Paris, November 5, 2002

Broadband technology serving the medical community A new experimental application known as Argonaute 3D makes it possible to share patients’ medical records in real time for in-depth analysis and enhanced preparation of optimum surgical strategies. Following the success in 2001 of Operation Lindbergh - the world’s first transatlantic telesurgical procedure - France Telecom and IRCAD (Institute for Research into Cancer of the Digestive System) are continuing their partnership with the creation of the Argonaute 3D experimental platform. Argonaute 3D lets medical professionals at different geographic locations analyze and work together on a patient’s medical records with 3D elements in real time in order to determine the optimal possible strategy for surgery. Argonaute 3D is an experimental application that lets medical professionals – general practitioner, radiologist, surgeon – at different locations to share and work together in real time using a 3D image that reconstitutes a patient’s clinical data from MRI or CT scans. This analysis lets specialists and referring physicians together determine the optimal time and strategy for a surgical intervention. Argonaute 3D enables inputs from specialists anywhere in the world so long as they have a broadband DSL link to the Internet. Argonaute 3D is a totally secure platform, thus guaranteeing complete confidentiality of medical records. How the application functions The current scenario is as follows: a patient visits his or her primary care physician, whose examination indicates the risk of a tumor. The physician requests an MRI (Magnetic Resonance Imaging) or CT scan. The 3D imaging reveals several tumors in the digestive system. The doctor then asks for an analysis by the radiologist and then contacts the surgeon, who determines the surgical procedure to be carried out. The surgeon will request a second opinion from an expert to define the best possible strategy for each individual case. Argonaute 3D completely changes the way each of the medical professionals works. Thanks to a simple broadband Internet access to the collaborative working platform they can discuss the patient’s pathology using 3D data in real time without leaving their offices. The shared image lets them confirm the tumor diagnosis and prepare the optimum treatment or surgical intervention. The combined competencies of IRCAD and France Telecom bring patients significant benefits thanks to in-depth medical expertise and swifter responsiveness in assessing their case.

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The experimental platform presented today brings together several medical practitioners and experts: - in Paris, an expert in digestive surgery and cancer of the digestive system, Professor Jacques Marescaux; - in Strasbourg, an expert in 3D medical imaging, Professor Luc Soler of IRCAD, accompanied by a radiologist, Professor Afshim Gangi; - in Brest (in Brittany, in Western France), a hospital surgeon, Professor Patrick Lozac’h; - In Lannion (also in Brittany), a general practitioner, Doctor Christine Vidal. For this first demonstration, an existing France Telecom commercial videoconference platform will be used to assure the coordination among the four remote sites. “Argonaute 3D represents a significant advance for the entire medical community,” says Professor Jacques Marescaux, a surgeon who is the president and founder of the IRCAD Institute for Research into Cancer of the Digestive System. “At IRCAD we are convinced that information technologies can make a pivotal contribution to medical care. This is why we have since 1995 been working on a tool to create three-dimensional reconstitutions of patient pathology data, coupled with dedicated videoconferencing solutions. Until now, however, we were missing an essential component, the ability to work together with colleagues at remote locations in real time on a patient’s clinical case. When France Telecom explained that this type of collaborative working was possible simply using broadband Internet links, we immediately began working on a platform, pooling our competencies. Argonaute 3D introduces a new phase in patient treatment and reshapes the way medical professionals work together.” Jean-Pierre Temime, Director of Marketing at France Telecom’s Large Business Division, added: “Making it possible for people to communicate is what France Telecom does. This new challenge gave us an opportunity to combine existing solutions with innovation from our research center, France Telecom R&D. Our broadband networks make it very simple to transmit 3D images, and the experimental collaborative working platform developed by our engineers opens up new possibilities for the medical community. Argonaute 3D creates exciting opportunities not only for medical professionals but also for everyone who works with 3D images – urban planners and architects, for example. What’s more, the application has great potential for computer-aided design in industries like aerospace or automobiles, and in general for all types of activities that can save time and gain efficiency thanks to collaborative working with people at other geographic locations.” The Argonaute 3D experimental platform combines innovation with solutions that are already available: - Broadband Internet connections based on DSL technology, such as Wanadoo eXtense or Oléane; - the 3D VSP application developed by IRCAD, which creates 3D reconstructions from patient images (MRI or CT scans); - the Spin-3D collaborative working application developed by France Telecom R&D engineers. This collaborative working application has multiple benefits : • Benefits for patients: - accelerated diagnosis: networked cooperation between medical experts saves considerable time in analyzing the pathology and preparing for surgical intervention; - enhanced diagnosis and surgical strategy: exchanges between medical professionals enable real-time discussion, leading to a more in-depth analysis of each clinical case;

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- easier access to expert medical opinions: wherever patients are located, even in remote areas, they benefit from this sophisticated technology since their case can be examined by specialists regardless of their location thanks to the availability of their medical records on the network. • Benefits for medical professionals - General practitioners, who are sometimes faced with difficulties in interpreting scans and x-rays can see problems with great precision thanks to Argonaute 3D, which clearly localizes the tumor. This aids considerably in seeking the opinion of specialists who work in other cities (or even countries). This process limits the need for further examinations, along with the need for the patient to make multiple visits to medical facilities. Primary physicians are fully involved in the preparation of the surgery on patients and can better contribute direct knowledge of the patient. They can also provide more helpful information to patients and their families on the procedure and treatment. - Radiologists are able to discuss the diagnosis with colleagues by sharing 3D medical images that all experts can understand and decide on the most appropriate medical act for the patient. - For surgeons, consulting opinions from experts in several specialized fields is important. This solution enables them to discuss a case in real time thanks to interactive applications. Real-time information exchange results in a faster consensus on the diagnosis in order to determine the best surgical strategy. - The treatment aid tools integrated in Argonaute 3D help the medical team precisely evaluate the precision of the surgical actions selected. The application simulates navigation inside organs, as well as destruction of tumors, cutting of organs and calculation of volumes following the virtual surgery. Medical imaging: a revolution in the approach to treatment of pathologies Computer processing of medical images figures at the core of the research work pursued since 1995 by IRCAD. A series of 3D images of the patient’s anatomical and pathological structures is created. These images are extremely useful to preparing and performing a surgical intervention, which requires precise knowledge of the patient’s anatomy. While analysis of the case using two-dimension images (MRI or CT scans) is essential, only observation during the actual surgical act confirms the exact shape and position of the organs. IRCAD has developed a program called “3D VSP” which enables surgeons to view a 3D reconstruction of the patient’s anatomy right in the operating room on a standard laptop computer. By combining the 3D VSP software and a collaborative working interface developed by France Telecom R&D – Spin-3D – IRCAD and France Telecom have conceived the Argonaute 3D solution. Collaborative working in 3D: a revolution in the uses of 3D Spin-3D creates a virtual meeting space where participants can communicate and interact. They are represented by clones that transcribe their actions and both verbal and non-verbal interaction. Thanks to the innovative design, which does not attempt to mimic the real world, Spin-3D lets users focus on the collaborative task, taking advantage of maximum communications input. The system enables wider availability of medical expertise for efficient analysis of medical images, detection of pathologies, definition of surgical procedures and patient follow-up. The result is optimized treatment for patients.

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The press kit and a demonstration video clip of Argonaute 3D are posted on the websites: www.francetelecom.com and www.websurg.com Illustrations and images can also be obtained from the France Telecom media library by calling: +33 1 49 09 85 39

Press contacts: France Telecom Nilou du Castel / Estelle Rozine / Caroline Ponsi +33 1 44 44 93 93 [email protected] [email protected] [email protected]

IRCAD Marie Gauthier +33 3 88 11 90 08 [email protected]

IRCAD IRCAD (Institut de Recherche contre les Cancers de l’Appareil Digestif - Institute for Research into Cancer of the Digestive System) has since 1994 worked on applying basic cancer research and developing new medical technologies. In 1993, recognizing that surgery was making a fast and ineluctable transition from the industrial era to the computer era, Professor Jacques Marescaux created an innovative private sector organization dedicated to leveraging the value of basic cancer research, with IRCAD, and developing new computer-based technologies for surgery, with EITS. The idea was to create a center where surgeons, physicians, researchers, engineers and computer specialists could combine their talents at a single site. This initiative aimed to meet a two-fold challenge: innovate to demonstrate European capability for creativity and innovation in a sector where the United States already enjoyed a reputation for excellence, and develop high-level training. Indeed, expanding the use new technologies in this area is intimately linked to providing high-level training. IRCAD-EITS has grown into a world-class surgical training institution, considered one of the top in the world. This success is reflected in the number and diverse origins of the surgeons who enroll for its courses. The center welcomes more than 3,000 surgeons annually from everywhere in the world, who receive training thanks to the collaboration of an international team of 800 experts.

France Telecom France Telecom is one of the world's leading telecommunications carriers, with more than 108 million customers on the five continents (220 countries and territories) and consolidated operating revenues of 43 billion Euro for 2001 (22.5 billion Euro at June 30, 2002). Through its major international brands, including Orange, Wanadoo, Equant and GlobeCast, France Telecom provides businesses, consumers and other carriers with a complete portfolio of solutions that spans local, long-distance and international telephony, wireless, Internet, multimedia, data, broadcast and cable TV services. France Telecom is the second-largest wireless operator and Internet access provider in Europe, and a world leader in telecommunications solutions for multinational corporations. France Telecom (NYSE: FTE) is listed on the Paris and New York stock exchanges. France Telecom R&D, the France Telecom group s research and development center, drives innovation for all group units in France and worldwide. The center anticipates technological revolutions and paradigm shifts in usage. The center focuses on innovation that provides customers with best-in-class communications solutions, paving the way for technologies that will become ubiquitous in the future. The performance of France Telecom R&D makes it Europe’ s leading telecom research and development center.

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