Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Workshop on Hadron Beam Therapy of CancerErice, Sicily April 24-May 1 2009

© Siemens AG 2009. All rights reserved.

Matthias HerforthVP Business Development and Communications

IONTRISSynchrotron based PT Solutions from Siemens AG

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Status Siemens Takes Complete Responsibility for Combined Systems

2003 Siemens decided to provide combined proton & heavier ions systemsPositive clinical trials for protons and carbon ions including biological advantages of carbon ions to treat radio-resistant tumorsEconomic advantage of carbon ions due to potential hypo-fractionation

Siemens licensed GSI patents and initiated knowledge transfer10 years of clinical experience in active scanning technology with carbon ions

Siemens decided to take responsibility for the complete systemWorkflow driven top down design of PT system and its subcomponents

2004

2008

Joint development of Siemens with DanfysikMedical engineering knowhow and accelerator technology within one collaboration

Acquisition of PT branch of Danfysik A/SDanfysik has been integrated into PT and became a 100% subsidiary of Siemens

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

StatusAchievements of Siemens in the Particle Therapy

Order: complete PT equipment fora project in Asia

2009

Order: complete facility including building forNRoCK Kiel, University of Schleswig-Holstein, German

2008

Order: Treatment planning system for CNAO, Pavia, Italy

2007

Order: complete PT equipment forPTZ Marburg University, Rhoen Clinic, Germany

2006

Order: Patient environment for HIT, Heidelberg University, Germany

2005

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Status - Implementation has Top PriorityWe focus on Implementation - Acquisitions of new Projects are Suspended

Resources have to be focused on developing, implementing, optimizing and innovating the systems under contract

Sales activities are being discontinued, our customer relationship management will stay present for the Particle Therapy community

Siemens PT has increased R&D spending furthermore and is still ramping up staff

Siemens continues to develop PT technology further together withour existing clinical and industrial partners

Siemens is committed to long-term maintenance and uptime servicecontracts

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Market SituationLet us Face the Challenges Together !

RevenuesMore approved clinical applications (clinical trials/protocols) medical communityLong term secured reimbursement rates healthcare payers

Patient numbersExcellent workflow to support high patient numbers vendors / users Long term technical operation secured by maintenance contract vendors

Patient benefitsMore proven clinical outcomes medical communityShort treatment courses, e.g. by hypo fractionation medical communityHigh patient comfort vendors Best treatment precision (conformity and positioning) vendors

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Long system lifetime Flexible and future proven technology vendors / operators (e.g. additional ions and medical applications)

Risk sharingTechnical risk (installation and maintenance) vendorsMarket risk (patient referral) operator or PPP model

(public private partnership)

Economic feasibilityFits to customers and vendors business plan vendors / operatorsOverall cost and time optimization (incl. project execution) vendors

Market SituationLet us Face the Challenges Together !

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Energy range85 - 430 MeV/u (Carbon) 50 - 250 MeV (Protons) more than 200 energy levelsRange up to 30 cm in water

Ramping speed til max. energy0.5 s (protons) 1.0 s (carbon ions)

Extraction time from 1 to 10 sMaximum intensity

2 x 1010 protons/cycle1 x 109 carbon ions/cycle

Synchrotron diameter 22 mShort switching times

10 s same ion species30 s with change of ion species

Accelerator Design Specs

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Revised HIT Accelerator Design by a Cooperation of GSI, Danfysik and Siemens

The GSI / HIT accelerator design has been modifiedto improve technical capabilities to reduce construction and operating costs

Examples12 dipoles (each 8 tons) instead of 6 (each 25 tons)

cost reduction, easier installation and handlingSmaller and lighter quadrupoles

cost reduction, less power consumptionOptimized injection and extraction system

higher intensity, shorter treatment times3 sources

more flexibility, other ions speciesPreventive and condition based maintenance concept

high uptime

Courtesy of HIT and Danfysik

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

PT-System Architecture Highest Precision for Treatment

Courtesy of GSI, Darmstadt, Germany

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Beam position and profile measurement 2 redundant multi-wire proportional chambersPosition measurement: every 50-200 µsPosition accuracy: circle with r = 0.5 mm

Intensity measurement3 parallel plate ionization chambers (redundant and diverse)Readout every 10 µs - Data on file -

Improved GSI Detector System Design Specs - Beam Application and Monitor System

Development based on GSI concept:Detector system with highly integrated readout electronics

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Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Advantages of the Robotic SystemsHighest Precision Design and Workflow Optimization

Robotic patient positioning systemIdentical in treatment and CT roomsPosition correction in 6 degrees of freedomAbsolute position accuracy independent from patient weight R ≤ 0,5 mm

Robotic imaging systemOrthogonal x-ray and Cone beam CTPosition verification in treatment positions

Workflow optimizationAutomated hand over of table top Automated positioning according to treatment planReduction of patient preparation time in treatment roomSemi automated QA procedures

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Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

45° and 90° Beam in one Treatment RoomRobotic Patient Positioner and Imaging System

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Robotic Patient Positioning and Verification SystemHeidelberg Ion Therapy Center (HIT)

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

The University of Heidelberg ProjectHeidelberg Ion Therapy Center (HIT)

Siemens supplies all componentsrelated to patient environment:

Scanning and monitoring systemRobotic patient positionerImaging system (2D x-ray and CB CT)Therapy control system (TCS)

Collaboration on syngo ® PT planningCourtesy of the University Hospital of Heidelberg, Germany

Start of construction: November 2003Start of Siemens installation: June 2006

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Status - Heidelberg Ion Therapy Center HIT Scanning System at HIT is in Operation

Intensity and position controlled scanning system in operation

Irradiation of complicated patterns (Autumn 2007)

Homogeneity (Spring 2008)Homogeneity of scanned fields: ~1,7% in central 80%

Position stability (Spring 2008)Better than 0.25 mm with position control

Still ongoingIntegration of IT subsystems into overall system andsystem test

Time [50µs/sample]

~0.25mm

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Rhön Klinikum AGUniversity of Marburg /Giessen

Project start: September 2006

Ground breaking: August 2007

First patient planned:December 2010

Configuration:3 rooms with horizontal beams1 room with semi vertical beamdesigned for more than 2000 patients /a

All particle therapy equipment will be provided by Siemens

Courtesy of Rhön-Klinikum AG, Germany

66m / 216.5ft

110m / 361ft

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Rhön Klinikum AGUniversity of Marburg /Giessen

Up to now all milestones have been reached (construction and installation):

Project start:September 2006

Ground breaking:August 2007

Start of installation:August 2008

Start of commissioning:January 2009

First patient planned:December 2010

Courtesy of Rhön-Klinikum AG, Germany

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Rhön Klinikum AG - University of Marburg /GiessenSources

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Rhön Klinikum AG - University of Marburg /GiessenSynchrotron

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Rhön Klinikum AG - University of Marburg /GiessenHEBT

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Ground breaking: July 2008First patient planned:Conventional radiation therapy End of 2011Particle therapy Begin of 2012Configuration:

3 rooms for particle therapy +1 room for further extension2 rooms for conventional radiation therapyModalities (CT for Therapy Planning, PET-CT, MRCyclotron, Hot LabBrachy TherapyTherapy specific IT - SolutionsClinical care rooms (30)

University Hospital Schleswig-HolsteinNRoCK – Nordeuropäisches Radioonkologisches Centrum Kiel

Public Private Partnership Project (Consortial partners: SAG, Bilfinger Berger Hochbau)Largest PPP project in the German health-care sector to date

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

Project Structure / Organization

EstateUK S-H

(University Hospital)

Defined Rate of PaymentPPP-Contract

(Finance, Build, Non-medical Service)

Project Company(PTZ GmbH und Co. KG.)Sponsors (Equity) Debt (Banks)

City Kiel

Operating Company for Medical Service(NRoCK GmbH)

Health Insurance Funds;

PatientsEstate

Urban

Develo

pmen

t

Contra

ct

Facility Management

HSG

Technical Operation and

Maintenance PTSiemens AG CS

Building Consortium

Bidding Consortium

Federal StateSchleswig-

Holstein

Design & Build (Building)

Bilfinger Berger Hoch/Tief

Development & Delivery

(Particle Therapy)Siemens AG PT

Siemens Particle Therapy products and solutions are works-in-progress and require country specific regulatory approval prior to clinical use.

University Hospital Schleswig-Holstein (NRoCK)Facility Layout of the Turn Key Project