American Shared Hospital Services (AMS) 10-K6 Apr 212020 FY Annual reportFinancial data

Company Profile

Cover Page

Cover Page - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
Cover Page - USD ($) shares in Thousands, $ in Thousands	Dec. 31, 2020	Mar. 22, 2021	Jun. 30, 2020
Document and Entity Information [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2020
Current Fiscal Year End Date	--12-31
Document Transition Report	false
Entity File Number	1-08789
Entity Registrant Name	American Shared Hospital Services
Entity Incorporation, State or Country Code	CA
Entity Tax Identification Number	94-2918118
Entity Address, Address Line One	Two Embarcadero Center
Entity Address, Address Line Two	Suite 410,
Entity Address, City or Town	San Francisco,
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	94111-4107
City Area Code	415
Local Phone Number	788-5300
Title of 12(b) Security	Common Stock No Par Value
Trading Symbol	AMS
Security Exchange Name	NYSEAMER
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	false
Entity Shell Company	false
Entity Public Float			$ 8,188
Entity Common Stock, Shares Outstanding		5,801
Documents Incorporated by Reference	Portions of the registrant’s definitive Proxy Statement for the 2021 Annual Meeting of Shareholders are incorporated by reference into Part III of this report.
Amendment Flag	false
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	FY
Entity Central Index Key	0000744825

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
CURRENT ASSETS
Cash and cash equivalents	$ 3,961	$ 1,429
Restricted cash	364	350
Accounts receivable, net of allowance for doubtful accounts of $100,000 at December 31, 2020 and December 31, 2019	4,303	6,894
Other receivables	272	169
Prepaid expenses and other current assets	1,950	1,900
Total current assets	10,850	10,742
PROPERTY AND EQUIPMENT, net	30,418	41,480
LAND	19	0
GOODWILL	1,265	0
INTANGIBLE ASSETS	78	0
RIGHT OF USE ASSETS	886	1,106
OTHER ASSETS	137	455
TOTAL ASSETS	43,653	53,783
CURRENT LIABILITIES
Accounts payable	683	557
Employee compensation and benefits	405	234
Other accrued liabilities	2,045	1,779
Asset retirement obligations	1,270	0
Income taxes payable	373	130
Working capital payment due	197	0
Current portion of lease liabilities	305	279
Current portion of long-term debt	1,157	1,526
Current portion of finance leases	5,945	3,709
Total current liabilities	12,380	8,214
LONG-TERM LEASE LIABILITIES, less current portion	581	827
LONG-TERM DEBT, less current portion	3,440	1,954
LONG-TERM FINANCE LEASES, less current portion	2,974	8,177
DEFERRED REVENUE, less current portion	210	286
DEFERRED INCOME TAXES	418	2,514
COMMITMENTS AND CONTINGENCIES (See Note 12)
SHAREHOLDERS’ EQUITY
Common stock, no par value (10,000,000 authorized; Issued and outstanding shares – 5,714,000 at December 31, 2018 and 5,710,000 at December 31, 2017	10,753	10,753
Additional paid-in capital	7,024	6,725
Retained earnings	1,497	8,555
Total equity- American Shared Hospital Services	19,274	26,033
Non-controlling interests in subsidiaries	4,376	5,778
Total shareholders’ equity	23,650	31,811
TOTAL LIABILITIES AND SHAREHOLDERS’ EQUITY	$ 43,653	$ 53,783

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Balance Sheet Parenthetical [Abstract]
Allowance for doubtful accounts	$ 100	$ 100
Common stock, par value (in dollars per share)	$ 0	$ 0
Common stock, shares authorized (in shares)	10,000,000	10,000,000
Common stock, shares issued (in shares)	5,791,000	5,817,000
Common stock, shares outstanding (in shares)	5,791,000	5,817,000

STATEMENTS OF OPERATIONS

STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	12 Months Ended
STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Revenues:
Revenues	$ 17,837	$ 20,605
Costs of revenue:
Maintenance and supplies	2,385	2,618
Depreciation and amortization	6,789	7,341
Other direct operating costs	4,197	3,726
Costs and expenses	13,371	13,685
Gross margin	4,466	6,920
Selling and administrative expense	4,608	4,060
Interest expense	1,057	1,318
Loss on write down of impaired assets and associated removal costs	8,264	0
Operating (loss) income	(9,463)	1,542
Interest and other income	10	16
(Loss) income before income taxes	(9,453)	1,558
Income tax (benefit) expense	(1,737)	128
Net (loss) income	(7,716)	1,430
Less: net loss (income) attributable to non-controlling interests	658	(771)
Net (loss) income attributable to American Shared Hospital Services	$ (7,058)	$ 659
Net (loss) income per share attributable to American Shared Hospital Services:
(Loss) income per common share - basic (in dollars per share)	$ (1.14)	$ 0.11
(Loss) income per common share - diluted (in dollars per share)	$ (1.14)	$ 0.11

CONSOLIDATED STATEMENT OF SHARE

CONSOLIDATED STATEMENT OF SHAREHOLDERS' EQUITY - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Retained Earnings	Sub-Total ASHS	Non-controlling Interests in Subsidiaries
Balance at beginning at Dec. 31, 2018	$ 31,048	$ 10,711	$ 6,495	$ 7,896	$ 25,102	$ 5,946
Balance at beginning (in shares) at Dec. 31, 2018		5,714,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation expense	230		230		230
Stock-based compensation expense (in shares)		4,000
Options exercised	$ 42	$ 42			42
Options exercised (in shares)	16,000	16,000
Issuance of restricted stock awards (in shares)		83,000
Cash distributions to non-controlling interests	$ (939)					(939)
Net income	1,430			659	659	771
Balance at end at Dec. 31, 2019	31,811	$ 10,753	6,725	8,555	26,033	5,778
Balance at end (in shares) at Dec. 31, 2019		5,817,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation expense	$ 299		299		299
Stock-based compensation expense (in shares)		103,000
Options exercised (in shares)	0
Cash distributions to non-controlling interests	$ (761)					(761)
Net income	(7,716)			(7,058)	(7,058)	(658)
NCI investment in acquisition	$ 17					17
Restricted common shares returned to plan (in shares)	(129,000)
Balance at end at Dec. 31, 2020	$ 23,650	$ 10,753	$ 7,024	$ 1,497	$ 19,274	$ 4,376
Balance at end (in shares) at Dec. 31, 2020		5,791,000

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
OPERATING ACTIVITIES
Net (loss) income	$ (7,716)	$ 1,430
Adjustments to reconcile net income to net cash from operating activities (excluding assets acquired and liabilities assumed):
Depreciation and amortization	6,970	7,411
Non cash lease expense	288	256
Loss on write down impaired assets	8,184	0
Deferred income taxes	(2,162)	(444)
Accrued interest on lease financing	0	29
Stock-based compensation expense	299	230
Interest expense associated with lease liabilities	65	76
Changes in operating assets and liabilities:
Receivables	2,966	(1,187)
Prepaid expenses and other assets	762	260
Accounts payable, accrued liabilities and deferred revenue	263	28
Lease liabilities	(353)	(332)
Income taxes payable	179	130
Net insurance proceeds receivable	0	160
Net cash from operating activities	9,745	8,047
INVESTING ACTIVITIES
Payment for purchase of property and equipment	(455)	(990)
Payment for acquisition, net of cash acquired	(2,084)	0
Proceeds from sale of equipment	150	0
Net cash (used in) investing activities	(2,389)	(990)
FINANCING ACTIVITIES
Principal payments on long-term debt	(1,726)	(1,980)
Principal payments on finance leases	(3,199)	(4,142)
Proceeds from financing from acquisition	1,425	0
Distributions to non-controlling interests	(761)	(939)
Debt issuance costs	(30)	0
Proceeds from warrants and options exercised	0	42
Principal payments on short-term financing	(519)	(51)
Net cash (used in) financing activities	(4,810)	(7,070)
Net change in cash, cash equivalents and restricted cash	2,546	(13)
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, beginning of year	1,779	1,792
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, end of year	4,325	1,779
SUPPLEMENTAL CASH FLOW DISCLOSURE
Cash paid for interest	938	1,318
Cash paid for income taxes	339	397
SCHEDULE OF NONCASH INVESTING AND FINANCING ACTIVITIES
Lease reassessment right of use assets and lease liabilities	67
Right of use assets and lease liabilities	135	1,362
Interest capitalized to property and equipment	119	110
Acquisition of equipment with finance leases	496	1,293
Acquisition of equipment with long-term debt financing	1,184	0
Acquisition of insurance with short-term financing	634	$ 526
First working capital payment related to acquisition, withholding taxes	43
Estimated subsequent working capital payment for acquisition	$ 154

BUSINESS AND BASIS OF PRESENTAT

BUSINESS AND BASIS OF PRESENTATION	12 Months Ended
BUSINESS AND BASIS OF PRESENTATION	Dec. 31, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
BUSINESS AND BASIS OF PRESENTATION	B USINESS AND B ASIS OF P RESENTATION Business – These consolidated financial statements include the accounts of American Shared Hospital Services and its subsidiaries (the “Company”) as follows: the Company wholly-owns the subsidiaries American Shared Radiosurgery Services (“ASRS”), PBRT Orlando, LLC (“Orlando”), OR21, Inc., and MedLeader.com, Inc. (“MedLeader”); the Company is the majority owner of Long Beach Equipment, LLC (“LBE”); ASRS is the majority-owner of GK Financing, LLC (“GKF”) which wholly-owns the subsidiary Instituto de Gamma Knife del Pacifico S.A.C. (“GKPeru”). GKF is the majority owner of the subsidiaries Albuquerque GK Equipment, LLC (“AGKE”) and Jacksonville GK Equipment, LLC (“JGKE”). GKF formed HoldCo GKC S.A. (“HoldCo”) to acquire Gamma Knife Center Ecuador S.A. (“GKCE”). The Company (through ASRS) and Elekta AG (“Elekta”), the manufacturer of the Gamma Knife (through its wholly-owned United States subsidiary, GKV Investments, Inc.), entered into an operating agreement and formed GKF. During 2020 GKF provided Gamma Knife units to fifteen medical centers in the United States in the states of Arkansas, California, Florida, Illinois, Indiana, Massachusetts, Mississippi, Nebraska, New Mexico, New York, Ohio, Oregon, Tennessee, and Texas. GKF also owns and operates single-unit Gamma Knife facilities in Lima, Peru and Guayaquil, Ecuador. The Company through its wholly-owned subsidiary, Orlando, provided proton beam radiation therapy (“PBRT”) and related equipment to a customer in the United States. The Company formed the subsidiary GKPeru and acquired GKCE for the purposes of expanding its business internationally; Orlando and LBE to provide PBRT equipment and services in Orlando, Florida and Long Beach, California, respectively; and AGKE and JGKE to provide Gamma Knife equipment and services in Albuquerque, New Mexico and Jacksonville, Florida, respectively. AGKE began operations in the second quarter of 2011 and JGKE began operations in the fourth quarter of 2011. Orlando treated its first patient in April 2016. GKPeru treated its first patient in July 2017. LBE is not expected to generate revenue within the next two years. On June 12, 2020, GKF, through HoldCo, purchased approximately 98% of the total outstanding shares of GKCE, from GKCE’s majority shareholders (the “Acquisition”). As of December 31, 2020, the Company had acquired approximately 99.3% of the total outstanding shares of GKCE and intends to acquire the remaining 0.7% at a later date. The base purchase price for the Acquisition, including acquisition of the minority shares was approximately $2,000,000. This purchase price was paid with $575,000 in cash and a $1,425,000 loan from the United States International Development Finance Corporation (“DFC”). The purchase price is subject to certain post-closing adjustments, including adjustment for GKCE's working capital and excess cash. The DFC loan is denominated in U.S. dollars, which is also the currency of Ecuador. See “Note 4. GKCE Acquisition” for further discussion. The Company continues to develop its design and business model for The Operating Room for the 21st Century SM through its 50% owned OR21, LLC (“OR21”). The remaining 50% of OR21 is owned by an architectural design company. OR21 is not expected to generate significant revenue within the next two years. MedLeader was formed to provide continuing medical education online and through videos for doctors, nurses, and other healthcare workers. This subsidiary is not operational at this time. All significant intercompany accounts and transactions have been eliminated in consolidation. The Company is subject to risks and uncertainties as a result of the COVID-19 pandemic and the extent and duration of the future impact on the Company's business is highly uncertain and difficult to predict. The COVID-19 pandemic has adversely impacted, and is likely to further adversely impact, nearly all aspects of the Company’s business and markets, including its employees, operations, contractors, customers, government and third party payors and others. The full extent to which the pandemic will directly or indirectly impact the Company's business, results of operations and financial condition will depend on future developments that are highly uncertain and difficult to predict.

ACCOUNTING POLICIES

ACCOUNTING POLICIES	12 Months Ended
ACCOUNTING POLICIES	Dec. 31, 2020
Accounting Policies [Abstract]
ACCOUNTING POLICIES	A CCOUNTING P OLICIES Use of estimates in the preparation of financial statements – In preparing the consolidated financial statements in conformity with accounting principles generally accepted in the United States of America, management makes estimates and assumptions that affect the reported amounts of assets and liabilities and disclosures of contingent assets and liabilities at the date of the consolidated financial statements, as well as the reported amounts of revenues and expenses during the reporting period. Significant accounting estimates reflected in the Company’s consolidated financial statements include the estimated useful lives of fixed assets and its salvage values, revenues and costs of sales for turn-key and revenue sharing arrangements. Actual results could differ from those estimates. Advertising costs – The Company expenses advertising costs as incurred. Advertising costs were $237,000 and $144,000 during the years ended December 31, 2020 and 2019. Advertising costs are recorded in other direct operating costs and sales and administrative costs in the consolidated statements of operations. Cash and cash equivalents – The Company considers all liquid investments with original maturities of three months or less at the date of purchase to be cash equivalents. Restricted cash is not considered a cash equivalent for purposes of the consolidated statements of cash flows. Restricted cash – Restricted cash represents the minimum cash that must be maintained in GKF to fund operations, per the subsidiary’s operating agreement, the minimum cash that must be maintained by GKF per it’s financing agreement with DFC, and the minimum cash that must be maintained in Orlando per the subsidiary’s financing agreement. Business and credit risk – The Company maintains its cash balances, which exceed federally insured limits, in financial institutions. The Company believes it is not exposed to any significant credit risk on cash, cash equivalents. The Company monitors the financial condition of the financial institutions it uses on a regular basis. All of the Company’s revenue was provided by eighteen and seventeen customers in 2020 and 2019. One customer accounted for approximately 35% and 30% of the Company’s total revenue in 2020 and 2019. At December 31, 2020, four customers each individually accounted for 11%, 11%, 11% and 20% of total accounts receivable, respectively. At December 31, 2019, three customers each individually accounted for 12%, 15% and 30% of total accounts receivable, respectively. The Company performs credit evaluations of its customers and generally does not require collateral. The Company has not experienced significant losses related to receivables from individual customers or groups of customers in any particular geographic area. All of the Company’s radiosurgery devices have been purchased through Elekta, to date. However, there are other manufacturers that also make radiosurgery devices. Accounts receivable and doubtful accounts – Accounts receivable are recorded at net realizable value. An allowance for doubtful accounts is estimated based on historical collections plus an allowance for probable losses. Receivables are considered past due based on contractual terms and are charged off in the period that they are deemed uncollectible. Recoveries of receivables previously charged off are offset against bad debt expense when received. Non-controlling interests - The Company reports its non-controlling interests as a separate component of shareholders’ equity. The Company also presents the consolidated net income and the portion of the consolidated net income allocable to the non-controlling interests and to the shareholders of the Company separately in its consolidated statements of operations. Property and equipment – Property and equipment are stated at cost less accumulated depreciation. Depreciation for Gamma Knife, IGRT, and other equipment is determined using the straight-line method over the estimated useful lives of the assets, which for medical and office equipment is generally 3 – 10 years, and after accounting for salvage value on the equipment where indicated. Salvage value is based on the estimated fair value of the equipment at the end of its useful life. The Company acquired a building as part of the Acquisition in June 2020. Depreciation for buildings is determined using the straight-line method over 20 years. Depreciation for PBRT and related equipment is determined using the modified units of production method, which is a function of both time and usage of the equipment. This depreciation method allocates costs considering the projected volume of usage through the useful life of the PBRT unit, which has been estimated at 20 years. The estimated useful life of the PBRT unit is consistent with the estimated economic life of 20 years. The Company capitalizes interest incurred on property and equipment that is under construction, for which deposits or progress payments have been made. When a rate is not readily available, imputed interest is calculated using the Company’s incremental borrowing rate. The interest capitalized for property and equipment is the portion of interest cost incurred during the acquisition periods that could have been avoided if expenditures for the equipment had not been made. The Company capitalized interest of $119,000 and $110,000 in 2020 and 2019, respectively, as costs of medical equipment. The Company leases Gamma Knife and radiation therapy equipment to its customers under arrangements accounted for as operating leases. At December 31, 2020, the Company held equipment under operating lease contracts with customers with an original cost of $75,241,000 and accumulated depreciation of $45,416,000. At December 31, 2019, the Company held equipment under operating lease contracts with customers with an original cost of $92,135,000 and accumulated depreciation of $55,148,000. As of December 31, 2020, the Company recognized a loss on the write down of impaired assets of $8,264,000. The impaired assets included six (6) Gamma Knife units and the Company's deposits towards purchase of proton beam systems and related capitalized interest. See further discussion under Note 2 - Long-lived asset impairment and Note 3 - Property and Equipment for further discussion. Fair value of financial instruments – The Company’s disclosures of the fair value of financial instruments is based on a fair value hierarchy which prioritizes the inputs to the valuation techniques used to measure fair value into three levels. Level 1 inputs are unadjusted quoted market prices in active markets for identical assets and liabilities that the Company has the ability to access at the measurement date. Level 2 inputs are inputs other than quoted prices within Level 1 that are observable for the asset or liability, either directly or indirectly. Level 3 inputs are unobservable inputs for assets or liabilities, and reflect the Company’s own assumptions about the assumptions that market participants would use in pricing the asset or liability. The estimated fair value of the Company’s assets and liabilities as of December 31, 2020 and 2019 were as follows (in thousands): Level 1 Level 2 Level 3 Total Carrying Value December 31, 2020 Assets: Cash, cash equivalents, restricted cash $ 4,325 $ — $ — $ 4,325 $ 4,325 Total $ 4,325 $ — $ — $ 4,325 $ 4,325 Liabilities Debt obligations $ — $ — $ 4,662 $ 4,662 $ 4,624 Total $ — $ — $ 4,662 $ 4,662 $ 4,624 December 31, 2019 Assets: Cash, cash equivalents, restricted cash $ 1,779 $ — $ — $ 1,779 $ 1,779 Total $ 1,779 $ — $ — $ 1,779 $ 1,779 Liabilities Debt obligations $ — $ — $ 3,075 $ 3,075 $ 3,480 Total $ — $ — $ 3,075 $ 3,075 $ 3,480 Revenue recognition - The Company recognizes revenues under ASC 842 Leases (“ASC 842”) and ASC 606 Revenue from Contracts with Customers (“ASC 606”). Rental income from medical services – The Company recognizes revenues under ASC 842 when services have been rendered and collectability is reasonably assured, on either a fee per use or revenue sharing basis. The terms of the contracts do not contain any guaranteed minimum payments. The Company’s contracts are typically for a 10-year term and are classified as either fee per use or retail. Retail arrangements are further classified as either turn-key or revenue sharing. Revenues from fee per use contracts is determined by each hospital’s contracted rate. Revenues are recognized at the time the procedures are performed, based on each hospital’s contracted rate and the number of procedures performed. Under revenue sharing arrangements, the Company receives a contracted percentage of the reimbursement received by the hospital. The amount the Company expects to receive is recorded as revenue and estimated based on historical experience. Revenue estimates are reviewed periodically and adjusted as necessary. Under turn-key arrangements, the Company receives payment from the hospital in the amount of the hospital’s reimbursement from third party payors, and the Company is responsible for paying all the operating costs of the equipment. Operating costs are determined primarily based on historical treatment protocols and cost schedules with the hospital. The Company records an estimate of operating costs which are reviewed on a regular basis and adjusted as necessary to more accurately reflect the actual operating costs. For turn-key sites, the Company also shares a percentage of net operating profit. The Company records an estimate of net operating profit based on estimated revenues, less estimated operating costs. The operating costs and estimated net operating profit are recorded as other direct operating costs in the consolidated statement of operations . As of December 31, 2020 and 2019, the Company recognized revenues of approximately $16,204,000 and $19,396,000 under ASC 842, respectively. Patient income – The Company has stand-alone facilities in Lima, Peru and Guayaquil, Ecuador, where a contract exists between the Company’s facilities and the individual patient treated at the facility. Under ASC 606, the Company acts as the principal in this transaction and provides, at a point in time, a single performance obligation, in the form of a Gamma Knife treatment. Revenue related to a Gamma Knife treatment is recognized on a gross basis at the time when the patient receives treatment. There is no variable consideration present in the Company’s performance obligation and the transaction price is agreed upon per the stated contractual rate. GKPeru's payment terms are typically prepaid for self-pay patients and insurance provider payments are paid net 30 days. GKCE's patient population is primarily covered by a government payor and payments are paid approximately 30 to 60 days upon invoice. The Company did not capitalize any incremental costs related to the fulfillment of its customer contracts. Accounts receivable earned by GKPeru were not significant for the year ended December 31, 2020 and 2019. GKCE's accounts receivable were $467,000 for the year ended December 31, 2020. As of December 31, 2020 and 2019, the Company recognized revenues of approximately $1,633,000 and $1,209,000 under ASC 606, respectively. Stock-based compensation – The Company measures all stock-based compensation awards at fair value and records such expense in its consolidated financial statements over the requisite service period of the related award. See Note 9 for additional information on the Company’s stock-based compensation programs. Costs of revenue – The Company's costs of revenue consist primarily of maintenance and supplies, depreciation and amortization, and other operating expenses (such as insurance, property taxes, sales taxes, marketing costs and operating costs from the Company’s retail sites). Costs of revenues are recognized as incurred. Sales and Marketing – The Company markets its services through its preferred provider status with Elekta and a direct sales effort led by its Senior Vice President of Sales and Business Development, its President and Chief Financial and Operating Officer and its Chief Executive Officer (“CEO”). The Company typically provides the equipment, as well as planning, installation, reimbursement and marketing support services. Income taxes – The Company accounts for income taxes using the asset and liability method. Under this method, deferred tax assets and liabilities are determined based on differences between the financial reporting and tax bases of assets and liabilities and are measured using the enacted tax rates and laws that will be in effect when the differences are expected to reverse. The Company accounts for uncertainty in income taxes as required by the provisions of ASC 740 Income taxes (“ASC 740”), which clarifies the accounting for uncertainty in income taxes recognized in an enterprise’s financial statements. The first step is to evaluate the tax position for recognition by determining if the weight of available evidence indicates that it is more likely than not that the position will be sustained on audit, including resolution of related appeals or litigation processes, if any. The second step is to estimate and measure the tax benefit as the largest amount that is more than 50% likely of being realized upon ultimate settlement. It is inherently difficult and subjective to estimate such amounts, as this requires the Company to determine the probability of various possible outcomes. The Company considers many factors when evaluating and estimating the Company’s tax positions and tax benefits, which may require periodic adjustments and may not accurately anticipate actual outcomes. See Note 8 for further discussion on income taxes. Functional currency – Based on guidance provided in accordance with ASC 830, Foreign Currency Matters (“ASC 830”), the Company analyzes its operations outside the United States to determine the functional currency of each operation. Management has determined that these operations are initially accounted for in U.S. dollars since the primary transactions incurred are in U.S. dollars and the Company provides significant funding towards the startup of the operation. When Management determines that an operation has become predominantly self-sufficient, the Company will change its accounting for the operation to the local currency from the U.S. dollar. The Company analyzed it’s Gamma Knife site in Peru under ASC 830 as of December 31, 2020 and 2019 and concluded the functional currency was the U.S. dollar. As facts and circumstances change, the Company will revisit this conclusion. Asset Retirement Obligations – Based on the guidance provided in ASC 410 Asset Retirement Obligations (“ASC 410”), the Company analyzed its existing lease agreements and determined an asset retirement obligation (“ARO”) exists to remove the respective units at the end of the lease terms. As of December 31, 2020, four (4) of the Company's Gamma Knife customers notified the Company of their intent to terminate their contracts at the contract lease term. The Company recorded an ARO liability for these four (4) sites, using estimates from Elekta. No liability has been recorded as of December 31, 2020 for the remaining Gamma Knife sites, or as of December 31, 2019, because it is uncertain these units will be removed and the Company historically has not removed the Gamma Knife equipment at the end of the lease term. The Company will re-evaluate the need to record additional ARO liabilities on a periodic basis when facts and circumstances change that could affect this conclusion. Earnings per share – Basic earnings per share excludes dilution and is computed by dividing income available to common shareholders by the weighted average number of common shares outstanding for the year. The fully vested restricted stock units not issued and outstanding, are also included therein. Diluted earnings per share reflect the potential dilution that could occur if common shares were issued pursuant to the exercise of options or warrants. Because the Company reported a loss for the year ended December 31, 2020, the potentially dilutive effects of approximately 13,000, of the Company's unvested restricted stock awards were not considered for the reporting periods. On March 31, 2020, the Company’s Award Agreements (as defined below) expired and the unvested performance share awards were returned to the Company’s stock incentive plan - see Note 9 for further discussion. Based on the guidance provided in accordance with ASC 260, the weighted average common shares for basic earnings per share, for the year ended December 31, 2019 excluded the weighted average impact of the unvested performance share awards. These awards were legally outstanding but not deemed participating securities and therefore were excluded from the calculation of basic earnings per share. The unvested shares were also excluded from the denominator for diluted earnings per share because they were considered contingent shares not deemed probable as of December 31, 2019. The following table illustrates the computations of basic and diluted earnings per share for the years ended December 31, 2020 and 2019. 2020 2019 Numerator for basic and diluted (loss) earnings per share $ (7,058,000) $ 659,000 Denominator: Denominator for basic and diluted (loss) earnings per share – weighted-average shares 6,182,000 5,919,000 Effect of dilutive securities Employee stock options and restricted stock — 11,000 Denominator for diluted (loss) earnings per share – adjusted weighted-average shares 6,182,000 5,930,000 (Loss) earnings per common share- basic $ (1.14) $ 0.11 (Loss) earnings per common share- diluted $ (1.14) $ 0.11 In 2020, options outstanding to purchase 406,000 shares of common stock at an exercise price range of $2.25 - $3.90 per share and 13,000 restricted stock units were not included in the calculation of diluted earnings per share because they would be anti-dilutive. In 2019, options outstanding to purchase 387,000 shares of common stock at an exercise price range of $2.68 - $3.90 per share and 3,000 restricted stock units were not included in the calculation of diluted earnings per share because they would be anti-dilutive. Business segment information - Based on the guidance provided in accordance with ASC 280 Segment Reporting (“ASC 280”), the Company analyzed its subsidiaries which are all in the business of leasing radiosurgery and radiation therapy equipment to healthcare providers, and concluded there are two reportable segments, domestic and foreign. The Company provides Gamma Knife and PBRT equipment to fifteen hospitals in the United States and owns and operates two single-unit facilities in Lima, Peru and Guayaquil, Ecuador as of December 31, 2020. The Company determined two reportable segments existed due to similarities in economics of business operations and geographic location. The operating results of the two reportable segments are reviewed by the Company’s CEO and President, Chief Operating and Financial Officer, who are also deemed the Company’s Chief Operating Decision Makers (“CODMs”). As of December 31, 2019, the Company had one reportable segment. Following the Company's acquisition of GKCE in June 2020, the Company concluded it had two reportable segments. The revenues, profit or loss, and net property and equipment allocations for the Company's two reportable segments as of December 31, 2020 consists of the following: 2020 2019 Revenues Domestic $ 16,204,000 $ 19,396,000 Foreign 1,633,000 1,209,000 Total $ 17,837,000 $ 20,605,000 2020 2019 Profit or (loss) Domestic $ (7,082,000) $ 769,000 Foreign 24,000 (110,000) Total $ (7,058,000) $ 659,000 2020 2019 Property and equipment, net Domestic $ 27,223,000 $ 38,593,000 Foreign 3,195,000 2,887,000 Total $ 30,418,000 $ 41,480,000 Long lived asset impairment – The Company assesses the recoverability of its long-lived assets when events or changes in circumstances indicate their carrying value may not be recoverable. Such events or changes in circumstances may include: a significant adverse change in the extent or manner in which a long-lived asset is being used, significant adverse change in legal factors or in the business climate that could affect the value of a long-lived asset, an accumulation of costs significantly in excess of the amount originally expected for the acquisition or development of a long-lived asset, current or future operating or cash flow losses that demonstrate continuing losses associated with the use of a long-lived asset, or a current expectation that, more likely than not, a long-lived asset will be sold or otherwise disposed of significantly before the end of its previously estimated useful life. The Company performs impairment testing at the asset group level that represents the lowest level for which identifiable cash flows are largely independent of the cash flows of other assets and liabilities. The Company assesses recoverability of a long-lived asset by determining whether the carrying value of the asset group can be recovered through projected undiscounted cash flows over their remaining lives. If the carrying value of the asset group exceeds the forecasted undiscounted cash flows, an impairment loss is recognized, measured as the amount by which the carrying amount exceeds estimated fair value. An impairment loss is charged to the consolidated statement of operations in the period in which management determines such impairment. As of December 31, 2020, the Company determined circumstances existed indicating its assets could be impaired, concluded an impairment existed, and recognized a loss on the write down of impaired assets of $8,264,000. No such impairment has been noted as of December 31, 2019. See Note 3 - Property and Equipment for further discussion. Goodwill and intangible assets - The Company recorded goodwill of $1,265,000 and an intangible asset with a fair value of $78,000 as part of the Acquisition in June 2020. The intangible asset identified was GKCE's trade name and the Company assigned an indefinite useful life to the asset. Based on the guidance provided in accordance with ASC 350 Intangibles-Goodwill and Other (“ASC 350”), the Company does not amortize the intangible asset because it has an indefinite life. The Company assesses goodwill at the reporting unit level, which has been determined to be GKCE. Each reporting period, the Company assesses whether events or circumstances continue to support an indefinite useful life for the intangible asset. Per ASC 350, the Company tests goodwill and intangibles for impairment annually or as events or circumstances change that indicate the fair value may be below the carrying amount. As of December 31, 2020, there has been no change to the Company's assessment of the value of intangible assets or goodwill. Acquisitions - The Company records acquisitions according to ASC 805 Business Combinations (“ASC 805”) using the acquisition method of accounting. Under the acquisition method of accounting, all assets acquired, including goodwill and other intangible assets, should be stated at fair value at the time of acquisition. The allocation of purchase price consideration is preliminary, pending the completion of the fair value of certain tangible, intangible assets, and residual goodwill. During the measurement period, which can be no more than one year from the Closing Date, the Company expects to continue to obtain information to assist in determining the final fair value of assets acquired. See Note 4 - GKCE Acquisition for further discussion on acquisitions. Accounting pronouncement issued and adopted – In February 2018, the FASB issued ASU No. 2018-03 Recognition and Measurement of Financial Assets and Financial Liabilities (“ASU 2018-03”), which clarifies certain aspects of ASU 2016-1. These are: equity securities without a readily determinable fair value – discontinuation, equity securities without a readily determinable fair value – adjustments, forward contracts and purchased options, presentation requirements for certain fair value option liabilities, fair value option liabilities denominated in a foreign currency, and transition guidance for equity securities without a readily determinable fair value. In August 2018, the FASB issued ASU No. 2018-13 Fair Value Measurement (Topic 820): Disclosure Framework – Changes to the Disclosure Requirements to Fair Value Measurement (“ASU 2018-13”), which amended the effective date and other certain measurement aspects of ASU 2018-03. The new guidance is effective for fiscal years and interim periods within those fiscal years beginning after December 15, 2019. The Company adopted ASU 2018-03 and ASU 2018-13 on January 1, 2020. There was no significant impact on its consolidated financial statements and related disclosures. Accounting pronouncement issued and not yet adopted – In December 2019, the FASB issued ASU 2019-12 Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes (“ASU 2019-12”) which removes specific exceptions to the general principles in Topic 740 and eliminates the need for an organization to analyze whether the following apply in a given period: exception to the incremental approach for intraperiod tax allocation; exceptions to accounting for basis differences when there are ownership changes in foreign investments; exception in interim period income tax accounting for year-to-date losses that exceed anticipated losses. The new guidance is effective for fiscal years and interim periods beginning after December 15, 2020. The Company is currently evaluating ASU 2019-12 to determine the impact it may have on its consolidated financial statements.

PROPERTY AND EQUIPMENT

PROPERTY AND EQUIPMENT	12 Months Ended
PROPERTY AND EQUIPMENT	Dec. 31, 2020
Property, Plant and Equipment [Abstract]
PROPERTY AND EQUIPMENT	P ROPERTY AND E QUIPMENT Property and equipment consists of the following: DECEMBER 31, 2020 2019 Medical equipment and facilities $ 75,657,000 $ 92,132,000 Office equipment 330,000 594,000 Construction in progress 170,000 1,965,000 Deposits towards purchase of proton beam systems — 2,250,000 76,157,000 96,941,000 Accumulated depreciation (45,739,000) (55,461,000) Net property and equipment $ 30,418,000 $ 41,480,000 As of December 31, 2020, approximately $3,195,000 of the net property and equipment balance is outside of the United States. As December 31, 2020, the Company recognized a loss on the write down of impaired assets of $8,264,000. The impaired assets included six (6) Gamma Knife units and related removal costs, and two (2) deposits towards the purchase of proton beam systems and related capitalized interest. The six (6) Gamma Knife units that were impaired consisted of two (2) units that had been taken out of service in prior years, one (1) unit that was taken out of service in 2020 and three (3) units that have already been, or the Company anticipates will be, taken out of service in 2021 , totaling $3,051,000. In addition to this impairment write-off of $3,051,000 were estimated costs of de-install and removal (ARO) of four (4) of the Gamma Knife units of $1,350,000 (of which, the Company has paid $80,000) as of December 31, 2020. Total impairment related to the Gamma Knife business was $4,401,000 for the year ended December 31, 2020. The Company reviews the carrying value of its long-lived assets for impairment on a quarterly basis, or as events or circumstances might indicate that the carrying value may not be recoverable. The Company has reviewed its Gamma Knife equipment, in light of available information as of December 31, 2020 and based on current customer prospects, the probability of future contract extensions or renewals, and the high turnover rate in contract terminations compared to the Company's historical contract termination rate, the Company determined that these six (6) Gamma Knife units were more-than temporarily impaired. Prior to December 31, 2020, the Company had $2,250,000 in deposits toward the purchase of two MEVION S250i PBRT systems from Mevion. The Company reviews the carrying value of its deposits for impairment on a quarterly basis, or as events or circumstances might indicate that the carrying value may not be recoverable. The Company has reviewed the deposits, in light of available information, as of December 31, 2020 and based on its current customer prospects, the impact that the COVID-19 pandemic has had on medical centers undertaking large capital expenditure projects for a limited patient base, and the length of time required to negotiate and implement a proton therapy project, the Company determined that its deposits of $2,250,000, related capitalized interest and other charges of $1,613,000 were other-than temporarily impaired. Total impairment related to the proton therapy business was $3,863,000.

GKCE ACQUISITION

GKCE ACQUISITION	12 Months Ended
GKCE ACQUISITION	Dec. 31, 2020
Business Combinations [Abstract]
GKCE ACQUISITION	GKCE ACQUISITION On June 18, 2019, the Company entered into a Stock Purchase Agreement to acquire Gamma Knife Center Ecuador S.A. (“GKCE”) from GKCE’s selling majority shareholders. GKCE is a well-established Gamma Knife operation founded in 2009 as a private clinic to introduce advanced stereotactic radiosurgery into Ecuador and continues to operate the only Gamma Knife unit in the country. The Company acquired GKCE for the continued expansion of its business internationally. On June 12, 2020 (the “Closing Date”), the Company acquired approximately 98% of the total outstanding shares of GKCE. As of December 31, 2020, the Company acquired approximately 99.3% of the total outstanding shares of GKCE and intends to acquire the remaining 0.7% at a later date. The fair value of the non-controlling interests (“NCI”) on the Closing Date was approximately $58,000, which was consistent with the purchase price in the executed NCI agreements. The total purchase consideration for 100% of the outstanding shares of GKCE was $2,883,000, including $2,000,000 of base purchase price, subject to certain price adjustments for current assets and liabilities and tax withholding. The base purchase price of $2,000,000 was paid with $575,000 of cash and a $1,425,000 loan from the United States International Development Finance Corporation (“DFC”). The DFC loan is denominated in U.S. dollars, which is also the currency of Ecuador. The price adjustments will be paid by the Company in the post-closing period with the adjustments related to the amount of working capital that GKCE had as of the Closing Date. The first price adjustment for working capital as of the Closing Date was approximately $515,000, which was paid by the Company in August 2020. As of December 31, 2020, the Company owed the withholding taxes related to this payment totaling approximately $43,000. The Company estimates an additional contingent consideration of approximately $368,000 will be remitted to the seller based on the collection of Closing Date accounts receivable balances, net of related costs, during the three-month, six-month and twelve-month periods after the Closing Date. As of December 31, 2020, $214,000 of the contingent considerations had been paid and $154,000 is estimated to be paid for the twelve-month period after the Closing Date. The Company reviewed historical patient treatments, invoice, and collection data from GKCE to determine an appropriate estimate of the contingent consideration at the Closing Date. The acquisition has been accounted for according to ASC 805 using the acquisition method of accounting. Under the acquisition method of accounting, all assets acquired, including goodwill and other intangible assets, should be stated at fair value at the time of acquisition. The allocation of purchase price consideration is preliminary, pending the completion of the fair value of certain tangible, intangible assets, and residual goodwill. During the measurement period, which can be no more than one year from the Closing Date, the Company expects to continue to obtain information to assist in determining the final fair value of assets acquired. The assets acquired were recorded based on valuations derived from estimated fair value assessments and assumptions used by the Company. Thus, the provisional measurements of fair value discussed below are subject to change. As of December 31, 2020, accounting for the Closing Date accounts receivable balances, allowance on the uncollected accounts receivable balances, and related liabilities, was not complete. The accounting for these amounts will be complete following the twelve-month period after the Closing Date, per the terms of the Stock Purchase Agreement. The Company expects to finalize the valuation as soon as practicable, but no later than one year from the Closing Date. While the Company believes its estimates and assumptions underlying the valuations are reasonable, different estimates and assumptions could result in different valuations assigned to the individual assets acquired, and the resulting amount of goodwill. After the Acquisition date, the Company received additional information regarding the amounts recorded as accounts receivable as of June 12, 2020. After reviewing the information obtained, the Company booked an additional $27,000 of accounts receivable as of December 31, 2020. As a result, related liabilities were increased by $13,000 and the contingent consideration increased by $14,000. There was no impact to goodwill or net loss as of December 31, 2020. N OTE 4 - GKCE ACQUISITION (CONTINUED) The fair value of assets acquired and liabilities assumed were as follows: June 12, 2020 Cash and cash equivalents $ 432,000 Accounts receivable 854,000 Prepaid expense and other 22,000 Building 385,000 Land 19,000 Medical equipment 319,000 Purchased intangible assets 78,000 Goodwill 1,265,000 Total assets acquired $ 3,374,000 Accounts payable $ (193,000) Income taxes payable (141,000) Deferred income taxes (66,000) Employee compensation and benefits (91,000) Total liabilities assumed (491,000) Consideration allocated to assets acquired and liabilities assumed $ 2,883,000 First working capital payment $ (515,000) Estimated subsequent working capital payment (368,000) Base purchase consideration $ 2,000,000 The Company has allocated the purchase price of GKCE to the tangible assets, liabilities, and intangible asset acquired, based on their estimated fair values. Goodwill represents the excess of the purchase price consideration over the fair value of the identifiable tangible and intangible assets assumed. The Company believes the amount of goodwill resulting from the acquisition is primarily attributable to expected synergies from an assembled and trained workforce and enhanced opportunities for growth and innovation. The goodwill resulting from the acquisition is not tax deductible. The preliminary value of the acquired tangible assets acquired are as follows: Fair Value Useful Life (in Years) Building $ 385,000 20 Land 19,000 Medical equipment 302,000 2 Other fixed assets 17,000 2 Total tangible assets $ 723,000 The Company also acquired intangible assets with a fair value of $78,000. The intangible asset identified was GKCE's trade name and the Company assigned an indefinite useful life to the asset. The Company incurred costs related to the acquisition of approximately $93,000 for the three-month period ended June 30, 2020 and $69,000 for the three-month period ended September 30, 2020. All acquisition related costs were expensed as incurred and have been recorded in selling and administrative expense in the Company's consolidated statement of operations. N OTE 4 - GKCE ACQUISITION (CONTINUED)

LONG TERM DEBT

LONG TERM DEBT	12 Months Ended
LONG TERM DEBT	Dec. 31, 2020
Debt Disclosure [Abstract]
LONG TERM DEBT	LONG TERM DEBT Long-term debt consists primarily of seven notes with three financing companies collateralized by the Gamma Knife equipment having an aggregate net book value of $11,023,000, the individual customer contracts, and related accounts receivable of $1,718,000 at December 31, 2020. These notes are predominantly payable in 36 to 84 fully amortizing monthly installments, mature between January 2021 and September 2027. The notes accrue interest at fixed annual rates between 3.67% and 6.90%. As of December 31, 2019, the Company had six notes with two financing companies collateralized by the Gamma Knife equipment having an aggregate net book value of $13,130,000, the individual customer contracts, and related accounts receivable of $1,848,000. The following are contractual maturities of long-term debt by year at December 31, 2020, excluding debt issuance costs of $27,000: Year ending December 31, Principal 2021 $ 1,157,000 2022 768,000 2023 802,000 2024 839,000 2025 592,000 Thereafter 466,000 $ 4,624,000

FINANCE LEASES

FINANCE LEASES	12 Months Ended
FINANCE LEASES	Dec. 31, 2020
Debt Disclosure [Abstract]
FINANCE LEASES	FINANCE LEASES The Company has six finance lease obligations with two financing companies, collateralized by Gamma Knife and PBRT equipment having an aggregate net book value of $18,093,000, the individual customer contracts, and related accounts receivable of $1,892,000 at December 31, 2020. These obligations have imputed interest rates ranging between 4.73% and 13.00%, are predominantly payable in 36 to 84 monthly installments, and mature between November 2021 and September 2024. As of December 31, 2019, the Company had ten finance lease obligations with three financing companies, collateralized by Gamma Knife and PBRT equipment, having an aggregate net book value of $22,860,000, the individual customer contracts, and related accounts receivable of $4,600,000. At the end of each lease term, the Company has a bargain purchase option to purchase the equipment. Future minimum lease payments, together with the present value of the net minimum lease payments under finance leases at December 31, 2020, are summarized as follows: Net Present Value of Minimum Lease Payments Year ending December 31, 2021 $ 6,590,000 2022 1,576,000 2023 1,083,000 2024 522,000 Total finance lease payments 9,771,000 Less imputed interest 852,000 8,919,000 Less current portion 5,945,000 $ 2,974,000

LEASES

LEASES	12 Months Ended
LEASES	Dec. 31, 2020
Leases [Abstract]
LEASES	LEASES The Company determines if a contract is a lease at inception. Under ASC 842, the Company is a lessor of equipment to various customers. Leases that commenced prior to ASC 842 adoption date were classified as operating leases under historical guidance. As the Company has elected the package of practical expedients allowing it to not reassess lease classification, these leases are classified as operating leases under ASC 842 as well. All of the Company’s lessor arrangements entered into after ASC 842 adoption are also classified as operating leases. Some of these lease terms have an option to extend the lease after the initial term, but do not contain the option to terminate early or purchase the asset at the end of the term. The Company’s Gamma Knife and PBRT contracts with hospitals are classified as operating leases under ASC 842. The related equipment is included in medical equipment and facilities on the Company’s consolidated balance sheets (see further discussion at Note 2). As all income from the Company’s lessor arrangements is solely based on procedure volume, all income is considered variable payments not dependent on an index or a rate. As such, the Company does not measure future operating lease receivables. The Company’s lessee operating leases are accounted for as right-of-use (“ROU”) assets, other current liabilities, and lease liabilities on the consolidated balance sheets. Operating lease ROU assets and liabilities are recognized based on the present value of the future minimum lease payments over the lease term at commencement date. The Company’s operating lease contracts do not provide an implicit rate for calculating the present value of future lease payments, so the Company determined its incremental borrowing rate to be in the range of approximately 4.0% and 6.0% by using available market rates and expected lease terms. The operating lease ROU assets and liabilities also include any lease payments made and excludes lease incentives and initial direct costs incurred. Lease expense for minimum lease payments is recognized on a straight-line basis over the lease term. The Company’s lessee operating lease agreements are for administrative office space and related equipment, and the agreement to lease clinic space for its stand-alone facility in Lima, Peru. These leases have remaining lease terms between 2 and 3 years, some of which include options to renew or extend the lease. As of December 31, 2020, operating ROU assets and liabilities were $886,000. During the year ended December 31, 2020, the Company elected to not renew its lease for a satellite office in Fairfield, California. The Company previously included the renewal term in its assessment of the lease term for the ROU asset and liability. The Company accounted for this change as a lease reassessment under ASC 842. At the reassessment date, the remaining lease balance was not material to the Company's consolidated balance sheets and the Company wrote off the related ROU assets and liabilities of $67,000. Also during the year ended December 31, 2020, the Company agreed to a rent increase for its clinic space for its stand-alone facility in Lima, Peru. The rent increase was effective as of January 1, 2020 and the Company increased the related ROU assets and liabilities by $135,000. The following table summarizes maturities of lessee operating lease ROU assets and liabilities as of December 31, 2020: Year ending December 31, Operating Leases 2021 346,000 2022 353,000 2023 248,000 2024 8,000 Total lease payments 955,000 Less imputed interest (69,000) Total $ 886,000

INCOME TAXES

INCOME TAXES	12 Months Ended
INCOME TAXES	Dec. 31, 2020
Income Tax Disclosure [Abstract]
INCOME TAXES	I NCOME T AXES As of December 31, 2020 and 2019 the Company recorded an income tax benefit of $1,737,000 and income tax expense of $128,000, respectively. The decrease in the Company’s provision for income taxes as of December 31, 2020 is due to a loss on the write down of impaired assets. The components of the provision (benefit) for income taxes as of December 31, 2020 and 2019 consist of the following: YEARS ENDED DECEMBER 31, 2020 2019 Current: Federal $ 209,000 $ 443,000 State 88,000 207,000 Foreign 117,000 130,000 Total current 414,000 780,000 Deferred: Federal (1,909,000) (311,000) State (266,000) (251,000) Foreign 24,000 (90,000) Total deferred (2,151,000) (652,000) $ (1,737,000) $ 128,000 Significant components of the Company’s deferred tax liabilities and assets as of December 31, 2020 and 2019 are as follows: DECEMBER 31, 2020 2019 Deferred tax liabilities: Property and equipment $ (564,000) $ (3,112,000) Total deferred tax liabilities (564,000) (3,112,000) Deferred tax assets: Net operating loss carryforwards 99,000 117,000 Accruals and allowances 43,000 248,000 Tax credits 5,000 4,000 Other – net 50,000 229,000 Capital loss carryover 627,000 921,000 Total deferred tax assets 824,000 1,519,000 Valuation allowance (678,000) (921,000) Deferred tax assets net of valuation allowance 146,000 598,000 Net deferred tax liabilities $ (418,000) $ (2,514,000) These amounts are presented in the financial statements as follows: DECEMBER 31, 2020 2019 Deferred income taxes (non-current) $ (418,000) $ (2,514,000) $ (418,000) $ (2,514,000) The (benefit) provision for income taxes differs from the amount computed by applying the U.S. federal statutory tax rate (21% in 2020 and 2019) to income before taxes as follows: YEARS ENDED DECEMBER 31, 2020 2019 Computed expected federal income tax $ (1,844,000) $ 167,000 State income taxes, net of federal benefit (199,000) (80,000) Non-deductible expenses 6,000 29,000 Return to Provision True-up 22,000 39,000 Uncertain Tax Positions 16,000 80,000 Capital loss carryforward expiration 246,000 — Change in valuation allowance (243,000) (175,000) Other deferred tax adjustments 259,000 68,000 $ (1,737,000) $ 128,000 At December 31, 2020, the Company exhausted the remainder of its net operating loss carryforward for federal income tax return purposes. The Company has net operating loss carryforwards for state income tax purposes of approximately $2,219,000 that begin to expire in 2029. The Company has net operating loss carryforwards for its international subsidiaries of approximately $32,000. Utilization of the net operating loss and credit carryforwards may be subject to an annual limitation due to the ownership change limitations provided by the Internal Revenue Code of 1986, as amended (the “Code”), and similar state provisions. Any annual limitation may result in the expiration of net operating losses and credits before utilization. At December 31, 2020, the Company has a capital loss carryforward for federal income tax return purposes of approximately $2,586,000 which starts to expire in 2021. The Company has capital loss carryforwards for state income tax purposes of approximately $129,000 which starts to expire in 2021. Due to uncertainty surrounding the realization of impairment losses, capital losses and foreign operating losses in future years, the Company has placed a valuation allowance against a portion of its net domestic and foreign deferred tax assets. The net valuation allowance decreased by $243,000 and $175,000 for the tax years ended December 31, 2020 and 2019, respectively. During the year ended December 31, 2019, the Company released the valuation allowance related to GKPeru deferred tax assets, which resulted in an income tax benefit of $104,000. The Company concluded, based upon the preponderance of positive evidence (i.e. cumulative profit before tax adjusted for permanent items over the previous twelve quarters, a history of taxable income in recent periods, and the current forecast of income before taxes for GKPeru going forward) over negative evidence and the anticipated ability to use the deferred tax assets, that it was more likely than not that the deferred tax assets will be realized. If there are unfavorable changes to actual operating results or to projections of future income, the Company may determine that it is more likely than not such deferred tax assets may not be realizable. The tax return years 2016 through 2019 remain open to examination by the major domestic taxing jurisdictions to which the Company is subject. In 2019, the Company settled a New York State examination for tax years 2015 through 2017 with no material adjustments. Net operating losses generated on a tax return basis by the Company for calendar years 1999 through 2004, 2009, 2010, 2012, 2014, 2015, 2016, 2017 and 2018 remain open to examination by the major domestic taxing jurisdictions. The Company has adopted accounting standards which prescribe a recognition threshold and measurement attribute for the financial statement recognition and measurement of uncertain tax positions taken or expected to be taken in a company's income tax return, and also provides guidance on derecognition, classification, interest and penalties, accounting in interim periods, disclosure, and transition. Additionally, these accounting standards specify that tax positions for which the timing of the ultimate resolution is uncertain should be recognized as long-term liabilities. The Company has made no reclassifications between current taxes payable and long term taxes payable under this guidance. As of December 31, 2020, the unrecognized tax benefit was $275,000 which, if recognized, will not affect the annual effective tax rate as these unrecognized tax benefits would increase deferred tax assets which would be subject to a full valuation allowance. A reconciliation of the beginning and ending amount of unrecognized tax benefit is as follows: YEARS ENDED DECEMBER 31, 2020 2019 Balance at beginning of year $ 259,000 $ 87,000 Additions based on tax positions of prior years 16,000 172,000 Balance at end of year $ 275,000 $ 259,000 The Company's policy for deducting interest and penalties is to treat interest as interest expense and penalties as taxes. As of December 31, 2020, the Company had $15,000 accrued for the payment of penalties and zero interest related to unrecognized tax benefits. The Company does not expect any material changes to our uncertain tax positions within the next 12 months.

STOCK-BASED COMPENSATION EXPENS

STOCK-BASED COMPENSATION EXPENSE	12 Months Ended
STOCK-BASED COMPENSATION EXPENSE	Dec. 31, 2020
Stockholders' Equity Note [Abstract]
STOCK-BASED COMPENSATION EXPENSE	STOCK-BASED COMPENSATION EXPENSE Incentive Compensation Plan In June 2010 shareholders approved an amendment and restatement of the Company’s stock incentive plan, renaming it the Incentive Compensation Plan (the “Plan”), and among other things, increasing the number of shares of the Company’s common stock reserved for issuance under the Plan to 1,630,000. The Plan provides that the shares reserved under the Plan are available for issuance to officers of the Company, other key employees, non- employee directors, and advisors. The Plan is a successor to the Company’s previous plans, and any shares awarded and outstanding under those plans were transferred to the Plan. No further grants or share issuances will be made under the previous plans. On June 21, 2019, the Company’s shareholders approved an amendment and restatement of the Plan in order to extend the term of the Plan by two years to February 22, 2022. As of December 31, 2020, approximately 437,000 shares remain available for grant under the Plan. Under the Plan, a total of 456,000 restricted stock units have been granted, consisting of 43,000 of annual automatic grants to non-employee directors and the corporate secretary, 293,000 of deferred retainer fees to non-employee members of the Board, 20,000 grants issued in lieu of commission, to two (2) employees of the Company and 100,000 restricted stock units issued to the CEO during 2020, see further discussion below. Of the total restricted stock units granted under the Plan 210,000 of them are fully vested but not yet deemed issued and outstanding, 233,000 are fully vested and outstanding, and 13,000 are outstanding as of December 31, 2020. Changes in restricted stock units, consisting primarily of annual automatic grants, deferred compensation to non-employee directors, and restricted stock units awards to the CEO, under the Incentive Compensation Plans during 2020 and 2019 are as follows: Restricted Stock Units Grant Date Weighted- Average Fair Value Intrinsic Value Outstanding at January 1, 2019 4,000 $ 2.68 $ — Granted 36,000 $ 2.50 $ — Vested (37,000) $ 2.47 $ — Outstanding at December 31, 2019 3,000 $ 3.03 $ — Granted 144,000 $ 1.96 $ — Vested (134,000) $ 1.98 $ — Outstanding at December 31, 2020 13,000 $ 1.97 $ 2,000 For the year ended December 31, 2020, total compensation expense recorded in the consolidated statements of operations related to restricted stock units in lieu of retainer fees was $80,000. For the year ended December 31, 2020, total compensation expense recorded in the consolidated statements of income for annual restricted stock units awarded was $7,000, with an offsetting tax benefit of $1,000, as this expense is deductible for income tax purposes. As of December 31, 2020, there was $2,000 of total unrecognized compensation cost related to annual restricted stock units which is expected to be recognized over a period of 0.5 years. During 2020 and 2019, shares of restricted stock units totaling 3,000 and 4,000 each, respectively, with a fair value of approximately $9,000 and $11,000, respectively, vested and became unrestricted. Certain Executive Equity Awards Effective May 4, 2020, the Company appointed Raymond C. Stachowiak as Interim President and Chief Executive Officer (“Interim CEO”). As part of his Offer Letter, the Interim CEO was granted 50,000 restricted stock awards that vested in full on August 3, 2020. The Interim CEO was granted additional restricted stock awards totaling 10,000 common shares per month, which vest in full at the end of each 30-day period following issuance. On October 1, 2020 the Interim CEO was appointed the CEO. For the year ended December 31, 2020, 100,000 restricted stock awards were issued to the CEO and 90,000 became fully vested. Additionally, Ernest R. Bates, Senior Vice President, Sales and Business Development, International Operations, was awarded 10,000 restricted stock awards, which vested in full on December 31, 2020. For the year ended December 31, 2020, total compensation expense recorded in the consolidated financial statements of operations related to executive equity awards was $195,000. On January 4, 2017, the Company entered into a Performance Share Award Agreement with three executive officers of the Company (the “Award Agreements”) for 161,766 restricted stock awards which vest upon the achievement of certain performance metrics. The Award Agreements expired on March 31, 2020. Based on the guidance in ASC 718 Stock Compensation (“ASC 718”), the Company concluded these were performance-based awards with vesting criteria tied to performance metrics. As of December 31, 2017, the Company achieved one of the certain performance metrics under the Award Agreements and recognized stock compensation expense of approximately $108,000 related to these awards. The unrecognized stock-based compensation expense for these awards was approximately $421,000 and unvested restricted stock awards of approximately 129,000 were returned to the plan as of March 31, 2020. As of December 31, 2020, stock compensation expense recorded in the consolidated financial statements is summarized as follows: Stock-Based Awards Issued Compensation Award Type and Vested Expense Options — $ 17,000 RSUs Issued in Lieu of Retainer Fees — 80,000 Annual RSU Awards 3,000 7,000 Executive Compensation 100,000 195,000 Balance at of December 31, 2020 103,000 $ 299,000 Stock Options Changes in stock options outstanding under the Incentive Compensation Plans during 2020 and 2019 are as follows: Options Number of Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term (Years) Aggregate Intrinsic Value Balance at December 31, 2018 613,000 $ 2.85 3.14 $ — Granted 18,000 $ 2.87 7.00 $ — Exercised (16,000) $ 2.59 — $ — Forfeited (165,000) $ 3.07 — $ — Balance at December 31, 2019 450,000 $ 2.78 2.44 $ 27,000 Granted 10,000 $ 1.88 7.00 $ — Forfeited (43,000) $ 2.54 — $ — Balance at December 31, 2020 417,000 $ 2.79 1.61 $ 2,000 Exercisable at December 31, 2019 425,000 $ 2.79 2.25 $ — Exercisable at December 31, 2020 405,000 $ 2.80 1.48 $ — The weighted average grant-date fair value of the options granted during the years 2020 and 2019 was $0.78 and $1.54, respectively. There were no options exercised and accordingly, no intrinsic value of options exercised during the year ended December 31, 2020. There were 16,000 options exercised during the year ended December 31, 2019. Total stock-based compensation expense recognized for stock options for the years ended December 2020 and 2019 was $17,000 and $141,000, respectively. There was no cash received from options exercised under any share-based payment arrangements for the year ended December 31, 2020, and as a result, there was no actual tax benefit realized for tax deductions from option exercises in that year. The Company received approximately $42,000 from the exercise of 16,000 options under the share-based arrangements for the year ended December 31, 2019. A summary of the status of the Company’s non-vested stock options as of December 31, 2020 and 2019, and changes during the years ended December 31, 2020 and 2019 is presented below: Nonvested Options Number of Options Weighted Average Grant-Date Fair Value Nonvested at December 31, 2018 125,000 $ 1.20 Granted 18,000 $ 1.54 Vested (118,000) $ 1.22 Nonvested at December 31, 2019 25,000 $ 1.40 Granted 10,000 $ 0.78 Vested (23,000) $ 1.22 Nonvested at December 31, 2020 12,000 $ 1.07 At December 31, 2020, there was approximately $12,000 of unrecognized compensation cost related to non-vested share-based compensation arrangements granted under the Plan. This cost is expected to be recognized over a period of approximately three years. The Company’s stock-based awards to employees are calculated using the Black-Scholes options valuation model. The Black-Scholes model was developed for use in estimating the fair value of traded options which have no vesting restrictions and are fully transferable. In addition, the Black-Scholes model requires the input of highly subjective assumptions including the expected stock price volatility. The Company’s stock-based awards have characteristics significantly different from those of traded options, and changes in the subjective input assumptions can materially affect the present value estimates. For these reasons, management believes that the existing models do not necessarily provide a reliable single measure of the fair value of its stock-based awards to employees. The fair value of the Company’s option grants issued during 2020 and 2019 were estimated using assumptions for expected life, volatility, dividend yield, forfeiture rate, and risk-free interest rate which are specific to each award as summarized in the following table. The estimated fair value of the Company’s options is amortized over the period during which the optionee is required to provide service in exchange for the award, usually the vesting period. The fair value of the Company’s option grants under the Plan in 2020 and 2019 was estimated using the following assumptions: 2020 2019 Expected life (years) 7.0 7.0 Expected forfeiture rate 0.0 % 0.0 % Expected volatility 40 % 50 % Dividend yield 0 % 0 % Risk-free interest rate 0.4 % 1.9 % Repurchase of Common Stock, Common Stock Warrants and Stock Options In 1999 and 2001, the Board of Directors approved resolutions authorizing the Company to repurchase up to a total of 1,000,000 shares of its own stock on the open market, which the Board reaffirmed in 2008. There were no shares of the Company repurchased during 2020 or 2019. There are approximately 72,000 shares remaining under this repurchase authorization.

RETIREMENT PLAN

RETIREMENT PLAN	12 Months Ended
RETIREMENT PLAN	Dec. 31, 2020
Retirement Benefits [Abstract]
RETIREMENT PLAN	R ETIREMENT P LAN

OPERATING LEASES

OPERATING LEASES	12 Months Ended
OPERATING LEASES	Dec. 31, 2020
Leases, Operating [Abstract]
OPERATING LEASES	O PERATING L EASES The Company leases office space and equipment under operating leases expiring at various dates through 2021 and 2024. On August 13, 2016, the Company entered into a 7 year operating lease for an office space located in San Francisco, CA. The Company also owns and operates a stand-alone Gamma Knife facility in Lima, Peru where it leases approximately 1,600 square feet for approximately $7,800 per month with a lease expiration date in January 2024. Future minimum payments under non-cancelable operating leases having initial terms of more than one year consisted of the following: Year ending December 31, 2021 $ 350,000 2022 355,000 2023 259,000 2024 8,000 $ 972,000 Payments for repair and maintenance agreements incorporated in operating lease agreements are not included in the future minimum operating lease payments shown above. Net rent expense was $404,000 and $380,000 for the years ended December 31, 2020 and 2019, respectively, and includes the above operating leases as well as month-to-month rental and certain executory costs.

COMMITMENTS AND CONTINGENCIES

COMMITMENTS AND CONTINGENCIES	12 Months Ended
COMMITMENTS AND CONTINGENCIES	Dec. 31, 2020
Commitments and Contingencies Disclosure [Abstract]
COMMITMENTS AND CONTINGENCIES	C OMMITMENTS AND C ONTINGENCIES On December 20, 2018, the Company signed Second Amendments to two System Build Agreements for the Company’s second and third Mevion PBRT units. The Company and Mevion have agreed to upgrade the second and third PBRT units for which the Company has purchase commitments. The Company is actively seeking sites for these units but, to date, has not entered into agreements with any party for either placement of a PBRT unit or the related financing. The Company projects that it will be required to commence delivery of the second and third PBRT units no later than 2023. In the event the Company is unable to enter into customer agreements within the requisite time frame or receive an extension from Mevion, the Company could forfeit its deposits, which are described below. As of December 31, 2020, the Company had commitments to perform three (3) Cobalt-60 reloads and install four (4) Leksell Gamma Knife Icon Systems (“Icon”) at existing customer sites, and purchase two (2) Linear Accelerator ("LINAC") systems, one to be placed at an existing customer site and one at a new customer site. The Company also has a commitment to upgrade the Gamma Knife unit at its stand-alone facility in Ecuador to a Perfexion. The Cobalt-60 reloads, Icon upgrades, and LINAC purchases are scheduled to occur between 2021 and 2022. The Company expects to upgrade the equipment in Ecuador in the second quarter of 2021. Total Gamma Knife and LINAC commitments as of December 31, 2020 were $12,210,000. There are no significant cash requirements, pending financing, for these commitments in the next 12 months. There can be no assurance that financing will be available for the Company’s current or future projects, or at terms that are acceptable to the Company. On July 21, 2017, the Company entered into a Maintenance and Support Agreement (the “Mevion Service Agreement”) with Mevion, which provides for maintenance and support of the Company’s PBRT unit at Orlando Health. The Mevion Service Agreement began September 5, 2017, was amended in 2018, and renews annually over a five (5) year period. The agreement requires an annual prepayment of $1,572,000 for the current contractual period. This payment portion was recorded as a prepaid contract and will be amortized over the one As of December 31, 2020, the Company had commitments to service and maintain its Gamma Knife and PBRT equipment. The service commitments are carried out via contracts with Mevion, Elekta and Mobius Imaging, LLC. In addition, in April 2019, the Company signed agreements to service the Icon upgrades which will be installed at various dates between 2021 and 2022. The Company’s commitments to purchase two LINAC systems also include a 9-year and 5-year agreement to service the equipment, respectively. Total service commitments as of December 31, 2020 were $10,493,000. The Gamma Knife and certain other service contracts are paid monthly, as service is performed. The Company believes that cash flow from cash on hand and operations will be sufficient to cover these payments. The Company estimates the following commitments for each of the equipment systems, with expected timing of payments as follows as of December 31, 2020: Total amounts committed 2021 2022-2023 2024-2025 After 5 years Long-term debt (includes interest) $ 5,251,000 $ 1,373,000 $ 1,854,000 $ 1,543,000 $ 481,000 Finance leases (includes interest) 9,771,000 6,590,000 2,659,000 522,000 — Future equipment purchases 46,210,000 2,175,000 44,035,000 — — Equipment service contracts 10,493,000 2,030,000 2,585,000 2,999,000 2,879,000 Acquisition working capital payments 197,000 197,000 — — — Operating leases 972,000 350,000 614,000 8,000 — Total Commitments $ 72,894,000 $ 12,715,000 $ 51,747,000 $ 5,072,000 $ 3,360,000

RELATED PARTY TRANSACTIONS

RELATED PARTY TRANSACTIONS	12 Months Ended
RELATED PARTY TRANSACTIONS	Dec. 31, 2020
Related Party Transactions [Abstract]
RELATED PARTY TRANSACTIONS	R ELATED P ARTY T RANSACTIONS

ACCOUNTING POLICIES (Policies)

ACCOUNTING POLICIES (Policies)	12 Months Ended
ACCOUNTING POLICIES (Policies)	Dec. 31, 2020
Accounting Policies [Abstract]
Use of estimates in the preparation of financial statements	Use of estimates in the preparation of financial statements – In preparing the consolidated financial statements in conformity with accounting principles generally accepted in the United States of America, management makes estimates and assumptions that affect the reported amounts of assets and liabilities and disclosures of contingent assets and liabilities at the date of the consolidated financial statements, as well as the reported amounts of revenues and expenses during the reporting period. Significant accounting estimates reflected in the Company’s consolidated financial statements include the estimated useful lives of fixed assets and its salvage values, revenues and costs of sales for turn-key and revenue sharing arrangements. Actual results could differ from those estimates.
Advertising costs	Advertising costs – The Company expenses advertising costs as incurred. Advertising costs were $237,000 and $144,000 during the years ended December 31, 2020 and 2019. Advertising costs are recorded in other direct operating costs and sales and administrative costs in the consolidated statements of operations.
Cash and cash equivalents	Cash and cash equivalents – The Company considers all liquid investments with original maturities of three months or less at the date of purchase to be cash equivalents. Restricted cash is not considered a cash equivalent for purposes of the consolidated statements of cash flows.
Restricted cash	Restricted cash – Restricted cash represents the minimum cash that must be maintained in GKF to fund operations, per the subsidiary’s operating agreement, the minimum cash that must be maintained by GKF per it’s financing agreement with DFC, and the minimum cash that must be maintained in Orlando per the subsidiary’s financing agreement.
Business and credit risk	Business and credit risk – The Company maintains its cash balances, which exceed federally insured limits, in financial institutions. The Company believes it is not exposed to any significant credit risk on cash, cash equivalents. The Company monitors the financial condition of the financial institutions it uses on a regular basis. All of the Company’s revenue was provided by eighteen and seventeen customers in 2020 and 2019. One customer accounted for approximately 35% and 30% of the Company’s total revenue in 2020 and 2019. At December 31, 2020, four customers each individually accounted for 11%, 11%, 11% and 20% of total accounts receivable, respectively. At December 31, 2019, three customers each individually accounted for 12%, 15% and 30% of total accounts receivable, respectively. The Company performs credit evaluations of its customers and generally does not require collateral. The Company has not experienced significant losses related to receivables from individual customers or groups of customers in any particular geographic area. All of the Company’s radiosurgery devices have been purchased through Elekta, to date. However, there are other manufacturers that also make radiosurgery devices.
Accounts receivable and doubtful accounts	Accounts receivable and doubtful accounts – Accounts receivable are recorded at net realizable value. An allowance for doubtful accounts is estimated based on historical collections plus an allowance for probable losses. Receivables are considered past due based on contractual terms and are charged off in the period that they are deemed uncollectible. Recoveries of receivables previously charged off are offset against bad debt expense when received.
Non-controlling interests	Non-controlling interests - The Company reports its non-controlling interests as a separate component of shareholders’ equity. The Company also presents the consolidated net income and the portion of the consolidated net income allocable to the non-controlling interests and to the shareholders of the Company separately in its consolidated statements of operations.
Property and equipment	Property and equipment – Property and equipment are stated at cost less accumulated depreciation. Depreciation for Gamma Knife, IGRT, and other equipment is determined using the straight-line method over the estimated useful lives of the assets, which for medical and office equipment is generally 3 – 10 years, and after accounting for salvage value on the equipment where indicated. Salvage value is based on the estimated fair value of the equipment at the end of its useful life. The Company acquired a building as part of the Acquisition in June 2020. Depreciation for buildings is determined using the straight-line method over 20 years. Depreciation for PBRT and related equipment is determined using the modified units of production method, which is a function of both time and usage of the equipment. This depreciation method allocates costs considering the projected volume of usage through the useful life of the PBRT unit, which has been estimated at 20 years. The estimated useful life of the PBRT unit is consistent with the estimated economic life of 20 years. The Company capitalizes interest incurred on property and equipment that is under construction, for which deposits or progress payments have been made. When a rate is not readily available, imputed interest is calculated using the Company’s incremental borrowing rate. The interest capitalized for property and equipment is the portion of interest cost incurred during the acquisition periods that could have been avoided if expenditures for the equipment had not been made. The Company capitalized interest of $119,000 and $110,000 in 2020 and 2019, respectively, as costs of medical equipment. The Company leases Gamma Knife and radiation therapy equipment to its customers under arrangements accounted for as operating leases. At December 31, 2020, the Company held equipment under operating lease contracts with customers with an original cost of $75,241,000 and accumulated depreciation of $45,416,000. At December 31, 2019, the Company held equipment under operating lease contracts with customers with an original cost of $92,135,000 and accumulated depreciation of $55,148,000. As of December 31, 2020, the Company recognized a loss on the write down of impaired assets of $8,264,000. The impaired assets included six (6) Gamma Knife units and the Company's deposits towards purchase of proton beam systems and related capitalized interest. See further discussion under Note 2 - Long-lived asset impairment and Note 3 - Property and Equipment for further discussion.
Fair value of financial instruments	Fair value of financial instruments – The Company’s disclosures of the fair value of financial instruments is based on a fair value hierarchy which prioritizes the inputs to the valuation techniques used to measure fair value into three levels. Level 1 inputs are unadjusted quoted market prices in active markets for identical assets and liabilities that the Company has the ability to access at the measurement date. Level 2 inputs are inputs other than quoted prices within Level 1 that are observable for the asset or liability, either directly or indirectly. Level 3 inputs are unobservable inputs for assets or liabilities, and reflect the Company’s own assumptions about the assumptions that market participants would use in pricing the asset or liability.
Revenue recognition	Revenue recognition - The Company recognizes revenues under ASC 842 Leases (“ASC 842”) and ASC 606 Revenue from Contracts with Customers (“ASC 606”). Rental income from medical services – The Company recognizes revenues under ASC 842 when services have been rendered and collectability is reasonably assured, on either a fee per use or revenue sharing basis. The terms of the contracts do not contain any guaranteed minimum payments. The Company’s contracts are typically for a 10-year term and are classified as either fee per use or retail. Retail arrangements are further classified as either turn-key or revenue sharing. Revenues from fee per use contracts is determined by each hospital’s contracted rate. Revenues are recognized at the time the procedures are performed, based on each hospital’s contracted rate and the number of procedures performed. Under revenue sharing arrangements, the Company receives a contracted percentage of the reimbursement received by the hospital. The amount the Company expects to receive is recorded as revenue and estimated based on historical experience. Revenue estimates are reviewed periodically and adjusted as necessary. Under turn-key arrangements, the Company receives payment from the hospital in the amount of the hospital’s reimbursement from third party payors, and the Company is responsible for paying all the operating costs of the equipment. Operating costs are determined primarily based on historical treatment protocols and cost schedules with the hospital. The Company records an estimate of operating costs which are reviewed on a regular basis and adjusted as necessary to more accurately reflect the actual operating costs. For turn-key sites, the Company also shares a percentage of net operating profit. The Company records an estimate of net operating profit based on estimated revenues, less estimated operating costs. The operating costs and estimated net operating profit are recorded as other direct operating costs in the consolidated statement of operations . As of December 31, 2020 and 2019, the Company recognized revenues of approximately $16,204,000 and $19,396,000 under ASC 842, respectively. Patient income – The Company has stand-alone facilities in Lima, Peru and Guayaquil, Ecuador, where a contract exists between the Company’s facilities and the individual patient treated at the facility. Under ASC 606, the Company acts as the principal in this transaction and provides, at a point in time, a single performance obligation, in the form of a Gamma Knife treatment. Revenue related to a Gamma Knife treatment is recognized on a gross basis at the time when the patient receives treatment. There is no variable consideration present in the Company’s performance obligation and the transaction price is agreed upon per the stated contractual rate. GKPeru's payment terms are typically prepaid for self-pay patients and insurance provider payments are paid net 30 days. GKCE's patient population is primarily covered by a government payor and payments are paid approximately 30 to 60 days upon invoice. The Company did not capitalize any incremental costs related to the fulfillment of its customer contracts. Accounts receivable earned by GKPeru were not significant for the year ended December 31, 2020 and 2019. GKCE's accounts receivable were $467,000 for the year ended December 31, 2020. As of December 31, 2020 and 2019, the Company recognized revenues of approximately $1,633,000 and $1,209,000 under ASC 606, respectively.
Stock-based compensation	Stock-based compensation – The Company measures all stock-based compensation awards at fair value and records such expense in its consolidated financial statements over the requisite service period of the related award. See Note 9 for additional information on the Company’s stock-based compensation programs.
Costs of revenue	Costs of revenue – The Company's costs of revenue consist primarily of maintenance and supplies, depreciation and amortization, and other operating expenses (such as insurance, property taxes, sales taxes, marketing costs and operating costs from the Company’s retail sites). Costs of revenues are recognized as incurred.
Sales and Marketing	Sales and Marketing – The Company markets its services through its preferred provider status with Elekta and a direct sales effort led by its Senior Vice President of Sales and Business Development, its President and Chief Financial and Operating Officer and its Chief Executive Officer (“CEO”). The Company typically provides the equipment, as well as planning, installation, reimbursement and marketing support services.
Income taxes	Income taxes – The Company accounts for income taxes using the asset and liability method. Under this method, deferred tax assets and liabilities are determined based on differences between the financial reporting and tax bases of assets and liabilities and are measured using the enacted tax rates and laws that will be in effect when the differences are expected to reverse. The Company accounts for uncertainty in income taxes as required by the provisions of ASC 740 Income taxes (“ASC 740”), which clarifies the accounting for uncertainty in income taxes recognized in an enterprise’s financial statements. The first step is to evaluate the tax position for recognition by determining if the weight of available evidence indicates that it is more likely than not that the position will be sustained on audit, including resolution of related appeals or litigation processes, if any. The second step is to estimate and measure the tax benefit as the largest amount that is more than 50% likely of being realized upon ultimate settlement. It is inherently difficult and subjective to estimate such amounts, as this requires the Company to determine the probability of various possible outcomes. The Company considers many factors when evaluating and estimating the Company’s tax positions and tax benefits, which may require periodic adjustments and may not accurately anticipate actual outcomes. See Note 8 for further discussion on income taxes.
Functional currency	Functional currency – Based on guidance provided in accordance with ASC 830, Foreign Currency Matters (“ASC 830”), the Company analyzes its operations outside the United States to determine the functional currency of each operation. Management has determined that these operations are initially accounted for in U.S. dollars since the primary transactions incurred are in U.S. dollars and the Company provides significant funding towards the startup of the operation. When Management determines that an operation has become predominantly self-sufficient, the Company will change its accounting for the operation to the local currency from the U.S. dollar. The Company analyzed it’s Gamma Knife site in Peru under ASC 830 as of December 31, 2020 and 2019 and concluded the functional currency was the U.S. dollar. As facts and circumstances change, the Company will revisit this conclusion.
Asset Retirement Obligations	Asset Retirement Obligations – Based on the guidance provided in ASC 410 Asset Retirement Obligations (“ASC 410”), the Company analyzed its existing lease agreements and determined an asset retirement obligation (“ARO”) exists to remove the respective units at the end of the lease terms. As of December 31, 2020, four (4) of the Company's Gamma Knife customers notified the Company of their intent to terminate their contracts at the contract lease term. The Company recorded an ARO liability for these four (4) sites, using estimates from Elekta. No liability has been recorded as of December 31, 2020 for the remaining Gamma Knife sites, or as of December 31, 2019, because it is uncertain these units will be removed and the Company historically has not removed the Gamma Knife equipment at the end of the lease term. The Company will re-evaluate the need to record additional ARO liabilities on a periodic basis when facts and circumstances change that could affect this conclusion.
Earnings per share	Earnings per share – Basic earnings per share excludes dilution and is computed by dividing income available to common shareholders by the weighted average number of common shares outstanding for the year. The fully vested restricted stock units not issued and outstanding, are also included therein. Diluted earnings per share reflect the potential dilution that could occur if common shares were issued pursuant to the exercise of options or warrants. Because the Company reported a loss for the year ended December 31, 2020, the potentially dilutive effects of approximately 13,000, of the Company's unvested restricted stock awards were not considered for the reporting periods.
Business segment information	Business segment information - Based on the guidance provided in accordance with ASC 280 Segment Reporting
Long lived asset impairment	Long lived asset impairment – The Company assesses the recoverability of its long-lived assets when events or changes in circumstances indicate their carrying value may not be recoverable. Such events or changes in circumstances may include: a significant adverse change in the extent or manner in which a long-lived asset is being used, significant adverse change in legal factors or in the business climate that could affect the value of a long-lived asset, an accumulation of costs significantly in excess of the amount originally expected for the acquisition or development of a long-lived asset, current or future operating or cash flow losses that demonstrate continuing losses associated with the use of a long-lived asset, or a current expectation that, more likely than not, a long-lived asset will be sold or otherwise disposed of significantly before the end of its previously estimated useful life. The Company performs impairment testing at the asset group level that represents the lowest level for which identifiable cash flows are largely independent of the cash flows of other assets and liabilities. The Company assesses recoverability of a long-lived asset by determining whether the carrying value of the asset group can be recovered through projected undiscounted cash flows over their remaining lives. If the carrying value of the asset group exceeds the forecasted undiscounted cash flows, an impairment loss is recognized, measured as the amount by which the carrying amount exceeds estimated fair value. An impairment loss is charged to the consolidated statement of operations in the period in which management determines such impairment. As of December 31, 2020, the Company determined circumstances existed indicating its assets could be impaired, concluded an impairment existed, and recognized a loss on the write down of impaired assets of $8,264,000. No such impairment has been noted as of December 31, 2019. See Note 3 - Property and Equipment for further discussion.
Goodwill and intangible assets	Goodwill and intangible assets - The Company recorded goodwill of $1,265,000 and an intangible asset with a fair value of $78,000 as part of the Acquisition in June 2020. The intangible asset identified was GKCE's trade name and the Company assigned an indefinite useful life to the asset. Based on the guidance provided in accordance with ASC 350 Intangibles-Goodwill and Other
Acquisitions	Acquisitions - The Company records acquisitions according to ASC 805 Business Combinations (“ASC 805”) using the acquisition method of accounting. Under the acquisition method of accounting, all assets acquired, including goodwill and other intangible assets, should be stated at fair value at the time of acquisition. The allocation of purchase price consideration is preliminary, pending the completion of the fair value of certain tangible, intangible assets, and residual goodwill. During the measurement period, which can be no more than one year from the Closing Date, the Company expects to continue to obtain information to assist in determining the final fair value of assets acquired. See Note 4 - GKCE Acquisition for further discussion on acquisitions.
Accounting pronouncement issued and adopted and issued and not yet adopted	Accounting pronouncement issued and adopted – In February 2018, the FASB issued ASU No. 2018-03 Recognition and Measurement of Financial Assets and Financial Liabilities (“ASU 2018-03”), which clarifies certain aspects of ASU 2016-1. These are: equity securities without a readily determinable fair value – discontinuation, equity securities without a readily determinable fair value – adjustments, forward contracts and purchased options, presentation requirements for certain fair value option liabilities, fair value option liabilities denominated in a foreign currency, and transition guidance for equity securities without a readily determinable fair value. In August 2018, the FASB issued ASU No. 2018-13 Fair Value Measurement (Topic 820): Disclosure Framework – Changes to the Disclosure Requirements to Fair Value Measurement (“ASU 2018-13”), which amended the effective date and other certain measurement aspects of ASU 2018-03. The new guidance is effective for fiscal years and interim periods within those fiscal years beginning after December 15, 2019. The Company adopted ASU 2018-03 and ASU 2018-13 on January 1, 2020. There was no significant impact on its consolidated financial statements and related disclosures. Accounting pronouncement issued and not yet adopted – In December 2019, the FASB issued ASU 2019-12 Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes (“ASU 2019-12”) which removes specific exceptions to the general principles in Topic 740 and eliminates the need for an organization to analyze whether the following apply in a given period: exception to the incremental approach for intraperiod tax allocation; exceptions to accounting for basis differences when there are ownership changes in foreign investments; exception in interim period income tax accounting for year-to-date losses that exceed anticipated losses. The new guidance is effective for fiscal years and interim periods beginning after December 15, 2020. The Company is currently evaluating ASU 2019-12 to determine the impact it may have on its consolidated financial statements.

ACCOUNTING POLICIES (Tables)

ACCOUNTING POLICIES (Tables)	12 Months Ended
ACCOUNTING POLICIES (Tables)	Dec. 31, 2020
Accounting Policies [Abstract]
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis	The estimated fair value of the Company’s assets and liabilities as of December 31, 2020 and 2019 were as follows (in thousands): Level 1 Level 2 Level 3 Total Carrying Value December 31, 2020 Assets: Cash, cash equivalents, restricted cash $ 4,325 $ — $ — $ 4,325 $ 4,325 Total $ 4,325 $ — $ — $ 4,325 $ 4,325 Liabilities Debt obligations $ — $ — $ 4,662 $ 4,662 $ 4,624 Total $ — $ — $ 4,662 $ 4,662 $ 4,624 December 31, 2019 Assets: Cash, cash equivalents, restricted cash $ 1,779 $ — $ — $ 1,779 $ 1,779 Total $ 1,779 $ — $ — $ 1,779 $ 1,779 Liabilities Debt obligations $ — $ — $ 3,075 $ 3,075 $ 3,480 Total $ — $ — $ 3,075 $ 3,075 $ 3,480
Schedule of Earnings Per Share, Basic and Diluted	The following table illustrates the computations of basic and diluted earnings per share for the years ended December 31, 2020 and 2019. 2020 2019 Numerator for basic and diluted (loss) earnings per share $ (7,058,000) $ 659,000 Denominator: Denominator for basic and diluted (loss) earnings per share – weighted-average shares 6,182,000 5,919,000 Effect of dilutive securities Employee stock options and restricted stock — 11,000 Denominator for diluted (loss) earnings per share – adjusted weighted-average shares 6,182,000 5,930,000 (Loss) earnings per common share- basic $ (1.14) $ 0.11 (Loss) earnings per common share- diluted $ (1.14) $ 0.11
Schedule of Domestic and Foreign Break out Percentages	The revenues, profit or loss, and net property and equipment allocations for the Company's two reportable segments as of December 31, 2020 consists of the following: 2020 2019 Revenues Domestic $ 16,204,000 $ 19,396,000 Foreign 1,633,000 1,209,000 Total $ 17,837,000 $ 20,605,000 2020 2019 Profit or (loss) Domestic $ (7,082,000) $ 769,000 Foreign 24,000 (110,000) Total $ (7,058,000) $ 659,000 2020 2019 Property and equipment, net Domestic $ 27,223,000 $ 38,593,000 Foreign 3,195,000 2,887,000 Total $ 30,418,000 $ 41,480,000

PROPERTY AND EQUIPMENT (Tables)

PROPERTY AND EQUIPMENT (Tables)	12 Months Ended
PROPERTY AND EQUIPMENT (Tables)	Dec. 31, 2020
Property, Plant and Equipment [Abstract]
Property, Plant and Equipment	Property and equipment consists of the following: DECEMBER 31, 2020 2019 Medical equipment and facilities $ 75,657,000 $ 92,132,000 Office equipment 330,000 594,000 Construction in progress 170,000 1,965,000 Deposits towards purchase of proton beam systems — 2,250,000 76,157,000 96,941,000 Accumulated depreciation (45,739,000) (55,461,000) Net property and equipment $ 30,418,000 $ 41,480,000

GKCE ACQUISITION (Tables)

GKCE ACQUISITION (Tables)	12 Months Ended
GKCE ACQUISITION (Tables)	Dec. 31, 2020
Business Combinations [Abstract]
Schedule of purchase price consideration	The fair value of assets acquired and liabilities assumed were as follows: June 12, 2020 Cash and cash equivalents $ 432,000 Accounts receivable 854,000 Prepaid expense and other 22,000 Building 385,000 Land 19,000 Medical equipment 319,000 Purchased intangible assets 78,000 Goodwill 1,265,000 Total assets acquired $ 3,374,000 Accounts payable $ (193,000) Income taxes payable (141,000) Deferred income taxes (66,000) Employee compensation and benefits (91,000) Total liabilities assumed (491,000) Consideration allocated to assets acquired and liabilities assumed $ 2,883,000 First working capital payment $ (515,000) Estimated subsequent working capital payment (368,000) Base purchase consideration $ 2,000,000
Schedule of tangible assets acquired as part of business combination	The preliminary value of the acquired tangible assets acquired are as follows: Fair Value Useful Life (in Years) Building $ 385,000 20 Land 19,000 Medical equipment 302,000 2 Other fixed assets 17,000 2 Total tangible assets $ 723,000

LONG TERM DEBT (Tables)

LONG TERM DEBT (Tables)	12 Months Ended
LONG TERM DEBT (Tables)	Dec. 31, 2020
Debt Disclosure [Abstract]
Schedule of Maturities of Long-term Debt	The following are contractual maturities of long-term debt by year at December 31, 2020, excluding debt issuance costs of $27,000: Year ending December 31, Principal 2021 $ 1,157,000 2022 768,000 2023 802,000 2024 839,000 2025 592,000 Thereafter 466,000 $ 4,624,000

FINANCE LEASES (Tables)

FINANCE LEASES (Tables)	12 Months Ended
FINANCE LEASES (Tables)	Dec. 31, 2020
Debt Disclosure [Abstract]
Schedule of Future Minimum Lease Payments for Finance Leases	Future minimum lease payments, together with the present value of the net minimum lease payments under finance leases at December 31, 2020, are summarized as follows: Net Present Value of Minimum Lease Payments Year ending December 31, 2021 $ 6,590,000 2022 1,576,000 2023 1,083,000 2024 522,000 Total finance lease payments 9,771,000 Less imputed interest 852,000 8,919,000 Less current portion 5,945,000 $ 2,974,000

LEASES (Tables)

LEASES (Tables)	12 Months Ended
LEASES (Tables)	Dec. 31, 2020
Leases [Abstract]
Summary of Maturities of Lessee Operating Lease	The following table summarizes maturities of lessee operating lease ROU assets and liabilities as of December 31, 2020: Year ending December 31, Operating Leases 2021 346,000 2022 353,000 2023 248,000 2024 8,000 Total lease payments 955,000 Less imputed interest (69,000) Total $ 886,000 Future minimum payments under non-cancelable operating leases having initial terms of more than one year consisted of the following: Year ending December 31, 2021 $ 350,000 2022 355,000 2023 259,000 2024 8,000 $ 972,000

INCOME TAXES (Tables)

INCOME TAXES (Tables)	12 Months Ended
INCOME TAXES (Tables)	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Schedule of Components of Income Tax Expense (Benefit)	The components of the provision (benefit) for income taxes as of December 31, 2020 and 2019 consist of the following: YEARS ENDED DECEMBER 31, 2020 2019 Current: Federal $ 209,000 $ 443,000 State 88,000 207,000 Foreign 117,000 130,000 Total current 414,000 780,000 Deferred: Federal (1,909,000) (311,000) State (266,000) (251,000) Foreign 24,000 (90,000) Total deferred (2,151,000) (652,000) $ (1,737,000) $ 128,000
Schedule of Deferred Tax Assets and Liabilities	Significant components of the Company’s deferred tax liabilities and assets as of December 31, 2020 and 2019 are as follows: DECEMBER 31, 2020 2019 Deferred tax liabilities: Property and equipment $ (564,000) $ (3,112,000) Total deferred tax liabilities (564,000) (3,112,000) Deferred tax assets: Net operating loss carryforwards 99,000 117,000 Accruals and allowances 43,000 248,000 Tax credits 5,000 4,000 Other – net 50,000 229,000 Capital loss carryover 627,000 921,000 Total deferred tax assets 824,000 1,519,000 Valuation allowance (678,000) (921,000) Deferred tax assets net of valuation allowance 146,000 598,000 Net deferred tax liabilities $ (418,000) $ (2,514,000)
Schedule of Amounts Presented in Financial Statements	These amounts are presented in the financial statements as follows: DECEMBER 31, 2020 2019 Deferred income taxes (non-current) $ (418,000) $ (2,514,000) $ (418,000) $ (2,514,000)
Schedule of Effective Income Tax Rate Reconciliation	The (benefit) provision for income taxes differs from the amount computed by applying the U.S. federal statutory tax rate (21% in 2020 and 2019) to income before taxes as follows: YEARS ENDED DECEMBER 31, 2020 2019 Computed expected federal income tax $ (1,844,000) $ 167,000 State income taxes, net of federal benefit (199,000) (80,000) Non-deductible expenses 6,000 29,000 Return to Provision True-up 22,000 39,000 Uncertain Tax Positions 16,000 80,000 Capital loss carryforward expiration 246,000 — Change in valuation allowance (243,000) (175,000) Other deferred tax adjustments 259,000 68,000 $ (1,737,000) $ 128,000
Schedule of Unrecognized Tax Benefits Roll Forward	A reconciliation of the beginning and ending amount of unrecognized tax benefit is as follows: YEARS ENDED DECEMBER 31, 2020 2019 Balance at beginning of year $ 259,000 $ 87,000 Additions based on tax positions of prior years 16,000 172,000 Balance at end of year $ 275,000 $ 259,000

STOCK-BASED COMPENSATION EXPE_2

STOCK-BASED COMPENSATION EXPENSE (Tables)	12 Months Ended
STOCK-BASED COMPENSATION EXPENSE (Tables)	Dec. 31, 2020
Stockholders' Equity Note [Abstract]
Schedule of Share-based Compensation, Restricted Stock and Restricted Stock Units Activity	Changes in restricted stock units, consisting primarily of annual automatic grants, deferred compensation to non-employee directors, and restricted stock units awards to the CEO, under the Incentive Compensation Plans during 2020 and 2019 are as follows: Restricted Stock Units Grant Date Weighted- Average Fair Value Intrinsic Value Outstanding at January 1, 2019 4,000 $ 2.68 $ — Granted 36,000 $ 2.50 $ — Vested (37,000) $ 2.47 $ — Outstanding at December 31, 2019 3,000 $ 3.03 $ — Granted 144,000 $ 1.96 $ — Vested (134,000) $ 1.98 $ — Outstanding at December 31, 2020 13,000 $ 1.97 $ 2,000
Disclosure of Share-based Compensation Arrangements by Share-based Payment Award	As of December 31, 2020, stock compensation expense recorded in the consolidated financial statements is summarized as follows: Stock-Based Awards Issued Compensation Award Type and Vested Expense Options — $ 17,000 RSUs Issued in Lieu of Retainer Fees — 80,000 Annual RSU Awards 3,000 7,000 Executive Compensation 100,000 195,000 Balance at of December 31, 2020 103,000 $ 299,000
Share-based Compensation, Stock Options, Activity	Changes in stock options outstanding under the Incentive Compensation Plans during 2020 and 2019 are as follows: Options Number of Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term (Years) Aggregate Intrinsic Value Balance at December 31, 2018 613,000 $ 2.85 3.14 $ — Granted 18,000 $ 2.87 7.00 $ — Exercised (16,000) $ 2.59 — $ — Forfeited (165,000) $ 3.07 — $ — Balance at December 31, 2019 450,000 $ 2.78 2.44 $ 27,000 Granted 10,000 $ 1.88 7.00 $ — Forfeited (43,000) $ 2.54 — $ — Balance at December 31, 2020 417,000 $ 2.79 1.61 $ 2,000 Exercisable at December 31, 2019 425,000 $ 2.79 2.25 $ — Exercisable at December 31, 2020 405,000 $ 2.80 1.48 $ —
Schedule of Nonvested Share Activity	A summary of the status of the Company’s non-vested stock options as of December 31, 2020 and 2019, and changes during the years ended December 31, 2020 and 2019 is presented below: Nonvested Options Number of Options Weighted Average Grant-Date Fair Value Nonvested at December 31, 2018 125,000 $ 1.20 Granted 18,000 $ 1.54 Vested (118,000) $ 1.22 Nonvested at December 31, 2019 25,000 $ 1.40 Granted 10,000 $ 0.78 Vested (23,000) $ 1.22 Nonvested at December 31, 2020 12,000 $ 1.07
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions	The fair value of the Company’s option grants under the Plan in 2020 and 2019 was estimated using the following assumptions: 2020 2019 Expected life (years) 7.0 7.0 Expected forfeiture rate 0.0 % 0.0 % Expected volatility 40 % 50 % Dividend yield 0 % 0 % Risk-free interest rate 0.4 % 1.9 %

OPERATING LEASES (Tables)

OPERATING LEASES (Tables)	12 Months Ended
OPERATING LEASES (Tables)	Dec. 31, 2020
Leases, Operating [Abstract]
Schedule of Future Minimum Rental Payments for Operating Leases	The following table summarizes maturities of lessee operating lease ROU assets and liabilities as of December 31, 2020: Year ending December 31, Operating Leases 2021 346,000 2022 353,000 2023 248,000 2024 8,000 Total lease payments 955,000 Less imputed interest (69,000) Total $ 886,000 Future minimum payments under non-cancelable operating leases having initial terms of more than one year consisted of the following: Year ending December 31, 2021 $ 350,000 2022 355,000 2023 259,000 2024 8,000 $ 972,000

COMMITMENTS AND CONTINGENCIES (

COMMITMENTS AND CONTINGENCIES (Tables)	12 Months Ended
COMMITMENTS AND CONTINGENCIES (Tables)	Dec. 31, 2020
Commitments and Contingencies Disclosure [Abstract]
Schedule of Long-term Purchase Commitment	The Company estimates the following commitments for each of the equipment systems, with expected timing of payments as follows as of December 31, 2020: Total amounts committed 2021 2022-2023 2024-2025 After 5 years Long-term debt (includes interest) $ 5,251,000 $ 1,373,000 $ 1,854,000 $ 1,543,000 $ 481,000 Finance leases (includes interest) 9,771,000 6,590,000 2,659,000 522,000 — Future equipment purchases 46,210,000 2,175,000 44,035,000 — — Equipment service contracts 10,493,000 2,030,000 2,585,000 2,999,000 2,879,000 Acquisition working capital payments 197,000 197,000 — — — Operating leases 972,000 350,000 614,000 8,000 — Total Commitments $ 72,894,000 $ 12,715,000 $ 51,747,000 $ 5,072,000 $ 3,360,000

BUSINESS AND BASIS OF PRESENT_2

BUSINESS AND BASIS OF PRESENTATION - Narrative (Details) - USD ($) $ in Thousands	Jun. 12, 2020	Dec. 31, 2020
GKCE acquisition
Asset acquisition, percentage of shares acquired	98.00%	99.30%
Asset acquisition, percentage of shares remaining	0.70%
Base purchase consideration	$ 2,000
Payments for asset acquisitions	575
Asset acquisition, transaction costs	$ 1,425
OR21 LLC
Equity method investment, ownership percentage		50.00%
Architectural Design Company
Equity method investment, ownership percentage		50.00%

ACCOUNTING POLICIES - Narrative

ACCOUNTING POLICIES - Narrative (Details) $ / shares in Units, shares in Thousands, $ in Thousands	Jun. 12, 2020USD ($)	Dec. 31, 2020USD ($)segmentunitcustomersite$ / sharesshares	Dec. 31, 2019USD ($)$ / sharesshares
Accounting Policies [Line Items]
Advertising expense		$ 237	$ 144
Interest costs capitalized		119	110
Original cost of operating lease contracts		30,418	41,480
Accumulated depreciation		45,739	55,461
Loss on write down of impaired assets and associated removal costs		$ (8,264)	0
Term of contract		10 years
Revenues		$ 17,837	$ 20,605
Percentage of tax benefit realized upon settlement		50.00%
Antidilutive securities excluded from computation of earnings per share (in shares) \| shares		406	387
Number of reportable segments \| segment		2
GKCE acquisition
Accounting Policies [Line Items]
Goodwill	$ 1,265
GKCE acquisition \| Purchased intangible assets
Accounting Policies [Line Items]
Purchased intangible assets	$ 78
Revenues
Accounting Policies [Line Items]
Revenues		$ 17,837	$ 20,605
Customer One \| Revenues
Accounting Policies [Line Items]
Concentration risk, percentage		35.00%	30.00%
Customer One \| Accounts Receivable
Accounting Policies [Line Items]
Concentration risk, percentage		11.00%	12.00%
Customer Two \| Accounts Receivable
Accounting Policies [Line Items]
Concentration risk, percentage		11.00%	15.00%
Customer Three \| Accounts Receivable
Accounting Policies [Line Items]
Concentration risk, percentage		11.00%	30.00%
Customer Four \| Accounts Receivable
Accounting Policies [Line Items]
Concentration risk, percentage		20.00%
Restricted Stock Units (RSUs)
Accounting Policies [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares) \| shares		13	3
Accounting Standards Update 2016-02
Accounting Policies [Line Items]
Revenue recognized, including assessed tax		$ 16,204	$ 19,396
Accounting Standards Update 2014-09
Accounting Policies [Line Items]
Revenues		$ 1,633	1,209
Proton Beam Radiation Therapy (“PBRT”)
Accounting Policies [Line Items]
Property equipment, useful life		20 years
Gamma Knife And Radiation Therapy
Accounting Policies [Line Items]
Original cost of operating lease contracts		$ 75,241	92,135
Accumulated depreciation		45,416	$ 55,148
Gamma Knife Center Ecuador S.A. (“GKCE”)
Accounting Policies [Line Items]
Accounts receivable		$ 467
Gamma Knife Unit
Accounting Policies [Line Items]
Number of impaired asset units \| unit		6
Number of customers with intent to terminate contract \| customer		4
Number of sites \| site		4
Maximum
Accounting Policies [Line Items]
Stock options exercise price (in dollars per share) \| $ / shares		$ 3.90	$ 3.90
Maximum \| Medical and Office equipment
Accounting Policies [Line Items]
Property equipment, useful life		10 years
Minimum
Accounting Policies [Line Items]
Stock options exercise price (in dollars per share) \| $ / shares		$ 2.25	$ 2.68
Minimum \| Medical and Office equipment
Accounting Policies [Line Items]
Property equipment, useful life		3 years

ACCOUNTING POLICIES - Schedule

ACCOUNTING POLICIES - Schedule of Fair Value (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Assets:
Cash, cash equivalents, restricted cash, Carrying Value	$ 3,961	$ 1,429
TOTAL ASSETS	43,653	53,783
Assets, Fair Value Disclosure [Abstract]
Cash, cash equivalents, restricted cash	4,325	1,779	$ 1,792
Total, Fair Value	4,325	1,779
Liabilities, Fair Value Disclosure [Abstract]
Debt obligations, Fair Value	4,662	3,075
Total, Fair Value	4,662	3,075
Carrying Value
Assets:
Cash, cash equivalents, restricted cash, Carrying Value	4,325	1,779
TOTAL ASSETS	4,325	1,779
Liabilities
Debt obligations, Carrying Value	4,624	3,480
Total Liabilities	4,624	3,480
Fair Value, Inputs, Level 1
Assets, Fair Value Disclosure [Abstract]
Cash, cash equivalents, restricted cash	4,325	1,779
Total, Fair Value	4,325	1,779
Liabilities, Fair Value Disclosure [Abstract]
Debt obligations, Fair Value	0	0
Total, Fair Value	0	0
Fair Value, Inputs, Level 2
Assets, Fair Value Disclosure [Abstract]
Cash, cash equivalents, restricted cash	0	0
Total, Fair Value	0	0
Liabilities, Fair Value Disclosure [Abstract]
Debt obligations, Fair Value	0	0
Total, Fair Value	0	0
Fair Value, Inputs, Level 3
Assets, Fair Value Disclosure [Abstract]
Cash, cash equivalents, restricted cash	0	0
Total, Fair Value	0	0
Liabilities, Fair Value Disclosure [Abstract]
Debt obligations, Fair Value	4,662	3,075
Total, Fair Value	$ 4,662	$ 3,075

ACCOUNTING POLICIES - Schedul_2

ACCOUNTING POLICIES - Schedule of EPS (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Accounting Policies [Abstract]
Numerator for basic and diluted (loss) earnings per share	$ (7,058)	$ 659
Denominator:
Denominator for basic and diluted (loss) earnings per share – weighted-average shares (in shares)	6,182	5,919
Effect of dilutive securities
Effect of dilutive securities Employee stock options and restricted stock (in shares)	0	11
Denominator for diluted (loss) earnings per share – adjusted weighted-average shares (in shares)	6,182	5,930
(Loss) earnings per common share - basic (in dollars per share)	$ (1.14)	$ 0.11
(Loss) earnings per common share - diluted (in dollars per share)	$ (1.14)	$ 0.11

ACCOUNTING POLICIES - Schedul_3

ACCOUNTING POLICIES - Schedule of Domestic and Foreign Break out Percentages (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Accounting Policies [Line Items]
Revenues	$ 17,837	$ 20,605
Net income (loss)	(7,058)	659
Property and equipment, net	30,418	41,480
Revenues
Accounting Policies [Line Items]
Revenues	17,837	20,605
Net Income (Loss)
Accounting Policies [Line Items]
Net income (loss)	(7,058)	659
Property, Plant and Equipment
Accounting Policies [Line Items]
Property and equipment, net	30,418	41,480
Domestic \| Revenues
Accounting Policies [Line Items]
Revenues	16,204	19,396
Domestic \| Net Income (Loss)
Accounting Policies [Line Items]
Net income (loss)	(7,082)	769
Domestic \| Property, Plant and Equipment
Accounting Policies [Line Items]
Property and equipment, net	27,223	38,593
Foreign \| Revenues
Accounting Policies [Line Items]
Revenues	1,633	1,209
Foreign \| Net Income (Loss)
Accounting Policies [Line Items]
Net income (loss)	24	(110)
Foreign \| Property, Plant and Equipment
Accounting Policies [Line Items]
Property and equipment, net	$ 3,195	$ 2,887

PROPERTY AND EQUIPMENT (Details

PROPERTY AND EQUIPMENT (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Gross property and equipment	$ 76,157	$ 96,941
Accumulated depreciation	(45,739)	(55,461)
Net property and equipment	30,418	41,480
Medical equipment and facilities
Property, Plant and Equipment [Line Items]
Gross property and equipment	75,657	92,132
Office equipment
Property, Plant and Equipment [Line Items]
Gross property and equipment	330	594
Construction in Progress
Property, Plant and Equipment [Line Items]
Gross property and equipment	170	1,965
Deposits towards purchase of proton beam systems
Property, Plant and Equipment [Line Items]
Gross property and equipment	$ 0	$ 2,250

PROPERTY AND EQUIPMENT - Narrat

PROPERTY AND EQUIPMENT - Narrative (Details) $ in Thousands	12 Months Ended
PROPERTY AND EQUIPMENT - Narrative (Details) $ in Thousands	Dec. 31, 2020USD ($)unitdeposit	Dec. 31, 2019USD ($)
Property, Plant and Equipment [Line Items]
Property and equipment, net	$ 30,418	$ 41,480
Loss on write down of impaired assets and associated removal costs	(8,264)	$ 0
Non-US
Property, Plant and Equipment [Line Items]
Property and equipment, net	$ 3,195
Gamma Knife Unit
Property, Plant and Equipment [Line Items]
Number of impaired asset units \| unit	6
Impairment of long-lived assets to be disposed of	$ 3,051
Number of removed asset units \| unit	4
Asset retirement obligation liability	$ 1,350
Increase (decrease) in accounts payable	(80)
Tangible asset impairment charges	4,401
Proton Beam Radiation Therapy (“PBRT”)
Property, Plant and Equipment [Line Items]
Tangible asset impairment charges	$ 3,863
Deposits towards purchase of proton beam systems
Property, Plant and Equipment [Line Items]
Number of deposits \| deposit	2
Two MEVION S250i Proton Beam Radiation Therapy Systems
Property, Plant and Equipment [Line Items]
Accumulated capitalized interest costs	$ 1,613
Long term purchase commitment deposits for assets	$ 2,250
Units removed from service in prior years \| Gamma Knife Unit
Property, Plant and Equipment [Line Items]
Number of impaired asset units \| unit	2
Units removed from service in current year \| Gamma Knife Unit
Property, Plant and Equipment [Line Items]
Number of impaired asset units \| unit	1
Units that will be removed from service in future years \| Gamma Knife Unit
Property, Plant and Equipment [Line Items]
Number of impaired asset units \| unit	3

GKCE ACQUISITION - Narrative (D

GKCE ACQUISITION - Narrative (Details) - USD ($) $ in Thousands	Jun. 12, 2020	Sep. 30, 2020	Jun. 30, 2020	Dec. 31, 2020
Business Acquisition [Line Items]
First working capital payment				$ 43
Payments to acquire asset				214
Estimated subsequent working capital payment for acquisition				$ 154
GKCE acquisition
Business Acquisition [Line Items]
Asset acquisition, percentage of shares acquired	98.00%			99.30%
Asset acquisition, percentage of shares remaining	0.70%
Fair value of noncontrolling interest	$ 58
Percentage of outstanding shares	100.00%
Consideration allocated to assets acquired and liabilities assumed	$ 2,883
Base purchase consideration	2,000
Payments for asset acquisitions	575
Asset acquisition, transaction costs	1,425
First working capital payment	515
Additional consideration transferred	368
Accounts receivable	854			$ 27
Liabilities assumed	491			13
Increase in amount of contingent consideration				$ 14
Acquisition related costs		$ 69	$ 93
GKCE acquisition \| Purchased intangible assets
Business Acquisition [Line Items]
Purchased intangible assets	$ 78

GKCE ACQUISITION - Schedule of

GKCE ACQUISITION - Schedule of Purchase Price Consideration (Details) - USD ($) $ in Thousands	Jun. 12, 2020	Dec. 31, 2020
Business Acquisition [Line Items]
First working capital payment		$ (43)
GKCE acquisition
Business Acquisition [Line Items]
Cash and cash equivalents	$ 432
Accounts receivable	854	27
Prepaid expense and other	22
Property, plant and equipment, additions	723
Goodwill	1,265
Total assets acquired	3,374
Accounts payable	(193)
Income taxes payable	(141)
Deferred income taxes	(66)
Employee compensation and benefits	(91)
Total liabilities assumed	(491)	$ (13)
Consideration allocated to assets acquired and liabilities assumed	2,883
First working capital payment	(515)
Estimated subsequent working capital payment	(368)
Base purchase consideration	2,000
GKCE acquisition \| Building
Business Acquisition [Line Items]
Property, plant and equipment, additions	385
GKCE acquisition \| Land
Business Acquisition [Line Items]
Property, plant and equipment, additions	19
GKCE acquisition \| Medical equipment
Business Acquisition [Line Items]
Property, plant and equipment, additions	319
GKCE acquisition \| Purchased intangible assets
Business Acquisition [Line Items]
Purchased intangible assets	$ 78

GKCE ACQUISITION - Schedule o_2

GKCE ACQUISITION - Schedule of Tangible Assets Acquired as Part of Business Combination (Details) - GKCE acquisition $ in Thousands	Jun. 12, 2020USD ($)
Business Acquisition [Line Items]
Property, plant and equipment, additions	$ 723
Building
Business Acquisition [Line Items]
Property, plant and equipment, additions	$ 385
Property equipment, useful life	20 years
Land
Business Acquisition [Line Items]
Property, plant and equipment, additions	$ 19
Medical equipment
Business Acquisition [Line Items]
Property, plant and equipment, additions	$ 302
Property equipment, useful life	2 years
Other fixed assets
Business Acquisition [Line Items]
Property, plant and equipment, additions	$ 17
Property equipment, useful life	2 years

LONG TERM DEBT - Narrative (Det

LONG TERM DEBT - Narrative (Details) $ in Thousands	12 Months Ended
LONG TERM DEBT - Narrative (Details) $ in Thousands	Dec. 31, 2020USD ($)note	Dec. 31, 2019USD ($)note
Debt Instrument [Line Items]
Number of notes \| note	7	6
Debt issuance costs	$ 27
Gamma Knife Unit
Debt Instrument [Line Items]
Aggregate net book value	11,023	$ 13,130
Accounts receivable	$ 1,718	$ 1,848
Minimum
Debt Instrument [Line Items]
Monthly installments	36 years
Long-term debt percentage rate	3.67%
Maximum
Debt Instrument [Line Items]
Monthly installments	84 months
Long-term debt percentage rate	6.90%

LONG TERM DEBT (Details)

LONG TERM DEBT (Details) $ in Thousands	Dec. 31, 2020USD ($)
Principal
2021	$ 1,157
2022	768
2023	802
2024	839
2025	592
Thereafter	466
Long-term debt	$ 4,624

FINANCE LEASES - Narrative (Det

FINANCE LEASES - Narrative (Details) $ in Thousands	12 Months Ended
FINANCE LEASES - Narrative (Details) $ in Thousands	Dec. 31, 2020USD ($)lease	Dec. 31, 2019USD ($)lease
Lessee, Lease, Description [Line Items]
Number of financing leases \| lease	6	10
Net book value of finance lease obligations	$ 18,093	$ 22,860
Accounts receivable	$ 1,892	$ 4,600
Minimum
Lessee, Lease, Description [Line Items]
Finance lease obligation interest rate	4.73%
Monthly installments	36 years
Maximum
Lessee, Lease, Description [Line Items]
Finance lease obligation interest rate	13.00%
Monthly installments	84 years

FINANCE LEASES (Details)

FINANCE LEASES (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Debt Disclosure [Abstract]
2021	$ 6,590
2022	1,576
2023	1,083
2024	522
Total finance lease payments	9,771
Less imputed interest	852
Gross minimum lease payments	8,919
Less current portion	5,945	$ 3,709
Noncurrent portion finance lease liability	$ 2,974	$ 8,177

LEASES - Narrative (Details)

LEASES - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
LEASES - Narrative (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Operating Leased Assets [Line Items]
Operating lease, right-of-use asset	$ 886	$ 1,106
Operating lease, liability	886
Lease reassessment right of use assets and lease liabilities	67
Right of use assets and lease liabilities	$ 135	$ 1,362
Minimum
Operating Leased Assets [Line Items]
Lessee, discount rate	4.00%
Operating lease remaining lease term	2 years
Maximum
Operating Leased Assets [Line Items]
Lessee, discount rate	6.00%
Operating lease remaining lease term	3 years

LEASES - Summary of Maturities

LEASES - Summary of Maturities of Lessee Operating Lease (Details) $ in Thousands	Dec. 31, 2020USD ($)
Leases [Abstract]
2021	$ 346
2022	353
2023	248
2024	8
Total lease payments	955
Less imputed interest	(69)
Total	$ 886

INCOME TAXES - Narrative (Detai

INCOME TAXES - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
INCOME TAXES - Narrative (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Line Items]
Income tax (benefit) expense	$ (1,737)	$ 128
Federal statutory income tax rate, percent	21.00%	21.00%
State and local operating loss carryforwards	$ 2,219
Decrease in net valuation allowance	(243)	$ (175)
Unrecognized tax benefits	275	259	$ 87
Amount accrued for income tax penalties and interest accrued	15
Peru
Income Tax Disclosure [Line Items]
Income tax (benefit) expense		$ (104)
Domestic Tax Authority
Income Tax Disclosure [Line Items]
International operating loss carryforwards	32
Foreign Tax Authority
Income Tax Disclosure [Line Items]
Domestic operating loss carryforwards	2,586
State and Local Jurisdiction
Income Tax Disclosure [Line Items]
State and local operating loss carryforwards	$ 129

INCOME TAXES - Schedule of Comp

INCOME TAXES - Schedule of Components of Income Tax Expense (Benefit) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Current:
Federal	$ 209	$ 443
State	88	207
Foreign	117	130
Total current	414	780
Deferred:
Federal	(1,909)	(311)
State	(266)	(251)
Foreign	24	(90)
Total deferred	(2,151)	(652)
Income tax expense (benefit)	$ (1,737)	$ 128

INCOME TAXES - Schedule of Defe

INCOME TAXES - Schedule of Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Deferred tax liabilities:
Property and equipment	$ (564)	$ (3,112)
Total deferred tax liabilities	(564)	(3,112)
Deferred tax assets:
Net operating loss carryforwards	99	117
Accruals and allowances	43	248
Tax credits	5	4
Other – net	50	229
Capital loss carryover	627	921
Total deferred tax assets	824	1,519
Valuation allowance	(678)	(921)
Deferred tax assets net of valuation allowance	146	598
Net deferred tax liabilities	$ (418)	$ (2,514)

INCOME TAXES - Schedule of Amou

INCOME TAXES - Schedule of Amounts Presented in Financial Statements (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Deferred income taxes (non-current)	$ (418)	$ (2,514)
Net deferred tax liabilities	$ (418)	$ (2,514)

INCOME TAXES - Schedule of Effe

INCOME TAXES - Schedule of Effective Income Tax Rate Reconciliation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Computed expected federal income tax	$ (1,844)	$ 167
State income taxes, net of federal benefit	(199)	(80)
Non-deductible expenses	6	29
Return to Provision True-up	22	39
Uncertain Tax Positions	16	80
Capital loss carryforward expiration	246	0
Change in valuation allowance	(243)	(175)
Other deferred tax adjustments	259	68
Income tax expense (benefit)	$ (1,737)	$ 128

INCOME TAXES - Schedule of Unre

INCOME TAXES - Schedule of Unrecognized Tax Benefits Roll Forward (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Balance at beginning of year	$ 259	$ 87
Additions based on tax positions of prior years	16	172
Balance at end of year	$ 275	$ 259

STOCK-BASED COMPENSATION EXPE_3

STOCK-BASED COMPENSATION EXPENSE - Narrative (Details)	Aug. 03, 2020shares	Jan. 04, 2017USD ($)shares	Sep. 30, 2020shares	Jun. 30, 2020shares	Dec. 31, 2020USD ($)employee$ / sharesshares	Dec. 31, 2019USD ($)$ / sharesshares	Dec. 31, 2018USD ($)shares	Mar. 31, 2020USD ($)shares	Jun. 30, 2010shares	Dec. 31, 2001shares
Class of Stock [Line Items]
Outstanding (in shares)					417,000	450,000	613,000
Shares vested in period (in shares)					103,000
Period for recognition					3 years
Allocated share-based compensation expense \| $					$ 299,000
Grant date weighted-average fair value, granted (in dollars per share) \| $ / shares					$ 0.78	$ 1.54
Options exercised in period (in shares)					0	16,000
Proceeds from stock options exercised \| $					$ 0	$ 42,000	$ 0
Unrecognized compensation cost related to non-vested shares \| $						$ 12,000
Number of shares authorized to be repurchased (in shares)										1,000,000
Remaining number of shares authorized to be repurchased (in shares)					72,000
Restricted Stock Units (RSUs)
Class of Stock [Line Items]
Shares vested in period (in shares)					134,000	37,000
Shares outstanding (in shares)					13,000	3,000	4,000
Options granted in period (in shares)					144,000	36,000
Grant date weighted-average fair value, granted (in dollars per share) \| $ / shares					$ 1.96	$ 2.50
Options
Class of Stock [Line Items]
Shares vested in period (in shares)					0
Allocated share-based compensation expense \| $					$ 17,000	$ 141,000
Incentive Compensation Plan
Class of Stock [Line Items]
Shares reserved for future issuance (in shares)									1,630,000
Remaining shares available for grant (in shares)					437,000
Number of shares available for grant (in shares)					456,000
Incentive Compensation Plan \| Restricted Stock Units (RSUs)
Class of Stock [Line Items]
Shares vested in period (in shares)					210,000
Shares vested and outstanding (in shares)					233,000
Employee benefits and share-based compensation \| $					$ 7,000
Offsetting tax benefit \| $					1,000
Unrecognized compensation cost \| $					$ 2,000
Period for recognition					6 months
Restricted stock units (in shares)					3,000	4,000
Fair value of options vested in period \| $					$ 9,000	$ 11,000
Incentive Compensation Plan \| Employee
Class of Stock [Line Items]
Shares issued for services (in shares)					20,000
Number of employees \| employee					2
Incentive Compensation Plan \| Non Employee Directors and Corporate Secretary
Class of Stock [Line Items]
Number of shares available for grant (in shares)					43,000
Executive Equity Awards
Class of Stock [Line Items]
Allocated share-based compensation expense \| $					$ 195,000
Executive Equity Awards \| Chief Executive Officer \| Restricted Stock
Class of Stock [Line Items]
Award vesting period	30 days
Options granted in period (in shares)	10,000			50,000
Executive Equity Awards \| Chief Executive Officer \| Restricted Stock Units (RSUs)
Class of Stock [Line Items]
Shares issued for services (in shares)					100,000
Shares vested in period (in shares)					90,000
Executive Equity Awards \| Senior Vice President \| Restricted Stock
Class of Stock [Line Items]
Shares issued for services (in shares)			10,000
Performance Share Award Agreement
Class of Stock [Line Items]
Unrecognized compensation cost \| $								$ 421,000
Allocated share-based compensation expense \| $		$ 108,000
Performance Share Award Agreement \| Restricted Stock
Class of Stock [Line Items]
Options granted in period (in shares)		161,766
Amount of nonvested options (in shares)								129,000
Retainer Fees \| Restricted Stock Units (RSUs)
Class of Stock [Line Items]
Employee benefits and share-based compensation \| $					$ 80,000
Retainer Fees \| Incentive Compensation Plan \| Non Employee Directors
Class of Stock [Line Items]
Number of shares available for grant (in shares)					293,000

STOCK-BASED COMPENSATION EXPE_4

STOCK-BASED COMPENSATION EXPENSE - Schedule of Share-based Compensation, Restricted Stock and Restricted Stock Units Activity (Details) - $ / shares	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Restricted Stock Units
Vested (in shares)	(103,000)
Grant Date Weighted- Average Fair Value
Grant Date Weighted-Average Fair Value, Granted (in dollars per share)	$ 0.78	$ 1.54
Restricted Stock Units (RSUs)
Restricted Stock Units
Outstanding beginning balance (in shares)	3,000	4,000
Granted (in shares)	144,000	36,000
Vested (in shares)	(134,000)	(37,000)
Outstanding ending balance (in shares)	13,000	3,000
Grant Date Weighted- Average Fair Value
Grant Date Weighted-Average Fair Value, Outstanding (in dollars per share)	$ 3.03	$ 2.68
Grant Date Weighted-Average Fair Value, Granted (in dollars per share)	1.96	2.50
Grant Date Weighted-Average Fair Value, Vested (in dollars per share)	1.98	2.47
Grant Date Weighted-Average Fair Value, Outstanding (in dollars per share)	1.97	3.03
Intrinsic Value
Intrinsic Value, Outstanding (in dollars per share)	0	0
Intrinsic Value, Granted (in dollars per share)	0	0
Intrinsic Value, Vested (in dollars per share)	0	0
Intrinsic Value, Outstanding (in dollars per share)	$ 2,000	$ 0

STOCK-BASED COMPENSATION EXPE_5

STOCK-BASED COMPENSATION EXPENSE - Disclosure of Share-based Compensation Arrangements by Share-based Payment Award (Details) - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	$ 299
Shares vested in period (in shares)	103
Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	$ 17	$ 141
Shares vested in period (in shares)	0
RSUs Issued in Lieu of Retainer Fees
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	$ 80
Shares vested in period (in shares)	0
Annual RSU Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	$ 7
Shares vested in period (in shares)	3
Executive Compensation
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	$ 195
Shares vested in period (in shares)	100

STOCK-BASED COMPENSATION EXPE_6

STOCK-BASED COMPENSATION EXPENSE - Share-based Compensation, Stock Options, Activity (Details) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Number of Options
Outstanding beginning balance (in shares)	417,000	450,000	613,000	417,000	450,000	613,000
Granted (in shares)	10,000	18,000
Exercised (in shares)	0	(16,000)
Forfeited (in shares)	(43,000)	(165,000)
Outstanding ending balance (in shares)	417,000	450,000	613,000
Number of Options, Exercisable (in shares)				405,000	425,000
Weighted Average Exercise Price
Weighted Average Exercise Price, Beginning balance (in dollars per share)	$ 2.78	$ 2.85
Weighted Average Exercise Price, Granted (in dollars per share)	1.88	2.87
Weighted Average Exercise Price, Exercised (in dollars per share)		2.59
Weighted Average Exercise Price, Forfeited (in dollars per share)	2.54	3.07
Weighted Average Exercise Price, Ending balance (in dollars per share)	$ 2.79	$ 2.78	$ 2.85
Weighted Average Exercise Price, Exercisable (in dollars per share)				$ 2.80	$ 2.79
Weighted Average Remaining Contractual Term (Years)
Weighted Average Remaining Contractual Term (Years)	1 year 7 months 9 days	2 years 5 months 8 days	3 years 1 month 20 days
Weighted Average Remaining Contractual Term (Years) Granted	7 years	7 years
Weighted Average Remaining Contractual Term (Years), Exercisable	1 year 5 months 23 days	2 years 3 months
Aggregate Intrinsic Value
Aggregate Intrinsic Value, Balance				$ 2,000	$ 27,000	$ 0
Aggregate Intrinsic Value, Exercisable				$ 0	$ 0

STOCK-BASED COMPENSATION EXPE_7

STOCK-BASED COMPENSATION EXPENSE - Schedule of Nonvested Share Activity (Details) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Number of Options
Outstanding beginning balance (in shares)	25	125
Granted (in shares)	10	18
Vested (in shares)	(23)	(118)
Outstanding ending balance (in shares)	12	25
Weighted Average Grant-Date Fair Value
Grant Date Weighted-Average Fair Value, Outstanding (in dollars per share)	$ 1.40	$ 1.20
Grant Date Weighted-Average Fair Value, Granted (in dollars per share)	0.78	1.54
Weighted Average Grant-Date Fair Value, Nonvested, Vested (in dollars per share)	1.22	1.22
Grant Date Weighted-Average Fair Value, Outstanding (in dollars per share)	$ 1.07	$ 1.40

STOCK-BASED COMPENSATION EXPE_8

STOCK-BASED COMPENSATION EXPENSE - Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions (Details)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Stockholders' Equity Note [Abstract]
Expected life (years)	7 years	7 years
Expected forfeiture rate	0.00%	0.00%
Expected volatility	40.00%	50.00%
Dividend yield	0.00%	0.00%
Risk-free interest rate	0.40%	1.90%

RETIREMENT PLAN (Details Textua

RETIREMENT PLAN (Details Textual) - USD ($) $ in Thousands	12 Months Ended
RETIREMENT PLAN (Details Textual) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Retirement Benefits [Abstract]
Employer matching contribution, percent of employee gross pay	4.00%
Cost of contribution	$ 37	$ 38

OPERATING LEASES (Details)

OPERATING LEASES (Details) $ in Thousands	Dec. 31, 2020USD ($)
Leases, Operating [Abstract]
2021	$ 350
2022	355
2023	259
2024	8
Total Future Minimum Payments Due	$ 972

OPERATING LEASES - Narrative (D

OPERATING LEASES - Narrative (Details)	Aug. 13, 2016	Dec. 31, 2020USD ($)ft²	Dec. 31, 2019USD ($)
Leases, Operating [Abstract]
Lease expiration period	7 years
Area of facility \| ft²		1,600
Monthly lease expense		$ 7,800
Rent expense		$ 404,000	$ 380,000

COMMITMENTS AND CONTINGENCIES -

COMMITMENTS AND CONTINGENCIES - Narrative (Details) $ in Thousands	Sep. 05, 2017USD ($)	Dec. 31, 2020USD ($)reloadinstallpurchase
Commitments And Contingencies [Line Items]
Number of Cobalt-60 reloads \| reload		3
Number of Leksell Gamma Knife Icon System installs \| install		4
Number of purchase commitments \| purchase		2
Gamma Knife Perfexion System
Commitments And Contingencies [Line Items]
Long-term purchase commitment amount		$ 12,210
LINAC system
Commitments And Contingencies [Line Items]
Long-term purchase commitment amount		12,210
Service commitment, amount		$ 10,493
LINAC system \| Maximum
Commitments And Contingencies [Line Items]
Service commitment, period		9 years
LINAC system \| Minimum
Commitments And Contingencies [Line Items]
Service commitment, period		5 years
Mevion Medical Systems Inc \| Maintenance and Support Agreement (the “Mevion Service Agreement”)
Commitments And Contingencies [Line Items]
Renewal term	5 years
Purchase agreement annual prepayment	$ 1,572
Commitment period	1 year

COMMITMENTS AND CONTINGENCIES_2

COMMITMENTS AND CONTINGENCIES - Schedule of Long-term Purchase Commitment (Details) $ in Thousands	Dec. 31, 2020USD ($)
Long-term Purchase Commitment [Line Items]
Total amounts committed	$ 72,894
2021	12,715
2022-2023	51,747
2024-2025	5,072
After 5 years	3,360
Long-term debt (includes interest)
Long-term Purchase Commitment [Line Items]
Total amounts committed	5,251
2021	1,373
2022-2023	1,854
2024-2025	1,543
After 5 years	481
Finance leases (includes interest)
Long-term Purchase Commitment [Line Items]
Total amounts committed	9,771
2021	6,590
2022-2023	2,659
2024-2025	522
After 5 years	0
Future equipment purchases
Long-term Purchase Commitment [Line Items]
Total amounts committed	46,210
2021	2,175
2022-2023	44,035
2024-2025	0
After 5 years	0
Equipment service contracts
Long-term Purchase Commitment [Line Items]
Total amounts committed	10,493
2021	2,030
2022-2023	2,585
2024-2025	2,999
After 5 years	2,879
Acquisition working capital payments
Long-term Purchase Commitment [Line Items]
Total amounts committed	197
2021	197
2022-2023	0
2024-2025	0
After 5 years	0
Operating leases
Long-term Purchase Commitment [Line Items]
Total amounts committed	972
2021	350
2022-2023	614
2024-2025	8
After 5 years	$ 0

RELATED PARTY TRANSACTIONS (Det

RELATED PARTY TRANSACTIONS (Details Textual)	Dec. 31, 2020reloadupgradeinstall
Related Party Transaction [Line Items]
Number of Cobalt-60 reloads \| reload	3
Number of Perfexion upgrades \| upgrade	1
Number of Leksell Gamma Knife Icon System installs \| install	4
GKF Subsidiary
Related Party Transaction [Line Items]
Noncontrolling Interest, Ownership Percentage by Parent	81.00%
U.S. Subsidiary Of Elekta
Related Party Transaction [Line Items]
Noncontrolling Interest, Ownership Percentage by Parent	19.00%