Good morning to everybody from Oslo, Norway. My name is Kari Krogstad, and together with CFO Thomas Jakobsen, we are here today to present to you the fourth quarter results for Medistim. We'll take a look at the preliminary full year results. We'll go through first the highlights now, and then Thomas will go through the details of the financial statements. I'll get back to some more comments about the various business segments in Medistim and then wind up with some comments to implementing our strategy. The fourth quarter. Well, I'm very happy and very proud to being able to present an all-time high sales for a quarter, once again. This is actually the fourth quarter in a row where we are delivering sales results above NOK 100 million. That's really good news.
We are seeing that these sales are coming from a very good development in our imaging segment portfolio, growing this quarter by 50% in Norwegian currency. At the same time, we also see that our flow portfolio is doing very well. When we are looking at the vascular segment, where we're also strategically focusing in order to build this as a future growth segment for Medistim, we're seeing very good traction also this quarter with 54% growth. Cardiac is also doing very well. As we can see to the left here, we can see that we have some unfavorable currency effects when we are comparing these sales results to the same period last year. A 7.1% effect on this.
If we adjust for this, the currency neutral growth was actually 26.8% for the total Medistim business. Looking at our own products in isolation, that means 38.4% growth. This is, of course, a very, very good development. We're seeing this quarter that all of the regions, with the exception of Europe, is delivering very strongly, United States up 58%, Asia up 143%, and also rest of the world delivering very well. We will get back to looking a little bit at Europe, which was this quarter down by 5.6%. When it comes to our third-party products, which represents less than 20% of the total revenues, this quarter it's down by 13.4%.
When we are looking at the EBIT, you will notice that it's a bit weaker than the same quarter last year, but this is very much linked to higher activity level this fourth quarter, as we are getting the business sort of back on track, with a lot of traveling and conferences, and we're also seeing some effects of bonus payments for the good results, et cetera. Thomas will get more into detail there. If you take a look very quickly at the number of units sold, we will note that we are continuing to see very good development in the flow probes. The number of flow probes sold outside of the United States growing at almost 28%, and also procedures in the United States also growing at 28%.
These are great indicators of the activity levels out there in the operating rooms. Very good developments. Also, piece of information for the fourth quarter is that the board is suggesting to pay out a dividend of NOK 3.75 per share. That was the quarter. If you take then a look at the preliminary results for the full year, this is actually the best year ever for both revenue and EBIT. We're looking at a record year for sales revenues. This is up 16.3% to NOK 422 million. Looking at where the sales is coming from, we're seeing that imaging sales is picking up very nicely.
We know that it was a bit down during the most affected quarters of the COVID pandemic, but this is now getting back to the same growth levels that we saw before the pandemic. Also the flow business is getting back very nicely. Vascular sales, the same story there. We're getting up at 21% for the year, and at the same time, Cardiac is also bouncing back from the pandemic period. We can also see here that for the full year we have a significant currency effect. We, if we adjust for this, we're looking at 24.6% growth in total sales for the business and 26% for our own products.
Looking at the regions here, we see that all the regions, including Europe, which has a little bit weaker fourth quarter, are contributing to the annual result. U.S. up 28%, Europe up almost 16%, Asia up 50%, rest of the world up also a little bit. In addition to the sales revenues, we note that in second quarter we also had an extraordinary revenue of NOK 5.3 million. This is coming from the COVID-related U.S. Paycheck Protection Program that we were granted in the second quarter. If we add this also to the total revenue, that takes us to NOK 427.3 million and 17.6% growth in Norwegian currency.
I mentioned that the third party was a bit down in the fourth quarter, but as we see for the year, it's a solid development also for the third party business with a growth of 10%. For the year, we're looking at the record EBIT margin at 27.3%. All in all, of course, we are very happy with how this has ended for the year 2021. With that, I will leave the floor to Thomas to give us some more further details on the financials.
Thank you, Kari. Good morning, everyone. I will dive into the details in the P&L and the balance sheet and give you some comments on the various expenses and balance sheet items. As normal, I would not comment too much on the revenue. Kari will return to that in her business segment update and give you details related to specific sales, as usual. When we look at the cost of goods sold, I have to mention that the reason for our higher level of cost of goods sold for this quarter is related to product mix. That means that we've sold more imaging compared to comparable quarter last year. That means that much of our growth, which Kari mentioned earlier, is related to imaging sales and therefore.
Imaging has a higher cost, therefore we get a higher cost of goods sold. In addition to the fact that much of this increase in sales comes from the distributor network, and that gives us slightly lower margin, obviously. When it comes to salary and social expenses, this is up NOK 9.2 million for this quarter, so that seems like quite a lot. There are a couple of reasons for it, and I have to mention that the fourth quarter 2020 was very much affected by COVID, and our sales team in the U.S. has a compensation package where 40%-60% is variable, and that's then related to bonuses or commissions.
These bonuses and commissions were very modest in 2020, where our sales team did not reach their quota, did not get any bonuses and so forth, and therefore, their compensation was absolutely very modest compared to a normal year in 2020. However, in 2021, most of our sales reps have reached their quota and even exceeded their quota. That means that the commission is higher and also the expenses is higher related to the fact that the sales team has actually reached their bonuses. That is actually very nice that our sales team is reaching their goals. Very much the same story for the rest of the organization. Bonuses were very modest in 2020.
We did not reach our goals because we did not foresee the COVID. In 2021, however, most people have reached their targets and even their stretch targets, and therefore the bonus is higher this year compared to last year, and it amounts to about NOK 4 million. Other operating expenses is also up this quarter. We've had almost normal activity when it comes to sales and marketing activities. That means traveling and exhibition participation. The major event was the ICC, the International Coronary Congress in New York in the fourth quarter, where we were very well represented. In addition to that, we also had high activity related to audits, both financial audits, but also regulatory audits and other regulatory work.
We had expenses related to recruitments and also IT expenses related to a CRM project that was just about to land in the fourth quarter. That gives us this increase in other operating expenses. This results in EBITDA lower than compared to last year. Our depreciation is at the same level as last year, and our EBIT result ends at NOK 19.5 million, compared to NOK 22.1 million last year. Net finance is practically zero on the effect. It's related to foreign currency. We do not have any interest expense related to loans because we've repaid all our loans during 2021.
This gives us a pre-tax profit of NOK 19.4 million compared to NOK 19.9 million last year, almost the same. Profit after tax is actually up 18.7% because we have a lower tax expense this quarter. This is related to the fact that intercompany profit has changed in a favorable way for us, that means gives us a lower tax expense for this quarter. If you go further to the total year 2021, very proud that you know we have a new record, over NOK 400 million or well over NOK 400 million. This is the best year ever in Medistim. Cost of goods sold this year is up, again explained very much by the same fact for the quarter.
We have had a very good development in sales of imaging and therefore a higher cost of goods sold. I also want to mention that also the third-party business has grown by 10%, and that also affects our cost of goods sold obviously. Salary and social expenses, the explanation for the increase is the same as for the quarter. I would also like to mention that, you know, if I compare this number with 2019, which was the last normal year before COVID, our salary and social expenses increases only by 10%. In 2021, we were actually 4-5 more heads than we were in 2019, just for comparison. Also other operating expenses increases and the increase comes from the fourth quarter, more or less.
I would like to compare this to 2019, and if we do that, the increase is actually only 4%. All in all, EBITDA at almost NOK 140 million compared to NOK 118.6 million last year. Depreciation at the same level, more or less. Yes, at the same level as last year. Our operating result, EBIT, a new record, NOK 116.3 million and record EBIT percent 27.6% compared to 26.3% last year. Net finance, again, related to foreign currency, and pre-tax profits ends at NOK 114.1 million compared to NOK 191.6 million last year.
Our tax expense is lower in % compared to last year, again explained by the intercompany profit, as I mentioned for the quarter, but also the fact that the Paycheck Protection Program, the $5.3 million in revenue, is also tax-free, so that's very good for us. That leaves us with a profit after tax of NOK 19.9 million, 30% up compared to our record from last year. Lastly, I just want to mention the currency effects, 2021 compared to 2020. If you have the same currency rates in 2021 as in 2020, our top line would have been NOK 25 million higher. That means we have a negative currency effect in 2021, and the profit effect is negatively NOK 6.5 million.
That just underlines that 2021 is a really good year for Medistim. Quickly going to the balance sheet. Our cash position is the best ever, almost NOK 130 million in cash by the end of the year. Our inventory is still high. We are securing end-of-life components and critical components, but it has been somewhat reduced, and we are also experiencing longer lead times from our suppliers when it comes to delivering components, which I guess is a general thing in the markets these days. The board has decided to suggest a dividend of 3.75 NOK per share, amounting to NOK 68.4 million, which then will be suggested to the general meeting in April.
Further on to the balance sheet, equity and debt. Our equity ends at NOK 306 million. That means we have about 76% equity, so very solid and strong balance sheet. We have no interest-bearing debt, so the long-term debt that we see here is related to our lease contracts. NOK 17.1 million is long-term, and the remaining long-term debt here is related to deferred revenue. That means we have service contracts that will be revenue in 2022 or even in 2023, depending upon the length of the service contracts. That was what I had to comment on when it comes to the numbers and, with that, I leave the word to Kari again. Thank you.
Okay. We will take a look at the developments in our various business segments in a little more detail. Starting with the imaging portfolio, and as you're all aware, we have a big installed base out there in the marketplace based on flow measurement technology, and it's a major strategy for us to convert that big installed base into imaging systems. That is very much what we are, you know, marketing and selling and having clinical activities around the globe in order to achieve. This quarter, we're seeing a very good development in the development of imaging system sales in units, and here we're counting all the capital sales from all the regions in the world. 64% growth this quarter in units.
We can also see that it's a very positive development since the second and third quarter, 2020, which was heavily impacted by the COVID situation. We're seeing a similar picture when it comes to the imaging probes, from 25 probes sold this quarter last year to 50 probes sold this year, and we're seeing also a steady positive development here telling us that this imaging strategy seems to be continuing its effects and growth path as we saw before the pandemic. Flow measurement technology is, of course, still critical and really the core of what Medistim is all about, and it's important that we're continuing to see good developments here as well.
When we're looking at the flow system sales this quarter, it's percentage-wise a very high development, 53% growth. This tells us that in total, we actually have a super good development in system sales here, if you're counting both the flow systems only and the combined flow and imaging systems, it's a growth in units of 56%. When we are commenting on the development in procedures and probe sales, which is indicators of the activity level, that's fantastic. At the same time, it's nice to see that we're able to outplace new systems.
Of course, some of these are replacements of old systems out there, but we're also gaining new customers. Speaking of indicators of activity level, this is the development of flow probe sales in units outside of the United States, which is increasing by almost 38% this quarter and is really a good indicator that activity level is getting back to normal and even filling some pent-up demand. If we take a look at the same revenue figures, but per region, we can see that it's a good development for the quarter for all regions, with exception of the United States. For the year, it's a good development for all the large regions, and we can see that the rest of the world is slightly declining here in Norwegian currency. It would show a slight growth if we are currency adjusting this.
All in all, it's a very positive story. When it comes to Europe, just want to make sure that everybody remembers that in Europe we are selling both our own products and also third-party products. For the quarter, we see a decrease for both categories actually, 10.5% in Norwegian currency for our own products and 13.4% for the third-party. When it comes to the year, full year figures for both categories, we are on the other hand seeing good growth and actually at 15.7% currency neutral for our own products and the 10% growth in the third-party. There is no particular reason for a slight dip in this fourth quarter. It's just quarterly variation.
When it comes to the other segments here, the United States, we see that while it's a great development in Norwegian currency, it's even bigger when we are currency adjusting this. It's great also to see that the Asia region, which is for the most part consisting of China and Japan as the biggest markets, are doing very well for the quarter and also for the year. Rest of the world is smaller sales territory for us, but it's holding its stance. Looking at the same numbers now, divided by product categories, it's also nice to see that all product categories are developing very favorably. Procedure revenues from the United States, we can see 22% growth this quarter in Norwegian currency.
Flow probes are growing, flow systems are growing, imaging systems are growing, imaging probes are growing, both for the quarter and for the year. Again, third party just a bit down this quarter, but good growth for the year. When we are looking at sort of the discrepancies in percentages between the volume developments in unit compared to these figures in Norwegian currency, it's three factors that are the explanations for this. It always depends where we are selling our products, whether we are selling through our direct sales channels in the United States, Germany, Spain, U.K., and Norway and Denmark, or whether we are selling in any of the other markets through our distributor networks. Then we also have a couple of business models in the United States.
We are selling both capital equipment, and we're also selling the same devices through the pay-per-procedure model or lease models. The third effect is the currency, of course. This is explained on this slide, and I will not go through each and every category. Just to keep the perspective of the impact from the COVID-19, we've said that we have seen a gradual decrease, decreasing impact to strong recovery. Here we can see the currency neutral change quarter-over-quarter. From the second quarter 2020 when we really saw the effect of the COVID, this went down by almost 20%. It was a significant effect both in the third and the fourth quarter 2020.
We are seeing a recovery which was extremely strong in the second quarter and is still very good in the third and the fourth quarter. All in all, very, very positive development and recovery from the COVID situation. It's still not completely back to normal. We still have some travel restrictions to some countries. Some hospitals are not that interested in seeing medical representatives just to talk about new sales opportunities. Of course, we're welcome to do servicing and also clinical testing when the prospects and customers are interested in those type of contacts.
We also continue to get some heads up that from time to time some countries and states see the necessity to postpone some of the surgeries. But this has become a smaller and smaller problem. A couple of comments to our strategy. As you know, we have strategies developed for our coronary artery bypass grafting, so the Cardiac segment, and also for the vascular segment. In particular for the coronary artery bypass grafting, the CABG segment, we have strategies that are adapted to the current market situation in the various geographies. We have some strong markets where we are really dominating in terms of share of the procedures that are performed in these individual countries. Then we have developing markets where we have some share, but not that high.
The third one here, the emerging markets, where we are just starting to build a position. When it comes to the United States, it's sort of in the middle, after 2021, we have recalculated our estimating our share of the procedures in the United States. We have said that we had about 23% of that market until now. It's a bit difficult to judge the current situation due to some of this bounce back and the pent-up demand. We are at least estimating that our share now is about 25%. We are continuing to take share of this market. Developing the U.S. market is a key priority. It represents about 1/3 of the total market, very important for Medistim's success going forward.
The performance here for the quarter, currency neutral, looking at the growth of 58% for the quarter, 28% for the full year. This is not including this extraordinary Paycheck Protection Program revenues that would take this growth even further. Looking at the total number of procedures, really the hard facts when it comes to utilization of our equipment, and we can see that the quarter is developing very nicely. We can also see that of the total number of procedures, the highest growth is coming from the imaging part, which is a very deliberate strategy and result for us. We are seeing strong capital sales both for the quarter and also for the year, and of course, that impacts also the sales results in the short term.
Last but not least, we are continuing to see strong growth in new customers. At the end of this year, we have 40 new accounts, compared to 25 new in 2020. That should be very reassuring that we are able to maintain the customer contacts and really progress in our sales processes and close deals, also after this COVID period. Also back to our strategy, it's important for us to use clinical projects in our marketing. We are very much depending on clinical acceptance for the technologies. As I said, a prime strategy for us is to convert an established flow measurement market to using flow and imaging in combination. This doesn't happen by itself.
It's very important that we are supporting centers and opinion leaders and other interested environments and surgeons out there to really continue to look at the clinical benefits of using the technology and then publishing these results. When it comes to our clinical marketing, I also mentioned this in our previous presentation, but this actually happened in the fourth quarter, and it's a very important comment to make when we are looking back on the full year 2021, because it was really a breakthrough year for expert consensus statements. We saw a number of editorials and literature reviews and opinions being placed in the various journals out there, and all of them advocating for the necessity of using flow measurement technology for every CABG patient and by every surgeon.
Of course, we believe that this is really cementing the clinical value. We know that it's very well proven and there's a lot of evidence for this. To have these opinion leaders really stating their opinions in these various fora is really cementing this as a clinical value that is very broadly accepted. Of course, we believe that this has potential to further accelerate change in clinical practice, and that is what we are striving for every day, and this is great help for us in that endeavor. We also believe that and hope that this will continue to influence and strengthen clinical guideline endorsements. All of this is very good. One of these papers is really pivotal.
This review article that was published on October fifth in Circulation. Circulation is not just any journal, it's one of the 1-2 top journals in cardiology and cardiovascular medicine. It's just amazing to see that we have a review article of this with this content in such a journal that gets a lot of attention. This particular review article was authored by 19 world-renowned cardiac surgeons experts. Four of them was also participating in the REQUEST study, which was really a Medistim initiated study. There are also sort of newer names into the picture here that is really showing that there is more people coming on board, and it's really a ripple effect within sort of the peer community here.
More and more people want to participate and actually advocate for using this technology. Okay. Just a few more comments about this specific paper. The name is "The Use of Intraoperative Transit-Time Flow Measurement for CABG." The method that was used here was really a very systematic and deep literature review. They started with 2,200 articles that were identified. 1,500 of these were screened. 229 publications were systematically reviewed, and 38 of them are cited in this review article. It ended up with 10 expert statements for how to use flow measurements, and it came to agreement through this peer group in a very structured way.
The main conclusion from this paper is really consensus statement number one, that TTFM should be used in every CABG case. They're also writing that these consensus statements will help to standardize the use of flow in clinical practice and provide guidance in clinical decision-making. This is also a comment and a statement that they feel that we're lacking endorsements from the large medical associations in the United States, the STS and the AATS. While we are working to get that and they are advocating for getting that, they wanted to make their own statement. This whole publication is really giving a recipe for how to use the technology, how to do it, how not to do it, and explaining the value of doing it.
It's referring to a lot of Medistim screenshots from our technology and really using a lot of our material. Having said that, we have had absolutely no involvement in the preparations or in the process that led to this article, so it's a completely independent review article, which we will of course use a lot in our marketing going forward. I think that rounds off a great year for us in a great way. I'm not sure whether we have any questions that has come in in our chat. Mm, they are not. No. Doesn't sound that we have any questions for now, but you know where to find us. Please don't hesitate to make contact if there's any more information needed.
Thank you, everybody, for listening, and we will see each other again at the next presentation.