positioning for a mammogram can be difficult; it’s painful, and the patients don’t want to go back, so the mammography utilization rate is less than 10%, while in the United States, it’s 60%—but the breast-cancer rate is rising rapidly in Asia, especially in China’s cities. Currently, in the Western world, one out of eight women will develop breast cancer, while in China, it’s one out of 29. Despite the appearance of having a low incidence rate when breast cancer occurs in Asian women, the average age among breast-cancer patients is 10 years younger than the average age of Western women, and because they’re so much younger, the cancer tends to be more aggressive. In addition, widespread screening is not standard, so much of the breast cancer, when it’s found, is at a later stage. Given all of these factors, it seems obvious that breast MRI is the best technology for this population. This is a chance for this very useful clinical product to save lives, and it could be used for first-line screening because, as discussed, mammography has not been well suited for this group.ImagingBiz: As a businessperson, you must find the sheer size of the Chinese market very attractive. What are your projections for this market for medical imaging, and for Aurora in particular? How does it compare to other markets? Cheng: We believe the market is still in its infancy, but has the potential to be larger than the US market (which, in the past, has represented 50% of the world market in medical-imaging technology). That percentage is going down because other markets are catching up now. I think it’s tremendous for our US company to be able to export our product overseas, helping our own economy and saving lives—and it doesn’t get any better than that.ImagingBiz: There have been some well-publicized business challenges for global companies doing business in China in recent months. How is doing business in China different from doing business in other countries where Aurora Imaging Technology sells technology? Cheng: Any time you cross borders or cross cultures, there are differences, of course. I came over from Asia more than 30 years ago, and that was a culture shock, at first. To do business in other countries, you need to learn about their culture and how they deal with each other. If you fail to recognize the nuances of doing business with other countries, regardless of which country we are talking about, there will be misunderstandings. In any relationship, business or personal, it is a good communication that is the foundation.ImagingBiz: You’ve worked extensively to improve breast-cancer screening and diagnosis in Asian women. You recently forged a relationship with Shanghai Ruijin Hospital to showcase the clinical potential of dedicated breast MRI. Can you share details on that partnership and what you hope will come out of it? Cheng: Everyone always looks to a leader, and in Asia, it is no different. The industry looks to the teaching hospitals to see what they are doing and how it can emulate them. We aligned ourselves with a famous, top-ranked teaching hospital, and through our partnership with it, we can reach more physicians and patients to educate them on the value of breast MRI. We consider this partnership very important; Ruijin Hospital is the teaching hospital for Shanghai Jiao Tong University, which is the premier university in China. We would like it to be the teaching center for all the new sites in China, and for physicians from all over China to learn about this technology and its clinical applications.ImagingBiz: In your experience as CEO of Aurora Imaging Technology, what do you see as the challenges of bringing a novel medical technology to market? What is your vision for the future of your company and its technology? Cheng: People in medicine are extremely intelligent; they’re also very conservative because they deal with people’s lives. They don’t just accept things as fact, so it takes a long time to establish that relationship and confidence in your technology. At Aurora Imaging Technology, we are thrilled with the technology we spent so much time developing; seeing the clinical benefit gave us a confidence boost, and because of that, we’ve also attracted world scientists to join our advisory board. We hope to take that experience and expand it beyond breast cancer to the detection of other cancers as well.Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal. .