Niramai: A Non-Invasive,Low-cost, Portable Device curbing Breast-cancer

By Deepa Natarajan

Niramai is a low cost, accurate, automated, portable cancer screening tool can be operated by even a simple technician with remote radiologist support.What’s more, it’s non-invasive and radiation free thereby being completely safe for repeated use, writes Deepa Natarajan

Over 1.5 million women are affected with breast cancer every year and it’s the leading cause of cancer-related deaths among women today. To add to this alarming statistic, a recent Lancet study revealed that India has a low breast cancer survival rate of 66 per cent, owing to lack of awareness and non-availability of resources and resource persons.   

Early screening process is the need of the hour and Niramai (Non-Invasive Risk Assessment with Machine Intelligence), a Bangalore-based healthcare start-up, has come up with a novel and hassle-free way to detect breast cancer at a much earlier stage. The low cost, accurate, automated, portable cancer screening tool can be operated by even a simple technician with remote radiologist support. Niramai test is available in many hospitals and diagnostic centres across the country today. What’s more, it’s non-invasive and radiation free thereby being completely safe for repeated use.

Dr Geetha Manjunath

Just back from attending one of the largest breast cancer conference in the US and receiving validation of Niramai’s trial results at the San Antonio Breast Cancer Symposium, Dr Geetha Manjunath, the founder, CEO and CTO of Niramai, talks to Deepa Natarajan on the growth of the company and its future plans among other things.  

Tell us about the early days of your career.

I have been a computer scientist and an intrepreneur for 25 years. I started my career in an Indian research institute, CDAC and was part of the team who built the first commercial supercomputer of India. Later, I worked in the research groups of Hewlett Packard and Xerox and have proposed and led many innovative projects. As an education background, I did my Ph.D in Artificial Intelligence from the Indian Institute of Science and management degree from Kellogg’s School at Chicago. 

How did the concept of Niramai emerge?

When two of my cousin sisters were detected with breast cancer, I was really alarmed and started to think about the solutions for it. During a discussion with a senior colleague from the US who was working on using cameras for health vital monitoring, I found out that the thermal imaging had been used by doctors over the years to detect early stage breast cancer. However, that was not in medical practise as visual interpretation of thermal images required a lot of expertise and was very subjective as the image is very complex to make a critical decision for a disease like cancer. So, we wanted to automate the process and increase the accuracy of interpretation to create a simple, non-invasive, high sensitivity method for early detection of cancer.  

We then set up a collaboration with a reputed hospital to collect thermal images of cancer patients and developed an algorithm to detect the location of tumour in thermal images in 2014. Post this, we experimented further to use it in the screening process for a privacy aware early screening.

Once the algorithms were ready, we tied up with reputed hospitals and competent doctors to evaluate the technology through clinical trials comparing our technique with other methods of detecting cancer. Only after proving the efficacy of our test published in international journals, we started providing the test in different diagnostic centres and hospitals.

NIRAMAI Co-founders Dr. Geetha Manjunath & Nidhi Mathur

What were the challenges you faced in setting it up?

The results of just thermal imaging were not great at start. For instance, even if there are no abnormalities, they turn up as red spots in a screening. Not all red spots are cancerous. So we had to do a lot of research in machine learning algorithms and we now see promising results.  In fact, I decided to quit my corporate job in January 2017 to focus completely on Niramai solution. My co-founder is Nidhi Mathur from a marketing and finance background and two of my ex-team members, Himanshu and Siva also joined me for the startup. It’s been two years now since we started working with Niramai full-time and I must say it has been a very good journey so far. It’s a solution that has impacted so many lives.

What are the mental and emotional challenges faced by women for breast cancer screening?

Firstly, women are hesitant to go for breast screening as it involves disrobing and there is also a stigma for a person to go to a cancer hospital for a test. Our method is privacy aware where no one touches or sees the person during the test and the test can also be conducted in small health centres and work places, not necessarily in cancer centres.

The common method used for breast screening is mammography and it involves compression of the breasts between two plates and passing of X-rays. It’s not only uncomfortable and painful but not applicable to women under 45 years of age. Younger women have fibrous or dense breasts which means the whole breast will appear white in the XRay and abnormalities get hidden. Our screening is painless, applicable to women of all ages and radiation free.

Where all is it available?

Niramai test is now available in 18 centres in 9 cities across India which includes many small diagnostic centres. We even conduct corporate camps in MNCs for those who are hesitant to go to a hospital or do not have time for it. It’s just a 15 minute screening process and they can do it during their work hours. We also partner with cancer societies for rural camps.

Team NIRAMAI

How cost-effective are the tools?

Very cost-effective compared to a standard mammography. In fact hospitals have to spend one-tenth on Niramai hardware when compared to mammography. While a mammography machine costs over a crore, we can do it for under 10 lakh. For the end-user too, it’s subsidized and costs one third of a mammography.  

What’s the potential of artificial intelligence today?

Artificial Intelligence technology has evolved a lot over the last 10 years. Although we had AI in the 90s, the compute being much faster, pervasive and affordable makes complex algorithms to run much faster. What the C-DAC supercomputer could do back then can be done on a cell phone today. In addition, explosion of data through digitization in different fields makes it possible for data-based decision making or machine learning methods to work.

As a result, new techniques are being researched and are becoming more accurate, which is highly important because these algorithms are needed for critical decision-making in healthcare.  

To sum it up, AI is seeing a greater adoption in healthcare today and it is the best time to be working on AI today.

What's in the pipeline for Niramai?

Last year, we only had one installation in Bangalore but now, we are in nine cities. This year, we want to reach out to every city since we get a lot of requests from people across the country. Our vision is to help every lady do a screening every year and not wait till a symptom or lump is seen. Late detection reduces treatment effectiveness and the chances of recurrence are also high.