Good morning, everybody, and thanks for joining us for our FY 2025 full-year results. As most of you know, we are leaders in enterprise imaging and radiology information systems. We work in three jurisdictions – our group headquartered in Melbourne, Australia, our R&D center and support center in Berlin, and our largest market, which is about 90% of our revenue from North America, with our offices in San Diego. We have two product lines in Australia. It's the Visage RIS, which does more of the practice management, back office, billing, scheduling, and Visage 7, which is a clinical product. It's the radiologist's desktop that they use to call up images, enhance them, and make the diagnosis. That's the product we sell globally and particularly in the U.S. In terms of our results, I think it's fair to say that all of our key financial metrics move materially in the right direction.
Revenue up just under 32%, profit after tax approximately up 40%, underlying EBIT around 40%, and our margins, which are more than any of our competitors by multiples in the industry, went up from mid-72% to 74%. As a result, we increased our retained earnings by about 36%, and we've announced a fully franked dividend of $0.30 per share for the half, up 37.5%. In terms of the summary of the year, it was another record year by any measure. We won seven contracts, totaling $520 million at minimums. We also renewed two large contracts worth $130 million, and we had upgrades for additional products with existing clients for a total of $39 million. In all sales areas, new sales, renewals, and upgrades, we made material strides. We also did seven implementations. We signed a research collaboration agreement with UCSF that joins those from Yale, Mayo, and NYU Langone.
RSNA, which many of you know is our key conference that's in November, December, and the 2024 was our busiest to date. We made significant progress with other AI applications and AI, which I'll talk about a little later. All of that, we think, forms a very strong base for continued growth in FY 2026 and beyond. In terms of the highlights of the year, in terms of sales, our first sale came very early in the year. It was a specialist children's hospital in Chicago. Just after the AGM, some five months later, we had a slew of contracts that came in a short period. The largest being Trinity Health at $330 million. We think it's most probably the biggest contract let in the industry, software only. In December, Julie for $30 million, a key academic in UK healthcare for $33 million in January.
BayCare, a large RDN in Florida for $57 million. Some more early on in March and April with LucidHealth Iowa. As mentioned previously, we had two sales of additional products. We often get asked, will our copy be sold back to additional clients? Here were two examples: NYU Langone taking both Visage 7 Open Archive and Worklist, Duke University taking Visage 7 Open Archive. As part of that process for both of them, we're transitioning them from on-premise to cloud. The two renewals I spoke about a little earlier, Mercy and a renewal of an Australian contract. As we said, RSNA was busy and we were very busy on the implementation front. In terms of revenue split, for those that are new to the graph, the salmon color is recurring transaction revenue.
The blue is recurring revenue, normally around service contracts from the older style where we used to sell upfront licenses and service. The green is professional services. We charge for implementation and training. Those costs are spread equally, amortized equally across the life of the contract. If it's a five-year contract, we take a fifth of that revenue every year. The yellow is the data migration. As we're doing more and more full stack, more and more archive, including NYU Langone and Duke University, the archive migration component this year did kick up. We expect that it will continue to grow as more and more new contracts come in, particularly those that have archive as a component. The model that most of you are familiar with, we believe it's highly scalable with a lot of operating leverage. We don't sell hardware. Cloud fees are netted off below the line.
We're not part of any of these revenue figures. We charge for our training and implementation and travel once the contract is signed. We have maintained a highly contained cost base. As a result, our margins, as I mentioned, would be industry leading by a long shot, continue to grow in the full year. The transaction model, again, we talk about a concept of a minimum. If we meet, we have a new opportunity, they tell us how many examinations they did the prior 12 months. We usually get them to commit to, on average, around 80% of that volume. That's what we call the minimum. Each of these contracts that we announce has material upside built into it, even if they just do the same volume as they did the previous 12 months, which invariably they do.
We've noticed that our clients as a whole grow well above the industry average. All that growth then gets captured in additional transaction volume. The forward revenue has increased materially with the recent sales. It's a five-year window. It's moved up from, you know, low $600 million- $948 million. Again, these are minimums. We see upside as client examinations continue to grow. We see this very much as an annuity-style revenue base. In terms of who we service, many of you would already know we service pretty much all the markets, all the segments of the market in the academic medical centers, or we call them tier one academics. We do 11 out of the top 20. Now, these are usually all academic centers because they're rated on clinical excellence and research.
I think we do at least two, if not more multiples, or higher multiples than our nearest competitor. The other area of the market, which is the biggest area of the market, is the IDNs. IDN stands for Integrated Delivery Network. They are usually regional hospital systems. The bigger ones are often multi-state, and we've seen that in some of the clients. Early days, we had Mercy and Sutter. A number of years ago, gained Intermountain and MedStar. Another swathe with Novant, Inova, and Allina. Recently, obviously, our biggest one to date, which is Trinity. A very large section of the market, very important for us, and we have some material clients in that space. The next is the RIS product. As mentioned, that's largely Australia-focused. We do have some implementations in Canada. That was our core product prior to acquiring Visage in February 2009.
We deal with the two largest groups in Australia in I-MED and what used to be Primary, now called Lumus. We are seeing some increased growth as new practices start to form in this market. You will have noticed that our Australian business grew just under 5% this year, largely through new additions around the RIS for not only existing clients but some newer, smaller clients. Visage 7, that's a key product we sell in the U.S. We believe we are still number one in the three core areas that make the product that's so important to the product – speed, functionality, the capability of doing 3D, 4D, advanced visualization, as well as 2D in the one product. We believe we're unique in that capability and scalability because some of our clients are literally dealing with petabytes of data per year.
Cloud is also a key part of that equation around scalability. In terms of what's driving the industry, it continues unabated. The datasets are just getting exponentially bigger. Breast imaging is usually the canary in the coal mine. In the past, 2D mammography was a few hundred megabytes each exam. We have now 3D, which is called digital breast tomosynthesis, where we're now talking about three gigabytes per exam. In high resolution, they can go as high as six gigabytes per exam. The datasets are increasing massively with all of the new modalities. In other words, all of the new acquisition devices. What makes us different? We think that all of our competitors use a standard legacy technology of compress and send, where the files come from a scanner. They're compressed as much as they can be without losing any fidelity.
That file is sent to a workstation that is highly configured, unpacks the file, and does all the enhancements and manipulation locally on that workstation. We, on the other hand, have a unique and proprietary streaming technology where the files come to a central spot today. That's cloud. All the 3D and advanced visualization is done in near real time, and we actually stream the pixels. We don't actually move the file. This causes a delta, particularly around speed, that can sometimes be many orders of magnitude. We are sub one second in most exams, whereas in some cases, if compress and send technology was used, that could be many minutes as a comparison.
It is a huge differentiator, particularly important as organizations get larger and more distributed, and particularly now that pretty much every radiologist wants some capability to work at home for part of the week, and they need the same functionality and speed at home as they do within the hospital. Just going through some of the clients, I talk about Trinity that came just after the AGM. It is one of the top 10 IDNs in North America. I think they have facilities in 26 states. Just to give you an idea of their size, they have committed to us for 10 years for the full stack. It will be fully cloud deployed. We will do our first go live in October this year.
It will be phased over an 18-month period purely because of the regional spread, and two of their smaller regions are getting new electronic health records, which they want completed before we complete those. We believe the Trinity deal is one of the largest deals announced in our industry historically. The other market that we talked about in the past was the private market. This is usually partnerships of radiologists. A lot of them have sold fully or partially to consortiums or private equity. It had been dormant because there was a massive amount of M&A activity culminating up until 2023. We are seeing movement in that market and landed two deals in the year, one in December at LucidHealth and one with Julie Health. A total of $70 million just at minimum for those private.
This joins some of our other private clients like BayCare and CRL that we had previously announced. I think the main thing about this is it opens up that segment of the market, but importantly, it also shows that the platform is well suited to a broad range of market segments and not confined just to one or two. We did have two renewals. Again, I won't go into it too much. Our run rate for renewals remains at 100%. Just post-financial year in the beginning of July, we renewed the last renewal for this year, which was FMOL. They not only did a renewal but took the archive and made a cloud transition at the same time. Our next renewal will be in calendar year 2026. No further renewals scheduled for this year. We also had the Visage 7 Open Archive upgrades. As I mentioned, two key clients.
Again, their material implementations, material revenue, $24 million from NYU Langone and $15 million from Duke University. That is additional to the existing contracts for viewers. That sits on top of the contracts we announced for those clients when they originally signed up with us years ago. We believe that this is a logical upgrade path for many of the clients that currently are viewer only and on-prem. They're looking to cloud, and we're able to transition them seamlessly by converting their archive from on-prem to Visage 7 Open Archive in cloud and then bringing the whole viewer stack into cloud as we do for all our new implementations. The solution we talk about when we look at what is our Nirvana is one cloud instance with all of the branches of diagnostic imaging being serviced. Advanced visualization, 3D breast imaging, all in the one viewer.
We're now looking at the connectivity with AI and with all the other modalities and other areas, which I'll talk about as we progress. The other strength we have, which clearly relies on the technology, is the ability to implement. We believe it's unique to us. We're able to implement even the largest scale enterprises in a quarter or a fifth of the time of industry norm. As an example, we completed the go-lives for Baylor Scott & White within a three-month window. Prior to Trinity Health, they were our biggest client. It gives you an example of how we can do this seamlessly and quickly, which we believe is a significant factor in reducing the barrier to change because previously, companies would take two, two and a half years to complete an implementation, whereas we do it in a matter of weeks or months.
ROI, we position ourselves as a premium product in the market. We believe we provide significant return on investment, multiples of what the clients spend with us in two areas. One is infrastructure and unparalleled clinician efficiency. We quote north of 25% radiologist improvement, which we've been able to log in a number of clients. As important as that is, there's also the clinical capability because it is a clinical product. We do believe that we have moved the needle in terms of what a radiologist is capable of doing with our application as compared to others. That changes the clinical outcome, which clearly is a very important part of our technology stack going forward. In terms of our growth strategy, it is multifactorial. Obviously, expanding footprint, which we did more in this last 12 months in terms of new sales than we've done previously.
We have got transaction growth from our existing clients, which is, we think, about 2x-3x the industry average across the client base. New product offerings, which I'll talk about in a minute. We're leveraging our R&D capability in terms of not only new product in other areas, but also in AI and some of the research collaborations that we have with existing clients, including the new one with UCSF. The TAM, we've updated our figure from $650 million- $670 million based on growth rate of roughly 3%. In any one year, the industry grows between 2% and 3% organically. We believe we're able to address 100% of that TAM from a product perspective and about 85% from a commercial perspective. That is the tail of 15%. Some of the opportunities are most probably too small to address one-on-one.
That tail is shrinking as a lot of the smaller people are being merged into some of the larger health organizations in their area. Including a recent sale of U Colorado, which came just after June 30, we estimate our current penetration is about 10% and growing. Whilst we have a material footprint, we still think we have a very large addressable runway. We often get asked about pipeline. Clearly, the pipeline is dynamic. We're standing up at the AGM in November. I think the pipeline was the biggest it's ever been. We had all of the sales that occurred within the next three to four months still in the pipeline at that time, a week later. Trinity transitioned from pipeline to contract and then all the other contracts. I'm pleased to say that as a result of RSNA24 and other opportunities, the pipeline has been continually refreshed.
I think the U Colorado opportunity was a perfect example of that that may have just come into the pipeline around then, but obviously came from pipeline to contract in early July. The product set has expanded over the years. Archive was the first. I won't go into it too much other than to say it's an integral part of our strategy of moving people into cloud. That strategy, like with Duke University and NYU Langone, and of course, all the full stack solutions, all cloud-based, all Visage 7 Open Archive. It's an integral part of our go-forward strategy. Like our viewer, it's a transaction-based model. There's potential upside with every deal. The last of our three core products, Workflow, we released a few years ago. It's been very popular. We've been able to sell that back to NYU Langone and to others like Yale.
All of our new opportunities, or the majority of them, take the Workflow as well as Archive as part of the full stack solution. This clearly increases our total contract value. Not only that, it makes implementations easier as we don't have to deal with third parties. It is a transaction-based model with upside. One of our key strengths is cloud. We believe we are the only company that does 100% full cloud at scale. There's no hardware on site anymore. There's no PACS hardware. That all gets decommissioned and it's all 100% in cloud, as you would expect. We have been able to show it's suitable for all size implementations from some smaller IDNs that we do all the way up to the groups of the likes of Baylor Scott & White, where we're talking about millions of exams and petabytes per year.
I think the important thing about cloud is the market has shifted drastically towards cloud over the last three to four years and maybe a bit longer. For us, we are agnostic. In other words, we work well in all three cloud environments – AWS, Azure, and Google's GCP. If our clients have an existing agreement with one of the three, we enable them to use that agreement because they've made commitments that they want to use, and we allow them to do that without any delta between the three. We see that cloud and the ability to work in all three as a major advantage going forward. Just rounding out in the last few minutes, we have talked in the past about one view of all modalities. We did announce about two RSNAs ago our cardiology product, which is not only out in the market.
We had our first implementation in the year, but we are able to not only work in the other modalities, but also reflective light, photo, and video because we see image becoming a much bigger part of the patient's electronic healthcare record. We did talk about cardiology. I think the important thing that often gets missed, it is in the same code base as the Visage 7 product. It's part of Visage 7. It's not a separate product. It's not a separate platform. We believe it's the first offering that is fully integrated into the one platform. It has native tools, clearly, that allow specialist cardiology measurements that are required. It has integration into third party because, particularly in cardiac ultrasound, there's a statutory need to transfer that information to a healthcare body.
You need an interface that allows for that to occur over and above what you normally do in radiology. Cardiology, we think, is often, as I mentioned, off and running. Our first implementation's gone well. With UCHealth, it was a material sum that was involved in the cardiology going forward. Something new most of you wouldn't have heard from us before is digital pathology. Again, unlike others, it's not a separate platform. It's part of the same code base. We are starting to show it to prospective clients. It is a work in progress. We believe we will have it out in the market this calendar year. It is, again, fully cloud-based and one of the few.
The other thing that's very interesting is we've also interfaced it with our Visage 7 for Visage Ease Pro, which means that pathologists could potentially use Visage Ease Pro to replace both screen and microscope, which we believe no one has done before. We've also had it recently validated at the IHE Connectathon, where it's an interoperability against standards Connectathon. We believe we were the first to satisfy the digital pathology profile. AI, a few things that have transpired during the year when we think position as well. We have co-developed a breast cancer detection algorithm with NYU Langone, which is commercialization, getting ready to commercialize pending FDA clearance. This will sit next to our breast density and provide a full breast AI suite.
We have made an investment in Elucid for cardiac CT AI to help round out some of our cardiac offering and recently an investment in the Australian-based 4DMedical for lung AI. We've also announced an additional research collaboration agreement with UCSF, which is one of the top academic medical centers in the U.S. We have a growing number of third-party AI integrations that we're bringing to market. Again, Visage 7 for Visage Ease Pro, without going through all the details, we were the first to release a product for this. We are seeing some real-world use cases emerging from our client base, particularly around interventional guidance for procedures. As I said, we see some of this potentially moving into other fields as we release our pathology offering going forward. This gives you an idea of what it looks like through the goggles.
There's a 3D volume that you can manipulate using your fingers and gestures, as well as being able to see what looks like a screen. You can actually do the two concurrently. Finally, RSNA 2024, it was our biggest to date. This is a shot of the booth that we built for a conference. This is yours truly in front with Clayton right next to me. We had about 52 people staff. This year, we think we'll be even bigger purely to meet demand. In summary, most successful year in our company's history by any measure. We've expanded our product portfolio full stack, and that's proven to be very popular. Our implementation and support capability continues. We're refining it and are able to do even the biggest ones even quicker than we were, say, two or three years ago. Cloud is a huge strategic advantage.
Our North American footprint and pipeline, we believe, continue to grow strongly. Cardiology, as I said, first site was implemented very successfully, now with UCHealth Colorado to follow in this financial year. We will be releasing digital pathology towards the end of this calendar year. We think the efforts we've done in the AI will be able to leverage as AI becomes mainstream. We are seeing increased use cases for Visage Ease on Apple Vision Pro. At that point, I thank you and we look to take questions.
Thank you. If you wish to ask a question via the phones, you will need to press the star key followed by the number one on your telephone keypad. If you wish to ask a question via the webcast, please type your question into the ask a question box. We ask today that you limit yourself to two questions per person, after which you may then rejoin the queue. Your first question today is a phone question from Gary Sherriff with Royal Bank of Canada. Please go ahead.
Morning, or morning Sam and Clayton. Question on pathology and a question on AI. The first one, the pathology product, certainly exciting. In terms of a market sizing perspective, we've done a little bit of digging on the size of the market. I just wanted to try and clarify it with you. In terms of volumes for those relevant areas of pathology, like histopathology, it appears to be about two-thirds the size of the radiology market. I just wanted to clarify that that was about right. Secondly, from a pricing perspective, how are you thinking about pathology exam pricing versus radiology exam pricing?
Yeah. I think the pathology market is where the radiology market was about 20 years ago. Radiology, as you know, went from film to digital. The use case and the imperative for pathology to do so is slightly different because the bulk of pathology is not image. It's what we call biochemistry, like someone's cholesterol or hemoglobin count. Having said that, the big drivers for digital pathology are around AI and the ability pathology is becoming very subspecialized, much like radiology has. You can't have a melanoma specialized pathologist at every single point that you do it. I think the ability to remotely read has become a little bit more acute in pathology than it was in the past. I think the market, we've sized it maybe a bit less than what you think, but to be honest, I don't think anyone really knows.
It also will depend on whether the organizations will scan their historical slides because they're these glass slides that by law they still have to keep. Mind you, small. There's six small glass slides on average per test. I think a few things about pathology. We are seeing it as an emerging market. We think our technology, particularly with cloud and with storage, because pathology files are huge because they're color and high glyph, our platforms will suit it. I think it is an expanding market. Your, you know, the figures we have may be slightly smaller than yours, but I don't think anyone really knows because it's so nascent in terms of overall adoption. We think that will speed up pretty quickly from here.
Thank you, Sam. In terms of the pricing, how are you thinking about that relative to radiology?
We haven't done that. We're doing some of that analysis. We do believe it will be a similar model. In other words, how many tests you actually do. All the hospitals know roughly how many new tests that they do. We believe it will be on a per test basis, but we haven't determined that pricing yet.
Understood. Next question, just moving to AI. Given the advances we're seeing in AI, you know, ChatGPT-5, people are creating CRM systems in like 16 seconds. It's seeing a democratization, I guess, of software development and algorithm creation. As a consequence, I assume barriers to entry are starting to fall a little bit. How do you defend your existing technological leadership position when these barriers appear to be falling purely from a technological perspective?
Yeah. I suppose there are two things. You know, a lot of what we talk about, generative AI, we're seeing more of that on what we call the reporting side because, as you know, radiologists dictate the clinical impression of the images. We're seeing that sort of ChatGPT generative AI more in that area. The AI that we're also looking in and the things like breast cancer detection with NYU Langone is clinical. There you have to go through quite a rigorous clinical validation process. You can't just do it and say, we tried it on five breast mammography exams and therefore it works. There has to be quite a rigorous clinical process behind it. That's actually not only time-consuming, but you need willing partners, AKA the hospitals, to do that. I think there are two streams of AI in our space.
Generative AI, where you know if it's going to help and do conclusions for a report, you don't need FDA. That's an aid and an efficiency. I think the clinical part, there's still quite material barriers to entry and FDA clearance, et cetera, that you have to go through. I don't think, I mean, you know, the way of learning has changed because of large language models, but the actual key parts of the process are the same.
Thank you. Your next question comes from David Low with JP Morgan. Please go ahead.
Thanks very much. Sam, if we could just start with cardiology and the addressable market there, just wondering how you think about the back book there. I mean, like how much opportunity is there from the existing list of customers? Is that the first port of call or is cardiology pretty different? If you could size it for us, that'd be great.
Yeah. Cardiology works with the same equipment as radiology. The one that was always deemed to be cardiology specific was ultrasound or cardiac echo, which is the first option that we put forward. We are seeing a lot of significant increase in cardiac CT as a screening test instead of angiography that it's replacing in a lot of places. There is cardiac MRI and cardiac nuclear. With all of those together, we think depending on the organization, if they took all four, it could be between 15% and 20% of radiology. There are far fewer tests done, but each test is more expensive in terms of what you can charge. The industry charges more for cardiology because they're more involved. If you get all of them, between 15% and 20%. In UCHealth, what we did was the key piece of ultrasound, and that was north of 10%. It is material.
We do think we will be able to sell it back to existing clients, and we are putting it out in conjunction with full stack as something that new clients can take from the get-go.
Any reason we should think that the uptake would be different for the experience with radiology? Is the opportunity that the starting period is, I guess, gradual? You add one or two customers, and then we see a speed up in the growth rates. Is cardiology likely to be different in what you've experienced so far?
Not really. You have a slightly different audience, as I mentioned, with ultrasound because you're dealing with cardiologists where, you know, image and acquiring and diagnosing image is part of their day, whereas with a radiologist, it's 100% of their day. Having said that, once you build the base of referenceability, then clearly the ability to sell after that gets easier. We think the first step was getting it out. Next step, getting our first client. We think we've taken another step with this new sale. Again, we think that, yes, it should have a similar dynamic to what we did with radiology.
Thanks. Just to clarify, when you say 15%- 20% of radiology, do you mean by value or by volume?
Value. Dollar value.
Great. I'll get back in the queue. Thanks very much.
Your next question comes from Mathieu Chevrier with Citi. Please go ahead.
Hey, good morning. Thank you for taking my questions. I was just wondering about the shape of the revenue stream for an open archive upgrade compared to a new customer that goes with full stack. For example, we have this NYU add-on $24 million over five years. Is that evenly distributed over time, or is that more front-loaded?
Yeah, Matthew, it's Clayton here. Because of the data migration that they need to go through, we can take a lot of that, or we take that revenue upfront. We bill it on milestones, so we normally bill on a quarterly basis, but we take a percentage of completion of the data migration. That revenue is taken as we do it. The exam revenue is spread pretty evenly over the rest of the period. For NYU Langone's sake, that would be about, because it was announced separately, you know, 10%- 15% of that total contract value. For full stack clients, it'll be a smaller percentage because there's more revenue in the mix, more exam revenue from all three components.
Yeah, the charging model's the same.
Correct.
Whether they take it upfront or whether they take it as an additional module like NYU and Duke.
I was just more asking from a modeling point of view. I was just curious to get your views on, I don't know if you've seen this, but RAMNet has come up with a solution called TechLive that received FDA approval just a few days ago for remote scanning. I was just wondering what kind of opportunities and challenges that you think those kind of solutions could bring to Pro Medicus.
It's not the area we work in. That's the image acquisition area. From what I understand and have read, it means that a technologist can supervise a scanner that they're not next to. We don't see that as any threat whatsoever. It's something more on the client side. It wouldn't impact the number of scans that we would see or do or charge for. It's neither here nor there. It enables groups, and I would assume our clients as well if they use similar technology. A lot of the equipment manufacturers are trying to bring that out so that if you have 10 scanners, you don't need 10 technologists. That really is more client-side and really doesn't impact us at all.
Do you think it could be a tailwind though to volume growth over time?
It could mean that you need fewer people to do more scans, which could be good for us.
Got it. Thank you so much.
Your next question comes from Andrew Paine with CLSA. Please go ahead.
Yeah, hi. Thanks for taking my questions. Just one that we get all the time, but just in terms of the older legacy systems, just be good to know how long you think these can continue to serve us, radiology, and what % of the market you think remains on these older systems.
Yeah, that's an interesting question. I think that in certain areas, that sort of technology is cracked. The canary in the coal mine is always in breast imaging because that was always where the files were large, and they've now become just exponentially larger. Some groups are just struggling under the load. The other thing that's created a much bigger load is breast imaging mammography used to be 2D. With the advent of breast tomosynthesis, the files can be up to 10 x what they used to be in 2D because it's like a 3D. It's like a scan, like a CT. Tomo means a scan at a certain level of anatomy. The interesting thing is in the U.S. in particular, and the rest of the world will follow, tomosynthesis 3D has overtaken 2D in screening. It's more than 50%.
You've seen a new technology become mainstream and those files becoming huge. Having said that, it's the same with everything. In the old days, a CT scan had a few hundred slices. Now, you know, it can be 5,000, 10,000 slices. We're seeing the datasets getting bigger and bigger and bigger, and particularly when you start looking at remote, a lot of these systems are starting to, what I call, crack. We think we're going to see more and more of it where they just don't really keep up. Breast imaging, canary in coal mine, in reality, we're seeing this, particularly with remote reading with other modalities as well.
Okay, that's great. Just the size of the market for these legacy systems is probably pretty hard to estimate, but have you got any idea there?
Sorry, we didn't. We couldn't hear you, Andrew.
Sorry, just in terms of the size of the market for these legacy systems, what percentage of market share you think they still have?
90% because we have 10%. It's probably the most straightforward answer. Bear in mind, some of them have, you know, over the years developed more sophistication around how they push the images around. That is coming to a tight watermark as well. We really don't believe anybody else has been able to do this on demand, regardless of, you know, you push the button and the file's there in full res in one second. We don't believe anybody else has been able to crack that nut except for us.
That's great. Just as a follow-up to that, probably the second most asked question that we get is just around any steps by these legacy systems to update or why aren't they updating and trying to remain in the market given it's quite an attractive market still.
Yeah, to do it, and people have tried in the past but have stopped, you have to go right back to the beginning. You can't upgrade them. You have to bring out a totally new platform, and that's a multi-year job. You have to get it FDA approved. Is it possible? Absolutely. Is it a simple 12-month process? No. The last thing is our product is proprietary. Visage 7 was built from the ground up by the team in Berlin, and it was built without using an existing toolkit. You can't get a sort of Microsoft toolkit and get to 70% out of the box and then refine the rest. Those that have got existing systems, it's a really, really, really big job to bring out a new system, and then not only that, get it FDA approved, get it hardened, get it scaled, and then transition clients to it.
As far as we know, and I think we have a pretty good view over the market, no one's been able to do that.
Okay, that's great. Thanks.
Your next question comes from Josh Kannourakis with Barrenjoey. Please go ahead.
Hi, Sam and Clayton. Just a couple of questions from me. First, just on pathology, do you have a bit of a read-through of how many players in the market are using specific pathology solutions versus those that are sort of inbuilt to broader enterprise agreements that, you know, would be using radiology plus pathology, et cetera?
Yeah, so pathology is actually, you know, just starting to come of age. It's a very small percentage that have adopted it. In the past, the reason was around it's a small part of the enterprise, but a very data-intensive part. If you did it on-prem, the cost of data storage was just a bit too high. There are a number of pathology-only players that have tried to get into the market. Most pathology is sold by our radiology competitors where they package someone else's or package or do that as a separate platform and sell it as part of that, like a Philips or a Fuji or et cetera. In those cases, they're all separate platforms. It's not part of the main radiology platform. It's a totally different one. It's the same badge, two platforms.
I think there's only been a small number of pure pathology players, particularly in the U.S. There's been more in Europe, and that's where a lot of them come from. One or two have just got FDA. The thing with pathology, selling it on its own, in its own rights, a bit like cardiology, there's a high cost of sale, and the actual dollar value of the sale is nowhere near as big as radiology, certainly not at this stage. The competitors are two, the sort of standard ones that we deal with on the diagnostic imaging side. We are seeing a small number of independent pathology players, but a lot of them are hitching their wagon, not so much to the platform, but more to AI around it.
Got it. No, that makes sense. Just to round out, like, you know, we talk about, you know, cardiology being 15%- 20% of radiology in total. How are you sort of thinking today about pathology?
Yeah, it's sort of one of the questions we got asked at the beginning. We haven't really sized it. It's very hard. We thought we needed to do it to get a complete single platform across everything. That was one incentive. We think that market will continue to grow. I don't think it'll be as big as radiology, certainly not from what we're seeing, but it could be material if it goes from, you know, the 5% or 7% adoption to a more generalized adoption.
Got it. Just a second question, just around the funding environment. Obviously, the big beautiful bills come out. There's underlying code there, a bit of a crunch on funding. I think if you sort of look into the detail, there's quite a bit of a shift in reimbursements to the sort of outpatient clinics, which has been happening for a while in the U.S. anyway. How are your clients reacting to that? If you could give any sort of context around how you think you guys could be impacted from a positive or negative perspective in terms of demand for the platform?
Yeah, I think more earlier than that, I think the COVID crunch, like a lot of industries, a lot of hospitals bulked up and now they're standing saying, "We, you know, our profitability was impacted. We need to sort of, you know, optimize." You can look at optimization, particularly in our area, through two prisms. One is just cut costs by something cheaper. The other, which I think makes more sense, is buy the most efficient product because that's where you'll get the most bang for buck. Obviously, there are times, as you know, that we don't win every single opportunity. Pretty much 100% of the time, it's because of perceived cost. I think that's actually the wrong way to go because you spend the money, you don't get the full result.
Clearly, we seem to be winning those arguments more than we're losing them, and hence the reason for all the additional sales. Yes, there is a feeling, and maybe this big beautiful bill will sort of heighten that. We haven't seen that, but there has been a feeling that hospitals, particularly post-COVID, became unprofitable, and now they're sort of tightening their belts and optimizing, and our area is one of them. If they use us, then we believe we give them the result.
Got it. Thanks, guys.
Your next question comes from Annabel Li with Goldman Sachs. Please go ahead.
Good morning, Sam and Clayton. I also just have two questions, please, and I might ask them one by one. First, just on a follow-up on pathology, are you able to comment on the uplift in R&D or sales headcount that might be required and potentially any forward indications from customers that you might have already received so far?
Yeah, so the actual product is in our current R&D budget. The R&D figures for the year included pathology. I think if, as the product evolves, we most probably not so much in R&D, but you know, we'll get more domain knowledge through a product specialist, you know, someone that's lived and breathed pathology. It's similar to radiology, but it's not exactly the same. I don't think you should expect significant cost increases around that opportunity. It's all pretty much what we're releasing has been already incorporated in the existing R&D budget. Yeah.
It's the huge advantage of obviously using the same code base for both cardiology and now digital pathology, or within the Visage 7 platform, the development team is already in play. As Sam mentioned, as we get people on board, similar to what we've done in radiology, we'll have product specialists, but the core development team stays relatively the same.
Yeah, and all the other things we've built around radiology, we look at saying, how can they apply to pathology? An interesting thing is Vision Pro. This is incredibly early days, and it's a concept. The difference between a radiologist and a pathologist looking at an image is the radiologist has an image and they move their head to see the whole image because it's on a big screen in front of them. In pathology, a pathologist looks down a microscope. They actually move the slide under the microscope. They never move their field of vision. The thing you can actually do with the Vision Pro is exactly that, that the goggles can sort of almost be like this immersive microscope where with your hands you move the image in front of your eyes.
We're trying to see what other assets we have in terms of not just the core platform, but, you know, Visage 7, Visage Ease Pro that will make the pathology offering even more differentiated. That won't require much R&D because we already have those technological assets as part of the core stack. As Clayton Hatch said, being able to do it as the one platform not only has huge implications for us in terms of development, it also has massive implications for the clients because currently sometimes they have to manage, you know, 50, 60 different backends to get what we do in one. Again, it's part of the R&D, but we're also looking to see what other assets we have that will make it applicable to pathology.
Perfect. Thank you. Just on contract renewals, I appreciate you won't have anything come up until next year. I am just wondering if you'd started these conversations and maybe what the initial response has been and your expectations that they will stay on Visage 7?
Yeah, we have started conversations, and it's fair to say that they're pretty much in the same format as we've had all the previous ones. You would expect, particularly with the bigger ones, some of the bigger ones, where they want to have the conversation a little earlier. Sometimes it's quicker. Sometimes it's something that they talk about, put on the back burner, and then as time gets closer, it comes to the front. They each have their different cadence. Yes, we've sort of started with some of the ones more towards the front of the year and broaching that conversation. It's pretty much what we've had, similar sort of conversations to what we've had in the past.
Thank you both. Your next question comes from John Hester with Bell Potter. Please go ahead.
Hi, Sam. A couple of questions for you. For Clayton, can you just run through the implementation schedule for the next six months, please, Clayton, starting with Trinity and working through Julie and so on?
Oh, look, I don't have them right in front of me at the moment, John, so I can probably take that offline. They haven't changed too much. As Sam mentioned, someone like Trinity starts in October and is spread over an 18-month period. Julie, I believe, is early next year and over a different period. Nothing has changed much from the contract announcements, but I can certainly take that offline with you.
Yeah, no problem. I just want to come back to the investment you made or the development facility you established with 4DMedical.
Yeah.
A $10 million facility, Sam. Tell us, what was your thinking process on that? Also, is that the extent of your commitment to this company, or is there more to come, do you think?
For full disclosure, as you know, I was on their advisory board prior to them listing, and after they listed, I am no longer. I knew the company. I think this was purely an investment made through the board. I abstained from voting on it because of my prior association. I think some of the rationale around it was the new VQ product that they're looking at, which is a replacement of an existing test to determine pulmonary embolus. We think it is more in our wheelhouse in terms of AI capability that could be useful on our platform. We looked at it, the company looked at PME, looked at it through two, presence and investment. Will the algorithm, could that be something we could potentially add to the platform as we would, let's say, in Elucid? That's why we did it. I wouldn't read more into it than that.
I can't talk about future investments. I don't, at this point, I think the whole concept was that one and leaving it there.
Okay, this is a potential add-on of technology, but you're sort of saying that you're open-minded as to whether there's more investment to come?
I'm saying that we looked at the $10 million as the investment. We haven't really discussed more.
Okay, thank you.
Your next question comes from Christine Trinh with Macquarie Bank. Please go ahead.
Hi, Sam and Clayton. Congratulations on a strong result. Just two for me.
Thank you.
No worries. Just to, for me, personal pathology, to piggyback off of Annabel's previous question, I think you mentioned you started kind of soft launching pathology to clients. What's the initial reaction been? Do you think pathologists are kind of ready for this technology, or will it be a bit of a slower uptake?
The reaction has been good, but you know, it's early days. Let me preface it. A lot of the issue around pathology is with the large datasets, and that's our strong suit. The fact that two things, one, that we can handle them and store them and store them efficiently in cloud, because if you don't, it breaks the piggy bank. I think each test is about 6- 8 GB because they're color. Being able to efficiently store it is an important part, and I think pathologists realize that. The other thing is the speed because it's a streaming platform, and they have all the things that what makes it good for radiology makes it good for pathology. It's early days. As I said, most institutions are thinking about digital pathology but haven't gone fully down that path.
We're at the very beginning of a new cycle, whereas in radiology, it's a replacement cycle because everyone went digital 20 years ago. Slightly different dynamics in the market. We think there's an advantage to having it all on one platform because it then becomes a licensing issue, not an infrastructure issue. It has all the attributes of streaming cloud, all the things that are, you know, that our diagnostic imaging product has. We think it has a lot of advantages, but it's very early days. We'll update the market as we progress further. Clearly, FDA is one of the steps. As I said, we believe we'll be putting it in for that this calendar year.
Perfect. Just quickly on the U.S. defense contract, you're probably tired of answering this one, but have you got any updates for us there?
Military? Oh, yeah, sorry. No, there's been a fair bit of interest and activity. The military hasn't actually done anything other than, you know, they're looking and they're continuing to investigate what's out there. We don't know, again, of anyone that's got, other than us, that's got FedRAMP for cloud, but they may. It's one of those things. Certainly, that has positioned us well in terms of further discussion. The military is government and the government, as you know, in America, everything's been avulsed with the new president. You would expect it would be going slowly. It is, you know, we are getting engagement. What that means long term, we'll just have to wait and see.
Right. Thanks, guys. Your next question is a webcast question from Michael Porter with Economic Concepts. This reads, can you quantify cardiology, e.g., ejection fraction type growth in Pro Medicus business, scope for penetration in China market profitability?
Yeah, so cardiology, if you're looking at ejection fraction, that is the ultrasound portion. As we said, that's somewhere around between 10% and 13%, 14% of radiology, depending on the organization and how much they do. Certainly, we're looking to sell it back and replace what are the traditional systems that are used because the traditional systems are used by the equipment vendors. They'd sell 20 or 25 ultrasounds to an institution and that cardiology's ultrasound package on top, which really just does that. It's not part of a broader package, which ours is, which you need to have. In terms of China, we don't have any current aspirations for sales in China due to a whole lot of reasons. Could it be used as technically? Absolutely, it could be used anywhere.
It's purely because there are nuances around the Chinese market that we currently feel we should, you know, it's not part of our, not a region that we're actively looking at at this point.
Your next question comes from Daniel Stewart, a private investor. This reads, does Pro Medicus plan to take the relationship with 4DMedical further than just an investment, such as distributing 4DMedical's products?
As I mentioned, just in answer to one of the previous client questions, that's a possibility. The agreement we have with them and the investment opens the possibility for that, but we don't have that at this point. It's a bit too early to have a reseller agreement. It's possible, but there's nothing firmly on the table yet.
Your next question comes from Michael Porter with Economic Concepts and reads, has Mayo Clinic upgraded full package?
No, Mayo Clinic is one of the ones we're speaking to about renewal next year. Currently, the whole of Mayo uses an archive called MIDIA that they co-developed. At this point, the answer to that is no. What happens in the future, clearly we have to see what plays out.
Thank you. Your next question comes from Neil Stovick with Far Eastern Group. This reads, can you explain a contract and its terms, e.g., $15 million minimum over seven years, is $15 million over five, about $3 million per year or $15 million per year? When start paying, three months later, pay upfront, e.g., on January 1st every year or in arrears? Move to subscription base. For a Duke, are you a U.S.-based company selling to Duke? Hence, no tariffs on U.S.-based software sales.
I'll answer the last question first. There are no tariffs at this stage on software, but we do contracts for our U.S.-based customers. For any of the opportunities, that's what we do. In terms of the contract, yes, a $15 million deal over five years is, you know, $3 million per year at minimum. It's at a minimum number of exam volumes. There's always inherent upside to that contract on the actual exam numbers that they do. In terms of payment, we have some professional services that we bill upfront and pay that over time. They get paid and spread over the length of the contract. We bill on a quarterly basis in arrears and get paid for it on a quarterly basis. It's already pretty much a subscription model based on a minimum number of examinations that get topped up.
Your next question is from Stella Wang, a private investor. This reads, regarding the next major renewals, when is Mayo first signed July 2016 due to be renewed? If I remember right, they only previously signed for Viewer. What's the profitability of Mayo taking up the full stack? Thank you.
Yeah, so you're right, it's Viewer only. As I just mentioned with the answer to a previous question, we are looking to renew them. The first part is around the Viewer, clearly because that's the contract they have with us. In terms of other applications, often we don't do those deals at time of renewal because the organization is just looking to get a renewal out of the way. FMOL, which was our last renewal, was an exception to that because not only did they renew, they took the archive. We can't talk about the future, but clearly we are making them aware of all the applications we have, including archive, worklist, cardiology, and now we're also making them aware of our cardiopathology offering.
Your next question comes from Neil Stovick from Far Eastern Group. This reads, can you discuss your competitive landscape, please? Your financial metrics are so strong, why doesn't GE, Siemens, Google, Tempus AI, etc. work to buy you or compete aggressively against you? Aren't competitors enhancing AI research collaboration? How soon before AI and cardiology reach inflection points? Estimated 2027, 2028.
In terms of competitive landscape, you're right. We compete against a broad range of competitors, and they all compete aggressively against us. Whether they're Siemens or whether they're a cloud-based startup, we see them all as competition. In terms of acquisition, I can't speak for them, but no one has offered to buy us, and we try and run our own race. Everybody is looking to enhance their AI capability. I think our strategy is multipronged. We think that the platform itself is the best platform for AI, regardless of who actually creates the algorithms. It's not just developing algorithms or partnering to create algorithms. It's the platform itself. In terms of inflection points for AI cardiology, we think we've taken, as I mentioned before, some big steps in cardiology. UCHealth will be the next one. AI, I think, is still an emerging market.
I believe you'll see more and more pockets emerge in the coming year or two. Is it going to be an avalanche? I don't think so, but those pockets will coalesce. I think both markets are emerging, and we have keen interest in both of them.
Your next question comes from Ian Lee with Alliance Global Investors. This reads, Sam, what % of your pipeline is now cardiology?
There are two parts to it. Cardiology that we're looking to sell back to existing clients. Clearly, we're putting our best foot forward, showing clients what exists, trying to get in front of their cardiologists because, as I mentioned, it's a different audience to the radiologists. We're obviously doing that. In a number of RFPs, we're starting to see the re-emergence of cardiology and radiology together, and the fact that we have a really good offering for cardiology positions as well. I think UCHealth Colorado is the perfect example of that. We're looking at it through both existing clients and, clearly, new RFPs.
Your next question comes from Tony Tan, a private investor. Would you be able to name one to two closest competitors to Visage in terms of cloud and AI implementation? What is Pro Medicus Limited doing to maintain the moat?
Yeah, in terms of cloud, I'll be honest, you go to RSNA and everybody has those exact two words on every single stand: cloud and AI. Reality is we don't believe that any of our major competitors have a truly 100% cloud-based offering. They talk about hybrids where you have to have a system on site. To me, that's not non-cloud cloud. It totally defeats the purpose. As far as we know, whilst there's a lot of marketing hype and noise around it, we believe we're the only ones that can do true cloud at scale. As evidence of that, we haven't put an on-prem implementation in the U.S. in the last four years, and all the small to biggest have been cloud.
AI is something similar that everybody says they have AI in various bits and pieces, but we don't know anyone that's taken the march on AI and won the market by any means. Quite the opposite.
Your next question comes from Claude Walker with A Rich Life. This reads, congratulations on the multiple big wins this year. I just wanted to check, has the company lost any of the pipeline contracts to competitors in the last year?
We will never have a 100% hit rate. I wish we did. That would be unbelievable, bearing in mind that we think we outsell most of our competitors put together. The ones that we sometimes lose early on, they just look at price and go, you've got to be kidding. Having said that, it's not unheard of for those people to come back a few years later. Sometimes people just look at something and they feel that their budget is X. There will always be some that were either excluded from fairly early on or people have looked at price. Sometimes there's the concept that maybe the opposition have a broader range of product, which I don't believe is the case. We're not going to have 100%, but clearly our recent hit rate has been the highest we've ever had.
Your next question comes from Sinclair Curry with MA Mollis Australia. This reads, do you have any insights about timing of when customers' contracts with alternative solution providers roll? Can it provide any information about timing of pipeline conversions?
We have some. It's very hard because some of the systems that have other vendors will sometimes just roll over a contract for a year. We tend not to do that. Our contracts and renewals, as you know, are longer term. So we have some insight, but it's not like a clear crystal ball. I don't think anybody has that. We try and remember that and certainly at RSNA try and encourage those people to come and see us, but it's not as easy to ascertain as you might think from the outside.
Your next question comes from Neil Stovick with Far Eastern Group. This reads, what are your efforts to build sales and scale in Germany and Asia? Three to five years later, large are the TAMs for Germany and growing Asia, respectively large relative to the U.S. What are your obstacles? Sales technicians, regulatory approval, competitors largely from North America or Europe?
There are really two markets we look at as blocks, or you could think of them as three now. Europe, UK, and Asia as a block, excluding China, and at this point, Japan, because Japan has its own regulatory cycle and very different market dynamics to maybe places like Korea and Taiwan. We have said in the past, and we still say, the U.S. is the biggest market. I think it's about 60% of healthcare spend globally is spent in the U.S. That's how big it is. Having said that, we've had some success in Europe, particularly in Germany, which is our base, and we're looking at the possibility of extending our capability there. It's not a technical thing. It probably will work anywhere. It's purely market dynamics. Having said that, the cost of sale is much higher in Europe. Each opportunity is smaller.
Each opportunity is pretty much government-run, so a lot more bureaucracy, a lot bigger tenders. The bang for buck in terms of returns is not there, as it is in the U.S. We are seeing slowly a change, particularly as cloud vendors come into the mix, because currently there's pretty much zero cloud in healthcare in Europe, and that may help us. Our message, I think, is we maintain a U.S.-first. That's where the biggest opportunity is. We've got a material foothold of 10%, but huge runway, and that's where we see the least impedance to doing business. Clearly, as things change, particularly with cloud, we can see the other markets, Europe and Asia, possibly opening up in the future.
Your next question comes from Abhishek Jain with Citi. This reads, what level of OpEx growth should we be expecting for FY26 versus FY25? Thank you.
Yeah, I think it'll be a similar level of growth in our operating costs, mainly through bringing on new headcount, which will help drive that growth for newer opportunities. It'll be in similar areas that we've done in the past, both in sales, implementation, project management, development, and all the key areas that we have in terms of headcount. It should be on a similar level to what we've done in 2025.
Your next question comes from Jacob Garfield with Avidity Partners. This reads, what is the rate limiting factor on signing more new customers?
There's not any particular rate limiting factor. It's purely in terms of what RFPs, you know, come to market. It's not that we don't have capacity or other bits and pieces. It's purely the number, and it's purely, as I said before, putting our best foot forward and showing the value that we have rather than just competing on price, which we don't do. There are no particular limiting factors at this point.
The next question comes from Matthew Nicolades, a private investor. This reads, are you seeing any delays in implementations due to client resourcing or macro factors?
No, not at this stage. As I mentioned, I won't go through them individually, but we haven't pushed out any of the implementations from a client level or macro level. They are pretty much on, or they are on track from what we've announced previously in the contract announcements. All ahead in terms of implementations. We do have a number of them, but we do have a schedule that'll see them follow through.
Your next question comes from Jacob Garfield with Avidity Partners. This reads, which cloud-based startups are you seeing compete: New Lantern, Sirona, Synthesis?
Every startup and anyone in our area we see as competition, and we don't take any of them lightly. We have not seen those particular companies in major RFPs that we're currently tendering for. That's not to say that maybe some of the smaller organizations, really small ones, would look at them rather than ourselves or any of our key competitors. We haven't seen them in the mainstream of what we're currently doing, certainly not up to this point.
Thank you. There are no further questions at this time. I'll now hand the conference back to Dr. Sam Hupert.
Just wanted to say thank you, everybody, for joining us and for your questions. Appreciate it very much. Thank you.
That does conclude our conference for today. Thank you for participating. You may now disconnect.