The 10-Minute CMR Scan

Business Opportunity Assessment

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Agenda
Introduction
Coronary Artery Disease
Diagnostic Imaging
The Opportunity

Primary Market Research

Current Challenges
Clinical Needs
Competitive Technologies

The Market
Target Market
Key Drivers
Competition

The Business Plan

Revenue Models
Financial Modelling
Project Plan

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Coronary Artery Disease (CAD)

Cardiovascular Disease Largest Healthcare Expenditure Coronary Artery Disease

Leading Cause of Global Deaths Accounts for over 30% of all Accounts for 45.1% of all CVD Deaths
Estimated 17.3 million death in 2013 healthcare expenditure

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Diagnosis of CAD
Coronary Artery Disease – Reduction of blood flow to the heart muscles caused by the narrowing of
coronary arteries

1 Severity of CAD 3 Myocardial Viability

Is the chest pain acute or chronic?
Is there damage to the heart tissue?
What is the severity?
How much damage?

2 Localization of CAD
Which region of the heart is there a lack of oxygen?
Is it caused by a blockage?

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Diagnostic Imaging for CAD
Anatomical Assessment Functional Assessment

Coronary Cardiac CT Cardiac MR Echocardiography Nuclear Stress

Angiography Test

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Modality Comparison
Comprehensiveness Safety Availability Cost Ease of Use

Coronary Angio.    $$$ 

Cardiac CT    $ 

Cardiac MR    $$ 

Echocardiography    $ 

Nuclear    $$ 

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The Opportunity

The assessment of CAD is one of the ten most expensive hospital principle discharges in the US with an
annual cost of $10.5 billion and among the most common diagnostic evaluation with nearly 20 million
imaging and exercise stress tests performed annually.

The 10-minute CMR scan has an opportunity to capture a significant portion of this market by offering
a non-invasive diagnostic test that is fast, accurate, safe and easy to use.

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 Primary Market Research
The Goal - To understand the cardiovascular MR market and the needs of a rapid cardiovascular MR scan

8 Participants 5 CMR Center

2 Radiologists 1 Cardiologist
Directors

Average Scans at Each Center

60-Minute One-on-one Interviews
MR 337
Nuclear 783
Echo 688
North America, Europe, Asia and South Coronary Angiography 250
America CTA 369

Current Competitive Adoption &

Clinical Needs
Challenges Technologies Barriers

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The Current Challenges in CMR

Speed of Acquisition Speed of Post Processing Lack of Quantification

Cost Ease of Use
Availability

Others – Education and training and obtaining the right image quality

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 Clinical Needs
Key Clinical Biomarkers Top MR Sequences Top Features

8 8
7 7 8 8

6
6

1 1 1 1

LV Function Tissue and Perfusion Plaque Flow SSFP Cine LGE Perfusion Contrast-Free Quantitative Speed of Post Processing Post Processing Biomarkers
Scar T1 Perfusion Sequence Automation Ease of Use

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Competitive Technologies
CT Angiography
Ranking of Substitute Products
Strong Trial Data from SCOT-HEART Trial

4 Wide Availability
Easy to Use
3

1 1 Nuclear Stress Imaging

Strong reimbursement in the US

CTA Nuclear Stress CT FFR CT Myocardial Stress Echo Strong lobbying

Imaging Perfusion Wide Availability

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Barriers & Adoptions
Vendor Support
5 Potential Barriers
Fast Acquisition Protocols
Ease of Use For Acquisition
3 3 Hardware Support

1 1 Post-processing Support
Ability to Process the Reconstructed Images
Ease of Use & Automation
Accurate Results

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Market Trends in CV Diagnostics

CV Diagnostic Market MR Scanners CT Scanners

CAGR Growth of 8.5% between 2018 - 2024 Globally 30,908 MR Scanners Globally 44,949 CT Scanners
Total Market of $19.8 Billion By 2024 Approximately 3000 Cardiac Dedicated Almost All Cardiac Capable
North America the Leading Region 10 Million CMR Scans Annually > 30 Million Cardiac CT Scans Annually
Followed by Europe

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The CMR Target Markets
Coronary Angiograms Coronary CTA
13 million CTA scan annually in US
7.6 million diagnostic procedures annually in US Professional reimbursement of $121 per scan
Reimbursement of $859 per scan $1.5 billion market
$3.4 billion market
$3.4 Billion
Coronary Angiograms
$1.5 Billion
Coronary CTA

$728
Million
Nuclear
Stress Test

Nuclear Stress Test

9.1 million nuclear scans annually in US
Professional Reimbursement of $80 per scan
$728 million market

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The CMR Target Markets

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Key Drivers for Adoption and Growth
Clinical Acceptance
Validation
Trials
Novel Development of Fast Sequences
Guidelines
Vendor Support
Post Processing Support
Training and Education

Government Support
Reimbursement
Regulation

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Circle and Its Competitors
Easy to Use

Circle Advantages
The Employee Base

Vendor Relationship
Limited Tools in CMR Comprehensive Tools in CMR
Large Base of Key Opinion Leaders

Rapid Development Cycle

Cumbersome to Use

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The Business Model
Software Licensing Software Subscription Fee-for-Service
Existing Circle Model Software-As-A-Service Software-As-A-Service

$5 Million capital investment $5 Million capital investment $5 Million capital investment

$2 Million clinical validation investment $2 Million clinical validation investment $25 Million clinical validation investment

$20,000 Per license per user $8000 Per user per year $350 Per scan
750 User license sold in year 2 750 User license sold in year 2 4,300 Scans in Year 4
(0.5% Market Penetration in Year 1)

Current model in the cardiovascular Reoccurring revenue stream Highest Revenue Potential
post processing market
Low initial income Requires High Clinical Trial Investment
Small reoccurring component
Requires infrastructure and support Requires Reimbursement Code

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 The Financial Modelling
Cash Flow Net Present Value Internal Rate of Return

2,500
200 200%
Operating Income ($Millions)

Net Present Value ($ Millions)

2,000

Internal Rate of Return

150
150%
1,500
100
100%
1,000
50

500 50%
0
1 2 3 4 5 6
-50 0 0%
Year Conservative Normal Optimistic
Licensing Subscription Fee-For-Service
Licensing Model Subscription Fee-For-Service Model
Licensing Subscription Fee-For-Service

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The Project Plan
Sources of Funding
National Research of Council of Canada IRAP - $1.5 Million
Monthly Income Forecast
Calgary Economic Development - $2.0 Million
2,000,000
Circle Internal Funding - $3.5 Million

1,500,000

Monthly Income
Staffing
1,000,000
Technical Staff – 2 Product Managers, 25 Software Engineers,
13 QA Analysts, 3 UI Designers
500,000
Regulatory Analyst – 1 Regulatory Analyst
Clinical Validation Specialists – External KOLs
0
Sales and Marketing – 40 Circle sales staff 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35
Month

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Conclusion
The 10-minute CMR scan has the potential to disrupt the market for the diagnosis of CAD by offering a
non-invasive diagnostic test that is fast, accurate, safe and easy to use.

Investment The Market Execution Plan

Capital Investment of $5 + $2 Million 20 Million Diagnostic Tests for CAD Annually Dedicated Development Team
Net Present Value of $193 Million SOM: $210M, SAM: $1.1B, TAM: 6.2B Leveraging Existing Sales Team
Internal Rate of Return of 173% Goal of 750 Licenses In Year 2

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 Questions?

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