Imricor Medical Systems, Inc. (IMR) Earnings Call Transcript & Summary
November 18, 2022
Earnings Call Speaker Segments
Simon Hinsley
attendeeWelcome to Imricor's virtual open house and business overview. This morning, we have from the company, the Founder, Executive Chair, President and CEO, Steve Wedan; the company's Chief Operating Officer, Gregg Stenzel; the company's Vice President of Marketing and Business Development, Nick Twohy; and; Dan Sunnarborg, the Vice President of Engineering. Before I hand it over to Steve to get started and go through the session, we'll hold a Q&A at the end of the briefing, which you can submit through the Q&A button at the bottom of the screen. But without any further ado, I'll hand over to Steve to get started. Thanks very much.
Steve Wedan
executiveThanks, Simon. So again, welcome, everybody, to Imricor's 2022 open house. Just as a brief overview. As many of you know, we're dedicated here at Imricor to changing the standard of care for cardiac ablations, away from procedures that are performing X-ray, fluoroscopy labs and toward procedures that are performed in iCMR labs. The whole idea is to deliver better, faster, safer and more cost-effective treatments for patients with cardiac arrhythmias like atrial flutter, ventricular tachycardia, atrial fibrillation and many more. And we're doing this by allowing physicians to take advantage of the superior imaging capabilities of MRI. It's really pretty simple. The heart is invisible to X-rays, so doctors can't actually see the thing they're working on in a conventional X-ray lab. With MRI, they can see what they're doing, and they can see the physical effects of the ablation therapy that they are delivering. The major trick in making this happen was creating all the systems and devices that are needed for an ablation procedure and making sure that every one of these devices is MRI-compatible. This is a much harder problem than it seems, which is why from the mid-1990s all the way until I founded Imricor in 2006, no one had been able to do it, even though many, many people tried. Today, Imricor is still the only company in the world who has solved the problem of making ablation devices compatible with MRI. And we've also partnered with a few other companies who make MRI equipment itself like Siemens, Philips and, we hope soon, GE and companies that make other support equipment for the [ iCMR ]. Now remember, the challenging opportunity for Imricor, especially as it relates to our consumable catheter devices, is that every tool using an ablation procedure in an iCMR lab, which stands for interventional cardiac magnetic residence lab, has to be made MR compatible, every one of those devices. And that means that we can't just make one device and get started by leveraging what's already existing in the world. We need to make every device just to get started. But once we do, we capture all of the consumable revenue from every iCMR ablation procedure. And the good news is the development is behind us, and we're launching our products now. Some are commercial and being used in clinical practice today, some are in the regulatory approval cycle and all are ready for our next big clinical trial to treat ventricular tachycardia, but kind of difficult complex ablation procedure that I had in mind when I started this company in the first place. We're here today in our iCMR design center in Minneapolis. This looks a little bit like one of those stock photos of the background for Zoom, but it's not. This is our design center. It's one of the 2 sites that we have here in Minneapolis. And the goal of this open house is really to give you each a better feel for our facilities, our devices, the iCMR lab itself and a few of our group leaders. So we'll pop around the different locations here at the design center, and you'll hear from a few members of our executive team as they describe what we're delivering to make real-time iCMR ablations a clinical reality today. We'll start by taking a look at our consumable devices with Nick Twohy, our Vice President of Marketing and Business Development, who is standing by in the design lab. So Nick?
Nick Twohy
executiveAll right. Thanks, Steve. So I'm here in one of our engineering labs, where our teams work on all the new tools that we have coming in the future. We do a lot of our testing, a lot of our development. We don't do any manufacturing in this lab. But nonetheless, a lot of our programs are run and developed right in this lab here. I wanted to show you, as Steve mentioned, some of the products that we have today. As we mentioned, ablations are performed to treat abnormal heart signals. And as you can imagine, treating arrhythmias from the inside of your heart requires real specialized tools to ensure we're able to properly treat those heart signals. So a couple of the tools that I wanted to run through today. One of them is a cardiac ablation catheter. So this catheter is introduced through an artery in the groin area and advanced up into the patient's heart. And as you can see, maybe from the -- if I can get it to stop shaking here a little bit. You see a tip electrode on the end. It's deflectable, so it allows the clinician to adjust and accurately get to any location that he or she is interested in treating. A couple of the other tools that we do have. This is a deflectable sheath. So this is one of the tools that you can use to help adjust and get to specific areas of the heart with the ablation catheter. Now this sheath also works with a dilator. This trackable dilator helps the MR identify exactly where in the heart the sheath is. Now the ablation catheter in and of itself can treat arrhythmia on the right side of the heart relatively easily. Some of the more complex arhythmia are on the left side of the heart, which requires us to move through the septal wall and that we do that with a transseptal needle along with the sheath and a dilator. So once we get over to the left side of the heart, we're able to advance our catheter over on to that side and treat arrhythmia. So that's -- those are the tools that we have right now. These tools are ready to go and ready for our upcoming clinical trial that's slated to start at the end of this year, beginning of next. And with that, I'm going to pass it over to Dan Sunnarborg, who's our Vice President of Research and Development. He's going to talk you through exactly the surgical environment that our clinicians today treat patients that have these arrhythmias in. Dan?
Dan Sunnarborg
executiveThanks, Nick. Yes, I'm here in the magnet room of our iCMR lab. This is set up exactly like it would be in the clinic. It's similar to a conventional lab, except for the fact that we use an MRI scanner here to image the patient's heart and our devices instead of an X-ray fluoroscopy system. Same devices are used -- that are used in the fluoroscopy lab are used here, except we -- like Steve said, we had to make them all MRI-compatible. So obviously, we have the MRI scanner itself. We have third-party partners that make MRI-compatible displays. We have an in-room defibrillator to shock the patient if something bad was to happen. We have some communication headsets for the physicians to be able to communicate from this room into the control room, and we also have a 12-lead ECG system to put on the patient as well. All of these systems have to be MR-compatible when they're in the presence of this very large magnetic field. We also have the Imricor Advantage MR system, which is an amplifier and a cardiac stimulator. So an amplifier displays the tiny signals that are in the heart through the catheter, and the cardiac stimulator allows the physician to pace the heart through the catheters to detect arrhythmias and to help with the pacing. We also have 4 components of the Advantage system. The first is the power supply that sits on the bottom of this stack here; the amplifier, which sits on top of it; and then our patient device interface, which is right here sits bedside, which is what all the catheters plug into; and then we also have a tracking interface that takes those signals from the catheter and feeds them into the MRI scanner. So many of these devices that are in this room then connect to workstations that are in the control room, and then I will pass that on to our Chief Operating Officer, Mr. Gregg Stenzel, to explain that.
Gregg Stenzel
executiveSorry I had to unmute myself there. As Dan mentioned, I'm in the MR control room. It sits, as you can see, right next to the MR magnet room. You can see it through the mirror. This is where the physicians, technologists and nurses sit and work with the people that are actually performing the procedure in the other room. The other thing in this room is a bunch of capital equipment from our third-party partners. We have the MR console. We have communication headsets. We also have MR image analysis equipment. But I want to show you a little closer look on some of the other piece of equipment from our third-party vendors. Down here on the end is a 12-lead ECG, It's MR-compatible. This is the RF generator that supplies the ablative energy to our catheter inside the MR. This causes the -- or this creates the lesions within the heart that cures arrhythmias. And this monitor here is our Advantage MR system. This is a device that we create at Imricor. So you can see here the 12-lead ECG from down at the other end of the table, along with some electrical signals from the catheters called intercardiac electrograms are shown. In addition, the Advantage MR system can pace the heart through the catheters that it's also controlled here on the side. Also, up here on top of the Advantage monitor. It shows that we interface to the RF generator, and we can bring all of the metrics that the RF generator supplies to both the Advantage MR system and the next products that I want to show. And this is really, really kind of the newest and most exciting product that we currently have, and we call it the Northstar MR 3D mapping system. This is really where everything comes together. Northstar interfaces with the MRI system, the Advantage MR system and also works with the MR image analysis tools, which I'll show in a second. So with Northstar, I'm going to bring you in a little closer just so you can see really well. So with Northstar, you can control the whole MRI system. You can receive all the real-time MR images as they're created much like I have here on the screen. Just to the image of the heart. You can see here the spine, and this is a slice through the heart. But unlike the MRI system, the Northstar doesn't just display in 2D. It also displays in 3D images. So you can see here how we can rotate the heart in 3D space. So since we can work in 3D, we can also display MR images in 3D. So we can bring in shells. I'm going to spin it the other way. We can bring in shells of the heart and mix the 2D image with a 3D image. So this is an image of the right atrium. I can turn on. This is an image of the right ventricle. And these shells that are created, they come in from the MR scanner in 3D MR image sets. So since this is connected to the Advantage system, we can track our catheters using the MR system as the catheters move around the patient in real time. We can also measure on Advantage the cardiac activity and then put it on these shells. So we can take measurements and then apply them to the shells. So here's 2 mapping points. So these would be mapping points coming over from Advantage, and then we can just put them on the shell, and now you have an electrical anatomical map. In addition to putting measurements, electrical measurements, we can also put therapy points on here. So if the physician happens to create a lesion and they want to mark that spot using the RF generator, they can bring in a therapy point and put it right on the shell. Let's zoom everyone in here. So lastly, I want to show you how Northstar interfaces with the MR image analysis tools as it specifically relates to our VT ablations and our upcoming visible VT clinical trial. So if I turn off some of these shells, turn off the mapping points. I can bring in one of the -- this is actually an image of the right -- or sorry, the left ventricle, and this is brought in from the MR image analysis tools. And what you see here are areas of scar. These are the scar spots, and this is normal tissue It's specifically, these kinds of channels where there's normal tissue between the scar areas, that have slow conduction and caused ventricular tachycardias. Without MRI and the Northstar system and being able to bring in these shells in this analysis, you have to painstakingly drag a catheter inside of the ventricle and measure the electrical activity to find these channels. So with MRI and Northstar, you can see where the problem is immediately just by doing imaging and go directly to work, ablate these spots and fix the VT. So this is all just scratching the surface of what we can do right now. This is obviously a prototype, and what we'll be able to do in the future with Northstar is so much more. This prototype system will be installed in some customers in the upcoming weeks, and we're going to gain physician feedback moving into our VT trial. Now we're going to go back to Steve for a status update.
Simon Hinsley
attendeeGreat. Thanks for that. Just a reminder, if you did want to ask a question at the end of this, please do so by the Q&A button at the bottom of the screen, but we'll now head to the boardroom.
Steve Wedan
executiveVery good. Just want to check back the technology's working. Can you hear me okay, Simon? ]
Simon Hinsley
attendeeThat's perfect. Thanks, Steve.
Steve Wedan
executiveGood. So I want to give you a couple of pieces of just status updates while the other guys are working their way back here to the boardroom. Joining us also now is Jon Gut Jon is our CFO, and he's around for the Q&A session. In terms of status, a couple of things that I thought were interesting to give the data on. One is that Gregg just mentioned a moment ago is that this Northstar development now is complete from a prototype standpoint, and we are working toward deploying that into hospital sites actually just in the coming weeks. So we have a date set in December. I don't want to spoil surprise yet, but it's -- it'll be the first opportunity for clinicians to use Northstar, alongside the procedures that they're already doing with our devices and see what kind of capabilities that, that can add. That allows us to get customer feedback for the system, to modify it and to also plan the road map ahead for what types of features that physicians want to see. But every one of these devices from the consumable devices to our Advantage system to the Northstar system, for all devices we're a team -- Nick's marketing team has got a group of physicians. We do a lot of polling these physicians, a lot of conversations with them, find out what are the features that they want and need to do ablation procedures in the iCMR. Always keeping in mind that this is a brand-new environment. So we remind them they're new capabilities that they've never had before. And so if they had those capabilities, what would they like to see out of these devices. So we're excited about the clinical traction the devices are getting. The VT clinical trial is coming up as well as now Northstar and getting some initial feedback on that to drive it forward. Visible VT trial something that was also mentioned. That is the name of our ventricular tachycardia clinical trial in Europe. It's a 64-patient study, single arm but multicenter, and we have submitted our documentation set for approval to start that particular trial. There are 2 things that have to be reviewed or 2 bodies that review that submission. One is the Ethics Committee at our primary or principal investigator site. And the second then after that review is complete is the [ Compton ] authority in the country in which that site exists. So we have submitted to the Leipzig Heart Centre Ethics Committee. We've had one round of feedback, conversation with them and resubmitted then the -- our answers to the questions that came up in the first review. They meet next week. And we hope that, that will end that phase, moving on to the Compton authority group. As soon as we have approval, we are ready to get started with this clinical trial. All the devices are ready. The lab is set up. We've talked to physicians about the protocols. We've worked through the protocols with them. Everything is ready to go, so we're pretty excited to get started with that VT trial. I personally feel that when the first time we do a VT case, and we tell the world that we've done a ventricular tactical ablations guided by real-time MRI in the iCMR lab, that's the kind of thing that I think is going to change the face of this particular field of interventional electrophysiology. And again, that's the reason I started this company, to do complex ablation procedures that are really difficult conventionally. And to do those, guided by MRI, taking advantage of what MRI can offer. From a other business standpoint, from a sales standpoint, we are continuing now. We relaunched our products. For those of you who have fun following the story, you know. But for those of you who are new, we launched our products about 1.5 months, 2 months before the pandemic hit, and that shut all of our customer sites down. So we have paused our virtualization efforts for a couple of years and really just relaunched our products now in the second quarter, and we are continuing to build traction at these sites to -- we have 15 sites or so that are signed, but not all of them are actively doing procedures. And it's quite a process to get them to do procedures and get them all set up, install, train and going. And that's the process that we're doing now. We're also working with each of the sites that are doing procedures, increase the volume of procedures that they are doing. Northstar is a big component of that. That's the kind of thing that gets people excited. They see where the future is going. It gets them in that lab, gets them doing these procedures and keeping them interested, not only in atrial flutter that we treat now, but ventricular tachycardia and atrial fibrillation. So that -- it's an ongoing effort. It's not the most important thing that we're doing. Clearly, the most important thing we're doing is breaking up this world by doing a complex ablation procedure in MRI like the ventricular tachycardia. That's clearly the most important thing that we're doing. That's the thing that we think will really catalyze everything else that. The other thing that we're doing on a sales standpoint is something I talked about recently in one of our updates, and that is to get started. We can always take our equipment into an existing MRI lab, and that's a quick way to get a hospital started, and we were doing that in many of our initial sites and it worked for the purposes that were intended. But long term, what we'd like is we'd like cardiologists to own this MRI scanner, the same way they own the X-ray fluoroscopy equipment that they use. So an iCMR lab is just another EP lab in the cardiology department. Just happens to have an MRI in it rather than this X-Ray fluoroscopy. And that's an important distinction because no matter how collaborative your radiology and cardiology departments are and they are very collaborative, everybody is positively motivated to do these procedures. That MRI that already exists, it was purchased already for a reason: to generate revenue and scan patients diagnostically. And so even if you have time scheduled out, if something has to give, it's usually our procedures, and they move to a conventional lab so that diagnostic imaging can happen instead of doing the procedure. So we found that in labs that are owned by cardiology, which is always the long-term strategic goal. Those labs that are owned by cardiology are the labs that can control the number of procedures they do, knowing that some procedures go great quickly. Sometimes they take a little bit longer, it's a little bit. You can't know until you get into the middle then get started. So that's what our sales team is now focused on. Instead of saying to us -- a hospital, we can get you started right away if you can work with radiology to a way to use that lab. We're instead saying, "Let's talk about what you want to do with your practice this year and next year and for the years moving forward. Here's what we're doing at Imricor and how we are changing the standard of care. And now is a great time for you to start the proper planning, budgeting, installation and construction of an iCMR lab along with perhaps new equipment that you're already planning to update in your hospital or as an augmentation to the equipment that you already have." And that's a better long-term strategy, and it's already -- we can see that the pipeline is full, not of people who can just get started and maybe do a procedure here and there, but people who are taking active steps to move the program forward as if it were just another EP lab in their practice. So that's an important new distinction, and we see it working now in the field. So with that, I think it's not a bad time to open it up to Q&A. I'm going to try to talk less and let these guys answer questions. So yes, let's get started.
Simon Hinsley
attendeePerfect. Thanks, Dave. Thanks, guys. There's a bunch of questions through, more so for you, Steve. Do you have plans to raise capital for future operations?
Steve Wedan
executiveWe do. Yes, of course, we've been watching it very carefully. So we, like many companies, are -- have fallen victim to, first, the pandemic and then the economic aftermath of that pandemic. It made it -- it has made it difficult for us to do what we would have intended to do, which is just one last placement on the ASX to fund our clinical trials in the EU and fund our clinical trials here in the U.S. for FDA approval, which is another program that is right on track, and we expect to get approval to start a clinical trial in the U.S. this year. But those trials cost money. So we were going to raise some money. If you rewind 18 months, the idea would have been for us to do one last raise to fund these clinical trials. It's made it very difficult with the current market conditions. So we've looked at alternate means of financing that are less dilutive to our existing shareholders, but still give us the money that we need to move our operations forward. Part of that, our economic incentive programs that exist in our region for expanding our manufacturing capacity, the way that we already need you -- the way we already have budgeted for into different areas that are looking to grow that sector in the area. And that is a very effective way for us to raise non-dilutive or minimally dilutive capital. We're also looking at -- we've done a private placement in the U.S. with existing U.S. shareholders. We did that a few months ago. We brought in AUD 2.9 million in that. And we're looking at additional lower -- less dilutive financing needs here in the U.S. and in Canada as well. Things like for instance, convertible note structures that can allow us to -- debt instruments that allow us to raise money effectively at a higher price per share than we -- than the market would allow, right?
Simon Hinsley
attendeeThanks, Steve. Just with regards to the existing cash, how long do you expect that to provide with regards to runway?
Steve Wedan
executiveJon?
Jonathon Gut
executiveSo we ended September with approximately $6.9 million of cash in the bank, and that will take us into the first quarter of 2023, absent some inflows from the other found raising activities that Steve just mentioned.
Simon Hinsley
attendeeGot it. Thanks, Jon. Just a question from Sarah Mann at Moelis Australia. Can you please give us an update on procedure volumes, Steve?
Steve Wedan
executiveSo I think let's see. Gregg, maybe you're the best one to answer the question.
Gregg Stenzel
executiveI would say at this point, we're on track to exceed the previous quarter. But cases continue to be scheduled, some get canceled. We follow through with some. So again, I think the best answer to that question is we're on pace to do better than the third quarter.
Steve Wedan
executiveI would add to that, that one of the things that's catalyzing that, for instance, is the deployment of Northstar. We start to get that out. We believe that, that will drag. So everyone should remember, we started with atrial flutter, and there's good reasons to do atrial flutter in the MRI. So same time or faster. It's the same procedure, obviously. Our effectiveness has been superior. But statistically, we'll just say it's the same effectiveness. It's nearly the same cost. It depends on which country you're in. But it's a radiation-free procedure, and that is some motivation. And that's what -- in early 2020, that was enough, and people were really moving into the MRI to do these procedures, and it was really new and exciting. We did some procedures throughout the pandemic as we could. And we found that, okay, now that's sort of 2 years old. People are looking for the next thing, and Northstar gives them that next thing. Because now they can, first of all, do even, I think, a faster job for atrial flutter making it more efficient and more effective, and we can then leverage that to show them what can be -- what can happen when we get to VT or atrial fibrillation or both Parkinson's [indiscernible] or [indiscernible] on and on, on to all different types of ablations. So napping system is a big deal, and we had originally intended for our scanner manufacturing partners to make these mapping systems. Both Siemens and Philips had systems in development. Both of those, if you look back to our prospectus should be in commercial CE Mark products on the market a year or 2 ago, and neither of them are. It's one of the reasons we decided now is the time for us to take control of this so we can control our destiny because getting those mapping systems out in the market, I think, is a big deal for growing excitement and growing the number of procedures. So we're looking forward to December to a nice upstep in the procedure volume.
Simon Hinsley
attendeeThanks, Steve. Another question from Sarah at Moelis. What is the recent feedback being from some of the EP conferences you've held? And so how has this flowed into your pipeline?
Steve Wedan
executiveSo do you have feedback from the conference we can share?
Unknown Executive
executiveI would say it's continued excitement in terms of the new clinical trial that's coming Northstar. I think we've been engaging with a number of physicians in both the beginning of that study, how it's designed and what our goals are. We're on the [indiscernible] of starting that study right now, so I think that there's a lot of excitement to get going and to participate. One of the things that precludes some folks from doing that is the availability of the mapping system. Now with that hurdle past us, I think that we're seeing a lot of excitement in a number of these countries as we enter new markets within and throughout Europe.
Steve Wedan
executiveI'd also add to that, that this is another thing that's just sort of getting started. What you'd like to do with your new technology, right, is have people use it and then write papers about it, present at conferences about it. And we would expect that, that's what we'd be doing right now. But with people not doing any procedures of any real volume during the pandemic, once it was over and they started doing procedures, now they've got something to write about and something to talk about. And VT gives them another thing to talk about, and the mapping system gives them another thing to talk about. We've got doctors who now are planning they want to do live cases at some of the upcoming conferences, broadcast into the conference. So this is the time when we're going to really get our stride in terms of getting the word out from what we're doing. It's -- but it takes a little bit of priming the pump because people have to do some procedures before they can talk about them. That's how it's being done now, and the talking is coming soon. So we're looking forward to a good conference season coming up
Simon Hinsley
attendeeThanks, Steve. And just a final question from Sarah. What were the main points for feedback from the ethic review? And are you comfortable you have addressed those issues in your submission?
Steve Wedan
executiveYes. You can never -- I mean we're comfortable, but you can never know if new questions are going to come up, but here are the kind of questions that came up. They said, "Gosh, we look at this and you've got inflation catheter, a second-generation ablation catheter." An update to the Advantage system, transseptal puncture kit, so that's a needle, a sheath, a dilator, a defibrillator system. And well the development of CGs is already a diagnostic catheter. There are 7 investigational devices in this name. They're like this is a lot of investigational devices. It's exactly what I said earlier. And so that's why I said at them. That's right. It is a lot of devices, but to do anything like VT and the MRI, everything has to be available and everything has to be MRI-compatible. So it's a necessity of moving this field to the next step to have all those devices be investigational devices. There's no other way to do it. You can't do it one at a time. And so what we didn't do, is just write that down and submitted it back to them. In between the 2 meetings that they had scheduled, we scheduled one call with them and talked through this. And that's usually a pretty effective way to make sure we understand the questions and make sure that they understand what our answers are and that they're comfortable with it. So I'd say we're feeling pretty good about that, and we hope they'll move to the next step after their next meeting.
Simon Hinsley
attendeeGreat. Thanks, Steve. Does the new mapping system have licensing potential. And can you also expect to patent protections for consumables as well as lab-mapping product set, et cetera?
Steve Wedan
executiveLicensing potentials are not something that we've considered. In terms of IP, yes, we have -- we continue and always update our patent portfolio. We have a pretty robust patent portfolio now. It's mostly geared toward the devices that are in that MRI environment, but we will continue to add and, we do continue to add new patent applications. We filed a new patent application just a couple of weeks ago. We've got a couple more there in drafting now. This is always an ongoing thing that we will continue to do for the rest of -- ever. So yes, we are very careful to make sure that we're protecting the space. One of the things though even outside of patents, and I think it's important for everyone to keep in mind, as you look at patents, of course, as a head start, a runway that gets you started to establish yourself in a market before competitors can come flooding in. But this medical devices, as you know, if you followed us for a while, if you followed any medical device company. It takes a long time to take something from a working prototype to an approved device in some region, whether it be Europe or the United States or Australia or anywhere. So there's a natural head start that's built into all of that as well. Nonetheless, our patents don't even start to expire until 2030, and we have a good long runway ahead of us, and we'll continue to build that portfolio.
Simon Hinsley
attendeeGot it. Thanks. And if you take the constraints you talked about earlier within the MRI labs away and assume full capacity with the current labs, what would that revenue flow look like?
Steve Wedan
executiveI'm not sure if I understand the question. Can you say it again?
Simon Hinsley
attendeeSo if you take the constraints talked about earlier within the MRI labs away and assumed full capacity with your current labs, what would potential revenue flow look like?
Steve Wedan
executiveYes. So we think there's a couple of ways to look at that. It's if you take all of the labs that are in Europe, and let's just focus on Europe, all the labs that are in Europe and divide by the number of atrial flutter relations, so the one indication that we have now, you get to about 70 flutter cases per year per site. But the sites that we're at are typically high-end universal, university medical centers that do more procedures than the average. So we think that, that number is around 70 to 100 to, in some cases, 120. But it does take time for us to capture all of those procedures. And one of the things that's happened through the pandemic is increasingly, we are finding patients being treated for atrial flutter and atrial fibrillation at the same time. And if that happens, of course, we don't have tools that are applied for -- to atrial fibrillation yet. So there may be fewer atrial flutter patients in the world than there were pure atrial flutter ablation patients than there were 3 or 4 years ago. But we're working with some of our sites like one at the site that is getting the Northstar system early on to talk about procedures where they can do an atrial fibrillation ablation in an X-ray lab and the flutter part of that same procedure in a conjoined MR lab. And so we're working with our customers to continue to grow the volume. And in other sites, it's that's just a matter of getting started, changing their behavior, making sure schedulers are moving patients into the MRI lab, that physicians are always available and ready. It's not just one team but multiple people who could take any number of those roles so that we can get that volume. It's a challenging thing. It's a big thing that we're changing. So when you look at in EP practice where there's 3, 4 or 5 conventional EP labs everyone can mix and match in those labs. Everyone can fill in a blank. But when we go to the MRI lab, there might be a smaller team, certainly just our devices, but it might be a smaller team that's really trained and comfortable in that lab. So it takes time for us to grow that comfort across everybody so anyone can go from that X-ray lab into that MR lab. This is what's happening now. And it's -- I hope that when we see this sort of positive movement forward that that's what people will focus on. It's -- we really do believe we're changing world of interventional cardiology, but that takes a little bit of time. And once we do it, though, it also has that inertia and the momentum that goes along with that same thing.
Simon Hinsley
attendeeGreat. Thanks, Steve. That concludes the Q&A segment. Before I hand it back to you for closing remarks, I'll just remind attendees that are on the line that this has been recorded, and the recording will be available shortly after by the same link that was released to the ASX. Steve, I'll just hand it back to you for closing remarks, and we'll finish up there.
Steve Wedan
executiveAll right. That sounds good. I think one of the things that I'd like to remind those of us who are here in the United States is that for the first couple of years since our IPO on the ASX, we had a foreign restriction that prohibited U.S. citizens from being able to purchase CDIs on the ASX. You could sell them if you already had shares, but you couldn't purchase them. That always happens for 12 months after any time we do a placement on the ASX, and that 12 months has expired since the last time we raised money in Australia. So now everybody in the world is allowed to purchase and sell and trade Imricor's stock or CDIs on the ASX. So if -- I just want to get that out and make sure that everyone is aware because that's something that has changed just recently. It might not last forever. If we do another placement on the ASX, we'll have to put that foreign restriction on again for the following 12 months. But for now, we like the idea that more people can participate in what we're doing. Other than that, it's after hours here, so I guess I'll let these guys go home. But we really appreciate everybody joining us tonight. And if there's some follow-up questions or anything, we're always available to talk to folks to set up meetings, to spread the word about what we're doing so. Again, thanks very much. We appreciate your attention.
Simon Hinsley
attendeeGreat. Thanks, guys, and thanks all for joining. Have a good day.
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