4DMedical Limited (MQ7.F) Earnings Call Transcript & Summary

Thank you for standing by, and welcome to the 4DMedical Investor Webinar. [Operator Instructions] I would now like to hand the conference over to Dr. Andreas Fouras, CEO. Please go ahead.

Hey everybody. Really, thank you so much for joining this call. I'm incredibly appreciative of your interest. I hope you can bear with me. My voice is pretty hoarse. I've literally had hundreds and hundreds of conversations with doctors over the last 3 days talking about CT:VQ at the RSNA conference. And it also doesn't help that it's currently below freezing here in Chicago where the whole place is covered in snow. Let's get into it. Here is, of course, important notices. For those of you who are really new to the business, to 4DX, we are a structural and functional imaging software company. We take CT scans and add significant value to those to help the whole range of doctors, radiologists, lung doctors, surgeons. We have about 130 folks across our team with a key focus of our U.S. team being on our market and the rest of the team being in Australia. And we have -- we're excited. We now have 9 FDA-cleared devices as of early September when we got CT:VQ cleared by the FDA. So this is our portfolio. One of the key things that we've learned over the last few years, in particular, since getting CT LVAS to market and the acquisition, which -- and this information led to the acquisition of Imbio, that there is really significant value in being a full-service offering. There's significant value that when our hospital signs up to get 4DMedical's products, that they can have the whole spectrum of everything that they need that's covered inside that one CT scan. So for example, one CT of the lungs has, of course, has the heart in it. So you can see, for example, a coronary artery calcification. You could see lung density analysis. And of course, we'd really like and folks are overwhelmingly lining up now to get to our third-generation product, pulmonary function product, CT:VQ. They're highlighted there in yellow on the left, our pulmonary function products game changers in their space and that they show things to a radiologist or to a doctor that they could not see no matter how long they spend staring at that image. And in particular, CT:VQ shows both the ventilation and perfusion in the lungs. And I'm going to repeat it probably quite a few times over the course of the call, but we're really very proud of the fact that CT:VQ is the only technology in the world that allows you to see blood flow in the lungs without the use of any injected contrast. And so that gives us this tag line, and this is exactly one of the key slides that we show at RSNA as we're talking to doctors when they come in saying, "Hey, I've just been out there. I spoke to Dr. XYZ. They told me that I had to come and learn all about V/Q from you." And our starting point in the conversation is always this, that you get all of the contrast without requiring any of the injections. And that's particularly exciting to radiologists because they are doing noncontrast CTs routinely. They're doing them all day every day. And so having -- that's really the center of their interaction with lung doctors. And by being able to add additional value on top of that with software, that requiring them to go out and buy new hardware or service new hardware or have new technicians to do the scanning operations. So that is something that they find very exciting. And once again, for those who are new to the story, if you look here at the top of the picture on the right, that colored image. So we take this routine CT scan on the left, we add value to it, that dramatic value inflection to that scan through our software, and that gives you a ventilation image shown there at the top and a perfusion image there on the bottom. And a key thing that this is used for there's right now today in the market 2 core technologies that deliver perfusion imaging in the lungs. And they are both CT with contrast or CTN geography. But for us right now at the center of our bull's eye, at the core of where we're looking to make the biggest impact is the standard of care really for perfusion imaging, which is a SPECT V/Q in the U.S. Now I know this might seem like a little bit of a detail, but SPECT is a modern technology that delivers a 3-dimensional image, a 3-dimensional nuclear image. And so how does that work? What it does is the patient in some way or another is given, is ingested radioactive material and then the SPECT system measures or images in 3 dimensions where that nuclear material is. So for example, well, for example, specifically for a SPECT V/Q image, the patient goes off to a special room where they're given a canister of radioactive powder or fine aerosol or dust of radioactive materials. And that radioactive material in that container, you pant into the container, it kicks it up, and it comes in and sticks to the inside of your lungs. You then leave that special room, go into the imaging chamber where the radio activity that is coming out of your body is image and you see that there in that SPECT image. You then inject it with radioactive material, and that gives you the SPECT image on the right, which is the perfusion image. And then just one final point, sorry for all of this detail, it's important to understand the market. That is a 3-dimensional image done on a very sophisticated mono equipment. In the United States, 2/3 of all nuclear V/Q images are delivered with -- to a flat image. So basically a hat camera that doesn't create the full 3-dimensional atonal image and actually creates an image quality that I would say is substantially less good than this example you see here. But nevertheless, so this is SPECT ventilation in the middle, perfusion on the right. And at the start of all of this process, when the surgeon sent you off or the doctor sent you off to get that SPECT V/Q image. First of all, they took a CT scan. And what 4DMedical is offering here with CT:VQ is the ability for that surgeon, that interventional pulmonologist, interventional cardiologist is to use the CT scan that they'd already taken on you and just simply order our software to be run and that delivers images that you see right here. And I'll just quickly flick backwards and forwards there you see, that's the current standard of care. In fact, that's the top 1/3 of the market. And then here we see our images. Now the key advantage, I think a lot of folks prefer the look of those images that we have there. I think they look cleaner and crisper but actually, that's just one of many drivers that are driving doctors to be extremely excited to say things to us, like I've been hearing at the conference over the last few days, like I must have this, I need this for my clinical practice. And those key drivers are not just has said that there was a really nice clean crisp image and that, that sits on the CT that they're already used to dealing with. They don't need another procedure. But actually, they don't need another procedure. It's like that they don't have to send the patient off to go to nuclear med and get this quite complex procedure. It takes about 45 minutes to an hour to do it, requires the patient to go through a number of steps, requires expensive infrastructure that's only used for this, for example, equipment to generate aerosols or powder forms of the radioactive material. Overall, that's complex. On the other hand, they already got the CT and they can run our software, they get exactly what they want. That is the core thing that's driving doctors to come across and use our technology. So there is, as I've been saying, a really significant -- we're excited, and we have identified really at the core, at the center, not the entire market, which is many, many billions of dollars, perhaps USD 10 billion a year. But at the center of our bull's eye is the 1 million V/Q scans performed annually in the United States with an average billable of $11.50. So that's a USD 1.15 billion market and globally a $2.6 billion market. There are, of course, you can think of that as a target without a ring or an onion with more and more layers. There is replacing the CTN geography business. There is other global opportunities. But for now, we are laser-focused in terms of execution on that central million scans of currently of V/Q. And we firmly believe we know for a fact that right now that nuclear V/Q had some key issues for the folks who actually deliver the nuclear V/Q scan. I've been talking about some of the inconvenience like that you need specialized equipment and the fact that there is only a modest number of nuclear setups across the United States. There are 10x more CT setups in the U.S. than nuclear and it takes about 1/4 of the time or less to do a CT scan. And so you can think there's at least 40x the infrastructure to do it. But I think also, you can't have a conversation like this about habits and decisions without also talking about the economics. So let's have a quick talk about the cost or the reimbursement, the payment that the hospital gets. And these numbers are gross inflows, so gross payments made to the hospital. In fact, these numbers get more appealing or more favorable to 4D when we start looking down and doing a breakdown after costs. But here, we have a nuclear V/Q scan, reimbursed at $530 per scan, a 16-minute procedure, that's $8.97 a minute. And instead of doing that by shifting it from a space where it takes about an hour to do the test to someone where it can be done in just a few minutes, just a 5-minute procedure, then you add our reimbursement, which is a little higher, $650 versus $530. But the key driver is not that 15% increase in the reimbursement is that you can do it in a fraction of the time. And so the revenue per minute is dramatically higher. But on top of that, there's a spot now in the nuclear medicine department. And there's a whole range of opportunities those nice medicine departments like everywhere in medical imaging today ask any of the experts in medical imaging today and they talk about just the overwhelming demand, just how busy everybody is, how hard it is to do to get through all of the workload. And instead of doing instead of doing that test that gives $8.97 per minute, they can do, for example, a myocardial PET stress test that bills at $22.50 or is $30 per minute, significantly more or they could do a theranostic scan such as you might have heard of Telix and the procedures, so the theranostic procedures, imaging and treatment that they do that bills at $6,000 per procedure. So we have this really phenomenal opportunity where instead of the scan coming there into the middle, the V/Q peels off to the left and this myocardial PET stress test comes in to the right, and both of those departments are more profitable, have drawn in more revenue. And additionally, right, so there's more money. It's more convenient for the surgeon because they don't have to send somebody off. They don't have to complicate their scheduling for their procedure room for their operating theater or their procedure room, better for the patient, they are inhaled, radioactive powder. They don't get injected with radioactive material. The scan quality is beautiful. We just have this every single reason for a decision to be made here drives in the same direction. And then, of course, on top of that, if you're in the 2/3 of the U.S. market, that is on the old-fashioned 2D imaging. You also get to say that you get to skip from 2D to 3D imaging at the same time. So having seen this, having seen these compelling reasons and the massive opportunity that CT:VQ represents our friends, with whom we already have an existing agreement with Philips have agreed to add CT:VQ to that existing agreement to expand that. And they have played, they've made the extraordinary step of adding minimum order commitment over a 2-year term. And additionally, to support us and to support that minimum order commitment, they are adding business development sales and clinical specialist team members to their team both specifically dedicated exclusively to V/Q and also partially dedicated to V/Q across our opportunity. We've already started. Some of you may have seen that we did a breakfast opportunity. So co-marketing, joint marketing activity, there was a breakfast at RSNA. And you can see here on the screen, those 2 pictures here are pictures where there were big audience of leading radiologists, including some that I had the opportunity to talk to one very senior radiologist there stayed and spoke to me for 50 minutes after that presentation, which is just absolutely extraordinary. So it is this great lineup of speakers that included leaders, leading radiologists in the United States, leading pulmonologist, our Chief Medical Officer and a senior executive from Philips, in fact, the North American leader for software sales in the U.S. And we've said that commitment or as we said in our announcement yesterday, that commitment includes a mechanism where that commitment is underwritten on a cash basis, with really significant growth baked into -- baked in as well. So we've been working hard, working diligently. I think I'm very proud to say we have one of the hardest working teams in health care and we have worked to bring to validate our technology. We've got 100 -- over 100 patents, 9 FDA clearances, hundreds of peer-reviewed academic publications. We have proven products, process and people. So our full pulmonary imaging suite, CT:VQ is an unrivaled disruptor, the only technology in the world that allows blood flow without an injection. We have been demonstrated that we are navigating U.S. health care proud of winning Deloitte being listed in the Deloitte Fast 50 as the seventh fastest-growing technology company in Australia. We've been achieving that with our second-generation product, and with the great people and our deep understanding of U.S. health care. And that's all being delivered by our internal people. And now that Philips have stepped up formally in writing, backed by cash backed by resources, have strengthened our team by adding something like more than 25x the other people power to that same effort. We have a bursting pipeline and I think the -- it's one of the reasons why I'm so excited is because time after time after time today at RSNA, I had global leaders, U.S. leaders in health care walking up to our booth, walking up to me and saying, I have heard about this V/Q thing. Can you tell me about it? It sounds unbelievable. And then by the time they leave, they're saying to me, I need to have this. This is an incredible technology. This is going to help me get my job done, help me deliver better health care to my patients. And we are well funded. So cash in the bank already, and we have a high expectation of additional -- some or, in fact, really all of that additional $30 million from excise options. And in fact, more than 1/4 of those have already been exercised. So if I just pause there just for one split second. So we have -- all of these things in place. This is the core of our plan. This is where we're putting our resources, and this is where we will deliver. And on top of that also with Philips, our strong partner we have a really significant opportunity. And if I just cover this really quickly, this slide here is in numerous slide decks that have been put out on the ASX before. Let's look at the right-hand side of this. There are 4 million veterans who through PACT Act registration have registered as being impacted by toxic exposures. A surgical biopsy would cost $30,000 and require a 3-day stay in a hospital, cost $120 billion. The short pitch that we're making to the U.S. government to the Department of Veterans Affairs, and you can see there in that picture, in Congress, second from the left or third from the right, CEO, Jeff DiLullo, West Point graduate, Army Ranger, CEO of Philips, friend of 4DMedical standing up giving testimony and Congress saying that a way that one of the best ways that the U.S. government can save money by implementing technology in health care is by implementing 4DMedical's screening technology to screen these veterans. And so that's -- we say that's a $4 billion opportunity. We're very excited about that. And that stacks as a very exciting opportunity on top of our core plan which we are executing and will execute over the next few years. So look, thank you very much for your time. I really appreciate your interest. And from here, we will be going on to questions.

Your first question comes from John from Taylor Collison who asks, no doubt the RSNA conference is an event that will lead to new leads for 4DX. But is it also an event where companies execute new agreements with groups they have been engaged with in recent months?

Yes, absolutely, that's the case. So there's a lot of business happening here in the hallways. Whether it's, for example, I had a very full day yesterday, so I had to be up at 3:15 if I was going to get the chance to do a bit of a work out before I got to the breakfast event with Philips. And of course, well, not, of course, but I was excited to say that right there in the gym was a very particular radiologist that I've been meaning to catch up with and I've been working hard to see. And there we were, we had that meeting, and we made some really great progress towards an arrangement. Also, businesses are doing business with each other sites. We had a number of meetings with Philips in between tightly packed meetings with radiologists, with doctors. So business of all kinds is happening at RSNA and it's happening from 3:00 in the morning, actually probably 24 hours all the way through, whether you're maybe perhaps the type like me to get up to go to the gym 3 or the type that's getting from a big night at 3:00 in the morning. Either way, this business happening pretty much 24 hours a day over the whole 3 days here at RSNA.

Your next question is from Craig, a private investor, who asks, is there an opportunity to include the LVAS test wind in the CT:VQ test?

Look, that's a great question. I think the way -- and absolutely, yes. And in fact, not just the LVAS test. There's a really significant opportunity. I'm going to bring up our whole portfolio here. There's a significant opportunity. When you have a CT of your lungs, of your torso, your chest, as the doctors often call it, then we see that as the hospital has invested buying that CT scanner. The doctor has organized the time, you have organized the time, probably some money and there's some radiation given to your body as a result of that test. And we at 4DMedical are there working with doctors to make sure that every single bit of value possible that can be extracted out of that CT is extracted. And that's exactly what this portfolio of products is about. From that from that lung cancer screening CT that you might get, you can also see, do you have coronary artery calcification or do you have emphysema through lung density analysis or when you get the CT:VQ, absolutely, you can get an LVAS and you can have really detailed readouts of the ventilation as well as those images of ventilation and perfusion. So we are there, you've come in, you've made that offer. Some of you may know that Chicago is famous for steakhouses. Beef is at least as big here in the U.S. as it is back home in Australia. And if you come into -- you'll tend to pick your Chicago steakhouse based on your CT:VQ. What is the core stake, what's that really best stake are they famous for delivering that flagship product? But while you're there, if you're in there, of course, you want to have a drink with that, you want to have a salad, you want to have that whole offering, fries, of course, let's be honest. But you want to have that whole offering there side by side. And while someone might walk in the door because of the stake, they might leave because after time, they think that they want to have the full offering. And 4DMedical has the biggest, most complete offering of any company, big or small, on the planet. So you just can't get that value anywhere else like you do in the same way that you can't get CT:VQ anywhere else. And I'm sorry if I dragged this out but on top of that, in the world audiology, like if you're in a restaurant, it'd be a pain to get out, to cross the road, buy a bottle of wine, come back in and ask them to cork it. That's annoying. In the same way, in the world of radiology, going and getting all of the IT approvals, getting the connection done, getting the contracting done having all of those products carried under one contract, one IT approval really makes it easier for the hospital and creates a barrier for entry for our competition for us.

Your next question comes from Scott from Shaw and Partners, who asks, is the FDA approval for CT:VQ a temporary approval or permanent? How does the reimbursement mechanism work? And is it guaranteed reimbursement for each scan or at the discretion of health insurers?

Well, I may -- as I said, I've been -- haven't had a lot of sleep in the last 3 days. I may need some of that to be read back to me, but I'll give it a and see where I get to. So first of all, the FDA approval is indeed for all time. So we have that permanent coverage. And in terms of the specifics of an FDA approval, we have a very high quality approval. And what I mean by that is we have a very broad indication. So we have the right and doctors have the right -- we have the right to market. Doctors always have the right to use a product, however they want. That's an important point. But we have the right to market the technology very, very broadly. And we have really significant evidence base that allows us -- we've got more than 2,500 patients worth of V/Q data that we're able to show people at the conference here at RSNA. And I believe the second part of this was insurance. Now if we're going to be -- if we're going to have an honest conversation, then we're going to say that insurers absolutely have the discretion to not pay claims. That's something that is well known. And companies have hospitals is absolutely in hospital's interest to get their reimbursement as much as possible. But from time to time, hospitals absolutely won't pay this. And you can go back and you can look at some of our presentations that we've made when we got the reimbursement where this is covered in more detail. But one of the things that can change, yes, from time to time, insurers won't pay those claims, and we're going to be working with the hospitals to get that claim rate up as high as we can up towards 100%. But it's also worth noting that the $650, when we talk about this in the simple sense, we give the Medicare number, which is $650, whereas in imaging, especially in our sector of imaging, the usual is the private insurers will pay about 180%, so 1.8x the -- 1.8x to 2x the Medicare rate. So we have an opportunity for reimbursement, private payer reimbursement at about the 1,000 to 13 -- sorry, $1,000 to $1,300 dollar range. One final point, though, because you have brought up reimbursement, I think a lot of folks see and I talked about the reimbursement. I might even throw that reimbursement slide back up to clarify. This is indeed an important driver the fact that the reimbursement process is absolutely tilted in our favor. But nevertheless, all of that pulls into insignificance to the key value of our technology of streamlining the workflow of surgeons to get patients in their operating rooms. A noninvasive procedure in the U.S. is about $25,000. I know there were several hundred people on the call with Dr. Kyle Hogarth, listening into him talk about that market. A lung volume reduction surgery, an LVRS, I think reimburses at about $55,000 and a lung transplant operation in the United States, I believe, reimburses at about USD 600,000. One small scheduling snafu, because someone had to go down to medical and go down to nuclear imaging and people weren't sure if they were going to be booked in this week or next week, that leads to an empty spot in a procedure room, that blows out the water. Yes, these numbers here, the reimbursement, super valuable, really helps drive the story. But actually, the biggest value proposition is even bigger. It's we make it easier for the hospital to win those $50,000 procedures every single hour time after time. And one thing we know about hospitals and surgeons, interventionalists have authority. They are the ones who bring in the money, the CEOs, the CFOs of the hospitals listen to them. When they thump their fist on the table and they say V/Q is the thing we really need, the rest of the hospital listens.

Your next question comes from Wen, a private investor who asks, could you please confirm that the Philips CT:VQ arrangement is not exclusive?

Yes. So look, there is -- it's very much aligned with our previous arrangement, Wen. And so that means that the details as talked about before, they do have exclusivity in the government, right? So that is so, for example, selling to the VA. And I think at any rate, I just can't imagine anyone, any corporation in the world who are more dedicated to serving veterans and to getting our products in there to the veteran communities. So I think that is a win-win for everybody, certainly for us, for our shareholders and for Philips, to have that exclusivity in government, right, which means basically means the VA. And we certainly, we'll be out there. We'll be continuing to sell V/Q. Our sales team won't be standing down. They'll be working to sell product. And of course, they'll be looking and evaluating and there'll be, I think, quite regularly they'll be saying, Oh, this one, see this lead here, I was the one to talk to my friends at Philips last night, they said to me, they've got great connections in at this hospital, where I'm trying to get this deal done. I'm going to pass this over to them. They're going to be able to get it done faster, contracted faster." And that's because Philips has the largest installed base for packs of any provider, right? So we -- it is out their packs or their software team that's selling this product, and they are across literally thousands of hospitals across the United States. We're not relying on sites that are, for example, have a Philips CT scanner. This is a software product. Yes, we could be included as a bundle on a Philips CT sale, but we are being sold or our team is focused as software salespeople, and they have the largest installed base. As an example, I think they have 51% of installed base in government and as said, the largest base, somewhere in about the 1/3 mark of the rest of the U.S. market. I can see where getting -- we're getting reasonably close on time. Perhaps we just have 1 or 2 more questions.just to respect everyone's time -- sorry, we're over time, I apologize. So I know there seems like a lot of questions and really keen to get to them, but also want to respect peoples' schedules. So perhaps we'll just do another couple of questions and then wrap up.

Your next question comes from [ Amit ], a private investor, who asks, can you run a CT:VQ scan on an old CT scans that was done in the past and archived? Or does it need to happen when the CT scan is originally done?

Well, thank you so much for this question. This is a really great question. And the short answer is we absolutely can and we regularly do. And for folks who are wondering, hang on how has 4DMedical been reducing its R&D cost, reducing its clinical trial cost and have 2,500 patients worth of data here at RSNA, and this is one of the drivers of that, that and the smarts of our really top globally competitive top-tier clinical trial team. But more importantly than the fact that doctor can look at it retrospectively, what does that mean? What it means is that a doctor can order say, look, you know what, I want -- Andreas, I'm going to have a look at -- I need to remove I need to chop this little bit of your lung out over here. I need to do that, I need a V/Q scan. So I'm going to order that. But actually, you've been seeing me for a couple of years. I also want to pull up those CTs that you did with me when you came to see me last year, and I want to run V/Q on that as well so I can see how you've changed over the last year. That will help inform me as to the decision I make. And even better than all of that is the doctor can be paid for that. The reimbursement is specifically written into our reimbursement code, but the doctor can claim a reimbursement for doing both of those V/Q scans. And of course, I think it goes without saying when an injection into the body is required, there's no way to travel back in time and put an injection into me a year ago. A CT angiogram or a nuclear V/Q can't be retrospectively ordered back into the past. But if you do have that CT like thousands of people who are seeing doctors for chronic lung disease, millions of people seeing doctors for chronic lung disease have, they do have those CTs back on file. And one more time, just in case you didn't hear it, and they can get paid and we can get paid for both of those.

Your next question is from [ Leon ] from [ NorthCroft Capital ] who asks, if we were to fast-forward 12 months' time, what position would the business be in you to view it as a success? What achievements would you expect to be celebrating?

Over the next 12 months, 4DMedical is going to establish an incredible group of reference customers, the top-tier reference customers in the United States. We're very proud of the fact that we already have Stanford University. And I was saying to you, we're incredibly excited by how over the last 3 days at RSNA, the most senior doctors from the best hospitals in the United States were in amongst the crowd of all of the rest of folks who are coming in to see us. And it's long been a 4DMedical strategy, a true strategy that our top priority is to win those academic medical centers, those AMCs, as our reference customers so that as we turn around from there and to go out to attack the rest of the market, when folks say, "Who else is using it?" We can perhaps say, "Oh, it's not just Stanford, it's Cleveland Clinic, it's Mayo Clinic, it's University of Chicago, it's Duke," and so on. So we're going to be collecting those. We are also going to be well into our progress of as I said, turning that around, building that up. We'll also have Philips well established with their pipeline and their progress. And when we come back to RSNA next year, it's really going to be people saying to themselves, all of my friends are using this product, all of the people I look up to. I just went and saw a talk about V/Q. What else -- I need to get on this bandwagon before it gets too late. I'm starting to look like I'm really not on top of the current technology, and I'm getting left behind. So I'd say it's going to be a really amazing 12 months for us. I mean, I'm incredibly excited about where we're at. As I said a little before, we have the product, we have the processes, we have the people to deliver. And as you all know, we've got the cash in the bank to get it all done as well.

Your last question comes from [ Flynn ] from [ Knight Frank ] who asks, as adoption grows, what do you see as the strongest competitive moat for CT:VQ? And how defensible is that as other AI imaging players emerge?

Look, that's a great question. And the thing about an incredible opportunity, right, the thing about 1 million scans a year t to us hundreds of dollars, $650 reimbursement, times 1 million scans a year is $650 million opportunity. And 4DMedical has long talked about a $4 cost of delivery each one of those scans. So the thing about a $650 million market at a 99% margin is everybody likes it, everybody wants it, right? So we have been thinking for quite some time about how do we build an incredible defensive moat around what we've got. We have over 100 patents. So we've got over 17 patent families, over 100 patents, and we have been here first in this space for quite some time. And in addition to that, we are seeing -- we are the adopters. Everybody allocates everybody mentally associates 4DMedical with CT:VQ. Additionally in the marketplace, a lot of products that are out in our software medical software imaging space are based on AI. And there's a lot of great things about that. And in fact, we have AI products in our wide portfolio. But AI is getting more and more regulated. There's a recent article and radiology business today talking about the challenges of AI with the FDA. The FDA is getting tougher and tougher on AI products. 4DMedical stands somewhat uniquely as a mathematical process right in the middle of that. 110 patents around it and we're also not going to sit still, right? We're building those reference customers, those academic medical centers around us supporting us. We're taking into market. We're also not going to sit still, where we are, I don't know. So we have several hundred years. We have about 500 years of R&D. So in other words, if you have -- we've had about -- we've got about 60 people in our R&D team right now. If you add up all of the years, that team spent on V/Q, it's several hundred years. company X tomorrow, multinational can't put 100 engineers on it. It takes them 3 years to catch up to us technologically. By the time they do that, get to us, we're not going to be still on the same version of this and also how they're going to get around those 100 patents. And also by then, it's going to be more than 100. We are also staying uniquely as a company with a full-time patent attorney on staff as deeply embedded in our engineering efforts, our R&D efforts. So moat is something we've been thinking about for a long time. It's a beautiful opportunity, $650 million market opportunity, 99% margin. That's a beautiful, beautiful thing. There's very, very few companies on the planet that have that. So of course, we're going to be here fiercely defending that moat with everything we've got.

Thank you. There are no further questions at this time. I'll hand back to Andreas closing remarks.

Look, I really want to say thank you so much for your interest in 4DMedical. We are in an unbelievable position despite how committed and how much of a believer I am in V/Q. This conference has amplified my belief, even more. Just the caliber of the people walking in and giving us quotes like I have to have this, my patients have to have this. I believe that we're going to be able to go faster and better than even we thought just a few weeks ago. We have built all the fundamentals we need, we've left nothing on the table. You don't have to just take it in my words. You can listen to it in my voice as well. We've absolutely left everything on the field. And I'm incredibly proud of what we've done to date to build a company of the foundations that we have and to attract the caliber of customers that we've got knocking on our door begging for this product. So thank you very much for your interest. Thank you very much for your support, and I look forward to keeping up to date, even quite confident over the rest of December some more exciting news. Thanks a lot.