8/21/2026

speaker
Kari Krogstad
Chief Executive Officer

Very good morning everyone and welcome to Medistim's second quarter and first half of 2026 financial results presentation. My name is Kari Krogstad and together with CFO Thomas Jakobsen we are here to go through the results. As always, we like to just remind ourselves about Medicin's track record. And we are looking back on decades of growth, both in sales and in operating profit. And that has been our promise to our shareholders to deliver constant profitable growth also going forward. If we look at just the recent period from 21 to 25, we are looking to a 13% annualized growth in sales. So definitely a strong track record to look back on. So with that, we are entering into the second quarter. The second quarter last year was a strong comparable, and we're seeing that we are beating it with high margin and also setting new records for both sales and EBIT. So this is definitely strong performance. As we can see, we are delivering another record quarter with sales reaching 202 million NOX. Thank you for watching! Our own products are growing by 33.6% currency neutral, and we can see that all the sales regions are really contributing nicely to this result. Americas is up 46.3%, EMEA is up 19.4%, and Asia-Pacific up 22.4%. The third-party products is down 7%. We're also setting then a new record for quarterly operating profit, delivering 65.3 million in EBIT this quarter. This gives an EBIT margin on the high side at 32.3%, very much driven by the strong sales development of our own products. We will see also that this is the first quarter where we are delivering sales through our direct operations in Japan. Looking back at the month of May, we paid out a dividend of 8 NOX per share, totaling 146.3 million. And the board will also propose to the general meeting to authorize a distribution of quarterly dividends going forward. Moving on to looking at highlights for the first half. So this is continued to be very strong numbers. It's a record first half year. The first time we are surpassing 400 million in sales revenues. And again, we have this negative currency effect. And adjusting for this, we're looking at currency neutral sales development in total at 23.4%. Again, it's really our own products that are driving this. In total, up 31.8%. And again, all regions are contributing very positively. Americas, growing 37%. EMEA, up 16%. Asia-Pacific, up 43.7%. and the third-party products in the first half is down 19.9% and we will remember that we had an extraordinary sale in the first quarter last year equipping new hospitals in Norway so it was not anticipated to being able to repeat that strong sales for the third parties in this year. We are looking then at very strong first half performance, operating profit reaching a new record of 122.4 million, and again EBIT margins on the high side at 30.3%. You will also note that there is a substantial increase in operating expenses. This is reflecting higher commercial activity. So both more people working in the field and also seeking to spend more time with customers and other marketing activities. We also have now a team of 10 people working for us in Japan, which we didn't have at the same period last year. And also we see some one-off expenses, which is due to ongoing IT system migration to the cloud. So with that as an introduction, we will take a closer look at the financial statements and get back to some further details later on.

speaker
Thomas Jakobsen
Chief Financial Officer

Good morning, everyone. And I will, as usual, take us through the financials for the first, sorry, first half and the second quarter for Medistim. Looking at the P&L for the quarter, Kari will go through revenue in more detail when it comes to geographic split and split of units. But again, this is another record quarter for Medistim with revenue more than 200 million for a quarter. Our gross margin ends at 82.2%. That's an improvement from last year, 81.9%. And that is despite the fact that on the cost of material, we have expensed 5 million in tariffs related to the U.S. In the second quarter last year, tariff was introduced, but Medestim shipped all the goods that we had available before the tariff was active, which then led to that Medestim did not pay any tariffs in 2025 before the fourth quarter last year. And I will have some comments, more comments on that later on. But anyway, salary and social expenses increases with 4 million. 2 million of this is related to more general adjustments from 25 to 26, but the additional 2 million is related to our direct operation that we have established in Japan. This is a quarter with a lot of activities and other operating expenses increases from 30 to 42 million. And there are some main reasons for that. The IT project that Kari mentioned is actually to take all of our systems to the cloud is expensed in this quarter with around 3 million NOX. In addition, our direct operation in Japan, we had expenses, other operating expenses amounting to 1.6 million. Patent study we talked about before and in this quarter we expensed around 3 million related to that study. And last but not least we're also having high level of commercial activities like traveling and exhibition participation and so forth amounting to more than 2 million for the quarter. So all in all very high activity level. Opening profit EBITDA ends at 71.3 million versus 60.5 million last year and EBITDA percentage at almost the same as last year, 35.3% versus 35.8% last year. Depreciation, no major changes, same level as last year and our EBIT for the quarter ends at 32.3% versus 32% last year. Thank you very much. Net finance ends positive at 3.6 million, and this is currency related, converting US dollars and euros to Norwegian crowns. Profit before tax ends at 68.9 million, that's up 22% compared to last year, and profit after tax ends at 52.2 million versus 42.9 million last year. If you then look at the year today, or the first half, or 26, a new record for Medistim, revenue ending at 403.7 million. Gross margin is down from 82.5 million to 80.9 million. Again, here's a tariff expensed on the cost of material of 10 million Norwegian krones. Salary and social expenses and other operating expenses has more or less the same explanations as for the quarter, only larger numbers, so I don't go into that detail. However, under other operating expenses, I just want to remind that we had in the first quarter an agent commission of around 2.5 million. EBITDA ends for the first half at 134.6 million versus 125.2 million last year. Depreciations at the same level, more or less, a little bit higher than last year, but not by much. And operating profit ends at 122.4 million versus 113.3 million last year, an EBIT margin of 30.3%. Net finance negative for the first half, again related to currency. Profit before tax ends at 120.4 million and profit after tax at 92.5 million. Last comment I want to make for the P&L is related to the US tariff that was deemed unlawful in the US. And you probably heard about companies that get refund for this unlawful tariff. And to our understanding, the US customs are now gradually refunding this month by month. And the last that we heard is that they refunded as of July 2025. As I mentioned earlier, Medistim did not pay any tariff before the fourth quarter 2025. And as we speak, we are working on documenting and putting all the paperwork together in order to file a refund for the tariff that we paid in the fourth quarter of 2025. This amounts to 760,000 US dollars and that is not reflected in these financials that we now are presenting to you. So this will be an upside when we get the refund. If I look at the balance sheet, intangible assets increases and this is mainly because of our development projects ongoing, the automated production project and also our software project related to Intuit, but also the IT project related to taking our systems to the cloud. No investments in fixed assets this year and therefore a decline. Inventory levels has gradually been reduced quarter by quarter after our peak in the first half of 2025 and ends at 156.5 million. However, we will continue to keep high inventory levels both because of critical components that we need to have and also if there are end of life on components that we are dependent on before we can get new regulatory approvals. Accounts receivable are increasing, and that is because we also have very strong sales, so that's a natural increase, and it also increases our working capital. Cash ends at 100 million, and that is after paying 146.3 million in dividend in May, and as Kari mentioned, The board is now proposing that they are authorized to pay a quarterly dividend. And we will have to come back on that later on. And we will comment on that when we send out. There will also be sent out a notice with a general meeting to give the board this authorization. Equity and liability, strong balance sheet, more than 70% equity, no interest bearing bank debt. The long term liability is related to extended warranties and lease obligations that we have. Key figures, earnings per share follow obviously the increase in profits, so we have a strong development here in the second quarter, and by the first half we have earnings per share of just over 5 NOK per share. Cashflow. Cashflow operation suffers a bit from the increase in change in working capital, as you can see, both for the quarter and for the first half. And the main reason is explained by the increase in accounts receivables. Investments is our development projects and the IT projects we talked about. and cash from financing is negative with 152 million where the majority is dividend and the remaining is payment of our lease obligations. Net cash is negative in the first half of 111 or 112 million and cash ends at 100 million by the end of the first half and improvement from last year's 96.3%. And with that, I leave the word to Kari. Thank you.

speaker
Kari Krogstad
Chief Executive Officer

Yes, so let's take a look further into the details of the markets and product segments. and starting with looking at how we're doing on the flow and imaging systems sales in units of course this is a very important product for us it's the higher higher value and also higher priced product we can see that we're delivering a total of 22 systems this quarter on the same level as this quarter last year and they're very important for us to see that we are at this level in total Funny enough, each region is actually delivering exactly the same number of units as this quarter last year. When it comes then to the imaging probes in units, we are two units down this quarter. Of course, there are quarterly variations. As we can see, this graph is also depicting. America's this quarter is up by five units, while EMEA is down by five units, and Asia-Pacific is also down by two units. Looking at the flow-only systems in units, we are three units down. Mercus delivers at the same level as last year. EMEA is also at the same level with 12 units, and we see this quarter particularly strong contributions from the distributors in EMEA. This is also something we see varying from quarter to quarter. Sometimes the direct market is sort of the stronger part, and sometimes the distributors are the ones that are growing the most. Asia Pacific down three units for the quarter. And we can note that we had a very strong first quarter in terms of number of units for Asia Pacific. So I wouldn't be very worried about this. Looking at flow probes in unit, which is of course a good indicator of both utilization and sales in general of the new equipment, we see a good development of 16.5% growth in this quarter. America, as a region, is delivering the same level in number of probes as last year. But I should already now note that USA is definitely showing an increase in number of flow probes, and we will see that reflected in the number of procedures in a little while. It is Canada and South America that is having a lower number of probes this quarter, and the Americas then ends up at the same level as last year. EMEA, very strong, up 22.5%, and Asia-Pacific also up 20.6%. Yes, so looking further into the Americas region, so delivering 103.7 million NOx, so more than 50% of the total for revenues in medicine for the quarter. Currency neutral, as already mentioned, up 46% for the quarter. I just mentioned that the total units of flow probes and systems sold for the region are at the same level as last year, and the revenue growth that we will see from the probes and systems are then driven by price increase. We will also note that there is good growth in number of flow procedures to lease and PPP accounts, and also the imaging probe unit sales is up. Sales in Canada increased 19%, so this is more driven by systems than probes. and further detail on the unit sales development in USA in isolation. Already mentioned the flat development on the system sales for the quarter. We're actually down two for the first half and these are two lease out placements that we did last year that we're not repeating this year. But the number of capital sales of systems is the same. When we're looking at number of procedures from the various components here, we see really good and strong development all over. We see especially, as I mentioned, flow probes, which was flat for America. It's definitely growing for the US. And this is reflected in actually 20,739 procedures coming from this capital probe phase for the quarter. and that gives the 28.6% growth and we can also see for the first half very strong development in number of procedures from capital probe sales, 32.1%. Also worth noticing, imaging probes to capital customers also definitely going in the right direction, 10% growth for the quarter, 12.5% growth in the first half. Asia Pacific, 26 million in the quarter, currency neutral. This translates to 22.4% growth. And we are, of course, following the development in China very closely, where we have been direct now for a couple of years. Up 15.9% for the quarter and reaching 14.8 million. So very good quarter and then also a strong first half for China. We just always want to remind that still we are selling through local subsidiaries and agents, and this will sometimes end up with some quarterly variations. So there will be some inconsistency in the developments over the quarter. Japan, we established our own team and subsidiary in Japan in the end of the first quarter. And now in the second quarter, this is the first time we're actually delivering sales through this organization. It is quite modest for the first quarter. This is just representing probe sales. and we are now working in the field to build the pipeline to replace old systems out in Japan. We know we have a very high penetration rate there and also working in the vascular side to establish new customer opportunities. We also note that all duration distributors have a strong quarter, growing 28% and then delivering 8 million in sales. The EMEA region delivers 48.9 million in the quarter. This is currency neutral 19.4% growth. As I alluded to earlier, it is really the distributors that are providing the highest growth this quarter, actually growing 59% currency neutral. While the direct markets are relatively at the same level as last year. And this is also something we have noted over time, that we have these variations from quarter to quarter, whether it's the direct markets or the distributors that are really driving the development in EMEA. We can just also keep in mind that the direct markets account for about 55% of the revenues in EMEA and distributors around 45%. So both sales channels are of course important. When it comes to the third-party products, I already mentioned this, so 7% down for this quarter. It was a tougher first quarter here, so at the first half of the year, we are then looking at a 19.9% decline so far this year, and I explain that with a very, very strong first quarter in 2025. Summarized, we are looking at, and this is in Norwegian currency, so not currency adjusted, we look at the Americas region, 31.4% growth for the quarter, 23.2% for the half year. Asia Pacific up 17.5% for the quarter, up 37.3% for the first half. EMEA up 14.3% for the quarter and 11.3% for the first half. So strong performance from all regions and bringing us to the total of 19.5% growth for the quarter and 15.1% for the first half. Here we can see that the cardiac surgery segment is really driving the growth both for the quarter and for the first half. Very strong performance of our cardiac product portfolio. When it comes to the vascular, we will remember that in the first quarter we reported 1% increase in vascular sales. and now in the second quarter we are looking at 9.3 percent decline and this is definitely weaker than we've seen in the recent years you will remember that we have had 20 and 30 percent growth in the vascular product portfolio in recent years and what we're seeing right now is not reflecting a shift in the underlying demand it's rather a temporary product mix effect and I'll try to explain this because this ultimate systems that we are providing is delivering both the cardiac and the vascular applications and we sell this as sort of a broad-based package and enabling the hospitals to use our technology both in the cardiac department and in the vascular department. Now it's a fact that we have launched a new Intui software, and currently it's only available on the Kardec systems. So that has led to a lower number of ultimate system sales and a higher level of Kardec system sales. For instance, in the US, in the first half, we have sold five less ultimates and eight more Kardec systems. and then also reflecting around the high price of the ultimate system, so around 220k US dollars. Of course, a shift like that has an impact on the revenues. And it's also important to just remember that the revenues from an ultimate sales is allocated then 50% to cardiac and 50% to vascular. This is the product mix effect that is driving this sort of negative development for the vascular sales reporting that we are seeing right now. We will continue to see this, we believe, until we are launching the Intuit software also and making it available for the vascular and the ultimate systems. And that's planned to happen at least in the first half of next year, as early as possible, of course. When it comes to the split between flow products and imaging products, we see that the flow products are continuing to develop very nicely, both for the quarter and for the first half. Our imaging products are also really going in a nice direction. We will remember that the imaging products have shown high growth for a number of years, but had a dip in 2023 and 2024 in the tougher macroeconomic circumstance that we saw. This came back really nicely in 2025, and we've also seen continued strong performance in first half of 26. So this is good to see. We have never lost confidence in our imaging portfolio. We always experience really high interest from new users in that technology. So we're continuing to be optimistic for it going forward. The component of recurring revenues versus capital revenue, here we continue to see really high contribution from the recurring products. So that means capital probes and PPP cards and lease contracts. And the last 12 months period is showing a 70% part of recurring sales. So quite in line with historical performance. So that's a review of details when it comes to performance for the quarter and for the first half. And I would like to comment a little bit about sort of our outlook going forward. This is our simplified description of our growth strategy. And we can see that we are targeting the cabbage market, the vascular surgery market. In this are also the transplant procedures and other open surgery, which is connected to cabbage, you could say. Today I would like to point to the size of the annual revenue opportunity here. 7 billion NOC in total opportunity. And remembering our sales performance last year in 2025, we reached about 700 million. So meaning that we are addressing only 10% of the estimated market opportunity. So highlighting then the significant runway for continued growth. If we're also looking at market penetration in terms of procedures and start discussing the cabbage market, we've always taken a deliberate conservative view of the global cabbage market, and we don't want to exaggerate the size, so we've always said it's more than 700,000. And although we can actually find data to say that perhaps this market is both 800,000 and 900,000 procedures, but the sources are not always that reliable. So we've kept it sort of very conservative at 700,000. And that would mean that we're currently serving around 40% of these procedures with our flow technology. That also means that there's of course a big incremental opportunity to convert these flow-only users to flow and imaging users. Thank you very much. Thank you very much. So, based on this, I just mentioned in my introduction the 13% annualized sales growth that we have shown over the past five years. We can also think back on the six record quarters that we've just reported on. And with this big growth opportunity that I've just described, I will... We like to update our long-term outlook for our business. And as part of our annual strategy review with the board in June, we have updated our view on this. Our revised plan indicates that we are expecting to see actually a higher growth trajectory than achieved over the past five years, and that it should definitely be possible to deliver continued margin expansion in this scenario. And that also means that based on this outlook, we expect to reach our first milestone of 1 billion NOC in annual revenue in just a couple of years. And our confidence is supported not only by sort of past success, but the continued expansion and increasing effectiveness of our sales organization. Of course, we have gone direct in more countries. We have invested in broadening the sales force and we are prepared to continue to expand our direct sales forces and continuing also to work on the effectiveness part of this. Together with then upcoming launches, as I just mentioned, Myrky Ultimate, Myrky Vascular, coming now in TUI sometime next year. And also in this period, we will see the report out of large important trials, such as the patent for peripheral bypass and SmartFlow, the randomized clinical trial for CABG. Of course, all long-term predictions are subject to uncertainty, so we would like to highlight that. But again, we feel it's right to share our positive view on our future here. So with that as a final statement, I guess we will open up for questions.

speaker
Unknown
Investor Relations / Moderator

We have quite a few questions today. The Americas region is again showing impressive growth. As the capital sale is quite similar to previous quarters, a lot of the growth comes from procedure sale and price increases. How do you think this will develop in the future?

speaker
Thomas Jakobsen
Chief Financial Officer

First of all, the capital sales and the comparable from last year is very strong. So in a sense, it's encouraging that we are at least at the same level. However, I think going forward, we will continue to see that the growth and the growth driver in the US will still be on the capital side and not on the procedure side. So and we've seen that over the past five, six, seven quarters that the main driver for the growth is increased capital sales of flow and imaging systems and what follows with probes and imaging probes. So going forward, I would still say that I would expect higher growth on capital than on procedures.

speaker
Unknown
Investor Relations / Moderator

Another one on the US market here. Pricing. Can you quantify the amount of one-off costs you took in the quarter? For example, what is the underlying EBIT?

speaker
Thomas Jakobsen
Chief Financial Officer

Well, of course, this is related to what I mentioned with the IT project, taking our systems to the cloud. It was around 3 million for the second quarter, and we are expecting to go live in the fourth quarter this year. We also have the patent expense. That is to what extent one of the patent study will still be ongoing, but it's not part of our ordinary operational expenses as such. So even though it will continue going forward, it will be an end to it in 27-28. So that is, in that sense, a one-off. And when it comes to the operating expenses related to Japan, that will definitely continue to be ongoing going forward. although we had some additional expenses when we are establishing ourselves but I would say maybe around half a million there is additional expenses and then that is in one way a one-off but we will still continue to build the Japanese organizations so to say exactly what other operating expenses will be there is a bit hard to predict going forward. So I think that is my answer to that.

speaker
Unknown
Investor Relations / Moderator

Thank you. Another one on the US here. The US is showing very strong momentum for you. Is it anything temporary that we should be mindful of when looking at the pipeline? And what is your US team communicating back to you? How would you describe the outlook? I think you touched on it.

speaker
Kari Krogstad
Chief Executive Officer

So, I mean, if you're just looking back at, you know, 2005 and so far in 26, there has been consistent, very positive, strong performance from our US team. and also historically we shouldn't forget that you know going back USA has been the growth driver for Medistim in many years and then things goes a little bit up and down but definitely come back very strongly in 25 and so far in 26. As mentioned before we have made changes to The organization in the US and we have made changes to compensation plans. We have set other and stricter expectations when it comes to field time and face time with customers. We have also invested in much higher quality training programs for our sales force, so we are definitely supporting them in a In a better way than before. So I think there is logical explanations as to why we are seeing increased performance. Of course, pricing and, you know, I would say having the courage to actually work actively with pricing is also a positive contributor here. And going forward, you know, we are not guiding, but our pipelines are looking good when it comes to the deal pipeline.

speaker
Unknown
Investor Relations / Moderator

And one on pricing. Can you quantify the effect of the price increases for the flow and imaging products?

speaker
Thomas Jakobsen
Chief Financial Officer

Well, we see in the second quarter the increase in revenue since we have the same level of number of units sold. That in itself is related to price increases. If you look at the underlying growth, the way we look at it, the total growth in the US for the quarter currency neutral was 46%. Around 9% of that is the volume growth and the rest is pricing. So the pricing is quite impactful.

speaker
Unknown
Investor Relations / Moderator

Good. Then is a question on Japan. How has the direct operation in Japan developed so far?

speaker
Kari Krogstad
Chief Executive Officer

Well, I think the priority for our team has to build a team and to adjust the team and making sure that we have the right people in the various roles. And their priority then has been, of course, to present themselves to the market and the customers and really start building direct relationships with the users. As we know, we have more than 90% penetration in the Japanese market for cabbage and the flow technology. So there's a lot of customers there, there's a lot of hospitals, there's a lot of connections to be made, and that has been our priority so far. And I think I mentioned that the model sales we saw in the second quarter, that's based on probe sales to current customers. But we are also, of course, building the pipeline for replacement sales of systems. And also we're working to establish a business in the vascular, which has not been really entertained at all so far by our former distributor. and we are then expecting to see a more positive development from a sales perspective in the second half. What else? I think I can report that from the users and the customer side, the feedback we're receiving is that we feel very welcome by the surgical community that Medisteam as a manufacturer and owner of the technologies are Thank you very much. Thank you. What is the rationale for changing to quarterly dividend distributions?

speaker
Thomas Jakobsen
Chief Financial Officer

Well, we have over several quarters now shown solid results and also very good cash flow. So I guess this is kind of a gesture to our shareholders that instead of paying it annually, we will look at a quarterly payout. And also what's the reasoning behind it is that instead of Medistim collecting cash at the bank interest, we would rather distribute that excess cash that the company is generating to the shareholders and then they can reinvest or, you know, whatever they, how they want to utilize that excess cash to the best for themselves rather than Medistim having it sitting in a bank account.

speaker
Unknown
Investor Relations / Moderator

Thank you. Could you please elaborate on what's driving the relative increase in accounts receivables?

speaker
Thomas Jakobsen
Chief Financial Officer

Very easily the increase in sales that we see over the quarters. And there's also somewhat timing from quarter to quarter when you have a quarter and how customers are paying and so forth. But the general thing is that when we increase sales, sales as much as we have done with you know more than 50 million for the first half it's natural that the accounts receivable are also increasing we are very much focused on it we have a goal of having a daily sales outstanding around 45 days which we previously was at 60 days now with what we've seen we are closer to 60 days so we will definitely put focus on trying to get that down to 45 days

speaker
Unknown
Investor Relations / Moderator

Thank you. Then it's a question on vascular. I didn't fully catch the effect you explained in the vascular segment and the ultimate machine. Can you please repeat?

speaker
Kari Krogstad
Chief Executive Officer

Yes, it is a bit complicated, but we have three modalities or three versions of our system. You can buy it as a cardiac specific application system. So with the software that has really been adapted to the cardiac procedures. Or you can buy it as a vascular system. And again, software is adapted to the vascular procedures, including transplant. or you can buy it as an ultimate and then both these software versions are included in the ultimates and that can be a very good solution if you are planning to maybe you're starting with cardiac procedures but you have a vision of taking that into the vascular space later on of course this is also It can make sense in finding the financing at the hospital that you're buying something that can provide value to the broader surgical departments. In the current position, if a customer is in that position, so they want to buy a new system, they are primarily or in the beginning only going to use it for cardiac surgery. and they know that we have a cardiac system with the new Intui software which we have of course promoted quite heavily and they are very interested in getting hold of this new software. Well then there is a chance that they will in this situation then opt for the cardiac version. And if they do so, that's a lower priced version than the ultimate, naturally, because you only get access to the cardiac application support and not the vascular application support. When we are selling ultimate, then this higher price, 50% of that is recorded as cardiovascular revenue. So a lower number of ultimates that will hurt the vascular recognition as we're seeing it in the reports. So this is a more technical product mix issue at this point in time. It will go away as soon as we have the Intuvi also available for the vascular systems and for the ultimate systems.

speaker
spk00

Thank you. Many questions coming in here.

speaker
Unknown
Investor Relations / Moderator

Have you seen any impact on US sales from the removal of the COVID subsidies to the Affordable Care Act? Some US hospital systems have reported weaker patient numbers, especially on elective procedures, as US patients have lost their health care insurance.

speaker
Kari Krogstad
Chief Executive Officer

I can't say that we have seen any effects of that.

speaker
Unknown
Investor Relations / Moderator

Thank you. What is your current view on share buybacks?

speaker
Thomas Jakobsen
Chief Financial Officer

Well, over the years we have done that occasionally, but I think our board is a little bit reluctant to do a buyback of shares. We have done so relatively recently to support the share program for management key personnel, but in general, Our board would rather pay out a dividend than do a buyback of shares and that this was reflected in the report that they will seek the authorization to actually make a dividend on a quarterly basis.

speaker
Unknown
Investor Relations / Moderator

Thank you. Thanks for the hard work for us shareholders. You mentioned the board has tuned up the growth plan for the next years. Can you give some insights into where the outlook has improved? Thank you.

speaker
Kari Krogstad
Chief Executive Officer

All of that, as I said, we have growth opportunities in the cabbage market still. Several geographies are over-penetrated. The USA is actually one of them. And there are new markets like India and Turkey and big numbers of procedures where we are just getting started. So cabbage in itself for flow is actually a growth opportunity. Then you have the conversion to imaging, which continues to be a big opportunity. And the traction that we're seeing in our direct markets, again, US as the leader, but over the years, very strong performance in Germany, in Spain. In the Nordics and in China, not the least, very, very strong results after we sort of got normalized the situation over there. And again, expecting to see more traction also from Japan when we are taking control there. So it's both geographies that's opening, or not opening, but are continuing to provide really big opportunities. And it's both sort of historical performance, but also the near term, you know, the recent term performance that we have pointed to over the past one and a half year. and the changes we've made and also upcoming product launches and so on. All this together gives us the confidence that we should be able to actually accelerate that growth rate and keep it at even stronger margins.

speaker
Unknown
Investor Relations / Moderator

From the procedure sale overview, we can see that the product sales are strong for all regions. Given your manual production process, will the product sales growth be a challenge going forward?

speaker
Kari Krogstad
Chief Executive Officer

Yes, of course, production capacity and ability to deliver is pivotal for us. It's a great problem to have, just to say that. As we have reported previously, we have a project ongoing in order to establish a semi-automated production line of our high volume flow probes. This is technically quite complex and then you have both verification validation challenges and you have of course the regulatory process also that will take some time so it's not an immediate solution but it's something that we are investing quite heavily in so that's the longer term solution for us in order to make sure that we have the right capacity. In the nearer term, we just continue to add heads to our probe production and making sure that we are coping that way.

speaker
Unknown
Investor Relations / Moderator

Yeah, I think we're around after and I hope we have replied most of the questions. It's a lot sitting here and it's a bit overlapping, so I think we have touched into most of them.

speaker
Kari Krogstad
Chief Executive Officer

Okay, then I guess we close the call and thank everybody for participating.

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