4DX eyes a bigger prize in CTPA scans
While 4DX built its case on replacing nuclear VQ scans, founder Andreas Fouras says the CTPA scan market is where the bigger commercial opportunity actually sits.
Dr Andreas Fouras, founder and CEO of 4DMedical (ASX: 4DX), sat down with Henry Jennings to unpack the lung-imaging company’s growth trajectory – from its original nuclear VQ replacement thesis to a far bigger prize in CTPA scanning, and why he thinks the market’s short interest is set up to work against the shorts.
The bigger market is CTPA, not VQ
4DMedical’s original opportunity was replacing the roughly one million nuclear VQ scans performed annually. But Fouras is now pointing investors to a much larger target: the five million CTPA scans done each year to detect pulmonary embolisms. The pitch is straightforward – the software can analyse a patient’s existing CT scan without a second scan, without contrast dye, and without the delay that comes with both. Fouras cites pulmonary embolisms as linked to roughly 10% of hospital deaths, giving the clinical case as much weight as the commercial one.
A recent Bell Potter estimate pegged 4DMedical’s potential CTPA share at 20% over three to five years. Fouras thinks that’s conservative, pointing to hospital contracts closing in three months rather than the usual six to twelve, and citing clinical data showing procedure success rates improving from 46% to 76% when the technology is used in planning.
Regulatory approvals are largely secured
4DMedical has now gone nine-for-nine on FDA submissions, including clearance covering both the VQ-replacement and pulmonary embolism detection applications – the two milestones Fouras describes as the ones that mattered. TGA approval in Australia has also already come through.
Balance sheet gives room to move
Following an $83 million raise earlier this year, 4DMedical now holds more than $250 million in cash – around 20 quarters of runway at current spend, by Fouras’s own account. That funded the acquisition of contextflow, which gave the company a foothold in Europe, and leaves room for further opportunistic deals.
The short interest, reframed
With roughly 67 million shares shorted (around 11% of the register), Fouras argues the position reflects a surface-level read – high market cap, modest current revenue, low institutional ownership – that misses the customer-adoption trajectory underneath. His view: if hospital wins keep converting to revenue, limited stock available to borrow could turn the short position into a tailwind rather than a headwind.
US expansion is the priority
4DMedical’s US team is approaching 40 people, with physicians now working alongside sales reps in the field to build credibility with hospitals. Fouras splits his time between Melbourne and the US, where his family is now based – a deliberate move to stay close to the market he considers most important. Europe is framed as roughly half the size of the US opportunity in revenue terms, useful for diversification but secondary to the US push.
Looking ahead, Fouras’s target for the next 12 months is over half of the top 20 US hospitals actively using the technology, expansion into major hospital networks, and a first foray into government customers such as the US Department of Veterans Affairs.