Z Corp. Medical Modeling Solutions Improving Patient Outcomes With 3D Precision

1. Z Corp. Medical Modeling SolutionsImproving Patient Outcomes With 3D Precision

2. Agenda • Leading Customers • Applications and Case Examples • Emerging Applications • Additional Capabilities • Technical Requirements • The Z Corp. Advantage

3. 3D Medical Models • Z Corp.’s 3D Printers enable surgeons to rapidly produce inexpensive 3D models to obtain better case information to reduce operating time, enhance patient and physician communication and improve patient outcomes. • The speed of Z Corp. Printers enables 3D models to be used for trauma cases; a significant advancement for use in the medical field.

4. Orthopaedics & Maxillo-Facial University of New Mexico Medical Center Seoul National University Plastic Surgery Fukushima Medical University Clinica Olinda Faminsa Implant Manufacturers Synthes EBI Service Bureaus Medical Modeling Javelin 3D Stereolithographers Pediatrics University of New Mexico Diverse Customer Base

5. Applications and Case Examples Enables pre-operative analysis of complex total hip replacement Pre-operative sizing of uni-compartmental total knee replacement

6. Leading Applications • Pre-surgical planning • Implant pre-contouring • Screw trajectory • Screw selection/location • Instrument selection • Technique rehearsal • Custom implant manufacture • Physician to physician communication • Powerful patient presentation tool • Medical student/resident education • 3D Surface Scanning/Custom Prosthesis Design

7. Pre-Surgical Planning: Implant Pre-contouring • Z Corp. models enable implants to be pre-contoured prior to opening patients • Significantly reduces O.R. time • Lowers cost • Reduces O.R. team fatigue • Enhances patient outcomes • Reduces “re-do” procedures • Minimizes size of incisions • Speeds recovery time • Improves anatomical alignment • Bone “sucks in” to the plates • Enables multiple procedure rehearsals

8. Case Example: Maxillo-facial Surgery • Z Corp. models used for facial trauma cases can be sawed apart and re-aligned for proper anatomical fit of pre-contoured plates • Bone virtually “sucks” up against the implant, insuring a perfect fit

9. Case Example: Maxillo-Facial SurgeryMandible Reconstruction • Pre-contoured mandible plate reduced time in the O.R. by 45 minutes • Dr. Fernando Urrutia Plastic Surgeon (Mexico City, Mexico)

10. Case Example: Orthopaedic Surgery – Acetabula Reconstruction • Pre-contouring acetabula fixation plates can reduce O.R. time by as much as 2 hours • Incisions can be reduced from over 12” to as little as 4” in some cases • Dr. George Brown Chief, Division of Spine Surgery University of New Mexico Health Science Center Albuquerque, NM Complex pelvic and acetabula fracture

11. Pre-Surgical Planning: Screw Trajectory • Z Corp. models are used to analyze fractures and determine the precise location and trajectory of alignment screws and fixation plates Complex bi-lateral pelvic fracture

12. Pre-Surgical Planning: Screw Selection and Location • Z Corp. models permit detailed analysis of bone mass to enable screw length selection and location to occur pre-operatively • Reduces O.R. time • Improves fit of implant hardware

13. Custom Implant Manufacture • Z Corp. models permit the world’s leading implant manufacturers to fabricate custom implants rapidly and cost effectively for the ultimate in performance

14. Case Example: Custom Implant Manufacture • Silicone septum implant was constructed and fit to the Z Corp. model saving 1 hour of O.R. time Dr. Fernando Urrutia Plastic Surgeon Clinica Olinda Mexico City, Mexico

15. Enhance Physician to Physician Communication • Z Corp. models permit excellent communication between physicians and surgical teams; particularly useful in multi-disciplinary cases

16. Patient Communication Tool • Z Corp. models enhance the physician’s ability to communicate with patients; raising confidence in the surgeon and the likelihood of a successful outcome Silicone cheek implant

17. Medical Student/Resident Education Z Corp. models prove very useful in communicating with students and residents Complex 2D images can be converted into easy to understand 3D models that can be held and easily manipulated for a more complete understanding of the anatomy

18. Emerging Applications

19. Cardiology • Advancements in CT technology now permit 3D capture of soft tissue data • Physicians can better quantify size, shape and function of the heart. • Examining the whole, beating heart makes examinations and surgical procedures more precise and rapid.

20. 3D Surface Scanning/ Custom Prosthesis Design • Utilizing 3D surface imaging technology; custom prosthesis can be fabricated from Z Corp. models used as patterns for the development of molds

21. FE Analysis • Full color Z Corp. medical models enable surgeons to better understand the affects of impact and compressive stress on bone to anticipate additional areas of concern

22. Additional Capabilities

23. Model Labeling • Using Z Corp.’s ZPrint software, surfaces can be labeled to mark particular areas of interest on the 3D model • Label text can be raised (or colored on the Z®406 and Z810 Printers)

24. Precision Fixtures • Z Corp. models can be accompanied with precise fixtures to enable measurements and protect models with complex cavities Vascular tumor captured with an MRI

25. Technical Requirements • CT and MRI data in DICOM 3.0 format • 0.5mm – 3mm slices • Mimics™ imaging software (Materialise) • Z Corp. 3D Printer • ZPrinter™310 • Z406 Color 3D Printer • Z810 Large Format, Color 3D Printer

26. Z Corp. Advantages vs. Legacy Technology • Cost • Z Corp. models are the lowest cost in the RP world • $1 - $2 per cubic inch • Speed • Critical trauma data can be captured and transformed into 3D models in hours • Build rate is 1” – 2” vertical inches per hour • Complex Geometries • No support structures permit the most detailed, delicate models with complex cavities to be built and easily post-processed • Material Properties • Models can be sawed, drilled, scribed, painted and bonded very simply

27. Z Corp. Advantages vs. Legacy Technology • Simplicity of Use • Z Corp. 3D Printers and software enable users to be fully trained in 2 days • Full Color Capabilities • Z Corp. models can be printed in millions of colors to communicate FEA (finite element analysis), bone density and tumor location data • Office Friendly • Z Corp. 3D Printers are simple to operate in any office environment and require minimal space

28. Value Delivered • Z Corp. 3D models deliver accurate information rapidly to enable faster, less costly surgical procedures • Pre-contoured surgical implants are positioned easier, more precisely and minimize the likelihood of hardware complications • Communication between individuals, physicians and patients alike, is simplified and easily shared

29. Reimbursement • Several U.S. surgeons have informed Z Corp. about the following CPT codes that can be used to obtain reimbursement funds for 3DP models. • CPT code 76375 was recently created as an adjunct to CT/MRI codes to cover “printed holography” with modifier 22 (unusual procedural service) • Z Corp. has been told by the AMA that the additional codes listed below can also be used to identify what our models are used for. These codes are all now used for making custom equipment/devices for treatment, planning, and simulation. These fall within the 77300 family of codes. They are 77332, 77333, 77334. Each code essentially covers components of varying degrees of complexity.

30. Maxillo-facial and Orthopaedic Surgery References “Simply stated, our Z Corp. models are improving patient outcomes with 3D, computer aided precision.” Dr. Jon Wagner and Dr. George Brown University of New Mexico Health Science Center Albuquerque, New Mexico