Hi all, and good afternoon everyone, and warm welcome to today's event focusing on innovation and product launches. My name is Peter Nyquist. I'm head of investor relations at Elekta. With me here in Stockholm in the studio, I have our CEO and President, Gustaf Salford, our CFO, Tobias Hägglöv, and in the studio in Crawley, England, we have our head of Linac and Software Solutions, Maurits Wolleswinkel. Welcome all.
Thank you.
Thank you. So our product portfolio is critical for the future success of Elekta. There is a great interest from both investors and analysts in what our product portfolio actually includes and what value that can bring in growing revenues and increased profitability. This is an interest that has increased dramatically since we launched Evo and Elekta ONE. But I also recognize a knowledge gap in regards to the features and functionalities, including our product and our customer views of offering. Hopefully, today in this event is the first step to clarify that and to change that gap. So today, so walk to the first slide, we will start with Gustaf presenting the overall picture, what we have done with innovation and product launches. Maurits will go more in depth into innovations improves personalization and productivity. Tobias will then address how our innovations will drive financial performance.
After the presentation, there will be time for questions and answers, and this is important. We would like to limit the questions asked today covering today's topics on innovation and product launches, but before starting the presentation, I would like to read the following. I would like to remind you that some of the information discussed on this call contains forward-looking statements that include projections regarding revenue, operating results, cash flow, as well as products and product development. Since these statements involve assumptions and estimates that are subject to risk and uncertainty, results could differ materially from those set out in this statement. Certain of these risks and uncertainties are described further in the annual report in section Risks and Uncertainties. With that said, I would like to hand over the presentation to you, Gustaf.
Thank you, Peter, and thank you all for listening in just here before the holidays. And we are very excited to be able to talk a lot about innovation, a very important topic for us, and the latest product launches and how they will be commercialized now in the coming periods here. But I would like to start where I almost always start, and it is what is the problem that we try to solve for our customers? What's happening out there in the market, and what are the key trends that's impacting Elekta and radiotherapy and cancer care and the healthcare systems? And as we all know, cancer burden is just increasing. Every year, around 10 million people die of cancer, and around 20 million get their cancer diagnosis.
And this has just been growing post-COVID, and it will continue to grow because we are in an age of an aging population in many, many countries. So this gap or this burden of cancer will just increase in the years to come in almost all countries. At the same time, the healthcare system has a huge challenge to find and train the right personnel to take care of this burden. So the skilled clinical staff, there's such a big gap of that globally. It's in mature markets, but it's absolutely also in emerging markets. And for radiotherapy, it's extremely important with doctors, the radiation oncologists, or the medical physicists as well, the RTTs, the therapists, and also the technicians that's driving this forward, taking care of the patients.
A quote we often get from our customers, and this is a real quote, is, "Elekta, please help us to, we have the problem, we have a double patient volumes, but we only have half of the staff is what we look at going forward." What can we do? With innovation, I truly believe that we can, what we state here, innovate to personalize precision and elevate productivity for our customers. If we do that, and we are doing that, we will close this gap. We are part of the solution. You really have to understand cancer, and cancer is not one disease. It is not one area. It is many. It is up to hundreds of different cancer types. You can see on the slide here that we have looked at how in the U.S. they've been able to improve their five-year survival rates by cancer type.
From pancreas, that's very low, up to, for example, prostate, that's much higher. So it has gone from around 50% five-year survival rates up to 70%. And this is the U.S. So this is not the same situation globally. But we can say this is a very encouraging trend, and it's just going faster and faster. But we need to do two things here. We need to both improve the clinical outcomes for areas like lung and liver, esophagus, pancreas. I'll come back to that: brain, glioblastomas, for example. But at the same time, we need to work a lot to improve the operational efficiency out in the hospitals and the radiotherapy clinics globally. So this is how we think about how we can help our customers, the clinicians, as much as possible, and of course, their patients.
So if we take the next slide, you can see here that radiotherapy is truly a pillar of cancer care. Because if you look at how is cancer treated, it's really about, you can say, local treatments, but it could also be systemic treatment. And if you look at systemic treatments, the dark blue areas, it's small molecule, it's radiopharmaceutical, it's biological drugs, but you can also see that they are not always applied to all different cancer types. However, if you look at surgery, other technologies, but especially radiotherapy, it is and should be applied to around 50%-70% of cancer patients. Just imagine if radiotherapy was a drug. Because it's so important to also see that you can link radiotherapy's almost always part as a combination of another therapy.
It could be a palliative or curative treatment on its own, but very often it's combined with other treatments. So this will continue to be the case in the decades to come. So we see a strong growth in radiotherapy linked to the overall cancer burden. So what do we do from a product and solution point of view to support our customers to deal with these topics and trends I've been talking about? We have the most comprehensive product portfolio in the industry, and it's image-guided. That's so important that you look into the body while you treat the before and after, and also adaptive, that you adapt the treatments when you treat the patients. We, of course, have the Neuro and Brachy portfolio. That's the Leksell Gamma Knife platform together with our Brachy therapy, the Brachy suite or the Elekta Studio. Of course, we have our Linac solutions.
You see the MR-Linac in the middle, Unity, and then we have Evo, that we'll talk a lot more about going forward. We also have the Elekta ONE software suite. This is the most comprehensive portfolio in the industry. If you start to deep dive in the Neuro and brachytherapy, we'll come back to the Linac solution and software suites. We can see that we have placed and put a lot of innovation out in the market over the last couple of years. We launched Elekta Esprit. You see the Gamma Knife here to the left on the Neuro side. That way, it's Leksell software, so much more efficient than the treatment planning software. The Gamma Knife is still the gold standard for SRS and for the Neuro segment of radiosurgery and radiotherapy. You can see that the Gamma Knife adoption is increasing.
You can see that the SRS sessions in the U.S. also is increasing, and we both treat oncology patients. You can see it in the gray area with all the brain mets, but we also do what we call functional cases in the neurosurgery departments. We have seen a really good and strong rollout of Elekta Esprit, that innovation globally since the launch. And we see a mix of new installed, and that's great in the segment, together with upgrades to the current installed base. That's a truly global installed base. On the brachytherapy side, we did an exciting acquisition of Xoft. And that's a miniaturized low-energy X-ray source. You see it here on the tip of a finger how small this source is. And that enables us to have an even wider application of the clinical settings and usage of brachytherapy.
You also require minimal shielding since it's non-radioactive. This is an area where we can go into new segments like dermatology, for example, or go into maybe even more into emerging markets where we don't need all the investments in shielding, etc. We also have the Elekta Imaging Ring, or part of the Elekta Studio. That's image-guided adaptive brachytherapy in the room when the treatment happens. We also have Elekta Geneva, and that's the most innovative applicator portfolio together with Venezia and all the other applicators we sell to our customers in this area. In both these segments, both the Neuro and brachy segment, we really have the market-leading innovation with an increasing adoption globally. We'll continue to invest and grow into these areas.
If we then move into the Linac solutions and this Elekta ONE software suite, that's an area we'll talk more about today, and I will leave it to Maurits to go through all the technicalities and all the innovations that we put into this portfolio, but I would just like to highlight a couple of areas, and we are so proud. This was the best Christmas present I think we could have gotten, and that was that the first clinical Evo treatment at DTZ in Germany treated with Elekta Evo. And it was a curative treatment for bladder cancer that happened just a couple of days ago, so super exciting that we now have the first patient treated on an Evo in Germany, and with the Iris capability of the better image quality, we can get this CT image quality improved significantly.
It's AI-enhanced images, and you can reconstruct them. By doing so, you get a much clearer visibility of the targets and also on the organs at risk. With the quote here from Dr. Lampe, who was responsible for the first treatment, he's saying that Elekta Evo will allow us to realize real-time treatment planning with online adaptive radiation therapy. More to come in Maurits' presentation, but we're really, really proud of this milestone. How will we actually commercialize these new technologies, these new innovations? I think it's very exciting, this part of the commercialization, because we can both sell it to the new sites. We can install new systems and the software suite of Elekta ONE. We have the opportunity now to install the most versatile Linac, and it's ready for both online and offline adaptive.
It has this AI-enhanced image quality with Iris technology. And then on top of that, you also have the Elekta ONE suite, the software suite that really streamlines existing workflows to increase the productivity and also facilitate really complex workflows efficiently. So that's a new solution revenues you will see as a key growth driver going forward. If we then look at our vast installed base, Tobias will come back to that a bit later in the presentation, but we have a great opportunity now to upgrade the current installed base with new technology. And that is, we have a lot of those discussions how we can take, for example, a Versa HD machine to an Elekta Evo functionality. We also have opportunities to discuss a lot on Elekta ONE Planning on the treatment planning software side together with the whole oncology information systems as well.
That will enable upgrade revenues in years to come for Elekta and a key part of our profitable growth journey ahead. With that, it was a brief introduction to where we are. I would then like to hand it over to my dear colleague, Maurits Wolleswinkel in Crawley. Thank you.
Thank you so much, Gustaf, and a warm welcome from my side as well. I would like to touch a little bit more on personalization with productivity and specifically apply to the Linac portfolio as well as our software solutions. If we go back in 2020, when we really set out a clear strategy for ourselves with the question, how can we elevate personalization in our treatment, but do it with less effort or with higher productivity?
And how do we specifically apply informatics, use software, use the latest software advancement in AI, etc., to help solve this quest? And since then, we have been actually very successful. And now, five years later, we have an extremely exciting and competitive portfolio that is really ready for today's challenges and for tomorrow's challenges. And software has played and continues to play a very important role in that journey as well. So if you look at the left side, you see our treatment solutions over here. The Elekta Harmony with focus on high productivity, software played an important role in that development. And of course, Elekta Evo. I will talk about more in later of my presentation. And then, of course, the Unity. So three examples of recent product introductions, important devices where software played an important role.
Software to increase the productivity, but software to also enable what Gustaf already mentioned, adaptive treatments. And on the other side, we have what we call the departmental software. So departmental software boils down to essentially two types of product. The oncology information systems, our MOSAIQ solution powered by what we call smart workflows. And then the recently introduced Elekta ONE Planning that we developed together with our partner, MIM. And there it's all about productivity as well, but then productivity for the department. And it's also very important that that software basically caters and enables these adaptive treatments. So adaptive treatments, the word has been mentioned a couple of times. And to explain that better and to understand where all these product and software solutions fit in, I thought it would be helpful to look at a clinic and how a typical average site clinic looks like.
Let me quickly talk through the average workflow of how a radiation oncology department works today. A patient comes into the reception area. First visit is with the physician, of course, to basically discuss the treatment as well. That's where the treatment objectives are being set by the physician. The next step is the simulation room. In the simulation room, you typically have CTs and now more and more MRs. You simulate the treatment and you simulate how the patient is immobilized on the table, and you take diagnostic images. You take these images where the patient is lying in the treatment position, and you take them to the dosimetry department. The dosimetry department, the treatment plan is made. Once the treatment plan is made, then you go to the treatment room.
Whether it's external beam treatment room or brachytherapy or non-Elekta devices, then the actual treatment will take place. We know it's not a one-time event, but in radiation oncology, we have this concept of fractionation where you have multiple fractions of treatment that add all up to the total dose to be given. A key role in this whole department is the oncology information system. It's the orchestrator of that workflow and all these different steps in the workflow. It's also essential to track how the dose sort of evolves over the various sessions, fractions. Good to mention as well, there's always a big IT component in radiation oncology as well. A lot of software solutions that are historically always put on servers in the clinic, but we see more and more that our customers like to host these applications in the cloud.
And then finally, that hospital information system needs to be connected with the oncology information system as well. So what does it tell us? It tells us that number one, Elekta is in almost all these spaces. And in this case, Elekta ONE Planning, Elekta ONE MOSAIQ. If we have a typical four-vault department, we could have an Esprit for brain SRS, an Evo, a Versa HD Linac with adaptive and Harmony for productivity, and a Unity MR-Linac, a Brachy Studio, and maybe a third-party device. And Elekta also offers cloud services. And so it tells us that Elekta is present in all these places as well. It also tells us that interoperability has always and continues to be very important for Elekta. Interoperability with the various devices, Elekta, non-Elekta, but also with the outside world as well. And that brings me to adaptive.
So how do we explain adaptive? Visualize the clinic for a second, and let me first start to talk how the current practice, what we call image-guided RT, that is the current standard of care, how that works. So visualize the clinic, and in a very simplified way, I sort of go through the steps. So you start with simulation, MR and or CT and more and more MR. Then you take the images, you make your treatment plan. And when the treatment plan is done, you go to the treatment room, and there is where the fractionation takes place. And so the treatment plan is fixed, and you use the imaging on the treatment devices to basically position the patient against the plan. That's what you do. And then you deliver multiple fractions. And on average, it's 20. It can be up to 30.
It really depends on the indication, and the oncology information system is continuously recording these treatments, so what is then the change with adaptive RT? It's not that much, but it's quite fundamental what the impact is on it, so there can still be simulation. There can still be treatment planning, but the fundamental change is that the treatment planning is not only done before, but it's also available on the machine itself, and two things are very important to make that available. First of all, the quality of the images of the treatment device need to be good enough to be able to use it for treatment planning, so image quality is very important. The second thing is that treatment planning packages need to be fully integrated in the workflow to make that process very quick because the patient is lying on the table.
So you don't want to take too much time for it, and you want to do it very safe as well. So integration is very essential. Adaptive planning enables us to essentially take away a level of uncertainty. And if you take a level of uncertainty away by basically being able to continuously adapt your plan to the situation of the patient at that moment in time, you take away uncertainty. Uncertainty means less margins, less safety margins to be taken. And then as a consequence, you're also able to put more dose into one single fraction. So what you see here is that as a consequence of adaptive, the number of fractions potentially goes down to five or sometimes even three fractions as well. So adaptive, on one hand, you could say is more work, but on the other hand, can drive an immense productivity as well.
And that adaptive makes a lot of sense, and that it's a very logical evolution in radiation oncology is shown over here. Just three examples. So what we typically see that in the time between simulation and the first fraction, and that can be one, two weeks, we already see a change of the tumor. The size can change, the shape can change, and we see that in brain tumors, for example. So when you start the treatment, actually the tumor shape is different than the size as well. Another typical case is that the tumor actually responds to radiation, so it's shrinking. And if that happens, you actually want to adapt for that during the course of treatment. We see that also, for example, in rectal cancers.
And the third one, especially in areas where there are a lot of soft tissues, we see that the tumor position can change or there's certain motion over time. The bladder can be filled. The rectum is full or the rectum is empty. It pushes the prostate a little bit up or down. And as a consequence, you're less accurate in your delivering of the treatment. So the prostate is a good example of that. So my point is that if the tools are right, adaptive makes a lot of sense, and it's a logical evolution into radiation oncology. So what about adoption? How quickly will this adaptive radiotherapy be adopted in the market? And for that, it's actually good to go back to the early days of image-guided RT. So actually, Elekta was the innovator of image-guided RT.
Elekta was the first one to put imaging on the treatment device. That was back in 2003. And what you saw and what we learned from that, that actually took quite some time before the clinical proof was sufficient, that the guidelines were adapted and that it became standard of care. But because it was put as an option, an additional capability on the device, the customers were able to do tryout IGRT in the early days, but also were able to do conventional treatments. So they were not forced in one side or the other. And given the market believed that this is the direction to go and you typically buy equipment for the next 10 years, we saw a much higher and quicker uptake of image-guided RT from a customer perspective. So the adoption of the equipment and the capability was way ahead before standard of care.
That idea and that learning we also applied to Evo. What is Evo? Evo is a high-quality and versatile delivery system, as we know them today, but we put a new imaging system on it. I said imaging is super important. High-definition AI-enhanced imaging. That's Iris. Secondly, you can put online plan adaptation on it. Plan adaptation on the console. But crucial, the customer can choose, the user can use adaptive radiotherapy treatment, or they can still use it also for IGRT. Better imaging also gives better IGRT as well. We're not forcing. See the little bit as a hybrid car in that sense. You can choose between the two different workflows. How is Evo doing in the market? We have CE. We are 510(k) pending. The first adoption is in Europe, and we're doing very well there.
We treated the first patient this week. We already have the 10th installation just started as well. And we also started the first Iris upgrade. So it's not only about new machines, but also about upgrades. And also important, we see a substantial value perception from the customer that translates into a price uplift as well. So the market really sees that this represents a substantial value, and the prices are accordingly. Now, you might ask yourself, but what about Unity? I thought Unity was all about adaptive. And yes, Unity is all about adaptive, but it really brings adaptive to a next level. So like in radiology, there's CTs and there's MRs. And with the CT, you can't see what you can see with an MR and with an MR, not with a CT. So that's why in radiology, we see both devices.
We expect exactly the same to happen in radiation oncology as well. Elekta Evo is a CT Linac, as we call it. CT images are very good in density boundaries, clear density boundaries. It can be a bladder full of water. It can be bony structures, etc. That is what CT imaging typically sees very well. With Unity MR, MR is excellent in seeing soft tissue differentiation. Think about the abdominal area where you have a lot of organs or in head and neck, but also in the pelvic, prostate, rectum, etc. Even to the point that with the Unity, you can spot individual lymph nodes, individual oligometastasis, something you would never be able to see on a CT as well.
So yes, Unity is also an adaptive machine, but opens up even more capabilities by seeing certain tissues that are not able to be seen before. And with that, also expands the application of radiation oncology. But there's something more that the MR-Linac is doing. It's not only having adaptive, having superior soft tissue contrast, but it also includes real-time motion management. And that's super important as well. So now you see exactly what you're treating while you're treating in real-time. And this is the case of lung metastasis being treated as well. And now with the latest advancement with Comprehensive Motion Management, we can in real-time track the tumor and turn on and off the beam if it's not inside the treatment window. And why is that so essential? Because I started to talk about uncertainty in radiation oncology.
There was always uncertainty when there was no imaging at all, for example. Then we had image-guided RT. We reduced uncertainty adaptive. We further reduce uncertainty with real-time motion management. We see exactly the tumor in real-time, and if you reduce all these uncertainties, you don't need all the safety margins. You don't need to treat healthy tissue, and you can escalate the dose, giving more dose per fraction even more, and that is the best way to represent it in this picture, so this essentially shows you a typical image-guided, conventional image-guided RT treatment. It's the same steps. You make your treatment plan. You start to deliver multiple fractions. You do a review of how things are going. You continue to treat, and these treatments can take up to eight weeks, 20, 30, sometimes even more fractions.
With adaptive, you basically make the treatment session slightly longer because you do plan adaptations. But because you reduce the uncertainty, you can increase the dose per fraction. You actually need less fractions as well. That's where the productivity comes in. And then with MR-guided, we introduce what we call even ultra-hyperfractionation. With ultra-hyperfractionation, we have the real-time imaging as well and can even further squeeze it. And we are now running trials of only doing two fraction prostate treatments. So MR-Linac, in that sense, has more to prove because MR is a new imaging modality. CT is well known. We know CT in simulation for years, but MR is new. We have more to prove. We can expand the market. We can expand the indications. But that's why we also have the MR-Linac consortium. We have the Momentum project.
And if you see what has happened over the past years, we put a lot of effort into basically showing that the system works. It's safe. It does what it should do. It treats how it should do. And that is what the main focus has been over the past years. But now we're really moving to the next level by showing and demonstrating superiority. And to date, we have six studies in total that really show superiority over the standard of care. And a number of them, 23, are actually in progress as we speak. So expect a lot of superiority evidence being expanded in the years to come. And that brings me to the total portfolio. And Gustaf alluded to it as well. We have the most comprehensive portfolio. And another way to look at that portfolio is look at what we call the intensity of interventions.
So, how targeted, how focal you are in your treatment, all the way from conventional treatments that still are relevant and are happening to what we call offline adaptive, stereotactic body, stereotactic brain, and radiotherapy, where we have multiple options, the Gamma Knife, the Evo, the Versa, etc. But the Unity as well, we see some very good results over there. Then we have in the adaptive space two options unique in the industry, both CT and MR Linac. And then the most focal therapy is, of course, brachytherapy, where Elekta is the market leader. So let's talk about software a little bit more, and then I talk about departmental software. So in 2023, we introduced Elekta ONE. And what's Elekta ONE? To recap that, it's a unified software environment. It's an evolving ecosystem.
So that means it builds on existing products, adds additional products and overlays on it, and brings that together so that you don't have a loss of functionality, and very important, and I alluded to that as well, it's about interoperability and strengthening the interoperability with devices as well as the hospital environment, and the fact that the first phase of Elekta ONE was successful, we see that in the MOSAIQ. The first focus was on the MOSAIQ and specifically the smart workflows that drive productivity, and last year, we actually, or this year, we're very happy to be again the class, the best in class winner in oncology information systems, so we really turned the corner in our MOSAIQ space. This year, we introduced a new family member called Elekta ONE Planning, powered by our partner, MIM, so what is Elekta ONE Planning all about?
Elekta Planning is really a lot of things. It's not a small improvement, but truly resetting, I would say, for Elekta what treatment planning is all about. It's also not a commercial bundling between MIM and Elekta, but it's really an integrated product with multiple advancements from both sides as well. Plan Anywhere. So it's a client-server infrastructure, very important. It's super fast, and that's why it's also very useful for online adaptive treatments as well. GPU-based, we use the latest computing power. Plan automation is introduced as well, and as well as AI tools like auto-contouring included as well. It's vendor-agnostic. So we're really determined as Elekta to not only serve Elekta devices, but also non-Elekta devices, including proton therapy. Integration, as said, the relationship with MIM is not just a distribution, but it's very much also a co-development relationship where we really build on each other's strength.
We're very good in dose and optimization. MIM is very good in physician user experience tool, and really, we bring these two best-in-class capabilities together in the solution, and finally, Elekta ONE Planning is built for adaptive. It has a full set of adaptive tools because now you need to track the progress of your treatment in a different way. You don't have a single treatment plan anymore, but you have multiple treatment plans that you need to track. Secondly, what's very important as well, that the user experience for your regular treatment planning will exactly be the same for the integrated treatment planning on the device as well. So we believe that's a very strong argument as well. I talked about proton therapy already for a second.
Actually, Elekta has been in proton therapy for a longer time, but our TPS offering was not in place over the past, I would, five to 10 years. So if you look at the MOSAIQ side in proton therapy, we actually had a global market share leader, and we continue to be there. Over the past years with our partner, IBA, we really talked about, we really worked on treatment planning for proton therapy. And very proud that in November last month, we actually treated the first patient with Elekta's treatment planning solutions. So really the kickstart of a journey back into proton therapy treatment planning as well. So how is Elekta ONE Planning going? How's the commercialization and the rollout going? So with Evo, we sort of focused and started off in Europe.
With Elekta ONE Planning, actually, we started more on the U.S. side, although we now also have the first site installed in Europe as well. So Kettering Health was one of the first sites we piloted Elekta ONE Planning with. It's good to stress that Elekta ONE Planning is both CE and 510(k) cleared. The first clinics are live with very positive response. We see also here a substantial price uplift versus our traditional Monaco TPS system as well. And the excitement is really overwhelming, I have to say, not only in the U.S., but also in the rest of the world. And it really also supports that our customers think that our partnership with MIM is a very good way forward as well. So a very strong order development we see there as well. So where is Elekta ONE going?
Initially supporting Elekta Linac, non-Elekta Linac, but we also started to move outside of the Linac space as well, protons, and in the end, supporting also the full Elekta suite, including neuro and brachytherapy as well that currently have their own treatment planning systems. Smart Workflows, Elekta ONE Planning, these modules are all coming together in the same space. Now there's something else around software that I'd like to stress here as well, and that we actually put quite some time and effort into over the past year to enable these opportunities, and the first one is Elekta SaaS, our software as a service business. This is becoming a more and more important component of commercial offering that initially started in the MOSAIQ space, but now with Elekta ONE Planning, we moved that also towards the treatment planning side.
And we also expect that SaaS becomes actually also a part of the Linac device side as well. So SaaS becomes a very important way how we basically manage our business, how our customers buy our evolving capabilities. But for Elekta, it's also meaning that a growing share of recurring revenue as well. And what we see very positively in the transition as well is that if you have customers that are on today's maintenance and support contracts, that if they move towards SaaS, that a typical uplift in price is more than 50%. The other side is the move to cloud. I mentioned it already when we talked about the virtual clinic as well. Elekta offers a cloud solution called Axis Cloud, and we see more and more driven by security, cybersecurity concerns that customers are basically asking Elekta to host all the applications in the cloud.
So we see there also a fast adoption. And as part of our R&D investment in software platform and capabilities, we more and more also develop our new applications as what we call cloud-ready-based strategy. And that helps also to adopt new capabilities and roll them out quicker in the market. So maybe going back to 2020 and the first slide I started when we started this journey of how do we create more personalization in our treatments with higher productivity. So back in 2020 and the Capital Markets Day in 2021, we also said we're going to invest more in innovation. And that's what we did over the past year. And we continue to spend a substantial amount moving forward. But the question is, maybe, where did you spend the money? So this picture illustrates that.
It's good to highlight that in every medical device company, there's always a level of maintenance. You need to do product maintenance, end-of-life components. It can be new regulations. It can be fixing bugs in the software, etc. A substantial part is maintenance-related. We see more and more that requirements related to cybersecurity, the newer standards that are more quickly coming to us, that that portion has actually increased. We're spending relatively more versus 2022 on these kinds of topics as well. We happily spend it because it's super important that all our solutions are very safe and cybersecure. The largest difference you see on the hardware and mainly the software. You see that the relative increase was the largest in software. Most of our additional innovation spend was in software.
But I also like to stress that we didn't stop spending on devices as well. And where did we spend? Workflow, AI, automation, imaging, motion management, adaptive tools. So both facilitating productivity and personalization. The new first cloud-first platform, also looking at how we can lower the cost of deployment of our software solutions. And then more on the device side, we spent quite some money and continue to spend on product integration, as we call it. We always look also at the next generation platforms that drive productivity, personalization, but also lower costs of goods. So in summary, we started the journey in 2020. We started to spend more on innovation. The first wave was with Unity and Harmony. We're in the second wave, Unity with comprehensive motion management, Elekta ONE, Elekta One OIS with smart workflows, Elekta ONE Planning, and now this year, Evo as well.
But most important to say as well, the journey hasn't stopped yet. You can expect many more innovations in the short to midterm around workflow advancement, workflow integration, deeper interoperability of our products, AI automation, related quality tools as well, imaging, motion management, and so on and so on. So very exciting journey. And that brings me to the concluding slide. We are very well positioned, we believe, to really capture this emerging trend of adaptive solution with a flexible approach, but also with both a CT and an MR Linac offering. We continue to be committed to open interoperability. We believe that's very important to stay relevant, to also gain market share, being as a more open player. And it's something that's also important for our customers as well.
Finally, we did a lot of effort in capturing really the SaaS and the cloud opportunity that is here to stay as well. With that, back to the studio in Stockholm. Thank you.
Thank you, Maurits, and good afternoon, everyone. Let's now look into the connection here between the innovations and how that will drive our financial performance. When you look at this on a time period, we're coming now from a peak period in terms of investing in our innovation pipeline and R&D portfolio. As you heard here during Maurits' presentation and Gustaf earlier on, this has really resulted now in a number of products. You see them here on the slide and also that Maurits was referring to: the Elekta Harmony, the Elekta Studio, Elekta Esprit, Elekta ONE, comprehensive motion management, and now here lately, the Elekta Evo and One Planning.
When you look at this in a time horizon, we expect the gross R&D, the cash R&D, to continue to go down as a percentage of the sales and actually progress towards approximately 10%. By these investments, as you just heard, we now have the most comprehensive portfolio in the industry, and then when we look at this from a financial point of view, on this slide, you recognize from previous presentations, but of course, we are not happy where we are with our current gross margin level, and there is not one silver bullet for this. It's a combination of tools to actually how to recover and improve our gross margin. Of course, it's about volume growth, it's about price mix, and it's about also to increase the productivity in terms of better scale and also cost reduction.
But importantly here, related to the presentation that you just heard, is really the price mix improvement and also the acceleration of volume growth, where actually these innovations play a key role. So when we look at it and look at purely by price, you have heard us talk a lot of price and that we've seen during the last three quarters now that the price improvements actually start to be visible also in our revenues and not just, as it was a couple of years ago when we started to see it on orders, is that of course when you provide the customers with an enhanced product offering, the whole negotiation also becomes very different. And therefore we see that the improved customer value by these products also then will lead to higher price points and of course then better margin.
So we also see that in terms of the mix improvement, both by the newly installed products, but also then to go after more software sales. And I will actually describe this a little bit more in detail later on in the presentation. But it's also a cornerstone of actually accelerating our growth in mature markets. One of them, which you actually saw here in Maurits' presentation, the US market, which is highly important for us. So looking into the next slide, and this is actually describing the installed base for our Linacs and Gamma Knives. We have now about 5,500 units out there. And this is one of the most valuable assets that we have. We can here on this installed base bring out after-sale. We can upgrade our existing installed base.
And it's of course an important growth element, but even more importantly, how we target to mix up our value offering and also improve then the revenue and profit by customer. So looking at the next slide and actually what we talk about, you hear us a lot about talking about the product mix. And this is of course a number of things. But key here is really the new product launches that you just have seen, both in our recent conferences and also being presented here today. It is about to drive the software growth and actually by that improving the workflow and the personalization within the clinics, but also for us to enable a better financial return.
And then also here, which Maurits was alluding to, that this is also an important part to actually grow our recurring revenues to improve the resilience and also increase the value and revenue per customer. So by that, I hand over to you, Peter. Thank you.
Thank you, Tobias. Thank you, Gustaf, and thank you, Maurits from Crawley in England. So with that, we will move to the next section of this presentation, the Q&A section. And I have some instructions here. First of all, as I said in the beginning, please limit the questions to today's subjects, product launches, and innovation. So what I would like you to do is, as you always do in a Teams meeting, raise your hand function, use the hand function, and by that, you will be able to ask your questions.
What I will do then, I will then call out your name, and then you will try to, or you will unmute yourself, and I will unmute you from my side as well. A bit of small, small technical steps here, but hopefully we'll be able to do it. We are a tech company, so let's try. So the first question we will have from Rickard Anderkrans at Handelsbanken. Rickard, can you hear us?
Yes, hopefully you can hear me as well.
We can do that. Perfect.
Great. So first question on my end, thanks for the presentation, is a little bit on Iris. So as far as I understand, and the only images I've seen is Iris focusing on the pelvis area or being optimized for pelvis. Is it optimized and ready to use for all major areas of the body?
As far as I understand, bladder is one of the easier adaptive radiotherapy cases. So I'm just trying to understand if Iris is a fully sort of commercial product ready for use in all major areas of the body, or if it's still in sort of a work in progress for other use cases. So I start there. Thank you.
So maybe you can start. Yeah, I think that's more question to you, Maurits, if you can give the background here.
Yeah. And you can hear me?
Yes.
Yes. Perfect. Yes.
Okay. Now, we took a certain approach to image quality improvement and bring it as close as possible to what we call diagnostic quality imaging. And we believe that a body-site specific approach and optimization of the imaging is the way forward. So it's definitely not a prototype or early development, but we basically release capabilities per body site.
Started with pelvic, that is the first area where we elevate the image quality substantially. But also, let's be clear that all other areas can be imaged with Iris as well. We don't maybe recommend it to use it for online planning, but it's still available. We have image-guided RT for all the body sites. So Evo is not limited to any body site. But to elevate the quality, we do it per body site, and we bring that in steps to the market as well. And you will expect in the next 18 months that we basically go body site by body site. And that's our technical approach we have taken because we believe that gives the best and the most superior quality of imaging to do adaptive planning in a secure and in a good and a robust way.
Thanks, Maurits. Anything to add?
No, I think it was an excellent answer. Thank you, Maurits.
And Rickard, you're good with that answer?
Yes, thank you very much. Can I ask one more or?
Sure, sure. Go ahead.
Good. So in the presentation, you called out currently executing on the 10th installation of the Versa HD. Can you comment anything about the pipeline or how many orders there's been and how is Elekta Evo and the software launch tracking versus the business plan from the beginning of this fiscal year? Thank you.
It's a good question for you, Gustaf.
Thank you, Rickard. So we have, as we said, really focused on bringing Evo out. I mean, you see the 10. We just talked about the handful a couple of weeks ago when we launched or when we had an earnings call. So really good progress on the installation side and focused on Europe, of course.
We focused, we got a lot of questions on that. We really focused on the, so to say, new machines installations because we wanted those reference sites. At the same time, we were preparing for the upgrade to Elekta Evo as well. That's ongoing now. That's where we're kind of starting at the moment. In the U.S., we focus a lot on Elekta ONE Planning. We have a big installed base in the U.S. and we want to bring new innovations there as quickly as possible. That has been a focus together with focusing in the European area as well with Elekta ONE Planning. It's important to say that CE Mark often gives you access to other markets also outside Europe. It could be places in the Middle East, it could be Australia, New Zealand, it could be parts of Africa, etc.
We can sell this product as well, and then you often get regulatory clearance in the country and then you can install it so we start to see interest outside Europe for Evo and Elekta ONE Plan outside also then U.S. When it comes, compared to the plan, I would say it goes very well according to the plan, if not better. You asked about the orders on the Evo side, very big interest. We see orders coming in. We have a great sales funnel for both Evo in Europe, other countries, as well as Elekta ONE P lanning so this is something we really track, I would say, day by day to enable and also being able to install and roll out that in this year.
We've said financially on the revenue side, it will be skewed towards the fourth quarter, of course, because now we take the orders and then we need to plan and then we need to install. So that's still the case. But I would say the rollout is going very well. And I would say in line with the plan we had.
Great. Thanks for taking my questions. Thank you.
No problem. Thank you, Rickard. We will move to the next question. It's from Niuding Jiang from Citi. I will now see if I can allow your microphone. Hello, can you hear us?
Yes, I can hear you. Can you hear me now?
Perfect.
Yes, thanks. Hello.
Hi guys, thanks for taking my questions. I have two please. So I'll just ask them one by one.
The first question is just on the sort of financial profile of the new Elekta Evo and also to an extent Elekta ONE. So during the presentation, you commented on the substantial pricing uplift for both. I was wondering if you could provide a little bit more details as to how we should best think about the magnitude of the pricing uplift on Evo and One separately and maybe when they come together. And then also you also mentioned that with the next generation platform, you see a reduction in COGS. So perhaps you could also comment on the COGS profile of the new products as well. Thanks.
Absolutely. So if we start with the pricing, we'll not disclose any specific prices and so on. We're still in the early phase on the commercialization.
But what we have seen both in the machines and software we have delivered and also what we filled up the sales funnel with is significantly higher price point on, if you were saying, Evo versus a Versa HD. Because it gives a totally new way of treating many patients and it also gives the customers the opportunity to be part of the adaptive train, so to say, that's really speeding up at the moment. We haven't said any specific numbers and so on, but it's significantly higher. And as you know, in med tech, when you come with these innovations, it's kind of an S curve. That's where you have the biggest price increases and then over the next couple of years, smaller, based on that first initial price level. So significantly higher. If you look at the Elekta ONE Planning side, it's a much more comprehensive suite.
And it also has so many more functionalities and improvements compared to what we had before with Elekta Monaco. But when we go to Elekta ONE Planning powered by MIM, that would also be a significantly higher price point. And we've seen that realized as well in the sales situation. When you look at the upgrade opportunity, so if you go from a Versa HD and upgrade it to Evo functionality, that's also a significant sale for us, let's say, with a good price point and a good after-sales type of profitability. And the same goes if you go to new modules with Elekta ONE across the software architecture infrastructure that you have in the clinic. So that's also an upsell opportunity.
So what I'm really excited about, what we discussed over the last hour, is that it was a very long time since Elekta had so much after-sales and upgrade opportunities. We saw that once before. That was in, say, 2012 when we launched a Versa HD. And we also had the best multi-leaf collimator on the market Agility. And then we had quite a few years where we could have these upgrade sales that also helped our profitability at that point in time as well. So we see a good uptake, we see good price realization, and we see a good opportunity for after-sales and software business as well.
And I can maybe add on that as well that, I mean, here we come from this higher levels of investments in our innovation pipeline.
And this is actually now what we're looking for, not only from a customer and patient perspective, but also to get the financial return and just what Gustaf said here, by higher prices and then, of course, also financially creative to our performance.
And then I picked up your other question as well. And I will start, Maurits, maybe you want to say a couple of words. We always invest in new platforms. In this industry, you have a five to ten year horizon, even longer sometimes, about the platforms you put out in the markets. And when we refer to kind of next generation platforms, that's what we're referring to. And that's why we also believe that we will be around 10% in gross R&D as a percentage of revenue. It's a bit where the competition is as well, because we always need to think about what's next.
We believe that COGS is important. We're looking at the different platforms to say, okay, how can we make them more efficient, less material consumption, more sustainability, serviceability? There's so many of those areas that we are thinking about for the future. That has a positive impact on the material cost situation, both on existing platforms, but of course also on the new platforms with the latest technology. But Maurits, maybe you want to add a couple of words.
Yeah, I mean, the only thing I can say is that if you look at our sort of elevated investment in R&D, and that will slowly over time sort of stabilize around the 10%, that we're not only looking at the near term, but also continue to invest in platforms, as we call it.
So it's continuously, and of course, we always talk in these types of conversations about the short term, but I think it's important to know for all our stakeholders and investors and owners of Elekta that we're not only looking at the near term, but also in the long term where you really look at structural cost reduction, but also how certain other capabilities can be better integrated to streamline workflow. So that's why I was saying it's not only about cost, but it's also about higher levels of productivity and higher levels of personalization as well.
Thanks, Maurits. And Jiang, you had another question as well.
Yes, if that is okay with you guys. Very quick questions. When you think of Elekta Evo in the US, whenever you have secured your 510(k) approvals, would you need to make extra investment in sales to leverage this opportunity?
Gustaf?
No, I don't believe so, because we did a big launch at ASTRO with great interest. So now, of course, we can discuss the product out with our customers around the U.S. It will be sold by our existing sales force. Of course, I think when we talk about adaptive and some of the software additions and the imaging is a new way of treating. So I think we need to continue to invest in those types of clinical discussions as well. But I don't foresee any specific around Evo in the U.S. We really did that in a big bang launch we did at ASTRO in Washington in September.
Thanks, Gustaf. Thanks, Jiang. Thank you.
Thank you.
So I'll move to the next question, and I will unmute the mic from Kristofer Liljeberg at Carnegie. Hello, Kristofer.
Hi, Kristofer.
Allow me. Kristofer, can you hear me?
Yeah, there we go. Sorry. There we go.
I can hear you. Yeah, yeah.
You have to unmute yourself.
Loud and clear.
Okay, thanks. Yes, a question on the rollout of Evo. So when do you expect to have more ongoing installations of this new product compared with Versa HD in Europe?
Gustaf?
That's a great question, Gustaf. I don't really know the answer, but what I do know is that almost all of our discussions with customers in Europe is about Evos, so not Versa HDs at the moment, because people want to be part of this. And then if you think about it, we often book orders. It could be on average a year, a year and a half, sometimes two and three years if it's a big public procurement process in Europe, for example.
It will take some time before we kind of install all of the Versa HDs we have in the backlog. However, when that inflection points happen, I don't know, but it shouldn't take too long. But I would say 12 to 24 months would be my perspective. But I'm looking a bit to Maurits as well. Do you have some more insights there, Maurits?
Yeah, I think once the product is available in a certain market, that very quickly the Evo will be the default solution. So I think it's also important to stress two things. First of all, you can also buy an Evo without online adaptive, but just use the better image quality. That can be sometimes an attractive first step. And then maybe later on add online adaptive to it. So that is still an option as well.
So essentially, if the product is cleared in a certain market, I expect that the Versa HD will be succeeded by the Evo across all the markets. I think the second thing I like to clarify a bit also around the US and the 510(k), we inform the market about Evo, yes, but be clear that the product is 510(k) pending. We're not actively marketing the product and we cannot sell it. I think we need to make that clear as well. That's the formal regulatory status we have. It's currently 510(k) pending.
Could I ask follow-up? So the reason I'm asking is, of course, the potential positive impact on the gross margin here. But how large proportion of installations in a certain market do you think have to be Evo or upgrades for this to have a more meaningful impact on the gross margin? Thank you.
I mean, of course, that depends what you mean by meaningful. But I mean, it starts quite quickly. This is probably the biggest segment we have in our P&L. If you look, if you would break down our revenue, this segment of the market when it comes to the Linac business, that is our biggest segment, is of course significant. So I mean, I don't have any specific number, but it doesn't have to be so high as a percentage of all the Linacs in order to have a very meaningful contribution to the Linac business gross margin. And then I talk about the solution kind of device side. If you then have the add-ons that we've been discussing with Elekta ONE Planning and different Elekta ONE modules, that could be a very creative part of our business on the software side.
Then we also have the SaaS solution that could be very large standalone to some extent deals that we go from an on-premise solution on a site maybe in the U.S. or in other parts of the world, a bit what Maurits was talking about previously, and lift that to the cloud. So that could be a strong software growth opportunity. And that's a recurring revenue stream. So that takes a bit longer. But to summarize on your question, Kristofer, Elekta Evo will have a meaningful impact even though the percentage initially of the Linac revenue mix will not be that high. But over the next 24 months, it will increase significantly.
Yeah, and I can ask that. So I mean, that inflection point that we were talking about, I mean, it will be visible in the gross margin before that. Okay.
Could I ask you just one more quick on Elekta ONE Planning? The installations you have done, have you replaced any competing planning systems there or is that all the Elekta sites? Thank you.
Maurits, I think you can take that one.
So the first sites are typically pilot sites where they are very close to Elekta, where you test out new things. So they were existing Elekta TPS users. But we already have the first orders where we basically exchange an existing TPS system for Elekta ONE Planning for more than one vendor, I can say here as well.
So what is, I think, a very important to stress is that once the customer sees that adaptive is going to happen, once they bought into, I need to have an Evo, even when I'm not sure how to use it from day one, I need to learn it, et cetera. If they understand that with Evo, you have an online treatment planning system that is different from the one in your department, why would you still have two different planning systems? So I think that conversation becomes increasingly important as well. And that awareness in the market that having two different solutions, one on the Linac, on the treatment device, and the other one for the department, is maybe the most optimal thing from a workflow perspective, but also from a financial perspective. So we see really traction in that conversation as well.
Thank you.
Thank you, Kristofer, and thank you, Maurits and Gustaf, for those answers. I'll move further in the queue here. I will say here, David Adlington, if you can unmute yourself, I think you should be on live. Hello, David.
Hey, guys.
Hi. Hi, David.
Hello, David.
Just one sort of big picture question, really. I suppose if you compare and contrast your offering now, or once all the products are launched with your key competitor, what is the killer differentiator that you will pitch to clients?
Gustaf can start.
Yeah, no, thank you, David. I'll start, and please, Maurits, chip in. I think it starts really about that we're focused on radiotherapy. We're also clear partners to the clinicians and how they want to set up their clinics, as Maurits said. And within that clinic, we do everything. We do the comprehensive portfolio. We can do the CT Linacs.
We can do the adaptive CT Linacs. We can do the MR adaptive Linacs. We can have the gold standard for brain mets with the Leksell Gamma Knife, and we have the best offering when it comes to brachytherapy as well. Our treatment planning software now, Elekta ONE Planning powered by MIM, is something where we take a huge leap when it comes to attractiveness for the customers, and all of this is connected to an oncology information system, Elekta ONE, that we can connect the whole of the department, and if the customer wants to have another technology within his department, that has always been the strength of Elekta, what we call our open architecture, so we can enable that within the department, so we're focused on radiotherapy.
We have the most comprehensive portfolio in the industry, and we also have an open architecture if the customer wants to have some other technology to add on to our offering. We have also been focusing in two areas where we maybe did not have the strongest positions before. That was in the treatment planning software space. We are really close, and now we're excelling in that area. It was in the high-end Linac segment where we now go in with Elekta Evo with adaptive treatments. That is what I will tell the customer. That's a very exciting offering for many, many of our customers, but also the competition's customer around the world. That's what we'll drive going forward as well. Maurits, something you want to add on the offerings?
No, I can echo that only. I would maybe call out two specifics.
Open interoperability has been a differentiator, of course, that we are not only supporting Elekta devices, but also non-Elekta devices. We've always done that in our OIS, but now we can also do that with our planning offering as well. Actually, one of the early sites is an Elekta customer with OIS and TPS, but running non-Elekta Linac. That is, for us, an excellent proof point that also in this situation, Elekta has a very competitive solution in the market as well. Then, of course, the Unity remains a differentiator as well. Especially that we have the Unity and the CT-Linac as well. We don't have a complicated discussion about, yeah, your only adaptive machine is an MR adaptive machine. Now we have an MR adaptive, a CT adaptive. That's a unique proposition.
And as I showed in the more mid-size, larger-size hospitals or oncology clinics, if you have three, four machines, it becomes a very relevant discussion what type of equipment you want to have to basically cover all the main indications. So yeah, on the devices as well as on the software, I would say interoperability. And I would call out still MR Linac as well as a big differentiator.
Thanks to Maurits. David, did you have a second question as well?
I do, if that's okay. Yeah, it's actually about some things you've not talked about today, but on the R&D side. So does anyone have any updates in terms of how your latest thinking is around both cardioablation and also FLASH therapy?
Two interesting areas, but Maurits, do you want to start on that one? I can add. Cardioablation and FLASH .
Oh, FLASH , yeah.
We'll start with the second one with FLASH . We see that most traction was driven out of the proton therapy community. Maybe that became a little bit less loud after our main competitor stepped out of the proton business. But we see most activity there. We're also entertaining it as well. We have a few research activities running to also explore FLASH with photon/electron machines as well. But we believe that technology will at least take a decade before it matures. Then the point about ablative cardiac ablation, actually, and I mean, we also started to entertain that a little bit. We believe that the Unity would be an excellent candidate for that, really looking in real time at the beating heart. But also there, cardiac ablation is really in its early stage.
And the question is if that typical application also will end up in the radiation oncology clinic. So you could argue how quickly the adoption, if proven all effective, will actually take place. But it's something we definitely look at as well.
Perfect. Thanks, James.
Thanks, Maurits.
Thank you.
Good. So I'll look at my screen here. If you have a question, then please raise your hand, and I will conduct from there. I don't see any further questions. Yes, here we go again with Rickard. So you can unmute yourself, Rickard.
Hello. Hello. Can you hear me?
Yeah. Hello, Rickard.
Sorry. Sorry. I had some issues on mute. Just a quick follow-up question, if I could. Trying to get a sense of the interest and traction you're getting with the Versa HD installed base upgrades of Iris and Elekta ONE Planning.
Can you share anything of what share of the installed base has as of today expressed interest in upgrading or are sort of in discussions looking at this, just trying to get a sense if it's limited to a handful or a small percentage of the installed base or if it's a meaningful share that's already in discussions? Thank you.
Gustaf?
I can start with that one. So we've been looking at the Versa HD installed base. We are looking at the age. We are looking at where they are in their purchasing processes and so on. And currently, if you look at the whole portfolio here right now, we believe it's 1,500-1,600 opportunities. Then at the moment, what we're doing, we're kind of driving campaigns now to say, okay, do you want to do this upgrade? We will help you.
And also discussing about these adaptive workflows to better imaging quality, et cetera. And we've seen a great interest in that area. And so now it's just to translate it into sales and to installations that we're working at the moment. We haven't really quantified exactly how big that interest is, but it's a lot of activities ongoing in the installed base and at conferences and so on to discuss how you take a Versa HD to get to Evo functionality, so to say. So it's an exciting area, but maybe you want to add something there, Maurits, as well. Yeah, maybe two things to add here. I think the first thing is that if we look at upgrade opportunities, then the sweet spot is a certain configuration, let's take the Versa HD between, let's say, three and seven years old.
So it's not like bought yesterday, but it's also not too old. So that's where the 1,500 comes from. We call that the addressable installed base. But it doesn't mean if customers that have a newer machine or an older machine can't do it. But it's a high-value upgrade. So typically, that's a sweet spot for that type of business. So very substantial installed base, I would say. And I think the attractiveness of that as well, that if you have a department with two, three, four Linacs, you don't need to replace all your Linacs. You buy an Evo and you upgrade your other two Linacs to the same level. And all of a sudden, your whole department is becoming adaptive or your whole department has elevated their IGRT capabilities. That's a very attractive proposition.
So often, our customers that have more than one Linac not only look at the Evo, but also see how they can sort of streamline the capabilities in the department. The second thing I would add to this as well is that we introduced the upgrade on the Versa HD, but something we consider towards the future as well, looking at Harmony, for example, at some point in time, what is stopping us to bring these image quality capabilities in that space as well. We believe that adaptive is something that the whole market will have at some point in time, also Harmony users. So while we start to look at the Versa install base now, it doesn't say that we can't offer it to a larger portion of our install base down the road as well.
And then there is an opportunity from the backlog point of view, orders we've taken over the last years to transfer those Versa HDs with a negotiation to Evos before we install them. So that's another opportunity that we're working on out in the markets as well.
Thanks.
Thanks, Richard, for that question. Thank you. We will move to the next one, and I will allow Julien Dormois at the Bank of America. Julien, can you hear us?
Perfect. Can you hear me well?
Yes. Perfect. Yes. Thank you.
Hello, Jordan. Yes. Perfect. Hi. So I was about to ask about the opportunity to upgrade the Versa HD in the backlog, but you just answered it. My other question is just, I mean, have you provided already the clearance timing for the Chinese market?
I mean, you're pretty, let's say, pretty big there in terms of Elekta ONE, Elekta Evo, and we are also hearing that United Imaging is getting traction there. Do you think that with the new innovation, like everything that you discussed today, do you think you will have, let's say, the perfect tools just to fight and protect your market share in China in the coming years?
Yes, we believe we have the right, and I call it truly ecosystem. And I've often mentioned that before in China because we have production there. We have software development there. We have joint ventures, firstly with the Sinopharm on the service side, access side, and we did it with AnSheng. That's a very exciting area that is kind of software, oncology information system that's localized to China. We also have a lot of device development there as well.
And we see the stimulus packages and the new quota that's coming out, for example, for MR Linac. If you take the specific question on CT adaptive, that will take a bit longer time as it always does in China. We bring it from CE to China in the regulatory process, and that often takes around. I'll let Maurits comment on exactly the timing, but that's quite the extended period. But we're also looking at localized solutions in China for adaptive workflows to serve that growing trend locally. So I think we'll have a strong adaptive and software and device offering now and in the years to come for China. But on the regulatory process, Maurits, any more updates?
Yeah, I mean, the rule of thumb is that it is roughly a year. We try to accelerate. Sometimes we are good at that.
But if I would say the rule of thumb is that it takes a year or so to go through the whole clearance in the U.S. If you take CE as a starting point, where essentially all our technical documentation is ready, then that's the average lead time to do that. So yeah.
Thanks, Maurits. Thanks, Gustaf. Julien, did you have another question as well?
No, no. All good. Thanks. Thanks a lot. Thank you for the.
So with that, actually, we would conclude this Q&A for this deep dive seminar number one. We are planning for a second one coming up here in later April before the CMD that is planned for June 10th. But before closing this session, Gustaf, some final words.
Final words. No, thank you to all for listening in here. And thank you for the team that made it happen.
And thank you to Peter for initiating this because it gave us a great opportunity to talk about something that we love a lot, and that is our comprehensive product portfolio and all the innovation that we have been able to do over the last three to four years, also during very tough times. Because I believe, and the team believes, that innovation is what will create profitable growth for Elekta, not just in the next quarter or half year or year, but really in the next years and decades to come for our company. That's what we have been talking about, and I hope you enjoyed it. But I also wish you a fantastic happy holidays when you get it and look forward to seeing you in the new year. Thank you.
Thank you.
Thank you.
Thank you.
Thank you.