iCAD (ICAD) Q4 2020 Earnings Call Transcript

iCAD (ICAD 2.63%)
Q4 2020 Earnings Call
Feb 24, 2021, 4:30 p.m. ET

Contents:

• Prepared Remarks
• Questions and Answers
• Call Participants

Prepared Remarks:

Operator

Greetings. Welcome to iCAD, Inc. fourth-quarter and full-year 2020 earnings call. [Operator instructions] Please note, this conference is being recorded.

I will now turn the call over to your host, Jeremy Feffer. You may begin.

Jeremy Feffer -- Investor Relations

Thank you, Stacey, and good afternoon, everyone. Thank you for participating in today's call. Joining me from iCAD are Michael Klein, chairman and chief executive officer; Stacey Stevens, president; and Scott Areglado, chief financial officer. Earlier this afternoon, iCAD announced financial results for the three and 12 months ended December 31st, 2020.

Before we begin, I would like to caution that comments made during this conference call by management contain forward-looking statements, involve risks and uncertainties regarding the operations and future results of iCAD. I would also note that management may refer to certain non-GAAP financial measures. Management believes that these measures provide meaningful information for investors and reflect the way that they view the operating performance of the company. You can find a reconciliation of our GAAP to non-GAAP measures at the end of this earnings release.

I encourage you to review the company's filings with the Securities and Exchange Commission, including, without limitation, Form 10-Q and 10-K, which identifies specific risk factors that may cause actual results or events to differ materially from those described in the forward-looking statements. Furthermore, the content of this conference call contains time-sensitive information that is accurate only as of the date of this live broadcast, February 24th, 2021. iCAD undertakes no obligation to revise or update any statements to reflect events or circumstances after the date of this conference call. With that said, it's my pleasure to turn over the -- turn the call over to Michael Klein.

Mike?

Michael Klein -- Chairman and Chief Executive Officer

Thank you, Jeremy, and good afternoon, everyone. I'd like to begin by highlighting a few financial highlights, with a particular focus on iCAD's top-line revenue momentum. iCAD's fourth-quarter total revenue of $10.5 million, represents a 47% sequential growth over the third quarter. We are pleased to report that revenue growth of our flagship high margin ProFound AI offering grew by 70% over our third-quarter revenues.

To further punctuate the performance of ProFound AI in the U.S., our most profitable market, total sales of AI and services collectively grew on a sequential quarterly basis by an even greater amount, 72% from Q3 to Q4. It is also noteworthy that this substantial quarterly growth also represents a 21% increase in detection product revenue over the fourth quarter of 2019 which was the prior high watermark for ProFound AI sales. In our detection business, we recently achieved a critical milestone, the installation of our 1,000th ProFound AI system since our product launch in early 2019. We believe it is particularly noteworthy that nearly 40% of these 1,000 installs have been installed during the course of this pandemic.

We see ourselves currently in an enhanced position to offer a steady flow of new AI offerings, product offerings that we anticipate bringing to market with an accelerating cadence. iCAD's newest offering ProFound AI for risk assessment is a product that looks into the future and provides a unique and personalized probability score for potential future breast cancers. ProFound risk assessment can find cancers that are not visible or discernible today, yet may still exist in a subvisual range. Our cutting-edge AI Risk algorithm could see these cancers two years before they enter a physician's visual field, and in doing so, provides a unique future risk score for patients' examination in the future.

With our new Risk product, this would be in addition -- which would be in addition to a score for breast cancer. Today, we result -- we wind up with two products, two scores versus one today, one for the future and one that examines risk today -- I'm sorry, that examine detection today. We now have a total of 7,500 2D and 3D installation. We see this along with our unique ability to integrate with all mammographic systems, workstations, and PACS providers as a significant barrier to entry.

As I've said in the past, there are over 1,800 different combinations of technologies when all put together that we've had to solve over many years to be able to apply our solutions into the market. In addition, in the area of risk assessment, we believe that we are years ahead of foreseeable competition. Our risk assessment software took eight years of intense effort and literally hundreds of thousands of images. This launch into the U.S.

and OUS breast cancer screening market could not have occurred at a more opportune moment. We are now well-positioned with a novel product offering optimally suited for a pandemic, where it can assist with the scheduling, and prioritizing of patient screening for breast cancer. Now moving in parallel with the growth of our AI offering, we also experienced significant quarterly growth in our therapy business, with Xoft new product sales and installations in Q4 2020. Xoft new equipment revenues and the installations of new systems at sites are lead indicators for follow-on recurring revenue sales.

Post-install sales tied to procedure volume, represent the majority of Xoft's quarterly sales volume. Recurring disposable sales and x-ray source usage volume also have a significantly better profit margin and profile than the initial equipment sale. We deploy a classic razor blade model, [Inaudible]. While as a total business, iCAD achieved the above-mentioned sequential revenue growth of 47% Q4 over Q3, iCAD also grew 11% over Q4 2020.

Simultaneous with this, we decreased our operating expenses in Q4 by 3% from prior-year Q4. Thus, we have realized both leverage and a surge in productivity while our development teams have achieved growth of products and release of products at an accelerated pace. Sales growth, combined with cost controls and the above productivity gains, allowed us to reduce iCAD's pre-tax loss to $1.5 million in Q4, 16% lower than Q3 losses and 50% lower than Q4 2019. We also ended the year with cash and cash equivalents of $27.2 million.

These numbers are the result of a very deliberate effort and planned trajectory to achieve positive cash flow and EBITDA in our core detection and therapy businesses. It is also worth noting that we are achieving a goal that I'd like to refer to as frictionless procurement. This is a dynamic where sites can access iCAD technology by their choice of, either an OEM mammographic system, their local distributor, mostly OUS, through tax providers or through our own direct salesforce. In addition, we have also introduced what I'll refer to as frictionless pricing.

This will increasingly characterize our go-to-market approach, as customers are now able to purchase via: one, upfront licenses with recurring annual service fees; or two, monthly subscription pricing; or three, purchasing on a SaaS basis which is fundamentally a payment for each patient analyzed. We are excited about the continuing emergence of subscription and SaaS pricing. Though still in the nascent, yet growing stage of adoption, ProFound AI systems secured through these vehicles will increasingly generate recurring and predictable revenues. Revenues that will move our already high-margin products to an even more attractive level.

We anticipate that over time, predictable recurring revenues will also mitigate seasonal fluctuations and as screening procedures flow more evenly than healthcare procurement cycles. As we reflect on 2020, we effectively lost a full quarter of selling. Even when customer doors were open, we experienced distracted, clinical, and administrative decision-making. It took almost four and a half months until mid-summer before sites returned to full screening with 100% of sites open.

Active screening has sustained throughout the fall and winter months and now well into 2021. As you may recall, Q3 detection AI product sales grew 44% over Q2, and as stated above, Q4 detection product sales grew sequentially 70% over Q3. With this as an overview of our recent performance and sales momentum, let me provide some brief commentary about our new risk assessment offering. iCAD's new ProFound AI Risk offering is now available for the large 2D mammography market.

As we've said in earlier calls, in many parts of the world, the 2D market is larger than the 3D market. In the coming months, our risk offering will be available for 3D mammography systems as well. This means that we will shortly have not one, but two breakthrough and novel first mover AI offering for both 2D and 3D mammography. Both will be offered in the U.S.

and OUS, and both will be sold through all channels and utilize the aforementioned range of pricing vehicles. Through the use of frictionless customer purchasing, we are increasingly using the best demonstrated practices of leading software companies, practices that have successfully been pioneered to achieve dramatic growth and value creation. With that, let me highlight two large deals we closed in Q4, Solis mammography and Wake Radiology. Our five-year deal with Solis represents the single-largest deal in iCAD history.

It includes both ProFound AI for detection and ProFound AI for risk assessment, and it covers 160 mammography systems. Solis operates in more than 80 branded centers in 11 states, as well as, seven offices in the DC capital vicinity. Further, Solis has stated its intention to triple its installations and market size and reach over the course of this agreement. Solis is uniquely skilled at raising patient awareness of their unique mammographic capabilities.

This approach attracts and increases patient flow in their 80-served markets. We see this agreement accelerating the adoption of ProFound AI by other screening centers adopting within these 80 catchment areas. It is our belief that a deal with this magnitude with a clear industry leader validates iCAD's broad-based clinical utility, workflow capability, and economic value proposition. The fact that Solis was a flagship site for Hologic's 3D mammography system, now vastly expands iCAD's footprint as a provider of AI for all mammography vendors and healthcare systems.

Now our agreement with Wake Radiology, North Carolina is the largest provider of 3D mammographic services in North Carolina, and it covers 22 systems in many new and important markets. It is another example of the cascading impact of ProFound in essential markets and key catchment areas and where we see the adoption at one notable site influencing or prompting the sale and adoption in other sites or at other sites in local markets. Wake's use of ProFound detection AI provides them with a significant differentiator against market competitors. They highlighted ProFound AI in their own self-generated media campaign and press release once about a month ago.

This is yet another Hologic mammography site and further expands our well balanced sales reach across all available mammography systems. Finally, I'd like to review some developments in intraoperative radiation therapy or IORT, related to the treatment of glioblastomas on a recurrent basis, also referred to as GBM. As we've discussed at our well-attended innovation day in the fourth-quarter and in our last earnings call, the updated data on glioblastoma showed continued, and in fact, rather dramatic improvement compared to the control group. In the endpoint areas of overall cancer survival, as well as, progression-free survival time, dramatic results were seen.

Our new study is now enrolling and is designed to further validate these outcomes at prestigious sites in both the U.S. and in Europe. Dr. Santosh Kesari, a nationally prominent neurooncologist at the John Wayne Cancer Center will serve as the principal investigator of our trial.

And in the trials are key and will be used to treat current GBMs, following surgical excision of the malignancy. It will be compared to the current radiation therapy standard of care and the trial is now under way and sites are now recruiting for patients. The trial design and details can be found at clinicaltrials.gov. The primary outcome of this 80- to 100-patient trial will be an assessment of overall patient survival.

The secondary endpoints would be to assess the pattern of disease progression, potential adverse events, and quality of life. This is not an overly long or expensive trial since most sites already have access to Xoft FDA-cleared technology. We anticipate the first patient treatments in the weeks ahead. We also anticipate that preliminary data will be submitted for presentation by the end of this year, 2021.

Xoft therapy can be delivered real time, at the same time as the surgery, and offers an important advantage, especially during COVID. Other forms of radiation therapy typically require the need to wait four to five weeks post-surgery before commencing treatment. Xoft offers real-time, on-demand treatment for a disease that typically grows as rapidly as 1% per day. Our technology offers a unique clinical advantage and a chance on impacted disease progression that typically moves quickly and do so at a significant and earlier stage.

So in summary, we are now -- we now see ourselves operating with high momentum in a vastly improved clinical and economic environment, in spite of COVID-19 and perhaps, in some ways because of it, we are making significant progress and making important leap forward throughout our business. Both our detection and therapy segments are at a clear and palpable inflection point. With continued growth rates anticipated, we have an increasingly strong balance sheet and continue -- and will continue our steady march toward positive EBITDA and cash flow. And with that, I'd like to turn the call over to our chief financial officer, Scott Areglado.

Scott?

Scott Areglado -- Chief Financial Officer

Good afternoon, everyone, and thank you, Mike. I'll now summarize our financial results for the fourth quarter ended December 31st, 2020. As I have mentioned previously, we believe it is useful to compare our sequential revenues from the prior quarter in addition to our year-over-year comparisons. Fourth-quarter 2020 total revenues were $10.5 million, representing a sequential increase of $3.4 million or 47%, as compared to $7.1 million in the third quarter of 2020.

Detection revenues were $8.1 million in the fourth quarter of 2020, an increase of 53%, driven by a 70% increase in detection product revenue. Looking at our Q4 revenue on a year-over-year basis, total revenues for the fourth quarter of 2020 increased $1.1 million or 11%, with detection revenues increasing $1.3 million or 18%. Moving on to gross profit. On a percentage basis, gross profit was 71% for the fourth quarter of 2020, compared to 76% for the fourth quarter of 2019.

On a pure dollar basis, gross profit for the fourth quarter of 2020 was $7.5 million, as compared to $7.2 million in the fourth quarter of 2019. Total operating expenses for the fourth quarter of 2020 were $8.9 million, a $0.2 million or 3% decrease from $9.1 million in the fourth quarter of 2019. Importantly, our expense management resulted in a net loss of $1.6 million or $0.07 per share, as compared to a Q4 '19 loss of $3.4 million or $0.17 per share. We remain committed to managing expenses while strategically investing in our ongoing initiatives to drive growth.

Moving on to profit metrics. GAAP net loss for the fourth quarter of 2020 reflected an improvement of $1.8 million to a loss of $1.5 million or $0.07 per diluted share, compared with a GAAP net loss of $3.3 million or $0.17 per diluted share for the fourth quarter of 2019. Non-GAAP adjusted EBITDA for the fourth quarter of 2020 was a loss of $0.9 million which represented an improvement of $0.5 million, compared to the fourth-quarter 2019 non-GAAP adjusted EBITDA loss of $1.4 million. Non-GAAP adjusted net loss for the fourth quarter of 2020 was $1.4 million or $0.06 per diluted share, as compared to a non-GAAP adjusted net loss of $1.9 million or $0.10 per diluted share for the fourth quarter of 2019.

Moving on to the balance sheet. As of December 31st, 2020, the company had cash and cash equivalents of $27.2 million, compared to cash and equivalents of $22.6 million at September 30th, 2020. During the fourth quarter of 2020, the company received $6.1 million in net proceeds from the sale of common stock to select institutional investors. In addition, as of December 31st, the company achieved the revenue milestone as set forth in the Western Alliance loan agreement, and as a result, we have deferred repayment of the note from September 1st to March 2022.

This concludes the financial highlights of our presentation, and I would now like to turn the call over to Stacey. Stacey?

Stacey Stevens -- President

Thank you, Scott, and good afternoon, everyone. Although COVID-19 continued to impact many companies in Q4 including ours, we continue to be encouraged by the overall performance of our company. Despite unforeseen challenges brought on by the pandemic in 2020, our team continued to advance our innovative solutions in a rapidly evolving marketplace. We believe our dedication to providing precise powerful healthcare solutions that are expertly engineered to optimize operational efficiency, clinician confidence, and patient outcomes will continue to enhance our competitive position in both segments of our business.

While the COVID-19 pandemic introduced practice-changing challenges on many facets of healthcare, including cancer detection and treatment, there has never been a greater need for our cancer detection and therapy solutions. The World Health Organization recently announced that breast cancer has overtaken lung cancer as the No. 1 diagnosed cancer globally. This is compounded by the fact that medical care was severely disrupted in many areas at the height of the pandemic, resulting in an enormous backlog of mammograms which is now estimated to be as high as 8 million to 10 million as a result of decreased cancer screening last year.

Given these circumstances, we firmly believe that our technologies offer a unique value proposition that is exceptionally timely and positions the company and our technologies for success as we look ahead in 2021 and beyond. Let's begin by highlighting the success of our company's latest advancement, ProFound AI Risk. This first-in-time technology uniquely combines age, breast density, and subtle mammographic patterns, including those that may not be apparent to the human eye to yield a highly accurate and personalized two-year risk assessment. We are excited about the benefits this software can offer to both clinicians, and most importantly, patients.

And we are continuing to drive forward several key initiatives relative to expanding our clinical validation on a global basis, including developing KOL research sites and clinical centers of excellence with multiethnic, multigeographic data diversity, all aimed at driving adoption globally, and ensuring product efficacy across a diverse range of patients. We are working to finalize the risk algorithm for 3D breast tomosynthesis. This process requires a collection of 3D cases for both training and validation. We have made significant progress in collecting the cases needed for each of the DBT systems to be supported and the preliminary performance results with the 3D images are very promising.

ProFound AI Risk will be particularly well-positioned for success in the years ahead as mammography begins to transition from what is an age-based screening paradigm today to a risk-adjusted screening paradigm. This technology offers a practical solution that empowers physicians to offer more personalized screening, truly individualized for each woman. We believe this technology may ultimately lead to supplemental screening being applied to a smaller, but correctly targeted percentage of women and to lowering total cost per patient spend over time. Expanding the body of clinical evidence supporting our technologies with high-impact clinical studies remains an important focus area for us.

ProFound AI Risk is already supported by a recent study published in radiology. And in Q4, we continued efforts to initiate a multicenter European initiative to conduct a global retrospective analysis of 2D risk. We are continuing to work with a number of highly influential thought leaders in Italy, France, Spain, and Germany to refine the study protocol and ensure multigeographic data diversity. As we have previously stated, a U.S.

retrospective analysis study of it's 2D and 3D will also be led by Dr. Emily Conant, Professor of Radiology at the hospital of the University of Pennsylvania, whose data also reflects an ethnically diverse group of women with a special focus on genetically predisposed women at high risk, such as younger African-American women. We are currently identifying additional sites for inclusion of other ethnic groups, including Southeast Asian American and women of Hispanic origin. It is our hope that this research will contribute to the growing body of evidence supporting our technology and potentially pave the way toward more personalized screening recommendations in national clinical guideline organizations such as National Cancer Institute and the National Comprehensive Cancer Network.

High-impact clinical studies also have the potential to feed healthcare economics and payer relations studies which could validate economic benefits of the model, improve savings to the health system. In summary, we continue to see tremendous interest for risk in the market and remain very positive about the impact our innovative risk solution will have on our business moving forward. I look forward to providing further updates on ProFound Risk in the coming months. In addition to our focus on ProFound Risk, we are continuing to advance ProFound AI for DBT, our flagship breast cancer detection algorithm.

In late 2020, we finalized the development of the third-generation release which demonstrates improved clinical performance, especially related to specificity or false positives of the algorithm versus the current commercial product. The new version was submitted to the FDA and our notified body in Europe for CE Mark and is currently under review by both bodies, and we anticipate receiving clearance to market and sell in the U.S. and Europe in the coming weeks. The new ProFound AI release will also be accompanied by an updated platform release which will further reduce the time it takes to process images, as well as, introduce the ProFound AI index card which will provide our customers with a simplified summary of all iCAD AI results in a single view.

Additionally, the release will offer enhancements to how our AI integrates with PACS and mammography workstations to further improve reading workflow and efficiency for our customers. I'd now like to review our strong overall performance internationally. Our total ex-U.S. revenues of $2.8 million for full-year 2020, represented a 20% increase over full-year 2019.

In a year significantly impacted by COVID-19, we are extremely pleased with these results. Let me review some recent international achievements. During Q4, we sold our first ProFound AI system into Israel and shipped two evaluation systems to the largest medical group in that country, where 70% of Israelis are treated. For the first time, we participated in the Israeli Radiology Congress with our own KOL speakers, providing us the opportunity to introduce our suite of products to this large target market.

France continues to be a key market for us. We completed our first installation in the South of France, which generated extensive TV, radio, and print coverage, as well as, an installation at one of France's best known hospitals in Paris, La Pitie Salpetriere. In addition, we signed an exclusive commercial contract with a leading private clinic group. Our sales channel investments in 2019 and 2020 are generating results, and we expect continued growth in this geography in 2021.

Now let's quickly switch gears and discuss our Xoft business which has demonstrated important progress in multiple areas during a period of uncertainties due to COVID-19. As I stated on our last earnings call, we have brought in new senior leadership in Jeff Derrick and the business has seen some significant changes from an operational and strategic standpoint. We have implemented a two-tier strategy to drive revenues around the current applications while developing the new indications, neuro and rectal, through our clinical trials, registry, KOL sites, and pre-commercial efforts which we will talk a lot more about in our Future Innovation Day. In Q4, there were seven systems sold worldwide, including our first neuro commercial site in Germany [Inaudible] Hospital which will be using the system for multiple applications.

Additionally, the skin business was restarted in Q4 due to some favorable reimbursement change and we received an order for several systems. These purchases for KOL users were for -- on multiple dermatology sites in both the West and Southeastern U.S. areas. In the OUS business, including China, we have seen consistency with controller placements and source usage.

We had two milestone wins in China in Q4, including Union Hospital in Beijing, one of the most influential hospitals in China, and they will be treating multiple applications. Moving on to the new clinical applications. The protocol for treating recurrent GBM has been approved and now resides on the clinicaltrials.gov website, as Mike mentioned. This is a milestone and it's vital as we finalize the first treatment sites and gain IRB approval from individual hospitals.

In the EU, we have focused effort and hospitals identified to join our trial and begin treating GBM patients. Some of these sites are current users and others are completely new healthcare systems that we are targeting. We expect to be treating GBM patients in two to three sites in the second quarter. So in summary, we are excited about the progress and accomplishments we have driven across both sides of our business, and we look forward to providing you with further updates as we continue to advance our business forward in 2021, drive sustained leadership, and create additional shareholder value.

Now we will open the call for questions. Operator?

Questions & Answers:

Operator

Our first question comes from Kyle Mixon with Cantor Fitzgerald. Please go ahead.

Kyle Mixon -- Cantor Fitzgerald -- Analyst

Hi, guys. Thanks for taking the questions. Congrats on a great quarter here. So I wanted to talk about the sequential detachment business growth.

It was obviously stronger than it wasn't 3Q and that was -- I want to break it down to a couple of categories. So first of all, which of the sales channels was the most successful during the fourth quarter? And then secondly, you know, were a number of those insulting detection away from previous quarters. And finally, what were the main types of customers that bought the software? Thank you.

Scott Areglado -- Chief Financial Officer

So, Kyle, How are you doing? This is Scott. So, most of the growth in the revenue was from the direct -- our direct channel versus OEM growth, and it was primarily around 3D and Risk.

Kyle Mixon -- Cantor Fitzgerald -- Analyst

OK. But was anything pushed out from previous quarters or anything like that? Because it was obviously, really an impressive number.

Scott Areglado -- Chief Financial Officer

So we had a big enterprise sale. You know, we referred to it a couple of times and those things take a while to develop. So it's -- it happened in the fourth quarter.

Kyle Mixon -- Cantor Fitzgerald -- Analyst

OK. Got it. Thanks, Scott, for that. And, um, I just want to also touch on the entrance of the new competitive products in the fourth quarter as well.

I know it's been a few months, but I want to get an update there. So, obviously, it's only going to affect customers with a certain type of camera. I just was curious, if there was any changes in the competitive landscape and how that's kind of impacted the way you're going to market or the customer response to your products? And then, of course, how did risk kind of play into that? Because, you know, have your strategy there?

Scott Areglado -- Chief Financial Officer

Mike, do you want to? Mike is Stacey going to speak to that?

Stacey Stevens -- President

Yeah, sure. I'm not sure if we lost Mike there, but is that Mike? OK. We might have lost him. Yeah.

So, you know, the new competitor in the space that you're referring to, we really feel a lot of confidence in our ability to win deals in those accounts and we have a lot of evidence so far given that the large accounts that we have landed even in Q4 that were -- you know, that that had that imaging equipment. You know, we really have stronger clinical claims. If you look at the claims from a sensitivity to specificity, to reading time, these types of things, if you look at those altogether, our clinical claims are far superior. What? Mike?

Michael Klein -- Chairman and Chief Executive Officer

Yeah. I think -- can you hear me? I think my --

Stacey Stevens -- President

Yeah, we can, we can. And so from a competitive standpoint, Kyle, we feel very good about our ability to compete on the clinical performance elements. And then I would say, remember, we're on the third generation of our product, right. So as new entrants are coming into the market, they're coming in with products that are in the first generation, not only are we already on the third generation, which we expect to come out of the FDA in a matter of weeks, that we'll have further improved clinical performance, we also are now increasingly including risk as part of all of these deals and there's tremendous interest in risk.

And in fact, it's actually driving the customers choice for ProFound AI and in many cases. So the combination of material superior clinical claims and having a risk that nobody else has, a short-term risk algorithm, at this point, I think puts us in a very strong position, competitively.

Kyle Mixon -- Cantor Fitzgerald -- Analyst

OK.

Michael Klein -- Chairman and Chief Executive Officer

And if I could -- could add. Yeah. I don't know if I'm live now. I think, uh --

Kyle Mixon -- Cantor Fitzgerald -- Analyst

Hey, Mike.

Michael Klein -- Chairman and Chief Executive Officer

Somehow my, you know, my line went cold there for a moment, but I think those points were well established. But I would just add that -- because one of the benefits or just an unanticipated consequence of COVID is very hard to launch into a market especially for new players out of the market. And I think, we thought we were going to have that dynamic at some point this year. But the competitive dynamics we anticipate seeing, both from international and domestically, we've just not seen emerge.

We -- we continue to only see in the U.S. our PDA system solution for detection. And certainly on the risk side, that sort of puts us, at what we call, the extra mile, where we think there are a few others. So thanks for the question.

Kyle Mixon -- Cantor Fitzgerald -- Analyst

Thanks much for that. That definitely answers the other question, so does a couple questions. So on -- but I've been thinking about change, obviously, recently with the on the Optum acquisition and it's our view that changes in imaging business is really fit into Optum site's main business areas, and honestly, I think it could be better off divesting the business. So I just want to ask, how iCAD would be affected if that were to happen.

In other words, if the imaging business was separated from change. Would you be better off or worse off, if one or the other tax vendors kind of added that -- the change assets and had that larger scale?

Michael Klein -- Chairman and Chief Executive Officer

You know, we're -- you know, we're sort of agnostic on this guidance on that and that the business would change as we have great expectations for that business as it continues to gain traction. If they stay merged with another packed player, that would be fine as well, and we're already working with the majority of them. And I will say, if they continue in the current consolation that that they're in with -- as part of United, we think that that is actually very exciting because it provides data to a carrier -- an insurance carrier that can actually be used to make term-positive determinations about the economics of care. If someone is against it in the door that we are longing to get into and I'll have data from from their own sources in terms of the the efficacy of care of the -- where disease is found, at what stage disease is found.

So we kind of like where it is now and we're fine if it happens to attract itself, where it attracts itself to another tax or enterprise, it's -- either way, it's -- I feel like it's a -- it's a win-win.

Kyle Mixon -- Cantor Fitzgerald -- Analyst

All right. Got it. Thanks, Mike. And just one last question.

Hopefully, it'll be quick. So you just mentioned repeatedly, recently, that both sides of the business should grow really strong rates going up over the next few years. Last week or at least recently, you mentioned I think 50% growth. So I know you're not providing long-term guidance, but can we maybe see that in 2021 or possibly in '22? I'm just trying to think about what the roadmap in the near-term, as you kind of drive for success in both segments.

Michael Klein -- Chairman and Chief Executive Officer

Yeah. We do -- we do see significant growth in, and in fact, collectively and on both sides of the business. The -- you may have heard me talk about this frictionless procurement which means, multiple channels. It can be purchased through, as well as, frictionless purchasing which allows it to be acquired, either, you know, as an upfront purchase with recurring revenue service subscription or SaaS.

And because of that, there's going to be some undulations in terms of which channels it comes in. Some of these channels actually might, just as an example, take $1 million sale, instead of getting it upfront with some service, it might come in at $400,000 this year, $400,000 the next, and continue to give at $400,000. So because of that, we've been a little bit -- we've been -- we've been a little bit premature to provide firm guidance because we -- our goal is to be able to meet the market where it is. But in some ways, we know that if we take $1 million off the board and do it in a fast model, it's going to help margin, it's going to help recurring revenue to be predictable, but it could have some effect on the -- on this year's revenue.

There's -- to the extent that it occurs. There's no doubt that any deal we take today will, not only have an impact this year, will have an even bigger impact for the year -- in the years to come. So back to your point, we do think that the growth can accelerate in every year, if we take subscription deals or SaaS deals today.

Operator

Thank you. Our next question comes from Frank Takkinen with Lake Street Capital Markets. Please go ahead.

Frank Takkinen -- Lake Street Capital Markets -- Analyst

Hey, congrats on a good quarter, and thanks for taking my questions.

Michael Klein -- Chairman and Chief Executive Officer

Hey, Frank.

Frank Takkinen -- Lake Street Capital Markets -- Analyst

A couple here on -- a couple here on Solis to start off. Obviously, this is a giant win with it being very, very clear indicator of it being the most superior technology on the market, given the whole logic account. So I wanted to ask a couple more questions here and see if we get some more color. First, can you give us any color into the expected rollout ramp into Solis locations? Two, any color on, whether or not, these will be upfront purchases or subscriptions? And then three, as you spoke to tripling, I believe you said tripling, the installed base over the next five years, whether or not, ProFound would be almost a standard option as they roll out these new installs.

Michael Klein -- Chairman and Chief Executive Officer

Yeah. So --

Scott Areglado -- Chief Financial Officer

Frank, it's a perpetual license sale. So we, you know, we delivered a significant portion of the system to Solis in 2019 -- in 2020. And then, the rollout and the installation of that into Solis will happen on their timeline in 2021. So it's a five-year agreement.

The majority -- we recognize a significant amount of revenue in 2020 and then the remainder, will generally come in rateably over the remaining four years, just tied to the service and some installation. And then as they grow and as they add more ProFound location -- more locations, they would add ProFound into those locations and we would get additional incremental revenue when they add them. Does that help?

Frank Takkinen -- Lake Street Capital Markets -- Analyst

Yeah. Absolutely.

Michael Klein -- Chairman and Chief Executive Officer

And now to that effect, if I can just add to that one piece on the -- going forward. The reason that -- there's a particular reason this was made as a five or structured as a five-year agreement, which is also consistent with your point about tripling, and they do in T&C, ProFound, both detection and risk, as a core differentiator. So it is integral to the growth equation in markets as they -- as they move forward. In fact, there, you know, there are some anticipated additions to the Solis universe that we expect to hear in Q2 and later this year.

And we believe, we'll be -- we'll be part of those deals, as per the agreement.

Frank Takkinen -- Lake Street Capital Markets -- Analyst

Got it. Helpful. On the Solis -- I'm sorry, on the ProFound Gen 3 that you spoke to, Stacey, is there potentially a commercialization strategy change as you're going to your already installed users with Gen 3, something along the lines of, we're going to continuously roll out new generations. Maybe there's an interest in converting over to a subscription model, where you can be a part of these updates without having to purchase new every year or my overthinking a little bit here?

Stacey Stevens -- President

No, I mean, it's a great question and we already have customers today that are buying service plans that enable them access to all of the generations of software updates that get launched in any given year. So we have some experience in doing this. So I don't think it's going to change our commercial model at all. We are seeing, at this point, some customers who are expressing an interest from moving from a capital model to a SaaS type model or a subscription type model.

Usually that's customers that may not have budget in 2021 and may not be getting budget until next year, but really, urgently, want to acquire that technology this year, right. So, I think, we'll see a mix of models and we're prepared to offer the customer the ability to purchase it any way they want, whether it's a perpetual license or a subscription-based model or monthly fee financing. We have the ability to offer all of those different ways and that's what Mike sort of referred to as frictionless sales model. And we can adapt to the customer's needs from a budgeting standpoint and we are seeing customers want to accelerate the acquisition of the technology regardless of whether they have the budget today.

So that's a dynamic that that has caused us to be able to offer that flexibility to customers.

Operator

Thank you. Our next question comes from Per Ostlund with Craig-Hallum. Please go ahead.

Per Ostlund -- Craig-Hallum Capital Group -- Analyst

Thanks. Good afternoon, everybody. I want to come back to the notion of Genius AI since it was introduced and cleared kind of around RSA there. Given that your two big announcements commercially for the quarter were sizable Hologic sites, is it a reasonable conclusion to think that, in a way, Hologic's FDA clearance sort of represents a bit of a bit of a dam breaking, if you will, maybe the market was a little held hostage while sites were sort of waiting to see what Hologic actually had? And that now, that it's sort of out there and would seem to be clearly inferior, that sort of driven folks your direction.

Michael Klein -- Chairman and Chief Executive Officer

Yeah, Per. This -- that's a very good question. The -- there's no doubt that, you know, it's pretty typical for large-market players to want to quote unquote, freeze the market or say, you know, we've got a solution we're coming out with and we've got to look at the solution ourselves and side by side with other -- with some of these deals that matured in the fourth quarter into, you know, to not get into too much granularity, I would say this. There's three things that sites need to see in an AI solution.

One is that you want to have -- you want to make sure the detection is high, you want to make sure it doesn't come at the expense of false positives, and you want to make sure it comes -- that all this happens without the expense of increasing reading time. And we use the calculation which is called AUC, area under the curve. It's basically the miles per gallon for AI and in the release which is published, you can't hide these things. The FDA publishes them on the FDA site, on Hologic sites, the area under the curve, which is sort of a byproduct of sensitivity and false positives.

What you catch, which is what you caught but you shouldn't have. You know, we have a number that's double that of a competitive offering -- of the largest offering. Further to the point, is that you want to make sure -- one of the reasons for using, that's probably why people bought 3D was that it reduced false positives. You don't want a product that actually increases false positives, especially during the pandemic.

The data on the Hologic site, again, I don't typically speak this way about competitors, but it's -- just on the site, actually increased false positives. And the third piece, which is probably one of the more challenging elements is that, when you've gone from four images to three to four hundred, you want software that's a workflow productivity tool that reduces the amount of time and we do that to the effective 53% and almost 58% for complex images. And in the case of Hologic, it actually resulted in increased amount of time and that's all on the site. So, I think, you're correct, people sort of waited, took a look at that and then, you know, it basically -- it came back to us and we say, here's the product and it's not only where it is today, but it's going to get moved to the third generation in the weeks ahead and it has risks.

And I think, given those dynamics, it's creating a very favorable set of circumstances for us.

Per Ostlund -- Craig-Hallum Capital Group -- Analyst

Clear. OK. That makes sense. Since -- since GBM hasn't been brought up in the Q&A, I think I'd like to do that.

You know, far be it for me to fast forward beyond the trial that you're -- you're just embarking upon now. Let's stipulate that the data that the trial that you have being led by Dr. Kesari, more or less, matches that of the [Inaudible] data out of Russia. Mike, you've talked about potentially partnering with another player in this space, potentially to act as a bit of a selling arm for you, for IORT.

Is that -- is that still something that's on your radar? Is it something you would consider, sort of a bifurcated commercialization effort, where you do some direct through your existing channels and partner with somebody else? How -- how could that look?

Michael Klein -- Chairman and Chief Executive Officer

Well, it's -- it is interesting, Per. It's a really good question. You know, how do we optimize the value of Xoft? You know, we see Xoft falling into a couple of buckets. One, you just mentioned, Xoft-Neuro.

There's also Xoft, you might say, [Inaudible] Xoft, Xoft-Derm, which is Aesthetic dermatology and then there's Xoft GI. In each of these areas, it's pretty clear to us that adding our own salesforce as in each of these areas, since they're all unique markets, may not optimize the technology. And that this technology will, given the pricing of the extra resources and the technologies and the reimbursement in these areas, can allow for distribution partners, that even if they took 20%, 25%, 30% revenue, would still provide very, very favorable returns for this business, perhaps even greater than the returns today because the reimbursement profile is high. So when you look at neuro, clearly, it makes sense.

Well, initially, we'll have perhaps, you have two or three reps that'll be working to cede the market because this product is for sale right now. But we're not positioning ourselves as competitive to any player, but we see ourselves as additive or injunctive, and that sets up a framework for us to be able to partner with other players out there, who may have 30 to 50 people out there. And may be an excellent bet to diffuse the technology and still provide very, very handsome gross margin returns. And by the way, we think that could be the case for, not only neuro, but for other areas as well.

And so, as you can see, that we have sort of a hybrid. We nurse the products along and then where it's a breakout opportunity, we might add some dedicated capability or rather some partner capability to diffuse it into the appropriate channels and do more with the technology.

Operator

Thank you. Next question --

Michael Klein -- Chairman and Chief Executive Officer

And that -- yeah, yeah, go ahead.

Operator

Dave Turkaly with JMP Securities. Please go ahead.

Dave Turkaly -- JMP Securities -- Analyst

Great. Thanks and congrats. Mike or maybe even Scott, if we look at that $6.6 million detection product revenue, and I don't think you broke out, sort of the the -- to derisk from the ProFound AI, but I'd love to get any color there that you might be able to give us. And maybe on the 2D versions, even if it could be sort of a geographic split, but I know you mentioned the three ways you're going to price this.

I assume in this quarter that most of it was licensing like the ProFound in the past. Would that be a safe assumption? And any color you could give us would be -- would great.

Michael Klein -- Chairman and Chief Executive Officer

Let me give to the macro picture and I'll let Scott color in with some -- with some numbers. Keep in mind that we launched it first in international and we trained in Australia and we didn't launch it until September. And then we had sales branding for reps and distributors in October. So we only had a couple of months, but it was a very meaningful couple of months.

And then in the U.S., we also launched it in a soft launch toward the middle of the fourth quarter. And this was designed -- because our plan with risk is to also, we've learned from from detection to try to get it out to the major sites that are going to publish the data. And if we didn't have a hard launch with the data published and all these luminary key opinion leader sites already out there, it'll strengthen the launch. Just, you know, the stronger launch, although, it would be preceded by a softer launch.

Having said that, the product has had unexpected outcomes for us in terms of data mining very well with reimbursement dynamics outside the U.S. and it actually was a key swing factor with some of the deals. So, Scott, do you want to comment a little bit on some of the elements in the mix with the list that we saw in the fourth quarter?

Scott Areglado -- Chief Financial Officer

Yeah. So, look, it was, you know, primarily license sales as we've been selling historically here and risk was a big part of the offering for, both Solis and for Wake. So, you know, we get some significant revenue. You know, we're not breaking it out, but it just say that it's an embedded piece of the overall sale, and it was certainly, a big value driver in getting both of those sites.

Dave Turkaly -- JMP Securities -- Analyst

Got it. And then I guess, you mentioned part of the license, I imagine it's a similar price point. I guess, my follow-up question would be, if you sold some ProFound AI to some of these accounts now, and obviously, through 2020 as a whole, can we think about adding, maybe risk to some of your already ProFound accounts and maybe putting some sort of, I don't know, $30,000 whatever license ASP might be. Looking ahead, even on some of the places that you've already put ProFound this year, what do you think the propensity to upgrade is and would it be a fee like that?

Michael Klein -- Chairman and Chief Executive Officer

Yeah. So, I would say, David, that that certainly, where you've got now north of a thousand in Xoft into a market in the U.S. that in the high teens and worldwide could be $35 million to $40 million. And you know, we have as I said, 55 of the 2D sites and a thousand ProFound sites, the first place you going to go is to your own site, about 2D and 3D.

What I would say, however, is that and we're being intentionally vague on this point by design, about switching over to a model, where at some point this year, close to the mid-year, we're going to move from a licensing model for risk to a subscription-only model. And there's a reason for that and that is, that this is an offering that's going to rapidly evolve in new ways. And rather than have to offer an offering, six months, twelve months, which makes the new risk factors, we want to get people -- we're ceding the market in key accounts and you know, it's almost like the first people that put money down on their Tesla, right. So with key accounts, move the market along and then, what we're hearing is not just our model that sites are going to want to buy out a subscription base, it's just that the product is going to be such that it'll be smarter tomorrow than it is today.

So we are indeed going to go after the low-hanging fruit. Our existing accounts are certainly going after novel accounts. This is a big differentiator. You saw that in Q4 with these deals and we do anticipate it moving toward a model, where we'll be on a subscription or per-SaaS basis.

And obviously, we're going to work with folks that sort of present these models, how you would see them laying out. It's one of our obligations to folks who own the new models. So we'll give proper introduction as we start moving in that direction. But by design, we're being a little bit on the quieter side just when that turnover will happen.

Dave Turkaly -- JMP Securities -- Analyst

No, I appreciate that. I mean, it's gonna have a massive impact, positive impact on your P&L. So, yeah, I think we're all excited about that. I think, lastly, you did get asked something about sort of sustainability here.

You know, given -- I know the first quarter usually is a step down from fourth, but the momentum that you saw in the quarter that still had some impact. I don't know. As we look at next year and their introduction until later this year now, and vaccines and everything kind of kicking in and some of those $8 million to $10 million backlogs coming through. I mean, and I know you don't want to give guidance, but I'm just trying to wrap my head.

I didn't have you doing a $10 million quarter though, fourth quarter of '21. So I made a bit of a quandary as to, you know, how this is going to play out. But there would certainly seem that there could be upside or, you know, is that differently that you could sustain this momentum even, maybe even in some of the earlier parts of '21.

Michael Klein -- Chairman and Chief Executive Officer

I would say, you know, look, I mean there's no doubt this market is in a buying mood and it is an option in our approach is to take it as we've said frictionless. So the -- so as these sites progress, and for example, we're dealing today with just, you know, and I'll just call it, won't get into the account. Just as an example, we're dealing with an account that could be a million-dollar deal, but it could come in as $400,000 this year, next year, and for three years thereafter, right. So while it could be an amazing deal, it could also take $1 million out of this year or this quarter, put it into $400,000 spread out over the year.

But yet, you know, we're going to love that we did this deal and then we'll have higher margins, so that makes it a little bit tricky. But the important thing is, our mantra is, if people want to buy the product, anyway, anyhow, anywhere they want to pay for it, any channel, we're gonna be there. Because we do feel like we have a, not only a first mover, but kind of, at the moment, almost the sole mover advantage. Certainly, that's the case with risk.

The way to keep moving quickly, but you made the point that this is one of the reasons we like the subscription model, is that there are episodes during the year when people do their buying, just like people buy cars at the end of the year or the end of the month. The SaaS model allows us to smooth that out over the course of procedures. But there is this hardcoded pattern of when people buy and it typically is the end of the year and they typically kind of fixed to get ready in the early parts of the year. So that panel we look to smooth out over time.

Dave Turkaly -- JMP Securities -- Analyst

Got it. Thank you for that.

Operator

Next question comes from Yale Jen with Laidlaw & Company. Please go ahead.

Yale Jen -- Laidlaw & Company -- Analyst

Good afternoon and thanks for taking the questions, as well as, my congrats on the very great quarters happen.

Michael Klein -- Chairman and Chief Executive Officer

Thanks, Yale.

Yale Jen -- Laidlaw & Company -- Analyst

My first question is that, given that you have two major accounts signed in the fourth quarter, even they are not fully -- not all the sides are purchasing. But is that, do you consider that a little bit lumpy type of event that make a jump on the revenue? And should we think about -- think about that way for forecasting going forward? Or is the starting point for already higher baseline moving forward?

Michael Klein -- Chairman and Chief Executive Officer

There's a clear tilt that a lot of this sit in Q4 but not all of it. And and in fact, as Scott will say, the first things get shipped are hardware and some software, and that's often kept suppressed as gross margins, as they have been seen in the fourth quarter. And then there sells that kind of spill out over the next quarter or two and then, of course, all service revenues hit 12 months or 12 months and let's say, the first day of month 13, where the service revenues kick in, it should be noted that these deals also have some service agreements on them. So I think that, there's going to be a certain degree of lumpiness and that will combined with a certain amount of seasonality in the procurement cycle and some of that is -- leads us to the conclusion that that we want to move quickly.

And we're going to take on sites that want to buy even if it means that we have to take them in creative ways such as fast lanes because in the long run, that's a great opportunity. So we're still going to have a little bit of this lumpiness in the seasonality for this year and it's going to get mitigated over time. But it's clearly good news and there are other big deals in the pipeline that are triggered by these other things. But it is important to note, that all of these super tanker deals, they're -- the selling cycles which is typically known only 90 to 120 days at most, but for these larger sites, they're more or they're closed at least four to six months.

There's just so many more people that have to be involved, so those deals tend to push out a little bit and and take a little bit longer.

Yale Jen -- Laidlaw & Company -- Analyst

OK. That's very helpful. And to maybe follow-up a little bit on that which is that, both on the Solis and the Wake, at least on the fourth quarter, that the site actually make the purchase. Among all the sites, they -- under their management, is that a very small portion of that? I know it's a five-year deal for Solis, but how should we think about lease on this particular vendor?

Michael Klein -- Chairman and Chief Executive Officer

I'd say in general, you should take it -- so for Solis' turn accounts, you should think of it as mostly all Solis deals were captured in the fourth quarter to some extent. In other words, not every piece of revenue, but the super majority of revenue in Q4, and certainly, the hardware and software, and a big deal and a good amount of the software. Wake has more momentum as not all of their sites will be up and running, and that'll be something that will flow over the next six months. You may have noticed that, even when we did deals a year and a half ago with SimonMed, we announced a big $1 million deal, that took three quarters for that to be fully implemented.

In the case of Solis, much of that has already been captured in the fourth quarter with a certain amount that'll go through, as stated in Q1, a little bit Q2. And also notice that that we've not included the service revenues which are significant, that won't kick in until 12 months after installing.

Operator

Thank you. Our next question comes from Gene Mannheimer with Dougherty & Company. Please go ahead.

Gene Mannheimer -- Dougherty & Company -- Analyst

Thanks. Good afternoon and congrats on a strong finish to 2020. You know, on Wake, nice agreement there. I just wanted to clarify, they committed to buying the risk product at this point, although, so when it comes generally available or is that going to be a separate sale? Thanks.

Michael Klein -- Chairman and Chief Executive Officer

I'm going to turn this one over to Stacey because she brought this deal with [Inaudible] so she knows all the details. Stace?

Stacey Stevens -- President

This is actually a team effort on the part of our sales team and many people in the company. But to answer your question, Gene, they are trialing our risk product and making a decision on, how much they would like to deploy that throughout their site. So this is a little bit of a sort of half purchase, half trial scenario here and we got the first part of the purchase and now, we have some products on trial and then they'll make a decision on acquiring the rest of the solution. But we're very hopeful that they will see the value in risk.

Gene Mannheimer -- Dougherty & Company -- Analyst

OK. Excellent. Thanks for that color. And Scott, you're your OPEX was down 3% in the quarter as you called out.

I'm just curious if that's a representative of the go-forward cost structure or you know, do you expect expenses to tick up as travel and hiring kind of kick into gear this year? Thank you.

Scott Areglado -- Chief Financial Officer

Yeah. Yeah. Look, you know, clearly with a bigger revenue quarter, there's one-time expenses in the quarter. So I would say, Q4 OPEX wouldn't be your opening run rate for 2021 for sure.

And as far as travel and the rest of the stuff, Gene, you know, we'll see how it goes. Obviously, there's not a lot of people traveling yet and we'll just -- we'll build those expenses in as we start -- as it starts to unfold.

Gene Mannheimer -- Dougherty & Company -- Analyst

OK.

Michael Klein -- Chairman and Chief Executive Officer

Just going to add one piece to that, Gene. It's been really, really interesting. I think all of this, we always felt that we have to show up and do that because it was the norm, right? You have to show up. You have to -- when I say show up, I mean, you got to be there to finalize deals and all that.

Certainly, my 90% travel supports that, but we've been amazed in how much we can get done maybe because the norms have changed. Just by all these Zoom and Teams, etc. I would say that in this year, the team -- we've looked at it, and since that most of the conferences this year are still going to be pushed out, that we've converted to far more cost-effective ways of using online tools. Some of these conferences can cost $300,000-$400,000 to a [inaudible] to travel and meals and all that stuff.

We've been going to get the same kind of face time through the same -- through internet tools and webinars and things such as that. So we're thinking carefully before we add back those full expenses. And the other thing I'll just add to that is that, in terms of productivity, I -- this is one quick anecdote, I said to one of our software -- the whole software team had a very productive year. I said -- so you've been incredibly productive this year.

I did like two years of work in like half a year or nine months. And he being a thoroughbred, self-proclaimed introvert said, Mike, I've been waiting my entire life for this moment, you know, where I can just code, code, code, and I have to go to business tradeshows, etc. So I think we're going to get the dual productivity increase and cost savings for this year. And I think, we're going to have to figure out what the right blend will be going forward.

For example, should we -- we're going to be taking a look at downsizing facility sizes, travel, all these things. We're going to have a new reality of work and it's going to be more cost effective.

Scott Areglado -- Chief Financial Officer

Yeah. And I think, fortunately, for us, Stacey's team had the marketing team had the vision to be out in front of this before the pandemic hit. So we were really able to kind of capitalize on that and get through 2020 with some of the investments we had already made.

Gene Mannheimer -- Dougherty & Company -- Analyst

OK. Very good. Thank you for that. And last thing for me, on the GPM side, how far are you along in recruiting those 80 to 100 patients? I'm just curious how difficult it is to maybe identify the patients that are to be best suited for this trial? Thank you.

Michael Klein -- Chairman and Chief Executive Officer

Well, the good thing is we have a sites, right? And at each site we'll probably see five or six patients that are candidates and we only need 80 patients, right? And we think, we can -- and we expect to actually treat our first patients at, at least, two likely three of those sites in the next 30 to 45 days. So once we get going, COVID slowed things down a little bit, but not much because after all, single fraction radiation therapy is great appeal during COVID. You're not going to get six to eight weeks radiation therapy. So we're recruiting, we'll have three sites -- up to three sites actively treating, we believe.

Let's say, late March, April, and then, we'll have all signed by in Q2. I can't exactly see how long it will take us to get to 80, but it's not a big number, if you can get all sites treating, it could be 12 to 18 months. And that's pretty useful because a lot of the survival time for patients can be measured during that time. And one of the reasons we say, you'll see information toward the end of the year is that even if we have a dozen patient spend by midyear, we'll track them at six months.

And by that point, we will have been beyond the control group's recurrence rates and we'll be able to see some meaningful data even in the latter part of this year. We're super excited about this, not really expensive trial and that they already have the equipment and it's just balloons. Really, what we're paying for is the imaging and people can also use it commercially. So we hope to get some commercial sales since it is an FDA-cleared product and we can't -- they can't use it commercially and get reimbursement, if we're also getting them the balloons which are not very costly and paying for the imagery.

So I think we're going to see a lot of development of this coming year, particularly, as we get through s midyear on GBM.

Gene Mannheimer -- Dougherty & Company -- Analyst

Great. Thank you. I appreciate it.

Operator

Next question, Andrew D'Silva with B. Riley Securities. Please go ahead.

Andrew D'Silva -- B. Riley Securities -- Analyst

Hey, thanks for taking my questions and sorry, I was hopping between calls. So just let me know if you answered any of these, but really wanted to delve a little bit deeper into the Solis win. Is it just fair to say that the overwhelming majority of the revenue related to that contract was already recognized in the fourth quarter? And if so, could you kind of let us know how much of the fourth-quarter year-over-year growth in detection would you, say, would be attributable to that?

Michael Klein -- Chairman and Chief Executive Officer

Well, I'll add to the first point, I'd say that a very significant part of that hit Q4. And, Scott, you can give the breakdown of this 21%, because you heard the comment, Andrew, about 21% year over year Q4 product sales. So that's -- what you're looking for is the subset of that that was Solis, right? Or how much Solis representative of that? I'll turn it to you.

Scott Areglado -- Chief Financial Officer

Yeah, we're not -- I'm not going to break it out specifically, here, Andy. But it's a significant portion of the year-over-year growth. But remember, just -- and just to put some color behind this, right? We had a pretty significant Q4, kind of one-time Q4 deal last year as well. I know you weren't here, so fourth quarter is certainly the time when we get, both years comparatively, we've had some big deals.

But this one was a bigger percentage of the quarter than it was last year.

Andrew D'Silva -- B. Riley Securities -- Analyst

OK. That gives good context on kind of thinking about how to [Inaudible] sequentially and year over year.

Michael Klein -- Chairman and Chief Executive Officer

Let me just add one thing, Andrew. And that is that if you look -- if you Google Solis, obviously, you'll see that they did an acquisition even in Q1 after the deal, 17 systems, right? So we don't have the exact closure date of that and there may be a lag between that and when orders are placed. But that's an example of this -- this is an account that 160 sites that want to go to 160 cameras that wants to go to 500 and wants to go from 80 locations to 250 and get there with us. So there is this deal and then there will be -- and there is the revenues that may follow, as Scott said, the majority of it is going to be in Q4, but some of it will hit in the early part of this year on a more modest amount.

But then there is the service revenue and then there is, again, the adding to the Solis mammography universe, which is a very aggressive private equity backed company.

Andrew D'Silva -- B. Riley Securities -- Analyst

No, that's a very useful context. Thank you and just given Solis' historic equipment base and how that can tie into the competitive landscape of Hologic. Now that Genius AI has released their data and you have a very notable win subsequent to that, can you maybe talk about the sales and pipeline traction? And what the cadence looks like subsequent to that? Have you seen a material change in any sort of, at least, inbounds or just conversations that are starting or decision-making process? Any color there, I think, would be very valuable, given the equipment market dynamics that exist out there right now.

Michael Klein -- Chairman and Chief Executive Officer

Whenever you're in a sales process and somebody says, look, I want to -- I'm obligated to check out what my mammography then just bring it to market. They feel having a sense to do that. In some ways, the fact was the -- it's almost like uh, the -- something like the misery of uncertainty is worse than the certainty of misery. Well, in this case, we have certainty, and the certainty here allows our situation to be actively compared.

So to answer your question, it's helping us. It's helping us.

Andrew D'Silva -- B. Riley Securities -- Analyst

Yeah.

Michael Klein -- Chairman and Chief Executive Officer

And it does take away the obstacle of something and unknown -- it turns into a known something that was unknown. And that combined with any other competitive threats that we may have seen from abroad has put us in a situation that two years in, we still have not seen a competitive system in the market and we don't foresee one for the near future. That could obviously change, but it is -- this -- one of the things about AI is that your results are published. It's there for everybody to see.

It's black and like, so there is no selling around that. And that's all we ask for us and educate -- our whole approach here is educating customers and we sell through education and that we've done from day one. And as long as we're on that path, I think we'll wind up in a strong position and to answer your question, this scenario doesn't, in fact, play to our advantage.

Andrew D'Silva -- B. Riley Securities -- Analyst

OK. So fair to kind of highlighted as the cadence of the business has materially improved as far as it relates to ProFound AI traction subsequent to what happened in December. That were -- I mean, if I were to highlight that as like a point, that makes sense.

Michael Klein -- Chairman and Chief Executive Officer

It's fair to say that if a sale was taking 90 to 120 days and there was another player they were considering, then they've added another one or two months to that sales process. But if they look at the data and say, OK, I've seen it or if they look at other flagship sites, I mean, this is what's so emblematic about this. You know, some of these sites are converting. That's sort of like, OK, I get it.

I've been watching them. So people watch other vendors, but they also see where the big movers, the big chains have gone. So with SimonMed, which is right behind Solis inside and with -- then, of course, Solis and then big groups like what we've seen in Wake and with MD Anderson, which was another big site, which we had, at that point, we couldn't really talk a lot about when you start getting the supertanker sites converting, it starts giving people an indication of where sort of the alpha product is.

Andrew D'Silva -- B. Riley Securities -- Analyst

OK. No, very useful. Thank you again. Last couple of questions for me, just going related to the glioblastoma opportunity.

So, obviously, you're doing a much more substantive trial right now, but you had earlier data that was very favorable. Could you talk about what your sales and marketing initiatives are at the early data stage, considering you can actually still sell the product? Is a DRG out there that seems to be favorable when you utilizing new systems? And then, I would just be kind of curious, if things related to the APM benefit or impact, how that's perceived in the market right now?

Michael Klein -- Chairman and Chief Executive Officer

Yeah. Well, let me do it in reverse order. On the APM side, and I know you don't -- I know you know this very well. The APMs don't only affect breast cancer, they also affect all areas of radiation therapy.

So if you're going from, let's say, $20,000 reimbursement for study radiation therapy for brain, and now you're getting reduced from $20,000 down to $12,000, you are going to try to find a way to shorten the radiation therapy cycle to two to three weeks which we expect will happen in all areas in radiation therapy, which by the way, we call that the Canadian model because that's how they typically treat. They hypofractionate and they do that in Europe. The fact that you could deliver a significant portion of the dose, if not all the dose, during surgery, allows for a model where people can actually reduce external in radiation therapy and do so in two weeks. And the fact that we're coming under a DRG, means that you can get the radiation oncology code after the DRG, so that definitely benefits this.

Andrew D'Silva -- B. Riley Securities -- Analyst

I didn't know that last part. That's useful. OK. And just last thing, as I think about the glioblastoma opportunity, does your end market going to be just overwhelmingly neurosurgeons? Or is some portion of that, should we still think about it as like the traditional radiation oncology market?

Michael Klein -- Chairman and Chief Executive Officer

I think it's going to be neurosurgeons who are going to have to pull. It's going to be both in Neurosurgeon. I look at the neurooncologist like the air traffic controller. He's going to pull everybody together.

It's going to be the medical oncologists as well. The neurosurgeon is going to do the cutting and the radiation oncologist will get them to [Inaudible], the radiation, the therapy. The oncologist is super interested in this because the standard we're comparing to is called RTOG1205 which is a six- to eight-week radiation therapy regimen that uses Avastin to prevent radionecrosis. And basically, what the study is designed to do, using the people who are the study leaders for that radiation therapy protocol that are in this study is, can be beat the established protocol in radiotherapy, which is patients with 13, 14 months if you treat with sole radiation therapy and they go four or five months between -- between progression.

These are rough numbers. So this is where -- and so that is the control arm of our study. So the evaluation is, can we beat the established protocol? So the radiation therapy community is very, very excited to be able to see if this can beat that control. This doesn't mean it replaces radiation therapy nor would it replace temozolomide or the optune helmet from Novocure, but it may make them better.

Instead of wearing that helmet for 20 hours a day, they may only need to wear them five hours a day. You might get better results with temozolomide, you might get better results with radiation therapy in a shorter period of time. So that's what we're looking for, very excited about -- and it's all because we're treating -- we're denaturing, producing double-trend DNA breaks real-time at the time of surgery, we actually produce an immuno response and we're doing it in four to six weeks. And if you wait four to six weeks after surgery and you're growing 1% a day, you're already trying to beat that disease that's regrown over the course of time.

Operator

I would like to turn the floor over to Michael for closing comments.

Michael Klein -- Chairman and Chief Executive Officer

Well, I want to thank everybody for hanging in there with us, and I'll quickly summarize and thank everybody for joining us, and for those who hung in the full time, which I believe is the largest in the people. It has been our pleasure to share our full-year 2020 earnings. And again, to summarize the highlights around our current business, and I'll just iterate a couple of key points. One is the sales momentum we were seeing driven by ProFound with significant growth in Q4.

And on top of significant growth in Q3, significant near-term commercial opportunity with the launch of ProFound AI Risk, a product that's a giant leap going two shots on goal in accounts in a growing market of, not only 3D, but 2D sites. Technology, that's been validated with major deals at Solis mammography and Wake Radiology. And finally, a very, very significant opportunity in the high-value indication of glioblastoma with an FDA-cleared product that can be used real-time in Xoft IORT and is one that's actually starting treating patients as we speak and can be found on clinicaltrials.gov. So we look forward to providing you with further updates on our progress in the coming months and we want to thank you for your continued interest in iCAD.

And please enjoy the rest of the day, and please stay safe.

Operator

[Operator signoff]

Duration: 83 minutes

Call participants:

Jeremy Feffer -- Investor Relations

Michael Klein -- Chairman and Chief Executive Officer

Scott Areglado -- Chief Financial Officer

Stacey Stevens -- President

Kyle Mixon -- Cantor Fitzgerald -- Analyst

Frank Takkinen -- Lake Street Capital Markets -- Analyst

Per Ostlund -- Craig-Hallum Capital Group -- Analyst

Dave Turkaly -- JMP Securities -- Analyst

Yale Jen -- Laidlaw & Company -- Analyst

Gene Mannheimer -- Dougherty & Company -- Analyst

Andrew D'Silva -- B. Riley Securities -- Analyst

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