Peter Nyquist   Head of Investor Relations

Hi, everyone, and welcome to the Elekta Investor Update 2025, both in the audience here in Stockholm and you online. And I did it because once I start -- when -- I worked at Ericsson before, and I moved from my previous job at Electrolux. And I moved to Ericsson, and I opened the Capital Market Day at Ericsson. That was about 15 years old -- 15 years ago. And I said, welcome to the Electrolux Capital Market Day. But I didn't do it wrong this time. So I had it.

So welcome to Elekta's Capital Market Day. It's great to see all of you here. So my name is Peter Nyquist. And I've been heading up Investor Relations here for -- since March last year. Before that, obviously worked for Ericsson and, before that, Electrolux and a number of other Swedish blue-chip companies.

And there are, which I think is interesting, a lot of interesting resemblance when you look at a company like Ericsson and Elekta. It is really tech to start with, but it's driven by 2 things. If you look at valuation, it's driven by R&D. It's driven by recurring software revenues. And as you're going to hear today, these are topics and items that will be brought forward to you throughout the day in different presentations.

So a little bit, we were supposed to have a full-loaded CMD here. But clearly, with the changes in management, we decided instead to have an investor update. And the purpose today is not really to present new financial targets or update a strategy. It's more to go through events that we have taking place in Elekta right now. It's a lot of things that is happening, and you will hear that as well today.

So we will have a main session that is both in person here at Medicinska Föreningen, Stockholm, and the sun is shining for you online. And there is also people online. So that's the main session. After the main session, we will move over to our head office, Forskaren, for 3 deep dives, which I know some of you here will follow us to do. And I will give you more details about that later on.

But I would like to start with some reflections, some feedback that I have received. And I think Martin together with my team and Jonas and Tobias, when we have met investors not just only recently, but at the last months here. I think there are a couple of things that always comes back. And one is really that the gross margin we presented here in Q4 that is improving is not sustainable. I think you will see today, not at least in Tobias' presentation, a clear bridge how we actually return to prepandemic level plus 40% in gross margin through volume growth, through price increases, mix improvements and productivity. So that's going to be important in today's presentations.

Another thing that comes back, which I understand, is really the launch of Evo, in particular U.S. that the delay we have now with FDA will jeopardize the whole strategy in U.S. for Elekta. But I think what you will see here today, we have control over that process. Jonas will talk about it shortly. But also it's not only Evo in U.S. It's not only linacs in the U.S. We have a very profitable and growing business through our Brachy, Neuro and software business, and we'll come back to that as well during the day.

But -- and also remember, which I think is important, we had the best Q4 gross margin ever in the history of Elekta without having a U.S. business performing. I think that's important. And even more important maybe, wherever Evo has been launched, in particular in Europe, it is a success. So remember that.

Another thing that comes back in discussions we do have is the future of the software business. It's not going to be sustainable. You're not going to see that growing. But I think you're going to -- today, both here and the deep dives that we're going to have later on, you're going to understand the traction we have with Elekta ONE right now.

And also coming back again, which is very important, is really that we had 20% growth revenue software last year. A lot of that happened in Q4. So I think that also provides you with a good development this year.

Another thing, I think it's been highlighted today, it's the order review that we have done. We have a lot of discussions with investors. They have questioned the quality of the order book. And we present today a review of the order book. And the purpose with that is to cancel nonaccretive orders to increase the profitability of Elekta but also increase the forecastability so we know what's going to happen going forward.

So I think that's important, and we're going to have a lot of things about -- Tobias is talking about that. Habib will talk about that, how we've done that and how it looks like.

So coming back to -- I think I need a pointer, Tobias. So if you don't want to -- here. Coming back to today's event. So we will start then with introduction from me. Jonas will enter the stage after me here. And then Tobias, he's going to be the third speaker. Then we have a short break, a coffee break, for about 15 minutes.

We will then continue with the commercial execution, where order books will one of the topics, but also the strategy in U.S. with Habib Nehme, who's going to talk as our Chief Commercial Officer about the strategy. We're going to have Ardie Ermers from Seattle. So he's not going to be here, so we're going to connect him, and he will talk about Americas. And then we'll move to personalization and productivity, to the product side, and where we have Christopher Busch talking about software solutions for -- or Linac and Software solutions. And then we have John Lapré, who is the President of Brachy in Europe. Then we'll have Q&A. And then we have a few closing remarks by Jonas as we end this.

And just before I hand over to you, Jonas, we'll start the second part of this session at 16:20, back again, as I said, at Forskaren. We will have 3 deep dives, one about software, with Anish Patankar, who is the Head of Software. We will have one called Clinical Development of Elekta Unity with John Christodouleas, who is here in the audience, I think, as well. And then we will have the possibility to visit our Gamma Knife that we have in the building, which will be led by Head of Neuro, Caroline Leksell Cooke. And then we will end the day with mingle and dinner.

So that's it for today from my side and introductions. With that, I would like to hand over the word to Jonas. And I guess you need this.

Jonas Bolander   Acting President & CEO

Yes, please. Thank you, Peter. So warmly welcome, everyone, and warmly welcome, the participants online as well. And I would then, as CEO, like to kick off this meeting.

So we are here at Medicinska Föreningen, and we will soon transition to our relatively new office. We've been in this office for 1.5 years, and I'm really looking forward to show you the office for the ones that haven't been there. So I hope that you will be able to join us.

Then a bit of news from yesterday. So the Board has conducted their search process and finalized that yesterday evening. And I guess you have all seen the announcement. It's been my privilege to be part of that process, and I'm super pleased that Jakob is able to join us. I think he is a great fit for Elekta. First of all, his track record, really driving a profitable business. But also from a culture perspective, it's a very, very good fit for the company. I'm feeling super comfortable with having him in the leader seat there.

Then a few words of the team presenting here. First, myself, I have met some of you, but not all of you. I've been with the company for 20 years and have been in different roles in the company. I've been -- I'm a trained lawyer from the start. And then I've been heading a large number of corporate functions in my latest role. I know Elekta. I know the products inside out. I know maybe at least half of the employees in person. I know many of the customers. I know the challenges that we have had over the years, and I also know our strength.

Then we will have Tobias during the financial update. And I think most of you have met Tobias. And then as we said before, we will focus a bit on commercial execution with Habib and Ardie presenting. And then we will focus more on the product side with John and Christopher presenting. And Christopher, take a few minutes with him. He has been -- he's relatively new in his role, but not new at Elekta. I'm super pleased to work with Christopher. It's going very, very well, with great focus on deliverables and the product road map.

So first of all, going a bit back in the history. And this is basically a reiteration of the earnings call. So we are very, very proud of this and very pleased with this. I think someone said that no one really expected that for the fourth quarter, of you. We have a very strong gross margin. That is -- I'm particularly proud of that. I think it's -- as Peter said, it's the strongest gross margin since 2017. And there, you see that the programs that we implemented, the price increases, the product mix and the new products and so on are really starting to bite. So we see a great improvement there.

And then, of course, the launch of Elekta Evo and Elekta ONE, we see a large momentum of those products, in particular, in Europe, where it's being launched in all European countries. And now we launched it in market after market after market. Then Tobias will come back a bit and talk about the impairment and so on that we took as part of -- at the other side of my job, so to say, the cleaning part of the job.

This is a slide that we also showed on the earnings call. The objective of this slide is to put tariff exposure a bit into perspective. China, we have a very, very local business in China. We manufacture all our products in China. The linacs, we have software development in China. We have Brachy and Neuro products in China. The exposure is very limited. We export some parts from China to the U.S. and to Europe, but very, very limited.

And then if you look at the exposure in the U.S., you kind of could split the business there in the U.S. in 3 parts. One part is service, very local, local labor and so on, dependent on spare parts that are imported, but anyway for quite nominal value considering a service contract and so on. Then you have a software business in the U.S., which is completely local in the U.S. And then finally, you have the devices in the -- that are imported into the U.S., predominantly then from the U.K. where you have a set tariff of 10%. And also good for you to know is that the tariff is applied on the transfer price of the product. So that is -- limits our exposure quite significantly.

Then we have Gamma Knife from Sweden. However, the cobalt comes from Canada that is exempt from tariffs. You have the Brachy afterloaders coming out of Veenendaal in Holland. So that is a bit to give you some more information on how we look at tariffs and so on. Of course, this is something that we work with on a daily basis because as you have seen, it's a kind of moving target.

The outlook, you saw that on the earnings call. It's unchanged for the year. You see that Q1, it's not a huge quarter for Elekta. The volumes are not as significant as in the fourth quarter. And we have some on cost in the first quarter and also some FX effects, meaning that you can't just extrapolate -- I think most of you knew that anyway. You can't just extrapolate Q4 on Q1.

Full year, we're kind of bullish for the full year. We believe that we have our business under control. We will handle these conditions, and we put great trust in our price increases and the new product launches.

And then you have the midterm guidance, with 14% EBIT and prepandemic levels. Prepandemic levels could or should mean over 40% with respect to gross margin.

This is one slide that I would like to spend some time. It's actually my favorite slide in the pack here. So what are we trying to say here? We say that we operate in a financially very, very sound environment. This is kind of -- it's a very attractive industry. If you look at this, we are working in a growing market. Many persons today, they don't get cancer only once in life. They may get it twice or 3 times. Scanning is getting better and so on. So the underlying market is constantly growing.

We are working in a very, very consolidated market. On the linacs side, it's basically a duopoly. It's we and Siemens Healthineers. And on the Brachy and Neuro side, we are clear market leaders in those segments as well. If you look at Brachy, very consolidated. Gamma Knife, yes, we're basically alone, even though there are some new entrants and so on coming into that market.

It's not that easy to start a company in this market. The barriers to entrance are enormously high. First of all, it's quite complicated products that we work with, with high safety requirements. And also the regulatory hurdles to get into the market is enormously high, with large demands on the quality system, with large demands on regulatory filings and so on.

Then if you look at the business as such, it's a bit of an asset-light business. That's a bit of a mind shift as well. We look at our installed base. We look at our service, our software and our capability to upsell to the pretty large installed base. I will show you a slide on that later. And finally, going to the installed base here with, as I mentioned, pretty large possibilities to upsell to it.

And then -- so what have we done then? And we haven't been sitting still. We -- as you have heard, we have reviewed our balance sheet and looked at our capitalized R&D. Tobias will tell you a bit more about that. You also saw it today that we have reviewed our order book quite significantly.

And what is the purpose of that going through every order that we have there and so on? It's to make sure that the orders are profitable. That's why we review the orders. We have a quite long time between order intake and revenue. We need to make sure that the orders we have in our backlog are profitable. Hence, the order review. And then we haven't been able to cancel out everything. So there maybe still some orders because it's binding and so on. But the orders we've been able to attack, we have attacked them.

And then, of course, leverage on our R&D investment, which I sell a bit -- I said a bit before, to leverage on our upgrades, our software, our services. And also what is good for you to know is that we see a bit of a shift in the company. Christopher will come to that. It's less big iron today. It's way much more incremental development, smaller upgrade orders, smaller capabilities, smaller SaaS offerings and so on to upsell to the installed base.

And then, of course, profit and growth. Evo and Iris, product mix improvement, completely established a new price segment for the products, enormously efficient to launch new products with new functionality in the market. And then, of course, to leverage our strong -- we are really strong in Neuro and Brachy and to leverage that market leader position. And it's high-margin segments as well.

Then, of course, we have constantly worked with price increases. There is more to do, and we are constantly monitoring it. We're working to increase prices. We implemented -- implementing price controls and so on. And it's a bit culture shift in the company as well. Today, we take profitable orders. We don't take unprofitable orders. Growing the market is not everything for us.

And then as Peter said then, we have changed our submission strategy in the U.S. Together with the FDA, we have discussed it through and then have come to a conclusion to change the strategy because it will go faster with the new strategy rather than the old one. So we have done that now. And we, knock on wood, hope to get approval, yes, some time after the FDA has reviewed our submission there.

Also, a bit like Peter said, we delivered very, very strong quarter, but we don't have Evo approved in the U.S. It's a bit icing on the cake, as I see it. Then hopefully, we can get the same traction that we have in Europe with Evo launched in the U.S.

So this is the strategy that we've been living with for quite a while. We end that strategy now and going into more an interim year. It wouldn't be fair to launch a new strategy when we have a new CEO joining the company and so on. So now we have an interim strategy. But first, I would like to close off the 2025 strategy a bit and tell you a bit of what we have gained out of that strategy.

So first of all, we have spent a lot of time and a lot of money to develop our products. And now we have a really solid foundation. We are adaptive across all our product segment, leading to quite much more efficient treatment, less off time and, of course, a huge patient benefit as well that doesn't have to go back and forth through the clinic and so on. So very much directed towards efficiency, shortening treatment's time and so on. You will see a bit of that when we go back to Forskaren. And then also, I would like to iterate again, smaller incremental development projects with the capability to upsell to the installed base.

This is also a good slide. So here, you see, it kind of separates us a bit from competition and so on. Here, you see a cancer clinic as we would prefer to see a cancer clinic. Not every clinic looks like it, but some does. And here, you see that we cover the entire spectrum in the cancer clinic. And you have it from the cloud solutions that we provide, the Brachy therapy solutions that we provide. You have the patient handling, the oncology informatics system and then, of course, the treatment modalities with Elekta Esprit, our Gamma Knife, our new product Elekta Evo, Harmony, which is more throughput product and so on and then, of course, the gold standard for adaptive, Elekta Unity.

This is another key takeaway from our ACCESS 2025 strategy. It provided us with a huge installed base, that same installed base now where we have possibilities to use that to upsell and upgrade.

Then to focus a bit on what we call the interim strategy. This is what we will work with during my tenure and during this year. So really, really strong focus on profitability and the transaction. We just get rid of everything else with strong focus from the company, and we control what we can control. We -- as I mentioned, we increased our focus on profitability, profitable markets. And then, of course, driving price increases, which is necessary in this landscape that we have around us today. And that will then get us to the prepandemic level and an EBIT margin of 14%.

Tobias Hagglov   CFO

Hello, everyone. A big warm welcome here to Stockholm again. I'm third presenter saying that. My name is Tobias Hägglöv. I've been running as the CFO in Elekta here for the last 3.5 years. I have, throughout my career, spent my time in various leading roles within finance. And all of my recent roles, both as CFO as well as group controller for sizable companies, we have been able to deliver a margin expansion. And I'm absolutely convinced that we can do that here in Elekta as well.

You heard here from Jonas and Peter, we're coming out really strong from Q4. We delivered the highest gross margin for being in Q4 for the last 5 years. And maybe more important, which I think you alluded a bit to, Jonas, was that it was not a coincidence. It was based on our strategy. It was based on what we want to do. And today, I will share some more light on this and how we think moving ahead to drive the margin forward.

I will then cover here in 3 blocks. I will start here what I just mentioned, talk about how to improve the profitability and the emphasis and importance of a gross margin expansion. Then I will talk about R&D and the balance sheet. And I will end up here with some findings about capital allocations and how we think upon that.

So starting here with how to improve profitability. Firstly, I would like to echo here what Jonas said. This is a good industry to operate in. It's a growing industry. It's a consolidated industry with a few players. We also see here that just as Jonas mentioned, that the barriers to entry are high: regulatory aspects, safety aspects, technological aspects. And also when -- from a commercial point of view, that you as a customer, if you have chosen an Elekta solution, you actually tend to choose an Elekta solution again.

With that said, our gross margin development here over the years have not been favorable. We have seen a deterioration here over the year. And even though you might say that from somewhere '21, '22, it has been relatively stable, it's still not good enough. And clearly, when we look at ourselves, we see we need to improve from here, and that, we will do. And I think from the presentations today, you will also find why Elekta is better equipped to do this than what we have been over the last years.

One important aspect is here that -- and we will talk about R&D, but there has been a need for product development, for shaping up our competitive edge, both in terms of market position, but also being able to get the value here in terms of higher prices from our customers.

The gross margin development here has also been a consequence of that Elekta has very successfully been able to broaden installed base and really capture the growth in emerging markets, a lot of greenfield where the price points have been lower.

It has also, as you see here on the slide, been that we were hit first by supply chain challenges, followed by high inflation, especially on niche components into our products, where we did not really fully compensate this by rolling it over to the customers in the form of price increases. However, looking where we are now and, again, coming back to Q4, we see this as a major step to bring back the financial development to a place where we should be.

And here today, I will now walk you through here the 4 basis blocks. I will talk about the volume growth. I will talk about the price increases that Jonas mentioned and that we really firmly here, both in our management team, but started also to change throughout the organizations are driving.

Mix improvement. Coming here from -- we talked about the product launches. I will also share some lights on how we think on the high-margin businesses. You will hear Christopher and later, Anish, share some light on the software. You will also hear from John Lapré here talking about the Neuro and Brachy products. But essentially, we have a very strong competitive position, and we can use this both to drive revenues as such but maybe more important to raise the profitability.

And then the final aspect here is productivity that we need to have in our DNA to run here, finding that extra productivity. And focus here will change a little bit over the next coming years, and I will come back on this one, but it's also to get more leverage on the gross margin expansion.

So starting here with volume contribution and volume growth. We have a very comprehensive product portfolio, and it's further strengthened here by the new products that we just launched here to the market. We are at the beginning of a launch phase. We see a strong traction in Europe. We will work through here the FDA clearance in the U.S., and we see markets such as China, which are recovering, and the launch that we are on that will expand here on a global base.

Jonas, you were also alluding here to just the installed base and the opportunities that we see here. We have, excluding our Brachy products, more than 5,500 solutions out there that we can upsell, cross-sell and utilize to drive software growth and to drive more service revenue. And if we would include the Brachy business here, it will actually add up to 7,500, which you will cover here later, Habib.

And this is a great opportunity, both to drive the revenues and also with the focus here, not just grow. And I think here, today's announcement, and I'll come back on that in how we manage the backlog. It's the same theme. It's to drive a profitable growth ahead of us.

We do have a strong backlog. We actually currently have a backlog here of approximately SEK 37 billion. And many of you saw the announcement here today. But I would really state that this is to enforce profitable growth moving ahead. So what we have done is to address nonaccretive orders, orders with lower profitability than average. Some of them has also been loss-making.

This, we have addressed, and this is a fundamental. If we're going to drive the profitable growth and really mean what we say, then we also need to proactively work with the backlog and create a more healthy backlog. We do have macroeconomic uncertainties, and certain things have changed here over the years. And I received here, have you received a lot of strong customer reactions, and we have not done that. But it's essential for us, and it's healthy to look at what value will we deliver to our shareholders in terms of higher profits.

What you also see here is that this is nominated in the Swedish krona. So part of this is just the mathematical exercises that the value of backlog nominated in U.S. dollar, euro and pound is actually less worth in Swedish krona, but that's just the currency development.

In the year, we delivered a book-to-bill ratio of 1.09. We came out from a Q4, and there were some questions about the orders. But again, I think that the Q4, we could recognize a book-to-bill of 1.12, clearly above 1, to fund future revenues. And what we also see in this number is the momentum for our products, the recovery in China, and it's actually also including a weak U.S. development currently. Elekta is not only U.S., but of course, with the FDA clearance in the U.S., that will create an even better platform for future development.

Pricing, and Jonas was alluding to this. Our price increases on orders, they will continue. This is a tedious work. This is a work that you never can let go. I've rarely been in a company where it's actually applauded by a sales organization to raise prices. And for us, it has also been a bit of a cultural shift here.

But what we have done and what we will continue to do is that an increased focus on profitability. We have built up, under your lead, Habib, a pricing office and a structure here for industrialize a more effective method to go with price increases. And the price increases currently are clearly higher on orders than the revenues, supporting again the margin profile in the backlog, and that work will continue. We have also changed the sales incentives here, moving a bit from volumes to more on profitability, including then price levels.

When we talk about mix, we will run this in 2 aspects. First of all, looking at the product dimension. In our plan on how we will drive the business is really to enforce a larger share of high-margin products. Throughout the year, which I also will come back to, you heard Jonas here, we can recognize clearly a higher growth for software of 7% compared to the 1% as a group in total on revenues. On orders, we could actually recognize a growth more than 20%, and that work will continue here into the years to come.

Service, again, the installed base, opportunities to upsell and use our service offering very intelligently to provide more value to the customers. And by doing so, we can also then enhance the value and also the financial value and also margin expansion.

When we look at the market mix and geographical point of view, it is, of course, the FDA clearance in the U.S., but it's also to continue to build on the momentum here that we are on in Europe. I will share later on that 60% of the orders in the second half in Europe of linac orders were actually related to Elekta Evo, another aspect to combine the geographical point of view with the product point of view.

And then finally, here, China, as most of you know, a little bit less than 2 years ago, they started an anticorruption campaign in China. It led to a huge order drop within the public segment of China, which stands for 70% to 80% of the market. That also led to pressure on the revenue. What we see now in China is a recovery of the Chinese market. And we have actually passed now, so the orders are higher than the revenues. And we are running now in China with a book-to-bill above 1. And that is also something that we will utilize now moving ahead.

If you then look into software a little bit more in detail. On the left-hand side, you see that the software development over the last years have been quite stable, except for the last year where you actually can see that the share of revenue coming from software has increased. More than 20% of our business are actually related to software. And more than 2,500 clinics worldwide are using Elekta solutions. When you look at the split, 2/3 are coming from oncology information and 1/3 from treatment planning.

So looking a little bit more here in terms of contribution from a financial point of view. I talked about that it's -- we could see an order growth above 20% in the last fiscal year in terms of orders that will be reflected in higher revenues moving ahead. More than 25% of the OIS orders actually relates to SaaS, software as service. And this is quite interesting because on average, you get 80% more value by a range and a solution like this compared to a point of sale. It will also create a smoother trajectory of the revenue stream. And that will, of course, enable a better resource allocation and also higher predictability.

Productivity then. This is something that we will constantly drive and constantly crunch out from our operations. But the focus here will change a bit. You have seen over the last years here that we have successfully implemented 2 cost reduction initiatives, a larger one during '22, '23 and a fairly sizable one also in the last fiscal year. It has been across the P&L, so we have taken out costs both within COGS, within R&D and also within SG&A. But moving ahead, and I think here we do have a great opportunity to leverage more on the COGS aspects and then, again, support the gross margin development.

When you think about the COGS of Elekta, some areas are quite similar to a standard industrialized -- industry company, but some of them are also a little bit different. So when you look at the procurement, this is something that many companies do, and we will do that as well, optimize the supply chain, work here with smarter -- with procurement deals and getting leverage from that.

But it will also be to work through here, what says here, a simplified and accelerated order to cash project. So really, how do we most effectively complete our projects, running with an order fulfillment, as we say, process and really from the order point of view until we have collected cash. A big focus on that now in Elekta to make it more effective.

We also, when it comes to service, which is another area here is that here, we see opportunity by investing in digital solution to provide more remote service and, by that, reduce the working hours, travel time, which then also we save cost.

Then when it comes to the R&D aspects and you will hear, I really line here with Jonas and the great start of Christopher, how we will continue to work with the -- automate and streamline our R&D efforts here to drive COGS development as well. And of course, designing also products here for faster and easier deployment and upgradability, coming back here to the upselling to the installed base.

So these 4 blocks, it will be about volume growth, it will be about prices, it will be about how we enforce and drive the product mix, both purely on a product point of view but also geographical point of view, and then lastly, supported by enhanced productivity. That is how we will drive the gross margin and raise the gross margin ahead.

And I received the question, okay, what do you mean with prepandemic levels? Yes, what we mean is we should establish ourselves north of 40% gross margin that we will deliver upon.

So then shifting gears a little bit, moving on to the R&D. Jonas was mentioning this. We did, in the Q4 results, an impairment in the size of SEK 1.1 billion following the IFRS standards. It's also a calibration of the product development road map. It is predominantly done within software. And we have changed here from an internally developed cloudware to using external supplier.

But again, and also connecting here to the Q4, R&D is essential for Elekta, and we will benefit hugely from the investments that we do. And there is a clear reason why we will continue to invest in our products because it will lead to a competitive edge and a clear opportunity to also mix up both the value from the customers and the patients but also for us in terms of higher profits and profitability.

The impairment also leads to a reduction of the increase of amortization. As we have communicated, we see higher amortization as planned. Here, the impairment will reduce that increase of SEK 100 million.

And when you then look at the different components on the R&D, we will see that the capitalization rate will go down gradually as the R&D projects that we're on will gradually move into more mature phases, where the share of the purely operating expenses defined then as pure cost on the P&L, that will increase, and the rate of capitalization will gradually go down.

So all in all, this will lead then to -- when you look at the cash R&D, namely the gross R&D and the net R&D, which is really what you see here in the P&L in terms of the gross R&D and you remove the capitalization and amortization, those 2 will converge. This will also lead, in the future, to better cash conversion and a higher cash flow performance, everything else equal with the same margins. And it is in line also which we want to do and how we plan the R&D projects.

Then some wording on capital allocation. Three areas: organic growth, selective acquisitions, and also here, we have strategic partnerships and joint ventures and then finally, direct return in the form of dividends.

So starting here then organically. And if you look at actually how we use our capital, I mean, a big chunk of that is going into the R&D. And I think you can see here the contribution in Q4 in terms of gross margin contribution. What you will see is that in terms of share of sales, this will gradually go down towards a level of 10%, but still, it's quite sizable investment. And again, it's a strict connection to drive profitable growth and margin expansion.

When you then look into the M&A agenda and the strategic partnerships and joint venture, we will leverage what we have done. Starting here with recent strategic partnerships, I mean you have seen the announcement here with Philips, with GE, et cetera. More recently, we have started to work here with the Sinopharm in China, which really provide us a much better exposure to the Chinese market, especially when it comes to these Tier 3, 4 hospitals and cities, which are a little bit more cumbersome to access just a supplier. So this provides us an even stronger edge in the Chinese market where we are by far #1.

We have also done some strategic acquisitions. We had Xoft in Brachy. We have also done some investments here in the software area. What you've also seen over the years is that we have acquired distributors. And the reasons for those have been twofolded. One is that to get a better control over the market and the customers by getting closer to the customers. But it has also been a very effective method to raise the profitability in that specific country.

We have also established new offices here in key countries here, Philippines, Indonesia, Romania. And moving ahead here, looking at the M&A agenda going forward, yes, we will do so, we will continuously monitoring it. And where we see opportunities, either to accelerate growth opportunities or to actually address specific items, either from a market point of view or a product point of view, we will do so. But it's more a complement to the organic strategy because we are strong with the product offering that we have.

The Board recommends an unchanged dividend of SEK 2.40 per share. And obviously, it's supported by a very strong Q4 cash flow. Moving ahead, and I think it goes with our results and also for the cash flow, we are proud on the Q4 performance, but far from satisfied. This is at the beginning. We are in the start of a launch phase. And that means we should continue to raise profits, raise profitability and, as a consequence of that as well, improve the cash flow generation here as well. And that will, of course, then be the fundament for driving a dividend growth as well.

So key takeaways here. I've talked about here, I'm absolutely convinced that we will deliver on the midterm targets. It is to deliver an operating margin north of 14%. And it is to bring back the gross margin to prepandemic levels, and what we mean with that is to establish ourselves of a gross margin above 40%.

The way there, the route, the path will be via improved volumes, and you saw the components, how that play out. It will be continuous efforts on price increases. We will utilize and enhance mix, both from a product point of view and a geographical point of view, with acceleration in mature markets. And of course, as a basis for this, also having the productivity supporting it.

We have taken actions to adjust the balance sheet, and you will see how the gross and net R&D will continue to convert. And finally here, we will improve our cash flow via higher earnings, and we will leverage our R&D investments, and that will be the support for future dividend growth.

So with those words, a pleasure to see you all, and thanks from me. Over to you, Peter.

Peter Nyquist   Head of Investor Relations

Great. Thanks, Tobias. So it's time for coffee. But I missed out in the beginning here on some housekeeping issues. First of all, this, as you probably are aware of right now, is filmed. So you have to be aware of that. That's -- you need to tell the audience that. Secondly, I guess all of you have seen that, that there is a WiFi, KI Guest. No security code, so you can access that. That's it on the housekeeping side.

Then I would like to have you back and also you online, at 10 past 2 CET. So 14:10. We will start the next session at that point. Thank you.

Peter Nyquist   Head of Investor Relations

Welcome back from the coffee break, you here in Stockholm, and welcome back, all of you online. I heard there's around 160 people joining there as well live. So that's a good number.

And numbers, we've talked about. And now we continue with the next part, which is commercial execution and then personalization and productivity. So that's going to be the next part of our session here. The first part will start by our Chief Commercial Officer, Habib. And then Ardie, as I said before, will join from Seattle. And then we have Christopher Busch as well as John Lapré talking about personalization and productivity.

So with that, I leave the word to Habib.

Habib Nehme   Chief Commercial Officer

Thank you, Peter.

Peter Nyquist   Head of Investor Relations

The clicker's over there.

Habib Nehme   Chief Commercial Officer

Yes. Warm welcome, everyone, for the fourth time, I think, and thank you for being present here, either in person or online. Maybe good morning, those online or good afternoon for you here.

So I'm Habib Nehme. I'm the Chief Commercial Officer of Elekta since 18 months. My mandate with my team in the regions and in central marketing and central service order fulfillment, commercial excellence is to design the -- and execute on the commercial strategy for Elekta and to deliver the profitable revenue, the profitable market share.

Before joining Elekta, I was 27 years in GE Healthcare, where I occupied position -- executive positions in Europe and in emerging markets. And I was as well the Chief Pricing Officer of GE Healthcare International in 2008 during, you remember, the financial crisis. So pricing is something that we know a little bit how to deliver on it.

So today, I'm very pleased to have been given this opportunity to talk with you and show you how the Elekta solutions are addressing customers and partners and clinician and as well as stakeholders and shareholders' needs. And my goal would be to work with you through the global markets of radiotherapy and explain how Elekta is delivering in these markets. And the second point, how our solutions, either on hardware or on software, combined with a strong installed base globally, are reinforcing our positions or expanding our positions in this market.

And commercial strategy without execution is useless. So I want to explain to you how our commercial execution rigor is transforming the commercial operation of Elekta to deliver sustainable, predictable growth for our shareholders and for our partners.

So first, Elekta global presence is its core strength. We have balanced and mixed geographical revenue coming from all around the world with growth drivers in each region. So when we talk about Americas as a continent, it constitutes -- it makes up 29% of Elekta revenue. U.S. stand as a high market and high value for us. And Ardie Ermers, who is in Seattle here, will explain to you Elekta commercial approach and solutions for this market.

EMEA makes up to 37% of Elekta revenue. And EMEA is Europe and Middle East and Africa. Europe is 80% of this number, and Elekta enjoys a very strong position there, and we'll talk more about the solutions and how we win in Europe there. Nevertheless, Middle East, Africa constitute 20%, and we see very strong momentum, and Elekta has a strong position in this area.

Now Asia Pacific, that includes Japan and India and China. It constitutes 35% of Elekta sales, where China, where Elekta has a leadership position, is 40% of this market and -- 40% of this revenue, and definitely, we'll talk 40% of market share as well. And India is a fast-growing market where Elekta is constantly investing in this market.

So overall, as we go forward, we want to keep our leadership position in China. And in mature market, we want to grow our profitable shares, U.S. and Europe, and scale our presence as we go in emerging markets.

So now we don't have one-size-fits-all strategy. We tailor our commercial approach in function of the market, in function of the competitive environment, in function of our presence in this market and in function as well of the growth perspective and reimbursement and other consideration of this market.

So for example, in India, in Southeast Asia, in South America, in part of emerging China as well where we have a strong market share, we grow in steps with the expansion of the market, and we differentiate ourselves with service. I mean, Tobias talked about service potential with a growing installed base, and we'll see more about that.

In another part of developed China and in Europe, we target existing installed base, existing customers with new product introduction, definitely with differentiated software and customer-centric service.

In U.S., and we'll see more about it, where we have a large portfolio position in Neuro, in Brachy and especially in software, we leverage this to deepen our clinical footprint in this market. In -- basically in the mature market in Europe and U.S., we want to grow profitably the existence of the installed base. And at the same time, we -- as we said, we scale our presence in emerging markets. So it's about precision. It's about matching our right strategy to the right market and maximizing the impact, maximizing the return and the value.

Now is this sustainable and why Elekta has the ingredients in its solutions to grow profitably here? Because we are backed by the world's most comprehensive portfolio in radiotherapy. We have the solution that fits either emerging markets or mature market. 63% of our revenues comes from mature market, 37% from emerging markets. And when we look at the 2 segments of brachytherapy and neuro radiosurgery, we have a leadership position here. These are 2 specialized segments, highly defensible segment there. What you heard about the entry barrier is high there. And we have leadership position there globally.

Now when we look at our portfolio in CT-Linac and MR-Linac, we have the most comprehensive portfolio, adaptive ready or adaptive available, either off-line or online. When we look at the CT-Linac, we have the imaging, Iris, which is the artificial intelligence imaging enhanced, that provides the most precise auto-contouring and speed for adaptive treatment when the patient is on the table and online adaptive.

Now all the investments that we did on software here is paying off. And when we look at the Elekta ONE in software environment, it's not only a growth engine for Elekta, but it's a productivity for our customers who are streamlining their workflow globally there in this aspect.

So actually, how do we win in Europe? Let's take some example. We combine the commercial momentum with the most clinically proven portfolio. So it's about commercial. It's about clinical value added to our customers. So we provide the most versatile, as I said, CT-Linac. We talked about the adaptive off-line or online. We have the imaging-enhanced capabilities for the auto-contouring there. And we have the Elekta ONE suite in software that you're going to hear more about and have a deep dive with Anish on it, which is allowing to streamline the workflow and enable more complex and more advanced workflow for the customers.

At the same time, when we talk about stereotactic radiosurgery or stereotactic radiotherapy, either on the body or in neuro, for example, I give the Esprit in neuro, which is a gold standard in SRS. When we talk about the brachytherapy, the Elekta Studio, the Elekta Studio delivers enabled capabilities of planning in brachytherapy. And all this in Europe is already available, is offered and making that we have a leadership position in Europe, this combination.

Now we go to another interesting market: China. China, the existence of Elekta there is back to 4 decades. We moved from being a supplier to a local investor. We are investing in the health care system of China. In 2006, we started manufacturing. Look at the vision of Elekta that's still there. We still started investing in manufacturing of CT-Linac in China, 2006. And actually, we manufacture, we scale it, to manufacture brachytherapy, neuro and as well software.

Beyond this, we built strategic joint venture there, as Tobias has talked about, in -- with Sinopharm, with AnSheng in software that allow us as well to compete in all segments, either public or private. Beyond this, we have a center of excellence for research and development, for innovation. We have a center of excellence of clinical education that provides the values, not only for China but as well globally.

So all these, I would say, actions, since many years, makes that the customers trust Elekta in China and is considering us as a local player with international and global quality standards. So we -- it allowed us to grow our installed base significantly. For example, on linac, the last 5 years, we grew our installed base despite all the crisis by 9%. And this allow us as well to have -- to keep, despite the competition, despite the drop in the market, a leadership position on the north of 40% of market share.

So this China is a very important market, one of the most, I would say, important market in the world, and Elekta wants to keep the leadership position there. And why we need to keep a leader position there? Because I mean, China has the fundamentals of growth, still. The density of linac per million of inhabitants is low. And the cancer plan announced to China 2030 plan favors the expansion of the linac and access to radiotherapy in China. So we want to play there. Moreover, there is an increased interest of the procedures of hypofractionations and as well adaptive radiotherapy. And it aligns with our strategy. So it's synchronized, it resonates, and it matches our strategy there.

So the same thing, our -- and why we will win, why we'll keep winning? Because we don't have accidental presence. We have a structural go-to-market there. We have local manufacturing. We have a center of excellence. We have a strategic partnership. And therefore, we are in a very good position to keep growing there and compete, either with local manufacturers or other manufacturers.

The other point as well, we are delivering what the customer wants. He wants products, he wants quality, and he want trust, somebody who's been here for a long time, and this is Elekta. So very confident about Elekta presence and strategy as we go forward there.

So now we go to the solutions side and to the installed base and to show you how our growth is powered by a dual-engine commercial strategy. The first one is getting a new installed base. The other one is harvesting or leveraging the existing installed base.

So how we get a new installed base? We get installed base by delivering adaptive-ready systems. I say around CT-Linac or MR-Linac, and we deliver them by steps. Depending on the clinical need of the customer, we can go ready adaptive to adaptive off-line, to adaptive online, CT-Linac, MR-Linac. And this as well to match with the budgets of the customers' buildup. And all we talk about is software and that we can sell there or with Evo. So this is part of our value proposition.

Now in the same time, we have an active installed base, an active installed base on which we can still sell upgrades, capabilities. And this is building high-value relation with our customer, is building as well loyalty. It's not about selling more. It's more about having more value for the customer that is translated into margin to Elekta as well. So we have this path of the installed base.

So truth be said that with our Elekta 2025 ACCESS strategy, we built a large installed base. And 70% of this installed base is under service contract. What does it mean? It means that we have unmatched visibility on this installed base. We know the installed base, the capability, the configuration. So this allow us to structure life cycle programs. So to move to Flexitron, for example, in Brachy, or to move to Esprit in Neuro or to move to Evo in the Linac. So this is unlocking high-margin revenue on the installed base.

We are applying the same thing. I mean the 7,500 includes the Brachy as well include the Neuro. It's not only the Linac and include the software. So out of it, you have 2,500 installed base of software in which we are transforming into software as a service and allowing us to have a predictable high-margin revenue. And for example, now we started upgrading the Monaco installed base, which is the treatment planning systems to Elekta ONE planning, allowing more depth in the clinical capabilities and, at the same time, more productivity and more speed. And recently, we launched the Elekta planning on the brachytherapy to enhance the capability of planning of the brachytherapy and will follow with the Neuro side.

So this is about the solutions and about the installed base coupled together to create this dual engine of growth. Now let's go to the commercial rigor and the execution side.

You know that we are in a business to a big extent, besides software, Brachy, is a backlog model business. So it's very important to have a very strong, predictable and high-margin order book. And this is what we did in order to get this strong order backlog. We took hard decision, but necessary decision to cancel nonaccretive order, all in the frame of the contractual agreement with our customers. And we find that actually, we have a SEK 37 billion of strong executable backlog, where 82% of this backlog, we have a plan to deliver in the coming 3 years.

So we worked around 3 main topics. One is how we can get the orders booked in a criteria that allow predictable transferability of the backlog. Second one, how we can get a good management of this backlog, either on the profitability side or the predictability side. And the third one, how we can continuously monitor this, I would say, engine of growth, and this is core business of the backlog. And what we did so on the first side, is the order quality. We make sure that we have -- when we book an order, we have all the criteria that give us visibility on the transferability of the backlog, and we keep our sales people engaged until this happens. So we allow all this collaboration in order to get transferable backlog.

And the second part is continuous monitoring of this core asset, which is a backlog. When a backlog becomes older than 3 years, we go back to the customers and renegotiate either prices or other conditions before taking any other decision. So actually, we found ourselves in a position where we have a strong executable backlog of SEK 37 billion divided between solutions and service.

And finally, before introducing Ardie from Seattle, I want to leave you with our simple commercial strategy, is retain our customers, increase their loyalty, grow our installed base, and the third one, boost our services on this installed base. First, we retain them by proposing continuous upgrade and continuous improvement of the life cycle of their installed base, which creates loyalty. Second one, grow with a new offer and go to new customers with the value proposition of adaptive and with a large portfolio. And the third one, we boost this installed base or revenue, we boost our revenue through services offer of software and other high-value upgrades.

Having said that, I thank you, and it's my pleasure to introduce Ardie Ermers, who is leading Americas from Seattle. To you, Ardie.

Ardie Ermers  

Thank you so much, Habib, and welcome, everybody. A warm welcome from Seattle. My name is Ardie Ermers. I'm the EVP for Americas based out of Atlanta. And before the SI, I was EVP in Europe, where we were able to turn around this trajectory into positive market share gains. And now you can see, obviously, the impact of those wins with some very good growth out of Region Europe. Before this, I was in the United States for 17 years, working for a company called Philips.

Is this better?

Unknown Executive  

Just a minute. You can talk.

Ardie Ermers  

Yes. You turn it down, I turn it up. Is this better? Yes. Is the quality better? Can I proceed? Yes. Okay. Yes.

So yes, so to go back and introduce myself, Ardie Ermers, I'm the EVP for Americas based out of Atlanta where our headquarters is based. Before this, I was EVP in Europe, where we were able to change the trajectory of Elekta into positive market share gains. And now you see the results of that work and showing the positive trajectory in Region Europe. Before this, I was 17 years in the United States for a company called Philips. And today, I'm going to share a little bit about our strategy to be more successful in Region Americas, specifically in the U.S.A.

Next slide. So just like in Europe, we see that radiotherapy is evolving. Also in the U.S.A., we see that there's a heavy pressure based on the cancer burden, and our customers are looking at ways to deliver radiation in a more efficient way. The way to do that is to really focus on a term called hypofractionation, which is to reduce the amount of fractions and to be more accurate and more precise in delivering the dose.

This trend has been started many years ago, and Europe is leading the charge, where also the reimbursement system has adopted to these ways of delivery. We see the same needs in the U.S. market and customers are asking us on how to do this in a more efficient way. There's also staff challenges. So people want to make sure that they can deliver this dose in a very accurate manner, but also do this with the pressure on staffing.

The way to do this is to develop new product portfolio. And what you heard today from the speakers is that we are heavily focused on adaptive radiotherapy, because adaptive radiotherapy is going to enable us to do hypofractionation, it's going to give the tools in order to deliver this dose much more efficient and therefore, being able to treat this patient in a shorter manner.

Also, what's helping us here and setting us up for a good growth path is that the systems that are currently being used in the U.S.A., on average, have a lifespan of about 14 years. That means on the older systems, people are still being treated with 30 to 35 fractions. And you can imagine, if you have cancer and you have to go to the hospital 30 to 35x for a radiation treatment, that obviously is not very exciting. So the centers that are winning and that get the choice of the patient are the ones that are in improving their portfolio, improving their linac installed base with systems that can handle this hypofractionation. So for us, this is a great opportunity to come into the marketplace with new innovation that addresses this need. And we are working currently with the FDA closely to get this solution into the marketplace, and we are anticipating to have this very, very soon.

Next slide. Next slide. So while we are working with the FDA on getting this new adaptive therapy solution into the marketplace, we're not sitting still in Region Americas. And specifically in the U.S.A., we are enjoying a fantastic market leadership position with our Brachy portfolio. Flexitron is the market-leading product and Brachy is a high-profit business that is really showing growth in the marketplace. And we see that especially for certain applications, especially in cervical cancer and OB/GYN, the Flexitron is the gold standard. And the Brachy boost is the standard delivery of every center in the U.S.A. We show that we are growing this marketplace together with our collaborators and see that the future for Brachy has a very strong position.

We also launched a new platform called Esprit a couple of years ago. And now we're seeing the fruits of that labor with very, very strong growth in the Neuro segment, again, with very, very high business -- high margins. And most importantly, once we launched our new software suite called Elekta ONE Planning, we see a rapid adoption towards this new software solution. In this case, our therapy planning engine has reduced the therapy planning lead times about 80%, and so customers are really eager to adopt this Elekta ONE planning software to make sure that they can deliver this radiation in a much more efficient way.

So the pipeline for Elekta ONE Planning is rapidly increasing, and we see that the customers have a very strong interest and obviously, benefiting from these technologies. The combination with our partner, MIM, which is the gold standard in contouring, is really, really perceived very well. They have a very strong market share position in the U.S.A., and we're working very closely with them to delight our customers with these new software solutions.

One thing that customers also ask is to make sure that we don't focus only on our traditional Linac and MR-Linac business, but that we also incorporate the other 2 key businesses. And we have launched now Elekta ONE Planning for Brachy, which shows how we are integrating this into the software suite of the hospital, and the next step will be to do the same for Neuro. And as you can see on the right-hand side, this is really helping us with the profitability of the U.S.A. and the profitability for Elekta as a whole.

Next slide. Next slide. To show the evidence that this strategy is working, we are very proud to announce that we have now installed 30 Esprits across the U.S.A. The Gamma Knife is a very, very strong portfolio and a very strong offering for our SRS customers. You see that the reimbursement rates in combination with the clinical efficacy of Leksell Gamma Knife is really showing a big impact. And most of these centers are treating over 150 to 200 patients per year, enjoying very good financial stability, but also showcasing that if you want to do brain mets, the best way to do this is just with the Gamma Knife. And the uptake of Esprit shows that the future for the Neuro business is very, very strong.

On the right-hand side, you have been asking when are we starting to see impact of ViewRay getting out of the marketplace. And we have to admit that it took a little while for customers to realize that ViewRay is not really coming back. Now we're starting to talk with customers, and they're really looking for solutions to commit to an MR-Linac program, but to make sure that they have obviously the best MR-Linac in the industry, which is the Unity.

And the strongest example we have is that Moffitt Cancer Center in Tampa is this month deinstalling their ViewRay unit and starting to install the Unity, and they expect to be up and running by the end of the year. This is the first example of a customer that is switching their ViewRay system to Unity, and we have a very strong pipeline with other ViewRay customers to do the same.

To show the impact of Evo in Region Americas, we also see strong uptake in Latin America, and we are really proud to celebrate our second Evo in Argentina. You see a picture here of the pediatric hospital, Garrahan, who will be going live after the summer. And this is a strong testament that also in our developing market in Latin America, adaptive therapy is a key interest.

Our strength, on the left-hand side on the bottom, is our software offering. We have the best cloud solution in the industry and especially customers that are suffering from cyber attacks coming to us really for help to get them back up and running with a lot of good expertise, but also to then have the conversation about how to transfer to cloud. And the combination with SaaS orders, like Tobias said, is really helping us with the profitability and increasing, in this case, the margins for the region as a whole. The software business is very healthy, driven by the fact that we've invested heavily in a very strong cloud architecture in collaboration with our partner, Microsoft, and making sure that we expand the solutions in that software stack. So we see a very strong uptake of SaaS orders. Over 30% to 35% is now SaaS-based in the U.S.A., which is also giving a very stable revenue profile.

Next slide. Now how do we prepare for this launch? Because what we saw in Europe is that our key collaborators there are paving the way, and we're starting to see fantastic results coming out of Europe where they can do an adaptive treatment in under 15 minutes. This is an amazing speed and it's also necessary because you want to make sure that you don't have to schedule extra patients loss in order to provide this kind of treatment.

So what are we doing here in the U.S. is that we are working with some key collaborators to start paving the way for the future. And as you can see on this list, we have some very prominent names like Sunnybrook, UT Southwest, Medical College of Wisconsin, MD Anderson, Sloan Kettering, Princess Margaret and so on. And what these customers do with us is that they are basically providing the solution so that we can build the workflow that people will need to adopt in order to go to adaptive therapy.

These key opinion leaders share their knowledge. They share their wisdom about how to set up the centers, and we put this into a consortium approach. Just like you saw from our MR-Linac consortium, we have now included also the CT side of the business. And this is where we learn from each other. So if customers want to adopt to this new way of working, they tap into the knowledge of these key partners that we have developed. And so they can go up and running really, really fast.

We have implemented this solution in our link in our Atlanta Experience Center, where customers can come to see it, to get trained on it and to get ready for this change in radiotherapy. And it's driven by our strong software platform, like I said, Elekta ONE Planning, the combination of AI contouring and a very fast dose engine that is GPU-based, is enabling us to really get the speeds that I just described. So with the launch of adaptive Linac, we are really positioned well to take care of this growth opportunity with the average age of 14 years of Linacs. So this is going to really help us establish a leadership position on hypofractionation and adaptive therapy.

Next slide. Now one thing that has been hampering the U.S. market a lot is that also the reimbursement system is not the same as, for instance, in the Netherlands, where paper fraction is currently the standard in the U.S.A., meaning that you get paid for every fraction you deliver. So you can imagine that if you're in a community-based hospital and you get radiation for prostate, that they're not focused on doing this in 5 fractions. They want to make sure that they get financially paid. So they are going to deliver 30 to 35 fractions. And like I said earlier, the impact this has on the family, to go to the hospital 30 to 35x, is tremendous.

So we are working closely with some key thought leaders on how we can change this and driven by ASTRO, we are now launching a change in the reimbursement schemes for the U.S.A. This is called radiation oncology case rate or ROCR. And over the last 3 months, the support that we've seen across the U.S.A. for this new legislation that's going to help us with reimbursement based on a bundled payment system is growing rapidly. We are now over 122 institutions in the U.S. that support this legislation. It's bipartisan, supported by Democrats and Republicans. And we believe that with the CBO scoring, that's going to be done in the next 2 months, that we will have a very strong case to change the reimbursement cycle for the U.S.A. for radiation therapy.

Now you can imagine that if you get a bundled payment for radiation, you want to focus on hypofractionation. You want to focus on adaptive therapy. And this is going to drive replacement of those older machines.

As proved that we are the leaders in this space, on the right-hand side, you see the new picture of the Fort Worth campus of UT Southwest. UT Southwest is the leader in SBRT and the leader in adaptive therapy. And if selected exclusively Elekta for this new campus to equip this center with MR-Linac, with CT-Linac and also with brachytherapy to provide the best standard of care for adaptive in the future. So this gives us a very strong starting point to start working with administrators to do the business case about why it makes sense to upgrade their Linacs right now and go towards the new platforms that Elekta is launching. So we're really anticipating a fantastic summer coming ahead of us.

Next slide. So the key takeaways about our strategy in the Americas. We're going to keep focused on driving high-margin product performance, as you have seen, with market-leading products in Brachy and in Neuro. We are going to accelerate our software growth driven by Elekta ONE, which is the gold standard now for adaptive therapy planning, but also where we get incorporated the broad elective portfolio evident by also incorporating Brachy and later on Neuro. And we are the hypofractionation leader in the market. Globally, we are seen as the leaders of adaptive therapy, and we're going to drive this strategy into the U.S. where this reimbursement climate is going to help us change and we believe that we're going to be in a much stronger position heading in the future.

So thank you for your time. I hand it back over to Christopher, and I look forward to the Q&A session. Thank you so much.

Christopher Busch   President of Linac & Software Solutions

So we believe that this is something that uniquely differentiates what we have because you can do this on a machine that can also do standard normal non-adaptive treatment in this side on the day. You don't have to have a dedicated machine that only does online adaptive. But you also don't have a software that's stand-alone, but doesn't really integrate into the control systems of the linac where you really must make sure that the right things are happening in the right very way, and with the quality assurance there as well.

So we believe our solutions with Elekta ONE as the kind of best-in-suite kind of approach, one hand has the OIS linked to Smart Workflows. The right, we have the planning, the analytics also they are the high speed, and this will all lead to a reduction in burden for the specialists and simplification of workflow, also an increase in safety. Because the more complex you make workflows, the higher error -- the error-prone -- the more error-prone they are.

And this is also kind of a dilemma slide, right? If you look at how we look at the ecosystem for these solutions. If you go to start from the very right, if this ecosystem is extremely open, and you just look at DICOM standard, FIHR, HL7 kind of interoperability, you can basically combine many, many things from different vendors, self-made, self-written software together into one way to treat a certain patient. This is what many academic institutes are doing. This is what mainly leading clinics are doing to explore what's possible, what are options. And they want to have total freedom, and that's totally right thing for them to do. They pay the price of productivity for that. But for any of you in the research stage, productivity is something you optimize later. First, you want to show that the treatment is really better.

If you go to the very left, it's very close. Well, that means often that you say the treatment choices, the options that one vendor can offer or that maybe one device can offer are limited. You have a very high productivity, but you trade in, in flexibility. And what we try to do with intelligent operability is to balance these 2 things and to give clinicians the choice, do I want to optimize more for the right side? Do I want to optimize more for the left side?

So there, we look at innovation often led by Elekta, but then working together with best-in-class partners and MIM from GE was already mentioned as a key choice of a strategic partner. And then the choice is how much do you want to optimize left or right? If you want to have a fully highly productive, efficient online adaptive workflow, you probably want to be more on the left. But you can choose also not to do this. And if you are in a research environment and you write your own segmentation, AI enhanced tools, you can plug them in through standard interfaces. But again, you will lose productivity. These trade-offs, we believe, are different for different institutions in different reimbursement situations, and we want to keep these choices open for our customers.

So my key takeaways, hopefully, for you. We have this dilemma between personal and productivity. We believe we have a way forward to do this. And with Elekta, we believe we can go both for better outcomes and higher productivity, and the choice where you optimize is left to the customer. We have an integrated but also comprehensive portfolio. At the same time, our portfolio should not be limiting, but it will favor certain ways of working. And with asset-light innovation, many software-driven, not all, we will go through installed base upgrades and also, as mentioned before, SaaS business models that makes many of these innovation easier, affordable for our customer instead of having this big capitalized -- this big CapEx kind of acquisitions that they need to make.

Having said that, I want to hand over to John Lapré, he's actually one of the guys who has envisioned about this personalization productivity for a long time, and he's leading our Brachy and Neuro business. John, up to you.

John Lapre   President of Brachy & Neuro Solutions

Thanks, Christopher, for the introduction. I hope to be able to radiate a little bit of the enthusiasm that I have for these businesses. I've been 16 years in Brachy, 13 years in Elekta. I've been CTO for a couple of years and since a couple of years, responsible for Brachy and Neuro businesses.

But more importantly, it's not about my enthusiasm. It's about our customers' enthusiasm for these businesses. We have huge market shares, as was discussed, if you look at intracranial radiosurgery, the Gamma Knife is the golden standard. I will come to that as well. For Brachy after loading-based Brachy. We are by far the market leader as well in that space. And being a market leader brings also some kind of extras that you need to do. And we have a very loyal and active customer base. The BrachyAcademy we supported, that's a peer-to-peer training platform across the world. It's even been cited in scientific journals now with publications as the way of doing peer-to-peer training.

Leksell Gamma Knife Society coming up in September, started in 1989, already, a huge interaction platform, neurosurgeons, radiation oncologists around the Gamma Knife. And what can you do? How can you exchange information? Well, not only that. So it's a loyal customer base where these customers also pay well for our solutions. Why? I'll come back to that. But we are Brachy and Neuro combined about 20% of the revenue, but very highly accretive to the EBIT contribution of Elekta.

Now why are those customers so enthusiastic? Why are they saying we need to have the Gamma Knife, we need to do Brachy? There's a huge clinical evidence out there with very important data on patient impact, quality of life, effectiveness, both for neuro radiosurgery and that's mainly the Gamma Knife, and for brachytherapy. On the left side, you already can see that 3 more publications and all other technologies around intracranial radiosurgery.

A fast treatment for multiple brain mets, it's not about one met. We see more and more brain mets coming with better diagnosis, longer survival of cancer patients. And this is the machine to really have more than one brain met effectively done in one fraction. I'll come back to that.

Also, very clear that if you do whole brain radiotherapy, you take margin, you take quite some margin, you irradiate healthy tissue. The Gamma Knife has the lowest margin in all the machines that we have to exactly do the tumor and precise localization of the radiation. That brings another potential benefit that when there's a recurrence, you can use, again, an irradiation because you didn't touch the healthy tissues.

Brachytherapy, also a lot of information. And I should say about these studies, it's not we're spending clinical studies like pharma. These are studies initiated by our customers. These are studies that are done with our customers.

In brachytherapy, very important in cervical cancer, Ardie also mentioned that as a boost with external beam. And what you see in this graph is if you only do external beam, this is the light blue one, no brachy. You have a certain survival, 5-year survival. Now you add a very rudimentary brachy, 2D brachy, we call it, you see an increase. Then the recent studies, the EMBRACE studies, one was retrospective looking back. The last one is really almost the golden standard of how you'd like to see some of these clinical trials. It's a multicenter trial. It's prospective. It's looking forward with a standardized protocol, and you see what it does versus no brachy on the overall survival, 25% plus a 10% additional gain.

Now what that had was an MR step. So using an MR when the applicator is brought in. That means your applicator needs to be MR-safe. We have the widest portfolio of MR-safe products and consumables, there you see one. I will not disclose prices, but don't think that this is a couple of euros. This is a very profitable part for our business, including consumables, including recurrence.

So neuro radiosurgery with the Gamma Knife and brachytherapy really contribute to patient's survival and quality of life, not only our opinion. That's why our customers are so loyal and use this. So what are those products? Caroline Leksell Cooke is sitting over there. We'll show you the Esprit later on. The Leksell Gamma Knife, as you can see here, but it's not enough. We need to do treatment planning as well, like Christopher also said. And then we have basically the Leksell vantage system and the arcs.

Now the Leksell Gamma Knife was, of course, the own set of Elekta. This is how Elekta started. And having it still there is so much kind of testimony of what this equipment is able to do. It's one fraction, as I said. So further hypofractionation. You cannot do a half a fraction. So further hypofractionation is, of course, not possible. There are a lot of potential intracranial indications where you can use it.

Now if we then look at Esprit and you will see more of that, there's an imaging component there because if you give one fraction, you need to know that you give it at the right spot. The same was done for Brachy, where we have introduced the imaging ring because for Brachy, otherwise, you get an applicator. You have to be transported through the hospital to a CT or an MR with this applicator in which moves, et cetera. This Elekta Studio allows you to do it in room, in the treatment room. You can do it in principle, as many times as you like, make it adaptive say, hey, the bladder is filling or whatever. I need to adapt my plan and have a better personalization based on that one in room, image-guided and adaptive.

Hypofractionation as well. Brachy is 2 to 4 fractions. Again, knowing where you give the radiation is important. Now Christopher also already said that there is a kind of penalty when you do these kind of adaptive things. It's the same a bit in Neuro and Brachy. The workflow improvement is so software dependent. We need to make sure that we can plan as quickly as possible. And one of the previous ones was that you saw was software, including lightning for the Gamma Knife. That basically saves more than 50% of the of the time for planning. There's a customer quote who also says this saves so much time. It's so fast that gives us so much time back for the neurosurgeon. And that's important. For Brachy, we do it with Elekta ONE Planning, much more integrated as well.

Now if you then look at, all right, John, great. We heard about 2,000 Brachy, about 350 Gamma Knifes. Well, here, you see the potential for upselling and for upgrading. Still a huge installed base in Neuro of perfection and icon that we push to Esprit, including the software that we are developing. And the same for Brachy with microSelectron to Flexitron will be pushed as much as we can to upgrade as well with the Elekta ONE Brachy Planning around that.

But it's not enough. That's basically from our installed base. We want to grow further into growth markets as well. That means some clinical indication expansions we're going to look at. We're looking at other business models. I already talked about the applicators, very, very profitable, and the subscription model is to make it -- the total cost of ownership more insightful for our customers. Every 3 years, these applicators have to be replaced and have a subscription model with Brachy as a service, if you will, is another push that we're doing.

And I want to briefly go to cervical cancer because I can hear sometimes people thinking cervical cancer, well, that's we have HPV, right? At this moment, as we speak, 600 females per day are dying of cervical cancer. It's not about toxicity. This is dying. And that means there's still a lot of work, and it's not evenly distributed over the globe either. So in the growth markets, you see much more of these than in the more mature markets. And we feel that also with new business models in those markets, we should be able to tap into this big deep. The WHO has declared a war on cervical cancer, and we're working with the Elekta Foundation, IAA, et cetera, to ensure that we can help here out.

So expand clinically and grow the installed base by also some benign indications for Neuro. So it's not only about cancer. We're looking into neurological functional disorders, but it's not an easy one to get a lot of approvals for. But we do it. Parkinson's is one, but maybe OCDs.

For prostate cancer, also there, it was already mentioned, a boost of Brachy to help hypofractionation on the linac is another one that we're really looking at. And again, rectal cancer, as was mentioned by Christopher as well, the combination potentially for rectal cancer.

But where it all comes back to, if we need to shorten the treatment times and we do that by software, so Elekta ONE and Lightning. And so we're able to have very productive workflows and very much personalized.

So the key takeaways, as you can see, these are high-performing and solid business lines are always saying these are indispensable parts of radiotherapy and indispensable parts of Elekta, highly margin accretive. We have the market-leading positions that we really should thrive on, as Ardie also said. The reason that these are high-margin and loyal customers is we have superior clinical outcomes. And the sustainable growth path are around installed base, but also around new clinical indications as well, but a lot of it will be around software and workflows.

With that, I thank you for your attention. I give it to Peter.

Peter Nyquist   Head of Investor Relations

Great. So we'll do a quick -- thank you. We will prepare ourselves for a Q&A. And Emily here will move some of the tables. And you also have clearly here, in the audience, the possibility to ask questions. Online, you can also ask questions live, and you can also post questions on the chat. So you have those possibilities. And I will try to alternate the questions here between online as well as in the audience.

So by that, I would like to invite the speakers back to the stage. So please join me here. Yes, I will move here. Even though we're running a little bit late, we will keep the Q&A as thorough as possible. And I think Emily, are you going to run around with -- Monica is cool with doing that.

So maybe we start with Sten in the back there. Please, Sten, you can ask the first question.

Sten Gustafsson   ABG Sundal Collier Holding ASA

Sten Gustafsson from ABG Sundial Collier. First question to Tobias. You talked about simplified and accelerated order to cash. What exactly does that mean? What are you going to do different this time?

Tobias Hagglov   CFO

Yes. Thank you for that question, Sten. So what we really are doing, please fill in here, Habib, is that we're really comprehensive now going through all the steps to make sure that we have a fully flat execution across. So it's really a seamless process and optimize the various steps. It will enhance the quality of the process. It will enhance the effectiveness and it's also -- we'll bring down our spend in the process as well. So it would lead to better quality, will lead to lower costs, and it's really a comprehensive approach really from when the order is taken on until we have collected the cash, and it's actually several steps. And it's also, I think, here in the work to create a very predictable, stable revenue stream. This is a key element to be really on top of the execution of our orders.

Habib Nehme   Chief Commercial Officer

Yes. It's a comprehensive approach where once we take the order, we understand the customer and the contractual delivery date. So when we know the customer delivery dates, we can align all the processes going from preparing the goods to booking for the shipment, to the preparation of the installation in its phases. So all this is about continuous monitoring of our backlog that I talked about, where we have a good visibility and predictability about the backlog to align all the processes together that from the time we take the order, we know when we're going to deliver, when the customer is going to be ready and we're going to deliver and where we're going to recognize revenue and we get the cash. So it's all about predictability.

Sten Gustafsson   ABG Sundal Collier Holding ASA

Right. If I may, just a quick follow-up or not follow-up, but then a different question. Jonas, you said you were quite bullish about the full year. Could you elaborate a little bit, give us some colors?

Jonas Bolander   Acting President & CEO

No, I think it -- we -- as we said during the earnings call, the guidance or the outlook still stands there. But we're feeling quite good about that.

Tobias Hagglov   CFO

Maybe to add a little bit on that question as well. I mean, here, what you saw in Q4, and we have talked about it throughout the day here, we were able to strongly improve the gross margin. We are at the beginning of the launch phase and should really build on that and utilize here the enhanced value that we can provide to our customers. So it will be a continued hard work. You have seen the guidance. And I think how you should look upon this is that yes, we have the guidance of increasing the revenues here in the fiscal year that we're in. And it's also an important step here towards the midterm targets of reaching an operating margin north of 14% and the gross margin here to establish ourselves above 40%.

Peter Nyquist   Head of Investor Relations

Thanks, Sten. I think [ Kristofer ] had a question. We'll move there and then we'll move further down the room later on. So Kristofer?

Unknown Analyst  

Yes. The order cancellations, will that have any impact on sales? And also it seems this increased focus on margins you have, do you think that will impact your ability to get back to growing sales in line with market or even above market, which was the ambition a few years ago?

Tobias Hagglov   CFO

I can maybe start and you can fill in here, Habib. No, it doesn't change the revenue outlook. This is actually enhancing the quality of the backlog and actually removing nonaccretive orders. So we stay firm on the path we're on and built on the strong outcome here in Q4, and that is a work that is about to continue. So no, it's not about to adjusting any revenue outlook based on this at all.

Habib Nehme   Chief Commercial Officer

[ Kristofer ], as well, it's the opposite because as you saw, we have 82% of the backlog still active. And what we look at is the old orders that have not moved with -- has been taken when the currency was at a different level than now and the cost of goods at different levels. So it's all -- it's boosting more the vitality, I would say, of the backlog and making it predictable and accretive.

Peter Nyquist   Head of Investor Relations

Great. Let's move to the London table, we can call it here, where we can start with Veronika. So please.

Veronika Dubajova   Citigroup Inc.

Veronika Dubajova from Citi. Three questions for me, please. One, just a follow-up on the order cancellation. Do you expect it to have any impact on how customers perceive you and whether they want to do business with you? Obviously, if you've shown up and canceled an order they placed a couple of years ago, it might have some repercussions.

And then just maybe a bigger picture question on the commercial strategy in developed markets. You have historically been very successful in tenders where I think your big competitor was maybe not as willing to be price competitive. Is what you're telling us today a clear sign of that change in that strategy? And how should we think about your ability to win in those tenders, which have been an important driver of growth for you?

And then maybe if I can squeeze in my third one, just on the U.S. reimbursement changes, obviously, there's kind of 2 very clear paths either we end up with a big cuts heading for 2026 or 1031 or whatever the bill number is passes. Just curious about how you think about the market outlook under the scenario that ASTRO is not successful, and we do end up with much more draconian cuts to reimbursement.

Peter Nyquist   Head of Investor Relations

Habib, you start with 2 questions, and then we'll move to Ardie for the third one.

Habib Nehme   Chief Commercial Officer

Sure. So Veronika, we act in the frame of the contractual agreement with the customers. So either we have a consent from the customer because it's went beyond the 3 years of installation or we have a consent with this. So we act in that frame. Second point, from our competitiveness in the public tenders, not more about price. Now we see even in the public tenders, customers more wants like a continuum in their installed base. They want upgradability. They want to go to hyperfractionation and to go to -- yes, to adaptive in some cases. So we fill all the cases -- all the -- we take all the criteria for that, not only on price. And the third one, I think, question is for Ardie for you for U.S. about reimbursement.

Ardie Ermers  

Yes. Thank you for the question. And while this situation is obviously a little bit fluid, we're working really closely with ASTRO and ACR. The draconian measure you mentioned was really related to bundling, radiology and radiation oncology. And the feedback we're getting from the bodies is that they are trying to dissolve this because this is a mistake.

But the fact that there is now a groundswell from 122 institutions that are signing up for Roche and also getting good support at the hill from both parties, we feel strongly that the Roche legislation is going to get passed. Now we will have to obviously see how this is playing out this year and when the bill is going to be taken up but if it goes into the draconian direction, obviously, we have to regroup. But we're focused on making sure we protect the reimbursement rates for radiation oncology. We believe that cancer care is a very vital piece of health care in the U.S. And therefore, we strongly support ASTRO and this endeavor.

Peter Nyquist   Head of Investor Relations

I think we have -- David, you had a question and then Robert, to you.

David Adlington   JPMorgan Chase & Co

David Adlington from JPMorgan. Just I'm afraid coming back to canceled orders. I just wondered what you expected on balance customers to do there? Do you expect them to come back and make new orders at a higher price or they just disappear? And then related to that, typically, I think you take a deposit on an order. I just wondered if there are any cash flow implications of the canceled orders? Do we have to pay deposits back? And if not, does that mean you get to recognize some revenue?

Tobias Hagglov   CFO

Well, I'll start with the second question. No, there are no deposits here. So that's the answer. So it will not have a cash flow impact for [ SC ]. On these orders, no.

Habib Nehme   Chief Commercial Officer

And as I said, we act in the frame of the contractual. So the customers, first, everybody understand that after 3 years, I mean, the macroeconomic change, the cost of goods change everybody feel the inflation -- felt the inflation. So they're not surprised on this. But I repeat again, we act in the frame of the contractual agreement where we know that we have the right to change or to cancel based on the contractual clauses that we have in our contracts.

Jonas Bolander   Acting President & CEO

And then to clarify that a bit, David, the customers may come back and order again or they may not.

Peter Nyquist   Head of Investor Relations

Here, we'll go to Robert in the front here.

Robert Davies   Morgan Stanley

It's Robert Davies from Morgan Stanley. Three questions. First one was also on just the order cancellations. Just be curious, when you look through the profile of the orders that you haven't taken out the backlog, I think you mentioned a number of 82% of the backlog was still "active," what's involved with the remaining sort of 18%? Is that stuff that hasn't been canceled, you can't cancel? It's within that sort of 3- to 5-year window? Just that was the first question.

The second one was just, I think you put up a slide during the contribution of software around 21% of sales that have been relatively flat over the last few years, given that's been such a big focus for the company, perhaps you could give us a little more color of how you're expecting to accelerate growth in the software element specifically?

And then sort of tied to that, the Software-as-a-Service bit of your business, just if you could provide a bit more color in terms of what that contribution is now, where you expect it to be in 3 to 5 years? And is there anything you can give us on sort of growth on margins around that bit specifically?

Peter Nyquist   Head of Investor Relations

Maybe Habib, you can start with the first one, the 5 years order book.

Habib Nehme   Chief Commercial Officer

Yes. So you rightly noticed that there is still 18% of the backlog. And some orders to be materialized takes more than 3 years. So this is why either -- I mean, we understand that these orders will still move because the customer has the financing and has a delay in the realization and the price and the margin is good or some others are still on hold under investigation to decide about the status, either cancellation or keep them. But the bottom line is that 82% is still active and transferable.

Peter Nyquist   Head of Investor Relations

You can continue with the software questions.

Tobias Hagglov   CFO

Software question, yes. So it has been a relative stable development if you look over the last 5 years, which I was presenting here. However, what you see here in the last year is actually the pickup that we are 1% up as a group in total, while software is actually growing by 7%. So there is a -- and when you look at the share of sales here for software, there's also enhancing in the last fiscal year. When you look at the order development then, we are running here with an order growth above 20%. And this is not something that randomly has happened.

It follows by a very precise and conscious investments that we have done, ensuring that we have software installers, ensuring that it's fully integrated in the commercial offering, ensuring that, I mean here, a very long-term work here in coming out here with Elekta ONE and what just Christopher presenting. So I think actually, when you looked at it and saw here, again, I'm coming back to Q4 and the gross margin improvement we've had, it's not a coincidence.

It's based on actually planned actions here, both when it comes to price increases. We talked about Elekta Evo, but it's also an acceleration of high-margin businesses. And what we have seen here -- and it's actually been also when you look at the software development, it's actually the 3 last quarters, which have been strong in terms of the revenue growth. And that work to emphasize software and drive software growth, that will continue.

Christopher Busch   President of Linac & Software Solutions

Maybe add one more thing to that because I think you mentioned it in your slide as one of the kind of productivity points that we are pursuing that we have a very active program now on increasing and simplifying the installability, the deployment of software, make that as easy and as smooth as possible, where in the past, you had to send a service engineer to a site who has to go into the department, maybe even into the bunker and has to put out a CD ROM or something like that and has to install it. We are increasingly moving towards much more automated updatability.

So this will also, in the future, and that's again a little bit forward-looking, make the speed and the increase, the simplicity also for our customers to get software upgrades in an easy and nondisruptive way much more -- and that's -- much more easy. And that's also something we are and have been investing on. And specifically, when you talk about the complex software installations of our OIS, of our comprehensive motion management, which is usually a suite of software, these things are going to benefit very greatly from our efforts in R&D and investments to make these processes easier, even though the clinical functionality will not change, but just the upgradability will become a major multiplier for our efforts.

John Lapre   President of Brachy & Neuro Solutions

And in the coming years, when we get Brachy on Elekta ONE, that adds another potential of 2,000 installed base for upselling and upgrading for Elekta ONE.

Peter Nyquist   Head of Investor Relations

So we'll move over to [ Bo ] in the front table here. You'll get it here. Sorry.

Unknown Analyst  

[ Bo at JO Pharma ]. A quick or a small question or big for the team Europe and a very big one for the U.S. and start with the first question then on Europe, and that is -- so Evo, I think back-of-the-envelope calculation was that you had orders above 25 in your fiscal third quarter. How many orders did you have in the fourth quarter? And how fast can the trajectory be compared to the Versa HD launched in 2014, '15?

Tobias Hagglov   CFO

Yes, I can answer no on that question. So what you actually saw both in Q3, we don't provide explicit volumes here by quarter. But what you could see was a strong traction and momentum both in Q3 and Q4 from Elekta Evo in Europe. And that is something to build on also when we roll out the global launch here of Elekta Evo.

Habib Nehme   Chief Commercial Officer

60% of our linac is now Evo and...

Tobias Hagglov   CFO

Second half, yes.

Habib Nehme   Chief Commercial Officer

In second half. But as we go forward, we think that the Evo would be -- in this segment more than 50% of the orders of linac will be Evo.

Unknown Analyst  

And it was 50% in Q3. So much higher than in Q4, if it's 60% in H2.

Tobias Hagglov   CFO

I think it's -- when we talked in Q3, then we talked about the, sort of say, total orders. But I think that the key here, what you see both in Q3 and Q4 is that we have a strong traction, which we need to build on. And it is a global launch. And that means that everything will not be a straight line, but it's actually to build here and drive the momentum ahead of us. And so far, it has went very well. And I think we are equipped here with a great product that we will continue to utilize, not only in Europe, but also on a global level. But the traction in Europe is good.

Unknown Analyst  

And how big part was the software upgrade in Q4 or second half?

Tobias Hagglov   CFO

So we have not shared explicit details here by quarter as well. But what you could see is clearly an order growth of software, which was much larger than the average order growth in Elekta. So that was very notable. And that is also a consequence of what you just heard here Christopher presenting and what you will also hear more from Anish, which I really recommend to listen into later on.

Unknown Analyst  

And then Ardie, a much more difficult question, but I guess you are new in your role and been successful in Europe. And could you talk about the U.S. before you arrived, what you have seen and what you expect to do going forward, excluding the upcoming approval of Evo?

Ardie Ermers  

Yes. So I think arriving in the United States and looking at it from an outside-in perspective, you see, obviously, this is the home market of Varian. So I think a strong installed base there from our competitor and also a lot of, I would say, academic leadership there where you see that the comfort level with the Varian solutions is a little bit higher than with Elekta. On the other hand, people do see that the radiotherapy market is changing. And especially, I think, in the direction we're heading with our solutions to give a flexible offering on doing adaptive treatments, I think really separates us from our competitor.

They have basically focused on a strategy where they launched a product called Ethos, which is the machine you have to buy to do adaptive therapies, whereas we, as Elekta, have chosen the different path. Not only do we provide, obviously, an opportunity to go to adaptive treatments with Unity, but also in the future, we can deliver this with the linacs. And most importantly, it's also upgradable. So we have a big installed base of Versa, as you know, which is a great potential for us to upgrade not only on Iris image quality, but also in the future for adaptive treatments.

So I think we have a good starting point here to really start growing again in this marketplace, strengthened also by the fact that we see that now also with CMM rollout, key institutions like Memorial Sloan Kettering, NYU, MD Anderson seen uptick in throughput with the Unity and started to see that also there's more indications being treated with MR-linac. So this brand image that we're creating around adaptive therapy really sets us up for growth. And I'm really strengthened by the fact, obviously, that the reimbursement climate is under a big focus here to make sure that we also help our customers getting paid for these additional steps.

So it's going to be, I think, an exciting time for us here in the United States and working with our customers, confirming that they want to have a strong competitor to Varian. The other thing we don't really know yet is the impact of Siemens Healthineers dropping the Varian name for January 1. It has a very strong brand value in the U.S. market, as you know. And so we definitely want to stay close to our customers, making sure that we can benefit from that change.

Peter Nyquist   Head of Investor Relations

Let's move back to Mattias in the back.

Mattias Vadsten   SEB

I have 3 questions. I appreciate all of the discussion around margins and the path forward to make it more profitable growth. But what we are lacking here a bit, I think, is commentary on future growth ambitions from Elekta. You clearly covered the efforts, of course, everything you're doing. But -- so how are you seeing market growth going forward and what is reasonable for Elekta to achieve, particularly perhaps interested in the U.S., I mean, given the sort of fading number of installations we have seen in recent decade and we saw in the presentation and of course, a high density of linacs as well, less fractionations should mean less need of linacs. So maybe cover that.

And then also on the U.S., I think we have seen a decline in constant currencies over the past 6 to 12 months in service revenues. So just help me understand a little bit what is driving that development and when that could turn positive again? And then lastly, so gross R&D moving towards 10% of sales. What is maintenance CapEx for Elekta? And how is that expected to develop going forward? Those were my questions.

Peter Nyquist   Head of Investor Relations

Maybe you can start with the first question about growth. And then Ardie can add on the U.S. side on that as well. So...

Habib Nehme   Chief Commercial Officer

No. We see like the growth is a different dynamic in the different part of the world. And we see in China, for example, this year, the orders coming back on the growth. We still have growth opportunities, Southeast Asia and other part of the world, we -- in the emerging market, the growth would come as well from more installed base where we do not have high installed base, and this is the expansion on our installed base with the adaptive radiotherapy. So it can grow with the market in some growing market, but as well it's growing with more competitiveness with the new solutions that is coming.

We see still a growth in the replacement market in Europe, very active replacement market. It's not only about access. It's more about elevation of the care and having to hire techniques. And I would say before going to U.S., it's not only about top line growth. It's more about accretive growth. So I wanted to comment as well before about the solutions, I would say, backlog. It's not only about having like MR-linac, which might be less accretive than the software or the Brachy or the Neuro. So it's managing and forecasting as well the profitability rather than the top line here. And this is what we are about here. So maybe U.S.

Peter Nyquist   Head of Investor Relations

Ardie, you can add that to the U.S.

Ardie Ermers  

Yes. So just to rephrase your question, really, what's the impact here of going to hypofractionation for the marketplace. Yes, the answer is that, obviously, if you can do hypofractionation, you can treat more patients. I think for us at Elekta, this is a very positive development because that means that the older equipment, as you saw in my slide, the average of 14 years, those are older linacs that basically just do the basics, and if you want to go to advanced treatment techniques like VMAT and later on hypofractionated adaptive therapy, those capabilities are not available in those centers. So it's an opportunity for us to upgrade these machines to our technology.

We believe that our offering in that area is stronger than from a competitor. And therefore, we believe that this change is going to be beneficial for our linac growth. It's obviously also clear that we have focused a lot on Unity developments, but now we start to see with the developments we have on the linac and the software side, we have a very good uptake and starting to turn this ship around. So what you will see over the next couple of quarters is that we indeed are starting to increase again on the solutions revenue side and then also on the service revenue side.

Peter Nyquist   Head of Investor Relations

And maybe, Ardie, you can add on the question around services development in U.S. as well on that question. How you see that?

Ardie Ermers  

Yes. So if you look at the services development, where we have strong installed base, we see that those services are actually increasing. On the linac side, I just described, obviously, that there was a little bit of a weakness that we are now addressing with this new portfolio coming out. So therefore, I see that, that sets us up for a future growth path with good profitability.

Peter Nyquist   Head of Investor Relations

Thanks, Ardie. And maybe Tobias, there was a question about gross R&D, how big portion of that could be maintenance investment?

Tobias Hagglov   CFO

Right. No, that is a number that we don't provide per SE. But what you can say is that the current R&D investments that we are on allows us to have a strong innovation pipeline and actually sizable investments for developing our products. That's how I would frame it.

Christopher Busch   President of Linac & Software Solutions

And maybe to add a little bit to that because when we talk about maintenance, it very much depends also about what product or part of the product portfolio we are talking about. We have some very modern, very recent releases that are fully on par with the tech stack and maintenance is there, but it's also already quite automated and modern in a web environment often. Of course, we have also a lot of history and there, we need to do some active work right now, which we are doing. But also there, and that's something, again, utilizing innovation not only for our products, but also for the way we are working, we are active -- very active right now in programs also how to automate many of the more basic innovation topics that we need to do, like test automation, which can be a huge effort, but you can also automate that.

We are using generative AI right now to automate or to generate our test cases that used to be done manually. So I think also there, you will see that our innovation capacity for the high value-add topics will go up. And of course, maintenance as a percentage of overall, let's say, effort will probably still be reasonably high. But you see that the manual part of that will decrease, and we reallocate those highly valuable manual people in our R&D teams towards the value-added topics.

John Lapre   President of Brachy & Neuro Solutions

Yes. And there's maybe one thing -- I don't like maintenance as well. But if you look at continuous engineering, yes, we have sometimes that we have obsolescence. We need new parts, and that's immediately an opportunity for COGS reduction. So it basically cuts through multiple things.

Peter Nyquist   Head of Investor Relations

We have one more question there.

Estelle Pang   Sanford C. Bernstein & Co.

This is Estelle Pang from Bernstein. I'm asking on behalf of Lisa Clive. So just to quickly kind of understand a bit more of the canceled order in the backlog. Is there any common theme behind those cancellations? Were they more from emerging markets? Or were there any like large tender-based contracts?

Tobias Hagglov   CFO

So the common theme is that it's nonaccretive orders, which actually here where we see an opportunity to enhance the quality of the backlog. So that is what we -- and yes, there is a clear part, which is from emerging markets as well.

Peter Nyquist   Head of Investor Relations

Good. If no further questions in the audience, yes, Robert, you could -- let's move there to -- let's start with Robert here. Then we'll take Erik as the next question.

Robert Davies   Morgan Stanley

I just had one follow-up question around how you structure partnerships within your business, both on the hardware and software side. You're obviously kind of putting up a fully sort of integrated workflow solution. How often are you using partners? Where are you using them? How heavily are you leaning on partners, particularly on the software development side, I'd be quite interested in that.

Christopher Busch   President of Linac & Software Solutions

Well, we are, of course, working with partners and some of them are exclusive. Some of them are preferred and some of them where we are agnostic and just basically provide the interoperability to be able to interact with an Elekta solution. And when we talk about the strategic ones, we are and will be very selective because there, we really need a long-term multiyear commitment to have a co-development effort, and that includes not only the development effort on the engineering side, but also a business case and a business model that is beneficial for both parties.

When we talk about having increased interoperability and then you can talk about partners where we have preferred partners, but are not exclusive. There we will have open access to certain interfaces that are accessible for everybody, and we will have some selected kind of more proprietary protocols that we will open up also with new business model for partners that allow them to integrate deeper. But we don't need to really do co-development for that. We can open them up and then we have maybe a co-test and co-validation of the resulting workflows.

And the last point, we, as Elekta, are committed to an open ecosystem. So we will continue to expand our interoperability, and that is not only with partners, but also with parties like EMR providers that, of course, also have large IT infrastructure in the hospital that we need to be able to connect to and they need to connect -- be able to connect to us. So expect also there some developments in the future.

Peter Nyquist   Head of Investor Relations

Thanks. We will -- yes, maybe Christopher here. If you move to Christopher, then we have Veronika. No, we have Erik, sorry, Erik first.

Erik Cassel   Danske Bank A/S

Erik from Danske Bank. You said in the introduction way back that you're now only going to take profitable orders, which sounds like a good starting point. But I would have thought that you've always taken profitable orders, but then maybe over the past couple of years, maybe got caught out first from supply chain and then inflation. So what's actually different with the way you take orders now? Do you have a larger margin of safety on margins? Do you bake in clauses? Do you have additional protections in any way?

Jonas Bolander   Acting President & CEO

Do you want to speak about that? Or should I start a bit?

Habib Nehme   Chief Commercial Officer

You start and I can see...

Jonas Bolander   Acting President & CEO

So I think what we've done and Habib talked about that is we have really digged into the processes around our order to cash program and so on and have quite much stronger safety net also with the capabilities to adjust prices way much quicker than we have been able in the past. Maybe, Habib, you...

Habib Nehme   Chief Commercial Officer

Yes. So actually, when we look at the quote to order to revenue, we reviewed our pricing model. And in the pricing model, we anticipated the standard costs that we can take into consideration in the beginning as a cost and as well what targeted market value we can have with the value that we are conveying to our customers. So first, much more robust pricing model, embedding the standard cost in order not to have surprises like we got in 2021, where we had a surge in the COGS and surge in the logistics and so on. So now it's much more stable and very robust pricing model, plus we compare ourselves to a target value, which our customer is ready to pay for our solutions. So much more robust pricing model.

Peter Nyquist   Head of Investor Relations

So we have time for one more question. Did you have a follow-up or...

Erik Cassel   Danske Bank A/S

No, I want to ask something else.

Peter Nyquist   Head of Investor Relations

Okay. One more, Erik, and then we have 2.

Erik Cassel   Danske Bank A/S

Okay. Just -- I think software is probably going to be the most important part for the next 10 years, maybe forever. But you have quite a different selling process compared to others. The way you sell software, especially to the U.S., I believe you're only going to sell it as a service, but no one else seems to be doing that. And when I buy something as a service, I buy it because I want to be able to cancel it. When someone buys a linac, they know they're going to use it for 12 to 15 years, and they're going to need software on it. So what's the rationale of even selling it as a service when customers have that sort of approach to using it?

Peter Nyquist   Head of Investor Relations

Maybe, Tobias, you can start on that question and Christopher can add on that.

Tobias Hagglov   CFO

I think you can fill in here more from a sort of commercial and technological point of view. But what we are aiming to do here is, of course, that you have a partnership with your customer over a long period of time. And you work here with the upsell and cross-sell opportunities where Software- as-a-Service come as a national ingredients to both work together with the customer, but also then that, of course, for the customers, it means that you have a lower CapEx at the beginning, you have a more smoother, you can also plan your operations than having spikes in investments when new innovation comes out. This actually allows the customers to have a more planned and also predictable cost for the software and also the usage of the software and the benefits from the software. So that I would say, and maybe here, Christopher, you can add on from here.

Christopher Busch   President of Linac & Software Solutions

Sure. I mean, number one, you mentioned the kind of the ease of cancellation. It's not a Netflix kind of subscription that you can cancel and you go to Disney+ or something like that. Once you are in an ecosystem of an oncology informatics system or have treatment planning software, these are usually very sticky projects -- for products and projects because they are closely related to how you train, educate your staff, how the whole workforce is being used to follow certain processes and everything. So to shift from one software to another, regardless of whether it's a SaaS model or not, is a huge, major undertaking.

I mean that's something if you have seen what happened in the U.S. when they had to shift to the EMRs, those were multiyear, multibillion-dollar projects sometimes. And this is a little bit easier. But nonetheless, it's a nontrivial thing regardless of SaaS or not. Secondly, SaaS provides the flexibility to be in an evergreen situation and saying you don't have to worry about having a capital budget for the next upgrade or install. You know you can get it and you know it's easy to install.

And the third point that increasingly will play a role here is the topic of cybersecurity, right? SaaS models, specifically when they're in the cloud are much easier to have certainty about having the latest updates also related to cybersecurity, which are different and also seen by the FDA, different from clinical upgrades and updates. So the CIO, the Chief Information Officer in the hospital will increasingly demand these kind of models for the departments to work.

And that's not just specific for an oncology department, but it's a hospital-wide decision. So I believe that SaaS models maybe not for all departmental isolate things, but for specific bank also the backbone and the infrastructure for hospitals will become increasingly dominant. And as said, the flexibility to cancel is there, but it's always and has always been a major undertaking that's not taken lightly.

Peter Nyquist   Head of Investor Relations

Thanks. We have time for one more question. I guess maybe, Rickard, you can take that, and then we will move over to the concluding remarks from Jonas here. So Rickard, you have the chance to -- and you all have -- who's going to stay here in this opportunity in the deep dives to ask question as well.

Rickard Anderkrans   Handelsbanken Capital Markets AB

Yes. Rickard Anderkrans from Handelsbanken. Just a final product-related question. So Elekta Planning Pro with the adaptive functionality, is that still only for pelvic indications? And has there been any expansion of indications? And what's the willingness for Versa HD customers to actually pay and sort of adapt this technology given the limitations there?

Christopher Busch   President of Linac & Software Solutions

Well, that's, of course, a statement that at this moment, we have the CE clearance for the pelvic area. We are very close to release, not details further to release the next body parts and then have a sequence of body parts that we have a complete coverage of all the organs that are really needed. That's a commitment we already make to our customers, and there is a committed road map for that. Then, of course, you will see that increasingly, we will not only have also updates of the specific body part models, so Pelvis 1.1, 1.3 because also their technology moves ahead.

But we will also start next to the more body parts, we will start releasing packages related to the imaging that are more related to motion management to artifact reduction of gas bubbles, metal implants in the hip, in the face. So you will see that there's going to be a full road map of further things. So this is not just a onetime release, you say you have 3 body parts, you're done. This is a full road map, both within the body parts because the technology will improve, but also going increasingly from static body part improvements to dynamic motion management.

And there, we are benefiting very much from the learnings that we have from Unity and there's comprehensive motion management. So stay tuned, but you will see in the not-too-far future that we'll start to introduce motion management also for CT linacs. That will be a major new thing.

Peter Nyquist   Head of Investor Relations

Great. Thank you all, and thank you all for the questions here in the audience. Let's -- we have Jonas staying on the stage, concluding this first part of the day for both online as well as you here in the audience. Then I will be back and tell you a little bit what's going to happen later on.

Jonas Bolander   Acting President & CEO

Thank you, Peter. And thank you all for coming and attending, and I hope that you will join us later at Forskaren. It's been a real pleasure having you here, and it's my first investor update and very, very interesting, and thank you for all the interesting questions. I won't be lengthy. I just want to reiterate that this is our short-term strategy that we're working on now, which we have seen during the fourth quarter, been very successful driving the business with the focus that we have on profitability and margin and so on and puts us in a different maturity level.

With that, I thank you all and see you later. Thank you.