Lodox

A 30-year-old construction worker was admitted to Rashid Hospital in Dubai, following an approximate nine metre fall. Doctors were rightly concerned – these types of injuries carry a high mortality rate as patients usually present with multiple, dispersed injuries. Without the capability of producing a single full body image, multiple x-ray views would have been needed to fully assess the patient’s condition. This not only takes a long time, but also exposes the patient to high doses of radiation. The use of Lodox full body x-ray imaging reduced the overall radiological examination time significantly, allowing for rapid assessment and movement of the patient to the operating theatre. The benefit of acquiring full-body diagnostic image fast to provide full diagnosis of all major injuries in a short timeframe is evident in this case.

Similarly, in 2017, at the University Hospital in Bern, Switzerland, a 19-yearold female patient was admitted, suspected of ingesting a foreign object. Doctors were rightly concerned – in the USA alone, 1500 people die each year in similar circumstances. The patient had a psychological disorder and was not cooperative with emergency room staff. Needing to assess the situation, doctors settled on the Lodox over a CT scan or a conventional x-ray, which were both ruled out. The patient refused to lay in the CT scanner and the high dosage, along with image overlapping, ruled out conventional x-ray techniques. The solution came in the form of the South African-designed and manufactured Lodox full body scanner. Emergency room staff were able to use the scanner to perform a full body scan, very quickly, and with a very low radiation dose while still gaining an image of supreme quality and clarity. This was seen as the safest option for the patient who had only given limited medical history to staff at the hospital.

Speed, image quality, low radiation dosage and full body image capability is the nature of the Lodox business. The Lodox allows for whole body imaging at high speeds to enable quick, informed decision making in a way that is safe for patients and hospital staff.

Based in Johannesburg, the company’s roots go back to the diamond mining industry. In the 90s, one of South Africa’s big diamond mining houses was looking for a technology that could quickly and safely scan employees to stop diamond theft from the mines. With hundreds of miners moving in and out of the mines each day, the process had to be seamless. With some diamonds being relatively small, the process had to be detailed and provide highquality imagery. And with employees being subject to the scan every day, radiation safety was a big concern. A team of R&D engineers were tasked with developing a solution.

The result was the first Lodox scanner – the Scannex Mark 1 security scanner, developed in 1995.

The success of the technology was great. Theft from mines was vastly reduced. The innovative minds behind the product quickly saw opportunities for expansion into medical applications.

In 2002, Lodox was formed as an independent company, breaking away from the mining industry. The idea to use the product in the medical field had long been a target for the young business and, following successful prototyping in Cape Town’s Groote Schuur Hospital, the first international order was received for an installation in Maryland Shock Trauma Centre, Baltimore, USA.

Before long, the advantages of using a Lodox machine were becoming clear for all to see and medical facilities around the world started looking to South Africa for supply.

CLEAR, NO GREY

A flagship moment for this inventive business came in 2013 when a Lodox machine was featured in an episode of the hit US medical drama show, Grey’s Anatomy. The TV series, which was one of the highest-rated and most commercially successful of all time, showed the machine in use in an Emergency Room during episode 18 of the ninth season.

This helped to catapult the Lodox name into the public space in South Africa and around the world.

Today, Lodox is focussed on growing its presence internationally while always delivering the best possible service to clients. In the future, Lodox will use its strong base in emergency trauma and forensic pathology to attack new geographic markets while leveraging the qualities of its product to achieve further growth and success.

“The markets that we are actively targeting are emergency trauma and forensics in our local market and the neighbouring countries in southern Africa, namely Botswana, Namibia and Swaziland,” explains CEO, Mbuyazwe Magagula. “We are also looking into East Africa, the Middle East, the Far East, and Eastern Europe. We are also looking at growing, through our subsidiary in North America, into Central and South America. We really believe that Lodox has a massive impact on how trauma is handled and how forensic facilities and mortuaries can operate. We think that it is particularly useful in developing countries that do not have the resources that developed countries have in terms of skills and funds. Lodox is well-positioned in terms of price, operating costs and skills required to operate the machine.”

Compared to CT scanning, MRI scanning, or conventional x-ray technology, Lodox machines can complete a full body scan in just 13 seconds, producing images of extremely high quality with the radiation dose a fraction of what a patient would receive with these modalities. The negligible scatter dose also makes it safer for operating and nearby staff. The system is user friendly and operators do not require specialised training.

The future holds further improvement and innovation. Building capacity, finding parallel uses, and improving access will all be undertaken soon.

“Our facility has the capacity to produce 30 machines each year,” says Magagula. “With the people we have and the equipment we have, we are not quite utilising that capacity so we could up our production without increasing our facility. When we get beyond 30 machines per year, we will certainly look at employing more people in manufacturing, sales, marketing, and service and maintenance.

“We are always looking at how we can improve its features – can we improve the speed, can we lower the dose, can we improve the image quality? Currently, we are looking at the detector, which helps capture the image, to see if we can improve the technology to make sure we get a sharper, clearer image which can also show tissue. The project is still in development and regulatory requirements still need to be fulfilled and we hope to launch in the near future.

“The other thing we are looking at, because it’s a high-capital product, price can be an issue and becomes a barrier for some facilities, so we are trying to develop an entry-level model which might not have the full feature set of the Lodox machine we have now thereby being able to get the price down. This may allow smaller facilities that don’t have high caseloads, and might have budget constraints, to at least purchase one of our products,” he adds.

In 2012, Lodox launched the Xmplar-dr, an improved version of the machine, which has been described as a ‘shift in digital radiology’. It is the only DR system that provides a single (non-stitched), high-resolution radiographic image of the entire body (up six feet body length). The machine provides safety improvements for staff, significantly reduced radiation dose for patients and uninterrupted resuscitation during imaging.

Again in 2017, Lodox launched the most recent iteration of the Lodox scanner: the eXero-dr, the first and only full body, high speed, low radiation digital radiology solution specifically designed for forensic pathology. The full body, fast, low radiation format makes imaging faster and easier for staff thus improving throughput, efficiency and worker safety, all in the promotion of justice.

CROSS SELL

Because of the nature of the Lodox business, manufacturing medical devices, there are several other obligatory processes that run alongside its core activities. In true entrepreneurial style, Lodox sees opportunity with these processes.

“Because of the capability that we have in terms of quality management, service and maintenance, and clinical applications, we see opportunities for growth. We can identify other device manufacturers in southern Africa, that are smaller and don’t have inhouse quality management capability, and try and assist them with that service,” details Magagula. “On the service and maintenance side, you typically find that the Lodox machine is one of several machines that are provided by various manufacturers. Our technicians understand x-rays and they could service and maintain third-party manufactured machines as well. The difficulty with that is the confidentiality agreements, but we do find that hospitals struggle with having four or five different providers of x-ray products.”

If the company can expand these channels, it will start to become a fully integrated medical supplier to South Africa’s healthcare and other significant industry sectors.

“With the current product we have, we believe we can grow,” says Magagula. “We believe we can create awareness in other niche applications such as mass-disaster situations, paediatrics, the military, victim identification and anthropology. We don’t have to push huge volumes but combined together, those could become significant for us.

“We are also looking at a product, which is only in the R&D phase at this stage, which is used in primary healthcare to help pregnant women detect difficulties with pregnancy and prevent stillbirths. Clinical trials are being conducted and we are hopeful that we can get the necessary internal approvals and regulatory registrations to manufacture and sell the product.” The company’s involvement across the entire value chain brings knowledge and experience that others might not have, and this is essential for an aspiring organisation. The company boasts its own inhouse R&D department, inhouse engineers, software developers, mechanical and electrical designers and a strong production department. While there is outsourcing of a number of components, all assembly is done inhouse. Testing and quality checking is all completed by Lodox, and the company can even handle installation, training of users, and detailed service and maintenance.

In the future, Lodox will also use its experience to determine how AI and machine learning principles can be added to the product. According to Magagula, there is appetite and opportunity for exploration in these areas and the company will push for innovation while always trying to increase brand awareness within its target markets.

SEEING THROUGH COMPETITION

Because of the complexity and significance of machines involved in the healthcare industry, manufacturers can usually charge a premium for their work. This encourages many to enter the market. Needs of customers are always developing and there is always room for improvement, so it is vital for companies to be innovative.

Lodox is the perfect example of how to enter and succeed in the market – do things faster, with better quality, and always fulfil a need. Because the company has focussed on this mantra, it has continued to grow in an industry that is crowded with competitors.

“We have around 98 active installations. We hope that by the end of the year, that number will get to around 108,” says Magagula.

“Lodox is a one-of-a-kind machine – there is no directly comparable machine. To make a quick, safe assessment in an emergency room, with sufficient information and confidence – there is nothing like Lodox in the world,” he adds. “There is intense competition from other technologies like CT, MRI, Ultrasound and Conventional X-ray. These, in the local market and around the world, are provided by multinationals and we experience intense competition from those. These are different modalities and are more expensive, requiring specialist skills and the Lodox can co-exist with these modalities. There is no direct competition for us in terms of rapid image acquisition, low dosage and large field of view.”

He highlights the combination of speed, image size, radiation dose, image quality, and reliability of the system as a true separator.

“We see our competitive advantage as our ability to empower emergency room staff to make quick decisions. Providing top-notch customer service, ensuring users know how to operate the machine and gain maximum benefit is a real advantage for us. Price is an issue and there are usually constraints in terms of budgets but that is why we need to look at ways of reducing the cost of the machine.

“Whether it’s in forensic pathology or emergency trauma, the machine is a solution that saves time and money, but ultimately saves lives as a doctor can decide on an intervention very quickly.” “In our niche market of full body two-dimensional, low dose, rapid x-ray imaging, with exceptional image quality, we are certainly an industry leader, by far,” he confirms.

Through its North American subsidiary, Lodox has captured 30% of the forensic market. This has resulted in companies active in the security industry – producing scanners for airports – becoming interested in applications in the medical field. “We have created awareness of how full body imaging can be used in a forensic facility,” says Magagula.

ECONOMIC TRAUMA?

One threat to the ongoing success of Lodox, and many other businesses operating globally out of South Africa, is uncertainty in the economy.

Uncertainty brings slow investment, lacking business confidence, market indecision, and slow growth. Against this backdrop, it is hard for businesses to develop in a meaningful way.

For Lodox, a company exporting around the world but also active locally, the slack performance of the South African economy coupled with uncertainty in various international markets makes planning difficult.

“The current economic climate is really challenging,” admits Magagula. “Locally, we’ve seen input costs - whether that’s electricity, labour, components – rise sharply. We import some components from Dollarbased markets and our currency has depreciated over time. Input costs have really shot up and that is purely down to the economic climate. In South Africa, we predominantly sell into the public sector where government expenditure is constrained. Expenditure for machines like Lodox falls away as government chooses to focus on other areas of healthcare. Globally, we find that as the economy slows down, most countries start to look inwards and favour buying local over importing and we are finding that threat materialising now.”

In the first quarter of 2019, South Africa’s GDP growth rate decreased by 3.2%. These figures follow on from a decade of uncertainty, characterised by several technical recessions and mostly below average growth for the region. Fortunately, Lodox is a sustainable business that can look beyond the short-term.

“It is difficult, but we are taking a long-term view and understanding that there will be short-term shocks. We believe in the product, we believe in its ability to meet customer needs and make an impact in the health sector so long-term, we stand behind it. As long as we keep enhancing the product, being innovative, and looking at other products so that we can diversify, we should be able to continue growing.”

Aside from economic conditions, which Lodox has no control over, the other challenge faced by the company is red tape. This, within government, has consistently been identified as one of the core elements which restrict business development and growth. Small Business Development Minister, Lindiwe Zulu, has been pushing the development of a national strategy to help reduce red tape and help small businesses to run more efficiently.

Magagula agrees that the problem needs to be addressed. “The onerous requirements in terms of regulatory compliance through quality management systems has become costly and burdensome. This creates barriers for small and medium sized enterprises and we are finding that the increase in costs, and the demand to meet various quality requirements, is extremely challenging.”

If Zulu can push through her programme – reports suggest this could happen by the end of 2019 – companies like Lodox will be able to overcome some of the burdensome administration which swallows time and money.

PROBLEM SOLVERS

Today, Lodox remains a business that solves problems – just as it was when it was established 17 years ago. However, unlike Grey’s Anatomy, the Lodox story is not finished. In fact, the company is still at the start of its journey with a dedicated team of staff.

“There are other regions of the world where we don’t currently have a footprint so we certainly believe we can grow and contribute to the economy,” says Magagula.

“Because we operate in a high-tech industry, we believe we can contribute to skills-development. We need highlyskilled, highly-qualified, technologicallyminded people and we believe we will be creating those jobs, especially in sales and marketing and service and maintenance. People are at the centre of what we do.”

Ultimately, if the devices produced by Lodox can continue to serve patients in the efficient manner realised by the young patient in Bern, the construction worker in Dubai and many others, there is no reason why this South African success story cannot go on to conquer the global x-ray imaging market, solving problems through innovation at every turn. “We aim to form long term partnerships with users, key opinion leaders and suppliers to be the partner of choice in emergency trauma and forensic pathology. Lodox saves time, saves money and saves lives,” Magagula concludes.