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Team 
17 
PET/X 
Improving outcomes, reducing costs 
Initial idea: Help oncologists pick better personalized 
therapies for breast-cancer patients 
$10B 
TAM 
$1.2B 
SAM 
$600M 
Target 
Pa:ent 
B 
Tx 
Failed 
✗ 
Pa:ent 
A 
✓ 
Tx 
Worked 
Before 
1 
dose 
Tx 
AAer 
Total 
interviews: 
106
Larry MacDonald 
Co-­‐Founder 
(IE) 
Background: 
Biomedical 
Physics 
Paul Kinahan 
Co-­‐Founder 
(CL) 
Background: 
Engineering 
Physics 
Team 
17 
William Hunter 
Principal 
Inves:gator 
(PI) 
Background: 
Nuclear 
& 
Semiconductor 
Physics 
PET/X 
Improving outcomes, reducing costs
Week 
1: 
Added 
a 
lot 
to 
explore 
all 
possible 
VP, 
CS, 
and 
RS
A"er 
Week 
1: 
Posi.ve 
indica.ons 
for 
key 
VP 
Hypothesis 
Experiment 
Results 
New 
technology 
requires 
trial 
Asked 
developers 
of 
previous 
data 
(mul:ple) 
projects 
A 
magic 
image 
can 
change 
an 
industry 
more 
quickly 
(but 
opposing 
views 
on 
this) 
Results 
from 
current 
clinical 
PET/CT 
scanners 
provide 
low-­‐ 
fidelity 
MVP 
data 
Asked 
medical 
imaging 
clinical 
experts 
Affirmed 
Insurance 
companies 
have 
small 
research 
programs 
Asked 
ques:on 
to 
a 
healthcare 
economist 
Some 
insurance 
companies 
have 
huge 
research 
programs/budgets 
No 
role 
for 
PET/X 
in 
diagnosis 
Asked 
mul:ple 
clinicians 
Strong 
support 
for 
use 
in 
diagnosis 
(opposing 
views) 
90% 
of 
new 
BC 
pa:ents 
are 
candidates 
Asked 
medical 
imaging 
clinical 
experts 
only 
35% 
for 
sure, 
could 
go 
up 
to 
75% 
Payers 
and 
providers 
are 
separate 
customers 
Serendipitous 
ques:on 
to 
a 
healthcare 
economist 
Combined 
payer/providers 
would 
be 
good 
first 
adopters 
No 
reimbursement 
limit 
(on 
numbers 
of 
scans) 
Asked 
na:onal 
medical 
imaging 
clinical 
experts 
Affirmed
Week 
4: 
Start 
to 
rule 
out 
CS, 
VP 
based 
on 
interviews
W
eek 
4 
(VPCS): 
Thinning
Petx I-Corps@NIH 121014
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 ,
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2	
 
Reimbursment 
Decision 
Maker 
Coopera:ve 
trial 
PI
Aer 
Week 
4: 
Differen.ated 
Customer 
segments 
Hypothesis 
Experiment 
(n) 
Results 
Fixed 
materials 
price 
:ers 
; 
materials 
subject 
to 
tariffs 
Interview 
materials 
vendor 
(2) 
Found 
vendor 
with 
lower 
and 
(claimed) 
controlled 
price 
Billing: 
Reimbursement 
is 
feasible 
Interviewed 
billing 
expert 
(2) 
Probably 
yes, 
but 
there 
are 
Medicare 
requirements 
for 
scanners 
Radiologist/iCRO: 
PETX 
useful 
for 
clinical 
trials? 
Interviewed 
radiologist 
CTO 
(1) 
Could 
be 
(s:ll 
gegng 
mixed 
results) 
Interest 
in 
pre-­‐surgery 
staging 
Interviewed 
surgeon 
(2) 
Confirmed 
interest; 
also 
affirmed 
poten:al 
for 
assessment 
Easy 
integra:on 
into 
clinical 
workflow 
Interviewed 
clinical 
manager 
(2) 
PETX 
similar 
to 
other 
add-­‐on 
procedures 
Guidance 
for 
balancing 
resources 
between 
spinout 
and 
univ. 
Interviewed 
experienced 
spin-­‐out 
entrepreneur 
(2) 
Address 
customers’ 
obstacles 
to 
adop:ng 
PETX; 
Confirmed 
important 
nego:a:ons 
with 
univ.
Week 
10: 
Validated 
the 
product 
– 
market 
fit
Aer 
Week 
10: 
More 
Financial 
Details 
Hypothesis 
Experiment 
(n) 
Results 
ROI 
in 
5 
years 
Interviewed 
Exec. 
Directors 
of 
Radiology 
(3) 
For 
mid-­‐range 
capital 
expenses 
ROI 
expected 
in 
~3 
years, 
but 
varies 
by 
Org 
size 
Must 
have 
ROI 
 
Price 
Interviewed 
Exec. 
Directors 
of 
Radiology 
(2) 
Not 
all 
capital 
equip 
has 
to 
show 
a 
profit 
if 
it 
brings 
in 
revenue 
in 
subsequent/other 
services. 
Technical 
sales 
staff 
could 
assist 
with 
supported 
RD 
Interviewed 
Principal 
Engineer 
(1) 
 
Tech. 
sales 
staff 
(2) 
Must 
keep 
separate 
so 
that 
cost 
of 
clinical 
studies 
are 
not 
subtracted 
from 
system 
cost 
by 
Medicare. 
Margins 
on 
sales 
of 
capital 
equipment 
is 
lower 
than 
small 
device 
margins 
Interviewed 
Tech. 
sales 
reps 
(2 
lrg 
 
2 
small 
companies) 
(4) 
Hard 
to 
get 
concrete 
numbers, 
but 
confirmed 
it 
was 
typically 
less 
than 
65%. 
Purchase 
decision 
based 
solely 
on 
net 
clinic 
reimbursement. 
Interviewed 
Exec 
Dir 
Rad 
(1) 
 
Apending 
Physicians 
(4) 
Breast 
Cancer 
is 
an 
emo:onally 
charged 
topic. 
Huge 
pa:ent 
advocacy 
pressure 
can 
drive 
purchase 
decision 
even 
at 
net 
loss.
PET/X 
• Sales 
• Service 
Hospital 
or 
Clinic 
using 
PET/X 
Pa:ent 
Imaging 
physician 
CMS 
Insurance 
Capital 
equipment 
decision 
influencers 
Breast 
cancer 
advocacy 
groups 
Larger 
Medical 
Imaging 
company 
Capital 
equipment 
Decision 
makers 
Imaging 
Technologist 
Referring 
Oncologist 
NCCN 
 
other 
guidelines 
Finances 
 
opera:ons 
revenue 
stream 
purchase 
decision 
influence 
or 
control 
FDA 
Crux 
of 
the 
issue: 
Purchase
Imaging 
Site 
Revenue 
Model
PET/X 
– 
Sales 
Revenue 
Model 
# 
Pa:ents/year 
Reimbursement 
CPT 
code 
7811 
Shared 
Purchase 
Fee 
for 
Service 
3yr 
Clinic 
Purchase 
ROI 
No 
4yr 
ROI 
No 
5yr 
ROI 
Yes 
Yes 
Unlikely 
to 
buy 
# 
Scan 
Opera:on 
Cost 
No 
Yes 
Direct 
sell 
price 
Cost 
of 
Goods 
Personnel 
Sales 
RD 
Profit 
GA 
Training 
Amor:zed 
Cost 
:me 
Cost 
of 
Goods 
Sales 
RD 
Profit 
GA 
Personnel 
Training 
Sales 
RD 
GA 
Training 
Profit 
Cost 
of 
Goods 
Personnel 
Profit
Income, 
Finance 
and 
Opera:ons 
Timeline 
Ac.vity/Item 
Year 
1 
Year 
2 
Year 
3 
Scanner 
Sales 
2 
4 
8 
Price 
per 
scanner 
$650K 
$650K 
$650K 
Service 
Income 
0 
20% 
of 
prior 
sales 
20% 
of 
prior 
sales 
Total 
Revenues 
$1.30M 
$2.86M 
$5.98M 
Cost 
of 
Goods 
/ 
scanner 
$195K 
$203K 
$211K 
Personnel 
/ 
scanner 
$235K 
$183K 
$143K 
Sales 
/ 
scanner 
$50K 
$40K 
$30K 
Training 
/ 
scanner 
$50K 
$40K 
$35K 
RD 
0 
5% 
of 
Y1 
revenue 
5% 
of 
Y2 
revenue 
GA 
$200K 
$220K 
$242K 
Total 
Expenses 
$1.26M 
$2.23M 
$3.89M 
Net 
$40K 
$633K 
$2.09M 
Cumula.ve 
Net 
$40K 
$673K 
$2.76M
Medical 
Device 
Investment 
Readiness 
Level 
Plausible 
exit 
Cash 
to 
exit 
Unit 
economics 
Validated 
Reimbursement 
Regulatory 
Intellectual 
Property 
Aprac:ve 
solu:on 
 
ID 
of 
MVP 
Compelling 
clinical 
need 
+ 
large 
mkt 
Effec:ve 
team? 
3.5 
4.5 
IRL 
7 
IRL 
6 
Oct 
10 
Dec 
10 
discovered 
data
Road 
to 
first 
sale 
We 
now 
have 
• Defined 
customer 
sub-­‐segment: 
therapy 
 
imaging 
centers 
for 
invasive 
breast 
cancer 
• Ini:al 
marke:ng 
informa:on 
 
financial 
models 
• Validated 
preferred 
exit 
(licensing) 
• Submiped 
a 
Phase 
II 
using 
materials 
from 
I-­‐Corps 
on 
valida:on 
of 
product-­‐market 
fit 
and 
financial 
models 
Next 
we 
will 
• Complete 
MVP 
• Partner 
with 
luminary 
sites 
• Collect 
 
disseminate 
quality 
data
Petx I-Corps@NIH 121014
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Petx I-Corps@NIH 121014

  • 1. Team 17 PET/X Improving outcomes, reducing costs Initial idea: Help oncologists pick better personalized therapies for breast-cancer patients $10B TAM $1.2B SAM $600M Target Pa:ent B Tx Failed ✗ Pa:ent A ✓ Tx Worked Before 1 dose Tx AAer Total interviews: 106
  • 2. Larry MacDonald Co-­‐Founder (IE) Background: Biomedical Physics Paul Kinahan Co-­‐Founder (CL) Background: Engineering Physics Team 17 William Hunter Principal Inves:gator (PI) Background: Nuclear & Semiconductor Physics PET/X Improving outcomes, reducing costs
  • 3. Week 1: Added a lot to explore all possible VP, CS, and RS
  • 4. A"er Week 1: Posi.ve indica.ons for key VP Hypothesis Experiment Results New technology requires trial Asked developers of previous data (mul:ple) projects A magic image can change an industry more quickly (but opposing views on this) Results from current clinical PET/CT scanners provide low-­‐ fidelity MVP data Asked medical imaging clinical experts Affirmed Insurance companies have small research programs Asked ques:on to a healthcare economist Some insurance companies have huge research programs/budgets No role for PET/X in diagnosis Asked mul:ple clinicians Strong support for use in diagnosis (opposing views) 90% of new BC pa:ents are candidates Asked medical imaging clinical experts only 35% for sure, could go up to 75% Payers and providers are separate customers Serendipitous ques:on to a healthcare economist Combined payer/providers would be good first adopters No reimbursement limit (on numbers of scans) Asked na:onal medical imaging clinical experts Affirmed
  • 5. Week 4: Start to rule out CS, VP based on interviews
  • 6. W
  • 7. eek 4 (VPCS): Thinning
  • 9. ! #
  • 10. # $%
  • 13. , !- ,) . /,) 0 (,( '1 ' 2 Reimbursment Decision Maker Coopera:ve trial PI
  • 14. Aer Week 4: Differen.ated Customer segments Hypothesis Experiment (n) Results Fixed materials price :ers ; materials subject to tariffs Interview materials vendor (2) Found vendor with lower and (claimed) controlled price Billing: Reimbursement is feasible Interviewed billing expert (2) Probably yes, but there are Medicare requirements for scanners Radiologist/iCRO: PETX useful for clinical trials? Interviewed radiologist CTO (1) Could be (s:ll gegng mixed results) Interest in pre-­‐surgery staging Interviewed surgeon (2) Confirmed interest; also affirmed poten:al for assessment Easy integra:on into clinical workflow Interviewed clinical manager (2) PETX similar to other add-­‐on procedures Guidance for balancing resources between spinout and univ. Interviewed experienced spin-­‐out entrepreneur (2) Address customers’ obstacles to adop:ng PETX; Confirmed important nego:a:ons with univ.
  • 15. Week 10: Validated the product – market fit
  • 16. Aer Week 10: More Financial Details Hypothesis Experiment (n) Results ROI in 5 years Interviewed Exec. Directors of Radiology (3) For mid-­‐range capital expenses ROI expected in ~3 years, but varies by Org size Must have ROI Price Interviewed Exec. Directors of Radiology (2) Not all capital equip has to show a profit if it brings in revenue in subsequent/other services. Technical sales staff could assist with supported RD Interviewed Principal Engineer (1) Tech. sales staff (2) Must keep separate so that cost of clinical studies are not subtracted from system cost by Medicare. Margins on sales of capital equipment is lower than small device margins Interviewed Tech. sales reps (2 lrg 2 small companies) (4) Hard to get concrete numbers, but confirmed it was typically less than 65%. Purchase decision based solely on net clinic reimbursement. Interviewed Exec Dir Rad (1) Apending Physicians (4) Breast Cancer is an emo:onally charged topic. Huge pa:ent advocacy pressure can drive purchase decision even at net loss.
  • 17. PET/X • Sales • Service Hospital or Clinic using PET/X Pa:ent Imaging physician CMS Insurance Capital equipment decision influencers Breast cancer advocacy groups Larger Medical Imaging company Capital equipment Decision makers Imaging Technologist Referring Oncologist NCCN other guidelines Finances opera:ons revenue stream purchase decision influence or control FDA Crux of the issue: Purchase
  • 19. PET/X – Sales Revenue Model # Pa:ents/year Reimbursement CPT code 7811 Shared Purchase Fee for Service 3yr Clinic Purchase ROI No 4yr ROI No 5yr ROI Yes Yes Unlikely to buy # Scan Opera:on Cost No Yes Direct sell price Cost of Goods Personnel Sales RD Profit GA Training Amor:zed Cost :me Cost of Goods Sales RD Profit GA Personnel Training Sales RD GA Training Profit Cost of Goods Personnel Profit
  • 20. Income, Finance and Opera:ons Timeline Ac.vity/Item Year 1 Year 2 Year 3 Scanner Sales 2 4 8 Price per scanner $650K $650K $650K Service Income 0 20% of prior sales 20% of prior sales Total Revenues $1.30M $2.86M $5.98M Cost of Goods / scanner $195K $203K $211K Personnel / scanner $235K $183K $143K Sales / scanner $50K $40K $30K Training / scanner $50K $40K $35K RD 0 5% of Y1 revenue 5% of Y2 revenue GA $200K $220K $242K Total Expenses $1.26M $2.23M $3.89M Net $40K $633K $2.09M Cumula.ve Net $40K $673K $2.76M
  • 21. Medical Device Investment Readiness Level Plausible exit Cash to exit Unit economics Validated Reimbursement Regulatory Intellectual Property Aprac:ve solu:on ID of MVP Compelling clinical need + large mkt Effec:ve team? 3.5 4.5 IRL 7 IRL 6 Oct 10 Dec 10 discovered data
  • 22. Road to first sale We now have • Defined customer sub-­‐segment: therapy imaging centers for invasive breast cancer • Ini:al marke:ng informa:on financial models • Validated preferred exit (licensing) • Submiped a Phase II using materials from I-­‐Corps on valida:on of product-­‐market fit and financial models Next we will • Complete MVP • Partner with luminary sites • Collect disseminate quality data
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  • 181. Week 10 Drilling down on details
  • 182. Customer types Interviewed Type (subtype) n Medical Oncologist 6 Surgeons 3 Imaging Physicians 23 Nuc Med Imaging 12 Mammo Imaging 4 Diagnos;c Imaging 3 Rheumatology 2 Technologists 6 mammo 4 nuc med 2 Pharma 4 RD 2 Exec 2 Type (subtype) n Radiology / Hospital 5 business execu:ves Regulatory 5 Reimbursement/coding 1 IP Lawyer 1 Health Economist 1 Imaging Scien:st 7 Sta:s:cian 1 Clinical Physicist 10 Imaging industry 33 Sales/marke;ng 9 rd, CTO 9 execu;ves 12 compe;ng 3