4DMedical Doubled Its Scan Count and Its Revenue Went Backwards

Twelve months ago this company was worth about $123 million. It is now worth $2.03 billion. Over those same twelve months its revenue fell 0.8%, to $5.81 million. That puts the shares on 349 times a trailing revenue line that is going backwards, which is a price only a volume story can support.

The volume story is real, and it is the whole case for the stock. In the six months to 31 December 2025 the company produced 151,905 scans, up 110% on the prior corresponding period. It had software deployed at 430 sites globally, up 43%. It cleared the US Food and Drug Administration in September 2025 for a non-contrast, CT-based ventilation-perfusion product, and it signed agreements with a set of American hospital names that need no introduction.

What did not happen is revenue.

The claim#

The market is paying for conversion: that a scan count compounding at triple digits, running through newly reimbursable software at newly signed marquee sites, becomes a revenue ramp. Every element of that claim is disclosed by the company and none of it is in dispute here. Scans are up. Sites are up. The regulatory clearance is real.

The claim being tested is narrower: that the scan count is a leading indicator of revenue.

The constraint#

The constraint is the company’s own statutory accounts, which are audited, which are not a management metric, and which the company does not get to restate as “underlying”.

Statutory revenue for the December 2025 half was $2,852,227, against $2,895,250 in the prior corresponding half. That is a fall of 1.5%, against scan growth of 110%.

Set the two series side by side, indexed so they start at the same point, and the shape of the problem is immediate.

Divide one by the other and the decline is not a wobble. It is a trend across three consecutive halves.

Revenue per scan fell from about $40.03 to $24.16 to $18.78 across H1 FY25, H2 FY25 and H1 FY26 — down 53% in a year. The same pattern shows up per site: annualised revenue per site fell from $19,238 to $13,266 while the site count grew 43%.

The gap#

The company’s own annual report contains the explanation, in a single clause that has not been quantified since.

…driven by a material uplift across the subscription-based product portfolio… and non-revenue generating scans delivered to seed the market with influential customers or for product demonstration sites.

4DMedical, Annual Report 2025, operating and financial review

Scan volume, the metric on which the stock has been repriced sixteen-fold, explicitly includes scans that generate no revenue. The proportion is not disclosed — not in FY25, not in the December 2025 half, and not in any announcement reviewed for this note.

That single disclosure resolves the arithmetic and opens a larger question. If the billable share of volume were stable, blended revenue per scan would be roughly stable too. It has halved. On the company’s own framing, the most direct reading is that non-billable scans have grown considerably faster than billable ones. This is the desk’s inference from the disclosed figures, not a company statement, and the company has not been asked to comment on it.

The alternative readings are set out below, and one of them may well be right. What is not available to a reader of these filings is the number that would decide between them.

Corroboration#

These are secondary. None of them is the thesis; each is consistent with it.

The statutory revenue lines fell where the story says they should be rising. The SaaS line — the company’s core measure — went from $2,874,974 to $2,781,296, down 3.3%. United States revenue, the entire commercial focus, went from $2,890,840 to $2,765,732, down 4.3%. The results commentary reported “underlying” SaaS growth of 31% over the same period. The half-year report contains no reconciliation between the two figures. Non-IFRS measures are common and often legitimate; a 34-point gap between an underlying measure and the audited line it adjusts is worth a reconciliation.

Customers are not the largest source of cash. Government grants and R&D tax incentives received have exceeded revenue in every reported period.

In FY24 the ratio was 3.4 to 1. In FY25 it was 1.5 to 1. In the December 2025 half it widened again to 2.3 to 1.

The cost base is an order of magnitude above the revenue base. Employee benefits expense for the half was $18,436,824 — up 21% year-on-year, and 6.5 times revenue. Net cash used in operating activities was $12,661,470, or 4.4 times revenue.

Operating cash outflow did improve, from $14,149,447 to $12,661,470, a 10.5% reduction. The cost discipline the company announced in March 2025 is visible in the accounts. It is also, at this revenue base, arithmetically insufficient.

The agreements behind the re-rating carry no volume commitment. After the October 2025 announcements of an expanded Stanford agreement and five Brazilian hospital deployments, ASX issued a query letter. In its response the company said the expanded Stanford agreement adds pay-per-scan access without guaranteed scan volumes, that revenue to date from Stanford and the Brazilian hospitals is immaterial, and that the agreements run for initial 12-month periods. The company argued the agreements were material for strategic rather than financial reasons — that they establish reference sites — and pointed to section 4.15 of ASX Guidance Note 8.

That argument is defensible. It is also, read plainly, a statement to the regulator that the deals which moved the share price do not yet carry revenue.

What could explain this instead#

Three explanations would take the thesis apart. Each is plausible and each is testable.

The J-curve is real and the period is simply too early. FDA clearance landed in September 2025, three and a half months into the half being measured. Reimbursement pathways in US healthcare take quarters to move from coded to billed to collected, and a hospital does not switch a modality on in a month. Under this reading, volume genuinely does lead revenue, the seeding scans are deliberate market development, and the lag will close in FY27. What would settle it: two consecutive halves in which revenue growth exceeds volume growth. Watch the FY26 full-year result and the December 2026 half.

Blended revenue per scan is the wrong denominator. If the commercial fleet prices at a stable rate and the growth in volume is concentrated in free research, screening-partnership and demonstration scans, then revenue per billable scan could be flat or rising while the blended figure collapses — and the blended figure would be measuring the marketing budget, not the business. This is the strongest counter-argument, and it is the company’s own framing. What would settle it: the billable/non-billable split. It is not disclosed. Field verification item 1 exists to obtain it.

The revenue model is per-site, not per-scan. Subscription contracts with fixed periodic fees would break the link between volume and revenue by design; more scans at an existing site would add cost, not revenue, and the metric to watch would be site count and contract value. Site count did grow 43%. What would settle it: annualised revenue per site holding steady. It did not — it fell 31%, from $19,238 to $13,266. This explanation is available but the numbers do not currently support it.

A fourth, weaker explanation deserves a mention. Revenue recognised over time fell while revenue recognised at a point in time rose ($2,405,947 to $2,005,251, and $489,303 to $846,976). A shift in contract structure could depress recognised revenue in a transition half without any change in economics. The effect is real but small against a 110% volume move.

Kill criteria#

The thesis fails if any of the following holds.

1. The company discloses a billable/non-billable split showing billable scans grew in line with total volume, and revenue per billable scan is flat or rising.
2. Half-yearly revenue exceeds $4.5m — roughly 1.6× the current run rate — with scan volume flat or higher, in either of the next two reporting periods.
3. The 31% underlying SaaS figure reconciles to the statutory line through an ordinary, disclosed adjustment that leaves the core subscription base growing.
4. Contracted minimum volumes or take-or-pay terms are disclosed at the marquee sites, converting reference agreements into revenue commitments.
5. Government grants and R&D incentives fall below revenue for two consecutive periods on the strength of revenue growth rather than a reduced claim.

Kill criterion 2 is the near one. The FY26 full-year result is expected in late August 2026.

Right of reply#

The company was not contacted before publication. Every claim above is drawn from its own lodged filings, its own annual report and its own response to a regulator’s query, each linked in full. Where the company has publicly addressed a point — the seeding scans, the strategic rationale for the Stanford agreement, the underlying SaaS measure — its position is stated in its own words and engaged with rather than dismissed. Nothing here alleges any breach of law or of the listing rules.