4DMedical Limited (4DX) Earnings Call Transcript & Summary

Good morning, and welcome to our 4DMedical presentation this morning. Thank you for your interest and joining and listening in today. It's very much appreciated. We have at 4DMedical an approach at the global respiratory diagnostics market. Lung health is $1 trillion spend around the world every year. And of that, about 4% of the lung health spend is spent on lung diagnostics, lung tests. And that is according to the usual rules of thumb, spread about the largest by far share to the United States, but a little bit unusually across 4 -- just tightly across 4 technologies, X-ray, Pulmonary Function Tests, CT and Nuclear Medicine VQ. And these technologies are invented in -- for X-ray technology in the 1800s and -- sorry, for Pulmonary Function Tests and X-ray technology in the 1800s and Nuclear Medicine VQ and CT at 1945 and 1970 or so -- sorry, 1960 and 1970s, respectively. These lung technologies are failing us. And we have 3 key -- these old out-of-date technologies are failing us. And there's 3 stories that we have around how that impacts patients, doctors and the health care system. We talk about lung health screening first. COPD is the fourth largest cause of death in the world. And many of you will be interested in industrial-related diseases such as silicosis, pneumoconiosis, et cetera. And the method, the way that healthcare has been moving over the last few decades is as much as possible, can we treat these conditions before they become chronic onset diseases? Can we detect them early, treat them early and save suffering and cost? And as yet, there really aren't technologies available to us. So none of those 4 technologies that I referred to before are able to reliably predict the onset of COPD or silicosis and so on. Unexplained dyspnea as -- there's a really great article published in the Medical Journal of Australia that talks about the multibillion-dollar cost, $12 billion cost of unexplained dyspnea or breathlessness. And here my story on this is, this is when -- and 9.5% of adults have this clinically relevant breathlessness. The story here is you walk into your GP office and you say, "Hey, doc, when I carry the shopping up the stairs nowadays, I get puffed and I don't really know why. Can you help me with that?" And really, the GP has the option of sending you to a lung specialist, a heart specialist or maybe somewhere else perhaps to counsel you about getting more in shape or something related to that. But it's a very difficult thing for them to do from just what they see speaking to you in that meeting. And about 2/3 of the time doctors are unable to get you first to the right appointment. And that might not sound like a big deal, but if you're that patient, you get sent off to your cardiologist, it takes you 6 months to get that appointment. You then take a few months to get some tests, speak to them, then discover that your heart is perfectly fine, to then be sent back to the GP, to then start all over again. There's a lot of friction in that. Meanwhile, a year or so or more has passed while your condition is getting worse, the cardiologist isn't happy with seeing the wrong patients, the pulmonologist isn't happy that they don't get to see their patients as early as they could, you're not happy. So really, nobody is happy. A lot of money is being spent. And that problem in the United States is about a $600 billion a year problem. And of course, for many of you on this call, you'll also be familiar with the story of burn pits and deployment-related respiratory disease. For about 20 years now, the U.S. Military has engaged in a practice of burning its trash in open-air burn pits. So they dig a shallow hole, put the rubbish, so human waste, which may include all of the obvious pits, but perhaps body parts, maybe laptops, military things, files, documents, tires, puts them in the shallow pit, pours gasoline or jet fuel on top of them and sets it on fire. And if you're imagining the fires that grandad or your parents might have used to light back in the day in the backyard, the burn pit in Balad, Iraq, where [ Leo Torres ] is pictured here, are served, it was 4 acres of burning rubbish and can be seen from space. And once again, there is no really adequate test for those folks. None of the 4 tests that I showed on that previous slide are able to detect deployment-related respiratory disease. The only way to detect that disease reliably today is with a surgical biopsy. That's obviously cutting in between the ribs, taking 3 pieces of lung tissue out. It costs tens of thousands of dollars. It takes at least a 3-day stay if you don't have complications. And in 1 in 30 patients, there's severe complications that can include death. So all of these things are really examples of how those 4 products that I mentioned before are not serving us as the general public, not looking after us, which also represents at the same time, for us as 4DMedical, a multibillion-dollar opportunity to do better. And here, unfortunately, today, I'm unable to share these with you as videos. But I think the -- at its core, what our technology does, the solution that we have is to take existing images, existing CT images, apply our software analysis and generate significant value add for everybody in that chain for the doctor, for the patient and for the bill -- those who are paying the bills. Here, we're showing examples of, on the left from, for example, our CT LVAS technology that enables doctors and patients to see ventilation, to see airflow in the lungs as patient breathes in and out. And soon, we'll have available, we're excited, and we'll talk to you a bit more about that later today, our perfusion technology, which allows us to see blood flowing throughout the lungs as with every beat of the heart. So we have these technologies that take the existing CT imaging technology and add significant value to that and allow that to enhance the health care experience for everyone. So here, if we get into our product portfolio. About 4.5 years ago, we had one product here. We had XV LVAS, the lung ventilation analysis software that runs on X-ray or Fluoroscopy. And over that period of time, so about 4 years ago, we had just that one product, and we're working tirelessly to bring that technology to market. And we had, at that time, a range of doctors who are working with us excited by the technology who wanted to bring that technology into that practice to the benefit of their patients. But despite our work, it was tough going. It took us longer to bring that technology to market than we would have liked. Things moved more slowly than we wanted to. However, through those efforts, through that work, we learned a lot about how to crack the code of how to bring those products to market. And one of the key things that we learned was that individual products have a high amount of friction and product suites together have -- get to share that friction between them and have a much easier time of coming into the market. And so through our ongoing R&D, for example, once again, listening to the market and seeing that we needed to bring our LVAS technology across to the CT platform as well. And then the -- not just having the LVAS available on X-ray, but also having LVAS available on CT as well as through the acquisition of Imbio and the integration of their portfolio, we now have the most comprehensive test diagnostic product suite of any company, large or small. And this has really been a key driver. And I think those of you who looked at our most recent 4C have seen that we've now grown our revenue run rate to greater than $6 million per year, in large part to having this comprehensive portfolio of products here available. Another way of looking at this product suite is by breaking these down into pulmonary function. So these are products, technologies that allow us to share with the doctor and the patient information that would not be available in any other way to see air flow and blood flow, for example. Also, we've learned that side-by-side with these high-value reimbursed products, there's great value and market penetration and having products that enhance the workflow that deliver something that perhaps the radiologist could have done anyway, but to do so with quantification, with confidence, with speed and efficiency that would be difficult for them to do, not possible for them to do by themselves. And of course, we're also adding our cardiovascular suite. If you're taking a CT of someone's lungs, it's impossible not to get their heart right there in that. And so there's a lot of value that we can add through that imaging as well. We have a clear comprehensive commercial strategy. We have segmented the market, both by territory and by market type. And we have identified the clear value proposition of each of those opportunities and are going after each of them across that market. We've had a really great year. Over the past 12 months, we continue to have great engagement with the VA. We've successfully integrated Imbio into our -- and really genuinely have just one company between us now. One U.S. Medicare reimbursements, including most recently $650 per CT for CT LVAS. That is a really -- that is off the charts compared to the average reimbursement that is available for technologies in this space and represents a really significant asset for 4D going forward. We had a little bit of a head start, especially for CT LVAS in Australia, and that's really showing now -- we've expanded into Perth with Qscan, into South Australia with Jones, and additional radiology clinics are signing up regularly to join that. We have the master reseller agreement executed with Philips and have expanded on until just in the last 2 days, that product portfolio is now live on their quoting tools and in their catalog. So we now have 2 days of progress there with that Philips sales team joining side-by-side with ours to take us to market. Recently had FDA approval for IQ-UIP, and the multibillion-dollar opportunities that IQ-UIP brings us for pulmonary fibrosis. Ongoing interest from the United States Department of Defense in our technology, including most recently for VQ even before it's approved, customers are signing up for -- across the United States. So really great progress there over the last 12 years -- sorry, over the last 12 months. I think here is at the core, what that progress looks like. So we have sites growing at a 41% year-on-year basis, scans growing at a 77% year-on-year basis. So really, if you -- what that's really saying is that we've got a 41% increase in the number of sites and about a 30% increase in the number of scans per site. And then on top of that, we continue to increase the average revenue we get per scan for our core XV technology scans. And so right now, we've got that up at the $349 mark, but the high watermark for that is really about the $1,000 per scan mark as represented by the USD 650 per scan for CT LVAS. So I think that our sales team have been working hard. As I said, we had that hard thought information for our early years of fighting to take XV LVAS to market by itself. We now have a new invigorated sales team, taken those learnings and are bringing them to market and have experienced or delivered for us that growth that we've just said, as I said, growing in number of sites, growing in number of scans per site, and growing in average billable per scan. And now as of 2 days ago, we now have an additional -- so we have our 10 sales folks are now reinforced by 250 people from Philips. And these are not folks who are -- they don't have a catalog of a whole range of similar products. Our lung diagnostic products are the only products that deliver those for that market, and they're incredibly well connected. For example, Philips software team, our business is at its core, connected to the PACS and AI part of the Philips business and also at its core connected to the VA. And so that subset, that inner core of VA sales of PACS and AI from Philips last year exceeded USD 100 million. So they're there every single day. That's more than $2 million a week of sales there for those products. They're there. They have the connections, they have the relationships, and we now get the turbocharge as of just earlier this week. Our 10 folks being reinforced by 250 people who are there at the coalface making those types of sales each and every day. And of course, I think, in addition to our organic growth and the growth multiplier of having Philips there, we also have coming down the pipeline a really incredible opportunity with CT:VQ. When we presented CT:VQ clinical trial data at RSNA in December of last year, the part of the level of excitement is that VQ is seen as a problem that requires solving in healthcare. And that problem has an immediate opportunity attached to it of -- there's 1 million scans per year delivered in the United States with an average billable of USD 1,150. So USD 1.15 billion as the immediate first phase displacement opportunity with multiple layers of opportunity, each of them that scale up above that beyond. And Nuclear VQ is plagued by logistical and technical challenges. I've had a Nuclear VQ scan. So if I tell you my experience of getting that scan, I think that's helpful to understand. Firstly, you have to travel away from radiology down to the -- typically to the basement of a hospital where the nuclear medicine departments are. And a Nuclear VQ test is actually 2 scans, right? So the way that scan is delivered to you is you get 2 tests. One of them is you've given a container that you -- effectively you pant into that's full of radioactive powder or radioactive dust, that's kicked up by your panting and sucked into your lungs where that radioactive material sticks to the lining of your lungs. And you then get an image such as the ones on the left-hand side here, these ventilation images of where that powder has stuck to the inside of your lungs. You then get the second part of the test where a very similar material is injected into your bloodstream and you get -- you're then imaged to see where that radioactive material is now in your blood. And so they give you images of where that powder stuck when you breathe it in, and where that dye went to or that material went to when it was injected into your bloodstream. So an image of where the air goes roughly and where the blood goes in your lungs. It's a 1-hour appointment, typically takes about 45 minutes to do the test, a 1-hour appointment and delivers the images that are not as clean and crisp as much of medical imaging is today. But it does add tremendous value to healthcare, which is why $1 billion or so is spent on it every year. And to cut to the chase, CT:VQ offers the opportunity to deliver all of that clinical value but without any of the logistical difficulties and we believe with superior image quality. So you see side-by-side here, the SPECT ventilation imaging, the airflow imaging and the SPECT perfusion imaging here side by side comparing CT:VQ, which is delivered without inhaling anything, without having anything injected from an ordinary CT scan that you could get on any given day. So effectively, it takes all of that value that Nuclear VQ imaging delivers, that $1 billion plus of value every year, and moves it from logistically the most difficult part of the hospital workflow system into the easiest part, especially for chest radiologists and for lung doctors. And I think -- so because of those -- I guess, all of those natural opportunities, we see reduction in cost, increase in convenience, increase in image fidelity. It's very rare that you get to do something faster, safer, cheaper all at once in healthcare. It's a once-in-a-generation opportunity. And it's also from a commercial and from a sales perspective, the first time that 4DMedical sales team will have the luxury, the ability to sell a product that's replacing something that's already in the market. To date, they've had to do the incredibly hard work, which having cracked the code, has been working for them over the last few years of selling new technology that solves old problems. Here, they get to replace an existing product for something that, as I said, delivers something at least as good, but without those logistical challenges. So I think really, that's the core of our update where 4DMedical is at today. We have growing with our organic, our in-house sales team of about 10 folks, been rapidly growing the number of sites, been growing the scans per site, been growing the average revenue per scan, that's grown us more or less from a run rate of 0 revenue to $6 million run rate over the last 2 years. Those 10 folks are now being joined by Philips, that will scale that up into day-to-day healthcare delivery for the VA. They also have the opportunity to together target a really big swing, a really big shot on goal for a national rollout of burn pit screening. There's 6 million veterans who need screening. We have reimbursement at $650, that's about AUD 6 billion opportunity right there. And then coming down the pipe is this tsunami that CT:VQ will deliver for us, revolutionizing that sector of lung health. So as you'll have seen, we have an SPP out in the marketplace. We'd absolutely welcome your support. We think this offer has been -- this offer provides a great opportunity for our loyal retail shareholders to participate, to support and also to get their reward and share in the amazing year that we're looking forward to here at 4DMedical. So thank you very much for your time and your attention today, and I look forward to keeping you informed of the great year we're going to have ahead. Thank you.