借助AI将MRI从艺术转变为科学 - Vista AI

大家好，欢迎回到《医疗创新播客》。我是布兰诺夫。我的搭档厄本今天没能来，但我们为大家准备了一期非常精彩的节目。今天，我们有幸邀请到Vista AI的首席执行官丹尼尔·霍金斯。

Hey, everyone. Welcome back to the Medical Innovation Podcast. My name is Branov. My cohost, Urban, couldn't make it today, but we're have a very exciting episode for you. Today, we're speaking with Daniel Hawkins, the CEO of Vista AI.

丹尼尔，首先非常感谢你能来参加我们的节目。我们非常高兴能邀请到你。感谢你。你在医疗科技领域拥有数十年令人惊叹的职业生涯，包括在直觉外科的工作经历。你还创立了多家公司，比如Shockwave、Avelmed Systems等。

Daniel, you have a first of all, thank you for joining us. We're really glad to have you here. Thank you. You have a really incredible and impressive career with decades in the med tech space, including roles at Intuitive Surgical. You founded several companies like Shockwave, Avelmed Systems.

你能否简单分享一下你的背景，以及你是如何走到今天这个位置的？

Would you mind sharing a little bit about your background and your journey to where you are now?

当然可以。我与医疗保健的渊源可以追溯到童年时期，因为我父亲是医生。同时我也很早就接触了创业，因为他从医学院毕业后就自立门户。我11岁就开始了人生第一次创业尝试，在圣诞节期间挨家挨户售卖装饰用的冬青枝，就像卖女童军饼干一样，从此我就迷上了创业。

Yeah. Sure. So, my interaction with health care starts back as a child because my father's a physician. And my interaction with entrepreneurship starts in as well because he hung his own shingle out of med school. I got involved in some of my first entrepreneurial efforts when I was 11 years old selling decorative holly around Christmas time door to door like a Girl Scout cookie, and I I got hooked.

我一直对科学充满兴趣，同时也兼具临床思维和技术思维。虽然我不是工程师也不是临床医生，曾考虑过读医学院，但最终选择了商业方向。所以我本科和研究生都攻读商科，期间还涉足了风险投资。

I've always been scientifically minded, but, and and clinically minded and technically minded. I'm not an engineer. I'm not a clinician. I thought about going to med school and favored the business angle. So undergrad in business and grad in business and in between venture capital.

研究生毕业后，我只想去一个地方——医疗器械领域。我的职业生涯始于Pomo支架问世之前，至今已有32年。我进入血管成形术领域时，业界还在争论血管成形术和外科手术哪种对患者更好。在那里工作数年后，我获得了参与早期项目的机会，最终加入了一家当时还只是个构想的公司。

When I finished grad school, there was only one place I wanted to go, and that was in the medical devices. My tenure starts prior to Pomo shot stent introduction, so I've been in the business thirty two years now. I was in angioplasty when it was still a debate as to whether or not angioplasty or surgery is the better pathway for for patients. There for a number of years and then, had an opportunity to get involved in, early stage. So I, I ended up at a company that was then just an idea.

这家公司当时在梅菲尔德基金孵化，他们后来退出了医疗投资领域。但当时的梅菲尔德基金同时投资科技和医疗。公司由弗雷德·穆尔领导孵化，他是安全套管针的发明者，也是微创手术得以发展的关键人物。他创立了直觉外科公司，我在1995年就开始与他共事，那时公司刚起步，只有寥寥数人。

It was being incubated in what was then Mayfield Funds. They, they have since left the health care practice. But Mayfield Funds back then was both tech and health care, And it was being incubated, there with a lead entrepreneur by the name of Fred Mull, who's the inventor of the safety trocar. And the reason why minimal invasive surgery got kicked off in the first place, He had founded a company called Intuitive Surgical, and I, I ended up working with him back in 1995. So super early days, just a handful of folks around.

我以第六号成员的身份加入，和弗雷德以及另一位先生一起为达芬奇机器人制定了规格，进行了流程开发，并负责销售和安装了第一套系统。我们积累了极其丰富的创新经验和市场开拓经验，因为那时候在手术室里，机器人还是个忌讳词。我们甚至——对那些熟悉电视剧《急诊室》的听众来说——当时我负责市场营销，接到了《急诊室》副制片人的电话，想让我们把达芬奇机器人放进某一集剧情里。

I joined in as number six, and Fred and I and one other, one other gentleman set the specifications for the da Vinci robot, did procedure development, and I sold the first system and installed it. And we've got lots and lots of great innovation experience and market creation experience because back then, robotics was a dirty word in the OR. We, we even had for those who, those listeners are familiar with a television show called ER. I I, running marketing, and I got a a call from the, assistant producer of ER to try to put the da Vinci onto an ER episode.

哦。哦。

Oh. Oh.

普拉纳夫，当时我们对机器人这个词的公众形象非常谨慎，不希望使用‘机器人’这个字眼，也不想让它被塑造成那种《迷失太空》里失控机器人的形象。所以我回复说可以合作，但我们必须掌控编辑内容。结果对方立刻挂断了电话，显然对此毫无兴趣。

And, we were concerned enough, Pranav, about the public perception of robot that we didn't want the word robot used, and we didn't want it to be viewed as a, you know, lost in space robot go awry kind of a thing. So I said, well, sure, but we need to control editorial content. And Right. Phone call ended immediately. And they didn't have any interest in that.

这没关系，但你知道，必须保护品牌形象。对吧？

Which is fine, but I you know, you had to protect. Right?

确实如此。当然。

That's Right. Of course.

这就是我那时的工作。干了几年后，由于家庭原因我们决定搬回东部。后来我得到了一个非常有趣的机会，与勒罗伊·胡德共事——他是安进公司的核心创始人之一，也是人类基因组测序仪的发明者。他与一位生物信息学公司的创始人合作，我们共同创立了一家公司，做的是23andMe那种深度临床化的版本，专攻慢性疾病的并发症领域。

That was the job. There for a number of years, and then, for family reasons, we decided to move back east. I had a really interesting opportunity to work with Leroy Hood, who is, one of the key founders behind Amgen and, the inventor of the human genome sequencing machine. He, had paired up with a bioinformatics, company founder, and we launched a company that was a very deeply clinical version of twenty three minute. We were going after, chronic complications of, sorry, complications and chronic diseases.

比如糖尿病患者的视网膜病变这类病症。但9·11事件爆发后，我不得不关闭那个项目。后来我意外获得了可能是世界上最酷的工作机会：几位风险投资人给我资金，让我去西雅图联合一些工程师，找出未被满足的临床需求，发明相应的医疗设备来解决问题，他们会提供创业资金。

So think retinopathy for diabetics, that sort of thing. Nine 11 happened. I had to shut that one down. And, then end up being asked to do one of the coolest jobs on the planet, in my view. I was given money by a couple of venture capitalists, and they said join some engineers in Seattle, identify an unmet clinical need, and invent medical devices to solve those needs, and we'll give you the money to start the company.

那就像是一个狩猎展览会，我们名义上是有报酬的。

So it was like a hunting exposition where we were paid nominally.

听起来是个很棒的机会。

That sounds like a great opportunity.

非常酷。我们开始研究一系列事物，恰好看到了用于乳房切除术后重建的组织扩张器。其中一位工程师突然有了灵感——他本身是1型糖尿病患者——他说，如果我们把这项技术的原理反过来运用，就能非常稳定地输送药物。大约十分钟后，我们就站在白板前，画出了后来成为长效胰岛素贴片泵基础的设计图。

It was very cool. We we, started looking at a number of things, and we happen to be looking at tissue expanders for post mastectomy breast construction. And one of the, one of the engineers had a realization. He's a type one diabetic, and he said, you know, if we do what this technology does but in reverse, we could very consistently deliver drug. And then probably ten minutes later, we're at a whiteboard, and we're drawing what became the foundations for a perennial insulin delivery patch pump.

对。

Right.

后来成立了Calibra Medical公司，被强生收购后，技术剥离给了一家叫Secur（拼写为c e q u r）的企业，现已商业化。我对此着了迷。后来受邀...抱歉。我们把公司搬到了旧金山后，我又主动请缨再次创业。

Became a company called Calibra Medical. It was acquired by Johnson and Johnson, and the technology was divested to a company called Secur, c e q u r, and it's commercial right now. I got hooked on that. And I was then asked, sorry. I, We ended up moving that company to San Francisco, and then I asked to do it again.

两位工程师中的一位加入了我，我们开始四处探索。当时我正好在研究肾结石适应症，凭借血管成形术背景，我将两者结合异想天开，最终提出了血管内碎石术的方案。我意识到可以把碎石术置于血管成形球囊内，在扩张前预先碎裂钙化斑块，从而获得更佳疗效并减少并发症。工程师们教会了我如何发明创造，于是我开始源源不断地产生新想法。

One of the two engineers joined me, and, we started poking around. And, I happened to be looking at at kidney stones as an indication. And given my angioplasty background, I put two and two together and came up with five in the form of intravascular lithotripsy. So I realized you could put lithotripsy inside of an angioplasty balloon, prefractured calcium prior to dilation, you'd end up with a better end result with fewer complications. And, you know, the engineers had taught me how to invent, so I started coming up with all these ideas.

后来我和合伙人约翰·亚当斯一起完善了这些创意。但没人看好——风投机构不感兴趣。2009年正值初创企业的经济寒冬，根本融不到资。最后我用孩子的大学基金从孵化器买断了这项知识产权。

And then my partner, John Adams, and I flushed those ideas out. Nobody wanted it. Like, the venture guys didn't want it. It was 2009, economic disaster for startups, and was unfundable. So I bought the IP with my kid's college fund out of the incubator.

我知道。这非常激进，非常激进。

I know. It's very aggressive. It's very aggressive.

大胆的举动。

Bold move.

那确实是个大胆的举动。之后我们用同一笔资金支持了那个知识产权项目，而我则去做了别的事。有个叫托德·布里顿的人加入我们，最初算是医疗顾问，后来逐渐承担起医疗总监之类的角色，还协助我们进行产品设计等工作。但你知道，约翰和我全职推进项目，我们三人花了两年半时间，利用夜晚和周末，做出了原型机等等。最后我回去找弗雷德·穆尔展示了成果，他为后来的A轮融资奠定了基础。

It was a bold move. And then supported that IP using the same funds, while I went off to do something else. A guy by the name of Todd Britton joined us as, kind of a medical adviser and then ultimately ended up being more than that medical director type role and helping us with product design and whatnot. But, you know, John and I were full time kinda pushed that forward, and the three of us together over a period of, two and a half years, nights and weekends, that sort of thing, got prototypes and whatever. And then I ultimately went back to Fred Mull and showed him what we were doing, and he provided the foundation for for what became the series a.

当时我住在西雅图做其他工作，利用晚上和周末时间筹集了400万美元。随后我正式创立了Shockwave公司。2012年2月我成为全职CEO，运营了大约五年半。最后一轮融资引入了普信集团，那时我就知道公司即将上市。

So I raised $4,000,000 while I was living in Seattle at the time doing something else. I raised, $4,000,000 nights and weekends, and and then I launched Shockwave. So Shockwave Medical was formally launched, and I took over as a full time CEO in February '12 and ran it for about five and a half years. The last round of funding I brought in included T. Rowe Price, and I knew we were headed public.

我发明这项技术时，我那时九岁的儿子还没出生。我还没准备好同时担任竞争激烈的市场中的新手CEO、上市公司的新手CEO以及年轻孩子的父亲。这实在难以兼顾。于是我主动提出组建猎头委员会，几个月后我们找到了道格·戈德歇尔。他后来表现出色，打造了顶尖团队，执行力超强。公司最终在约18个月前被强生收购。

My then nine year old son wasn't born when I invented it, and I wasn't ready to be a first time CEO in a very competitive market and a first time public company CEO and also dad of a young guy. That was too much. So raised my hand in the and we put together a search committee. And a number of months later, we identified a guy called Doug Godshall, who the rest of his history, did a ridiculously good job and built a hell of a team, and they executed really well. The company was acquired, know, I guess, about eighteen months ago at this point by Johnson and Johnson.

之后我很快进入数字医疗领域，联合创立了Aveilmed Systems公司。我们创新性地运用远程医疗技术，通过专用设备让销售代表和临床专家虚拟进入手术室。我们曾与几家供应商建立了强劲的商业合作，但最终融资环境变得极其艰难，客户群体内部也出现变故。

I ended up in the digital space shortly after that, as a cofounder of a company called, Aveilmed Systems, and we were actually using telemedicine in a different way. We were bringing sales reps and clinical specialists into the Operating Room virtually using a piece of equipment and proprietary hardware software setup. We, excuse me, had very strong commercial traction with a couple of vendors, our customers, paying customers for the vendors of the world. And, ultimately, the financing environment got very, very challenging. And some circumstances within, within customer base also became challenging.

结果我们失去了资金支持，不得不关闭公司。从这些经历中学到很多——之前和李·胡德合作的项目在9·11后被迫终止，加上这次Aveilmed，这是我参与的所有初创企业中仅有的两次失败案例。

And as a result of that, we ended up losing funding and had to close that one down. Right. You know, you learn a lot from those experiences. The, you know, the one I was doing with Lee Hood, we had to shut down after 09:11, then we had to shut down Avail. Those are the only two shutdowns out of the all the startups I was involved with.

其他公司都有退出机制，大多数最终上市了。所以我自认为非常幸运，但与此同时，这一路上也学到了很多。确实如此。我休息了一段时间，收到了多家公司邀约。最终吸引我的是思科，也就是我现在任职的地方。

Every other one had an exit, and most of those went public. So I consider myself very fortunate, but at the same time, you learn a lot along the way. I'm sure. I took a break for a little bit and fielded offers to, to run companies. The one that caught my attention was Cisco, which is where I am now.

简而言之，我们正在运用神经网络技术实现对MRI设备的读写控制，从而提升成像质量、确保检查时间稳定并缩短检测时长——这意味着更高的设备周转率能为医疗机构带来更好的经济效益，当然也会催生更多后续诊断需求。对吧？所以诊断之后通常就是治疗环节。

Very high level, we're using, neural networks to activate read write control of MRI machines and doing that to the benefit of increased quality, consistent time to do the exam, and less time to do the exam, which means higher throughput turns into better economics for the exam for the facilities, also turns into more downstream diagnostics, of course. Right? So if you Right. Other downstream procedures that are a result of the diagnostics. So if you diagnose, typically, you treat.

最后从患者角度来说——我绝不会说这是最不重要的，而是同等重要——患者能获得更短的候检时间和更高质量的检查。虽然我们目前还缺乏数据支撑，但我们坚信这最终会降低复查率。这就是我的职业背景以及如何走到今天的故事。

And then lastly, from a patient's perspective, lastly, and and I'm not gonna say least important, I'm gonna say equally important. From a patient's perspective, lower wait time to be able to get an exam and and, very high quality, which, you know, we believe ultimately, we don't have the dataset yet to prove it, but we believe ultimately will result in fewer redis. Right. So that's a bit about my background and how I ended up where I am.

这真是一段令人难以置信的非凡旅程。你提到加入达芬奇机器人团队时只有六个人，当时还处于市场开拓期。如今达芬奇机器人几乎遍布全国每家医院，在全球广泛应用。单就泌尿外科而言，这些机器人几乎是全天候运转。看到这样的发展轨迹实在令人惊叹。

That is a really incredible and phenomenal journey. When you mentioned you joined and started working on the the DaVinci robots, its market creation when there was just six people on the team. And now DaVinci robots are in pretty much every hospital in the country and used widely around the world. Urology alone uses the DaVinci robots pretty much twenty four seven. That's really incredible to see that growth trajectory.

我们前几期节目还采访过一位创始人，他正在研发自动化机器人手术方案。看到技术发展到如此高度真是令人震撼，而想到你作为个人在其中发挥的巨大影响力更觉不可思议。

We even had a, a founder on a couple episodes ago who's working on developing solutions to automate robotic surgery. So it's really amazing to see how far things have come, and it's incredible to think about how much an impact you had on it as an individual.

感谢这么说。我从未听人这样评价过，实在受之有愧。创造价值确实能带来经济效益，但...确实如此。

I appreciate that. It's it's I've never heard anybody say that. That's humbling. The economics are are good if you create things and all of that. But Right.

你知道强生收购Shockwave的新闻标题吧？131亿美元。皆大欢喜对吧？这就是所有人关注的焦点。

You know, there was a headline on on J and J's acquisition of Shockwave. 13,100,000,000.0. Yay. Right? So that's what everybody looks at.

对。

Right.

往下看两段，或者可能是三段。我记不清了。它已经在40万患者中使用过。对。当你可以...我告诉我父亲时，你知道，再说一次，他是，他是一名医生？

You go two paragraphs down or maybe it's maybe it's three. I can't remember. It's been used in 400,000 patients. And Right. When when you can I told my dad when, you know, again, he's, he's a physician?

我告诉他当我决定不去医学院时，我跟他分享了这件事。他说，没关系。我理解。你不必走我的路。你看起来有兴趣，但如果你不想做，那就这样吧。

I told him when, I decided not to go to med school, and I I shared that with him. And he said, no. Understood. And you don't have to follow my path. You seemed interested, but if you don't wanna do it, so be it.

我说，你知道，我不想这么做的原因是因为我觉得自己没有适合一对一照顾病人的性格。

I said, you know, the reason I didn't wanna do it is because I didn't feel like I had the appropriate disposition to one on one care for patients.

对。

Right.

而且因为我认为通过技术，我可以产生比一对一更大的影响，实现一对百万的效果。你知道，我了解达芬奇系统。我并没有发明达芬奇，但早期我是团队的一员，我们共同开拓了市场等等。很棒。

And because I think I can actually have more of an impact to go instead of one to one, one to millions, and do that through technology. And, you know, I know the da Vinci. I didn't invent the da Vinci. I was part of the teams in the early days, and we created the market and all the rest of that. Great.

这非常了不起。我不想贬低它。但就我个人贡献而言，虽然在当时意义重大，但对于最终成为直觉外科公司的整个历程来说，只是时间线上的一个点。对。Chalk Way对我来说感觉不同，因为它是那种从无到有的事物。

And it's phenomenal. I don't wanna take anything away from it. But my personal contribution, while very meaningful in that moment, is a is a dot in time of what became ultimately Intuitive Surgical. Right. Chalk Way feels different for me because it was one of those things where it didn't exist.

我创造了它，克服了重重困难。虽然它卖了很多钱，但我并不觉得这有什么。没错，就是这样。让我深感谦卑的是，截至那时已有40万患者使用了它。

I created it, fought against the odds. And I'm not it's fine that it sold for a whole bunch of money. It's Right. Fine. I am utterly humbled that it was used on 400,000 patients as of that writing.

现在这个数字已经超过500了，没错。公司里有人这么说过，但我不确定是否完全准确。看起来增长非常迅速，但事实就是如此。

It's now north of 500 as Right. As as somebody is in the company has shared that, and I don't know that that's truly accurate. It seems like a lot of growth very quickly, but what have you.

我认为重要的是你正在影响患者的生活。

I think the important thing is you're impacting patients' lives.

确实如此。产生了积极的影响。确实。其中一位患者实际上是我的聊天机器人。

It's causing Exactly. Positive weights. Exactly. And one of those patients is is my chatbot.

哦，哇。

Oh, wow.

其中一位患者是世界上最早的心脏病患者之一，准确地说，我认为用'最早50人或30人之一'来描述更合适——那是我的联合创始人约翰·亚当斯。我之所以能坦然说出这些，是因为已经征得了相关方的同意。约翰·亚当斯曾亲自前往我们当时开展临床工作的英国，在皇家布朗普顿医院接受治疗。那种感觉，真的无法用言语形容。

And one of those patients one of the first cardiac patients in the world, actually, I'm gonna say one of the first 50 is probably the best way to describe it or 30, It's my cofounder, John Adams. And I'm comfortable saying in both of those cases because I've cleared with both of them. But John Adams has actually gone out there and described it and talked about it. But he he flew all the way to England where we were, we were set up to, to do some clinical work there, and he went to the Royal Brompton, and he got treated. And, that's you can't touch that feeling.

作为一名发明家、医疗设备创业者，能知道自己正在做这样的事，这种感觉简直像毒品一样让人上瘾。至今我仍会在领英等平台收到消息，有人说'你改变了我的行医方式，帮助我救治患者'。这就是我坚持做这件事的原因——因为我根本停不下来，不知道该如何停止。

And as a inventor, medical device entrepreneur, that's that's literally a drug, to be able to know that you're doing that sort of thing. And I still get messages on LinkedIn and whatever, saying, hey. You've changed my practice, and you know, help me help patients. And so that that's why I keep doing this, because I just can't I don't know how to stop. I don't know how to stop.

我记得在我生物医学工程学位的第一天，项目负责人告诉我们：如果你去医学院成为临床医生，你可以一次帮助很多病人——但一次只能帮一个。但如果选择工程路线，开发新的解决方案和技术，理论上你一次可以造福成千上万甚至数百万患者，在更大规模上发挥作用。这个理念一直伴随着我，推动我走向医疗保健领域的创新与创业。我后来确实去了医学院，照顾过许多病人，热爱这份工作也学到了很多，但最终意识到那并非最适合我的道路。

I remember on the very first day of my engineering biomedical engineering, degree, the head of the program told us that if you go to medical school and become a clinician, you can help patients lots of patients one at a time. But if you go the engineering route, if you develop new solutions, develop new technologies, you can theoretically help patients in the thousands or millions at a time and work on a much larger scale. And that's something that's always stuck with me and what's pushed me more towards the innovation, the entrepreneurship side of health care. I went to medical school. I cared for lots of patients, loved it, learned a lot, but realized that it wasn't the right path for me.

如果幸运的话，我希望能够拥有与你相似的职业轨迹，一次影响数百万患者的生活。

And if I'm lucky, I'll be able to have a trajectory similar to yours where I can impact the lives of millions of patients at a time.

确实如此。这种感觉很棒。要知道，以连续方式帮助他人的人数通常以数百或几千计。如果我们都在第一次或第二次尝试后就停下，那创新会变成什么样？

Exactly. And, there's, yeah. It's just it's a great feeling. And, you know, there's the number of folks that do it in a in a in a serial way is measured in hundreds or maybe short thousand or something. If we all stopped after the first or second, then what of innovation?

没错。

Right.

看看弗雷德的例子。弗雷德·莫尔发明了安全牵引车，卖给了利昂·赫希。这成为美国外科公司微创手术业务的基础，也是实验室结肠技术的奠基之作。对吧？

Right? Take a look at Fred. Fred invented the safety Fred Moll invented safety tow cars, sold it to Leon Hirsch. That became the underpinning for US surgical's minimally invasive surgery business and the and the foundation for the lab colon. Right?

非凡的成就。本可以就此止步。但他继续创立了被礼来公司收购的Origin医疗系统公司，成为Guidant的一部分，同样专注于微创领域。在Origin期间，他再次燃起热情，意识到可以在外科医生的手与患者之间应用技术——从斯坦福研究院获得战场应用技术的授权，创立了直觉外科公司。之后又创立了汉森医疗。

Extraordinary achievement. One could stop there. He went on to found, a a company that was acquired by, Eli Lilly and became part of Guidant, also in the minimally invasive space called Origin Med Systems. And at Origin, he got the itch again and realized you can use technology between the surgeon's hand and the patient and license the technology out of SRI, Stanford Research Institute, that was designed for battlefield applications and founded Intuita Surgical. Then he went on to found Hansen Medical.

接着他又创立了奥里斯健康。所有这些成就堆叠起来，展现了一种'我无法停止创新'的精神。我并非自诩达到弗雷德的水平，但如果我停下，如果弗雷德或其他我立刻能想到的人停下，那么世界上做这类事情的经验就会减少。

Then he went on to found Auris Health. And all of that, that's a stack, right, of I can't stop doing this, and there's so much innovation. And, you know, I'm I'm, I'm not gonna sit here and say I'm I'm at Fred's level. I'm not. But if I were to stop, Fred were to stop, or some of the other folks I can think of immediately, would stop, then, you know, there's less experience out there doing it.

你知道，虽然我绕了一大圈才说到重点，但我坚信：如果我们有能力做某事，就有责任去完成它。

And, and, you know, that's a long winded way to introduce what I truly believe that, if we have a capability of doing it, we have a responsibility to do it.

我不会说第二次会更容易，但我确信每当你第二次、第三次、第四次做时，都能更快一点，少犯些错误，更高效地推向市场。对，就是能更快产生影响。所以我完全理解你的意思。

I won't say it's easier the second time around, but I'm sure every single time you do it the second, third, fourth, you can move a little bit faster, make fewer mistakes, and just be more efficient in getting to market. Oh, yeah. Just have an impact faster. So I totally get what you're saying.

没错。还有，如果我不提两个名字就太失礼了——汤姆·福格蒂和乔什·麦考尔。这些人成就斐然，他们所做的一切都在切实帮助患者，并以此创造了传奇。

Yeah. Exactly. And and, you know, another name that I I, I'd be remiss if I didn't mention two names, Tom Fogarty and and Josh Mackauer. I mean, those guys are just prolific. And, you know, they're doing it to touch patients, and they've created legacies around it.

对。在我停止做这件事之前，我要确保自己至少帮助过一百万患者。

Right. You know, before I stop doing this, I wanna make sure that I've, I've well crossed a million patients.

我相信你一定能做到。

I'm sure you will get there.

这就是目标。

That's the goal.

非常感谢你分享这些关于你背景和经历的故事，真的很了不起。不过我想稍微转个话题，聊聊你现在合作的Vista公司。你提到你加入的时间还相对较短。

Yeah. Thank you so much for sharing that about your background and your journey. It's really incredible. But I'd love to pivot a little bit more into Vista, the the company you're working with right now. You mentioned you joined it just relatively recently.

我知道这在你来之前的事，但能否请你分享一下Vista背后的灵感来源，以及它是如何诞生的？

I know this is before your time, but would you mind sharing a little bit about the inspiration behind Vista and sort of what brought it about?

好的，当然。这项技术的核心能力可以说源自斯坦福大学的MRI研究实验室，该实验室由VISTA的联合创始人之一——一位名叫Robert Hu博士的心脏病专家领导。

Yeah. Sure. So the technology was developed I'll say the core, core capabilities that led to the technology that is now Vista came out of the Stanford, MRI Research Lab. That was run by, one of the cofounders of VISTA, a gentleman by the name of, doctor Robert Hu, a cardiologist

对。

Right.

他后来离开了斯坦福的职务，现在在帕洛阿尔托医疗基金会（隶属于Sutter医疗网络）。如果我没记错的话，他在那个实验室领导了25年，获得了多项NIH资助，并得到了GE和西门子的工程支持。那个实验室实际上创造了一些基础性AI技术，后来成为GE和西门子用于图像后处理的降噪AI。当然，他们后来在这项基础技术上各自发展，叠加了多层功能。但基础性工作源自斯坦福大学电气工程系的MRI研究实验室。

Who has since separated from, his duties at Stanford and is at the Palo Alto Medical Foundation, in Palo Alto, part of the Sutter network. He ran that lab for, if memory serves me, twenty five years under multiple NIH grants and with engineering support from GE and Siemens. And that lab actually created some of the foundational AI that, became the denoising AI that is used to post process images by both GE and Siemens. They've since, of course, taken their own path with that foundational technology and created layers upon layers of capability on top. But the foundational work came out of the Stanford Research, MRI Research Lab in the Department of Electrical Engineering.

Bob有两名博士生，William Overall和Juan Santos。两人最终加入了Bob的团队，当时有人提议不再用AI进行图像后处理和降噪等操作，而是用AI来控制机器。Bob对这个提议的回应是：'是的，这是可能的。'

Bob, had two PhD students, William Overall and, Juan Santos. And the two of them, ultimately ended up joining Bob, when he was prompted to instead of having AI post process images and denoise them and whatever, use AI to control the machine. Right. And that it there was a prompt that came, and Bob's response to the prompt was, yeah. It's possible.

我们可以开始研究这个方向。当他深入探索后，事情逐渐推进，他意识到这完全可行。顺便说，不如围绕这个成立一家公司。我对这段陈述以及Coastal Ventures的投资有些模糊，中间似乎有些时间间隔。

We can start working on that. And when he started poking at it, one thing leads to another, and he comes to realize, yeah. It's absolutely possible. And, oh, by the way, let's peel off and form a company around this. And, I'm a little fuzzy on the that statement and then funding from Coastal Ventures, but there's some measure of gap.

但早期的种子探索工作得到了Coastal Ventures的资金支持。我必须向当时的团队致敬，他们显然有能力促成这件事，并为此进行了长期投入。同时，我也要致敬过去18个月在Vista工作期间所见的团队——他们以远见卓识看待行业彻底变革的可能性，并支持这些愿景，明白实现目标需要翻越起伏的山脉。有时，这甚至是漫长的山脉。

But the early seed exploratory work was supported by funding from Coastal Ventures. And, I gotta tip my hat to the team there at that time, obviously, to be able to enable this and the long investment that it took to be able to make that happen and tip my hat to what I have since seen in the last eighteen months of working at Vista and exposure to the team. They had visionary visionary looks of of complete changes to industries, And they support those visions and understand that it's a mountain range of ups and downs to be able to get there. It is. And sometimes it's a long mountain range.

他们始终坚守支持承诺，直至为公司做出正确决策的早期商业化阶段。而我加入是因为这项技术，因为有机会影响一个我从未涉足的医疗领域的患者。我一直从事介入治疗，始终如此。

And they stay true to the support and all the way up to, doing what's right for the company and in in the early, early commercial phases. And, I joined because of the technology. I joined because of the opportunity to impact patients in a segment I've never touched before. I've always been at intervention. Always.

我职业生涯的每个环节，除了远程医疗，都是关于那些进入患者体内、执行操作后离开或长期留置的设备。我从未涉足诊断领域。在我的职业生涯中，执行过数千例跨专科手术，我见过不少——应该说相当多——实例表明更好的术前影像本可以改善结果：或许能缩短手术时间因为医生能更早看清状况，甚至可能让患者免于手术。

Every element of my career with the exception of the telemedicine has been a device that goes into a patient, does something, and leaves, or goes into a patient and stays there. I've never been at the diagnostic. And, I'll say that in my career and literally thousands of procedures across specialties that I've seen, I've seen a few instances, probably more than a few, where better pre procedural imaging would have helped. Maybe the patient would have, had a shorter procedure because they had to see what they needed to do earlier. Maybe they wouldn't be on the table.

确实。

Right.

对吧？在我职业生涯后期这类情况较少，早期则更多。这总让我感到不安，而现在有机会站在诊疗流程的顶端——通过改变技术可及性来最大限度拓宽入口。Vista AI凭借神经网络能力，降低了操作MRI设备进行心脏扫描（未来还包括其他部位，但目前是心脏）的技术门槛，这极大改善了患者就诊机会。

Right? And, you know, less of that in the in the latter half of my career, more of that in the earlier part of my career. But, I always found that a little troubling and a chance to instead be at the top of the funnel. Let's widen the top of the funnel as much as possible by changing access. Vista AI, because of the capability of the neural networks, the skill requirements to operate an MRI machine are are reduced for cardiac scans and ultimately other anatomies, but right now cardiac scans, which helps a lot in terms of patient access.

心脏核磁共振是文献记载中无可争议的金标准——经过同行评审的先进心脏成像技术。但每年仅进行40万例，相比之下无创功能性超声检查有1600万例。这太荒谬了，真的荒谬。

Cardiac MRIs are by far the gold standard proven in literature, published literature, peer reviewed, the gold standard in advanced cardiac imaging. Yet only four hundred thousand are done every year against sixteen million functional echos, nonstress. That's bananas. Right. It's bananas.

于是我们调研原因。在全球最大的经导管心血管治疗大会(TCT)上询问心脏科医生：为何不更频繁开具CMR检查？90%的医生首选答案是：检查可及性、等待时间和技师水平。而我们的技术正解决了这三大障碍。

So you ask why. So we surveyed cardiologists at a very large conference called the Transgapital Therapeutics Conference, largest in the world, TCT, and ask them what keeps you from writing for CMR more often than you do. Number one answer. 90% of cardiologists said access, wait times, technologist skill. That This dissolves access, wait times, and technology skill.

事实上，正因为这三个因素，全美仅有不到2%的MRI设备会常规用于心脏检查。2%！根据我们商业调研中接触过的约75-100家顶级心脏MR中心的反馈，患者平均等待时间——准确说是我们观察到的等待时间范围...

Actually, because of those three things, only, fewer than 2% of all MRI machines are regularly used for cardiac MR. Two percent. That's very true. Yes. The average wait time a patient has to suffer through, well, I'll say the range of wait time in our commercial experience, we've now spoken to probably 75 or a 100, of the of the top, cardiac MR centers.

等待时间从四周起。你现在传达给病人的信息是，我们认为你的问题已经足够严重。我需要你做个心脏核磁共振检查。四周到十六周不等。

The wait times range from four weeks. This is still a patient you're now delivering the message that we think you have enough of a problem. I want an MRI of your heart. Four weeks to sixteen weeks.

十六周。哇。

Sixteen week. Wow.

十六周。在布莱根医院，他们的积压工作达到了28个日历天，因为他们周末也做扫描。28天，而我们把它缩短到了1天。

Sixteen weeks. At the Brigham, they were at 28 calendar days of backlog because they they scan on the weekends. Twenty eight days, and we took them to one.

哦，哇。这是个巨大的改变，对吧？

Oh, wow. That's an immense change. Right?

比如，怎么做到的？他们的技术非常精湛。我是说，你们已经算是顶尖中的顶尖了。

Like, how? So their technologies are very skilled. I mean, you're already at kinda creme de la creme.

但一个人能做的毕竟有限。

But one person can only do so much.

是的。现实情况是，对于不熟悉的听众来说，核磁共振检查需要人工决策——它是一系列图片，包含多种不同类型的切片。有时里面还有被称为微型电影的内容。在获取每一个切片或静态图片前，技师需要评估图像，做出决策，就像一位技艺高超的摄影师操作极其复杂的相机那样，然后拍摄图片，评估这张图片是否符合预期，是否具有足够的诊断价值。如果不满足，就调整参数重新拍摄，直到满意为止，然后才进行下一张图片的拍摄。

Yes. And the reality is that the decision making a human needs to go through prior to for those not familiar that are, listeners not familiar, an MRI is a series of pictures, variety of different types of I'll call them slices. And sometimes there's mini movies in there, called. Prior to each one of those slices or still pictures, the technologist needs to, assess an image, make some decisions like a very, very skilled photographer working in incredibly complicated camera, and then take the picture, make an assessment of that picture, decide if it's what he or she expected, if it has enough diagnostic yield. If not, tweak that those settings, retake the image, and repeat until they're satisfied, and then move on to the next picture.

这些都需要时间。这正是人工智能大显身手的绝佳领域。实际上我们已为此申请了专利——先获取初始图像，随后AI会读取该图像并与预期值进行比对。若存在差异，系统便会自动调整参数和设置。

That all takes time. That is a wonderful place for artificial intelligence to take over. So we actually have a patent on this where we can take a first image. The AI then reads that image and compares it against what it was expecting. If there's a difference, then it makes adjustments to parameters, settings Right.

整个过程包括重新拍摄图像都能自动完成，无需人工干预。

To retake an image and do that all automatically without human interaction.

这太不可思议了。

That's incredible.

因此我们能够将决策时间压缩到极小值。由于AI经过专业训练，我们的神经网络经过专业训练，评估图像的速度不仅远超人类，在许多情况下质量也更优，参数设置自然更快。最终我们获得了统计学上更优的质量指标——p值达到0.01（抱歉刚才说成0.03了）。

And we are thereby able to shrink that decision time to an infinitesimally low number. And, because AI trained properly, our neural networks trained properly, can, can assess an image faster and in many, many instances, a little better than a human, we can set the parameters faster. Right. So we get statistically improved quality, p values, double zero threes, and oh, sorry. Double zero ones, not threes.

应该是0.01。根据已发表研究的分界点，质量在统计学上更优。虽然不确定临床意义如何，但统计数据显示我们绝无劣势，100%不逊色。同时扫描时间变异性降低了50%。

I think they're double zero ones. Statistically better quality at the break of its published study. I don't know if it's clinically meaningful, but statistically, we're not worse. A 100%, we're not worse. But we are, 50% reduction in scan time variability.

扫描时间绝对值减少26%，这意味着他们的排班时段、影像检查预约时长都能相应缩短。

50. And a 26% reduction in scan time absolute numbers, which means that their schedule blocks, the appointments for a, a scan can shrink

没错。

Right.

因为他们不再需要担心异常情况了。规模可以缩小，因为我们像节拍器一样稳定，在时间窗口内非常一致。现在95%的检查都能在45分钟内完成。患者随到随做。在Vista系统之前，这个比例只有30%。

Because they don't need to worry about the outliers anymore. It can shrink because we're very consistent, like a metronome, very consistent within a window. Right now, ninety five percent of exams are under forty five minutes. Patient on, patient off. Prior to Vista, that number was thirty percent.

正因95%的检查都能在45分钟内完成，他们每天能处理更多病例，这意味着可以消化积压工作。现在波士顿的心脏科医生周一转诊患者去做扫描，最迟周三或周四就能完成检查。这完全是另一回事了。

So because ninety five percent are on 45, they can put more in a day, which means they can work their backlog, which means now a cardiologist in Boston can send somebody there, refer somebody to, to a scan on Monday, and they're scanned by Wednesday or Thursday at the latest. It's a different deal.

这太不可思议了。确实。

That's amazing. Yeah.

这就是我们存在的意义。本质上就是为了这个目标。所以我们一直在积极推广，开拓市场。这已经是我第三次开拓新市场了。

That's why we exist. It's fundamentally for that. So so we're out there evangelizing. We're creating market. And, this is now my third time creating markets.

机器人技术、血管内碎石术，现在又是这个领域。

Robotics, intravascular lithotripsy, and now those.

哇，这真的太厉害了。虽然可能有几十家初创公司在研究AI医学影像，但据我所见绝大多数都只做后处理。除了你们，我还没见过谁真正试图接管整个流程——就像你说的，一键完成核磁共振检查。这确实带来了诸多好处。

Wow. That's that's amazing. I think there's, you know, probably dozens of startups out there working on AI medical imaging, but the vast majority that I've seen are all just doing post processing. No one that I've seen besides you is really trying to take over the whole process where you just, you know, one click, an MRI is done for you. That's as you mentioned, there's so many benefits.

积压病例得以解决，质量也更高等等。这确实是个现实问题。我亲眼见过患者因为积压和技术人员短缺，要连续等好几周才能做上核磁共振。你们这个方案彻底解决了所有这些问题。

The backlog can be taken down. The quality is higher, etcetera. So that's it's a real problem. I've personally seen patients having to wait, you know, weeks on end to get an MRI because of the backlog, because of the lack of availability of skilled technicians. This sort of takes care of all of that.

是的，这就是目标。准确地说，这就是目标。

Yep. That's the goal. That is precisely the goal.

但这确实是个非常新颖的想法。我相信你肯定面临过许多质疑或反对。我很好奇，当你最初启动首个针对真实患者的临床试验时，与你共事的临床医生或技术人员的反应是怎样的？

But this is a very novel idea. I'm sure you faced a lot of uncertainty or backlash. I'm curious. When you first started you first tried to start your first clinical trial to use on real patients. What was the reaction you got from the clinicians or technicians who were you were working with?

他们当时是怎么想的？

What were their thoughts?

那么，我打算倒序回答这个问题，先谈谈技术专家们。他们通常被称为技术专家而非技术员，毕竟他们接受过专业教育。AI就像是藏在暗门后的怪物，会来抢走我的工作——这就是他们的第一反应：哇，你们是来取代我的。但我们真不是来抢任何人饭碗的。

So, I'm gonna take this in reverse order and talk about technologists first. They're generally known as technologists versus technicians, but, they go to a school for this. AI is the is the boogeyman behind the dark door that is gonna come take my job, and that was the reaction that, woah. You're coming for my job. We're not coming for anybody's job.

实际上我们在做一件截然不同的事。技术专家的工作——容我用外行话描述下我的观察——他们显然需要在将患者送入磁体前做好护理。有些患者行动自如，能自己躺上检查台配合指令，这很顺利。但还有些患者做不到，他们需要照料。技术专家本质上就是护理者。

We're actually doing something very different, and that is, the technologist, and I'm I'm gonna I'm gonna do a layman's description of what I see the technologist having to do, as part of their job. They obviously need to care for the patient prior to positioning the patient in the magnet. You've got patients who are otherwise healthy, able to walk in there and hop on the table and go underneath and listen to directions and everything's great. And then you have those that don't, and they can't work. Caregivers are exactly that, and the technologist is a caregiver.

当操作需求迫使他/她每天完成越来越多的扫描时，留给患者护理的时间必然被压缩。你还能从哪里挤时间呢？除了检查本身，还有大量文书工作必须完成。检查过程中你得紧盯屏幕——在没有Vista技术的情况下，你不可能按两个按钮就去玩十二分钟纸牌等序列结束。

When he or she is is, by operational necessity, required to do more and more and more and more and more scans every day, The ability to have time to care for the patients is compromised. It necessarily has to because where can you put time? There's an extraordinary amount of paperwork that has to get done, and that has to get done in addition to the exams. And the exams themselves, you gotta stare at the screen. Not like you can without Vista technology, it's not like you can click two buttons and then go off and play solitaire for twelve minutes while a sequence is finished.

现实不是那样的。你必须盯着屏幕，因为患者一旦移动就会产生伪影，影响成像质量。如果你没盯着屏幕，就发现不了这个问题。对吧。

It doesn't work like that. You have to stare at the screen. Because if the patient moves, there's gonna be an artifact, and the image quality is gonna be poor. And if you're not staring at the screen, you're not gonna see that. Right.

你得随后跟进。没错。然后你会浪费更多时间，而且很难提高处理效率等等等等。你必须从早上的第一次扫描到晚上的最后一次扫描都保持最佳状态。这并不容易。

You'll you'll go afterwards. Exactly. And then you're wasting more time, and it's hard to get your throughput and etcetera, etcetera, etcetera. And you've gotta be top of your game from first scan in the morning to last scan in the evening. That's not easy.

不。不是

No. Not

这非常困难。对于那些简单的病人我们可以全自动处理——当你觉得'对，这个病例不复杂'时。我们只是做个随访评估，但因为病人有主动脉反流病史并出现相关症状，所以要做个基础功能检查。在这个例子中，经验丰富的技师完全可以采用全自动模式。

It's super tough. We can be on full auto for those straightforward patients where you're like, yes. There's nothing complicated here. We're just doing a follow-up assessment, but we're doing a basic functional exam because there's a history of regurgitation from the aortic, and the patient has some symptomology that is indicative, so we're gonna do a quick functional. We can be full auto in that example for a highly skilled technologist.

如果病人情况稍复杂，装有医疗设备或心律失常，特别是需要造影剂的病例。可能他们患有相对复杂的心律失常，这时技师会倾向于手动操作而非使用自动门控。这种情况下我们可以半自动处理，就像副驾驶一样。它会根据实际需求调整扫描强度。因为最终决定下游诊断质量的，还是操作扫描仪的人。

A patient that's a little complicated, has devices, has arrhythmias, certainly one that needs contrast. Maybe they've got, arrhythmias that are relatively complicated, and rather than using the automatic gating that we have, they wanna step in. We can do partial auto for that, like like like a copilot almost. What it does is it changes the intensity of the scanning portion of a job that needs to get done. Because at the end of the day, he or she at the scanner is determining the quality of the diagnostic downstream.

责任重大。如果你每天在心脏科要做8到12例这样的检查，或者在脊柱或脑部科室每天做15到20例相对心脏检查更简短直接的扫描——这对任何人来说都很难持续保持高质量。所以

It's a lot of responsibility. And if you're doing eight, ten, 12 of those a day in a cardiac, are you doing 15 or 20 of those a day in a spine or a brain that are that are shorter exams and comparatively a bit more straightforward relative to cardiac? That's hard. It's hard for any human to do all of that. So

我们至少要保证足够高的质量，

we are at a high enough quality, like,

才能做好。没错。所以我们是在全程提供辅助。你问我整个讨论分支是怎么来的——这其实源自你最初关于'技术员反应如何'的问题。技术员最初的反应就像是'哇哦'。

to do it well. That's right. So we are an assist in all of that. And, you asked me this whole branch of discussion came, you know, off of off of your, you know, initial question of what was the reaction. The initial technologist reaction was akin to, woah.

哇哦，哇哦，等一下，伙计。这很正常，也是预料之中的。

Woah. Woah. Hold on a second, buddy. Which is fine. It'd be expected.

这是预料之中的。实际上并非所有人，那些经验不足的人会说‘请继续吧，这很难’，但更有经验的人则会说‘哇哦，哇哦’。

It's expected. Not not not all of them, actually. Some that are less experienced are like, oh, please bring it because this is hard. But the ones who are more experienced are going, woah. Woah.

稍等一下。我们确实收到了一些负面反应。但随着时间的推移，情况发生了变化。其中一些人现在成了我们最有力的支持者。没错，这实际上让我作为行业资深人士能有更多时间照顾病人，减少因硬塞进更多病人而产生的压力。

Hold on a minute. And we got some negative reaction. And over time, that changed. And some of those same people are now some of our greater advocates. Right, of this actually has allowed me as somebody tenured in my profession to have more time for my patients, to have less stress that I've gotta squeeze another one in and I'm jamming it up.

这是技术人员的一些反馈。临床医生的反应是——我受到的转诊医生的压力更小了，因为我能提供更短的等待时间，运营效率更高。最重要的是，阿纳夫，我早期去过布里格姆的阅片室，对吧？

So that's been some of the technologist reaction. Clinician reaction is my I get I get less, less heat from the referring physicians because I can give them shorter wait times. I have more efficient operations. And then very importantly, Arnav, I went into the reading room at, at the Brigham early on. Right?

因为我想和那些正在读片的人聊聊。当然。我问他们在使用Vista前后感觉如何？我听到的第一件事——我问的两男一女三个人都首先提到‘结果更一致了。我知道要看什么，所以能更快得出临床结论’。

Because I wanted to talk to the folks that are reading the images that are coming off. Of course. And I asked them pre vista, post vista, what's it like? First thing I heard, each one of the three guys that I, two guys and a gal that I, that I asked, first thing I heard, it's more consistent. I know what I'm gonna be I know what I'm gonna be looking at, so it's a more it's a faster read to get to clinical conclusion.

而且我要读的检查相对更简单了，能更快确诊。还能要求什么呢？对吧？还能要求什么？这些就是他们的反应。

And I've got comparatively easier exams to read, and I can get to diagnostic certainty. What more do you want? Right? What more do you want? So those have been the reactions.

这很合理。和任何新技术一样，总会遇到阻力或不确定性，但我很高兴看到你们能迅速证明其效果，本质上就是投资回报率，展示出它的益处。

That makes sense. And as with any new technology, you can always expect resistance or uncertainty, but I'm glad to see that you were able to prove the outcomes, the ROI essentially, very quickly on why it's beneficial.

是的。我完全理解这些担忧。说实话，在加入之前，我做了些功课——只要还在这个行业，我就有些朋友可以坐下来访谈，还咨询了一些技术专家。我甚至浏览了那些公开的在线聊天室，花了数月时间阅读聊天记录，试图理解技术人员眼中的行业现状。

Yeah. And I I fully respect the concerns. And, frankly, before I joined, one of the things I did is is, you know, I have some as long as I am in the business, I had some friends who, I could sit down and interview, and I spoke to some technologists about it. And I went on to the online chat rooms that had public access to it. And I read months and months and months of chat to try to understand sort of what the technologist's life saw.

我听到最多的反馈是：'他们不断要求我做更多工作。文书堆积如山，我根本没时间照顾病人。'而当我们提供的解决方案出现时，简直就像量身定制。从这方面看，这种反馈非常有力。

And a lot of what I heard was I keep asking you they keep asking me to do more. There's so much paperwork. I don't have enough time for patients. And then I look at what we're able to provide, and that was hand in glove. And the, so from that perspective, that feedback has been really strong.

显然从管理角度看，缩短等待时间意味着更多患者留在体系内，减少患者流失——尤其是分支机构的流失。中心医院是一回事，但分支机构的运营确实充满挑战。比如我们有家客户（不便透露名字），他们的心脏核磁中心做得非常出色。

And and, obviously, from an administrative standpoint, shorter wait times mean more patients stay in the system, less leakage, of patients to outside of the system, particularly on the spokes. Right? The hub is one thing, but the spokes are challenging. You know, one of our customers, I won't name them. It's probably not appropriate, but phenomenal high volume cardiac MR program at the hub.

但在分支机构的末端，他们在处理量和质量方面遇到更大困难，于是向我们求助。当我们介入后，技术人员反应近乎'天啊，太感谢了'。质量水平提升了，现在他们感觉能更好地服务分支机构末端了。

And the tips of the spokes, they had more challenges in getting the throughput they needed and the quality they needed, so they asked us to help out. And we went in, and the technologists were like, oh my god. Thank you. And the, you know, the the quality level went up. And now they feel like they can help the tips of the spokes.

坦率地说，我们现有客户和许多潜在客户都在表达同样的诉求：'我们需要把这种技术能力延伸到分支机构末端，让影像服务直达患者所在之处'。

Frankly, perhaps several of our customers, current ones as well as, frankly, quite a number of pending customers are all saying the same thing. We wanna be able to bring this skill to the tips of the spokes and bring imaging to where the patients are.

这很合理。一旦价值得到验证，他们的需求只会越来越强烈。我

That makes sense. And once the value is proven, they're just gonna want it more and more. I

猜是这样

guess that

这实际上引出了我的下一个问题，关于中心辐射模型。你们的市场进入策略是怎样的，或者未来会如何发展？你们的目标是那些MRI检查量较大的大型学术中心吗？还是先从更偏远或规模较小的中心开始，这些地方可能更需要帮助，技术人员配备较少。你们的策略是什么？

leads into my next question, actually, the hub and spoke model. What is your go to market strategy sort of look like, or what is it going to look like in the future? Are you targeting the more large academic centers that maybe see higher volume of MRIs? Are you see starting off with more of the, I don't know, sort of more rural or smaller centers that maybe need the help more of less technicians on staff. What has your strategy been?

是什么促使了这样的策略？

What sort of prompted that?

所以我笑了，因为这并非单一策略。没关系，策略有很多种。实际上它是基于客户画像的。你刚才描述了两种不同的客户类型。

So, I started to smile because it's not one. It's Okay. Many strategies. It it's it's really based on the customer persona. You just described two different personas.

这些都是医院类型的客户。还有完全独立的门诊影像中心类型，以及医院集团类型。这些类似于大型医院（非常繁忙）和小型医院（完全不开展此类业务）的组合。还有那些从未开展过心脏核磁检查但非常渴望开展的机构。

Those are both hospital based personas. There's also the fully independent outpatient imaging center personas. There are the the hospital group personas. Those are akin to a combination of the large hospital, very busy, small hospital, don't do any at all. And there's the the those centers that have never done a cardiac MR in their existence and very much want to.

最初我在Vista的前任认为存在一种通用的市场进入策略。但当你真正深入分析时，会发现需求差异非常大。目前全国范围内所有解剖学领域的技术人员短缺率达18%，而技术人员年流动率也接近18%（实际上是17.5%）。哇。

The initial my predecessor at Vista and and so thought was there's kinda one go to market. And then when you really peel back the onion, you realize there's very, very different needs. There's an 18% shortage of technologists in this country right now across all anatomy capability. And a nearly same 18, it's actually 17 and a half percent turnover of technologists every year. Wow.

这非常惊人。从比例角度想想：每年有六分之一的人离职。这太不可思议了。那么如何维持科室运转呢？

Which is extraordinary. Just think about that from a ratio standpoint. About one in six leaves their jobs every year. That's amazing. So how do you keep a department running?

如何在辐射网络的中间或末端保持完整的人员配置？基本上做不到。因此你无法在辐射网络末端提供像中心区域那样复杂的扫描范围和诊断能力。我们的软件能实现这方面的标准化。所以之前那句看似随意的'他们希望把影像检查带到患者所在的地方'，就是这个意思。

How do you keep a full staff in the in the middle or or tips of spokes? You kinda can't. And then you can't offer the kind of range of complexity of scan and, therefore, diagnostic capability in the mid to tips of spokes that you can in the hub. Our software enables normalization of that. So that earlier somewhat throwaway comment of they wanna bring patients, bring, imaging to where the patients are, that's what I meant by that.

如果深入剖析，中心辐射模式的上市策略是让辐射影像中心具备核心能力。而对于完全没有心脏核磁项目的医院来说，竞争劣势就在于缺乏影像能力。缺少影像支持，就意味着会遗漏部分治疗效果——抱歉说错了，是治疗效果的一部分。实在抱歉，窗口打开了。

So if you really peel that back, it's, the go to market for the hub and spoke model is to enable hub capability to be in spoke imaging centers. The go to market for hospitals that don't have any cardiac MR program at all is, competitively, you're missing the imaging. And if you're missing the imaging, there's a portion of the die of the, sorry, resultant therapy that you missed. So sorry about that. The window opened.

我做不到这点。对你来说那就是旧金山市区。有句老话说得好：能看到病症才能治疗病症。以心脏核磁为例，如果没有影像能力，你在本院或医疗网络内收治这类患者的可能性就会大幅降低。所以这些项目都希望建立这种能力。

I'm not gonna able do that. That'll be Downtown San Francisco for you. So, you know, there's there's an old adage that if you, if you image a condition, you you treat the condition. Well, if you don't have the imaging, for cardiac MR by way of example, your likelihood of being able to capture that patient for, for treatment within your facility or your network decreases significantly. So those those programs are interested in creating the capability.

还有完全独立的影像中心，我们有些客户就是这种商业模式。但心脏检查太复杂，他们从不提供这项服务。现在我们已经签约了几家开始提供此类服务的机构。哇，仔细想想还挺了不起的。

And then you've got the fully independent imaging centers, and we've got a few of those as customers where their whole business is creating the imaging. And cardiac is too complicated, so they just have never offered it. We have signed on a few of those that are now offering it. Oh, wow. And that's kind of extraordinary when you think about it.

没错。你们让检查变得更便捷。人们不必再去医院或专科中心，直接到社区影像中心就行，哪里最方便就去哪里。完全正确。就能获得所需扫描。

Right. You're making it much more accessible. And you don't have to go to a hospital, some specialized center anymore. You can just go to your neighborhood imaging center, whatever is closest to what's most convenient Exactly. And get the scans you need.

这正是目标所在。我要分享一个促使我加入Vista的关键原因——恰好与心脏相关。之前说的都比较宏观，现在我要具体展开。鲍勃·胡是斯坦福心脏病专家，联合创始人，不仅在AI和神经网络领域，在心脏病学方面也造诣极深。

That's the goal, and I'm gonna share your share with you something that was my my lynchpin driver to join Vista. And it happens to be related to cardiac. And everything else I told you is kinda higher level, but I'm gonna bring it all the way down. Sure. Bob Hu, again, cofounder, he's a cardiologist from Stanford, very experienced and extraordinarily knowledgeable, not only in AI and neural networks, but in the field of cardiology.

他给我看的几篇论文表明：二尖瓣反流患者（俗称瓣膜渗漏）——这是心衰前兆之一——仅靠超声评估时，手术指征判断经常出现低估或高估。为什么呢？

He provided a couple of papers to me that showed, showed that mitral regurgitation patients, for those not familiar, leaky valves. Alright? So that's a precursor for what ultimately becomes a stage of, one of the one of the stages of heart failure. Mitral regurgitation patients that are assessed only on echo very frequently have undercall and overcall for surgery. Why is that?

因为获取精准超声图像非常困难。15%的超声检查因患者体质或技师操作问题无法确诊——这是文献证实的数据。

Because it's very challenging to get the right echo image. Fifteen percent of echos are nondiagnostic nondiagnostic because of patient characteristic or technique of the sonographer. That's proven in literature.

不。回声很难传导，而且与...相比很难获得一致的图像

No. Echoes are very hard to conduct, and it's very hard to get a consistent image compared to

是的。

Yes.

例如，你说你的核磁共振扫描结果非常一致，所以放射科医生能准确预知结果。

For example, you're saying you have very consistent MRI scan, so the radiologist knows exactly what to expect.

没错。有趣的是，即使做了完美的同步检查，回声也无法量化实际发生的返流量。明白吗？这需要由读片者来估算。

Exactly. So here's the other part that's interesting is that if even if there's a perfect synoptic that's done, the resultant regurgitation that happens is not quantified on echo. K? It's estimated by the reader.

对。

Right.

为什么这很重要？因为理论上人类在回声检查中可能出错。我们刚讨论过这点。但我假设了这是完美检查的情况。好吧。

Why does that matter? It matters because a human could theoretically make an error on the echo. We just covered that. But then I qualified it as being perfect. Okay.

然后人类需要进行估算。这个估算很重要，因为返流体积存在30%的临界值。25还是30来着，我记不清了。见谅。

Then the human needs to estimate. That estimate is important because there's a crossover value at 30% regurgitant volume. 25 or 30. I'm forgetting which one. Forgive me.

一旦超过那个临界值，你就得做手术了。没错。这完全取决于临床医生的判断眼光。所以你又有机会面对变数了。

And if you cross that threshold, you're going for surgery. Right. And it's fully up to the judgmental eye of the clinician. So you have yet another opportunity to have variability.

非常主观。

Very subjective.

非常主观。MRI凭借其能力可以精确量化。有项研究先用超声筛查患者，随后对其中部分患者再用核磁共振筛查。在那部分患者中，十人里有七人未被核磁共振确诊为严重二尖瓣反流，三人确诊。

Very subjective. MRI can quantify it to precision because of the capability of MRI. So there was a study done that, that screened patients using echo, and then a subset of those patients were subsequently screened using MR. And in that subset, seven out of ten patients were not confirmed with MR as having severe mitral regurgitation. Three out of ten were.

十人中有三人在手术后显现出临床获益，七人没有。哇。是的。哇。

The three out of ten showed clinical benefit from surgery. The seven didn't. Wow. Yes. Wow.

这直接体现了你们的影响力，对吧？

Shows a direct impact you're having. Right?

没错。这说明有些本不该做手术的患者被送上了手术台。

Yes. So that told me that there are patients going to surgery that shouldn't be going to surgery.

对。

Right.

我又回到了

And I went back to

还有那些风险，你知道的，感染

the risks as well, you know, infection

风险、医疗事故，如此之多

risks, malpractice. So many different

事情可能会出错，对吧？

things can go wrong. Right?

有费用问题，有临床风险，有术后恢复风险，有围手术期风险，而且这完全没必要。

There's expense. There's clinical risks. There's post recovery risk. There's perioperative risk. And it's just unnecessary.

涉及发病率，还涉及一定程度的潜在死亡率。鲍勃告诉我这些时，我的回答是：绝对不行，对吧？这就是行动的号召。哇。

There's morbidity involved and a certain measure of potential mortality involved. Bob told me that, and my answer was, oh, hell no. Right? So, that was the call to action. Wow.

对吧？我听到后就想，不，不，不，不。

Right? I heard that, and I thought, no. No. No. No.

不，不，不。我们必须确保诊断准确。我知道爱德华生命科学正在进行的几项关于主动脉反流装置的研究，他们完全认识到超声与磁共振的挑战，但他们无法获得足够的磁共振数据，所以正在进行磁共振的子研究。

No. No. No. So we gotta get the diagnostics right. I'm aware of a couple of studies that are being done by, Edwards Lifesciences on aortic regurgitant, devices, And they fully recognize the challenges of echo versus MR, but they can't get enough MR, and they're doing sub studies on MR.

坦白说，我们已就潜在协助展开过对话，对方对此很感兴趣。同样地，出于相同原因，一些二尖瓣和三尖瓣反流装置也是如此。这是一个能惠及众多患者的机会，我们Vista对此充满热情。

And, you know, candidly, we've had dialogue about potentially helping those out, and there's interest there. And, similarly, you know, some of the other mitral and tricuspid regurgitation devices for the same reason. So, you know, this is, this is a chance to touch a lot of patients, and we're fired up to do that at Vista.

确实如此。太棒了。过去两三年我断断续续关注Vista，看到公司发展如此迅速、影响力不断扩大，真是令人惊叹。不过我很好奇，展望未来，我知道你们目前正在或即将开始B轮融资——

It is. Yes. That's phenomenal. I've been following Vista on and off for the past almost couple of two or three years, so it's been really incredible to see how much the company has grown, the impact has scaled. I am curious, though, looking forward, I know you I think you're currently raising your or starting to raise your series b.

你们计划将业务范围从心脏磁共振扩展到身体其他部位。未来一年、五年内希望实现什么目标？你希望Vista发展到什么程度？

You are you have a pipeline you plan to expand beyond just cardiac MRIs to different parts of the body. What do you hope to achieve in the next year, next five years? Where do you hope Vista goes?

五年内，我们肯定要为所有解剖部位提供Vista自动化磁共振解决方案。每年有4000万次扫描，心脏仅占1%，大脑25%，脊柱26%。根据不同统计，前列腺占4%-7%。我提到前列腺，是因为大脑和前列腺功能正在接受FDA审查。

So I'd like to certainly, in five years, it will be the case that we will have a Vista automated MR solution for every anatomy there is. There's 40,000,000 scans done every year. Only one percent are cardiac, 25 are brain, twenty six percent are spine. Depending on whose stats you believe, four, six, 7% is prostate. I bring up prostate, because brain and prostate, capability on Vista are in, FDA review right now.

我们希望能——敲木头祈愿——在今年晚些时候获得批准实现商业化。目前我们正在开发脊柱、肩部和膝关节的商业解决方案，并将持续拓展。五年内我们将覆盖所有部位。

We, we hope, knock wood somewhere. We hope, that, we will, we will have appropriate clearance later on this year to be able to commercialize. We're currently working on, on, business solutions for spine, shoulder, and knee. We're gonna keep going. So in five years, we're gonna have all the unanimous.

关于我们希望产生的影响，最宏观的表述是：在采用VISTA的医疗机构中，患者将不再面临检查资源短缺问题，等待时间不超过一天半到两天，且始终获得高质量影像。现在许多机构因技术限制，根本无法运行价值数百万美元的磁共振设备。

In terms of, impact we hope to have, I'd say probably the, the the the greatest overarching statement I would make is that there is no access issue. And and and in centers that are using VISTA, no access issue and no more than a day and a half, two day wait for patients with consistent high quality imaging. There are centers, lots of centers that, can't even operate multimillion dollar magnets because they don't have the technologies.

对，就是

Right. That's

太疯狂了。简直疯狂。太棒了。

crazy. It's crazy. It's amazing.

确实如此。是的。

Be the case. Yeah.

这不该发生。你看，在这个患者需要长时间等待、磁共振设备却有空置或运营效率低下的世界里，这些问题我们都能解决。我希望五年内能让Vista覆盖美国75%到80%的磁共振设备。虽然这个目标可能过于大胆，但这就是我的愿景——覆盖全美75%到80%的磁共振设备。

It should not be the case. So, in, you know, in a world where, you know, patients are waiting the way they're waiting and there's empty space on magnets or, you know, inefficient operations that we can solve. I'd like to have I'd like to have Vista on in five years, 75, 80% of all magnets in The US. From being overly bold, that's probably it. 75, 80% of all magnets.

不，你确实需要大胆。必须追求力所能及的最佳结果，我认为

No. It's you want to be bold, though. You have to strive for the best you can do, which is I think

试试看。

Try it.

要知道，磁共振在多数情况下都是金标准。但正如你所说，由于积压和各种原因，很多患者无法接受检查，只能转做CT扫描，承受不必要的辐射或错过必要筛查。如果能实现75%到80%的覆盖率，整个行业效率将大幅提升，数百万患者就能获得所需扫描，减少不必要的伤害。

There's, I mean and MRIs are the gold standard in so many cases. And like you said, because of the backlog, because of various reasons, they're just not done. You just patients just sent to CT scans or getting unnecessary radiation or not getting the screening they need. So if you can hit seventy five, eighty percent, that would make the whole industry so much more efficient, and so many millions more patients will be able to get the scans they need and have less.

确实如此。要知道，GE和西门子都认识到了这一点，他们是我们实现目标的重要合作伙伴。GE和西门子合计占据了市场上70%到75%的磁体份额。如果把我的上句话和现在这句话联系起来，我想成为每台GE和西门子设备的一部分。我相信你们能做到。

Exactly. And, you know, both GE and Siemens recognize that, and they're great partners with us to be able to enable that. And GE and Siemens collectively represent 70 or 75% of all magnets that are out there. So if you connect my last statement to the one I just made, I wanna be on every GE and Siemens Meg. I believe in you.

就是这样。我知道我们是其中一员。

This way. I know we're one of them.

是的。我知道我们时间不多了，所以我想请教您，对于像我或我们观众中那些想效仿您的人——比如希望影响患者、对行业产生积极影响、改变他人生活的人——您有什么建议？

Yeah. I know we're running up on time, so I would love to ask you, what advice do you have for someone, say, someone like me or one of our audience members who is interested in doing something similar to you, you know, impacting patients, having a positive impact on the industry, and just touching lives?

当年我从Avid Vascular转型到直觉外科时，直觉外科的一位投资人——梅菲尔德基金的合伙人曾对我说‘我们投资止痛药’。当时我天真地以为他说的是制药。其实他指的是那些所有人都公认存在的基础性结构问题。无论你问哪个临床医生，针对哪个临床细分领域，他们都会承认这是痛点。用他的原话说，这些问题‘处理起来很痛苦’。

So back in the days when I was, when I was making a transition from what is now Avid Vascular to Intuitive Surgical, one of the investors in Intuitive was a a partner over at Mayfield Funds, said to me that we invest in painkillers. And when he said that, I I naively thought was talking about pharmaceuticals. What he was talking about is, fundamental structural problems that are virtually everybody would agree is a problem. Everybody who asked clinician, whatever your target clinical or subsegment is, they would agree it's a problem. And they're a, quote, pain to deal with, unquote.

这些痛点很复杂，耗时过长，存在变数，技术门槛太高，或者我无法充分帮助患者。这是尚未被解决的难题之一。

Pain, they're complicated. They take too much time. There's variability. There's too much technique, or I can't sufficiently help my patients. It's one of these problems that hasn't been solved.

当我投身血管内碎石术和巧克力球囊治疗钙化病变时，数不清的人说我疯了——近50家风投机构都这么认为。这很正常。毕竟这是个大胆的想法，之前尝试过的公司都成了‘坟场’。那么像我丹尼尔·奥钦这样既非工程师又非临床医生、初次创业的人，到底能怎么应对呢？

And, when I went into calcium modification with intravascular lithotripsy and chocolate, I cannot accurately tell you how many people told me I was crazy, but, almost 50 venture firms did. And that's fine. I mean, I, you know, I can't fall. There was a bold idea, and there's a graveyard of companies that had attempted. So what in the devil do you think first time entrepreneur, non engineer, non clinician guy with an idea called Daniel Auchin's gonna do about that?

当你冒险尝试新事物时，总会遇到阻力。人们总会说这是个蠢主意，你不该这么做。所以——

When when you're taking a risk, doing something new is always gonna be backlash. People are always gonna say, it's a dumb idea. You shouldn't do this. So

没错。关于这一点，我的学习心得以及想与考虑这条道路的人分享的是：做好功课，弄清楚你所做的事情为何会成功或失败，哪些因素会促成或阻碍成功，深入了解其他方法论中的规律，直至止痛药层面。这就是我之前提到止痛药的原因。要针对真正结构性问题去解决问题。对吧？

That's right. So so my learning in that and what I would share with with folks who are considering that path is do your homework, understand why what you're doing will or won't work, what will make it work or not work, understand what laws there are in other methodologies down to the level of painkiller. That's why I brought up painkiller before. Go after a problem that is truly, structurally a problem. Right?

有些心脏病专家在冲击波疗法早期曾对我说：'我对钙化问题不大，可能只有5%的情况会遇到，Dana。你为什么要研究这个？'于是我换了个角度问他们关于钙化的问题，然后我反转了提问。我说：'医生，我很感谢您的观点。'

There are those cardiologists that said to me in the early days of shock wave, I don't have a problem with calcium. Maybe 5% of the time, Dana. Why why are you doing that? So I asked them the question about, you know, about calcium in that way, and then I flipped the question. And I said, I appreciate that, doctor.

你们遇到冠状动脉支架展开不全的情况有多频繁？对于临床经验不足的人说明一下，支架展开不全几乎总是由于某种程度的钙化造成的。所以我反转了问题。

How often do you have a coronary stent that is under deployed? And for those clinically not aware, an under deployed stent almost all the time is due to some level of calcification. So I flipped the question.

对。

Right.

当我反转问题时，对方回答：'你所谓的展开不全是什么意思？就是支架没有像管子那样完美呈圆形...呃...我不确定。大约25%的情况下总会有些小问题。'我追问：'但那不就是钙化吗？'对方只好承认：'嗯，是的。'

And when I flipped the question, the answer said, well, I mean, what do you mean under deployed? I mean, where it's not perfectly round like a tube, like, you know, perfectly oh oh, I don't know. About 25% of the time, there's always a little something there. And I said, but isn't that calcium? And well, yeah.

那里有纤维化组织，确实...里面是有钙化，但我认为这不算大问题。我抓住这个关键点，然后去请教弗吉尼亚州CV Path的心血管病理学家Renu Vermani。Renu是个宝藏。

There's fibrotic tissue. There's yeah. There's calcium in there, but I it's not really a problem. I take that little nugget, and then I go to a cardiovascular pathologist named Renu Vermani at a CV path in in Virginia. Renu is a gem.

我对Renu说：'告诉我真相。'她说：'噢，不，不。全都是钙化。当你进行尸检时就会发现——它们全都充满了钙质。'

I I said, Renu, tell me about this. She said, oh, no. No. They're all calcium. When you do a postmortem and you get they're all filled with calcium.

我问Renu，碎石术怎么样？如果我把钙质打碎会怎样？她说，哦，那样组织就会拉伸。所以我检查了问题的后端。没错。

I said, Renu, what about lithotripsy? What if I break that calcium? She said, oh, well, then the tissue will stretch. So I checked the back end of the problem. Right.

仅仅因为某人拥有资质，或是临床专家，并不意味着他们擅长评估潜在解决方案。世界上既有那些率先思考的人，也有未必如此的人。这并非他们的缺点，只是思维方式不同。如果你想开辟新天地，就必须听取各方意见，并确保你真正倾听的人具备可能性和创新思维。

Just because somebody has credentials in there, otherwise a clinical expert, doesn't mean they are expert in evaluating a potential solution. There are there are those folks who are first mover thinkers, and there are those folks who are not necessarily. And there's no negative on on them for that. It's just not how their mind works necessarily. If you're gonna try to break into new ground, understand that you have to take a lot of opinions from different sides of the story and make sure the people that you're truly listening to have a mindset towards possibility and innovation.

不是盲目地说‘哦酷，我们可以试试’。不，我们要探究背后的科学原理。

Not blinded like, oh, cool. Yeah. We can try that out. What no. Let's get to the science of why.

如果你能理解这点并依然坚信，那就前进吧年轻人。前进吧，但要明白这绝非易事。

If you can get to that and you still have conviction, go forward, young man, young woman. Go forward, but do it knowing it's not gonna be easy.

没错。

Right.

昨晚我刚对儿子说，创业的关键在于信念——是信念、坚持和排除万难的专注力的结合。那是一种痴迷。我对Truckwave就是如此痴迷，无法停止思考。

And I was just I was just describing to my son last night that a key to entrepreneurship is conviction, a combination of conviction, perseverance, and absolute distraction against everything else that you're gonna get it done. It's obsession. And that's what I had with Truckwave. It was just pure obsession. I couldn't stop thinking about it.

每次与临床医生讨论时，我都在学习，不断追问‘如果这样会怎样？’。当我再也提不出新问题，也无人能反驳我的方案时，我知道该组合已经成熟可以推进了。各位，这就是我想分享的建议。

Every conversation I was having with any clinician about it, I was learning from it, and I was going the back door of, but what if? But what if? And when I ran out of new questions from clinicians and I ran out of objections to what I was presenting, I knew I had the right combination of things to go forward. Right. Guys, that's that's some of the advice I'd yeah.

我给出的部分建议是：做好自己的功课，坚持自己的立场。不要自欺欺人，明白吗？如果确实好，那就是真的好。

Some of the advice I'd, I'd give is do your own homework. Call your own stuff. Don't don't drink your own Kool Aid. You know? If it's good, it's good.

如果孩子长得丑，那就承认他丑。实话实说。

If it's if the baby's ugly, then the baby's ugly. Call it.

没错。

Right.

对吧？但如果你找不到任何人——不是随便什么人，而是多个能提供扎实反对论据的人——那很可能你的想法确实可行。最后我想补充的是，在我完成自己的尽职调查后，我会请教真正顶尖的心脏病专家：请帮我找出漏洞，彻底推翻我的设想。

Right? But if you can't find anyone to give you a good solid reason based argument against, not anyone, but multiple people, chances are you're gonna have something. And, the last piece on that that I would offer is I would ask really, really bright cardiologists towards the end of my process of my own diligence. I'd ask them, please break my story for me. Break it.

我要你们找出漏洞，告诉我哪里会失败。而当他们无话可说时，我就知道没问题了。对吧。

I want you to break it. Tell me where it's going to fail. And they stopped having things to talk about. And I I I knew I was okay. Right.

于是我们继续推进。最终，这个方案在临床上取得了非凡的成功，并展现出卓越的安全性。

So we pushed forward. And, ultimately, it turned out to be, extraordinary successful clinically with an extraordinary safety profile.

没错。这建议太棒了。非常感谢。我相信我们的

Right. That's that's amazing advice. Really appreciate it. I'm sure our

当然。

Certainly.

听众们也会的。丹尼尔，很高兴能邀请到你。非常感谢你抽出时间，这确实是一种荣幸。

Listeners will too. Well, Daniel, it's been great having you. Thank you so much for your time. It's Certainly. Really been an honor.

噢，别这么说。我很感激。谢谢你邀请我参加，做这些总是很有趣。希望收听的一两位、十位或二十位朋友会决定去追求他们可能错过的医学事业。这就是我一直努力在做的事，而且我不会停下。

Oh, no. I appreciate that. Thank you for, for asking me to join, and, it's always fun to do these. And, hopefully, one or two or 10 or 20 folks listening will decide to pursue what they think might lose medicine. That's what I've always tried to do, and I ain't gonna stop.

希望如此。

Hope so.