1. Nucletron is a leading provider of radiation therapy solutions headquartered in Veenendaal, Netherlands with over 550 employees and a presence in over 100 countries. 2. Brachytherapy involves placing a radiation source inside or next to the tumor to allow precise radiation dose delivery. Nucletron offers brachytherapy solutions for prostate, gynecological, and other cancers. 3. Nucletron's prostate brachytherapy solution uses real-time ultrasound imaging along with pre-treatment MR images to contour the tumor and guide the robotic SeedSelectron device for automated, precise placement of radioactive seeds in the prostate.

1. Scherpschieten op de prostaat “ Van handbediend naar automaat” John Lapré Vice-President R&D Nucletron

3. Nucletron at a glance

4. The Big “Oncology” Picture Biopsy DX Imaging Surgery Chemotherapy Radiation Cancer Patient Imaging Chemotherapy Life-long follow up imaging Radiation could be delivered as External Beam RT or Brachytherapy (LDR, PDR or HDR) Pre-Treatment Imaging Treatment Planning Treatmment Delivery & Imaging Post-Ttreatment Imaging

6. Evolution continues Flexitron 1982 1983 1986 Evolution continues 1975 1994 First µ-processor digital LDR First Brachyplanning PC First cervix ring applicator First µ-processor digital HDR First digital interstitial LDR First digital HDR with dummy First digital PDR First IBU First Intravascular brachy First simultanuous ch selector First locked ovoid applicator First locked to prostate template First AL 3 drive stepping system First dual source Innovation continues 1975 1981 1981 1982 1983 1986 1989 1991 1992 2007 2007 2008 2009 2009

7. Brachytherapy has multiple patient benefits across different tumor sites: today’s focus is on prostate 1. . Pötter R. Radiother Oncol 2009;91:141-146 2. Ferrer M, Suarez JF, Guedea F et al. Int J Radiat Oncol Biol Phys , 2008; 72(2): 421–32. 3. Hoskin PJ & Bownes P, Semin Radiat Oncol 2006;16(4):209-17. 4. Pisansky TM, Gold DG, Furutani KM et al . Mayo Clin Proc 2008;83(12):1364-72. 15 American Brachytherapy Society. 26 Polgar C, Major T, Fodor J, et al. Int J Radiat Oncol Biol Phys 2004;60(4):1173-81. 37 Arthur DW & Vincini, FA. J Clin Oncol 2005;23(8):1726-35. 78 Guix B, Finestres F, Tello J et al . Int J Radiat Oncol Biol Phys 2000; 47:95-102. 9. Musmarcher J . Jnl Clin Oncol 2006 ; 24(18S):15543.

8. Experts support Brachytherapy Prostate BT provides superior PSA control over EBRT in patients with low-risk and selected intermediate-risk prostate cancers. Until the results of randomized studies comparing BT with either EBRT or surgery are available within the next decade, nonrandomized comparative studies can provide the yardstick by which patients and physicians can make informed decisions about which treatment is likely to best suit them. For many, that will be prostate BT. (Vaginal Brachytherapy) VBT is effective in ensuring vaginal control, with fewer gastrointestinal toxic effects than with EBRT. VBT should become the standard of care for women with endometrial cancer of intermediate and high-intermediate risk.

10. Nucletron’s Prostate Solution with new 3D integrated realtime ultrasound

11. Off-line MR Image: Fusion with real-time Ultrasound in OR

12. Contouring the tumor

13. Insertion into the prostate

14. Evaluation of the treatment plan

17. Animation of robotic seed placement (SeedSelectron)

18. SeedSelectron in a clinical setting

19. Needles insert ion SeedSelectron setup Treatment Delivery

20. 192 Ir tungsten container HDR treatment requires automated remote afterloading: Microselectron or Flexitron afterloaders

21. Source A Source B Test source HDR: Ir-192 source through the catheters to treat after testing for obstructions in the catheters Test Treat Test Test Treat Test Treat Test Treat Treat 1 2 3 4 5

22. Everyday we are bombarded with COMPLEXITY

23. The Art of Simplicity “ ” Apple believes in one thing – FOCUSED SIMPLICITY . We are a $30B company with less than 30 products. In product design and business strategy, subtraction often adds value . A designer knows he has achieved perfection not when there is nothing more to add, but when there is nothing to take away. - Steve Jobs

24. Our innovations focus on a safe, fast and simple treatment SPEED SIMPLICITY SPECIFICITY Reduce treatment times Remove complex set-up S A F E T Y Improve Patient Outcome Early Detection Advanced diagnosis

25. Single Fraction Monotherapy HDR for prostate cancer First Patient treated Dec 2010

27. There is more........ Fully Robotized Minimal Invasive Bladder Surgery using DaVinci Alysis/Rijnstate Ziekenhuis