Surgery Business Newsletter August 2012

South-

Surgery Business South- Newsletter .....................................................1 Announcements............................2 US News and World Report - Best Hospitals 2012: Neurology and Neurosurgery ...............................2 Brainwash 2.0...............................3 Return of items to AG....................4 Ultrasound as a Navigation tool.....4 Technical Troubleshooting Tips......4

Announcements
US News and World Report - Best Hospitals 2012: Neurology and Neurosurgery
Rank 1 2 3 4 5 6 7 8 9 10 Top 50 Institutions Johns Hopkins Hospital Mayo Clinic (ENT & CMF) Location Baltimore, MD Rochester, MN IGS Details 8 IGS Systems (3 Kolibri, 4 VVSky, dedicated pediatric VVSky), iPlanNet, DLB, iMRI 4 ENT Kolibri, CMF, iPlanNet, iPlanRT, ExacTrac 7 IGS Systems (3 VVSky, 2 VVc, 2 Kolibri), iMRI, iCT, iPlanNet 9 IGS Systems (VVSky, Navivision, 6 Curves, Kolibri), iPlanNet, iAngio, SRT

Massachusetts General Boston, MA Hospital New York Presbyterian University Hospital New York, NY of Columbia and Cornell Cleveland Clinic UCSF Medical Center Cleveland, OH San CA

3 IGS Systems (2 VV2, VVSky), iMRI, iPlanNet, Novalis Francisco,9 IGS Systems (2 Curve, 5 VV2, 2 VVc), iPlanNet Kolibri, iPlanNET, DLB 4 IGS Systems (2 Kolibri, 2 VVFlex), iPlanNet MDT N/A Partner with NY Presbyterian

UPMC University of Pittsburgh Medical Pittsburgh, PA Center NYU Langone Medical Center New York, NY Barnes Jewish HospitalWashington St. Louis, MO University Hospital for Special Surgery New York, NY

US News and World Report - Best Hospitals 2012: The Honor Roll (Best Overall)
Rank 1 2 3 4 5 Top 50 Institutions Massachusetts Hospital Johns Hopkins Hospital Mayo Clinic (ENT & CMF) Cleveland Clinic General Location Boston, MA Baltimore, MD Rochester, MN Cleveland, OH IGS Details 7 IGS Systems (3 VVSky, 2 VVc, 2 Kolibri), iMRI , iCT, iPlanNet 8 IGS Systems (3 Kolibri, 4 VVSky, dedicated pediatric VVSky), iPlanNet, DLB, iMRI 4 ENT Kolibri, CMF, iPlanNet, iPlanRT, ExacTrac 3 IGS Systems (2 VV2, VVSky), iMRI, iPlanNet (expecting PO for Kolibri, 2 Curve by 8/10/12), Novalis

Ronald Reagan UCLA Medical Los Angeles, CA 4 IGS Systems (4 Curve), iPlanNet, Novalis Center

6 7 8 9 10

Barnes Jewish HospitalWashington St. Louis, MO University New YorkPresbyterian Hospital of New York, NY Columbia and Cornell Duke University Medical Center Durham, NC Brigham and Womens Hospital Boston, MA UPMC- University of Pittsburgh Medical Pittsburgh, PA Center

MDT 9 IGS Systems (VVSky, Navivision, 6 Curve, 1 Kolibri), iPlanNet, iAngio, SRT 5 IGS Systems (1 Kolibri, 4 VV2), Novalis 2 Curve, iMRI, iCT, iPlanNet Go-Live 2013 3 IGS Systems (VVSky, 2 VVc), iMRI, iAngio, iPlanNet, Novalis Kolibri, iPlanNet, DLB

US News and World Report - Best Pediatric Hospitals 2012: Neurology and Neurosurgery
Rank 1 2 3 4 5 5 7 8 9 10 Top 50 Institutions Boston Childrens Hospital Childrens Philadelphia Childrens Cleveland Clinic Cincinnati Hospital Medical Center Johns Hopkins Center Hospital Location Boston, MA ofPhiladelphia, PA IGS Details 2 IGS Systems (VVSky, VV2), iPlan, iMRI MDT

Hospital Childrens

3 IGS Systems (2 VV2, VVSky), iMRI, Cleveland, OH iPlanNet (expecting PO for Kolibri, 2 Curve by 8/10/12), Novalis Cincinnati, OH 3 IGS Systems (2VVSky, Kolibri), iMRI, 3D Fluoro, iPlanNet

Childrens

8 IGS Systems (3 Kolibri, 4 VVSky, Baltimore, MD dedicated pediatric VVSky), iPlanNet, DLB, iMRI Houston, TX MDT MDT MDT VV2 iMRI Go-Live 2013 2 IGS Systems (VVSky, Kolibri), iMRI, iPlanNet, IGSonic, Spine

Texas Childrens Hospital

St. Louis Childrens Hospital- Washington St. Louis, MO University Seattle Childrens Hospital Seattle, WA Childrens National Medical Washington, Center DC Nationwide Childrens Columbus, OH Hospital

Brainwash 2.0
Tool is intended for anonymizing (xBrain or DICOM) patient data in order to ensure the patients privacy Any Brainlab employee shall use Brainwash if patient data needs to be transferred from Brainlabs customers to Brainlab for technical assistance, complaint investigation or testing activities. FTP location: /universal/Software/ReleasesInternal/BrainLAB Tools

Return of items to AG
I want to let you know that all RMA products always go back to Chicago office. Please do not send any parts for repair or RMA any products to AG. Remember, that INC. is a subsidiary of AG and purchases products from the AG office. When products are sent to AG, they remain unaccountable at INC. thus affecting our internal revenue.

Ultrasound as a Navigation tool

-Chad Jacobs Ultrasound can be a very powerful tool for Brainlab. In order to sell the surgeon on the product, you need to feel comfortable at least talking about the key features; but since few hospitals utilize ultrasound integration, few people feel comfortable talking about it. Take a look at some of the key talking points below and try to bring them up if you are in a room with a surgeon who utilizes ultrasound or is interested in ultrasound. After working the Aloka-Brainlab ultrasound partner booth for several days at this past AANS, I did not encounter a single surgeon who was already an ultrasound user that did not think ultrasound integration would be of great use, and the features we offer help surgeons who are not trained on ultrasound learn the technology. Ultrasound allows the surgeon to intraoperatively acquire a series of ultrasound images, and these are reconstructed into a 3D dataset, just like a CT or MRI, that the surgeon can then navigate off of with any of his other navigated instrumentation. This is the key feature that sold Dr. Goodman on the technology, because he could navigate off of an intraoperatively acquired images, without an iCT or iMRI, to account for what he feels is 5-10cm of brainshift in any given brain surgery. The integration provides the ability to overlay the live ultrasound view on top of your navigated MRI, CT, etc. scan, with pre-planned objects, and shows the angle of the ultrasound slice in the 3D views. This is a great tool for surgeons trying to learn ultrasound who were not trained on it, because it correlates the sometimes challenging to interpret ultrasound view with the pre-op scan images they are familiar with. It also provides the surgeons with the ability to verify the level of brainshift, comparing the real time ultrasound images with the pre-op scan, and even use the object shift function to move and adjust their objects into the correct position on the dataset. Our ultrasound integration can couple with any external ultrasound, and any probe. If we do not already produce an adaptor to fit a specific ultrasound probe, there is a kit that allows us to take a mold of the probe and an adaptor will be made (see the Ultrasound for Cranial/ENT SM 10-251 for a link to the list of existing probes). Stryker cannot do ultrasound integration, and Medtronic has a difficult time with it. Another company named Sonowand tries to sell a combination navigation-ultrasound unit for $400,000-$500,000 and it only does ultrasound with no other specialized navigation or planning features, such as BOLD, fibertracking, microscope integration, and on and on, combining an inferior ultrasound unit with an inferior navigation unit. The burr hole probe can be calibrated so that a navigated biopsy needle or shunt stylet can be seen passing live down the ultrasound view on real time anatomy. By learning the key features of ultrasound and being able to talk about them to pique a surgeons interest, we can help build upon this powerful tool and lean on a technology that our competitors cannot match

Technical Troubleshooting Tips

Plan content gets lost when importing via Interactive DICOM Viewer (in combination with Patient Data Manager 1.x) into Cranial/ENT 2.x Scenario: When loading treatment plans via "Interactive DICOM Viewer" into Cranial/ENT 2.x, parts of the content gets lost, e.g. registration markers (pre- or intra-operative), registration information (for restoring a registration), and intra-operative acquired landmarks for reregistration or 2D image sets. Solution: Workaround 1 (in case the intraoperative data load is not available): Always start the navigation software directly from Patient Data Manager 1.x, e.g. by pressing Cranial 2.1, and then select the corresponding treatment plan. By starting the navigation with the previously navigated plan you will never lose any content. Workaround 2: Press the Load Data button within the Data menu and choose the corresponding treatment plan. The content that was eliminated by Interactive Dicom Viewer will be available by then. Decreased performance of Cranial / ENT 2.x due to acquisition of many screenshots. Scenario: Acquiring many screenshots decreases the performance of the software. Short term solution: Avoid acquisition of more than 20 screenshots per case. Long term solution: Next Cranial / ENT software version internally called Poseidon will solve this issue. Software crash when pressing the 3D Ultrasound acquisition button. Scenario: Pressing the 3D Ultrasound button might lead to a crash under certain circumstances. Short term solution: Define the cone during the ultrasound calibration not exactly at the image border, but 1 or 2 pixels beside the border. Long term solution: Next Cranial / ENT software version internally called Poseidon will solve this issue. No screenshots available when saving plan from navigation to USB stick. Scenario: Patient Browser 2.x is currently only extracting the screenshots from xbrain if the data is saved in a compressed archive. Due to a bug in Patient Browser 2.x screenshots are currently not extracted from xbrain if there is already unpacked/uncompressed xbrain data of the same patient on the USB stick. Solution: Workaround 1 (PREFERRED): The software where you create the plan for the navigation should be configured to write xbrain data only in Brainlabs compressed xbrain format (xbrain-Archive). Positive side effect for user: Writing xbrain data as xbrain archive accelerates the write process on USB as well. (Reason: Writing one big single file is easier to handle for windows than several small files.) So if you look at your archive settings in iPlan 3.0.x, make sure you have the compression checked under the archive settings when saving xbrain data to the USB. Workaround 2: Avoid saving patient data on a USB stick where unpacked patient data of this patient are already stored -> To be safe: Only export data on empty USB sticks