Akumin (AKUMQ) 10-Q 10 May 22 2022 Q1 Quarterly report Financial data

Cover Page

Cover Page - shares	3 Months Ended
	Mar. 31, 2022	May 10, 2022
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2022
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q1
Trading Symbol	AKU
Entity Registrant Name	AKUMIN INC.
Entity Central Index Key	0001776197
Entity File Number	333-261815
Current Fiscal Year End Date	--12-31
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 Transition Report	false
Document Quarterly Report	true
Entity Interactive Data Current	Yes
Entity Small Business	true
Entity Common Stock, Shares Outstanding		89,516,513
Entity Address, State or Province	FL
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

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 40,242	$ 48,419
Accounts receivable	126,480	121,525
Prepaid expenses	8,409	8,196
Other current assets	5,012	7,025
Total current assets	180,143	185,165
Property and equipment, net	247,138	259,122
Operating lease right-of-use assets	189,263	194,565
Goodwill	840,874	840,353
Other intangible assets, net	409,157	414,146
Other assets	24,908	25,475
Total assets	1,891,483	1,918,826
Current liabilities:
Accounts payable	34,118	34,326
Current portion of long-term debt	15,667	14,789
Current portion of obligations under finance leases	6,031	6,460
Current portion of obligations under operating leases	20,764	20,794
Other accrued liabilities	85,476	87,813
Total current liabilities	162,056	164,182
Long-term debt, net of current portion	1,209,700	1,197,596
Obligations under finance leases, net of current portion	13,986	15,951
Obligations under operating leases, net of current portion	179,654	184,375
Other liabilities	36,829	35,574
Total liabilities	1,602,225	1,597,678
Redeemable noncontrolling interests	37,049	37,469
Shareholders' equity:
Common stock, no par value; unlimited number of shares authorized; 89,516,513 and 89,026,997 shares issued and outstanding as of March 31, 2022 and December 31, 2021, respectively	229,656	228,595
Accumulated other comprehensive income	64	18
Accumulated deficit	(154,235)	(123,424)
Total shareholders' equity	75,485	105,189
Noncontrolling interest	176,724	178,490
Total equity	252,209	283,679
Total liabilities, redeemable noncontrolling interests and equity	$ 1,891,483	$ 1,918,826

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	3 Months Ended	12 Months Ended
	Mar. 31, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Common Stock, No Par Value	$ 0	$ 0
Common Stock, Shares Authorized, Unlimited	Unlimited	Unlimited
Common Stock, Shares, Issued	89,516,513	89,026,997
Common Stock, Shares, Outstanding	89,516,513	89,026,997

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Income Statement [Abstract]
Revenues	$ 186,263	$ 63,963
Operating expenses:
Cost of operations, excluding depreciation and amortization	157,479	55,142
Depreciation and amortization	24,731	4,490
Stock-based compensation	1,061	427
Other operating losses (gains), net	(54)	90
Total operating expenses	183,217	60,149
Income from operations	3,046	3,814
Other expense (income):
Interest expense	28,681	8,368
Acquisition related costs	382	1,279
Settlement and related recoveries	(137)	(24)
Other non-operating gains, net	(11)	(3,366)
Total other expense, net	28,915	6,257
Loss before income taxes	(25,869)	(2,443)
Income tax expense	563	65
Net loss	(26,432)	(2,508)
Less: Net income attributable to noncontrolling interest	4,379	369
Net loss attributable to common shareholders	(30,811)	(2,877)
Comprehensive loss, net of taxes:
Net income (loss)	(26,432)	(2,508)
Unrealized gain on hedging transactions, net of taxes	29	0
Reclassification adjustment for losses included in net loss, net of taxes	17	0
Other comprehensive income	46	0
Comprehensive loss, net of taxes	(26,386)	(2,508)
Less: Comprehensive income attributable to noncontrolling interest	4,379	369
Comprehensive loss attributable to common shareholders	$ (30,765)	$ (2,877)
Net loss per share attributable to common shareholders:
Basic and diluted	$ (0.35)	$ (0.04)

Condensed Consolidated Statem_2

Condensed 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, 2020	$ 85,170	$ 160,965		$ (80,133)	$ 80,832	$ 4,338
Beginning balance, Shares at Dec. 31, 2020		70,178,428
Net income (loss)	(2,508)			(2,877)	(2,877)	369
Stock-based compensation	427	$ 427			427
Other comprehensive income	0
Distributions paid to noncontrolling interests	(449)					(449)
Ending Balance at Mar. 31, 2021	82,640	$ 161,392		(83,010)	78,382	4,258
Ending balance, Shares at Mar. 31, 2021		70,178,428
Beginning Balance at Dec. 31, 2021	283,679	$ 228,595	$ 18	(123,424)	105,189	178,490
Beginning balance, Shares at Dec. 31, 2021		89,026,997
Net income (loss)	(26,432)
Net income (loss), net of the net income attributable to redeemable noncontrolling interests	(27,012)			(30,811)	(30,811)	3,799
Issuance of common stock under stock-based awards, Shares		489,516
Stock-based compensation	1,061	$ 1,061			1,061
Other comprehensive income	46		46		46
Distributions paid to noncontrolling interests	(5,726)					(5,726)
Other equity transactions	161					161
Ending Balance at Mar. 31, 2022	$ 252,209	$ 229,656	$ 64	$ (154,235)	$ 75,485	$ 176,724
Ending balance, Shares at Mar. 31, 2022		89,516,513

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Operating activities:
Net loss	$ (26,432)	$ (2,508)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization	24,731	4,490
Stock-based compensation	1,061	427
Non-cash interest expense	12,105	0
Amortization of deferred financing costs and accretion of discount on long-term debt	30	478
Deferred income taxes	307	0
Other non-cash items	607	(3,276)
Changes in operating assets and liabilities, net of acquisitions:
Accounts receivable	(4,922)	(1,902)
Prepaid expenses and other assets	1,510	968
Accounts payable and accrued liabilities	(207)	8,627
Operating lease liabilities and right-of-use assets	528	445
Net cash provided by operating activities	9,318	7,749
Investing activities:
Purchases of property and equipment	(9,878)	(1,173)
Other investing activities	3	(4,588)
Net cash used in investing activities	(9,875)	(5,761)
Financing activities:
Proceeds from revolving loan	10,000	0
Principal payments on revolving loan	(10,000)	0
Proceeds from long-term debt	5,539	78,750
Principal payments on long-term debt	(4,039)	(99)
Principal payments on finance leases	(2,394)	(699)
Payment of debt issuance costs	0	(1,162)
Distributions paid to noncontrolling interests	(6,726)	(449)
Net cash provided by (used in) financing activities	(7,620)	76,341
Net increase (decrease) in cash and cash equivalents	(8,177)	78,329
Cash and cash equivalents, beginning of period	48,419	44,396
Cash and cash equivalents, end of period	40,242	122,725
Supplemental disclosure of cash flow information:
Interest paid	14,606	195
Income taxes paid, net	(10)	(39)
Supplemental disclosure of non-cash investing and financing activities:
Interest payable-in-kind on long-term debt	12,105	0
Property and equipment purchases in accounts payable and other accrued liabilities	$ 6,118	$ 306

Basis of Presentation

Basis of Presentation	3 Months Ended
	Mar. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	1. Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared by Akumin Inc. (the “Company” or “Akumin”) and do not include all of the information and disclosures required by accounting principles generally accepted in the U.S. (“GAAP”). In the opinion of management, all normal recurring accruals and adjustments considered necessary for a fair presentation have been included. The results for the three months ended March 31, 2022 are not necessarily indicative of the results that may be expected for the year ending December 31, 2022. The accompanying condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements and notes to the consolidated financial statements for the year ended December 31, 2021. The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the amounts reported in the condensed consolidated financial statements and accompanying notes. Actual results could differ from those estimates.

New Accounting Standards

New Accounting Standards	3 Months Ended
	Mar. 31, 2022
Accounting Standards Update and Change in Accounting Principle [Abstract]
New Accounting Standards	2. New Accounting Standards Recently Adopted Accounting Standards ASU 2021-04, 470-50), 815-40) In April 2021, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2021-04, 470-50), 815-40). 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 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 2021-08, In October 2021, the FASB issued ASU 2021-08, Business Combinations (Topic 805): 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

Alliance Acquisition

Alliance Acquisition	3 Months Ended
	Mar. 31, 2022
Business Combinations [Abstract]
Alliance Acquisition	3. Alliance Acquisition On September 1, 2021, the Company acquired all of the issued and outstanding common stock of Thaihot Investment Company US Limited, which owns 100% of the common stock of Alliance, from Thaihot Investment Co., Ltd. for a total purchase price of $785.6 million (the “Alliance Acquisition”). The acquisition included Alliance’s ownership interests in its joint ventures which had a fair value of $212.0 million on the acquisition date. As of the acquisition date, 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. During the three months ended March 31, 2022, 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) a decrease in property and equipment acquired of $0.5 million due to a refinement in the valuation analysis, (ii) a decrease in other liabilities of $0.2 million due to an adjustment in an estimated accrued liability and (iii) an increase in noncontrolling interest of $0.2 million due to a refinement in the valuation analysis. The net effect of the changes to preliminary fair value of the assets acquired and liabilities assumed resulted in an increase in goodwill of $0.5 million. The final determination of the fair value of certain assets acquired and liabilities assumed, including deferred tax liabilities and the assignment of goodwill to reporting units, was not complete as of March 31, 2022, but will be finalized within the allowable one-year measurement period. The following table summarizes the revised 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 205,940 Operating lease right-of-use 69,919 Goodwill 456,281 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 1,195,746 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 7,189 197,953 Net assets acquired 997,793 Less redeemable noncontrolling interests 37,040 Less noncontrolling interests 175,137 Purchase price $ 785,616

Variable Interest Entities

Variable Interest Entities	3 Months Ended
	Mar. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Variable Interest Entities	4. 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,

Property and Equipment

Property and Equipment	3 Months Ended
	Mar. 31, 2022
Property, Plant and Equipment [Abstract]
Property and Equipment	5. Property and Equipment Property and equipment consist of the following: (in thousands) March 31, December 31, Medical equipment $ 233,510 $ 227,796 Leasehold improvements 40,764 39,763 Equipment under finance leases 33,196 34,597 Office and computer equipment 17,794 16,701 Transportation and service equipment 8,980 8,996 Furniture and fixtures 3,336 3,130 Construction in progress 7,257 6,423 344,837 337,406 Less accumulated depreciation 97,699 78,284 $ 247,138 $ 259,122 Depreciation expense for the three months ended March 31, 2022 and 2021 was $19.7 million and $3.8 million, respectively. As of March 31, 2022 and December 31, 2021, the equipment under finance leases had a net book value of $19.6 million and $22.2 million, respectively.

Goodwill

Goodwill	3 Months Ended
	Mar. 31, 2022
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, 2021 $ 681,993 $ 158,360 $ 840,353 Adjustments 360 161 521 Balance, March 31, 2022 $ 682,353 $ 158,521 $ 840,874 The Company tests its goodwill and indefinite-lived intangible assets annually or more frequently depending on certain impairment indicators. As of March 31, 2022, there were no indications of impairment of the Company’s goodwill balances.

Other Intangible Assets

Other Intangible Assets	3 Months Ended
	Mar. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Other Intangible Assets	7. Other Intangible Assets Other intangible assets consist of the following: Weighted Life (in years) March 31, 2022 December 31, 2021 (dollars in thousands) Gross Accumulated Other Gross Accumulated Other Finite-lived intangible assets: Customer contracts 20 $ 266,224 $ (7,764 ) $ 258,460 $ 266,224 $ (4,437 ) $ 261,787 Trade names 18 77,466 (7,337 ) 70,129 77,466 (6,054 ) 71,412 Management agreements 17 10,200 (350 ) 9,850 10,200 (200 ) 10,000 Other 4 4,814 (3,654 ) 1,160 4,814 (3,425 ) 1,389 Total $ 358,704 $ (19,105 ) 339,599 $ 358,704 $ (14,116 ) 344,588 Certificates of Need 69,558 69,558 Total other intangible assets $ 409,157 $ 414,146 The Company performs an impairment test when indicators of impairment are present. As of March 31, 2022, 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 $5.0 million and $0.7 million for the three months ended March 31, 2022 and 2021, respectively. Estimated annual amortization expense related to finite-lived intangible assets is presented below: (in thousands) Year ending December 31: 2022 (remaining nine months) $ 14,825 2023 18,837 2024 18,132 2025 17,475 2026 17,421 Thereafter 252,909 $ 339,599

Long-Term Debt

Long-Term Debt	3 Months Ended
	Mar. 31, 2022
Disclosure Text Block [Abstract]
Long term debt	8. Long-Term Debt Long-term debt consists of the following: March 31, December 31, (in thousands) 2022 2021 2028 Senior Notes $ 375,000 $ 375,000 2025 Senior Notes 475,000 475,000 Subordinated Notes 384,575 372,470 Equipment Debt 60,327 58,827 1,294,902 1,281,297 Debt discount and deferred issuance costs (69,535 ) (68,912 ) 1,225,367 1,212,385 Less current portion 15,667 14,789 Long-term debt, net of current portion $ 1,209,700 $ 1,197,596 During the three months ended March 31, 2022, the Company elected to pay interest in-kind The minimum annual principal payments with respect to long-term debt as of March 31, 2022 are as follows: (in thousands) Year ending December 31: 2022 (remaining nine months) $ 11,485 2023 16,900 2024 14,140 2025 485,404 2026 3,732 Thereafter 763,241 $ 1,294,902 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 March 31, 2022.

Finance Leases

Finance Leases	3 Months Ended
	Mar. 31, 2022
Leases [Abstract]
Finance Leases	9. Finance Leases The information pertaining to obligations under finance leases is as follows: (in thousands) March 31, December 31, Obligations under finance leases $ 20,017 $ 22,411 Less current portion 6,031 6,460 Non-current $ 13,986 $ 15,951 The components of finance lease cost recognized in the condensed consolidated statements of operations and comprehensive loss are as follows. Three Months Ended March 31, (in thousands) 2022 2021 Amortization expense for equipment under finance leases $ 1,271 $ 916 Interest expense on finance lease liabilities 298 181 Finance lease cost $ 1,569 $ 1,097 Undiscounted cash flows for finance leases recorded in the condensed consolidated balance sheet as of March 31, 2022 are as follows. (in thousands) Year ending December 31: 2022 (remaining nine months) $ 5,213 2023 5,666 2024 5,236 2025 3,411 2026 1,760 Thereafter 665 Total minimum lease payments 21,951 Less amount of lease payments representing interest 1,934 Present value of future minimum lease payments 20,017 Less current portion 6,031 Non-current $ 13,986 The lease term and discount rates are as follows: Three Months Ended March 31, 2022 2021 Weighted average remaining lease term – finance leases (years) 3.7 4.8 Weighted average discount rate – finance leases 5.0 % 4.6 % Supplemental cash flow information related to finance leases is as follows: Three Months Ended March 31, (in thousands) 2022 2021 Operating cash flows from finance leases $ 298 $ 181 Equipment acquired in exchange for finance lease obligations — 617

Operating Leases

Operating Leases	3 Months Ended
	Mar. 31, 2022
Leases [Abstract]
Operating Leases	10. Operating Leases The information pertaining to obligations under operating leases is as follows: March 31, December 31, (in thousands) 2022 2021 Obligations under operating leases $ 200,418 $ 205,169 Less current portion 20,764 20,794 Non-current $ 179,654 $ 184,375 The components of operating lease cost recognized in the condensed consolidated statements of operations and comprehensive loss are as follows. Three Months Ended March 31, (in thousands) 2022 2021 Operating lease cost $ 9,666 $ 5,094 Variable lease cost 1,936 959 Short-term lease cost 475 43 Total operating lease cost $ 12,077 $ 6,096 Undiscounted cash flows for operating leases recorded in the condensed consolidated balance sheet as of March 31, 2022 are as follows. (in thousands) Year ending December 31: 2022 (remaining nine months) $ 20,485 2023 34,247 2024 30,930 2025 27,895 2026 23,377 Thereafter 178,953 Total minimum lease payments 315,887 Less amount of lease payments representing interest 115,469 Present value of future minimum lease payments 200,418 Less current portion 20,764 Non-current $ 179,654 The lease term and discount rates are as follows: Three Months Ended March 31, 2022 2021 Weighted average remaining lease term – operating leases (years) 11.4 12.5 Weighted average discount rate – operating leases 7.7 % 7.4 % Supplemental cash flow information related to operating leases is as follows: Three Months (in thousands) 2022 2021 Operating cash flows from operating leases $ 9,130 $ 4,649 Right-of-use 801 656

Other Accrued Liabilities

Other Accrued Liabilities	3 Months Ended
	Mar. 31, 2022
Payables and Accruals [Abstract]
Other Accrued Liabilities	11. Other Accrued Liabilities Other accrued liabilities consist of the following: March 31, December 31, (in thousands) 2022 2021 Accrued compensation and related expenses $ 34,283 $ 26,486 Accrued interest expense 18,821 16,840 MAAPP funds (Note 23) 1,093 2,398 Other 31,279 42,089 Total $ 85,476 $ 87,813

Redeemable Noncontrolling Inter

Redeemable Noncontrolling Interests	3 Months Ended
	Mar. 31, 2022
Noncontrolling Interest [Abstract]
Redeemable Noncontrolling Interests	12. 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 March 31, 2022, the Company holds redeemable noncontrolling interests of $37.0 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 condensed 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 three months ended March 31, 2022: (in thousands) Balance, December 31, 2021 $ 37,469 Net income attributable to redeemable noncontrolling interests 580 Distribution paid to redeemable noncontrolling interests (1,000 ) Balance, March 31, 2022 $ 37,049

Financial Instruments

Financial Instruments	3 Months Ended
	Mar. 31, 2022
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 March 31, 2022 Fair Value as of December 31, 2021 (in thousands) Level 1 Level 2 Level 3 Total Level 1 Level 2 Level 3 Total Current and long-term assets: Interest rate contracts $ — $ 25 $ — $ 25 $ — $ 3 $ — $ 3 Current and long-term liabilities: Derivative in subordinated notes $ — $ — $ 7,692 $ 7,692 $ — $ — $ 7,522 $ 7,522 Interest rate contracts $ — $ 14 $ — $ 14 $ — $ 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 March 31, 2022 and December 31, 2021 use unobservable inputs for probability weighted time until an exit event of 4.1 years and 4.2 years, respectively, and an exit event probability weighting of 24.3% and 24.5%, 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 three months ended March 31, 2022: (in thousands) Balance, December 31, 2021 $ 7,522 Change in fair value 170 Balance, March 31, 2022 $ 7,692 The Company’s interest rate contracts are primarily pay-fixed, Assets and Liabilities for which Fair Value is only Disclosed The estimated fair values of other current and non-current March 31, December 31, (in thousands) 2022 2021 2028 Senior Notes $ 292,500 $ 345,938 2025 Senior Notes 389,500 446,500 Subordinated Notes 310,376 323,620 Equipment Debt 59,118 56,879 Total $ 1,051,494 $ 1,172,937 As of March 31, 2022 and 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: March 31, December 31, (in thousands) 2022 2021 Financial assets measured at amortized cost: Cash and cash equivalents $ 40,242 $ 48,419 Accounts receivable 126,480 121,525 $ 166,722 $ 169,944 Financial liabilities measured at amortized cost: Accounts payable $ 34,118 $ 34,326 Current portion of long-term debt 15,667 14,789 Current portion of leases 26,795 27,254 Non-current 1,209,700 1,197,596 Non-current 193,640 200,326 Other accrued liabilities 85,476 87,813 $ 1,565,396 $ 1,562,104 Financial liabilities measured at fair value through earnings: Derivative in subordinated notes $ 7,692 $ 7,522 Financial assets measured at fair value through other comprehensive income: Interest rate contracts $ 25 $ 3 Financial liabilities measured at fair value through other comprehensive income: Interest rate contracts $ 14 $ 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 March 31, 2022 and December 31, 2021, the Company had $1.2 million and $1.8 million, respectively, 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 had no outstanding balance as of March 31, 2022 or December 31, 2021. The Company’s exposure to interest rate risk from a 1% increase or decrease in the variable interest rates is not material.

Stock-Based Awards

Stock-Based Awards	3 Months Ended
	Mar. 31, 2022
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 March 31, 2022 and December 31, 2021, common shares reserved for issuance under the 2017 Stock Plans were 8,951,651 and 8,902,699, 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 Restricted stock 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 generally 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, 2021 2,029,032 $ 2.41 Granted 799,085 1.10 $ 875 Vested (489,516 ) 3.19 $ 1,561 Outstanding and unvested at March 31, 2022 2,338,601 $ 1.80 $ 4,210 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, 2021 5,680,120 $ 2.54 4.4 $ 2,344 Outstanding at March 31, 2022 5,680,120 $ 2.54 4.1 $ 1,144 Exercisable at March 31, 2022 5,084,519 $ 2.45 4.0 $ 1,144 Aggregate intrinsic value for outstanding and exercisable stock options in the table above represents the difference between the closing stock price on March 31, 2022 and the exercise price multiplied by the number of in-the-money No stock options were granted during the three months ended March 31, 2022. Stock-Based Compensation Expense During the three months ended March 31, 2022 and 2021, the Company recorded total stock-based compensation expense related to all stock-based awards of $1.1 million and $0.4 million, respectively. As of March 31, 2022, there was $3.1 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	3 Months Ended
	Mar. 31, 2022
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 March 31, 2022, the obligations for these future purchase commitments totaled $35.7 million, of which $24.7 million is expected to be paid during the remaining nine months of 2022 and $11.0 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 March 31, 2022, 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. Because the two statements of claim involve similar subject matter and some of the same class members, the second Ontario plaintiff firm requested a motion for carriage under the Class Proceedings Act, 1992 (Ontario) so the court could determine which plaintiff firm will have carriage of the class action proceedings. That carriage motion was heard by the court on March 31, 2022 and, on April 27, 2022, the court rendered a decision in favor of the second plaintiff. As such, the second plaintiff has been awarded carriage of the class action claim and the action by the first plaintiff is stayed. 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 condensed 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	3 Months Ended
	Mar. 31, 2022
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: Three Months Ended March 31, (in thousands) 2022 2021 Patient fee payors: Commercial $ 69,101 $ 50,799 Medicare 21,172 8,184 Medicaid 3,102 1,831 Other patient revenue 3,274 2,652 96,649 63,466 Hospitals and healthcare providers 87,459 — Other revenue 2,155 497 $ 186,263 $ 63,963

Cost of Operations, excluding D

Cost of Operations, excluding Depreciation and Amortization	3 Months Ended
	Mar. 31, 2022
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: Three Months Ended March 31, (in thousands) 2022 2021 Employee compensation $ 77,365 $ 23,118 Third-party services and professional fees 29,177 6,859 Rent and utilities 12,477 7,684 Reading fees 11,498 9,984 Administrative 11,624 4,356 Medical supplies and other 15,338 3,141 $ 157,479 $ 55,142

Other Operating and Non-Operati

Other Operating and Non-Operating Losses (Gains)	3 Months Ended
	Mar. 31, 2022
Other Income and Expenses [Abstract]
Other Operating and Non-Operating Losses (Gains)	18. Other Operating and Non-Operating Other operating losses (gains) consist of the following: Three Months Ended March 31, (in thousands) 2022 2021 Loss on disposal of property and equipment, net $ 202 $ 90 Other, net (256 ) — $ (54 ) $ 90 Other non-operating Three Months Ended March 31, (in thousands) 2022 2021 Earnings from equity method investments $ (240 ) $ — Fair value adjustment on derivative 170 — Gain on conversion of debt to equity investment (Note 19) — (3,360 ) Other, net 59 (6 ) $ (11 ) $ (3,366 )

Investment in Unconsolidated In

Investment in Unconsolidated Investees	3 Months Ended
	Mar. 31, 2022
Other Investments [Abstract]
Investment in Unconsolidated Investees	19. 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 condensed consolidated statement of operations and comprehensive loss. The financial position and results of operations these

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2022
Income Tax Disclosure [Abstract]
Income Taxes	20. Income Taxes The effective tax rate for the three months ended March 31, 2022 and 2021 differs from the Canadian statutory rate of 26.5% primarily due to earnings in foreign jurisdictions that are subject to tax rates which differ from the Canadian statutory tax rate, as well as the impact of valuation allowances applied against losses in jurisdictions for which no tax benefit or expense is recognized.

Basic and Diluted Loss per Shar

Basic and Diluted Loss per Share	3 Months Ended
	Mar. 31, 2022
Earnings Per Share [Abstract]
Basic and Diluted Loss per Share	21. 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. Three Months Ended March 31, (in thousands, except share and per share amounts) 2022 2021 Net loss attributable to common shareholders $ 30,811 $ (2,877 ) Weighted average common shares outstanding: Basic and diluted 89,074,282 70,178,428 Net loss per share attributable to common shareholders: Basic and diluted $ (0.35 ) $ (0.04 ) Employee stock options, warrants and restricted stock units excluded from the computation of diluted per share amounts as their effect would be antidilutive 1,844,044 1,811,298

Segment Information

Segment Information	3 Months Ended
	Mar. 31, 2022
Segment Reporting [Abstract]
Segment Information	22. 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 maker, who is responsible for allocating resources and assessing performance of the operating segments, has been identified as the Chief Executive Officer. Prior to the Alliance Acquisition, the Company had one reportable segment, which was outpatient diagnostic imaging services. As a result of the acquisition, the Company operates in two reportable segments: Radiology and Oncology. All intercompany revenues, expenses, payables and receivables are eliminated in consolidation and are not reviewed when evaluating segment performance. Each segment’s performance is evaluated based on revenue and earnings before interest, income taxes, depreciation and amortization (“EBITDA”) and Adjusted EBITDA. The following table summarizes the Company’s revenues by segment: Three Months Ended March 31, (in thousands) 2022 2021 Radiology $ 155,340 $ 63,963 Oncology 30,923 — $ 186,263 $ 63,963 Adjusted EBITDA is defined as net income before interest expense, income tax expense (benefit), depreciation and amortization, stock-based compensation, acquisition-related costs, losses (gains) on disposal of property and equipment, 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 following table summarizes the Company’s Adjusted EBITDA by segment: Three Months Ended March 31, (in thousands) 2022 2021 Adjusted EBITDA: Radiology $ 28,589 $ 10,843 Oncology 10,033 — Corporate (6,604 ) (1,640 ) $ 32,018 $ 9,203 A reconciliation of the net loss to total Adjusted EBITDA is shown below: Three Months Ended March 31, (in thousands) 2022 2021 Net loss $ (26,432 ) $ (2,508 ) Interest expense 28,681 8,368 Income tax expense 563 65 Depreciation and amortization 24,731 4,490 EBITDA 27,543 10,415 Adjustments: Stock-based compensation 1,061 427 Acquisition-related costs 382 1,279 Loss on disposal of property and equipment, net 202 90 Settlement and related recoveries (137 ) (24 ) Gain on conversion of debt to equity investment — (3,360 ) Severance, restructuring and other charges 2,453 — Other losses (gains), net 182 (69 ) Deferred rent expense 332 445 Adjusted EBITDA $ 32,018 $ 9,203 The following table summarizes the Company’s total assets by segment: March 31, December 31, (in thousands) 2022 2021 Identifiable assets: Radiology $ 1,434,449 $ 1,451,905 Oncology 432,931 440,416 Corporate 24,103 26,505 Total $ 1,891,483 $ 1,918,826 The following table summarizes the Company’s capital expenditures by segment: Three Months Ended March 31, (in thousands) 2022 2021 Capital expenditures: Radiology $ 8,812 $ 1,173 Oncology 976 — Corporate 90 — Total $ 9,878 $ 1,173

CARES Act

CARES Act	3 Months Ended
	Mar. 31, 2022
Coronavirus Aid Relief And Economic Security Act [Abstract]
CARES Act	23. 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 The CARES Act also 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 March 31, 2022 and December 31, 2021, $4.3 million related to these deferred payments are included in other accrued liabilities in the condensed consolidated balance sheets.

Alliance Acquisition (Tables)

Alliance Acquisition (Tables)	3 Months Ended
	Mar. 31, 2022
Business Acquisition [Line Items]
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows	The following table summarizes the revised 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 205,940 Operating lease right-of-use 69,919 Goodwill 456,281 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 1,195,746 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 7,189 197,953 Net assets acquired 997,793 Less redeemable noncontrolling interests 37,040 Less noncontrolling interests 175,137 Purchase price $ 785,616

Property and Equipment (Tables

Property and Equipment (Tables)	3 Months Ended
	Mar. 31, 2022
Property, Plant and Equipment [Abstract]
Summary of Detailed Information of Property and Equipment	Property and equipment consist of the following: (in thousands) March 31, December 31, Medical equipment $ 233,510 $ 227,796 Leasehold improvements 40,764 39,763 Equipment under finance leases 33,196 34,597 Office and computer equipment 17,794 16,701 Transportation and service equipment 8,980 8,996 Furniture and fixtures 3,336 3,130 Construction in progress 7,257 6,423 344,837 337,406 Less accumulated depreciation 97,699 78,284 $ 247,138 $ 259,122

Goodwill (Tables)

Goodwill (Tables)	3 Months Ended
	Mar. 31, 2022
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, 2021 $ 681,993 $ 158,360 $ 840,353 Adjustments 360 161 521 Balance, March 31, 2022 $ 682,353 $ 158,521 $ 840,874

Other Intangible Assets - (Tabl

Other Intangible Assets - (Tables)	3 Months Ended
	Mar. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule Of Intangible Assets Excluding Goodwill	Other intangible assets consist of the following: Weighted Life (in years) March 31, 2022 December 31, 2021 (dollars in thousands) Gross Accumulated Other Gross Accumulated Other Finite-lived intangible assets: Customer contracts 20 $ 266,224 $ (7,764 ) $ 258,460 $ 266,224 $ (4,437 ) $ 261,787 Trade names 18 77,466 (7,337 ) 70,129 77,466 (6,054 ) 71,412 Management agreements 17 10,200 (350 ) 9,850 10,200 (200 ) 10,000 Other 4 4,814 (3,654 ) 1,160 4,814 (3,425 ) 1,389 Total $ 358,704 $ (19,105 ) 339,599 $ 358,704 $ (14,116 ) 344,588 Certificates of Need 69,558 69,558 Total other intangible assets $ 409,157 $ 414,146
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 (remaining nine months) $ 14,825 2023 18,837 2024 18,132 2025 17,475 2026 17,421 Thereafter 252,909 $ 339,599

Long-Term Debt (Tables)

Long-Term Debt (Tables)	3 Months Ended
	Mar. 31, 2022
Disclosure Text Block [Abstract]
Schedule of Long-term Debt Instruments	Long-term debt consists of the following: March 31, December 31, (in thousands) 2022 2021 2028 Senior Notes $ 375,000 $ 375,000 2025 Senior Notes 475,000 475,000 Subordinated Notes 384,575 372,470 Equipment Debt 60,327 58,827 1,294,902 1,281,297 Debt discount and deferred issuance costs (69,535 ) (68,912 ) 1,225,367 1,212,385 Less current portion 15,667 14,789 Long-term debt, net of current portion $ 1,209,700 $ 1,197,596
Summary of Maturities of Long-term Debt	The minimum annual principal payments with respect to long-term debt as of March 31, 2022 are as follows: (in thousands) Year ending December 31: 2022 (remaining nine months) $ 11,485 2023 16,900 2024 14,140 2025 485,404 2026 3,732 Thereafter 763,241 $ 1,294,902

Finance Leases (Tables)

Finance Leases (Tables)	3 Months Ended
	Mar. 31, 2022
Leases [Abstract]
Summary of Finance Lease Liabilities	The information pertaining to obligations under finance leases is as follows: (in thousands) March 31, December 31, Obligations under finance leases $ 20,017 $ 22,411 Less current portion 6,031 6,460 Non-current $ 13,986 $ 15,951
Summary of Finance Lease Cost	The components of finance lease cost recognized in the condensed consolidated statements of operations and comprehensive loss are as follows. Three Months Ended March 31, (in thousands) 2022 2021 Amortization expense for equipment under finance leases $ 1,271 $ 916 Interest expense on finance lease liabilities 298 181 Finance lease cost $ 1,569 $ 1,097
Summary of Undiscounted Cash Flows For Finance Leases	Undiscounted cash flows for finance leases recorded in the condensed consolidated balance sheet as of March 31, 2022 are as follows. (in thousands) Year ending December 31: 2022 (remaining nine months) $ 5,213 2023 5,666 2024 5,236 2025 3,411 2026 1,760 Thereafter 665 Total minimum lease payments 21,951 Less amount of lease payments representing interest 1,934 Present value of future minimum lease payments 20,017 Less current portion 6,031 Non-current $ 13,986
Summary of Finance Lease Term and Discount Rates	The lease term and discount rates are as follows: Three Months Ended March 31, 2022 2021 Weighted average remaining lease term – finance leases (years) 3.7 4.8 Weighted average discount rate – finance leases 5.0 % 4.6 %
Summary of Supplemental Cash Flow Information Related to Finance Leases	Supplemental cash flow information related to finance leases is as follows: Three Months Ended March 31, (in thousands) 2022 2021 Operating cash flows from finance leases $ 298 $ 181 Equipment acquired in exchange for finance lease obligations — 617

Operating Leases (Tables)

Operating Leases (Tables)	3 Months Ended
	Mar. 31, 2022
Leases [Abstract]
Summary of Operating Lease Liabilities	The information pertaining to obligations under operating leases is as follows: March 31, December 31, (in thousands) 2022 2021 Obligations under operating leases $ 200,418 $ 205,169 Less current portion 20,764 20,794 Non-current $ 179,654 $ 184,375
Summary of Operating Lease Cost	The components of operating lease cost recognized in the condensed consolidated statements of operations and comprehensive loss are as follows. Three Months Ended March 31, (in thousands) 2022 2021 Operating lease cost $ 9,666 $ 5,094 Variable lease cost 1,936 959 Short-term lease cost 475 43 Total operating lease cost $ 12,077 $ 6,096
Summary of Undiscounted Cash Flows For Operating Leases	Undiscounted cash flows for operating leases recorded in the condensed consolidated balance sheet as of March 31, 2022 are as follows. (in thousands) Year ending December 31: 2022 (remaining nine months) $ 20,485 2023 34,247 2024 30,930 2025 27,895 2026 23,377 Thereafter 178,953 Total minimum lease payments 315,887 Less amount of lease payments representing interest 115,469 Present value of future minimum lease payments 200,418 Less current portion 20,764 Non-current $ 179,654
Summary of Operating Lease Term and Discount Rates	The lease term and discount rates are as follows: Three Months Ended March 31, 2022 2021 Weighted average remaining lease term – operating leases (years) 11.4 12.5 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: Three Months (in thousands) 2022 2021 Operating cash flows from operating leases $ 9,130 $ 4,649 Right-of-use 801 656

Other Accrued Liabilities (Tabl

Other Accrued Liabilities (Tables)	3 Months Ended
	Mar. 31, 2022
Payables and Accruals [Abstract]
Summary of Other Accrued Liabilities	Other accrued liabilities consist of the following: March 31, December 31, (in thousands) 2022 2021 Accrued compensation and related expenses $ 34,283 $ 26,486 Accrued interest expense 18,821 16,840 MAAPP funds (Note 23) 1,093 2,398 Other 31,279 42,089 Total $ 85,476 $ 87,813

Redeemable Noncontrolling Int_2

Redeemable Noncontrolling Interests (Tables)	3 Months Ended
	Mar. 31, 2022
Noncontrolling Interest [Abstract]
Summary of Redeemable Noncontrolling Interests	The following is a rollforward of the activity in the redeemable noncontrolling interests for the three months ended March 31, 2022: (in thousands) Balance, December 31, 2021 $ 37,469 Net income attributable to redeemable noncontrolling interests 580 Distribution paid to redeemable noncontrolling interests (1,000 ) Balance, March 31, 2022 $ 37,049

Financial Instruments (Tables)

Financial Instruments (Tables)	3 Months Ended
	Mar. 31, 2022
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 March 31, 2022 Fair Value as of December 31, 2021 (in thousands) Level 1 Level 2 Level 3 Total Level 1 Level 2 Level 3 Total Current and long-term assets: Interest rate contracts $ — $ 25 $ — $ 25 $ — $ 3 $ — $ 3 Current and long-term liabilities: Derivative in subordinated notes $ — $ — $ 7,692 $ 7,692 $ — $ — $ 7,522 $ 7,522 Interest rate contracts $ — $ 14 $ — $ 14 $ — $ 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 three months ended March 31, 2022: (in thousands) Balance, December 31, 2021 $ 7,522 Change in fair value 170 Balance, March 31, 2022 $ 7,692
Schedule Of Fair Value Of Other Current And Non Current Liabilities	The estimated fair values of other current and non-current March 31, December 31, (in thousands) 2022 2021 2028 Senior Notes $ 292,500 $ 345,938 2025 Senior Notes 389,500 446,500 Subordinated Notes 310,376 323,620 Equipment Debt 59,118 56,879 Total $ 1,051,494 $ 1,172,937
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: March 31, December 31, (in thousands) 2022 2021 Financial assets measured at amortized cost: Cash and cash equivalents $ 40,242 $ 48,419 Accounts receivable 126,480 121,525 $ 166,722 $ 169,944 Financial liabilities measured at amortized cost: Accounts payable $ 34,118 $ 34,326 Current portion of long-term debt 15,667 14,789 Current portion of leases 26,795 27,254 Non-current 1,209,700 1,197,596 Non-current 193,640 200,326 Other accrued liabilities 85,476 87,813 $ 1,565,396 $ 1,562,104 Financial liabilities measured at fair value through earnings: Derivative in subordinated notes $ 7,692 $ 7,522 Financial assets measured at fair value through other comprehensive income: Interest rate contracts $ 25 $ 3 Financial liabilities measured at fair value through other comprehensive income: Interest rate contracts $ 14 $ 53

Stock-Based Awards (Tables)

Stock-Based Awards (Tables)	3 Months Ended
	Mar. 31, 2022
Share-based Payment Arrangement [Abstract]
Summary of RSU Activity	Restricted stock 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 generally 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, 2021 2,029,032 $ 2.41 Granted 799,085 1.10 $ 875 Vested (489,516 ) 3.19 $ 1,561 Outstanding and unvested at March 31, 2022 2,338,601 $ 1.80 $ 4,210
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, 2021 5,680,120 $ 2.54 4.4 $ 2,344 Outstanding at March 31, 2022 5,680,120 $ 2.54 4.1 $ 1,144 Exercisable at March 31, 2022 5,084,519 $ 2.45 4.0 $ 1,144

Supplemental Revenue Informat_2

Supplemental Revenue Information (Tables)	3 Months Ended
	Mar. 31, 2022
Revenue from Contract with Customer [Abstract]
Summary of Revenue Information	The following table summarizes the components of the Company’s revenues by payor category: Three Months Ended March 31, (in thousands) 2022 2021 Patient fee payors: Commercial $ 69,101 $ 50,799 Medicare 21,172 8,184 Medicaid 3,102 1,831 Other patient revenue 3,274 2,652 96,649 63,466 Hospitals and healthcare providers 87,459 — Other revenue 2,155 497 $ 186,263 $ 63,963

Cost of Operations, excluding_2

Cost of Operations, excluding Depreciation and Amortization (Tables)	3 Months Ended
	Mar. 31, 2022
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: Three Months Ended March 31, (in thousands) 2022 2021 Employee compensation $ 77,365 $ 23,118 Third-party services and professional fees 29,177 6,859 Rent and utilities 12,477 7,684 Reading fees 11,498 9,984 Administrative 11,624 4,356 Medical supplies and other 15,338 3,141 $ 157,479 $ 55,142

Other Operating and Non-Opera_2

Other Operating and Non-Operating Losses (Gains) (Tables)	3 Months Ended
	Mar. 31, 2022
Other Income and Expenses [Abstract]
Schedule of Other Operating Losses (gains)	Other operating losses (gains) consist of the following: Three Months Ended March 31, (in thousands) 2022 2021 Loss on disposal of property and equipment, net $ 202 $ 90 Other, net (256 ) — $ (54 ) $ 90
Schedule Of Other Non-operating Losses (gains)	Other non-operating Three Months Ended March 31, (in thousands) 2022 2021 Earnings from equity method investments $ (240 ) $ — Fair value adjustment on derivative 170 — Gain on conversion of debt to equity investment (Note 19) — (3,360 ) Other, net 59 (6 ) $ (11 ) $ (3,366 )

Basic and Diluted Loss per Sh_2

Basic and Diluted Loss per Share (Tables)	3 Months Ended
	Mar. 31, 2022
Earnings Per Share [Abstract]
Summary Of Earnings Per Share Basic And Diluted	Three Months Ended March 31, (in thousands, except share and per share amounts) 2022 2021 Net loss attributable to common shareholders $ 30,811 $ (2,877 ) Weighted average common shares outstanding: Basic and diluted 89,074,282 70,178,428 Net loss per share attributable to common shareholders: Basic and diluted $ (0.35 ) $ (0.04 ) Employee stock options, warrants and restricted stock units excluded from the computation of diluted per share amounts as their effect would be antidilutive 1,844,044 1,811,298

Segment Information (Tables)

Segment Information (Tables)	3 Months Ended
	Mar. 31, 2022
Segment Reporting [Abstract]
Summary Of Revenue By Segment	The following table summarizes the Company’s revenues by segment: Three Months Ended March 31, (in thousands) 2022 2021 Radiology $ 155,340 $ 63,963 Oncology 30,923 — $ 186,263 $ 63,963
Summary Of Company's Adjusted EBITDA	The following table summarizes the Company’s Adjusted EBITDA by segment: Three Months Ended March 31, (in thousands) 2022 2021 Adjusted EBITDA: Radiology $ 28,589 $ 10,843 Oncology 10,033 — Corporate (6,604 ) (1,640 ) $ 32,018 $ 9,203
Summary of Net Income (Loss) to Total Adjusted EBITDA	A reconciliation of the net loss to total Adjusted EBITDA is shown below: Three Months Ended March 31, (in thousands) 2022 2021 Net loss $ (26,432 ) $ (2,508 ) Interest expense 28,681 8,368 Income tax expense 563 65 Depreciation and amortization 24,731 4,490 EBITDA 27,543 10,415 Adjustments: Stock-based compensation 1,061 427 Acquisition-related costs 382 1,279 Loss on disposal of property and equipment, net 202 90 Settlement and related recoveries (137 ) (24 ) Gain on conversion of debt to equity investment — (3,360 ) Severance, restructuring and other charges 2,453 — Other losses (gains), net 182 (69 ) Deferred rent expense 332 445 Adjusted EBITDA $ 32,018 $ 9,203
Schedule Of Segment Reporting Information By Segment	The following table summarizes the Company’s total assets by segment: March 31, December 31, (in thousands) 2022 2021 Identifiable assets: Radiology $ 1,434,449 $ 1,451,905 Oncology 432,931 440,416 Corporate 24,103 26,505 Total $ 1,891,483 $ 1,918,826 The following table summarizes the Company’s capital expenditures by segment: Three Months Ended March 31, (in thousands) 2022 2021 Capital expenditures: Radiology $ 8,812 $ 1,173 Oncology 976 — Corporate 90 — Total $ 9,878 $ 1,173

Alliance Acquisition - Addition

Alliance Acquisition - Additional information (Detail) - Alliance Acquisition [Member] - USD ($) $ in Thousands	Sep. 01, 2021	Mar. 31, 2022
Alliance Acquisition
Business combination, consideration transferred	$ 785,600
Business acquisition, Percentage of voting interests acquired	100.00%
Business combination, Acquisition of less than hundred percent, Noncontrolling interest, Fair value	$ 212,000	$ 175,137
Goodwill purchase accounting adjustments		500
Business combination, provisional information, initial accounting incomplete, adjustment, property, plant, and equipment		500
Business combination, provisional information, initial accounting incomplete, adjustment, other liabilities		200
Business combination, provisional information, initial accounting incomplete, adjustment, non controlling interest		$ 200

Alliance Acquisition - Summary

Alliance Acquisition - Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows (Detail) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021	Sep. 01, 2021
Non-current assets
Goodwill	$ 840,874	$ 840,353
Alliance Acquisition [Member]
Current assets
Cash and cash equivalents	26,125
Net working capital	14,221
Non-current assets
Property and equipment	205,940
Operating lease right-of-use assets	69,919
Goodwill	456,281
Other assets	8,170
Assets	1,195,746
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	7,189
Liabilities	197,953
Net assets acquired	997,793
Less redeemable noncontrolling interests	37,040
Less noncontrolling interests	175,137		$ 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

Variable Interest Entities - Ad

Variable Interest Entities - Additional information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021	Dec. 31, 2021
Assets	$ 1,891,483		$ 1,918,826
Liabilities	1,602,225		1,597,678
Net cash provided by (used in) operating activities	9,318	$ 7,749
Variable Interest Entity, Primary Beneficiary [member]
Assets	22,700		20,400
Liabilities	100		$ 600
Revenues	46,000	39,000
Net cash provided by (used in) operating activities	$ 46,300	$ 51,200

Property and Equipment - Summar

Property and Equipment - Summary of Detailed Information of Property and Equipment (Detail) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	$ 344,837	$ 337,406
Accumulated depreciation	97,699	78,284
Total property and equipment – net	247,138	259,122
Medical equipment [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	233,510	227,796
Leasehold improvements [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	40,764	39,763
Equipment under finance leases [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	33,196	34,597
Total property and equipment – net	19,600	22,200
Office and computer equipment [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	17,794	16,701
Transportation and service equipment [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	8,980	8,996
Furniture and fixtures [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	3,336	3,130
Construction in progress [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	$ 7,257	$ 6,423

Property and Equipment - Additi

Property and Equipment - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Property and equipment - net	$ 247,138		$ 259,122
Depreciation	19,700	$ 3,800
Equipment under finance leases [Member]
Property, Plant and Equipment [Line Items]
Property and equipment - net	$ 19,600		$ 22,200

Goodwill - Schedule of Goodwill

Goodwill - Schedule of Goodwill (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2022USD ($)
Goodwill [Line Items]
Balance – Beginning of period	$ 840,353
Adjustments	521
Balance – End of period	840,874
Radiology [Member]
Goodwill [Line Items]
Balance – Beginning of period	681,993
Adjustments	360
Balance – End of period	682,353
Oncology [Member]
Goodwill [Line Items]
Balance – Beginning of period	158,360
Adjustments	161
Balance – End of period	$ 158,521

Other Intangible Assets - Sched

Other Intangible Assets - Schedule Of Intangible Assets Excluding Goodwill (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Gross Carrying Amount	$ 358,704	$ 358,704
Finite-Lived Intangible Assets, Accumulated Amortization	(19,105)	(14,116)
Finite-Lived Intangible Assets, Net	339,599	344,588
Indefinite-lived Intangible Assets (Excluding Goodwill)	69,558	69,558
Intangible Assets, Net (Including Goodwill)	$ 409,157	414,146
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	266,224
Finite-Lived Intangible Assets, Accumulated Amortization	(7,764)	(4,437)
Finite-Lived Intangible Assets, Net	$ 258,460	261,787
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	77,466
Finite-Lived Intangible Assets, Accumulated Amortization	(7,337)	(6,054)
Finite-Lived Intangible Assets, Net	$ 70,129	71,412
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	10,200
Finite-Lived Intangible Assets, Accumulated Amortization	(350)	(200)
Finite-Lived Intangible Assets, Net	$ 9,850	10,000
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	4,814
Finite-Lived Intangible Assets, Accumulated Amortization	(3,654)	(3,425)
Finite-Lived Intangible Assets, Net	$ 1,160	$ 1,389

Other Intangible Assets - Summa

Other Intangible Assets - Summary of Finite-Lived Intangible Assets Net Amortization Expense (Detail) $ in Thousands	Mar. 31, 2022USD ($)
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract]
2022 (remaining nine months)	$ 14,825
2023	18,837
2024	18,132
2025	17,475
2026	17,421
Thereafter	252,909
Total	$ 339,599

Other Intangible Assets - Addit

Other Intangible Assets - Additional Information (Detail) - USD ($) $ in Millions	Mar. 31, 2022	Mar. 31, 2021
Amortization expense of finite-lived intangible assets	$ 5	$ 0.7

Long-Term Debt - Summary of Lon

Long-Term Debt - Summary of Long term debt consists (Detail) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term Debt, Gross	$ 1,294,902	$ 1,281,297
Debt discount and deferred issuance costs	(69,535)	(68,912)
Long-term Debt	1,225,367	1,212,385
Less current portion	15,667	14,789
Long-term debt, net of current portion	1,209,700	1,197,596
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	375,000
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	475,000
Subordinated Debt [Member]
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term Debt, Gross	384,575	372,470
Equipment Debt [Member]
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term Debt, Gross	$ 60,327	$ 58,827

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	Mar. 31, 2022	Dec. 31, 2021
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
2022 (remaining nine months)	$ 11,485
2023	16,900
2024	14,140
2025	485,404
2026	3,732
Thereafter	763,241
Long-term Debt, Gross	$ 1,294,902	$ 1,281,297

Long-Term Debt - Additional Inf

Long-Term Debt - Additional Information (Details) $ in Millions	3 Months Ended
	Mar. 31, 2022USD ($)
Subordinated Debt [Member]
Debt Instrument [Line Items]
Debt Instrument, Increase, Accrued Interest	$ 12.1

Finance Leases - Summary of Fin

Finance Leases - Summary of Finance Lease Liabilities (Detail) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Obligations under finance leases	$ 20,017	$ 22,411
Less current portion	6,031	6,460
Non-current obligations under finance leases	$ 13,986	$ 15,951

Finance Leases - Summary of F_2

Finance Leases - Summary of Finance Lease Cost (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Leases [Abstract]
Amortization expense for equipment under finance leases	$ 1,271	$ 916
Interest expense on finance lease liabilities	298	181
Finance lease cost	$ 1,569	$ 1,097

Finance Leases - Summary of Und

Finance Leases - Summary of Undiscounted Cash Flows For Finance Leases (Detail) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Finance Lease, Liability, Payment, Due [Abstract]
2022 (remaining nine months)	$ 5,213
2023	5,666
2024	5,236
2025	3,411
2026	1,760
Thereafter	665
Total minimum lease payments	21,951
Less amount of lease payments representing interest	1,934
Present value of future minimum lease payments	20,017	$ 22,411
Less current portion	6,031	6,460
Non-current obligations under finance leases	$ 13,986	$ 15,951

Finance Leases - Summary of F_3

Finance Leases - Summary of Finance Lease Term and Discount Rates (Detail)	Mar. 31, 2022	Mar. 31, 2021
Leases [Abstract]
Weighted average remaining lease term – finance leases (years)	3 years 8 months 12 days	4 years 9 months 18 days
Weighted average discount rate – finance leases	5.00%	4.60%

Finance Leases - Summary of Sup

Finance Leases - Summary of Supplemental Cash Flow Information Related to Finance Leases (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Leases [Abstract]
Operating cash flows from finance leases	$ 298	$ 181
Equipment acquired in exchange for finance lease obligations	$ 0	$ 617

Operating Leases - Summary of O

Operating Leases - Summary of Operating Lease Liabilities (Detail) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Obligations under operating leases	$ 200,418	$ 205,169
Less current portion	20,764	20,794
Non-current obligations under operating leases	$ 179,654	$ 184,375

Operating Leases - Summary of_2

Operating Leases - Summary of Operating Lease Cost (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Leases [Abstract]
Operating lease cost	$ 9,666	$ 5,094
Variable lease cost	1,936	959
Short-term lease cost	475	43
Total operating lease cost	$ 12,077	$ 6,096

Operating Leases - Summary of U

Operating Leases - Summary of Undiscounted Cash Flows For Operating Leases (Detail) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Lessee, Operating Lease, Liability, Payment, Due [Abstract]
2022 (remaining nine months)	$ 20,485
2023	34,247
2024	30,930
2025	27,895
2026	23,377
Thereafter	178,953
Total minimum lease payments	315,887
Less: Amount of lease payments representing interest	115,469
Present value of future minimum lease payments	200,418	$ 205,169
Less current portion	20,764	20,794
Non-current obligations under operating leases	$ 179,654	$ 184,375

Operating Leases - Summary of_3

Operating Leases - Summary of Operating Lease Term and Discount Rates (Detail)	Mar. 31, 2022	Mar. 31, 2021
Leases [Abstract]
Weighted average remaining lease term-operating leases (years)	11 years 4 months 24 days	12 years 6 months
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	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Leases [Abstract]
Operating cash flows from operating leases	$ 9,130	$ 4,649
Right-of-use assets obtained in exchange for operating lease obligations	$ 801	$ 656

Other Accrued Liabilities - Sum

Other Accrued Liabilities - Summary of Other Accrued Liabilities (Detail) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Payables and Accruals [Abstract]
Accrued compensation and related expenses	$ 34,283	$ 26,486
Accrued interest expense	18,821	16,840
MAAPP funds (Note 23)	1,093	2,398
Other	31,279	42,089
Total	$ 85,476	$ 87,813

Redeemable Noncontrolling Int_3

Redeemable Noncontrolling Interests - Additional Information (Detail) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Noncontrolling Interest [Abstract]
Redeemable noncontrolling interests	$ 37,049	$ 37,469

Redeemable Noncontrolling Int_4

Redeemable Noncontrolling Interest - Summary of Redeemable Noncontrolling Interests (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2022USD ($)
Noncontrolling Interest [Abstract]
Balance, December 31, 2021	$ 37,469
Net income attributable to redeemable noncontrolling interests	580
Distributions paid to redeemable noncontrolling interests	(1,000)
Balance, March 31, 2022	$ 37,049

Financial Instruments - Schedul

Financial Instruments - Schedule of Fair Value Measurements, Recurring and Nonrecurring (Details) - Fair Value, Recurring [Member] - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Derivative In Subordinated Notes [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial Liabilities Fair Value Disclosure	$ 7,692	$ 7,522
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	7,692	7,522
Interest Rate Contracts [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Receivables, Fair Value Disclosure	25	3
Financial Liabilities Fair Value Disclosure	14	53
Interest Rate Contracts [Member] | Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Receivables, Fair Value Disclosure	0	0
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]
Receivables, Fair Value Disclosure	25	3
Financial Liabilities Fair Value Disclosure	14	53
Interest Rate Contracts [Member] | Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Receivables, Fair Value Disclosure	0	0
Financial Liabilities Fair Value Disclosure	$ 0	$ 0

Financial Instruments - Summary

Financial Instruments - Summary of Reconciliation of Liability Related to the Embedded Derivative (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2022USD ($)
Disclosure Of Movement In Embedded Derivative Liabilities [Line Items]
Change in fair value	$ (170)
Subordinated Debt [Member] | Stone Peak Magnet | Level 3 [Member]
Disclosure Of Movement In Embedded Derivative Liabilities [Line Items]
Balance, December 31, 2021	7,522
Change in fair value	170
Balance, March 31, 2022	$ 7,692

Financial Instruments - Sched_2

Financial Instruments - Schedule Of Fair Value Of Other Current And Non Current Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	$ 1,051,494	$ 1,172,937
2028 Senior Notes [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	292,500	345,938
2025 Senior Notes [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	389,500	446,500
Subordinated Notes [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	310,376	323,620
Equipment Debt [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	$ 59,118	$ 56,879

Financial Instruments - Sched_3

Financial Instruments - Schedule of Information Regarding The Carrying Value Of Financial Instruments (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash and cash equivalents	$ 40,242	$ 48,419
Accounts receivable	126,480	121,525
Accounts payable	34,118	34,326
Current portion of long-term debt	15,667	14,789
Non-current portion of long-term debt	1,209,700	1,197,596
Reported Value Measurement [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash and cash equivalents	40,242	48,419
Accounts receivable	126,480	121,525
Financial assets measured at amortized cost	166,722	169,944
Accounts payable	34,118	34,326
Current portion of long-term debt	15,667	14,789
Current portion of leases	26,795	27,254
Non-current portion of long-term debt	1,209,700	1,197,596
Non-current portion of leases	193,640	200,326
Other accrued liabilities	85,476	87,813
Financial liabilities measured at amortized cost	1,565,396	1,562,104
Derivative in subordinated notes	7,692	7,522
Financial assets measured at fair value through other comprehensive income: Interest rate contracts	25	3
Financial liabilities measured at fair value through other comprehensive income: Interest rate contracts	$ 14	$ 53

Financial Instruments - Additio

Financial Instruments - Additional Information (Detail) $ in Millions	3 Months Ended	12 Months Ended
	Mar. 31, 2022USD ($)yr	Dec. 31, 2021USD ($)yr
Level 3 [Member] | Measurement Input Probability Weighted Time
Embedded derivative liability measurment input | yr	4.1	4.2
Level 3 [Member] | Measurement Input Probability Of Exit Event Percentage [Member]
Embedded derivative liability measurment input	24.3	24.5
Equipment Debt [Member]
Long term debt unhedged | $	$ 1.2	$ 1.8
Revolving Credit Facility [Member] | Interest Rate Contract [Member]
Increase decrease in the variable rate of interest	1.00%	1.00%

Stock-Based Awards - Summary of

Stock-Based Awards - Summary of RSU Activity (Detail) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2022USD ($)$ / sharesshares
Share-based Payment Arrangement [Abstract]
Number of RSUs, Outstanding and unvested | shares	2,029,032
Number of RSUs, Granted | shares	799,085
Number of RSUs, Vested | shares	(489,516)
Number of RSUs, Outstanding and unvested | shares	2,338,601
Weighted-Average Grant Date Fair Value, Outstanding and unvested | $ / shares	$ 2.41
Weighted-Average Grant Date Fair Value, Granted | $ / shares	1.10
Weighted-Average Grant Date Fair Value, Vested | $ / shares	3.19
Weighted-Average Grant Date Fair Value, Outstanding and unvested | $ / shares	$ 1.80
Aggregate Fair Value, Granted | $	$ 875
Aggregate Fair Value, Vested | $	1,561
Aggregate Fair Value, Outstanding and unvested | $	$ 4,210

Stock-Based Awards - Summary _2

Stock-Based Awards - Summary of the Stock Option Activity (Detail) - Stock Options [Member] - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of Options, Outstanding	5,680,120
Number of Options, Exercisable	5,084,519
Number of Options, Outstanding	5,680,120	5,680,120
Weighted- Average Exercise price, Outstanding	$ 2.54
Weighted-Average Exercise price, Exercisable	2.45
Weighted- Average Exercise price, Outstanding	$ 2.54	$ 2.54
Weighted- Average Remaining Contractual Term, Outstanding	4 years 1 month 6 days	4 years 4 months 24 days
Weighted-Average Remaining Contractual Term, Exercisable	4 years
Aggregate Intrinsic Value, Outstanding	$ 1,144	$ 2,344
Aggregate Intrinsic Value, Exercisable	$ 1,144

Stock-Based Awards - Additional

Stock-Based Awards - Additional Information (Detail) $ in Millions	Nov. 14, 2017	Mar. 31, 2022USD ($)shares	Mar. 31, 2021USD ($)	Dec. 31, 2021shares
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share-based Payment Arrangement, Expense		$ 1.1	$ 0.4
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount		$ 3.1
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		8,951,651		8,902,699

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Details) - Commitement For The Purchase Of Equipment [Member] $ in Millions	Mar. 31, 2022USD ($)
Loss Contingencies [Line Items]
Purchase Obligation	$ 35.7
Within Next Twelve Months [Member]
Loss Contingencies [Line Items]
Purchase Obligation	24.7
Greater Than Twelve Months [Member]
Loss Contingencies [Line Items]
Purchase Obligation	$ 11

Supplemental Revenue Informat_3

Supplemental Revenue Information - Summary of Revenue Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Disaggregation of Revenue [Line Items]
Other revenue	$ 2,155	$ 497
Total revenue	186,263	63,963
Sales Channel, Directly to Consumer [Member]
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	96,649	63,466
Commercial | Sales Channel, Directly to Consumer [Member]
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	69,101	50,799
Medicare | Sales Channel, Directly to Consumer [Member]
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	21,172	8,184
Medicaid | Sales Channel, Directly to Consumer [Member]
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	3,102	1,831
Other patient revenue | Sales Channel, Directly to Consumer [Member]
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	3,274	2,652
Hospitals and healthcare providers | Sales Channel, Through Intermediary [Member]
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	$ 87,459	$ 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	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	$ 157,479	$ 55,142
Employee compensation
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	77,365	23,118
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	29,177	6,859
Rent and utilities
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	12,477	7,684
Reading fees
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	11,498	9,984
Administrative
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	11,624	4,356
Medical supplies and other
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	$ 15,338	$ 3,141

Other Operating and Non-Opera_3

Other Operating and Non-Operating Losses (Gains) - Schedule of Other Operating Losses (gains) (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Schedule Of Other Operating Cost And Expense By Component
Loss on disposal of property and equipment, net	$ 202	$ 90
Other, net	(256)
Other Operating Losses (gains)	$ (54)	$ 90

Other Operating and Non-Opera_4

Other Operating and Non-Operating Losses (Gains) - Schedule Of Other Non-operating Losses (gains) (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Schedule Of Other Non operating Income Expense [Line Items]
Earnings from equity method investments	$ (240)	$ 0
Fair value adjustment on derivative	170
Gain on conversion of debt to equity investment (Note 19)	0	(3,360)
Other, net	59	(6)
Total other expense, net	$ (11)	$ (3,366)

Investment in Unconsolidated _2

Investment in Unconsolidated Investees - Additional information (Detail) - USD ($) $ in Millions	Mar. 01, 2021	Mar. 31, 2021	Mar. 31, 2022
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 - Additional Infor

Income Taxes - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Operating Loss Carryforwards [Line Items]
income tax rate, percent	26.50%	26.50%

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	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Earnings Per Share [Abstract]
Net loss attributable to common shareholders	$ (30,811)	$ (2,877)
Weighted average common shares outstanding:
Basic and diluted	89,074,282	70,178,428
Net loss per share attributable to common shareholders:
Basic and Diluted	$ (0.35)	$ (0.04)
Employee stock options, warrants and restricted stock units excluded from the computation of diluted per share amounts as their effect would be antidilutive	1,844,044	1,811,298

Segment Information - Summary o

Segment Information - Summary of Company's Revenues By Segment (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenues	$ 186,263	$ 63,963
Radiology [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenues	155,340	$ 63,963
Oncology [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenues	$ 30,923

Segment Information - Summary_2

Segment Information - Summary of Company's Adjusted EBITDA (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted Earnings Before Interest Tax Depreciation And Amortization	$ 32,018	$ 9,203
Radiology [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted Earnings Before Interest Tax Depreciation And Amortization	28,589	10,843
Oncology [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted Earnings Before Interest Tax Depreciation And Amortization	10,033	0
Corporate Segment [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted Earnings Before Interest Tax Depreciation And Amortization	$ (6,604)	$ (1,640)

Segment Information - Summary_3

Segment Information - Summary of Net Income (Loss) to Total Adjusted EBITDA (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Segment Reporting [Abstract]
Net loss	$ (26,432)	$ (2,508)
Interest expense	28,681	8,368
Income tax expense	563	65
Depreciation and amortization	24,731	4,490
EBITDA	27,543	10,415
Adjustments:
Stock-based compensation	1,061	427
Acquisition-related costs	382	1,279
Loss on disposal of property and equipment, net	202	90
Settlement and related recoveries	(137)	(24)
Gain on conversion of debt to equity investment	0	(3,360)
Severance, restructuring and other charges	2,453
Other losses (gains), net	182	(69)
Deferred rent expense	332	445
Adjusted EBITDA	$ 32,018	$ 9,203

Segment Information - Schedule

Segment Information - Schedule Of Segment Reporting Information By Segment (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021	Dec. 31, 2021
Segment Reporting Information [Line Items]
Identifiable assets	$ 1,891,483		$ 1,918,826
Capital expenditures	9,878	$ 1,173
Radiology [Member]
Segment Reporting Information [Line Items]
Identifiable assets	1,434,449		1,451,905
Capital expenditures	8,812	$ 1,173
Oncology [Member]
Segment Reporting Information [Line Items]
Identifiable assets	432,931		440,416
Capital expenditures	976
Corporate Segment [Member]
Segment Reporting Information [Line Items]
Identifiable assets	24,103		$ 26,505
Capital expenditures	$ 90

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, 2020	Mar. 31, 2022	Dec. 31, 2021
Coronavirus Aid Relief And Economic Security Act [Line Items]
Other accrued liabilities			$ 4.3	$ 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			$ 1.1	$ 2.4