Advanced Robotic Positioningfor CT & PET-CT Guided Interventions

About Us

• Robotic targeting solutions for Interventional Oncology [IO]

• Largest installed base of IO planning and targeting solutions globally

• Products Co-created with customers.

• Presenting in most leading markets. R&D labs in the USA.

Towards Global Leadership in IO Assistance

ISO 13485

Clinical Mentors

Co-creating with the best

Dr Mohammed Razavi, MDSt Joseph Hospital, Orange, CA

Dr Yuman Fong, MDMemorial Sloan Kettering, NYC

Dr Damian Edward Dupuy, MD, FACRRhode Island Hospital, Providence

Dr David Lu, MD UCLA, LA

Dr Roy Santosham, MDSRMCH, Chennai, India

Dr Ricardo Lencioni, MDUniversity of Pisa, Italy

Dr Fred Moeslein, MDUMMC, Baltimore

Dr Stephen Solomon, MD Memorial Sloan Kettering, NYC

Our Customer Base

Winning with customers globally

Existing Customers Planned Additions ‘12 & ‘13

Customer List

Pls note that this is a partial list of our customers. For more details pls feel free to contact us.

AIIMS - India Dept. of Radiology

Dept. of Nuclear Medicine

Alfred Hospital - Melbourne Makati Medical Center - PhillipinesNational Cancer Institute,

Sri Lanka RS Hasan Sadikin - Indonesia

Global Hospitals - India Lilavati Hospital - India KG Hospitals - India Sree Chitra Tirunal - India

ILBS - DelhiTata Memorial Hospital - India JIPMER - IndiaCancer Institute - India

King Edward Hospital - India

Jaslok Hospital - India

BHU - India Vijaya Medical Center - India Nivaran Scan - India Saral Diagnostics - India Mahajan Diagnostics - India

Platform of Solutions

New Directions in Interventional Oncology

2009First generation

Robotic targeting system

2011Next generation

Robotic targeting system

2012Planning and

Targeting system for CT guided ablation

FUTUREPlanning and Targeting

system for U/sound guided ablation

New Directions in Interventional Oncology

Computer aided InstaRegTM

system enables quick registration

Integrated Planning Station helps Radiologist plan and verify procedures

Robotic arm converts plan to

needle trajectory

CE Certified

3 2

1

Clinical Application

• Pain Care

• Biopsy

• FNAC

• RFA & Alcohol Ablations

• Drainage Procedures

• Fiducial Marker placement

A Wide Range of Procedures for Radiologists

Click above to play Procedure Video

Robotic Targeting: Accuracy

Mediastinal mass within

2mm of right bronchus and

pulmonary artery targetted

with orbital angle of 27.9°,

through intercostal space

safely

Accuracy enhances patient comfort

Robotic Targeting: Speed

Dr. Atila, University of Istanbul, Turkey performing a procedure with the aid of Perfint’s robotic device

Accuracy enhances patient comfort

Case Registry Summary Total No of Cases 1638Min time (mins) 9Avg Time (mins) 15.5Check Scans/Passes (Avg #) 1.5Smallest lesion size (mm) 7Complications NilCases needing at least 1 manual manipulation

14%

Robotic Targeting: Small Lesions, Angulation

Lung tissue biopsy performed with 22° Orbital and 18° Crano-Caudaul angulation to avoid entry into lung tissue at mid-liver level and angulated towards head.

Sub cm lesion precisely targeted at a depth of 57mm and an orbital angle of -12.82 degrees, without traumatizing critical organs

Assists experts perform complex procedures

Robotic Targeting: Standardized Workflow

Relevant across skill levels …

Retroperitoneal Adenopathy“My first biopsy case was very complex. I was able to plan and place the needle precisely in the first attempt.”

Dr. Arun Kumar, Radiology Resident , Chennai, India

Robotic Targeting: Intuitive as free hand

Your IO Assistant

No Laser guides No Tracked Needles, Fiducials

No Cameras No Fluoro No Stick on Templates

Addressing Patient Movement & Respiratory Motion

Solutions to Clinical Challenges

Tru-cut biopsy of Lung mass close to diaphragm Orbital - 25.84°, CC 1.84. Breath-Hold monitor used.

Univ of Istanbul Turkey

Mayo Clinic designed Medspira Breath Hold monitor for target stabilisation

Patient Stabiliser

Robotic Targeting: A better alternative

ROBIO EX : 100+ customers globally

Robotic Targeting

Unguided Free-hand

Freehand under Fluoro

EM Navigation Optical Navigation

Products in market ROBIO NA i-fluoro / DynaCT IG4 / PercuNav ActiViews

Procedure Time Low High Low High Low

Patient safety High Low Low Medium High

Disposables Low Low Low High Low

Complexity Low Low Medium High Low

Expertise Required Low High Medium High Low

Position accuracy (RMS) 0 mm to 3.0 mm Varies with

Doctors skill Medium 6.4 mm to 13.8 mm ??

Registration time 0.5 min NA NA 10-20 min 10 mins ?

*Perfint hasn’t conducted any comparative study vs other technologies. The data shown here is based on discussions with users / literature available

Features & Benefits Summary

The next level in IO Assistance …

• Robotic accuracy for small and complex targets - CT / PET-CT interventions

• Quick registration using InstaReg TM

• Patient movement & respiratory motion solution

• Procedure specific workflow & reporting

Less radiationNo fluoro for needle placement. Safe on doctor. Safe on patient.

Reproducible Quality Even less experienced physicians achieve excellent results.

Broad Application Improved ability to perform complex procedures.

Challenging Cases

The next level in IO Assistance …

• Biopsy • FNAC • Pain Care • PET CT

Challenging Cases

Retro Peritoneum Mass BiopsyGlobal Hospital, Chennai, India

Retroperitoneal mass (depth: 85mm, orbital angle: 1.72 degrees) was precisely targeted with ROBIO within an accuracy of 1mm in single pass

Time taken for procedure: 10 minutes.

Challenging Cases

Trucut biopsy of lower lobe Lung massIstanbul University, Turkey

Tru-cut biopsy of Lung mass close to diaphragm performed with ROBIO using Medspira Interactive Breath-Hold system was used to synchronize with Orbital angle- 25.84°, Craniocaudal angle1.84°.

The lesion was just above the diaphragm and was moving with respiration. Breath Hold System was used to stabilize the target.

Challenging Cases

Biopsy - Mediastinal massAIIMS Radiology, New Delhi, India

A mass within 3mm of trachea and Aorta at a depth of 87mm.

Targeted with ROBIO without traumatizing the vital structures.

Challenging Cases

Liver biopsy with 3D angle plan

Tru-cut biopsy of a Liver lesion at seventh segment of liver, which was surrounded by Lung tissue performed carefully with 22° Orbital and 18° Crano-Caudaul angulation to avoid entry into lung tissue at mid-liver level and angulated towards head. Needle reached target as per plan at a depth of 84 mm without involving lung tissues.

Challenging Cases

Lung mass biopsy TTSH, Singapore

Sub cm lesion precisely targeted at a depth of 57mm and an orbital angle of -12.82 degrees, without traumatising major organs.

Challenging Cases

Lung FNAC 8.5mm lesion Makati Medical centre, Manila, Philippines

Sub cm lesion precisely targeted at a depth of 57mm and an orbital angle of -12.82 degrees, without traumatising major organs.

Challenging Cases

FNAC of mediastinal mass Apollo Hospital, Hyderabad, India

Mediastinal mass within 2mm of right bronchus and pulmonary artery targetted with orbital angle of 27.9° through intercostal space safely.

Challenging Cases

Facet Joint Injection Makati Medical Center, Philippines

Bilateral facet joint steroid injection for pain management ... both the needles reached target precisely with an orbital angle of 7° to 8° in a single pass.

Challenging Cases

Bilateral celiac plexus alcohol ablation Global Hospital

A deep seated Celiac ganglion (contrast enhanced) was accurately targeted with ROBIO within a single needle pass, without involving critical abdominal structures.

Challenging Cases

Selective Nerve Root Block

Facet joint steroid injection was precisely delivered with ROBIO, both the needles reached target (size 2mm) safely at a depth of 54mm with an orbital angle of 7° in a single pass.

Challenging Cases

PET CT Case – Lung mass biopsy

The active region spotted with PET CT at peripheral region of mass close to left chest wall. The FDG hyper activity region was precisely targeted with ROBIO without traumatizing major organs.

Challenging Cases

PET CT Case – FNAC of Mediastinal Mass

Mediastinal mass proximal to vital blood vessels. PET CT findings - Hotspot noted close to anterior chest wall. The FDG hyper activity hotspot was precisely targeted with ROBIO at orbital angle of 14.75 deg.

Challenging Cases

PET CT Case – Liver biopsy

PET CT reveals the active lesion (mass right lobe of the liver) within the mass on the right side. The hot spot region in the liver-mass targeted With ROBIO at an orbital angle of -6.79 degrees.

New Developments

New Developments

• 3D Visualization and tumor segmentation

• Tumor boundary definition

• Probe path simulation and planning

• Simulated ablation volume display

• Robotic targeting

• Intra-operative adaptive planning and execution

• Post procedure visual validation

• Sterile disposables for execution assistance