Is 4D Medical the real deal? CEO Dr Andreas Fouras makes his case

Please note, this interview was recorded Friday, 4 September 2026

Any time the share price of a burgeoning growth company explodes higher, questions arise.

Does the rally have legs? Has the market lost its mind? Is the company the real deal? Will the future growth justify the share price?

Some of those questions are unanswerable. No one knows what the market will do next, and valuation will always divide opinion. Whether the underlying company is the real deal, however, can be easier to discern.

After speaking with 4D Medical (ASX: 4DX) founder and CEO Dr Andreas Fouras, it’s hard to argue against the company’s legitimacy.

Fouras knows what investors are asking. As he put it early in our conversation:

“What investors are looking for right now is evidence that this is all working out. And I completely appreciate that.”

Increasingly, it appears that the evidence is not only there but also quite compelling. The investment case still needs to be proven in revenue and cash flow, but the checklist of what you would want to see at this stage is taking shape:

• A highly engaged founder: Fouras has spent 13 years building 4D Medical and says he has “never been more excited” about its prospects.
• World-class hospitals are adopting the technology: Mayo Clinic, Cleveland Clinic and UC San Diego are already on board, with more leading US institutions expected to follow.
• Doctors are using it and telling their peers: clinicians at major institutions are presenting real-world outcomes at conferences, providing the kind of word-of-mouth validation that can accelerate adoption.
• Early users are moving towards deeper adoption: Cleveland Clinic has signed a three-year agreement with minimums, while Fouras says some doctors are discussing switching completely from incumbent technology to CT:VQ.
• There are multiple routes into the US market: 4D Medical has its own salesforce targeting major hospitals, Philips helping open doors into the US Department of Veterans Affairs, and SimonMed providing access to 170 outpatient imaging centres across 10 states.
• The opportunity could get much bigger: the CLEAR study could support CT:VQ’s expansion into the much larger pulmonary embolism market, while recent acquisitions are designed to build a broader lung-imaging ecosystem around the core platform.

Of course, none of these guarantees the ultimate outcome, but they are tangible markers investors can use to judge whether the story is progressing from promise to commercial reality.

In the attached interview, Fouras unpacks all of these elements and more, including why FY27 will be the “year of conversion”, what 4D Medical has learnt from Pro Medicus, the scale of the US opportunity and where he plans to deploy the company’s sizeable cash war chest.

FY27: From adoption to conversion

For all the excitement around 4D Medical, investors ultimately want to see its growing footprint translate into scans, revenue and cash.

Fouras describes FY27 as the “year of conversion”, with several milestones shareholders can watch.

Over the next six months, he expects more leading US hospitals to adopt the technology, including additional institutions from the top 20, as well as the first paying customers from the Department of Veterans Affairs.

But the bigger shift will be inside hospitals where CT:VQ is already being used. At Cleveland Clinic, Fouras says the first group of doctors using the technology is discussing “turning off the old service” and moving towards 100% CT:VQ usage. Similar conversations are beginning with other major US institutions.

That creates a simple commercial progression: more hospitals, more doctors within each hospital and more scans per doctor.

“First, you’ll see that in the scan numbers,” Fouras says. “And then a little while after that … you see it in the hard cash in the bank account.”

The clinical evidence is also beginning to build. Fouras pointed to research from Michigan showing the success rate for a particular procedure increasing from 46% to 76% when using the technology, while Cleveland Clinic has reported cutting procedure work-up time from seven weeks to three.

Borrowing from the Pro Medicus playbook

There is another ASX healthcare success story looming large over 4D Medical’s US strategy: Pro Medicus (ASX: PME).

Fouras says Pro Medicus founder Dr Sam Hupert and his team have been generous with their time, even before the relationship between the two companies became public.

More importantly, 4D Medical is borrowing from the Pro Medicus playbook: get the technology into prestigious US institutions, win over influential doctors and let those clinicians become advocates.

“We are looking for those references, we’re looking for those key doctors to do what they’re doing for us, show up at the conferences and say, ‘Hey, this 4D Medical product is great for my practice and you should use it too.’”

Fouras says that approach is “working incredibly well”.

Three roads into the US market

Importantly, 4D Medical isn’t relying on one channel. Fouras believes the company’s own salespeople will remain its biggest growth driver, taking CT:VQ directly into major US hospitals.

Philips provides another route, particularly into the Department of Veterans Affairs, an opportunity Fouras has pursued for years. He now expects VA hospitals to begin signing up, while proposed US legislation could potentially fund a much larger pilot program.

SimonMed provides a third route. Its network of 170 centres across 10 states gives 4D Medical access to patients receiving imaging outside major hospitals, extending its reach beyond where its own salesforce is concentrated.

As Fouras puts it, Philips can help with regard to the government and military business, SimonMed reaches patients “out in the community”, while 4D Medical’s own salesforce goes “through the front door at the major hospitals”.

The opportunity beyond nuclear VQ

The next major prize could be pulmonary embolism. CT:VQ is already FDA-approved for pulmonary embolism, but 4D Medical deliberately chose to initially target the smaller nuclear VQ replacement market.

Fouras estimates that market at around 1 million scans annually and a US$500 million opportunity. The strategy is to establish CT:VQ inside leading hospitals first, then use the CLEAR study to support expansion into pulmonary embolism.

That study includes around 750 patients, roughly eight times the dataset Fouras says was required for the company’s original FDA approval.

The strategic importance is straightforward: if CLEAR delivers the data 4D Medical hopes for, the company won't be approaching hospitals as an unknown vendor. Its technology could already be installed, integrated into hospital IT systems and trusted by clinicians.

“We're going to already have VQ in all of these sites,” Fouras says. 

“VQ is already going to be trusted, already penetrated. We'll have contracts there. The IT, all of that's going to be done.”

Fouras believes that could make selling into the larger market a “very different experience”.

Building an ecosystem around the lungs

4D Medical’s ambitions also extend beyond CT:VQ. The acquisitions of ContextFlow, RevealDx and Arza AI raise an obvious question: how does management pursue multiple opportunities without losing focus?

Fouras’ answer is that VQ remains the core, with adjacent technologies selected partly for their ability to feed into that opportunity.

Reveal, for example, helps radiologists assess the risk associated with lung nodules. Patients identified through lung cancer screening can subsequently require biopsies, surgery or other procedures where CT:VQ can play a role.

“We're trying to build a whole ecosystem here where 4D Medical is right in the heart of everything that's happening,” Fouras says.

The goal is for hospitals and doctors dealing with lung disease to see 4D Medical not as the provider of a single product, but as a partner across multiple stages of diagnosis and treatment.

Where the money goes next

4D Medical also has something many growing healthcare companies would love: a sizeable cash balance and, according to Fouras, enough funding to reach breakeven and profitability while retaining surplus capital.

So where does that money earn the best return? For now, Fouras is clear: inside the existing business.

“The best ROI on this is going to be spending it organically inside the business. There are some great ways that we can add to VQ.”

He views VQ as a platform rather than a single-use technology. Beyond nuclear VQ and pulmonary embolism, Fouras sees potential applications stemming from the platform’s ability to visualise blood flow without injections.

Acquisitions remain on the table where they can expand the business, add products or provide entry into new geographies. But the priority remains unchanged.

“We're going to stay focused on VQ,” Fouras says.

And after 13 years building the company, he finished our conversation with an even simpler message for shareholders:

“We’re just getting started here.”