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Moore's Law and the Convergence of In-Vitro and In-Vivo Diagnostic Technologies
Lab InfoTechMarch 5, 2007
Don Rucker, MDVice President, Chief Medical OfficerSiemens Medical Solutions USA
Diagnostic Products CorporationA Siemens Company
Siemens, GE Enter In-Vitro Diagnostics Market
Opportunities for growth in healthcarearise from the megatrend of demographic change
Growing demand for healthcare
MajorImplication
Demographic Change
i.e. agingand growingpopulation
RelevantMegatrend
Capturing of efficiency potentialin healthcare systems
Healthcare costs
MajorChallenges
Our portfolio reflects the growth opportunities
GrowthOpportunities
WorkflowImprovement,e.g. through:
Earlierdiagnosis &interventionDiseaseorientationKnowledge-based decisionsupportIntegrated IT systems
NORTH AMERICA
Growth: 6.3% LATIN AMERICA
Growth: 6.4% ASIA PACIFIC
Growth: 11.1% JAPAN
Growth: -1.4%
EUROPE
Growth: 4.0%
North America44%
Europe37%
Japan9%
Asia Pacific7%
Latin America3%
U.S. makes up the largest piece of the pie, but Asia Pacific is growing the fastest
2010 - 26.2 Billion Euro
North America47%
Europe34%
Japan6%
Asia Pacific10%
Latin America3%
2005 - 19.4 Billion Euro
*Source: Bayer Strategic Planning Group based on consultant data
SIEMENS MED: International scale
A AudiologyAX Angiography,
Fluoroscopy,Radiographic Systems
CO ComponentsCT Computed
TomographyDX DiagnosticsGS Global SolutionsHS Healthcare ITMI Molecular ImagingMR Magnetic
ResonanceOCS Oncology Care
SystemsRV Vacuum
TechnologySP Special SystemsSW Software FactoryUS Ultrasound
Knoxville MI
Madrid SP
Goa CO
Concord OCS
Hoffmann Estates(Chicago)
MIAX Piscataway
A
Oxford MR Erlangen/Forchheim
AX, SP, CT, GS, MR, AHS, CO, RV, SW
Singapore A
Shanghai CT, AX, CO
Malvern HS
Mountain View US
Suzhou A
Divisions
Manufacturing Sites
Shenzhen MR
Kemnath CO
Rudolstadt RV
Bangalore SW, HS, US
SeoulR&D Center
Kyongju-siUS
Wuxi RV
Indonesia A
> 40,000 employees worldwide
Americas Europe Asia
Tarrytown DX
Los AngelesDX
Through recent acquisitionswe aim to serve the full continuum of care
Workflow-oriented IT
Prevention&
EarlyDetection
CareTherapy
Diagnosis
In-vitroDiagnostics
(IVD)
In-vivoDiagnostics
(Imaging)
2000:Shared Medical
2006:DPCBayer Diagnostics
2005:CTI
Our Strategy
Innovation
Process improvement
CostQuality
Dr. Elias Zerhouni / NIH
Predictive
Preventive
Personalized
Some interesting news recently…
Molecular prevention…
1950’s - Discovery of cholesterol synthesis
1970’s – Statins synthesized
1980’s – Start of statin therapy – Merck’s Mevacor
“Prediction is extremely difficult. Especially about the future.”
- Niels Bohr
Moore’s Law
The number of transistors on an The number of transistors on an integrated circuit & therefore integrated circuit & therefore performance will double every performance will double every 18 months.18 months.
–– MooreMoore’’s Law 1965s Law 1965
Modern medical technology
Two breakthrough technologies:
Modern imagingMoore’s Law works here!
GenomicsMoore’s Law works here!
CT then & now
SIRETOM (1974)
5 min = 1slice
SOMATOM Sensation 64(2005)
0.33s = 64 slices
30-Sec.-Scan: 3.687 axial images with 64-slice Dual-Source CT compared to 41 axial images taken earlier with 2-slice CT
Dual Source CT2 Slice CT
As with “omics”, imaging is HIGH DIMENSIONAL!
Clinical Summary
Echo
Nuclear and Post-processing
EP Lab
Rest EKG
Stress Lab
Lab Results
Registration
Echo ReportsEcho Data
EKG ReportsEKG Data
EP DataEP Reports
Tracings
Nuclear ReportsNuclear Data
Cath Network
EKG Mgmnt System
Soarian Cardiology
Integrating Images and Information
Cath Lab
Cath ReportsCath Data
Imaging now requires IT
Headline
SOMATOM Sensation 64
11sec for 144 mm64 x 0.6mm (2x32)Resolution 0.4 mmRotation 0.37 sec120 kV / 500 mAs
3mm Stent
Courtesy of University of Erlangen, Department of Radiology and Cardiology DHZ Munich
Computer Aided Detection (CAD) –syngo Lung CAD
Steps:
Identification of nodes1
1
Quantification2
2
Comparison withprior exams
3 3
FDA* approval received
in October 2006
* CE approval expected for early 2007
Morphology Physiology Metabolism Molecules
CT
US
MRI, MRS
NM
Fluorescence(optical)
Dynamic, Perfusion
Dynamic, Flow-through, Perfusion
Dynamic, Flow-through, Perfusion, Diffusion, Molecules
Perfusion, Molecules
1 Molecule/Cell
106 -108
Molecules/Cell
Molecules
Multiple Molecules/Cell
In vivo is coming to the scale of in vitro
Biograph TM – PET/CT Image Fusion
PET/CT
Radiation Therapy Planning
Fused PET/CT Target Definition
PET/CT-based Treatment Plan
First ever in-vivo images simultaneously acquired by MR and PET (11.17.06)
PETMR MR-PETCourtesy of University of Tennessee, USA and University of Tuebingen, Germany
BrainPET for MAGNETOM Trio
IT throughout in-vitro and in-vivo diagnostics
X-Ray ComputedTomography
MagneticResonance
MolecularImaging
Ultrasound
In-vivo diagnostics (medical imaging systems)
Immuno-diagnostics
Clinical Chemistry
Nucleid AcidTesting
Hematology Lab Automation
UrinalysisNearPatientTesting
In-vitro diagnostics (medical laboratory systems)
Workflow Management- the missing link to sustainable performance improvement
1HospitalDischargeOrder
2NurseNotified
14House-keepingAdvised
17RoomQueued
3NurseReviewOrders
11PatientEducation
5FamilyNotified
6PharmFills d/cRx's
10FamilyArrives
12TransportNotified
13Pt Out ofRoom
4Nurse d/cProcess
8DietaryNotified
9RespNotified
7PharmNotified
15House-keepingNotified
16RoomCleaned
18NursingSupervisorNotified
19NurseAssigned
20NotifyAdmitting
21Notify ER
Bed TurnaroundHandoffs
PatientDischarged
RoomAssignment
RoomRefresh
Step = Worklist Item = Activity
Source: DPC, Siemens MI
In-Vitro Diagnosticse.g. PTH Testing
In-Vivo Diagnosticse.g. SPECT•CT
Management of ectopicparathyroid adenoma
Para-Thyroid Hormone (PTH) estimation is commonly used to diagnose hyperparathyroidism SPECT•CT can exactly diagnose and localize ectopic parathyroid adenoma
SPECT•CT helps plan the proper surgical approach and ensures full resection of ectopic adenoma
Intraoperative PTH measurements during surgery help the physician to verify and ensure total resection and minimize chance of residual adenoma being left unresected or second adenoma missed outSymbia TruePoint SPECT•CT
IMMULITE 1000 Turbo
An integrated in-vivo in-vitro workflow...
Changing the VALUE equation
Both in-vivo and in-vitro diagnostics have great potential to change the value of the care patients receive
Medicine is one of the few areas where the guild mentality still lives
As we re-enter market economies throughout the world, prevention and early diagnosis gain new currency
Modern in-vitro and in-vivo diagnosis will very likely drive the data sets that underpin cost effective treatment (not the Hx & PE)
? Massive disruptions
Conclusions
• Increasing merger of in vitro and in vivo molecular level diagnosis
• High dimensional, integrated data driven by Moore’s Law
• Rich tool sets to analyze the data
• IT as the driver of workflows
• Central to personalized preventive care
Thank you!
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