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!