Medical: Turner Imaging Systems

I’m an X-ray geek. My license plate says ‘X-Ray Man,’ so I’m a little bit of a fanatic about it

Dr. Clark is the founder and CEO of Turner Imaging Systems, a commercial-stage medical device company with a U.S. FDA-approved portable, lightweight, cordless C-arm X-ray machine called Smart-C. The key attribute of Smart-C is point-of-care. It can be used anywhere, anytime, with no need to plug it in or move the patient to the OR. And Smart-C produces both static X-ray (still image) and fluoroscopy (video), which is paramount for dynamic applications. The product does the same job as the big 400+ pound systems sold to hospitals and ambulatory surgical centers by GE, Hologic, and Orthoscan; only the Turner device weighs just 16 pounds and can collapse for transport and storage.

It’s ideal for use in the field - for example, the battlefield. The company has engaged with the U.S. Military to put Smart C on the frontline with its far-forward surgical teams. It’s also ideal for the ballfield. Turner has sold Smart C devices to roughly half of the NFL football teams and about a third of Major League Baseball teams.

Guys like the NFL or other sports teams, they want to be able to diagnose right there on the sideline and know if a guy can go back in, or do they need to get him advanced care? We can show right there if it is a broken ankle or just a sprain.

What truly differentiates Smart C is the product's ability to be used at the point of care. Beyond these field-portable applications for sports and military use is the even larger surgical practice setting. Turner is targeting orthopedic surgeons and other ambulatory surgical centers where these patients might have traditionally been sent to a hospital for an X-ray. There are approximately 30,000 orthopedic surgeons in the U.S. (source: American Academy of Orthopedic Surgeons, 2019), and many do not have in-house X-ray capability.

One of the first companies to recognize this tremendous potential was healthcare giant Siemens Healthineers. Turner has a master reseller agreement in the U.S. with Siemens, whereby Siemens markets and sells the Smart C under the Turner brand. The company is also in talks with Siemens for its home market in Germany, as well as with Siemens Japan.

Revenue in 2022 was approximately $4.5 million, and the company is on track to achieve revenues of around $8 million in 2023. Dr. Turner believes the company will be profitable in the fourth quarter of this year. Turner projects the current market for mobile C-arm devices is approximately $2.2 billion, with Siemens controlling just over 27% share, followed by major competitors such as GE, Hologic, and Ziehm Imaging GmbH (Orthoscan).

It’s important to note that Siemens does not have exclusivity to the Turner Smart C in the U.S. Turner sells the device directly themselves and, in the past, had negotiations with Philips Healthcare. The Smart C device is manufactured by Turner MedTech, another affiliate of Turner Innovations, and sold to Siemens at a (profitable) gross margin. The primary marketing efforts to date have centered around creating awareness and education through print and social media. The company also has a large presence at trade shows, such as the American Academy of Orthopedic Surgeons (AAOS), the Society of Hand Surgeons (ASSH), and the American Orthopaedic Foot and Ankle Society.

This is where the current “Gen One” device is ideally suited - body extremities such as the hands, arms, and feet. Turner is also working on a “Gen Two” device that will be slightly larger - approximately 30 lbs - and more powerful but still battery-powered and handheld. The US Air Force has provided funding to build an alpha prototype. This device will be able to do full-body imaging. This is where military use has a particular utility.

“They're especially interested in hips; when you have an IED explosion, and somebody has trauma injuries, there's a good chance you'll have internal bleeding that they don't know about. And so they want a very quick way to take an X-ray and see if the hip is fractured or intact.”

Turner’s long-term forecast projects revenues in excess of $60 million in 2027. And as unit placements grow - Turner placed approximately 200 units to date - services and software revenue to support in-market units becomes a larger and recurring portion of the business. And as part of the next generation of Turner Smart C devices, the company will include artificial intelligence (AI) software that improves fracture detection and precision diagnosis.

We’ve been told that GE makes more money on service than actual devices, so we want to incorporate AI algorithms to aid in the diagnosis and provide feedback to the physician about areas of concern. These will be monthly subscription services that include online data image storage and AI assistance. That’s all part of the roadmap.

And finally, the company is working on a “Gen Three” device that will be able to take multiple 2D images and use software and AI algorithms to construct a 3D image. These products exist today but are 500 pounds and fixed within the surgery center. Turner Imaging’s goal is to bring this capability truly mobile, which should enable dozens of new applications and dramatically increase the standard of care for diagnostic X-ray imaging. 

I'd like to be able to build something of lasting value. My big vision is a hundred years from now, instead of three names in X-ray, Siemens, GE, and Philips, they're four. It's Siemens, GE, Philips, and Turner.