Setting the record straight about Ezra
Full-body MRI scans are a new tool for early disease detection, capable of finding cancer and other conditions at early stages when treatment can be more effective. However, for you to make an informed decision about which provider to choose you need the facts. This page corrects misleading claims and omissions made by Ezra about its full-body MRI service versus Prenuvo, focusing on facts (not marketing) to help you make informed decisions. Where there is a lack of information we have provided our consensus opinion based on our extensive experience in whole body MRI encompassing well over 100,000 patients.
What Ezra doesn’t tell you that might be important
Ezra doesn’t have a Chief Medical Officer
You may be surprised to learn that Ezra does not full-time employ a single physician, let alone a Chief Medical Officer or radiologist. By contrast, Prenuvo has invested deeply in medical leadership and considers physician governance critically important to ensuring imaging quality and diagnostic accuracy, particularly in an emerging field such as whole-body MRI. We proudly have a medical group which consists of over 100 licensed providers, including 80+ Board Certified radiologists. Prenuvo’s medical leadership team includes Dr. Daniel J. Durand (CMO - trained at Johns Hopkins), Dr. Amar Patel (VP of Neuroradiology - Stanford), Dr. Jason Itri (VP of Body Imaging - University of Pennsylvania), Dr. Ty Vachon (VP of Quality, Safety and Informatics - US Naval Medical Center San Diego), Dr. Sean London (VP of the US Radiology Practice - University of Washington), Dr. Vikash Modi (Senior Medical Director of preventative Medicine - Medical College of Georgia).
Ezra’s image quality is not equivalent to that of Prenuvo on important metrics
Medical image quality is notoriously difficult for consumers to understand. In order to clarify things, we took the images from an Ezra Flash scan and compared them to a Prenuvo comprehensive scan. We evaluated each on four dimensions:
- Voxel count. A voxel, a 3D pixel, is a unit of information about your physiology. The more voxels acquired, the more clinically relevant signal there is.
- Reconstructed voxel count. There are various techniques to accelerate image acquisition (or acquire better images). The most common are compressed sense, parallel imaging and deep learning (in k-space or in image space). Prenuvo takes advantage of all of these techniques (though only performs deep learning in k-space). Ezra imaging will likely depend on the particular machine that is used to acquire their images.
- Tissue-weighted score. A weighting score that rewards the number of different tissue weighting and orientations that are taken of each part of the body. A “weighting” is an image set filtering for blood, fluid, fat, proteinaceous tissue, etc, and an orientation is sagittal, axial or coronal. The more tissue weighting and orientations present, the more medically accurate the radiology can be.
- Diffusion-voxel average counts. Diffusion is a special filter for “hardness” that is particularly important for lesion identification and classification into concerning/benign. A higher count generally leads to greater sensitivity for cancer and fewer false positives.
The logic for these 3 metrics is better explained here: https://prenuvo.com/blog/breaking-it-down-prenuvos-whole-body-mri-screening-explained
Below you will find a comparison of scan across these four metrics.
Ezra doesn’t report any efficacy data
Ezra proudly claims that it “has helped 6% of our members identify potential cancer early”. However to our knowledge Ezra has never published any scientific study reporting on the actual efficacy of its scan - that is, how many of those potential cancers turn out to be cancer and how many actual cancers it misses on average. Without having performed and published any outcomes-based research, the 6% tells one absolutely nothing about how medically accurate the exam is. Prenuvo by comparison has published extensively, including work on patient outcomes. In our largest study of patient outcomes that followed over 1,000 patients for 1 year, we reported potential cancer in about 2% of screened patients at 1 year follow-up and we found a positive biopsy rate of approximately 50% (about half of patients who reported being biopsied after a Prenuvo scan had found evidence of pathologically proving cancer). The same study found a false negative rate of just 0.2%, suggesting a negative Prenuvo scan offers patients reassurance based on real world evidence. We do not believe this can be said for the Ezra scan. In fact, the 6% rate that Ezra reports is so far above the actual annual rate of cancer in the population that either an Ezra scan produces a high number of false positives or the average Ezra patient is much sicker than the average American.
Ezra doesn’t operate its own facilities - it’s a virtual operation
If you take a look at Ezra’s website you will see imagery of patients checking into what appears to be an Ezra facility, complete with a sign on the wall that reads “Ezra”. Ezra does not operate any of its own facilities, subcontracting instead with various outpatient imaging centers. These imaging centers are not specialized in whole-body image acquisition, operate a wide range of different imaging equipment, and mainly focus on doing more traditional and far simpler outpatient scans like knee MRIs. There is thus an unknown degree of local variation in terms of quality control, and the patient experience and accuracy may be very different depending on where you happen to live. You can think of Ezra as a “virtual operation,” which arguably has no place in essential services like healthcare. Prenuvo believes that owning and operating facilities is an important advantage as it enables the selection of optimal hardware, the development of tailored imaging protocols, the standardization of image quality, the hiring and training of high-quality MRI technologists and the provision of an excellent clinic experience for patients.
Ezra doesn’t perform its own radiology
The most important aspect of a whole-body examination is the radiology reading. At Prenuvo, we work with 80+ board certified radiologists, many of whom primarily or even exclusively practice whole-body radiology. Ezra contracts out its radiology to its partner imaging centers for which Ezra radiology is a small part of their business. In fact, many of these imaging centers may screen fewer Ezra patients in a month than a single Prenuvo clinic does in a day. Prenuvo believes that mastery in radiology comes from frequent repetition, particularly for a complex imaging exam like a whole-body examination. Additionally, Prenuvo radiologists work together as a community to improve the quality of whole-body reading, something which is hard to replicate under Ezra’s model. Prenuvo’s internal standards for radiologist quality are extremely stringent. As a group, Prenuvo radiologists perform quality assurance at a rate that is approximately double the industry standard.
What Ezra tells you that is misleading
Use of AI in the Ezra imaging exam
Ezra claims in various communications that its use of image acquisition AI leads to various benefits including “improved image quality” and “more accurate early cancer detection”. These statements go beyond the marketing claims that Ezra’s FDA approval allows, notably that these algorithms simply “reduce image noise.” Further, Ezra makes use of these algorithms to denoise noisier, lower resolution scans, which means the use of the algorithm is not intended to improve image quality but to instead reduce scan time and lower costs for Ezra and their partners. Prenuvo believes that deep learning-based image post-processing algorithms should not be employed in a clinical setting because of the risk that the signal of a small but clinically significant pathology (e.g. a small 1 cm cancer) is lost in the noise of the low resolution images acquired.
ACR accredited facilities
Ezra wants you to infer that by virtue of its facilities being ACR accredited, that they are of higher quality than Prenuvo facilities. However, the ACR process in question relates to traditional radiology exams like knee and brain MRIs. To the best of our knowledge, the ACR does not currently offer any accreditation that reviews whole body imaging specifically. While Prenuvo has the utmost respect for the ACR accreditation process, we do not believe in its current form that it can be used to distinguish between whole body imaging providers. If the ACR ever offers a pathway for dedicated whole body imaging centers not using intravenous contrast to gain accreditation, we will be among the first to apply.
Radiology turnaround time
Ezra claims that Prenuvo returns radiology reports in 10-15 days when in fact the vast majority (over 90%) of our US radiology is currently reported in under 1 week.
Putting it all together - Innovating within diagnostic medicine requires full ownership
Whole body MRI is a revolutionary technology that has the potential to change the way people understand and manage their health. But consistently and responsibly delivering high-quality whole body MRI services in the real world requires a rare and nuanced combination of people, process, and technology. Prenuvo has invested heavily in each of these pillars to ensure both the precision and accuracy of our services across the globe: we operate a fleet of essentially identical research-grade MRI machines; we have built standardized protocols for acquiring images, reading scans, and communicating the results and subsequent care pathway recommendations to patients and physicians; we directly employ/contract the professionals who obtain the images and read the scans and care for our patients. Ezra is a virtual operation and has to our knowledge not done all or most of these things. Based on our market-leading level of experience serving over 100,000 patients, we believe that Prenuvo is the better choice in terms of precision, accuracy, and patient outcomes.
Setting the record straight about Ezra
Full-body MRI scans are a new tool for early disease detection, capable of finding cancer and other conditions at early stages when treatment can be more effective. However, for you to make an informed decision about which provider to choose you need the facts. This page corrects misleading claims and omissions made by Ezra about its full-body MRI service versus Prenuvo, focusing on facts (not marketing) to help you make informed decisions. Where there is a lack of information we have provided our consensus opinion based on our extensive experience in whole body MRI encompassing well over 100,000 patients.
What Ezra doesn’t tell you that might be important
Ezra’s image quality is not equivalent to that of Prenuvo on important metrics
Medical image quality is notoriously difficult for consumers to understand. In order to clarify things, we took the images from an Ezra Flash scan and compared them to a Prenuvo comprehensive scan. We evaluated each on four dimensions:
- Voxel count. A voxel, a 3D pixel, is a unit of information about your physiology. The more voxels acquired, the more clinically relevant signal there is.
- Reconstructed voxel count. There are various techniques to accelerate image acquisition (or acquire better images). The most common are compressed sense, parallel imaging and deep learning (in k-space or in image space). Prenuvo takes advantage of all of these techniques (though only performs deep learning in k-space). Ezra imaging will likely depend on the particular machine that is used to acquire their images.
- Tissue-weighted score. A weighting score that rewards the number of different tissue weighting and orientations that are taken of each part of the body. A “weighting” is an image set filtering for blood, fluid, fat, proteinaceous tissue, etc, and an orientation is sagittal, axial or coronal. The more tissue weighting and orientations present, the more medically accurate the radiology can be.
- Diffusion-voxel average counts. Diffusion is a special filter for “hardness” that is particularly important for lesion identification and classification into concerning/benign. A higher count generally leads to greater sensitivity for cancer and fewer false positives.
The logic for these 3 metrics is better explained here: https://prenuvo.com/blog/breaking-it-down-prenuvos-whole-body-mri-screening-explained
Below you will find a comparison of scan across these four metrics.
Ezra doesn’t report any efficacy data
Ezra proudly claims that it “has helped 6% of our members identify potential cancer early”. However to our knowledge Ezra has never published any scientific study reporting on the actual efficacy of its scan - that is, how many of those potential cancers turn out to be cancer and how many actual cancers it misses on average. Without having performed and published any outcomes-based research, the 6% tells one absolutely nothing about how medically accurate the exam is. Prenuvo by comparison has published extensively, including work on patient outcomes. In our largest study of patient outcomes that followed over 1,000 patients for 1 year, we reported potential cancer in about 2% of screened patients at 1 year follow-up and we found a positive biopsy rate of approximately 50% (about half of patients who reported being biopsied after a Prenuvo scan had found evidence of pathologically proving cancer). The same study found a false negative rate of just 0.2%, suggesting a negative Prenuvo scan offers patients reassurance based on real world evidence. We do not believe this can be said for the Ezra scan. In fact, the 6% rate that Ezra reports is so far above the actual annual rate of cancer in the population that either an Ezra scan produces a high number of false positives or the average Ezra patient is much sicker than the average American.
Ezra doesn’t operate its own facilities - it’s a virtual operation
If you take a look at Ezra’s website you will see imagery of patients checking into what appears to be an Ezra facility, complete with a sign on the wall that reads “Ezra”. Ezra does not operate any of its own facilities, subcontracting instead with various outpatient imaging centers. These imaging centers are not specialized in whole-body image acquisition, operate a wide range of different imaging equipment, and mainly focus on doing more traditional and far simpler outpatient scans like knee MRIs. There is thus an unknown degree of local variation in terms of quality control, and the patient experience and accuracy may be very different depending on where you happen to live. You can think of Ezra as a “virtual operation,” which arguably has no place in essential services like healthcare. Prenuvo believes that owning and operating facilities is an important advantage as it enables the selection of optimal hardware, the development of tailored imaging protocols, the standardization of image quality, the hiring and training of high-quality MRI technologists and the provision of an excellent clinic experience for patients.
Ezra doesn’t perform its own radiology
The most important aspect of a whole-body examination is the radiology reading. At Prenuvo, we work with 80+ board certified radiologists, many of whom primarily or even exclusively practice whole-body radiology. Ezra contracts out its radiology to its partner imaging centers for which Ezra radiology is a small part of their business. In fact, many of these imaging centers may screen fewer Ezra patients in a month than a single Prenuvo clinic does in a day. Prenuvo believes that mastery in radiology comes from frequent repetition, particularly for a complex imaging exam like a whole-body examination. Additionally, Prenuvo radiologists work together as a community to improve the quality of whole-body reading, something which is hard to replicate under Ezra’s model. Prenuvo’s internal standards for radiologist quality are extremely stringent. As a group, Prenuvo radiologists perform quality assurance at a rate that is approximately double the industry standard. We proudly have a medical group which consists of over 100 licensed providers, including 80+ Board Certified radiologists. Prenuvo’s medical leadership team includes Dr. Daniel J. Durand (CMO - trained at Johns Hopkins), Dr. Amar Patel (VP of Neuroradiology - Stanford), Dr. Jason Itri (VP of Body Imaging - University of Pennsylvania), Dr. Ty Vachon (VP of Quality, Safety and Informatics - US Naval Medical Center San Diego), Dr. Sean London (VP of the US Radiology Practice - University of Washington), Dr. Vikash Modi (Senior Medical Director of preventative Medicine - Medical College of Georgia).
What Ezra tells you that is misleading
Use of AI in the Ezra imaging exam
Ezra claims in various communications that its use of image acquisition AI leads to various benefits including “improved image quality” and “more accurate early cancer detection”. These statements go beyond the marketing claims that Ezra’s FDA approval allows, notably that these algorithms simply “reduce image noise.” Further, Ezra makes use of these algorithms to denoise noisier, lower resolution scans, which means the use of the algorithm is not intended to improve image quality but to instead reduce scan time and lower costs for Ezra and their partners. Prenuvo believes that deep learning-based image post-processing algorithms should not be employed in a clinical setting because of the risk that the signal of a small but clinically significant pathology (e.g. a small 1 cm cancer) is lost in the noise of the low resolution images acquired.
ACR accredited facilities
Ezra wants you to infer that by virtue of its facilities being ACR accredited, that they are of higher quality than Prenuvo facilities. However, the ACR process in question relates to traditional radiology exams like knee and brain MRIs. To the best of our knowledge, the ACR does not currently offer any accreditation that reviews whole body imaging specifically. While Prenuvo has the utmost respect for the ACR accreditation process, we do not believe in its current form that it can be used to distinguish between whole body imaging providers. If the ACR ever offers a pathway for dedicated whole body imaging centers not using intravenous contrast to gain accreditation, we will be among the first to apply.
Radiology turnaround time
Ezra claims that Prenuvo returns radiology reports in 10-15 days when in fact the vast majority (over 90%) of our US radiology is currently reported in under 1 week.
Putting it all together - Innovating within diagnostic medicine requires full ownership
Whole body MRI is a revolutionary technology that has the potential to change the way people understand and manage their health. But consistently and responsibly delivering high-quality whole body MRI services in the real world requires a rare and nuanced combination of people, process, and technology. Prenuvo has invested heavily in each of these pillars to ensure both the precision and accuracy of our services across the globe: we operate a fleet of essentially identical research-grade MRI machines; we have built standardized protocols for acquiring images, reading scans, and communicating the results and subsequent care pathway recommendations to patients and physicians; we directly employ/contract the professionals who obtain the images and read the scans and care for our patients. Ezra is a virtual operation and has to our knowledge not done all or most of these things. Based on our market-leading level of experience serving over 100,000 patients, we believe that Prenuvo is the better choice in terms of precision, accuracy, and patient outcomes.
Setting the record straight about Ezra
Full-body MRI scans are a new tool for early disease detection, capable of finding cancer and other conditions at early stages when treatment can be more effective. However, for you to make an informed decision about which provider to choose you need the facts. This page corrects misleading claims and omissions made by Ezra about its full-body MRI service versus Prenuvo, focusing on facts (not marketing) to help you make informed decisions. Where there is a lack of information we have provided our consensus opinion based on our extensive experience in whole body MRI encompassing well over 100,000 patients.
What Ezra doesn’t tell you that might be important
Ezra’s image quality is not equivalent to that of Prenuvo on important metrics
Medical image quality is notoriously difficult for consumers to understand. In order to clarify things, we took the images from an Ezra Flash scan and compared them to a Prenuvo comprehensive scan. We evaluated each on four dimensions:
- Voxel count. A voxel, a 3D pixel, is a unit of information about your physiology. The more voxels acquired, the more clinically relevant signal there is.
- Reconstructed voxel count. There are various techniques to accelerate image acquisition (or acquire better images). The most common are compressed sense, parallel imaging and deep learning (in k-space or in image space). Prenuvo takes advantage of all of these techniques (though only performs deep learning in k-space). Ezra imaging will likely depend on the particular machine that is used to acquire their images.
- Tissue-weighted score. A weighting score that rewards the number of different tissue weighting and orientations that are taken of each part of the body. A “weighting” is an image set filtering for blood, fluid, fat, proteinaceous tissue, etc, and an orientation is sagittal, axial or coronal. The more tissue weighting and orientations present, the more medically accurate the radiology can be.
- Diffusion-voxel average counts. Diffusion is a special filter for “hardness” that is particularly important for lesion identification and classification into concerning/benign. A higher count generally leads to greater sensitivity for cancer and fewer false positives.
The logic for these 3 metrics is better explained here: https://prenuvo.com/blog/breaking-it-down-prenuvos-whole-body-mri-screening-explained
Below you will find a comparison of scan across these four metrics.
Ezra doesn’t report any efficacy data
Ezra proudly claims that it “has helped 6% of our members identify potential cancer early”. However to our knowledge Ezra has never published any scientific study reporting on the actual efficacy of its scan - that is, how many of those potential cancers turn out to be cancer and how many actual cancers it misses on average. Without having performed and published any outcomes-based research, the 6% tells one absolutely nothing about how medically accurate the exam is. Prenuvo by comparison has published extensively, including work on patient outcomes. In our largest study of patient outcomes that followed over 1,000 patients for 1 year, we reported potential cancer in about 2% of screened patients at 1 year follow-up and we found a positive biopsy rate of approximately 50% (about half of patients who reported being biopsied after a Prenuvo scan had found evidence of pathologically proving cancer). The same study found a false negative rate of just 0.2%, suggesting a negative Prenuvo scan offers patients reassurance based on real world evidence. We do not believe this can be said for the Ezra scan. In fact, the 6% rate that Ezra reports is so far above the actual annual rate of cancer in the population that either an Ezra scan produces a high number of false positives or the average Ezra patient is much sicker than the average American.
Ezra doesn’t operate its own facilities - it’s a virtual operation
If you take a look at Ezra’s website you will see imagery of patients checking into what appears to be an Ezra facility, complete with a sign on the wall that reads “Ezra”. Ezra does not operate any of its own facilities, subcontracting instead with various outpatient imaging centers. These imaging centers are not specialized in whole-body image acquisition, operate a wide range of different imaging equipment, and mainly focus on doing more traditional and far simpler outpatient scans like knee MRIs. There is thus an unknown degree of local variation in terms of quality control, and the patient experience and accuracy may be very different depending on where you happen to live. You can think of Ezra as a “virtual operation,” which arguably has no place in essential services like healthcare. Prenuvo believes that owning and operating facilities is an important advantage as it enables the selection of optimal hardware, the development of tailored imaging protocols, the standardization of image quality, the hiring and training of high-quality MRI technologists and the provision of an excellent clinic experience for patients.
Ezra doesn’t perform its own radiology
The most important aspect of a whole-body examination is the radiology reading. At Prenuvo, we work with 80+ board certified radiologists, many of whom primarily or even exclusively practice whole-body radiology. Ezra contracts out its radiology to its partner imaging centers for which Ezra radiology is a small part of their business. In fact, many of these imaging centers may screen fewer Ezra patients in a month than a single Prenuvo clinic does in a day. Prenuvo believes that mastery in radiology comes from frequent repetition, particularly for a complex imaging exam like a whole-body examination. Additionally, Prenuvo radiologists work together as a community to improve the quality of whole-body reading, something which is hard to replicate under Ezra’s model. Prenuvo’s internal standards for radiologist quality are extremely stringent. As a group, Prenuvo radiologists perform quality assurance at a rate that is approximately double the industry standard. We proudly have a medical group which consists of over 100 licensed providers, including 80+ Board Certified radiologists. Prenuvo’s medical leadership team includes Dr. Daniel J. Durand (CMO - trained at Johns Hopkins), Dr. Amar Patel (VP of Neuroradiology - Stanford), Dr. Jason Itri (VP of Body Imaging - University of Pennsylvania), Dr. Ty Vachon (VP of Quality, Safety and Informatics - US Naval Medical Center San Diego), Dr. Sean London (VP of the US Radiology Practice - University of Washington), Dr. Vikash Modi (Senior Medical Director of preventative Medicine - Medical College of Georgia).
What Ezra tells you that is misleading
Use of AI in the Ezra imaging exam
Ezra claims in various communications that its use of image acquisition AI leads to various benefits including “improved image quality” and “more accurate early cancer detection”. These statements go beyond the marketing claims that Ezra’s FDA approval allows, notably that these algorithms simply “reduce image noise.” Further, Ezra makes use of these algorithms to denoise noisier, lower resolution scans, which means the use of the algorithm is not intended to improve image quality but to instead reduce scan time and lower costs for Ezra and their partners. Prenuvo believes that deep learning-based image post-processing algorithms should not be employed in a clinical setting because of the risk that the signal of a small but clinically significant pathology (e.g. a small 1 cm cancer) is lost in the noise of the low resolution images acquired.
ACR accredited facilities
Ezra wants you to infer that by virtue of its facilities being ACR accredited, that they are of higher quality than Prenuvo facilities. However, the ACR process in question relates to traditional radiology exams like knee and brain MRIs. To the best of our knowledge, the ACR does not currently offer any accreditation that reviews whole body imaging specifically. While Prenuvo has the utmost respect for the ACR accreditation process, we do not believe in its current form that it can be used to distinguish between whole body imaging providers. If the ACR ever offers a pathway for dedicated whole body imaging centers not using intravenous contrast to gain accreditation, we will be among the first to apply.
Radiology turnaround time
Ezra claims that Prenuvo returns radiology reports in 10-15 days when in fact the vast majority (over 90%) of our US radiology is currently reported in under 1 week.
Putting it all together - Innovating within diagnostic medicine requires full ownership
Whole body MRI is a revolutionary technology that has the potential to change the way people understand and manage their health. But consistently and responsibly delivering high-quality whole body MRI services in the real world requires a rare and nuanced combination of people, process, and technology. Prenuvo has invested heavily in each of these pillars to ensure both the precision and accuracy of our services across the globe: we operate a fleet of essentially identical research-grade MRI machines; we have built standardized protocols for acquiring images, reading scans, and communicating the results and subsequent care pathway recommendations to patients and physicians; we directly employ/contract the professionals who obtain the images and read the scans and care for our patients. Ezra is a virtual operation and has to our knowledge not done all or most of these things. Based on our market-leading level of experience serving over 100,000 patients, we believe that Prenuvo is the better choice in terms of precision, accuracy, and patient outcomes.