Akumin (AKUMQ) 10-K 16 Mar 22 2021 FY Annual report Financial data

Cover Page

Cover Page - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Mar. 01, 2022	Jun. 30, 2021
Cover [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2021
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	FY
Trading Symbol	AKU
Entity Registrant Name	AKUMIN INC.
Entity Central Index Key	0001776197
Entity File Number	001-39479
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	No
Entity Current Reporting Status	Yes
Entity Filer Category	Accelerated Filer
Entity Emerging Growth Company	true
Entity Ex Transition Period	false
Entity Shell Company	false
Title of 12(b) Security	Common Shares
Security Exchange Name	NASDAQ
Document Annual Report	true
Document Transition Report	false
Entity Voluntary Filers	No
Entity Interactive Data Current	Yes
Entity Small Business	true
Entity Public Float			$ 140.5
Entity Common Stock, Shares Outstanding		89,026,997
Entity Address, State or Province	FL
ICFR Auditor Attestation Flag	false
Entity Address, Address Line One	8300 W. Sunrise Boulevard
Entity Address, City or Town	Plantation
Entity Address, Postal Zip Code	33322
Entity Incorporation, State or Country Code	A6
City Area Code	844
Local Phone Number	730-0050
Entity Tax Identification Number	00-0000000
Auditor Name	Ernst & Young LLP
Auditor Firm ID	42
Auditor Location	Orlando, Florida

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 48,419	$ 44,396
Accounts receivable	121,525	62,259
Prepaid expenses	8,196	2,996
Other current assets	7,025	1,435
Total current assets	185,165	111,086
Property and equipment, net	259,122	63,714
Operating lease right-of-use assets	194,565	127,062
Goodwill	840,353	351,610
Other intangible assets, net	414,146	6,748
Other assets	25,475	4,832
Total assets	1,918,826	665,052
Current liabilities:
Accounts payable	34,326	16,213
Current portion of long-term debt	14,789	406
Current portion of obligations under finance leases	6,460	3,265
Current portion of obligations under operating leases	20,794	9,345
Other accrued liabilities	87,813	22,771
Total current liabilities	164,182	52,000
Long-term debt, net of current portion	1,197,596	389,580
Obligations under finance leases, net of current portion	15,951	12,309
Obligations under operating leases, net of current portion	184,375	122,954
Other liabilities	35,574	3,039
Total liabilities	1,597,678	579,882
Redeemable noncontrolling interests	37,469	0
Shareholders' equity:
Common stock, no par value; unlimited number of shares authorized; 89,026,997 and 70,178,428 shares issued and outstanding as of December 31, 2021 and 2020, respectively	228,595	160,965
Accumulated other comprehensive income	18
Accumulated deficit	(123,424)	(80,133)
Total shareholders' equity	105,189	80,832
Noncontrolling interest	178,490	4,338
Total equity	283,679	85,170
Total liabilities, redeemable noncontrolling interests and equity	$ 1,918,826	$ 665,052

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - $ / shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Common Stock, No Par Value	$ 0	$ 0
Common Stock, Shares Authorized, Unlimited	Unlimited	Unlimited
Common Stock, Shares, Issued	89,026,997	70,178,428
Common Stock, Shares, Outstanding	89,026,997	70,178,428

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Income Statement [Abstract]
Revenues	$ 421,079	$ 245,626
Operating expenses:
Cost of operations, excluding depreciation and amortization	359,735	205,635
Depreciation and amortization	44,895	17,060
Stock-based compensation	2,792	2,084
Other operating losses (gains)	583	(4,130)
Total operating expenses	408,005	220,649
Income from operations	13,074	24,977
Other expense (income):
Interest expense	62,575	32,781
Acquisition related costs	20,233	1,079
Settlement and related costs (recoveries)	(539)	2,324
Other non-operating losses (gains)	(3,990)	22,387
Total other expense, net	78,279	58,571
Loss before income taxes	(65,205)	(33,594)
Income tax expense (benefit)	(30,391)	562
Net loss	(34,814)	(34,156)
Less: Net income attributable to noncontrolling interest	8,477	2,585
Net loss attributable to common shareholders	(43,291)	(36,741)
Comprehensive loss, net of taxes:
Net income (loss)	(34,814)	(34,156)
Unrealized loss on hedging transactions, net of taxes	(10)	0
Reclassification adjustment for losses included in net loss, net of taxes	28	0
Other comprehensive income	18	0
Comprehensive loss, net of taxes	(34,796)	(34,156)
Less: Comprehensive income attributable to noncontrolling interest	8,477	2,585
Comprehensive loss attributable to common shareholders	$ (43,273)	$ (36,741)
Net loss per share attributable to common shareholders:
Basic and diluted	$ (0.56)	$ (0.52)

Consolidated Statements of Equi

Consolidated Statements of Equity - USD ($) $ in Thousands	Total	Common Stock [Member]	Accumulated Other Comprehensive Loss	Accumulated Deficit [Member]	Parent [Member]	Noncontrolling Interest [Member]
Beginning Balance at Dec. 31, 2019	$ 118,989	$ 158,881		$ (43,392)	$ 115,489	$ 3,500
Beginning balance, Shares at Dec. 31, 2019		69,840,928
Net income (loss)	(34,156)			(36,741)	(36,741)	2,585
Issuance of common stock under stock-based awards, Shares		337,500
Stock-based compensation	2,084	$ 2,084			2,084
Other comprehensive income	0
Distributions paid to noncontrolling interests	(1,747)					(1,747)
Ending Balance at Dec. 31, 2020	85,170	$ 160,965		(80,133)	80,832	4,338
Ending balance, Shares at Dec. 31, 2020		70,178,428
Net income (loss)	(34,814)
Net income (loss), net of the net income attributable to redeemable noncontrolling interests	(35,576)			(43,291)	(43,291)	7,715
Acquisition consideration	33,878	$ 33,878			33,878
Acquisition consideration, Shares		15,198,569
Other issuance	10,000	$ 10,000			10,000
Other issuance, Shares		3,500,000
Warrants issued	21,014	$ 21,014			21,014
Stock options exercised	75	$ 75			75
Stock options exercised, Shares		150,000
Stock-based compensation	2,792	$ 2,792			2,792
Other comprehensive income	18		18		18
Distributions paid to noncontrolling interests	(9,969)					(9,969)
Acquisition of noncontrolling interests	174,976					174,976
Other equity transactions	1,301	(129)			(129)	1,430
Ending Balance at Dec. 31, 2021	$ 283,679	$ 228,595	$ 18	$ (123,424)	$ 105,189	$ 178,490
Ending balance, Shares at Dec. 31, 2021		89,026,997

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Operating activities:
Net loss	$ (34,814)	$ (34,156)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization	44,895	17,060
Stock-based compensation	2,792	2,084
Deferred income taxes	(30,432)	700
Non-cash interest expense	15,470	2,241
Amortization of deferred financing costs and accretion of discount on long-term debt	1,508	3,241
Non-cash change in fair value of financial instruments	(100)	(5,457)
Loss on extinguishment of debt	0	18,279
Loss on settlement of derivative	0	4,162
Other non-cash items	(2,888)	1,273
Changes in operating assets and liabilities, net of acquisitions:
Accounts receivable	12,308	(3,075)
Prepaid expenses and other assets	3,175	273
Accounts payable and accrued liabilities	4,134	9,037
Operating lease liabilities and right-of-use assets	1,002	2,953
Net cash provided by operating activities	17,050	18,615
Investing activities:
Purchases of property and equipment	(17,867)	(5,344)
Business acquisitions, net of cash acquired	(758,114)	(3,199)
Other investing activities	(3,190)	(464)
Net cash used in investing activities	(779,171)	(9,007)
Financing activities:
Proceeds from long-term debt	803,045	406,300
Principal payments on long-term debt	(5,997)	(371,524)
Principal payments on finance leases	(4,342)	(1,525)
Payment of debt issuance costs	(22,037)	(15,216)
Payment of earn-out liability	(4,689)	(4,689)
Proceeds from issuance of common stock	10,505	0
Payment of issuance costs for common stock and warrants	(1,334)	0
Contributions received from noncontrolling interests	1,239	0
Distributions paid to noncontrolling interests	(11,541)	(1,747)
Other financing activities	1,295	(200)
Net cash provided by financing activities	766,144	11,399
Net increase in cash and cash equivalents	4,023	21,007
Cash and cash equivalents, beginning of period	44,396	23,389
Cash and cash equivalents, end of period	48,419	44,396
Supplemental disclosure of cash flow information:
Interest paid	35,028	22,844
Income taxes paid, net	217	1,172
Supplemental disclosure of non-cash investing and financing activities:
Interest payable-in-kind on long-term debt	15,470	2,241
Warrants issued with long-term debt	21,918	0
Embedded derivative related to long-term debt	7,622	0
Property and equipment purchases in accounts payable and other accrued liabilities	$ 9,534	$ 334

Description of the Company

Description of the Company	12 Months Ended
	Dec. 31, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Description of the Company	1. Description of the Company General Business Information Akumin Inc. (“Akumin” or the “Company”) and its subsidiaries provide services to U.S. hospitals, health systems and physician groups, with solutions addressing outsourced radiology and oncology service line needs. With the acquisition of Alliance HealthCare Services, Inc. (“Alliance,” see Note 4), Akumin provides fixed-site outpatient diagnostic imaging services through a network of approximately ; and (X-ray), The Company’s revenue is derived from a diverse mix of third-party payors, including private, managed care, capitated and government payors, as well as directly from hospitals and healthcare providers. The Company derives a substantial portion of its revenue from direct billings to governmental healthcare programs, such as Medicare and Medicaid, and private health insurance companies and/or health plans. COVID-19 Commencing during the first quarter of 2020 and continuing through the present, a pandemic relating to the novel coronavirus known as COVID-19 non-essential The Company instituted several realignment and cost containment measures to respond to the drop in volume that resulted from the COVID-19 The Company’s cost containment measures included the temporary closure of certain of the Company’s imaging centers to consolidate volume to nearby centers and reduced operating hours at the remainder of its imaging centers, with the mid-April In light of the improving business environment for the Company, it gradually increased its workforce during 2021. Effective January 1, 2021, all reduced salaries had been returned to normal levels. Clinical operations have resumed to normal operating hours as patient volumes allow and substantially all of the clinics that had temporarily closed due to the COVID-19 COVID-19 re-institute In connection with the COVID-19

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2021
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	2. Summary of Significant Accounting Policies Principles of Consolidation and Basis of Financial Statement Presentation The audited consolidated financial statements of the Company include the assets, liabilities, revenues and expenses of all subsidiaries over which the Company exercises control. Intercompany balances and transactions have been eliminated in consolidation. The Company evaluates participating rights in its assessment of control in determining consolidation of joint venture partnerships. The Company records noncontrolling interests related to its consolidated subsidiaries that are not wholly owned. Investments in non-consolidated Variable Interest Entities In accordance with consolidation guidance, a reporting entity with a variable interest in another entity is required to include the assets and liabilities and revenues and expenses of that separate entity (i.e., consolidate with the financial statements of the reporting entity) when the variable interest is determined to be a controlling financial interest. A reporting entity is considered to have a controlling financial interest in a variable interest entity (“VIE”) if (i) the reporting entity has the power to direct the activities of the VIE that most significantly impacts its economic performance and (ii) the reporting entity has the obligation to absorb losses of the VIE that could be potentially significant to the VIE. As a result of the financial relationship established between the Company and certain entities (the “Revenue Practices”) through respective management service agreements, the Revenue Practices individually qualify as VIEs as the Company, which provides them non-medical, technical and administrative services, has the power to direct their respective activities and the obligation to absorb their gains and losses. As a result, the Company is considered the primary beneficiary of the Revenue Practices, and accordingly, the assets and liabilities and revenues and expenses of the Revenue Practices are included in these consolidated financial statements. The following information excludes any intercompany transactions and costs allocated by the Company to the Revenue Practices. As of December 31, 2021 and 2020, the Revenue Practices’ assets included in the Company’s consolidated balance sheets were $20.4 million and $34.1 million, respectively , Use of Estimates The preparation of consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates. The COVID-19 The most significant assumptions and estimates underlying these consolidated financial statements involve revenue recognition, accounts receivable, business combinations, impairments of long-lived assets including goodwill, income taxes and fair value of financial instruments. Revenue Recognition The majority of the Company’s revenues are derived from net patient fees received from various payors and patients themselves based on established contractual billing rates, less allowances for contractual adjustments and implicit price concessions. Revenues are also derived directly from hospitals and healthcare providers. The Company recognizes revenue in the period in which performance obligations are satisfied by providing services to customers. The Company records the amount of revenue that reflects the consideration that it expects to receive in exchange for those services. The Company applies the following five-step model in order to determine this amount: (i) identification of the contract with a customer; (ii) identification of the promised services in the contract and determination of whether they represent performance obligations, including whether they are distinct in the context of the contract; (iii) measurement of the transaction price, including the constraint on variable consideration; (iv) allocation of the transaction price to the performance obligations; and (v) recognition of revenue when (or as) the Company satisfies each performance obligation. Patient Fee Payors Patient fee revenues are generated from freestanding facilities managed and operated by the Company, which submit billings and collect fees directly from the patients and third-party payors. The Company’s performance obligations are to provide outpatient medical services to patients, such as diagnostic services, radiation therapy, or the provision of goods and services during a patient visit. Revenues are recorded during the period the obligations to provide medical services are satisfied. Performance obligations for medical services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payor (Medicare, Medicaid, managed care health plans, attorneys, employers and commercial insurance companies, including plans offered through the health insurance exchanges) and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payors. The payment arrangements with third-party payors for the services the Company provides to the related patients typically specify payments at amounts less than standard charges and generally provide for payments based upon predetermined rates per diagnostic services or discounted fee-for-service Revenue recorded is based upon the estimated amounts the Company expects to be entitled to receive from patients and third-party payors. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements, negotiated rates and historical and expected payment patterns. Revenues related to uninsured patients, uninsured copayment, and deductible amounts for patients who have healthcare coverage may have discounts applied (uninsured discounts and contractual discounts). The Company also records estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record self-pay Hospital and Healthcare Providers Revenues are derived from services provided under an outsourced contract arrangement with hospitals, physician groups and other healthcare providers. Under outsourced service contracts with hospitals and other healthcare provider customers, the Company provides medical services to patients at a fixed site facility or mobile unit. The Company typically bundles its services in providing diagnostic imaging or radiation therapy services, staffing, supplies and other patient related administrative tasks depending on the customers’ needs. The majority of the Company’s contracts have a single performance obligation, as a series of distinct services that are substantially the same are provided and are transferred with the same pattern to the customer. The Company bills customers on a fee per procedure, percentage of collections, or fixed-payment methodology. Service fees based on fee per procedure and fixed-payment methodology are negotiated and agreed upon by both parties. The Company does not have a business practice of accepting less than contractual amounts. Any amounts not collected do not represent implicit price concessions and instead are due to general credit risk; therefore, the Company treats the allowance for doubtful accounts related to these arrangements as bad debt expense, which is recorded in operating expenses in the consolidated statements of operations and comprehensive loss. For service fees based on a percentage of collections, the Company receives payment after the hospital and other healthcare provider customers are paid by third-party payors and patients. Revenue is recognized over time as medical services are provided and the measurement of the transaction price is generally consistent with the methodology used with patient fee payors. Other Other revenue consists of miscellaneous fees under contractual arrangements, including service fee revenue under capitation arrangements with third-party payors, management fees, government grants and fees for other services provided to third parties. The Company records revenue from management services that it performs based upon management service contracts with predetermined pricing and records such revenues in the period in which the service is performed and at the amounts expected to be collected. During the years ended December 31, 2021 and 2020, the Company received grants from HHS (see Note 24). No single payor or provider accounted for more than 10% of consolidated revenues during the years ended December 31, 2021 and 2020. Segment Reporting Operating segments are defined as components of an enterprise about which separate financial information is available that is evaluated regularly by the chief operating decision maker (“CODM”) in deciding how to allocate resources and in assessing performance. The Company operates in two reportable segments: Radiology and Oncology. Each of these segments, on a stand-alone basis, provides and makes available its respective medical services in similar settings and operates within a singular regulatory environment. Further, management assesses the Company’s segment operations and each segment’s degree of efficiency and performance based on this structure of financial reporting and primarily makes operating decisions from these reportable segment results. Cash and Cash Equivalents The Company classifies short-term investments with original maturities of three months or less as cash equivalents. Accounts Receivable The Company provides shared and single-user diagnostic imaging and oncology equipment and technical support services to the healthcare industry and directly to patients on an outpatient basis. Substantially all of the Company’s accounts receivable are due from health insurance providers (including Medicare and Medicaid), hospitals, other healthcare providers and patients, located throughout the U.S. A significant portion of the Company’s services are provided directly to patients or pursuant to long-term contracts with hospitals and other healthcare providers. Estimated credit losses are provided for in the consolidated financial statements. Accounts receivable are reported at realizable value, net of allowances for price concessions and doubtful accounts, which are estimated and recorded in the period the related revenue is recorded. Implicit price concessions are recorded as a reduction in revenue with an offsetting amount reducing the carrying value of the receivable. The Company has a standardized approach to estimate and review the collectability of its receivables based on a number of factors, including the age of the receivable balances. Changes to the allowance for doubtful accounts estimates are recorded as an adjustment to bad debt expense within operating expenses in the consolidated statements of operations and comprehensive loss. Receivables deemed to be uncollectible are charged against the allowance for doubtful accounts at the time such receivables are written-off. Concentration of Credit Risk Financial instruments that potentially subject the Company to a concentration of credit risk principally consist of cash, cash equivalents and accounts receivable. The Company maintains its cash and cash equivalents in high-credit-quality financial institutions. Deposits held with banks may exceed the amount of insurance provided on such deposits. The Company’s accounts receivable are primarily from third-party payors and clients in the healthcare industry. No individual customer represented more than 10% of the Company’s accounts receivable at December 31, 2021 and 2020. Property and Equipment Property and equipment are stated at cost. Property and equipment acquired through business combinations are recorded at their acquisition date fair value. Depreciation is calculated using the straight-line method over the following estimated useful lives:​​​​​​​ Estimated Useful Life Medical equipment and equipment under finance leases 2 to 10 years Office and computer equipment 2 to 7 years Transportation and service equipment 3 to 10 years Furniture and fixtures 5 to 10 years Leasehold improvements Shorter of the lease term or estimated useful life Routine maintenance and repairs are charged to expense as incurred. Major repairs and purchased software and hardware upgrades, which extend the life of or add value to the equipment, are capitalized and depreciated over the remaining useful life. Operating lease right-of-use Leases The Company’s operating lease portfolio primarily consists of real estate leases for its imaging centers, oncology centers and corporate offices. A smaller portion consists of medical and office equipment leases. The Company determines if an arrangement is a lease at inception. Operating leases are included in operating lease ROU assets, current portion of obligations under operating leases, and obligations under operating leases, net of current portion in the consolidated balance sheets. Finance leases are included in property and equipment, current portion of obligations under finance leases, and obligations under finance leases, net of current portion in the consolidated balance sheets. The Company has elected to use the accounting policy practical expedients by class of underlying asset to (i) combine associated lease and non-lease ROU assets represent the Company’s right to use an underlying asset for the lease term and lease liabilities represent the Company’s obligation to make lease payments arising from the lease. Operating lease liabilities are recorded at the present value of remaining lease payments not yet paid for the lease term discounted using the incremental borrowing rate associated with each lease. Operating lease ROU assets represent operating lease liabilities adjusted for prepayments, accrued lease payments, lease incentives and initial direct costs. Certain of the Company’s leases include renewal or termination options. Calculation of operating lease ROU assets and liabilities includes the initial lease term unless it is reasonably certain a renewal or termination option will be exercised. Variable components of lease payments fluctuating with a future index or rate are estimated at lease commencement based on the index or rate at lease commencement. If the payments change as the result of a change in an index or rate subsequent to lease commencement, the difference is recognized in the consolidated statements of operations and comprehensive loss in the period in which the change occurs. Variable payments for maintenance such as common area maintenance costs and taxes, are not included in determining lease payments and are expensed as incurred. Most of the Company’s leases do not contain implicit borrowing rates, and therefore to measure lease liabilities, the Company uses its incremental borrowing rates based on the information available at the lease commencement date. Lease liabilities are remeasured when there is a significant change in the lease contracts. Goodwill and Intangible Assets Goodwill and indefinite-lived intangible assets are not amortized but instead tested for impairment at least annually at the reporting unit level. A reporting unit is an operating segment or one level below an operating segment (also known as a component). A component of an operating segment is a reporting unit if the component constitutes a business for which discrete financial information is available and reviewed by management. The Company has evaluated and concluded there are two operating segments: Radiology and Oncology. The Company has assessed that each component listed above meets the definition of a reporting unit based on the conclusions that each component constitutes a business, discrete financial information is available for each component, and management regularly reviews the results of such financial information. The Company performs an annual impairment test in the fourth quarter for goodwill and indefinite-lived intangible assets or more frequently if an event occurs or circumstances change that would more-likely-than-not In evaluating goodwill for impairment, the Company first assesses qualitative factors to determine whether it is more-likely-than-not more-likely-than-not The quantitative impairment analysis utilizes two primary approaches to calculate the fair value of the reporting unit: the discounted cash flow (“DCF”) method and the Guideline Public Company (“GPC”) method. Under the DCF method, fair value is measured as the present worth of anticipated future net cash flows generated by a business. In a multi-period model, net cash flows attributable to a business are forecast for an appropriate period and then discounted to present value using an appropriate discount rate. In a single-period model, net cash flow or earnings for a normalized period are capitalized to reach a determination of present value. The methods, key assumptions, degree of uncertainty associated with the key assumptions, and the potential events or changes in circumstances that could reasonably be expected to negatively affect the key assumptions with respect to the reporting unit are the estimated future net cash flows generated and the discount rate applied to capture the associated risks. The ability to achieve anticipated future net cash flows is subject to numerous assumptions and risks, including company-specific risks such as the ability to maintain and grow revenues, maintain or improve operating margins, control costs and anticipate working capital requirements. The anticipated future net cash flows are also dependent on industry-level factors, such as the impact of legislation, patient volumes, cost-reimbursement levels, and continued availability of qualified doctors and other medical professionals who are necessary to staff the Company’s operations, among other potential impacts. Under the GPC method, value is estimated by comparing the subject company to similar companies with publicly-traded ownership interests. Guideline companies are selected based on comparability to the subject company, and valuation multiples are calculated and applied to subject company operating data. The key assumption used in connection with the GPC method focuses on identifying guideline companies that operate in the same (or similar) line of business as the reporting units with the same (or similar) operating characteristics. Eligible companies are selected based on Global Industry Classification Standard codes, Standard Industrial Classification codes, company descriptions, and industry affiliations. Considered factors include relative risk, profitability and growth considerations of the reporting unit relative to the guideline companies. Value estimates for the reporting unit involve using multiples of market value of invested capital excluding cash to revenue and earnings before interest, income taxes, depreciation and amortization (“EBITDA”). Valuations derived using the GPC method rely on information primarily obtained from available industry market data and publicly available filings with the Securities and Exchange Commission (“SEC”). In evaluating indefinite-lived intangible assets for impairment, the Company first assesses qualitative factors to determine whether it is more-likely-than-not more-likely-than-not Finite-lived intangible assets are amortized over their respective estimated useful lives (see Note 7) on a straight-line basis and are reviewed for impairment consistent with property and equipment. Impairment of Long-Lived Assets Long-lived assets, including property and equipment and purchased intangible assets subject to amortization, are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to undiscounted future net cash flows expected to be generated by the asset. If the carrying amount of an asset exceeds its estimated undiscounted future cash flows, an impairment charge is recognized for the amount by which the carrying amount of the asset exceeds the fair value of the asset. Assets to be disposed of are reported at the lower of the carrying amount or fair value less costs to sell. Business Combinations The assets acquired and liabilities assumed in a business combination are recorded at their estimated fair values on the date of acquisition. The difference between the purchase price amount and the net fair value of assets acquired and liabilities assumed is recognized as goodwill if it exceeds the estimated fair value and as a bargain purchase gain if it is below the estimated fair value. Non-controlling Acquisitions of entities over which the Company exercises control have been recorded using the acquisition method of accounting and, accordingly, results of their operations have been included in the Company’s consolidated financial statements as of the effective date of each respective acquisition. Redeemable Noncontrolling Interests The Company has noncontrolling interests with redemption features. These redemption features could require the Company to make an offer to purchase the noncontrolling interests in the case of certain events, including (i) the expiration or termination of certain operating agreements of the joint venture, or (ii) the noncontrolling interests’ tax-exempt As of December 31, 2021, the Company holds redeemable noncontrolling interests of $37.5 million which are not currently redeemable or probable of becoming redeemable. The redemption of these noncontrolling interests is not solely within the Company’s control, therefore, they are presented in the temporary equity section of the Company’s consolidated balance sheets. The Company does not believe it is probable the redemption features related to these noncontrolling interest securities will be triggered as the triggering events are generally not probable until they occur. As such, these noncontrolling interests have not been remeasured to redemption value. The following is a rollforward of the activity in the redeemable noncontrolling interests for the year ended December 31, 2021: (in thousands) Balance, December 31, 2020 $ — Fair value at time of Alliance Acquisition 37,040 Net income attributable to redeemable noncontrolling interests 762 Contributions received from redeemable noncontrolling interests 1,239 Distributions paid to redeemable noncontrolling interests (1,572 ) Balance, December 31, 2021 $ 37,469 Stock-Based Compensation The Company recognizes compensation expense for all stock-based awards, including restricted share units (“RSUs”) and stock options, based on estimated fair value on the measurement date. The Company recognizes stock-based compensation expense over the requisite service period for each separately vesting portion of the award. The fair value of RSUs is computed based on the market value of the Company’s common stock on the date of grant. The fair value of stock options is computed using the Black-Scholes option pricing model, which is affected by the Company’s common stock price and related volatility, expected dividend yield, term of the option, exercise price and risk-free interest rate. The Company recognizes forfeitures as they occur. Income Taxes Income tax expense is computed using the asset and liability method. Deferred tax assets and liabilities are determined based on the temporary differences between the financial reporting and tax bases of assets and liabilities, applying enacted statutory tax rates in effect for the year in which the differences are expected to reverse. Future income tax benefits are recognized only to the extent that the realization of such benefits is considered to be more likely than not. The Company regularly reviews its deferred tax assets for recoverability and establishes a valuation allowance, when it is more likely than not that such deferred tax assets will not be recoverable, based on historical taxable income, projected future taxable income, and the expected timing of the reversals of existing temporary differences. Earnings per share The Company computes basic net income per share attributable to common shareholders based on the weighted-average number of common shares outstanding during the periods presented. Diluted net income per share attributable to common shareholders is computed based on the weighted-average number of common and any dilutive potential common shares outstanding using the treasury method. Comprehensive Income Comprehensive income includes all changes in equity other than transactions with shareholders and noncontrolling interests. The Company’s accumulated other comprehensive income consists of unrealized gains and losses, and related reclassification adjustments, related to interest rate swaps that qualify as cash flow hedges. Fair Value of Financial Instruments The Company uses the following methods and assumptions in estimating fair value disclosure for financial instruments: • Debt: • Derivative instruments: period-end. Assets and liabilities subject to fair value measurements are required to be disclosed within a fair value hierarchy. The fair value hierarchy ranks the quality and reliability of the information used to determine fair value. Accordingly, assets and liabilities carried at fair value are classified within the fair value hierarchy in one of the following categories: • Level 1 • Level 2 • Level 3 . Derivatives, Cash Flow Hedges and Embedded Derivatives The Company has interest rate swap agreements to hedge the future interest payments on portions of its variable-rate equipment debt in order to reduce volatility in operating results due to fluctuations in interest rates. Management has determined the interest rate swap agreements are derivative instruments designated as cash flow hedges. The Company formally measures effectiveness of its hedging relationships at hedge inception in accordance with its risk management policy. The Company’s derivatives are recorded on the consolidated balance sheets at fair value. The Company does not recognize hedge ineffectiveness in its consolidated statements of operations but instead recognizes the entire change in the fair value of cash flow hedges in other comprehensive income. The amounts recorded in other comprehensive income are subsequently reclassified to earnings in the same line item in the consolidated statements of operations as impacted by the hedged item when the hedged item affects earnings. The Company reviews the terms of debt and equity financing transactions to identify whether there are any embedded derivatives that require separation from the related host financial instrument. Any such embedded derivatives are presented at fair value in the consolidated balance sheets, with changes in fair value recorded in other non-operating Warrants The Company reviews the terms of warrants to purchase its common stock to determine whether warrants should be classified as liabilities or shareholders’ equity in its consolidated balance sheets. In order for a warrant to be classified in shareholders’ equity, the warrant must be (i) indexed to the Company’s equity and (ii) meet the conditions for equity classification. If a warrant does not meet the conditions for shareholders’ equity classification, it is carried on the consolidated balance sheets as a warrant liability measured at fair value, with subsequent changes in the fair value of the warrant recorded in other non-operating Self-Insurance The Company has purchased large deductible insurance policies for certain of its workers’ compensation, auto liability, general liability and professional liability exposures. For a portion of the exposures, the Company is self-insured and retains the risk for certain liabilities. The Company’s policy is to accrue amounts equal to the actuarially estimated costs to settle open claims of insureds, as well as an estimate of the cost of insured claims that have been incurred but not reported. The Company develops information about the size of the ultimate claims based on historical experience, current industry information, and actuarial analysis and evaluates the estimates for claim loss exposure on an annual basis. The Company believes that adequate provision has been made in the consolidated financial statements for these liabilities. The most significant assumptions used in the estimation process include determining the trend in costs, the expected cost of claims incurred but not reported and the expected costs to settle or pay damage awards with respect to unpaid claims. Recorded liabilities are based upon estimates, and while management believes the estimates of loss are reasonable, the ultimate liability may be in excess of or less than the recorded amounts.

New Accounting Standards

New Accounting Standards	12 Months Ended
	Dec. 31, 2021
Accounting Standards Update and Change in Accounting Principle [Abstract]
New Accounting Standards	3. New Accounting Standards Recently Adopted Accounting Standards ASU 2018-15, 350-40) In August 2018, the Financial Accounting Standard Board (“FASB”) issued ASU 2018-15, Internal-Use 350-40). internal-use internal-use Recently Issued Accounting Standards Not Yet Effective ASU 2016-13, In June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments ASU 2020-04, In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848), Facilitation of the Effects of Reference Rate Reform on Financial Reporting ASU 2021-01, In January 2021, the FASB issued ASU 2021-01, Reference Rate Reform (Topic 848), Scope ASU 2021-04, 470-50), 815-40) In April 2021, the FASB issued ASU 2021-04, Earnings Per Share (Topic 260), Debt— Modifications and Extinguishments (Subtopic 470-50), 815-40) ASU 2021-08, In October 2021, the FASB issued ASU 2021-08, Accounting for Contract Assets and Contract Liabilities from Contracts with Customers Business Combinations Revenue from Contracts with Customers 610-20, Gains and Losses from the Derecognition of Nonfinancial Assets off-market ASU 2021-10, Government Assistance (Topic 832): Disclosures by Business Entities about Government Assistance In November 2021, the FASB issued ASU 2021-10, Government Assistance (Topic 832): Disclosures by Business Entities about Government Assistance 2021-10 Government Assistance 2021-10

Business Combinations

Business Combinations	12 Months Ended
	Dec. 31, 2021
Business Combinations [Abstract]
Business Combinations	4. Business Combinations Alliance Acquisition On September 1, 2021, the Company acquired all of the issued and outstanding common stock of Thaihot Investment Company US Limited, which own s The acquisition was financed with (i) cash on hand, (ii) $340.0 million of proceeds from the issuance of unsecured notes, (iii) $10.4 million of proceeds from the issuance of 3,500,000 shares of the Company’s common stock at a price of $2.98 per share, (iv) $375.0 million of proceeds from a private offering of 7.5% senior secured notes, and (v) the issuance of 14,223,570 shares of the Company’s common stock to the Seller at a price of $2.17 per share, which represents the closing market price of the Company’s common stock immediately prior to the acquisition date. The following table summarizes the fair value of the purchase consideration for the Alliance Acquisition as of the date of the acquisition: (in thousands, except share and per share amounts) Shares of common stock issued 14,223,570 Per share value of common stock issued $ 2.17 Fair value of common stock issued $ 30,865 Cash paid at closing 748,490 Working capital and other adjustments 6,261 Total purchase price $ 785,616 The following table summarizes the preliminary assessment of fair value of the assets acquired and liabilities assumed as of the date of the acquisition: (in thousands) Assets acquired: Cash and cash equivalents $ 26,125 Net working capital 14,221 Property and equipment 206,475 Operating lease right-of-use assets 69,919 Goodwill 455,760 Intangibles – Customer contracts 266,224 Intangibles – Trade names 69,108 Intangibles – Third party management agreements 10,200 Intangibles – Certificates of need 69,558 Other assets 8,170 1,195,760 Liabilities assumed: Equipment debt 54,673 Obligations under finance leases 9,041 Obligations under operating leases 74,290 Deferred tax liabilities 52,760 Other liabilities 7,364 198,128 Net assets acquired 997,632 Less redeemable noncontrolling interests 37,040 Less noncontrolling interests 174,976 Purchase price $ 785,616 As of September 30, 2021, the Company had preliminarily estimated the fair value of the assets acquired and liabilities assumed and allocated a portion of the total purchase price to tangible and identifiable intangible assets acquired and liabilities assumed based on their estimated fair values as of the date of the acquisition. Noncontrolling interests have also been recorded at fair value as of the acquisition date. The fair value of the total enterprise applicable to joint ventures has been allocated to the individual joint ventures; the amount allocated to each noncontrolling interest has been computed by multiplying the respective joint venture total fair value by the ownership interest percentage of the noncontrolling interest and applying an appropriate lack of control discount. During the three months ended December 31, 2021, the Company updated the preliminary assessment of the fair value of the tangible and identifiable intangible assets acquired and liabilities assumed, resulting in certain changes to the preliminary amounts previously recorded. These changes were composed primarily of (i) an increase in identifiable intangible assets acquired of $52.4 million due to refinements in the valuation analysis, (ii) an increase in deferred tax liabilities of $15.1 million related to the tax effect of the assets acquired and liabilities assumed, (iii) a decrease in each of the operating lease right-of-use Leases v one-year The acquisition enabled the Company to expand its business into areas of the United States in which it previously did not have operations. The excess of the purchase price over the fair value of the net assets acquired was recorded as goodwill, which will not be deductible for income tax purposes. The total goodwill has been allocated $297.4 million and $ 158.4 $155.2 million and income before income taxes of $4.5 million to the Company’s consolidated results of operations. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive loss from the acquisition date. The unaudited pro forma financial data presented below gives effect to the acquisition as if it had occurred on January 1, 2020. The unaudited pro forma information includes adjustments to amortization and depreciation for acquired intangible assets and property and equipment, interest expense and related gains and losses on Alliance’s term loan and credit facilities, and transaction costs. For the year ended December 31, 2020, non-recurring Year Ended December 31, (unaudited; in thousands) 2021 2020 Pro forma net revenues $ 746,550 $ 741,834 Pro forma net loss before income taxes (132,494 ) (181,554 ) The values of the intangible assets relating to customer contracts, trade names and certificates of need represent Level 3 measurements as they were based on unobservable inputs reflecting the Company’s assumptions used in determining the fair value of the assets. These inputs required significant judgments and estimates at the time of the valuation. The following table describes the valuation techniques used to calculate fair values for assets in Level 3. The significant unobservable inputs used in the fair value measurement of the Company’s identifiable intangible assets are growth and attrition rates, discount rate and royalty rate. Significant changes in these inputs would result in a significant change of fair value measurement. (in thousands) Fair value at Valuation Unobservable Selected Customer contracts $ 266,224 Attrition rate Attrition rate Growth rate Discount rate 2.8% - 5.8% 3.0% 9.0% - 12.3% Trade names 69,108 Relief from royalty method Royalty rate Discount rate 1.5% 9.0% - 12.3% Certificates of need 69,558 Acquisition costs Discount rate 9.0% - 12.3% Acquisition and integration costs related to the Alliance Acquisition were $13.6 million for the year ended December 31, 2021, and are included in acquisition-related costs in the Company’s consolidated statements of operations and comprehensive loss. Massachusetts Acquisition On June 1, 2021, the Company acquired through a subsidiary, all of the issued and outstanding equity interests in a company that owns three outpatient diagnostic imaging centers in Massachusetts for cash consideration of $0.4 million (the “Massachusetts Acquisition”). Subsequent to the completion of the acquisition, the cash purchase price was increased by $0.05 million due to working capital adjustments in accordance with the purchase agreement. During 2021, the Company completed the final assessment of the fair value of the assets acquired and liabilities assumed. The results of the final assessment were not material. The following table summarizes the final allocation of the purchase price to the fair value of the assets acquired and liabilities assumed as of the date of acquisition: (in thousands) Assets acquired: Cash $ 5 Accounts receivable 59 Property and equipment 329 Operating lease right-of-use 1,413 Goodwill 94 1,900 Liabilities assumed: Accounts payable and other accrued liabilities 33 Obligations under operating leases 1,413 1,446 Purchase price $ 454 This acquisition was an opportunity for the Company to enter the Massachusetts market. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, as well as potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive loss from the acquisition date. Since the acquisition date, the revenues and loss before income taxes contributed by this acquisition to the Company’s consolidated results of operations were not material. Florida Acquisition On May 1, 2021, the Company acquired, through a subsidiary, six outpatient diagnostic imaging centers in Florida in six simultaneous transactions with related sellers, for aggregate cash consideration of $34.5 million and share consideration of $3.0 million through issuance of 974,999 common shares of the Company at a price of $3.09 per share based on the share price at the close of April 30, 2021 (the “Florida Acquisition”). Subsequent to the completion of the acquisition, the cash purchase price was decreased by $0.4 million due to working capital adjustments in accordance with the purchase agreement. During 2021, the Company completed the final assessment of the fair value of the tangible and identifiable intangible assets acquired and liabilities assumed. The results of the final assessment were not material. The following table summarizes the final allocation of the purchase price to the fair value of the assets acquired and liabilities assumed as of the date of acquisition: (in thousands) Assets acquired: Accounts receivable $ 3,594 Prepaid expenses 83 Property and equipment 483 Operating lease right-of-use 6,874 Goodwill 32,610 Other intangible assets 841 44,485 Liabilities assumed: Accounts payable and other accrued liabilities 350 Obligations under finance leases 136 Obligations under operating leases 6,874 7,360 Purchase price $ 37,125 This acquisition was an opportunity for the Company to increase its economies of scale in Florida. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, as well as potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive loss from the acquisition date. Since the acquisition date, the revenues and income before income taxes contributed by this acquisition to the Company’s consolidated results of operations were not material. Sunrise Acquisition On May 1, 2021, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging center in Sunrise, Florida for cash consideration of $0.8 million (the “Sunrise Acquisition”). This asset acquisition was considered a business combination. The following table summarizes the final allocation of the purchase price to the fair value of the assets acquired and liabilities assumed as of the date of acquisition: (in thousands) Assets acquired: Property and equipment $ 521 Operating lease right-of-use 2,308 Goodwill 279 3,108 Liabilities assumed: Obligations under operating leases 2,308 Purchase price $ 800 This acquisition was an opportunity for the Company to increase its economies of scale in Florida. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, as well as potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive loss from the acquisition date. Since the acquisition date, the revenues and loss before income taxes contributed by this acquisition to the Company’s consolidated results of operations were not material. Coral Springs Acquisition On January 1, 2020, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging center in Coral Springs, Florida for cash consideration of $2.1 million (the “Coral Springs Acquisition”). In accordance with the transaction agreement, $0.1 million of this purchase price was withheld as security for indemnity obligations and was released to the seller during June 2020. This asset acquisition was considered a business combination. The following table summarizes the final allocation of the purchase price to the fair value of the assets acquired and liabilities assumed as of the date of acquisition: (in thousands) Assets acquired: Prepaid expenses $ 33 Property and equipment 412 Operating lease right-of-use 2,428 Goodwill 1,275 Other assets 369 4,517 Liabilities assumed: Obligations under operating leases 2,428 Purchase price $ 2,089 This acquisition was an opportunity for the Company to increase its economies of scale in Florida. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, as well as potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive loss from the acquisition date. Crystal Lake Acquisition On January 1, 2020, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging center in Crystal Lake, Illinois for cash consideration of $1.2 million (the “Crystal Lake Acquisition”). In accordance with the transaction agreement, $0.1 million of this purchase price was withheld as security for indemnity obligations and was released to the seller during June 2020. This asset acquisition was considered a business combination. The following table summarizes the final allocation of the purchase price to the fair value of the assets acquired and liabilities assumed as of the date of acquisition: (in thousands) Assets acquired: Property and equipment $ 820 Operating lease right-of-use 555 Goodwill 400 Other assets 6 1,781 Liabilities assumed: Obligations under operating leases 555 Purchase price $ 1,226 This acquisition was an opportunity for the Company to increase its presence in Illinois. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, as well as potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive loss from the acquisition date.

Property and Equipment

Property and Equipment	12 Months Ended
	Dec. 31, 2021
Property, Plant and Equipment [Abstract]
Property and Equipment	5. Property and Equipment Property and equipment consist of the following: December 31, (in thousands) 2021 2020 Medical equipment $ 227,796 $ 62,406 Leasehold improvements 39,763 19,360 Equipment under finance leases 34,597 23,169 Office and computer equipment 16,701 452 Transportation and service equipment 8,996 — Furniture and fixtures 3,130 1,479 Construction in progress 6,423 — 337,406 106,866 Less accumulated depreciation 78,284 43,152 $ 259,122 $ 63,714 Depreciation expense for the year ended December 31, 2021 and 2020 was $36.4 million and $14.4 million, respectively. As of December 31, 2021 and 2020, the equipment under finance leases had a net book value of $22.2 million and $15.0 million, respectively.

Goodwill

Goodwill	12 Months Ended
	Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	6. Goodwill Changes in the carrying amount of goodwill are as follows: (in thousands) Radiology Oncology Total Balance, December 31, 2019 $ 355,667 $ — $ 355,667 Acquisitions 1,675 — 1,675 Adjustments (5,732 ) — (5,732 ) Balance, December 31, 2020 351,610 — 351,610 Acquisitions 330,383 158,360 488,743 Balance, December 31, 2021 $ 681,993 $ 158,360 $ 840,353 The Company tests its goodwill and indefinite-lived intangible assets annually or more frequently depending on certain impairment indicators. There were no interim impairment tests performed. Goodwill was tested for impairment at the reporting unit level as of October 1, 2021 and 2020, the dates of the Company’s annual impairment review for the years ended December 31, 2021 and 2020, respectively. The Company performed a quantitative test as part of its annual impairment review. In both 2021 and 2020, the respective annual impairment tests yielded individual fair values for its reporting units that exceeded their respective carrying values. In estimating fair values as of October 1, 2021, the Company used a combination of the income approach (the DCF method) and the market approach (the GPC method). Specifically, the Company utilized the following Level 3 estimates and assumptions in its analyses: October 1, 2021 Discount rate 9.5% Perpetual growth rate 2.5% Tax rate 26.0% Risk-free interest rate 2.5% EBITDA multiple 7.5x to 10.5x The estimated fair values at October 1, 2021 exceeded their carrying values by 4% Changes in estimates or assumptions could materially affect the determination of fair value and the conclusions of the Company’s impairment test. In addition to its annual review, the Company performs a test of impairment when indicators of impairment are present. As of December 31, 2021 and 2020, there were no indications of impairment of the Company’s goodwill balances.

Other Intangible Assets

Other Intangible Assets	12 Months Ended
	Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Other Intangible Assets	7. Other Intangible Assets Other intangible assets consist of the following: Weighted Life (in years) December 31, 2021 December 31, 2020 (dollars in thousands) Gross Accumulated Intangible Gross Accumulated Intangible Finite-lived intangible assets: Customer contracts 20 $ 266,224 $ (4,437 ) $ 261,787 $ — $ — $ — Trade names 18 77,466 (6,054 ) 71,412 7,823 (3,258 ) 4,565 Management agreements 17 10,200 (200 ) 10,000 — — — Other 4 4,814 (3,425 ) 1,389 4,508 (2,325 ) 2,183 Total $ 358,704 $ (14,116 ) 344,588 $ 12,331 $ (5,583 ) 6,748 Indefinite-lived intangible assets 69,558 — Total other intangible assets $ 414,146 $ 6,748 Indefinite-lived intangible assets consist of Certificates of Need, which arose from the Alliance Acquisition, were tested for impairment as of October 1, 2021, the date of the Company’s annual impairment review for the year ended December 31, 2021. There were no indefinite-lived intangible assets as of December 31, 2020. The Company elected to perform a qualitative assessment of factors to determine whether further impairment testing was required. Based on its testing, the Company concluded there was no impairment of indefinite-lived intangible assets as of October 1, 2021. In addition to its annual review, the Company performs an impairment test when indicators of impairment are present. As of December 31, 2021 and 2020, there were no indications of impairment of the Company’s other intangible assets balances. The aggregate amortization expense for the Company’s finite-lived intangible assets was $8.5 million and $2.7 million for the years ended December 31, 2021 and 2020, respectively. Estimated annual amortization expense related to finite-lived intangible assets is presented below: (in thousands) Year ending December 31: 2022 $ 19,814 2023 18,837 2024 18,132 2025 17,475 2026 17,421 Thereafter 252,909 $ 344,588

Long-Term Debt

Long-Term Debt	12 Months Ended
	Dec. 31, 2021
Disclosure Text Block [Abstract]
Long term debt	8. Long-Term Debt Long-term debt consists of the following: December 31, (in thousands) 2021 2020 2028 Senior Notes $ 375,000 $ — 2025 Senior Notes 475,000 400,000 Subordinated Notes 372,470 — Equipment Debt 58,827 1,129 1,281,297 401,129 Debt discount and deferred issuance costs (68,912 ) (11,143 ) 1,212,385 389,986 Less current portion 14,789 406 Long-term debt, net of current portion $ 1,197,596 $ 389,580 The minimum annual principal payments with respect to long-term debt as of December 31, 2021 are as follows: (in thousands) Year ending December 31: 2022 $ 14,789 2023 15,807 2024 13,009 2025 484,376 2026 2,570 Thereafter 750,746 $ 1,281,297 2028 Senior Notes On August 9, 2021, the Company closed its offering of $375.0 million of aggregate principal amount of 7.5% senior secured notes due August 1, 2028 (the “2028 Senior Notes”). The offering was completed by Akumin Escrow Inc., a wholly owned subsidiary of the Company, in escrow. The proceeds of the offering were used to fund the Alliance Acquisition and were released from escrow contemporaneously with the completion of the acquisition. In addition, upon closing of the acquisition, the Company assumed all obligations of Akumin Escrow Inc., including all obligations due under the 2028 Senior Notes, and all assets of Akumin Escrow Inc. were liquidated to the Company. The 2028 Senior Notes are fully and unconditionally guaranteed, jointly and severally, by Akumin and each of its direct or indirect wholly owned subsidiaries and Alliance and its wholly owned subsidiaries, and secured against substantially all of the assets of the Company and the guarantors pari passu with the security granted in connection with the 2025 Senior Notes and 2020 Revolving Facility. The 2028 Senior Notes indenture is substantially similar to the indenture for the 2025 Senior Notes, except the principal payment is due at maturity on August 1, 2028. Interest is accrued and payable every six months on February 1 and August 1 at a rate of 7.5% per annum. On August 9, 2021, the 2028 Senior Notes were issued at their face value of $375.0 million net of debt issuance costs of $7.8 million. As of December 31, 2021, the 2028 Senior Notes had a face value of $375.0 million and an amortized cost balance of $367.7 million. The effective interest rate of the 2028 Senior Notes is 7.88%. 2025 Senior Notes On November 2, 2020, the Company closed an offering of $400.0 million of aggregate principal amount of 7.0% senior secured notes due November 1, 2025 (the “2025 Senior Notes”). The net proceeds from this offering were used to repay in full the Amended May 2019 Term Loans and related Revolving Facility, and net derivative financial instrument liabilities, in accordance with their respective contracts, and to pay related financing fees and expenses. A balance of $19.0 million was retained as cash. In connection with the repayment of the Amended May 2019 Term Loans, the Company recognized an $18.3 million loss on extinguishment of debt. In addition, the Company terminated and settled an interest rate cap derivative financial instrument and recognized a $4.2 million loss on settlement of this derivative. The loss on extinguishment of debt and loss on settlement of derivative are recorded in other non-operating The Company’s obligations under the 2025 Senior Notes are fully and unconditionally guaranteed, jointly and severally, by each of the Company’s direct or indirect subsidiaries, and secured against substantially all of the assets of the Company and the guarantors pari passu with the security granted in connection with the 2020 Revolving Facility. On November 2, 2020, the 2025 Senior Notes were issued at their face value of $400.0 million net of debt issuance costs of $11.5 million. On February 11, 2021, the Company completed a private offering of $75.0 million aggregate principal amount of additional 7.0% senior secured notes due November 2025 (the “New Notes” and together with the 2025 Senior Notes, the “2025 Senior Notes”). The New Notes were offered as additional notes under the same indenture as the previously issued 2025 Senior Notes and will be treated as a single series with the 2025 Senior Notes. The Company applied part of the net proceeds from the New Notes for acquisitions, with any unused proceeds to be used for working capital and other general corporate purposes. The New Notes were issued at 5.0% premium to their face value of $75.0 million net of debt issuance costs of $1.1 million. The premium on issuance of New Notes of $3.75 million is being amortized to interest expense over the remaining term of the 2025 Senior Notes. The Company also received accrued interest on the New Notes from November 2, 2020 to February 10, 2021 of $1.4 million. This accrued interest was repaid by the Company along with the balance of the accrued interest on April 29, 2021. As of December 31, 2021, the 2025 Senior Notes had a face value of $475.0 million and an amortized cost balance of $468.0 million. The effective interest rate of the 2025 Senior Notes is 7.64%. The 2025 Senior Notes indenture allows the Company to redeem the 2025 Senior Notes prior to maturity together with any accrued and unpaid interest. The 2025 Senior Notes indenture provides for the following (capitalized terms used below in this note and not defined elsewhere in these notes have the respective meanings given to them in the 2025 Senior Notes indenture): Payments The principal payment is due at maturity on November 1, 2025. Interest is accrued and payable every six months on May 1 and November 1. Restrictive covenants The 2025 Senior Notes indenture restricts the Company’s ability to, among other things: incur certain additional indebtedness and issue preferred stock; make certain distributions, investments and other restricted payments; sell certain assets; agree to any restrictions on the ability of the subsidiaries to make payments to the Company; create certain liens; merge, consolidate or sell substantially all of the Company’s assets; and enter into certain transactions with affiliates. These covenants are subject to exceptions and qualifications and many of these covenants will not be applicable during any period when the 2025 Senior Notes have an investment grade rating. Financial covenants There are no maintenance financial covenants. There are incurrence-based covenants related to the restrictive covenants noted above. The Company is in compliance with the covenants and has no events of default under this indenture as of December 31, 2021. Events of default Events of default under the 2025 Senior Notes indenture include, among others, failure to pay principal or interest on the 2025 Senior Notes and certain final judgments when due (subject to appropriate periods and conditions); failure to comply, within appropriate period, with obligations under certain covenants or any provision in the 2025 Senior Notes indenture; certain events of bankruptcy or insolvency and if any Guarantee by a Significant Subsidiary is held in a judicial proceeding to be unenforceable or invalid. The occurrence of an event of default would permit the Trustee or holders of at least 25% of the 2025 Senior Notes to declare all of the 2025 Senior Notes together with unpaid accrued interest to be immediately due and payable and to exercise other default remedies. 2020 Revolving Facility Concurrently with the closing of the 2025 Senior Notes, the Company entered into a new revolving credit agreement (the “2020 Revolving Credit Agreement”) with a US financial institution, as administrative and collateral agent, and other financial institutions, as lenders, to provide a senior secured revolving credit facility in an aggregate principal amount of $55.0 million (the “2020 Revolving Facility”, and together with 2025 Senior Notes, the “2025 Loans”), with sub-limits The availability of borrowings under the 2020 Revolving Facility is subject to customary terms and conditions. The 2020 Revolving Facility was undrawn at November 2, 2020. The issuance costs related to this credit facility were $2.0 million (including $0.9 million related to the prior Revolving Facility since the settlement of that Revolving Facility was considered debt modification for accounting purposes). These costs are included in other assets in the consolidated balance sheets and are being amortized to interest expense over the term of the 2020 Revolving Facility on a straight-line basis. The annual commitment fee related to the 2020 Revolving Facility is capped at 0.5% of the aggregate principal amount of $55.0 million. As of December 31, 2021 and 2020, the 2020 Revolving Facility had a face value and amortized cost balance of zero. The 2020 Revolving Credit Agreement provides for the following (capitalized terms used below in this note and not defined elsewhere in these notes have the respective meanings given to them in the 2020 Revolving Credit Agreement): Interest The interest rates payable on the 2020 Revolving Facility are as follows: (i) each Eurodollar Rate Loan bears interest on the outstanding principal amount at Adjusted Eurodollar Rate plus the Applicable Rate; (ii) each Base Rate Loan bears interest on the outstanding principal amount at the Base Rate (the highest of (a) the Prime Rate, (b) the Federal Reserve Bank of New York Rate plus 0.5% and (c) one-month Restrictive covenants In addition to certain covenants, the 2020 Revolving Credit Agreement places limits on the Company’s ability to declare dividends or redeem or repurchase capital stock (including options or warrants), prepay, redeem or purchase debt, incur liens and engage in sale-leaseback transactions, make loans and investments, incur additional indebtedness, amend or otherwise alter debt and other material agreements, engage in mergers, acquisitions and asset sales, enter into transactions with affiliates and alter the business the Company and the subsidiaries currently conduct. Financial covenant The 2020 Revolving Credit Agreement contains a financial covenant related to a leverage ratio that is tested on the last day of any fiscal quarter (commencing with the fiscal quarter ended March 31, 2021) only if on the last day of any such fiscal quarter, the outstanding amount under the 2020 Revolving Facility (excluding certain letter of credit obligations) exceeds 30% of the total commitment under the 2020 Revolving Facility of $55.0 million. There were no borrowings under the 2020 Revolving Facility as of December 31, 2021 and therefore did not exceed 30% of the total commitment under the 2020 Revolving Facility. As a result, the Company is in compliance with the financial covenant. Events of default Events of default under the 2020 Revolving Credit Agreement include, among others, failure to pay principal or interest on the 2020 Revolving Facility when due, failure to pay any fee or other amount due, failure of any loan party to comply with any covenants or agreements in the loan documents (subject to applicable grace periods and/or notice requirements), a representation or warranty contained in the loan documents is incorrect or misleading in a material respect when made, events of bankruptcy and a change of control. The occurrence of an event of default would permit the lenders under the 2020 Revolving Credit Agreement to declare all amounts borrowed, together with accrued interest and fees, to be immediately due and payable and to exercise other default remedies. Subordinated Notes The purchase price for the Alliance Acquisition was funded on September 1, 2021 partly with debt and equity commitments from Stonepeak Magnet Holdings LP (“Stonepeak Magnet”) (the “Stonepeak Financing”). On September 1, 2021, Stonepeak Magnet purchased $ 340.0 million principal amount of unsecured notes of Akumin Corp., a wholly-owned indirect subsidiary of the Company (the “Stonepeak Notes” or “Subordinated Notes”), together with warrants to purchase 17,114,093 common shares of Akumin (the “Stonepeak Warrants”) with an exercise price of $ 2.98 per share and an expiry term of ten years from date of issuance, and 3,500,000 common shares of the Company (the “Stonepeak Shares”) at a price of $ 2.98 per share for total cash consideration of $ 10.4 million. No consideration was paid for the Stonepeak Warrants. The Company capitalized $ 53.0 million relating to Stonepeak Financing debt issuance costs and debt discount, which are being accreted to the Stonepeak Notes using the effective interest method. The Stonepeak Warrants contain standard antidilution provisions that may change the number of shares or exercise price per warrant share. The Stonepeak Warrants may be exercised at the option of Stonepeak Magnet by either delivering the exercise price and receiving common shares on a gross basis or by cashless exercise (net share settlement). The Stonepeak Notes, Stonepeak Warrants, Stonepeak Shares and additional draws were made available on the terms of the Series A Notes and Common Share Purchase Agreement dated June 25, 2021 among the Company, Akumin Corp., and Stonepeak Magnet. The Company has the right under the Stonepeak Notes to elect to pay interest in-kind The Stonepeak Notes contain certain covenants similar to the covenants in the 2025 Senior Notes indenture. The Company is in compliance with the covenants and has no events of default as of December 31, 2021. For a three-year period following September 1, 2021, provided certain conditions are met, the Company will be permitted to draw up to an additional $349.6 million from Stonepeak Magnet. Any such future subscription by Stonepeak Magnet will involve a further issuance of Stonepeak Notes and Stonepeak Warrants, in each case on terms substantially similar to those issued upon closing of the Alliance Acquisition; provided, however, that the number of additional Stonepeak Warrants would equal 20% of the dollar amount drawn by the Company divided by 120% of the 10-day At any time after seven years from the issuance date of the Stonepeak Notes, the Company may redeem such Stonepeak Notes, in whole or in part, by paying in cash the principal amount and any accrued but unpaid interest, in each case, plus a prepayment premium of 5%. To the extent that the Company has not redeemed any Stonepeak Notes by the eleventh anniversary of the issuance date of such Stonepeak Notes, the Company will be required to redeem: (a) 50% of such Stonepeak Notes on the eleventh anniversary of such issuance date by paying in cash the principal amount and any accrued but unpaid interest, in each case, plus 5%; and (b) the remaining balance by the twelfth anniversary of such issuance date by paying in cash the principal amount and any accrued but unpaid interest, in each case, plus 5%. In the event of a change of control before the seventh (7th) anniversary of the issuance date, the Company or Stonepeak Magnet may elect to redeem the Stonepeak Notes in part or in whole and the Company will be required to pay Stonepeak Magnet the principal amount to be redeemed plus a prepayment premium that varies between 25% and 5% depending on the timing of the change of control (first to 7th anniversary of the issuance date) with respect to the prepaid amount (the “Change of Control Redemption Election”). The Company determined the Change of Control Redemption Election held by Stonepeak Magnet meets the accounting definition of an embedded derivative that must be separated from the Stonepeak Notes and initially and subsequently be reported as a liability and measured at fair value. The fair value of the Change of Control Redemption Election liability was determined using a probability weighted scenario analysis regarding a potential change of control during the seven years from September 1, 2021. The estimated value of the redemption premium was discounted by the expected weighted average time to exit at a discount rate of 11%. The fair value of the Change in Control Redemption Election of $7.6 million at September 1, 2021 was recorded as a derivative liability and included in other liabilities in the consolidated balance sheet. The fair value of the Change in Control Redemption Election at December 31, 2021 is $7.5 million and is recorded in other liabilities in the consolidated balance sheet as of December 31, 2021. The $0.1 million change in the fair value of the Change in Control Redemption Election derivative is recorded as a gain and included in other non-operating The fair value of the Stonepeak Warrants at the date of issuance was determined to be $1.2807 per warrant using the Black-Scholes option pricing model based on the following assumptions: common share price of $2.17 per share, which represents the closing market price of the Company’s common stock immediately prior to the Alliance Acquisition, exercise price of $2.98, historical common share price volatility of 56%; term of warrants of ten years from September 1, 2021; expected dividend yield of zero; and annual risk-free interest rate of 1.30%. The fair value of Stonepeak Warrants was $21.9 million on September 1, 2021. The Company determined the Stonepeak Warrants should be classified in shareholders’ equity in accordance with the accounting guidance for equity classification of contracts based on an entity’s own shares. The relative The table below shows the allocation of the gross proceeds of $350.4 million from the Stonepeak Notes and Stonepeak Shares to the three financial instruments and the embedded derivative at the issuance date. The discount generated due to the allocation of proceeds to Stonepeak Warrants of $21.9 million and the Change in Control Redemption Election of $7.6 million, together with the issuance costs allocated to the Stonepeak Notes of $6.5 million and the 5% repayment premium of $17.0 million, was treated as debt discount, which is being accreted to interest expense over the term of the Stonepeak Notes using the effective interest method and an effective interest rate of 13.0%. (dollars in thousands) Standalone Relative % Allocation on Relative Allocation of Embedded Allocation of Allocation of Gross Transaction Stonepeak Notes $ 318,082 90.8 % $ 318,082 $ 13,116 $ 304,966 $ (7,622 ) $ 6,649 $ 303,993 Stonepeak Shares 10,430 3.0 % 10,430 430 10,000 — — 10,000 Stonepeak Warrants 21,918 6.2 % 21,918 904 21,014 — — 21,014 Embedded Derivative — — — — — 7,622 — 7,622 $ 350,430 100.0 % $ 350,430 $ 14,450 $ 335,980 $ — $ 6,649 $ 342,629 On September 1, 2021, the Stonepeak Notes were issued at their face value of $357.0 million (including the 5% repayment premium of $17.0 million) net of discount and debt issuance costs totaling $53.0 million. Since September 1, 2021, the principal balance of the Stonepeak Notes has increased by $14.7 million to $354.7 million due to PIK interest and the resulting face value of these notes has increased to $372.5 million (due to 5% repayment premium of $17.8 million) at December 31, 2021. The increase in repayment premium of $0.7 million due to PIK interest has been treated as interest expense accretion during the three months ended December 31, 2021. As of December 31, 2021, the Stonepeak Notes had a face value of $372.5 million and an accreted cost balance of $318.0 million. Equipment Debt The Company’s equipment debt is composed of financing arrangements with various lenders, which are collateralized by the related equipment. Certain of the debt obligations are subject to covenants with which the Company must comply on a quarterly or annual basis. The Company was in compliance with all such covenants as of December 31, 2021.

Finance Leases

Finance Leases	12 Months Ended
	Dec. 31, 2021
Leases [Abstract]
Finance Leases	9. Finance Leases The information pertaining to obligations under finance leases is as follows: December 31, (in thousands) 2021 2020 Obligations under finance leases $ 22,411 $ 15,574 Less current portion 6,460 3,265 Non-current $ 15,951 $ 12,309 The components of finance lease cost recognized in the consolidated statements of operations and comprehensive loss are as follows. Year Ended December 31, (in thousands) 2021 2020 Amortization expense for equipment under finance leases $ 4,184 $ 2,927 Interest expense on finance lease liabilities 885 637 Finance lease cost $ 5,069 $ 3,564 Undiscounted cash flows for finance leases recorded in the consolidated balance sheet as of December 31, 2021 are as follows. (in thousands) Year ending December 31: 2022 $ 7,424 2023 5,906 2024 5,414 2025 3,652 2026 1,743 Thereafter 587 Total minimum lease payments 24,726 Less amount of lease payments representing interest 2,315 Present value of future minimum lease payments 22,411 Less current portion 6,460 Non-current $ 15,951 The lease term and discount rates are as follows: Year Ended December 31, 2021 2020 Weighted average remaining lease term – finance leases (years) 3.9 4.9 Weighted average discount rate – finance leases 5.2 % 4.6 % Supplemental cash flow information related to finance leases is as follows: Year Ended December 31, (in thousands) 2021 2020 Operating cash flows from finance leases $ 877 $ 637 Equipment acquired in exchange for finance lease obligations 1,070 8,817

Operating Leases

Operating Leases	12 Months Ended
	Dec. 31, 2021
Leases [Abstract]
Operating Leases	10. Operating Leases The information pertaining to obligations under operating leases is as follows: December 31, (in thousands) 2021 2020 Obligations under operating leases $ 205,169 $ 132,299 Less current portion 20,794 9,345 Non-current $ 184,375 $ 122,954 The components of operating lease cost recognized in the consolidated statements of operations and comprehensive loss are as follows. Year Ended December 31, (in thousands) 2021 2020 Operating lease cost $ 27,027 $ 20,625 Variable lease cost 4,515 4,109 Short-term lease cost 671 247 Total operating lease cost $ 32,213 $ 24,981 Undiscounted cash flows for operating leases recorded in the consolidated balance sheet as of December 31, 2021 are as follows. (in thousands) Year ending December 31: 2022 $ 34,990 2023 33,294 2024 30,385 2025 26,430 2026 22,922 Thereafter 175,681 Total minimum lease payments 323,702 Less amount of lease payments representing interest 118,533 Present value of future minimum lease payments 205,169 Less current portion 20,794 Non-current $ 184,375 The lease term and discount rates are as follows: Year Ended December 31, 2021 2020 Weighted average remaining lease term – operating leases (years) 11.4 12.7 Weighted average discount rate – operating leases 7.7 % 7.4 % Supplemental cash flow information related to operating leases is as follows: Year Ended December 31, (in thousands) 2021 2020 Operating cash flows from operating leases $ 25,245 $ 17,672 Right-of-use 3,769 10,818

Other Accrued Liabilities

Other Accrued Liabilities	12 Months Ended
	Dec. 31, 2021
Payables and Accruals [Abstract]
Other Accrued Liabilities	11. Other Accrued Liabilities Other accrued liabilities consist of the following: December 31, (in thousands) 2021 2020 Accrued compensation and related expenses $ 26,486 $ 3,831 Accrued interest expense 16,840 4,588 MAAPP funds (Note 24) 2,398 3,085 Earn-out — 4,689 Other 42,089 6,578 Total $ 87,813 $ 22,771

Earn-Out Liability

Earn-Out Liability	12 Months Ended
	Dec. 31, 2021
Business Combinations [Abstract]
Earn-Out Liability	12. Earn-Out A portion of the purchase price payable related to the 2019 acquisition of earn-out Earn-out Management estimated the fair value of the ADG Acquisition Earn-out Earn-out Earn-out Earn-out

Financial Instruments

Financial Instruments	12 Months Ended
	Dec. 31, 2021
Financial Instruments [Abstract]
Financial Instruments	13. Financial Instruments Assets and liabilities that are measured at fair value on a recurring basis The following table summarizes the valuation of the Company’s financial instruments that are reported at fair value on a recurring basis: Fair Value as of December 31, 2021 Fair Value as of December 31, 2020 (in thousands) Level 1 Level 2 Level 3 Total Total Level 1 Level 2 Level 3 Current and long-term liabilities: Derivative in subordinated notes $ — $ — $ 7,522 $ 7,522 $ — $ — $ — $ — Interest rate contracts $ — $ 53 $ — $ 53 $ — $ — $ — $ — The derivative in subordinated notes relates to the Change of Control Redemption Election included in the Subordinated Notes (see Note 8). The estimated fair values of the Change of Control Redemption Election as of December 31, 2021 and September 1, 2021 (inception) use unobservable inputs for probability weighted time until an exit event of 4.2 years and 4.1 years, respectively, and an exit event probability weighting of 24.5% and 25.0%, respectively. The following is a reconciliation of the opening and closing balances for the liability related to the embedded derivative included in the Subordinated Notes measured at fair value on a recurring basis using significant unobservable inputs (Level 3) during the year ended December 31, 2021: (in thousands) Balance, December 31, 2020 $ — Fair value at time of Alliance Acquisition 7,622 Change in fair value (100 ) Balance, December 31, 2021 $ 7,522 The Company’s interest rate contracts arose from the Alliance Acquisition and are primarily pay-fixed, Assets and liabilities for which fair value is only disclosed The estimated fair values of other current and non-current December 31, (in thousands) 2021 2020 2028 Senior Notes $ 345,938 $ — 2025 Senior Notes 446,500 424,016 Subordinated Notes 323,620 — Equipment Debt 56,879 1,122 Total $ 1,172,937 $ 425,138 As of December 31, 2021, the estimated fair values of the 2028 Senior Notes and 2025 Senior Notes were determined using Level 2 inputs and the estimated fair values of the Subordinated Notes and Equipment Debt were determined using Level 3 inputs. The carrying value of cash and cash equivalents, accounts receivable, accounts payable, other accrued liabilities, and the current portion of lease liabilities approximates their fair value given their short-term nature. The carrying value of the non-current Financial instruments are classified into one of the following categories: amortized cost, fair value through earnings and fair value through other comprehensive income. The following table summarizes information regarding the carrying value of the Company’s financial instruments: December 31, (in thousands) 2021 2020 Financial assets measured at amortized cost: Cash and cash equivalents $ 48,419 $ 44,396 Accounts receivable 121,525 62,259 $ 169,944 $ 106,655 Financial liabilities measured at amortized cost: Accounts payable $ 34,326 $ 16,213 Current portion of long-term debt 14,789 406 Current portion of leases 27,254 12,610 Non-current 1,197,596 389,580 Non-current 200,326 135,263 Other accrued liabilities 87,813 22,771 $ 1,562,104 $ 576,843 Financial liabilities measured at fair value through earnings: Derivative in subordinated notes $ 7,522 $ — Financial liabilities measured at fair value through other comprehensive income: Interest rate contracts $ 53 $ — Assets and liabilities that are measured at fair value on a nonrecurring basis The Company measures certain non-financial Interest Rate Risk Interest rate risk is the risk the fair value or future cash flows of a financial instrument will fluctuate because of changes in market interest rates. Changes in lending rates can cause fluctuations in interest payments and cash flows. Certain of the Company’s equipment debt arrangements have interest rate swap agreements to hedge the future variable cash interest payments in order to avoid volatility in operating results due to fluctuations in interest rates. As of December 31, 2021, the Company had $1.8 million of variable interest rate equipment debt that is not hedged. In addition, the Company is exposed to variable interest rates related to the 2020 Revolving Facility, which was not drawn upon during the years ended December 31, 2021 or 2020. The Company’s exposure to interest rate risk from a 1% increase or decrease in the variable interest rates i s

Stock-Based Awards

Stock-Based Awards	12 Months Ended
	Dec. 31, 2021
Share-based Payment Arrangement [Abstract]
Stock-Based Awards	14. Stock-Based Awards The Company may grant stock-based awards to employees, directors and consultants under the Amended and Restated Restricted Share Unit Plan, adopted as of November 14, 2017 (the “RSU Plan”) and the Amended and Restated Stock Option Plan, adopted as of November 14, 2017 (the “Stock Option Plan” and together with the RSU Plan, the “2017 Stock Plans”). Under the 2017 Stock Plans, the collective maximum number of shares reserved for issuance is equal to 10% of the number of capital shares of the Company that are outstanding from time to time. As of December 31, 2021 and 2020, common shares reserved for issuance under the 2017 Stock Plans were 8,902,699 and 7,017,842, respectively. The 2017 Stock Plans are administered by the Board of Directors, which has authority to select eligible persons to receive awards and to determine the terms and conditions of the awards. Restricted Share Units RSUs represent a right to receive a share of common stock at a future vesting date with no cash payment from the holder. RSUs granted vest over two years from the date of grant. A summary of RSU activity is as follows: Number of RSUs Weighted- Average Grant Date Fair Value Aggregate Fair Value (in thousands) Outstanding and unvested at December 31, 2019 337,500 $ 3.89 Vested (337,500 ) 3.89 $ 1,313 Outstanding and unvested at December 31, 2020 — — Granted 2,029,032 2.41 Outstanding and unvested at December 31, 2021 2,029,032 $ 2.41 $ 4,890 Stock Options Stock options are awarded as consideration in exchange for services rendered to the Company. Stock options granted generally have terms of 7 to 10 years and vest over 3 years. A summary of the stock option activity is as follows: Number of Weighted- Weighted- Aggregate (in thousands) Outstanding at December 31, 2019 5,778,120 $ 2.47 Cancelled (18,000 ) 3.74 Outstanding at December 31, 2020 5,760,120 2.47 Granted 70,000 3.58 Exercised (150,000 ) 0.50 $ 413 Outstanding at December 31, 2021 5,680,120 $ 2.54 4.4 $ 2,344 Exercisable at December 31, 2021 5,060,719 $ 2.44 4.2 $ 2,344 Aggregate intrinsic value for outstanding and exercisable stock options in the table above represents the difference between the closing stock price on December 31, 2021 and the exercise price multiplied by the number of in-the-money The fair value of stock options granted during the year ended December 31, 2021 have been estimated using the Black-Scholes option pricing model. The weighted-average fair value and underlying assumptions are as follows: Fair value $ 1.39 Expected volatility 35.5 % Risk-free interest rate 1.2 % Expected life (years) 7.0 Dividend yield — Stock-Based Compensation Expense During the year ended December 31, 2021 and 2020, the Company recorded total stock-based compensation expense related to As of December 31, 2021, there was $3.3 million of total unrecognized compensation costs related to outstanding stock-based awards. These costs are expected to be recognized over a weighted-average period of 1.9 years.

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2021
Commitments and Contingencies Disclosure [Abstract]
Commitments and contingencies	15. Commitments and Contingencies Purchase Commitments The Company has certain binding purchase commitments primarily for the purchase of equipment from various suppliers. As of December 31, 2021, the obligations for these future purchase commitments totaled $24.8 million, of which $15.9 million is expected to be paid over the next twelve months and $8.9 million is expected to be paid thereafter. Guarantees and Indemnities In the normal course of business, the Company has made certain guarantees and indemnities, under which it may be required to make payments to a guaranteed or indemnified party, in relation to certain transactions. The Company indemnifies other parties, including customers, lessors, and parties to other transactions with the Company, with respect to certain matters. The Company has agreed to hold the other party harmless against losses arising from certain events as defined within the particular contract, which may include, for example, litigation or claims arising from a breach of representations or covenants. In addition, the Company has entered into indemnification agreements with its executive officers and directors and the Company’s bylaws contain similar indemnification obligations. Under these arrangements, the Company is obligated to indemnify, to the fullest extent permitted under applicable law, its current or former officers and directors for various amounts incurred with respect to actions, suits or proceedings in which they were made, or threatened to be made, a party as a result of acting as an officer or director. It is not possible to determine the maximum potential amount under these indemnification agreements due to the limited history of prior indemnification claims and the unique facts and circumstances involved in each particular agreement. Historically, payments made related to these indemnifications have been immaterial. As of December 31, 2021, the Company has determined that no liability is necessary related to these guarantees and indemnities. Legal Matters On November 22, 2021, an alleged shareholder of the Company filed a putative class action claim with the Ontario Superior Court of Justice against the Company and certain of its directors and officers alleging violations of Securities Act (Ontario), negligent misrepresentation and other related claims. The claims generally allege that certain of the Company’s prior public financial statements misrepresented the Company’s revenue, accounts receivable and the value of its assets based upon the Company’s August 12, 2021, October 12, 2021 and November 8, 2021 disclosures relating to a review of certain procedures related to its financial statements and to the restatement of financial statements affecting accounts receivable and net book value of property and equipment. The claim does not quantify a damage request. Defendants have not yet responded to the claim. On December 20, 2021 a second statement of claim was filed by a new plaintiff making similar allegations. The new statement of claim names additional directors of the Company as well as the auditors of the Company. As the two statements of claim involve similar subject matter and some of the same class members, the new plaintiff firm has requested a motion for carriage under the Class Proceedings Act, 1992 (Ontario) so the court can determine which plaintiff firm will have carriage of the class action proceedings. Other Matters The Company is party to various legal proceedings, claims, and regulatory, tax or government inquiries and investigations that arise in the ordinary course of business. With respect to these matters, management evaluates the developments on a regular basis and accrues a liability when it believes a loss is probable and the amount can be reasonably estimated. Management believes that the amount or any estimable range of reasonably possible or probable loss will not, either individually or in the aggregate, have a material adverse effect on the Company’s business and consolidated financial statements. However, the outcome of these matters is inherently uncertain. Therefore, if one or more of these matters were resolved against the Company for amounts in excess of management’s expectations, the Company’s results of operations and financial condition could be materially and adversely affected.

Supplemental Revenue Informatio

Supplemental Revenue Information	12 Months Ended
	Dec. 31, 2021
Revenue from Contract with Customer [Abstract]
Supplemental Revenue Information	16. Supplemental Revenue Information Revenues consist primarily of net patient fees received from various payors and patients based on established contractual billing rates, less allowances for contractual adjustments and implicit price concessions. Revenues are also derived directly from hospitals and healthcare providers. Other revenue consists of miscellaneous fees under contractual arrangements, including service fee revenue under capitation arrangements with third-party payors, management fees, government grants and fees for other services provided to third parties. The following table summarizes the components of the Company’s revenues by payor category: Year Ended December 31, (in thousands) 2021 2020 Patient fee payors: Commercial $ 226,843 $ 193,917 Medicare 51,238 27,874 Medicaid 8,002 7,700 Other patient revenue 11,499 8,833 297,582 238,324 Hospitals and healthcare providers 118,491 — Other revenues 5,006 7,302 $ 421,079 $ 245,626

Cost of Operations, excluding D

Cost of Operations, excluding Depreciation and Amortization	12 Months Ended
	Dec. 31, 2021
Cost Of Operations Excluding Depreciation And Amortization [Abstract]
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization	17. Cost of Operations, excluding Depreciation and Amortization The following table summarizes the components of the Company’s cost of operations, excluding depreciation and amortization: Year Ended December 31, (in thousands) 2021 2020 Employee compensation $ 164,053 $ 84,038 Third-party services and professional fees 63,301 30,183 Reading fees 42,842 37,818 Rent and utilities 37,158 30,203 Administrative 24,660 12,231 Medical supplies and other 27,721 11,162 $ 359,735 $ 205,635

Supplemental Statement of Opera

Supplemental Statement of Operations Information	12 Months Ended
	Dec. 31, 2021
Supplemental Statement of Operations Information [Abstract]
Supplemental Statement of Operations Information	18. Supplemental Statement of Operations Information Acquisition-related costs for the year ended December 31, 2021 consist primarily of $13.6 million related to the Alliance Acquisition. Other acquisition-related costs relate to various other acquisitions and potential transactions. Settlement and related costs (recoveries) for the year ended December 31, 2021 consist primarily of a $1.3 million recovery from insurance due to weather related damage to two locations, partially offset by other costs. Settlement and related costs (recoveries) for the year ended December 31, 2020 consist primarily of an $0.8 million settlement of a government investigation related predominantly to historical reimbursements paid under federal healthcare programs to certain of the Company’s subsidiaries, which was reached in January 2021

Other Operating and Non-Operati

Other Operating and Non-Operating Losses (Gains)	12 Months Ended
	Dec. 31, 2021
Other Income and Expenses [Abstract]
Other Operating and Non-Operating Losses (Gains)	19. Other Operating and Non-Operating Other operating losses (gains) consist of the following: Year Ended December 31, (in thousands) 2021 2020 Gain on revaluation of earn-out $ — $ (5,457 ) Loss on disposal of property and equipment, net 748 1,327 Other gains (165 ) — $ 583 $ (4,130 ) Other non-operating Year Ended December 31, (in thousands) 2021 2020 Loss on extinguishment of debt (Note 8) $ — $ 18,279 Loss on settlement of interest rate cap derivative (Note 8) — 4,162 Gain on conversion of debt to equity investment (Note 20) (3,360 ) — Earnings from equity method investments (291 ) — Other gains (339 ) (54 ) $ (3,990 ) $ 22,387

Investment in Unconsolidated In

Investment in Unconsolidated Investees	12 Months Ended
	Dec. 31, 2021
Other Investments [Abstract]
Investment in Unconsolidated Investees	20. Investments in Unconsolidated Investees Effective March 1, 2021, the Company completed a common equity investment in an artificial intelligence business (“AI business”) as part of a private placement offering for $4.6 million. The AI business develops artificial intelligence aided software programs for use in medical businesses, including outpatient imaging services provided by the Company. As a result of the investment, a previous investment in a convertible note instrument issued by the AI business to the Company in May 2020 converted to common equity. The Company’s total common equity investment is estimated to be valued at $7.9 million and represents a 34.5% interest in the AI business on a non-diluted non-operating The Company has a 15% direct ownership in an unconsolidated investee and provides management services under a management agreement with the investee. The Company provides services as part of its ongoing operations for and on behalf of the unconsolidated investee, which reimburses the Company for the actual amount of the expenses incurred. The Company records the expenses in cost of operations and the reimbursement as revenue in the 2021 consolidated statement of operations and comprehensive loss. The financial position and results of operations of these unconsolidated investees are not material to the Company’s consolidated financial statements.

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Income Taxes	21. Income Taxes The income tax expense (benefit) shown in the consolidated statements of operations and comprehensive loss consists of the following: Year Ended December 31, (in thousands) 2021 2020 Current: Federal $ — $ — State 41 (138 ) Total current 41 (138 ) Deferred: Federal (25,362 ) 700 State (5,070 ) — Total deferred (30,432 ) 700 Total income tax expense (benefit) $ (30,391 ) $ 562 Significant components of the Company’s net deferred tax assets (liabilities) are as follows: December 31, (in thousands) 2021 2020 Deferred tax assets: Net operating losses $ 54,050 $ 16,559 Lease-related liabilities 45,367 31,615 Accruals not currently deductible 27,538 13,332 Interest expense limitation 25,123 2,025 Othe r 11,760 6,192 Valuation allowanc e (2,398 ) (16,852 ) Total deferred tax asset s 161,440 52,871 Deferred tax liabilities : Intangible assets (50,213 ) (441 ) Operating lease right-of-use (42,642 ) (30,349 ) Property and equipment (42,474 ) (11,197 ) Basis difference in joint ventures (30,539 ) — Goodwill (13,979 ) (10,661 ) Other (5,620 ) (1,916 ) Total deferred tax liabilities (185,467 ) (54,564 ) Net deferred tax liabilities $ (24,027 ) $ (1,693 ) A reconciliation of the total income tax expense (benefit) with the amount computed by applying the Canadian statutory tax rate of 26.5% to the loss before income taxes is as follows: Year Ended December 31, (in thousands) 2021 2020 Tax benefit at Canadian statutory rate $ (17,279 ) $ (8,902 ) Non-deductible 4,367 40 Stock-based compensation 973 397 Noncontrolling interests (2,246 ) (685 ) Valuation allowance (15,547 ) 8,916 Other (659 ) 796 Income tax expense (benefit) $ (30,391 ) $ 562 As of December 31, 2021, the Company had net operating loss (“NOL”) carryforwards of $210.6 million and million for U.S. federal and state income tax purposes, respectively. These loss carryforwards will expire at various dates from 2031 through 2037 Based on the Company’s earnings history and available objectively verifiable positive and negative evidence, the Company determined that it is more likely than not that a portion of its deferred tax assets will not be realized in the future. As of December 31, 2021 and 2020, the Company recorded a valuation allowance of $2.4 million and $16.9 million, respectively, against its deferred tax assets that were determined to not be more likely than not realizable. The income tax benefit for the year ended December 31, 2021 includes a $15.5 million reversal of the valuation allowance on deferred tax assets that had been previously established based on management’s prior year determination that it was more likely than not that a portion of the deferred tax assets would not be realized in the future. In connection with the acquisition of Alliance in 2021, management recorded deferred tax liabilities that provided sufficient evidence regarding future taxable income and, accordingly, recorded a release of a portion of the valuation allowance recorded in prior years. The amount of the deferred tax assets considered realizable could be adjusted if there are changes in the estimates of future taxable income during the carry forward period. The Company has made significant investments in its U.S. operations and asserts that earnings from such operations will be indefinitely reinvested. Therefore, the determination of unrecognized deferred tax liabilities on outside basis differences is not practicable at this time. A roll forward of the activity for the gross unrecognized tax benefits is as follows: (in thousands) 2021 Unrecognized tax benefits at January 1 $ — Increases for positions taken in current year 112 Decreases for positions taken in a prior year (7 ) Decreases for lapses in the applicable statute of limitations (25 ) Unrecognized tax benefits at December 31 $ 80 The Company recognizes accrued interest and penalties related to unrecognized tax benefits in income tax benefit in the consolidated statements of operations and comprehensive loss. Accrued interest and penalties related to unrecognized tax benefits as of December 31, 2021 were not material. The Company is subject to Canadian and U.S. federal income tax as well as income tax of multiple state tax jurisdictions. The Company’s Canadian income tax returns are currently open to audit under the applicable statute of limitations for the years ended December 31, 2017 through 2021. The Company’s U.S. federal income tax returns are currently open to audit under the statute of limitations by the Internal Revenue Service for the years ended December 31, 2018 through 2021. The Company’s state income tax returns are open to audit under the applicable statutes of limitations for the years ended December 31, 2017 through 2021. The Company does not anticipate a significant change to the total amount of unrecognized tax benefits within the next 12 months.

Basic and Diluted Loss per Shar

Basic and Diluted Loss per Share	12 Months Ended
	Dec. 31, 2021
Earnings Per Share [Abstract]
Basic and Diluted Loss per Share	22. Basic and Diluted Loss per Share The loss per share is calculated by dividing the net loss attributable to common shareholders by the weighted average common shares outstanding during the period. Year ended December 31, (in thousands, except share and per share amounts) 2021 2020 Net loss attributable to common shareholders $ (43,291 ) $ (36,741 ) Weighted average common shares outstanding: Basic and diluted 76,836,032 70,101,618 Net loss per share attributable to common shareholders: Basic and diluted $ (0.56 ) $ (0.52 ) Employee stock options, warrants and restricted stock units excluded from the computation of diluted per share amounts as their effect would be antidilutive 2,215,163 1,664,231

Segment Information

Segment Information	12 Months Ended
	Dec. 31, 2021
Segment Reporting [Abstract]
Segment Information	23. Segment Information Operating segments are reported in a manner consistent with the internal reporting provided to the chief operating decision maker. The chief operating decision makers, who are responsible for allocating resources and assessing performance of the operating segments, have been identified as the Co-Chief The following table summarizes the Company’s revenues by segment: Year Ended December 31, (in thousands) 2021 2020 Radiology $ 374,402 $ 245,626 Oncology 46,677 — $ 421,079 $ 245,626 Adjusted EBITDA is defined as net income before interest expense, income tax expense (benefit), depreciation and amortization, stock-based compensation, acquisition-related costs, settlement and related costs (recoveries), financial instruments revaluation and related losses (gains), loss on extinguishment of debt, severance and related costs, restructuring charges, asset impairments, other losses (gains), deferred rent expense and one-time The Company is unable to present comparable Adjusted EBITDA by segment for the year ended December 31, 2020, as it is impracticable to do so. The following table summarizes the Company’s Adjusted EBITDA for the year ended December 31, 2021: (in thousands) Year Ended December 31, 2021 Adjusted EBITDA: Radiology $ 64,992 Oncology 15,466 Corporate (13,555 ) $ 66,903 A reconciliation of the net loss to total Adjusted EBITDA is shown below: Year Ended December 31, (in thousands) 2021 2020 Net loss $ (34,814 ) $ (34,156 ) Interest expense 62,575 32,781 Income tax expense (benefit) (30,391 ) 562 Depreciation and amortization 44,895 17,060 EBITDA 42,265 16,247 Adjustments: Stock-based compensation 2,792 2,084 Acquisition-related costs 20,233 1,079 Settlement and related costs (recoveries) (539 ) 2,324 Gain on revaluation of earn-out — (5,457 ) Loss on extinguishment of debt — 18,279 Loss on settlement of interest rate cap derivative — 4,162 Gain on conversion of debt to equity investment (3,360 ) — Severance, restructuring and other charges 3,368 — Other losses, net 342 407 Deferred rent expense 1,802 2,953 Adjusted EBITDA $ 66,903 $ 42,078 The following table summarizes the Company’s total assets by segment: December 31, (in thousands) 2021 2020 Identifiable assets: Radiology $ 1,451,905 $ 662,191 Oncology 440,416 — Corporate 26,505 2,861 Total $ 1,918,826 $ 665,052 The following table summarizes the Company’s capital expenditures by segment: Year Ended December 31, (in thousands) 2021 2020 Capital expenditures: Radiology $ 12,478 $ 5,344 Oncology 5,117 — Corporate 272 — Total $ 17,867 $ 5,344

CARES Act

CARES Act	12 Months Ended
	Dec. 31, 2021
Coronavirus Aid Relief And Economic Security Act [Abstract]
CARES Act	24. CARES Act The CARES Act provided for qualified healthcare providers to receive advanced payments under the existing Medicare Accelerated and Advance Payments Program (“MAAPP”) during the COVID-19 In addition, the CARES Act provided waivers, reimbursement, grants and other funds to assist healthcare providers during the COVID-19 COVID-19. The CARES Act provided for the deferred payment of the employer portion of Social Security taxes between March 27, 2020 and December 31, 2020, with 50% of the deferred amount due December 31, 2021 and the remaining 50% due December 31, 2022. As of December 31, 2021, $4.3 million related to these deferred payments are included in other accrued liabilities in the consolidated balance sheet.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2021
Accounting Policies [Abstract]
Principles of Consolidation and Basis of Financial Statement Presentation	Principles of Consolidation and Basis of Financial Statement Presentation The audited consolidated financial statements of the Company include the assets, liabilities, revenues and expenses of all subsidiaries over which the Company exercises control. Intercompany balances and transactions have been eliminated in consolidation. The Company evaluates participating rights in its assessment of control in determining consolidation of joint venture partnerships. The Company records noncontrolling interests related to its consolidated subsidiaries that are not wholly owned. Investments in non-consolidated
Use of Estimates	Use of Estimates The preparation of consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates. The COVID-19 The most significant assumptions and estimates underlying these consolidated financial statements involve revenue recognition, accounts receivable, business combinations, impairments of long-lived assets including goodwill, income taxes and fair value of financial instruments.
Revenue Recognition	Revenue Recognition The majority of the Company’s revenues are derived from net patient fees received from various payors and patients themselves based on established contractual billing rates, less allowances for contractual adjustments and implicit price concessions. Revenues are also derived directly from hospitals and healthcare providers. The Company recognizes revenue in the period in which performance obligations are satisfied by providing services to customers. The Company records the amount of revenue that reflects the consideration that it expects to receive in exchange for those services. The Company applies the following five-step model in order to determine this amount: (i) identification of the contract with a customer; (ii) identification of the promised services in the contract and determination of whether they represent performance obligations, including whether they are distinct in the context of the contract; (iii) measurement of the transaction price, including the constraint on variable consideration; (iv) allocation of the transaction price to the performance obligations; and (v) recognition of revenue when (or as) the Company satisfies each performance obligation. Patient Fee Payors Patient fee revenues are generated from freestanding facilities managed and operated by the Company, which submit billings and collect fees directly from the patients and third-party payors. The Company’s performance obligations are to provide outpatient medical services to patients, such as diagnostic services, radiation therapy, or the provision of goods and services during a patient visit. Revenues are recorded during the period the obligations to provide medical services are satisfied. Performance obligations for medical services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payor (Medicare, Medicaid, managed care health plans, attorneys, employers and commercial insurance companies, including plans offered through the health insurance exchanges) and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payors. The payment arrangements with third-party payors for the services the Company provides to the related patients typically specify payments at amounts less than standard charges and generally provide for payments based upon predetermined rates per diagnostic services or discounted fee-for-service Revenue recorded is based upon the estimated amounts the Company expects to be entitled to receive from patients and third-party payors. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements, negotiated rates and historical and expected payment patterns. Revenues related to uninsured patients, uninsured copayment, and deductible amounts for patients who have healthcare coverage may have discounts applied (uninsured discounts and contractual discounts). The Company also records estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record self-pay Hospital and Healthcare Providers Revenues are derived from services provided under an outsourced contract arrangement with hospitals, physician groups and other healthcare providers. Under outsourced service contracts with hospitals and other healthcare provider customers, the Company provides medical services to patients at a fixed site facility or mobile unit. The Company typically bundles its services in providing diagnostic imaging or radiation therapy services, staffing, supplies and other patient related administrative tasks depending on the customers’ needs. The majority of the Company’s contracts have a single performance obligation, as a series of distinct services that are substantially the same are provided and are transferred with the same pattern to the customer. The Company bills customers on a fee per procedure, percentage of collections, or fixed-payment methodology. Service fees based on fee per procedure and fixed-payment methodology are negotiated and agreed upon by both parties. The Company does not have a business practice of accepting less than contractual amounts. Any amounts not collected do not represent implicit price concessions and instead are due to general credit risk; therefore, the Company treats the allowance for doubtful accounts related to these arrangements as bad debt expense, which is recorded in operating expenses in the consolidated statements of operations and comprehensive loss. For service fees based on a percentage of collections, the Company receives payment after the hospital and other healthcare provider customers are paid by third-party payors and patients. Revenue is recognized over time as medical services are provided and the measurement of the transaction price is generally consistent with the methodology used with patient fee payors. Other Other revenue consists of miscellaneous fees under contractual arrangements, including service fee revenue under capitation arrangements with third-party payors, management fees, government grants and fees for other services provided to third parties. The Company records revenue from management services that it performs based upon management service contracts with predetermined pricing and records such revenues in the period in which the service is performed and at the amounts expected to be collected. During the years ended December 31, 2021 and 2020, the Company received grants from HHS (see Note 24). No single payor or provider accounted for more than 10% of consolidated revenues during the years ended December 31, 2021 and 2020.
Segment Reporting	Segment Reporting Operating segments are defined as components of an enterprise about which separate financial information is available that is evaluated regularly by the chief operating decision maker (“CODM”) in deciding how to allocate resources and in assessing performance. The Company operates in two reportable segments: Radiology and Oncology. Each of these segments, on a stand-alone basis, provides and makes available its respective medical services in similar settings and operates within a singular regulatory environment. Further, management assesses the Company’s segment operations and each segment’s degree of efficiency and performance based on this structure of financial reporting and primarily makes operating decisions from these reportable segment results.
Cash and Cash Equivalents	Cash and Cash Equivalents The Company classifies short-term investments with original maturities of three months or less as cash equivalents.
Accounts Receivable	Accounts Receivable The Company provides shared and single-user diagnostic imaging and oncology equipment and technical support services to the healthcare industry and directly to patients on an outpatient basis. Substantially all of the Company’s accounts receivable are due from health insurance providers (including Medicare and Medicaid), hospitals, other healthcare providers and patients, located throughout the U.S. A significant portion of the Company’s services are provided directly to patients or pursuant to long-term contracts with hospitals and other healthcare providers. Estimated credit losses are provided for in the consolidated financial statements. Accounts receivable are reported at realizable value, net of allowances for price concessions and doubtful accounts, which are estimated and recorded in the period the related revenue is recorded. Implicit price concessions are recorded as a reduction in revenue with an offsetting amount reducing the carrying value of the receivable. The Company has a standardized approach to estimate and review the collectability of its receivables based on a number of factors, including the age of the receivable balances. Changes to the allowance for doubtful accounts estimates are recorded as an adjustment to bad debt expense within operating expenses in the consolidated statements of operations and comprehensive loss. Receivables deemed to be uncollectible are charged against the allowance for doubtful accounts at the time such receivables are written-off.
Concentration of Credit Risk	Concentration of Credit Risk Financial instruments that potentially subject the Company to a concentration of credit risk principally consist of cash, cash equivalents and accounts receivable. The Company maintains its cash and cash equivalents in high-credit-quality financial institutions. Deposits held with banks may exceed the amount of insurance provided on such deposits. The Company’s accounts receivable are primarily from third-party payors and clients in the healthcare industry. No individual customer represented more than 10% of the Company’s accounts receivable at December 31, 2021 and 2020.
Property and Equipment	Property and Equipment Property and equipment are stated at cost. Property and equipment acquired through business combinations are recorded at their acquisition date fair value. Depreciation is calculated using the straight-line method over the following estimated useful lives:​​​​​​​ Estimated Useful Life Medical equipment and equipment under finance leases 2 to 10 years Office and computer equipment 2 to 7 years Transportation and service equipment 3 to 10 years Furniture and fixtures 5 to 10 years Leasehold improvements Shorter of the lease term or estimated useful life Routine maintenance and repairs are charged to expense as incurred. Major repairs and purchased software and hardware upgrades, which extend the life of or add value to the equipment, are capitalized and depreciated over the remaining useful life. Operating lease right-of-use
Leases	Leases The Company’s operating lease portfolio primarily consists of real estate leases for its imaging centers, oncology centers and corporate offices. A smaller portion consists of medical and office equipment leases. The Company determines if an arrangement is a lease at inception. Operating leases are included in operating lease ROU assets, current portion of obligations under operating leases, and obligations under operating leases, net of current portion in the consolidated balance sheets. Finance leases are included in property and equipment, current portion of obligations under finance leases, and obligations under finance leases, net of current portion in the consolidated balance sheets. The Company has elected to use the accounting policy practical expedients by class of underlying asset to (i) combine associated lease and non-lease ROU assets represent the Company’s right to use an underlying asset for the lease term and lease liabilities represent the Company’s obligation to make lease payments arising from the lease. Operating lease liabilities are recorded at the present value of remaining lease payments not yet paid for the lease term discounted using the incremental borrowing rate associated with each lease. Operating lease ROU assets represent operating lease liabilities adjusted for prepayments, accrued lease payments, lease incentives and initial direct costs. Certain of the Company’s leases include renewal or termination options. Calculation of operating lease ROU assets and liabilities includes the initial lease term unless it is reasonably certain a renewal or termination option will be exercised. Variable components of lease payments fluctuating with a future index or rate are estimated at lease commencement based on the index or rate at lease commencement. If the payments change as the result of a change in an index or rate subsequent to lease commencement, the difference is recognized in the consolidated statements of operations and comprehensive loss in the period in which the change occurs. Variable payments for maintenance such as common area maintenance costs and taxes, are not included in determining lease payments and are expensed as incurred. Most of the Company’s leases do not contain implicit borrowing rates, and therefore to measure lease liabilities, the Company uses its incremental borrowing rates based on the information available at the lease commencement date. Lease liabilities are remeasured when there is a significant change in the lease contracts.
Goodwill and Intangible Assets	Goodwill and Intangible Assets Goodwill and indefinite-lived intangible assets are not amortized but instead tested for impairment at least annually at the reporting unit level. A reporting unit is an operating segment or one level below an operating segment (also known as a component). A component of an operating segment is a reporting unit if the component constitutes a business for which discrete financial information is available and reviewed by management. The Company has evaluated and concluded there are two operating segments: Radiology and Oncology. The Company has assessed that each component listed above meets the definition of a reporting unit based on the conclusions that each component constitutes a business, discrete financial information is available for each component, and management regularly reviews the results of such financial information. The Company performs an annual impairment test in the fourth quarter for goodwill and indefinite-lived intangible assets or more frequently if an event occurs or circumstances change that would more-likely-than-not In evaluating goodwill for impairment, the Company first assesses qualitative factors to determine whether it is more-likely-than-not more-likely-than-not The quantitative impairment analysis utilizes two primary approaches to calculate the fair value of the reporting unit: the discounted cash flow (“DCF”) method and the Guideline Public Company (“GPC”) method. Under the DCF method, fair value is measured as the present worth of anticipated future net cash flows generated by a business. In a multi-period model, net cash flows attributable to a business are forecast for an appropriate period and then discounted to present value using an appropriate discount rate. In a single-period model, net cash flow or earnings for a normalized period are capitalized to reach a determination of present value. The methods, key assumptions, degree of uncertainty associated with the key assumptions, and the potential events or changes in circumstances that could reasonably be expected to negatively affect the key assumptions with respect to the reporting unit are the estimated future net cash flows generated and the discount rate applied to capture the associated risks. The ability to achieve anticipated future net cash flows is subject to numerous assumptions and risks, including company-specific risks such as the ability to maintain and grow revenues, maintain or improve operating margins, control costs and anticipate working capital requirements. The anticipated future net cash flows are also dependent on industry-level factors, such as the impact of legislation, patient volumes, cost-reimbursement levels, and continued availability of qualified doctors and other medical professionals who are necessary to staff the Company’s operations, among other potential impacts. Under the GPC method, value is estimated by comparing the subject company to similar companies with publicly-traded ownership interests. Guideline companies are selected based on comparability to the subject company, and valuation multiples are calculated and applied to subject company operating data. The key assumption used in connection with the GPC method focuses on identifying guideline companies that operate in the same (or similar) line of business as the reporting units with the same (or similar) operating characteristics. Eligible companies are selected based on Global Industry Classification Standard codes, Standard Industrial Classification codes, company descriptions, and industry affiliations. Considered factors include relative risk, profitability and growth considerations of the reporting unit relative to the guideline companies. Value estimates for the reporting unit involve using multiples of market value of invested capital excluding cash to revenue and earnings before interest, income taxes, depreciation and amortization (“EBITDA”). Valuations derived using the GPC method rely on information primarily obtained from available industry market data and publicly available filings with the Securities and Exchange Commission (“SEC”). In evaluating indefinite-lived intangible assets for impairment, the Company first assesses qualitative factors to determine whether it is more-likely-than-not more-likely-than-not Finite-lived intangible assets are amortized over their respective estimated useful lives (see Note 7) on a straight-line basis and are reviewed for impairment consistent with property and equipment.
Impairment of Long-Lived Assets	Impairment of Long-Lived Assets Long-lived assets, including property and equipment and purchased intangible assets subject to amortization, are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to undiscounted future net cash flows expected to be generated by the asset. If the carrying amount of an asset exceeds its estimated undiscounted future cash flows, an impairment charge is recognized for the amount by which the carrying amount of the asset exceeds the fair value of the asset. Assets to be disposed of are reported at the lower of the carrying amount or fair value less costs to sell.
Business Combinations	Business Combinations The assets acquired and liabilities assumed in a business combination are recorded at their estimated fair values on the date of acquisition. The difference between the purchase price amount and the net fair value of assets acquired and liabilities assumed is recognized as goodwill if it exceeds the estimated fair value and as a bargain purchase gain if it is below the estimated fair value. Non-controlling Acquisitions of entities over which the Company exercises control have been recorded using the acquisition method of accounting and, accordingly, results of their operations have been included in the Company’s consolidated financial statements as of the effective date of each respective acquisition.
Redeemable Noncontrolling Interests	Redeemable Noncontrolling Interests The Company has noncontrolling interests with redemption features. These redemption features could require the Company to make an offer to purchase the noncontrolling interests in the case of certain events, including (i) the expiration or termination of certain operating agreements of the joint venture, or (ii) the noncontrolling interests’ tax-exempt As of December 31, 2021, the Company holds redeemable noncontrolling interests of $37.5 million which are not currently redeemable or probable of becoming redeemable. The redemption of these noncontrolling interests is not solely within the Company’s control, therefore, they are presented in the temporary equity section of the Company’s consolidated balance sheets. The Company does not believe it is probable the redemption features related to these noncontrolling interest securities will be triggered as the triggering events are generally not probable until they occur. As such, these noncontrolling interests have not been remeasured to redemption value. The following is a rollforward of the activity in the redeemable noncontrolling interests for the year ended December 31, 2021: (in thousands) Balance, December 31, 2020 $ — Fair value at time of Alliance Acquisition 37,040 Net income attributable to redeemable noncontrolling interests 762 Contributions received from redeemable noncontrolling interests 1,239 Distributions paid to redeemable noncontrolling interests (1,572 ) Balance, December 31, 2021 $ 37,469
Stock-Based Compensation	Stock-Based Compensation The Company recognizes compensation expense for all stock-based awards, including restricted share units (“RSUs”) and stock options, based on estimated fair value on the measurement date. The Company recognizes stock-based compensation expense over the requisite service period for each separately vesting portion of the award. The fair value of RSUs is computed based on the market value of the Company’s common stock on the date of grant. The fair value of stock options is computed using the Black-Scholes option pricing model, which is affected by the Company’s common stock price and related volatility, expected dividend yield, term of the option, exercise price and risk-free interest rate. The Company recognizes forfeitures as they occur.
Income Taxes	Income Taxes Income tax expense is computed using the asset and liability method. Deferred tax assets and liabilities are determined based on the temporary differences between the financial reporting and tax bases of assets and liabilities, applying enacted statutory tax rates in effect for the year in which the differences are expected to reverse. Future income tax benefits are recognized only to the extent that the realization of such benefits is considered to be more likely than not. The Company regularly reviews its deferred tax assets for recoverability and establishes a valuation allowance, when it is more likely than not that such deferred tax assets will not be recoverable, based on historical taxable income, projected future taxable income, and the expected timing of the reversals of existing temporary differences.
Earnings per Share	Earnings per share The Company computes basic net income per share attributable to common shareholders based on the weighted-average number of common shares outstanding during the periods presented. Diluted net income per share attributable to common shareholders is computed based on the weighted-average number of common and any dilutive potential common shares outstanding using the treasury method.
Comprehensive Income	Comprehensive Income Comprehensive income includes all changes in equity other than transactions with shareholders and noncontrolling interests. The Company’s accumulated other comprehensive income consists of unrealized gains and losses, and related reclassification adjustments, related to interest rate swaps that qualify as cash flow hedges.
Fair Value of Financial Instruments	Fair Value of Financial Instruments The Company uses the following methods and assumptions in estimating fair value disclosure for financial instruments: • Debt: • Derivative instruments: period-end. Assets and liabilities subject to fair value measurements are required to be disclosed within a fair value hierarchy. The fair value hierarchy ranks the quality and reliability of the information used to determine fair value. Accordingly, assets and liabilities carried at fair value are classified within the fair value hierarchy in one of the following categories: • Level 1 • Level 2 • Level 3 .
Derivatives, Cash Flow Hedges and Embedded Derivatives	Derivatives, Cash Flow Hedges and Embedded Derivatives The Company has interest rate swap agreements to hedge the future interest payments on portions of its variable-rate equipment debt in order to reduce volatility in operating results due to fluctuations in interest rates. Management has determined the interest rate swap agreements are derivative instruments designated as cash flow hedges. The Company formally measures effectiveness of its hedging relationships at hedge inception in accordance with its risk management policy. The Company’s derivatives are recorded on the consolidated balance sheets at fair value. The Company does not recognize hedge ineffectiveness in its consolidated statements of operations but instead recognizes the entire change in the fair value of cash flow hedges in other comprehensive income. The amounts recorded in other comprehensive income are subsequently reclassified to earnings in the same line item in the consolidated statements of operations as impacted by the hedged item when the hedged item affects earnings. The Company reviews the terms of debt and equity financing transactions to identify whether there are any embedded derivatives that require separation from the related host financial instrument. Any such embedded derivatives are presented at fair value in the consolidated balance sheets, with changes in fair value recorded in other non-operating
Warrants	Warrants The Company reviews the terms of warrants to purchase its common stock to determine whether warrants should be classified as liabilities or shareholders’ equity in its consolidated balance sheets. In order for a warrant to be classified in shareholders’ equity, the warrant must be (i) indexed to the Company’s equity and (ii) meet the conditions for equity classification. If a warrant does not meet the conditions for shareholders’ equity classification, it is carried on the consolidated balance sheets as a warrant liability measured at fair value, with subsequent changes in the fair value of the warrant recorded in other non-operating
Self-Insurance	Self-Insurance The Company has purchased large deductible insurance policies for certain of its workers’ compensation, auto liability, general liability and professional liability exposures. For a portion of the exposures, the Company is self-insured and retains the risk for certain liabilities. The Company’s policy is to accrue amounts equal to the actuarially estimated costs to settle open claims of insureds, as well as an estimate of the cost of insured claims that have been incurred but not reported. The Company develops information about the size of the ultimate claims based on historical experience, current industry information, and actuarial analysis and evaluates the estimates for claim loss exposure on an annual basis. The Company believes that adequate provision has been made in the consolidated financial statements for these liabilities. The most significant assumptions used in the estimation process include determining the trend in costs, the expected cost of claims incurred but not reported and the expected costs to settle or pay damage awards with respect to unpaid claims. Recorded liabilities are based upon estimates, and while management believes the estimates of loss are reasonable, the ultimate liability may be in excess of or less than the recorded amounts.
Variable Interest Entities	Variable Interest Entities In accordance with consolidation guidance, a reporting entity with a variable interest in another entity is required to include the assets and liabilities and revenues and expenses of that separate entity (i.e., consolidate with the financial statements of the reporting entity) when the variable interest is determined to be a controlling financial interest. A reporting entity is considered to have a controlling financial interest in a variable interest entity (“VIE”) if (i) the reporting entity has the power to direct the activities of the VIE that most significantly impacts its economic performance and (ii) the reporting entity has the obligation to absorb losses of the VIE that could be potentially significant to the VIE. As a result of the financial relationship established between the Company and certain entities (the “Revenue Practices”) through respective management service agreements, the Revenue Practices individually qualify as VIEs as the Company, which provides them non-medical, technical and administrative services, has the power to direct their respective activities and the obligation to absorb their gains and losses. As a result, the Company is considered the primary beneficiary of the Revenue Practices, and accordingly, the assets and liabilities and revenues and expenses of the Revenue Practices are included in these consolidated financial statements. The following information excludes any intercompany transactions and costs allocated by the Company to the Revenue Practices. As of December 31, 2021 and 2020, the Revenue Practices’ assets included in the Company’s consolidated balance sheets were $20.4 million and $34.1 million, respectively ,

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2021
Accounting Policies [Abstract]
Summary of Property and Equipment and Estimated Useful Lives Using the Straight Line Method	Depreciation is calculated using the straight-line method over the following estimated useful lives: Estimated Useful Life Medical equipment and equipment under finance leases 2 to 10 years Office and computer equipment 2 to 7 years Transportation and service equipment 3 to 10 years Furniture and fixtures 5 to 10 years Leasehold improvements Shorter of the lease term or estimated useful life
Summary of Redeemable Noncontrolling Interests	The following is a rollforward of the activity in the redeemable noncontrolling interests for the year ended December 31, 2021: (in thousands) Balance, December 31, 2020 $ — Fair value at time of Alliance Acquisition 37,040 Net income attributable to redeemable noncontrolling interests 762 Contributions received from redeemable noncontrolling interests 1,239 Distributions paid to redeemable noncontrolling interests (1,572 ) Balance, December 31, 2021 $ 37,469

Business Combinations (Tables)

Business Combinations (Tables)	12 Months Ended
	Dec. 31, 2021
Business Acquisition [Line Items]
Summary of pro forma data is presented for illustrative purposes as follows	Year Ended December 31, (unaudited; in thousands) 2021 2020 Pro forma net revenues $ 746,550 $ 741,834 Pro forma net loss before income taxes (132,494 ) (181,554 )
Coral Springs [Member]
Business Acquisition [Line Items]
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows	Coral Springs Acquisition On January 1, 2020, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging center in Coral Springs, Florida for cash consideration of $2.1 million (the “Coral Springs Acquisition”). In accordance with the transaction agreement, $0.1 million of this purchase price was withheld as security for indemnity obligations and was released to the seller during June 2020. This asset acquisition was considered a business combination. The following table summarizes the final allocation of the purchase price to the fair value of the assets acquired and liabilities assumed as of the date of acquisition: (in thousands) Assets acquired: Prepaid expenses $ 33 Property and equipment 412 Operating lease right-of-use 2,428 Goodwill 1,275 Other assets 369 4,517 Liabilities assumed: Obligations under operating leases 2,428 Purchase price $ 2,089
Crystal Lake [Member]
Business Acquisition [Line Items]
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows	Crystal Lake Acquisition On January 1, 2020, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging center in Crystal Lake, Illinois for cash consideration of $1.2 million (the “Crystal Lake Acquisition”). In accordance with the transaction agreement, $0.1 million of this purchase price was withheld as security for indemnity obligations and was released to the seller during June 2020. This asset acquisition was considered a business combination. The following table summarizes the final allocation of the purchase price to the fair value of the assets acquired and liabilities assumed as of the date of acquisition: (in thousands) Assets acquired: Property and equipment $ 820 Operating lease right-of-use 555 Goodwill 400 Other assets 6 1,781 Liabilities assumed: Obligations under operating leases 555 Purchase price $ 1,226
Sunrise Acquisition [Member]
Business Acquisition [Line Items]
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows	Sunrise Acquisition On May 1, 2021, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging center in Sunrise, Florida for cash consideration of $0.8 million (the “Sunrise Acquisition”). This asset acquisition was considered a business combination. The following table summarizes the final allocation of the purchase price to the fair value of the assets acquired and liabilities assumed as of the date of acquisition: (in thousands) Assets acquired: Property and equipment $ 521 Operating lease right-of-use 2,308 Goodwill 279 3,108 Liabilities assumed: Obligations under operating leases 2,308 Purchase price $ 800
Florida Acquisition [Member]
Business Acquisition [Line Items]
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows	Florida Acquisition On May 1, 2021, the Company acquired, through a subsidiary, six outpatient diagnostic imaging centers in Florida in six simultaneous transactions with related sellers, for aggregate cash consideration of $34.5 million and share consideration of $3.0 million through issuance of 974,999 common shares of the Company at a price of $3.09 per share based on the share price at the close of April 30, 2021 (the “Florida Acquisition”). Subsequent to the completion of the acquisition, the cash purchase price was decreased by $0.4 million due to working capital adjustments in accordance with the purchase agreement. During 2021, the Company completed the final assessment of the fair value of the tangible and identifiable intangible assets acquired and liabilities assumed. The results of the final assessment were not material. The following table summarizes the final allocation of the purchase price to the fair value of the assets acquired and liabilities assumed as of the date of acquisition: (in thousands) Assets acquired: Accounts receivable $ 3,594 Prepaid expenses 83 Property and equipment 483 Operating lease right-of-use 6,874 Goodwill 32,610 Other intangible assets 841 44,485 Liabilities assumed: Accounts payable and other accrued liabilities 350 Obligations under finance leases 136 Obligations under operating leases 6,874 7,360 Purchase price $ 37,125
Massachusetts Acquisition [Member]
Business Acquisition [Line Items]
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows	Massachusetts Acquisition On June 1, 2021, the Company acquired through a subsidiary, all of the issued and outstanding equity interests in a company that owns three outpatient diagnostic imaging centers in Massachusetts for cash consideration of $0.4 million (the “Massachusetts Acquisition”). Subsequent to the completion of the acquisition, the cash purchase price was increased by $0.05 million due to working capital adjustments in accordance with the purchase agreement. During 2021, the Company completed the final assessment of the fair value of the assets acquired and liabilities assumed. The results of the final assessment were not material. The following table summarizes the final allocation of the purchase price to the fair value of the assets acquired and liabilities assumed as of the date of acquisition: (in thousands) Assets acquired: Cash $ 5 Accounts receivable 59 Property and equipment 329 Operating lease right-of-use 1,413 Goodwill 94 1,900 Liabilities assumed: Accounts payable and other accrued liabilities 33 Obligations under operating leases 1,413 1,446 Purchase price $ 454
Alliance Acquisition [Member]
Business Acquisition [Line Items]
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows	The following table summarizes the fair value of the purchase consideration for the Alliance Acquisition as of the date of the acquisition: (in thousands, except share and per share amounts) Shares of common stock issued 14,223,570 Per share value of common stock issued $ 2.17 Fair value of common stock issued $ 30,865 Cash paid at closing 748,490 Working capital and other adjustments 6,261 Total purchase price $ 785,616 The following table summarizes the preliminary assessment of fair value of the assets acquired and liabilities assumed as of the date of the acquisition: (in thousands) Assets acquired: Cash and cash equivalents $ 26,125 Net working capital 14,221 Property and equipment 206,475 Operating lease right-of-use assets 69,919 Goodwill 455,760 Intangibles – Customer contracts 266,224 Intangibles – Trade names 69,108 Intangibles – Third party management agreements 10,200 Intangibles – Certificates of need 69,558 Other assets 8,170 1,195,760 Liabilities assumed: Equipment debt 54,673 Obligations under finance leases 9,041 Obligations under operating leases 74,290 Deferred tax liabilities 52,760 Other liabilities 7,364 198,128 Net assets acquired 997,632 Less redeemable noncontrolling interests 37,040 Less noncontrolling interests 174,976 Purchase price $ 785,616
Summary of significant unobservable inputs used in the fair value measurement of the Company's identifiable intangible assets are growth and attrition rates, discount rate and royalty rate	(in thousands) Fair value at Valuation Unobservable Selected Customer contracts $ 266,224 Attrition rate Attrition rate Growth rate Discount rate 2.8% - 5.8% 3.0% 9.0% - 12.3% Trade names 69,108 Relief from royalty method Royalty rate Discount rate 1.5% 9.0% - 12.3% Certificates of need 69,558 Acquisition costs Discount rate 9.0% - 12.3%

Property and Equipment (Tables

Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2021
Property, Plant and Equipment [Abstract]
Summary of Detailed Information of Property and Equipment	Property and equipment consist of the following: December 31, (in thousands) 2021 2020 Medical equipment $ 227,796 $ 62,406 Leasehold improvements 39,763 19,360 Equipment under finance leases 34,597 23,169 Office and computer equipment 16,701 452 Transportation and service equipment 8,996 — Furniture and fixtures 3,130 1,479 Construction in progress 6,423 — 337,406 106,866 Less accumulated depreciation 78,284 43,152 $ 259,122 $ 63,714

Goodwill (Tables)

Goodwill (Tables)	12 Months Ended
	Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	Changes in the carrying amount of goodwill are as follows: (in thousands) Radiology Oncology Total Balance, December 31, 2019 $ 355,667 $ — $ 355,667 Acquisitions 1,675 — 1,675 Adjustments (5,732 ) — (5,732 ) Balance, December 31, 2020 351,610 — 351,610 Acquisitions 330,383 158,360 488,743 Balance, December 31, 2021 $ 681,993 $ 158,360 $ 840,353

Other Intangible Assets - (Tabl

Other Intangible Assets - (Tables)	12 Months Ended
	Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule Of Intangible Assets Excluding Goodwill	Other intangible assets consist of the following: Weighted Life (in years) December 31, 2021 December 31, 2020 (dollars in thousands) Gross Accumulated Intangible Gross Accumulated Intangible Finite-lived intangible assets: Customer contracts 20 $ 266,224 $ (4,437 ) $ 261,787 $ — $ — $ — Trade names 18 77,466 (6,054 ) 71,412 7,823 (3,258 ) 4,565 Management agreements 17 10,200 (200 ) 10,000 — — — Other 4 4,814 (3,425 ) 1,389 4,508 (2,325 ) 2,183 Total $ 358,704 $ (14,116 ) 344,588 $ 12,331 $ (5,583 ) 6,748 Indefinite-lived intangible assets 69,558 — Total other intangible assets $ 414,146 $ 6,748
Summary of Finite-Lived Intangible Assets Net Amortization Expense	Estimated annual amortization expense related to finite-lived intangible assets is presented below: (in thousands) Year ending December 31: 2022 $ 19,814 2023 18,837 2024 18,132 2025 17,475 2026 17,421 Thereafter 252,909 $ 344,588

Long-Term Debt (Tables)

Long-Term Debt (Tables)	12 Months Ended
	Dec. 31, 2021
Disclosure Text Block [Abstract]
Schedule of Long-term Debt Instruments	Long-term debt consists of the following: December 31, (in thousands) 2021 2020 2028 Senior Notes $ 375,000 $ — 2025 Senior Notes 475,000 400,000 Subordinated Notes 372,470 — Equipment Debt 58,827 1,129 1,281,297 401,129 Debt discount and deferred issuance costs (68,912 ) (11,143 ) 1,212,385 389,986 Less current portion 14,789 406 Long-term debt, net of current portion $ 1,197,596 $ 389,580
Summary of Maturities of Long-term Debt	The minimum annual principal payments with respect to long-term debt as of December 31, 2021 are as follows: (in thousands) Year ending December 31: 2022 $ 14,789 2023 15,807 2024 13,009 2025 484,376 2026 2,570 Thereafter 750,746 $ 1,281,297
Disclosure Details of Allocation of Gross Proceeds from Subordinated Debt Shares Warrants and Derivatives	(dollars in thousands) Standalone Relative % Allocation on Relative Allocation of Embedded Allocation of Allocation of Gross Transaction Stonepeak Notes $ 318,082 90.8 % $ 318,082 $ 13,116 $ 304,966 $ (7,622 ) $ 6,649 $ 303,993 Stonepeak Shares 10,430 3.0 % 10,430 430 10,000 — — 10,000 Stonepeak Warrants 21,918 6.2 % 21,918 904 21,014 — — 21,014 Embedded Derivative — — — — — 7,622 — 7,622 $ 350,430 100.0 % $ 350,430 $ 14,450 $ 335,980 $ — $ 6,649 $ 342,629

Finance Leases (Tables)

Finance Leases (Tables)	12 Months Ended
	Dec. 31, 2021
Leases [Abstract]
Summary of Finance Lease Liabilities	The information pertaining to obligations under finance leases is as follows: December 31, (in thousands) 2021 2020 Obligations under finance leases $ 22,411 $ 15,574 Less current portion 6,460 3,265 Non-current $ 15,951 $ 12,309
Summary of Finance Lease Cost	The components of finance lease cost recognized in the consolidated statements of operations and comprehensive loss are as follows. Year Ended December 31, (in thousands) 2021 2020 Amortization expense for equipment under finance leases $ 4,184 $ 2,927 Interest expense on finance lease liabilities 885 637 Finance lease cost $ 5,069 $ 3,564
Summary of Undiscounted Cash Flows For Finance Leases	Undiscounted cash flows for finance leases recorded in the consolidated balance sheet as of December 31, 2021 are as follows. (in thousands) Year ending December 31: 2022 $ 7,424 2023 5,906 2024 5,414 2025 3,652 2026 1,743 Thereafter 587 Total minimum lease payments 24,726 Less amount of lease payments representing interest 2,315 Present value of future minimum lease payments 22,411 Less current portion 6,460 Non-current $ 15,951
Summary of Finance Lease Term and Discount Rates	The lease term and discount rates are as follows: Year Ended December 31, 2021 2020 Weighted average remaining lease term – finance leases (years) 3.9 4.9 Weighted average discount rate – finance leases 5.2 % 4.6 %
Summary of Supplemental Cash Flow Information Related to Finance Leases	Supplemental cash flow information related to finance leases is as follows: Year Ended December 31, (in thousands) 2021 2020 Operating cash flows from finance leases $ 877 $ 637 Equipment acquired in exchange for finance lease obligations 1,070 8,817

Operating Leases (Tables)

Operating Leases (Tables)	12 Months Ended
	Dec. 31, 2021
Leases [Abstract]
Summary of Operating Lease Liabilities	The information pertaining to obligations under operating leases is as follows: December 31, (in thousands) 2021 2020 Obligations under operating leases $ 205,169 $ 132,299 Less current portion 20,794 9,345 Non-current $ 184,375 $ 122,954
Summary of Operating Lease Cost	The components of operating lease cost recognized in the consolidated statements of operations and comprehensive loss are as follows. Year Ended December 31, (in thousands) 2021 2020 Operating lease cost $ 27,027 $ 20,625 Variable lease cost 4,515 4,109 Short-term lease cost 671 247 Total operating lease cost $ 32,213 $ 24,981
Summary of Undiscounted Cash Flows For Operating Leases	Undiscounted cash flows for operating leases recorded in the consolidated balance sheet as of December 31, 2021 are as follows. (in thousands) Year ending December 31: 2022 $ 34,990 2023 33,294 2024 30,385 2025 26,430 2026 22,922 Thereafter 175,681 Total minimum lease payments 323,702 Less amount of lease payments representing interest 118,533 Present value of future minimum lease payments 205,169 Less current portion 20,794 Non-current $ 184,375
Summary of Operating Lease Term and Discount Rates	The lease term and discount rates are as follows: Year Ended December 31, 2021 2020 Weighted average remaining lease term – operating leases (years) 11.4 12.7 Weighted average discount rate – operating leases 7.7 % 7.4 %
Summary of Supplemental Cash Flow Information Related to Operating Leases	Supplemental cash flow information related to operating leases is as follows: Year Ended December 31, (in thousands) 2021 2020 Operating cash flows from operating leases $ 25,245 $ 17,672 Right-of-use 3,769 10,818

Other Accrued Liabilities (Tabl

Other Accrued Liabilities (Tables)	12 Months Ended
	Dec. 31, 2021
Payables and Accruals [Abstract]
Summary of Other Accrued Liabilities	Other accrued liabilities consist of the following: December 31, (in thousands) 2021 2020 Accrued compensation and related expenses $ 26,486 $ 3,831 Accrued interest expense 16,840 4,588 MAAPP funds (Note 24) 2,398 3,085 Earn-out — 4,689 Other 42,089 6,578 Total $ 87,813 $ 22,771

Financial Instruments (Tables)

Financial Instruments (Tables)	12 Months Ended
	Dec. 31, 2021
Financial Instruments [Abstract]
Schedule of Fair Value Measurements, Recurring and Nonrecurring	The following table summarizes the valuation of the Company’s financial instruments that are reported at fair value on a recurring basis: Fair Value as of December 31, 2021 Fair Value as of December 31, 2020 (in thousands) Level 1 Level 2 Level 3 Total Total Level 1 Level 2 Level 3 Current and long-term liabilities: Derivative in subordinated notes $ — $ — $ 7,522 $ 7,522 $ — $ — $ — $ — Interest rate contracts $ — $ 53 $ — $ 53 $ — $ — $ — $ —
Summary of Reconciliation of Liability Related to the Embedded Derivative	The following is a reconciliation of the opening and closing balances for the liability related to the embedded derivative included in the Subordinated Notes measured at fair value on a recurring basis using significant unobservable inputs (Level 3) during the year ended December 31, 2021: (in thousands) Balance, December 31, 2020 $ — Fair value at time of Alliance Acquisition 7,622 Change in fair value (100 ) Balance, December 31, 2021 $ 7,522
Schedule Of Fair Value Of Other Current And Non Current Liabilities	The estimated fair values of other current and non-current December 31, (in thousands) 2021 2020 2028 Senior Notes $ 345,938 $ — 2025 Senior Notes 446,500 424,016 Subordinated Notes 323,620 — Equipment Debt 56,879 1,122 Total $ 1,172,937 $ 425,138
Schedule of Information Regarding The Carrying Value Of Financial Instruments	The following table summarizes information regarding the carrying value of the Company’s financial instruments: December 31, (in thousands) 2021 2020 Financial assets measured at amortized cost: Cash and cash equivalents $ 48,419 $ 44,396 Accounts receivable 121,525 62,259 $ 169,944 $ 106,655 Financial liabilities measured at amortized cost: Accounts payable $ 34,326 $ 16,213 Current portion of long-term debt 14,789 406 Current portion of leases 27,254 12,610 Non-current 1,197,596 389,580 Non-current 200,326 135,263 Other accrued liabilities 87,813 22,771 $ 1,562,104 $ 576,843 Financial liabilities measured at fair value through earnings: Derivative in subordinated notes $ 7,522 $ — Financial liabilities measured at fair value through other comprehensive income: Interest rate contracts $ 53 $ —

Stock-Based Awards (Tables)

Stock-Based Awards (Tables)	12 Months Ended
	Dec. 31, 2021
Share-based Payment Arrangement [Abstract]
Summary of RSU Activity	RSUs represent a right to receive a share of common stock at a future vesting date with no cash payment from the holder. RSUs granted vest over two years from the date of grant. A summary of RSU activity is as follows: Number of RSUs Weighted- Average Grant Date Fair Value Aggregate Fair Value (in thousands) Outstanding and unvested at December 31, 2019 337,500 $ 3.89 Vested (337,500 ) 3.89 $ 1,313 Outstanding and unvested at December 31, 2020 — — Granted 2,029,032 2.41 Outstanding and unvested at December 31, 2021 2,029,032 $ 2.41 $ 4,890
Summary of the Stock Option Activity	A summary of the stock option activity is as follows: Number of Weighted- Weighted- Aggregate (in thousands) Outstanding at December 31, 2019 5,778,120 $ 2.47 Cancelled (18,000 ) 3.74 Outstanding at December 31, 2020 5,760,120 2.47 Granted 70,000 3.58 Exercised (150,000 ) 0.50 $ 413 Outstanding at December 31, 2021 5,680,120 $ 2.54 4.4 $ 2,344 Exercisable at December 31, 2021 5,060,719 $ 2.44 4.2 $ 2,344
Summary of Weighted-Average Fair Value and Underlying Assumptions	The weighted-average fair value and underlying assumptions are as follows: Fair value $ 1.39 Expected volatility 35.5 % Risk-free interest rate 1.2 % Expected life (years) 7.0 Dividend yield —

Supplemental Revenue Informat_2

Supplemental Revenue Information (Tables)	12 Months Ended
	Dec. 31, 2021
Revenue from Contract with Customer [Abstract]
Summary of Revenue Information	The following table summarizes the components of the Company’s revenues by payor category: Year Ended December 31, (in thousands) 2021 2020 Patient fee payors: Commercial $ 226,843 $ 193,917 Medicare 51,238 27,874 Medicaid 8,002 7,700 Other patient revenue 11,499 8,833 297,582 238,324 Hospitals and healthcare providers 118,491 — Other revenues 5,006 7,302 $ 421,079 $ 245,626

Cost of Operations, excluding_2

Cost of Operations, excluding Depreciation and Amortization (Tables)	12 Months Ended
	Dec. 31, 2021
Cost Of Operations Excluding Depreciation And Amortization [Abstract]
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization	The following table summarizes the components of the Company’s cost of operations, excluding depreciation and amortization: Year Ended December 31, (in thousands) 2021 2020 Employee compensation $ 164,053 $ 84,038 Third-party services and professional fees 63,301 30,183 Reading fees 42,842 37,818 Rent and utilities 37,158 30,203 Administrative 24,660 12,231 Medical supplies and other 27,721 11,162 $ 359,735 $ 205,635

Other Operating and Non-Opera_2

Other Operating and Non-Operating Losses (Gains) (Tables)	12 Months Ended
	Dec. 31, 2021
Other Income and Expenses [Abstract]
Schedule of Other Operating Losses (gains)	Other operating losses (gains) consist of the following: Year Ended December 31, (in thousands) 2021 2020 Gain on revaluation of earn-out $ — $ (5,457 ) Loss on disposal of property and equipment, net 748 1,327 Other gains (165 ) — $ 583 $ (4,130 )
Schedule Of Other Non-operating Losses (gains)	Other non-operating Year Ended December 31, (in thousands) 2021 2020 Loss on extinguishment of debt (Note 8) $ — $ 18,279 Loss on settlement of interest rate cap derivative (Note 8) — 4,162 Gain on conversion of debt to equity investment (Note 20) (3,360 ) — Earnings from equity method investments (291 ) — Other gains (339 ) (54 ) $ (3,990 ) $ 22,387

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Summary of reconciliation of income tax expense (benefit)	The income tax expense (benefit) shown in the consolidated statements of operations and comprehensive loss consists of the following: Year Ended December 31, (in thousands) 2021 2020 Current: Federal $ — $ — State 41 (138 ) Total current 41 (138 ) Deferred: Federal (25,362 ) 700 State (5,070 ) — Total deferred (30,432 ) 700 Total income tax expense (benefit) $ (30,391 ) $ 562
Summary Of Reconciliation Of Effective income tax rate amounts	A reconciliation of the total income tax expense (benefit) with the amount computed by applying the Canadian statutory tax rate of 26.5% to the loss before income taxes is as follows: Year Ended December 31, (in thousands) 2021 2020 Tax benefit at Canadian statutory rate $ (17,279 ) $ (8,902 ) Non-deductible 4,367 40 Stock-based compensation 973 397 Noncontrolling interests (2,246 ) (685 ) Valuation allowance (15,547 ) 8,916 Other (659 ) 796 Income tax expense (benefit) $ (30,391 ) $ 562
Summary of the Companys deferred tax assets and liabilities	Significant components of the Company’s net deferred tax assets (liabilities) are as follows: December 31, (in thousands) 2021 2020 Deferred tax assets: Net operating losses $ 54,050 $ 16,559 Lease-related liabilities 45,367 31,615 Accruals not currently deductible 27,538 13,332 Interest expense limitation 25,123 2,025 Othe r 11,760 6,192 Valuation allowanc e (2,398 ) (16,852 ) Total deferred tax asset s 161,440 52,871 Deferred tax liabilities : Intangible assets (50,213 ) (441 ) Operating lease right-of-use (42,642 ) (30,349 ) Property and equipment (42,474 ) (11,197 ) Basis difference in joint ventures (30,539 ) — Goodwill (13,979 ) (10,661 ) Other (5,620 ) (1,916 ) Total deferred tax liabilities (185,467 ) (54,564 ) Net deferred tax liabilities $ (24,027 ) $ (1,693 )
Summary Of Reconciliation Of Unrecognized Tax Benefits	A roll forward of the activity for the gross unrecognized tax benefits is as follows: (in thousands) 2021 Unrecognized tax benefits at January 1 $ — Increases for positions taken in current year 112 Decreases for positions taken in a prior year (7 ) Decreases for lapses in the applicable statute of limitations (25 ) Unrecognized tax benefits at December 31 $ 80

Basic and Diluted Loss per Sh_2

Basic and Diluted Loss per Share (Tables)	12 Months Ended
	Dec. 31, 2021
Earnings Per Share [Abstract]
Summary Of Earnings Per Share Basic And Diluted	Year ended December 31, (in thousands, except share and per share amounts) 2021 2020 Net loss attributable to common shareholders $ (43,291 ) $ (36,741 ) Weighted average common shares outstanding: Basic and diluted 76,836,032 70,101,618 Net loss per share attributable to common shareholders: Basic and diluted $ (0.56 ) $ (0.52 ) Employee stock options, warrants and restricted stock units excluded from the computation of diluted per share amounts as their effect would be antidilutive 2,215,163 1,664,231

Segment Information (Tables)

Segment Information (Tables)	12 Months Ended
	Dec. 31, 2021
Segment Reporting [Abstract]
Summary Of Revenue By Segment	The following table summarizes the Company’s revenues by segment: Year Ended December 31, (in thousands) 2021 2020 Radiology $ 374,402 $ 245,626 Oncology 46,677 — $ 421,079 $ 245,626
Summary Of Company's Adjusted EBITDA	The Company is unable to present comparable Adjusted EBITDA by segment for the year ended December 31, 2020, as it is impracticable to do so. The following table summarizes the Company’s Adjusted EBITDA for the year ended December 31, 2021: (in thousands) Year Ended December 31, 2021 Adjusted EBITDA: Radiology $ 64,992 Oncology 15,466 Corporate (13,555 ) $ 66,903
Summary of Net Income (Loss) to Total Adjusted EBITDA	A reconciliation of the net loss to total Adjusted EBITDA is shown below: Year Ended December 31, (in thousands) 2021 2020 Net loss $ (34,814 ) $ (34,156 ) Interest expense 62,575 32,781 Income tax expense (benefit) (30,391 ) 562 Depreciation and amortization 44,895 17,060 EBITDA 42,265 16,247 Adjustments: Stock-based compensation 2,792 2,084 Acquisition-related costs 20,233 1,079 Settlement and related costs (recoveries) (539 ) 2,324 Gain on revaluation of earn-out — (5,457 ) Loss on extinguishment of debt — 18,279 Loss on settlement of interest rate cap derivative — 4,162 Gain on conversion of debt to equity investment (3,360 ) — Severance, restructuring and other charges 3,368 — Other losses, net 342 407 Deferred rent expense 1,802 2,953 Adjusted EBITDA $ 66,903 $ 42,078
Schedule Of Segment Reporting Information By Segment	The following table summarizes the Company’s total assets by segment: December 31, (in thousands) 2021 2020 Identifiable assets: Radiology $ 1,451,905 $ 662,191 Oncology 440,416 — Corporate 26,505 2,861 Total $ 1,918,826 $ 665,052 The following table summarizes the Company’s capital expenditures by segment: Year Ended December 31, (in thousands) 2021 2020 Capital expenditures: Radiology $ 12,478 $ 5,344 Oncology 5,117 — Corporate 272 — Total $ 17,867 $ 5,344

Description of the Company - Ad

Description of the Company - Additional Information (Detail)	Dec. 31, 2021HospitalsStatesLocations
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Number of owned and or operated imaging locations | Locations	200
Number of hospitals for which services has been provided | Hospitals	1,000
Number of states of health systems for which services has been provided | States	46

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Summary of Property and Equipment and Estimated Useful Lives Using the Straight Line Method (Detail)	12 Months Ended
	Dec. 31, 2021
Leasehold improvements [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	Shorter of the lease term or estimated useful life
Minimum [Member] | Medical equipment and equipment under finance leases [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	2 years
Minimum [Member] | Office and computer equipment [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	2 years
Minimum [Member] | Transportation and service equipment [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	3 years
Minimum [Member] | Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	5 years
Maximum [Member] | Medical equipment and equipment under finance leases [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	10 years
Maximum [Member] | Office and computer equipment [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	7 years
Maximum [Member] | Transportation and service equipment [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	10 years
Maximum [Member] | Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	10 years

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Summary of Redeemable Noncontrolling Interests (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2021USD ($)
Accounting Policies [Abstract]
Balance, December 31, 2020	$ 0
Fair value at time of Alliance Acquisition	37,040
Net income attributable to redeemable noncontrolling interests	762
Contributions received from redeemable noncontrolling interests	1,239
Distributions paid to redeemable noncontrolling interests	(1,572)
Balance, December 31, 2021	$ 37,469

Summary of Significant Accoun_6

Summary of Significant Accounting Policies - Additional Information (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2021USD ($)Segments	Dec. 31, 2020USD ($)
Significant Accounting Policies [Line Items]
Assets	$ 1,918,826	$ 665,052
Liabilities	1,597,678	579,882
Net cash provided by (used in) operating activities	$ 17,050	18,615
Number of operating segments | Segments	2
Number of reportable segments | Segments	2
Redeemable noncontrolling interests	$ 37,469	$ 0
Minimum [Member]
Significant Accounting Policies [Line Items]
Lessee, operating lease, term of contract	3 years
Lessee, operating lease, renewal term	10 years
Minimum [Member] | Customer Concentration Risk [Member] | Revenue Benchmark [Member] | No Customer [Member]
Significant Accounting Policies [Line Items]
Concentration risk percentage	10.00%	10.00%
Minimum [Member] | Customer Concentration Risk [Member] | Accounts Receivable [Member] | No Customer [Member]
Significant Accounting Policies [Line Items]
Concentration risk percentage	10.00%	10.00%
Maximum [Member]
Significant Accounting Policies [Line Items]
Lessee, operating lease, term of contract	15 years
Lessee, operating lease, renewal term	30 years
Variable Interest Entity, Primary Beneficiary [member]
Significant Accounting Policies [Line Items]
Assets	$ 20,400	$ 34,100
Liabilities	600	2,400
Variable Interest Entity, , Revenues	173,600	139,200
Net cash provided by (used in) operating activities	$ 180,600	$ 134,700

Business Combinations - Summary

Business Combinations - Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows (Detail) - USD ($) $ / shares in Units, $ in Thousands	Apr. 30, 2021	Dec. 31, 2021	Sep. 01, 2021	Dec. 31, 2020	Dec. 31, 2019
Non-current assets
Goodwill		$ 840,353		$ 351,610	$ 355,667
Other intangible assets		414,146		$ 6,748
Sunrise Acquisition [Member]
Non-current assets
Property and equipment		521
Goodwill		279
Operating lease right-of-use assets		2,308
Non-current assets		3,108
Non-current liabilities
Obligations under operating leases		2,308
Purchase price		800
Florida Acquisition [Member]
Business Acquisition [Line Items]
Shares of common stock issued	974,999
Per share value of common stock issued	$ 3.09
Cash paid at closing	$ 3,000
Current assets
Accounts receivable		3,594
Prepaid expenses		83
Non-current assets
Property and equipment		483
Goodwill		32,610
Operating lease right-of-use assets		6,874
Other intangible assets		841
Assets		44,485
Current liabilities
Obligations under finance leases		136
Accounts payable and accrued liabilities		350
Non-current liabilities
Obligations under operating leases		6,874
Liabilities		7,360
Purchase price		37,125
Massachusetts Acquisition [Member]
Current assets
Cash		5
Accounts receivable		59
Non-current assets
Property and equipment		329
Goodwill		94
Operating lease right-of-use assets		1,413
Assets		1,900
Current liabilities
Accounts payable and accrued liabilities		33
Non-current liabilities
Obligations under operating leases		1,413
Liabilities		1,446
Purchase price (cash and shares)		454
Coral Springs [Member]
Current assets
Prepaid expenses		33
Non-current assets
Property and equipment		412
Goodwill		1,275
Other assets		369
Operating lease right-of-use assets		2,428
Assets		4,517
Non-current liabilities
Obligations under operating leases		2,428
Purchase price		2,089
Crystal Lake [Member]
Non-current assets
Property and equipment		820
Goodwill		400
Other assets		6
Operating lease right-of-use assets		555
Non-current assets		1,781
Non-current liabilities
Obligations under operating leases		555
Purchase price		$ 1,226
Alliance Acquisition [Member]
Business Acquisition [Line Items]
Shares of common stock issued		14,223,570
Per share value of common stock issued		$ 2.17
Fair value of common stock issued		$ 30,865
Cash paid at closing		748,490
Working capital and other adjustments		6,261
Total purchase price		785,616
Current assets
Cash		26,125
Acquired net working capital		14,221
Non-current assets
Property and equipment		206,475
Goodwill		455,760
Other assets		8,170
Operating lease right-of-use assets		69,919
Current liabilities
Equipment debt		54,673
Obligations under finance leases		9,041
Non-current liabilities
Obligations under operating leases		74,290
Deferred tax liability		52,760
Other liabilties		7,364
Liabilities		198,128
Net assets acquired		997,632
Less redeemable noncontrolling interests		37,040
Noncontrolling interests		174,976	$ 212,000
Purchase price		785,616
Alliance Acquisition [Member] | Customer Contracts [Member]
Non-current assets
Intangible assets		266,224
Alliance Acquisition [Member] | Trade Names [member]
Non-current assets
Intangible assets		69,108
Alliance Acquisition [Member] | Certificates Of Need [Member]
Non-current assets
Intangible assets		69,558
Alliance Acquisition [Member] | Third Party Management Agreements [Member]
Non-current assets
Intangible assets		10,200
Assets		$ 1,195,760

Business Combinations - Additio

Business Combinations - Additional information (Detail) - USD ($)	Sep. 01, 2021	Jun. 01, 2021	May 01, 2021	Apr. 30, 2021	Jan. 01, 2020	Jun. 30, 2020	Dec. 31, 2021	Dec. 31, 2021	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Goodwill							$ 840,353,000	$ 840,353,000	$ 840,353,000	$ 351,610,000	$ 355,667,000
Depreciation, Depletion and Amortization									44,895,000	17,060,000
Interest Expense									62,575,000	32,781,000
Acquisition related costs									20,233,000	1,079,000
Sunrise Acquisition [Member]
Business Acquisition [Line Items]
Business combination, consideration transferred			$ 800,000
Goodwill							279,000	279,000	279,000
Florida Acquisition [Member]
Business Acquisition [Line Items]
Business combination, consideration transferred			$ 34,500,000
Business combination, consideration transferred, equity interests issued and issuable				$ 3,000,000
Business acquisition, share price				$ 3.09
Business acquisition, equity interest issued or issuable, number of shares				974,999
Goodwill							32,610,000	32,610,000	32,610,000
Business combination provisional information initial incomplete adjustment consideration transferred							400,000
Massachusetts Acquisition [Member]
Business Acquisition [Line Items]
Business combination, consideration transferred		$ 400,000
Goodwill							94,000	94,000	94,000
Business combination provisional information initial incomplete adjustment consideration transferred							50,000
Coral Springs [Member]
Business Acquisition [Line Items]
Business combination, consideration transferred					$ 2,100,000	$ 100,000
Goodwill							1,275,000	1,275,000	1,275,000
Crystal Lake [Member]
Business Acquisition [Line Items]
Business combination, consideration transferred					$ 1,200,000	$ 100,000
Goodwill							$ 400,000	400,000	400,000
Alliance Acquisition [Member]
Business Acquisition [Line Items]
Business combination, consideration transferred	$ 785,600,000
Business acquisition, revenue								$ 155,200,000
Business combination, consideration transferred, equity interests issued and issuable									$ 748,490,000
Business acquisition, share price							$ 2.17	$ 2.17	$ 2.17
Business acquisition, equity interest issued or issuable, number of shares									14,223,570
Business acquisition, Percentage of voting interests acquired	100.00%
Business combination, Acquisition of less than hundred percent, Noncontrolling interest, Fair value	$ 212,000,000						$ 174,976,000	$ 174,976,000	$ 174,976,000
Goodwill							455,760,000	455,760,000	455,760,000
Acquisition related costs									$ 13,600,000
Business combination provisional information initial accounting incomplete accounting adjustments intangibles							52,400,000
Business combination provisional information initial accounting incomplete accounting adjustments operating lease right of use assets							12,700,000
Business combination provisional information initial accounting incomplete accounting adjustments accounts receivable							2,000,000
Goodwill purchase accounting adjustments							35,000,000
Business acquisition net income loss before tax								$ 4,500,000
Business combination provisional information initial accounting incomplete accounting adjustments deferred tax liabilities							$ 15,100,000
Alliance Acquisition [Member] | Acquisition-related Costs [Member]
Business Acquisition [Line Items]
Business acquisition, transaction costs										30,400,000
Depreciation, Depletion and Amortization										59,200,000
Interest Expense										$ 7,400,000
Alliance Acquisition [Member] | Radiology Segment [Member] | Operating Segments [Member]
Business Acquisition [Line Items]
Goodwill	297,400,000
Alliance Acquisition [Member] | Oncology Segment [Member] | Operating Segments [Member]
Business Acquisition [Line Items]
Goodwill	$ 158,400
Alliance Acquisition [Member] | Business Acquisition Financing Events [Member]
Business Acquisition [Line Items]
Stock issued during the period shares	14,223,570
Sale of stock issue price per share	$ 2.17
Alliance Acquisition [Member] | Business Acquisition Financing Events [Member] | Stonepeak Magnet Holdings LP [Member]
Business Acquisition [Line Items]
Business combination, consideration transferred	$ 10,400,000
Stock issued during the period shares	3,500,000
Sale of stock issue price per share	$ 2.98
Alliance Acquisition [Member] | Business Acquisition Financing Events [Member] | 2028 Senior Notes [Member]
Business Acquisition [Line Items]
Proceeds from issuance of senior long term debt	$ 375,000,000
Debt instrument interest rate stated percentage	7.50%
Alliance Acquisition [Member] | Business Acquisition Financing Events [Member] | Unsecured Debt [Member] | Stonepeak Magnet Holdings LP [Member]
Business Acquisition [Line Items]
Proceeds from issuance of unsecured debt	$ 340,000,000

Business Combination - Summary

Business Combination - Summary of pro forma data is presented for illustrative purposes as follows (Detail) - Alliance Acquisition [Member] - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Business Acquisition Pro Forma Information [Line Items]
Pro forma net revenues	$ 746,550	$ 741,834
Pro forma net loss before income taxes	$ (132,494)	$ (181,554)

Business Combination - Summar_2

Business Combination - Summary of significant unobservable inputs used in the fair value measurement of the Company's identifiable intangible assets are growth and attrition rates, discount rate and royalty rate (Detail) $ in Thousands	Sep. 30, 2021	Sep. 01, 2021USD ($)
Customer Contracts [Member] | Attrition Rate [Member] | Measurement Input, Discount Rate [Member] | Minimum [Member] | Level 3 [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination Acquired Finite Lived Intangible Asset Measurement Input	9
Customer Contracts [Member] | Attrition Rate [Member] | Measurement Input, Discount Rate [Member] | Maximum [Member] | Level 3 [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination Acquired Finite Lived Intangible Asset Measurement Input	12.3
Alliance Acquisition [Member] | Customer Contracts [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Fair Value		$ 266,224
Alliance Acquisition [Member] | Customer Contracts [Member] | Attrition Rate [Member] | Measurement Input Attrition Rate [Member] | Minimum [Member] | Level 3 [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination Acquired Finite Lived Intangible Asset Measurement Input	2.8
Alliance Acquisition [Member] | Customer Contracts [Member] | Attrition Rate [Member] | Measurement Input Attrition Rate [Member] | Maximum [Member] | Level 3 [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination Acquired Finite Lived Intangible Asset Measurement Input	5.8
Alliance Acquisition [Member] | Customer Contracts [Member] | Attrition Rate [Member] | Measurement Input, Long-term Revenue Growth Rate [Member] | Level 3 [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination Acquired Finite Lived Intangible Asset Measurement Input	3
Alliance Acquisition [Member] | Trade Names [member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Fair Value		69,108
Alliance Acquisition [Member] | Trade Names [member] | Relief From Royalty Method [Member] | Measurement Input, Discount Rate [Member] | Minimum [Member] | Level 3 [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination Acquired Finite Lived Intangible Asset Measurement Input	9
Alliance Acquisition [Member] | Trade Names [member] | Relief From Royalty Method [Member] | Measurement Input, Discount Rate [Member] | Maximum [Member] | Level 3 [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination Acquired Finite Lived Intangible Asset Measurement Input	12.3
Alliance Acquisition [Member] | Trade Names [member] | Relief From Royalty Method [Member] | Measurement Input Royalty Rate [Member] | Level 3 [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination Acquired Finite Lived Intangible Asset Measurement Input	1.5
Alliance Acquisition [Member] | Certificates Of Need [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Indefinite-lived Intangible Assets (Excluding Goodwill), Fair Value Disclosure		$ 69,558
Alliance Acquisition [Member] | Certificates Of Need [Member] | Valuation, Cost Approach [Member] | Measurement Input, Discount Rate [Member] | Minimum [Member] | Level 3 [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination Acquired Indefinite Lived Intangible Asset Measurement Input	9
Alliance Acquisition [Member] | Certificates Of Need [Member] | Valuation, Cost Approach [Member] | Measurement Input, Discount Rate [Member] | Maximum [Member] | Level 3 [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination Acquired Indefinite Lived Intangible Asset Measurement Input	12.3

Property and Equipment - Summar

Property and Equipment - Summary of Detailed Information of Property and Equipment (Detail) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	$ 337,406	$ 106,866
Accumulated depreciation	78,284	43,152
Total property and equipment – net	259,122	63,714
Medical equipment [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	227,796	62,406
Leasehold improvements [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	39,763	19,360
Equipment under finance leases [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	34,597	23,169
Total property and equipment – net	22,200	15,000
Office and computer equipment [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	16,701	452
Transportation and service equipment [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	8,996	0
Furniture and fixtures [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	3,130	1,479
Construction in progress [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	$ 6,423	$ 0

Property and Equipment - Additi

Property and Equipment - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Property and equipment - net	$ 259,122	$ 63,714
Depreciation	36,400	14,400
Equipment under finance leases [Member]
Property, Plant and Equipment [Line Items]
Property and equipment - net	$ 22,200	$ 15,000

Goodwill - Schedule of Goodwill

Goodwill - Schedule of Goodwill (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Goodwill [Line Items]
Balance – Beginning of period	$ 351,610	$ 355,667
Acquisitions	488,743	1,675
Adjustments		(5,732)
Balance – End of period	840,353	351,610
Radiology [Member]
Goodwill [Line Items]
Balance – Beginning of period	351,610	355,667
Acquisitions	330,383	1,675
Adjustments		(5,732)
Balance – End of period	681,993	$ 351,610
Oncology [Member]
Goodwill [Line Items]
Acquisitions	158,360
Balance – End of period	$ 158,360

Goodwill - Schedule Of Signific

Goodwill - Schedule Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill (Detail)	Oct. 01, 2021
Minimum [Member]
Disclosure In Tabular Form Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill [Line Items]
Goodwill Measurement Input Earnings Before Interest Tax Depreciation And Amortization	7.5
Maximum [Member]
Disclosure In Tabular Form Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill [Line Items]
Goodwill Measurement Input Earnings Before Interest Tax Depreciation And Amortization	10.5
Measurement Input, Discount Rate [Member]
Disclosure In Tabular Form Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill [Line Items]
Goodwill Measurement Input	9.5
Measurement Input Perpetual Growth Rate
Disclosure In Tabular Form Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill [Line Items]
Goodwill Measurement Input	2.5
Measurement Input Tax Rate
Disclosure In Tabular Form Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill [Line Items]
Goodwill Measurement Input	26
Measurement Input Risk Free Interest Rate
Disclosure In Tabular Form Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill [Line Items]
Goodwill Measurement Input	2.5

Goodwill - Additional Informati

Goodwill - Additional Information (Detail)	Oct. 01, 2021
Radiology
Disclosure In Tabular Form Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill
Reporting unit perentage of fair value in excess of carrying amount	4.00%
Oncology
Disclosure In Tabular Form Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill
Reporting unit perentage of fair value in excess of carrying amount	2.00%

Other Intangible Assets - Sched

Other Intangible Assets - Schedule Of Intangible Assets Excluding Goodwill (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Gross Carrying Amount	$ 358,704,000	$ 12,331,000
Finite-Lived Intangible Assets, Accumulated Amortization	(14,116,000)	(5,583,000)
Finite-Lived Intangible Assets, Net	344,588,000	6,748,000
Indefinite-lived Intangible Assets (Excluding Goodwill)	69,558,000	0
Intangible Assets, Net (Including Goodwill)	$ 414,146,000	6,748,000
Customer Contracts [Member]
Finite-Lived Intangible Assets [Line Items]
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life	20 years
Finite-Lived Intangible Assets, Gross Carrying Amount	$ 266,224,000
Finite-Lived Intangible Assets, Accumulated Amortization	(4,437,000)
Finite-Lived Intangible Assets, Net	$ 261,787,000
Trade Names [Member]
Finite-Lived Intangible Assets [Line Items]
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life	18 years
Finite-Lived Intangible Assets, Gross Carrying Amount	$ 77,466,000	7,823,000
Finite-Lived Intangible Assets, Accumulated Amortization	(6,054,000)	(3,258,000)
Finite-Lived Intangible Assets, Net	$ 71,412,000	4,565,000
Management Agreements [Member]
Finite-Lived Intangible Assets [Line Items]
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life	17 years
Finite-Lived Intangible Assets, Gross Carrying Amount	$ 10,200,000
Finite-Lived Intangible Assets, Accumulated Amortization	(200,000)
Finite-Lived Intangible Assets, Net	$ 10,000,000
Other Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life	4 years
Finite-Lived Intangible Assets, Gross Carrying Amount	$ 4,814,000	4,508,000
Finite-Lived Intangible Assets, Accumulated Amortization	(3,425,000)	(2,325,000)
Finite-Lived Intangible Assets, Net	$ 1,389,000	$ 2,183,000

Other Intangible Assets - Summa

Other Intangible Assets - Summary of Finite-Lived Intangible Assets Net Amortization Expense (Detail) $ in Thousands	Dec. 31, 2021USD ($)
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract]
2022	$ 19,814
2023	18,837
2024	18,132
2025	17,475
2026	17,421
Thereafter	252,909
Total	$ 344,588

Other Intangible Assets - Addit

Other Intangible Assets - Additional Information (Detail) - USD ($)	Dec. 31, 2021	Dec. 31, 2020
Indefintely lived intangible assets	$ 69,558,000	$ 0
Amortization expense of finite-lived intangible assets	$ 8,500	$ 2,700

Long-Term Debt - Summary of Lon

Long-Term Debt - Summary of Long term debt consists (Detail) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term Debt, Gross	$ 1,281,297	$ 401,129
Debt discount and deferred issuance costs	(68,912)	(11,143)
Long-term Debt	1,212,385	389,986
Less current portion	14,789	406
Long-term debt, net of current portion	1,197,596	389,580
2028 Senior Notes [Member]
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term Debt, Gross	375,000	0
2025 Senior Notes [Member]
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term Debt, Gross	475,000	400,000
Subordinated Debt [Member]
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term Debt, Gross	372,470	0
Equipment Debt [Member]
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term Debt, Gross	$ 58,827	$ 1,129

Long-Term Debt - Summary The mi

Long-Term Debt - Summary The minimum annual principal payments with respect to long-term debt (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
2022	$ 14,789
2023	15,807
2024	13,009
2025	484,376
2026	2,570
Thereafter	750,746
Long-term Debt, Gross	$ 1,281,297	$ 401,129

Long-Term Debt -Summary of Disc

Long-Term Debt -Summary of Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants And Derivatives (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2021	Dec. 31, 2020
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Equity equity related warrants and debt at fair value.	$ 350,430	$ 350,430
Stonepeak Shares		10,505	$ 0
Stonepeak Notes		22,037	$ 15,216
Stone Peak Magnet [Member]
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Stonepeak Notes	318,082	318,082
Stonepeak Shares	10,430	10,430
Stonepeak Warrants	$ 21,918	$ 21,918
Stonepeak Notes	90.80%	90.80%
Stonepeak Shares	3.00%	3.00%
Stonepeak Warrants	6.20%	6.20%
Equity equity related warrants and debt fair value percentage.	100.00%	100.00%
Stonepeak Notes	$ 318,082
Stonepeak Shares	10,430
Stonepeak Warrants	21,918
Proceeds from the issuance of debt and equity.	350,430
Stonepeak Notes	13,116
Stonepeak Shares	430
Stonepeak Warrants	904
Payment of Financing and Stock Issuance Costs	14,450
Stonepeak Notes	304,966
Stonepeak Shares	10,000
Stonepeak Warrants	21,014
Proceeds from equity debt equity related warrants and embedded derivatives net before adjusting prepaid transaction costs.	335,980
Stonepeak Notes	(7,622)
Embedded Derivative	7,622
Embedded derivative net adjustment.	0
Stonepeak Notes	6,649
Stonepeak Shares	0
Stonepeak Warrants	0
Allocation of stock warrants and subordinated debt costs to prepaid transaction costs.	6,649
Stonepeak Notes	303,993
Stonepeak Shares	10,000
Stonepeak Warrants	21,014
Embedded Derivative	7,622
Proceeds from subordinated debt shares warrants and embedded derivatives after adjustment of prepaid transaction costs	$ 342,629

Long-Term Debt - Additional Inf

Long-Term Debt - Additional Information (Details)	Dec. 31, 2021USD ($)Agreementshares$ / shares	Sep. 01, 2021USD ($)$ / sharesshares	Aug. 31, 2021USD ($)	Aug. 09, 2021USD ($)	Aug. 01, 2021shares	Dec. 31, 2021USD ($)Agreementshares$ / shares	Dec. 31, 2021USD ($)Agreementshares$ / shares	Aug. 31, 2021USD ($)	Dec. 31, 2020USD ($)
Debt Instrument [Line Items]
Payments For Debt Issuance Costs							$ 22,037,000		$ 15,216,000
Long-term Debt	$ 1,212,385,000					$ 1,212,385,000	1,212,385,000		389,986,000
Stock issued during the period value other							10,000,000
Paid In Kind Interest							$ 15,470,000		2,241,000
Common Stock Warrants [Member]
Debt Instrument [Line Items]
Class of warrants or rights number of securities called by the warrants or rights | shares		17,114,093
Class of warrants or rights exercise price per unit | $ / shares		$ 2.98
Stock issued during the period shares other | shares					3,500,000
Stock issued during the period value other		$ 10,400,000
Warrants and rights outstanding term		10 years
Stone Peak Magnet [Member]
Debt Instrument [Line Items]
Payments For Debt Issuance Costs	$ 6,500,000
Debt instrument effective interest rate percentage	13.00%					13.00%	13.00%
Proceeds from common stock subordinated notes and warrants							$ 350,400,000
Discount on common stock and warrants							21,900,000
Embedded derivative liability	$ 7,600,000					$ 7,600,000	7,600,000
Debt prepayment premium	17,000,000					17,000,000	17,000,000
Subordinated debt	354,700,000					354,700,000	354,700,000
Stone Peak Magnet [Member] | Other Non operating Income Expense
Debt Instrument [Line Items]
Embedded derivative liability	$ 7,500,000					$ 7,500,000	7,500,000
Unrealized gain loss on embedded derivatives							$ 100,000
Stone Peak Magnet [Member] | Common Stock Warrants [Member]
Debt Instrument [Line Items]
Business combination share price | $ / shares		$ 2.98
Class of warrants or rights fair value per warrant | $ / shares	$ 1.2807					$ 1.2807	$ 1.2807
Warrants not settleable in cash fair value disclosure	$ 21,900,000					$ 21,900,000	$ 21,900,000
Stone Peak Magnet [Member] | Common Stock Warrants [Member] | Measurement Input, Share Price [Member]
Debt Instrument [Line Items]
Warrants and rights outstanding measurement input | shares	2.98					2.98	2.98
Stone Peak Magnet [Member] | Common Stock Warrants [Member] | Measurement Input, Price Volatility [Member]
Debt Instrument [Line Items]
Warrants and rights outstanding measurement input | Agreement	56					56	56
Stone Peak Magnet [Member] | Common Stock Warrants [Member] | Measurement Input, Risk Free Interest Rate [Member]
Debt Instrument [Line Items]
Warrants and rights outstanding measurement input | Agreement	1.30					1.30	1.30
Stone Peak Magnet [Member] | Common Stock Warrants [Member] | Measurement Input, Expected Term [Member]
Debt Instrument [Line Items]
Warrants and rights outstanding term	10 years					10 years	10 years
2028 Senior Notes [Member]
Debt Instrument [Line Items]
Debt Face Amount				$ 375,000,000
Debt Interest Rate			7.50%					7.50%
Debt Maturity Date								Aug. 1, 2028
Payments For Debt Issuance Costs				$ 7,800,000
Long-term Debt			$ 367,700,000					$ 367,700,000
Debt instrument effective interest rate percentage			7.88%					7.88%
2020 Revolving Facility [Member]
Debt Instrument [Line Items]
Long-term Debt	$ 0					$ 0	$ 0		$ 0
Subordinated Debt [Member]
Debt Instrument [Line Items]
Unamortized debt issuance costs			$ 53,000,000					$ 53,000,000
Subordinated Debt [Member] | Stone Peak Magnet [Member]
Debt Instrument [Line Items]
Debt Face Amount	372,500,000	$ 357,000,000				372,500,000	372,500,000
Long-term Debt	$ 318,000,000					$ 318,000,000	$ 318,000,000
Term for excercising the option for payment of interest either in cash or in kind			2 years
Period after which the debt instrument may be redeemed	7 years
Debt instrument prepayment premium percentage	5.00%	5.00%				5.00%	5.00%
Debt prepayment premium	$ 17,800,000	$ 17,000,000				$ 17,800,000	$ 17,800,000
Unamortized debt issuance costs		53,000,000
Paid In Kind Interest							$ 14,700,000
Accretion Of Prepayment Premium						$ 700,000
Subordinated Debt [Member] | Stone Peak Magnet [Member] | Year One From The Issuance Date [Member]
Debt Instrument [Line Items]
Debt instrument percentage of the principal amount redeemable	25.00%
Subordinated Debt [Member] | Stone Peak Magnet [Member] | Year Seven From The Issuance Date [Member]
Debt Instrument [Line Items]
Debt instrument percentage of the principal amount redeemable	5.00%
Subordinated Debt [Member] | Stone Peak Magnet [Member] | Eleventh Year From The Date Of Maturity [Member]
Debt Instrument [Line Items]
Debt instrument percentage of the principal amount redeemable	50.00%
Interest accured on the overdue principal amount	5.00%					5.00%	5.00%
Subordinated Debt [Member] | Stone Peak Magnet [Member] | Twelfth Year From The Date Of Maturity [Member]
Debt Instrument [Line Items]
Interest accured on the overdue principal amount	5.00%					5.00%	5.00%
Subordinated Debt [Member] | Stone Peak Magnet [Member] | Additional Amount That Can Be Withdrawn [Member]
Debt Instrument [Line Items]
Debt Face Amount	$ 349,600,000					$ 349,600,000	$ 349,600,000
Percentage of the additional amount borrowed	20.00%
Percentage of the volume weighted average price of common shares	120.00%
Number of consecutive days for determining the volume weighted average price per shares	10 days
Unfunded commitement.	$ 349,600,000					$ 349,600,000	$ 349,600,000
Subordinated Debt [Member] | Stone Peak Magnet [Member] | Payable In Kind [Member]
Debt Instrument [Line Items]
Debt Interest Rate			13.00%					13.00%
Subordinated Debt [Member] | Stone Peak Magnet [Member] | Payable In Cash [Member]
Debt Instrument [Line Items]
Debt Interest Rate			11.00%					11.00%
Subordinated Debt [Member] | Unsecured Notes Purchased [Member]
Debt Instrument [Line Items]
Debt Face Amount		$ 340

Finance Leases - Summary of Fin

Finance Leases - Summary of Finance Lease Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Obligations under finance leases	$ 22,411	$ 15,574
Less current portion	6,460	3,265
Non-current obligations under finance leases	$ 15,951	$ 12,309

Finance Leases - Summary of F_2

Finance Leases - Summary of Finance Lease Cost (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Amortization expense for equipment under finance leases	$ 4,184	$ 2,927
Interest expense on finance lease liabilities	885	637
Finance lease cost	$ 5,069	$ 3,564

Finance Leases - Summary of Und

Finance Leases - Summary of Undiscounted Cash Flows For Finance Leases (Detail) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Finance Lease, Liability, Payment, Due [Abstract]
2022	$ 7,424
2023	5,906
2024	5,414
2025	3,652
2026	1,743
Thereafter	587
Total minimum lease payments	24,726
Less amount of lease payments representing interest	2,315
Present value of future minimum lease payments	22,411	$ 15,574
Less current portion	6,460	3,265
Non-current obligations under finance leases	$ 15,951	$ 12,309

Finance Leases - Summary of F_3

Finance Leases - Summary of Finance Lease Term and Discount Rates (Detail)	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Weighted average remaining lease term – finance leases (years)	3 years 10 months 24 days	4 years 10 months 24 days
Weighted average discount rate – finance leases	5.20%	4.60%

Finance Leases - Summary of Sup

Finance Leases - Summary of Supplemental Cash Flow Information Related to Finance Leases (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Operating cash flows from finance leases	$ 877	$ 637
Equipment acquired in exchange for finance lease obligations	$ 1,070	$ 8,817

Operating Leases - Summary of O

Operating Leases - Summary of Operating Lease Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Obligations under operating leases	$ 205,169	$ 132,299
Less current portion	20,794	9,345
Non-current obligations under operating leases	$ 184,375	$ 122,954

Operating Leases - Summary of_2

Operating Leases - Summary of Operating Lease Cost (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Operating lease cost	$ 27,027	$ 20,625
Variable lease cost	4,515	4,109
Short-term lease cost	671	247
Total operating lease cost	$ 32,213	$ 24,981

Operating Leases - Summary of U

Operating Leases - Summary of Undiscounted Cash Flows For Operating Leases (Detail) - USD ($)	Dec. 31, 2021	Dec. 31, 2020
Lessee, Operating Lease, Liability, Payment, Due [Abstract]
2022	$ 34,990
2023	33,294
2024	30,385
2025	26,430
2026	22,922
Thereafter	175,681
Total minimum lease payments	323,702,000
Less: Amount of lease payments representing interest	118,533,000
Present value of future minimum lease payments	205,169,000	$ 132,299,000
Less current portion	20,794,000	9,345,000
Non-current obligations under operating leases	$ 184,375,000	$ 122,954,000

Operating Leases - Summary of_3

Operating Leases - Summary of Operating Lease Term and Discount Rates (Detail)	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Weighted average remaining lease term-operating leases (years)	11 years 4 months 24 days	12 years 8 months 12 days
Weighted average discount rate-operating leases	7.70%	7.40%

Operating Leases - Summary of S

Operating Leases - Summary of Supplemental Cash Flow Information Related To Operating Leases (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Operating cash flows from operating leases	$ 25,245	$ 17,672
Right-of-use assets obtained in exchange for operating lease obligations	$ 3,769	$ 10,818

Other Accrued Liabilities - Sum

Other Accrued Liabilities - Summary of Other Accrued Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Payables and Accruals [Abstract]
Accrued compensation and related expenses	$ 26,486	$ 3,831
Accrued interest expense	16,840	4,588
MAAPP funds (Note 24)	2,398	3,085
Earn-out liability (Note 12)	0	4,689
Other	42,089	6,578
Total	$ 87,813	$ 22,771

Earn-Out Liability - Additional

Earn-Out Liability - Additional Information (Detail) - ADG [Member] - Earn-out liability [Member] $ in Millions	12 Months Ended
	Dec. 31, 2020USD ($)	Dec. 31, 2019USD ($)
Business Acquisition, Contingent Consideration [Line Items]
Business combination contingent consideration liability	$ 9.4	$ 14.8
Change in amount of contingent consideration liability	5.5
Payment of contingent consideration liability	$ 4.7
Level 3 [Member]
Business Acquisition, Contingent Consideration [Line Items]
Business combination contingent consideration liability		$ 14.7
Level 3 [Member] | Measurement Input, Discount Rate [Member]
Business Acquisition, Contingent Consideration [Line Items]
Contingent consideration liability measurement input (%)		7

Senior loans payable - Addition

Senior loans payable - Additional Information (Detail) - USD ($) $ in Thousands	Feb. 11, 2021	Dec. 31, 2020	Nov. 02, 2020	Feb. 10, 2021	Dec. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Payments For Debt Issuance Costs					$ 22,037	$ 15,216
Loss on extinguishment of debt					0	(18,279)
Long-term Debt, Gross		$ 401,129			1,281,297	401,129
Loss on settlement of interest rate cap derivative (Note 8)					0	(4,162)
7.0% senior secured notes [Member]
Debt Instrument [Line Items]
Debt Face Amount	$ 75,000		$ 400,000
Debt Interest Rate	7.00%		7.00%
Debt Maturity Date			Nov. 1, 2025
2025 Senior Notes [Member]
Debt Instrument [Line Items]
Debt Face Amount	$ 75,000		$ 400,000		475,000
Debt Maturity Date			Nov. 1, 2025
Cash			$ 19,000
Payments For Debt Issuance Costs	1,100		11,500
Line of credit facility maximum borrowing capacity		50,000				50,000
Debt Instrument, Unamortized Premium	$ 3,750
Loss on extinguishment of debt			$ 18,300
Minimum debt instrument holders percentage to declare amount immediately due in debt default			25.00%
Debt instrument Premium Percentage	5.00%
Debt Instrument, Increase, Accrued Interest				$ 1,400
Long-term Debt, Gross					468,000
Loss on settlement of interest rate cap derivative (Note 8)			$ 4,200
2020 Revolving Facility [Member]
Debt Instrument [Line Items]
Line of credit facility maximum borrowing capacity		55,000			$ 55,000	$ 55,000
Line of credit maturity period						5 years
Line of credit facility issuance costs		$ 2,000				$ 2,000
Annual Commitment Fee Capped Percentage		0.50%
Line of credit debt service coverage ratio					30.00%
Total Commitment amount					$ 55,000
Prior Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Line of credit facility issuance costs		$ 900				$ 900

Financial Instruments - Schedul

Financial Instruments - Schedule of Fair Value Measurements, Recurring and Nonrecurring (Details) - Fair Value, Recurring [Member] - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Derivative In Subordinated Notes [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial Liabilities Fair Value Disclosure	$ 7,522	$ 0
Derivative In Subordinated Notes [Member] | Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial Liabilities Fair Value Disclosure	0	0
Derivative In Subordinated Notes [Member] | Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial Liabilities Fair Value Disclosure	0	0
Derivative In Subordinated Notes [Member] | Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial Liabilities Fair Value Disclosure	7,522	0
Interest Rate Contracts [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial Liabilities Fair Value Disclosure	53	0
Interest Rate Contracts [Member] | Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial Liabilities Fair Value Disclosure	0	0
Interest Rate Contracts [Member] | Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial Liabilities Fair Value Disclosure	53	0
Interest Rate Contracts [Member] | Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial Liabilities Fair Value Disclosure	$ 0	$ 0

Financial Instruments - Summary

Financial Instruments - Summary of Reconciliation of Liability Related to the Embedded Derivative (Details) - Subordinated Debt [Member] - Stone Peak Magnet - Level 3 [Member] $ in Thousands	12 Months Ended
	Dec. 31, 2021USD ($)
Disclosure Of Movement In Embedded Derivative Liabilities [Line Items]
Balance, December 31, 2020	$ 0
Fair value at time of Alliance Acquisition	7,622
Change in fair value	(100)
Balance, December 31, 2021	$ 7,522

Financial Instruments - Sched_2

Financial Instruments - Schedule Of Fair Value Of Other Current And Non Current Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	$ 1,172,937	$ 425,138
2028 Senior Notes [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	345,938	0
2025 Senior Notes [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	446,500	424,016
Subordinated Notes [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	323,620	0
Equipment Debt [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	$ 56,879	$ 1,122

Financial Instruments - Sched_3

Financial Instruments - Schedule of Information Regarding The Carrying Value Of Financial Instruments (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash and cash equivalents	$ 48,419	$ 44,396	$ 23,389
Accounts receivable	121,525	62,259
Accounts payable	34,326	16,213
Current portion of long-term debt	14,789	406
Non-current portion of long-term debt	1,197,596	389,580
Reported Value Measurement [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash and cash equivalents	48,419	44,396
Accounts receivable	121,525	62,259
Financial assets measured at amortized cost	169,944	106,655
Accounts payable	34,326	16,213
Current portion of long-term debt	14,789	406
Current portion of leases	27,254	12,610
Non-current portion of long-term debt	1,197,596	389,580
Non-current portion of leases	200,326	135,263
Other accrued liabilities	87,813	22,771
Financial liabilities measured at amortized cost	1,562,104	576,843
Derivative in subordinated notes	7,522	0
Interest rate contracts	$ 53	$ 0

Financial Instruments - Additio

Financial Instruments - Additional Information (Detail) $ in Millions	12 Months Ended
	Dec. 31, 2021USD ($)yr	Sep. 01, 2021yr
Level 3 [Member] | Measurement Input Probability Weighted Time
Embedded derivative liability measurment input | yr	4.2	4.1
Level 3 [Member] | Measurement Input Probability Of Exit Event Percentage [Member]
Embedded derivative liability measurment input	24.5	25
Equipment Debt [Member]
Long term debt unhedged | $	$ 1.8
Revolving Credit Facility [Member] | Interest Rate Contract [Member]
Increase decrease in the variable rate of interest	1.00%

Stock-Based Awards - Summary of

Stock-Based Awards - Summary of RSU Activity (Detail) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Payment Arrangement [Abstract]
Number of RSUs, Outstanding and unvested	0	337,500
Number of RSUs, Vested		(337,500)
Number of RSUs, Granted	2,029,032
Number of RSUs, Outstanding and unvested	2,029,032	0
Weighted-Average Grant Date Fair Value, Outstanding and unvested	$ 0	$ 3.89
Weighted-Average Grant Date Fair Value, Vested		3.89
Weighted-Average Grant Date Fair Value, Granted	2.41
Weighted-Average Grant Date Fair Value, Outstanding and unvested	$ 2.41	$ 0
Aggregate Fair Value, Vested		$ 1,313
Aggregate Fair Value, Outstanding and unvested	$ 4,890

Stock-Based Awards - Summary _2

Stock-Based Awards - Summary of the Stock Option Activity (Detail) - Stock Options [Member] - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of Options, Outstanding	5,760,120	5,778,120
Number of Options, Cancelled		(18,000)
Number of Options, Granted	70,000
Number of Options, Exercised	(150,000)
Number of Options, Exercisable	5,060,719
Number of Options, Outstanding	5,680,120	5,760,120
Weighted- Average Exercise price, Outstanding	$ 2.47	$ 2.47
Weighted- Average Exercise price, Cancelled		3.74
Weighted-Average Exercise price, Granted	3.58
Weighted-Average Exercise price, Exercised	0.50
Weighted-Average Exercise price, Exercisable	2.44
Weighted- Average Exercise price, Outstanding	$ 2.54	$ 2.47
Weighted- Average Remaining Contractual Term, Outstanding	4 years 4 months 24 days
Weighted-Average Remaining Contractual Term, Exercisable	4 years 2 months 12 days
Aggregate Intrinsic Value, Exercised	$ 413
Aggregate Intrinsic Value, Outstanding	2,344
Aggregate Intrinsic Value, Exercisable	$ 2,344

Stock-Based Awards - Summary _3

Stock-Based Awards - Summary of Weighted-Average Fair Value and Underlying Assumptions (Detail) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021USD ($)$ / shares
Share-based Payment Arrangement [Abstract]
Fair value | $ / shares	$ 1.39
Expected volatility	35.50%
Risk-free interest rate	1.20%
Expected life (years)	7 years
Dividend yield | $	$ 0

Stock-Based Awards - Additional

Stock-Based Awards - Additional Information (Detail) $ in Millions	Nov. 14, 2017	Dec. 31, 2021USD ($)shares	Dec. 31, 2020USD ($)shares
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share-based Payment Arrangement, Expense		$ 2.8	$ 2.1
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount		$ 3.3
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition		1 year 10 months 24 days
Restricted Stock Units (RSUs) [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Terms of Award	two years
Employee Stock Option
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period	3 years
Employee Stock Option | Minimum [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Terms of Award		7
Employee Stock Option | Maximum [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Terms of Award		10 years
2017 Stock Plans
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Percent Common stock options reserved for issuance	10
Common stock options reserved for issuance | shares		8,902,699	7,017,842

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Details) - Commitement For The Purchase Of Equipment [Member] $ in Millions	Dec. 31, 2021USD ($)
Loss Contingencies [Line Items]
Purchase Obligation	$ 24.8
Within Next Twelve Months [Member]
Loss Contingencies [Line Items]
Purchase Obligation	15.9
Greater Than Twelve Months [Member]
Loss Contingencies [Line Items]
Purchase Obligation	$ 8.9

Supplemental Revenue Informat_3

Supplemental Revenue Information - Summary of Revenue Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Disaggregation of Revenue [Line Items]
Other revenue	$ 5,006	$ 7,302
Total revenue	421,079	245,626
Sales Channel, Directly to Consumer [Member]
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	297,582	238,324
Commercial | Sales Channel, Directly to Consumer [Member]
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	226,843	193,917
Medicare | Sales Channel, Directly to Consumer [Member]
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	51,238	27,874
Medicaid | Sales Channel, Directly to Consumer [Member]
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	8,002	7,700
Other patient revenue | Sales Channel, Directly to Consumer [Member]
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	11,499	8,833
Hospitals and healthcare providers | Sales Channel, Through Intermediary [Member]
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	$ 118,491	$ 0

Cost of Operations, excluding_3

Cost of Operations, excluding Depreciation and Amortization - Summary of Cost of Goods and Services Excluding Depletion Depreciation And Amortization (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization (note 22)	$ 359,735	$ 205,635
Employee compensation
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization (note 22)	164,053	84,038
Third party services and professional fees
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization (note 22)	63,301	30,183
Reading fees
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization (note 22)	42,842	37,818
Rent and utilities
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization (note 22)	37,158	30,203
Administrative
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization (note 22)	24,660	12,231
Medical supplies and other
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization (note 22)	$ 27,721	$ 11,162

Supplemental Statement of Ope_2

Supplemental Statement of Operations Information - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Acquisition-related costs	$ 20,233	$ 1,079
Settlement cost related to four vendors		$ 1,100
Loss Contingency Settlement Maturity Date		Jan. 31, 2021
Loss From Catastrophes Member
Amount related to a settlement of recovery from insurance	1,300
Federal Health Care Programs to Subsidiaries or Revenue Practice
Amount related to a settlement of government investigation		$ 800
Alliance Acquisition [Member]
Acquisition-related costs	$ 13,600

Other Operating and Non-Opera_3

Other Operating and Non-Operating Losses (Gains) - Schedule of Other Operating Losses (gains) (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Schedule Of Other Operating Cost And Expense By Component
Gain on revaluation of earn-out liability (Note 12)	$ 0	$ (5,457)
Loss on disposal of property and equipment, net	748	1,327
Other gains	(165)	0
Other Operating Losses (gains)	$ 583	$ (4,130)

Other Operating and Non-Opera_4

Other Operating and Non-Operating Losses (Gains) - Schedule Of Other Non-operating Losses (gains) (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Schedule Of Other Non operating Income Expense [Line Items]
Loss on extinguishment of debt (Note 8)	$ 0	$ 18,279
Loss on settlement of derivative	0	4,162
Gain on conversion of debt to equity investment (Note 20)	(3,360)	0
Earnings from equity method investments	(291)	0
Other gains	(339)	(54)
Total other expense, net	$ (3,990)	$ 22,387

Investment in Unconsolidated _2

Investment in Unconsolidated Investees - Additional information (Detail) - USD ($) $ in Millions	Mar. 01, 2021	Dec. 31, 2021
Other Investments [Line Items]
Payments to acquire Investments	$ 4.6
Equity method investments		$ 7.9
Equity method investment, ownership percentage	34.50%	34.50%
Unconsolidated Investee [Member]
Other Investments [Line Items]
Equity method investment, ownership percentage		15.00%
Other Financial Instruments Revaluation and other (Gains) Losses Member [Member]
Other Investments [Line Items]
Gain (loss) on conversion of debt investments		$ 3.4
Common Equity Member [Member] | Share Purchase Warrants Member [Member]
Other Investments [Line Items]
Payments to acquire Investments	$ 0.4
Equity method investment, ownership percentage		2.40%

Income Taxes - Summary of Recon

Income Taxes - Summary of Reconciliation of Income Tax Expense (Benefit) (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Current:
Federal	$ 0	$ 0
State	41	(138)
Total current	41	(138)
Deferred:
Federal	(25,362)	700
State	(5,070)	0
Total Deferred	(30,432)	700
Total income tax expense (benefit)	$ (30,391)	$ 562

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Operating Loss Carryforwards [Line Items]
Deferred Tax Assets, Valuation Allowance	$ 2,398	$ 16,852
Interest Expense Limitation Carryforward	20,400
Deferred tax assets reversal of the valuation allowance	$ 15,500
Maximum [Member]
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards, Expiration Date	Dec. 12, 2037
Minimum [Member]
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards, Expiration Date	Dec. 12, 2031
U.S federal
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards	$ 210,600
State
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards	170,500
Operating Loss Carrforward Do not Expire
Operating Loss Carryforwards [Line Items]
Deferred tax assets operating loss carryforwards not subject to expiration	$ 133,100

Income Taxes - Summary of the C

Income Taxes - Summary of the Company's deferred tax assets and liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Net operating losses	$ 54,050	$ 16,559
Lease-related liabilities	45,367	31,615
Accruals not currently deductible	27,538	13,332
Interest expense limitation	25,123	2,025
Other	11,760	6,192
Valuation allowance	(2,398)	(16,852)
Net deferred tax assets	161,440	52,871
Intangible assets	(50,213)	(441)
Operating lease right-of-use assets	(42,642)	(30,349)
Property and equipment	(42,474)	(11,197)
Basis difference in joint ventures	(30,539)	0
Goodwill	(13,979)	(10,661)
Other	(5,620)	(1,916)
Total deferred tax liabilities	(185,467)	(54,564)
Net deferred tax liabilities	$ (24,027)	$ (1,693)

Income Taxes - Summary Of Rec_2

Income Taxes - Summary Of Reconciliation Of Effective income tax rate amounts (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Effective Income Tax Rate Reconciliation, Amount [Abstract]
Tax benefit at Canadian statutory rate	$ (17,279)	$ (8,902)
Non-deductible items	4,367	40
Stock-based compensation	973	397
Noncontrolling interest	(2,246)	(685)
Valuation allowance	(15,547)	8,916
Other	(659)	796
Income tax expense (benefit)	$ (30,391)	$ 562

Income Taxes Summary Of Reconci

Income Taxes Summary Of Reconciliation Of Effective income tax rate amounts (Parenthetical) (Detail)	12 Months Ended
	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Statutory tax rate	26.50%

Income Taxes - Summary Of Rec_3

Income Taxes - Summary Of Reconciliation Of Unrecognized Tax Benefits (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2021USD ($)
Income Tax Disclosure [Abstract]
Unrecognized tax benefits at January 1	$ 0
Increases for positions taken in current year	112
Decreases for positions taken in a prior year	(7)
Decreases for lapses in the applicable statute of limitations	(25)
Unrecognized tax benefits at December 31	$ 80

Basic and Diluted Loss per Sh_3

Basic and Diluted Loss per Share - Summary of Earnings Per Share Basic and Diluted (Detail) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Earnings Per Share [Abstract]
Net loss attributable to common shareholders	$ (43,291)	$ (36,741)
Weighted average common shares outstanding:
Basic and diluted	76,836,032	70,101,618
Net loss per share attributable to common shareholders:
Basic and Diluted	$ (0.56)	$ (0.52)
Employee stock options, warrants and restricted stock units excluded from the computation of diluted per share amounts as their effect would be antidilutive	2,215,163	1,664,231

Segment Information - Summary o

Segment Information - Summary of Company's Revenues By Segment (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenues	$ 421,079	$ 245,626
Radiology [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenues	374,402	$ 245,626
Oncology [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenues	$ 46,677

Segment Information - Summary_2

Segment Information - Summary of Company's Adjusted EBITDA (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted Earnings Before Interest Tax Depreciation And Amortization	$ 66,903	$ 42,078
Radiology [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted Earnings Before Interest Tax Depreciation And Amortization	64,992
Oncology [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted Earnings Before Interest Tax Depreciation And Amortization	15,466
Corporate Segment [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted Earnings Before Interest Tax Depreciation And Amortization	$ (13,555)

Segment Information - Summary_3

Segment Information - Summary of Net Income (Loss) to Total Adjusted EBITDA (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Segment Reporting [Abstract]
Net loss	$ (34,814)	$ (34,156)
Interest expense	62,575	32,781
Income tax expense (benefit)	(30,391)	562
Depreciation and amortization	44,895	17,060
EBITDA	42,265	16,247
Adjustments:
Stock-based compensation	2,792	2,084
Acquisition-related costs	20,233	1,079
Settlement and related costs (recoveries)	(539)	2,324
Gain on revaluation of earn-out liability	0	(5,457)
Loss on extinguishment of debt	0	18,279
Loss on settlement of interest rate cap derivative	0	4,162
Gain on conversion of debt to equity investment	(3,360)	0
Severance, restructuring and other charges	3,368
Other losses, net	342	407
Deferred Rent Expense	1,802	2,953
Adjusted EBITDA	$ 66,903	$ 42,078

Segment Information - Schedule

Segment Information - Schedule Of Segment Reporting Information By Segment (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Segment Reporting Information [Line Items]
Identifiable assets	$ 1,918,826	$ 665,052
Capital expenditures	17,867	5,344
Radiology [Member]
Segment Reporting Information [Line Items]
Identifiable assets	1,451,905	662,191
Capital expenditures	12,478	5,344
Oncology [Member]
Segment Reporting Information [Line Items]
Identifiable assets	440,416
Capital expenditures	5,117
Corporate Segment [Member]
Segment Reporting Information [Line Items]
Identifiable assets	26,505	$ 2,861
Capital expenditures	$ 272

CARES Act - Additional Informat

CARES Act - Additional Information (Detail) - Coronavirus Aid Relief And Economic Security Act [Member] - USD ($) $ in Millions	Sep. 01, 2021	Dec. 31, 2021	Dec. 31, 2020
Coronavirus Aid Relief And Economic Security Act [Line Items]
Government grants received		$ 0.8	$ 5.1
Other accrued liabilities		4.3
Social Security Tax [Member] | Due On December 31, 2021 [Member]
Coronavirus Aid Relief And Economic Security Act [Line Items]
Percentage of deferred payment of the employer portion			50.00%
Social Security Tax [Member] | Due On December 31, 2022 [Member]
Coronavirus Aid Relief And Economic Security Act [Line Items]
Percentage of deferred payment of the employer portion			50.00%
Medicare Accelerated and Advance Payments Program [Member]
Coronavirus Aid Relief And Economic Security Act [Line Items]
Amount received as accelerated medicare payments			$ 3.1
Medicare Accelerated and Advance Payments Program [Member] | Alliance [Member]
Coronavirus Aid Relief And Economic Security Act [Line Items]
Amount received as accelerated medicare payments	$ 3.3
Business combination identifiable advance medicare payments assumed		$ 2.4