Welcome to this presentation of the third quarter results from Medistim. I am Kari Krogstad, and I'm joined with CFO Thomas Jakobsen this morning, and we will take you through the results. We'll start with the highlights, go through the financial statements, give some comments about the development in the various business segments, and then also add some comments to how we're implementing our strategy. Now, as you will recall, the second quarter was really a very strong comeback after the COVID-19 pandemic for Medistim. Of course, it's great interest to see how the results are doing now in the third quarter. As we can see here, we are reporting the third quarter in a row with sales above NOK 100 million, and we're very pleased about that. NOK 102.1 million, providing a 22.5% growth over the same quarter last year.
We can also see that the EBIT is developing also very nicely, ending at NOK 25.1 million and a 20.3% increase and with a solid margin of 24.6%. If we're looking at the sales here then, this is also the first time for a third quarter that we are going above NOK 100 million in sales. The third quarter typically is the weakest sales quarter in our business, so that's also sort of a record for us to report. We're always following the imaging business very closely, and as we have seen also in the second quarter, we have seen a rebound of that portion of the business, and this is continuing into this third quarter. 43.5% increase in the imaging sales in the third quarter. Flow sales is also developing nicely at 16.3% growth.
The vascular business was coming back a little bit in the second quarter. Now we can see a really strong pickup here in the third quarter with 57% growth in NOK. The cardiac is also following nicely. As we can see here, we do have a bad currency development. There is still an issue with the Norwegian krone strengthening compared to the same period last year. If you're adjusting for this, we will see that the currency-neutral growth in total was above 30% for this quarter. If we're looking at our own products only and currency-neutral growth, we will see that that is at a high 33% growth. It's also very nice to see that this growth is coming from all the geographical regions.
U.S. up almost 25%, Europe up 39%, Asia almost 28%, and rest of the world is up 126% this quarter. Also the third-party products is contributing to the development with a growth of 19%. All in all, very nice development in all areas. We are also following the volume developments in number of units sold or outplaced. The two most important indicators is the development in the flow probe sales outside of the U.S., and we can see that this quarter, it's growing by almost 51%. Also the procedure sales in the U.S. growing at almost 29%. Really good indicators that we are seeing a really high activity level out in the hospitals. With this third quarter, we are looking at the year-to-date performance with the best year-to-date September ever for both revenue and EBIT.
Looking at the sales isolated, it's up 15% to NOK 309 million. We see that the imaging sales is picking up nicely, the vascular sales is picking up nicely. The currency-neutral growth, as we see, there's a negative currency effect also for the whole period here. Currency-neutral growth was 24.5% for the total business and 25.3% for own products. Again, we can see good contributions from all regions with one exception, rest of the world, a smaller sales region, which varies a lot. We will also remember that in the second quarter, we reported an extraordinary revenue of NOK 5.3 million related to the U.S. Paycheck Protection Program. If we take that also into account, the total revenue for this period is NOK 314.5 million, and then giving a 17% growth.
The EBIT is looking very nice, ending at NOK 96.8, a 32% growth, and this is actually higher than what we saw for the full year of 2020. Again, the indicators for the activity level out in the hospitals very nicely now for the whole period. 28.7% growth in flow probes and 28.6% growth for procedures. With that, I will leave the floor to colleague Thomas.
I'll take you through the numbers for the quarter and also year-to-date September. We jump straight into the numbers. Again, as Kari mentioned, I'm also very pleased to see that we are above the 100 million mark for the third quarter. Naturally, the third quarter is the slowest quarter in Medistim due to the fact that there's a holiday season in most country around the world in July and August. This is a really strong performance. Kari will return to split the sales from a geographical point of view and also product mix, so I won't go into that much detail here. However, cost of goods sold is higher this quarter compared to same quarter last year and the reason for that is product mix.
We sell more of imaging systems, which have a lower margin than flow products, and we also have very strong sales through our distributor network. Naturally, we have lower margin when we sell through distributors compared to selling direct. Salary and social expenses have increased. We have some more employees, but the main driver for the expense increase is related to sales commissions and bonuses to our sales rep, especially in the U.S. A large portion of their compensation is related to sales performance. When we do well in the U.S., this expense will naturally also be higher. Other operating expenses is also higher compared to last year. We are still affected by the pandemic, and there are lower activity than what we would consider as normal, but higher compared to comparable quarter last year.
This gives us an EBITDA at NOK 31 million, just over 30% margin compared to NOK 26.6 million last year. Depreciation, a slight increase. The main driver for this increase is related to investment in infrastructure and our new ERP system that went live in June and is now in production, and therefore we are depreciating this investment. Operating result or EBIT ends at NOK 25.1 million.
This is almost 25% EBIT margin and more or less at the same level as we had last year. Net finance is related to foreign exchange gains and losses, realized and unrealized, and because of the strengthening of the Norwegian krone, we have a negative net finance of NOK 1.1 million. Net profit before tax ends at NOK 23.9 or 24 million if you round up. Profit after tax for the quarter ends at NOK 18.8 million, 30% up from last year. Another strong quarter.
If I move to year-to-date numbers, third consecutive quarter with over NOK 100 million in sales. Therefore, this is the first time we are over NOK 300 million in sales after September. Kari mentioned the PPP program or Paycheck Protection Program in the U.S. We recorded an extraordinary revenue in the second quarter. Total revenue so far this year ends at NOK 114.5 million. Again, cost of goods sold. The reason for the higher level of cost of goods sold is basically the same as I explained for the third quarter. In addition, I'd like to mention that we also had a write-down of NOK 2.5 million related to the termination of the SonoSite products, which obviously adds to cost of goods sold. Salary and social expenses, same explanation as for the quarter. Other operating expenses, however, are at the same level as last year.
Keep in mind, first quarter in 2020, we had the more or less normal activity, and then we had the shutdown because of the pandemic in the third and second quarter last year. This year, we were still much affected by the pandemic in the first and second quarter, but we see slightly more activity now in the third quarter. All in all, year to date, we end at the same level when it comes to expenses. EBITDA ends at NOK 114.2 million, up from NOK 19.2 million. Depreciation, in addition to the investment in the infrastructure that I mentioned, we also have additional system placed out as a lease in the U.S., and those are also depreciated, and that increases the expense. Operating result, EBIT, so far this year, NOK 96.8 million, a margin of 13.8%. That's an improvement compared to last year.
Net finance, negative NOK 2.2 million, and pre-tax profit of NOK 94.7 million, and a profit after tax of NOK 74.8 million, which is a 34% increase compared to same period last year. Good development. We go further on to the balance sheet. Intangible assets are reduced by about NOK 3 million. This is depreciation of previous projects that has been activated in our development department. Fixed assets, the reduction is mainly related to less lease obligations related to premises, basically. The total intangible and fixed assets are reduced with about NOK 10 million. When it comes to inventory, it's reduced compared to the level going into the year. I will still emphasize that we have much focus on end-of-life components and securing critical components. We will still make sure that we have high inventory levels to make sure we can deliver products.
Customer receivables increase as a natural consequence of increased sale. Our cash position is also improved compared to when we ended the year and ends at NOK 89.7 million. If you then look at equity and liability, equity change is basically profit for this period and paid dividend. As you can see, we have a very strong balance sheet, 77% equity. The long-term liability is related to lease obligations. We can see a reduction compared to when we went into the year because we then have less lease obligation when we are ending September. Basically that's what I have to comment on related to the numbers as of September. With that, I will leave the word to Kari again.
Thank you, Thomas. Let's take a look at the business segments here and starting with the imaging probes and systems that we are selling. Looking at the imaging systems development, well, clearly we can see that the imaging sales took a hit when COVID also hit Medistim in the second quarter. We have seen that several of the projects that we had in our pipeline was developing from a potential imaging sale and ended up as a flow system type of sale. This is now coming very strongly back. Of course, since we have a weak comparison here, the growth will be very high in percentage, but this is the development that we're really looking forward to seeing, to getting the imaging system sales back to the normal state. We can see the same tendency here for imaging probes.
Very nice pickup since the second and third quarter last year, this year having a really strong quarterly percentage-wise growth. When it comes to the flow probes, also here, the flow systems showing a flat development this quarter. As we can see, it's leveling back to normal. It's flat and that's actually okay since it's our strategy to convert the flow systems only into a flow and imaging combined type of technology. As long as the imaging sales is picking up, this is fine. If we're adding the two system types together, we will see that the growth in total number of systems this quarter is 17.5%.
When it comes to the flow probes, of course, as I've said already, strong indicator of the activity level out there in the hospitals, and really nice development through the quarters since second and third quarter last year, and this quarter, more than 50% growth. Really showing that the activity level is getting back to normal. We are also going to take a look at the revenue performance by region. Here we can see that all the regions are contributing nicely to the quarterly growth, both Europe, U.S., Asia, and the rest of the world. Here, just a couple of comments. For Europe, it's important to remember that this is encompassing both our own products and also the third-party products. For this quarter, we can see that both categories are contributing very positively to these total results for Europe.
When it comes to the U.S.A., we see the good results in NOK. We know that it's negative currency effect here, so it's actually even stronger in U.S. dollars. When it comes to the year-to-date result, just a reminder about the Paycheck Protection Program and the additional income there. Asia is doing well, rest of the world being small and, well, showing always a lot of variation. On the bottom of this slide here, the total negative currency effects for the year-to-date compared to this period last year amounts to NOK 20 million, so it's actually quite substantial. If you now look at the revenue performance by product category, it's also very nice to see that all categories is contributing very positively. We see that the procedure sales in the United States is developing very nicely.
Is the flow probes, flow systems, imaging systems, imaging probes, and also the third party. As we can see, there is a discrepancy in the development when we are looking at the volumes, compared to what we're seeing here in Norwegian currency. For instance, I said that the flow systems was flat, and here we can see a 21% increase. This is explained partly by currency effects, but also the fact that we have two different sales channels. We are selling through distributors, and we are selling through direct sales teams. Of course, if we sell a unit through a direct channel, we are getting a much higher revenue. Also in the United States, we have two different business models.
One is the capital sales, which is providing a good contribution for the quarter in question, and we also have the leasing income model, which is providing income more for the longer term. This is important to keep in mind when we are comparing the various data here. We have some detailed explanation, which I will not go through in this presentation, but which can be studied as needed. Okay. I think it's fair to say now that what we're seeing so far is definitely a recovery from the COVID-19 pandemic. We have seen a gradually decreasing impact to really strong recovery in the second and the third quarter. It's illustrated here by the currency neutral sales development since the onset of the pandemic, second quarter last year, to this very strong second quarter this year, and a very strong follow-up also in the third quarter.
Very positive development. I have to always put a little reminder that we still do see and face some restrictions out there for our sales reps to enter hospitals. It's not as easy as it used to be. We're also seeing some travel restrictions continuously. We are also seeing and reported from some of the countries that some of the elective surgeries are still up for postponement. Of course, all in all, this is definitely developing in the right direction, and we remain very positive for the remainder of the year and also for the future going further. Okay, comments about implementing our strategy. One of the key strategies for us is really to do what we can to develop those markets where we are not having a dominant market position or market penetration today.
The United States is definitely one of those countries. We have about 23% of the CABG procedures performed in the United States. It's therefore very important for us to continue to, as we say, fight ignorance, fight indifference, and fight ease-of-use objections. We do that through our clinical marketing guidelines, initiatives, educational programs, of course, also with product innovation and also with the sales force and how they're operating and their total capacity. To illustrate this, the status now in the United States, as I said, currency neutral sales revenue for the quarter up almost 25% and year to date at 23%. Really showing that we are in a good state and the growth that we've seen for several years now is continuing. It's also illustrated by the number of procedures.
This was up almost 29% in the quarter and also for the year to date. We're seeing that both flow procedures and imaging procedures are contributing to this. We are always following the number of capital systems that we sell. As I said, if we have a high degree of capital sales in the quarter, that will very positively impact the short-term revenues. It's important to keep an eye on that. We sold 10 units this quarter compared to nine last year, so almost the same level. Year to date, it's 27 units compared to 23 last year. We have been very happy to see the strong growth in new customers during 2021. Very important, of course, when we are getting out of the pandemic situation.
Year to date, we see that we have 33 new customers versus 18 that we had at the same time point last year. All in all, very good performance in the United States. Then very important to actually develop these type of markets, and I would say also drive utilization in established markets, is supported by new publications. I will draw the attention to a new review article that was just recently published in the journal Circulation. This review article was authored by 19 cardiac surgeon experts. They come from all over the world. Four of them are very familiar to Medistim. They were participating in the REQUEST study.
This literature review and consensus statement that they have made here has been done completely without any influence on Medistim, and it was news to us that it was to the rest of the world when this came out as a publication earlier this month. I would like to say that just to have a publication like this in a journal like Circulation means a lot because this is really one of the highest ranked, it's typically ranked as number one or number two in the cardiology and cardiovascular medicine space. We are very proud to have this attention to the transit time flow measurement technology in this prestigious journal and with this great expert team as authors. Just to say a few words about what this paper is saying. The method here was really a very systematic literature review.
They started with identifying more than 2,000 publications out there. They screened more than 1,500, ending up with a systematic review of 229 publications, and 38 of those have been cited in this review. Their goal was really to reach consensus on what have we learned, what is it fair to say, what can they stand behind and be advocates for when it comes to statements about the use of transit time flow measurement in coronary bypass surgery. In order to come to these 10 expert statements, they developed a voting system and they also needed to have more than 80% agreement in order to accept one individual statement. They also added a scale for talking about the clinical benefit, whether that was a very strong clinical benefit or a more moderate clinical benefit.
The conclusion in this paper, first of all, that TTFM's cost-benefit ratio seems largely favorable in view of the potential clinical consequences of graft dysfunction. That's very positive. They're saying these consensus statements will help to standardize the use of TTFM in clinical practice and to provide guidance in clinical decision-making. The authors are arguing in this paper that these are some of the objections or obstructions in the adoption of the technology out there, because the question is why are not every country sort of as developed and in the utilization of this technology. These authors really say that we need to standardize, we need to be clear about how to approach utilizing this technology and really making a benefit of it, and we need to provide guidance in order to do so.
The 10 consensus statements were developed, and the first statement reads, "TTFM should be used in every CABG case." We couldn't agree more, and we're extremely happy to have this solid work to back up our technology, and we believe this is very positive. In addition to this recent review article in Circulation, we have seen several expert consensus statements published just in this last year. I'm highlighting a few of these here, and we can see that it really advocates for using this technology and really addressing this issue of why are we not using it, why is it not being used every time. The titles here are alluding to these problems, addressing the time to recognize the elephant outside in the operating room. That's a good question.
The 10 commandments for multi-arterial grafting is also talking about the necessity of measuring flow in order to be successful. The third transit time flow measurement in coronary artery bypass grafting for every patient and every surgeon. These are very strong statements, and I feel it's really fair to say that the advocacy for using the technology is getting louder and it's getting more prominent. I would say that I think this is an effect of the deliberate strategy that Medistim also have been working on for several years in order to be really close to the customers, to the experts, to the societies, and really engaged in important clinical work together with them in order to have this topic really high on the agendas for the societies and in the cardiac meetings and so on.
We are convinced that work like this and voices like this, advocacy like this, will be influencing their peers. It will help drive routine use, and it will help setting this as a standard of care. I also believe that it's reasonable to expect that we will see new and stronger clinical guideline endorsement based on this stronger advocacy. With that, we are closing the presentation, and we would open for questions if we have been able to take one or some. There might have been some technical issues here, so we might not have been able to do that. Then I would just encourage people with questions to make direct contact with the company, and we will be very happy to address them later today or next week for that matter.
Thank you very much for listening, and we will meet again for the next quarter's presentation. Thank you.