Akumin (AKUMQ) 10-Q 12 Dec 23 2023 Q3 Quarterly report Financial data

Cover Page

Cover Page - shares	9 Months Ended
	Sep. 30, 2023	Dec. 04, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 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
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		91,173,491
Entity Central Index Key	0001776197
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q3
Amendment Flag	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 31,641	$ 59,424
Accounts receivable	118,100	114,166
Prepaid expenses	14,631	8,003
Other current assets	9,829	10,352
Total current assets	174,201	191,945
Property and equipment, net	191,968	221,214
Operating lease right-of-use assets	162,761	166,823
Goodwill	673,328	769,110
Other intangible assets, net	366,088	392,095
Other assets	22,484	23,928
Total assets	1,590,830	1,765,115
Current liabilities:
Accounts payable	57,061	36,618
Current portion of long-term debt	1,274,780	19,961
Current portion of obligations under finance leases	8,298	7,800
Current portion of obligations under operating leases	16,073	17,223
Accrued liabilities	94,077	86,916
Total current liabilities	1,450,289	168,518
Long-term debt, net of current portion	40,267	1,254,652
Obligations under finance leases, net of current portion	13,531	19,505
Obligations under operating leases, net of current portion	157,760	160,475
Other liabilities	19,112	20,674
Total liabilities	1,680,959	1,623,824
Redeemable noncontrolling interests	24,549	30,337
Stockholders’ deficit:
Preferred stock, $0.01 par value; 50,000,000 shares authorized; no shares issued and outstanding at September 30, 2023 and December 31, 2022	0	0
Common stock, $0.01 par value; 300,000,000 shares authorized; 91,173,491 shares issued and outstanding at September 30, 2023; 89,811,513 shares issued and outstanding at December 31, 2022	912	898
Additional paid-in capital	232,345	231,014
Accumulated other comprehensive income	2	73
Accumulated deficit	(494,370)	(280,185)
Total stockholders’ deficit	(261,111)	(48,200)
Noncontrolling interests	146,433	159,154
Total (deficit) equity	(114,678)	110,954
Total liabilities, redeemable noncontrolling interests and equity	$ 1,590,830	$ 1,765,115

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Sep. 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)	91,173,491	89,811,513
Common stock outstanding (in shares)	91,173,491	89,811,513

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Income Statement [Abstract]
Revenues	$ 180,624	$ 186,605	$ 553,056	$ 564,996
Operating expenses:
Cost of operations, excluding depreciation and amortization	158,047	151,230	472,949	462,784
Depreciation and amortization	20,942	25,079	78,950	75,010
Impairment charges	42,041	20,369	95,501	20,702
Restructuring charges	23	4,042	6,703	11,366
Severance and related costs	538	2,485	511	10,282
Settlements, recoveries and related costs	1,561	(576)	3,474	101
Other operating income, net	(347)	(7,574)	(621)	(7,328)
Total operating expenses	222,805	195,055	657,467	572,917
Loss from operations	(42,181)	(8,450)	(104,411)	(7,921)
Other expense (income):
Interest expense	33,872	29,679	95,733	87,650
Other non-operating expense (income), net	7,522	(422)	9,736	(2,433)
Total other expense, net	41,394	29,257	105,469	85,217
Loss before income taxes	(83,575)	(37,707)	(209,880)	(93,138)
Income tax expense (benefit)	(80)	12,038	(784)	9,118
Net loss	(83,495)	(49,745)	(209,096)	(102,256)
Less: Net income (loss) attributable to noncontrolling and redeemable noncontrolling interests	(1,110)	4,126	5,089	12,895
Net loss attributable to common stockholders	(82,385)	(53,871)	(214,185)	(115,151)
Comprehensive loss, net of taxes:
Net loss	(83,495)	(49,745)	(209,096)	(102,256)
Other comprehensive income (loss):
Unrealized gain (loss) on hedging transactions, net of taxes	(8)	11	(29)	47
Reclassification adjustment for gains (losses) included in net loss, net of taxes	(14)	(4)	(42)	22
Other comprehensive income (loss)	(22)	7	(71)	69
Comprehensive loss, net of taxes	(83,517)	(49,738)	(209,167)	(102,187)
Less: Comprehensive income (loss) attributable to noncontrolling and redeemable noncontrolling interests	(1,110)	4,126	5,089	12,895
Comprehensive loss attributable to common stockholders	$ (82,407)	$ (53,864)	$ (214,256)	$ (115,082)
Net loss per share attributable to common stockholders:
Basic (in USD per share)	$ (0.90)	$ (0.60)	$ (2.37)	$ (1.29)
Diluted (in USD per share)	$ (0.90)	$ (0.60)	$ (2.37)	$ (1.29)

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	(103,738)	(115,151)				(115,151)	11,413
Settlement of restricted share units (in shares)			634,516
Settlement of restricted share units	0		$ 7	(7)
Stock-based compensation	2,375	2,375		2,375
Other comprehensive income (loss)	69	69			69
Distributions paid to noncontrolling interests	(17,343)						(17,343)
Purchase accounting adjustments	(2,293)						(2,293)
Ending balance (in shares) at Sep. 30, 2022			89,661,513
Ending Balance at Sep. 30, 2022	162,749	(7,518)	$ 897	230,073	87	(238,575)	170,267
Beginning balance (in shares) at Jun. 30, 2022			89,516,513
Beginning balance at Jun. 30, 2022	220,492	45,790	$ 895	229,519	80	(184,704)	174,702
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss), net of the net income (loss) attributable to redeemable noncontrolling interests	(50,113)	(53,871)				(53,871)	3,758
Settlement of restricted share units (in shares)			145,000
Settlement of restricted share units	0		$ 2	(2)
Stock-based compensation	556	556		556
Other comprehensive income (loss)	7	7			7
Distributions paid to noncontrolling interests	(5,739)						(5,739)
Purchase accounting adjustments	(2,454)						(2,454)
Ending balance (in shares) at Sep. 30, 2022			89,661,513
Ending Balance at Sep. 30, 2022	$ 162,749	(7,518)	$ 897	230,073	87	(238,575)	170,267
Beginning balance (in shares) at Dec. 31, 2022	89,811,513		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	(208,587)	(214,185)				(214,185)	5,598
Settlement of restricted share units (in shares)			1,361,978
Settlement of restricted share units	0		$ 14	(14)
Stock-based compensation	1,345	1,345		1,345
Other comprehensive income (loss)	(71)	(71)			(71)
Distributions paid to noncontrolling interests	$ (18,319)						(18,319)
Ending balance (in shares) at Sep. 30, 2023	91,173,491		91,173,491
Ending Balance at Sep. 30, 2023	$ (114,678)	(261,111)	$ 912	232,345	2	(494,370)	146,433
Beginning balance (in shares) at Jun. 30, 2023			90,998,491
Beginning balance at Jun. 30, 2023	(26,244)	(179,209)	$ 910	231,842	24	(411,985)	152,965
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss), net of the net income (loss) attributable to redeemable noncontrolling interests	(82,375)	(82,385)				(82,385)	10
Settlement of restricted share units (in shares)			175,000
Settlement of restricted share units	0		$ 2	(2)
Stock-based compensation	505	505		505
Other comprehensive income (loss)	(22)	(22)			(22)
Distributions paid to noncontrolling interests	$ (6,542)						(6,542)
Ending balance (in shares) at Sep. 30, 2023	91,173,491		91,173,491
Ending Balance at Sep. 30, 2023	$ (114,678)	$ (261,111)	$ 912	$ 232,345	$ 2	$ (494,370)	$ 146,433

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Operating activities:
Net loss	$ (209,096)	$ (102,256)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization	78,950	75,010
Impairment charges	95,501	20,702
Stock-based compensation	1,345	2,375
Non-cash interest expense	37,739	37,509
Amortization of deferred financing costs and accretion of discount/premium on long-term debt	2,705	71
Deferred income taxes	(953)	9,012
Distributions from unconsolidated investees	431	1,157
Earnings from unconsolidated investees	(414)	(738)
Loss (gain) on sale of accounts receivable	1,046	(7,603)
Other non-cash items, net	(729)	(247)
Changes in operating assets and liabilities:
Accounts receivable	(4,084)	15,923
Prepaid expenses and other assets	(2,516)	(1,967)
Accounts payable and other liabilities	17,167	7,388
Operating lease liabilities and right-of-use assets	302	(400)
Net cash provided by operating activities	17,394	55,936
Investing activities:
Purchases of property and equipment	(19,493)	(32,765)
Other investing activities	1,900	1,139
Net cash used in investing activities	(17,593)	(31,626)
Financing activities:
Proceeds from revolving loan	40,000	29,000
Principal payments on revolving loan	(24,000)	(29,000)
Proceeds from long-term debt	1,706	25,892
Principal payments on long-term debt	(15,757)	(12,267)
Principal payments on finance leases	(5,935)	(6,130)
Contributions received from redeemable noncontrolling interests	721	0
Distributions paid to noncontrolling and redeemable noncontrolling interests	(24,319)	(20,868)
Net cash used in financing activities	(27,584)	(13,373)
Net (decrease) increase in cash and cash equivalents	(27,783)	10,937
Cash and cash equivalents, beginning of period	59,424	48,419
Cash and cash equivalents, end of period	31,641	59,356
Supplemental disclosure of cash flow information:
Interest paid	50,368	47,774
Income taxes paid, net of refunds	853	506
Supplemental disclosure of non-cash investing and financing activities:
Property and equipment purchases in accounts payable and accrued liabilities	7,446	4,414
Derecognition of operating lease right-of-use assets and lease liabilities associated with lease terminations	4,737	6,561
Equipment acquired in exchange for finance lease obligations	460	4,197
Operating lease right-of-use assets obtained in exchange for operating lease liabilities	$ 14,763	$ 1,159

Basis of Presentation

Basis of Presentation	9 Months Ended
	Sep. 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. (together with its subsidiaries, 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 nine months ended September 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. Certain reclassifications have been made to prior period condensed consolidated financial statements to conform to the current period presentation. Going Concern As of the date the accompanying unaudited condensed consolidated financial statements were issued, management evaluated the significance of the following adverse conditions in accordance with ASC 205-40, Going Concern. As disclosed in Note 20, Subsequent Events, on October 20, 2023, the Company entered into a Restructuring Support Agreement (including all exhibits thereto, collectively, the “RSA”) with the other Company Parties (as defined below) and certain Consenting Stakeholders. Under the terms of the RSA, the Company (together with its debtor affiliates, the "Debtors") and certain Consenting Stakeholders agreed to the terms of a restructuring of the Company (the “Restructuring”) pursuant to the terms set forth in the Joint Prepackaged Chapter 11 Plan of Reorganization of the Debtors (as amended, supplemented or otherwise modified from time to time, the “Prepackaged Plan”). In connection therewith, on October 22, 2023, the Debtors filed voluntary petitions under chapter 11 of title 11 of the United States Code, 11 U.S.C. §§ 101-1532 (the “Bankruptcy Code”) in the United States Bankruptcy Court for the Southern District of Texas (the “Bankruptcy Court”), thereby commencing chapter 11 cases for the Debtors (the “Chapter 11 Cases”). In the Chapter 11 Cases, on October 22, 2023, the Debtors filed with the Bankruptcy Court a variety of “first day” relief motions to ensure their ability to continue operating in the ordinary course, including authority to pay employee wages and benefits, taxes, and insurance in the ordinary course of business. On October 23, 2023, the Bankruptcy Court granted these motions, allowing the Debtors to continue to operate as “debtors-in-possession” under the jurisdiction of the Bankruptcy Court and in accordance with the applicable provisions of the Bankruptcy Code and orders of the Bankruptcy Court. Based on, among other things, (1) the DIP Financing (as defined below), (2) the confirmation of the Prepackaged Plan on November 30, 2023, and (3) management’s expectation that the Restructuring will be consummated in the first quarter of 2024, management contemplates that the Company will be able to settle liabilities and commitments in the normal course of business for twelve months following the issuance date of the accompanying unaudited condensed consolidated financial statements. Accordingly, the accompanying unaudited condensed consolidated financial statements have been prepared on the basis that the Company will continue to operate as a going concern. The filing of the Chapter 11 Cases constituted an event of default under Akumin’s 2025 Senior Notes and 2028 Senior Notes, the Revolving Facility, and the Subordinated Notes (each as defined below in Note 20), for which enforcement of any remedies by the Debtors’ creditors have been automatically stayed as a result of the pendency of the Chapter 11 Cases. However, management can provide no assurance that the Debtors’ creditors will ultimately not be able to exercise their remedies, which may include, among others, the cessation of the Debtors’ operations and liquidation of their assets. While management believes the Restructuring will position the Company for sustainable growth opportunities upon its emergence from the Chapter 11 Cases and enable the Company to continue to operate as a viable going concern, due to the event of default under the Company’s Debt Instruments (as defined below) and to other risks and uncertainties associated with the Chapter 11 Cases, management can provide no assurance that the Restructuring will be successfully completed under the terms set forth in the Prepackaged Plan, or at all. The risks and uncertainties associated with the Chapter 11 Cases include, but are not limited to: (a) the risk that the Prepackaged Plan may never become effective, (b) the risk that the RSA may be terminated by one or more of the parties thereto, and (c) the risk that the Bankruptcy Court may grant or deny motions in a manner that is adverse to the Debtors. Based on the consideration of the risks and uncertainties associated with the Chapter 11 Cases and of the events of default under the Company’s Debt Instruments, management has concluded that there is a substantial doubt regarding the Company’s ability to continue as a going concern within one year from the issuance of the accompanying unaudited condensed consolidated financial statements. The Company’s ability to continue as a going concern is contingent upon, among other things, its ability to implement the Restructuring, to successfully emerge from the Chapter 11 Cases, and to generate sufficient liquidity following the Restructuring to meet its obligations and operating needs as they arise.

New Accounting Standards

New Accounting Standards	9 Months Ended
	Sep. 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 U.S. Securities and Exchange Commission (the "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 all other entities, this ASU is effective for fiscal years beginning after December 15, 2023. The Company is considered an Emerging Growth Company as classified by the SEC, which gives the Company relief in the timing of implementation of

Variable Interest Entities

Variable Interest Entities	9 Months Ended
	Sep. 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 September 30, 2023 and December 31, 2022, the Revenue Practices’ assets included in the Company’s condensed consolidated balance sheets were $44.1 million and $36.0 million, respectively, and liabilities included in the Company’s condensed consolidated balance sheets were $1.7 million and $1.4 million, respectively. The assets of the Revenue Practices can only be used to settle their obligations. During the nine months ended September 30, 2023 and 2022, the Revenue Practices’ revenues were $129.0 million and $137.2 million, respectively, and the net cash provided by operating activities was $114.9 million and $161.0 million, respectively.

Property and Equipment

Property and Equipment	9 Months Ended
	Sep. 30, 2023
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment Property and equipment consists of the following: (in thousands) September 30, December 31, Medical equipment $ 258,224 $ 244,517 Leasehold improvements 41,852 43,382 Equipment under finance leases 45,348 44,845 Office and computer equipment 18,721 17,742 Transportation and service equipment 11,452 11,672 Furniture and fixtures 3,298 3,362 Construction in progress 7,605 4,636 386,500 370,156 Less accumulated depreciation 194,532 148,942 $ 191,968 $ 221,214 Depreciation expense was $16.4 million and $19.5 million for the three months ended September 30, 2023 and 2022, respectively, and $52.9 million and $59.4 million for the nine months ended September 30, 2023 and 2022, respectively.

Goodwill

Goodwill	9 Months Ended
	Sep. 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 (84,129) (11,000) (95,129) Goodwill written off in connection with site closures — (653) (653) Balance, September 30, 2023 $ 598,596 $ 74,732 $ 673,328 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 three months ended September 30, 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 September 30, 2023. In connection with the impairment tests for both the Radiology and Oncology reporting units, the Company concluded that the reporting units' carrying values exceeded their estimated fair values based on management's assessment of the outlook and long-term business plans for the divisions. Consequently, the Company recorded impairment charges of $30.6 million and $11.0 million related to the Radiology and Oncology reporting units, respectively. These charges were recorded in the condensed consolidated statements of operations and comprehensive loss for the three and nine months ended September 30, 2023. During the three months ended June 30, 2023, the Company recorded a goodwill impairment charge of $53.5 million related to the Radiology reporting unit, as its carrying value exceeded its estimated fair value based on management's assessment of the outlook and long-term business plans for the division. The impairment charge is included in the condensed consolidated statements of operations and comprehensive loss for the nine months ended September 30, 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 analyses during the three and nine months ended September 30, 2023: Discount rate 9.5% to 10.5% Perpetual growth rate 3.0% Tax rate 26.0% Risk-free interest rate 3.5% to 4.9% Revenue multiple 1.7 to 2.2 EBITDA multiple 7.5 to 11.0

Other Intangible Assets

Other Intangible Assets	9 Months Ended
	Sep. 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 September 30, 2023 December 31, 2022 Gross Accumulated Other Gross Accumulated Other Finite-lived intangible assets: Customer contracts 20 $ 250,733 $ (26,206) $ 224,527 $ 263,388 $ (17,588) $ 245,800 Trade names 18 76,391 (14,479) 61,912 77,135 (11,063) 66,072 Management agreements 17 10,200 (1,250) 8,950 10,200 (800) 9,400 Other 5 5,739 (4,598) 1,141 5,719 (4,454) 1,265 Total $ 343,063 $ (46,533) 296,530 $ 356,442 $ (33,905) 322,537 Certificates of Need 69,558 69,558 Total other intangible assets $ 366,088 $ 392,095 The Company performs an impairment test when indicators of impairment are present. As of September 30, 2023, there were no indications of impairment of the Company's other intangible assets balances.

Debt

Debt	9 Months Ended
	Sep. 30, 2023
Debt Disclosure [Abstract]
Debt	Debt Debt consists of the following: (in thousands) September 30, December 31, 2028 Senior Notes $ 375,000 $ 375,000 2025 Senior Notes 475,000 475,000 Subordinated Notes 461,042 423,303 Equipment Debt 58,703 72,754 Revolving Facility 16,000 — 1,385,745 1,346,057 Debt discount/premium and deferred issuance costs (70,698) (71,444) 1,315,047 1,274,613 Less current portion 1,274,780 19,961 Long-term debt, net of current portion $ 40,267 $ 1,254,652 During the nine months ended September 30, 2023, the Company elected to pay interest in-kind on the Subordinated Notes pursuant to the original agreement and, accordingly, $37.7 million of accrued interest was added to the principal balance of the Subordinated Notes. On September 29, 2023, Akumin Operating Corp., a wholly owned indirect subsidiary of the Company, and Stonepeak entered into a Temporary Waiver Agreement in connection with the Subordinated Notes. The Temporary Waiver Agreement, as amended by the First Amendment to Temporary Waiver Agreement, dated October 16, 2023, and as further amended on October 20, 2023, extended to October 23, 2023 the due date for the payment to Stonepeak of $3.9 million in cash interest which became due under the Subordinated Notes on September 29, 2023 and provided that no trigger event occurred upon the Company’s failure to pay Stonepeak $3.9 million in cash interest on September 29, 2023. Certain of the debt obligations are subject to covenants with which the Company must comply on a quarterly or annual basis. The Company was in compliance with, or had received waivers for, all such covenants as of September 30, 2023. As disclosed in Note 20, Subsequent Events, the Company commenced the Chapter 11 Cases on October 22, 2023. The commencement of the Chapter 11 Cases constituted an event of default that accelerated the Company’s obligations under the 2028 Senior Notes, 2025 Senior Notes, Subordinated Notes and Revolving Facility. Accordingly, all long-term debt associated with these obligations was classified as current on the accompanying unaudited condensed consolidated balance sheet as of September 30, 2023. However, any efforts to enforce payment obligations under the debt instruments are automatically stayed as a result of the Chapter 11 proceedings. See Note 20, Subsequent Events, for further information.

Accrued Liabilities

Accrued Liabilities	9 Months Ended
	Sep. 30, 2023
Payables and Accruals [Abstract]
Accrued Liabilities	Accrued Liabilities Accrued liabilities consist of the following: (in thousands) September 30, December 31, Accrued compensation and related expenses $ 17,621 $ 25,655 Accrued interest expense 23,091 18,183 Other 53,365 43,078 $ 94,077 $ 86,916

Redeemable Noncontrolling Inter

Redeemable Noncontrolling Interests	9 Months Ended
	Sep. 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 September 30, 2023, the Company holds redeemable noncontrolling interests of $24.5 million, which are not currently redeemable or probable of becoming redeemable. The redemption of these noncontrolling interests is not solely within the Company’s control, therefore, they are presented in the temporary equity section of the Company’s condensed consolidated balance sheets. The Company does not believe it is probable the redemption features related to these noncontrolling interests 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 nine months ended September 30, 2023: (in thousands) Balance, December 31, 2022 $ 30,337 Net loss attributable to redeemable noncontrolling interests (509) Contributions received from redeemable noncontrolling interests 721 Distributions paid to redeemable noncontrolling interests (6,000) Balance, September 30, 2023 $ 24,549

Financial Instruments

Financial Instruments	9 Months Ended
	Sep. 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 September 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 $ — $ 110 $ — $ 110 $ — $ 52 $ — $ 52 Long-term liabilities: Derivative in subordinated notes $ — $ — $ 5,710 $ 5,710 $ — $ — $ 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 September 30, 2023 and December 31, 2022 use unobservable inputs for probability weighted time until an exit event of 3.1 years and 3.5 years, respectively, and an exit event probability weighting of 20.9% 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 nine months ended September 30, 2023: (in thousands) Balance, December 31, 2022 $ 6,132 Change in fair value (422) Balance, September 30, 2023 $ 5,710 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 nine months ended September 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) September 30, December 31, 2028 Senior Notes $ 257,329 $ 228,894 2025 Senior Notes 368,445 339,385 Subordinated Notes 339,480 254,951 Equipment Debt 49,154 58,698 Revolving Facility 16,000 — $ 1,030,408 $ 881,928 As of September 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. The carrying value of the Revolving Facility is equal to its fair value as the Company has the ability to repay the outstanding principal at par value at any time. 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) September 30, December 31, Financial assets measured at amortized cost: Cash and cash equivalents $ 31,641 $ 59,424 Accounts receivable 118,100 114,166 $ 149,741 $ 173,590 Financial liabilities measured at amortized cost: Accounts payable $ 57,061 $ 36,618 Current portion of long-term debt 1,274,780 19,961 Current portion of leases 24,371 25,023 Non-current portion of long-term debt 40,267 1,254,652 Non-current portion of leases 171,291 179,980 Accrued liabilities 94,077 86,916 $ 1,661,847 $ 1,603,150 Financial assets measured at fair value through earnings: Fuel option contract $ 92 $ — Financial liabilities measured at fair value through earnings: Derivative in subordinated notes $ 5,710 $ 6,132 Financial assets measured at fair value through other comprehensive income: Interest rate contracts $ 18 $ 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 September 30, 2023 and December 31, 2022, the Company had $0.2 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 Revolving Facility, which had an outstanding balance of $16.0 million and $0 as of September 30, 2023 and December 31, 2022, respectively. 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	9 Months Ended
	Sep. 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 September 30, 2023 and December 31, 2022, shares of common stock reserved for issuance under the 2023 Stock Plans were 9,117,349 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 2,467,213 0.62 $ 1,530 Vested (1,361,978) 1.89 $ 2,581 Cancelled (57,078) 1.10 $ (63) Outstanding and unvested at September 30, 2023 3,191,758 $ 0.84 $ 2,671 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 September 30, 2023 5,348,120 $ 2.56 2.6 $ — Exercisable at September 30, 2023 5,325,020 $ 2.55 2.6 $ — Aggregate intrinsic value for outstanding and exercisable stock options in the table above represents the difference between the closing stock price on September 30, 2023 and the exercise price multiplied by the number of in-the-money options. No stock options were granted during the nine months ended September 30, 2023.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 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 September 30, 2023, the obligations for these future purchase commitments totaled $32.7 million, of which $9.2 million is expected to be paid during the remaining three months of 2023 and $23.5 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 September 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. Given the preliminary stages of this matter, the Company is unable to estimate the potential impact of this matter, if any. Other Matters

Supplemental Revenue Informatio

Supplemental Revenue Information	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Patient fee payors: Commercial $ 64,748 $ 66,760 $ 195,336 $ 207,470 Medicare 17,980 20,304 59,482 62,478 Medicaid 3,286 3,111 9,947 9,560 Other patient revenue 2,278 3,053 7,602 9,540 88,292 93,228 272,367 289,048 Hospitals and healthcare providers 90,292 91,092 274,267 269,202 Other revenue 2,040 2,285 6,422 6,746 $ 180,624 $ 186,605 $ 553,056 $ 564,996

Cost of Operations, excluding D

Cost of Operations, excluding Depreciation and Amortization	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Employee compensation $ 68,679 $ 67,278 $ 208,508 $ 214,426 Third-party services and professional fees 31,427 30,233 94,347 89,271 Rent and utilities 12,858 12,894 37,979 38,114 Reading fees 11,830 11,379 35,382 34,665 Administrative 11,440 12,473 34,805 35,621 Stock-based compensation 505 556 1,345 2,375 Medical supplies and other 21,308 16,417 60,583 48,312 $ 158,047 $ 151,230 $ 472,949 $ 462,784

Supplemental Statement of Opera

Supplemental Statement of Operations Information	9 Months Ended
	Sep. 30, 2023
Other Income and Expenses [Abstract]
Supplemental Statement of Operations Information	Supplemental Statement of Operations Information Impairment Charges Impairment charges relate to the following assets: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Goodwill (Note 5) $ 41,669 $ 20,000 $ 95,129 $ 20,000 Property and equipment 372 369 372 702 $ 42,041 $ 20,369 $ 95,501 $ 20,702 Restructuring Charges Restructuring charges consist of the following: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Transformation costs $ — $ 3,363 $ 6,659 $ 7,388 Lease termination costs — — 7 1,840 Domestication and related costs — 350 — 1,413 Other 23 329 37 725 $ 23 $ 4,042 $ 6,703 $ 11,366 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 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 (subject to the Company's rights and defenses to dispute such charges) are recognized based on a percentage of achievement of the related milestone or performance result. The project is expected to conclude in 2023. As of September 30, 2023, the accounts payable and accrued liability balance for unpaid transformation consulting costs was $5.6 million and $1.1 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 September 30, 2023, the unpaid balance of severance and related costs totaled $1.0 million, which will be paid during the next twelve months. Other Operating and Non-Operating Expense (Income) Other operating income, net consists of the following: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Loss (gain) on sale of accounts receivable $ — $ (7,603) $ 1,046 $ (7,603) Gain from insurance proceeds (45) — (821) — Loss (gain) on disposal of property and equipment, net (344) 26 (761) 398 Other, net 42 3 (85) (123) $ (347) $ (7,574) $ (621) $ (7,328) Other non-operating expense (income), net consists of the following: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Capital structure initiatives $ 7,604 $ — $ 9,516 $ — Acquisition-related costs 27 99 325 567 Fair value adjustment on derivative in subordinated notes (121) (271) (422) (1,110) Earnings from unconsolidated investees (135) (250) (414) (738) Other, net 147 — 731 (1,152) $ 7,522 $ (422) $ 9,736 $ (2,433) Capital structure initiatives represent costs associated with the Company’s initiative to restructure its debt.

Investments in Unconsolidated I

Investments in Unconsolidated Investees	9 Months Ended
	Sep. 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 September 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	9 Months Ended
	Sep. 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.

Basic and Diluted Loss per Shar

Basic and Diluted Loss per Share	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, (in thousands, except share and per share amounts) 2023 2022 2023 2022 Net loss attributable to common stockholders $ (82,385) $ (53,871) $ (214,185) $ (115,151) Weighted average common shares outstanding: Basic and diluted 91,044,143 89,540,046 90,460,245 89,378,653 Net loss per share attributable to common stockholders: Basic and diluted $ (0.90) $ (0.60) $ (2.37) $ (1.29) Employee stock options, warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive 1,988,559 2,571,041 2,086,216 2,548,000

Segment Information

Segment Information	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Radiology $ 153,930 $ 155,062 $ 467,622 $ 471,269 Oncology 26,694 31,543 85,434 93,727 $ 180,624 $ 186,605 $ 553,056 $ 564,996 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. The following table summarizes the Company’s Adjusted EBITDA by segment: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Adjusted EBITDA: Radiology $ 18,790 $ 31,218 $ 74,565 $ 95,832 Oncology 7,876 11,048 25,796 31,383 Corporate (3,184) (5,745) (17,211) (20,494) $ 23,482 $ 36,521 $ 83,150 $ 106,721 A reconciliation of the net loss to total Adjusted EBITDA is shown below: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Net loss $ (83,495) $ (49,745) $ (209,096) $ (102,256) Interest expense 33,872 29,679 95,733 87,650 Income tax expense (benefit) (80) 12,038 (784) 9,118 Depreciation and amortization 20,942 25,079 78,950 75,010 Impairment charges 42,041 20,369 95,501 20,702 Restructuring charges 23 4,042 6,703 11,366 Severance and related costs 538 2,485 511 10,282 Settlements, recoveries and related costs 1,561 (576) 3,474 101 Stock-based compensation 505 556 1,345 2,375 Loss (gain) on sale of accounts receivable — (7,603) 1,046 (7,603) Loss (gain) on disposal of property and equipment, net (344) 26 (761) 398 Capital structure initiatives 7,604 — 9,516 — Acquisition-related costs 27 99 325 567 Fair value adjustment on derivative (121) (271) (422) (1,110) Deferred rent expense 221 325 363 904 Other, net 188 18 746 (783) Adjusted EBITDA $ 23,482 $ 36,521 $ 83,150 $ 106,721 The following table summarizes the Company’s total assets by segment: (in thousands) September 30, December 31, Identifiable assets: Radiology $ 1,269,014 $ 1,400,938 Oncology 304,593 346,337 Corporate 17,223 17,840 $ 1,590,830 $ 1,765,115 The following table summarizes the Company’s capital expenditures by segment: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Capital expenditures: Radiology $ 6,844 $ 16,081 $ 16,711 $ 29,541 Oncology 1,124 1,207 2,124 3,041 Corporate 65 11 658 183 $ 8,033 $ 17,299 $ 19,493 $ 32,765

Subsequent Events

Subsequent Events	9 Months Ended
	Sep. 30, 2023
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events Ransomware Incident On October 11, 2023, the Company identified suspicious activity in its information technology network, which was the result of a ransomware incident (the "Ransomware Incident"). The incident disrupted the Company’s ability to provide services to its business partners starting on October 11, 2023. The Company began restoring services to its oncology, mobile, and fixed radiology units in a rolling fashion beginning on October 12, 2023. As of October 17, 2023, all of the Company's cancer centers had resumed treating patients with pre-defined plans and as of November 10, 2023, the Company had restored the majority of its systems and resumed scheduling patient appointments at most of its locations. While the Company has resumed patient-facing operations, some systems have not yet been restored and remain temporarily unavailable. As a result of the Ransomware Incident, the Company has incurred approximately $6.6 million in costs since October 11, 2023. The full scope of the costs and related financial impacts of this incident to the Company has not yet been determined. Restructuring Support Agreement On October 20, 2023, Akumin Inc. entered into the RSA with (i) certain of its affiliates and subsidiaries as set forth in the RSA (together with Akumin Inc., the “Company Parties”); (ii) Stonepeak Magnet Holdings LP (“Stonepeak”); (iii) certain Consenting 2025 Noteholders (as defined in the RSA); (iv) certain Consenting 2028 Noteholders (as defined in the RSA) (together with the Consenting 2025 Noteholders, the “Consenting Noteholders”); (v) certain Consenting RCF Lenders (as defined in the RSA); (vi) certain Consenting Equityholders (as defined in the RSA); (vii) certain Consenting Non-Debtor Hospital Partner Entities (as defined in the RSA); and (viii) certain Consenting Physician-Owned Entities (as defined in the RSA, and collectively with Stonepeak, the Consenting Noteholders, the Consenting RCF Lenders, the Consenting Equityholders and the Consenting Non-Debtor Partner Entities, the “Consenting Stakeholders”). Although the Company intends to pursue the Restructuring in accordance with the terms set forth in the RSA, there can be no assurance that the Company will be successful in completing the transactions contemplated by the RSA, whether on the same or different terms than those provided in the RSA and the Prepackaged Plan. As set forth in the RSA, the Company and the Consenting Stakeholders have agreed to the principal terms of the Restructuring through the Prepackaged Plan. The transactions contemplated by the RSA include, among other things, (i) the cancellation of the 2025 Senior Notes and the issuance of the New 2027 Notes (as defined in the RSA) to holders of the 2025 Senior Notes to the extent such 2025 Senior Notes are not repurchased in the Reverse Dutch Election Opportunity (as defined and described below); (ii) the cancellation of the 2028 Senior Notes and the issuance of the New 2028 Notes (as defined in the RSA) to holders of the 2028 Senior Notes to the extent the 2028 Senior Notes are not repurchased in the Reverse Dutch Election Opportunity; (iii) the cancellation of the Revolving Facility in exchange for the New RCF Exit Facility (as defined in the RSA); (iv) a capital investment by Stonepeak (in such capacity, the “Consenting Investor”) in the Company in the aggregate amount of $130 million (the “Consenting Investor Direct Investment”); and (v) a payment to all holders of Existing Common Stock Interests (as defined in the Prepackaged Plan) (other than the Consenting Investor) in an aggregate amount of $25 million in cash and certain contingent value rights (the “CVRs”). Additionally, $60 million of the Consenting Investor Direct Investment shall be made available for a Reverse Dutch Election Opportunity, pursuant to which holders of the 2025 Senior Notes and the 2028 Senior Notes shall have the opportunity to receive cash in lieu of the New 2027 Notes and/or New 2028 Notes, as applicable, on the terms set forth in the Prepackaged Plan. Further, in connection with the Restructuring, Stonepeak shall receive 100% of the common stock of the Reorganized Parent (as defined below) pursuant to the Prepackaged Plan upon emergence from the Chapter 11 Cases. The RSA may be mutually terminated by Stonepeak, the Required Consenting Noteholders (as defined in the RSA), and each Company Party. If not terminated earlier, the RSA will automatically terminate after the effective date of the Prepackaged Plan (the “Effective Date”). Moreover, Stonepeak, the Consenting Noteholders, the Consenting RCF Lenders, the Consenting Equityholders, the Consenting Physician-Owned Entities, the Company Parties and the Consenting Non-Debtor Hospital Partner Entities each have termination rights if certain conditions, including milestones set forth in the RSA, as applicable, are not met. Voluntary Petition for Bankruptcy On October 22, 2023, the Debtors filed voluntary petitions for relief under the Bankruptcy Code in the Bankruptcy Court to implement the Restructuring pursuant to the Prepackaged Plan. On October 21, 2023, the Debtors commenced solicitation of the Prepackaged Plan to creditors entitled to vote, including mailing certain bankruptcy disclosures related thereto (the “Disclosure Statement”). The Chapter 11 Cases have been jointly administered by the Bankruptcy Court under the case caption, In re Akumin Inc ., et al. (Case No. 23-90827). In the Chapter 11 Cases, on October 22, 2023, the Debtors filed with the Bankruptcy Court a variety of “first day” relief motions to ensure their ability to continue operating in the ordinary course, including authority to pay employee wages and benefits, taxes, and insurance in the ordinary course of business. On October 23, 2023, the Bankruptcy Court granted these motions, allowing the Debtors to continue to operate as “debtors-in-possession” under the jurisdiction of the Bankruptcy Court and in accordance with the applicable provisions of the Bankruptcy Code and orders of the Bankruptcy Court. In addition, and as discussed below, on October 23, 2023, the Bankruptcy Court approved interim relief for the Debtors’ DIP Facility. On November 17, 2023, the Bankruptcy Court also granted relief relating to the Debtors’ request to waive the appointment of a patient care ombudsman and rejection of certain unexpired leases of non-residential real property. On November 29, 2023, the DIP Facility was approved on a final basis, as amended (as discussed below). On November 30, 2023, the Bankruptcy Court issued an order (the “Confirmation Order”) confirming the Prepackaged Plan and approving on a final basis the adequacy of the Disclosure Statement. The Confirmation Order was filed as Exhibit 10.2 to the Company’s Current Report on Form 8-K filed with the SEC on December 5, 2023, and is filed as Exhibit 4.4 to this Quarterly Report on Form 10-Q and incorporated herein by reference. Debt Default The filing of the Chapter 11 Cases triggered events of default under the following debt instruments of the Company (the “Debt Instruments”): • that certain Revolving Credit Agreement, dated as of November 2, 2020, as amended by that certain Amendment No. 1, dated as of February 8, 2021, Amendment No. 2, dated as of July 26, 2021, Amendment No. 3 & Waiver, dated as of September 11, 2021 and Amendment No. 4 & Waiver, dated as of October 22, 2021 (as has been and may be further amended, supplemented, or otherwise modified from time to time), by and among the Company, as borrower, certain subsidiaries of the Company as guarantors (the “Guarantors”), PNC Bank, National Association, as successor to BBVA USA, as administrative agent and collateral agent, and the lenders from time to time party thereto, which is comprised of a revolving credit facility in an aggregate principal amount of $55 million (the “Revolving Facility”, and such agreement, the "2020 Revolving Credit Agreement"); • that certain Indenture dated November 2, 2020, as supplemented by that certain First Supplemental Indenture, dated as of February 11, 2021, that certain Second Supplemental Indenture, dated as of July 30, 2021, and that certain Third Supplemental Indenture, dated as of September 1, 2021 (as may be further amended, restated, supplemented, or otherwise modified from time to time), by and among the Company, as issuer, the Guarantors, as guarantors, the holders party thereto, and UMB Bank, National Association, in its capacity as trustee and collateral agent and the related prepetition security agreements, collateral agreements, pledge agreements, and guarantees, in the initial aggregate principal amount of $400 million, with an additional aggregate principal amount of $75 million issued through a private offering on February 11, 2021 (the “2025 Senior Notes”); • that certain Indenture dated August 9, 2021, as supplemented by that certain First Supplemental Indenture, dated as of September 1, 2021 (as may be further amended, restated, supplemented, or otherwise modified from time to time), by and among Akumin Escrow Inc. (whose obligations were assumed by the Company on closing of the acquisition of Alliance Healthcare Service on September 1, 2021), as issuer, the Guarantors, the holders party thereto, and UMB Bank, National Association, in its capacity as trustee and collateral agent, and the related prepetition security agreements, collateral agreements, pledge agreements, and guarantees, in the aggregate principal amount of $375 million (the “2028 Senior Notes”); and • that certain unsecured payment-in-kind toggle series A note, dated September 1, 2021 (as amended, restated, supplemented, or otherwise modified from time to time), issued by Akumin Operating Corp., a wholly owned indirect subsidiary of the Company, to Stonepeak with a face value of $357.0 million (including the 5% repayment premium of $17.0 million) as of September 1, 2021 (the “Subordinated Notes”). The Debt Instruments provide that, as a result of the Chapter 11 Cases, the principal and interest due thereunder shall be immediately due and payable without notice from the lenders thereunder. Any efforts to enforce such payment obligations under the Debt Instruments are automatically stayed as a result of the Chapter 11 Cases, and the lenders’ rights to enforce the Debt Instruments are subject to the applicable provisions of the Bankruptcy Code. Debtor-in-Possession Financing On October 23, 2023, the Bankruptcy Court entered an interim order (the “Interim DIP Order”) in the Chapter 11 Cases authorizing the Debtors to obtain up to $75 million of junior secured postpetition financing (the “DIP Financing,” and such facility, the “DIP Facility”) from Stonepeak (in such capacity, the “DIP Lender”) in accordance with the Interim DIP Order and on the terms and conditions set forth in the Summary of Proposed Terms and Conditions for DIP Financing and Use of Cash Collateral, dated October 20, 2023, which was attached as an exhibit to the Interim DIP Order (as amended, the “DIP Term Sheet”). On November 29, 2023, the Bankruptcy Court entered a final order (the “Final DIP Order”) authorizing the Debtors to obtain DIP Financing on a final basis, with an increase of the commitment under the DIP Facility to $130 million, in accordance with the Final DIP Order and on the terms and conditions set forth in the DIP Term Sheet attached thereto. Pursuant to the DIP Term Sheet and Final DIP Order, the Debtors unconditionally guaranteed, on a joint and several basis, the Company’s obligations in connection with the DIP Financing. The loans made under the DIP Facility (the “DIP Facility Loans”) accrue interest at 8.00% per annum payable in kind. Unless otherwise provided in accordance with the terms of the RSA, the DIP Facility Loans will convert to equity on the Effective Date on the same terms as the Consenting Investor Direct Investment and shall reduce the aggregate principal amount to be invested by Stonepeak as the Consenting Investor Direct Investment on a dollar-for-dollar basis. Approval of Disclosure Statement and Confirmation of Plan On November 30, 2023, the Bankruptcy Court entered the Confirmation Order, which approved the adequacy of the Disclosure Statement on a final basis and confirmed the Prepackaged Plan. After the satisfaction or waiver of the conditions precedent of the Prepackaged Plan, the Debtors intend to effect the transactions contemplated by the Prepackaged Plan and emerge from the Chapter 11 Cases. Treatment of Claims and Interests The Prepackaged Plan provides for the following treatment of Claims against and Interests in the Debtors upon the effectiveness of the Prepackaged Plan if Allowed (each capitalized term in this sentence as defined in the Prepackaged Plan): • Other Secured Claims (as defined in the Prepackaged Plan) shall receive (i) payment in full in cash; (ii) collateral securing such Claim; (iii) reinstatement of its Claim; or (iv) such other treatment that renders the Claim unimpaired. • Other Priority Claims (as defined in the Prepackaged Plan) shall receive payment in full in cash. • Each Holder of Prepetition RCF Claims (as defined in the Prepackaged Plan) shall receive its pro rata share of the New RCF Exit Facility. • Each Holder of Prepetition 2025 Notes Claims (as defined in the Prepackaged Plan) shall receive its pro rata share of (a)(x) the New 2027 Notes; provided that, for the avoidance of doubt, any Allowed (as defined in the Prepackaged Plan) Prepetition 2025 Notes Claims arising on account of Selected Reverse Dutch Election Participating Notes (as defined in the Prepackaged Plan) shall not receive any portion of the New 2027 Notes that such Holder would have otherwise been entitled to receive on account of such Claims; and (b)(y) the opportunity to voluntarily participate in the Reverse Dutch Election Opportunity by submitting a Reverse Dutch Election Form (as defined in the Prepackaged Plan) prior to the Reverse Dutch Election Deadline (as defined in the Prepackaged Plan). • Each Holder of Prepetition 2028 Notes Claims (as defined in the Prepackaged Plan) shall receive its pro rata share of (a)(x) the New 2028 Notes; provided that, for the avoidance of doubt, any Allowed 2028 Notes Claims (as defined in the Prepackaged Plan) arising on account of Selected Reverse Dutch Election Participating Notes shall not receive any portion of the New 2028 Notes that such Holder would have otherwise been entitled to receive on account of such Claims; and (b)(y) the opportunity to voluntarily participate in the Reverse Dutch Election Opportunity by submitting a Reverse Dutch Election Form prior to the Reverse Dutch Election Deadline. • The Holder of the Prepetition Series A Note Claims (as defined in the Prepackaged Plan) shall receive 100% of the new common stock of the reorganized Akumin Inc. (“Reorganized Parent”), subject to dilution (i) in accordance with the new corporate governance documents and (ii) for any common stock of the Reorganized Parent issued to Stonepeak as the DIP Lender. • Except to the extent that such holder agrees to different treatment, the Debtors shall continue to pay or dispute each General Unsecured Claim (as defined in the Prepackaged Plan) in the ordinary course of business as if the Chapter 11 Cases had never been commenced. • All Existing Common Stock Interests shall be canceled, released, and extinguished and will be of no further force or effect. Notwithstanding the foregoing, on the Effective Date, each Holder of an Existing Common Stock Interest (other than the Consenting Investor) shall receive its pro rata share (not taking into account the Existing Common Stock Interest held by the Consenting Investor) of $25 million in cash to be paid by the Consenting Investor to the Holders of Existing Common Stock Interests other than the Consenting Investor and, subject to meeting certain terms and conditions, CVRs; provided that no Holder of Existing Common Stock Interests shall be entitled to receive any interest in the CVRs to be distributed pursuant to the Prepackaged Plan if (A) the receipt of such CVRs by a particular holder (together with the other holders of CVRs) will prevent Reorganized Parent from becoming or remaining a privately held company whose securities are not required to be registered under the Securities Exchange Act of 1934, as amended, (B) the receipt of such CVRs by a particular holder will prevent Reorganized Parent from ceasing to be a reporting issuer under applicable Canadian securities laws on the Effective Date, or (C) such recipient has not satisfied the CVR Distribution Conditions (as defined in the Prepackaged Plan). • Other Equity Interests (as defined in the Prepackaged Plan) will not receive any distribution on account of such Interests (as defined in the Prepackaged Plan), which will be canceled, released, and extinguished as of the Effective Date, and will be of no further force or effect. For the avoidance of doubt, the Consenting Investor shall not receive any recovery on account of the Prepetition Consenting Investor Warrants (as defined in the Prepackaged Plan), which will be canceled, released, and extinguished as of the Effective Date, and will be of no further force or effect. Third Party Releases Upon the Effective Date of the Prepackaged Plan, the Debtors and certain Holders of Claims and Interests (as such terms are defined in the Prepackaged Plan), except as otherwise specified in the Prepackaged Plan or Confirmation Order, are deemed to release and discharge the Released Parties (as defined in the Prepackaged Plan) from certain claims, obligations, rights, suits, damages, causes of action and liabilities in connection with the Chapter 11 Cases.

New Accounting Standards (Polic

New Accounting Standards (Policies)	9 Months Ended
	Sep. 30, 2023
Accounting Standards Update and Change in Accounting Principle [Abstract]
Recently Adopted Accounting Standards and Recently Issued Accounting 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 U.S. Securities and Exchange Commission (the "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 all other entities, this ASU is effective for fiscal years beginning after December 15, 2023. The Company is considered an Emerging Growth Company as classified by the SEC, which gives the Company relief in the timing of implementation of

Property and Equipment (Tables)

Property and Equipment (Tables)	9 Months Ended
	Sep. 30, 2023
Property, Plant and Equipment [Abstract]
Schedule of Detailed Information of Property and Equipment	Property and equipment consists of the following: (in thousands) September 30, December 31, Medical equipment $ 258,224 $ 244,517 Leasehold improvements 41,852 43,382 Equipment under finance leases 45,348 44,845 Office and computer equipment 18,721 17,742 Transportation and service equipment 11,452 11,672 Furniture and fixtures 3,298 3,362 Construction in progress 7,605 4,636 386,500 370,156 Less accumulated depreciation 194,532 148,942 $ 191,968 $ 221,214

Goodwill (Tables)

Goodwill (Tables)	9 Months Ended
	Sep. 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 (84,129) (11,000) (95,129) Goodwill written off in connection with site closures — (653) (653) Balance, September 30, 2023 $ 598,596 $ 74,732 $ 673,328
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 analyses during the three and nine months ended September 30, 2023: Discount rate 9.5% to 10.5% Perpetual growth rate 3.0% Tax rate 26.0% Risk-free interest rate 3.5% to 4.9% Revenue multiple 1.7 to 2.2 EBITDA multiple 7.5 to 11.0

Other Intangible Assets - (Tabl

Other Intangible Assets - (Tables)	9 Months Ended
	Sep. 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 September 30, 2023 December 31, 2022 Gross Accumulated Other Gross Accumulated Other Finite-lived intangible assets: Customer contracts 20 $ 250,733 $ (26,206) $ 224,527 $ 263,388 $ (17,588) $ 245,800 Trade names 18 76,391 (14,479) 61,912 77,135 (11,063) 66,072 Management agreements 17 10,200 (1,250) 8,950 10,200 (800) 9,400 Other 5 5,739 (4,598) 1,141 5,719 (4,454) 1,265 Total $ 343,063 $ (46,533) 296,530 $ 356,442 $ (33,905) 322,537 Certificates of Need 69,558 69,558 Total other intangible assets $ 366,088 $ 392,095 The Company performs an impairment test when indicators of impairment are present. As of September 30, 2023, there were no indications of impairment of the Company's other intangible assets balances.

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2023
Debt Disclosure [Abstract]
Schedule of Debt Instruments	Debt consists of the following: (in thousands) September 30, December 31, 2028 Senior Notes $ 375,000 $ 375,000 2025 Senior Notes 475,000 475,000 Subordinated Notes 461,042 423,303 Equipment Debt 58,703 72,754 Revolving Facility 16,000 — 1,385,745 1,346,057 Debt discount/premium and deferred issuance costs (70,698) (71,444) 1,315,047 1,274,613 Less current portion 1,274,780 19,961 Long-term debt, net of current portion $ 40,267 $ 1,254,652

Accrued Liabilities (Tables)

Accrued Liabilities (Tables)	9 Months Ended
	Sep. 30, 2023
Payables and Accruals [Abstract]
Schedule of Other Accrued Liabilities	Accrued liabilities consist of the following: (in thousands) September 30, December 31, Accrued compensation and related expenses $ 17,621 $ 25,655 Accrued interest expense 23,091 18,183 Other 53,365 43,078 $ 94,077 $ 86,916

Redeemable Noncontrolling Int_2

Redeemable Noncontrolling Interests (Tables)	9 Months Ended
	Sep. 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 nine months ended September 30, 2023: (in thousands) Balance, December 31, 2022 $ 30,337 Net loss attributable to redeemable noncontrolling interests (509) Contributions received from redeemable noncontrolling interests 721 Distributions paid to redeemable noncontrolling interests (6,000) Balance, September 30, 2023 $ 24,549

Financial Instruments (Tables)

Financial Instruments (Tables)	9 Months Ended
	Sep. 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 September 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 $ — $ 110 $ — $ 110 $ — $ 52 $ — $ 52 Long-term liabilities: Derivative in subordinated notes $ — $ — $ 5,710 $ 5,710 $ — $ — $ 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 nine months ended September 30, 2023: (in thousands) Balance, December 31, 2022 $ 6,132 Change in fair value (422) Balance, September 30, 2023 $ 5,710
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) September 30, December 31, 2028 Senior Notes $ 257,329 $ 228,894 2025 Senior Notes 368,445 339,385 Subordinated Notes 339,480 254,951 Equipment Debt 49,154 58,698 Revolving Facility 16,000 — $ 1,030,408 $ 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) September 30, December 31, Financial assets measured at amortized cost: Cash and cash equivalents $ 31,641 $ 59,424 Accounts receivable 118,100 114,166 $ 149,741 $ 173,590 Financial liabilities measured at amortized cost: Accounts payable $ 57,061 $ 36,618 Current portion of long-term debt 1,274,780 19,961 Current portion of leases 24,371 25,023 Non-current portion of long-term debt 40,267 1,254,652 Non-current portion of leases 171,291 179,980 Accrued liabilities 94,077 86,916 $ 1,661,847 $ 1,603,150 Financial assets measured at fair value through earnings: Fuel option contract $ 92 $ — Financial liabilities measured at fair value through earnings: Derivative in subordinated notes $ 5,710 $ 6,132 Financial assets measured at fair value through other comprehensive income: Interest rate contracts $ 18 $ 52

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	9 Months Ended
	Sep. 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 2,467,213 0.62 $ 1,530 Vested (1,361,978) 1.89 $ 2,581 Cancelled (57,078) 1.10 $ (63) Outstanding and unvested at September 30, 2023 3,191,758 $ 0.84 $ 2,671
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 September 30, 2023 5,348,120 $ 2.56 2.6 $ — Exercisable at September 30, 2023 5,325,020 $ 2.55 2.6 $ —

Supplemental Revenue Informat_2

Supplemental Revenue Information (Tables)	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Patient fee payors: Commercial $ 64,748 $ 66,760 $ 195,336 $ 207,470 Medicare 17,980 20,304 59,482 62,478 Medicaid 3,286 3,111 9,947 9,560 Other patient revenue 2,278 3,053 7,602 9,540 88,292 93,228 272,367 289,048 Hospitals and healthcare providers 90,292 91,092 274,267 269,202 Other revenue 2,040 2,285 6,422 6,746 $ 180,624 $ 186,605 $ 553,056 $ 564,996

Cost of Operations, excluding_2

Cost of Operations, excluding Depreciation and Amortization (Tables)	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Employee compensation $ 68,679 $ 67,278 $ 208,508 $ 214,426 Third-party services and professional fees 31,427 30,233 94,347 89,271 Rent and utilities 12,858 12,894 37,979 38,114 Reading fees 11,830 11,379 35,382 34,665 Administrative 11,440 12,473 34,805 35,621 Stock-based compensation 505 556 1,345 2,375 Medical supplies and other 21,308 16,417 60,583 48,312 $ 158,047 $ 151,230 $ 472,949 $ 462,784

Supplemental Statement of Ope_2

Supplemental Statement of Operations Information (Tables)	9 Months Ended
	Sep. 30, 2023
Other Income and Expenses [Abstract]
Schedule of Restructuring Charges	Restructuring charges consist of the following: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Transformation costs $ — $ 3,363 $ 6,659 $ 7,388 Lease termination costs — — 7 1,840 Domestication and related costs — 350 — 1,413 Other 23 329 37 725 $ 23 $ 4,042 $ 6,703 $ 11,366
Schedule of Other Operating Income, Net	Other operating income, net consists of the following: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Loss (gain) on sale of accounts receivable $ — $ (7,603) $ 1,046 $ (7,603) Gain from insurance proceeds (45) — (821) — Loss (gain) on disposal of property and equipment, net (344) 26 (761) 398 Other, net 42 3 (85) (123) $ (347) $ (7,574) $ (621) $ (7,328)
Schedule Of Other Non-operating Losses (gains)	Other non-operating expense (income), net consists of the following: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Capital structure initiatives $ 7,604 $ — $ 9,516 $ — Acquisition-related costs 27 99 325 567 Fair value adjustment on derivative in subordinated notes (121) (271) (422) (1,110) Earnings from unconsolidated investees (135) (250) (414) (738) Other, net 147 — 731 (1,152) $ 7,522 $ (422) $ 9,736 $ (2,433)

Basic and Diluted Loss per Sh_2

Basic and Diluted Loss per Share (Tables)	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, (in thousands, except share and per share amounts) 2023 2022 2023 2022 Net loss attributable to common stockholders $ (82,385) $ (53,871) $ (214,185) $ (115,151) Weighted average common shares outstanding: Basic and diluted 91,044,143 89,540,046 90,460,245 89,378,653 Net loss per share attributable to common stockholders: Basic and diluted $ (0.90) $ (0.60) $ (2.37) $ (1.29) Employee stock options, warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive 1,988,559 2,571,041 2,086,216 2,548,000

Segment Information (Tables)

Segment Information (Tables)	9 Months Ended
	Sep. 30, 2023
Segment Reporting [Abstract]
Schedule of Revenue By Segment	The following table summarizes the Company’s revenues by segment: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Radiology $ 153,930 $ 155,062 $ 467,622 $ 471,269 Oncology 26,694 31,543 85,434 93,727 $ 180,624 $ 186,605 $ 553,056 $ 564,996
Schedule of Company's Adjusted EBITDA	The following table summarizes the Company’s Adjusted EBITDA by segment: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Adjusted EBITDA: Radiology $ 18,790 $ 31,218 $ 74,565 $ 95,832 Oncology 7,876 11,048 25,796 31,383 Corporate (3,184) (5,745) (17,211) (20,494) $ 23,482 $ 36,521 $ 83,150 $ 106,721
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 September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Net loss $ (83,495) $ (49,745) $ (209,096) $ (102,256) Interest expense 33,872 29,679 95,733 87,650 Income tax expense (benefit) (80) 12,038 (784) 9,118 Depreciation and amortization 20,942 25,079 78,950 75,010 Impairment charges 42,041 20,369 95,501 20,702 Restructuring charges 23 4,042 6,703 11,366 Severance and related costs 538 2,485 511 10,282 Settlements, recoveries and related costs 1,561 (576) 3,474 101 Stock-based compensation 505 556 1,345 2,375 Loss (gain) on sale of accounts receivable — (7,603) 1,046 (7,603) Loss (gain) on disposal of property and equipment, net (344) 26 (761) 398 Capital structure initiatives 7,604 — 9,516 — Acquisition-related costs 27 99 325 567 Fair value adjustment on derivative (121) (271) (422) (1,110) Deferred rent expense 221 325 363 904 Other, net 188 18 746 (783) Adjusted EBITDA $ 23,482 $ 36,521 $ 83,150 $ 106,721
Schedule of Segment Reporting Information By Segment	The following table summarizes the Company’s total assets by segment: (in thousands) September 30, December 31, Identifiable assets: Radiology $ 1,269,014 $ 1,400,938 Oncology 304,593 346,337 Corporate 17,223 17,840 $ 1,590,830 $ 1,765,115 The following table summarizes the Company’s capital expenditures by segment: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2023 2022 2023 2022 Capital expenditures: Radiology $ 6,844 $ 16,081 $ 16,711 $ 29,541 Oncology 1,124 1,207 2,124 3,041 Corporate 65 11 658 183 $ 8,033 $ 17,299 $ 19,493 $ 32,765

Variable Interest Entities (Det

Variable Interest Entities (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Variable Interest Entity [Line Items]
Assets	$ 1,590,830		$ 1,765,115
Liabilities	1,680,959		1,623,824
Net cash provided by operating activities	17,394	$ 55,936
Variable Interest Entity, Primary Beneficiary
Variable Interest Entity [Line Items]
Assets	44,100		36,000
Liabilities	1,700		$ 1,400
Revenues	129,000	137,200
Net cash provided by operating activities	$ 114,900	$ 161,000

Property and Equipment - Summar

Property and Equipment - Summary of Detailed Information of Property and Equipment (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Property, Plant and Equipment [Line Items]
Equipment under finance leases	$ 45,348	$ 44,845
Total property and equipment, gross	386,500	370,156
Less accumulated depreciation	194,532	148,942
Property and equipment, net	191,968	221,214
Medical equipment
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	258,224	244,517
Leasehold improvements
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	41,852	43,382
Office and computer equipment
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	18,721	17,742
Transportation and service equipment
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	11,452	11,672
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	3,298	3,362
Construction in progress
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	$ 7,605	$ 4,636

Property and Equipment - Additi

Property and Equipment - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Property, Plant and Equipment [Abstract]
Depreciation expense	$ 16.4	$ 19.5	$ 52.9	$ 59.4
Net book value of equipment under finance leases	$ 23.8		$ 23.8		$ 26.3

Goodwill - Changes in the Carry

Goodwill - Changes in the Carrying Amount of Goodwill (Details) - USD ($) $ in Thousands	3 Months Ended			9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Goodwill [Roll Forward]
Balance - Beginning of period				$ 769,110
Impairment	$ (41,669)		$ (20,000)	(95,129)	$ (20,000)
Goodwill written off in connection with site closures				(653)
Balance - End of period	673,328			673,328
Radiology
Goodwill [Roll Forward]
Balance - Beginning of period				682,725
Impairment	(30,600)	$ (53,500)		(84,129)
Goodwill written off in connection with site closures				0
Balance - End of period	598,596			598,596
Oncology
Goodwill [Roll Forward]
Balance - Beginning of period				86,385
Impairment	(11,000)			(11,000)
Goodwill written off in connection with site closures				(653)
Balance - End of period	$ 74,732			$ 74,732

Goodwill - Schedule Of Signific

Goodwill - Schedule Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill (Details)	Sep. 30, 2023	Jun. 30, 2023
Discount rate | Minimum
Goodwill [Line Items]
Goodwill measurement input	0.095	0.095
Discount rate | Maximum
Goodwill [Line Items]
Goodwill measurement input	0.105	0.105
Perpetual growth rate
Goodwill [Line Items]
Goodwill measurement input	0.030	0.030
Tax rate
Goodwill [Line Items]
Goodwill measurement input	0.260	0.260
Risk-free interest rate | Minimum
Goodwill [Line Items]
Goodwill measurement input	0.035	0.035
Risk-free interest rate | Maximum
Goodwill [Line Items]
Goodwill measurement input	0.049	0.049
Revenue multiple | Minimum
Goodwill [Line Items]
Goodwill measurement input	1.7	1.7
Revenue multiple | Maximum
Goodwill [Line Items]
Goodwill measurement input	2.2	2.2
EBITDA multiple | Minimum
Goodwill [Line Items]
Goodwill measurement input	7.5	7.5
EBITDA multiple | Maximum
Goodwill [Line Items]
Goodwill measurement input	11	11

Goodwill - Additional Informati

Goodwill - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended			9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Goodwill [Line Items]
Impairment	$ 41,669		$ 20,000	$ 95,129	$ 20,000
Radiology
Goodwill [Line Items]
Impairment	$ 30,600	$ 53,500		$ 84,129

Other Intangible Assets - Sched

Other Intangible Assets - Schedule Of Intangible Assets Excluding Goodwill (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 343,063	$ 356,442
Accumulated Amortization	(46,533)	(33,905)
Other Intangible Assets, Net	296,530	322,537
Certificates of Need	69,558	69,558
Total other intangible assets	$ 366,088	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	(26,206)	(17,588)
Other Intangible Assets, Net	$ 224,527	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	(14,479)	(11,063)
Other Intangible Assets, Net	$ 61,912	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	(1,250)	(800)
Other Intangible Assets, Net	$ 8,950	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	(4,598)	(4,454)
Other Intangible Assets, Net	$ 1,141	$ 1,265

Other Intangible Assets - Addit

Other Intangible Assets - Additional Information (Details) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) site	Sep. 30, 2022 USD ($)
Finite-Lived Intangible Assets [Line Items]
Amortization of Intangible Assets	$ 4.5	$ 5.6	$ 26.1	$ 15.6
Oncology
Finite-Lived Intangible Assets [Line Items]
Amortization of Intangible Assets			$ 12.1
Number of sites closed | site			2

Debt - Schedule of Debt Instrum

Debt - Schedule of Debt Instruments (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term debt	$ 1,385,745	$ 1,346,057
Debt discount/premium and deferred issuance costs	(70,698)	(71,444)
Total long-term debt	1,315,047	1,274,613
Less current portion	1,274,780	19,961
Long-term debt, net of current portion	40,267	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	461,042	423,303
Equipment Debt
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term debt	58,703	72,754
Revolving Facility
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items]
Long-term debt	$ 16,000	$ 0

Debt - Additional Information (

Debt - Additional Information (Details) - Subordinated Notes - USD ($) $ in Millions		9 Months Ended
	Sep. 29, 2023	Sep. 30, 2023
Debt Instrument [Line Items]
Accrued interest added to the principal balance		$ 37.7
Cash interest failure to pay	$ 3.9

Accrued Liabilities (Details)

Accrued Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Payables and Accruals [Abstract]
Accrued compensation and related expenses	$ 17,621	$ 25,655
Accrued interest expense	23,091	18,183
Other	53,365	43,078
Total accrued liabilities	$ 94,077	$ 86,916

Redeemable Noncontrolling Int_3

Redeemable Noncontrolling Interests - Additional Information (Detail) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Noncontrolling Interest [Abstract]
Redeemable noncontrolling interests	$ 24,549	$ 30,337

Redeemable Noncontrolling Int_4

Redeemable Noncontrolling Interest - Summary of Redeemable Noncontrolling Interests (Detail) $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($)
Stockholders' Equity Attributable to Noncontrolling Interest [Roll Forward]
Balance, December 31, 2022	$ 30,337
Net loss attributable to redeemable noncontrolling interests	(509)
Contributions received from redeemable noncontrolling interests	721
Distributions paid to redeemable noncontrolling interests	(6,000)
Balance, September 30, 2023	$ 24,549

Financial Instruments - Schedul

Financial Instruments - Schedule of Fair Value Measurements, Recurring and Nonrecurring (Details) - Fair Value, Recurring - USD ($) $ in Thousands	Sep. 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:	$ 110	$ 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:	110	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:	5,710	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:	$ 5,710	$ 6,132

Financial Instruments - Additio

Financial Instruments - Additional Information (Details) $ in Thousands	Sep. 01, 2021	Sep. 30, 2023 USD ($) yr	Dec. 31, 2022 USD ($) yr
Financial Instruments [Line Items]
Long-term debt		$ 1,385,745	$ 1,346,057
Revolving Facility
Financial Instruments [Line Items]
Long-term debt		$ 16,000	$ 0
Revolving 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		$ 200	$ 400
Level 3 | Measurement Input Probability Weighted Time
Financial Instruments [Line Items]
Embedded derivative liability measurement input | yr		3.1	3.5
Level 3 | Measurement Input Probability Of Exit Event Percentage
Financial Instruments [Line Items]
Embedded derivative liability measurement input		0.209	0.229
Subordinated Notes | Stone Peak Magnet
Financial Instruments [Line Items]
Debt covenant, redemption option, change of control period (in years)	7 years

Financial Instruments - Summary

Financial Instruments - Summary of Reconciliation of Liability Related to the Embedded Derivative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Disclosure Of Movement In Embedded Derivative Liabilities [Roll Forward]
Change in fair value	$ 121	$ 271	$ 422	$ 1,110
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			(422)
Balance, September 30, 2023	$ 5,710		$ 5,710

Financial Instruments - Sched_2

Financial Instruments - Schedule Of Fair Value Of Other Current And Non Current Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	$ 1,030,408	$ 881,928
2028 Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	257,329	228,894
2025 Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	368,445	339,385
Subordinated Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	339,480	254,951
Equipment Debt
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	49,154	58,698
Revolving Facility
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument fair value	$ 16,000	$ 0

Financial Instruments - Sched_3

Financial Instruments - Schedule of Information Regarding The Carrying Value Of Financial Instruments (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash and cash equivalents	$ 31,641	$ 59,424
Accounts receivable	118,100	114,166
Current portion of long-term debt	1,274,780	19,961
Non-current portion of long-term debt	40,267	1,254,652
Accrued liabilities	94,077	86,916
Financial assets measured at fair value through earnings:
Fuel option contract	92	0
Reported Value Measurement
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash and cash equivalents	31,641	59,424
Accounts receivable	118,100	114,166
Financial assets measured at amortized cost	149,741	173,590
Accounts payable	57,061	36,618
Current portion of long-term debt	1,274,780	19,961
Current portion of leases	24,371	25,023
Non-current portion of long-term debt	40,267	1,254,652
Non-current portion of leases	171,291	179,980
Accrued liabilities	94,077	86,916
Financial liabilities measured at amortized cost	1,661,847	1,603,150
Financial liabilities measured at fair value through earnings:
Derivative in subordinated notes	5,710	6,132
Financial assets measured at fair value through other comprehensive income:
Interest rate contracts	$ 18	$ 52

Stockholders' Equity - Addition

Stockholders' Equity - Additional Information (Detail)		9 Months Ended
	Apr. 18, 2023	Sep. 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)		9,117,349	8,981,151

Stockholders' Equity - Summary

Stockholders' Equity - Summary of RSU Activity (Detail) $ / shares in Units, $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($) $ / shares shares
Number of RSUs
Beginning balance (in shares) | shares	2,143,601
Granted (in shares) | shares	2,467,213
Vested (in shares) | shares	(1,361,978)
Cancelled (in shares) | shares	(57,078)
Ending balance (in shares) | shares	3,191,758
Weighted- Average Grant Date Fair Value
Beginning balance (in dollars per share) | $ / shares	$ 1.77
Granted (in dollars per share) | $ / shares	0.62
Vested (in dollars per share) | $ / shares	1.89
Cancelled (in dollars per share) | $ / shares	1.10
Ending balance (in dollars per share) | $ / shares	$ 0.84
Aggregate Grant Date Fair Value, Granted | $	$ 1,530
Aggregate Grant Date Fair Value, Vested | $	2,581
Aggregate Grant Date Fair Value, Cancelled | $	(63)
Aggregate Grant Date Fair Value, Outstanding and unvested | $	$ 2,671

Stockholders' Equity - Summar_2

Stockholders' Equity - Summary of the Stock Option Activity (Detail) - Stock Options - USD ($) $ / shares in Units, $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 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 7 months 6 days	3 years 3 months 18 days
Weighted-Average Remaining Contractual Term, Exercisable	2 years 7 months 6 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	Sep. 30, 2023 USD ($)
Loss Contingencies [Line Items]
Purchase commitments	$ 32.7
Remaining Three Months of Current Year
Loss Contingencies [Line Items]
Purchase commitments	9.2
Greater than Three Months in Current Year
Loss Contingencies [Line Items]
Purchase commitments	$ 23.5

Supplemental Revenue Informat_3

Supplemental Revenue Information (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Disaggregation of Revenue [Line Items]
Other revenue	$ 2,040	$ 2,285	$ 6,422	$ 6,746
Total revenue	180,624	186,605	553,056	564,996
Sales Channel, Directly to Consumer
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	88,292	93,228	272,367	289,048
Commercial | Sales Channel, Directly to Consumer
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	64,748	66,760	195,336	207,470
Medicare | Sales Channel, Directly to Consumer
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	17,980	20,304	59,482	62,478
Medicaid | Sales Channel, Directly to Consumer
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	3,286	3,111	9,947	9,560
Other patient revenue | Sales Channel, Directly to Consumer
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	2,278	3,053	7,602	9,540
Hospitals and healthcare providers | Sales Channel, Through Intermediary
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	$ 90,292	$ 91,092	$ 274,267	$ 269,202

Cost of Operations, excluding_3

Cost of Operations, excluding Depreciation and Amortization (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	$ 158,047	$ 151,230	$ 472,949	$ 462,784
Employee compensation
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	68,679	67,278	208,508	214,426
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	31,427	30,233	94,347	89,271
Rent and utilities
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	12,858	12,894	37,979	38,114
Reading fees
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	11,830	11,379	35,382	34,665
Administrative
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	11,440	12,473	34,805	35,621
Stock-based compensation
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	505	556	1,345	2,375
Medical supplies and other
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization	$ 21,308	$ 16,417	$ 60,583	$ 48,312

Supplemental Statement of Ope_3

Supplemental Statement of Operations Information - Schedule of Restructuring Charges (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Restructuring Cost and Reserve [Line Items]
Restructuring charges	$ 23	$ 4,042	$ 6,703	$ 11,366
Transformation costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges	0	3,363	6,659	7,388
Lease termination costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges	0	0	7	1,840
Domestication and related costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges	0	350	0	1,413
Other
Restructuring Cost and Reserve [Line Items]
Restructuring charges	$ 23	$ 329	$ 37	$ 725

Supplemental Statement of Ope_4

Supplemental Statement of Operations Information - Additional Information (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Restructuring Cost and Reserve [Line Items]
Accounts payable	$ 57,061	$ 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	$ 5,600	$ 1,100
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	$ 1,000

Supplemental Statement of Ope_5

Supplemental Statement of Operations Information - Schedule of Other Operating Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Other Income and Expenses [Abstract]
Loss (gain) on sale of accounts receivable	$ 0	$ (7,603)	$ 1,046	$ (7,603)
Gain from insurance proceeds	(45)	0	(821)	0
Loss (gain) on disposal of property and equipment, net	(344)	26	(761)	398
Other, net	42	3	(85)	(123)
Other operating income, net	$ (347)	$ (7,574)	$ (621)	$ (7,328)

Supplemental Statement of Ope_6

Supplemental Statement of Operations Information - Schedule of Other Non-operating Losses (gains) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Other Income and Expenses [Abstract]
Capital structure initiatives	$ 7,604	$ 0	$ 9,516	$ 0
Acquisition-related costs	27	99	325	567
Fair value adjustment on derivative in subordinated notes	(121)	(271)	(422)	(1,110)
Earnings from unconsolidated investees	(135)	(250)	(414)	(738)
Other, net	147	0	731	(1,152)
Other non-operating expense (income), net	$ 7,522	$ (422)	$ 9,736	$ (2,433)

Supplemental Statement of Ope_7

Supplemental Statement of Operations Information - Schedule of Impairment of Assets (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Other Income and Expenses [Abstract]
Goodwill	$ 41,669	$ 20,000	$ 95,129	$ 20,000
Property and equipment	372	369	372	702
Impairment charges	$ 42,041	$ 20,369	$ 95,501	$ 20,702

Investments in Unconsolidated_2

Investments in Unconsolidated Investees (Detail) - USD ($) $ in Millions	Mar. 01, 2021	Sep. 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		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Earnings Per Share [Abstract]
Net loss attributable to common stockholders	$ (82,385)	$ (53,871)	$ (214,185)	$ (115,151)
Weighted average common shares outstanding:
Basic (in shares)	91,044,143	89,540,046	90,460,245	89,378,653
Diluted (in shares)	91,044,143	89,540,046	90,460,245	89,378,653
Net loss per share attributable to common stockholders:
Basic (in USD per share)	$ (0.90)	$ (0.60)	$ (2.37)	$ (1.29)
Diluted (in USD per share)	$ (0.90)	$ (0.60)	$ (2.37)	$ (1.29)
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)	1,988,559	2,571,041	2,086,216	2,548,000

Segment Information - Additiona

Segment Information - Additional Information (Details)	9 Months Ended
	Sep. 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		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenues	$ 180,624	$ 186,605	$ 553,056	$ 564,996
Radiology
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenues	153,930	155,062	467,622	471,269
Oncology
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenues	$ 26,694	$ 31,543	$ 85,434	$ 93,727

Segment Information - Summary_2

Segment Information - Summary of Company's Adjusted EBITDA (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted EBITDA	$ 23,482	$ 36,521	$ 83,150	$ 106,721
Corporate
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted EBITDA	(3,184)	(5,745)	(17,211)	(20,494)
Radiology | Operating Segments
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted EBITDA	18,790	31,218	74,565	95,832
Oncology | Operating Segments
Segment Reporting, Revenue Reconciling Item [Line Items]
Adjusted EBITDA	$ 7,876	$ 11,048	$ 25,796	$ 31,383

Segment Information - Summary_3

Segment Information - Summary of Net Income (Loss) to Total Adjusted EBITDA (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Segment Reporting [Abstract]
Net loss	$ (83,495)	$ (49,745)	$ (209,096)	$ (102,256)
Interest expense	33,872	29,679	95,733	87,650
Income tax expense (benefit)	(80)	12,038	(784)	9,118
Depreciation and amortization	20,942	25,079	78,950	75,010
Impairment charges	42,041	20,369	95,501	20,702
Restructuring charges	23	4,042	6,703	11,366
Severance and related costs	538	2,485	511	10,282
Settlements, recoveries and related costs	1,561	(576)	3,474	101
Stock-based compensation	505	556	1,345	2,375
Loss (gain) on sale of accounts receivable	0	(7,603)	1,046	(7,603)
Loss (gain) on disposal of property and equipment, net	(344)	26	(761)	398
Capital structure initiatives	7,604	0	9,516	0
Acquisition-related costs	27	99	325	567
Fair value adjustment on derivative	(121)	(271)	(422)	(1,110)
Deferred rent expense	221	325	363	904
Other, net	188	18	746	(783)
Adjusted EBITDA	$ 23,482	$ 36,521	$ 83,150	$ 106,721

Segment Information - Schedule

Segment Information - Schedule Of Segment Reporting Information By Segment (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Segment Reporting Information [Line Items]
Identifiable assets	$ 1,590,830		$ 1,590,830		$ 1,765,115
Capital expenditures	8,033	$ 17,299	19,493	$ 32,765
Corporate
Segment Reporting Information [Line Items]
Identifiable assets	17,223		17,223		17,840
Capital expenditures	65	11	658	183
Radiology | Operating Segments
Segment Reporting Information [Line Items]
Identifiable assets	1,269,014		1,269,014		1,400,938
Capital expenditures	6,844	16,081	16,711	29,541
Oncology | Operating Segments
Segment Reporting Information [Line Items]
Identifiable assets	304,593		304,593		$ 346,337
Capital expenditures	$ 1,124	$ 1,207	$ 2,124	$ 3,041

Subsequent Events (Details)

Subsequent Events (Details) - Subsequent Event - USD ($)			2 Months Ended
	Oct. 23, 2023	Oct. 20, 2023	Dec. 13, 2023	Nov. 29, 2023
Subsequent Event [Line Items]
Ransomware related incident costs			$ 6,600,000
Restructuring support agreement, capital investment, aggregate amount		$ 130,000,000
Restructuring support agreement, capital investment, acquisition of existing common stock		25,000,000
Restructuring support agreement, capital investment, amount available for reverse dutch election opportunity		$ 60,000,000
Restructuring support agreement, capital investment, percentage of stock owned		100%
Reorganization, Chapter 11, Debtor-in-Possession
Subsequent Event [Line Items]
Debtor-in-possession financing, maximum amount arranged	$ 75,000,000			$ 130,000,000
Debtor-in-possession financing, interest rate on borrowings outstanding	8%
Senior Notes | 2025 Senior Notes
Subsequent Event [Line Items]
Debt default, aggregate principal amount	$ 400,000,000
Senior Notes | 2025 Senior Notes, Private Issuance
Subsequent Event [Line Items]
Debt default, aggregate principal amount	75,000,000
Senior Notes | 2028 Senior Notes
Subsequent Event [Line Items]
Debt default, aggregate principal amount	375,000,000
Subordinated Notes
Subsequent Event [Line Items]
Debt default, aggregate principal amount	$ 357,000,000
Repayment premium, percentage	5%
Repayment premium, amount	$ 17,000,000
2020 Revolving Credit Agreement | Line of Credit
Subsequent Event [Line Items]
Debt default, aggregate principal amount	$ 55,000,000