1. Impact of Moly 99 Shortage on Cardiology Patrick White September 27, 2011

2. MedAxiom Network of 325 cardiology practices Average size – 18 physicians Robust Database of Practice Performance Metrics Consulting Services Meetings, Webcasts and Listservs Best Practices

3. Cardiac Nuclear Imaging Procedures Volumes are decreasing – overall and in ratio to volume of patients seen -Appropriate Use Criteria -Stewardship of Healthcare Dollars -Radiation Concerns -Radiology Benefit Managers -Economic Downturn -Higher Co-Pays and Deductibles

4. Cardiac Nuclear Imaging Procedures

8. Why is Moly-99 Important? Cardiac SPECT is a powerful diagnostic tool Cardiac PET requires Rubidium-82 which is currently unavailable Stress Echo has inferior Sensitivity to SPECT The shortage of Moly-99 may have had an effect on cardiac catheterization

9. A Potential Impact of the Shortage?

10. Cardiology’s Success