Investor Presentation

October 2018
Disclaimer
FORWARD-LOOKING STATEMENTS
This presentation has been prepared solely for use at this meeting and is intended for investors and analysts only. The material is given in conjunction with an oral presentation
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MEDICAL ADVICE DISCLAIMER

ViewRay is a medical device manufacturer and cannot and does not recommend specific treatment approaches. Individual results may vary.

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Driving a new standard of care in cancer
Powerful trend ➔ precise, minimally / non-invasive
therapies

ViewRay MRIdian® is a non-invasive radiation system

that provides surgery-like capabilities

Radiation therapy market large and ripe for

innovation

MRIdian offers clear advantages validated by early

clinical outcomes & KOL feedback

Broad market penetration requires focus on four key

workstreams:
▪ Commercial expansion
▪ Clinical evidence
▪ Technological innovation
▪ Operational infrastructure

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 Executive summary
Large Market Unique Technology
MRIdian MRIdian Linac >70 Scientific
8M Cancer cases diagnosed annually 1 FDA
Clearance
FDA
Clearance
Abstracts &
Publications
~$6.3B 2020 radiotherapy market (projected)
2

KOL & early Over 2000

clinical data Patients Treated
~1000 Linacs sold annually
2012 2018

Targeted
chemotherapies
Macro trends in oncology moving
Robotic
surgery towards more precise and less
invasive treatments
MRI-guided
radiotherapy

Precision Therapy Value Creation

1 Source: Globcan 2012
2 Markets & Markets, 2015 Radiotherapy Market Global Forecasts 2020 4
 Estimated addressable market

~$6.3B
Initial targets
global radiotherapy market 1 Academic centers & early adopters
in 2020 (projected)

~$5Bn Estimated 350 – 400 replacements / year 2

Global Linac
$4.6B
~ Market ~$2 – 2.5B annual target market 2

global radiotherapy market

1
in 2015 MRIdian fits inside standard linac vaults
2

1 Markets & Markets, 2015 Radiotherapy Market Global Forecasts 2020

2 Internal reports and survey data
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Disruptive, next generation technology
to better serve patients

Soft tissue
MRIdian potential benefits
visualization
MRIdian SmartVISION™
Optimized dose delivery to tumor

Shortened treatment course

On-table adaptive
treatments
MRIdian SmartADAPT™
Improved outcomes & reduced side effects

Targeting to preserve
healthy tissue
Improved quality of life
MRIdian SmartTARGET™

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An image is worth a thousand words

MRIdian Diagnostic-Quality Conventional

Imaging IGRT Imaging
(MRIdian image courtesy of Amsterdam UMC) (https://www.varian.com/oncology/products/treatment-delivery/iterative-cone-beam-ct?cat=halcyon)

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Disruptive, next gen technology
seamless integration of MRI and linac
CONE BEAM CT Linac MRIdian Linac
Potential limitations Potential benefits

Cannot see tumor boundaries Dose Dose Superior image quality

- Larger dose distribution area - Less impact to healthy tissue
TUMOR
TUMOR

Cannot see surrounding Real time imaging tracks

organs anatomy
- Unknowingly hitting organs at - Spares nearby organs &
risk permits higher dose to tumor

MR imaging
Cone Beam CT adds dose to - Does NOT add dose
patient
- Additional radiation exposure Imaging DURING
treatment
Poor image quality - No need for invasive
- Need for seed implants or fiducials markers

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SmartVISION: Soft tissue visualization

Clear visualization drives more accurate dose delivery

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SmartADAPT: On-table adaptive therapy
Non-adaptive RT: unfocused MRIdian: focused dose
dose

Real-time, on-table, adaptive radiotherapy (ROAR)

adjusts treatment for anatomical changes
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SmartTARGET: Real-time tissue targeting

Soft tissue tracking during beam delivery

with automated beam control
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Clinicians state…
“We can achieve truly ablative doses in the abdomen without also
achieving prohibitive levels of severe toxicity”
Lauren Henke, M.D. Washington University in St. Louis, Physics World Webinar July 2018

“Using ViewRay has changed our treatment options … we can treat

patients that in the past we would not…”
Salim Siddiqui, M.D. Ph.D. Henry Ford Hospital, ASTRO 2017 in-booth Presentation

“…for the first time we have made a difference in overall survival

with radiation therapy in pancreas cancer.”
Dr. Parag Parikh, M.D. Washington University in St. Louis, ASTRO 2017 in-booth Presentation

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 Early, promising results for the most challenging
cases
100%

2x Median
Survival 80%
MRIdian ROAR survival

% Overall Survival

Overall Toxicity
Increase 60%

40% Non-adaptive RT survival

0% Grade 3+
Toxicity
20%

0%
Non-adaptive RT toxicity

MRIdian ROAR toxicity

Months post-pancreatic cancer diagnosis

Launching Phase II Multi-institutional Trial: G3 Toxicity & Survival

Higher Maximum Biologic Effective Dose Utilizing Adaptive MRI Guided Radiation Therapy Improves Survival of Inoperable
Pancreatic Cancer Patients 13
Rudra S, Jiang N, Rosenberg S, Olsen J, Lagerwaard F, Bruynzeel A, Parikh P, Bassetti M, Lee P; ASTRO 2017
Clearly differentiated technology
MRIdian
SEE
Visualize the tumor and
surrounding organs in high-
definition

SHAPE
Adapt each treatment for daily
anatomical changes

STRIKE
Image soft tissue during beam-on
with automated beam control

SIZE
Fit through existing door openings
and into standard linac vaults

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Clearly differentiated technology
Other MRgRT
MRIdian
Technologies
SEE
Visualize the tumor and surrounding
organs in high-definition

SHAPE Aspirational.
Adapt each treatment for daily NO on-table adaptive
anatomical changes
functionality

STRIKE
Image soft tissue during beam-on Real-time imaging but
with automated beam control NO gating beam control

SIZE
Fit through existing door openings Requires wall and/or ceiling
and into standard linac vaults removal AND new 1.5m trench

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Clearly differentiated technology
MRIdian Other MRgRT Conventional IGRT
Technologies Linacs

SEE
Visualize the tumor and Non-diagnostic, low-
surrounding organs in high- contrast soft tissue imaging
definition

SHAPE Aspirational. Aspirational.

Adapt each treatment for NO on-table adaptive If you can’t see it,
daily anatomical changes functionality you can’t adapt to it

STRIKE
Image soft tissue during Real-time imaging but NO soft tissue imaging
beam-on with automated NO gating beam control during beam-on
beam control

SIZE Requires wall and/or ceiling

Fit through existing door removal AND new 1.5m
openings and into standard trench
linac vaults

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A thought leader speaks…

“Just as the 2-dimensional x-rays we relied on in

the 1980s were replaced by CT-guided
radiotherapy, so will MR-guided radiation
technology render CT-guided radiation obsolete.”
- Daphne A. Haas-Kogan, MD
Chair of the Department of Radiation Oncology at Dana-Farber Cancer
Institute, Brigham and Women's Hospital and Boston Children's Hospital
“Opportunities Abound for Radiation Oncology in the Era of Personalized Medicine.”
RSNA Daily Bulletin. November 2017

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How we drive growth…

Commercial Technological Operational

expansion innovation Clinical evidence infrastructure

Creating shareholder value

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Commercial expansion
increase reach & resources to drive adoption

Primary target markets

United States
Increase direct
representation and
EMEA bolster distribution
network
Japan

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 Technological innovation
protect & extend technology leadership

Rich innovation pipeline &

patent estate

Speed
92
Issued patents
1, 2

Machine
vision

Biological
129
Patent applications
2

imaging
1 Licensed or owned (1 jointly owned)
2 Patent date effective 8/6/18 20
Clinical strategy
shaping care patterns, clinical guidelines & reimbursement policies

Aspirations
breast cancer

Fewer mastectomies
Improved cosmesis
Building clinical
prostate cancer compendium
Fewer prostatectomies
Reduce ED &
incontinence

lung cancer

Fewer lobectomies
Superior quality of life

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Operational infrastructure
support & sustain growth

Build for growth &

global reach

Service & Education Back- Enhanced

support & training office capacity
support

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Driving a new standard of care in cancer
Powerful trend ➔ precise, minimally / non-invasive
therapies

ViewRay MRIdian® is a non-invasive radiation system

that provides surgery-like capabilities

Radiation therapy market large and ripe for

innovation

MRIdian offers clear advantages validated by early

clinical outcomes & KOL feedback

Broad market penetration requires focus on four key

workstreams:
▪ Commercial expansion
▪ Clinical evidence
▪ Technological innovation
▪ Operational infrastructure

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