Okay, we are getting ready to start. Before we get into today's topics, just a reminder that during this webinar, you will be kept on mute, and we'll take all the questions after the end of the presentation. We really encourage you to use this function to add your questions during the presentation. Just click on this arrow to expand or minimize your GoTo Meeting panel and add the questions in the Questions panel. I also want to say that this webinar will be added to our Investor Relations sections of our website within the end of today. With this, I welcome you to Medistim's second quarter and first half 2021 presentation. I am Kari Krogstad, CEO at Medistim, and together with Thomas Jakobsen, CFO, we're going to go through the results. Sticking to our established table of contents here, I will start with the highlights.
I'm very happy and proud to be able to present the best quarterly results ever for revenue and for EBIT. Starting with the sales revenues, this is a record quarter sales revenue up 36.6% to NOK 104.5 million. In this sales development, we are very happy to see that the imaging portfolio is coming strongly back after a couple of quarters with negative development due to the COVID pandemic. This quarter, we're back with 71% growth. This is really, really encouraging. Also the flow portfolio is strongly up 23.6% in Norwegian currency. This is for sure together with the development that we're also seeing in the cardiac portfolio going up 31.8%. This is clear indications that we are getting the activity levels back to normal and even a little bit better than that since the pandemic.
We're also seeing that the vascular sales is up this quarter. We have had a couple of quarters with negative development also for vascular. This time we're seeing we are back to growth with 6.1%. When looking at these sales revenues and adjusting for currency, which we can see is quite negative compared to the same period last year. We're seeing that the currency neutral growth in total of 36.7% and actually as high as 40.2% for our own products. Again, a very important indicator for how the Medistim business is doing. On top of this, we are seeing good growth contributions from all the geographies, both USA up 56.9%, Europe up 31.4%, Asia up 83%, and it's only the small sales region rest of the world that is down this quarter. Very strong.
On top of this sales revenue, also this quarter, we are looking at extraordinary revenue of NOK 5.3 million. This is coming from a COVID-related Paycheck Protection Program, which has been granted to Medistim by the U.S. federal government. The condition for actually being able to receive this support was to maintain all our employees in the U.S. organization during the pandemic, which we have done. This then takes the total revenue this quarter to NOK 109.8 million in total, and that is 33.1% before we adjust for currency. Also, the third-party product is contributing very nicely this quarter with 22.7% growth. Taking a quick look at the volume development with the number of units sold or outplaced in the USA.
We see very good development for most items here. I in particular draw the attention to the number of flow probes that we are selling outside of the USA, which is a good indicator for the activity level out there in the hospitals growing at 34.5%. Also, the number of procedures in the USA is showing the same tendency almost 50% up this quarter. Very strong signs of recovery after the pandemic. All of this leads to very good EBIT results. Also, the best quarterly EBIT results we have ever presented. This will be a record quarter for EBIT also excluding this extraordinary revenue of NOK 5.3. Margin is going up from 33.6% to 38.9%. This quarter, we are also launching the pay per procedure business model or feature. We've added that to the MiraQ system generation for the USA.
I'll get back to that and some further comments on that later in the presentation. Okay. Taking a look at where we stand after the first half year. This really strong catch up in the second quarter takes us to a best first half ever for both revenue and EBIT. Again, just looking at sales revenues, it's a record first half up 11.6% to NOK 207.1 million. As I mentioned, imaging came strongly back in second quarter. Not as strong in the first quarter, but year-over-year first half, we are up in imaging at 14%, which we very much like to see. The flow portfolio is up almost 10%. Vascular sales, still a bit down after the accumulated numbers of the first half year, but as we saw in the second quarter, we came back at growth.
We have good belief that we are going to be back on track in vascular also going forward. The cardiac portfolio is up 12.8% half year. Again, adjusting for currency, which is still negative after the first half, we see that the most important thing, currency-neutral growth of our own products, is 20.2%. Again, good contributions from all the major geographies, USA, Europe and Asia. We had to add this extraordinary revenue also for the first half numbers, and that will take the total revenue to NOK 212.8 million and a 14.4% growth. The third-party portfolio has performed well, not only in the second quarter but also in the first, and is at 21.6% growth mid-year. This is the best first half ever for EBIT, and our margin is now up from 28.3% to 33.8%.
As you will remember, in the first quarter, we reported that LivaNova has been appointed our new distributor in India. We have also previously reported that we have paid out a dividend of NOK 3 per share. That's the highlights, and I will leave the stage to Thomas.
Thank you, Kari. I will go through the P&L for the second quarter and for the first half. Since Kari will speak of revenue in terms of geography and the number of units later on, I will not go into details related to that. I just want to comment that the currency-neutral sales, if we have the same exchange rates in the second quarter 2020, and that would be the same rates in 2021, sales would have ended at NOK 118.8 million. That really shows the underlying growth we've been able to deliver for this quarter. That also includes the NOK 5.3 million Paycheck Protection Program. Even though taking that out, it's a very strong quarter and of course, a record in Medistim history. I go to cost of goods sold, which has increased in percentage of product sales for the quarter.
There are a couple of reasons for that. One is product mix, and also the fact that we have very strong sales through our distribution channel, and therefore we have a lower margin based upon that. In addition, we also had an inventory write-down of obsolete components of NOK 600,000 in the second quarter, therefore a higher cost of goods sold in percentage versus sales. Salary and social expenses increases from NOK 22.4 million to NOK 25.2 million, and that is based upon the fact that we are delivering strong sales and therefore a higher level of bonuses and commissions to our sales reps and other employees that have bonuses tied up to sales and profits. Other operating expenses is also higher than compared to second quarter last year. That means that the activity level this quarter is somewhat higher.
There are still restrictions related to traveling and less participation in exhibitions and so forth, There's a higher level of activity this quarter compared to 2Q last year, where there was a complete shutdown and actually no traveling and no exhibition whatsoever. This leaves us with a total operating expense of NOK 61.5 million versus NOK 49.2 million last year, and an EBITDA of NOK 48.3 million, up from NOK 33.3 million, and an EBITDA margin increasing from 40.4% to 44%. Very strong EBIT margin, EBITDA margin. Depreciation, same level as last year, That gives us an operating result or EBIT of NOK 42.7 million, which is up 54% compared to last year and gives us an EBIT margin of 38.9%. Net finance is slightly positive. This is related to foreign currency exchange related, either realized or unrealized gains and losses.
We have a slight net profit for this quarter, meaning that the Norwegian krone has slightly weakened itself towards the US dollars and euros. Pre-tax profit ends at NOK 42.8 million, and profit after tax ends at NOK 34.2 million, which is up 68% compared to the same period last year. A very strong profit. Look at the numbers for the first half. Again, also a record in terms of sales for the first half, and currency-neutral sales would have ended at NOK 229.6 million if you have the comparable rates for the first half of 2020. That means that the underlying growth is strong. Also, when it comes to cost of goods sold, this is higher compared to the same period last year. The main reason for that is the discontinuation of SonoWand products.
We have an inventory write-down related to that of NOK 2.5 million, and on top of that, we have the NOK 600,000 components write-down, which I mentioned for the second quarter. Selling, general and administrative expenses are also up from NOK 55 million to NOK 57.6 million. The reason for that is already explained by the good results in the second quarter. When it comes to other operating expenses, this is slightly down compared to last year. The reason for that is that there's still restrictions related to the pandemic. The activity in that level, especially related to traveling and exhibitions, has been lower. Keep in mind that the first quarter in 2020, we had very high activity and a lot of travel before the shutdown related to the pandemic also fell in late March.
Total operating expenses increases from NOK 122 million to NOK 129.2 million and gives us an EBITDA of NOK 83.2 million, and EBITDA percentage of 39.2%, up from 34.3% last year. Depreciation, basically the same level as last year. The increase is related to lease obligations that has increased somewhat in the first half of 2021. The operating result or EBIT ends at NOK 71.7 million and an EBIT margin of 33.8%, which is up from last year's 28.3%. Net finance is negative, that means that the Norwegian Krone has actually strengthened itself in the beginning of the year up until now. The Norwegian Krone has strengthened itself towards especially U.S. dollars and euros, which affects Medistim. Pre-tax profits ends at NOK 70.7 million, profit after tax ends at NOK 55.5 million, which is almost up NOK 50 million compared to the same period last year.
This is the best top line and bottom line Medistim has ever delivered. Going to the balance sheet. If you look at intangible and fixed assets, that has been reduced from the beginning of the year until now, and that means that we've been depreciating more at a higher level than we've actually invested. Inventory level is still high, and that is to be expected. We are securing end-of-life components and also critical components and making sure that we can deliver products. Cash position is at 53%, and that is also after a dividend of NOK 3 per share has been paid, and then the total payment was NOK 54.6 million. The cash position is recovering quite nicely after the dividend payments. Equity and liability. We have a strong balance sheet. Our equity ratio is 78.6%, so that's a very strong balance sheet. Our long-term debt is reduced.
That's basically because we have made some down payments of our loans, but also the fact that we have this debt forgiveness related to the Paycheck Protection Program loan that we received in the U.S. and is now forgiven. The amount was NOK 5.3 million, as Kari mentioned earlier. Of the NOK 19.5 million in long-term debt, NOK 18.1 million is related to the lease contracts. That means that basically the interest-bearing debt is practically zero. Again, a strong balance sheet. With that, I leave the word to Kari to speak a little bit more about the business update for this quarter. Thank you.
Yes. We will first have a look at our imaging portfolio, so sales of imaging probes and systems in units. We saw the 70% growth in revenues from imaging in the second quarter, and this is, of course, a result of significantly higher sales of imaging units. We can see the second quarter last year was a big hit of the imaging sales due to the pandemic, so we immediately saw a decline in sales revenues. It was actually down by 24% that quarter. We had a decline also in the third quarter with 25%, fourth quarter, 12%, first quarter this year, 12%, and now coming back at 71% growth. That is really great to see, and it leads to a quarter-over-quarter growth of 133%. When it comes to the imaging probes in units, we can see that this level is now back to normal.
Of course, with that weak comparable years, the growth is 66.7%. Also, when it comes to the flow probes and systems, when it comes to the number of units sold, we can see that this is a decline of 15% from the same quarter last year. Very much, I would say, back to a normal level. We must remember that it's our strategy to convert the market from flow only market to flow and imaging technology market. As long as we see rise in the imaging system sales, we are fine with seeing a somewhat lower flow system sales. If we're adding these two system groups together and looking at the total sales of systems, both the flow systems and the flow and imaging systems, we see a growth of 16% this quarter.
As mentioned briefly, sales of flow probes are really coming back to normal levels. This is then reflecting that the activity level out in the hospital is getting back to normal. Looking at revenues divided by geographical regions. In Europe, we know that these total numbers, we are looking at both sales of own products and also the third-party products. For the second quarter, the sales of own products increased to 24.6% in Norwegian currency and a bit more when we look at the currency neutral numbers. For the first half, it's also very positive, 13.5% in NOK and even more than currency neutral. Also, as mentioned, third party is contributing nicely all through the year so far. In the U.S.A., the total revenues for the quarter and first half include these extraordinary NOK 5.3 million that we talked about.
Also excluding this, the second quarter had a 35.8% increase in NOK, and currency neutral, a very high 56.8% growth. The similar tendencies we are seeing for the first half in total. Asia also strong contribution, still a strong growth from the first quarter and also for the first half. The rest of the world, very small sales region compared to the others, we see significant quarterly variations here, nothing much to point out. Just to be specific, the negative currency effect for the first half was NOK 16.3 million. There's some growth lost there in just currency. Looking at the same sales numbers now divided by the different product groups. In general here, there will be a discrepancies between the development in the number of units sold compared to the sales development in NOK.
It's due to the fact that we are selling both in our direct sales channel, where we of course get more of the revenues and the profit ourselves, and we also are selling to the distributed channel. Different contributions from these channels will impact the numbers here. Also the business model in the USA, we are selling both capital sales, which will give a very nice quick contribution to the quarterly numbers, while the lease models and the PPP sales will give more revenues secured over time. Of course, the currency effect is also playing a role here. Procedure sales in the USA, we see it's very good, 28.8% in Norwegian kroner for the quarter. Also positive for the first half. Again, driven by the high growth in procedures, increasing with almost 50% for the quarter, 28% for the first half.
This lower sales in NOK is explained by the currency effect that we have talked about and also this product mix between types of procedures. Flow probes. Here we see a nice correspondence between development in NOK and in volumes. The same for the flow systems. Imaging systems, we are seeing 132% increase in capital units and 95.6% increase in NOK for the quarter. For the first half, we have good correspondence between volume and NOK development. Third party contributing nicely as already said. Our strategy remains pretty much the same. One of our key targets is, of course, to get more traction in our what we call developing markets, and here we find the U.S. We have talked about this. We are coming back very strongly in the U.S. for the second quarter.
The sales revenue in US dollars increasing by almost 57% in the second quarter, 26.6% when we're looking at the first half. On top of that, we are getting this extraordinary revenue as well. It's really the total number of procedures that we're always following very closely. We can see not only a very strong growth over the same quarter last year, but it's really the highest quarter for quarterly sales in number of procedures it ever presented. That's very encouraging. Not surprising, it's the flow procedures that is showing the highest growth. Flow is still dominating out there, and when activity level is picking up, it is the flow procedures and the flow probe sales that we first see the effect. Also capital sales is contributing very good this quarter.
We are selling eight units in Q2 this year and only half of that last year. In the first half, we are looking at 17 units compared to 14 units sold last year. Maybe the most encouraging news from this whole presentation is really the strong growth in new customers in the USA. As you know, USA contributes with about 45, closer to 50% of the total revenues from our own products in Medistim. USA means a lot to us. We have about 23% market penetration today in terms of number of procedures. It's very important for us to continue to win new customers. This second quarter, we are actually winning 18 new customers versus the two we won last year.
This is extraordinary, not only because we are comparing to a low quarter last year, but it's really amazing to have so many new sales in any quarter. That leads us to 28 new customers in the first half compared to the eight we made last year. All in all, it tells us that we are succeeding in continuing to take our customers through the sales process. Of course, that has been challenging during the very last 12, 18 months. Are still succeeding with closing those new customers. We care about our U.S. customers, and that's also why we have decided to add the very popular pay per procedure model to the MiraQ system that we have also in the U.S. As you will remember, we are selling our products, offering solutions for product acquisition.
Of course, everybody in the whole world can buy our equipment, both our systems and our flow probes, just buying them as capital. We are also offering lease models in some countries, also in the USA. The USA has been the only country where we've also added this pay per procedure model, which has been, I think, a key contributor to getting the traction that we have been able to create in the U.S. market over time. The principle here is that we are outplacing the system and probes, and that they are paid from our customers buying smart cards, paying for each operating procedure. When we launched the MiraQ system in the USA, we felt that maybe it's not necessary to have this PPP model because the lease model is actually a very good alternative.
With all the variants of the MiraQ system, we have MiraQ for cardiac, MiraQ for vascular. We have MiraQ Ultimate models that can provide both cardiac and vascular, and we have with imaging and without imaging. There's a whole lot of models, and that means also a whole lot of cards. We have now rethought this, and since we have, well, still very significant revenue with this model making up close to 30% of the total U.S. revenue, and it's a fact that many of our largest customers prefer this model, we want to continue to offer this option. I hope people can hear me still. Do I need to repeat a little bit? The point here is that we've had this PPP model.
We offered it on the old Butterfly generation, for those who remember that, and also we've had it for the VeriQ and the VeriQ C. We tried to launch the MiraQ, or we did launch the MiraQ without the PPP, and that worked fine. We have not had any sort of setbacks due to that. We have found that we want to make sure that, in particular, our largest customers that rely on this model can also continue to use this model on the MiraQ. Therefore, we have launched the PPP solution also to this generation. Before we will open up for questions, just a comment on the situation with the pandemic now. What we are seeing is a gradually decreasing impact, and getting back to really a strong recovery this quarter. We can see that from the currency-neutral sales development.
We saw the effect of the COVID already in the second quarter, going down 19%. This is currency-neutral numbers of sales development. We can see that we have had a gradually decreasing impact over the quarters, getting back to low growth in the first quarter, of course, compared to a very strong comparable, and now with a very strong growth in the second quarter. Still, we're not quite back to normal, and I think everybody would agree that this situation is not completely over yet. We still are facing some travel and hospital access restrictions. As we are all experiencing that in some countries and some states in the USA, they are struggling with lower vaccination rates, and there is still a possibility that elective surgeries may still have to be postponed as a potential fourth wave with the Delta variant develops.
We do believe that as these vaccination rates continue to increase, we expect to see COVID patients in the hospitals, and that means that there will be capacity to treat patients that need cardiac and vascular surgery. All in all, we are looking at the remainder of the year as well as the long-term future for the company with a great deal of optimism. Of course, while we are remaining alert to the further development of the pandemic. With that, we will open for questions, if any.
From what it seems here, Kari, you've been very clear that there seems to be no questions.
Okay. We can make that interpretation. If there are questions, of course, after the presentation, you're free to make contact with us. The presentation will also be uploaded on the website, and then the report is also available. Thank you all for listening and looking forward to our next meeting. Thank you.