American Shared Hospital Services (AMS) 10-K 29 Mar 19 2018 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($)	12 Months Ended
	Dec. 31, 2018	Mar. 20, 2019	Jun. 30, 2018
Document and Entity Information [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2018
Document Fiscal Year Focus	2018
Document Fiscal Period Focus	FY
Entity Registrant Name	AMERICAN SHARED HOSPITAL SERVICES
Entity Central Index Key	0000744825
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Filer Category	Non-accelerated Filer
Entity Public Float			$ 10,027,000
Trading Symbol	AMS
Entity Common Stock, Shares Outstanding		5,714,000
Entity Shell Company	false
Entity Emerging Growth Company	false
Entity Small Business	true

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($)	Dec. 31, 2018	Dec. 31, 2017
CURRENT ASSETS
Cash and cash equivalents	$ 1,442,000	$ 2,152,000
Restricted cash	350,000	350,000
Trade accounts receivable, net of allowance for doubtful accounts of $100,000 at December 31, 2018 and December 31, 2017	5,502,000	5,019,000
Other receivables insurance proceeds	1,137,000	0
Other receivables	239,000	216,000
Prepaid expenses and other current assets	1,276,000	1,156,000
Total current assets	9,946,000	8,893,000
PROPERTY AND EQUIPMENT, net	46,694,000	48,491,000
OTHER ASSETS	862,000	792,000
TOTAL ASSETS	57,502,000	58,176,000
CURRENT LIABILITIES
Accounts payable	435,000	359,000
Employee compensation and benefits	207,000	187,000
Other accrued liabilities	1,329,000	1,188,000
Other accrued liabilities insurance payable	977,000	0
Current portion of long-term debt	2,119,000	2,459,000
Current portion of capital leases	4,407,000	4,814,000
Total current liabilities	9,474,000	9,007,000
LONG-TERM DEBT, less current portion	3,332,000	3,598,000
LONG-TERM CAPITAL LEASES, less current portion	10,308,000	12,272,000
DEFERRED REVENUE, less current portion	382,000	504,000
DEFERRED INCOME TAXES	2,958,000	2,910,000
COMMITMENTS AND CONTINGENCIES (See Note 11)
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	10,711,000	10,711,000
Additional paid-in capital	6,495,000	6,272,000
Retained earnings	7,896,000	6,873,000
Total equity- American Shared Hospital Services	25,102,000	23,856,000
Non-controlling interests in subsidiaries	5,946,000	6,029,000
Total shareholders' equity	31,048,000	29,885,000
TOTAL LIABILITIES AND SHAREHOLDERS' EQUITY	$ 57,502,000	$ 58,176,000

CONSOLIDATED BALANCE SHEETS _Pa

CONSOLIDATED BALANCE SHEETS [Parenthetical] - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Allowance for doubtful accounts (in dollars)	$ 100,000	$ 100,000
Common stock, shares authorized	10,000,000	10,000,000
Common stock, shares issued	5,714,000	5,710,000
Common stock, shares outstanding	5,714,000	5,710,000

STATEMENTS OF OPERATIONS

STATEMENTS OF OPERATIONS - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Revenues:
Revenues	$ 19,714,000	$ 19,556,000	$ 18,700,000
Costs of revenue:
Maintenance and supplies	2,399,000	1,359,000	874,000
Depreciation and amortization	6,745,000	6,601,000	6,262,000
Other direct operating costs	3,084,000	2,933,000	2,769,000
Costs of revenue	12,228,000	10,893,000	9,905,000
Gross margin	7,486,000	8,663,000	8,795,000
Selling and administrative expense	3,994,000	4,323,000	3,802,000
Interest expense	1,631,000	1,927,000	1,707,000
Operating income	1,861,000	2,413,000	3,286,000
Proceeds received from investment in equity securities	22,000	0	0
(Loss) on write down of investment in equity securities	0	(579,000)	0
(Loss) on early extinguishment of debt	0	0	(108,000)
Interest and other income	198,000	3,000	15,000
Income before income taxes	2,081,000	1,837,000	3,193,000
Income tax expense (benefit)	451,000	(1,103,000)	943,000
Net income	1,630,000	2,940,000	2,250,000
Less: net income attributable to non-controlling interests	(607,000)	(1,017,000)	(1,320,000)
Net income attributable to American Shared Hospital Services	$ 1,023,000	$ 1,923,000	$ 930,000
Net income per share attributable to American Shared Hospital Services:
Income per common share- basic	$ 0.18	$ 0.33	$ 0.17
Income per common share- diluted	$ 0.17	$ 0.33	$ 0.17
Health Care [Member]
Revenues:
Revenues	$ 19,714,000	$ 19,556,000	$ 18,700,000

CONSOLIDATED STATEMENT OF SHARE

CONSOLIDATED STATEMENT OF SHAREHOLDERS' EQUITY - USD ($)	Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	Sub-Total ASHS [Member]	Non-controlling Interest [Member]
Balances at Dec. 31, 2015	$ 25,180,000	$ 10,376,000	$ 5,734,000	$ 4,020,000	$ 20,130,000	$ 5,050,000
Balances (in shares) at Dec. 31, 2015		5,364,000
Stock-based compensation expense	215,000	$ 0	215,000	0	215,000	0
Stock-based compensation expense (in shares)		4,000
Proceeds from warrants exercised	220,000	$ 220,000	0	0	220,000	0
Proceeds from warrants exercised (in shares)		100,000
Non-controlling interest investment in subsidiaries	7,000	$ 0	0	0	0	7,000
Cash distributions to non-controlling interests	(699,000)	0	0	0	0	(699,000)
Net income	2,250,000	0	0	930,000	930,000	1,320,000
Balances at Dec. 31, 2016	27,173,000	$ 10,596,000	5,949,000	4,950,000	21,495,000	5,678,000
Balances (in shares) at Dec. 31, 2016		5,468,000
Stock-based compensation expense	323,000	$ 0	323,000	0	323,000	0
Stock-based compensation expense (in shares)		4,000
Restricted stock awards	0	$ 0	0	0	0	0
Restricted stock awards (in shares)		162,000
Warrants and options exercised	115,000	$ 115,000	0	0	115,000	0
Warrants and options exercised (in shares)		76,000
Cash distributions to non-controlling interests	(666,000)	$ 0	0	0	0	(666,000)
Net income	2,940,000	0	0	1,923,000	1,923,000	1,017,000
Balances at Dec. 31, 2017	29,885,000	$ 10,711,000	6,272,000	6,873,000	23,856,000	6,029,000
Balances (in shares) at Dec. 31, 2017		5,710,000
Stock-based compensation expense	223,000	$ 0	223,000	0	223,000	0
Stock-based compensation expense (in shares)		4,000
Cash distributions to non-controlling interests	(690,000)	$ 0	0	0	0	(690,000)
Net income	1,630,000	0	0	1,023,000	1,023,000	607,000
Balances at Dec. 31, 2018	$ 31,048,000	$ 10,711,000	$ 6,495,000	$ 7,896,000	$ 25,102,000	$ 5,946,000
Balances (in shares) at Dec. 31, 2018		5,714,000

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
OPERATING ACTIVITIES
Net income	$ 1,630,000	$ 2,940,000	$ 2,250,000
Adjustments to reconcile net income to net cash from operating activities:
Depreciation and amortization	6,818,000	6,677,000	6,327,000
Loss on disposal of assets	0	15,000	0
Loss on early extinguishment of debt	0	0	108,000
Loss on write down investment in equity securities	0	579,000	0
Amortization of accrued interest on lease financing	0	80,000	0
Deferred income tax expense (benefit)	48,000	(1,266,000)	772,000
Accrued interest on lease financing	39,000	33,000	414,000
Stock-based compensation expense	223,000	323,000	215,000
Other non-cash items	0	0	4,000
Changes in operating assets and liabilities:
Receivables	(420,000)	(860,000)	(1,230,000)
Prepaid expenses and other assets	(231,000)	(793,000)	(283,000)
Accounts payable, accrued liabilities and deferred revenue	115,000	125,000	(199,000)
Net insurance proceeds receivable	(160,000)	0	0
Net cash from operating activities	8,062,000	7,853,000	8,378,000
INVESTING ACTIVITIES
Payment for purchase of property and equipment	(1,577,000)	(803,000)	(1,042,000)
Proceeds from insurance	51,000	0	0
Proceeds from sale of equipment	0	150,000	0
Net cash (used in) investing activities	(1,526,000)	(653,000)	(1,042,000)
FINANCING ACTIVITIES
Principal payments on long-term debt	(2,467,000)	(2,314,000)	(2,968,000)
Principal payments on capital leases	(4,089,000)	(4,954,000)	(4,171,000)
Capital contributions from non-controlling interests	0	0	7,000
Distributions to non-controlling interests	(690,000)	(666,000)	(699,000)
Proceeds from warrants and options exercised	0	115,000	220,000
Proceeds from capital lease financing for reimbursement of payments for acquisition of equipment	0	0	1,137,000
Net cash (used in) financing activities	(7,246,000)	(7,819,000)	(6,474,000)
Net change in cash and cash equivalents	(710,000)	(619,000)	862,000
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, beginning of year	2,502,000	3,121,000	2,259,000
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, end of year	1,792,000	2,502,000	3,121,000
SUPPLEMENTAL CASH FLOW DISCLOSURE
Cash paid for interest	1,727,000	1,712,000	2,150,000
Cash paid for income taxes	459,000	126,000	266,000
SCHEDULE OF NONCASH INVESTING AND FINANCING ACTIVITIES
Acquisition of equipment with capital lease financing	1,679,000	2,153,000	8,878,000
Acquisition of equipment with long-term debt financing	1,853,000	992,000	570,000
Insurance proceeds receivable and due	$ 977,000	$ 0	$ 0

BUSINESS AND BASIS OF PRESENTAT

BUSINESS AND BASIS OF PRESENTATION	12 Months Ended
	Dec. 31, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block]	Note 1 – Business and Basis of Presentation Business – These consolidated financial statements include the accounts of American Shared Hospital Services (the “Company”) and its subsidiaries 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 also 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 also the majority-owner of the subsidiaries Albuquerque GK Equipment, LLC (“AGKE”), and Jacksonville GK Equipment, LLC (“JGKE”). The Company (through ASRS) and Elekta AB, the manufacturer of the Gamma Knife (through its wholly-owned United States subsidiary, GKV Investments, Inc.), entered into an operating agreement and formed GK Financing, LLC. During 2018 GKF provided Gamma Knife units to sixteen medical centers in the United States in the states of Arkansas, California, Florida, Illinois, Massachusetts, Mississippi, Nebraska, Nevada, New Jersey, New Mexico, New York, Ohio, Oregon, Tennessee, and Texas. GKF also owns and operates a single-unit Gamma Knife facility in Lima, Peru. 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 also directly provides radiation therapy and related equipment, including Intensity Modulated Radiation Therapy (“IMRT”), Image Guided Radiation Therapy (“IGRT”) and a CT Simulator to the radiation therapy department at an existing Gamma Knife site in Massachusetts. The Company formed the subsidiaries GKPeru and GK Financing U.K., Limited (“GKUK”) for the purposes of expanding its business internationally into Peru and the United Kingdom, respectively; Orlando and LBE to provide proton beam therapy equipment and services in Orlando, Florida and Long Beach, California; 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. GKUK was dissolved in November 2018. The Company continues to develop its design and business model for “The Operating Room for the 21st Century” SM 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.

ACCOUNTING POLICIES

ACCOUNTING POLICIES	12 Months Ended
	Dec. 31, 2018
Accounting Policies [Abstract]
Significant Accounting Policies [Text Block]	Note 2 – Accounting Policies 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 $113,000, $140,000, and $279,000 during the years ended December 31, 2018, 2017 and 2016, respectively. 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, 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, twenty, and eighteen customers in 2018, 2017, and, 2016, respectively. One customer accounted for approximately 26%, 21%, and 10% of the Company’s total revenue in 2018, 2017, and, 2016, respectively. At December 31, 2018 and 2017, three customers each individually accounted for more than 10% 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 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 and other comprehensive 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. 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 $115,000, $138,000, and $443,000 in 2018, 2017, and, 2016, respectively, as costs of medical equipment. The Company leases Gamma Knife and radiation therapy equipment to its customers under arrangements typically accounted for as operating leases. At December 31, 2018, the Company held equipment under operating lease contracts with customers with an original cost of $94,031,000 and accumulated depreciation of $53,716,000. At December 31, 2017, the Company held equipment under operating lease contracts with customers with an original cost of $95,923,000 and accumulated depreciation of $51,403,000. In April 2017, an existing customer exercised their option to purchase the Gamma Knife unit at its hospital at the end of the lease term for a predetermined purchase price, pursuant to the lease agreement. The lease terminated in April 2017, at which time, the unit was depreciated to the purchase price of the sale. Based on the guidance provided in 360 Property, Plant and Equipment During the year ended December 31, 2018, the Company recorded a receivable of $1,137,000 for insurance coverage related to damage that was incurred on the Company’s PBRT unit. The Company contracted with Mevion Medical Systems, Inc. (“Mevion”), formerly Still River Systems, to repair the damaged unit and incurred repair costs of approximately $977,000, which is included in the Company’s consolidated balance sheet for the year ended December 31, 2018. The Company recorded $185,000 of income from its business interruption insurance for the period the PBRT unit was down undergoing repair. All insurance proceeds and related costs were received and paid subsequent to year-end. 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, 2018 and 2017 were as follows (in thousands): Level 1 Level 2 Level 3 Total Carrying Value December 31, 2018 Assets: Cash, cash equivalents, restricted cash $ 1,792 $ - $ - $ 1,792 $ 1,792 Total $ 1,792 $ - $ - $ 1,792 $ 1,792 Liabilities Debt obligations $ - $ - $ 5,431 $ 5,431 $ 5,451 Total $ - $ - $ 5,431 $ 5,431 $ 5,451 December 31, 2017 Assets: Cash, cash equivalents, restricted cash $ 2,502 $ - $ - $ 2,502 $ 2,502 Total $ 2,502 $ - $ - $ 2,502 $ 2,502 Liabilities Debt obligations $ - $ - $ 6,082 $ 6,082 $ 6,057 Total $ - $ - $ 6,082 $ 6,082 $ 6,057 Revenue recognition Leases Revenue from Contracts with Customers Rental income $ 18,987,000 Patient income – 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 8 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 Vice President of Sales and Business Development and its Chief Operating Officer. The Company’s current business is the outsourcing of stereotactic radiosurgery services and radiation therapy services. 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 See Note 7 for further discussion on income taxes. Functional currency Foreign Currency Matters 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. The fair value of the ARO liability is not reasonable to estimate at this time, due to uncertainties about timing, cost and, outcome of the ARO, therefore no liability has been recorded as of December 31, 2018. The Company will re-evaluate this position 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. The following table illustrates the computations of basic and diluted earnings per share for the years ended December 31, 2018, 2017 and 2016. 2018 2017 2016 Numerator for basic and diluted earnings per share $ 1,023,000 $ 1,923,000 $ 930,000 Denominator: Denominator for basic and diluted earnings per share – weighted-average shares 5,836,000 5,754,000 5,570,000 Effect of dilutive securities Employee stock options and restricted stock 17,000 130,000 13,000 Denominator for diluted earnings per share – adjusted weighted-average shares 5,853,000 5,884,000 5,583,000 Earnings per common share- basic $ 0.18 $ 0.33 $ 0.17 Earnings per common share- diluted $ 0.17 $ 0.33 $ 0.17 In 2018, options outstanding to purchase 519,000 shares of common stock at an exercise price range of $2.82 - $3.90 per share and 4,000 restricted stock units were not included in the calculation of diluted earnings per share because they would be anti-dilutive. In 2017, options outstanding to purchase 14,000 shares of common stock at an exercise price of $3.90 per share and 4,000 restricted stock units were not included in the calculation of diluted earnings per share because they would be anti-dilutive. In 2016, options outstanding to purchase 581,000 shares of common stock at an exercise price range of $2.43 - $3.15 per share and 4,000 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 has analyzed its subsidiaries which are all in the business of leasing radiosurgery and radiation therapy equipment to healthcare providers, and concluded there is one reportable segment, Medical Services Revenue. The Company provides Gamma Knife, PBRT, and IGRT equipment to sixteen hospitals in the United States and owns and operates a single-unit facility in Lima, Peru as of December 31, 2018. These seventeen locations operate under different subsidiaries of the Company, but offer the same service, radiosurgery and radiation therapy. The operating results of the subsidiaries are reviewed by the Company’s Chief Executive Officer and Chief Financial Officer, who are also deemed the Company’s Chief Operating Decision Makers (“CODMs”) and this is done in conjunction with all of the subsidiaries and locations. Geographical information The Company did not have any international operations as of December 31, 2016 , but the Company’s single-unit facility in Peru treated its first patient in July 2017 . The following table provides a break out of domestic and foreign allocations of medical services revenues and net property and equipment: 2018 2017 2016 Medical services revenues Domestic 96 % 99 % 100 % Foreign 4 % 1 % 0 % Total 100 % 100 % 100 % 2018 2017 2016 Property and equipment, net Domestic 93 % 93 % 93 % Foreign 7 % 7 % 7 % Total 100 % 100 % 100 % 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. No such impairment has been noted as of December 31, 2018 and 2017. Accounting pronouncement issued and not yet adopted – Leases Leases (Topic 842) Codification Improvements to Topic 842, Leases Leases (Topic 842) Targeted Improvements Leases (Topic 842) Narrow-Scope Improvements Leases (Topic 842) Codification Improvements $ 1.0 M for its operating leases at January 1, 2019 , with no initial material impact to its consolidated statements of operations. In June 2016, the FASB issued ASU No. 2016-13 Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments (“ASU 2016-13”), which requires measurement and recognition of expected credit losses for financial assets held. The new guidance is effective for fiscal periods beginning after December 15, 2018. The Company does not expect ASU 2016-13 to have a significant impact on its consolidated financial statements and related disclosures. 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 2016-01. 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 does not expect ASU 2018-03 or ASU 2018-13 to have a significant impact on its consolidated financial statements and related disclosures. In July 2018, the FASB issued ASU No. 2018-09, Codification Improvements (“ASU 2018-09”). This standard does not prescribe any new accounting guidance, but instead makes minor improvements and clarifications of several different FASB Accounting Standards Codification areas based on comments and suggestions made by various stakeholders. Certain updates are applicable immediately while others provide for a transition period to adopt as part of the next fiscal year beginning after December 15, 2018. The Company is currently evaluating this guidance to determine the impact it may have on its consolidated financial statements.

PROPERTY AND EQUIPMENT

PROPERTY AND EQUIPMENT	12 Months Ended
	Dec. 31, 2018
Property, Plant and Equipment [Abstract]
Property, Plant and Equipment Disclosure [Text Block]	Note 3 – Property and Equipment Property and equipment consists of the following: DECEMBER 31, 2018 2017 Medical equipment and facilities $ 94,031,000 $ 95,923,000 Office equipment 589,000 576,000 Deposits and construction in progress 3,832,000 1,658,000 Deposits towards purchase of proton beam systems 2,250,000 2,000,000 100,702,000 100,157,000 Accumulated depreciation (54,008,000 ) (51,666,000 ) Net property and equipment $ 46,694,000 $ 48,491,000 The Company has equipment that is secured under capitalized leases, which is included in Medical equipment and facilities, with a total cost of $46,559,000 and associated accumulated depreciation of $20,292,000 as of December 31, 2018 and a total cost of $44,758,000 and associated accumulated depreciation of $16,777,000 as of December 31, 2017. As of December 31, 2018, the Company has one idle Gamma Knife unit with a cumulative net book value of $729,000. There are currently no commitments to place into service or trade in this unit during 2019. As of December 31, 2018, the Company has $3,832,000 in construction in progress. The construction in progress consists of costs associated with the Company’s new Gamma Knife site, which began treating patients in January 2019, deposits payments made for two Cobalt-60 reloads, capitalized and imputed interest, and other costs associated with on-going projects of the Company. As of December 31, 2018, the Company has $2,250,000 in deposits toward the purchase of two MEVION S250i PBRT systems from Mevion. The Company has a commitment for the remaining balance for each system. The Company’s first MEVION S250 treated its first patient in April 2016. The Company has entered into a partnership agreement (LBE) with a radiation oncology physician group, which has contributed $400,000 towards the deposits on the third machine. The Company currently does not have customer contracts for the second and third units. The Company reviews the carrying value of these 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, 2018 and has not identified any impairment. See Note 11-Commitments and Contingencies for additional discussion on purchase commitments.

INVESTMENT IN EQUITY SECURITIES

INVESTMENT IN EQUITY SECURITIES	12 Months Ended
	Dec. 31, 2018
Investments, All Other Investments [Abstract]
Cost-method Investments, Description [Text Block]	Note 4 – Investment in Equity Securities As of December 31, 2018 and 2017 the Company had a $0 investment in the common stock of Mevion. Based on guidance provided in ASC 320 Investments–Debt and Equity Securities Other Than Temporary Impairment (“OTTI”) of Certain Investments in Equity Securities During the period ended December 31, 2015, the Company engaged a third-party expert to review and corroborate its assessment of the fair value of the Mevion investment. Based on the third-party analysis, an additional impairment loss of $26,000 was recognized by the Company during the three months ended December 31, 2015. The fair value of the Company’s investment in Mevion, as of December 31, 2015 was approximately $579,000. The impairment loss for the year ended December 31, 2015 was $2,140,000. During the year ended December 31, 2017, the Company reviewed its investment in Mevion and determined the fair value of its investment was $0. Based on the Company’s assessment of its investment in Mevion, the Company recognized an impairment loss for the year then ended December 31, 2017 of $579,000. During 2018, Mevion entered into a merger transaction with Mevion Medical Technology Group Limited, and the Company’s common shares in Mevion were cancelled.

LONG-TERM DEBT

LONG-TERM DEBT	12 Months Ended
	Dec. 31, 2018
Debt Disclosure [Abstract]
Long-term Debt [Text Block]	Note 5 – 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 $13,016,000, the individual customer contracts and related accounts receivable at December 31, 2018. These notes are payable in 36 to 84 fully amortizing monthly installments, mature between December 2019 and March 2026, and are collateralized by the respective Gamma Knife units. The notes accrue interest at fixed annual rates between 4.96% and 6.90%. The following are contractual maturities of long-term debt by year at December 31, 2018: Year ending December 31, Principal Interest 2019 $ 2,119,000 $ 276,000 2020 1,378,000 163,000 2021 712,000 100,000 2022 263,000 71,000 2023 280,000 54,000 Thereafter 699,000 53,000 $ 5,451,000 $ 717,000

OBLIGATIONS UNDER CAPITAL LEASE

OBLIGATIONS UNDER CAPITAL LEASES	12 Months Ended
	Dec. 31, 2018
Debt Disclosure [Abstract]
Debt and Capital Leases Disclosures [Text Block]	Note 6 – Obligations Under Capital Leases The Company has eleven capital lease obligations with three financing companies, collateralized by Gamma Knife and PBRT equipment having an aggregate net book value of $26,267,000, the individual customer contracts and related accounts receivable at December 31, 2018. These obligations have imputed interest rates ranging between 4.73% and 13.00%, are payable in 44 to 84 monthly installments, and mature between July 2019 and October 2024. As of December 31, 2017, the Company had twelve capital lease obligations with four financing companies, collateralized by Gamma Knife and PBRT equipment having an aggregate net book value of $27,981,000. 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 capital leases at December 31, 2018, are summarized as follows: Net Present Value of Minimum Lease Payments Year ending December 31, 2019 $ 5,524,000 2020 4,017,000 2021 5,992,000 2022 970,000 2023 524,000 Thereafter 308,000 Total capital lease payments 17,335,000 Less imputed interest 2,620,000 14,715,000 Less current portion 4,407,000 $ 10,308,000

INCOME TAXES

INCOME TAXES	12 Months Ended
	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Income Tax Disclosure [Text Block]	Note 7 – Income Taxes As of December 31, 2018, 2017 and 2016 the Company recorded income tax provision expense of $451,000, an income tax provision benefit of $ 1,103,000 The increase in the Company’s provision for income taxes as of December 31, 2018 and December 31, 2016 is due to income from the PBRT system and operations of the Company’s subsidiaries. The income tax provision benefit recognized as of December 31, 2017 was due to the Tax Act. The components of the provision for income taxes as of December 31, 2018, 2017 and 2016 consist of the following: YEARS ENDED DECEMBER 31, 2018 2017 2016 Current: Federal $ 13,000 $ 55,000 $ 24,000 State 389,000 109,000 146,000 Total current 402,000 164,000 170,000 Deferred: Federal 259,000 (1,335,000 ) 680,000 State (210,000 ) 68,000 93,000 Total deferred 49,000 (1,267,000 ) 773,000 $ 451,000 $ (1,103,000 ) $ 943,000 Significant components of the Company’s deferred tax liabilities and assets as of December 31, 2018 and 2017 are as follows: DECEMBER 31, 2018 2017 Deferred tax liabilities: Property and equipment $ (3,566,000 ) $ (5,009,000 ) Total deferred tax liabilities (3,566,000 ) (5,009,000 ) Deferred tax assets: Net operating loss carryforwards 80,000 1,421,000 Accruals and allowances 275,000 157,000 Tax credits 194,000 438,000 Other – net 206,000 186,000 Capital loss carryover 948,000 959,000 Total deferred tax assets 1,703,000 3,161,000 Valuation allowance (1,096,000 ) (1,062,000 ) Deferred tax assets net of valuation allowance 607,000 2,099,000 Net deferred tax liabilities $ (2,959,000 ) $ (2,910,000 ) These amounts are presented in the financial statements as follows: DECEMBER 31, 2018 2017 Deferred income taxes (non-current) $ (2,959,000 ) $ (2,910,000 ) $ (2,959,000 ) $ (2,910,000 ) The (benefit) provision for income taxes differs from the amount computed by applying the U.S. federal statutory tax rate (21% in 2018, and 34% in 2017 and 2016) to income before taxes as follows: YEARS ENDED DECEMBER 31, 2018 2017 2016 Computed expected federal income tax $ 313,000 $ 279,000 $ 637,000 State income taxes, net of federal benefit 125,000 28,000 169,000 Non-deductible expenses (12,000 ) 41,000 42,000 Impact of US Tax Reform - (1,546,000 ) - Change in valuation allowance 34,000 180,000 25,000 Other (9,000 ) (85,000 ) 70,000 $ 451,000 $ (1,103,000 ) $ 943,000 On December 22, 2017, the U.S. government enacted the Tax Act. The Tax Act makes broad and complex changes to the U.S. tax code including, but not limited to, requiring a one-time transition tax on certain unrepatriated earnings of foreign subsidiaries that is payable over eight years (the "Transition Tax"), a reduction of the U.S. federal corporate tax rate from 34% to 21%, a general elimination of U.S. federal income taxes on dividends from foreign subsidiaries, net operating loss deduction limitations, a base erosion, anti-tax abuse tax (“BEAT”) and a deduction for foreign-derived intangible income (“FDII”) and a new provision designed to tax global intangible low-taxed income ("GILTI"). In December 2017, the SEC staff issued SAB No. 118 (“SAB 118”) which provides guidance on accounting for the tax effects of the Tax Act. SAB 118 provides a measurement period that should not extend beyond one year from the Tax Act enactment date for companies to complete the accounting under ASC 740 Income taxes Beginning in 2018, the GILTI provisions in the Tax Act require us to include, in our U.S. income tax return, foreign subsidiary earnings in excess of an allowable return on the foreign subsidiary’s tangible assets. Per guidance issued by the FASB, companies can either account for deferred taxes related to GILTI or treat tax arising from GILTI as a period cost. Both are acceptable methods subject to an accounting policy election. On December 31, 2018, we finalized our policy and have elected to use the period cost method for GILTI. In 2018, we did not incur any GILTI inclusion as our foreign subsidiaries generated losses. The BEAT provisions in the Tax Act eliminate the deduction of certain base-erosion payments made to related foreign corporations, and impose a minimum base erosion anti-abuse tax if greater than regular tax. In 2018, our Company was not subject to BEAT as it did not meet the requirements to be subject to BEAT. At December 31, 2018, the Company is expected to utilize 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 $636,000 that begin to expire in 2029. The Company has net operating loss carryforwards for Peru and UK income tax purposes of approximately $444,000. Utilization of the domestic NOL and tax credit forwards may be subject to a substantial annual limitation due to ownership change limitations that may have occurred or that could occur in the future, as required by the Internal Revenue Code Section 382, as well as similar state provisions. In general, an “ownership change,” as defined by the code, results from a transaction or series of transactions over a three-year period resulting in an ownership change of more than 50 percentage points of the outstanding stock of a company by certain stockholders or public groups. Any limitation may result in expiration of all or a portion of the NOL or tax credit carryforwards before utilization. At December 31, 2018, the Company has a capital loss carryforward for federal income tax return purposes of approximately $3,873,000 which starts to expire in 2020. The Company has capital loss carryforwards for state income tax purposes of approximately $195,000 which starts to expire in 2020. 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 increased by $34,000, $303,000, and $25,000 for the tax years ended December 31, 2018, 2017, and 2016, respectively. The tax return years 2014 through 2017 remain open to examination by the major domestic taxing jurisdictions to which the Company is subject. The Company is currently under examination in New York State for tax years 2015 through 2017. The Company believes the examination will conclude 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, 2018, the unrecognized tax benefit was $87,000 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, 2018 2017 2016 Balance at beginning of year $ - $ - $ - Additions based on tax positions of prior years 87,000 - - Balance at end of year $ 87,000 $ - $ - The Company's policy for deducting interest and penalties is to treat interest as interest expense and penalties as taxes. As of December 31, 2018, the Company had no amount accrued for the payment of interest and penalties related to unrecognized tax benefits. The Company does not expect any material changes to our uncertain tax positions within the next 12 months.

SHAREHOLDERS' EQUITY

SHAREHOLDERS' EQUITY	12 Months Ended
	Dec. 31, 2018
Stockholders' Equity Note [Abstract]
Stockholders' Equity Note Disclosure [Text Block]	Note 8 – Shareholders’ Equity 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 27, 2017, 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, 2020. As of December 31, 2018, approximately 320,000 shares remain available for grant under the Plan. The Plan provides for nonqualified stock options, qualified (or incentive) stock options and stock grants. The Plan has a provision to reduce the number of shares reserved for award and issuance under the Plan by a ratio of 1.59 shares of common stock for each share of common stock that is issued pursuant to a Full Value Award (stock grant). The Plan also provides for an Incentive Bonus Program with incentive bonus opportunities through performance unit awards and special cash incentive programs tied to the attainment of pre-established performance milestones. Provisions of the Plan include an automatic annual grant to each non-employee director of options to purchase up to 2,000 shares on the date of the Company’s Annual Shareholder Meeting, at an exercise price equal to the market price of the Company’s common shares on that date, an automatic annual grant of 500 restricted stock units of the Company’s common shares and an annual cash retainer fee for Board or Board Committee service, which may be converted to restricted stock unit awards. Options and restricted stock units awarded under the automatic annual grant program for non-employee directors vest after one year. Restricted stock units awarded in lieu of retainer fees vest quarterly, over a one year period. These awards become outstanding upon the conclusion of the individual Board members service on the Company’s Board of Directors. Other options may vest fully and immediately, or over periods of time as determined by the Plan Administrator, but no longer than seven years from the grant date. Discretionary options currently awarded under the Plan vest over a period of 5 years. Under the Plan, a total of 276,000 restricted stock units have been granted, consisting of 38,000 of annual automatic grants to non-employee directors and the corporate secretary, 228,000 of deferred retainer fees to non-employee members of the Board, and 10,000 grants issued in lieu of commission, to one employee of the Company. Of the total restricted stock units granted under the Plan 272,000 of them are fully vested but not yet deemed issued and outstanding as of December 31, 2018. Changes in restricted stock units, consisting primarily of annual automatic grants and deferred compensation to non-employee directors, under the Incentive Compensation Plans during 2018 and 2017 are as follows: Restricted Stock Units Grant Date Weighted- Average Fair Value Intrinsic Value Outstanding at January 1, 2017 4,000 $ 2.25 $ - Granted 22,000 $ 3.47 $ - Vested (22,000 ) $ 4.06 $ - Outstanding at December 31, 2017 4,000 $ 3.77 $ - Outstanding at January 1, 2018 4,000 $ 3.77 $ - Granted 35,000 $ 2.56 $ - Vested (35,000 ) $ 2.69 $ - Outstanding at December 31, 2018 4,000 $ 2.68 $ - For the year ended December 31, 2018, 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, 2018, total compensation expense recorded in the consolidated statements of income for annual restricted stock units awarded was $13,000, with an offsetting tax benefit of $3,000, as this expense is deductible for income tax purposes. As of December 31, 2018, there was $5,000 of total unrecognized compensation cost related to annual restricted stock units which is expected to be recognized over a period of .5 years. During 2018, 2017, and 2016 shares of restricted stock units totaling 4,000 each, respectively, with a fair value of approximately $11,000, $15,000 and $8,000, respectively, vested and became unrestricted. 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 expire 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 and recognized stock compensation expense of approximately $108,000 related to these awards. As of December 31, 2018 it is not probable that any of the remaining required metrics for vesting will be achieved. The unrecognized stock-based compensation expense for these awards was approximately $434,000 and unvested awards were approximately 129,000 as of December 31, 2018. If and when the Company determines that the remaining performance metrics’ achievement becomes probable, the Company will record a cumulative catch-up stock-based compensation amount and the remaining unrecognized amount will be recorded over the remaining requisite service period of the awards. As of December 31, 2016, the Company had warrants outstanding representing the right to purchase 100,000 shares of the Company’s common stock at $2.20 per share. These warrants were issued with the Notes to four members of the Company’s Board of Directors. See Note 12 – Note, Warrant, & Common Stock Purchase Agreement for further discussion regarding these warrants. During the year ended December 31, 2017, 100,000 of the warrants were exercised. 50,000 of the 100,000 warrants were exercised via a cashless exercise resulting in the net issuance of approximately 25,000 shares. There are no warrants outstanding as of December 31, 2018 and 2017. Changes in stock options outstanding under the Incentive Compensation Plans during 2018 and 2017 are as follows: Weighted Weighted Average Average Remaining Aggregate Number Exercise Contractual Intrinsic Options of Options Price Term (Years) Value Balance at December 31, 2016 625,000 $ 2.85 4.25 Granted 27,000 $ 3.31 6.66 Exercised (4,000 ) $ 2.81 - Forfeited (33,000 ) $ 2.82 - Balance at December 31, 2017 615,000 $ 2.87 3.48 $ 22,000.00 Granted 16,000 $ 2.68 6.46 Forfeited (18,000 ) $ 3.15 - Balance at December 31, 2018 613,000 $ 2.85 3.14 $ - Exercisable at December 31, 2017 395,000 $ 2.86 3.35 $ - Exercisable at December 31, 2018 488,000 $ 2.87 2.55 $ - The weighted average grant-date fair value of the options granted during the years 2018, 2017 and 2016 was $1.45, $1.50, and $0.97, respectively. There were no options exercised and accordingly, no total intrinsic value of options exercised during the year ended December 31, 2018. There were 4,000 options exercised during the year ended December 31, 2017. There were no options exercised and accordingly, no total intrinsic value of options exercised during the year ended December 31, 2016. Total stock-based compensation expense recognized for stock options for the years ended December 2018, 2017, and 2016 was $109,000, $144,000, and $139,000, respectively. The Company received approximately $6,000 from the exercise of 2,000 options under share-based payment arrangements for the year ended December 31, 2017. There was no cash received from options exercised under any share-based payment arrangements for the years ended December 31, 2018 and 2016, and as a result, there was no actual tax benefit realized for tax deductions from option exercises in any of those years. A summary of the status of the Company’s non-vested stock options as of December 31, 2018 and 2017, and changes during the years ended December 31, 2018 and 2017 is presented below: Weighted Average Number Grant-Date Nonvested Options of Options Fair Value Nonvested at December 31, 2016 321,000 $ 1.18 Granted 27,000 $ 1.50 Vested (117,000 ) $ 1.20 Forfeited (11,000 ) $ 1.27 Nonvested at December 31, 2017 220,000 $ 1.20 Granted 16,000 $ 1.45 Vested (111,000 ) $ 1.22 Nonvested at December 31, 2018 125,000 $ 1.20 At December 31, 2018, there was approximately $138,000 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 five 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 2018, 2017 and 2016 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 2018, 2017 and 2016 was estimated using the following assumptions: 2018 2017 2016 Expected life (years) 7.0 7.0 7.0 Expected forfeiture rate 0.0 % 0.0 % 0.0 % Expected volatility 50 % 53 % 53 % Dividend yield 0 % 0 % 0 % Risk-free interest rate 2.9 % 2.0 % 2.0 % 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 2018, 2017 or 2016. There are approximately 72,000 shares remaining under this repurchase authorization.

RETIREMENT PLAN

RETIREMENT PLAN	12 Months Ended
	Dec. 31, 2018
Retirement Benefits [Abstract]
Pension and Other Postretirement Benefits Disclosure [Text Block]	Note 9 – Retirement Plan The Company has a defined-contribution retirement plan (the “Retirement Plan”) that allows for a matching safe harbor contribution. For 2018, the Board of Directors elected to match participant deferred salary contributions up to a maximum of 4% of the participant’s annual compensation. Discretionary profit sharing contributions are allowed under the Retirement Plan in years that the Board does not elect a safe harbor match. The Company has accrued approximately $31,000 for the estimated safe harbor matching contribution for the year ended December 31, 2018. The Company contributed $29,000 and $27,000 to the Retirement Plan for the safe harbor match for the years ended December 31, 2017 and December 31, 2016.

OPERATING LEASES

OPERATING LEASES	12 Months Ended
	Dec. 31, 2018
Leases, Operating [Abstract]
Lessor, Operating Leases [Text Block]	Note 10 – Operating Leases The Company leases office space and equipment under operating leases expiring at various dates through 2019 and 2023. 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 has a satellite office in Fairfield, CA with a lease expiration date in April 2020. Future minimum payments under non-cancelable operating leases, net of expected sublease income, having initial terms of more than one year consisted of the following: Year ending December 31, 2019 $ 275,000 2020 257,000 2021 252,000 2022 259,000 2023 165,000 Thereafter - $ 1,208,000 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 $298,000, $308,000, and $307,000 for the years ended December 31, 2018, 2017 and 2016, respectively, and includes the above operating leases as well as month-to-month rental and certain executory costs. Total rent expense was recognized net of sublease income of $0, $0, and $76,000 for the years ended December 31, 2018, 2017 and 2016, respectively. In 2013, the Company subleased a portion of its existing office space through the remainder of its lease term at a rate lower than its lease rate, resulting in a cumulative loss of $115,000. This loss was amortized against total rent expense over the term of the sublease and it is included in total rent expense for 2016.

COMMITMENTS AND CONTINGENCIES

COMMITMENTS AND CONTINGENCIES	12 Months Ended
	Dec. 31, 2018
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies Disclosure [Text Block]	Note 11 – Commitments and Contingencies On December 20, 2018, the Company signed Second Amendments to two System Build Agreements (the “Amendments”) 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. As of December 31, 2018, the Company had commitments to purchase two MEVION S250i PBRT systems for $34,000,000 and the Company had $2,250,000 in non-refundable deposits toward the purchase of these two PBRT systems from Mevion. The non-refundable deposits are recorded in the Consolidated Balance Sheets as deposits and construction in progress. As of December 31, 2018, the Company had commitments to perform three Cobalt-60 reloads at existing customer sites and purchase one LINAC system, to be placed at a new customer site in 2019. The Cobalt-60 reloads are scheduled to occur in 2019. Total Gamma Knife and LINAC commitments as of December 31, 2018 were $4,235,000. It is the Company’s intent to finance these commitments. 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 and renews annually. The agreement requires an annual prepayment of $1,285,000 which was made on August 6, 2018 for the current contractual period. This payment portion was recorded as a prepaid contract and will be amortized over the one-year service period. The Mevion Service Agreement is for a five (5) year period. On December 20, 2018, the Company signed a Second Amendment to the Mevion Service Agreement, where the Company agreed to increase the annual service payment by $250,000, effective for the second service year, and for each year thereafter, if a second Mevion PBRT unit is not placed at Orlando Health prior to September 2019. The Company has accrued the pro-rata portion of this additional maintenance expense for the year ended December 31, 2018. As of December 31, 2018, the Company had commitments to service and maintain its Gamma Knife and PBRT equipment. The service commitments are carried out via contracts with Mevion and Elekta AB. The Company’s commitment to purchase a LINAC in 2019 includes a 9-year agreement to service the equipment. Total service commitments as of December 31, 2018 were $7,523,000. 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, 2018: 2019 Thereafter Total Proton Beam Units $ - $ 34,000,000 $ 34,000,000 Gamma Knife & Linac Units 4,235,000 - 4,235,000 Service Contracts 1,664,000 5,859,000 7,523,000 Total Commitments $ 5,899,000 $ 39,859,000 $ 45,758,000

NOTE, WARRANT, & COMMON STOCK P

NOTE, WARRANT, & COMMON STOCK PURCHASE AGREEMENT WITH RELATED PARTIES	12 Months Ended
	Dec. 31, 2018
Note, Warrant And Common Stock Purchase Agreement [Abstract]
Note, Warrant And Common Stock Purchase Agreement [Text Block]	Note 12 – Note, Warrant, & Common Stock Purchase Agreement with related parties In October 2014, the Company entered into a Note and Warrant Purchase Agreement (the “Note and Warrant Purchase Agreement”) with four members of the Company’s Board of Directors to issue an aggregate of $1,000,000 in principal amount of promissory notes (the “Notes”) and warrants (the “Warrants”) to purchase an aggregate of 200,000 shares of the common stock, no par value (the “Common Stock”), of the Company (the “Notes and Warrants Offering”). The Notes incurred interest at a rate of 15.0% per annum and had a maturity date of October 22, 2017. Interest only payments were due monthly with the option to prepay the outstanding principal on or after December 31, 2015. The Warrants expire three years after their initial issuance date and may be exercised for a purchase price equal to $2.20 per share of Common Stock, the closing price per share of the Company’s Common Stock on the New York Stock Exchange MKT on the date preceding the date of the Note and Warrant Purchase Agreement. During the year ended December 31, 2016, 100,000 of the warrants were exercised and 100,000 remain outstanding as of the year ended. During the year ended December 31, 2016, the Company paid down the Notes. Based on the guidance provided in accordance with ASC 405 Extinguishment of Liabilities (“ASC 405”) and ASC 470 Debt Modifications and Extinguishments (“ASC 470”), the pay-down of the Notes is considered an extinguishment of debt and, as such, the difference between the net carrying amount of the Notes and the costs of extinguishment was recognized as a loss on the Company’s condensed consolidated statements of operations. During the year ended December 31, 2016, the Company recorded a loss on early extinguishment of debt of $108,000. The Notes were issued with common stock warrants with an estimated fair value of $145,000. The unamortized balance of the discount on the Notes, of $80,000, and deferred fees incurred from the issuance of the Note of approximately $28,000, were recorded as a loss on early extinguishment. Concurrently with the Note and Warrant Purchase Agreement, the Company entered into a common stock purchase agreement (the “Common Stock Purchase Agreement”) with one member of the Company’s Board of Directors to sell, in a private offering, 100,000 shares of the Company’s Common Stock (the “Private Placement Shares”), for gross proceeds of $220,000 (the “Common Stock Offering” and, together with the Notes and Warrants Offering, the “Private Offering”). The Common Stock Purchase Agreement contains terms and conditions that are customary for a transaction of this type. The Company received gross proceeds of $1,220,000 in the Private Offering, which were used, together with cash on hand, to make two payments of $1,000,000 each to Mevion as deposits pursuant to the terms of purchase commitments with Mevion.

RELATED PARTY TRANSACTIONS

RELATED PARTY TRANSACTIONS	12 Months Ended
	Dec. 31, 2018
Related Party Transactions [Abstract]
Related Party Transactions Disclosure [Text Block]	Note 13 –Related Party Transactions The Company’s Gamma Knife business is operated through its 81% indirect interest in its GKF subsidiary. The remaining 19% of GKF is owned by a wholly owned U.S. subsidiary of Elekta, which is the manufacturer of the Gamma Knife. Since the Company purchases its Gamma Knife units from Elekta, there are significant related party transactions with Elekta such as equipment purchases, commitments to purchase equipment, deposits for such equipment purchases, and costs to maintain the equipment. The Company believes that all its transactions with Elekta are arm’s-length transactions. At December 31, 2018, the Company had commitments to purchase three Cobalt-60 reloads, as discussed in Note 11 – Commitments and Contingencies. The Company purchased one MEVION S250 PBRT machine from Mevion, and has $2,250,000 in non-refundable deposits towards the purchase of two additional MEVION S250i machines. The Company believes all of its transactions with Mevion were arm’s-length transactions. See Note 4 – Investment in Equity Securities for additional information.

ACCOUNTING POLICIES (Policies)

ACCOUNTING POLICIES (Policies)	12 Months Ended
	Dec. 31, 2018
Accounting Policies [Abstract]
Use of Estimates, Policy [Policy Text Block]	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, Policy [Policy Text Block]	Advertising costs – The Company expenses advertising costs as incurred. Advertising costs were $113,000, $140,000, and $279,000 during the years ended December 31, 2018, 2017 and 2016, respectively. Advertising costs are recorded in other direct operating costs and sales and administrative costs in the consolidated statements of operations.
Cash and Cash Equivalents, Policy [Policy Text Block]	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.
Cash and Cash Equivalents, Restricted Cash and Cash Equivalents, Policy [Policy Text Block]	Restricted cash – Restricted cash represents the minimum cash that must be maintained in GKF to fund operations, per the subsidiary’s operating agreement, and the minimum cash that must be maintained in Orlando per the subsidiary’s financing agreement.
Business And Credit Risk [Policy Text Block]	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, twenty, and eighteen customers in 2018, 2017, and, 2016, respectively. One customer accounted for approximately 26%, 21%, and 10% of the Company’s total revenue in 2018, 2017, and, 2016, respectively. At December 31, 2018 and 2017, three customers each individually accounted for more than 10% 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.
Trade and Other Accounts Receivable, Policy [Policy Text Block]	Accounts receivable and doubtful accounts
Non-controlling Interests [Policy Text Block]	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 and other comprehensive income allocable to the non-controlling interests and to the shareholders of the Company separately in its consolidated statements of operations.
Property, Plant and Equipment, Policy [Policy Text Block]	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. 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 $115,000, $138,000, and $443,000 in 2018, 2017, and, 2016, respectively, as costs of medical equipment. The Company leases Gamma Knife and radiation therapy equipment to its customers under arrangements typically accounted for as operating leases. At December 31, 2018, the Company held equipment under operating lease contracts with customers with an original cost of $94,031,000 and accumulated depreciation of $53,716,000. At December 31, 2017, the Company held equipment under operating lease contracts with customers with an original cost of $95,923,000 and accumulated depreciation of $51,403,000. In April 2017, an existing customer exercised their option to purchase the Gamma Knife unit at its hospital at the end of the lease term for a predetermined purchase price, pursuant to the lease agreement. The lease terminated in April 2017, at which time, the unit was depreciated to the purchase price of the sale. Based on the guidance provided in 360 Property, Plant and Equipment During the year ended December 31, 2018, the Company recorded a receivable of $1,137,000 for insurance coverage related to damage that was incurred on the Company’s PBRT unit. The Company contracted with Mevion Medical Systems, Inc. (“Mevion”), formerly Still River Systems, to repair the damaged unit and incurred repair costs of approximately $977,000, which is included in the Company’s consolidated balance sheet for the year ended December 31, 2018. The Company recorded $185,000 of income from its business interruption insurance for the period the PBRT unit was down undergoing repair. All insurance proceeds and related costs were received and paid subsequent to year-end.
Fair Value of Financial Instruments, Policy [Policy Text Block]	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, 2018 and 2017 were as follows (in thousands): Level 1 Level 2 Level 3 Total Carrying Value December 31, 2018 Assets: Cash, cash equivalents, restricted cash $ 1,792 $ - $ - $ 1,792 $ 1,792 Total $ 1,792 $ - $ - $ 1,792 $ 1,792 Liabilities Debt obligations $ - $ - $ 5,431 $ 5,431 $ 5,451 Total $ - $ - $ 5,431 $ 5,431 $ 5,451 December 31, 2017 Assets: Cash, cash equivalents, restricted cash $ 2,502 $ - $ - $ 2,502 $ 2,502 Total $ 2,502 $ - $ - $ 2,502 $ 2,502 Liabilities Debt obligations $ - $ - $ 6,082 $ 6,082 $ 6,057 Total $ - $ - $ 6,082 $ 6,082 $ 6,057
Revenue Recognition, Policy [Policy Text Block]	Revenue recognition Leases Revenue from Contracts with Customers Rental income $ 18,987,000 Patient income –
Compensation Related Costs, Policy [Policy Text Block]	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 8 for additional information on the Company’s stock-based compensation programs.
Cost of Sales, Policy [Policy Text Block]	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.
Selling, General and Administrative Expenses, Policy [Policy Text Block]	Sales and Marketing – The Company markets its services through its preferred provider status with Elekta and a direct sales effort led by its Vice President of Sales and Business Development and its Chief Operating Officer. The Company’s current business is the outsourcing of stereotactic radiosurgery services and radiation therapy services. The Company typically provides the equipment, as well as planning, installation, reimbursement and marketing support services.
Income Tax, Policy [Policy Text Block]	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 See Note 7 for further discussion on income taxes.
Foreign Currency Transactions and Translations Policy [Policy Text Block]	Functional currency Foreign Currency Matters
Asset Retirement Obligations Policy [Policy Text Block]	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. The fair value of the ARO liability is not reasonable to estimate at this time, due to uncertainties about timing, cost and, outcome of the ARO, therefore no liability has been recorded as of December 31, 2018. The Company will re-evaluate this position on a periodic basis when facts and circumstances change that could affect this conclusion.
Earnings Per Share, Policy [Policy Text Block]	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. The following table illustrates the computations of basic and diluted earnings per share for the years ended December 31, 2018, 2017 and 2016. 2018 2017 2016 Numerator for basic and diluted earnings per share $ 1,023,000 $ 1,923,000 $ 930,000 Denominator: Denominator for basic and diluted earnings per share – weighted-average shares 5,836,000 5,754,000 5,570,000 Effect of dilutive securities Employee stock options and restricted stock 17,000 130,000 13,000 Denominator for diluted earnings per share – adjusted weighted-average shares 5,853,000 5,884,000 5,583,000 Earnings per common share- basic $ 0.18 $ 0.33 $ 0.17 Earnings per common share- diluted $ 0.17 $ 0.33 $ 0.17 In 2018, options outstanding to purchase 519,000 shares of common stock at an exercise price range of $2.82 - $3.90 per share and 4,000 restricted stock units were not included in the calculation of diluted earnings per share because they would be anti-dilutive. In 2017, options outstanding to purchase 14,000 shares of common stock at an exercise price of $3.90 per share and 4,000 restricted stock units were not included in the calculation of diluted earnings per share because they would be anti-dilutive. In 2016, options outstanding to purchase 581,000 shares of common stock at an exercise price range of $2.43 - $3.15 per share and 4,000 restricted stock units were not included in the calculation of diluted earnings per share because they would be anti-dilutive.
Segment Reporting, Policy [Policy Text Block]	Business segment information – Based on the guidance provided in accordance with ASC 280 Segment Reporting (“ASC 280”), the Company has analyzed its subsidiaries which are all in the business of leasing radiosurgery and radiation therapy equipment to healthcare providers, and concluded there is one reportable segment, Medical Services Revenue. The Company provides Gamma Knife, PBRT, and IGRT equipment to sixteen hospitals in the United States and owns and operates a single-unit facility in Lima, Peru as of December 31, 2018. These seventeen locations operate under different subsidiaries of the Company, but offer the same service, radiosurgery and radiation therapy. The operating results of the subsidiaries are reviewed by the Company’s Chief Executive Officer and Chief Financial Officer, who are also deemed the Company’s Chief Operating Decision Makers (“CODMs”) and this is done in conjunction with all of the subsidiaries and locations. Geographical information The Company did not have any international operations as of December 31, 2016 , but the Company’s single-unit facility in Peru treated its first patient in July 2017 . The following table provides a break out of domestic and foreign allocations of medical services revenues and net property and equipment: 2018 2017 2016 Medical services revenues Domestic 96 % 99 % 100 % Foreign 4 % 1 % 0 % Total 100 % 100 % 100 % 2018 2017 2016 Property and equipment, net Domestic 93 % 93 % 93 % Foreign 7 % 7 % 7 % Total 100 % 100 % 100 %
Impairment or Disposal of Long-Lived Assets, Policy [Policy Text Block]	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. No such impairment has been noted as of December 31, 2018 and 2017.
New Accounting Pronouncements, Policy [Policy Text Block]	Accounting pronouncement issued and not yet adopted – Leases Leases (Topic 842) Codification Improvements to Topic 842, Leases Leases (Topic 842) Targeted Improvements Leases (Topic 842) Narrow-Scope Improvements Leases (Topic 842) Codification Improvements $ 1.0 M for its operating leases at January 1, 2019 , with no initial material impact to its consolidated statements of operations. In June 2016, the FASB issued ASU No. 2016-13 Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments (“ASU 2016-13”), which requires measurement and recognition of expected credit losses for financial assets held. The new guidance is effective for fiscal periods beginning after December 15, 2018. The Company does not expect ASU 2016-13 to have a significant impact on its consolidated financial statements and related disclosures. 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 2016-01. 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 does not expect ASU 2018-03 or ASU 2018-13 to have a significant impact on its consolidated financial statements and related disclosures. In July 2018, the FASB issued ASU No. 2018-09, Codification Improvements (“ASU 2018-09”). This standard does not prescribe any new accounting guidance, but instead makes minor improvements and clarifications of several different FASB Accounting Standards Codification areas based on comments and suggestions made by various stakeholders. Certain updates are applicable immediately while others provide for a transition period to adopt as part of the next fiscal year beginning after December 15, 2018. The Company is currently evaluating this guidance to determine the impact it may have on its consolidated financial statements.

ACCOUNTING POLICIES (Tables)

ACCOUNTING POLICIES (Tables)	12 Months Ended
	Dec. 31, 2018
Accounting Policies [Abstract]
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis [Table Text Block]	The estimated fair value of the Company’s assets and liabilities as of December 31, 2018 and 2017 were as follows (in thousands): Level 1 Level 2 Level 3 Total Carrying Value December 31, 2018 Assets: Cash, cash equivalents, restricted cash $ 1,792 $ - $ - $ 1,792 $ 1,792 Total $ 1,792 $ - $ - $ 1,792 $ 1,792 Liabilities Debt obligations $ - $ - $ 5,431 $ 5,431 $ 5,451 Total $ - $ - $ 5,431 $ 5,431 $ 5,451 December 31, 2017 Assets: Cash, cash equivalents, restricted cash $ 2,502 $ - $ - $ 2,502 $ 2,502 Total $ 2,502 $ - $ - $ 2,502 $ 2,502 Liabilities Debt obligations $ - $ - $ 6,082 $ 6,082 $ 6,057 Total $ - $ - $ 6,082 $ 6,082 $ 6,057
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	The following table illustrates the computations of basic and diluted earnings per share for the years ended December 31, 2018, 2017 and 2016. 2018 2017 2016 Numerator for basic and diluted earnings per share $ 1,023,000 $ 1,923,000 $ 930,000 Denominator: Denominator for basic and diluted earnings per share – weighted-average shares 5,836,000 5,754,000 5,570,000 Effect of dilutive securities Employee stock options and restricted stock 17,000 130,000 13,000 Denominator for diluted earnings per share – adjusted weighted-average shares 5,853,000 5,884,000 5,583,000 Earnings per common share- basic $ 0.18 $ 0.33 $ 0.17 Earnings per common share- diluted $ 0.17 $ 0.33 $ 0.17
Schedule of Domestic and Foreign Break out Percentages [Table Text Block]	The following table provides a break out of domestic and foreign allocations of medical services revenues and net property and equipment: 2018 2017 2016 Medical services revenues Domestic 96 % 99 % 100 % Foreign 4 % 1 % 0 % Total 100 % 100 % 100 % 2018 2017 2016 Property and equipment, net Domestic 93 % 93 % 93 % Foreign 7 % 7 % 7 % Total 100 % 100 % 100 %

PROPERTY AND EQUIPMENT (Tables)

PROPERTY AND EQUIPMENT (Tables)	12 Months Ended
	Dec. 31, 2018
Property, Plant and Equipment [Abstract]
Property, Plant and Equipment [Table Text Block]	Property and equipment consists of the following: DECEMBER 31, 2018 2017 Medical equipment and facilities $ 94,031,000 $ 95,923,000 Office equipment 589,000 576,000 Deposits and construction in progress 3,832,000 1,658,000 Deposits towards purchase of proton beam systems 2,250,000 2,000,000 100,702,000 100,157,000 Accumulated depreciation (54,008,000 ) (51,666,000 ) Net property and equipment $ 46,694,000 $ 48,491,000

LONG-TERM DEBT (Tables)

LONG-TERM DEBT (Tables)	12 Months Ended
	Dec. 31, 2018
Debt Disclosure [Abstract]
Schedule of Maturities of Long-term Debt [Table Text Block]	The following are contractual maturities of long-term debt by year at December 31, 2018: Year ending December 31, Principal Interest 2019 $ 2,119,000 $ 276,000 2020 1,378,000 163,000 2021 712,000 100,000 2022 263,000 71,000 2023 280,000 54,000 Thereafter 699,000 53,000 $ 5,451,000 $ 717,000

OBLIGATIONS UNDER CAPITAL LEA_2

OBLIGATIONS UNDER CAPITAL LEASES (Tables)	12 Months Ended
	Dec. 31, 2018
Debt Disclosure [Abstract]
Schedule of Future Minimum Lease Payments for Capital Leases [Table Text Block]	Future minimum lease payments, together with the present value of the net minimum lease payments under capital leases at December 31, 2018, are summarized as follows: Net Present Value of Minimum Lease Payments Year ending December 31, 2019 $ 5,524,000 2020 4,017,000 2021 5,992,000 2022 970,000 2023 524,000 Thereafter 308,000 Total capital lease payments 17,335,000 Less imputed interest 2,620,000 14,715,000 Less current portion 4,407,000 $ 10,308,000

INCOME TAXES (Tables)

INCOME TAXES (Tables)	12 Months Ended
	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Schedule of Components of Income Tax Expense (Benefit) [Table Text Block]	The components of the provision for income taxes as of December 31, 2018, 2017 and 2016 consist of the following: YEARS ENDED DECEMBER 31, 2018 2017 2016 Current: Federal $ 13,000 $ 55,000 $ 24,000 State 389,000 109,000 146,000 Total current 402,000 164,000 170,000 Deferred: Federal 259,000 (1,335,000 ) 680,000 State (210,000 ) 68,000 93,000 Total deferred 49,000 (1,267,000 ) 773,000 $ 451,000 $ (1,103,000 ) $ 943,000
Schedule of Deferred Tax Assets and Liabilities [Table Text Block]	Significant components of the Company’s deferred tax liabilities and assets as of December 31, 2018 and 2017 are as follows: DECEMBER 31, 2018 2017 Deferred tax liabilities: Property and equipment $ (3,566,000 ) $ (5,009,000 ) Total deferred tax liabilities (3,566,000 ) (5,009,000 ) Deferred tax assets: Net operating loss carryforwards 80,000 1,421,000 Accruals and allowances 275,000 157,000 Tax credits 194,000 438,000 Other – net 206,000 186,000 Capital loss carryover 948,000 959,000 Total deferred tax assets 1,703,000 3,161,000 Valuation allowance (1,096,000 ) (1,062,000 ) Deferred tax assets net of valuation allowance 607,000 2,099,000 Net deferred tax liabilities $ (2,959,000 ) $ (2,910,000 )
Schedule of Deferred Tax Assets and Liabilities [Table Text Block]	These amounts are presented in the financial statements as follows: DECEMBER 31, 2018 2017 Deferred income taxes (non-current) $ (2,959,000 ) $ (2,910,000 ) $ (2,959,000 ) $ (2,910,000 )
Schedule of Effective Income Tax Rate Reconciliation [Table Text Block]	The (benefit) provision for income taxes differs from the amount computed by applying the U.S. federal statutory tax rate (21% in 2018, and 34% in 2017 and 2016) to income before taxes as follows: YEARS ENDED DECEMBER 31, 2018 2017 2016 Computed expected federal income tax $ 313,000 $ 279,000 $ 637,000 State income taxes, net of federal benefit 125,000 28,000 169,000 Non-deductible expenses (12,000 ) 41,000 42,000 Impact of US Tax Reform - (1,546,000 ) - Change in valuation allowance 34,000 180,000 25,000 Other (9,000 ) (85,000 ) 70,000 $ 451,000 $ (1,103,000 ) $ 943,000
Schedule of Unrecognized Tax Benefits Roll Forward [Table Text Block]	A reconciliation of the beginning and ending amount of unrecognized tax benefit is as follows: YEARS ENDED DECEMBER 31, 2018 2017 2016 Balance at beginning of year $ - $ - $ - Additions based on tax positions of prior years 87,000 - - Balance at end of year $ 87,000 $ - $ -

SHAREHOLDERS' EQUITY (Tables)

SHAREHOLDERS' EQUITY (Tables)	12 Months Ended
	Dec. 31, 2018
Stockholders' Equity Note [Abstract]
Schedule of Share-based Compensation, Restricted Stock and Restricted Stock Units Activity [Table Text Block]	Changes in restricted stock units, consisting primarily of annual automatic grants and deferred compensation to non-employee directors, under the Incentive Compensation Plans during 2018 and 2017 are as follows: Restricted Stock Units Grant Date Weighted- Average Fair Value Intrinsic Value Outstanding at January 1, 2017 4,000 $ 2.25 $ - Granted 22,000 $ 3.47 $ - Vested (22,000 ) $ 4.06 $ - Outstanding at December 31, 2017 4,000 $ 3.77 $ - Outstanding at January 1, 2018 4,000 $ 3.77 $ - Granted 35,000 $ 2.56 $ - Vested (35,000 ) $ 2.69 $ - Outstanding at December 31, 2018 4,000 $ 2.68 $ -
Share-based Compensation, Stock Options, Activity [Table Text Block]	Changes in stock options outstanding under the Incentive Compensation Plans during 2018 and 2017 are as follows: Weighted Weighted Average Average Remaining Aggregate Number Exercise Contractual Intrinsic Options of Options Price Term (Years) Value Balance at December 31, 2016 625,000 $ 2.85 4.25 Granted 27,000 $ 3.31 6.66 Exercised (4,000 ) $ 2.81 - Forfeited (33,000 ) $ 2.82 - Balance at December 31, 2017 615,000 $ 2.87 3.48 $ 22,000.00 Granted 16,000 $ 2.68 6.46 Forfeited (18,000 ) $ 3.15 - Balance at December 31, 2018 613,000 $ 2.85 3.14 $ - Exercisable at December 31, 2017 395,000 $ 2.86 3.35 $ - Exercisable at December 31, 2018 488,000 $ 2.87 2.55 $ -
Schedule of Nonvested Share Activity [Table Text Block]	A summary of the status of the Company’s non-vested stock options as of December 31, 2018 and 2017, and changes during the years ended December 31, 2018 and 2017 is presented below: Weighted Average Number Grant-Date Nonvested Options of Options Fair Value Nonvested at December 31, 2016 321,000 $ 1.18 Granted 27,000 $ 1.50 Vested (117,000 ) $ 1.20 Forfeited (11,000 ) $ 1.27 Nonvested at December 31, 2017 220,000 $ 1.20 Granted 16,000 $ 1.45 Vested (111,000 ) $ 1.22 Nonvested at December 31, 2018 125,000 $ 1.20
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions [Table Text Block]	The fair value of the Company’s option grants under the Plan in 2018, 2017 and 2016 was estimated using the following assumptions: 2018 2017 2016 Expected life (years) 7.0 7.0 7.0 Expected forfeiture rate 0.0 % 0.0 % 0.0 % Expected volatility 50 % 53 % 53 % Dividend yield 0 % 0 % 0 % Risk-free interest rate 2.9 % 2.0 % 2.0 %

OPERATING LEASES (Tables)

OPERATING LEASES (Tables)	12 Months Ended
	Dec. 31, 2018
Leases, Operating [Abstract]
Schedule of Future Minimum Rental Payments for Operating Leases [Table Text Block]	Future minimum payments under non-cancelable operating leases, net of expected sublease income, having initial terms of more than one year consisted of the following: Year ending December 31, 2019 $ 275,000 2020 257,000 2021 252,000 2022 259,000 2023 165,000 Thereafter - $ 1,208,000

COMMITMENTS AND CONTINGENCIES (

COMMITMENTS AND CONTINGENCIES (Tables)	12 Months Ended
	Dec. 31, 2018
Commitments and Contingencies Disclosure [Abstract]
Long-term Purchase Commitment [Table Text Block]	The Company estimates the following commitments for each of the equipment systems, with expected timing of payments as follows as of December 31, 2018: 2019 Thereafter Total Proton Beam Units $ - $ 34,000,000 $ 34,000,000 Gamma Knife & Linac Units 4,235,000 - 4,235,000 Service Contracts 1,664,000 5,859,000 7,523,000 Total Commitments $ 5,899,000 $ 39,859,000 $ 45,758,000

BUSINESS AND BASIS OF PRESENT_2

BUSINESS AND BASIS OF PRESENTATION (Details Textual)	Dec. 31, 2018
OR21 LLC [Member]
Equity Method Investment, Ownership Percentage	50.00%
Architectural Design Company [Member]
Equity Method Investment, Ownership Percentage	50.00%

ACCOUNTING POLICIES (Details)

ACCOUNTING POLICIES (Details) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
ASSETS
Cash, cash equivalents, restricted cash, Carrying Value	$ 1,442,000	$ 2,152,000
Total, Carrying Value	57,502,000	58,176,000
Assets, Fair Value:
Cash, cash equivalents, restricted cash, Fair Value	1,792,000	2,502,000
Total, Fair Value	1,792,000	2,502,000
Liabilities, Fair Value
Debt obligations, Fair Value	5,431,000	6,082,000
Total, Fair Value	5,431,000	6,082,000
Carrying Value [Member]
ASSETS
Cash, cash equivalents, restricted cash, Carrying Value	1,792,000	2,502,000
Total, Carrying Value	1,792,000	2,502,000
Liabilities, Carrying Value
Debt obligations, Carrying Value	5,451,000	6,057,000
Total, Carrying Value	5,451,000	6,057,000
Fair Value, Inputs, Level 1 [Member]
Assets, Fair Value:
Cash, cash equivalents, restricted cash, Fair Value	1,792,000	2,502,000
Total, Fair Value	1,792,000	2,502,000
Liabilities, Fair Value
Debt obligations, Fair Value	0	0
Total, Fair Value	0	0
Fair Value, Inputs, Level 2 [Member]
Assets, Fair Value:
Cash, cash equivalents, restricted cash, Fair Value	0	0
Total, Fair Value	0	0
Liabilities, Fair Value
Debt obligations, Fair Value	0	0
Total, Fair Value	0	0
Fair Value, Inputs, Level 3 [Member]
Assets, Fair Value:
Cash, cash equivalents, restricted cash, Fair Value	0	0
Total, Fair Value	0	0
Liabilities, Fair Value
Debt obligations, Fair Value	5,431,000	6,082,000
Total, Fair Value	$ 5,431,000	$ 6,082,000

ACCOUNTING POLICIES (Details 1)

ACCOUNTING POLICIES (Details 1) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Accounting Policies [Line Items]
Numerator for basic and diluted earnings per share	$ 1,023,000	$ 1,923,000	$ 930,000
Denominator:
Denominator for basic and diluted earnings per share – weighted-average shares	5,836,000	5,754,000	5,570,000
Effect of dilutive securities
Effect of dilutive securities Employee stock options and restricted stock	17,000	130,000	13,000
Denominator for diluted earnings per share – adjusted weighted-average shares	5,853,000	5,884,000	5,583,000
Earnings per common share- basic	$ 0.18	$ 0.33	$ 0.17
Earnings per common share- diluted	$ 0.17	$ 0.33	$ 0.17

ACCOUNTING POLICIES (Details 2)

ACCOUNTING POLICIES (Details 2)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Medical Services Revenues [Member]
Accounting Policies [Line Items]
Break out, Percentage	100.00%	100.00%	100.00%
Property, Plant and Equipment [Member]
Accounting Policies [Line Items]
Break out, Percentage	100.00%	100.00%	100.00%
Domestic [Member] | Medical Services Revenues [Member]
Accounting Policies [Line Items]
Break out, Percentage	96.00%	99.00%	100.00%
Domestic [Member] | Property, Plant and Equipment [Member]
Accounting Policies [Line Items]
Break out, Percentage	93.00%	93.00%	93.00%
Foreign [Member] | Medical Services Revenues [Member]
Accounting Policies [Line Items]
Break out, Percentage	4.00%	1.00%	0.00%
Foreign [Member] | Property, Plant and Equipment [Member]
Accounting Policies [Line Items]
Break out, Percentage	7.00%	7.00%	7.00%

ACCOUNTING POLICIES (Details Te

ACCOUNTING POLICIES (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Jan. 01, 2019
Accounting Policies [Line Items]
Interest Costs Capitalized	$ 115,000	$ 138,000	$ 443,000
Property Subject to or Available for Operating Lease, Net, Total	94,031,000	95,923,000
Property Subject to or Available for Operating Lease, Accumulated Depreciation	$ 53,716,000	$ 51,403,000
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	519,000	14,000	581,000
Stock Options Exercise Price		$ 3.90
Advertising Expense	$ 113,000	$ 140,000	$ 279,000
Insurance Settlements Receivable, Current	1,137,000	$ 0
Revenue from Contract with Customer, Including Assessed Tax	$ 18,987,000
Percentage of Tax Benefit Realized Upon Settlement	50.00%
Mevion Medical Systems Inc [Member]
Accounting Policies [Line Items]
Gain on Business Interruption Insurance Recovery	$ 185,000
Sales Revenue, Net [Member]
Accounting Policies [Line Items]
Concentration Risk, Percentage	100.00%	100.00%	100.00%
Customer One [Member] | Sales Revenue, Net [Member]
Accounting Policies [Line Items]
Concentration Risk, Percentage	26.00%	21.00%	10.00%
Restricted Stock Units (RSUs) [Member]
Accounting Policies [Line Items]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	4,000	4,000	4,000
Accounting Standards Update 2014-09 [Member]
Accounting Policies [Line Items]
Revenue from Contract with Customer, Excluding Assessed Tax	$ 727,000
Accounting Standards Update 2016-02 [Member]
Accounting Policies [Line Items]
Operating Lease, Right-of-Use Asset				$ 1,000,000
PBRT [Member]
Accounting Policies [Line Items]
Property, Plant and Equipment, Useful Life	20 years
Mevion Medical Systems Inc [Member]
Accounting Policies [Line Items]
Cost of Property Repairs and Maintenance	$ 977,000
Mevion Medical Systems Inc [Member] | Insurance Settlement Receivable Current [Member]
Accounting Policies [Line Items]
Cost of Property Repairs and Maintenance	$ 977,000
Maximum [Member]
Accounting Policies [Line Items]
Stock Options Exercise Price	$ 3.90		$ 3.15
Maximum [Member] | Medical and Office equipment [Member]
Accounting Policies [Line Items]
Property, Plant and Equipment, Useful Life	10 years
Minimum [Member]
Accounting Policies [Line Items]
Stock Options Exercise Price	$ 2.82		$ 2.43
Minimum [Member] | Customer Three [Member] | Accounts Receivable [Member]
Accounting Policies [Line Items]
Concentration Risk, Percentage	10.00%	10.00%
Minimum [Member] | Medical and Office equipment [Member]
Accounting Policies [Line Items]
Property, Plant and Equipment, Useful Life	3 years

PROPERTY AND EQUIPMENT (Details

PROPERTY AND EQUIPMENT (Details) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Gross	$ 100,702,000	$ 100,157,000
Accumulated depreciation	(54,008,000)	(51,666,000)
Net property and equipment	46,694,000	48,491,000
Medical equipment and facilities [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Gross	94,031,000	95,923,000
Accumulated depreciation	(20,292,000)	(16,777,000)
Office equipment [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Gross	589,000	576,000
Deposits and construction in progress [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Gross	3,832,000	1,658,000
Deposits towards purchase of proton beam systems [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Gross	$ 2,250,000	$ 2,000,000

PROPERTY AND EQUIPMENT (Detai_2

PROPERTY AND EQUIPMENT (Details Textual) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Property, Plant and Equipment [Line Items]
Capital Leases, Lessee Balance Sheet, Assets by Major Class, Accumulated Depreciation	$ 54,008,000	$ 51,666,000
Property, Plant and Equipment, Net	46,694,000	48,491,000
Construction in Progress, Gross	3,832,000
Medical Equipment and Facilities [Member]
Property, Plant and Equipment [Line Items]
Capital Leased Assets, Gross	46,559,000	44,758,000
Capital Leases, Lessee Balance Sheet, Assets by Major Class, Accumulated Depreciation	20,292,000	$ 16,777,000
Radiation Oncology Physician Group [Member]
Property, Plant and Equipment [Line Items]
Long Term Purchase Commitment Deposits For Assets	400,000
Three Mevion S250 Proton Beam Radiation Therapy [Member]
Property, Plant and Equipment [Line Items]
Long Term Purchase Commitment Deposits For Assets	2,250,000
Gamma Knife Units [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Net	$ 729,000

INVESTMENT IN EQUITY SECURITI_2

INVESTMENT IN EQUITY SECURITIES (Details Textual) - USD ($)	1 Months Ended	12 Months Ended
	Jun. 30, 2015	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Investments, Fair Value Disclosure			$ 0
Other than Temporary Impairment Losses, Investments		$ 0	579,000	$ 0
Cost Method Investments		$ 0	0
Cost-method Investments, Other than Temporary Impairment					$ 26,000
Mevion Medical Systems Inc [Member]
Investments, Fair Value Disclosure	$ 600,000				579,000
Other than Temporary Impairment Losses, Investments	$ 2,114,000		$ 579,000		$ 2,140,000

LONG-TERM DEBT (Details)

LONG-TERM DEBT (Details)	Dec. 31, 2018USD ($)
Principal
2019	$ 2,119,000
2020	1,378,000
2021	712,000
2022	263,000
2023	280,000
Thereafter	699,000
Long-term Debt	5,451,000
Interest
2019	276,000
2020	163,000
2021	100,000
2022	71,000
2023	54,000
Thereafter	53,000
Interest	$ 717,000

LONG-TERM DEBT (Details Textual

LONG-TERM DEBT (Details Textual)	12 Months Ended
	Dec. 31, 2018USD ($)
Debt Instrument [Line Items]
Long-term Debt, Description	These notes are payable in 36 to 84 fully amortizing monthly installments, mature between December 2019 and March 2026
Gamma Knife Units [Member]
Debt Instrument [Line Items]
Debt Instrument, Collateral Amount	$ 13,016,000
Maximum [Member]
Debt Instrument [Line Items]
Long-term Debt, Percentage Bearing Variable Interest, Percentage Rate	6.90%
Minimum [Member]
Debt Instrument [Line Items]
Long-term Debt, Percentage Bearing Variable Interest, Percentage Rate	4.96%

OBLIGATIONS UNDER CAPITAL LEA_3

OBLIGATIONS UNDER CAPITAL LEASES (Details)	Dec. 31, 2018USD ($)
Capital Lease Obligations [Line Items]
2019	$ 5,524,000
2020	4,017,000
2021	5,992,000
2022	970,000
2023	524,000
Thereafter	308,000
Total capital lease payments	17,335,000
Less imputed interest	2,620,000
Gross Minimum Lease Payments	14,715,000
Less current portion	4,407,000
Net Minimum Lease Payments	$ 10,308,000

OBLIGATIONS UNDER CAPITAL LEA_4

OBLIGATIONS UNDER CAPITAL LEASES (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Capital Lease Obligations [Line Items]
Capital Lease Obligations	$ 26,267,000	$ 27,981,000
Description of Lessee Leasing Arrangements, Capital Leases	are payable in 44 to 84 monthly installments, and mature between July 2019 and October 2024​​​​​​​.
Maximum [Member]
Capital Lease Obligations [Line Items]
Capital Lease Obligation Interest Rate	13.00%
Minimum [Member]
Capital Lease Obligations [Line Items]
Capital Lease Obligation Interest Rate	4.73%

INCOME TAXES (Details)

INCOME TAXES (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Current:
Federal	$ 13,000	$ 55,000	$ 24,000
State	389,000	109,000	146,000
Total current	402,000	164,000	170,000
Deferred:
Federal	259,000	(1,335,000)	680,000
State	(210,000)	68,000	93,000
Total deferred	49,000	(1,267,000)	773,000
Income Tax Expense (Benefit)	$ 451,000	$ (1,103,000)	$ 943,000

INCOME TAXES (Details 1)

INCOME TAXES (Details 1) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Deferred tax liabilities:
Property and equipment	$ (3,566,000)	$ (5,009,000)
Total deferred tax liabilities	(3,566,000)	(5,009,000)
Deferred tax assets:
Net operating loss carryforwards	80,000	1,421,000
Accruals and allowances	275,000	157,000
Tax credits	194,000	438,000
Other - net	206,000	186,000
Capital loss carryover	948,000	959,000
Total deferred tax assets	1,703,000	3,161,000
Valuation allowance	(1,096,000)	(1,062,000)
Deferred tax assets net of valuation allowance	607,000	2,099,000
Net deferred tax liabilities	$ (2,959,000)	$ (2,910,000)

INCOME TAXES (Details 2)

INCOME TAXES (Details 2) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Line Items]
Deferred income taxes (non-current)	$ (2,958,000)	$ (2,910,000)
Total deferred tax liabilities	$ (2,959,000)	$ (2,910,000)

INCOME TAXES (Details 3)

INCOME TAXES (Details 3) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Line Items]
Computed expected federal income tax	$ 313,000	$ 279,000	$ 637,000
State income taxes, net of federal benefit	125,000	28,000	169,000
Non-deductible expenses	(12,000)	41,000	42,000
Impact of US Tax Reform	0	(1,546,000)	0
Change in valuation allowance	34,000	180,000	25,000
Other	(9,000)	(85,000)	70,000
Income Tax Expense (Benefit)	$ 451,000	$ (1,103,000)	$ 943,000

INCOME TAXES (Details 4)

INCOME TAXES (Details 4) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Line Items]
Balance at beginning of year	$ 0	$ 0	$ 0
Additions based on tax positions of prior years	87,000	0	0
Balance at end of year	$ 87,000	$ 0	$ 0

INCOME TAXES (Details Textual)

INCOME TAXES (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Income Tax Disclosure [Line Items]
Effective Income Tax Rate Reconciliation, Foreign Income Tax Rate Differential, Percent	21.00%	34.00%	34.00%
Deferred Tax Assets, Operating Loss Carryforwards, State and Local	$ 636,000
Net Operating Loss Carry Forwards And Other Deferred Tax Assets Percentage	50.00%
Income Tax Expense (Benefit)	$ 451,000	$ (1,103,000)	$ 943,000
Valuation Allowance, Deferred Tax Asset, Increase (Decrease), Amount	$ 34,000	$ 303,000	25,000
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent	21.00%	34.00%
Income Tax Reconciliation Change In Net Effect In Tax Rate		$ 1,546,000
Unrecognized Tax Benefits	$ 87,000	$ 0	$ 0	$ 0
State and Local Jurisdiction [Member]
Income Tax Disclosure [Line Items]
Deferred Tax Assets, Operating Loss Carryforwards, State and Local	195,000
Foreign Tax Authority [Member]
Income Tax Disclosure [Line Items]
Deferred Tax Assets, Operating Loss Carryforwards, Domestic	3,873,000
Domestic Tax Authority [Member]
Income Tax Disclosure [Line Items]
Operating Loss Carryforwards	$ 444,000

SHAREHOLDERS' EQUITY (Details)

SHAREHOLDERS' EQUITY (Details) - $ / shares	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Nonvested, Number of Options, Outstanding	220,000	321,000
Restricted Stock Units, Vested	(111,000)	(117,000)
Nonvested, Number of Options, Outstanding	125,000	220,000	321,000
Weighted Average Grant-Date Fair Value, Nonvested, Outstanding	$ 1.20	$ 1.18
Grant Date Weighted-Average Fair Value, Granted	1.45	1.50	$ 0.97
Grant Date Weighted-Average Fair Value, Vested	1.22	1.20
Weighted Average Grant-Date Fair Value, Nonvested, Outstanding	$ 1.20	$ 1.20	$ 1.18
Restricted Stock Units (RSUs) [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Nonvested, Number of Options, Outstanding	4,000	4,000
Restricted Stock Units, Granted	35,000	22,000
Restricted Stock Units, Vested	(35,000)	(22,000)
Nonvested, Number of Options, Outstanding	4,000	4,000	4,000
Weighted Average Grant-Date Fair Value, Nonvested, Outstanding	$ 3.77	$ 2.25
Grant Date Weighted-Average Fair Value, Granted	2.56	3.47
Grant Date Weighted-Average Fair Value, Vested	2.69	4.06
Weighted Average Grant-Date Fair Value, Nonvested, Outstanding	2.68	3.77	$ 2.25
Intrinsic Value, Outstanding	0	0
Intrinsic Value, Granted	0	0
Intrinsic Value, Vested	0	0
Intrinsic Value, Outstanding	$ 0	$ 0	$ 0

SHAREHOLDERS' EQUITY (Details 1

SHAREHOLDERS' EQUITY (Details 1) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of Options, Beginning balance	615,000	625,000
Number of Options, Granted	16,000	27,000
Number of Options, Exercised		(4,000)
Number of Options, Forfeited	(18,000)	(33,000)
Number of Options, Ending balance	613,000	615,000	625,000
Number of Options, Exercisable	488,000	395,000
Weighted Average Exercise Price, Beginning balance	$ 2.87	$ 2.85
Weighted Average Exercise Price, Granted	2.68	3.31
Weighted Average Exercise Price - Exercised		2.81
Weighted Average Exercise Price, Forfeited	3.15	2.82
Weighted Average Exercise Price, Ending balance	2.85	2.87	$ 2.85
Weighted Average Exercise Price, Exercisable	$ 2.87	$ 2.86
Weighted Average Remaining Contractual Term (Years)	3 years 1 month 20 days	3 years 5 months 23 days	4 years 3 months
Share-based Compensation Arrangement by Share-based Payment Award, Options, Granted, Weighted Average Remaining Contractual Term	6 years 5 months 16 days	6 years 7 months 28 days
Weighted Average Remaining Contractual Term (Years), Exercisable	2 years 6 months 18 days	3 years 4 months 6 days
Aggregate Intrinsic Value, Balance	$ 0	$ 22,000
Aggregate Intrinsic Value, Exercisable	$ 0	$ 0

SHAREHOLDERS' EQUITY (Details 2

SHAREHOLDERS' EQUITY (Details 2) - $ / shares	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Shareholders Equity [Line Items]
Nonvested, Number of Options, Outstanding	220,000	321,000
Number of Options, Granted	16,000	27,000
Nonvested, Number of Options, Vested	(111,000)	(117,000)
Nonvested, Number of Options, Forfeited		(11,000)
Nonvested, Number of Options, Outstanding	125,000	220,000	321,000
Weighted Average Grant-Date Fair Value, Nonvested, Outstanding	$ 1.20	$ 1.18
Weighted Average Grant-Date Fair Value, Nonvested, Granted	1.45	1.50	$ 0.97
Weighted Average Grant-Date Fair Value, Nonvested, Vested	1.22	1.20
Weighted Average Grant-Date Fair Value, Nonvested, Forfeited		1.27
Weighted Average Grant-Date Fair Value, Nonvested, Outstanding	$ 1.20	$ 1.20	$ 1.18

SHAREHOLDERS' EQUITY (Details 3

SHAREHOLDERS' EQUITY (Details 3)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected life (years)	7 years	7 years	7 years
Expected forfeiture rate	0.00%	0.00%	0.00%
Expected volatility	50.00%	53.00%	53.00%
Dividend yield	0.00%	0.00%	0.00%
Risk-free interest rate	2.90%	2.00%	2.00%

SHAREHOLDERS' EQUITY (Details T

SHAREHOLDERS' EQUITY (Details Textual) - USD ($)	Jan. 04, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Jun. 30, 2010	Dec. 31, 2001
Class of Stock [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period, Weighted Average Grant Date Fair Value		$ 1.45	$ 1.50	$ 0.97
Stock Repurchase Program, Number of Shares Authorized to be Repurchased						1,000,000
Stock Repurchase Program, Remaining Number of Shares Authorized to be Repurchased		72,000
Employee Service Share-based Compensation, Nonvested Awards, Compensation Cost Not yet Recognized, Total		$ 434,000
Allocated Share-based Compensation Expense	$ 108,000	$ 109,000	$ 144,000	$ 139,000
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period		111,000	117,000
Class of Warrant or Right, Outstanding				100,000
Class of Warrant or Right, Exercise Price of Warrants or Rights				$ 2.20
Class of Warrant or Right, Exercised		100,000	100,000	100,000
Noncash Warrants Exercised			50,000
Share-based Compensation Arrangement by Share-based Payment Award, Options, Exercises in Period			4,000
Proceeds from Stock Options Exercised			$ 6,000
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number		125,000	220,000	321,000
Warrant [Member]
Class of Stock [Line Items]
Stock Issued During Period, Shares, Warrants Exercised			25,000
Restricted Stock [Member]
Class of Stock [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period		272,000
Performance Share Award Agreement [Member]
Class of Stock [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number		129,000
Non Vested Shares [Member]
Class of Stock [Line Items]
Employee Service Share-based Compensation, Nonvested Awards, Compensation Not yet Recognized, Stock Options			$ 138,000
Share-based Compensation Award, Tranche One [Member]
Class of Stock [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Options, Exercises in Period			2,000
Employee [Member]
Class of Stock [Line Items]
Stock Issued During Period, Shares, Issued for Services		10,000
Incentive Compensation Plan [Member]
Class of Stock [Line Items]
Common Stock, Capital Shares Reserved for Future Issuance					1,630,000
Provision For Reduction Of Reserved Shares					1.59
Share-based Compensation Arrangement by Share-based Payment Award, Shares Purchased for Award		2,000
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant		276,000
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period		5 years
Share Based Compensation Arrangement By Share Based Payment Award Remaining Number Of Shares Available For Grant		320,000
Share-based Compensation Arrangement by Share-based Payment Award, Options, Vested in Period, Fair Value		$ 11,000	$ 15,000	$ 8,000
Employee Benefits and Share-based Compensation, Total		13,000
Offsetting Tax Benefit		3,000
Employee Service Share-based Compensation, Nonvested Awards, Compensation Cost Not yet Recognized, Total		$ 5,000
Weighted Average Number of Shares, Restricted Stock		4,000	4,000	4,000
Incentive Compensation Plan [Member] | Restricted Stock [Member]
Class of Stock [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period, Weighted Average Grant Date Fair Value	$ 161,766
Incentive Compensation Plan [Member] | Non Employee Directors [Member]
Class of Stock [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant		500
Incentive Compensation Plan [Member] | Non Employee Directors and Corporate Secretary [Member]
Class of Stock [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant		38,000
Retainer Fees [Member]
Class of Stock [Line Items]
Employee Benefits and Share-based Compensation, Total		$ 80,000
Retainer Fees [Member] | Incentive Compensation Plan [Member] | Non Employee Directors [Member]
Class of Stock [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant		228,000

RETIREMENT PLAN (Details Textua

RETIREMENT PLAN (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Defined Benefit Plan Disclosure [Line Items]
Defined Contribution Plan, Employer Matching Contribution, Percent of Employees' Gross Pay	4.00%
Defined Contribution Plan, Cost	$ 31,000	$ 29,000	$ 27,000

OPERATING LEASES (Details)

OPERATING LEASES (Details)	Dec. 31, 2018USD ($)
Operating Leased Assets [Line Items]
2019	$ 275,000
2020	257,000
2021	252,000
2022	259,000
2023	165,000
Thereafter	0
Total Future Minimum Payments Due	$ 1,208,000

OPERATING LEASES (Details Textu

OPERATING LEASES (Details Textual) - USD ($)	Aug. 13, 2016	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2013
Operating Leased Assets [Line Items]
Operating Leases, Rent Expense		$ 298,000	$ 308,000	$ 307,000
Operating Leases Cumulative Loss					$ 115,000
Operating Leases, Rent Expense, Net		$ 0	$ 0	$ 76,000
Lease Expiration Period	7 years

COMMITMENTS AND CONTINGENCIES_2

COMMITMENTS AND CONTINGENCIES (Details)	Dec. 31, 2018USD ($)
Long-term Purchase Commitment [Line Items]
2019	$ 5,899,000
Thereafter	39,859,000
Total	45,758,000
Proton Beam Unit [Member]
Long-term Purchase Commitment [Line Items]
2019	0
Thereafter	34,000,000
Total	34,000,000
Gamma Knife and Linac Units [Member]
Long-term Purchase Commitment [Line Items]
2019	4,235,000
Thereafter	0
Total	4,235,000
Service Contacts [Member]
Long-term Purchase Commitment [Line Items]
2019	1,664,000
Thereafter	5,859,000
Total	$ 7,523,000

COMMITMENTS AND CONTINGENCIES_3

COMMITMENTS AND CONTINGENCIES (Details Textual) - USD ($)	1 Months Ended		12 Months Ended
	Dec. 20, 2018	Jul. 21, 2017	Dec. 31, 2018	Aug. 06, 2018
Commitments And Contingencies [Line Items]
Long-term Purchase Commitment, Period		5 years	9 years
Purchase Agreement Annual Prepayment				$ 1,285,000
Gamma Knife Perfexion System [Member]
Commitments And Contingencies [Line Items]
Long-term Purchase Commitment, Amount			$ 4,235,000
LINAC system [Member]
Commitments And Contingencies [Line Items]
Long-term Purchase Commitment, Amount			7,523,000
Mevion Medical Systems Inc [Member]
Commitments And Contingencies [Line Items]
Long-term Purchase Commitment, Amount			34,000,000
Long-term Purchase Commitment, Deposits for Future Purchase			$ 2,250,000
Increase decrease Annual Service Fees	$ 250,000

NOTE, WARRANT, & COMMON STOCK_2

NOTE, WARRANT, & COMMON STOCK PURCHASE AGREEMENT WITH RELATED PARTIES (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Oct. 31, 2014
Note, Warrant And Common Stock Purchase Agreement [Line Items]
Common Stock, Shares, Issued	5,714,000	5,710,000
Class of Warrant or Right, Exercise Price of Warrants or Rights			$ 2.20
Gain (Loss) on Extinguishment of Debt	$ 0	$ 0	$ (108,000)
Class of Warrant or Right, Exercised	100,000	100,000	100,000
Class of Warrant or Right, Outstanding			100,000
Notes Payable [Member]
Note, Warrant And Common Stock Purchase Agreement [Line Items]
Warrants Not Settleable in Cash, Fair Value Disclosure			$ 145,000
Gain (Loss) on Extinguishment of Debt			108,000
Debt Instrument, Unamortized Discount			80,000
Deferred Fees From Issuance Of Note			$ 28,000
Private Placement [Member]
Note, Warrant And Common Stock Purchase Agreement [Line Items]
Sale of Stock, Number of Shares Issued in Transaction	100,000
Proceeds from Issuance of Private Placement	$ 220,000
Common Stock, Value, Subscriptions	1,220,000
Note and Warrant Purchase Agreement [Member]
Note, Warrant And Common Stock Purchase Agreement [Line Items]
Debt Instrument, Face Amount				$ 1,000,000
Common Stock, Shares, Issued				200,000
Debt Instrument, Interest Rate, Stated Percentage				15.00%
Class of Warrant or Right, Exercise Price of Warrants or Rights				$ 2.20
Mevion Medical Systems Inc [Member]
Note, Warrant And Common Stock Purchase Agreement [Line Items]
Cash Payments	$ 1,000,000

RELATED PARTY TRANSACTIONS (Det

RELATED PARTY TRANSACTIONS (Details Textual)	12 Months Ended
	Dec. 31, 2018USD ($)
Mevion Medical Systems Inc [Member]
Related Party Transaction [Line Items]
Retainage Deposit	$ 2,250,000
Cost of Property Repairs and Maintenance	$ 977,000
GKF Subsidiary [Member]
Related Party Transaction [Line Items]
Noncontrolling Interest, Ownership Percentage by Parent	81.00%
U.S. Subsidiary Of Elekta [Member]
Related Party Transaction [Line Items]
Noncontrolling Interest, Ownership Percentage by Parent	19.00%