Profound Medical Corp. Q2 FY2024 Earnings Call

Thank you. Good afternoon, everyone. Let me start by pointing out that this conference call will include forward-looking statements within the meaning of applicable securities laws in the United States and Canada. All forward-looking statements are based on Profound's current beliefs, assumptions, and expectations, and relate to, among other things, any expressed or implied statements or guidance regarding current or future financial performance and position, including the company's 2024 financial outlook and related assumptions, the expectations regarding the efficacy of Profound's technology in the treatment of prostate cancer, BPH, uterine fibroids, palliative pain treatment, and osteoma and its future revenues and financial results. Such statements involve known and unknown risks, uncertainties, and other factors that may cause actual results, performance, or achievements to be materially different from those implied by such statements. No forward-looking statement can be guaranteed. Listeners are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date of this conference call. Profound undertakes no obligation to publicly update or revise any forward-looking statements, whether as a result of new information, future events, or otherwise other than as required by law. Representing the company today are Dr. Arun Menawat, Profound's Chief Executive Officer, Rashed Dewan, the Company's Chief Financial Officer, and Dr. Mathieu Burtnyk, Profound's Chief Operating Officer. With that said, I'll now turn the call over to Rashed.

Good afternoon everyone, and welcome to our second quarter 2024 conference call. On behalf of the management team and everyone at Profound, I would like to thank you for your ongoing interest in our company. For those of you who are shareholders, we appreciate your continued interest and support. I will turn the call over to Mathieu in a moment to provide updates on TULSA clinical publications, utilization trends, the CAPTAIN clinical trial, and reimbursement. However, before I do, I would like to provide a brief summary of our second quarter 2024 financial results. To streamline things, all of the numbers I will refer to have been rounded so they are approximate. For the three month period ended June 30, 2024, the company recorded revenue of $2.23 million, with $1.46 million coming from recurring revenue, and $773,000 from a one-time sale of capital equipment. Second quarter 2024 revenue increased 39% from $1.6 million from the same period in 2023. Looking forward for the full year 2024, based on the company's current business planning and budgeting activities, we continue to anticipate revenue to be in the range of $11 million to $12 million. Gross margin in Q2, 2024, was 64% compared to 66% in Q2, 2023. As we mentioned on our last call, we expect gross margin to vary some quarter over quarter but just as we delivered about 60% margin in 2023, we continue to expect to deliver that or better in 2024. Total operating expenses in the 2024 second quarter, which consists of R&D, G&A, and sales and distribution expenses, were $9.3 million, an increase of 24% compared to $7.5 million in the second quarter of 2023. Breaking that down further, expenditures for R&D increased 33% on a year-over-year basis to $4.2 million. G&A expenses increased by 1% to $2.1 million, and sales and distribution expenses increased by 32% to $3 million. Net finance income for the 2024 second quarter was $934,000 compared to net finance expense of $884,000 for the same three month period of 2023. Overall, the company recorded its second quarter 2024 net loss of $6.9 million or $0.28 per common share, down from a net loss of $7.3 million or $0.35 per common share for the same three month period in 2023. As of June 30, 2024, Profound had cash of $34.1 million. With that, I will now turn the call over to Mathieu.

Thank you, Rashed, and hello everyone. In the second quarter, real-world utilization trends from TULSA providers continue to demonstrate the unique and unrivaled flexibility of the technology to become a mainstream procedure in the treatment of prostate disease, approximately three-quarters, or 73%, of the procedures were for the primary treatment of prostate cancer, 15% were hybrid patients suffering from both cancer and BPH, 8% were salvage treatments, and 4% were men with BPH only. Half of the procedures were prescribed whole gland treatment plans, 29% subtotal, but more than half the gland, and 21% were hemiablations or focal therapy. Prostate cancer patients across all grades of disease were treated primarily intermediaries, with 84% being grade group 2 and 3, 5% were low-risk grade group 1, and 11% high-risk grade group 4 or 5 cancer. Similarly, patients with all prostate shapes and sizes were treated from less than 20 CC to over 100 CC. This quarter, about one-half, or 51%, had prostate volumes under 40 CC. Another 30% had a prostate volume between 40 and 60 CC, and the remaining 19% had prostates over 60 CC. We continue to see TULSA as the only treatment modality which can be used across the entire spectrum of prostate volumes and disease with clinical evidence in patients with cancer or BPH, as well as the only option for hybrid patients who have both prostate cancer and BPH. The workflow step of creating the treatment plans within this spectrum of prostate diseases was recently made faster and easier with the release of Contouring Assistant, Profound's second TULSA AI module, which received FDA 510(k) clearance in May. Since its release, early physician feedback in the form of post-treatment surveys has confirmed that prostate segmentation with the TULSA AI module had excellent accuracy in real-world cases with decreased treatment planning time. In fact, in nearly all cases, urologists reported that Contouring Assistant improved the accuracy of their treatment plan information that we're planning to publish in conference presentations later this year. I would like to now shift focus to reimbursement and highlight some of the key aspects of the new TULSA category one CPT codes included in the proposed rules issued last month by the U.S. Centers for Medicare and Medicaid Services, or CMS, for short. These new codes have been designed to reflect the unique aspects of the TULSA procedure with respect to location of service, number of physicians performing the procedure, and intensity of post-procedure follow-up visits. First, the TULSA codes have been approved for use in all locations of service. That means TULSA can be performed and billed in hospitals, ambulatory surgical centers, or ASCs, and interestingly, within the physician-owned non-facility setting, which includes office-based lab or OBL, a physician office, a lugpa office, or an imaging center. The spectrum of location of service provides not only a broad install-based opportunity but also allows for maximum patient access and physician preference. The proposed rule has established TULSA as a level six Urology APC, with the hospital national average Medicare payment just over $9,200, which is on par with all other comparative prostate cancer procedures. However, with TULSA's faster intra-service time, the payment rate per hour within a hospital will actually be similar, if not better, to comparable procedures. Additionally, within the ASC environment, the proposed national average Medicare payment for TULSA of $7,195 has been set significantly higher than the $4,715 assigned to another longer ablative procedure. In the non-facility setting, the proposed equivalent national average Medicare payment for TULSA is even higher at over $9,400, which creates a unique and interesting opportunity within the physician-owned office setting. Second, the TULSA codes have been designed to optimize physician time for maximum efficiency. Unlike other comparable procedures, three TULSA codes enable the procedure to be performed entirely by one physician or two physicians working together from different or the same specialty. These physicians can share the procedure and bill for their own work performed, optimizing their RVUs per hour. The third key point is the zero-day global assigned to the TULSA procedure, which is unlike any other comparable prostate procedure that includes a 90-day global period. This allows flexibility for physicians to bill separately any additional services for each patient visit following the TULSA procedure at the appropriate level, based on E&M guidelines. Complex visits can be billed at a higher level, and this mitigates risks of variable or complicated patient follow-up demands that a 90-day global code creates. Following the publication of the proposed rule, CMS is accepting comments until September 9. They will then issue a final rule, likely in November this year, before the new codes and payment rates go into effect on January 1, 2025. Finally, with the new CPT codes becoming effective in 2025, I wanted to provide an update on our ongoing CAPTAIN study, designed to support positive coverage from private payers in the US. The CAPTAIN trial is the first and only level one study comparing head to head a new technology to robotic radical prostatectomy. It is powered to demonstrate non-inferior efficacy with superior quality of life outcomes such as urinary incontinence, sexual function, and penile length, among others. We continue to see strong interest in joining the study, given the high level of impact it is expected to have on the urology community. In the last quarter, we have onboarded three additional sites, including Stanford and the Mayo Clinic, adding to the top hospitals in the world participating in CAPTAIN. We are pleased to reaffirm that the rate of recruitment remains well-positioned to complete enrollment of the CAPTAIN study this year.

Thanks, Mathieu, and good afternoon everyone. Our message remains clear as we approach 2025 when we will start competing on a level playing field with respect to reimbursement. TULSA increasingly has the potential of becoming a mainstream treatment modality across the entire prostate disease spectrum, ranging from low, intermediate, or high-risk prostate cancer to hybrid patients suffering from both prostate cancer and BPH to men with BPH only, and also to patients requiring salvage therapy for radio-recurrent, localized prostate cancer. There are several reasons driving our confidence, which I would like to highlight. TULSA is an incision and radiation-free 'one and done' procedure performed in a single session that takes a few hours. Virtually all prostate shapes and sizes can be safely, effectively, and efficiently treated with TULSA. There is no bleeding associated with the procedure. No hospital stay is required, and most TULSA patients report a quick recovery to their normal routine. Also, the TULSA procedure is done with real-time imaging in the context of pixel-by-pixel precision. While some thought that might pose a unique challenge when we first introduced the technology to the market, it is now quickly evolving into one of TULSA's most distinct advantages. MR guidance allows for real-time temperature measurement and automated control to preserve prostate disease patients' urinary continence and sexual function while killing the targeted prostate tissue we at TULSA's sound absorption technology that safely and gently heats it to a temperature between 55 to 57 degrees. By the way, that's not just what the clinical evidence shows; it's what TULSA patients are saying. As we discussed in the past, the use of MRI is steadily growing in urology as clinical evidence continues to point to the benefits of MRI imaging, from early patient screening to diagnosing and treating with TULSA. Accordingly, we are now forging even closer relationships with the three major MRI companies to go beyond compatibility of our respective technologies and help maximize the tremendous opportunities that we see ahead to further support this modern treatment pathway. In addition, we continue to innovate with two of the main goals of increasing treatment efficacy and improving workflow efficiency. On that front, we are continuing development work on the third planned TULSA AI module, TULSA BPH; more details on that will be provided later this year. Finally, as you all know, adequate reimbursement is essential to drive forward physician adoption. Mathieu walked you through the proposed CMS rules for TULSA, so I won't repeat this information. However, I think it's fair and appropriate to highlight a couple of factors that we think should help TULSA become a mainstream treatment once reimbursement starts next year. First, while TULSA and radical prostatectomy will provide similar revenues to hospitals, we believe TULSA will be more profitable for them right away. It's often said that a first receipt, and especially a robotic receipt, is the most expensive real estate in the world. It costs, on average, around $3,000 an hour for a hospital to operate a surgery suite, versus around $800 an hour for an MR suite. Also, as I mentioned earlier, TULSA is a same-day procedure that doesn't require a hospital stay for recovery, unlike radical prostatectomy. So TULSA potentially represents a lot of cost savings for a hospital on that basis alone. Second, unlike TULSA, radical prostatectomy cannot be performed and is not reimbursed in a wide spectrum of treatment settings outside of the hospital, such as ASCs, OBL, a physician's office, a lugpa office, or an imaging center. So while we are working with our major MRI company partners to improve the treatment experience for urologists and their patients to ensure health can be readily accessed in the most suitable setting, the same cannot be said for radical prostatectomy, and as we help drive the migration of interventional MRI from radiology to the surgical department of hospitals, we will be coming to face them while they cannot come to us. To summarize, we continue to believe TULSA has the potential to become a mainstream treatment modality across the entire prostate disease spectrum. Patient enrollment in the CAPTAIN post-market study comparing TULSA to radical prostatectomy is progressing as planned. We will provide more details on our next TULSA AI module, TULSA BPH, later this year. We remain on track to grow our TULSA flow install rate to 275 systems this year. We look forward to competing with other cancer treatment modalities on a level reimbursement playing field for the first time, starting in January. This and our prepared remarks for today. With that, we are happy to take any questions you might have.

Let me start off with reimbursement. Obviously, this is a clear and compelling step forward. I guess a couple of questions. Maybe you'll expand on your Mathieu's excellent comments and yours several things. One, what kind of reaction are you getting from the physician community, from existing customers, and from potential customers? Are they talking us through? Is this accelerating discussions already, or will you have? Are people saying, no, let's talk once the rule is final, just some color around there, and maybe as well, talk about how you're getting prepared for what clearly will be a meaningfully more compelling reimbursement environment from a sales and marketing standpoint.

Yeah, Rick. Look, those are great questions. So I think since the proposal have come out, we have been talking with our physician community, and I can certainly already speak in general terms. So the first thing that they are all very appreciative of is the flexibility that this treatment can be used can be done in almost any setting. And so they're kind of now thinking about, 'Okay, do I do this at an imaging center, or do I go back to my hospital and have them establish it? Or if I do it, for example, in an office setting, have my own equipment. Can I now participate both on the physician payment side as well as the technical payment side, also on that equation?' So I think that flexibility that we talked about, that Mathieu and I talked about, is actually being well received. The second part of the message that I think people are starting to grasp onto is the fact that when we look at this from the perspective of dollars per hour or profitability overall. I think that the numbers actually can come out a little bit better for TULSA in those situations. And so, I think that a number of them are going through the numbers with us, but I think the general feedback is that there are going to be certain situations where they're going to be strong wins. So I can give you a couple of actually good examples. So if we look at our private urology practice, OBL, for example, the even the Medicare patient payment, there will be $9,800 national average, and if commercial payments are typically 1.5x of Medicare, you're looking at $14,700 or close to $15,000. So I think as we look at the landscape, there are going to be certain situations where there is going to be a clear win for TULSA from an economic perspective. Most people are prepared to talk at the proposal level and not waiting for the final rule to come out. Our team is in the market, talking with the physicians already. With respect to your second question on how are we preparing for it? I think we are, at the moment, visiting with our physicians. We have reengaged with the pipeline, which we feel very good about, and that we can now begin to justify the adoption or acquisition of the new device based upon 2025 numbers and so on. So we are in that process at the moment. We do think that we will need to add more salespeople, so we're starting to figure out exactly how and what locations, and we want to do that also, so that part is a little bit earlier stage, but we're absolutely preparing for it.

Another question, maybe the shorter term, you reiterated your goal of 75 systems by year-end, maybe help us better understand your line of sight. That's a big step up from the kind of when you think of as a third or fourth quarter run rates. Again, why are you so confident?

Yeah, obviously, we completely get the fact that this is a big step up in the second half of this year for us, but in the second quarter certainly. And I think, you know, in the earlier presentation this year, I sort of alluded to the fact that this is going to be a unique year for us as we transition to the reimbursement model as compared to cash pay models. I think that what we did see in the second quarter was people were saying, 'Well, you're only a couple of months away from getting the proposal. Let me see just to be sure that we're going to be okay.' So I think we did see that, but we have not only not lost the pipeline; we are actually seeing them even more engaged now that the proposed rule is out, and so the first team is pretty confident, and that's the basis that we felt that we should reiterate the guidance.

Just one last one for me. You talked sort of intriguingly. I think it's the first time I'm hearing you say that you're forging closer, even closer, I think were your words relationships with the three major MRI companies. Maybe you could just dig deeper a little bit there. What are you hoping for? What should we expect from all that? And is that something that's going to take years or something sooner? Just help us better understand what you're working toward. Thank you.

As I said in the prepared remarks, the fact that we use MRI originally was concerning, you know, is there, are they going to really use an MRI or not? But I think with the clinical data and the fact that a number of physicians have now actually used the procedure, I think they see the value of the MRI. They see the fact that this gentle heating, that heating tissue only to kill temperature, that continuous ability to monitor the temperature or make adjustments in the treatment plan if needed. And then with the TULSA AI module that was recently cleared because we have high-quality MRI images, we were able to develop it. I think the first thing that has happened is people now get it. They think that this is not a difficulty. This is something that really adds value to treatment and patient care. And I think based upon that, a number of companies are now also developing real-time in-bore biopsy procedures. So there are multiple companies that are saying, 'Hey, we can do in-bore biopsies', and they can be done in a very timely manner compared to historically, where they've taken a lot longer. The whole idea that we can use MR to screen patients, diagnose patients, maybe in-bore biopsy, and then treat patients is starting to really catch on. The MRI companies, this is very synergistic to the MRI companies. They are working with us to determine what is intervention MRI as compared to diagnostic MRI. An interventional MRI would be a mid-range magnet, rather than a 1.5 Tesla; it will be a 0.55 Tesla magnet, where we can use AI technologies to provide the same high-quality images. But we can also provide practical things where a surgeon can literally walk into the MRI and literally put their hand inside, and they can actually do interventions. Siemens has already announced that product. They are already publicly announced a leasing model for that product, and I think the synergy is what I'm talking about. You will hear from these companies later this year, and I think we will hear about it in our RSNA this year and at our own conference earlier this year that our product, the biopsies, the diagnostic images, and the treatment are all coming together, and you'll see multiple companies supporting this effort.

Just maybe following up a little bit on Rick's questions there and the relationships that you're forming with the MRI firms out there, what has kind of been their reaction to the proposed reimbursement? Isn't that something that kind of raises a flag for them?

Yeah. Ben, I mean, generally speaking, I think people expected that if we could level the playing field and the fact that we have a lower cost system in place, that we're going to be in decent place. When these companies are looking at how do we justify an MRI-centric prostate care strategy? They're looking at it and saying, 'Okay, we already have reimbursement for diagnosis. We already have reimbursement for biopsy. Now there is a level playing field for reimbursement for the TULSA procedure.' So they are basically looking at it and saying this adds to their ability to justify it financially, using all of these together. There are a number of ASCs, OBLs, or lugpads that have historically expressed interest in owning MRIs, and so when you combine all of this together, I think we can put it across the finish line towards a financial model that can justify it. This is how these MRI companies are looking, saying this adds to their ability to have full control of the patient from beginning to end, which means better care for the patient.

Okay, that's helpful. And then on the lugpads specifically, do they look at it and say, 'Well, yeah, the Medicare reimbursement looks fine to me, but I really need the commercial patients to be able to make this work,' or how do they tend to think about that to the extent that you can share?

Yeah, no. I mean, we've already been in extensive dialogue, and so I think we will have to come up with explicit, customized models for different situations. I do think that, to the way you're describing it, is in the realm of possibilities, is that they might want to pick, for example, for insurance patients where the payment is pretty good. If the ASC or the lugpad are owned by the physicians where they have the ability to get reimbursement from both sides of the payment equation, they're likely to take the private payers to those sites, and the Medicare patients typically go to the hospitals. You will see that as the economic models get developed further; I think you will be able to see that there are certain types of patients that they will take to one site where it can be more profitable, and another type of patient they can take to another site where that can be profitable also. The hospital will want to see adoption, because to a hospital, they are losing money on a Medicare patient. If we can show that they can actually break even or make some money on a Medicare patient, that's a win for them, in fact, also. They already have robotics well utilized, so they already have enough of a patient population to use the robot, and if they make some space for that by using the MRI for our procedure, they're actually making money or at least breaking even on the TULSA procedures and making money on the other procedures that go on the robot. It's not going to be a simple equation, but there are going to be plenty of different ways to demonstrate economic value here and we're quite excited about that.

Okay, that makes a lot of sense. I appreciate the color there. Well, that's it for me. Just on the TULSA AI clearances that you have now. I mean, it seems like both thermal boost and contour assist are kind of competent boosters for clinicians, but can you share maybe how much time Contouring Assistant will take off of a procedure? I mean, is that 10, 20, 30 minutes? What does that look like? And then anything more that you can share on the adoption so far of both thermal boost and contour assistant? among the folks that have it available to them?

Yes. Ben, absolutely. The thermal boost, you know, we explicitly talk about the wide variety of patients that are treated, and you heard that from Mathieu already. The thermal boost is one of the reasons why we are seeing these later stage treatments happening with TULSA, because they feel very confident that, 'Hey, if there is a little protuberance of the cancer at the outer edge, they can blast that region. Or if they suspect that there is some involvement to the muscle, they are able to blast into that region.' The latest statistic is about 50% of the patients being treated thermal boost is being used.

Yes, that's correct. About 50% of the treatments we see the use of thermal boost, at least for a portion of the treatment plan.

Highly valued. And then on the AI side, the majority of our sites now already have the AI; I would say about a third to maybe more than a third have already used it to treat patients. The initial feedback is quite positive, as we anticipated. There are two things that we're hearing. One is that the treatment designs are very smooth; they like the smoothness of the way the treatment designs are proposed, and the confidence that is coming from patients who were successfully treated in the past. The second thing we're hearing is definitely it is saving time in all these procedures. Our goal will actually be to present data as we get statistically significant information. We think the best way to put it is that ultimately, if they're doing two cases in a day, they will be able to do three. If they're doing three in a day, they will be able to do four. If they're doing four, they'll be able to do five. To me, that's the biggest benefit of this, in the sense that in about the same amount of time, they'll actually be able to do more cases, which speaks to the pocketbook and their whole workflow, their whole day. You will see; I think per procedure time, certainly, it will be several minutes, but I think procedures per day will see an increase, and that's going to be valuable to them.

So Rick and Ben did a perfect job asking many of the clarifying questions. So maybe I'll ask something about as you scale. So Arun, you were just talking about the docs going from one to two to three to four patients a day. Perhaps you could give us a little more clarity in terms of how the three codes can be leveraged for docs to potentially stack procedures and essentially increase the profitability per unit time, either by using residents or just creating efficiency in the system to make it more profitable for them.

Yeah, Rahul, I'm happy to. As I was saying before, the flexibility and the fact that we have multiple codes allows each site to determine what is the best way or the most effective and efficient way for them to treat the patient. If I'm a teaching site and I have a resident, I could have the resident do the initial workup of the patient, which will include putting the patient on the MR table, inserting the catheters, attaching the table to the MR suite, being with the patient during the time they're being anesthetized, and that we call medical device management; a resident could easily do that. The primary physician could then come in at the time when they need to start the treatment planning, which now is AI-based, but they can start to do the treatment planning. They can stay for the treatment itself, which from beginning to end, is based upon the CMS numbers, is less than 90 minutes total time for the physician. Then they can leave, and the resident could come back to unhook the patient's table and go with the patient to wake him up and remove the catheters. This is an efficient process. It brings the primary physician only for the core part of the procedure. It would be less than 90 minutes. If they do that, the resident could be using the medical device code, and the physician could be using the treatment part of the code; per hour basis will be almost nearly double or certainly 50% to 70% better. That’s just one example. In another setting, you could have a urologist and a radiologist both sharing the procedure. This is also why we talk about the number of patients per day rather than the time per procedure. Those are a couple of examples of how they will be able to use these codes to optimize the workflow that will be most efficient for them.

And so perhaps continuing on this theme and broadening into BPH. So sort of a two-part question. One, is there any update on Profound's aspirations around BPH? And very specifically, are the codes that are currently issued applicable in BPH, and how do you see the BPH strategy playing out, particularly, again, in this procedure stacking scenario?

Sure, yes. So great questions, Rahul. With respect to BPH, we kind of see ourselves in steps also. So the starting step for us is to focus on those patients where the prostate is larger than 100 CC and/or they have not only BPH, but they might also have some form of early stage disease. That patient would particularly benefit from our therapy, those that group of patients, because if they have large prostates, we can still treat them very quickly and we can basically ablate the transition zone and in some cases the median lobe if it is needed and still we can be relatively fast procedure for them. Because our prostates shrink, we're shrinking a very large prostate, and we think that should lead to durability over time. The codes currently issued allow for ablation of prostate tissue, so we will confirm it in the end, but at the moment, we think these codes should be good to go. We not only have momentum towards a reimbursement-based model, but we also think that we will introduce the BPH module as well.

And I'll just flip in one quick last question, and then will get back in the queue. Given all the talents we talked about today, how is the Profound team feeling? What is the sentiment in the company?

I mean, you know, the Profound team, I think the senior team has really gelled nicely. I think the goals are crystal clear for us. We know what we need to do. The general mood of the team at pretty much every level is, 'Let's go get this done,' and I feel pretty good about that.

Just to start, you know, just on the non-recurring non-capital revenue. It looks like that was down year-over-year, and maybe flat versus the prior quarter. Maybe just talk about what you saw in the quarter there. And then maybe give us some color on TULSA utilization or procedure growth for the quarter.

Revenue comparing to the year-over-year, I think we were 39%; the number of patients that we treated in Q1 is higher than the number of patients we treated in Q2. As I've said before, the fluctuation that you see in dollars is in thousands of dollars, and it more relates to shipment of the product to the sites as compared to the number of patients being treated. Capital revenues are coming in this year because more hospitals are saying, 'We do have funds for products like these.' Now that the reimbursement picture is becoming even clearer, I think you will continue to see this mix changing.

Understood. That's helpful. Thanks, Arun. And then, you added four TULSAs to the base in the quarter. Can you give us any color on how that broke out between capital sales versus just pure placements?

I think most of these are placements today for now. As I was saying before, I think in the second quarter, we did see that, you know, we weren't sure how this year was going to unfold. To some extent because of the reimbursement news being the 800-pound gorilla, and I think in the second quarter, we did see a little bit of that discussion with the hospital to say, 'Let me just wait until I get at least the proposed rule out before I sign on the dotted line.' But majority of the 2024 will still be placement-based. The placements will convert into capital as they start using it, and once they develop the economic models, I think you will start to see them convert so that they can reduce their per-case cost.

Most of the questions have kind of already been asked, but just following up on the last one around capital revenue. Because you did have, I think it was 700,000 plus this quarter in revenue from capital equipment. So is that, you know, sales in Europe or elsewhere, versus as kind of you're alluding to before, capital placement models?

It is a North American sale. For Europe or Asia, we would break it out but this is a North American sale.

Let's call it this river shed. So like it's already detailed in our segment report. If you look at our financial statements, it shows under North America.

I know it's not really fair to ask about procedures per day with real reimbursement yet, but your highest level users, maybe your top four or five guys or gals. How many procedures are they doing per day now? And where do they think those procedures per day will move to once reimbursement begins?

Very good question, Brian. We have, Mathieu, what 8% of the sites are doing four procedures per day already?

Yes, that's about right.

About 25% of the population is doing three to four procedures per day already. We think once this AI is fully in place, nearly every site will be able to increase one more patient. Our expectation is that we think we can provide up to a 20% advantage in terms of time.

That'd be great. On the MRIs and expanding relationships are the 0.55 Tesla interventional MRIs. Are they easier to install and operate, and what does it take for a facility to install a regular MRI today versus installing one of these interventional MRIs?

So Brian, today's MRIs typically are 1.5 to 3 Tesla, and they use a lot of helium. Hospitals typically put them on their main floor or their basement floor, because they weigh something in the order of 30,000 pounds, and they will require, especially rebuilding the foundation of the floor. The 0.55 Tesla counterparts weigh about 8,000 pounds, and with that less weight, they can actually replace them in the room of any operating room. The magnetism does not require significant shielding, which saves a lot of money in installation costs. And the reality is that physicians can literally stay in the MRI suite during the procedure because there's no issue related to magnetism. These advantages lead to a compelling proposition.

Okay, so this should be a big deal for adoption of these new systems, which in turn will directly benefit this whole continuum of MR prostate diagnosis, treatment, and post-treatment visualization that you guys have talked about for the last year or two.

That's exactly where we're going. That's exactly right. This is why I think MR companies have invested a lot of money to commercialize this type of product, because they see that whole thing sort of converging towards an MR-centric prostate care strategy.

Okay, last one for me, you mentioned the commercial reimbursement was higher than CMS patients. And I guess the one thing I didn't realize, and maybe you can expand on this, is that today, radical prostatectomy doing CMS patients is not profitable for a hospital system?

That's right. Doing robotic prostatectomy in a typical hospital does not pay enough to cover the cost of the hospital; it may actually lose money doing it. We think that with our reimbursement working, and the fact that there's a lower MR suite, and the fact that there's no hospital stay, we can show them a model that, in the worst case, will break even for even the lower cost hospitals.

So at a minimum, you should get a lot of the Medicare patients as your patients in the future, assuming they can figure out this MRI logjam?

That's exactly right. We are in dialogue with them to confirm everything. We want to make sure they can use their own data to see what we are describing to them. Based on the numbers that we see, we think this makes sense, and it will make sense for the hospital to make that transition.

And this does conclude the question and answer session. I would now like to turn it back to Dr. Menawat for closing remarks.

Thank you so much, and thank you for the vibrant questions. We're really looking forward to providing another significant update at the Q3 call. Thank you.

Thank you for your participation in today's conference. This does conclude the program. You may now disconnect.