Working With You

to Fight Cancer
Ridwan
Sammuel Mamessa
Jonathan Lou

Restricted © Siemens Healthineers, 2023

 Our Vision

A World Without
Fear of Cancer

Click to add footnote

second line
Cancer Cases are on the Rise

2020 + 19.3 M
new cases1)

2040 + 28.9 M
new cases2)
%
1) https://www.iarc.who.int/faq/latest-global-cancer-data-2020-qa/ 3
2) https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21660
Restricted © Siemens Healthineers, 2022
 Indonesia

4
Sources: Globocan 2020 Restricted © Siemens Healthineers, 2022
Connecting With Patients Throughout the Cancer Care Continuum

1 2 3 4 5 6

Screening & Imaging Diagnosis/ Multi-Disciplinary Multimodality Follow-up/

Prevention & Lab Analysis Treatment Treatment Survivorship
Planning Delivery Care

9 © 2021 VARIAN MEDICAL SYSTEMS, INC. For immediate recipient’s use only.
The Radiation Therapy Workflow

Author | Department 3
Unrestricted © Siemens Healthineers, 2019
Varian | A market
leader in cancer ARIA®
Oncology
Ethos™
Adaptive Radiotherapy

care
Information
TrueBeam®/VitalBeam®/Halcyon®
System
Radiation Innovative Treatment Delivery and
OIS
Therapy Management

Velocity™ Cancer BRAVOS®

Oncology Image Image Brachy
Treatment Product Suite for Planning
Focused on creating a Informatics Management Therapy
and Delivery

world without fear of

cancer Eclipse™ Edge® System
Treatment Treatment Radio-
Dedicated Full-Body
Planning System Planning surgery
Radiosurgery Platform

Proton ProBeam® and

InSightive™ Analytics ProBeam 360
Therapy
Oncology Proton Therapy
Analytics Systems

Cryocare CS®
DoseLab® Qumulate™ Interventional
QA Cryotherapy
Linac QA Intelligent QA Oncology
Patient
Mobius3D® Engagement –
Treatment PRO Microspheres
plan QA Embozene®
Oncozene®
Noona ®
ePRO application

33 © 2022 VARIAN MEDICAL SYSTEMS, INC. For immediate recipient’s use only.
Radiotherapy Distribution Map Indonesia

SUMUT
Total # of RT Centers: 52
RT Ctr Pvt: 4 Govt Ctr: 31
RT Ctr Gvt: 1 SULUT
Linac: 7
RIAU
KALTIM RT Ctr Pvt: 0 Private Ctr: 18
Cobalt: 0 RT Ctr Pvt: 0 RT Ctr Gvt: 1
RT Ctr Pvt: 1
RT Ctr Gvt: 1
RT Ctr Gvt: 2 Linac: 1 Total # of LINAC: 86
Linac: 3
Linac: 2 Cobalt: 0
Cobalt: 0
Total # of Cobalt: 15
Cobalt: 0 KALSEL
RT Ctr Pvt: 0 Machines Req: +/- 200
RT Ctr Gvt: 1
Linac: 0 Data as of Oct 2023
SUMSEL Cobalt: 1
RT Ctr Pvt: 0
RT Ctr Gvt: 1
Linac: 1
Cobalt: 1

JATENG
JAKARTA RT Ctr Pvt: 2
SUMBAR RT Ctr Pvt: 5
RT Ctr Pvt: 0 RT Ctr Gvt: 5
RT Ctr Gvt: 5 Linac: 9 SULSEL
RT Ctr Gvt: 2 Linac: 18 Cobalt: 8 RT Ctr Pvt: 1
Linac: 1 Cobalt: 0 RT Ctr Gvt: 3
Cobalt: 1
Linac: 4
Cobalt: 0

LAMPUNG
RT Ctr Pvt: 0
RT Ctr Gvt: 1
Linac: 1
Cobalt: 0

JABAR YOGYA JATIM BALI NTB

RT Ctr Pvt: 2 RT Ctr Pvt: 1 RT Ctr Pvt: 2 RT Ctr Pvt: 0 RT Ctr Pvt: 0
RT Ctr Gvt: 3 RT Ctr Gvt: 2 RT Ctr Gvt: 3 RT Ctr Gvt: 2 RT Ctr Gvt: 1
Linac: 6 Linac: 5 Linac: 7 Linac: 2 Linac: 1
Cobalt: 1 Cobalt: 1 Cobalt: 2 Cobalt: 2 Cobalt: 0
Radiotherapy Resources

• Linear Accelerator
• Brachytherapy
Device •
•
CT Simulator
Treatment Planning System
s • Oncology Information System
• Dosimetry
• Mold Room and Fixation

• Radiation Oncologist
• Medical Physicist
• Radiotherapist
Huma • Radiation Protection Officer
n •
•
Engineer
Nurse
Resour • Mold Room Technician
ces
VARIAN CONFIDENTIAL/ PROPRIETARY: DISCLOSED SOLELY FOR IMMEDIATE RECIPIENT ONLY
The Process

Pre • Construction License

Installation • Construction Supervision

Installation • Installation
• BATAN/BRIN Calibration

Go Clinical • Commissioning and Training

• BAPETEN Clinical/Operational License

VARIAN CONFIDENTIAL/ PROPRIETARY: DISCLOSED SOLELY FOR IMMEDIATE RECIPIENT ONLY

 Timeline for C Arm Linac
Bulan 1 Bulan 2 Bulan 3 Bulan 4 Bulan 5 Bulan 6 Bulan 7 Bulan 8 Bulan 9

Disain dan
Perhitungan
Bunker

Perizinan
Bunker

Renovasi Bunker
pararel indent Unit

Instalasi Linac

Beam Data
Collection

Perizinan
Operasional

Training
(tentative
schedule)

VARIAN CONFIDENTIAL/ PROPRIETARY: DISCLOSED SOLELY FOR IMMEDIATE RECIPIENT ONLY

Timeline Comparison C-Arm Linac & Halcyon RAD 4145a 2012-04

60
Beam Data Collection
5

2
Batan Calibration
1
Saving 132 days
45
Install
14

180
Indent
120

0 20 40 60 80 100 120 140 160 180 200

C ARM LINAC HALCYON

VARIAN CONFIDENTIAL/ PROPRIETARY: DISCLOSED SOLELY FOR IMMEDIATE RECIPIENT ONLY

Varian Products Upline
A Game Changer
 Halcyon in Story

• May 2017, Vienna

– Global launch at ESTRO

• September 2017, Philadelphia

– UPenn: First patient treated globally

• December 2019, Jakarta

– RSUPN. Dr. Ciptomangunkusumo : First
Halcyon installation in Indonesia

VARIAN CONFIDENTIAL/ PROPRIETARY: DISCLOSED SOLELY

VARIAN CONFIDENTIAL/
FOR IMMEDIATE PROPRIETARY:
RECIPIENT ONLY DISCLOSED SOLELY FOR IMMEDIATE RECIPIENT ON LY
Varian’s complimentary platforms
Every department has different needs.

The TrueBeam®/VitalBeam system is designed for The Halcyon™ system is designed for operational
versatility to support a wide range of excellence and high quality image-guided IMRT and
radiotherapy and radiosurgery. RapidArc® radiotherapy technology.

17
Varian’s complimentary platforms

The two products are

complementary
TrueBeam®/ VitalBeam system is optimized
for clinical versatility
Halcyon™ system is optimized for operational
efficiency.
TrueBeam® system DNA was used to create
the newest member of the Varian linac
family portfolio.

18
Halcyon™ system

Inspiration
and
Innovation
19
A broader definition of innovation
To solve the forthcoming challenges in radiotherapy

High
Patient
Quality
Safety
Therapy

Capital Operational
Efficiency Efficiencies

Halcyon™ system

Staff Patient
Satisfaction Experience

20
Halcyon™ system
Varian’s newest accelerator platform

The 3 pillars of Halcyon™ system

• High quality of care
• Operational excellence
• Human-centered design

21
Halcyon™ system
Total value of ownership

Connected system Latest technology

machine self-check Services Product fast RapidArc® and IMRT
integrated design ultrafast 100% IGRT

High throughput Small vault design

low maintenance Infra- embedded accessories
Finance
Structure
fast installation low electrical usage

Halcyon™ system

IT secured Human Simple, fast training

patient centric Management ease of operation
Resources
safety features reduced physics QA

22
“After delivering 3782 fractions, the average time a patient What Our Customers Say

is in the Halcyon bunker is 6:51 minutes”

-Dr. Matthias Kretschmer, MSc. Radiologische Allianz, Hamburg

“The Hamburg Halcyoneers”

Self-named by the staff at Radiologische Allianz, Hamburg
VitalBeam™ system

Inspiration
and
Innovation

24
VitalBeam™
Build the clinic you’ve always imagined

• Designed to help clinicians achieve new

clinical goals as their ability to expand their
clinical practice grow
• Platform that leverages the best of our
technology in a new scalable design
– Highest standards of precision, safety and
speed
– Innovative and expandable architecture
– High quality, high throughput radiation
therapy

25
VitalBeam™
Advanced architecture - Treat complex cases efficiently and accurately

Seamless integration
of imaging, Automated and
treatment and guided workflows
motion management

Built-in safety and

Intuitive user
performance
interface
checks

26
VitalBeam™
Maestro control system

Sophisticated control system

Maestro orchestrates dose, motion,

and imaging to deliver fast, efficient
treatment every day

27
Intuitive User Interface

• Two widescreen monitors enable larger

image displays
• User interface with tabbed info access
• Treatment fields auto ordering or drag-
and-drop ordering
• Image display filters allow better
visualization of patient’s anatomy

28
Intuitive User Interface

VitalBeam Control Console Area Competitor Control Console Area

Intuitive User Interface
Safety, Efficiency, Ease of Use
 Patient safety:
Central to Varian technology

Patient ID Verification Treatment Interlocks

Displays patient photo, name and ID Redundant sensors, no single-fault conditions,
collision avoidance system

Tx Plan Approval, Checklist Image-Guided Setup

Sign-off prior to treatment Visually confirms patient setup, position

Validity Checks In-Room Monitoring

Validate that instructions Live video, audio of patient and
are deliverable device

Daily Treatment Recording Accessory Verification

Tracks treatment progress, captures
Detects accessories, prevents
notes of important events
treatment unless correct

Quality Assurance Machine Performance Check

Fast, automated IMRT/RapidArc QA for Daily machine self-checks
simple electronic dose verification

31
Revenue Calculation (rough)

Tipe Treatment Estimasi Tariff

Tariff BPJS (tipe B) / Fraksi Pasien Rp962.000*Tergantung kelas RS

Simulasi Omset
Conservative Medium Aggressive
Kapasitas Pasien / Hari 60 70 80

Omset Pasien BPJS/Hari Rp57.720.000 Rp67.340.000 Rp76.960.000

5 hari kerja / minggu Rp288.600.000 Rp336.700.000 Rp384.800.000

50 minggu / tahun (asumsi libur hari raya) Rp14.430.000.000 Rp16.835.000.000 Rp19.240.000.000

Masa pakai 15 tahun Rp216.450.000.000 Rp252.525.000.000 Rp288.600.000.000

Note:
Perhitungan tidak termasuk inflasi tarif setiap 2-3 tahun
Perhitungan tidak termasuk asumsi pasien SBRT / SRS (Complex Advance Treatment Teknik)
Perhitungan tidak termasuk biaya CT Simulasi pasien ( tambahan income untuk department RT)
Bunker Design
1.910
mm

5.486
mm
1.930
mm
±8.000
mm

1.930
VARIAN CONFIDENTIAL/ PROPRIETARY: DISCLOSED SOLELY FOR IMMEDIATE 5.900
RECIPIENT ONLY
mm ±11.000 mm
mm
Bunker Design

VARIAN CONFIDENTIAL/ PROPRIETARY: DISCLOSED SOLELY FOR IMMEDIATE RECIPIENT ONLY

Varian Multi-Energy Linac (Phase 1)

VitalBeam LJ1
Photon Energy 6 & 10 MV
Photon FFF 6 MV (1400 MU/Min)
10 MV (2400 MU/Min)
Electron Energy 5 Electron Energy
Field Size (Static with 40 cm × 40 cm
MLC)
MLC 120 Multileaf Collimator
Treatment Couch 4DoF
Specification
MV Imager EPID & Portal Dose
Clinical Used 2D, 3D, IMRT & RapidArc

Options KV Imager 40 to 140 kV

PerfectPitch 6DoF- (for SRS/SBRT)
Gated CBCT
Respiratory Motion Management
Varian Mono-Energy Linac (Phase 1)

Halcyon Drive
MU/min @ Dmax 800
Imaging MV/MV, MV CBCT
Techniques
Tx Techniques 3D, IMRT, RapidArc
MV CBCT Speed 15 s
kV CBCT speed N/A
Gantry Speed 4 RPM
MLC resolution 0.5 cm
MLC Speed 5.0 cm/s

Options HyperSight
Conclusion 1/3
Halcyon
Highly efficient platform
Patient centered design
Operational efficiency
- Small/lightly shielded vault
- Low operating cost
- 100% IGRT
- Routine IMRT/VMAT
- Basic SRS/SBRT options
VitalBeam
TrueBeam platform
Highly configurable model
Scalable
Highly customizable:
- RapidArc
- Respiratory Gating
- MV Imaging Options
- KV Imaging Options
- High-Intensity Mode
Conclusion 2/3

Halcyon VitalBeam

Gantry Ring, 100 cm bore C Arm

Stand Small footprint, Beam stopper Compact, modulator cabinet

Beam 6 MV FFF, 800 cGy/min - Up to 3 photons (5-1400 MU/min)

- Up to 6 electrons (1000-2500 MU/min)
Collimator Dual layer MLC 120 MLC

Imaging 2D, 3D, MV & KV* - MV

- KV*
- Low MV Imaging
- Iterative CBCT*
Couch 3 DoF - 4 DoF
- 6 DoF*
Conclusion 3/3

Halcyon VitalBeam

Motion Patient motion monitoring* - Basic

Management - Advance respiratory motion management
system*
Treatment - IMRT - IMRT
Delivery - VMAT/RapidArc - VMAT
Technique - Gated VMAT*
- Delta couch*
Radiotherapy Development Pathway - Proposal

2024 2026

RS Alia Permata Hijau

LINAC
VitalBeam® TrueBeam®

RS Alia Depok
VitalBeam® Advance
Halcyon B/D®
with KV Imaging, RPM

Operational Comprehensive
Excellence Cancer Center
Integrated Multiple Site Solution

Centralization of Data, Planning and Practice

• Support multi center

• Support multi modality & brand
• Resolve professional shortage
• Standardization of practice – quality control
• Cost saving
• Security
• Simple system maintenance
 RAD 4145a 2012-04

Varian Installed Base

• Trilogy • Halcyon
• Siloam Hospital TBS – Jakarta • RSUPN Dr. Cipto Mangunkusumo – Jakarta
• RSUD. Pasar Minggu – Jakarta • RS Indriati – Solo
• RS. Kanker Dharmais 2 unit – Jakarta • RS Santosa Kopo Bandung
• RSUD Kanujoso – Balikpapan
• Clinac iX • RS Urip Sumoharjo – Lampung
• MRCCC Siloam 2 unit – Jakarta • RS Siloam Agora – Jakarta
• Santosa Hospital Bandung Kopo – Bandung • RSUD Soetomo – Surabaya
• RSUD Dr. Soetomo – Surabaya • RSUD Moewardi – Solo
• RS. Indriati - Solo • RS St. Borromeus – Bandung
• RS PKU Gamping - Yogyakarta
• Clinac cX
• VitalBeam
• RS. Kanker Dharmais – Jakarta
• RS Grandmed – Medan
• RS. Universitas Hasanuddin – Makassar
• RSUD Sidoardjo
• RSUP. Dr. Wahidin Sudirohusodo – Makassar
• RSUD Ir. Soekarno – Bangka
• RS. Universitas Andalas – Padang
• RS Pelni – Jakarta
• RSUD. Dr. H. Abdul Moeloek – Lampung
• RSUP. Prof. Dr. R.D. Kandou – Manado • TrueBeam
• RSUD. Bali Mandara – Bali • RSPAL Dr. Ramelan – Surabaya
• Unique • RSPAU Dr. S. Hardjolukito – Jogjakarta
RSUPN Dr. Cipto Mangunkusumo – Jakarta • RS Tk. II dr. Soepraoen – Malang RS Tk. II
RSUP. Dr. Kariadi 2 unit – Semarang • Pelamonia – Makassar RS Tk. III Ciremai – Cirebon
VARIAN CONFIDENTIAL/ PROPRIETARY: DISCLOSED SOLELY FOR IMMEDIATE RECIPIENT ONLY • RSAD Ciremai – Cirebon
• RSUD dr. M. Soewandhie – Surabaya
Thank you

Advanced Oncology Solutions

Together We Fight Cancer

Author | Department
Confidential © Siemens Healthineers, 2023