iCAD, Inc. (ICAD) Earnings Call Transcript & Summary

Good afternoon, and welcome to iCAD's Second Annual Virtual Investor Webinar: Optimizing Outcomes and Efficiency, iCAD's World-Class Solutions for the Early Detection and Treatment of Cancer. Today's event will feature a discussion with leading clinical and administrative experts who will share unique perspectives on iCAD's innovative cancer detection and treatment technologies. Moderating today's event will be iCAD's Executive Chairman and CEO, Mike Klein; ICD's President, Stacey Stevens; and iCAD's Chief Commercial Officer, Jeffrey Sirek. [Operator Instructions] As a reminder, this call is being recorded, and a replay will be made available on the iCAD website following the conclusion of the event. I'd now like to turn the call over to Stacey Stevens, President of iCAD, who will introduce our featured experts. Please go ahead, Stacey.

Thank you, Tara, and good afternoon, everyone. I'm Stacey Stevens, President of iCAD and I would like to welcome everyone to iCAD's second Annual Virtual Investor Webinar. Today's event will feature leading clinical and administrative experts from across the country who will discuss how iCAD's innovative cancer detection and treatment technologies can enhance clinical workflow, optimize operational efficiency and of course, improve outcomes for patients. First, we will discuss iCAD's portfolio of deep learning AI breast health solutions in a roundtable event featuring the following experts: First, we have Dr. Angela Fried, Director of Breast Imaging at SimonMed Imaging. SimonMed Imaging is one of the largest outpatient medical imaging providers and the largest physician practice radiology practices in the United States. With over 200 subspecialty trained radiologists, SimonMed operates across 9 states at more than 150 facilities. Last year, ProFound AI was deployed throughout SimonMed Imaging's entire network. Next, we have Sally Grady, who is the Director of Kettering Breast Evaluation Centers at Kettering Health; and Dr. Meghan Musser, a radiologist at Kettering Health. Kettering is a nonprofit network of 13 Dayton and Cincinnati area hospitals, Kettering College and 120 outpatient facilities. Kettering has been using ProFound AI for about 2 years and recently upgraded their full fleet of mammography systems to offer ProFound AI. And next, we have Matt Dewey, who is the Chief Information Officer at Wake Radiology. Wake is the oldest and largest outpatient imaging provider in the Raleigh-Durham area. Wake now includes more than 50 subspecialty radiologists at more than a dozen locations in Wake County and throughout the greater triangle. Wake Radiology was also the first outpatient radiology practice in the triangle to adopt ProFound AI. Following this part of the agenda, we'll then focus on our innovative Xoft technology, which is FDA-cleared for the treatment of cancer anywhere in the body, including non-melanoma skin cancer, early-stage breast cancer and gynecological cancers. During this portion of the event, iCAD's Chief Commercial Officer, Jeffrey Sirek will interview Dr. Sydney Smith, dermatologists and Chief Executive Officer at Georgia Skin & Cancer Clinic. Dr. Smith founded the Georgia Skin & Cancer Clinic in 1995 and has since expanded to include 16 locations throughout Southeast Georgia and South Carolina. Dr. Smith is well known in his community for his patient-first approach to dermatological care and recently adopted the Xoft system for the treatment of non-melanoma skin cancer. So with that, let's begin. Mike, I'll pass it over to you for the roundtable portion of the agenda.

Well, thanks Stacey. As you can see, we've created and assembled the world-class group of individuals. I'm so excited I'm already at RSNA at the booth and no one's come by yet. But I'm just kidding, we'll be there in a couple of weeks. So we'll use this format until that time, and we do have some great individuals who are going to be sharing a unique -- their unique experiences from both the clinical as well as an administrative perspective. And they'll be talking about how iCAD's leading-edge AI solutions for breast cancer, which is profound AI can optimize outcomes and efficiencies. So we're going to actually attack it from those 2 points. We're going to talk about outcomes as well as efficiencies. So to get us started, let's first talk about outcomes. So I'm going to start with [indiscernible] if i might, and speak a little bit about Kettering. And I understand Kettering recently upgraded all of its technology and now offers ProFound AI across the entire network of facilities, not just a few, the entire network. Can you discuss, Sally, why you chose ProFound AI in the first place, specifically and how it compares to other AI technologies for breast imaging that you may have looked at or assessed along the way?

Yes, I'd be happy to. And about 3 years ago, Kettering set upon a journey at our breast centers to really create world-class facilities. We knew we needed to upgrade all of our technology to 3D mammography. And as we were looking at different vendors, we really wanted to see who had the best technology. We chose GE Pristinas for our GE -- for our mammography vendor. However, one of the selling factors was also that we could get iCAD. And with iCAD, we got ProFound AI. And we really -- as we looked at the different components of our program, we really thought it was a game changer. Other technologies, other vendors we had looked at. I think I made the comment, it really felt more like smoke and mirrors. No one was really advanced with it, not near as much as what iCAD was and your road map as to where you were going in the future was something that we found very interesting. It was going to fit well with all of the other components we offered.

Thank you for that, Sally. We'll come back again with a follow-up to that question, but I appreciate for that initial -- a little bit of history and -- that went into your decision. And with that, I think I'll jump over to Dr. Fried because Dr. Fried, also at SimonMed, made a similar decision a little over a year ago to go with ProFound AI. And I'd love to ask you, Dr. Fried, if you can discuss some of the advantages of this technology and what is done in terms of your clinical practice and what it has done also for your patients and even the dialogue that you may have with your patients?

Yes, it has made a huge difference in our reading of tomosynthesis images, the number of images that you have to go through for a 3D mammogram versus a 2D is astronomical. And reader fatigue and distraction makes it much harder to identify areas that need further work up. So having a second set of eyes with iCAD ProFound AI is critical. It makes it much easier to find lesions and find subtle lesions that you may not have looked even if we found even if you look for a long time and very carefully. And that makes a big difference in being able to catch a cancer early versus 1 or 2 years later when it's significantly larger and will require a lot more treatment to cure. We -- I'd say when we first got the technology, it wasn't necessarily appreciated by my colleagues. But after a use for a year, you couldn't pry it away from them because it has really helped with deciding something as normal and can just go because it's that extra level of security that you're not missing something when the AI doesn't see anything as well. And it also helps make sure that -- because we're all very busy and that we're not missing major abnormalities that need to be worked up.

Yes, I'm going to go a little bit off script because I think our investors always appreciate this, that when you said it wasn't always appreciated by folks -- and I know we've had the conversation that first, it's like a handshake. It's a bit of a handle, there's a bit of a learning curve.

Definitely.

Yes. If you could just talk a bit your experience in this regard. It would be, I think, very helpful for our...

Well, the 2D CAD is something that radiologists have used for so long, and it's almost an afterthought at this point. people barely look at it because it's almost a random number generator or just circles everywhere and it isn't overly helpful. So when we introduced it, the radiologists are just like, "Ugh one more thing." It just didn't -- and you have to have time to trust it because it's circling things that I would blow off. And a year later, we're actually seeing these patients come back that had things that were circled an iPad that the radiologist at the time did not think was anything suspicious. And the next year, right, where iCAD had pointed, there's a little small cancer. And it really opened our eyes to the fact that this has seemed things on the images that we're not receiving and it would behoove us to pay attention because it means that we can really help the patient not have an advanced cancer when they're discovered with cancer.

Yes. Dr. Fried, thank you for sharing that information. I'm going to stay down this clinical path and jump over to Sally's colleague, Dr. Musser, over at Kettering. And we'll talk a little bit about ProFound AI, specifically in the area of difficult to detect cancers, things such as lobular carcinomas. Can you, Dr. Musser, explain that for our audience? And how, in particular, ProFound can help find those more difficult or challenging or complex cancers?

Absolutely. I would say our experience really mirrored Dr. Fried's experience. And as time went on, we built our confidence using ProFound AI. And it's really helpful when finding those subtle lesions like lobular cancers. Most breast radiologists are not going to miss the big mass and the big area of distortion. What's truly helpful in these very large studies are these subtle areas that you may not pick up on to have that -- I like that term, that extra set of eyes, that helps for you to take an extra second to look again at that area that you could have easily just moved on from because lobular cancers are so challenging, and it can just be a subtle change in that breast tissue and not that big mass that we're going to be able to very easily see. So Profound AI can really help with those subtle lesions.

Thank you, Dr. Musser. We'll be coming back some more. But I'm going to switch over to Matt Dewey for a moment because a lot of our investors have heard us talk about enterprise customers. And Wake radiology is a force in the North Carolina market, and it's classically that enterprise customer. In fact, he's the Chief Information Officer. So this is exactly the person we talked about when we talk to our invested. So Matt, I'm going to be asking you about efficiency in the second part of this, but upfront here, I'm going to -- asking you from your perspective of being a part of the decision-making team and the -- obviously, the implementation of the technology, what have you found from a clinical standpoint in terms of benefits? Can you elaborate on that? And again, I'm going to come back on the efficiency side. So there will be another part to this.

So on the clinical side, we found that it increased the cancer detections of the radiologists from -- they were finding 5 per 1,000 to 6 per 1,000, which is across the board. So it made a difference for all of our radiologists. We started it mainly with screening radiology and then we moved it to diagnostic as well because they found so much value there. So they -- it made a difference to quite a few patients themselves because we were finding things that we weren't finding before. So we did a year-over-year comparison, and we're able to prove that in our statistics.

So I told you I was going to double click here and also come back and talk about things that are unique to Chief Information Officer. So having talked a little bit about the clinical outcomes, which are obviously paramount. Can you speak a little bit about how ProFound AI fit into your goal as a chief information option? That's a unique orientation and a key decision-maker in the mix that we talk a lot. So I would love to hear from that angle as well, more of your informational well.

So one of the things that's important to us is always to be on the cutting edge to be trying new technologies to make our -- to distinguish ourselves in our market and to improve the radiologist both efficiency and clinically. And so that's why we were looking at different technologies to do that. And this -- I also need something that's easy enough for them to use that we can roll out that's going to -- going to bring value to our patients, and we were able to do that with ProFound AI. So it was a relatively easy application to get installed to technically support to roll out to them to get them trained on for them to understand and for them to see the outcomes as they were doing it. So it was valuable there.

I'm going to do something unique here, and my team is bracing itself. But I have one other question in this area, and I'm going to go to Sally in a moment and ask Sally about how this technology help, ProFound AI has enabled the ability to differentiate the facility. But since we've got a few minutes left in this section, I'm going to come back to our clinicians and ask how has it impacted the dialogue that one has with the patient. We've talked a lot about what it may be like as you're reading it, but does it change the way you have this conversation with your patients in any way or their care pattern in terms of when they may come back? But before we go there, I'm going to stop over at Sally, and I'm going to go again to Sally, and I'm going to ask you about the adoption of AI, it -- from what we've observed, it's elevated your ability to sort of differentiate your facility as a provider of personalized care. And so I'm going to go with this angle. I'll ask you first, how have your patients responded to this differentiation that you're offering?

So like Matt said, we're always looking for something that's going to set our center apart. And we did a lot of work with that. All of our patients that come in and get to take a free cancer risk assessment that looks at 8 different hereditary cancers. And then we also -- we look for technology that, number 1, is going to benefit the patient; Number 2, will benefit our radiologists as well as our institution. But part of my role as well is how do I market all of our comprehensive services so the patient wants to choose me, Kettering Health instead of our competitor in the area. ProFound AI, we felt so strongly about it. I'll be honest, we didn't do a lot of marketing until it was on all of our units. And we are getting ready to roll out a marketing plan specific to ProFound AI in the first quarter next year. But we felt very strongly that it was such a differentiator for our patients that if we didn't have it at every location that a patient might go to, it was too much of a difference in their overall care. So we were very pleased to be able to get it on all 22 of our gantries. So no matter what of our 14 locations a patient goes to, they can have this comprehensive service. ProFound AI for us has been the icing on the cake for all the other technology that we have. October is breast cancer awareness month. A lot of centers do a lot of marketing in October. We've chosen a little bit different path this year. We set out upon something called Pink Out 365. How to take better breast health for 365 days a year. So we are going to be looking at how we get our technology out to the public every month. So ProFound AI is going to play a very large part in that moving forward. I think patients are always looking for a center that has something more than just the typical technology. They assume their doctor is going to send them to a location that probably has a good mammography unit. So what am I going to do to set ourselves apart from that? And I think ProFound AI is what does that for us.

Yes. Thank you, Sally. I'm going to stay with that theme and as I said in advance, want to ask a question. This is -- there's a rule here as a CEO, don't ask a question you don't already know the answer to. But -- so I'm going to go to Dr. Fried and Dr. Musser because we've just come out of Breast Cancer Awareness Month. We -- and we're also in this pandemic. And one of the things that's clear in the pandemic is that people are advocating for the care. People are on their pillow tons, people have got their comapp, they're downloading, they haven't food delivered from places. People are -- and I think women are particularly good at being educated or more educated about their health. So they're asking a lot of questions. So I just wanted to get a sense from each of our physician/clinicians on the team, what that dialogue is like with patients who come in probably more informed than ever. and advocating for care, how is something like ProFound AI changed that dialogue? Maybe I'll start with Dr. Fried.

I can't say I honestly talk about it with patients too frequently. The most I've really used it for patients that are a little anxious and are not sure about that I don't really see anything. I can tell them, well, we have an AI system and it did not see anything suspicious on your mammogram and I didn't either. But I have used it before as well to talk to a patient that was skeptical about my biopsy recommendation and to tell her that the AI was suspicious of the lesion as well. And that mention of technology seems to go along way with patients because it's like an unbiased observer getting an opinion.

Yes. As was said, an extra pair of eyes. Yes. So -- Dr. Musser, could you -- are you comfortable jumping in?

Definitely. I agree. I don't necessarily bring up the technology itself very often with patients. But I think that it helps with my confidence level in regards to my decision-making, which then translates into the discussion that I have with the patient, especially in cases where maybe I'm on the fence about biopsy or follow the use of AI in that case can really help either push you one way or the other. And then I can have that better informed discussion with the patient about why I'm recommending what I'm recommending.

Okay. Thank you. All right. Well, thank you for responding to some questions that we kind of discussed in advance and then a few others that we didn't. So I appreciate that. So I want to go to part 2 of this, and where we're heading in a moment, is over to the other side of our business, and Jeff Sirek wants to talk about our therapy side. But we're not done. We're now going to move into a discussion on efficiency. And this is particularly relevant now more than ever. Facilities start recovering from the impact of the pandemic. You can -- whatever statistics you look at, if we were screening 40 million a year, we've been running perhaps 25% lower than that in a lot of cases. And even at that, as I think our folks may indicate that, we haven't been screening at full capacity because with social distancing and cleaning equipment, et cetera. It's not exactly been steady state. So this has been some unprecedented challenges. So with that as a backdrop -- and in particular, I think this has had an impact on mammography and maybe even the staging of disease that we see, I'd like to go back again to you, Dr. Musser, and talk about -- from the perspective of integrating ProFound AI, there's a learning curve. And here we are in the middle of this pandemic, and there's trying to get patients through the system, there's a learning curve. So given the context of everything mentioned, and the learning curve from a adoption all the way through trying to get patients back to screening, what's your experience been? And what's it's been like, particularly since when you're looking at a technology like AI, there is a handshake, there's a trust factor that goes back and forth. It's like the human brain interfacing with technology. Can you explain what that's like for you as a clinician?

I think that we've now had ProFound AI for a little over 2 years. So when you first start, yes, there's definitely that learning curve, and we all see the results from 2D CAD. So there was initial skepticism, I would say, from some of my colleagues about is this just going to be something that makes me more inefficient that I have to look at, but it's not actually going to help. But especially after kind of that first year, when you look back at some of the cases after you I would say probably at the end of that second year because we got our audit back and you're able to see some of those cases, maybe the interval cancers and you look back to see did ProFound AI call that area? Did they -- was there something present on that prior exam even if it was very subtle? I would say, in a good portion of those cases, ProFound AI did see something, and it was settled and thankfully, a small area, but it's really helped us build our confidence. And then Sally and our team worked really hard to get patients back into our centers and back on schedule. We closed our centers for about 6 weeks for screening, and they work tremendously hard to get patients back in. Having ProFound AI also helps us because I think that people's perspectives have changed and there was initially a lot of fear patients to come back to the hospital and to come back in. So to know that you have a technology that is helping you find those small subtle cancers that maybe you would have passed this year. Knowing that, that patient may -- it may be longer than prepandemic for them to come back in, gives us extra confidence.

Yes. Yes, I'm going to jump over. I'm going to change the order bit. I'm going to ask Sally and Matt, if you could comment on this notion, and others can chime in, on where are we in terms of being back to screening. Are we back to steady state? Are we still behind? And if we are, how far behind are we? I mean, we're -- we've had a period of time, if you remember, Q2 of 2020, where we were seeing nobody. And we're trying to catch up and we're not at full stress. So I don't want to lead the witness, but I'm really interested and your experience there, Sally, in terms of being back to screening. And Matt, you as well from a technology perspective. So maybe -- how about -- we'll go to Matt first on this.

So we're back and actually busier than we were before. So the -- we're having trouble getting all the patients in that want to come in. So it's -- our volumes are past what they were pre-pandemic.

Okay. I'm very delighted to hear that because it's a huge area of concern. Sally, what's your experience? And clearly, it's ramping up. Are we back to where we were? Are we making up for lost time?

We're having the same thing that Matt is saying. We are experiencing higher volumes than we did. And I look back and compare volumes back to 2019 as well, which was kind of like the last normal year, we rescheduled about 3,000 screening mammograms. A lot of those women, when we had to close our centers, they said, "I'll call you. I'll come back when I feel COVID is over." And we said, "Well, we don't really recommend that. You should probably get an appointment now." When we reopened, we really did a lot of marketing on its safe to come back we probably took a little bit of a different track. We didn't reduce our schedules. We actually opened up our schedules. We started working Saturdays, Dr. Musser and her colleagues worked every other Saturday doing diagnostics at at least usually 2 centers. So we've really seen an increase. I think what's been challenging for us is we've seen a huge increase in diagnostics and biopsies. So our screening rates up about 10%, our diagnostic rates up over 20% and -- But our biopsy, our stereotactic biopsy rate is up 30% compared to last year and 50% compared to 2019. So we're seeing that women have pushed it back, even though we've been busy and not seeing this decrease in volumes, there are these women out there who chose not to come in. When people start getting the vaccine, there was the discussion on, well, you can have lymphadenopathy in large lymph nodes. So you should wait 6 to 8 weeks. Dr. Musser did a great social media post that had more hits than anything we've done that entire year talking about come back, you don't put this off. We're going to ask you if you've had the vaccine. We're going to document if you did. So we're going to know if we're looking at something that you potentially had the vaccine that's causing this. And the worst is going to happen as we may call you back. But we've really pushed hard to get women back into our centers. But we have seen a lot more diagnostics, a lot more biopsies and a lot more positive pathologies.

Yes, I'm going to -- I'd like to stay with this theme at the risk again going off script, and go over to Dr. Fried and say, my original question, which I still want to hit is like what's your experience been with the handshake with the technology. But this is too important a theme to let go of here in terms of what we're experiencing clinically. So in whatever order, I want to ask you, Dr. Fried about your experience now with patients coming back and then, of course, the interchange with the technology. So you can take that in any -- either or that you want.

I think we are set up in a way that helps us contain the flow of patients coming in since we're outpatient and have many sites in the same area so we can move people around. But we also opened on weekends to do diagnostics and are still doing that to try and take up with the flow of patients that need the diagnostics. We have seen the same problem of more and more cancers since COVID started because people waited so long to come back. But the other problem is, is that when people do start coming back, there are so many films to be read. And honestly, the -- there's a shortage of breast radiologists in the country. If you look at any of the job postings on Society of Breast Imaging, the American College of Radiology, there are hundreds of breast imaging jobs that are available. And groups are having a hard time finding people that are willing to join their practice because there's just not many people to be had, and there are a lot of people that are retiring because we're not training as many breast rads as we need and people are aging out of our groups. So we have to be able to do more with less and be able to read more exams than we did in the past to be able to keep up with the load. And there's not like a way around it by just hiring somebody new because you may not find somebody at a fit that role. And so if we want to be able to continue to offer the services at the level that we do, you have to be able to work smarter and not necessarily barter.

A quick follow-up question because you have -- you operate in 9 states and 150 facilities, and growing. Are you seeing any differences geographically in terms of just patterns of care, disease representation, demographic differences? This is pretty much the same?

Demographics can be different depending on where you're coming from, but it's happening the same way everywhere. People are coming in with more advanced cancers. And everybody is coming back. It's -- yes, we have places in the East Coast, West Coast, South. It just is -- it seems to be universal.

Okay. I did want to just follow up in terms of this point that I ask Dr. Musser well about the handshake between the technology. There is kind of a -- someone said it's like going to dance school, you have to learn the dance with the partner. So who's leading, who's following? I'm curious what your experience has been or that of your colleagues in terms of interacting with the technology.

It was very interesting at first. But I think you have to see a case where it actually picks up something and you didn't notice it before you can really trust that this is seeing something because I think when you're reading screening, you're only supposed to call back 10%. So that means that 90% of the mammograms you're reading at the time are normal. So it takes a while for you to get enough of these abnormals that you may not have noticed to be picked up by the AI. So it takes a little while for the radiologists to not think it's just an expensive little machine that somebody got just for marketing. But every single 1 of my colleagues, even the most skeptical and old school of them now would tell me that they love it and that there's no way they want -- another thing that we have is, we do a lot of mobile mammography, and those units, we don't have one ProFound AI and everybody wants to know when we're going to get it on there. And our problem is the connection. We don't have a good connection, so it's not really feasible. But I get a lot of complaints that they don't have the ProFound AI on those specific units and all the rads want it.

Yes. I am going to go back to you, Dr. Musser, and double-click on that because I -- You've also expanded as a very substantial number of facilities. You commented from your own perspective, but what about some of your colleagues and how is their -- or even yourself with further elaboration, just adopted to the continued expansion of the use to technology?

Absolutely. When we first got ProFound AI, it was not available. We didn't have it on all of our units. And once we really built that confidence, it was a disparity that we had in our network that it wasn't available for all of our patients. And it was something that we as radiologists started to depend upon and really want. So now that we have it available for all of our patients coming in, it makes a big difference in our ability to read and really the care that we offer for our patients. And I would kind of mirror even the most skeptical of our breast rads are on board now. And that could be a challenge. Any time we adopt a new technology, there's always going to be someone who doesn't want to do it. And even the most skeptical is on board now.

Yes. Well, thank you for sharing that experience. So Matt, Sally, I'm coming your way. And going to start with you, Matt, because having met you online, you are kind of individual that does not suffer full slightly. You call it as you see it first. And I know the history at Wake was to really do a very, very diligent job almost a year ago, a little less than a year ago in making a decision. So I'm curious if you could kind of walk us through what was your decision-making process? Because I know you were -- just from speaking you, that you're going to tear apart everything and look at it high and low, upside, down, in and around. So can you share your experience in making this call and moving with around ProFound AI?

We looked at a lot of different systems. And I had a couple of key requirements, right? It needed to be -- it had to do 3D processing. I needed to be able to do Clarity HD, which is a logic protocol. I needed something that was going to be fast enough to deal with both screening studies where they've talked about a lot. And my radiologists, after we were doing some testing related to screening, we wanted it also for diagnostic. And diagnostic is real time. So you have the patient in front of you. You need to be able to process these exams fast enough that you can get the data to the radiologist before the tech might walk down the hall or even call the radiologists and say, "Did I get all the images that we needed?" And that was one thing that I was worried about. It had -- the algorithm had to be fast enough to be able to get the answer to my radiologist before that call came from the technologist. I didn't want the radiologist to tell the technologist, "Got to wait. Sorry, I don't have my data yet." The -- I have the same issues with the radiologists, right? I had to convince the radiologist that this would be something that was specifically going to be better than 2D CAD, right? They said, well, we've had this stuff for years and years and years, why is this different?" And I said, "Well, it's really different because of the amount of data that's been processed, it learns -- the versioning of this is going to be so different in what's happening. And it's not going to have all these false positives that we have a lot with calcifications in 2D." And so I had that as another issue. And we had multiple review type systems. And so I had to be able to have a system that could give me outputs in all of my review systems. So I have some radiologists that are reading on a Hologic secure view. I have some radiologists that are reading on Intelerad. And those 2 systems deal with a different type of standard format that is known as DICOM in the industry, but they display different, and I had to be able to solve for that, too. And not only do I need to be able to solve for that, I needed to make sure the value was still there when the format was changed. And so we had to go through that process as well. So there was lots of different things we had to make work and you guys were able to do all those things for us.

Yes. Matt, I appreciate you highlighting that. And I didn't know you're even going to go there because our investors have heard me talk about 1,800 combination locks. When you look at all the mammo vendors, all the workstation, all the mammo viewing stations and all the packs vendors, they're like different locks -- seamless on a lock, and you have to get them all in. So I'm really glad to hear that experience. So I'm coming back to you, Sally, because you're one of those bilingual people. You can talk clinically about the advantages and also from an efficiency and administrative perspective. So I want to ask you on that second point, double back on that. The improved reading accuracy plus the efficiency now. has translated into some benefits or typically does. So I'm curious now to kind of see if you could tie together both that accuracy and the efficiency. And again, you're bilingual in these things. So I'll direct this one particularly to you.

Well, I didn't know I was bilingual, but it's good to know now. But no, you're right. So every time we call a patient back, that woman assumes she has cancer. So I mean -- and it's a big deal when you get a call back from someone saying, the radiologist has recommended some additional imaging. So any time that we can reduce the number of women that we're calling back is just -- is a huge benefit to not only that patient, but also to our technologists, to the radiologists. We only want to call back women who really need it. And ProFound AI, I think helps us differentiate between that. And you can recall less patients potentially with the use of it. It's just -- it's a great tool from that perspective as well. And with the efficiency piece, anything that we can do to make our radiologists more efficient. If you look at our biopsy rates, -- That's taken a radiologist in that room many, many, many hours of many days performing biopsies at multiple locations that we have. So when they get to a chance to go in and read a screening mammogram or a diagnostic mammogram, we've got to make them as efficient as possible. So any tools like ProFound AI that allows them to speed up their interpretations look at that case score and say, okay, that one's a 90%, it's going to take me a little bit longer. So I'm going to push that one to the back when I can sit and really concentrate on it versus I've got a lot of these lower case scores, I can maybe read those a little bit more quickly and get through those. So tools like that, it helps our patients. They don't have to come back to see us and have that stress and it helps our radiologists be more efficient, and that reduces their stress as well.

Well, at this point, I want to pause and first of all, say thank you to all of our experts and participants. The good news is -- The surprising news, at least for me, is that we're not only on time, but we're a little bit ahead, which is a place I've never been, right? Usually, people say, "this is the earliest I've ever been late. So this is -- So -- but the good news is this is going to allow for more time for Q&A, but we're going to be stopping and take a look at our therapy business for a moment. but I want to stop here for the moment and thank everybody in our breast imaging experts, our efficiency, IT, admin experts. And again, there'll be some Q&A at the end. But before we get there, I'm going to introduce my very able colleague, Jeff Sirek, that good looking guy I just see pop up there with the blue background. And Jeff is our Chief Commercial Officer at the company and started on the Xoft side, the therapy side. Now he's managing the detection side as well. So we get to enjoy all his capabilities on both sides. So Jeff, I'm going to turn it over to you and you're going to introduce our next clinical expert and take us down the therapy path with a particular focus on dermatology.

Thank you, Mike. And what a great interchange that was -- I first want to say that was amazing. I learned something new all the time. And Dr. Smith, we get to go off script today according to Mike a couple of times. So this is going to be fun for you and I here today. But listen, it's great to me in the company with so many amazing clinical leaders today and excited to discuss the momentum we're seeing in the Cancer Therapy business, specifically in the areas of non-melanoma skin cancer. I will share some of the important points of their audience about the Xoft system today, then introduce our featured clinical expert. As many of you know, the Xoft system is FDA cleared, CE marked and licensed a growing number of countries for the treatment of cancer anywhere in the body, including early-stage breast cancer, non-melanoma skin cancers, in gynecological cancers. It utilizes the world's smallest X-ray source. And I'm going a little off script here again today, just to show, I don't think a lot of our investors or the individuals that are even using the system or never seen this before, right? This is the world's smallest x-ray source, and we utilize to save lives moving forward in our technology. Really an amazing piece of technology our team has developed. But it's targeted radiation therapy and expanded treatment options for a range of cancers here. Most recently, Xoft's data IORT in the area of recurrent glioblastoma was accepted for publication in a peer-reviewed journal. And we've initiated the GLIOX clinical trial and excitingly said that we did our very first patient last week. We're extremely excited as an organization, a significant milestone for the company, more importantly, for patient care moving forward. In the skin segment, the company is experiencing an exciting recurrence and resurgence of growth. Today, we're here to share with Dr. Sidney Smith, dermatologists and CEO of Georgia Skin and Cancer Clinic, which has 16 locations throughout Georgia and South Carolina; Dr. Smith, CEO, lead dermatology clinician in his practice, recently adopted the Skin eBx system as a clinician who makes a cell phone personally available to customers, which I think is amazing. I don't know how long it took me Dr. Smith, even get your cell phone, but the fact that every patient gets that just -- it shows your passion and your commitment to patient here moving forward. So with that introduction, I would like to start the interview here a little bit in the open forum. And again, I think we can talk off script, feel free to interject any of your thoughts here, Dr. Smith, but as a most surgeon in a superficial radiation therapy user, why did you decide to adopt the Xoft technology?

I appreciate the introduction, Jeff. Because I'm a dermatologist, I think the skin is the biggest organ in the body and the most common cancer in man. So I think we have the most important talk today. Xoft is very timely in the United States and the world today because cancer, skin cancer is so common. We treat more than anybody else in the Southeast, and I have so many patients coming to me every day for an efficacious efficient and a way that actually benefits the clinic. It differentiates us. Xoft feels a very interesting position because it is efficient. It requires 6 visits as compared to other treatment modalities that may be 2 or 3x that. It's also very beneficial to the patients because it doesn't take much time out of their schedules and being down here close to the Hilton head, they all want to go golfing and not have skin cancers cut off. So -- And then the other thing is this efficacious, it actually works. So it's been a very good benefit to us. if it'd be okay, I might give a little perspective to why all of this is important to Xoft in patients. Is that all?

Great, Dr. Smith. Thank you.

Well, we were talking about breast cancer. Each year, there's probably about 281,000 westside cancers each year. But skin cancer, there's about 3 million a year. 3 million cancers. And it's going to affect about 1 out of every 5 of us. So a significant number of the folks on this call will actually have a skin cancer that may need Xoft. So that is interesting. The other thing that's interesting is the incidence of skin cancer is dramatically increasing. So for example, over the past 20 years, basal cells have increased 150%, squamous cells 250%. And I see this in my clinics every day because there are so many people who have skin cancers. The other thing is that the cost of treating those cancers is about $4.8 billion a year, and that's a lot. But Xoft plays a very interesting role because it not only can be effective, but it can also be cost efficient relative to other more aggressive and invasive procedure. So I'm very excited to add this as an additional way that I can treat skin cancers beyond the most surgery.

Thank you, Dr. Smith. A very interesting perspective and a lot of great data there. Can you talk a little bit about the type of patients who might benefit from this therapy option?

Well, if anybody has ever had skin cancer, and I'm actually, believe it or not, who -- someone who's had skin cancer. I had a basal cell skin cancer. It's very common. And not often that these skin cancers, they may be on your ear, your nose or your lip, and these are very difficult areas to treat surgically. And I do Mohs surgery, and we have the highest cure rate. However, when we ask our patients, if I take this off and I have to repair this and put you to sleep we have to have general anesthesia and you're going to be disfigured for a significant amount of time or at your age, in this location, I can treat you with something that may require 6 treatments, and you can actually go golfing this afternoon. A lot of the patients made the decision to say, "Look, I would rather have something that has a very high cure rate that does not interfere with my life or quality of life." And Xoft has been a great addition to that special patient who needs that.

Excellent. And I'm a golfer myself, so I'd love to get out there a lot, sooner than later for sure. But when might a patient choose eBx over other treatment modalities? There are some choices out there. What would you say about that, Dr. Smith?

Well, I have a unique perspective because I used a competitor brand before I've added the Xoft therapy. I used the SRT, which is an older type of technology. And it requires about 13 to sometimes 20 treatment visits. I mean, think about that from a patient. If they're coming twice a week, there may be 10 weeks of therapy, as compared to Xoft, which is only 6, for the same efficacy. That's amazing. The other thing that's really interesting that physicians are concerned about is how easy is it to integrate this into their clinics. So for the older SRT units, you had to have lead lined rooms. Well, what that means to a physician is you got to get the state involved, you've got to get someone to lead line your room, the cost for that has to be audited or examined each year, as opposed to the Xoft, which is -- has a very small footprint and actually can be put into any exam room with no lead lining. Significantly different ease of integration to a practice.

Thank you, Dr. Smith. That was a great perspective on that. So we've talked a little bit about the patient benefits, but what benefits do you expect in your practice?

Well, in our area, we have so much skin cancer. We have patients who may have 10, 15, 50 skin cancers. Now of course, the highest cure rate would be most surgery, which I've done for a quarter of a century. But that leaves a defector a score. I mean if you can imagine someone who's, on his head, has had 50 skin cancers, it looks like you've taken a little divits out of his head with the 3 eyes. So when you compare that to a Xoft therapy where the skin would look normal after the treatment, that's a great example of how that's an additional tool. From a practitioner's perspective, what's also interesting is that can be delivered at the exact same time, you're continuing to see other patients. And with our volume of skin cancers to be able to treat patients simultaneously as we're treating others, and collaborate with the Xoft team, it's been a great advantage.

Great. So let's talk about that administering treatment, right? Skin eBx is unique and that there's a significant amount of collaboration between yourself, the dermatologist, and the radiation oncologist. How might this collaboration offer clinical benefits to the patients into your practice, in general?

What is interesting is that in skin cancers, you have to have an experience. Not all cancers are treated the same, and not all cancers that look the same will have the same outcomes. Some of them can be more invasive. And you need to know what you're looking at. It's often helpful to have 2 eyes. I guess it's like AI, except we've got the Xoft. And in that sense, what we do is once we identify the cancer and we biopsy didn't have confirmation of the histologic type. Then when we send it to you guys in collaboration, we actually have more of a team approach to how to treat it, what fields, how aggressively and how to follow that patient. So it's more of a collaborative experience as opposed to the older experience with the older technologies.

That makes a lot of sense to me. And the Xoft system has the minimal shielding requirements, as we've talked about, you brought it up a little bit as well, small footprint. You've got 16 locations. How do you imagine assisting with your growth plans moving forward?