ViewRay Inc (VRAY) 2022 Q4 法說會逐字稿

Good afternoon, ladies and gentlemen, and welcome to the ViewRay Q4 2022 Earnings Call. (Operator Instructions) This call is being recorded on Monday, February 27, 2023.

女士們先生們，下午好，歡迎來到 ViewRay 2022 年第四季度財報電話會議。 （操作員說明）此通話記錄於 2023 年 2 月 27 日星期一。

I would now like to turn the conference over to Matt Harrison, Director of Investor Relations. Please go ahead.

我現在想將會議轉交給投資者關係總監馬特哈里森。請繼續。

Thank you, operator, and welcome to ViewRay's fourth quarter conference call. Joining me today are Scott Drake, our President and Chief Executive Officer; and Bill Burke, our Chief Financial Officer.

謝謝運營商，歡迎來到 ViewRay 的第四季度電話會議。今天加入我的是我們的總裁兼首席執行官 Scott Drake；和我們的首席財務官 Bill Burke。

Earlier today, ViewRay issued a press release and appendix for today's call, both of which are available on our website. Going forward, we will be providing an appendix of key metrics, which will be filed with our 8-K in lieu of an earnings presentation. Today's call is being broadcast and webcast live. A replay will be available on our website for 14 days.

今天早些時候，ViewRay 為今天的電話會議發布了新聞稿和附錄，兩者都可以在我們的網站上找到。展望未來，我們將提供關鍵指標的附錄，該附錄將與我們的 8-K 一起提交，以代替收益報告。今天的電話會議正在直播和網絡直播中。重播將在我們的網站上提供 14 天。

Before we begin, I would like to remind you that the discussion during this conference call will include forward-looking statements. Factors that could cause actual results to differ materially are discussed in the company's most recent filings with the SEC. Also, the discussion will include certain non-GAAP financial measures. Reconciliations to the most directly comparable GAAP financial measure and 2 years of historical results can be found in our appendix and exhibit of our current report on Form 8-K filed today with the SEC.

在我們開始之前，我想提醒您，本次電話會議期間的討論將包括前瞻性陳述。公司最近向美國證券交易委員會提交的文件中討論了可能導致實際結果出現重大差異的因素。此外，討論將包括某些非 GAAP 財務指標。與最直接可比的 GAAP 財務指標和 2 年曆史結果的調節可以在我們今天向美國證券交易委員會提交的 8-K 表格的當前報告的附錄和展示中找到。

I will now turn the call over to Scott.

我現在將把電話轉給斯科特。

Thanks, Matt. Good afternoon, everyone, and thank you for joining us to review our 2022 fourth quarter and full year results.

謝謝，馬特。大家下午好，感謝您加入我們，回顧我們 2022 年第四季度和全年的業績。

Before we begin, I'd like to welcome our new Chief Financial Officer, Bill Burke. Bill previously served as CFO of Haemonetics and brings over 25 years of global financial and operational experience to ViewRay. He and I have known each other and worked together for many years. And he is a significant addition to our team. Welcome, Bill.

在我們開始之前，我想歡迎我們的新任首席財務官 Bill Burke。 Bill 之前曾擔任 Haemonetics 的首席財務官，並為 ViewRay 帶來了超過 25 年的全球財務和運營經驗。他和我相識並一起工作多年。他是我們團隊的重要補充。歡迎，比爾。

I'll start today's call by covering key patient metrics. I'll highlight our full year financial performance and some key innovation, clinical and commercial wins. Following my comments, Bill will cover our financial performance and guidance. Finally, I'll provide closing thoughts and open the call for Q&A.

我將通過介紹關鍵的患者指標來開始今天的電話會議。我將重點介紹我們全年的財務業績以及一些關鍵的創新、臨床和商業勝利。在我發表評論之後，比爾將介紹我們的財務業績和指導。最後，我將提供結束語並開啟問答環節。

As we've stated many times, therapy adoption is the precursor to our growth as a company. To date, MRIdian has treated over 29,000 patients. This number continues to grow rapidly as we expand the footprint of MRIdian centers and accelerate patient throughput. The vast majority of these patients were treated in 5 or fewer fractions with highly effective, virtually side effect-free therapy, allowing them to get back to health and get back to life quickly. The stark contrast between MRIdian and conventional treatment is what drives our team to pursue therapy adoption day in and day out. We ended the year with 56 MRIdians in the ground with about 80 more in backlog or some stage of installation.

正如我們多次聲明的那樣，採用治療是我們公司成長的先驅。迄今為止，MRIdian 已經治療了超過 29,000 名患者。隨著我們擴大 MRIdian 中心的足跡並加快患者吞吐量，這個數字繼續快速增長。這些患者中的絕大多數接受了 5 次或更少的分次治療，採用高效、幾乎無副作用的療法，使他們能夠恢復健康並迅速恢復生活。 MRIdian 與傳統治療之間的鮮明對比促使我們的團隊日復一日地追求採用治療。到年底，我們在地面上有 56 名 MRDians，還有大約 80 名處於積壓或某個安裝階段。

Turning to our full year financial results. We hit a major milestone by crossing over $100 million in revenue, driven by 46% top line growth. This performance is a testament to the great work our team has done. As projected, gross margin improved about 1,000 basis points. Gross margin was also at an all-time high for the company, and we will continue to drive this crucial metric higher. We finished the year with 32 orders, which reflects the impact of our clinical and commercial success. And the backlog increased to $380 million.

轉向我們的全年財務業績。在 46% 的營收增長的推動下，我們實現了一個重要的里程碑，收入超過 1 億美元。這種表現證明了我們團隊所做的出色工作。正如預期的那樣，毛利率提高了約 1,000 個基點。公司的毛利率也創歷史新高，我們將繼續提高這一關鍵指標。我們以 32 個訂單結束了這一年，這反映了我們在臨床和商業上取得成功的影響。積壓訂單增加到 3.8 億美元。

On the clinical front, we're pleased to share that the MIRAGE results were accepted in JAMA Oncology, a leading publication in the field. As a reminder, MIRAGE was a Phase III randomized controlled trial conducted by UCLA comparing MRIdian versus conventional SBRT for localized prostate cancer. JAMA Oncology highlighted that MRIdian significantly lowered acute grade 2 GU toxicity and GI toxicity was zero. Acute toxicity for these patients takes the form of sexual dysfunction and the life-altering effects of incontinence. We're pleased to see the great work by UCLA get picked up in this major publication. This adds to the growing body of evidence supporting the adoption of MRIdian therapy and is already helping our commercial efforts.

在臨床方面，我們很高興地宣布 MIRAGE 結果已被該領域的領先出版物 JAMA Oncology 接受。提醒一下，MIRAGE 是由加州大學洛杉磯分校進行的一項 III 期隨機對照試驗，比較 MRIdian 與傳統 SBRT 對局限性前列腺癌的影響。 JAMA Oncology 強調 MRIdian 顯著降低了急性 2 級 GU 毒性，並且 GI 毒性為零。這些患者的急性毒性表現為性功能障礙和失禁改變生活的影響。我們很高興看到加州大學洛杉磯分校的出色工作被這份主要出版物選中。這增加了支持採用 MRIdian 療法的越來越多的證據，並且已經在幫助我們的商業努力。

2022 yielded many strategic wins across the organization. On the innovation front, A3i, our next-generation feature set, was launched. Customer feedback on workflow, ease of use, throughput and brain treatment are resoundingly positive. Our clinical pipeline continues to take steps forward. Customers are proving critical value in both tough-to-treat and more common cancers alike. Through the SMART pancreas trial, we saw positive survival signals and the safety of MRIdian when treating with a belated short course therapy in this deadly disease.

2022 年在整個組織中取得了許多戰略勝利。在創新方面，推出了我們的下一代功能集 A3i。客戶對工作流程、易用性、吞吐量和大腦治療的反饋非常積極。我們的臨床管道繼續向前邁進。客戶在難以治療的癌症和更常見的癌症中都證明了關鍵價值。通過 SMART 胰腺試驗，我們看到了積極的生存信號和 MRIdian 在這種致命疾病中採用遲來的短期療程治療時的安全性。

We also announced LAP-ABLATE, a Phase III global multicenter randomized controlled trial in locally advanced pancreatic cancer. This trial is intended to demonstrate the survival benefits of MRIdian and change therapeutic guidelines for how pancreatic cancer is treated. We are also driving increased patient and clinician engagement through our market awareness efforts. Patient efficacy groups like PanCAN and ZERO have begun to highlight our data and are requesting educational events from our customers. This is driving greater levels of awareness and adoption. I've seen firsthand that when patients learn that highly effective, short course, virtually side effect-free therapy is available, they will demand it and travel for it.

我們還宣布了 LAP-ABLATE，一項針對局部晚期胰腺癌的 III 期全球多中心隨機對照試驗。該試驗旨在證明 MRIdian 的生存益處，並改變胰腺癌治療的治療指南。我們還通過我們的市場意識努力推動增加患者和臨床醫生的參與度。像 PanCAN 和 ZERO 這樣的患者療效團體已經開始強調我們的數據，並要求我們的客戶舉辦教育活動。這正在推動更高水平的認識和採用。我親眼看到，當患者得知可以使用高效、療程短、幾乎無副作用的療法時，他們會要求這種療法並為之旅行。

To further our efforts in patient awareness, we entered into a partnership with Katie Couric Media to leverage a trusted source and highlight that such therapy is available today to a broader and broader patient population. These results are evidence that our strategy is working as intended. Our innovation pipeline enables our clinical pipeline. Clinical data drives commercial demand, and market awareness amplifies the effect. All of these efforts drive therapy adoption, the precursor to revenue growth, margin expansion and P&L leverage. I'm proud of the work that we've done over the past year and all that was accomplished. Our team hit several major milestones and delivered on our promises despite significant macro challenges that persist. We very much look forward to 2023, another promising year for ViewRay, our customers and most importantly, cancer patients who need and deserve personalized precise therapy.

為了進一步提高患者意識，我們與 Katie Couric Media 建立了合作夥伴關係，以利用可信賴的來源並強調這種療法如今可供越來越廣泛的患者群體使用。這些結果證明我們的戰略正在按預期發揮作用。我們的創新管道使我們的臨床管道成為可能。臨床數據推動商業需求，而市場意識則放大了這種影響。所有這些努力都推動了治療的採用，這是收入增長、利潤率擴張和損益槓桿的先兆。我為我們在過去一年中所做的工作以及所有已完成的工作感到自豪。儘管仍然存在重大的宏觀挑戰，但我們的團隊實現了幾個重要的里程碑並兌現了我們的承諾。我們非常期待 2023 年，這對 ViewRay、我們的客戶以及最重要的是需要並值得個性化精準治療的癌症患者來說又是充滿希望的一年。

With that, I'll now turn the call over to Bill.

有了這個，我現在將電話轉給比爾。

Thank you, Scott, and good afternoon, everyone. Today, I will review our fourth quarter and fiscal '22 financial results and provide our 2023 guidance. Full details can be found in today's press release, and we will be filing our 10-K subsequent to this call.

謝謝斯科特，大家下午好。今天，我將回顧我們的第四季度和 22 財年財務業績，並提供我們 2023 年的指導。完整的細節可以在今天的新聞稿中找到，我們將在這次電話會議之後提交我們的 10-K。

Before I begin with the financials, I'd like to make a few comments. I'm excited to be part of the ViewRay team, which has graciously welcomed me as a teammate. I want to thank Zach for his ongoing support as we continue with the transition. The past 7 weeks have been a journey, learning about the amazing technology and experiencing the excitement, both internally and externally, about MRIdian's opportunity to become the standard of care for cancer treatment and the positive impact MRIdian is having on patients' lives. I've quickly learned that ViewRay is positioned to create long-term value anchored by its leading technology and clinical evidence.

在我開始財務之前，我想發表一些評論。我很高興成為 ViewRay 團隊的一員，該團隊熱情地歡迎我成為隊友。我要感謝 Zach 在我們繼續過渡期間一直以來的支持。過去的 7 周是一段旅程，了解了令人驚嘆的技術，並從內部和外部體驗了興奮，因為 MRIdian 有機會成為癌症治療護理的標準以及 MRIdian 對患者生活產生的積極影響。我很快了解到 ViewRay 定位於創造以其領先技術和臨床證據為基礎的長期價值。

During each quarter, we intend to install multiple MRIdian systems. Each individual installation represents a significant percentage of revenue for that quarter. There are elements of our business where we have limited influence, including customer site construction as well as permitting and other items, which are often required in connection with the sale of a MRIdian. Timing of these uncontrollable events may impact the installation process and quarterly results, but in no way impacts long-term value creation, which we measure in years. At this stage in the company's maturity and scale, annual results are a far more relevant barometer than quarterly measurement. Quarters are relevant in our business from a supply chain and resourcing perspective as we pace our installations throughout the year to satisfy these requirements for continued growth.

在每個季度，我們打算安裝多個 MRIdian 系統。每個單獨的安裝都佔該季度收入的很大一部分。在我們的業務中，有一些我們的影響力有限，包括客戶場地建設以及許可和其他項目，這些項目通常與 MRIdian 的銷售有關。這些不可控事件的發生時間可能會影響安裝過程和季度結果，但絕不會影響我們以年為單位衡量的長期價值創造。在公司成熟度和規模的現階段，年度業績是比季度衡量指標更相關的晴雨表。從供應鍊和資源的角度來看，季度與我們的業務相關，因為我們全年都會調整我們的安裝以滿足持續增長的這些要求。

Now moving on to financial results and guidance. Revenue in the fourth quarter grew 70% compared to the same period in the prior year to nearly $34.7 million, highlighted by 85% growth in product revenue, which was driven by 5 revenue units, an increase of 2 units compared to the prior year. We also grew service revenue by 23%. Revenue in fiscal '22 grew 46% compared to the same period in the prior year to approximately $102.2 million, including 53% growth in product revenue primarily driven by an increase of 6 revenue units to 16 units in fiscal '22. We also grew service revenue by 26% as the installed base continues to grow.

現在轉向財務結果和指導。第四季度的收入與去年同期相比增長了 70%，達到近 3470 萬美元，突出表現在產品收入增長了 85%，這是由 5 個收入單位推動的，比去年同期增加了 2 個單位。我們的服務收入也增長了 23%。 22 財年的收入與上年同期相比增長了 46%，達到約 1.022 億美元，其中產品收入增長了 53%，這主要是由於 22 財年的 6 個收入單位增加到 16 個單位。隨著安裝基數的持續增長，我們的服務收入也增長了 26%。

Gross margin in the fourth quarter was approximately 13% compared to minus 1% in the same prior year period. Gross margin was led by product margin of 14% compared to minus 5% in the same period last year, demonstrating the benefits of leveraging our expense base with additional revenue units. Gross margin on service was 3%, a decline from 9% in the same prior year period due to higher freight costs in the current quarter and onetime item that benefited the prior year. Sequential service gross margin from the third to fourth quarters declined by 200 basis points from 5% to 3%. The sequential decline was due to higher consumption of service parts in the fourth quarter compared to the third quarter. We do not anticipate the decline in the fourth quarter to be a trend in 2023.

第四季度的毛利率約為 13%，而去年同期為負 1%。毛利率由 14% 的產品利潤率領先，而去年同期為負 5%，這表明利用我們的費用基礎和額外的收入單位的好處。服務毛利率為 3%，較上年同期的 9% 有所下降，原因是本季度運費較高，且一次性項目使上年受益。第三至第四季度的連續服務毛利率從 5% 下降 200 個基點至 3%。環比下降是由於與第三季度相比，第四季度服務零件的消耗量增加。我們預計第四季度的下降不會成為 2023 年的趨勢。

Gross margin in fiscal '22 was approximately 10% compared to an essentially breakeven gross margin in the same prior year period. Gross margin was led by product margin of 10% compared to approximately 1% in the same prior year period, once again driven by the benefits of leverage from additional revenue units. Gross margin on service was 6%, an improvement from minus 1% in the same prior year period due to efficiency gains with the growth of the installed base. We continue to improve our gross margin, and we are well positioned to see gross margin expansion, mainly attributable to growth in revenue units in the short term and with our cost down initiative contribution in the longer term.

與去年同期基本盈虧平衡的毛利率相比，22 財年的毛利率約為 10%。毛利率由 10% 的產品利潤率領先，而去年同期約為 1%，這再次受到來自額外收入單位的槓桿優勢的推動。服務毛利率為 6%，較上年同期的負 1% 有所改善，這是由於裝機量增長帶來的效率提升。我們繼續提高毛利率，我們有能力看到毛利率的增長，這主要歸因於短期收入單位的增長以及我們長期降低成本計劃的貢獻。

In the fourth quarter, other income and expense was an expense of $1.8 million compared to income of $2.1 million in the same prior year period. For fiscal '22, other income expense was approximately $0 compared to a $6.4 million expense in the same prior year period. Other income was primarily impacted by the reduced warrant liability on our balance sheet from a lower year-over-year share price at the end of the period. Another notable driver was higher interest earned on our cash balance, offset by increased borrowing costs.

第四季度，其他收入和支出為 180 萬美元，而去年同期為收入 210 萬美元。對於 22 財年，其他收入支出約為 0 美元，而去年同期為 640 萬美元。其他收入主要受到期末股價同比下降導致我們資產負債表上的認股權證負債減少的影響。另一個值得注意的驅動因素是我們的現金餘額所賺取的利息增加，但被增加的借貸成本所抵消。

Net loss for the fourth quarter was $27.8 million or $0.15 per share compared to a net loss of $27.1 million or $0.16 per share in the same prior year period. Net loss in fiscal '22 was $107.3 million or $0.59 per share compared to a net loss of $110 million or $0.67 per share in the same prior year period. We ended fiscal '22 with $142 million in cash and cash equivalents.

第四季度淨虧損為 2780 萬美元或每股 0.15 美元，而去年同期為淨虧損 2710 萬美元或每股 0.16 美元。 22 財年的淨虧損為 1.073 億美元或每股 0.59 美元，而去年同期為淨虧損 1.1 億美元或每股 0.67 美元。我們以 1.42 億美元的現金和現金等價物結束了 22 財年。

Our cash usage for fiscal '22 was $77.3 million. Excluding term loan net proceeds from the November debt refinancing, cash usage for fiscal '22 was $91.2 million. Cash usage for the year was a combination of ongoing operating expenses and some impact from working capital as there was a deferral of certain customer collections pushed into future periods, partially offset by higher accounts payable. We regularly deal with elongated collection time frames. And this has been exacerbated by higher interest rates, foreign currency and inflation, but we have high confidence in collection.

我們在 22 財年的現金使用量為 7730 萬美元。不包括 11 月債務再融資的定期貸款淨收益，22 財年的現金使用量為 9120 萬美元。這一年的現金使用是持續運營費用和營運資金的一些影響的結合，因為某些客戶收款被推遲到未來期間，部分被更高的應付賬款所抵消。我們經常處理延長的收集時間範圍。更高的利率、外彙和通貨膨脹加劇了這種情況，但我們對收款有很高的信心。

Now turning to our fiscal '23 guidance. We expect revenue growth to be in the range of 25% to 40% with similar growth in system and service revenue. System revenue will be seasonally weighted to the back half of the fiscal year at about 60% of total revenue. This growth includes 2 planned turnkey units for approximately $15 million late in the fourth quarter. Revenue on these 2 turnkey units is primarily recognized at customer acceptance. A slight variation from our expected timeline may result in an update to our guidance but would not reflect any underlying concerns in the health of the business. We are initiating adjusted EBITDA as a guidance metric in fiscal '23, which will be a substitute for providing cash flow guidance as in prior years. We believe adjusted EBITDA is a more consistent and predictable measure of our business.

現在轉向我們的 23 財年指南。我們預計收入增長將在 25% 至 40% 的範圍內，系統和服務收入的增長類似。系統收入將在本財年下半年進行季節性加權，佔總收入的 60% 左右。這一增長包括 2 個計劃在第四季度末價值約 1500 萬美元的統包單位。這 2 個交鑰匙裝置的收入主要在客戶驗收時確認。與我們預期的時間表略有不同可能會導致我們的指南更新，但不會反映對業務健康的任何潛在擔憂。我們正在啟動調整後的 EBITDA 作為 23 財年的指導指標，這將替代前幾年提供的現金流量指導。我們認為調整後的 EBITDA 是衡量我們業務的更一致和可預測的指標。

Working capital or growth capital is critical for the company and our greatest pressure point, particularly within our supply chain and with elongated collection times. We estimate our adjusted EBITDA for fiscal '23 to be in the range of a $70 million to $80 million loss and includes $7 million to $10 million of nonrecurring engineering costs related to our product cost down initiatives. For comparison, the adjusted EBITDA loss in fiscal '22 was approximately $78.2 million.

營運資金或增長資金對公司和我們最大的壓力點至關重要，尤其是在我們的供應鏈中和收集時間較長的情況下。我們估計 23 財年調整後的 EBITDA 虧損在 7000 萬至 8000 萬美元之間，其中包括與產品成本降低計劃相關的 700 萬至 1000 萬美元的非經常性工程成本。相比之下，22 財年調整後的 EBITDA 虧損約為 7820 萬美元。

On the strength of revenue guidance, we expect gross margin in the mid- to high teens predicated largely on the number of A3i upgrades. We also anticipate experiencing operating expense leverage as revenue grows at a more significant rate than operating expenses despite short-term investments related to our product cost down initiatives. We expect to continue making strides growing into our overhead structure.

根據收入指引，我們預計中高檔的毛利率主要取決於 A3i 升級的數量。我們還預計，儘管與我們的產品成本降低計劃相關的短期投資，但隨著收入增長速度高於運營支出，我們預計將經歷運營支出槓桿。我們希望繼續在我們的開銷結構中取得長足進步。

With that, I'd like to pass the call back to Scott for a few closing comments.

有了這個，我想把電話轉回給斯科特，請他發表一些結束評論。

Thanks, Bill. 4 years ago, we chose to lead and differentiate with clinical data, and we are delivering on that promise. We are the only company in the space leading with meaningful clinical data, and we are very happy we put this stake in the ground. 4 years ago, MRIdian was perceived to be a niche therapy with limited patient application. Our customers have now treated tens of thousands of patients, over 65 tumor types across the expanse of tough-to-treat and more common cancers. 4 years ago, we heard from our customers a desire for increased throughput. Today, top quartile customers treat over 300 patients a year, and that is before the benefits of A3i take effect. 4 years ago, virtually 100% of our customers were academic centers. Now approximately 40% of our customers are community hospitals. Over the past 4 years, we have made significant progress. Our strategy is clearly working, and we are well positioned to drive greater levels of therapy adoption in the years ahead.

謝謝，比爾。 4 年前，我們選擇了引領臨床數據並使其與眾不同，我們正在兌現這一承諾。我們是該領域唯一一家擁有有意義的臨床數據的領先公司，我們很高興我們投入了這筆資金。 4 年前，MRIdian 被認為是一種適用於有限患者的利基療法。我們的客戶現在已經治療了數万名患者，涉及超過 65 種腫瘤類型，包括難以治療的癌症和更常見的癌症。 4 年前，我們從客戶那裡聽到他們希望提高吞吐量。如今，排名前四分之一的客戶每年治療 300 多名患者，而這還是在 A3i 的優勢發揮作用之前。 4 年前，我們幾乎 100% 的客戶都是學術中心。現在我們大約 40% 的客戶是社區醫院。在過去的 4 年裡，我們取得了重大進展。我們的戰略顯然正在奏效，我們有能力在未來幾年推動更高水平的治療採用。

With that, I'll open the call for Q&A.

有了這個，我將打開問答電話。

(Operator Instructions) Your first question comes from the line of Rick Wise from Stifel.

（操作員說明）您的第一個問題來自 Stifel 的 Rick Wise。

Maybe I'll start off with orders. You obviously had a good solid fourth quarter, 9 new orders, which we had heard before. But help us think through your order expectations for the year ahead and particularly related to the Chindex order. And I feel like if memory serves, you had talked about China representing potential upside to consensus models. So several things. Help us think about the first quarter orders in that context. What are you assuming as you're thinking and giving us guidance for the year? And how would we sort of think about order cadence as the year unfolds?

也許我會從訂單開始。您顯然在第四季度表現良好，有 9 個新訂單，這是我們之前聽說過的。但請幫助我們考慮您對來年的訂單預期，尤其是與 Chindex 訂單相關的預期。我覺得如果沒記錯的話，你曾談到中國代表著共識模型的潛在優勢。好幾件事。幫助我們考慮在這種情況下的第一季度訂單。您在考慮並為我們提供今年的指導時假設了什麼？隨著時間的推移，我們將如何考慮訂單節奏？

Yes. Thanks, Rick. I would tell you from an order perspective, I think we've had a pretty good track record of momentum over the past few years despite the macro challenges that we faced. Q4 was a record for the company with 9 orders. And given what we've already announced in Q1, we're going to surpass what we did in Q4. So we feel very good about the commercial momentum in the business. I think that's a consequence. As we've talked many times, it all originates with our innovation pipeline, which enables our clinical pipeline. That's amplified with market awareness, and all of that culminates in therapy adoption, which drives orders in every other metric in our business. So I feel very good about where we're at in terms of the commercial prospects of our business.

是的。謝謝，瑞克。我會從訂單的角度告訴你，儘管我們面臨宏觀挑戰，但我認為過去幾年我們的勢頭記錄非常好。第四季度是該公司的記錄，有 9 個訂單。鑑於我們在第一季度已經宣布的內容，我們將超越我們在第四季度所做的事情。因此，我們對業務的商業勢頭感到非常滿意。我認為這是一個結果。正如我們多次談到的那樣，這一切都源於我們的創新管道，它使我們的臨床管道成為可能。隨著市場意識的增強，所有這些都在治療採用方面達到頂峰，這推動了我們業務中所有其他指標的訂單。因此，就我們業務的商業前景而言，我對我們所處的位置感到非常滿意。

We don't guide to orders as, Rick, I know you know well, and we do that for a very good reason. It is the most difficult metric, I believe, in the company to actually forecast. But it is an indicator and an important one in terms of the future growth of the business. But we feel very good on that front. As it relates to the other embedded question, China, we encourage investors to still think about it in terms of upside or risk mitigation in terms of the plans that we have put out there. On one hand, we are very excited about the opportunity to penetrate China, which is the second largest and fastest-growing market. But on the other hand, what I think we've learned in other parts of Asia, Europe and the U.S., the real catalyst in our business is getting a system in the ground and treating patients. That is what really agitates a market. And I don't think we're going to have that in a demonstrable way in China for some period of time.

我們不指導訂單，因為 Rick，我知道你很清楚，我們這樣做是有充分理由的。我認為，這是公司中最難實際預測的指標。但它是一個指標，也是業務未來增長的重要指標。但我們在這方面感覺非常好。由於它與另一個嵌入式問題有關，中國，我們鼓勵投資者根據我們在那裡提出的計劃，從上行或風險緩解的角度考慮它。一方面，我們對有機會進入中國這個第二大且增長最快的市場感到非常興奮。但另一方面，我認為我們在亞洲、歐洲和美國的其他地區學到的東西，我們業務的真正催化劑是在地面上建立一個系統並治療患者。這才是真正攪動市場的因素。而且我認為我們不會在一段時間內以可證明的方式在中國擁有它。

Got you. Scott, we've heard from a lot of medtech companies so far this earnings season talking about the macro picture, supply chain, inflation, freight, FX, blah, blah, blah. And I think the message in general has been the macro environment, yes, everybody's got some specific issues. But the macro environment seems to be stable, if not improving, hearing a lot about improving. To what extent are macro headwinds stable or I hope, easing or do you expect in '23? Maybe help us understand what that could mean for ViewRay in terms of component availability. You've highlighted several times the complexity of judging installation times and again, how -- what's embedded in the kind of guidance you've given us?

明白了斯科特，本財報季到目前為止，我們已經聽到很多醫療技術公司談論宏觀形勢、供應鏈、通貨膨脹、運費、外匯等等。我認為總體上傳達的信息是宏觀環境，是的，每個人都有一些具體問題。但宏觀環境似乎穩定，即使沒有改善，也聽到很多關於改善的消息。宏觀逆風在多大程度上穩定或我希望在 23 年緩和或你期望？也許可以幫助我們理解這對 ViewRay 在組件可用性方面意味著什麼。你已經多次強調了判斷安裝的複雜性，你給我們的指導中嵌入了什麼？

Yes, Rick, great question. We try to take all of these kind of positive signals and the challenges and bake all of that into our guidance and thinking for the year. Obviously, from a revenue standpoint, we're coming off of a year that really exhibited pretty significant momentum with 46% growth on the top line. And now our backlog of around $380 million really represents quite an opportunity for us to continue to grow nicely in '23 and beyond. At the same time, we have shared in our prepared remarks and prior to this call that those macro challenges continue. While I would say the supply chain issues overall have improved, we still face those challenges unequivocally. And even though we're chasing fewer components today, it really only takes 1 or 2 of those components to be a problem in our business. So I would say supply chain is improving, but we still have very real challenges.

是的，里克，好問題。我們試圖接受所有這些積極信號和挑戰，並將所有這些融入我們今年的指導和思考中。顯然，從收入的角度來看，我們剛剛結束了真正表現出相當顯著勢頭的一年，收入增長了 46%。現在，我們約 3.8 億美元的積壓確實代表了我們在 23 世紀及以後繼續良好增長的機會。與此同時，我們在準備好的講話中和在本次電話會議之前分享了這些宏觀挑戰仍在繼續。雖然我會說供應鏈問題總體上有所改善，但我們仍然明確面臨這些挑戰。即使我們今天追求更少的組件，實際上只需要其中的 1 或 2 個組件就會成為我們業務中的問題。所以我想說供應鏈正在改善，但我們仍然面臨著非常現實的挑戰。

The other challenges that you mentioned that we and others face persist. Inflation, interest rates, currency work against us and work against our distribution partners. We have seen their behavior change pretty quickly, given the aggregate effect of those areas. And they're hanging on to their cash. But what we've learned over the past 3 years is how quickly things can change. Whether you're talking about when COVID first hit or inflation spiked up, et cetera, we've seen things change pretty rapidly. And we're now even seeing currency move back in the direction of our distribution partners.

您提到的我們和其他人面臨的其他挑戰仍然存在。通貨膨脹、利率、貨幣對我們不利，對我們的分銷合作夥伴不利。考慮到這些領域的綜合影響，我們已經看到他們的行為變化很快。而且他們還持有現金。但我們在過去 3 年中學到的是事情變化的速度有多快。無論您是在談論 COVID 首次爆發的時間還是通貨膨脹率飆升等，我們都看到事情發生了相當迅速的變化。我們現在甚至看到貨幣向我們的分銷合作夥伴的方向移動。

But with that dynamic backdrop, we've got to be very thoughtful in trying to take all of this into account. There is no doubt that supply chain, elongation of receivable cycles, those challenges continue in the business. But we do our very best to take all of that into account as we provide our guidance, and we'll provide transparency as we move forward.

但在這種動態背景下，我們必須非常周到地考慮所有這些因素。毫無疑問，供應鏈、應收賬款週期的延長，這些挑戰在企業中繼續存在。但我們會盡最大努力在提供指導時將所有這些考慮在內，並且在我們前進的過程中會提供透明度。

Okay. One last one for me if I could. And maybe we'll pick on Bill a little bit. Welcome to the call, Bill. I'll ask you the tough questions. I appreciate that quarters are tough to predict and as you say, not perfectly indicative of what's going on in the business. But maybe just good housekeeping suggests that we should -- I should at least ask about the first quarter. Current -- thank you for the first half, second half split, that's helpful. If I look at the current consensus midpoint and the midpoint of your guidance, that might suggest a first half 50%, 55% kind of range. And I'm looking at the first quarter consensus at 25 and change -- $25 million and change. Are you comfortable with this 27% sequential step down fourth quarter to first quarter? Am I setting -- am I expressing this all correctly just as we get the year underway?

好的。如果可以的話給我最後一張。也許我們會挑剔比爾一點點。歡迎致電，比爾。我會問你棘手的問題。我很欣賞季度很難預測，正如你所說，不能完全說明業務中發生的事情。但也許只是良好的內務管理表明我們應該 - 我至少應該詢問第一季度的情況。 Current——謝謝你的上半場，下半場，這很有幫助。如果我看一下當前的共識中點和你的指導中點，那可能表明上半年 50%、55% 的範圍。我正在看第一季度的共識，即 25 美元和變化——2500 萬美元和變化。您對第四季度到第一季度連續下降 27% 感到滿意嗎？我是否設置 - 我是否在我們開始新的一年時正確地表達了這一切？

Rick, thank you, and I'm happy to be at ViewRay here, and I appreciate the question. I'm going to try to stay away from specific quarterly guidance, but we did put out 25% to 40% growth for the year, which is a really healthy growth for us. And that growth range represents about 18 to 20 revenue units. And I'm going to just reiterate what you just said, which is we did say that the revenue would be weighted to the back half of the year to about 60%, right? So I'm going to stick with that for now.

里克，謝謝你，我很高興來到 ViewRay，我很欣賞這個問題。我將盡量遠離具體的季度指導，但我們確實實現了今年 25% 至 40% 的增長，這對我們來說是一個非常健康的增長。這個增長范圍代表了大約 18 到 20 個收入單位。我要重申你剛才說的話，我們確實說過收入將在今年下半年加權到 60% 左右，對嗎？所以我現在要堅持下去。

I do want to reiterate again that although we understand there's quarterly numbers out there, right, we still believe that the value of the company is definitely better viewed as -- on our annual guidance, our annual performance than a quarter-to-quarter basis. But I also do want to say quarters are important for us internally, too, right? We have -- how the cadence of installations run and the resources that we have to provide, both from a human resource standpoint and also from inventory planning is critical. So we do try to pace those installations and thus revenue units evenly throughout the year. So there is a business need to do that. So when you do look at the quarters, obviously, they're going to be more evenly weighted than 10 units at 1 quarter per se. So I'd like to just stick with the 60% in the back half of the year and so my other quarterly comments that I made.

我確實想再次重申，雖然我們知道那裡有季度數據，但我們仍然相信公司的價值肯定更好地被視為 - 根據我們的年度指導，我們的年度業績而不是季度業績.但我也確實想說宿舍對我們內部也很重要，對吧？我們有——從人力資源和庫存規劃的角度來看，安裝的節奏如何運行以及我們必須提供的資源是至關重要的。因此，我們確實嘗試在全年平均調整這些安裝的速度，從而調整收入單位。因此，企業需要這樣做。因此，當您查看季度時，很明顯，它們本身比 1 個季度的 10 個單位的權重更均勻。所以我想在今年下半年堅持 60% 以及我所做的其他季度評論。

Your next question comes from the line of Jason Bednar from Piper.

您的下一個問題來自 Piper 的 Jason Bednar。

Apologies in advance for any background noise here. Scott and Bill, the backlog you had here is impressive. It's obviously even stronger after taking into account the Chindex order you have here in the first quarter. Questions that we often get on your business are, in some cases, paradoxical, asking when book-to-bill will decline and hope that the denominator there starts to improve, that the backlog conversion gets better. It's a bit of a bigger picture topic, but can you talk about how you're thinking about converting this backlog with respect to either backlog conversion rates or book-to-bill rates you're anticipating as we look forward over the next few years?

提前為這裡的任何背景噪音道歉。斯科特和比爾，你們這裡的積壓工作令人印象深刻。考慮到第一季度您在這裡的美中互利訂單，它顯然更強勁。在某些情況下，我們經常遇到的關於您的業務的問題是自相矛盾的，詢問訂單到賬單何時會下降，並希望那裡的分母開始改善，積壓轉換變得更好。這是一個更大的主題，但您能否談談您如何考慮轉換積壓訂單轉換率或您預期的訂單出貨率，因為我們期待著未來幾年？

Yes, Jason, thanks for the question. I think it's actually -- you're right. It's kind of a paradoxical one because we want to have our order book continue to grow rapidly. That's a great leading indicator. And I would tell you that interest in MRIdian is definitely increasing. We really don't have much of a demand problem anymore or an interest problem. It's really urgency of getting these systems in the ground. And a lot of that is out of our control as we've highlighted here. And it is our motivation and we're having more conversations with customers expressing urgency of getting their system in the ground.

是的，傑森，謝謝你的提問。我認為這實際上是——你是對的。這有點自相矛盾，因為我們希望我們的訂單繼續快速增長。這是一個很好的領先指標。我會告訴你，對 MRIdian 的興趣肯定在增加。我們真的不再有太多的需求問題或利益問題。將這些系統部署到位真的很緊迫。正如我們在這裡強調的那樣，其中很多都是我們無法控制的。這是我們的動力，我們與客戶進行了更多對話，表達了讓他們的系統落地的緊迫性。

What I can tell you, if you take a step back and we attempted to address this a little bit in our prepared remarks. But if you look at the transformation of this company over the past 4 years, and then to your point, you try to project that forward, you see a pretty interesting set of things unfolding. 4 years ago, MRIdian was really perceived to be a niche technology. Not so today. We had virtually no clinical data, prospective Phase II, Phase III data. Compare that to today, and you know what the clinical compendium is both now and what lies ahead.

我可以告訴你的是，如果你退後一步，我們試圖在準備好的評論中稍微解決這個問題。但如果你看看這家公司在過去 4 年裡的轉型，然後就你的觀點而言，你嘗試將其向前推進，你會看到一系列非常有趣的事情正在展開。 4 年前，MRIdian 確實被認為是一項小眾技術。今天不是這樣。我們幾乎沒有臨床數據、前瞻性 II 期、III 期數據。與今天相比，您就會知道現在和未來的臨床綱要是什麼。

We had a throughput problem 4 years ago. I would say we don't have that today. And then you add the benefits of A3i, and we are very, very well positioned there along with an innovation pipeline that is incredibly rich that we have not talked publicly about nor will we hear today. And again, 4 years ago, we were in virtually exclusively academic centers, and now we have about 40% of our customers that are community hospitals. So I think when you look forward, Jason, it's very difficult to predict with those very significant changes and improvements that have taken place when would things ultimately slow down a bit and the book-to-bill would come down. We don't really see that happening here in the short term. And I think when you look at adoption of technology that's so different across many different parts of medtech, I think you would also see in those instances, it's very difficult to project what that adoption curve will look like.

4 年前我們遇到了吞吐量問題。我會說我們今天沒有那個。然後你加上 A3i 的好處，我們在這方面處於非常非常有利的位置，還有一個非常豐富的創新管道，我們沒有公開談論過，今天也不會聽到。再一次，4 年前，我們幾乎完全在學術中心，現在我們有大約 40% 的客戶是社區醫院。所以我認為，當你向前看時，Jason，很難預測發生的那些非常重大的變化和改進什麼時候事情最終會放緩一點，訂單到賬單會下降。我們並沒有真正看到短期內會發生這種情況。而且我認為，當你看到在醫療技術的許多不同部分採用如此不同的技術時，我認為你也會在這些情況下看到，很難預測採用曲線會是什麼樣子。

Our customers believe this is the future of radiation oncology, that you cannot unsee things and that the addition here to the field of very meaningful clinical data in both tough-to-treat and more common cancers is kind of a dawning of an age. So I agree with them in their characterization of MRIdian. And I think it's very difficult to characterize and quantify your question, but I appreciate it.

我們的客戶相信這是放射腫瘤學的未來，您無法看不到任何事物，而且在難以治療的癌症和更常見的癌症中增加非常有意義的臨床數據領域是一個時代的曙光。所以我同意他們對 MRIdian 的描述。我認為很難描述和量化你的問題，但我很感激。

Yes. I mean, maybe as a follow-up just to that, I mean, I'm wondering what changed the trajectory of the revenue piece, that denominator? Because that could also then shrink that book-to-bill, not that we want to see that, but I think a lot of folks are sitting, looking at your backlog and saying, "Hey, that's really darn impressive." But also saying, "Hey, we want to see that backlog convert." So I mean, is there something we can look at as far as backlog conversion rates may be over the next few years? What's maybe -- what's a normal look at that backlog conversion rate when we -- if we ever get back to normal?

是的。我的意思是，也許作為對此的後續行動，我的意思是，我想知道是什麼改變了收入部分的軌跡，即分母？因為這也可能會縮小訂單出貨比，並不是說我們希望看到這一點，但我認為很多人都坐在那裡，看著你的積壓訂單並說，“嘿，這真是令人印象深刻。”但也說，“嘿，我們希望看到積壓的轉換。”所以我的意思是，就未來幾年的積壓轉換率而言，我們可以看看什麼嗎？當我們恢復正常時，積壓轉換率的正常情況是什麼？

Yes. God willing, we will. Offsetting penalties as it relates to that, Jason, on one hand, Paul and I have conversations with customer, including a couple here over the past couple of weeks where customers are trying to get into our installation slots even here still in '23, and that's very good to see. And I think we have more instances of that. We never have enough or too much of that. That feels really good on one hand. But on the other hand, to Rick's question, we are fighting a lot of things that we don't control: the permitting process, construction, labor shortages, both at construction companies and at hospitals and obviously, supply chain.

是的。上帝保佑，我們會的。與此相關的抵消處罰，Jason，一方面，Paul 和我與客戶進行了對話，包括過去幾週在這裡的一對夫婦，客戶甚至在 23 年就試圖進入我們的安裝位置，並且很高興看到。我認為我們有更多這樣的例子。我們永遠不會擁有足夠或太多的東西。一方面感覺真的很好。但另一方面，對於里克的問題，我們正在與許多我們無法控制的事情作鬥爭：建築公司和醫院的許可程序、施工、勞動力短缺，顯然還有供應鏈。

So I would say there's very positive signals. And on the other hand, there are very real challenges that we have been facing over time. When those things are in the rearview mirror, perhaps we'll be able to speed things up. But we want to be very transparent in terms of both the positive things that are happening in the business and the very real challenges that we face today that, frankly, we've been facing over the past 3 years.

所以我想說有非常積極的信號。另一方面，隨著時間的推移，我們一直面臨著非常現實的挑戰。當這些事情出現在後視鏡中時，也許我們就能加快速度。但我們希望在業務中發生的積極事情和我們今天面臨的非常真實的挑戰方面非常透明，坦率地說，我們在過去 3 年一直面臨這些挑戰。

Okay. That's all fair. And maybe I'll squeeze in one more here. I mean, followed by the kind of the 3-question format that Rick set. I appreciate the color on the community center mix that you provided there, kind of where the business is at today. If you were to put on your -- kind of your wizard hat there, Scott, or whatever hat you want to wear, I guess, where does the community center mix go longer term for your business?

好的。這很公平。也許我會在這裡再擠一個。我的意思是，接下來是 Rick 設置的那種 3 問題格式。我很欣賞你在那裡提供的社區中心組合的顏色，就像今天的業務一樣。如果你要戴上你的 - 那種你的巫師帽，斯科特，或者你想戴的任何帽子，我猜，社區中心組合在哪裡對你的業務更長遠？

Yes, Jason, I can be kind of brief here. I think it goes up. I think there's more and more interest in MRIdian. I think people are fascinated by what our customers are doing. The clinical data, the throughput that they're showing, the fact that they're attracting net new patients, there's a lot of interest. And when you look at the number of community hospitals versus academic centers, the community hospital number is just so much larger. So I think you're going to see as we go forward, the proportion of our business that's represented by community hospitals is going to go up.

是的，傑森，我可以在這裡簡短一點。我認為它會上升。我認為人們對 MRIdian 的興趣越來越大。我認為人們對我們的客戶正在做的事情著迷。臨床數據，他們展示的吞吐量，他們吸引淨新患者的事實，引起了很多興趣。當您查看社區醫院與學術中心的數量時，社區醫院的數量要大得多。所以我認為你會看到，隨著我們的前進，社區醫院所代表的業務比例將會上升。

Any number you want to throw on that? Or just leave it as higher than 40?

你想在上面加上什麼數字？還是讓它高於 40？

That sounded like a fourth question. We're good. We're good.

這聽起來像是第四個問題。我們很好。我們很好。

Your next question comes from the line of Chris Pasquale from Nephron.

您的下一個問題來自 Nephron 的 Chris Pasquale。

Bill, I wanted to make sure I understood your comments about the 2 turnkey units. So first, maybe just define that term for us and how that's different from a typical install. And then could you just clarify whether those units are or are not included in the guidance you gave today?

比爾，我想確保我理解你對 2 個交鑰匙單元的評論。所以首先，也許只是為我們定義這個術語，以及它與典型安裝有何不同。然後你能澄清一下這些單位是否包含在你今天給出的指導中嗎？

Sure. Thanks for the question. So the turnkey units are both included in the guidance we provided. A turnkey unit in these units are specifically VA units. It's where revenue is recognized on the completion of the installation and customer acceptance. So if acceptance slips due to some change in the construction timeline, then the revenue may not be recognized until the following year, right? We're doing everything we can. I know the commercial team is laser-focused on getting these turnkey unit installations in as quickly as we can. And we understand we want to get them done by December 31 and get customer acceptance at that point.

當然。謝謝你的問題。因此，交鑰匙單位都包含在我們提供的指導中。這些單元中的交鑰匙單元特別是 VA 單元。這是在完成安裝和客戶驗收時確認收入的地方。那麼，如果由於施工時間表的某些變化而導致驗收單，那麼收入可能要到下一年才能確認，對嗎？我們正在竭盡所能。我知道商業團隊非常專注於盡快安裝這些交鑰匙單元。我們知道我們希望在 12 月 31 日之前完成它們，並在那時獲得客戶的認可。

But again, if they slip till customer acceptance on January 3, all the revenue wouldn't be recognized until 3 days later. And that doesn't change the trajectory or valuation or anything of the -- like that of the company. It's just a factor of what Scott just said in terms of the difficulty and construction timeline sometimes.

但同樣，如果他們推遲到 1 月 3 日客戶驗收，則所有收入將在 3 天后才能確認。這不會改變公司的軌跡或估值或任何東西。這只是斯科特剛才所說的難度和施工時間表有時的一個因素。

That's helpful. And maybe while I have you, Bill, I'd be curious. You've got a fresh set of eyes looking at this company's financials. Obviously, a company growing very quickly now, but trying to get the cost structure to line up with that revenue base. Anything in particular that you're focused on as you come in here and take a look at how working capital is being managed, how the balance sheet is structured, where you think there could be opportunities for improvement?

這很有幫助。也許當我有你的時候，比爾，我會很好奇。你對這家公司的財務狀況有了新的認識。顯然，一家公司現在發展非常迅速，但試圖讓成本結構與收入基礎保持一致。當你來到這裡並查看營運資本的管理方式、資產負債表的結構以及你認為可能存在改進機會的地方時，你特別關注的是什麼？

Yes, sure. So being here, I just finished my seventh week, right? I quickly established a set of priorities. And we've talked -- we actually just on the Q&A here, we've spoken about a few of them.

是的，當然。所以在這裡，我剛剛結束了第七週，對吧？我很快確定了一系列優先事項。我們已經談過了——我們實際上只是在這裡進行問答，我們已經談過其中的一些問題。

The first is really to ensure the supply chain continuity, right? To deliver our 25% to 40% growth that we guided towards and continue that growth going forward. The second part I have really is improving gross margin. Some of that gross margin improvement will come with revenue and the volume associated with that. But a portion of it longer term is because of the cost down initiative that we're running. And I mentioned in the prepared remarks that we have $7 million to $10 million of cost dedicated to that cost down program this year. And our intent is to spend that and get the fruits of that spending in later years. So that's imperative.

首先是確保供應鏈的連續性，對吧？實現我們指導的 25% 到 40% 的增長，並繼續保持這種增長。我真正擁有的第二部分是提高毛利率。部分毛利率的提高將來自收入和與之相關的銷量。但從長遠來看，其中一部分是因為我們正在運行的成本降低計劃。我在準備好的評論中提到，今年我們有 700 萬到 1000 萬美元的成本專門用於該成本降低計劃。我們的目的是花掉這筆錢，並在以後的幾年裡獲得這些支出的成果。所以這是勢在必行的。

And then the third really is continue to leverage the OpEx, right? So I think that's a combination of driving that top line revenue growth like I mentioned, but also being frugal around expenses, too, and taking a second look at what we're spending and what we're getting out of that spending. But I just want to say, overall, my impressions here after less than 2 months is like this is a very well-run company. I think Scott and not just the leadership team, but the leadership across the entire company really has set the company up for long-term value creation. There's a long run way -- a long runway has been created for continued success. And I think the right team is in place, and I think the right strategy is clearly in place, too. So I don't think there's going to be any radical changes by me coming on board there.

然後第三個真的是繼續利用 OpEx，對嗎？因此，我認為這是推動收入增長的結合，就像我提到的那樣，但也要節儉支出，並重新審視我們的支出以及我們從這些支出中獲得的收益。但我只想說，總的來說，在不到 2 個月的時間裡，我在這裡的印像是這是一家經營得很好的公司。我認為斯科特，不僅僅是領導團隊，而是整個公司的領導層，確實讓公司為長期價值創造做好了準備。有一條很長的路要走——一條長跑道是為了持續的成功而創造的。而且我認為正確的團隊已經到位，我認為正確的戰略也顯然已經到位。所以我認為我加入那裡不會有任何根本性的變化。

Your next question comes from the line of Suraj Kalia from Oppenheimer.

你的下一個問題來自 Oppenheimer 的 Suraj Kalia。

Scott, let me start out. The utilization in FY '22 took a significant step-up by our math, a little over 200 patients treated per machine installed on average. So I guess you mentioned about 1/4 of your systems are doing about 300. So we sort of have an idea about the utilization bell curve. More specifically, Scott, just compare and contrast what more established machines are doing so that we have sort of a relative framework how much MRIdian is being utilized versus, let's say, a CK or a Tomo or TrueBeam or something?

斯科特，讓我開始吧。根據我們的計算，22 財年的利用率有了顯著提高，平均每台安裝的機器治療了 200 多名患者。所以我猜你提到了大約 1/4 的系統正在做大約 300 個。所以我們對利用率鐘形曲線有點了解。更具體地說，Scott，只需比較和對比更成熟的機器正在做什麼，這樣我們就有了一個相對框架，與 CK、Tomo 或 TrueBeam 之類的東西相比，MRIdian 被使用了多少？

Yes, Suraj. So let me touch on that. And just for those who might be a little bit less familiar, if you go back a few years, one of the great pressure points that we were hearing from customers was throughput. And to your point, we've really addressed that even pre-A3i. And that's been done through not only the engineering and improvements in the system, but also in what we're doing to help train customers and bring them up to speed.

是的，蘇拉吉。所以讓我談談這個。對於那些可能不太熟悉的人來說，如果你回到幾年前，我們從客戶那裡聽到的最大壓力之一就是吞吐量。就您的觀點而言，我們已經真正解決了 A3i 之前的問題。這不僅是通過系統的工程和改進來實現的，而且還通過我們正在做的事情來幫助培訓客戶並讓他們跟上速度。

And what we find in one account after the next is they generally start with one type of cancer in mind. And often it's something either difficult like pancreas or more simple like prostate. And then they kind of have this aha moment over time, and they want to add new tumor types to what they're treating. And we're doing that very actively now, and that's a big part of what you're seeing here, Suraj, incremental tumor types being treated by individual customers.

我們在一個接一個的敘述中發現，他們通常從一種癌症開始。通常它要么像胰腺一樣困難，要么像前列腺一樣更簡單。然後隨著時間的推移，他們有點恍然大悟，他們想在他們正在治療的東西中添加新的腫瘤類型。我們現在正在非常積極地做這件事，這是你在這裡看到的很大一部分，Suraj，個體客戶治療的增量腫瘤類型。

And then what happens when the system is completely full and in many instances, and you know this personally, there are customers that have 8-, even 10-week backlogs on MRIdian, it forces them to contemplate or purchase incremental MRIdian systems. And that's what we're seeing a bit more of here. And I think that increase, that step-up in utilization on a per system basis, I think you can anticipate that, that will continue and be facilitated further by A3i.

然後當系統完全滿載時會發生什麼，在許多情況下，你個人知道這一點，有些客戶在 MRIdian 上有 8 週甚至 10 週的積壓，這迫使他們考慮或購買增量 MRIdian 系統。這就是我們在這裡看到的更多內容。而且我認為這種增加，每個系統的利用率提高，我認為你可以預期，A3i 將繼續並進一步促進。

Scott, if I could push you on this, let's say, 200 is average. Would you venture to say other systems normalized are doing what, 1,000 per year? Or how should we -- just somewhere a road map for us to look forward to.

斯科特，如果我可以強迫你解決這個問題，假設 200 是平均水平。您敢說其他規範化的系統正在做什麼，每年 1,000 個嗎？或者我們應該如何 - 只是我們期待的路線圖的某個地方。

Yes. I would say the outliers would be on the low end, give or take 100 or 150 patients a year. On the high end, we may have -- I'm looking at (inaudible) right now. A couple of customers doing north of 400, maybe on their way to 500 patients. I think that's kind of what you would find in the bell curve of our customers today. But again, I think you're going to see that bell curve shift to the right in a positive way as we go forward and once A3i is more fully implemented throughout the customer base.

是的。我會說異常值會處於低端，每年接收或接收 100 或 150 名患者。在高端，我們可能有——我現在正在看（聽不清）。幾個客戶正在做 400 名以上的患者，可能正在前往 500 名患者的途中。我認為這就是您今天在我們客戶的鐘形曲線中會發現的情況。但同樣，我認為隨著我們的前進，一旦 A3i 在整個客戶群中得到更全面的實施，您將看到鐘形曲線以積極的方式向右移動。

Got it. Scott, one last for you, and Bill, one for you. Scott, many years ago, I remember at a dinner meeting, you were musing about some sort of a leasing model for MRIdian. Would love to get any updated thoughts if that's still alive, that thought is still alive.

知道了。斯科特，最後一個給你，比爾，一個給你。斯科特，很多年前，我記得在一次晚宴上，你正在考慮 MRidian 的某種租賃模式。如果那個想法還活著，我很想得到任何更新的想法，那個想法還活著。

And Bill, specifically for you, I know on the backlog, there was a lot of questions about the book-to-bill. Maybe if I can rephrase the question, right? As you look at the backlog, how would you define as the backlog churn and maybe even more -- simplifying it even further, over the last 3 years, how many orders have been canceled? And we know how many have been added. So just sort of give us some flavor how the turnover is happening in the backlog.

比爾，特別是你，我知道在積壓工作中，有很多關於訂單到賬單的問題。也許我可以改一下問題，對吧？當您查看積壓訂單時，您將如何定義積壓訂單流失甚至更多 - 進一步簡化它，在過去 3 年中，有多少訂單被取消？我們知道添加了多少。因此，讓我們了解一下積壓工作中的營業額是如何發生的。

Thank you, Suraj. I'll help Bill out. He may know this, but in terms of over the last 3 years, I think we've had, on average, 5 systems per year. Maybe this year, 6 systems come out of backlog, and that's been pretty consistent over the past 3 years. Bill, I'm not sure if you have a ready answer for Suraj there on the other component of his question.

謝謝你，蘇拉吉。我會幫助比爾。他可能知道這一點，但就過去 3 年而言，我認為我們平均每年擁有 5 個系統。也許今年，有 6 個系統從積壓中解脫出來，這在過去 3 年中一直非常穩定。比爾，我不確定你是否對 Suraj 問題的其他部分有現成的答案。

No, I did know that answer, and you stole my thunder there. But generally, what we're seeing, right, is what you just said, Scott, right? We've seen 5 or 6 orders per year that we have taken out of backlog. And like this year, for example, we haven't seen any cancellations, right? So what's come out of the backlog is based on the criteria that we've established and the reviews that we do each quarter.

不，我確實知道那個答案，而你在那裡搶了我的風頭。但總的來說，我們看到的是你剛才所說的，斯科特，對嗎？我們每年從積壓訂單中取出 5 或 6 個訂單。就像今年一樣，我們沒有看到任何取消，對吧？因此，積壓的結果是基於我們建立的標準和我們每個季度進行的審查。

Also, we've added 32 orders to the backlog this year. We ordered -- we put 28 into the backlog last year. And we've seen 10 units come out last year and 16 units come out this year as revenue units. So that's really the type of churn that we're seeing. But overall, in terms of the growth in the backlog, right, we have a 21% increase in FY '22 compared to FY '21.

此外，我們今年在積壓訂單中增加了 32 個訂單。我們訂購了 - 去年我們將 28 件放入積壓訂單中。我們已經看到去年有 10 個單位出現，今年有 16 個單位作為收入單位出現。所以這確實是我們所看到的流失類型。但總的來說，就積壓的增長而言，與 21 財年相比，22 財年我們增加了 21%。

Yes. And Suraj, I'll touch on the other part of your question. We continue to have a lot of conversations with customers about various kind of acquisition models, if you will. Oftentimes, we have a customer that wants to acquire MRIdian that doesn't have the full amount of capital at the ready for the timing that they would like to get a system in. And we do have conversations about lower upfront models and more ongoing revenue. Those conversations, I would say, are ongoing, and if anything, increasing in frequency.

是的。 Suraj，我將談談你問題的另一部分。如果您願意，我們將繼續與客戶就各種收購模式進行大量對話。通常，我們有一個客戶想要收購 MRIdian，但他們沒有為他們希望進入系統的時間準備好全部資金。我們確實就較低的前期模型和更多的持續收入進行了對話.我想說的是，這些對話正在進行中，而且頻率也在增加。

But often when our customers do the math, they decide to just pay the average selling price of around $6 million for the system and the construction on top of that. And we're always looking for creative ways to reduce the friction and to increase the velocity of our overall commercial funnel. I do not think we have cracked the code there, but we will continue to work on it.

但通常當我們的客戶進行計算時，他們決定只支付大約 600 萬美元的平均售價來購買該系統及其基礎設施。我們一直在尋找創造性的方法來減少摩擦並提高我們整體商業渠道的速度。我不認為我們已經破解了那裡的密碼，但我們會繼續努力。

Your next question comes from the line of Neil Chatterji from B. Riley.

你的下一個問題來自 B. Riley 的 Neil Chatterji。

This is Brandon on for Neil. Congratulations on a strong end to the year. Regarding the University Hospital NPA, do you think that kind of agreement has a sort of halo effect on the region? And would you expect orders to tick up in the Ohio Midwest region as a result?

這是尼爾的布蘭登。祝賀你在今年結束時表現出色。關於 University Hospital NPA，您是否認為這種協議對該地區有某種光環效應？您是否希望俄亥俄州中西部地區的訂單因此增加？

Yes. I would say that it has certainly gotten the attention of other customers in Northern Ohio, also in Central Ohio, in Columbus and up in Pittsburgh as well. It's instigating some pretty interesting conversations. And we can't wait to get our first and hopefully multiple systems up and running with UH. I think they're going to do amazing things with the team that they have assembled there. So it will be interesting to see what happens and other key accounts in that geography. It is definitely already incited, I would say, more intense conversations. But I don't want to try to forecast something that's inherently difficult to forecast. But I would say interest is increasing in that geography, at least in part due to the UH announcement.

是的。我想說它肯定引起了俄亥俄州北部、俄亥俄州中部、哥倫布和匹茲堡其他客戶的注意。它引發了一些非常有趣的對話。我們迫不及待地想讓我們的第一個系統和希望多個系統與 UH 一起運行。我認為他們將與他們在那裡組建的團隊一起做一些了不起的事情。因此，看看該地區會發生什麼以及其他關鍵客戶將會很有趣。它肯定已經被煽動，我想說，更激烈的對話。但我不想嘗試預測一些本來就很難預測的事情。但我想說對該地區的興趣正在增加，至少部分是由於 UH 公告。

Okay. Yes. Do you have any color that you can provide on the recent China order with Chindex and the motivations in particular behind the system adoption in China? Are these motivations differentiated compared to other geographies?

好的。是的。對於美中互利最近在中國的訂單以及在中國採用該系統背後的動機，您有什麼可以提供的嗎？與其他地區相比，這些動機是否有所不同？

Yes, Brandon, I would say a couple of things. I would say at the highest level, independent of ViewRay, China -- the Chinese government is really putting their shoulder to the wheel to increase access to care, cancer generally. They have a real need there. The government has recognized it, and they're putting their money where their mouth is with their 2030 Healthy China initiative. I think MRIdian can play. And in the conversations with Chindex and in their conversations with end customers, I think there is a degree of interest that is increasing as it relates to the role that MRIdian can play there.

是的，布蘭登，我想說幾件事。我想說的是，在最高級別，獨立於 ViewRay，中國——中國政府確實在全力以赴，以增加獲得醫療服務的機會，通常是癌症。他們在那裡有真正的需要。政府已經認識到這一點，他們正在為 2030 年健康中國計劃投入資金。我覺得MRidian可以玩。在與 Chindex 的對話以及他們與最終客戶的對話中，我認為人們對 MRIdian 可以在那裡發揮的作用越來越感興趣。

As we have shared previously, we do not have any kind of Class A or Class B indication as yet. We anticipate that, that won't be the case until 2024. And we're more likely to be in that Class A categorization, given the cost and complexity of the system. But look, what's true in China is true in the rest of the world. Cancer patients deserve more precise, more personalized care. They deserve shorter courses of treatment with fewer negative side effects. And I think that's attractive to Chinese cancer patients. And frankly, I think it's attractive to cancer patients everywhere. And we are highly motivated in our partnership with Chindex to bring this therapy to Chinese cancer patients.

正如我們之前分享的那樣，我們目前還沒有任何類型的 A 類或 B 類適應症。我們預計，直到 2024 年才會出現這種情況。考慮到系統的成本和復雜性，我們更有可能屬於 A 類。但是你看，在中國是這樣，在世界其他地方也是這樣。癌症患者應該得到更精確、更個性化的護理。他們理應接受較短療程且副作用較少的治療。我認為這對中國癌症患者很有吸引力。坦率地說，我認為它對各地的癌症患者都有吸引力。我們非常積極地與 Chindex 合作，將這種療法帶給中國癌症患者。

Great. Maybe one last one from us. What have you heard from KOLs regarding the MIRAGE study now that the results have been published? Do you think that the publication has any incremental impact that we haven't already seen from, say, the ASTRO presentation?

偉大的。也許是我們的最後一個。既然結果已經公佈，您從 KOL 那裡聽到了關於 MIRAGE 研究的哪些信息？您認為該出版物是否具有我們尚未從 ASTRO 演示中看到的任何增量影響？

Yes. I think it sure does. I mean, whenever you get this kind of data that is this compelling in a publication that is this widespread, it is helpful to us. On an anonymized basis, I would tell you that multiple MRIdian customers are seeing demand increase as a consequence of the data that we have here in MIRAGE specifically.

是的。我認為確實如此。我的意思是，每當您在如此廣泛的出版物中獲得如此引人注目的數據時，這對我們很有幫助。在匿名的基礎上，我會告訴你，由於我們在 MIRAGE 中的數據，多個 MRIdian 客戶看到需求增加。

I think the publication helps it. I think that's broadly true, Brandon. We have customers who are seeing when they share with patients the full therapeutic set of options, whether you're talking about surgery or radiation therapy, they would tell you that more and more of their patients are choosing the noninvasive MRIdian option. And I think that has a significant degree to do with the clinical data that we have.

我認為該出版物對此有所幫助。我認為這大體上是正確的，布蘭登。我們的客戶看到，當他們與患者分享全套治療方案時，無論您是在談論手術還是放射治療，他們都會告訴您越來越多的患者正在選擇無創 MRIdian 方案。我認為這在很大程度上與我們擁有的臨床數據有關。

I think there's another component of it that is market awareness-based from one patient to another, patients talking to one another. That is having increased demand effect at multiple MRIdian customers. And I think that is a component of our strategy that we're talking about here, the innovation pipeline enabling the clinical pipeline. Those 2 allowing us to amplify the effect with market awareness, and all of that driving therapy adoption.

我認為它的另一個組成部分是基於市場意識，從一個病人到另一個病人，病人互相交談。這對多個 MRIdian 客戶產生了增加的需求效應。我認為這是我們在這裡討論的戰略的一個組成部分，即支持臨床管道的創新管道。這兩個使我們能夠通過市場意識和所有驅動療法的採用來放大效果。

I think that is the ViewRay story and ultimately, patients will write it. I have seen personally firsthand that when patients are aware that highly effective, short course, virtually side effect-free therapy, when they're aware that, that therapy is available, they'll demand it and travel for it, and we are experiencing that as we speak.

我認為這就是 ViewRay 的故事，最終，患者會寫下它。我親眼看到，當患者意識到高效、療程短、幾乎無副作用的療法時，當他們意識到該療法可用時，他們會要求它並為此而旅行，而我們正在經歷正如我們所說。

There are no further questions at this time. This concludes today's conference call. Thank you for your participation. You may now disconnect.

目前沒有其他問題。今天的電話會議到此結束。感謝您的參與。您現在可以斷開連接。