This Toronto Disruptor is Advancing a First-of-its-Kind, AI-driven Osteoporosis Screening Tool

Toronto-based 16 Bit’s pioneering technology is ready to scale thanks in good part to a unique program that significantly reduces barriers to finding and hiring high-demand technical talent

Dr. Mark Cicero (left) and Dr. Alex Bilbily, Co-CEOs, 16 Bit

Toronto, ON, — One in three women and one in five men will suffer a fracture due to bone loss in their lifetime and yet, only 22% of eligible at-risk patients are screened for osteoporosis, the underlying disease causing those preventable fractures.

Toronto-based 16 Bit, a startup founded by two radiologists as they were graduating their residency programs, is on a mission to reverse that trend with the launch of Rho™, a disruptive AI ‘radiology assistant’ that uses routine x-ray images to accurately screen and identify patients at risk of osteoporosis.

Thanks to national organization Mitacs — a not-for-profit organization that fosters growth and innovation in Canada — they’re now ready to scale their product after receiving innovation support from a hard to uncover but essential resource: highly skilled, specialized talent.

“The problem we’re trying to solve is the under-diagnosis of this prevalent disease,” said 16 Bit Co-CEO Dr. Mark Cicero, who founded the company with Co-CEO Dr. Alex Bilbily in 2016 to originally develop a smart tool for using x-rays to estimate bone age in children. “We know we can treat osteoporosis if we find it, but typically that only happens after people suffer a fracture, because the screening rates are so low,” he said.

The Canadian Task Force on Preventative Health currently recommends risk assessment-first screening only for women 65 years and up and recommends against screening men aged 40 and up. “But age and sex alone are poor predictors of someone’s risk of developing osteoporosis and fragility fracture” says Dr. Cicero.

Drs. Cicero and Bilbily are closing the gap with their personalized solution by making it possible to screen anyone over the age of 50 who goes for a routine x-ray for another medical reason. Rho, a machine learning system trained to identify low bone mineral density from up to 80% of x-ray images ordered, works in the background of a typical radiology information system to alert radiologists whenever suspected low bone density is detected in a patient.

“The idea is to raise a flag so the referring clinician can follow up with that patient, talk to them about osteoporosis risk factors and, when applicable, recommend further testing such as a DXA scan,” explained Dr. Bilbily, noting that early intervention leads to fewer fractures and lowers healthcare spending over the long term. “Usually AI is perceived as a nice-to-have. We believe it’s a must-have because if we want a sustainable healthcare system in Canada, we have to capitalize on approaches like this that maintain or improve care while decreasing costs to our system,” he said.

Talent key to fostering innovation, driving economic success

To advance their technology, Drs. Cicero and Bilbily are engaging with Mitacs, a national not-for-profit that provides SMEs across Canada with the talent they need to make their innovation projects a success. Mitacs is uniquely positioned to connect Canadian organizations to highly skilled post-secondary students who are experts in their fields

Through Mitacs, 16 Bit hired University of Toronto Master’s in Applied Computing international students Sarthak Narayan and Abdur Rahman to design and implement a cloud version of Rho that can easily scale as the company starts to market the technology as a Health Canada-approved software-as-a-medical device (SaMD).

“It’s very difficult in today’s day and age to compete with large tech companies for specialized talent. AI and cloud development are the hottest fields in tech and a lot of top students are getting job offers from the likes of Apple, Amazon and Google,” said Dr. Cicero. “Working with Mitacs allows us to attract top talent while they’re still in school. We benefit from the students’ cutting-edge learning and they benefit from our entrepreneurial mentoring and guidance, so that together we can develop a very impactful product,” he explained.

“SMEs and entrepreneurs in the innovation space have big meaningful ideas, but often they are working with limited resources and financial constraints,” said Mitacs CEO John Hepburn. “This is where Mitacs can play an important role in the success of Canada’s SMEs. Mitacs will bring the connections, expertise, funding, talent, insights — the whole community — needed to take SME innovation to the next level and drive commercial results and sustainable growth in Canada.”

Abdur and Sarthak, both of whom have accepted full-time positions at 16 Bit starting in January, are contributing their advanced software engineering skills to transition Rho from a standalone system to the cloud where it can be centrally managed. Hospitals and clinics will have the option to choose to run the software in the cloud or on premise, while installation becomes simpler and more scalable, making it easier to onboard new customers as the company grows.

Building a new for AI-based health model

For Abdur, the opportunity to learn the operational side of software development has been eye-opening. “Previously, I’ve had experience building quality software, but I’ve never had the chance to learn what happens after we have the software ready. At 16 Bit, I’ve had to make decisions about how to deliver it to customers and on-board them in a streamlined fashion,” he said.

Calling the internship an extremely valuable experience, Sarthak appreciates being part of a team to solve real-world challenges. “This product will have a positive impact on a lot of people as they age. It’s extremely fulfilling to know that I’m applying my software engineering skills to help people,” he said.

16 Bit received Health Canada approval for Rho in July 2022 and has since clinically screened more than 50,000 Ontario patients, 45% of whom were identified by Rho as being at risk of bone loss.

The company also recently completed a study at Sunnybrook Health Sciences Centre to better understand the social implications of using AI as a behind-the-scenes screening tool, and the team is now exploring the option of offering Rho directly to patients through online patient portals as they continue to market the product to hospitals and clinics.

“This is a new kind of tool,” said Dr. Bilbily. “There’s no AI assistant sitting in a Canadian hospital right now that discreetly analyzes patient images to provide clinical value. One of the biggest barriers we need to tackle is the social barrier. How will patients receive Rho? How will physicians receive Rho? This AI movement isn’t coming. It’s here.”


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