ViewRay Renaissance Business Case UWHC Authority Board November 3, 2010

1. ViewRay Renaissance Business CaseUWHC Authority BoardNovember 3, 2010

2. Introduction • Our vision is to provide the cancer patient with cutting edge technology that improves patient care and increases research opportunities • With Healthcare Reform on the horizon, it will be critical to differentiate ourselves from the competition in providing the most comprehensive treatment options for our patients as an accountable care organization • UWHC will be one of the first three facilities to receive the new equipment nationally. This new technology enhances UW Health’s position as a quaternary care provider • Our Radiation Oncologists and physics staff have been involved in this technology development, increasing our credibility as a global research partner • UW Health has already invested $450,000 into the Renaissance project to position ourselves as a technology leader

3. Renaissance Technology • Image Guided Radiation Therapy (IGRT) system • Provides external beam radiation from three gamma (cobalt) sources with real-time motion tracking by the Magnetic Resonance Imaging (MRI) • Used in tumors that may move over the course of a treatment due to breathing, internal movement, and changes in size of tumor • Provides automatic gating so beam turns off if target moves out of range • Most advantageous use in lung, liver, and prostate cancer

4. The RenaissanceTM System 1000

5. Targeting a Moving Tumor a) b) c) d) a) imaging of a lung tumor that is off target; b) motion of the tumor; c) treatment while the tumor is on target; and d) MRI data that enable the real-time imaging of the patient anatomy and targets.

6. University of Wisconsin Technology Assessment Committee—February 2010 • Pending Food and Drug Administration (FDA) approval, the Technology Assessment committee recommended the acquisition of the Renaissance due to: • reduction in patient radiation dose to healthy tissues • gain in market share from being a first mover with this new technology • enhanced research capabilities • positive financial outlook

7. Timeline of Future Events • Construction bid process: November/December 2010 • Start of Vault Construction: January 2011 • ViewRay expects to have final FDA approval March/April 2011 • Earliest expected Delivery of Equipment: August 2011 • Start of Validation Process: September 2011 • First patient treatment: December 2011

8. Business Case • Anticipates new market capture by year 3 of radiotherapy volumes of 8% over current (increase is modeled based on experience being the market leader introducing Tomotherapy), then tapering as technology is more widely adopted • Shifts appropriate volume from Computed Tomography (CT) guidance to ViewRay MRI guidance to maximize use of new technology for patient safety • Estimates that it will take two years for all payors to adopt coverage for new Current Procedural Terminology (CPT) Codes required for new technology and revenue will not be maximized until codes are established

9. Conclusion • Our vision is to provide the cancer patient with cutting edge technology that improves patient care as well as increases research opportunities • With Healthcare Reform on the horizon, it will be critical to differentiate ourselves from the competition in providing the most comprehensive treatment options for our patients as an accountable care organization. UWHC will be one of the first three facilities to receive the new equipment nationally • Baseline projections show a positive Internal Rate of Return (IRR) for most-likely scenarios • Purchase would enhance the positive image of University of Wisconsin Health and the Carbone Cancer Center to the community, patients, and referring physicians • Board Resolution