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Corporate Structure

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Headline Ziehm Imaging Worldwide

Global Mfg. HQ: Nuremburg, Germany

US HQ: Orlando, FL

Offices

1 Orlando (USA)

5 Shanghai (China)

6 Reggio Emilia (Italy)

7 Moscow (Russia)

8 Jävenpää (Finland)

9 Nuremberg (Germany)

Technological Growth

2

First DSA integrated into mobile c-arms

First compact mobile c-arm

without monitor cart

First active water cooling lengthens fluoroscopy time

First full DICOM integration

First true fully digital mobile c-arm with flat-panel detector

First Virtual Mechanics and 3D imaging

First Object Detected Dose Control (ODDC)

Introduction of Ziehm Vision2 – Integration of 1k2 image processing with 3D imaging & flat

panel detectors

2000s 1990s 1980s 1970s

First automatic exposure timer to control medical x-ray systems

Ziehm Quantum Introduced

Tech

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Product Portfolio >Ziehm Solo

>Ziehm Vision2 Family

– Ziehm Vision2

– Ziehm Vision2 Vario

– Ziehm Vision2 Vario 3D

– Ziehm Vision2 FD

– Ziehm Vision2 FD Vario

– Ziehm Vision2 FD Vario 3D

– Ziehm Vision R

– Ziehm Vision RFD

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Product Overview

Single component platform for simple maneuverability Ziehm Solo:

>Monitor mounted on

articulating support arm

>1k x 1k imaging chain for high

resolution

> Intuitive touchscreen user

interface

>Pulsed 2 kW monoblock

generator for optimal image

quality

>Light-weight design with

compact footprint

Vision Family Vision(2) Vision(2)FD

Vision RFD Vision R

Vision(2) FD Vario 3D Vision(2) Vario 3D

Overview: Ziehm Vision Family

Same Power: 2 kW

Same Power: 7.5 kW

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Same Power: 2 kW

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2D

2D + 3D

Unique Features

Ziehm Vision Family

Always Pulsing

> 1-25 pps. > (1-30 pps. For I.I. based systems)

> Conventional C-arm generators only pulse up to 8 pps unless using high dose level modes

> Delivers higher mA than real-time fluoro while limiting patient dose

> Improved anatomic visualization

> Reduced noise

> Short pulse widths can reduce blurring and motion lag when needed

> 4-30 ms., determined by unit selected and anatomic program

- For high IQ at a lower dose

Vision PulseTM Generator

Confidential - For Ziehm internal use only

25 pps. “real time fluoroscopy pulse” can provide either:

mA levels similar to conventional real-time fluoroscopy at a lower

dose

- or –

Higher mA output at a dose level similar to real time fluoroscopy

time

Vision Pulse Generator

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Conventional real-time fluoroscopy Ziehm Vision Pulse


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Monoblock Generator enables more efficient pulses More generator output contributes

to image quality

Vision Pulse ™ Monoblock Design

GE Pulse Technology = wasted energy

- Additional dose for patient and customer

that doesn’t contribute to image quality

- Additional heat accumulation

Monoblock technology: Power supply and tube located in the generator housing

High voltage travels through ≈ 8 ft. of high tension cables, causing capacitive discharge


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Liquid Cooled Heat Exchanger

> Enables Prolonged Fluoro Times

> Closed-loop Heat Exchanger

> Circulates hot air from the tube

housing to the C-arm’s base

> No tube fans to interfere with draping

> Cooling rate at over 100,000 hU/min -

Nearly 3X cooling rate of conventional C-

arms

Advanced Active Cooling

7:30am 9:00am 10:30am 1:00pm 2:30pm 4:00pm 5:30pm

Case Load 1 2 3 4 5 6 7

AAA EVAR DVT Therapy

Thoracic

Evar Renal Stent

Fistula

Delcot

Carotid

Stent AAA EVAR


Digital Cine Pulse

For demanding dynamic imaging procedures

Fast 12.5 or 25 pulses per second

Automatic Cine Recording

Up to 20 mA with Vision2

Up to 75 mA on Vision R and RFD

Available with the entire Vision family

DSA option not required

Ziehm Vision2 time

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75 mA

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20 mA

Ziehm Vision R and RFD time


Vision Center

Dual Touchscreen Control

> Duplicated at C-arm and Monitor Cart

> Simple Icons for easy use

> No need for technolgist to go to

workstation during the procedure

- For ease-of-use


Generator

Industry leading Power technology

BOOSTCAP® Ultra capacitors –

Lighter weight and compact design

No battery packages requiring replacement

Ziehm Vision R & RFD

Unique performance with pulsed power

- For high power performance, lighter weight


Improved light transfer efficiency 2 Ways:

> Camera lens size matched to CCD

element pixel size > CCD spectrally matched to

(green) output of I.I. More efficient light transfer means less

dose is required for anatomic visualization

Optimized Optics

1k² video with low dose


“Endo” option

>Large Landscape Format High-

resolution Color Monitor

>Displays Endo, Arthro or

Ureteroscopic image next to

the Fluroscopic Image

>Customized footswitch allows

simple physician control of:

– Fluoro

– Fluoro Save

– Fluoro Cine Record

– Color display on/off

ADCS – active S-distortion correction

package

Real-time magnetic field correction coils for

eliminating S-distortion

For 31 cm Image intensifier

Standard on Ziehm Vision & Vision R

31 cm/12“ I.I.

Without correction

Distortion correction

With correction


Ziehm Vision

ODDC Object Detected Dose Control

ODDC featuring:

Measurement grid over whole

field of view.

Detects anatomy and activates

Dose- and Video-control with

auto-histogram.

ODDC also featuring:

MD – Motion Detection

ADR – Automatic Dose

Reduction

AMC – Automatic Metal

Correction

Object Detected Dose Control

- For high IQ at lower dose

Object detected dose control ... in the background

How does ODDC work?

Ziehm’s Proprietary ODDC

with grid-measurement over

region of interest

256 cells covering the whole

FOV

Conventional Automatic

Exposure Rate Control

with measurement circle

Difficult adjustment of

exposure when anatomy

is not properly centered

- For fewer “re-takes”

ODDC benefits:

Independent object

positioning.

The whole field of

view could be used

for exposures.

Perfect help in

Trauma cases and in

specialized operative

orthopedics

ODDC insight:

Digital Dose- and Video- control Measurement-grid highlighted

Featuring 2 x 256 auto-Histogram over region of interest

in real time 30frames/s (for illustration only)


- For fewer “re-takes”

MD Motion Detection

Lowers noise reduction filters

automatically when object is moving.

Example:

-Positioning of patient

-Repositioning of fracture

-Catheterisation, etc


- To reduce blurring in moving anatomy

Object Detected Dose Control ... automatic dose reduction

ODDC is the base for automatic dose reduction

•Pulse rates automatically reduce when anatomic motion is absent

- For automatic dose reduction

AMC Automatic Metal Correction

Introducing real-time

interactive Metal correction for

elimination of Metal artifacts

such as blooming effect.

- For automatic adjustment to metal

Intraoperative 3D Imaging

Vision Family Vision(2) Vision(2)FD

Vision RFD Vision R

Vision(2) FD Vario 3D Vision(2) Vario 3D

Overview: Ziehm Vision Family

Same Power: 2.2 kW

Same Power: 7.5 kW

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Same Power: 2.2 kW

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2D

2D + 3D

Ziehm Vision² (FD) Vario 3D – Mechanics

Variable Iso Center

>Scan angle: 135°

>Scan time: 1 min

> Images: 110

Ziehm Vision² (FD) Vario 3D

Click here to view

Flash demonstration

Of Isocentric mechanics

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Mechanics

„Truly Isocentric C“ Ziehm Vision² (FD) Vario 3D – Variable Isocenter

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Ziehm Vision2 Vario 3D

Mechanical Advantages

>Actual Field of View affected by geometry

>Less dose to the patient

> Improved geometric detail

Ziehm

Ziehm Vision² (FD) Vario 3D – Mechanics

Advantages Variable Iso Center

Working closer to the patient

More anatomy demonstrated within the field of view

LAT setting 21 cm LAT setting 11 cm

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Siemens Arcadis Orbic 3D vs. Ziehm Vision² (FD) Vario 3D

Vision2 FD Vario 3D Siemens ARCADIS Orbic 3D

- 562 lbs. - 765 lbs.

- 35” freespace - 31” freespace

Vision2 FD Vario 3D Siemens ARCADIS Orbic 3D

63” long 85” long

New applications: Pedicle screws, Vertebroplasty and more

Click on Picture for cine playback

Click here to view

Flash demonstration

Of 3D workstation

Vision2 FD and Vision2 FD Vario 3D

Advantages of Flat Detector

Technology

1. IQ: Extended dynamic range

2. Larger Field of View

3. 5” More Free space in C

4. IQ: No Distortion

Extended Dynamic Range

True digital imaging

High dynamic range

(>16k grey levels)

>Visualization from the soft tissue

to bone

>Quantum efficiency: 80%

(I.I.: 65%, film: 30%)

Larger Field of View

Square 20 cm. detector

Benefits:

15% larger field of view

compared to 9” cm Image

Intensifier

Compact Design, Large C

Increased free space

>Smaller housing compared to I.I.

>Larger C-arm opening

>Easier positioning around table,

patient and instruments

+ 14 cm

+ 5.5´´


No Image Distortion

standard 30cm I.I.

True digital imaging

No image distortion

> No influences from terrestrial magnetic field

> Higher accuracy in combination with navigation systems

20cm flat detector 20cm flat detector

Applications – Spine

By the courtesy of University of Leipzig

Applications – Shoulder /Oral-Maxillofacial

By the courtesy of University of Hannover By the courtesy of University of Hamburg

Applications – Hip / SI Joint

By the courtesy of University of Hannover By the courtesy of University of Hannover

Applications – Brachytherapy – Prostate NEW!

By the courtesy of University of Erlangen

3D Imaging & Navigation

Stryker

>Available since February 2009 for

Vision² Vario 3D and Vision² FD Vario

3D

> Installation for Stryker’s Navigation

System II for SpineMap™ 3D

Navigation and OrthoMap® 3D

Navigation

Combination with Navigation Systems


BrainLAB

>Available since September 2008 for

Vision² Vario 3D – combined with 2D

Navigation

> Installation for BrainLAB’s

VectorVision or Kolibri navigation

stations

>Vision2 Vario 3D (I.I. Version) 3D

interface available since 2008

>Vision2 FD Vario 3D interface

available since 2009

Medtronic

>Work in progress for 2D and 3D

navigation interface


Vision RFD

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Highlights:

IMAGE QUALITY: Resolution: 1.5k x 1.5k (2.225M pixels) Dynamic Range: 16k grey scales Small vessel detail

PROCEDURE THROUGHPUT: 7.5kW Monoblock PULSE Generator Liquid Cooled Heat Exchanger Dose Reduction

FIELD OF VIEW: Area: 900cm² (30cm x 30cm) 2 Zoom Modes: 30-20-15cm

EASE OF USE:

Vision Center Control Panel Larger C-arm Opening 165° of Orbital Rotation

Ideally suited for complex procedures in; Endvascular Surgery, Interventional Radiology and Interventional Cardiology

Fixed Room Imaging in a mobile platform

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The Ziehm Vision RFD

> True digital imaging

> Active Matrix Flat Panel

> Amorphous Silicon Photodiode

> Cesium Iodide Scintillator

> 30 x 30cm Square imaging field

>Clinical Benefits:

> 49% Larger field of view

> Improved reliability

> Increased DQE

> Small vessel detail

Strictly confidential - For internal use only

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Vision RFD – Flat Panel Image Quality

True Digital Imaging

>Crisp Clear Vascular Imaging

>Dose Quantum efficiency: 80%

(I.I.: 65%, foil: 30%)

>High dynamic range –

visualization from the soft tissue

to bone

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Liquid Cooled Heat Exchanger

> Enables Prolonged Fluoro Times

> Closed-loop Heat Exchanger

> Circulates hot air from the tube

housing to the C-arm’s base

> No tube fans to interfere with draping

> Cooling rate at over 100,000 hU/min -

Nearly 3X cooling rate of conventional C-

arms

Advanced Active Cooling

7:30am 9:00am 10:30am 1:00pm 2:30pm 4:00pm 5:30pm

Case Load 1 2 3 4 5 6 7

AAA EVAR DVT Therapy

Thoracic

Evar Renal Stent

Fistula

Delcot

Carotid

Stent AAA EVAR


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Ziehm Vision RFD:

Customer Feedback

“This picture is definitely better than I’ve seen.

There’s much better visibility and accuracy. I’m

able to clearly see the vessels while deploying

the stent. The ability to see fine vessel detail is

critical in complex endovascular procedures and

the quality of the image from the Ziehm Vision RFD

provides the level of detail required for successful

stent or graft deployment.”

Dr. Zahi E. Nassoura, Vascular Surgeon and

Chief of Staff at Providence Tarzana Medical

Center, Tarzana, CA.

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Ziehm Vision RFD: Some Examples

Rome, 26.11.08

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Larger Free Space

Rome, 26.11.08

Space

54 Rome, 26.11.08

Thank you!

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