Akumin (AKUMQ) 10-Q 10 May 23 2023 Q1 Quarterly report Financial data

Cover Page

Cover Page - shares	3 Months Ended
	Mar. 31, 2023	May 08, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2023
Document Transition Report	false
Entity File Number	333-261815
Entity Registrant Name	AKUMIN INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	88-4139425
Entity Address, Address Line One	8300 W. Sunrise Boulevard
Entity Address, City or Town	Plantation
Entity Address, State or Province	FL
Entity Address, Postal Zip Code	33322
City Area Code	844
Local Phone Number	730-0050
Title of 12(b) Security	Common Stock, $0.01 par value per share
Trading Symbol	AKU
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	true
Entity Ex Transition Period	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		90,498,491
Entity Central Index Key	0001776197
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q1
Amendment Flag	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 45,399	$ 59,424
Accounts receivable	114,696	114,166
Prepaid expenses	8,325	8,003
Other current assets	8,097	10,352
Total current assets	176,517	191,945
Property and equipment, net	205,974	221,214
Operating lease right-of-use assets	160,250	166,823
Goodwill	769,110	769,110
Other intangible assets, net	387,354	392,095
Other assets	23,468	23,928
Total assets	1,722,673	1,765,115
Current liabilities:
Accounts payable	25,458	36,618
Current portion of long-term debt	20,432	19,961
Current portion of obligations under finance leases	7,751	7,800
Current portion of obligations under operating leases	15,775	17,223
Accrued liabilities	92,948	86,916
Total current liabilities	162,364	168,518
Long-term debt, net of current portion	1,262,708	1,254,652
Obligations under finance leases, net of current portion	17,600	19,505
Obligations under operating leases, net of current portion	154,964	160,475
Other liabilities	21,178	20,674
Total liabilities	1,618,814	1,623,824
Redeemable noncontrolling interests	28,657	30,337
Stockholders’ deficit:
Preferred stock, $0.01 par value; 50,000,000 shares authorized; no shares issued and outstanding at March 31, 2023 and December 31, 2022	0	0
Common stock, $0.01 par value; 300,000,000 shares authorized; 90,498,491 shares issued and outstanding at March 31, 2023; 89,811,513 shares issued and outstanding at December 31, 2022	905	898
Additional paid-in capital	231,406	231,014
Accumulated other comprehensive income	45	73
Accumulated deficit	(315,333)	(280,185)
Total stockholders’ deficit	(82,977)	(48,200)
Noncontrolling interests	158,179	159,154
Total equity	75,202	110,954
Total liabilities, redeemable noncontrolling interests and equity	$ 1,722,673	$ 1,765,115

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Mar. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Preferred stock, par or stated value per share (in USD per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	50,000,000	50,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par or stated value per share (in USD per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	300,000,000	300,000,000
Common stock issued (in shares)	90,498,491	89,811,513
Common stock outstanding (in shares)	90,498,491	89,811,513

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Income Statement [Abstract]
Revenues	$ 187,592	$ 186,263
Operating expenses:
Cost of operations, excluding depreciation and amortization	155,567	155,161
Depreciation and amortization	22,993	24,731
Restructuring charges	5,736	80
Severance and related costs	(49)	2,238
Settlements, recoveries and related costs	1,448	(137)
Stock-based compensation	399	1,061
Other operating income, net	(751)	(7)
Total operating expenses	185,343	183,127
Income from operations	2,249	3,136
Other expense (income):
Interest expense	30,697	28,681
Other non-operating expense (income), net	(132)	324
Total other expense, net	30,565	29,005
Loss before income taxes	(28,316)	(25,869)
Income tax expense	874	563
Net loss	(29,190)	(26,432)
Less: Net income attributable to noncontrolling interests	5,958	4,379
Net loss attributable to common stockholders	(35,148)	(30,811)
Comprehensive loss, net of taxes:
Net loss	(29,190)	(26,432)
Other comprehensive income (loss):
Unrealized gain (loss) on hedging transactions, net of taxes	(14)	29
Reclassification adjustment for losses included in net loss, net of taxes	(14)	17
Other comprehensive income	(28)	46
Comprehensive loss, net of taxes	(29,218)	(26,386)
Less: Comprehensive income attributable to noncontrolling interests	5,958	4,379
Comprehensive loss attributable to common stockholders	$ (35,176)	$ (30,765)
Earnings Per Share [Abstract]
Basic (in dollars per share)	$ (0.39)	$ (0.35)
Diluted (in dollars per share)	$ (0.39)	$ (0.35)

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Equity - USD ($) $ in Thousands	Total	Total Stockholders’ Equity	Common Stock	Additional Paid-In Capital	Accumulated Other Comprehensive Income (Loss)	Accumulated Deficit	Noncontrolling Interests
Beginning balance (in shares) at Dec. 31, 2021			89,026,997
Beginning balance at Dec. 31, 2021	$ 283,679	$ 105,189	$ 890	$ 227,705	$ 18	$ (123,424)	$ 178,490
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss), net of the net income (loss) attributable to redeemable noncontrolling interests	(27,012)	(30,811)				(30,811)	3,799
Settlement of restricted share units (in shares)			489,516
Settlement of restricted share units	0		$ 5	(5)
Stock-based compensation	1,061	1,061		1,061
Other comprehensive income	46	46			46
Distributions paid to noncontrolling interests	(5,726)						(5,726)
Purchase accounting adjustments	161						161
Ending balance (in shares) at Mar. 31, 2022			89,516,513
Ending Balance at Mar. 31, 2022	252,209	75,485	$ 895	228,761	64	(154,235)	176,724
Beginning balance (in shares) at Dec. 31, 2022			89,811,513
Beginning balance at Dec. 31, 2022	110,954	(48,200)	$ 898	231,014	73	(280,185)	159,154
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss), net of the net income (loss) attributable to redeemable noncontrolling interests	(30,336)	(35,148)				(35,148)	4,812
Settlement of restricted share units (in shares)			686,978
Settlement of restricted share units	0		$ 7	(7)
Stock-based compensation	399	399		399
Other comprehensive income	(28)	(28)			(28)
Distributions paid to noncontrolling interests	(5,787)						(5,787)
Ending balance (in shares) at Mar. 31, 2023			90,498,491
Ending Balance at Mar. 31, 2023	$ 75,202	$ (82,977)	$ 905	$ 231,406	$ 45	$ (315,333)	$ 158,179

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Operating activities:
Net loss	$ (29,190)	$ (26,432)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization	22,993	24,731
Stock-based compensation	399	1,061
Non-cash interest expense	13,757	12,105
Amortization of deferred financing costs and accretion of discount/premium on long-term debt	3	30
Deferred income taxes	734	307
Distributions from unconsolidated investees	183	520
Earnings from unconsolidated investees	(151)	(240)
Other non-cash items, net	(139)	327
Changes in operating assets and liabilities:
Accounts receivable	(655)	(4,922)
Prepaid expenses and other assets	1,287	1,510
Accounts payable and other liabilities	(5,610)	(207)
Operating lease liabilities and right-of-use assets	(307)	528
Net cash provided by operating activities	3,304	9,318
Investing activities:
Purchases of property and equipment	(2,508)	(9,878)
Other investing activities	325	3
Net cash used in investing activities	(2,183)	(9,875)
Financing activities:
Proceeds from revolving loan	0	10,000
Principal payments on revolving loan	0	(10,000)
Proceeds from long-term debt	0	5,539
Principal payments on long-term debt	(4,580)	(3,853)
Principal payments on finance leases	(1,953)	(2,580)
Distributions paid to noncontrolling interests	(8,613)	(6,726)
Net cash used in financing activities	(15,146)	(7,620)
Net decrease in cash and cash equivalents	(14,025)	(8,177)
Cash and cash equivalents, beginning of period	59,424	48,419
Cash and cash equivalents, beginning of period	45,399	40,242
Cash and cash equivalents, end of period
Interest paid	15,662	14,606
Income taxes refunded, net of payments	(35)	(10)
Income taxes refunded, net of payments
Property and equipment purchases in accounts payable and accrued liabilities	2,614	6,118
Derecognition of operating lease right-of-use assets and lease liabilities associated with lease terminations	3,282	110
Operating lease right-of-use assets obtained in exchange for operating lease liabilities	$ 1,373	$ 801

Basis of Presentation

Basis of Presentation	3 Months Ended
	Mar. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	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, 2023 are not necessarily indicative of the results that may be expected for the year ending December 31, 2023. 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, 2022. 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, 2023
Accounting Standards Update and Change in Accounting Principle [Abstract]
New Accounting Standards	New Accounting Standards Recently Adopted Accounting Standards ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments In June 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments , and related clarifying standards, which replaces the incurred loss impairment methodology in current GAAP with a methodology that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information to assess credit loss estimates. This ASU is effective for public entities for fiscal years beginning after December 15, 2019, with early adoption permitted. For all other entities, this ASU is effective for fiscal years beginning after December 15, 2022. The Company is considered an Emerging Growth Company as classified by the Securities and Exchange Commission (“SEC”), which gave the Company relief in the timing of implementation of this standard by allowing the private company timing for adoption. The Company adopted this standard on January 1, 2023 using the modified retrospective approach and it did not have a material impact on the Company's condensed consolidated financial statements, resulting in no adjustments to prior year earnings. Recently Issued Accounting Standards Not Yet Effective ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers (Topic 805) In October 2021, the FASB issued ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers , creating an exception to the recognition and measurement principles in ASC 805, Business Combinations . The amendments require an acquirer to use the guidance in ASC 606, Revenue from Contracts with Customers , rather than using fair value, when recognizing and measuring contract assets and contract liabilities related to customer contracts assumed in a business combination. In addition, the amendments clarify that all contracts requiring the recognition of assets and liabilities in accordance with the guidance in ASC 606, such as contract liabilities derived from the sale of nonfinancial assets within the scope of ASC 610-20, Gains and Losses from the Derecognition of Nonfinancial Assets , fall within the scope of the amended guidance in ASC 805. The amendments do not affect the accounting for other assets or liabilities arising from revenue contracts with customers in a business combination, such as customer-related intangible assets and contract-based intangible assets, including off-market contract terms. This ASU is effective for public entities for fiscal years beginning after December 15, 2022, with early adoption permitted. For

Variable Interest Entities

Variable Interest Entities	3 Months Ended
	Mar. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Variable Interest Entities	Variable Interest Entities In accordance with consolidation guidance, a reporting entity with a variable interest in another entity is required to include the assets and liabilities and revenues and expenses of that separate entity (i.e., consolidate with the financial statements of the reporting entity) when the variable interest is determined to be a controlling financial interest. A reporting entity is considered to have a controlling financial interest in a variable interest entity (“VIE”) if (i) the reporting entity has the power to direct the activities of the VIE that most significantly impacts its economic performance and (ii) the reporting entity has the obligation to absorb losses of the VIE that could be potentially significant to the VIE. As a result of the financial relationship established between the Company and certain entities (the “Revenue Practices”) through respective management service agreements, the Revenue Practices individually qualify as VIEs as the Company, which provides them non-medical, technical and administrative services, has the power to direct their respective activities and the obligation to absorb their gains and losses. As a result, the Company is considered the primary beneficiary of the Revenue Practices, and accordingly, the assets and liabilities and revenues and expenses of the Revenue Practices are included in the condensed consolidated financial statements. The following information excludes any intercompany transactions and costs allocated by the Company to the Revenue Practices. As of March 31, 2023 and December 31, 2022, the Revenue Practices’ assets included in the Company’s condensed consolidated balance sheets were $34.0 million and $36.0 million, respectively, and liabilities included in the Company’s condensed consolidated balance sheets were $2.4 million and $1.4 million, respectively. The assets of the Revenue Practices can only be used to settle their obligations. During the three months ended March 31, 2023 and 2022, the Revenue Practices’ revenues were $43.4 million and $46.0 million, respectively, and the net cash provided by operating activities was $41.8 million and $46.3 million, respectively.

Property and Equipment

Property and Equipment	3 Months Ended
	Mar. 31, 2023
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment Property and equipment consists of the following: (in thousands) March 31, December 31, Medical equipment $ 245,836 $ 244,517 Leasehold improvements 43,684 43,382 Equipment under finance leases 46,545 44,845 Office and computer equipment 18,644 17,742 Transportation and service equipment 11,562 11,672 Furniture and fixtures 3,439 3,362 Construction in progress 2,845 4,636 372,555 370,156 Less accumulated depreciation 166,581 148,942 $ 205,974 $ 221,214 Depreciation expense was $18.3 million and $19.7 million for the three months ended March 31, 2023 and 2022, respectively.

Goodwill

Goodwill	3 Months Ended
	Mar. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	GoodwillThe Company tests its goodwill and indefinite-lived intangible assets annually or more frequently depending on certain impairment indicators. Such indicators include a significant decline in expected future cash flows due to changes in company-specific factors or the broader business climate. As of March 31, 2023, there were no indications of impairment of the Company's goodwill balances. During the three months ended March 31, 2023, there was no change in the carrying value of goodwill.

Other Intangible Assets

Other Intangible Assets	3 Months Ended
	Mar. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Other Intangible Assets	Other Intangible Assets Other intangible assets consist of the following: (dollars in thousands) Weighted March 31, 2023 December 31, 2022 Gross Accumulated Other Gross Accumulated Other Finite-lived intangible assets: Customer contracts 20 $ 263,388 $ (20,910) $ 242,478 $ 263,388 $ (17,588) $ 245,800 Trade names 18 77,135 (12,245) 64,890 77,135 (11,063) 66,072 Management agreements 17 10,200 (950) 9,250 10,200 (800) 9,400 Other 5 5,719 (4,541) 1,178 5,719 (4,454) 1,265 Total $ 356,442 $ (38,646) 317,796 $ 356,442 $ (33,905) 322,537 Certificates of Need 69,558 69,558 Total other intangible assets $ 387,354 $ 392,095 The Company performs an impairment test when indicators of impairment are present. As of March 31, 2023, there were no indications of impairment of the Company's other intangible assets balances.

Long-Term Debt

Long-Term Debt	3 Months Ended
	Mar. 31, 2023
Debt Disclosure [Abstract]
Long-Term Debt	Long-Term Debt Long-term debt consists of the following: (in thousands) March 31, December 31, 2028 Senior Notes $ 375,000 $ 375,000 2025 Senior Notes 475,000 475,000 Subordinated Notes 437,061 423,303 Equipment Debt 68,173 72,754 1,355,234 1,346,057 Debt discount/premium and deferred issuance costs (72,094) (71,444) 1,283,140 1,274,613 Less current portion 20,432 19,961 Long-term debt, net of current portion $ 1,262,708 $ 1,254,652 During the three months ended March 31, 2023, the Company elected to pay interest in-kind on the Subordinated Notes pursuant to the original agreement and, accordingly, $13.8 million of accrued interest was added to the principal balance of the Subordinated Notes. 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, or had received waivers for, all such covenants as of March 31, 2023.

Accrued Liabilities

Accrued Liabilities	3 Months Ended
	Mar. 31, 2023
Payables and Accruals [Abstract]
Accrued Liabilities	Accrued Liabilities Accrued liabilities consist of the following: (in thousands) March 31, December 31, Accrued compensation and related expenses $ 20,833 $ 25,655 Accrued interest expense 19,541 18,183 Other 52,574 43,078 $ 92,948 $ 86,916

Redeemable Noncontrolling Inter

Redeemable Noncontrolling Interests	3 Months Ended
	Mar. 31, 2023
Noncontrolling Interest [Abstract]
Redeemable Noncontrolling Interests	Redeemable Noncontrolling Interests The Company has noncontrolling interests with redemption features. These redemption features could require the Company to make an offer to purchase the noncontrolling interests in the case of certain events, including (i) the expiration or termination of certain operating agreements of the joint venture, or (ii) the noncontrolling interests’ tax-exempt status is jeopardized by the joint venture. As of March 31, 2023, the Company holds redeemable noncontrolling interests of $28.7 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, 2023: (in thousands) Balance, December 31, 2022 $ 30,337 Net income attributable to redeemable noncontrolling interests 1,146 Distributions paid to redeemable noncontrolling interests (2,826) Balance, March 31, 2023 $ 28,657

Financial Instruments

Financial Instruments	3 Months Ended
	Mar. 31, 2023
Financial Instruments [Abstract]
Financial Instruments	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, 2023 Fair Value as of December 31, 2022 (in thousands) Level 1 Level 2 Level 3 Total Level 1 Level 2 Level 3 Total Current and long-term assets: Interest rate contracts $ — $ 37 $ — $ 37 $ — $ 52 $ — $ 52 Long-term liabilities: Derivative in subordinated notes $ — $ — $ 6,089 $ 6,089 $ — $ — $ 6,132 $ 6,132 The derivative in subordinated notes relates to the Change of Control Redemption Election included in the Subordinated Notes (see Note 7). The fair value of the Change of Control Redemption Election liability was determined using a probability weighted scenario analysis regarding a potential change of control during the seven years from initiation date. The estimated fair values of the Change of Control Redemption Election as of March 31, 2023 and December 31, 2022 use unobservable inputs for probability weighted time until an exit event of 3.4 years and 3.5 years, respectively, and an exit event probability weighting of 22.3% and 22.9%, respectively. The following is a reconciliation of the opening and closing balances for the derivative in subordinated notes liability measured at fair value on a recurring basis using significant unobservable inputs (Level 3) during the three months ended March 31, 2023: (in thousands) Balance, December 31, 2022 $ 6,132 Change in fair value (43) Balance, March 31, 2023 $ 6,089 The decrease in the fair value of the derivative in subordinated notes liability was recorded as a gain and included in other non-operating expense (income), net in the Company's condensed consolidated statements of operations and comprehensive loss for the three months ended March 31, 2023. The Company’s interest rate contracts are primarily pay-fixed, receive-variable interest rate swaps related to certain of the Company’s equipment debt. The amount that the Company expects to reclassify from accumulated other comprehensive income to interest expense over the next twelve months is immaterial. Assets and Liabilities for which Fair Value is only Disclosed The estimated fair values of other current and non-current liabilities are as follows: (in thousands) March 31, December 31, 2028 Senior Notes $ 262,463 $ 228,894 2025 Senior Notes 374,063 339,385 Subordinated Notes 283,587 254,951 Equipment Debt 58,705 58,698 $ 978,818 $ 881,928 As of March 31, 2023 and December 31, 2022, 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, 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 portion of lease liabilities approximates their fair value given the difference between the discount rates used to recognize the liabilities in the condensed consolidated balance sheets and the normalized expected market rates of interest is insignificant. 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: (in thousands) March 31, December 31, Financial assets measured at amortized cost: Cash and cash equivalents $ 45,399 $ 59,424 Accounts receivable 114,696 114,166 $ 160,095 $ 173,590 Financial liabilities measured at amortized cost: Accounts payable $ 25,458 $ 36,618 Current portion of long-term debt 20,432 19,961 Current portion of leases 23,526 25,023 Non-current portion of long-term debt 1,262,708 1,254,652 Non-current portion of leases 172,564 179,980 Accrued liabilities 92,948 86,916 $ 1,597,636 $ 1,603,150 Financial liabilities measured at fair value through earnings: Derivative in subordinated notes $ 6,089 $ 6,132 Financial assets measured at fair value through other comprehensive income: Interest rate contracts $ 37 $ 52 Assets and Liabilities that are Measured at Fair Value on a Nonrecurring Basis The Company measures certain non-financial assets at fair value on a nonrecurring basis, primarily intangible assets, goodwill and long-lived assets in connection with acquisitions and periodic evaluations for potential impairment. The Company estimates the fair value of these assets using primarily unobservable inputs; therefore, these are considered Level 3 fair value measurements. 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, 2023 and December 31, 2022, the Company had $0.4 million of variable interest rate equipment debt that is not hedged. In addition, the Company is exposed to variable interest rates related to the 2020 Revolving Facility, which had no outstanding balance as of March 31, 2023 or December 31, 2022. The Company’s exposure to interest rate risk from a 1% increase or decrease in the variable interest rates is not material.

Stockholders' Equity

Stockholders' Equity	3 Months Ended
	Mar. 31, 2023
Equity [Abstract]
Stockholders' Equity	Stockholders' Equity In connection with the Domestication in 2022, the Company amended its Certificate of Incorporation to provide for the issuance of up to 300,000,000 shares of common stock, par value $0.01 per share, and 50,000,000 shares of undesignated preferred stock, par value $0.01 per share. The effect of the change in the common stock from no par value to $0.01 par value per share has been reflected in the condensed consolidated financial statements on a retroactive basis for all periods presented. 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, 2023 and December 31, 2022, shares of common stock reserved for issuance under the 2017 Stock Plans were 9,049,849 and 8,981,151, 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 share units (“RSUs”) represent a right to receive a share of common stock at a future vesting date with no cash payment from the holder. RSUs granted vest over two years from the date of grant. A summary of RSU activity is as follows: Number of Weighted- Aggregate Outstanding and unvested at December 31, 2022 2,143,601 $ 1.77 Granted 350,000 1.08 $ 378 Vested (686,978) 2.34 $ 1,605 Cancelled (57,078) 1.10 $ (63) Outstanding and unvested at March 31, 2023 1,749,545 $ 1.43 $ 2,504 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 Outstanding at December 31, 2022 5,348,120 $ 2.56 3.3 $ 378 Outstanding at March 31, 2023 5,348,120 $ 2.56 3.1 $ 311 Exercisable at March 31, 2023 5,325,020 $ 2.55 3.1 $ 311 Aggregate intrinsic value for outstanding and exercisable stock options in the table above represents the difference between the closing stock price on March 31, 2023 and the exercise price multiplied by the number of in-the-money options. No stock options were granted during the three months ended March 31, 2023.

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	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, 2023, the obligations for these future purchase commitments totaled $39.4 million, of which $31.1 million is expected to be paid during the remaining nine months of 2023 and $8.3 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, 2023, the Company has determined that no liability is necessary related to these guarantees and indemnities. Legal Matters On December 20, 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 relating to the restatement of the Company’s financial statements that were filed in 2021. On February 17, 2023, the plaintiff delivered a motion record for certification and for leave to commence action under Part XXIII.1 of the Securities Act (Ontario). The Company plans to defend the claim and the motion, which has not yet been scheduled for hearing. Other Matters

Supplemental Revenue Informatio

Supplemental Revenue Information	3 Months Ended
	Mar. 31, 2023
Revenue from Contract with Customer [Abstract]
Supplemental Revenue Information	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) 2023 2022 Patient fee payors: Commercial $ 65,522 $ 69,101 Medicare 21,420 21,172 Medicaid 3,405 3,102 Other patient revenue 2,595 3,274 92,942 96,649 Hospitals and healthcare providers 92,462 87,459 Other revenue 2,188 2,155 $ 187,592 $ 186,263

Cost of Operations, excluding D

Cost of Operations, excluding Depreciation and Amortization	3 Months Ended
	Mar. 31, 2023
Cost Of Operations Excluding Depreciation And Amortization [Abstract]
Cost of Operations, excluding Depreciation and Amortization	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) 2023 2022 Employee compensation $ 71,527 $ 75,127 Third-party services and professional fees 30,829 29,177 Rent and utilities 12,341 12,477 Reading fees 11,599 11,498 Administrative 10,421 11,624 Medical supplies and other 18,850 15,258 $ 155,567 $ 155,161

Supplemental Statement of Opera

Supplemental Statement of Operations Information	3 Months Ended
	Mar. 31, 2023
Other Income and Expenses [Abstract]
Supplemental Statement of Operations Information	Supplemental Statement of Operations Information Restructuring Charges Restructuring charges consist of the following: Three Months Ended March 31, (in thousands) 2023 2022 Transformation costs $ 5,720 $ — Other 16 80 $ 5,736 $ 80 Transformation costs consist of third-party consulting fees associated with a significant project to identify, plan, and implement various business improvement initiatives designed to enhance growth opportunities and improve operations. The project is expected to continue into 2024. The consulting agreement provides for fixed fees totaling $12.5 million, milestone fees totaling up to $7.0 million that are earned upon the achievement of certain milestones, and performance fees totaling up to $15.0 million that are earned based on the achievement of certain performance results during the period of the contract. The Company recognizes the fixed fees over the contract period as the services are rendered. Milestone and performance fees that are probable of ultimately being paid are recognized based on a percentage of achievement of the related milestone or performance result. As of March 31, 2023, the accounts payable and accrued liability balance for unpaid transformation consulting costs was $2.3 million and $6.9 million, respectively. Severance and Related Costs Severance and related costs represent costs associated with employees whose employment with the Company has been terminated and are generally paid in the year recorded. In connection with certain terminated employees, severance benefits are being paid over periods of 12 to 18 months. As of March 31, 2023, the unpaid balance of severance and related costs totaled $3.0 million, which will be paid during the next twelve months. Other Operating and Non-Operating Expense (Income) Other operating income, net consists of the following: Three Months Ended March 31, (in thousands) 2023 2022 Gain from insurance proceeds $ (776) $ — Loss on sale of accounts receivable 124 — Loss (gain) on disposal of property and equipment, net (69) 202 Other, net (30) (209) $ (751) $ (7) Other non-operating expense (income), net consists of the following: Three Months Ended March 31, (in thousands) 2023 2022 Acquisition-related costs $ 143 $ 382 Fair value adjustment on derivative in subordinated notes (43) 170 Earnings from unconsolidated investees (151) (240) Other, net (81) 12 $ (132) $ 324

Investments in Unconsolidated I

Investments in Unconsolidated Investees	3 Months Ended
	Mar. 31, 2023
Other Investments [Abstract]
Investments in Unconsolidated Investees	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 has a carrying value of $7.9 million as of March 31, 2023 and represents a 34.5% interest in the AI business on a non-diluted basis. In addition, the Company holds share purchase warrants which, subject to the occurrence of certain events and certain assumptions, and the payment of $0.4 million, would entitle the Company to acquire an additional 2.4% ownership interest in the AI business common equity. 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 statements of operations and comprehensive loss.

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2023
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The Company is subject to U.S. federal income tax as well as income tax of multiple state jurisdictions. The Company is no longer subject to Canadian tax after the Domestication on September 30, 2022.The effective tax rate for the three months ended March 31, 2023 differs from the U.S. federal statutory rate of 21.0% primarily due to the impact of valuation allowances applied against losses in jurisdictions for which no tax benefit is recognized.

Basic and Diluted Loss per Shar

Basic and Diluted Loss per Share	3 Months Ended
	Mar. 31, 2023
Earnings Per Share [Abstract]
Basic and Diluted Loss per Share	Basic and Diluted Loss per Share The loss per share is calculated by dividing the net loss attributable to common stockholders by the weighted average common shares outstanding during the period. Three Months Ended March 31, (in thousands, except share and per share amounts) 2023 2022 Net loss attributable to common stockholders $ (35,148) $ (30,811) Weighted average common shares outstanding: Basic and diluted 89,819,146 89,074,282 Net loss per share attributable to common stockholders: Basic and diluted $ (0.39) $ (0.35) Employee stock options, warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive 2,301,518 1,844,044

Segment Information

Segment Information	3 Months Ended
	Mar. 31, 2023
Segment Reporting [Abstract]
Segment Information	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. 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 adjusted earnings before interest, taxes, depreciation and amortization ("Adjusted EBITDA"). The following table summarizes the Company’s revenues by segment: Three Months Ended March 31, (in thousands) 2023 2022 Radiology $ 157,401 $ 155,340 Oncology 30,191 30,923 $ 187,592 $ 186,263 Adjusted EBITDA is defined as net income before interest expense, income tax expense (benefit), depreciation and amortization, impairment charges, restructuring charges, severance and related costs, settlements and related costs (recoveries), stock-based compensation, loss (gain) on sale of accounts receivable, losses (gains) on disposal of property and equipment, acquisition-related costs, financial instrument revaluation adjustments, deferred rent expense, other losses (gains), and one-time adjustments. Adjusted EBITDA should not be considered a measure of financial performance under GAAP, and it should not be considered in isolation or as an alternative to net income, cash flows generated by operating, investing or financing activities, or other financial statement data presented in the condensed consolidated financial statements as indicators of financial performance or liquidity. Adjusted EBITDA is not a measurement determined in accordance with GAAP and is therefore susceptible to varying methods of calculation and may not be comparable to other similarly titled measures of other companies. Adjusted EBITDA is the most frequently used measure of each segment’s performance and is commonly used in setting performance goals. The following table summarizes the Company’s Adjusted EBITDA by segment: Three Months Ended March 31, (in thousands) 2023 2022 Adjusted EBITDA: Radiology $ 30,326 $ 28,589 Oncology 9,848 10,033 Corporate (7,033) (6,604) $ 33,141 $ 32,018 A reconciliation of the net income (loss) to total Adjusted EBITDA is shown below: Three Months Ended March 31, (in thousands) 2023 2022 Net loss $ (29,190) $ (26,432) Interest expense 30,697 28,681 Income tax expense 874 563 Depreciation and amortization 22,993 24,731 Restructuring charges 5,736 80 Severance and related costs (49) 2,238 Settlements, recoveries and related costs 1,448 (137) Stock-based compensation 399 1,061 Loss on sale of accounts receivable 124 — Loss (gain) on disposal of property and equipment, net (69) 202 Acquisition-related costs 143 382 Fair value adjustment on derivative (43) 170 Deferred rent expense 185 332 Other, net (107) 147 Adjusted EBITDA $ 33,141 $ 32,018 The following table summarizes the Company’s total assets by segment: (in thousands) March 31, December 31, Identifiable assets: Radiology $ 1,371,908 $ 1,400,938 Oncology 332,295 346,337 Corporate 18,470 17,840 $ 1,722,673 $ 1,765,115 The following table summarizes the Company’s capital expenditures by segment: Three Months Ended March 31, (in thousands) 2023 2022 Capital expenditures: Radiology $ 1,976 $ 8,812 Oncology 500 976 Corporate 32 90 $ 2,508 $ 9,878

New Accounting Standards (Polic

New Accounting Standards (Policies)	3 Months Ended
	Mar. 31, 2023
Accounting Standards Update and Change in Accounting Principle [Abstract]
Recently Adopted Accounting Standards and Standards Not Yet Effective	Recently Adopted Accounting Standards ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments In June 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments , and related clarifying standards, which replaces the incurred loss impairment methodology in current GAAP with a methodology that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information to assess credit loss estimates. This ASU is effective for public entities for fiscal years beginning after December 15, 2019, with early adoption permitted. For all other entities, this ASU is effective for fiscal years beginning after December 15, 2022. The Company is considered an Emerging Growth Company as classified by the Securities and Exchange Commission (“SEC”), which gave the Company relief in the timing of implementation of this standard by allowing the private company timing for adoption. The Company adopted this standard on January 1, 2023 using the modified retrospective approach and it did not have a material impact on the Company's condensed consolidated financial statements, resulting in no adjustments to prior year earnings. Recently Issued Accounting Standards Not Yet Effective ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers (Topic 805) In October 2021, the FASB issued ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers , creating an exception to the recognition and measurement principles in ASC 805, Business Combinations . The amendments require an acquirer to use the guidance in ASC 606, Revenue from Contracts with Customers , rather than using fair value, when recognizing and measuring contract assets and contract liabilities related to customer contracts assumed in a business combination. In addition, the amendments clarify that all contracts requiring the recognition of assets and liabilities in accordance with the guidance in ASC 606, such as contract liabilities derived from the sale of nonfinancial assets within the scope of ASC 610-20, Gains and Losses from the Derecognition of Nonfinancial Assets , fall within the scope of the amended guidance in ASC 805. The amendments do not affect the accounting for other assets or liabilities arising from revenue contracts with customers in a business combination, such as customer-related intangible assets and contract-based intangible assets, including off-market contract terms. This ASU is effective for public entities for fiscal years beginning after December 15, 2022, with early adoption permitted. For

Property and Equipment (Tables)

Property and Equipment (Tables)	3 Months Ended
	Mar. 31, 2023
Property, Plant and Equipment [Abstract]
Summary of Detailed Information of Property and Equipment	Property and equipment consists of the following: (in thousands) March 31, December 31, Medical equipment $ 245,836 $ 244,517 Leasehold improvements 43,684 43,382 Equipment under finance leases 46,545 44,845 Office and computer equipment 18,644 17,742 Transportation and service equipment 11,562 11,672 Furniture and fixtures 3,439 3,362 Construction in progress 2,845 4,636 372,555 370,156 Less accumulated depreciation 166,581 148,942 $ 205,974 $ 221,214

Other Intangible Assets - (Tabl

Other Intangible Assets - (Tables)	3 Months Ended
	Mar. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets Excluding Goodwill	Other intangible assets consist of the following: (dollars in thousands) Weighted March 31, 2023 December 31, 2022 Gross Accumulated Other Gross Accumulated Other Finite-lived intangible assets: Customer contracts 20 $ 263,388 $ (20,910) $ 242,478 $ 263,388 $ (17,588) $ 245,800 Trade names 18 77,135 (12,245) 64,890 77,135 (11,063) 66,072 Management agreements 17 10,200 (950) 9,250 10,200 (800) 9,400 Other 5 5,719 (4,541) 1,178 5,719 (4,454) 1,265 Total $ 356,442 $ (38,646) 317,796 $ 356,442 $ (33,905) 322,537 Certificates of Need 69,558 69,558 Total other intangible assets $ 387,354 $ 392,095

Long-Term Debt (Tables)

Long-Term Debt (Tables)	3 Months Ended
	Mar. 31, 2023
Debt Disclosure [Abstract]
Schedule of Long-term Debt Instruments	Long-term debt consists of the following: (in thousands) March 31, December 31, 2028 Senior Notes $ 375,000 $ 375,000 2025 Senior Notes 475,000 475,000 Subordinated Notes 437,061 423,303 Equipment Debt 68,173 72,754 1,355,234 1,346,057 Debt discount/premium and deferred issuance costs (72,094) (71,444) 1,283,140 1,274,613 Less current portion 20,432 19,961 Long-term debt, net of current portion $ 1,262,708 $ 1,254,652

Accrued Liabilities (Tables)

Accrued Liabilities (Tables)	3 Months Ended
	Mar. 31, 2023
Payables and Accruals [Abstract]
Summary of Other Accrued Liabilities	Accrued liabilities consist of the following: (in thousands) March 31, December 31, Accrued compensation and related expenses $ 20,833 $ 25,655 Accrued interest expense 19,541 18,183 Other 52,574 43,078 $ 92,948 $ 86,916

Redeemable Noncontrolling Int_2

Redeemable Noncontrolling Interests (Tables)	3 Months Ended
	Mar. 31, 2023
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, 2023: (in thousands) Balance, December 31, 2022 $ 30,337 Net income attributable to redeemable noncontrolling interests 1,146 Distributions paid to redeemable noncontrolling interests (2,826) Balance, March 31, 2023 $ 28,657

Financial Instruments (Tables)

Financial Instruments (Tables)	3 Months Ended
	Mar. 31, 2023
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, 2023 Fair Value as of December 31, 2022 (in thousands) Level 1 Level 2 Level 3 Total Level 1 Level 2 Level 3 Total Current and long-term assets: Interest rate contracts $ — $ 37 $ — $ 37 $ — $ 52 $ — $ 52 Long-term liabilities: Derivative in subordinated notes $ — $ — $ 6,089 $ 6,089 $ — $ — $ 6,132 $ 6,132
Summary of Reconciliation of Liability Related to the Embedded Derivative	The following is a reconciliation of the opening and closing balances for the derivative in subordinated notes liability measured at fair value on a recurring basis using significant unobservable inputs (Level 3) during the three months ended March 31, 2023: (in thousands) Balance, December 31, 2022 $ 6,132 Change in fair value (43) Balance, March 31, 2023 $ 6,089
Schedule of Fair Value Of Other Current And Non Current Liabilities	The estimated fair values of other current and non-current liabilities are as follows: (in thousands) March 31, December 31, 2028 Senior Notes $ 262,463 $ 228,894 2025 Senior Notes 374,063 339,385 Subordinated Notes 283,587 254,951 Equipment Debt 58,705 58,698 $ 978,818 $ 881,928
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: (in thousands) March 31, December 31, Financial assets measured at amortized cost: Cash and cash equivalents $ 45,399 $ 59,424 Accounts receivable 114,696 114,166 $ 160,095 $ 173,590 Financial liabilities measured at amortized cost: Accounts payable $ 25,458 $ 36,618 Current portion of long-term debt 20,432 19,961 Current portion of leases 23,526 25,023 Non-current portion of long-term debt 1,262,708 1,254,652 Non-current portion of leases 172,564 179,980 Accrued liabilities 92,948 86,916 $ 1,597,636 $ 1,603,150 Financial liabilities measured at fair value through earnings: Derivative in subordinated notes $ 6,089 $ 6,132 Financial assets measured at fair value through other comprehensive income: Interest rate contracts $ 37 $ 52

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	3 Months Ended
	Mar. 31, 2023
Equity [Abstract]
Summary of RSU Activity	A summary of RSU activity is as follows: Number of Weighted- Aggregate Outstanding and unvested at December 31, 2022 2,143,601 $ 1.77 Granted 350,000 1.08 $ 378 Vested (686,978) 2.34 $ 1,605 Cancelled (57,078) 1.10 $ (63) Outstanding and unvested at March 31, 2023 1,749,545 $ 1.43 $ 2,504
Summary of the Stock Option Activity	A summary of the stock option activity is as follows: Number of Weighted- Weighted- Aggregate Outstanding at December 31, 2022 5,348,120 $ 2.56 3.3 $ 378 Outstanding at March 31, 2023 5,348,120 $ 2.56 3.1 $ 311 Exercisable at March 31, 2023 5,325,020 $ 2.55 3.1 $ 311

Supplemental Revenue Informat_2

Supplemental Revenue Information (Tables)	3 Months Ended
	Mar. 31, 2023
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) 2023 2022 Patient fee payors: Commercial $ 65,522 $ 69,101 Medicare 21,420 21,172 Medicaid 3,405 3,102 Other patient revenue 2,595 3,274 92,942 96,649 Hospitals and healthcare providers 92,462 87,459 Other revenue 2,188 2,155 $ 187,592 $ 186,263

Cost of Operations, excluding_2

Cost of Operations, excluding Depreciation and Amortization (Tables)	3 Months Ended
	Mar. 31, 2023
Cost Of Operations Excluding Depreciation And Amortization [Abstract]
Summary of 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) 2023 2022 Employee compensation $ 71,527 $ 75,127 Third-party services and professional fees 30,829 29,177 Rent and utilities 12,341 12,477 Reading fees 11,599 11,498 Administrative 10,421 11,624 Medical supplies and other 18,850 15,258 $ 155,567 $ 155,161

Supplemental Statement of Ope_2

Supplemental Statement of Operations Information (Tables)	3 Months Ended
	Mar. 31, 2023
Other Income and Expenses [Abstract]
Schedule of Restructuring Charges	Restructuring charges consist of the following: Three Months Ended March 31, (in thousands) 2023 2022 Transformation costs $ 5,720 $ — Other 16 80 $ 5,736 $ 80
Schedule of Other Operating Losses (gains)	Other operating income, net consists of the following: Three Months Ended March 31, (in thousands) 2023 2022 Gain from insurance proceeds $ (776) $ — Loss on sale of accounts receivable 124 — Loss (gain) on disposal of property and equipment, net (69) 202 Other, net (30) (209) $ (751) $ (7)
Schedule Of Other Non-operating Losses (gains)	Other non-operating expense (income), net consists of the following: Three Months Ended March 31, (in thousands) 2023 2022 Acquisition-related costs $ 143 $ 382 Fair value adjustment on derivative in subordinated notes (43) 170 Earnings from unconsolidated investees (151) (240) Other, net (81) 12 $ (132) $ 324

Basic and Diluted Loss per Sh_2

Basic and Diluted Loss per Share (Tables)	3 Months Ended
	Mar. 31, 2023
Earnings Per Share [Abstract]
Summary of Earnings Per Share Basic and Diluted	The loss per share is calculated by dividing the net loss attributable to common stockholders by the weighted average common shares outstanding during the period. Three Months Ended March 31, (in thousands, except share and per share amounts) 2023 2022 Net loss attributable to common stockholders $ (35,148) $ (30,811) Weighted average common shares outstanding: Basic and diluted 89,819,146 89,074,282 Net loss per share attributable to common stockholders: Basic and diluted $ (0.39) $ (0.35) Employee stock options, warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive 2,301,518 1,844,044

Segment Information (Tables)

Segment Information (Tables)	3 Months Ended
	Mar. 31, 2023
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) 2023 2022 Radiology $ 157,401 $ 155,340 Oncology 30,191 30,923 $ 187,592 $ 186,263
Summary of Company's Adjusted EBITDA	The following table summarizes the Company’s Adjusted EBITDA by segment: Three Months Ended March 31, (in thousands) 2023 2022 Adjusted EBITDA: Radiology $ 30,326 $ 28,589 Oncology 9,848 10,033 Corporate (7,033) (6,604) $ 33,141 $ 32,018
Summary of Net Income (Loss) to Total Adjusted EBITDA	A reconciliation of the net income (loss) to total Adjusted EBITDA is shown below: Three Months Ended March 31, (in thousands) 2023 2022 Net loss $ (29,190) $ (26,432) Interest expense 30,697 28,681 Income tax expense 874 563 Depreciation and amortization 22,993 24,731 Restructuring charges 5,736 80 Severance and related costs (49) 2,238 Settlements, recoveries and related costs 1,448 (137) Stock-based compensation 399 1,061 Loss on sale of accounts receivable 124 — Loss (gain) on disposal of property and equipment, net (69) 202 Acquisition-related costs 143 382 Fair value adjustment on derivative (43) 170 Deferred rent expense 185 332 Other, net (107) 147 Adjusted EBITDA $ 33,141 $ 32,018
Schedule of Segment Reporting Information By Segment	The following table summarizes the Company’s total assets by segment: (in thousands) March 31, December 31, Identifiable assets: Radiology $ 1,371,908 $ 1,400,938 Oncology 332,295 346,337 Corporate 18,470 17,840 $ 1,722,673 $ 1,765,115 The following table summarizes the Company’s capital expenditures by segment: Three Months Ended March 31, (in thousands) 2023 2022 Capital expenditures: Radiology $ 1,976 $ 8,812 Oncology 500 976 Corporate 32 90 $ 2,508 $ 9,878

Variable Interest Entities (Det

Variable Interest Entities (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Variable Interest Entity [Line Items]
Assets	$ 1,722,673		$ 1,765,115
Liabilities	1,618,814		1,623,824
Net cash provided by operating activities	3,304	$ 9,318
Variable Interest Entity, Primary Beneficiary
Variable Interest Entity [Line Items]
Assets	34,000		36,000
Liabilities	2,400		$ 1,400
Revenues	43,400	46,000
Net cash provided by operating activities	$ 41,800	$ 46,300

Property and Equipment - Summar

Property and Equipment - Summary of Detailed Information of Property and Equipment (Detail) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Property, Plant and Equipment [Line Items]
Equipment under finance leases	$ 46,545	$ 44,845
Total property and equipment, gross	372,555	370,156
Less accumulated depreciation	166,581	148,942
Property and equipment, net	205,974	221,214
Medical equipment
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	245,836	244,517
Leasehold improvements
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	43,684	43,382
Office and computer equipment
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	18,644	17,742
Transportation and service equipment
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	11,562	11,672
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	3,439	3,362
Construction in progress
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	$ 2,845	$ 4,636

Property and Equipment - Additi

Property and Equipment - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Property, Plant and Equipment [Abstract]
Depreciation expense	$ 18.3	$ 19.7
Net book value of equipment under finance leases	$ 26.5		$ 26.3

Other Intangible Assets - Sched

Other Intangible Assets - Schedule Of Intangible Assets Excluding Goodwill (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 356,442	$ 356,442
Accumulated Amortization	(38,646)	(33,905)
Other Intangible Assets, Net	317,796	322,537
Certificates of Need	69,558	69,558
Total other intangible assets	$ 387,354	392,095
Customer contracts
Finite-Lived Intangible Assets [Line Items]
Weighted Average Useful Life (in years)	20 years
Gross Carrying Amount	$ 263,388	263,388
Accumulated Amortization	(20,910)	(17,588)
Other Intangible Assets, Net	$ 242,478	245,800
Trade names
Finite-Lived Intangible Assets [Line Items]
Weighted Average Useful Life (in years)	18 years
Gross Carrying Amount	$ 77,135	77,135
Accumulated Amortization	(12,245)	(11,063)
Other Intangible Assets, Net	$ 64,890	66,072
Management agreements
Finite-Lived Intangible Assets [Line Items]
Weighted Average Useful Life (in years)	17 years
Gross Carrying Amount	$ 10,200	10,200
Accumulated Amortization	(950)	(800)
Other Intangible Assets, Net	$ 9,250	9,400
Other
Finite-Lived Intangible Assets [Line Items]
Weighted Average Useful Life (in years)	5 years
Gross Carrying Amount	$ 5,719	5,719
Accumulated Amortization	(4,541)	(4,454)
Other Intangible Assets, Net	$ 1,178	$ 1,265

Other Intangible Assets - Addit

Other Intangible Assets - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expense of finite-lived intangible assets	$ 4.7	$ 5

Long-Term Debt - Summary of Lon

Long-Term Debt - Summary of Long-term debt (Detail) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term debt	$ 1,355,234	$ 1,346,057
Debt discount/premium and deferred issuance costs	(72,094)	(71,444)
Total long-term debt	1,283,140	1,274,613
Less current portion	20,432	19,961
Long-term debt, net of current portion	1,262,708	1,254,652
2028 Senior Notes
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term debt	375,000	375,000
2025 Senior Notes
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term debt	475,000	475,000
Subordinated Notes
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term debt	437,061	423,303
Equipment Debt
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term debt	$ 68,173	$ 72,754

Long-Term Debt - Additional Inf

Long-Term Debt - Additional Information (Details) $ in Millions	3 Months Ended
	Mar. 31, 2023 USD ($)
Subordinated Notes
Debt Instrument [Line Items]
Accrued interest added to the principal balance	$ 13.8

Accrued Liabilities (Detail)

Accrued Liabilities (Detail) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Payables and Accruals [Abstract]
Accrued compensation and related expenses	$ 20,833	$ 25,655
Accrued interest expense	19,541	18,183
Other	52,574	43,078
Total other accrued liabilities	$ 92,948	$ 86,916

Redeemable Noncontrolling Int_3

Redeemable Noncontrolling Interests - Additional Information (Detail) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Noncontrolling Interest [Abstract]
Redeemable noncontrolling interests	$ 28,657	$ 30,337

Redeemable Noncontrolling Int_4

Redeemable Noncontrolling Interest - Summary of Redeemable Noncontrolling Interests (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2023 USD ($)
Stockholders' Equity Attributable to Noncontrolling Interest [Roll Forward]
Balance, December 31, 2022	$ 30,337
Net income attributable to redeemable noncontrolling interests	1,146
Distributions paid to redeemable noncontrolling interests	(2,826)
Balance, March 31, 2023	$ 28,657

Financial Instruments - Schedul

Financial Instruments - Schedule of Fair Value Measurements, Recurring and Nonrecurring (Details) - Fair Value, Recurring - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Interest rate contracts
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Current and long-term assets:	$ 37	$ 52
Interest rate contracts | Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Current and long-term assets:	0	0
Interest rate contracts | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Current and long-term assets:	37	52
Interest rate contracts | Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Current and long-term assets:	0	0
Derivative in subordinated notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Long-term liabilities:	6,089	6,132
Derivative in subordinated notes | Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Long-term liabilities:	0	0
Derivative in subordinated notes | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Long-term liabilities:	0	0
Derivative in subordinated notes | Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Long-term liabilities:	$ 6,089	$ 6,132

Financial Instruments - Additio

Financial Instruments - Additional Information (Detail) $ in Millions	Sep. 01, 2021	Mar. 31, 2023 USD ($) yr	Dec. 31, 2022 USD ($) yr
Revolving Credit Facility | Interest Rate Contract
Financial Instruments [Line Items]
Increase decrease in the variable rate of interest		1%	1%
Equipment Debt
Financial Instruments [Line Items]
Long term debt unhedged | $		$ 0.4	$ 0.4
Subordinated Notes | Stone Peak Magnet
Financial Instruments [Line Items]
Debt covenant, redemption option, change of control period (in years)	7 years
Level 3 | Measurement Input Probability Weighted Time
Financial Instruments [Line Items]
Embedded derivative liability measurement input | yr		3.4	3.5
Level 3 | Measurement Input Probability Of Exit Event Percentage
Financial Instruments [Line Items]
Embedded derivative liability measurement input		0.223	0.229

Financial Instruments - Summary

Financial Instruments - Summary of Reconciliation of Liability Related to the Embedded Derivative (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Disclosure Of Movement In Embedded Derivative Liabilities [Roll Forward]
Change in fair value	$ 43	$ (170)
Subordinated Notes | Stone Peak Magnet | Level 3
Disclosure Of Movement In Embedded Derivative Liabilities [Roll Forward]
Balance, December 31, 2022	6,132
Change in fair value	(43)
Balance, March 31, 2023	$ 6,089

Financial Instruments - Sched_2

Financial Instruments - Schedule Of Fair Value Of Other Current And Non Current Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	$ 978,818	$ 881,928
2028 Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	262,463	228,894
2025 Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	374,063	339,385
Subordinated Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	283,587	254,951
Equipment Debt
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	$ 58,705	$ 58,698

Financial Instruments - Sched_3

Financial Instruments - Schedule of Information Regarding The Carrying Value Of Financial Instruments (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash and cash equivalents	$ 45,399	$ 59,424
Accounts receivable	114,696	114,166
Current portion of long-term debt	20,432	19,961
Non-current portion of long-term debt	1,262,708	1,254,652
Accrued liabilities	92,948	86,916
Reported Value Measurement
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash and cash equivalents	45,399	59,424
Accounts receivable	114,696	114,166
Financial assets measured at amortized cost	160,095	173,590
Accounts payable	25,458	36,618
Current portion of long-term debt	20,432	19,961
Current portion of leases	23,526	25,023
Non-current portion of long-term debt	1,262,708	1,254,652
Non-current portion of leases	172,564	179,980
Accrued liabilities	92,948	86,916
Financial liabilities measured at amortized cost	1,597,636	1,603,150
Financial liabilities measured at fair value through earnings:
Derivative in subordinated notes	6,089	6,132
Financial assets measured at fair value through other comprehensive income:
Interest rate contracts	$ 37	$ 52

Stockholders' Equity - Addition

Stockholders' Equity - Additional Information (Detail)		3 Months Ended
	Nov. 14, 2017	Mar. 31, 2023 $ / shares shares	Dec. 31, 2022 $ / shares shares
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Common stock, shares authorized (in shares)		300,000,000	300,000,000
Common stock, par or stated value per share (in USD per share) | $ / shares		$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)		50,000,000	50,000,000
Preferred stock, par or stated value per share (in USD per share) | $ / shares		$ 0.01	$ 0.01
Restricted Stock Units (RSUs)
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Vesting period		2 years
Employee Stock Option
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Vesting period		3 years
Options granted (in shares)		0
Employee Stock Option | Minimum
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Term of award		7 years
Employee Stock Option | Maximum
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Term of award		10 years
Domestication
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Common stock, shares authorized (in shares)		300,000,000
Common stock, par or stated value per share (in USD per share) | $ / shares		$ 0.01
Preferred stock, shares authorized (in shares)		50,000,000
Preferred stock, par or stated value per share (in USD per share) | $ / shares		$ 0.01
2017 Stock Plans
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Common stock options reserved for issuance (as a percent)	0.10
Common stock options reserved for issuance (in shares)		9,049,849	8,981,151

Stockholders' Equity - Summary

Stockholders' Equity - Summary of RSU Activity (Detail) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2023 USD ($) $ / shares shares
Number of RSUs
Beginning balance (in shares) | shares	2,143,601
Granted (in shares) | shares	350,000
Vested (in shares) | shares	(686,978)
Cancelled (in shares) | shares	(57,078)
Ending balance (in shares) | shares	1,749,545
Weighted- Average Grant Date Fair Value
Beginning balance (in dollars per share) | $ / shares	$ 1.77
Granted (in dollars per share) | $ / shares	1.08
Vested (in dollars per share) | $ / shares	2.34
Cancelled (in dollars per share) | $ / shares	1.10
Ending balance (in dollars per share) | $ / shares	$ 1.43
Aggregate Grant Date Fair Value, Granted | $	$ 378
Aggregate Grant Date Fair Value, Vested | $	1,605
Aggregate Grant Date Fair Value, Cancelled | $	(63)
Aggregate Grant Date Fair Value, Outstanding and unvested | $	$ 2,504

Stockholders' Equity - Summar_2

Stockholders' Equity - Summary of the Stock Option Activity (Detail) - Stock Options - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2023	Dec. 31, 2022
Number of Options
Beginning balance (in shares)	5,348,120
Ending balance (in shares)	5,348,120	5,348,120
Weighted- Average Exercise price
Beginning balance (in dollars per share)	$ 2.56
Ending balance (in dollars per share)	$ 2.56	$ 2.56
Stock Options Additional Disclosures
Number of Options, Exercisable (in shares)	5,325,020
Weighted-Average Exercise price, Exercisable (in dollars per share)	$ 2.55
Weighted- Average Remaining Contractual Term (Years)	3 years 1 month 6 days	3 years 3 months 18 days
Weighted-Average Remaining Contractual Term, Exercisable	3 years 1 month 6 days
Aggregate Intrinsic Value (in thousands)	$ 311	$ 378
Aggregate Intrinsic Value, Exercisable	$ 311

Commitments and Contingencies (

Commitments and Contingencies (Details) - Commitement For The Purchase Of Equipment $ in Millions	Mar. 31, 2023 USD ($)
Loss Contingencies [Line Items]
Purchase commitments	$ 39.4
Within the Remaining Nine Months
Loss Contingencies [Line Items]
Purchase commitments	31.1
Greater Than Nine Months
Loss Contingencies [Line Items]
Purchase commitments	$ 8.3

Supplemental Revenue Informat_3

Supplemental Revenue Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Disaggregation of Revenue [Line Items]
Other revenue	$ 2,188	$ 2,155
Total revenue	187,592	186,263
Sales Channel, Directly to Consumer
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	92,942	96,649
Commercial | Sales Channel, Directly to Consumer
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	65,522	69,101
Medicare | Sales Channel, Directly to Consumer
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	21,420	21,172
Medicaid | Sales Channel, Directly to Consumer
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	3,405	3,102
Other patient revenue | Sales Channel, Directly to Consumer
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	2,595	3,274
Hospitals and healthcare providers | Sales Channel, Through Intermediary
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	$ 92,462	$ 87,459

Cost of Operations, excluding_3

Cost of Operations, excluding Depreciation and Amortization (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	$ 155,567	$ 155,161
Employee compensation
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	71,527	75,127
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	30,829	29,177
Rent and utilities
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	12,341	12,477
Reading fees
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	11,599	11,498
Administrative
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	10,421	11,624
Medical supplies and other
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	$ 18,850	$ 15,258

Supplemental Statement of Ope_3

Supplemental Statement of Operations Information - Schedule of Restructuring Charges (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Restructuring Cost and Reserve [Line Items]
Restructuring charges	$ 5,736	$ 80
Transformation costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges	5,720	0
Other
Restructuring Cost and Reserve [Line Items]
Restructuring charges	$ 16	$ 80

Supplemental Statement of Ope_4

Supplemental Statement of Operations Information - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Dec. 31, 2022
Restructuring Cost and Reserve [Line Items]
Accounts payable	$ 25,458	$ 36,618
Minimum
Restructuring Cost and Reserve [Line Items]
Severance benefits, payment period	12 months
Maximum
Restructuring Cost and Reserve [Line Items]
Severance benefits, payment period	18 months
Transformation costs
Restructuring Cost and Reserve [Line Items]
Accounts payable	$ 2,300
Accrued liability for unpaid transformation consulting costs	6,900
Transformation Costs, Fixed Fees
Restructuring Cost and Reserve [Line Items]
Remaining transformation costs	12,500
Transformation Costs, Milestone Fees
Restructuring Cost and Reserve [Line Items]
Remaining transformation costs	7,000
Transformation Costs, Performance Fees
Restructuring Cost and Reserve [Line Items]
Remaining transformation costs	15,000
Employee Severance
Restructuring Cost and Reserve [Line Items]
Accrued liability for unpaid transformation consulting costs	$ 3,000

Supplemental Statement of Ope_5

Supplemental Statement of Operations Information - Schedule of Other Operating Expense (Income) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Other Income and Expenses [Abstract]
Gain from insurance proceeds	$ (776)	$ 0
Loss on sale of accounts receivable	124	0
Loss (gain) on disposal of property and equipment, net	(69)	202
Other, net	(30)	(209)
Other operating income, net	$ (751)	$ (7)

Supplemental Statement of Ope_6

Supplemental Statement of Operations Information - Schedule of Other Non-operating Losses (gains) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Other Income and Expenses [Abstract]
Acquisition-related costs	$ 143	$ 382
Fair value adjustment on derivative in subordinated notes	(43)	170
Earnings from unconsolidated investees	(151)	(240)
Other, net	(81)	12
Other non-operating expense (income), net	$ (132)	$ 324

Investments in Unconsolidated_2

Investments in Unconsolidated Investees (Detail) - USD ($) $ in Millions	Mar. 01, 2021	Mar. 31, 2023
Other Investments [Line Items]
Payments to acquire Investments	$ 4.6
Equity method investments		$ 7.9
Common Equity | Share Purchase Warrants
Other Investments [Line Items]
Payments to acquire Investments	$ 0.4
AI Business
Other Investments [Line Items]
Equity method investment, ownership percentage	34.50%	15%
AI Business | Common Equity | Share Purchase Warrants
Other Investments [Line Items]
Equity method investment, ownership percentage		2.40%

Basic and Diluted Loss per Sh_3

Basic and Diluted Loss per Share (Detail) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Earnings Per Share [Abstract]
Net loss attributable to common stockholders	$ (35,148)	$ (30,811)
Weighted average common shares outstanding:
Basic (in shares)	89,819,146	89,074,282
Diluted (in shares)	89,819,146	89,074,282
Net loss per share attributable to common stockholders:
Basic (in dollars per share)	$ (0.39)	$ (0.35)
Diluted (in dollars per share)	$ (0.39)	$ (0.35)
Employee stock options, warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive (in shares)	2,301,518	1,844,044

Segment Information - Additiona

Segment Information - Additional Information (Details)	19 Months Ended
	Mar. 31, 2023 segment
Segment Reporting [Abstract]
Number of reportable segments	2

Segment Information - Summary o

Segment Information - Summary of Company's Revenues By Segment (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenues	$ 187,592	$ 186,263
Radiology
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenues	157,401	155,340
Oncology
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenues	$ 30,191	$ 30,923

Segment Information - Summary_2

Segment Information - Summary of Company's Adjusted EBITDA (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted EBITDA	$ 33,141	$ 32,018
Corporate
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted EBITDA	(7,033)	(6,604)
Radiology | Operating Segments
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted EBITDA	30,326	28,589
Oncology | Operating Segments
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted EBITDA	$ 9,848	$ 10,033

Segment Information - Summary_3

Segment Information - Summary of Net Income (Loss) to Total Adjusted EBITDA (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Segment Reporting [Abstract]
Net income (loss), net of the net income attributable to redeemable noncontrolling interests	$ (29,190)	$ (26,432)
Interest expense	30,697	28,681
Income tax expense	874	563
Depreciation and amortization	22,993	24,731
Restructuring charges	5,736	80
Severance and related costs	(49)	2,238
Settlements, recoveries and related costs	1,448	(137)
Stock-based compensation	399	1,061
Loss on sale of accounts receivable	124	0
Loss (gain) on disposal of property and equipment, net	(69)	202
Acquisition-related costs	143	382
Fair value adjustment on derivative in subordinated notes	(43)	170
Deferred rent expense	185	332
Other, net	(107)	147
Adjusted EBITDA	$ 33,141	$ 32,018

Segment Information - Schedule

Segment Information - Schedule Of Segment Reporting Information By Segment (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Segment Reporting Information [Line Items]
Identifiable assets	$ 1,722,673		$ 1,765,115
Capital expenditures	2,508	$ 9,878
Corporate
Segment Reporting Information [Line Items]
Identifiable assets	18,470		17,840
Capital expenditures	32	90
Radiology | Operating Segments
Segment Reporting Information [Line Items]
Identifiable assets	1,371,908		1,400,938
Capital expenditures	1,976	8,812
Oncology | Operating Segments
Segment Reporting Information [Line Items]
Identifiable assets	332,295		$ 346,337
Capital expenditures	$ 500	$ 976