4DMedical delivered sharp growth in scans, sites and operating revenue as CT:VQ moved into commercial deployment across several global markets. But the company remains loss-making and its auditor issued a qualified opinion over the carrying value of goodwill and other intangible assets.
- Operating revenue up 21% to A$7.1 million
- Scans rose 77% to 344,075 across 540 sites
- Cash balance reached A$278.0 million after capital raisings
- Statutory loss was distorted by A$164.6 million non-cash remeasurement
- Auditor could not verify goodwill and intangible asset values
Auditor qualifies report over intangible assets
The strongest caution in 4DMedical Limited’s (ASX:4DX) FY26 annual report is not buried in the clinical research section. Auditor PKF Melbourne issued a qualified opinion because it could not obtain sufficient appropriate evidence to support the carrying value of the company’s goodwill and other intangible assets. The qualification does not state that an impairment exists, but it means the auditor could not determine whether adjustments were required.
That issue matters because 4DMedical carried A$68.5 million of intangible assets at 30 June 2026, including A$42.7 million of goodwill. Management’s impairment model assumes revenue growth of 67% to 240% over the outlook period, a pre-tax discount rate of 18.1% and a terminal growth rate of 5%. The directors concluded no impairment was required, while the auditor highlighted the gap between those forecasts and the company’s still-early commercialisation stage.
CT:VQ drives operational expansion
Against that accounting warning, the operating picture was materially stronger. FY26 operating revenue increased 21% to A$7.1 million, underlying SaaS revenue rose 23%, and gross margin exceeded 90%. The company processed 344,075 pulmonary and cardiovascular scans, up 77% on FY25, while its installed base grew 39% to 540 sites.
The commercial engine is centred on CT:VQ, 4DMedical’s non-contrast ventilation-perfusion imaging product. The technology received FDA clearance in September 2025, followed by US$650.50-per-scan CMS reimbursement and regulatory clearances across Europe, the UK, Canada, Australia and New Zealand. Early US adopters included Stanford University, Cleveland Clinic, UC San Diego Health, the University of Miami and the University of Chicago, while SimonMed signed a three-year commercial agreement covering its more than 170 imaging centres.
The company is also trying to turn distribution into scale. Philips’ North American agreement includes an underwritten minimum order commitment of approximately US$10 million in customer orders over calendar 2026 and 2027. In Australia, CT:VQ contracts were secured with several imaging providers after TGA clearance, although the company is still preparing its application for Medicare reimbursement through the Medical Services Advisory Committee.
Revenue growth has not yet displaced cash burn
4DMedical remains far from profitability. Operating expenditure excluding non-cash share-based payments was A$45.7 million, broadly unchanged from FY25, and operating cash outflow was A$31.3 million. The statutory result was shaped by a A$164.6 million non-cash expense from remeasuring the equity-linked Pro Medicus facility, leaving a loss for the year of A$204.4 million and a total comprehensive loss of A$203.0 million. On the company’s adjusted measure, which excludes that remeasurement and other non-cash items, the loss was A$32.9 million, compared with A$35.3 million a year earlier.
Cash nevertheless rose to A$278.0 million, largely because 4DMedical raised A$233 million through January and March placements and received A$10 million under the Pro Medicus facility. That balance provides considerable funding capacity, but the facility carries a minimum cash repayment of A$12.5 million and an equity-linked component whose valuation is highly sensitive to the share price. At year-end, the associated derivative liability was recorded at A$169.1 million.
Expansion adds opportunity and execution risk
The growth plan widened during and after FY26. The completed contextflow acquisition gave 4DMedical a Vienna-based European platform, an existing customer footprint and the CE-marked ADVANCE Chest CT product. The company also invested approximately US$3.4 million in RevealDx for a 10% fully diluted interest and secured distribution rights for RevealAI-Lung across Europe, Australia and New Zealand, alongside a non-exclusive US arrangement.
Clinical expansion is aimed at making CT:VQ relevant beyond the existing nuclear V/Q market. The CLEAR study, backed by approximately US$2 million of funding and led from Mass General Brigham, is comparing CT:VQ with CT pulmonary angiography in suspected pulmonary embolism. Management says the program could open access to a US$3 billion obtainable market, but that remains a market opportunity dependent on clinical evidence, adoption and reimbursement.
For investors, the next test is conversion rather than another regulatory milestone: whether Philips’ minimum commitments, SimonMed’s network and the expanding academic reference base produce a meaningful lift in recurring revenue and scan volumes. At the same time, future reports will need to resolve the auditor’s evidence concerns around the asset base while showing that a company spending more than A$31 million of cash a year can turn commercial momentum into operating leverage.
Bottom Line?
4DMedical has bought itself time with a large cash balance, but the investment case now depends on commercial conversion and a clearer audit trail for its intangible assets.
Questions in the middle?
- Can CT:VQ scan volumes and Philips’ commitments lift revenue quickly enough to narrow the operating cash deficit?
- Will the auditor obtain sufficient evidence for the goodwill and intangible asset balances in the next reporting cycle?
- How will the Pro Medicus facility’s share-price-linked repayment and derivative liability affect future results and dilution?