Good morning. Welcome to this presentation of our Q4 and full- year report. I'm here today, Göran Malmberg is my name, CEO of Mentice, and Gunilla Andersson, our CFO. We will walk you through our slide deck presenting the results from last year. We start with a financial update, and I will let Gunilla talk about the financials, and I will make some comments.
Yes. Good morning, everybody. The financials for this year starts with a really good order intake. We are actually above SEK 200 million for the first time. Order intake in the quarter on par with last year, but for the full- year, SEK 205.6 compared to SEK 168.6 last year. This is an increase with 22%. We also ended the year with a really good order book. By the end of the period, this is SEK 87 million, which is then 31% above last year.
A couple of comments on that. As Gunilla said, the first time over SEK 200 million, it's obviously a milestone for us, very nice to see. We also see that our business is continuously fueled by the medical device industry, very strong performance on that, 45% and change more for the year 2021 compared to the previous year. And also strong growth in the actual quarter for medical device. Moving on the order side, we can also note that the acquisition we did in October of 2020 have also moved very well in the year. We more than doubled the order intake from that business unit compared to the comparable year for 2020.
We had it in Mentice only for the Q4 , but if you look at full- year, we more than doubled that. That generated SEK 26 million in order intake for the full- year. That's very nice to see. That's predominantly US-based revenue, and we believe this year we were gonna be able to move it out to the rest of the year in a strong way. It's really nice to see how we execute from really leveraging our sales and distribution to bring those products out to the market. The hospital market is still slow. We, based on the pandemic, are obviously suffering from that all the way from 2020, sorry, and into 2021.
We saw an opening after the summer, but then when Omicron hit us in Q4, we saw that the market rapidly closed down again. We still behind the 2019 levels, actually, but also behind 2020 levels. We see on the device side that the large clients, which is a really important part of our strategy to really improve our work with the large and really large, or the mega clients. We can see that we have a larger amount of clients that produce order intake and sales above SEK 10 million. We also have a handful of clients over SEK 15 million. The largest client this year was somewhere SEK 30 million. That's also nice to see.
Last point on the order and order book side, as Gunilla said, the order book is moving up from 66 up to almost 90. That also really two comments there. One is that we're getting into 2022 with a good start, SEK 65 million is scheduled for this year, which is a nice start coming into the year. But we can also see that we are increasing the recurring revenue components, which is a combination of rental and kind of subscription. That's almost SEK 60 million as well. That's my comments on the order and the order book. We can continue with the rest of the financial components.
Yes. Net sales for the quarter amounted to SEK 67.7. This is an increase that is very close to 50%, 47.5%. We came in at SEK 185.1 for the full- year, a growth of 34.6%. We also finished the year with a strong gross margin in Q4, 78.9%. You might remember that we had a quite bad quarter last year at only 63.3%, very much linked to an unfavorable product mix. This takes us for the full- year to 81% gross margin compared to 77.9% the last year. Our cost levels increase. They're up 25% to SEK 152.6 compared to SEK 121.6 last year.
For the full- year, the acquisition of Vascular Simulations adds a total cost of SEK 9.7. We only had Q4 in our books last year, so that's the 2.3 that you see there in the brackets. Cash flow in the quarter was positive SEK 7.4. Not as positive as 20.1, which we delivered last year. It's the Q1 where we were positive during the year 2021. We ended then negative SEK 5.1, we had positive SEK 30.5 last year. This is mainly due to our growth in medical device industry, meaning that our current receivables are growing, but with really very safe and secure customers. The operating income, EBITDA, came in at SEK 12.0 in the quarter, and positive SEK 2.5 in the full- year.
This has been negatively impacted by some costs of non-recurring nature, and that then would have changed this result with SEK 4.6 if we would have taken them in, which we have. We've shown in the report exactly what those costs are.
All right. I think we had a very solid year, what we set out to do, and I think it's nice to see that we are delivering growth on par with the financial target that we have, 30%+, which is very nice. All right, getting into a little bit other reflections on the Q4 . First, if we look at the device industry, we are really stronger. I mean, we had a good year in 2020. We have an even stronger year in 2021, and we are continuing to see that our larger clients are increasing their spending.
As I said before, we are adding more clients that produces more revenue, up in the SEK 10 million level or even more. That pipeline is growing, the opportunities are growing, and we can see that the medical device company or segment will continue to drive or be the core part of our growth. We look at the hospital markets, we can see that, as I said, the pandemic obviously are impacting us. We believe that partly by we are past the. We'll get past the pandemic in 2022, which we're certain on. Obviously, we don't control that.
We hope that the conversion rates, when I talk about conversion rate, typically, we, if we have a pipeline, a list of opportunities, we convert about 20% of those into orders. But in 2020 and 2021, that was significantly lower. In 2021, that was below 10%. We believe, based on the view we have now, that we can get back to more normal level, maybe not up to 20%, but up to close to 20%. Looking at the strategic alliances, in collaboration with Siemens and Philips, we have moved those relationships forward.
I think the big breakthrough we talk a little bit more about in this presentation is the announcement we did connected to Corindus in China, where they have made a commitment to a bundle every sale of the Corindus robot in China going forward from 2022 with a Mentice system. That's a significant breakthrough for us. We believe that that's really to be followed by other regions in terms of Corindus. We monitor the China development and that's gonna have a positive impact for us in 2022.
We have talked about in some presentations what is our focus, what are we doing, and I think it's important to just re-emphasize that we are not only a training company. We are not only a simulation company. We are moving into an area where our specialty is really the therapy areas we focus on. We're talking about image-guided interventional therapies. That's our vertical. In this area, we want to provide solution sets and tools that inspire physicians to use the tools and help to make better clinical decisions. Obviously, also training is part of this, but we want to move further than that.
We're talking about what our market is really combining solutions for planning, diagnostic tools, use of data benchmarking, and integrated, for instance, with tools like instance segmentation. If you look at the market again, I mean, we can see that during the pandemic, there's been a lot of interest for solutions for simulation and training activities on the cloud, virtual environments.
We've been able to move that very rapidly during the last two years, where we now have proprietary products and projects where we run our simulation in the cloud and allow medical device companies, but also hospitals to engage with their clients and partners in a virtual environment and allow a real immersive realism in this environment and allow several people in a session located in different locations to be able to interact and really interfere with the actual simulation. This is something we see and real addition to what we have done prior.
We can see that the combination of the physical, so the acquisition we did a year ago with 3D printed anatomies and deployment of real devices also in combination with a virtual technologies from Mentice really makes a lot of sense. Go to the fiscal side, really the combination, we see more and more clients that want to have both be the synergy useful. We see the discussion with Corindus, where really we are used both for research and development, for their go-to-market activity, but also for the continuous use out in the market.
What is important to see is that we obviously are moving rapidly with our own development, but also as we talked about in last year, we have spent a lot of time here looking at what could make sense to complement our portfolio with in terms of acquire businesses. That's an important part of my work and our work to really identify that, and that will continue into this year. Some comments on the Siemens and the Corindus press release from China, I think will be very important for our hospital business and the Siemens-related business. It will also be important for the rest of the world's interaction we have with Siemens.
We can see on the medical device side that we add a lot of clients. I bring this company up here, Inari Medical. It was not announced at the press release because it was below our border for announcement of SEK 5 million. But it's a really critical or good example of us moving into new area. This company has innovative solution for thrombectomy in all parts of the body, and it's a new application for us, and it's a new start. This is a good example of new products, and we have multiple of those during the year. Another example is the Brazilian Neuroradiology Society that we have worked with.
This is an example of our interaction with societies on a country level. We have similar discussions and collaborations in Germany and Norway and some other places. This situation here in Brazil, the neuro society there have decided to use Mentice exclusively for training of all their trainees in the neuro area. But also they clearly want to move to the part where all physicians in the space will use Mentice for their training, for the certification and the ongoing improvement. That's a good example of the work we do on the hospital and the kind of society side.
2022 and beyond, we believe medical device will continue be a core driver, as will continue to be a large part of our business, hopefully and maybe a little bit less dominant than in 2021, but still a very, very important part of what we do. We said before the order book of close to SEK 70 million is obviously a very nice start for the year. We have an ambition and a belief that we can get back to more normal situation with the hospital side. We are continuing to invest in hospital. We have the resources there.
We have the solution set, so we are ready to make this happen, and we believe that the market will be more favorable for us in this year. Really in summary, strong finish for 2021, a good general view for 2022. Strong market position, we've seen very few, if any, competitors that are approaching the market the same way we do. We really see a strong demand from all regions and all segments, which is really nice. That was it. Do we have any questions?
No.
Ulrika Drotz Voksepp.
No questions.
Should we then say thank you? Thanks for your time, and very nice to be able to present 2021. It's a good year, and we're excited about 2022. Thank you.
Thanks a lot. There's no one left before. Thank you, Johan and Gunilla.
Thank you.