Wayne Summers

superDimension

Remember the old days!

Old analog telephones and type writers have been replaced by digitial cell phones and laptops

Much like other technologies, bronchoscopy will be enhanced with electromagnetic navigation

500,000 bronchoscopies performed annually in the US1

65% of bronchoscopies fail to reach peripheral lesions2

Failure of bronchoscopy leads to more invasive diagnostic procedures

Source:1. Ernst et al., 20032. Schwarz Y et al., 2006

i-Logic is:

• “GPS” for the lungs

• ELECTROMAGNETIC NAVIGATION and sensor feedback that DISPLAYS YOUR REAL-TIME POSITION regardless of visual obstruction or patient movement

• We reach 17+ GENERATIONS (to the pleura)– Our unique catheter design provides guidance, 360°

steerability, and access to virtually all peripheral lung lesions

•  We have REAL CLINICAL EXPERIENCE– Over 18 clinical publications covering over 700+

patients– 13,000+ CASES worldwide

Location Sensor

inReach Planning Software

PatientSensors

DICOM CD

PLANNING:

PROCEDURE :

CT Scan :

Coronal

Axial

Sagittal

3D Map (Global)

Local

3D CT VB Tip View

MIP

Video Bronchoscope

Navigation –Viewport Options

Lymph Node Procedure

Navigate to peripheral lesions and biopsy for diagnosis

Stage lymph nodes for diagnosis and pre-operative planning

Place radiosurgical markers in and around tumors for radiation therapy

Place markers to facilitate VATS localization

Guide high dose radiation catheters

Conventionally, in spine and CNS, gold fiducials have been placed by CT-guidance or fluoroscopy.

Usually placed in bone. Low complication rate.

In imaging technologies, a fiducial is an object in the field of view which serves as a point of reference.

Fiducials allow imaging systems to account for motion that might not otherwise be seen.

This is critical to preservation of normal tissue

CT placement of fiducials: 40%With concurrent biopsy: 57%Fiducial only: 35%Chest tube required: 40%

Reichner et al. Chest 2005; 128(4):162-3S. Banovac et al. Clinical Lung Cancer 2007;8(4):252-6.

CT-guided lung biopsy: 19%-60%Most commonly 25% to 30%.50% require chest tube placement.

Saji H et al. Chest 2002; 121: 1521-1526.

Small gold markers placed into or near the tumor.

Used by the computer to track the target lesion.

Ideally place 3-5 markers 2 cm apart from each other.

In difficult cases a single fiducial may be adequate.

Need to be in different plane than the 45’ fluoroscopy used in the CyberKnife suite.

Placing fiducials into the lung poses new risks: Pneumothorax. Bleeding Migration. Movement.

• Enhanced thoracoscopic localization for more precise excisional biopsy

• Substantial reduction in VATS conversion to thoracotomy

• Increased operability

Driving patients from Competitors to your hospital Patients Leaving Dothan for Treatment- 100 Number of patients being treated at competitive hospital

Watchful Waiting – hard to define; physicians would need to provide number of patients that are receiving serial CTs.

Non-malignant disease –there is a significant role for diagnosing benign disease.

Existing CT Guided Needle Biopsies – because of risk profile, some patients will do much better getting superDimension

Existing Bronchoscopies converted to superDimension – 14% bronchoscopic yield for peripheral lesions; if the lesion is beyond the visual field of the scope, superDimension will be used

Existing CT Guided Needle

Biopsies

A Portion of Current

Bronchoscopy Biopsies

Watchful Waiting Patients

CT and Bronchoscopy Biopsies Taken

From Competitors

ENB Procedure Volume

Radiation Oncology or Thoracic Surgery Benefit

HOSPITAL REVENUE: NEW PATIENTS # of Patients RevenuePatients from watchful waiting, new referrals, self referrals = new sD procedures 50

New patients referred for surgical consult 19

(assumes 37% of patients with malignancy)

IMRT, Lung Lesion $16,500.00 0 $0.00

External Beam Treatment, Lung Lesion $12,000.00 0 $0.00

Robotic Linear Radiosurgery, Lung Lesion $18,500.00 6 $111,000.00

Proton Beam Radiation, Lung Lesion $35,000.00 0 $0.00

Neutron Beam Therapy Lung Lesion $15,000.00 0 $0.00

Major Chest Procedure with MCC $25,629.00 2 $51,258.00

Major Chest Procedure with CC $13,309.00 8 $106,472.00

Major Chest Procedure wi/o MCC or CC $9,249.00 3 $27,747.00

New patients treated 19

Total RO or TS Revenue: New patients $296,477.00

The information contained in this model is provided to help you understand the inReach System costs and the reimbursement codes related to the System. It is not intended to be a complete Pro Forma for any center to include all costs, charges and revenue related to the complete procedure. The information contained in this document is provided for information and training purposes only and represents no statement, promise or guarantee by superDimension, Inc. concerning levels of reimbursement, payment or charge. Provides are encouraged to contact their local payers with questions regarding coverage, coding and payment.

For patients diagnosed in 2007, Medicare paid an averageof $43,327 for initial care of each lung cancer patient.

• 225-bed regional referral hospital serving 10 counties in Southeast Indiana

• Hospital Analysis– CEO driven/CFO supported– Integral Part of The Lung Center at Columbus Regional– Community service

• committed to providing comprehensive services, all in one location, for patients with acute and chronic lung disorders

• reduce time from diagnosis to treatment– Differentiate services from Indianapolis and Cincinnati– Increase Cancer Team procedures (surgery, radiation oncology, medical

oncology)– Increase Lung Center procedures (COPD, Asthma, Pulmonary

Hypertension)

Real Clinical Experience13,000+ cases

EducationsuperD UniversityRegional Education Network (REN)Speakers Bureau

MarketingMarketing Outreach

Patient ReferralsPhysician referralssuperD websitespotonyourlung.com website

NavigatorImplementation Program

Product PipelineNew product and indication development

The ProgramNavigator is a superDimension implementation model that outlines key program activities, timelines, processes and accountabilities.

The ProgramNavigator is a collaboration between superDimension and the Hospital and is intended to assist the Hospital in reaching their greatest potential.

Questions????