Akumin (AKUMQ) 10-Q 9 Aug 23 2023 Q2 Quarterly report Financial data

Cover Page

Cover Page - shares	6 Months Ended
	Jun. 30, 2023	Aug. 07, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2023
Document Transition Report	false
Entity File Number	001-39479
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		90,998,491
Entity Central Index Key	0001776197
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q2
Amendment Flag	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 37,968	$ 59,424
Accounts receivable	115,790	114,166
Prepaid expenses	8,477	8,003
Other current assets	10,309	10,352
Total current assets	172,544	191,945
Property and equipment, net	197,559	221,214
Operating lease right-of-use assets	156,778	166,823
Goodwill	715,269	769,110
Other intangible assets, net	370,512	392,095
Other assets	23,080	23,928
Total assets	1,635,742	1,765,115
Current liabilities:
Accounts payable	43,575	36,618
Current portion of long-term debt	19,282	19,961
Current portion of obligations under finance leases	7,837	7,800
Current portion of obligations under operating leases	15,744	17,223
Accrued liabilities	88,339	86,916
Total current liabilities	174,777	168,518
Long-term debt, net of current portion	1,273,077	1,254,652
Obligations under finance leases, net of current portion	15,991	19,505
Obligations under operating leases, net of current portion	151,957	160,475
Other liabilities	19,384	20,674
Total liabilities	1,635,186	1,623,824
Redeemable noncontrolling interests	26,800	30,337
Stockholders’ deficit:
Preferred stock, $0.01 par value; 50,000,000 shares authorized; no shares issued and outstanding at June 30, 2023 and December 31, 2022	0	0
Common stock, $0.01 par value; 300,000,000 shares authorized; 90,998,491 shares issued and outstanding at June 30, 2023; 89,811,513 shares issued and outstanding at December 31, 2022	910	898
Additional paid-in capital	231,842	231,014
Accumulated other comprehensive income	24	73
Accumulated deficit	(411,985)	(280,185)
Total stockholders’ deficit	(179,209)	(48,200)
Noncontrolling interests	152,965	159,154
Total equity (deficit)	(26,244)	110,954
Total liabilities, redeemable noncontrolling interests and equity	$ 1,635,742	$ 1,765,115

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Jun. 30, 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)	90,998,491	89,811,513
Common stock outstanding (in shares)	90,998,491	89,811,513

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Income Statement [Abstract]
Revenues	$ 184,840	$ 192,128	$ 372,432	$ 378,391
Operating expenses:
Cost of operations, excluding depreciation and amortization	158,495	154,574	314,062	309,735
Depreciation and amortization	35,015	25,200	58,008	49,931
Impairment charges	53,460	0	53,460	0
Restructuring charges	944	7,244	6,680	7,324
Severance and related costs	22	5,559	(27)	7,797
Settlements, recoveries and related costs	465	814	1,913	677
Stock-based compensation	441	758	840	1,819
Other operating expense (income), net	477	586	(274)	579
Total operating expenses	249,319	194,735	434,662	377,862
Income (loss) from operations	(64,479)	(2,607)	(62,230)	529
Other expense (income):
Interest expense	31,164	29,290	61,861	57,971
Other non-operating expense (income), net	2,346	(2,335)	2,214	(2,011)
Total other expense, net	33,510	26,955	64,075	55,960
Loss before income taxes	(97,989)	(29,562)	(126,305)	(55,431)
Income tax benefit	(1,578)	(3,483)	(704)	(2,920)
Net loss	(96,411)	(26,079)	(125,601)	(52,511)
Less: Net income attributable to noncontrolling interests	241	4,390	6,199	8,769
Net loss attributable to common stockholders	(96,652)	(30,469)	(131,800)	(61,280)
Comprehensive loss, net of taxes:
Net loss	(96,411)	(26,079)	(125,601)	(52,511)
Other comprehensive income (loss):
Unrealized gain (loss) on hedging transactions, net of taxes	(7)	7	(21)	36
Reclassification adjustment for gains (losses) included in net loss, net of taxes	(14)	9	(28)	26
Other comprehensive income (loss)	(21)	16	(49)	62
Comprehensive loss, net of taxes	(96,432)	(26,063)	(125,650)	(52,449)
Less: Comprehensive income attributable to noncontrolling interests	241	4,390	6,199	8,769
Comprehensive loss attributable to common stockholders	$ (96,673)	$ (30,453)	$ (131,849)	$ (61,218)
Earnings Per Share [Abstract]
Basic (in USD per share)	$ (1.07)	$ (0.34)	$ (1.46)	$ (0.69)
Diluted (in USD per share)	$ (1.07)	$ (0.34)	$ (1.46)	$ (0.69)

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Equity - USD ($) $ in Thousands	Total	Total Stockholders’ Equity (Deficit)	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	(53,625)	(61,280)				(61,280)	7,655
Settlement of restricted share units (in shares)			489,516
Settlement of restricted share units	0		$ 5	(5)
Stock-based compensation	1,819	1,819		1,819
Other comprehensive income (loss)	62	62			62
Distributions paid to noncontrolling interests	(11,604)						(11,604)
Purchase accounting adjustments	161						161
Ending balance (in shares) at Jun. 30, 2022			89,516,513
Ending Balance at Jun. 30, 2022	220,492	45,790	$ 895	229,519	80	(184,704)	174,702
Beginning balance (in shares) at Mar. 31, 2022			89,516,513
Beginning balance at Mar. 31, 2022	252,209	75,485	$ 895	228,761	64	(154,235)	176,724
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss), net of the net income (loss) attributable to redeemable noncontrolling interests	(26,613)	(30,469)				(30,469)	3,856
Stock-based compensation	758	758		758
Other comprehensive income (loss)	16	16			16
Distributions paid to noncontrolling interests	(5,878)						(5,878)
Ending balance (in shares) at Jun. 30, 2022			89,516,513
Ending Balance at Jun. 30, 2022	220,492	45,790	$ 895	229,519	80	(184,704)	174,702
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	(126,212)	(131,800)				(131,800)	5,588
Settlement of restricted share units (in shares)			1,186,978
Settlement of restricted share units	0		$ 12	(12)
Stock-based compensation	840	840		840
Other comprehensive income (loss)	(49)	(49)			(49)
Distributions paid to noncontrolling interests	(11,777)						(11,777)
Ending balance (in shares) at Jun. 30, 2023			90,998,491
Ending Balance at Jun. 30, 2023	(26,244)	(179,209)	$ 910	231,842	24	(411,985)	152,965
Beginning balance (in shares) at Mar. 31, 2023			90,498,491
Beginning balance at Mar. 31, 2023	75,202	(82,977)	$ 905	231,406	45	(315,333)	158,179
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss), net of the net income (loss) attributable to redeemable noncontrolling interests	(95,876)	(96,652)				(96,652)	776
Settlement of restricted share units (in shares)			500,000
Settlement of restricted share units	0		$ 5	(5)
Stock-based compensation	441	441		441
Other comprehensive income (loss)	(21)	(21)			(21)
Distributions paid to noncontrolling interests	(5,990)						(5,990)
Ending balance (in shares) at Jun. 30, 2023			90,998,491
Ending Balance at Jun. 30, 2023	$ (26,244)	$ (179,209)	$ 910	$ 231,842	$ 24	$ (411,985)	$ 152,965

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Operating activities:
Net loss	$ (125,601)	$ (52,511)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization	58,008	49,931
Impairment charges	53,460	0
Stock-based compensation	840	1,819
Non-cash interest expense	27,962	24,604
Amortization of deferred financing costs and accretion of discount/premium on long-term debt	1	54
Deferred income taxes	(914)	(3,368)
Distributions from unconsolidated investees	305	915
Earnings from unconsolidated investees	(279)	(488)
Other non-cash items, net	1,380	(498)
Changes in operating assets and liabilities:
Accounts receivable	(2,326)	(4,547)
Prepaid expenses and other assets	(1,181)	(1,919)
Accounts payable and other liabilities	6,171	6,502
Operating lease liabilities and right-of-use assets	129	585
Net cash provided by operating activities	17,955	21,079
Investing activities:
Purchases of property and equipment	(11,460)	(15,466)
Other investing activities	823	963
Net cash used in investing activities	(10,637)	(14,503)
Financing activities:
Proceeds from revolving loan	14,000	20,000
Principal payments on revolving loan	(14,000)	(20,000)
Proceeds from long-term debt	1,706	10,292
Principal payments on long-term debt	(10,618)	(8,365)
Principal payments on finance leases	(3,937)	(4,330)
Contributions received from redeemable noncontrolling interests	107	0
Distributions paid to noncontrolling and redeemable noncontrolling interests	(16,032)	(14,145)
Net cash used in financing activities	(28,774)	(16,548)
Net decrease in cash and cash equivalents	(21,456)	(9,972)
Cash and cash equivalents, beginning of period	59,424	48,419
Cash and cash equivalents, beginning of period	37,968	38,447
Cash and cash equivalents, end of period
Interest paid	33,986	32,439
Income taxes paid, net of refunds	929	502
Supplemental disclosure of non-cash investing and financing activities:
Property and equipment purchases in accounts payable and accrued liabilities	3,551	4,852
Derecognition of operating lease right-of-use assets and lease liabilities associated with lease terminations	3,656	3,635
Equipment acquired in exchange for finance lease obligations	460	1,433
Operating lease right-of-use assets obtained in exchange for operating lease liabilities	$ 3,500	$ 668

Basis of Presentation

Basis of Presentation	6 Months Ended
	Jun. 30, 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 and six months ended June 30, 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	6 Months Ended
	Jun. 30, 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	6 Months Ended
	Jun. 30, 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 June 30, 2023 and December 31, 2022, the Revenue Practices’ assets included in the Company’s condensed consolidated balance sheets were $39.6 million and $36.0 million, respectively, and liabilities included in the Company’s condensed consolidated balance sheets were $2.9 million and $1.4 million, respectively. The assets of the Revenue Practices can only be used to settle their obligations. During the six months ended June 30, 2023 and 2022, the Revenue Practices’ revenues were $85.7 million and $92.8 million, respectively, and the net cash provided by operating activities was $77.9 million and $93.2 million, respectively.

Property and Equipment

Property and Equipment	6 Months Ended
	Jun. 30, 2023
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment Property and equipment consists of the following: (in thousands) June 30, December 31, Medical equipment $ 254,247 $ 244,517 Leasehold improvements 44,000 43,382 Equipment under finance leases 45,348 44,845 Office and computer equipment 19,151 17,742 Transportation and service equipment 11,542 11,672 Furniture and fixtures 3,439 3,362 Construction in progress 3,550 4,636 381,277 370,156 Less accumulated depreciation 183,718 148,942 $ 197,559 $ 221,214 Depreciation expense was $18.2 million and $20.2 million for the three months ended June 30, 2023 and 2022, respectively, and $36.4 million and $39.9 million for the six months ended June 30, 2023 and 2022, respectively.

Goodwill

Goodwill	6 Months Ended
	Jun. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	Goodwill Changes in the carrying amount of goodwill are as follows: (in thousands) Radiology Oncology Total Balance, December 31, 2022 $ 682,725 $ 86,385 $ 769,110 Impairment (53,460) — (53,460) Goodwill written off in connection with site closure — (381) (381) Balance, June 30, 2023 $ 629,265 $ 86,004 $ 715,269 The 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. During the second quarter of 2023, the Company determined that potential indicators of impairment existed and thus performed a quantitative test for impairment at the reporting unit level as of May 31, 2023. In estimating fair values, the Company gave equal weight to an income approach (the DCF method) and a market approach (the GPC method). Specifically, the Company utilized the following Level 3 estimates and assumptions in its analysis: Discount rate 9.5% to 10.0% Perpetual growth rate 3.0% Tax rate 26.0% Risk-free interest rate 3.5% Revenue multiple 1.8 to 2.2 EBITDA multiple 7.5 to 9.5 The impairment test yielded a fair value for the Oncology reporting unit that exceeded its carrying value; therefore, this reporting unit was not considered at risk of impairment. In connection with the impairment test for the Radiology reporting unit, the Company concluded that the carrying value exceeded its estimated fair value based on management's assessment of the outlook and long-term business plans for this division. Consequently, the Company recorded an impairment charge of $53.5 million related to goodwill for the Radiology reporting unit, which was recorded in the condensed consolidated statements of operations and comprehensive loss for the three and six months ended June 30, 2023.

Other Intangible Assets

Other Intangible Assets	6 Months Ended
	Jun. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Other Intangible Assets	Other Intangible Assets Other intangible assets consist of the following: (dollars in thousands) Weighted June 30, 2023 December 31, 2022 Gross Accumulated Other Gross Accumulated Other Finite-lived intangible assets: Customer contracts 20 $ 250,733 $ (23,057) $ 227,676 $ 263,388 $ (17,588) $ 245,800 Trade names 18 76,391 (13,324) 63,067 77,135 (11,063) 66,072 Management agreements 17 10,200 (1,100) 9,100 10,200 (800) 9,400 Other 5 5,739 (4,628) 1,111 5,719 (4,454) 1,265 Total $ 343,063 $ (42,109) 300,954 $ 356,442 $ (33,905) 322,537 Certificates of Need 69,558 69,558 Total other intangible assets $ 370,512 $ 392,095 The Company performs an impairment test when indicators of impairment are present. As of June 30, 2023, there were no indications of impairment of the Company's other intangible assets balances.

Long-Term Debt

Long-Term Debt	6 Months Ended
	Jun. 30, 2023
Debt Disclosure [Abstract]
Long-Term Debt	Long-Term Debt Long-term debt consists of the following: (in thousands) June 30, December 31, 2028 Senior Notes $ 375,000 $ 375,000 2025 Senior Notes 475,000 475,000 Subordinated Notes 451,265 423,303 Equipment Debt 63,842 72,754 1,365,107 1,346,057 Debt discount/premium and deferred issuance costs (72,748) (71,444) 1,292,359 1,274,613 Less current portion 19,282 19,961 Long-term debt, net of current portion $ 1,273,077 $ 1,254,652 During the six months ended June 30, 2023, the Company elected to pay interest in-kind on the Subordinated Notes pursuant to the original agreement and, accordingly, $28.0 million of accrued interest was added to the principal balance of the Subordinated Notes.

Accrued Liabilities

Accrued Liabilities	6 Months Ended
	Jun. 30, 2023
Payables and Accruals [Abstract]
Accrued Liabilities	Accrued Liabilities Accrued liabilities consist of the following: (in thousands) June 30, December 31, Accrued compensation and related expenses $ 21,743 $ 25,655 Accrued interest expense 18,267 18,183 Other 48,329 43,078 $ 88,339 $ 86,916

Redeemable Noncontrolling Inter

Redeemable Noncontrolling Interests	6 Months Ended
	Jun. 30, 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 June 30, 2023, the Company holds redeemable noncontrolling interests of $26.8 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 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 six months ended June 30, 2023: (in thousands) Balance, December 31, 2022 $ 30,337 Net income attributable to redeemable noncontrolling interests 611 Contributions received from redeemable noncontrolling interests 107 Distributions paid to redeemable noncontrolling interests (4,255) Balance, June 30, 2023 $ 26,800

Financial Instruments

Financial Instruments	6 Months Ended
	Jun. 30, 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 June 30, 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 and fuel option contracts $ — $ 64 $ — $ 64 $ — $ 52 $ — $ 52 Long-term liabilities: Derivative in subordinated notes $ — $ — $ 5,831 $ 5,831 $ — $ — $ 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 June 30, 2023 and December 31, 2022 use unobservable inputs for probability weighted time until an exit event of 3.2 years and 3.5 years, respectively, and an exit event probability weighting of 21.7% 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 six months ended June 30, 2023: (in thousands) Balance, December 31, 2022 $ 6,132 Change in fair value (301) Balance, June 30, 2023 $ 5,831 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 six months ended June 30, 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. During the second quarter of 2023, the Company entered into a fuel call option contract to hedge against fluctuations in fuel prices through April 2024. 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) June 30, December 31, 2028 Senior Notes $ 247,705 $ 228,894 2025 Senior Notes 390,814 339,385 Subordinated Notes 294,380 254,951 Equipment Debt 53,272 58,698 $ 986,171 $ 881,928 As of June 30, 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) June 30, December 31, Financial assets measured at amortized cost: Cash and cash equivalents $ 37,968 $ 59,424 Accounts receivable 115,790 114,166 $ 153,758 $ 173,590 Financial liabilities measured at amortized cost: Accounts payable $ 43,575 $ 36,618 Current portion of long-term debt 19,282 19,961 Current portion of leases 23,581 25,023 Non-current portion of long-term debt 1,273,077 1,254,652 Non-current portion of leases 167,948 179,980 Accrued liabilities 88,339 86,916 $ 1,615,802 $ 1,603,150 Financial assets measured at fair value through earnings: Fuel option contract $ 36 $ — Financial liabilities measured at fair value through earnings: Derivative in subordinated notes $ 5,831 $ 6,132 Financial assets measured at fair value through other comprehensive income: Interest rate contracts $ 28 $ 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. See disclosure of Level 3 measurements related to the goodwill impairment analysis in Note 5. 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 June 30, 2023 and December 31, 2022, the Company had $0.3 million and $0.4 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 June 30, 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	6 Months Ended
	Jun. 30, 2023
Equity [Abstract]
Stockholders' Equity	Stockholders' Equity In connection with the Company's change of jurisdiction of incorporation from the province of Ontario, Canada, to the State of Delaware (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 April 18, 2023 (the “RSU Plan”) and the Amended and Restated Stock Option Plan, adopted as of April 18, 2023 (the “Stock Option Plan” and together with the RSU Plan, the “2023 Stock Plans”). Under the 2023 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 June 30, 2023 and December 31, 2022, shares of common stock reserved for issuance under the 2023 Stock Plans were 9,099,849 and 8,981,151, respectively. The 2023 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 2,217,213 0.67 $ 1,479 Vested (1,186,978) 2.06 $ 2,450 Cancelled (57,078) 1.10 $ (63) Outstanding and unvested at June 30, 2023 3,116,758 $ 0.89 $ 2,761 Stock Options Stock options are awarded as consideration in exchange for services rendered to the Company. Stock options granted generally have terms of 7 years, but in no event more than 10 years after the date of grant, 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 June 30, 2023 5,348,120 $ 2.56 2.8 $ — Exercisable at June 30, 2023 5,325,020 $ 2.55 2.8 $ — Aggregate intrinsic value for outstanding and exercisable stock options in the table above represents the difference between the closing stock price on June 30, 2023 and the exercise price multiplied by the number of in-the-money options. No stock options were granted during the six months ended June 30, 2023.

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 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 June 30, 2023, the obligations for these future purchase commitments totaled $38.4 million, of which $32.5 million is expected to be paid during the remaining six months of 2023 and $6.0 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 June 30, 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. Other Matters

Supplemental Revenue Informatio

Supplemental Revenue Information	6 Months Ended
	Jun. 30, 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 June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Patient fee payors: Commercial $ 65,066 $ 71,609 $ 130,588 $ 140,710 Medicare 20,082 21,002 41,502 42,174 Medicaid 3,256 3,347 6,661 6,449 Other patient revenue 2,729 3,213 5,324 6,487 91,133 99,171 184,075 195,820 Hospitals and healthcare providers 91,513 90,651 183,975 178,110 Other revenue 2,194 2,306 4,382 4,461 $ 184,840 $ 192,128 $ 372,432 $ 378,391

Cost of Operations, excluding D

Cost of Operations, excluding Depreciation and Amortization	6 Months Ended
	Jun. 30, 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 June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Employee compensation $ 68,302 $ 72,021 $ 139,829 $ 147,148 Third-party services and professional fees 32,091 29,919 62,920 59,096 Rent and utilities 12,780 12,742 25,121 25,219 Reading fees 11,953 11,788 23,552 23,286 Administrative 12,944 11,467 23,365 23,091 Medical supplies and other 20,425 16,637 39,275 31,895 $ 158,495 $ 154,574 $ 314,062 $ 309,735

Supplemental Statement of Opera

Supplemental Statement of Operations Information	6 Months Ended
	Jun. 30, 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 June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Transformation costs $ 939 $ 4,025 $ 6,659 $ 4,025 Lease termination costs 7 1,840 7 1,840 Domestication and related costs — 1,063 — 1,063 Other (2) 316 14 396 $ 944 $ 7,244 $ 6,680 $ 7,324 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 June 30, 2023, the accounts payable and accrued liability balance for unpaid transformation consulting costs was $3.4 million and $4.5 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 June 30, 2023, the unpaid balance of severance and related costs totaled $1.5 million, which will be paid during the next twelve months. Other Operating and Non-Operating Expense (Income) Other operating expense (income), net consists of the following: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Loss on sale of accounts receivable $ 922 $ — $ 1,046 $ — Gain from insurance proceeds — — (776) — Loss (gain) on disposal of property and equipment, net (348) 170 (417) 372 Other, net (97) 416 (127) 207 $ 477 $ 586 $ (274) $ 579 Other non-operating expense (income), net consists of the following: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Capital structure initiatives $ 1,912 $ — $ 1,912 $ — Acquisition-related costs 155 86 298 468 Fair value adjustment on derivative in subordinated notes (258) (1,009) (301) (839) Earnings from unconsolidated investees (128) (248) (279) (488) Other, net 665 (1,164) 584 (1,152) $ 2,346 $ (2,335) $ 2,214 $ (2,011) Capital structure initiatives represent costs associated with the Company’s initiative to restructure its long-term debt. Impairment Charges Impairment charges relate to the following assets: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Goodwill (Note 5) $ 53,460 $ — $ 53,460 $ — $ 53,460 $ — $ 53,460 $ —

Investments in Unconsolidated I

Investments in Unconsolidated Investees	6 Months Ended
	Jun. 30, 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 June 30, 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	6 Months Ended
	Jun. 30, 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 and six months ended June 30, 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	6 Months Ended
	Jun. 30, 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 June 30, Six Months Ended June 30, (in thousands, except share and per share amounts) 2023 2022 2023 2022 Net loss attributable to common stockholders $ (96,652) $ (30,469) $ (131,800) $ (61,280) Weighted average common shares outstanding: Basic and diluted 90,503,986 89,516,513 90,163,458 89,296,619 Net loss per share attributable to common stockholders: Basic and diluted $ (1.07) $ (0.34) $ (1.46) $ (0.69) Employee stock options, warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive 1,478,978 2,042,461 2,006,143 2,207,983

Segment Information

Segment Information	6 Months Ended
	Jun. 30, 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, receivables and payables 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 June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Radiology $ 156,291 $ 160,867 $ 313,692 $ 316,207 Oncology 28,549 31,261 58,740 62,184 $ 184,840 $ 192,128 $ 372,432 $ 378,391 Adjusted EBITDA is defined as net loss before interest expense, income tax benefit, depreciation and amortization, impairment charges, restructuring charges, severance and related costs, settlements and related costs, stock-based compensation, loss on sale of accounts receivable, capital structure initiatives, fair value adjustment on derivative, deferred rent expense, and items that we do not consider to be indicative of our core/ongoing operations. 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 June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Adjusted EBITDA: Radiology $ 25,449 $ 35,692 $ 55,775 $ 64,281 Oncology 8,072 10,302 17,920 20,335 Corporate (6,994) (7,810) (14,027) (14,414) $ 26,527 $ 38,184 $ 59,668 $ 70,202 A reconciliation of the net loss to total Adjusted EBITDA is shown below: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Net loss $ (96,411) $ (26,079) $ (125,601) $ (52,511) Interest expense 31,164 29,290 61,861 57,971 Income tax benefit (1,578) (3,483) (704) (2,920) Depreciation and amortization 35,015 25,200 58,008 49,931 Impairment charges 53,460 — 53,460 — Restructuring charges 944 7,244 6,680 7,324 Severance and related costs 22 5,559 (27) 7,797 Settlements, recoveries and related costs 465 814 1,913 677 Stock-based compensation 441 758 840 1,819 Loss on sale of accounts receivable 922 — 1,046 — Loss (gain) on disposal of property and equipment, net (348) 170 (417) 372 Capital structure initiatives 1,912 — 1,912 — Acquisition-related costs 155 86 298 468 Fair value adjustment on derivative (258) (1,009) (301) (839) Deferred rent expense (43) 247 142 579 Other, net 665 (613) 558 (466) Adjusted EBITDA $ 26,527 $ 38,184 $ 59,668 $ 70,202 The following table summarizes the Company’s total assets by segment: (in thousands) June 30, December 31, Identifiable assets: Radiology $ 1,304,358 $ 1,400,938 Oncology 312,992 346,337 Corporate 18,392 17,840 $ 1,635,742 $ 1,765,115 The following table summarizes the Company’s capital expenditures by segment: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Capital expenditures: Radiology $ 7,093 $ 4,648 $ 9,069 $ 13,460 Oncology 500 858 1,000 1,834 Corporate 1,359 82 1,391 172 $ 8,952 $ 5,588 $ 11,460 $ 15,466

New Accounting Standards (Polic

New Accounting Standards (Policies)	6 Months Ended
	Jun. 30, 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)	6 Months Ended
	Jun. 30, 2023
Property, Plant and Equipment [Abstract]
Schedule of Detailed Information of Property and Equipment	Property and equipment consists of the following: (in thousands) June 30, December 31, Medical equipment $ 254,247 $ 244,517 Leasehold improvements 44,000 43,382 Equipment under finance leases 45,348 44,845 Office and computer equipment 19,151 17,742 Transportation and service equipment 11,542 11,672 Furniture and fixtures 3,439 3,362 Construction in progress 3,550 4,636 381,277 370,156 Less accumulated depreciation 183,718 148,942 $ 197,559 $ 221,214

Goodwill (Tables)

Goodwill (Tables)	6 Months Ended
	Jun. 30, 2023
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, 2022 $ 682,725 $ 86,385 $ 769,110 Impairment (53,460) — (53,460) Goodwill written off in connection with site closure — (381) (381) Balance, June 30, 2023 $ 629,265 $ 86,004 $ 715,269
Schedule Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill	Specifically, the Company utilized the following Level 3 estimates and assumptions in its analysis: Discount rate 9.5% to 10.0% Perpetual growth rate 3.0% Tax rate 26.0% Risk-free interest rate 3.5% Revenue multiple 1.8 to 2.2 EBITDA multiple 7.5 to 9.5

Other Intangible Assets - (Tabl

Other Intangible Assets - (Tables)	6 Months Ended
	Jun. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets Excluding Goodwill	Other intangible assets consist of the following: (dollars in thousands) Weighted June 30, 2023 December 31, 2022 Gross Accumulated Other Gross Accumulated Other Finite-lived intangible assets: Customer contracts 20 $ 250,733 $ (23,057) $ 227,676 $ 263,388 $ (17,588) $ 245,800 Trade names 18 76,391 (13,324) 63,067 77,135 (11,063) 66,072 Management agreements 17 10,200 (1,100) 9,100 10,200 (800) 9,400 Other 5 5,739 (4,628) 1,111 5,719 (4,454) 1,265 Total $ 343,063 $ (42,109) 300,954 $ 356,442 $ (33,905) 322,537 Certificates of Need 69,558 69,558 Total other intangible assets $ 370,512 $ 392,095 The Company performs an impairment test when indicators of impairment are present. As of June 30, 2023, there were no indications of impairment of the Company's other intangible assets balances.

Long-Term Debt (Tables)

Long-Term Debt (Tables)	6 Months Ended
	Jun. 30, 2023
Debt Disclosure [Abstract]
Schedule of Long-term Debt Instruments	Long-term debt consists of the following: (in thousands) June 30, December 31, 2028 Senior Notes $ 375,000 $ 375,000 2025 Senior Notes 475,000 475,000 Subordinated Notes 451,265 423,303 Equipment Debt 63,842 72,754 1,365,107 1,346,057 Debt discount/premium and deferred issuance costs (72,748) (71,444) 1,292,359 1,274,613 Less current portion 19,282 19,961 Long-term debt, net of current portion $ 1,273,077 $ 1,254,652

Accrued Liabilities (Tables)

Accrued Liabilities (Tables)	6 Months Ended
	Jun. 30, 2023
Payables and Accruals [Abstract]
Schedule of Other Accrued Liabilities	Accrued liabilities consist of the following: (in thousands) June 30, December 31, Accrued compensation and related expenses $ 21,743 $ 25,655 Accrued interest expense 18,267 18,183 Other 48,329 43,078 $ 88,339 $ 86,916

Redeemable Noncontrolling Int_2

Redeemable Noncontrolling Interests (Tables)	6 Months Ended
	Jun. 30, 2023
Noncontrolling Interest [Abstract]
Schedule of Redeemable Noncontrolling Interests	The following is a rollforward of the activity in the redeemable noncontrolling interests for the six months ended June 30, 2023: (in thousands) Balance, December 31, 2022 $ 30,337 Net income attributable to redeemable noncontrolling interests 611 Contributions received from redeemable noncontrolling interests 107 Distributions paid to redeemable noncontrolling interests (4,255) Balance, June 30, 2023 $ 26,800

Financial Instruments (Tables)

Financial Instruments (Tables)	6 Months Ended
	Jun. 30, 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 June 30, 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 and fuel option contracts $ — $ 64 $ — $ 64 $ — $ 52 $ — $ 52 Long-term liabilities: Derivative in subordinated notes $ — $ — $ 5,831 $ 5,831 $ — $ — $ 6,132 $ 6,132
Schedule 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 six months ended June 30, 2023: (in thousands) Balance, December 31, 2022 $ 6,132 Change in fair value (301) Balance, June 30, 2023 $ 5,831
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) June 30, December 31, 2028 Senior Notes $ 247,705 $ 228,894 2025 Senior Notes 390,814 339,385 Subordinated Notes 294,380 254,951 Equipment Debt 53,272 58,698 $ 986,171 $ 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) June 30, December 31, Financial assets measured at amortized cost: Cash and cash equivalents $ 37,968 $ 59,424 Accounts receivable 115,790 114,166 $ 153,758 $ 173,590 Financial liabilities measured at amortized cost: Accounts payable $ 43,575 $ 36,618 Current portion of long-term debt 19,282 19,961 Current portion of leases 23,581 25,023 Non-current portion of long-term debt 1,273,077 1,254,652 Non-current portion of leases 167,948 179,980 Accrued liabilities 88,339 86,916 $ 1,615,802 $ 1,603,150 Financial assets measured at fair value through earnings: Fuel option contract $ 36 $ — Financial liabilities measured at fair value through earnings: Derivative in subordinated notes $ 5,831 $ 6,132 Financial assets measured at fair value through other comprehensive income: Interest rate contracts $ 28 $ 52

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	6 Months Ended
	Jun. 30, 2023
Equity [Abstract]
Schedule 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 2,217,213 0.67 $ 1,479 Vested (1,186,978) 2.06 $ 2,450 Cancelled (57,078) 1.10 $ (63) Outstanding and unvested at June 30, 2023 3,116,758 $ 0.89 $ 2,761
Schedule 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 June 30, 2023 5,348,120 $ 2.56 2.8 $ — Exercisable at June 30, 2023 5,325,020 $ 2.55 2.8 $ —

Supplemental Revenue Informat_2

Supplemental Revenue Information (Tables)	6 Months Ended
	Jun. 30, 2023
Revenue from Contract with Customer [Abstract]
Schedule of Revenue Information	The following table summarizes the components of the Company’s revenues by payor category: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Patient fee payors: Commercial $ 65,066 $ 71,609 $ 130,588 $ 140,710 Medicare 20,082 21,002 41,502 42,174 Medicaid 3,256 3,347 6,661 6,449 Other patient revenue 2,729 3,213 5,324 6,487 91,133 99,171 184,075 195,820 Hospitals and healthcare providers 91,513 90,651 183,975 178,110 Other revenue 2,194 2,306 4,382 4,461 $ 184,840 $ 192,128 $ 372,432 $ 378,391

Cost of Operations, excluding_2

Cost of Operations, excluding Depreciation and Amortization (Tables)	6 Months Ended
	Jun. 30, 2023
Cost Of Operations Excluding Depreciation And Amortization [Abstract]
Schedule 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 June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Employee compensation $ 68,302 $ 72,021 $ 139,829 $ 147,148 Third-party services and professional fees 32,091 29,919 62,920 59,096 Rent and utilities 12,780 12,742 25,121 25,219 Reading fees 11,953 11,788 23,552 23,286 Administrative 12,944 11,467 23,365 23,091 Medical supplies and other 20,425 16,637 39,275 31,895 $ 158,495 $ 154,574 $ 314,062 $ 309,735

Supplemental Statement of Ope_2

Supplemental Statement of Operations Information (Tables)	6 Months Ended
	Jun. 30, 2023
Other Income and Expenses [Abstract]
Schedule of Restructuring Charges	Restructuring charges consist of the following: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Transformation costs $ 939 $ 4,025 $ 6,659 $ 4,025 Lease termination costs 7 1,840 7 1,840 Domestication and related costs — 1,063 — 1,063 Other (2) 316 14 396 $ 944 $ 7,244 $ 6,680 $ 7,324
Schedule of Other Operating Expense (Income)	Other operating expense (income), net consists of the following: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Loss on sale of accounts receivable $ 922 $ — $ 1,046 $ — Gain from insurance proceeds — — (776) — Loss (gain) on disposal of property and equipment, net (348) 170 (417) 372 Other, net (97) 416 (127) 207 $ 477 $ 586 $ (274) $ 579
Schedule Of Other Non-operating Losses (gains)	Other non-operating expense (income), net consists of the following: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Capital structure initiatives $ 1,912 $ — $ 1,912 $ — Acquisition-related costs 155 86 298 468 Fair value adjustment on derivative in subordinated notes (258) (1,009) (301) (839) Earnings from unconsolidated investees (128) (248) (279) (488) Other, net 665 (1,164) 584 (1,152) $ 2,346 $ (2,335) $ 2,214 $ (2,011)
Schedule of Impairment of Assets	Impairment charges relate to the following assets: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Goodwill (Note 5) $ 53,460 $ — $ 53,460 $ — $ 53,460 $ — $ 53,460 $ —

Basic and Diluted Loss per Sh_2

Basic and Diluted Loss per Share (Tables)	6 Months Ended
	Jun. 30, 2023
Earnings Per Share [Abstract]
Schedule 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 June 30, Six Months Ended June 30, (in thousands, except share and per share amounts) 2023 2022 2023 2022 Net loss attributable to common stockholders $ (96,652) $ (30,469) $ (131,800) $ (61,280) Weighted average common shares outstanding: Basic and diluted 90,503,986 89,516,513 90,163,458 89,296,619 Net loss per share attributable to common stockholders: Basic and diluted $ (1.07) $ (0.34) $ (1.46) $ (0.69) Employee stock options, warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive 1,478,978 2,042,461 2,006,143 2,207,983

Segment Information (Tables)

Segment Information (Tables)	6 Months Ended
	Jun. 30, 2023
Segment Reporting [Abstract]
Schedule of Revenue By Segment	The following table summarizes the Company’s revenues by segment: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Radiology $ 156,291 $ 160,867 $ 313,692 $ 316,207 Oncology 28,549 31,261 58,740 62,184 $ 184,840 $ 192,128 $ 372,432 $ 378,391
Schedule of Company's Adjusted EBITDA	The following table summarizes the Company’s Adjusted EBITDA by segment: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Adjusted EBITDA: Radiology $ 25,449 $ 35,692 $ 55,775 $ 64,281 Oncology 8,072 10,302 17,920 20,335 Corporate (6,994) (7,810) (14,027) (14,414) $ 26,527 $ 38,184 $ 59,668 $ 70,202
Schedule of Net Income (Loss) to Total Adjusted EBITDA	A reconciliation of the net loss to total Adjusted EBITDA is shown below: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Net loss $ (96,411) $ (26,079) $ (125,601) $ (52,511) Interest expense 31,164 29,290 61,861 57,971 Income tax benefit (1,578) (3,483) (704) (2,920) Depreciation and amortization 35,015 25,200 58,008 49,931 Impairment charges 53,460 — 53,460 — Restructuring charges 944 7,244 6,680 7,324 Severance and related costs 22 5,559 (27) 7,797 Settlements, recoveries and related costs 465 814 1,913 677 Stock-based compensation 441 758 840 1,819 Loss on sale of accounts receivable 922 — 1,046 — Loss (gain) on disposal of property and equipment, net (348) 170 (417) 372 Capital structure initiatives 1,912 — 1,912 — Acquisition-related costs 155 86 298 468 Fair value adjustment on derivative (258) (1,009) (301) (839) Deferred rent expense (43) 247 142 579 Other, net 665 (613) 558 (466) Adjusted EBITDA $ 26,527 $ 38,184 $ 59,668 $ 70,202
Schedule of Segment Reporting Information By Segment	The following table summarizes the Company’s total assets by segment: (in thousands) June 30, December 31, Identifiable assets: Radiology $ 1,304,358 $ 1,400,938 Oncology 312,992 346,337 Corporate 18,392 17,840 $ 1,635,742 $ 1,765,115 The following table summarizes the Company’s capital expenditures by segment: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Capital expenditures: Radiology $ 7,093 $ 4,648 $ 9,069 $ 13,460 Oncology 500 858 1,000 1,834 Corporate 1,359 82 1,391 172 $ 8,952 $ 5,588 $ 11,460 $ 15,466

Variable Interest Entities (Det

Variable Interest Entities (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022
Variable Interest Entity [Line Items]
Assets	$ 1,635,742		$ 1,765,115
Liabilities	1,635,186		1,623,824
Net cash provided by operating activities	17,955	$ 21,079
Variable Interest Entity, Primary Beneficiary
Variable Interest Entity [Line Items]
Assets	39,600		36,000
Liabilities	2,900		$ 1,400
Revenues	85,700	92,800
Net cash provided by operating activities	$ 77,900	$ 93,200

Property and Equipment - Summar

Property and Equipment - Summary of Detailed Information of Property and Equipment (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Property, Plant and Equipment [Line Items]
Equipment under finance leases	$ 45,348	$ 44,845
Total property and equipment, gross	381,277	370,156
Less accumulated depreciation	183,718	148,942
Property and equipment, net	197,559	221,214
Medical equipment
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	254,247	244,517
Leasehold improvements
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	44,000	43,382
Office and computer equipment
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	19,151	17,742
Transportation and service equipment
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	11,542	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	$ 3,550	$ 4,636

Property and Equipment - Additi

Property and Equipment - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022
Property, Plant and Equipment [Abstract]
Depreciation expense	$ 18.2	$ 20.2	$ 36.4	$ 39.9
Net book value of equipment under finance leases	$ 25.4		$ 25.4		$ 26.3

Goodwill - Changes in the Carry

Goodwill - Changes in the Carrying Amount of Goodwill (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Goodwill [Roll Forward]
Balance - Beginning of period			$ 769,110
Impairment	$ (53,460)	$ 0	(53,460)	$ 0
Goodwill written off in connection with site closure			(381)
Balance - End of period	715,269		715,269
Radiology
Goodwill [Roll Forward]
Balance - Beginning of period			682,725
Impairment	(53,500)		(53,460)
Goodwill written off in connection with site closure			0
Balance - End of period	629,265		629,265
Oncology
Goodwill [Roll Forward]
Balance - Beginning of period			86,385
Impairment			0
Goodwill written off in connection with site closure			(381)
Balance - End of period	$ 86,004		$ 86,004

Goodwill - Schedule Of Signific

Goodwill - Schedule Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill (Details)	Jun. 30, 2023
Discount rate | Minimum
Goodwill [Line Items]
Goodwill measurement input	0.095
Discount rate | Maximum
Goodwill [Line Items]
Goodwill measurement input	0.100
Perpetual growth rate
Goodwill [Line Items]
Goodwill measurement input	0.030
Tax rate
Goodwill [Line Items]
Goodwill measurement input	0.260
Risk-free interest rate
Goodwill [Line Items]
Goodwill measurement input	0.035
Revenue multiple | Minimum
Goodwill [Line Items]
Goodwill measurement input	1.8
Revenue multiple | Maximum
Goodwill [Line Items]
Goodwill measurement input	2.2
EBITDA multiple | Minimum
Goodwill [Line Items]
Goodwill measurement input	7.5
EBITDA multiple | Maximum
Goodwill [Line Items]
Goodwill measurement input	9.5

Goodwill - Additional Informati

Goodwill - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Goodwill [Line Items]
Impairment	$ 53,460	$ 0	$ 53,460	$ 0
Radiology
Goodwill [Line Items]
Impairment	$ 53,500		$ 53,460

Other Intangible Assets - Sched

Other Intangible Assets - Schedule Of Intangible Assets Excluding Goodwill (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 343,063	$ 356,442
Accumulated Amortization	(42,109)	(33,905)
Other Intangible Assets, Net	300,954	322,537
Certificates of Need	69,558	69,558
Total other intangible assets	$ 370,512	392,095
Customer contracts
Finite-Lived Intangible Assets [Line Items]
Weighted Average Useful Life (in years)	20 years
Gross Carrying Amount	$ 250,733	263,388
Accumulated Amortization	(23,057)	(17,588)
Other Intangible Assets, Net	$ 227,676	245,800
Trade names
Finite-Lived Intangible Assets [Line Items]
Weighted Average Useful Life (in years)	18 years
Gross Carrying Amount	$ 76,391	77,135
Accumulated Amortization	(13,324)	(11,063)
Other Intangible Assets, Net	$ 63,067	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	(1,100)	(800)
Other Intangible Assets, Net	$ 9,100	9,400
Other
Finite-Lived Intangible Assets [Line Items]
Weighted Average Useful Life (in years)	5 years
Gross Carrying Amount	$ 5,739	5,719
Accumulated Amortization	(4,628)	(4,454)
Other Intangible Assets, Net	$ 1,111	$ 1,265

Other Intangible Assets - Addit

Other Intangible Assets - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Finite-Lived Intangible Assets [Line Items]
Amortization of Intangible Assets	$ 16.8	$ 5	$ 21.6	$ 10
Oncology
Finite-Lived Intangible Assets [Line Items]
Amortization of Intangible Assets	$ 12.1		$ 12.1

Long-Term Debt - Summary of Lon

Long-Term Debt - Summary of Long-term debt (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term debt	$ 1,365,107	$ 1,346,057
Debt discount/premium and deferred issuance costs	(72,748)	(71,444)
Total long-term debt	1,292,359	1,274,613
Less current portion	19,282	19,961
Long-term debt, net of current portion	1,273,077	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	451,265	423,303
Equipment Debt
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term debt	$ 63,842	$ 72,754

Long-Term Debt - Additional Inf

Long-Term Debt - Additional Information (Details) $ in Millions	6 Months Ended
	Jun. 30, 2023 USD ($)
Subordinated Notes
Debt Instrument [Line Items]
Accrued interest added to the principal balance	$ 28

Accrued Liabilities (Details)

Accrued Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Payables and Accruals [Abstract]
Accrued compensation and related expenses	$ 21,743	$ 25,655
Accrued interest expense	18,267	18,183
Other	48,329	43,078
Total accrued liabilities	$ 88,339	$ 86,916

Redeemable Noncontrolling Int_3

Redeemable Noncontrolling Interests - Additional Information (Detail) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Noncontrolling Interest [Abstract]
Redeemable noncontrolling interests	$ 26,800	$ 30,337

Redeemable Noncontrolling Int_4

Redeemable Noncontrolling Interest - Summary of Redeemable Noncontrolling Interests (Detail) $ in Thousands	6 Months Ended
	Jun. 30, 2023 USD ($)
Stockholders' Equity Attributable to Noncontrolling Interest [Roll Forward]
Balance, December 31, 2022	$ 30,337
Net income attributable to redeemable noncontrolling interests	611
Contributions received from redeemable noncontrolling interests	107
Distributions paid to redeemable noncontrolling interests	(4,255)
Balance, June 30, 2023	$ 26,800

Financial Instruments - Schedul

Financial Instruments - Schedule of Fair Value Measurements, Recurring and Nonrecurring (Details) - Fair Value, Recurring - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Interest rate and fuel option contracts
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Current and long-term assets:	$ 64	$ 52
Interest rate and fuel option 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 and fuel option contracts | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Current and long-term assets:	64	52
Interest rate and fuel option 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:	5,831	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:	$ 5,831	$ 6,132

Financial Instruments - Additio

Financial Instruments - Additional Information (Details) $ in Millions	Sep. 01, 2021	Jun. 30, 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 | $		$ 0.3	$ 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		3.2	3.5
Level 3 | Measurement Input Probability Of Exit Event Percentage
Financial Instruments [Line Items]
Embedded derivative liability measurement input		0.217	0.229

Financial Instruments - Summary

Financial Instruments - Summary of Reconciliation of Liability Related to the Embedded Derivative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Disclosure Of Movement In Embedded Derivative Liabilities [Roll Forward]
Change in fair value	$ 258	$ 1,009	$ 301	$ 839
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			(301)
Balance, June 30, 2023	$ 5,831		$ 5,831

Financial Instruments - Sched_2

Financial Instruments - Schedule Of Fair Value Of Other Current And Non Current Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	$ 986,171	$ 881,928
2028 Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	247,705	228,894
2025 Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	390,814	339,385
Subordinated Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	294,380	254,951
Equipment Debt
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	$ 53,272	$ 58,698

Financial Instruments - Sched_3

Financial Instruments - Schedule of Information Regarding The Carrying Value Of Financial Instruments (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash and cash equivalents	$ 37,968	$ 59,424
Accounts receivable	115,790	114,166
Current portion of long-term debt	19,282	19,961
Non-current portion of long-term debt	1,273,077	1,254,652
Accrued liabilities	88,339	86,916
Financial assets measured at fair value through earnings:
Fuel option contract	36	0
Reported Value Measurement
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash and cash equivalents	37,968	59,424
Accounts receivable	115,790	114,166
Financial assets measured at amortized cost	153,758	173,590
Accounts payable	43,575	36,618
Current portion of long-term debt	19,282	19,961
Current portion of leases	23,581	25,023
Non-current portion of long-term debt	1,273,077	1,254,652
Non-current portion of leases	167,948	179,980
Accrued liabilities	88,339	86,916
Financial liabilities measured at amortized cost	1,615,802	1,603,150
Financial liabilities measured at fair value through earnings:
Derivative in subordinated notes	5,831	6,132
Financial assets measured at fair value through other comprehensive income:
Interest rate contracts	$ 28	$ 52

Stockholders' Equity - Addition

Stockholders' Equity - Additional Information (Detail)		6 Months Ended
	Apr. 18, 2023	Jun. 30, 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
2023 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)		9,099,849	8,981,151

Stockholders' Equity - Summary

Stockholders' Equity - Summary of RSU Activity (Detail) $ / shares in Units, $ in Thousands	6 Months Ended
	Jun. 30, 2023 USD ($) $ / shares shares
Number of RSUs
Beginning balance (in shares) | shares	2,143,601
Granted (in shares) | shares	2,217,213
Vested (in shares) | shares	(1,186,978)
Cancelled (in shares) | shares	(57,078)
Ending balance (in shares) | shares	3,116,758
Weighted- Average Grant Date Fair Value
Beginning balance (in dollars per share) | $ / shares	$ 1.77
Granted (in dollars per share) | $ / shares	0.67
Vested (in dollars per share) | $ / shares	2.06
Cancelled (in dollars per share) | $ / shares	1.10
Ending balance (in dollars per share) | $ / shares	$ 0.89
Aggregate Grant Date Fair Value, Granted | $	$ 1,479
Aggregate Grant Date Fair Value, Vested | $	2,450
Aggregate Grant Date Fair Value, Cancelled | $	(63)
Aggregate Grant Date Fair Value, Outstanding and unvested | $	$ 2,761

Stockholders' Equity - Summar_2

Stockholders' Equity - Summary of the Stock Option Activity (Detail) - Stock Options - USD ($) $ / shares in Units, $ in Thousands	6 Months Ended	12 Months Ended
	Jun. 30, 2023	Dec. 31, 2022
Number of Options
Beginning balance (in share)	5,348,120
Ending balance (in share)	5,348,120	5,348,120
Weighted- Average Exercise price
Beginning balance (in USD per share)	$ 2.56
Ending balance (in USD 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)	2 years 9 months 18 days	3 years 3 months 18 days
Weighted-Average Remaining Contractual Term, Exercisable	2 years 9 months 18 days
Aggregate Intrinsic Value (in thousands)	$ 0	$ 378
Aggregate Intrinsic Value, Exercisable	$ 0

Commitments and Contingencies (

Commitments and Contingencies (Details) - Commitement For The Purchase Of Equipment $ in Millions	Jun. 30, 2023 USD ($)
Loss Contingencies [Line Items]
Purchase commitments	$ 38.4
Greater Than Six Months
Loss Contingencies [Line Items]
Purchase commitments	6
Within the Remaining Six Months
Loss Contingencies [Line Items]
Purchase commitments	$ 32.5

Supplemental Revenue Informat_3

Supplemental Revenue Information (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Disaggregation of Revenue [Line Items]
Other revenue	$ 2,194	$ 2,306	$ 4,382	$ 4,461
Total revenue	184,840	192,128	372,432	378,391
Sales Channel, Directly to Consumer
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	91,133	99,171	184,075	195,820
Commercial | Sales Channel, Directly to Consumer
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	65,066	71,609	130,588	140,710
Medicare | Sales Channel, Directly to Consumer
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	20,082	21,002	41,502	42,174
Medicaid | Sales Channel, Directly to Consumer
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	3,256	3,347	6,661	6,449
Other patient revenue | Sales Channel, Directly to Consumer
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	2,729	3,213	5,324	6,487
Hospitals and healthcare providers | Sales Channel, Through Intermediary
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	$ 91,513	$ 90,651	$ 183,975	$ 178,110

Cost of Operations, excluding_3

Cost of Operations, excluding Depreciation and Amortization (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	$ 158,495	$ 154,574	$ 314,062	$ 309,735
Employee compensation
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	68,302	72,021	139,829	147,148
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	32,091	29,919	62,920	59,096
Rent and utilities
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	12,780	12,742	25,121	25,219
Reading fees
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	11,953	11,788	23,552	23,286
Administrative
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	12,944	11,467	23,365	23,091
Medical supplies and other
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	$ 20,425	$ 16,637	$ 39,275	$ 31,895

Supplemental Statement of Ope_3

Supplemental Statement of Operations Information - Schedule of Restructuring Charges (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Restructuring Cost and Reserve [Line Items]
Restructuring charges	$ 944	$ 7,244	$ 6,680	$ 7,324
Transformation costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges	939	4,025	6,659	4,025
Lease termination costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges	7	1,840	7	1,840
Domestication and related costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges	0	1,063	0	1,063
Other
Restructuring Cost and Reserve [Line Items]
Restructuring charges	$ (2)	$ 316	$ 14	$ 396

Supplemental Statement of Ope_4

Supplemental Statement of Operations Information - Additional Information (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Dec. 31, 2022
Restructuring Cost and Reserve [Line Items]
Accounts payable	$ 43,575	$ 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	$ 3,400	$ 4,500
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	$ 1,500

Supplemental Statement of Ope_5

Supplemental Statement of Operations Information - Schedule of Other Operating Expense (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Other Income and Expenses [Abstract]
Loss on sale of accounts receivable	$ 922	$ 0	$ 1,046	$ 0
Gain from insurance proceeds	0	0	(776)	0
Loss (gain) on disposal of property and equipment, net	(348)	170	(417)	372
Other, net	(97)	416	(127)	207
Other operating expense (income), net	$ 477	$ 586	$ (274)	$ 579

Supplemental Statement of Ope_6

Supplemental Statement of Operations Information - Schedule of Other Non-operating Losses (gains) (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Other Income and Expenses [Abstract]
Capital structure initiatives	$ 1,912	$ 0	$ 1,912	$ 0
Acquisition-related costs	155	86	298	468
Fair value adjustment on derivative	(258)	(1,009)	(301)	(839)
Earnings from unconsolidated investees	(128)	(248)	(279)	(488)
Other, net	665	(1,164)	584	(1,152)
Other non-operating expense (income), net	$ 2,346	$ (2,335)	$ 2,214	$ (2,011)

Supplemental Statement of Ope_7

Supplemental Statement of Operations Information - Schedule of Impairment of Assets (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Other Income and Expenses [Abstract]
Goodwill	$ 53,460	$ 0	$ 53,460	$ 0
Impairment charges	$ 53,460	$ 0	$ 53,460	$ 0

Investments in Unconsolidated_2

Investments in Unconsolidated Investees (Detail) - USD ($) $ in Millions	Mar. 01, 2021	Jun. 30, 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		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Earnings Per Share [Abstract]
Net loss attributable to common stockholders	$ (96,652)	$ (30,469)	$ (131,800)	$ (61,280)
Weighted average common shares outstanding:
Basic (in shares)	90,503,986	89,516,513	90,163,458	89,296,619
Diluted (in shares)	90,503,986	89,516,513	90,163,458	89,296,619
Net loss per share attributable to common stockholders:
Basic (in USD per share)	$ (1.07)	$ (0.34)	$ (1.46)	$ (0.69)
Diluted (in USD per share)	$ (1.07)	$ (0.34)	$ (1.46)	$ (0.69)
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)	1,478,978	2,042,461	2,006,143	2,207,983

Segment Information - Additiona

Segment Information - Additional Information (Details)	22 Months Ended
	Jun. 30, 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		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenues	$ 184,840	$ 192,128	$ 372,432	$ 378,391
Radiology
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenues	156,291	160,867	313,692	316,207
Oncology
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenues	$ 28,549	$ 31,261	$ 58,740	$ 62,184

Segment Information - Summary_2

Segment Information - Summary of Company's Adjusted EBITDA (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted EBITDA	$ 26,527	$ 38,184	$ 59,668	$ 70,202
Corporate
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted EBITDA	(6,994)	(7,810)	(14,027)	(14,414)
Radiology | Operating Segments
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted EBITDA	25,449	35,692	55,775	64,281
Oncology | Operating Segments
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted EBITDA	$ 8,072	$ 10,302	$ 17,920	$ 20,335

Segment Information - Summary_3

Segment Information - Summary of Net Income (Loss) to Total Adjusted EBITDA (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Segment Reporting [Abstract]
Net loss	$ (96,411)	$ (26,079)	$ (125,601)	$ (52,511)
Interest expense	31,164	29,290	61,861	57,971
Income tax benefit	(1,578)	(3,483)	(704)	(2,920)
Depreciation and amortization	35,015	25,200	58,008	49,931
Impairment charges	53,460	0	53,460	0
Restructuring charges	944	7,244	6,680	7,324
Severance and related costs	22	5,559	(27)	7,797
Settlements, recoveries and related costs	465	814	1,913	677
Stock-based compensation	441	758	840	1,819
Loss on sale of accounts receivable	922	0	1,046	0
Loss (gain) on disposal of property and equipment, net	(348)	170	(417)	372
Capital structure initiatives	1,912	0	1,912	0
Acquisition-related costs	155	86	298	468
Fair value adjustment on derivative	(258)	(1,009)	(301)	(839)
Deferred rent expense	(43)	247	142	579
Other, net	665	(613)	558	(466)
Adjusted EBITDA	$ 26,527	$ 38,184	$ 59,668	$ 70,202

Segment Information - Schedule

Segment Information - Schedule Of Segment Reporting Information By Segment (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022
Segment Reporting Information [Line Items]
Identifiable assets	$ 1,635,742		$ 1,635,742		$ 1,765,115
Capital expenditures	8,952	$ 5,588	11,460	$ 15,466
Corporate
Segment Reporting Information [Line Items]
Identifiable assets	18,392		18,392		17,840
Capital expenditures	1,359	82	1,391	172
Radiology | Operating Segments
Segment Reporting Information [Line Items]
Identifiable assets	1,304,358		1,304,358		1,400,938
Capital expenditures	7,093	4,648	9,069	13,460
Oncology | Operating Segments
Segment Reporting Information [Line Items]
Identifiable assets	312,992		312,992		$ 346,337
Capital expenditures	$ 500	$ 858	$ 1,000	$ 1,834