Spectral CT Overview Different materials have different absorption profiles depending on the incident x-ray energy Spectral CT* uses this property to separate a multi-energy x-ray spectrum into components in order to distinguish different materials Possible applications Improved contrast visualization Improved bone removal Virtual non-contrast exams Kidney stone differentiation Lesion characterization Plaque characterization Molecular contrast agent visualization Low-Energy X-rays High-Energy X-rays *Works-in-Progress: Pending commercial availability and regulatory clearance.

Spectral CT approaches What is it? Dose Separation/Noise FOV Motion Philips Dual Scan Scan object twice Extra better Full Non-moving kV Switch Switch kV during single rotation Some Extra Poor Any object Dual Tube Tube A @ 80 kv, Tube B @ 140 kv ok Small Slow moving Dual Detector Double decker detector Normal Photon Counting Count each photon & determine its energy Less best Low-energy X-rays High-energy X-rays E1 E2 E total Total x-ray beam

Plaque characterization* Improved Iodine Visualization* Low Energy High Energy Virtual Non-Contrast Imaging* Plaque characterization* Simultaneous Multi Energy Detectors* Clinical Results Hadassah Medical Organization Jerusalem, Israel *Works-in-Progress: Pending commercial availability and regulatory clearance.

Spectral CT - Photon Counting Compton Scatter Spectral analysis Gd-high Ca-low I-low I-high Gd-low Ca-high Plastic Water Full Spectrum Image E1 E2 E3 E4 E5 E6 E7 E8 Photon counting may allow K-edge imaging (e.g. contrast only imaging) using a traditional CT source *Works-in-Progress: Pending commercial availability and regulatory clearance.

Spectral CT- Issues to Adoption Clinical evidence - only small pilot studies to date Financial evidence - Cost vs. Reimbursement vs. Time Alternative techniques Potential Benefit Alternate technique Improved iodine visualization 80 kV scanning Iodine maps Color map conventional CTA Contrast/bone separation Image processing Virtual non-contrast Low dose non-contrast

Spectral CT- Philips Leadership Spectral CT is an important area of fundamental research Philips is leading the Spectral CT Revolution Advanced clinical system* Dual Decker Detector prototype Over 1500 clinical exams on prototype since 2005 Advanced laboratory system* 2 Photon Counting prototypes Initial phantom & animal scans shown at RSNA 2007 Advanced applications* Spectral EBW prototype Works with any spectral data Advanced research network 15 global sites and growing Calcified plaque Iodine filled vessels *Works-in-Progress: Pending commercial availability and regulatory clearance.