American Shared Hospital Services (AMS) 10-K 30 Mar 22 2021 FY Annual report Financial data

Document And Entity Information

Document And Entity Information - USD ($)	12 Months Ended
	Dec. 31, 2021	Mar. 22, 2022	Jun. 30, 2021
Document Information [Line Items]
Entity Central Index Key	0000744825
Entity Registrant Name	AMERICAN SHARED HOSPITAL SERVICES
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Document Fiscal Period Focus	FY
Document Fiscal Year Focus	2021
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2021
Document Transition Report	false
Entity File Number	1-08789
Entity Incorporation, State or Country Code	CA
Entity Tax Identification Number	94-2918118
Entity Address, Address Line One	601 Montgomery
Entity Address, City or Town	San Francisco
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	94111-2619
City Area Code	415
Local Phone Number	788-5300
Title of 12(b) Security	Common Stock No Par Value
Trading Symbol	AMS
Security Exchange Name	NYSE
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	false
Entity Shell Company	false
Entity Public Float			$ 12,409,000
Entity Common Stock, Shares Outstanding		6,049,000
Auditor Name	Moss Adams LLP
Auditor Location	Seattle, WA United States
Auditor Firm ID	659

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($)	Dec. 31, 2021	Dec. 31, 2020
CURRENT ASSETS
Cash and cash equivalents	$ 8,145,000	$ 3,961,000
Restricted cash	118,000	364,000
Accounts receivable, net of allowance for doubtful accounts of $100,000 at At December 31, 2021 and December 31, 2020	4,211,000	4,303,000
Other receivables	613,000	272,000
Prepaid maintenance	1,174,000	1,169,000
Prepaid expenses and other current assets	826,000	781,000
Total current assets	15,087,000	10,850,000
PROPERTY AND EQUIPMENT, net	28,254,000	30,418,000
LAND	19,000	19,000
GOODWILL	1,265,000	1,265,000
INTANGIBLE ASSETS	78,000	78,000
RIGHT OF USE ASSETS	654,000	886,000
OTHER ASSETS	73,000	137,000
TOTAL ASSETS	45,430,000	43,653,000
CURRENT LIABILITIES
Accounts payable	746,000	683,000
Employee compensation and benefits	423,000	405,000
Other accrued liabilities	2,419,000	2,045,000
Asset retirement obligations	757,000	1,270,000
Income taxes payable	96,000	373,000
Working capital payment due	0	197,000
Current portion of lease liabilities	369,000	305,000
Current portion of long-term debt, net	1,081,000	1,157,000
Current portion of finance leases	0	5,945,000
Total current liabilities	5,891,000	12,380,000
LONG-TERM LEASE LIABILITIES, less current portion	359,000	581,000
LONG-TERM DEBT, net, less current portion	14,323,000	3,440,000
LONG-TERM FINANCE LEASES, less current portion	0	2,974,000
DEFERRED REVENUE, less current portion	140,000	210,000
DEFERRED INCOME TAXES	478,000	418,000
COMMITMENTS AND CONTINGENCIES (See Note 12)
SHAREHOLDERS’ EQUITY
Common stock, no par value (10,000,000 authorized; Issued and outstanding shares – 6,049,000 at December 31, 2021 and 5,791,000 at December 31, 2020	10,758,000	10,753,000
Additional paid-in capital	7,444,000	7,024,000
Retained earnings	1,691,000	1,497,000
Total equity- American Shared Hospital Services	19,893,000	19,274,000
Non-controlling interests in subsidiaries	4,346,000	4,376,000
Total shareholders’ equity	24,239,000	23,650,000
TOTAL LIABILITIES AND SHAREHOLDERS' EQUITY	$ 45,430,000	$ 43,653,000

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parentheticals) - USD ($) $ / shares in Thousands	Dec. 31, 2021	Dec. 31, 2020
Allowance for doubtful accounts	$ 100,000	$ 100,000
Common stock, no par value (in dollars per share)	$ 0	$ 0
Common stock, shares authorized (in shares)	10,000,000	10,000,000
Common stock, shares issued (in shares)	6,049,000	5,791,000
Common stock, shares outstanding (in shares)	6,049,000	5,791,000

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Revenues	$ 17,628,000	$ 17,837,000
Costs of revenue:
Maintenance and supplies	2,490,000	2,385,000
Depreciation and amortization	4,856,000	6,789,000
Other direct operating costs	3,556,000	4,197,000
Cost of Revenue, Total	10,902,000	13,371,000
Gross margin	6,726,000	4,466,000
Selling and administrative expense	4,531,000	4,608,000
Interest expense	739,000	1,057,000
Loss on write down of impaired assets and associated removal costs	105,000	8,264,000
Operating income (loss)	1,351,000	(9,463,000)
(Loss) on early extinguishment of debt	(401,000)	0
Interest and other (loss) income	(3,000)	10,000
Income (loss) before income taxes	947,000	(9,453,000)
Income tax expense (benefit)	269,000	(1,737,000)
Net income (loss)	678,000	(7,716,000)
Less: net (income) loss attributable to non-controlling interests	(484,000)	658,000
Net income (loss) attributable to American Shared Hospital Services	$ 194,000	$ (7,058,000)
Net income (loss) per share attributable to American Shared Hospital Services:
Income (loss) per common share- basic (in dollars per share)	$ 0.03	$ (1.14)
Income (loss) per common share- diluted (in dollars per share)	$ 0.03	$ (1.14)

Consolidated Statement of Share

Consolidated Statement of Shareholders' Equity - USD ($)	Common Stock [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	Parent [Member]	Noncontrolling Interest [Member]	Total
Balances (in shares) at Dec. 31, 2019	5,817,000
Balances at Dec. 31, 2019	$ 10,753,000	$ 6,725,000	$ 8,555,000	$ 26,033,000	$ 5,778,000	$ 31,811,000
Stock-based compensation expense (in shares)	103,000
Stock-based compensation expense	$ 0	299,000	0	299,000	0	299,000
Cash distributions to non-controlling interests	0	0	0	0	(761,000)	(761,000)
NCI investment in acquisition	$ 0	0	0	0	17,000	17,000
Restricted common shares returned to plan (in shares)	(129,000)
Restricted common shares returned to plan	$ 0	0	0	0	0	0
Net income (loss)	$ 0	0	(7,058,000)	(7,058,000)	(658,000)	$ (7,716,000)
Options exercised (in shares)						0
Balances (in shares) at Dec. 31, 2020	5,791,000					5,791,000
Balances at Dec. 31, 2020	$ 10,753,000	7,024,000	1,497,000	19,274,000	4,376,000	$ 23,650,000
Stock-based compensation expense (in shares)	130,000
Stock-based compensation expense	$ 0	420,000	0	420,000	0	420,000
Cash distributions to non-controlling interests	0	0	0	0	(514,000)	(514,000)
Net income (loss)	$ 0	0	194,000	194,000	484,000	$ 678,000
Options exercised (in shares)	5,000					22,000
Options exercised	$ 5,000	0	0	5,000	0	$ 5,000
Issuance of deferred restricted stock awards (in shares)	123,000
Issuance of deferred restricted stock awards	$ 0	0	0	0	0	$ 0
Balances (in shares) at Dec. 31, 2021	6,049,000					6,049,000
Balances at Dec. 31, 2021	$ 10,758,000	$ 7,444,000	$ 1,691,000	$ 19,893,000	$ 4,346,000	$ 24,239,000

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
OPERATING ACTIVITIES
Net income (loss)	$ 678,000	$ (7,716,000)
Adjustments to reconcile net income (loss) to net cash from operating activities (excluding assets acquired and liabilities assumed):
Depreciation and amortization	4,972,000	6,970,000
Non cash lease expense	309,000	288,000
Amortization of deferred issuance costs	59,000	0
Loss on write down impaired assets	105,000	8,184,000
Loss on sublease impairment, net	74,000	0
Loss on extinguishment of debt	401,000	0
Deferred income taxes	60,000	(2,162,000)
Stock-based compensation expense	420,000	299,000
Interest expense associated with lease liabilities	42,000	65,000
Changes in operating assets and liabilities:
Receivables	(519,000)	2,966,000
Prepaid expenses and other assets	14,000	762,000
Accounts payable, accrued liabilities and deferred revenue	851,000	263,000
Asset retirement obligations	(618,000)	0
Lease liability	(351,000)	(353,000)
Income taxes payable	(230,000)	179,000
Net cash from operating activities	6,267,000	9,745,000
INVESTING ACTIVITIES
Payment for purchase of property and equipment	(1,674,000)	(455,000)
Payment for acquisition, net of cash acquired	0	(2,084,000)
Proceeds from sale of equipment	0	150,000
Net cash (used in) investing activities	(1,674,000)	(2,389,000)
FINANCING ACTIVITIES
Principal payments on long-term debt	(3,927,000)	(1,726,000)
Principal payments on finance leases	(8,919,000)	(3,199,000)
Proceeds from financing for acquisition	0	1,425,000
Long-term debt financing	13,897,000	0
Prepayment penalties	(401,000)	0
Distributions to non-controlling interests	(514,000)	(761,000)
Debt issuance costs long-term debt	(325,000)	(30,000)
Proceeds from options exercised	5,000	0
Principal payments on short-term financing prepaid insurance	(471,000)	(519,000)
Net cash (used in) financing activities	(655,000)	(4,810,000)
Net change in cash and cash equivalents	3,938,000	2,546,000
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, beginning of year	4,325,000	1,779,000
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, end of year	8,263,000	4,325,000
SUPPLEMENTAL CASH FLOW DISCLOSURE
Cash paid for interest	680,000	938,000
Cash paid for income taxes	712,000	339,000
SCHEDULE OF NONCASH INVESTING AND FINANCING ACTIVITIES
Lease reassessment right of use assets and lease liabilities	0	67,000
Right of use assets and lease liabilities	151,000	135,000
Interest capitalized to property and equipment	0	119,000
Acquisition of equipment with finance leases	0	496,000
Acquisition of equipment with long-term debt financing	1,103,000	1,184,000
Acquisition of insurance with short-term financing	0	634,000
First working capital payment related to acquisition, withholding taxes	0	43,000
Subsequent working capital payment for acquisition	$ 0	$ 154,000

Note 1 - Business and Basis of

Note 1 - Business and Basis of Presentation	12 Months Ended
	Dec. 31, 2021
Notes to Financial Statements
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block]	NOTE 1 BUSINESS AND BASIS OF PRESENTATION Business OR21, The Company (through ASRS) and Elekta AG (“Elekta”), the manufacturer of the Gamma Knife (through its wholly-owned United States subsidiary, GKV Investments, Inc.), entered into an operating agreement and formed GKF. During 2021 two The Company formed the subsidiary GKPeru and acquired GKCE for the purposes of expanding its business internationally; Orlando and LBE to provide PBRT equipment and services in Orlando, Florida and Long Beach, California, respectively; and AGKE and JGKE to provide Gamma Knife equipment and services in Albuquerque, New Mexico and Jacksonville, Florida, respectively. AGKE began operations in the second 2011 fourth 2011. first April 2016. first July 2017. not two On June 12, 2020, December 31, 2021 5 The Company continues to develop its design and business model for The Operating Room for the 21st OR21, “OR21” OR21 OR21 not two MedLeader was formed to provide continuing medical education online and through videos for doctors, nurses, and other healthcare workers. This subsidiary is not All significant intercompany accounts and transactions have been eliminated in consolidation. The Company is subject to risks and uncertainties as a result of the COVID- 19 19 may third

Note 2 - Accounting Policies

Note 2 - Accounting Policies	12 Months Ended
	Dec. 31, 2021
Notes to Financial Statements
Significant Accounting Policies [Text Block]	NOTE 2 ACCOUNTING POLICIES Use of estimates in the preparation of financial statements Advertising costs d. Advertising costs were December 31, 2021 2020 Cash and cash equivalents three not Restricted cash second 2021. 6 Business and credit risk not All of the Company’s revenue was provided by seventeen and eighteen customers in 2021 2020 2021 2020 December 31, 2021 two December 31, 2020 four not not 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 Property and equipment June 2020. April 1, 2021, nine December 31, 2021 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 not 2021 2020 The Company leases Gamma Knife and radiation therapy equipment to its customers under arrangements accounted for as operating leases. At December 31, 2021 December 31, 2020 As of December 31, 2021 2020 , the Company recognized a loss on the write down of impaired assets of $105,000 and $8,264,000, respectively. The impaired assets included six two 2 3 Revenue recognition 842 Leases 842” 606 Revenue from Contracts with Customers 606” Rental income from medical services 842 not third . December 31, 2021 2020 842, Patient income 606, no 30 30 60 not not December 31, 2021 2020 December 31, 2021 2020 December 31, 2021 2020 606, Stock-based compensation 10 Costs of revenue Sales and Marketing The Company typically provides the equipment, as well as planning, installation, reimbursement and marketing support services. Income taxes The Company accounts for uncertainty in income taxes as required by the provisions of ASC 740 Income taxes 740” first not second 50% may may not See Note 9 Functional currency 830, Foreign Currency Matters 830” 830 December 31, 2021 2020 Asset Retirement Obligations 410 Asset Retirement Obligations 410” asset retirement obligation (“ARO”) December 31, 2020 four one December 31, 2021 December 31, 2021 December 31, 2020 not Earnings per share not Because the Company reported a loss for the year ended December 31, 2020 not The following table illustrates the computations of basic and diluted earnings per share for the years ended December 31, 2021 2020 2021 2020 Numerator for basic and diluted earnings (loss) per share $ 194,000 $ (7,058,000 ) Denominator: Denominator for basic and diluted earnings per share – weighted-average shares 6,044,000 6,182,000 Effect of dilutive securities Employee stock options and restricted stock 15,000 - Denominator for diluted earnings per share – adjusted weighted-average shares 6,059,000 6,182,000 Earnings (loss) per common share- basic $ 0.03 $ (1.14 ) Earnings (loss) per common share- diluted $ 0.03 $ (1.14 ) In 2020 not Business segment information 280 Segment Reporting 280” fourteen two December 31, 2021 two two The revenues, profit or loss, and net property and equipment allocations for the Company's two reportable segments as of December 31, 2021 2020 2021 2020 Revenues Domestic $ 14,719,000 $ 16,204,000 Foreign 2,909,000 1,633,000 Total $ 17,628,000 $ 17,837,000 2021 2020 Profit or (loss) Domestic $ 245,000 $ (7,082,000 ) Foreign (51,000 ) 24,000 Total $ 194,000 $ (7,058,000 ) 2021 2020 Property and equipment, net Domestic $ 25,557,000 $ 27,223,000 Foreign 2,697,000 3,195,000 Total $ 28,254,000 $ 30,418,000 Long lived asset impairment may not may not, December 31, 2020 December 31, 2021 one December 31, 2020 No December 31, 2021 3 Goodwill and intangible assets - June 2020. 350 Intangibles-Goodwill and Other 350” not 350, may December 31, 2021 2020, Acquisitions 805 Business Combinations 805” 5 Accounting pronouncements issued and not January 2021, 2021 01 Reference Rate Reform (Topic 848 2021 01” 2021 01 2021 01 March 12, 2020, 2021 01 may 6 Reclassifications December 31, 2020

Note 3 - Property and Equipment

Note 3 - Property and Equipment	12 Months Ended
	Dec. 31, 2021
Notes to Financial Statements
Property, Plant and Equipment Disclosure [Text Block]	NOTE 3 PROPERTY AND EQUIPMENT Property and equipment consists of the following: December 31, 2021 2020 Medical equipment and facilities $ 73,388,000 $ 75,657,000 Office equipment 472,000 330,000 Construction in progress 91,000 170,000 73,951,000 76,157,000 Accumulated depreciation (45,697,000 ) (45,739,000 ) Net property and equipment $ 28,254,000 $ 30,418,000 As of December 31, 2021 2020, As of April 1, 2021, nine December 31, 2021 As December 31, 2020 six two six two one 2020, one 2021, one January 2022, fourth 2022, four December 31, 2020 second 2021 December 31, 2021 December 31, 2021 one The Company reviews the carrying value of its long-lived assets for impairment on a quarterly basis, or as events or circumstances might indicate that the carrying value may not December 31, 2021 no Prior to December 31, 2020 two S250i may not December 31, 2020 19 December 31, 2021

Note 4 - Other Accrued Liabilit

Note 4 - Other Accrued Liabilities	12 Months Ended
	Dec. 31, 2021
Notes to Financial Statements
Other Liabilities Disclosure [Text Block]	NOTE 4 Other accrued liabilities consists of the following: December 31, 2021 2020 Equipment maintenance and upgrades $ 1,281,000 $ — Insurance 340,000 471,000 Professional services 90,000 211,000 Operating costs 397,000 703,000 Other 311,000 660,000 Total other accrued liabilities $ 2,419,000 $ 2,045,000

Note 5 - GKCE Acquisition

Note 5 - GKCE Acquisition	12 Months Ended
	Dec. 31, 2021
Notes to Financial Statements
Business Combination Disclosure [Text Block]	NOTE 5 On June 18, 2019, 2009 On June 12, 2020 ( December 31, 2021 r ended December 31, 2021 The base purchase price of $2,000,000 was paid with $575,000 of cash and $1,425,000 from the DFC Loan. The DFC Loan is denominated in U.S. dollars, which is also the currency of Ecuador. The price adjustments were paid by the Company in the post-closing period with the adjustments related to the amount of working capital that GKCE had as of the Closing Date. The first August 2020. three six twelve December 31, 2021 no The acquisition has been accounted for according to ASC 805 December 31, 2021 no one The fair value of assets acquired and liabilities assumed were as follows: June 12, 2020 Cash and cash equivalents $ 432,000 Accounts receivable 854,000 Prepaid expense and other 22,000 Building 385,000 Land 19,000 Medical equipment 319,000 Purchased intangible assets 78,000 Goodwill 1,265,000 Total assets acquired $ 3,374,000 Accounts payable $ (193,000 ) Income taxes payable (141,000 ) Deferred income taxes (66,000 ) Employee compensation and benefits (91,000 ) Total liabilities assumed (491,000 ) Consideration allocated to assets acquired and liabilities assumed $ 2,883,000 First working capital payment $ (515,000 ) Subsequent working capital payment (368,000 ) Base purchase consideration $ 2,000,000 The Company has allocated the purchase price of GKCE to the tangible assets, liabilities, and intangible asset acquired, based on their estimated fair values. Goodwill represents the excess of the purchase price consideration over the fair value of the identifiable tangible and intangible assets assumed. The Company believes the amount of goodwill resulting from the acquisition is primarily attributable to expected synergies from an assembled and trained workforce and enhanced opportunities for growth and innovation. The goodwill resulting from the acquisition is not The value of the acquired tangible assets acquired are as follows: Fair Value Useful Life (in Years) Building $ 385,000 20 Land 19,000 Medical equipment 302,000 2 Other fixed assets 17,000 2 Total tangible assets $ 723,000 The Company also acquired intangible assets with a fair value of $78,000. The intangible asset identified was GKCE's trade name and the Company assigned an indefinite useful life to the asset. The Company incurred costs related to the acquisition of approximately $162,000 for the year ended December 31, 2020. The revenue and earnings of GKCE have been included in the Company’s consolidated results since the Closing Date and are not not not not not not

Note 6 - Long Term Debt

Note 6 - Long Term Debt	12 Months Ended
	Dec. 31, 2021
Notes to Financial Statements
Long-term Debt [Text Block]	NOTE 6 As of December 31, 2020 seven three $11,023,000, the On April 9, 2021 five three first two two first 2021, second third five twelve December 31, 2021 twelve December 31, 2021 As of December 31, 2021, no 1 3 6 12 2023. one five The Credit Agreement contains customary covenants and representations, including without limitation, a minimum fixed charge coverage ratio of 1.25 and maximum funded debt to EBITDA ratio of 3.0 to 1.0 twelve December 31, 2021 The DFC Loan entered into in connection with the acquisition of GKCE was obtained through the Company’s wholly-owned subsidiary, HoldCo and is guaranteed by GKF. The DFC Loan is secured by a lien on GKCE’s assets. The amount outstanding under the DFC Loan is payable in 29 3.67%. December 31, 2021 The following are contractual maturities of long-term debt by year at December 31, 2021 $294,000: Year ending December 31, Principal 2022 $ 1,157,000 2023 1,719,000 2024 2,094,000 2025 2,469,000 2026 8,094,000 Thereafter 165,000 $ 15,698,000

Note 7 - Finance Leases

Note 7 - Finance Leases	12 Months Ended
	Dec. 31, 2021
Notes to Financial Statements
Lessee, Finance Leases [Text Block]	NOTE 7 The Company's finance lease obligations were refinanced by long-term debt on April 9, 2021. 6

Note 8 - Leases

Note 8 - Leases	12 Months Ended
	Dec. 31, 2021
Notes to Financial Statements
Lessee, Operating Leases [Text Block]	NOTE 8 The Company determines if a contract is a lease at inception. Under ASC 842, 842 not 842 842 not The Company’s Gamma Knife and PBRT contracts with hospitals are classified as operating leases under ASC 842. 2 not not On November 3, 2021, 410, August 2023. 601 1112, November 2024. 842 December 1, 2021, 842 360 360” December 1, 2021. December 31, 2021, The Company’s lessee operating leases are accounted for as ROU assets, other current liabilities, and lease liabilities on the consolidated balance sheets. Operating lease ROU assets and liabilities are recognized based on the present value of the future minimum lease payments over the lease term at commencement date. The Company’s operating lease contracts do not December 31, 2021 During the year ended December 31, 2020, not 842. not December 31, 2020, January 1, 2020 The following table summarizes maturities of lessee operating lease ROU assets and liabilities as of December 31, 2021 Year ending December 31, Operating Leases 2022 $ 406,000 2023 302,000 2024 58,000 Total lease payments 766,000 Less imputed interest (38,000 ) Total $ 728,000

Note 9 - Income Taxes

Note 9 - Income Taxes	12 Months Ended
	Dec. 31, 2021
Notes to Financial Statements
Income Tax Disclosure [Text Block]	NOTE 9 INCOME TAXES As of December 31, 2021 2020 December 31, 2021 The components of the provision (benefit) for income taxes as of December 31, 2021 2020 YEARS ENDED December 31, 2021 2020 Current: Federal $ 9,000 $ 209,000 State 93,000 88,000 Foreign 107,000 117,000 Total current 209,000 414,000 Deferred: Federal 98,000 (1,909,000 ) State (18,000 ) (266,000 ) Foreign (20,000 ) 24,000 Total deferred 60,000 (2,151,000 ) $ 269,000 $ (1,737,000 ) Significant components of the Company’s deferred tax liabilities and assets as of December 31, 2021 2020 December 31, 2021 2020 Deferred tax liabilities: Property and equipment $ (1,055,000 ) $ (564,000 ) Total deferred tax liabilities (1,055,000 ) (564,000 ) Deferred tax assets: Net operating loss carryforwards 360,000 99,000 Accruals and allowances 41,000 43,000 Lease liabilities 136,000 - Tax credits 4,000 5,000 Other – net 87,000 50,000 Capital loss carryover 646,000 627,000 Total deferred tax assets 1,274,000 824,000 Valuation allowance (697,000 ) (678,000 ) Deferred tax assets net of valuation allowance 577,000 146,000 Net deferred tax liabilities $ (478,000 ) $ (418,000 ) These amounts are presented in the financial statements as follows: December 31, 2021 2020 Deferred income taxes (non-current) $ (478,000 ) $ (418,000 ) $ (478,000 ) $ (418,000 ) The provision (benefit) for income taxes differs from the amount computed by applying the U.S. federal statutory tax rate (21% in 2021 2020 YEARS ENDED December 31, 2021 2020 Computed expected federal income tax $ 79,000 $ (1,844,000 ) State income taxes, net of federal benefit 69,000 (199,000 ) Non-deductible expenses 28,000 6,000 Return to Provision True-up 19,000 22,000 Uncertain Tax Positions 14,000 16,000 Capital loss carryforward expiration - 246,000 Change in valuation allowance 19,000 (243,000 ) Other deferred tax adjustments 41,000 259,000 $ 269,000 $ (1,737,000 ) As of December 31, 2021 2029. Utilization of the net operating loss and credit carryforwards may 1986, may At December 31, 2021 2024. 2024. Due to uncertainty surrounding the realization of impairment losses, capital losses and foreign operating losses in future years, the Company has placed a valuation allowance against a portion of its net domestic and foreign deferred tax assets. The net valuation allowance decreased by $465,000 and $243,000 for the tax years ended December 31, 2021 2020 The tax return years 2017 2020 1999 2004, 2009, 2010, 2012, 2014, 2015, 2016, 2017 2018 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 As of December 31, 2021 not YEARS ENDED December 31, 2021 2020 Balance at beginning of year $ 275,000 $ 259,000 Additions based on tax positions of prior years 20,000 16,000 Balance at end of year $ 295,000 $ 275,000 The Company's policy for deducting interest and penalties is to treat interest as interest expense and penalties as taxes. As of December 31, 2021 not 12

Note 10 - Stock-based Compensat

Note 10 - Stock-based Compensation Expense	12 Months Ended
	Dec. 31, 2021
Notes to Financial Statements
Share-based Payment Arrangement [Text Block]	NOTE 10 STOCK-BASED COMPENSATION EXPENSE Incentive Compensation Plan In June 2021, five February 22, 2027. No December 31, 2021 , approximately 1,453,000 shares remain available for grant under the Plan. Under the Plan, a total of 621,000 restricted stock units have been granted, consisting o f 53,000 o two 2021 2020, not 487,000 December 31, 2021 Changes in restricted stock units, consisting primarily of annual automatic grants, deferred compensation to non-employee directors, and restricted stock units awards to the CEO, under the Incentive Compensation Plans during 2021 2020 Restricted Stock Units Grant Date Weighted- Average Fair Value Intrinsic Value Outstanding at January 1, 2020 3,000 $ 3.03 $ — Granted 144,000 $ 1.96 $ — Vested (134,000 ) $ 1.98 $ — Outstanding at December 31, 2020 13,000 $ 1.97 $ 2,000 Granted 165,000 $ 2.61 $ — Vested (168,000 ) $ 2.57 $ — Outstanding at December 31, 2021 10,000 $ 2.57 $ — For the year ended December 31, 2021 December 31, 2021 $12,000, with an offsetting tax benefit of $3,000, December 31, 2021 four Certain Executive Equity Awards Effective May 4, 2020, August 3, 2020. October 1, 2020, December 31, 2020, December 31, 2020. December 31, 2020, December 31, 2021, On January 4, 2017, three March 31, 2020. 718 Stock Compensation 718” December 31, 2017, one March 31, 2020. As of December 31, 2021 Stock-Based Awards Issued Compensation and Vested Expense Options — $ 2,000 Options Exercised 5,000 — RSUs Issued in Lieu of Retainer Fees — 75,000 RSUs Issued in Lieu of Retainer Fees - vested and issued 121,000 — Annual RSU Awards 2,000 12,000 Executive Compensation 130,000 331,000 258,000 $ 420,000 Stock Options Changes in stock options outstanding under the Incentive Compensation Plans during 2021 2020 Options Number of Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term (Years) Aggregate Intrinsic Value Balance at December 31, 2019 450,000 $ 2.78 2.44 $ 27,000 Granted 10,000 $ 1.88 7.00 $ — Forfeited (43,000 ) $ 2.54 — $ — Balance at December 31, 2020 417,000 $ 2.79 1.61 $ 2,000 Granted 6,000 $ 2.92 7.00 $ — Exercised (22,000 ) $ 2.65 Forfeited (334,000 ) $ 2.81 — $ — Balance at December 31, 2021 67,000 $ 2.72 3.33 $ - Exercisable at December 31, 2020 405,000 $ 2.80 1.48 $ — Exercisable at December 31, 2021 58,000 $ 2.72 2.96 $ — The weighted average grant-date fair value of the options granted during the years 2021 2020 $1.10 December 31, 2021 December 31, 2020 December 2021 2020 The Company received approximately $5,000 from the exercise of 2,000 options under the share-based arrangements for the year ended December 31, 2021 December 31, 2020 A summary of the status of the Company’s non-vested stock options as of December 31, 2021 2020 anges during the years ended December 31, 2021 2020 is presen Nonvested Options Number of Options Weighted Average Grant-Date Fair Value Nonvested at December 31, 2019 25,000 $ 1.40 Granted 10,000 $ 0.78 Vested (23,000 ) $ 1.22 Nonvested at December 31, 2020 12,000 $ 1.07 Granted 6,000 $ 1.10 Vested (9,000 ) $ 0.91 Nonvested at December 31, 2021 9,000 $ 1.10 At December 31, 2021 four 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 not The fair value of the Company’s option grants issued during 2021 2020 The fair value of the Compan y’s option grants under the Plan in 2021 and 2020 was estimated using the following assumptions: 2021 2020 Expected life (years) 7.0 7.0 Expected forfeiture rate 0.0 % 0.0 % Expected volatility 40 % 40 % Dividend yield 0 % 0 % Risk-free interest rate 1.2 % 0.4 % Repurchase of Common Stock, Common Stock Warrants and Stock Options In 1999 2001, 2008. 2021 2020

Note 11 - Retirement Plan

Note 11 - Retirement Plan	12 Months Ended
	Dec. 31, 2021
Notes to Financial Statements
Retirement Benefits [Text Block]	NOTE 11 RETIREMENT PLAN The Company has a defined-contribution retirement plan (the “Retirement Plan”) that allows for a matching safe harbor contribution. For 2021 not December 31, 2021 December 31, 2020

Note 12 - Operating Leases

Note 12 - Operating Leases	12 Months Ended
	Dec. 31, 2021
Notes to Financial Statements
Lessor, Operating Leases [Text Block]	NOTE 12 OPERATING LEASES The Company’s corporate offices are located at 601 1112, November 2024. 410, August 2023. January 2024. Future minimum payments under non-cancelable operating l eases, excluding expected sublease income, havin one Year ending December 31, 2022 $ 406,000 2023 302,000 2024 58,000 $ 766,000 Payments for repair and maintenance agreements incorporated in operating lease agreements are not Net rent expense was $377,000 and $404,000 for the years ended December 31, 2021 2020 December 31, 2021,

Note 13 - Commitments and Conti

Note 13 - Commitments and Contingencies	12 Months Ended
	Dec. 31, 2021
Notes to Financial Statements
Commitments and Contingencies Disclosure [Text Block]	NOTE 13 COMMITMENTS AND CONTINGENCIES On December 20, 2018, two second third second third not second third no 2023. December 31, 2021 two S250i As of December 31, 2021 four one one 2022 2023. third 2022. Total Gamma Knife and LINAC commitments as of December 31, 2021 were . There are no 12 no and a line of credit of $7,000,000 to fund these projects. On July 21, 2017, September 5, 2017, 2018, five one As of December 31, 2021 , the Company had commitments to service and maintain its Gamma Knife and PBRT equipment. The service commitments are carried out via contracts with Mevion, Elekta and Mobius Imaging, LLC. In addition, in April 2019, 2022 2023. December 31, 2021 The Company estimates the following commitments for each of the equipment systems, with expected timing of payments as follows as of December 31, 2021 Payments Due by Period Contractual Obligations Total amounts committed 2022 2023 2024 2025 2026 After 5 years Long-term debt (includes interest) $ 17,650,000 $ 1,651,000 $ 4,672,000 $ 11,156,000 $ 171,000 Future equipment purchases 44,760,000 2,000,000 42,760,000 — — Equipment service contracts 8,408,000 453,000 2,618,000 2,709,000 2,628,000 Operating leases 766,000 406,000 302,000 58,000 — Total contractual obligations $ 71,584,000 $ 4,510,000 $ 50,352,000 $ 13,923,000 $ 2,799,000

Note 14 - Related Party Transac

Note 14 - Related Party Transactions	12 Months Ended
	Dec. 31, 2021
Notes to Financial Statements
Related Party Transactions Disclosure [Text Block]	NOTE 14 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 and service equipment, and costs to maintain the equipment December 31, 2021 2020 $ 1,103,000 $ 701,000 one four December 31, 2021 2020 13 December 31, 2021 60 fourth December 31, 2020

Significant Accounting Policies

Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2021
Accounting Policies [Abstract]
Use of Estimates, Policy [Policy Text Block]	Use of estimates in the preparation of financial statements
Advertising Cost [Policy Text Block]	Advertising costs d. Advertising costs were December 31, 2021 2020
Cash and Cash Equivalents, Policy [Policy Text Block]	Cash and cash equivalents three not
Cash and Cash Equivalents, Restricted Cash and Cash Equivalents, Policy [Policy Text Block]	Restricted cash second 2021. 6
Concentration Risk, Credit Risk, Policy [Policy Text Block]	Business and credit risk not All of the Company’s revenue was provided by seventeen and eighteen customers in 2021 2020 2021 2020 December 31, 2021 two December 31, 2020 four not not 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 [Policy Text Block]	Accounts receivable and doubtful accounts
Consolidation, Subsidiaries or Other Investments, Consolidated Entities, Policy [Policy Text Block]	Non-controlling interests
Property, Plant and Equipment, Policy [Policy Text Block]	Property and equipment June 2020. April 1, 2021, nine December 31, 2021 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 not 2021 2020 The Company leases Gamma Knife and radiation therapy equipment to its customers under arrangements accounted for as operating leases. At December 31, 2021 December 31, 2020 As of December 31, 2021 2020 , the Company recognized a loss on the write down of impaired assets of $105,000 and $8,264,000, respectively. The impaired assets included six two 2 3
Revenue [Policy Text Block]	Revenue recognition 842 Leases 842” 606 Revenue from Contracts with Customers 606” Rental income from medical services 842 not third . December 31, 2021 2020 842, Patient income 606, no 30 30 60 not not December 31, 2021 2020 December 31, 2021 2020 December 31, 2021 2020 606,
Compensation Related Costs, Policy [Policy Text Block]	Stock-based compensation 10
Cost of Goods and Service [Policy Text Block]	Costs of revenue
Selling, General and Administrative Expenses, Policy [Policy Text Block]	Sales and Marketing 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 uncertainty in income taxes as required by the provisions of ASC 740 Income taxes 740” first not second 50% may may not See Note 9
Foreign Currency Transactions and Translations Policy [Policy Text Block]	Functional currency 830, Foreign Currency Matters 830” 830 December 31, 2021 2020
Asset Retirement Obligation [Policy Text Block]	Asset Retirement Obligations 410 Asset Retirement Obligations 410” asset retirement obligation (“ARO”) December 31, 2020 four one December 31, 2021 December 31, 2021 December 31, 2020 not
Earnings Per Share, Policy [Policy Text Block]	Earnings per share not Because the Company reported a loss for the year ended December 31, 2020 not The following table illustrates the computations of basic and diluted earnings per share for the years ended December 31, 2021 2020 2021 2020 Numerator for basic and diluted earnings (loss) per share $ 194,000 $ (7,058,000 ) Denominator: Denominator for basic and diluted earnings per share – weighted-average shares 6,044,000 6,182,000 Effect of dilutive securities Employee stock options and restricted stock 15,000 - Denominator for diluted earnings per share – adjusted weighted-average shares 6,059,000 6,182,000 Earnings (loss) per common share- basic $ 0.03 $ (1.14 ) Earnings (loss) per common share- diluted $ 0.03 $ (1.14 ) In 2020 not
Segment Reporting, Policy [Policy Text Block]	Business segment information 280 Segment Reporting 280” fourteen two December 31, 2021 two two The revenues, profit or loss, and net property and equipment allocations for the Company's two reportable segments as of December 31, 2021 2020 2021 2020 Revenues Domestic $ 14,719,000 $ 16,204,000 Foreign 2,909,000 1,633,000 Total $ 17,628,000 $ 17,837,000 2021 2020 Profit or (loss) Domestic $ 245,000 $ (7,082,000 ) Foreign (51,000 ) 24,000 Total $ 194,000 $ (7,058,000 ) 2021 2020 Property and equipment, net Domestic $ 25,557,000 $ 27,223,000 Foreign 2,697,000 3,195,000 Total $ 28,254,000 $ 30,418,000
Impairment or Disposal of Long-Lived Assets, Policy [Policy Text Block]	Long lived asset impairment may not may not, December 31, 2020 December 31, 2021 one December 31, 2020 No December 31, 2021 3
Goodwill and Intangible Assets, Policy [Policy Text Block]	Goodwill and intangible assets - June 2020. 350 Intangibles-Goodwill and Other 350” not 350, may December 31, 2021 2020,
Business Combinations Policy [Policy Text Block]	Acquisitions 805 Business Combinations 805” 5
New Accounting Pronouncements, Policy [Policy Text Block]	Accounting pronouncements issued and not January 2021, 2021 01 Reference Rate Reform (Topic 848 2021 01” 2021 01 2021 01 March 12, 2020, 2021 01 may 6
Reclassification, Comparability Adjustment [Policy Text Block]	Reclassifications December 31, 2020

Note 2 - Accounting Policies (T

Note 2 - Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2021
Notes Tables
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	2021 2020 Numerator for basic and diluted earnings (loss) per share $ 194,000 $ (7,058,000 ) Denominator: Denominator for basic and diluted earnings per share – weighted-average shares 6,044,000 6,182,000 Effect of dilutive securities Employee stock options and restricted stock 15,000 - Denominator for diluted earnings per share – adjusted weighted-average shares 6,059,000 6,182,000 Earnings (loss) per common share- basic $ 0.03 $ (1.14 ) Earnings (loss) per common share- diluted $ 0.03 $ (1.14 )
Reconciliation of Revenue from Segments to Consolidated [Table Text Block]	2021 2020 Revenues Domestic $ 14,719,000 $ 16,204,000 Foreign 2,909,000 1,633,000 Total $ 17,628,000 $ 17,837,000
Reconciliation of Operating Profit (Loss) from Segments to Consolidated [Table Text Block]	2021 2020 Profit or (loss) Domestic $ 245,000 $ (7,082,000 ) Foreign (51,000 ) 24,000 Total $ 194,000 $ (7,058,000 )
Reconciliation of Assets from Segment to Consolidated [Table Text Block]	2021 2020 Property and equipment, net Domestic $ 25,557,000 $ 27,223,000 Foreign 2,697,000 3,195,000 Total $ 28,254,000 $ 30,418,000

Note 3 - Property and Equipme_2

Note 3 - Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2021
Notes Tables
Property, Plant and Equipment [Table Text Block]	December 31, 2021 2020 Medical equipment and facilities $ 73,388,000 $ 75,657,000 Office equipment 472,000 330,000 Construction in progress 91,000 170,000 73,951,000 76,157,000 Accumulated depreciation (45,697,000 ) (45,739,000 ) Net property and equipment $ 28,254,000 $ 30,418,000

Note 4 - Other Accrued Liabil_2

Note 4 - Other Accrued Liabilities (Tables)	12 Months Ended
	Dec. 31, 2021
Notes Tables
Other Liabilities [Table Text Block]	December 31, 2021 2020 Equipment maintenance and upgrades $ 1,281,000 $ — Insurance 340,000 471,000 Professional services 90,000 211,000 Operating costs 397,000 703,000 Other 311,000 660,000 Total other accrued liabilities $ 2,419,000 $ 2,045,000

Note 5 - GKCE Acquisition (Tabl

Note 5 - GKCE Acquisition (Tables)	12 Months Ended
	Dec. 31, 2021
Notes Tables
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed [Table Text Block]	June 12, 2020 Cash and cash equivalents $ 432,000 Accounts receivable 854,000 Prepaid expense and other 22,000 Building 385,000 Land 19,000 Medical equipment 319,000 Purchased intangible assets 78,000 Goodwill 1,265,000 Total assets acquired $ 3,374,000 Accounts payable $ (193,000 ) Income taxes payable (141,000 ) Deferred income taxes (66,000 ) Employee compensation and benefits (91,000 ) Total liabilities assumed (491,000 ) Consideration allocated to assets acquired and liabilities assumed $ 2,883,000 First working capital payment $ (515,000 ) Subsequent working capital payment (368,000 ) Base purchase consideration $ 2,000,000
Tangible Assets Acquired as Part of Business Combination [Table Text Block]	Fair Value Useful Life (in Years) Building $ 385,000 20 Land 19,000 Medical equipment 302,000 2 Other fixed assets 17,000 2 Total tangible assets $ 723,000

Note 6 - Long Term Debt (Tables

Note 6 - Long Term Debt (Tables)	12 Months Ended
	Dec. 31, 2021
Notes Tables
Schedule of Maturities of Long-term Debt [Table Text Block]	Year ending December 31, Principal 2022 $ 1,157,000 2023 1,719,000 2024 2,094,000 2025 2,469,000 2026 8,094,000 Thereafter 165,000 $ 15,698,000

Note 8 - Leases (Tables)

Note 8 - Leases (Tables)	12 Months Ended
	Dec. 31, 2021
Notes Tables
Lessee, Operating Lease, Liability, Maturity [Table Text Block]	Year ending December 31, Operating Leases 2022 $ 406,000 2023 302,000 2024 58,000 Total lease payments 766,000 Less imputed interest (38,000 ) Total $ 728,000

Note 9 - Income Taxes (Tables)

Note 9 - Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2021
Notes Tables
Schedule of Components of Income Tax Expense (Benefit) [Table Text Block]	YEARS ENDED December 31, 2021 2020 Current: Federal $ 9,000 $ 209,000 State 93,000 88,000 Foreign 107,000 117,000 Total current 209,000 414,000 Deferred: Federal 98,000 (1,909,000 ) State (18,000 ) (266,000 ) Foreign (20,000 ) 24,000 Total deferred 60,000 (2,151,000 ) $ 269,000 $ (1,737,000 )
Schedule of Deferred Tax Assets and Liabilities [Table Text Block]	December 31, 2021 2020 Deferred tax liabilities: Property and equipment $ (1,055,000 ) $ (564,000 ) Total deferred tax liabilities (1,055,000 ) (564,000 ) Deferred tax assets: Net operating loss carryforwards 360,000 99,000 Accruals and allowances 41,000 43,000 Lease liabilities 136,000 - Tax credits 4,000 5,000 Other – net 87,000 50,000 Capital loss carryover 646,000 627,000 Total deferred tax assets 1,274,000 824,000 Valuation allowance (697,000 ) (678,000 ) Deferred tax assets net of valuation allowance 577,000 146,000 Net deferred tax liabilities $ (478,000 ) $ (418,000 ) December 31, 2021 2020 Deferred income taxes (non-current) $ (478,000 ) $ (418,000 ) $ (478,000 ) $ (418,000 )
Schedule of Effective Income Tax Rate Reconciliation [Table Text Block]	YEARS ENDED December 31, 2021 2020 Computed expected federal income tax $ 79,000 $ (1,844,000 ) State income taxes, net of federal benefit 69,000 (199,000 ) Non-deductible expenses 28,000 6,000 Return to Provision True-up 19,000 22,000 Uncertain Tax Positions 14,000 16,000 Capital loss carryforward expiration - 246,000 Change in valuation allowance 19,000 (243,000 ) Other deferred tax adjustments 41,000 259,000 $ 269,000 $ (1,737,000 )
Schedule of Unrecognized Tax Benefits Roll Forward [Table Text Block]	YEARS ENDED December 31, 2021 2020 Balance at beginning of year $ 275,000 $ 259,000 Additions based on tax positions of prior years 20,000 16,000 Balance at end of year $ 295,000 $ 275,000

Note 10 - Stock-based Compens_2

Note 10 - Stock-based Compensation Expense (Tables)	12 Months Ended
	Dec. 31, 2021
Notes Tables
Share-based Payment Arrangement, Restricted Stock and Restricted Stock Unit, Activity [Table Text Block]	Restricted Stock Units Grant Date Weighted- Average Fair Value Intrinsic Value Outstanding at January 1, 2020 3,000 $ 3.03 $ — Granted 144,000 $ 1.96 $ — Vested (134,000 ) $ 1.98 $ — Outstanding at December 31, 2020 13,000 $ 1.97 $ 2,000 Granted 165,000 $ 2.61 $ — Vested (168,000 ) $ 2.57 $ — Outstanding at December 31, 2021 10,000 $ 2.57 $ —
Disclosure of Share-based Compensation Arrangements by Share-based Payment Award [Table Text Block]	Stock-Based Awards Issued Compensation and Vested Expense Options — $ 2,000 Options Exercised 5,000 — RSUs Issued in Lieu of Retainer Fees — 75,000 RSUs Issued in Lieu of Retainer Fees - vested and issued 121,000 — Annual RSU Awards 2,000 12,000 Executive Compensation 130,000 331,000 258,000 $ 420,000
Share-based Payment Arrangement, Option, Activity [Table Text Block]	Options Number of Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term (Years) Aggregate Intrinsic Value Balance at December 31, 2019 450,000 $ 2.78 2.44 $ 27,000 Granted 10,000 $ 1.88 7.00 $ — Forfeited (43,000 ) $ 2.54 — $ — Balance at December 31, 2020 417,000 $ 2.79 1.61 $ 2,000 Granted 6,000 $ 2.92 7.00 $ — Exercised (22,000 ) $ 2.65 Forfeited (334,000 ) $ 2.81 — $ — Balance at December 31, 2021 67,000 $ 2.72 3.33 $ - Exercisable at December 31, 2020 405,000 $ 2.80 1.48 $ — Exercisable at December 31, 2021 58,000 $ 2.72 2.96 $ —
Schedule of Nonvested Share Activity [Table Text Block]	Nonvested Options Number of Options Weighted Average Grant-Date Fair Value Nonvested at December 31, 2019 25,000 $ 1.40 Granted 10,000 $ 0.78 Vested (23,000 ) $ 1.22 Nonvested at December 31, 2020 12,000 $ 1.07 Granted 6,000 $ 1.10 Vested (9,000 ) $ 0.91 Nonvested at December 31, 2021 9,000 $ 1.10
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions [Table Text Block]	2021 2020 Expected life (years) 7.0 7.0 Expected forfeiture rate 0.0 % 0.0 % Expected volatility 40 % 40 % Dividend yield 0 % 0 % Risk-free interest rate 1.2 % 0.4 %

Note 12 - Operating Leases (Tab

Note 12 - Operating Leases (Tables)	12 Months Ended
	Dec. 31, 2021
Notes Tables
Lessee, Operating Lease, Maturity, Net of Sublease [Table Text Block]	Year ending December 31, 2022 $ 406,000 2023 302,000 2024 58,000 $ 766,000

Note 13 - Commitments and Con_2

Note 13 - Commitments and Contingencies (Tables)	12 Months Ended
	Dec. 31, 2021
Notes Tables
Long-term Purchase Commitment [Table Text Block]	Payments Due by Period Contractual Obligations Total amounts committed 2022 2023 2024 2025 2026 After 5 years Long-term debt (includes interest) $ 17,650,000 $ 1,651,000 $ 4,672,000 $ 11,156,000 $ 171,000 Future equipment purchases 44,760,000 2,000,000 42,760,000 — — Equipment service contracts 8,408,000 453,000 2,618,000 2,709,000 2,628,000 Operating leases 766,000 406,000 302,000 58,000 — Total contractual obligations $ 71,584,000 $ 4,510,000 $ 50,352,000 $ 13,923,000 $ 2,799,000

Note 1 - Business and Basis o_2

Note 1 - Business and Basis of Presentation (Details Textual)	Jun. 12, 2020USD ($)	Dec. 31, 2021USD ($)
OR21, LLC [Member]
Equity Method Investment, Ownership Percentage		50.00%
Gamma Knife Center Ecuador S.A. (GKCE) [Member]
Noncontrolling Interest, Ownership Percentage by Parent		99.30%
Noncontrolling Interest, Ownership Percentage by Noncontrolling Owners		0.70%
Gamma Knife Center Ecuador S.A. (GKCE) [Member]
Business Combination, Consideration Transferred, Total	$ 2,000,000	$ 2,883,000
Payments to Acquire Businesses, Gross	575,000
Business Combination, Consideration Transferred, Liabilities Incurred	$ 1,425,000
GK Financing, LLC (GKF) [Member] | Gamma Knife Center Ecuador S.A. (GKCE) [Member]
Business Acquisition, Percentage of Voting Interests Acquired	98.00%
Third Party [Member] | Gamma Knife Center Ecuador S.A. (GKCE) [Member]
Noncontrolling Interest, Ownership Percentage by Noncontrolling Owners		0.70%
Architectural Design Company [Member] | OR21, LLC [Member]
Equity Method Investment, Ownership Percentage		50.00%
Gamma Knife Center Ecuador S.A. (GKCE) [Member] | Gamma Knife Units [Member]
Number of Medical Centers		14

Note 2 - Accounting Policies (D

Note 2 - Accounting Policies (Details Textual)	Jun. 12, 2020USD ($)	Dec. 31, 2020USD ($)	Dec. 31, 2021USD ($)$ / sharesshares	Dec. 31, 2020USD ($)$ / sharesshares
Advertising Expense			$ 211,000	$ 237,000
Net Income (Loss) Attributable to Parent, Total			$ 194,000	$ (7,058,000)
Earnings Per Share, Diluted, Total (in dollars per share) | $ / shares			$ 0.03	$ (1.14)
Interest Costs Capitalized			$ 0	$ 119,000
Gain (Loss) on Sale of Assets and Asset Impairment Charges			$ (105,000)	$ (8,264,000)
Lessee, Operating Lease, Term of Contract (Year)			10 years
Share-based Payment Arrangement, Option, Exercise Price Range, Lower Range Limit (in dollars per share) | $ / shares				$ 2.25
Share-based Payment Arrangement, Option, Exercise Price Range, Upper Range Limit (in dollars per share) | $ / shares				$ 3.90
Number of Reportable Segments		2	2
Goodwill and Intangible Asset Impairment, Total			$ 0	$ 0
Gamma Knife Center Ecuador S.A. (GKCE) [Member]
Goodwill, Acquired During Period	$ 1,265,000
Gamma Knife Center Ecuador S.A. (GKCE) [Member] | Trade Names [Member]
Indefinite-lived Intangible Assets Acquired	$ 78,000
Restricted Stock Units (RSUs) [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount (in shares) | shares			13,000	13,000
Share-based Payment Arrangement, Option [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount (in shares) | shares				406,000
GK Peru [Member]
Accounts Receivable, Related Parties		$ 0	$ 0	$ 0
GKCE [Member]
Accounts Receivable, Related Parties		467,000	$ 435,000	467,000
Gamma Knife Units [Member]
Number of Customer with Intent to Terminate Contract			4
Asset Retirement Obligation, Ending Balance		0		0
Gamma Knife Units One [Member]
Asset Retirement Obligation, Ending Balance			$ 105,000
Other Gamma Knife Units [Member]
Asset Retirement Obligation, Ending Balance			0
Rental Income from Medical Services [Member]
Revenue from Contract with Customer, Including Assessed Tax			14,719,000	16,204,000
Patient Income [Member]
Revenue from Contract with Customer, Including Assessed Tax			2,909,000	1,633,000
Salvage Value [Member]
Net Income (Loss) Attributable to Parent, Total			$ 342,000
Earnings Per Share, Diluted, Total (in dollars per share) | $ / shares			$ 0.06
Office Equipment [Member] | Minimum [Member]
Property, Plant and Equipment, Useful Life (Year)			3 years
Office Equipment [Member] | Maximum [Member]
Property, Plant and Equipment, Useful Life (Year)			10 years
Building [Member]
Property, Plant and Equipment, Useful Life (Year)			20 years
Proton Beam Radiation Therapy PBRT [Member]
Property, Plant and Equipment, Useful Life (Year)			20 years
Gamma Knife And Radiation Therapy Equipment [Member]
Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization, Total		75,241,000	$ 72,972,000	75,241,000
Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, Accumulated Depreciation and Amortization		$ 45,416,000	$ 45,061,000	$ 45,416,000
Customer Concentration Risk [Member] | Revenue Benchmark [Member]
Number of Major Customers			17
Customer Concentration Risk [Member] | Revenue Benchmark [Member] | One Customer [Member]
Number of Major Customers				18
Concentration Risk, Percentage			34.00%	35.00%
Customer Concentration Risk [Member] | Accounts Receivable [Member]
Number of Major Customers			2	4
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Customer One [Member]
Concentration Risk, Percentage			31.00%	11.00%
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Customer Two [Member]
Concentration Risk, Percentage			10.00%	11.00%
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Customer Three [Member]
Concentration Risk, Percentage				11.00%
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Customer Four [Member]
Concentration Risk, Percentage				20.00%

Note 2 - Accounting Policies -

Note 2 - Accounting Policies - Computation of Basic and Diluted Earnings Per Share (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Numerator for basic and diluted earnings (loss) per share	$ 194,000	$ (7,058,000)
Denominator for basic and diluted earnings per share – weighted-average shares (in shares)	6,044,000	6,182,000
Effect of dilutive securities Employee stock options and restricted stock (in shares)	15,000	0
Denominator for diluted earnings per share – adjusted weighted-average shares (in shares)	6,059,000	6,182,000
Earnings (loss) per common share- basic (in dollars per share)	$ 0.03	$ (1.14)
Earnings (loss) per common share- diluted (in dollars per share)	$ 0.03	$ (1.14)

Note 2 - Accounting Policies _2

Note 2 - Accounting Policies - Revenues Allocations to Reportable Segments (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Revenues	$ 17,628,000	$ 17,837,000
Domestic Segment [Member]
Revenues	14,719,000	16,204,000
Foreign Segment [Member]
Revenues	$ 2,909,000	$ 1,633,000

Note 2 - Accounting Policies _3

Note 2 - Accounting Policies - Profit (Loss) Allocations to Reportable Segments (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Net Income (Loss) Attributable to Parent, Total	$ 194,000	$ (7,058,000)
Domestic Segment [Member]
Net Income (Loss) Attributable to Parent, Total	245,000	(7,082,000)
Foreign Segment [Member]
Net Income (Loss) Attributable to Parent, Total	$ (51,000)	$ 24,000

Note 2 - Accounting Policies _4

Note 2 - Accounting Policies - Property and Equipment Allocations to Reportable Segments (Details) - USD ($)	Dec. 31, 2021	Dec. 31, 2020
Property and equipment, net	$ 28,254,000	$ 30,418,000
Domestic Segment [Member]
Property and equipment, net	25,557,000	27,223,000
Foreign Segment [Member]
Property and equipment, net	$ 2,697,000	$ 3,195,000

Note 3 - Property and Equipme_3

Note 3 - Property and Equipment (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Net Income (Loss) Attributable to Parent, Total	$ 194,000	$ (7,058,000)
Earnings Per Share, Diluted, Total (in dollars per share)	$ 0.03	$ (1.14)
Gain (Loss) on Sale of Assets and Asset Impairment Charges	$ (105,000)	$ (8,264,000)
Two MEVION S250i Proton Beam Radiation Therapy Systems [Member]
Long Term Purchase Commitment Deposits for Assets		2,250,000
Accumulated Capitalized Interest Costs		1,613,000
Gamma Knife Units [Member]
Impairment of Long-Lived Assets to be Disposed of		3,051,000
Asset Retirement Obligation, Liabilities Incurred		1,350,000
Asset Retirement Obligation, Liabilities Settled	618,000	80,000
Tangible Asset Impairment Charges, Total	4,401,000
Proton Beam Radiation Therapy PBRT [Member]
Tangible Asset Impairment Charges, Total	0	3,863,000
Salvage Value [Member]
Net Income (Loss) Attributable to Parent, Total	$ 342,000
Earnings Per Share, Diluted, Total (in dollars per share)	$ 0.06
Non-US [Member]
Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization, Total	$ 2,697,000	$ 3,195,000

Note 3 - Property and Equipme_4

Note 3 - Property and Equipment - Summary of Property and Equipment (Details) - USD ($)	Dec. 31, 2021	Dec. 31, 2020
Property and equipment, gross	$ 73,951,000	$ 76,157,000
Accumulated depreciation	(45,697,000)	(45,739,000)
Net property and equipment	28,254,000	30,418,000
Medical Equipment and Facilities [Member]
Property and equipment, gross	73,388,000	75,657,000
Office Equipment [Member]
Property and equipment, gross	472,000	330,000
Construction in Progress [Member]
Property and equipment, gross	$ 91,000	$ 170,000

Note 4 - Other Accrued Liabil_3

Note 4 - Other Accrued Liabilities - Other Accrued Liabilities (Details) - USD ($)	Dec. 31, 2021	Dec. 31, 2020
Equipment maintenance and upgrades	$ 1,281,000	$ 0
Insurance	340,000	471,000
Professional services	90,000	211,000
Operating costs	397,000	703,000
Other	311,000	660,000
Total other accrued liabilities	$ 2,419,000	$ 2,045,000

Note 5 - GKCE Acquisition (Deta

Note 5 - GKCE Acquisition (Details Textual) - USD ($)	Jun. 12, 2020	Aug. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2021
Gamma Knife Center Ecuador S.A. (GKCE) [Member]
Noncontrolling Interest, Ownership Percentage by Parent			99.30%		99.30%
Noncontrolling Interest, Ownership Percentage by Noncontrolling Owners			0.70%		0.70%
Gamma Knife Center Ecuador S.A. (GKCE) [Member]
Business Combination, Acquisition of Less than 100 Percent, Noncontrolling Interest, Fair Value	$ 58,000
Business Combination, Consideration Transferred, Total	2,000,000				$ 2,883,000
Payments to Acquire Businesses, Gross	575,000
Business Combination, Consideration Transferred, Liabilities Incurred	1,425,000
Business Combination, Provisional Information, Initial Accounting Incomplete, Adjustment, Consideration Transferred		$ 515,000
Business Combination, Contingent Consideration Arrangements, Range of Outcomes, Value, High	368,000
Payment for Contingent Consideration Liability, Financing Activities			$ 368,000
Business Combination, Acquisition Related Costs				$ 162,000
Gamma Knife Center Ecuador S.A. (GKCE) [Member] | Trade Names [Member]
Indefinite-lived Intangible Assets Acquired	78,000
Gamma Knife Center Ecuador S.A. (GKCE) [Member] | DFC Loan [Member]
Business Combination, Consideration Transferred, Liabilities Incurred	$ 1,425,000
Gamma Knife Center Ecuador S.A. (GKCE) [Member] | Including Future Acquisition [Member]
Business Acquisition, Percentage of Voting Interests Acquired	100.00%
Gamma Knife Center Ecuador S.A. (GKCE) [Member] | GK Financing, LLC (GKF) [Member]
Business Acquisition, Percentage of Voting Interests Acquired	98.00%

Note 5 - GKCE Acquisition - Ass

Note 5 - GKCE Acquisition - Assets Acquired and Liabilities Assumed (Details) - USD ($)	Jun. 12, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2021
Goodwill		$ 1,265,000	$ 1,265,000	$ 1,265,000
First working capital payment		0	(43,000)
Subsequent working capital payment		$ 0	$ (154,000)
Gamma Knife Center Ecuador S.A. (GKCE) [Member]
Cash and cash equivalents	$ 432,000
Accounts receivable	854,000
Prepaid expense and other	22,000
Purchased intangible assets	78,000
Goodwill	1,265,000
Total assets acquired	3,374,000
Accounts payable	(193,000)
Income taxes payable	(141,000)
Deferred income taxes	(66,000)
Employee compensation and benefits	(91,000)
Total liabilities assumed	(491,000)
Consideration allocated to assets acquired and liabilities assumed	2,883,000
First working capital payment	(515,000)
Subsequent working capital payment	(368,000)
Base purchase consideration	2,000,000			$ 2,883,000
Gamma Knife Center Ecuador S.A. (GKCE) [Member] | Building [Member]
Tangible assets	385,000
Gamma Knife Center Ecuador S.A. (GKCE) [Member] | Land [Member]
Tangible assets	19,000
Gamma Knife Center Ecuador S.A. (GKCE) [Member] | Medical Equipment [Member]
Tangible assets	$ 319,000

Note 5 - GKCE Acquisition - Tan

Note 5 - GKCE Acquisition - Tangible Assets Acquired (Details) - USD ($)	Jun. 12, 2020	Dec. 31, 2021
Building [Member]
Useful life (Year)		20 years
Gamma Knife Center Ecuador S.A. (GKCE) [Member]
Tangible assets	$ 723,000
Gamma Knife Center Ecuador S.A. (GKCE) [Member] | Building [Member]
Tangible assets	$ 385,000
Useful life (Year)	20 years
Gamma Knife Center Ecuador S.A. (GKCE) [Member] | Land [Member]
Tangible assets	$ 19,000
Gamma Knife Center Ecuador S.A. (GKCE) [Member] | Medical Equipment [Member]
Tangible assets	$ 302,000
Useful life (Year)	2 years
Gamma Knife Center Ecuador S.A. (GKCE) [Member] | Property, Plant and Equipment, Other Types [Member]
Tangible assets	$ 17,000
Useful life (Year)	2 years

Note 6 - Long Term Debt (Detail

Note 6 - Long Term Debt (Details Textual)	Apr. 09, 2021USD ($)	Mar. 31, 2021USD ($)	Dec. 31, 2021USD ($)	Dec. 31, 2020USD ($)	Dec. 31, 2022
Finance Lease, Principal Payments			$ 8,919,000	$ 3,199,000
Gain (Loss) on Extinguishment of Debt, Total			(401,000)	$ 0
The Credit Agreement [Member] | Fifth Third Bank, N.A. [Member]
Number of Debt Instruments	3
Debt Instrument, Term (Year)	5 years
Line of Credit Facility, Maximum Borrowing Capacity	$ 22,000,000
Gain (Loss) on Extinguishment of Debt, Total			(401,000)
Debt Issuance Costs, Net, Total			$ 310,000
Debt Instrument, Covenant, Minimum Fixed Charge Coverage Ratio	1.25
Debt Instrument, Covenant, Maximum Funded Debt to EDITDA Ratio	3
The Credit Agreement, First Loan and Second Loan Facility [Member] | Fifth Third Bank, N.A. [Member]
Debt Instrument, Face Amount	$ 9,500,000
The Credit Agreement, First Loan and Second Loan Facility [Member] | Fifth Third Bank, N.A. [Member] | Forecast [Member]
Debt Instrument, Interest Rate, Stated Percentage					48.00%
The Credit Agreement, First Loan Facility [Member] | Fifth Third Bank, N.A. [Member]
Finance Lease, Principal Payments		$ 1,665,000
Cash, Ending Balance	1,061,000
The Credit Agreement, Second Loan Facility [Member] | Fifth Third Bank, N.A. [Member]
Debt Instrument, Face Amount	5,500,000
Finance Lease, Principal Payments	$ 5,026,000
The Credit Agreement, Third Loan Facility [Member] | Fifth Third Bank, N.A. [Member] | Revolving Credit Facility [Member]
Debt Instrument, Term (Year)	5 years
Line of Credit Facility, Maximum Borrowing Capacity	$ 7,000,000
Line of Credit Facility, Unused Capacity, Commitment Fee Percentage			0.25%
The Credit Agreement, Third Loan Facility [Member] | Fifth Third Bank, N.A. [Member] | Revolving Credit Facility [Member] | London Interbank Offered Rate (LIBOR) [Member]
Debt Instrument, Basis Spread on Variable Rate	3.00%
Notes Payable, Other Payables [Member]
Number of Debt Instruments				7
Debt Issuance Costs, Net, Total			$ 294,000
Notes Payable, Other Payables [Member] | Trade Accounts Receivable [Member]
Debt Instrument, Collateral Amount				$ 1,718,000
Notes Payable, Other Payables [Member] | Gamma Knife Units [Member]
Debt Instrument, Collateral Amount				$ 11,023,000
Gamma Knife Debt and Finance Leases [Member]
Short-term Debt, Refinanced, Amount	$ 6,774,000

Note 6 - Long Term Debt - Long-

Note 6 - Long Term Debt - Long-term Debt Maturities (Details)	Dec. 31, 2021USD ($)
2022	$ 1,157,000
2023	1,719,000
2024	2,094,000
2025	2,469,000
2026	8,094,000
Thereafter	165,000
Long-term Debt, Total	$ 15,698,000

Note 8 - Leases (Details Textua

Note 8 - Leases (Details Textual)	Nov. 03, 2021USD ($)ft²	Dec. 01, 2021USD ($)	Dec. 31, 2021USD ($)	Dec. 31, 2021USD ($)	Dec. 31, 2020USD ($)	Dec. 31, 2021USD ($)
Operating Lease, Right-of-Use Asset			$ 654,000	$ 654,000	$ 886,000	$ 654,000
Operating Lease, Liability, Total			$ 728,000	$ 728,000		$ 728,000
Minimum [Member]
Lessee, Operating Lease, Discount Rate			4.00%	4.00%		4.00%
Lessee, Operating Lease, Remaining Lease Term (Year)			2 years	2 years		2 years
Maximum [Member]
Lessee, Operating Lease, Discount Rate			6.00%	6.00%		6.00%
Lessee, Operating Lease, Remaining Lease Term (Year)			3 years	3 years		3 years
Sublease Office in San Francisco, California [Member]
Area of Real Estate Property (Square Foot) | ft²	3,253
Operating Lease, Monthly Expense	$ 21,370
Lessee, Operating Sublease, Monthly Income	$ 15,723
Operating Lease, Impairment Loss		$ 77,000
Operating Lease, Impairment Loss Recognized			$ 3,000
Lease Agreement for New Corporate Office [Member]
Area of Real Estate Property (Square Foot) | ft²	900
Operating Lease, Monthly Expense	$ 4,425
Operating Lease, Right-of-Use Asset		$ 151,000
Satellite Office in Fairfield, California [Member]
Increase (Decrease) in Operating Lease Right-of-use Asset and Liability					$ (67,000)
Stand-alone Facility in Lima, Peru [Member]
Operating Lease, Monthly Expense				$ 7,800
Operating Lease, Impairment Loss				77,000
Operating Lease, Impairment Loss Recognized				$ 3,000
Increase (Decrease) in Operating Lease Right-of-use Asset and Liability						$ 135,000

Note 8 - Leases - Summary of Ma

Note 8 - Leases - Summary of Maturities of Lessee Operating Lease Liabilities (Details)	Dec. 31, 2021USD ($)
2022	$ 406,000
2023	302,000
2024	58,000
Total lease payments	766,000
Less imputed interest	(38,000)
Total	$ 728,000

Note 9 - Income Taxes (Details

Note 9 - Income Taxes (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax Expense (Benefit), Total	$ 269,000	$ (1,737,000)
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent	21.00%	21.00%
Valuation Allowance, Deferred Tax Asset, Increase (Decrease), Amount	$ 465,000	$ 243,000
Unrecognized Tax Benefits, Ending Balance	295,000	$ 275,000	$ 259,000
Unrecognized Tax Benefits, Income Tax Penalties Accrued	28,000
Unrecognized Tax Benefits, Interest on Income Taxes Accrued	0
Domestic Tax Authority [Member]
Operating Loss Carryforwards, Total	1,100,000
Domestic Tax Authority [Member] | Capital Loss Carryforward [Member]
Tax Credit Carryforward, Amount	2,679,000
State and Local Jurisdiction [Member]
Operating Loss Carryforwards, Total	3,167,000
State and Local Jurisdiction [Member] | Capital Loss Carryforward [Member]
Tax Credit Carryforward, Amount	129,000
Foreign Tax Authority [Member]
Operating Loss Carryforwards, Total	$ 46,000

Note 9 - Income Taxes - Compone

Note 9 - Income Taxes - Components of Provision (Benefit) for Income Taxes (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Federal	$ 9,000	$ 209,000
State	93,000	88,000
Foreign	107,000	117,000
Total current	209,000	414,000
Federal	98,000	(1,909,000)
State	(18,000)	(266,000)
Foreign	(20,000)	24,000
Total deferred	60,000	(2,151,000)
Income Tax Expense (Benefit), Total	$ 269,000	$ (1,737,000)

Note 9 - Income Taxes - Signifi

Note 9 - Income Taxes - Significant Components of Deferred Tax Liabilities and Assets (Details) - USD ($)	Dec. 31, 2021	Dec. 31, 2020
Property and equipment	$ (1,055,000)	$ (564,000)
Total deferred tax liabilities	(1,055,000)	(564,000)
Net operating loss carryforwards	360,000	99,000
Accruals and allowances	41,000	43,000
Lease liabilities	136,000	0
Tax credits	4,000	5,000
Other – net	87,000	50,000
Capital loss carryover	646,000	627,000
Total deferred tax assets	1,274,000	824,000
Valuation allowance	(697,000)	(678,000)
Deferred tax assets net of valuation allowance	577,000	146,000
Net deferred tax liabilities	(478,000)	(418,000)
Deferred income taxes (non-current)	(478,000)	(418,000)
Deferred Tax Liabilities, Net, Total	$ (478,000)	$ (418,000)

Note 9 - Income Taxes - Reconci

Note 9 - Income Taxes - Reconciliation of Income Tax Provision (Benefit) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Computed expected federal income tax	$ 79,000	$ (1,844,000)
State income taxes, net of federal benefit	69,000	(199,000)
Non-deductible expenses	28,000	6,000
Return to Provision True-up	19,000	22,000
Uncertain Tax Positions	14,000	16,000
Capital loss carryforward expiration	0	246,000
Change in valuation allowance	19,000	(243,000)
Other deferred tax adjustments	41,000	259,000
Income Tax Expense (Benefit), Total	$ 269,000	$ (1,737,000)

Note 9 - Income Taxes - Recon_2

Note 9 - Income Taxes - Reconciliation of Unrecognized Tax Benefit (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Balance at beginning of year	$ 275,000	$ 259,000
Additions based on tax positions of prior years	20,000	16,000
Balance at end of year	$ 295,000	$ 275,000

Note 10 - Stock-based Compens_3

Note 10 - Stock-based Compensation Expense (Details Textual) - USD ($)	Aug. 03, 2020	May 04, 2020	Jan. 04, 2017	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2017	Jun. 30, 2021	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period (in shares)					258,000
Share-based Payment Arrangement, Expense					$ 420,000
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Weighted Average Grant Date Fair Value (in dollars per share)					$ 1.10	$ 0.78
Options Issued During Period, Cashless Stock Options Exercised (in shares)					5,000
Share-based Compensation Arrangement by Share-based Payment Award, Options, Exercises in Period (in shares)					22,000	0
Share-based Compensation Arrangement by Share-based Payment Award, Options, Exercises in Period, Intrinsic Value						$ 0
Proceeds from Stock Options Exercised					$ 5,000	$ 0
Share-based Compensation Arrangement by Share-based Payment Award, Options, Exercises in Period Using Cash (in shares)					2,000
Stock Repurchase Program, Number of Shares Authorized to be Repurchased (in shares)					1,000,000
Stock Repurchased During Period, Shares (in shares)					0	0
Stock Repurchase Program, Remaining Number of Shares Authorized to be Repurchased (in shares)					72,000
Restricted Stock Units (RSUs) [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period (in shares)					165,000	144,000
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period (in shares)					168,000	134,000
Share-based Compensation Arrangement by Share-based Payment Award, Non-Option Equity Instruments, Outstanding, Number, Ending Balance (in shares)					10,000	13,000			3,000
Restricted Stock Units (RSUs) [Member] | Chief Executive Officer [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period (in shares)					130,000
Share-based Payment Arrangement, Expense					$ 331,000
Restricted Stock Units (RSUs) [Member] | Non Employee Directors and Corporate Secretary [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period (in shares)					2,000
Share-based Payment Arrangement, Expense					$ 12,000
Restricted Stock Units (RSUs) [Member] | Non Employee Directors [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period (in shares)					121,000
Share-based Payment Arrangement, Expense					$ 75,000
Share-based Payment Arrangement, Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period (in shares)					5,000
Share-based Payment Arrangement, Expense					$ 2,000	$ 17,000
Share-based Payment Arrangement, Expense, Tax Benefit						0
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year)					4 years
Share-based Payment Arrangement, Nonvested Award, Option, Cost Not yet Recognized, Amount					$ 10,000
Incentive Compensation Plan [Member]
Common Stock, Capital Shares Reserved for Future Issuance (in shares)								2,580,000
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant (in shares)					1,453,000
Incentive Compensation Plan [Member] | Restricted Stock Units (RSUs) [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period (in shares)					621,000
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period (in shares)					123,000
Share-based Compensation Arrangement by Share-based Payment Award, Non-Option Equity Instruments, Vested And Expected To Vest, Outstanding, Number (in shares)					487,000
Share-based Compensation Arrangement by Share-based Payment Award, Non-Option Equity Instruments, Outstanding, Number, Ending Balance (in shares)					10,000
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount, Total					$ 20,000
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year)					4 years
Incentive Compensation Plan [Member] | Restricted Stock Units (RSUs) [Member] | Employees [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period (in shares)					20,000
Incentive Compensation Plan [Member] | Restricted Stock Units (RSUs) [Member] | Chief Executive Officer [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period (in shares)					220,000
Incentive Compensation Plan [Member] | Restricted Stock Units (RSUs) [Member] | Non Employee Directors and Corporate Secretary [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period (in shares)					53,000
Share-based Payment Arrangement, Expense					$ 12,000
Share-based Payment Arrangement, Expense, Tax Benefit					$ 3,000
Incentive Compensation Plan [Member] | Restricted Stock Units (RSUs) [Member] | Non Employee Directors [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period (in shares)					328,000
Share-based Payment Arrangement, Expense					$ 75,000
Executive Equity Awards [Member] | Restricted Stock Units (RSUs) [Member]
Share-based Payment Arrangement, Expense					$ 331,000	$ 195,000
Executive Equity Awards [Member] | Restricted Stock Units (RSUs) [Member] | Chief Executive Officer [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period (in shares)	10,000	50,000
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period (in shares)					120,000	90,000
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period (Day)	30 days
Stock Issued During Period, Shares, Issued for Services (in shares)					120,000	100,000
Executive Equity Awards [Member] | Restricted Stock Units (RSUs) [Member] | Senior Vice President [Member]
Stock Issued During Period, Shares, Issued for Services (in shares)						10,000
Performance Share Award Agreement [Member] | Performance Shares [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period (in shares)			161,766
Share-based Payment Arrangement, Expense							$ 108,000
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount, Total				$ 421,000
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Forfeited in Period (in shares)				129,000

Note 10 - Stock-based Compens_4

Note 10 - Stock-based Compensation Expense - Changes in Restricted Stock Units (Details) - $ / shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Vested (in shares)	(258,000)
Restricted Stock Units (RSUs) [Member]
Outstanding (in shares)	13,000	3,000
Outstanding, grant date weighted average fair value (in dollars per share)	$ 1.97	$ 3.03
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period (in shares)	165,000	144,000
Granted, grant date weighted average fair value (in dollars per share)	$ 2.61	$ 1.96
Vested (in shares)	(168,000)	(134,000)
Vested, grant date weighted average fair value (in dollars per share)	$ 2.57	$ 1.98
Outstanding (in shares)	10,000	13,000
Outstanding, grant date weighted average fair value (in dollars per share)	$ 2.57	$ 1.97

Note 10 - Stock-based Compens_5

Note 10 - Stock-based Compensation Expense - Stock Compensation Expense (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Payment Arrangement, Expense	$ 420,000
Awards issued and vested (in shares)	258,000
Share-based Payment Arrangement, Option [Member]
Share-based Payment Arrangement, Expense	$ 2,000	$ 17,000
Awards issued and vested (in shares)	5,000
Restricted Stock Units (RSUs) [Member]
Awards issued and vested (in shares)	168,000	134,000
Restricted Stock Units (RSUs) [Member] | Chief Executive Officer [Member]
Share-based Payment Arrangement, Expense	$ 331,000
Awards issued and vested (in shares)	130,000
Restricted Stock Units (RSUs) [Member] | Non Employee Directors [Member]
Share-based Payment Arrangement, Expense	$ 75,000
Awards issued and vested (in shares)	121,000
Restricted Stock Units (RSUs) [Member] | Non Employee Directors and Corporate Secretary [Member]
Share-based Payment Arrangement, Expense	$ 12,000
Awards issued and vested (in shares)	2,000

Note 10 - Stock-based Compens_6

Note 10 - Stock-based Compensation Expense - Summary of Stock Option Activity (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Balance (in shares)	417,000	450,000
Balance, grant date weighted-average exercise price (in dollars per share)	$ 2.79	$ 2.78
Balance, weighted average remaining contractual life (Year)	3 years 3 months 29 days	1 year 7 months 9 days	2 years 5 months 8 days
Granted (in shares)	6,000	10,000
Granted, grant date weighted-average exercise price (in dollars per share)	$ 2.92	$ 1.88
Granted, weighted average remaining contractual life (Year)	7 years	7 years
Forfeited (in shares)	(334,000)	(43,000)
Forfeited, grant date weighted-average exercise price (in dollars per share)	$ 2.81	$ 2.54
Balance, aggregate intrinsic value	$ 0	$ 2,000
Exercised (in shares)	(22,000)	0
Exercised, grant date weighted-average exercise price (in dollars per share)	$ 2.65
Balance (in shares)	67,000	417,000	450,000
Balance, grant date weighted-average exercise price (in dollars per share)	$ 2.72	$ 2.79	$ 2.78
Exercisable (in shares)	58,000	405,000
Exercisable, grant date weighted-average exercise price (in dollars per share)	$ 2.72	$ 2.80
Exercisable, weighted average remaining contractual life (Year)	2 years 11 months 15 days
Minimum [Member]
Exercisable, weighted average remaining contractual life (Year)		1 year 5 months 23 days

Note 10 - Stock-based Compens_7

Note 10 - Stock-based Compensation Expense - Non-vested Stock Options (Details) - $ / shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Nonvested (in shares)	12,000	25,000
Nonvested, weighted average grant date fair value (in dollars per share)	$ 1.07	$ 1.40
Granted (in shares)	6,000	10,000
Granted, weighted average grant date fair value (in dollars per share)	$ 1.10	$ 0.78
Vested (in shares)	(9,000)	(23,000)
Vested, weighted average grant date fair value (in dollars per share)	$ 0.91	$ 1.22
Nonvested (in shares)	9,000	12,000
Nonvested, weighted average grant date fair value (in dollars per share)	$ 1.10	$ 1.07

Note 10 - Stock-based Compens_8

Note 10 - Stock-based Compensation Expense - Assumptions (Details)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Expected life (years) (Year)	7 years	7 years
Expected forfeiture rate	0.00%	0.00%
Expected volatility	40.00%	40.00%
Dividend yield	0.00%	0.00%
Risk-free interest rate	1.20%	0.40%

Note 11 - Retirement Plan (Deta

Note 11 - Retirement Plan (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Defined Contribution Plan, Employer Matching Contribution, Percent of Employees' Gross Pay	4.00%
Defined Contribution Plan, Cost	$ 38,000	$ 39,000

Note 12 - Operating Leases (Det

Note 12 - Operating Leases (Details Textual)	Nov. 03, 2021USD ($)ft²	Dec. 01, 2021USD ($)	Dec. 31, 2021USD ($)ft²	Dec. 31, 2021USD ($)ft²	Dec. 31, 2020USD ($)
Operating Lease, Expense				$ 377,000	$ 404,000
Lease Agreement for New Corporate Office [Member]
Area of Real Estate Property (Square Foot) | ft²	900
Operating Lease, Monthly Expense	$ 4,425
Sublease Office in San Francisco, California [Member]
Area of Real Estate Property (Square Foot) | ft²	3,253
Operating Lease, Monthly Expense	$ 21,370
Lessee, Operating Sublease, Monthly Income	$ 15,723
Operating Lease, Impairment Loss		$ 77,000
Operating Lease, Impairment Loss Recognized			$ 3,000
Stand-alone Facility in Lima, Peru [Member]
Operating Lease, Monthly Expense				$ 7,800
Area of Land (Square Foot) | ft²			1,600	1,600
Operating Lease, Impairment Loss				$ 77,000
Operating Lease, Impairment Loss Recognized				$ 3,000

Note 12 - Operating Leases - Op

Note 12 - Operating Leases - Operating Leases (Details)	Dec. 31, 2021USD ($)
2022	$ 406,000
2023	302,000
2024	58,000
Lessee, Operating Lease, Liability, Payments, Net Of Sublease Income, Due	$ 766,000

Note 13 - Commitments and Con_3

Note 13 - Commitments and Contingencies (Details Textual)	Sep. 05, 2017	Dec. 31, 2021USD ($)
Number Of Purchase Commitments		2
Leksell Gamma Knife Icon Systems and Linear Accelerator System [Member]
Long-term Install Service and Purchase Commitment, Amount		$ 10,760,000
Long-term Commitment, Cash on Hand to Fund		8,263,000
Long-term Commitment, Line of Credit to Fund		$ 7,000,000
LINAC System [Member] | Maximum [Member]
Long-Term Service Commitment, Period (Year)		9 years
LINAC System [Member] | Minimum [Member]
Long-Term Service Commitment, Period (Year)		5 years
Long-Term Service Commitment, Amount		$ 8,408,000
Mevion PBRT Units [Member] | Upgrade and Purchase MEVION Systems [Member]
Long-term Purchase Commitment, Amount		34,000,000
Mevion Medical Systems Inc [Member] | Maintenance And Support Agreement, Mevion Service Agreement [Member]
Long-term Purchase Commitment, Renewal Term (Year)	5 years
Purchase Agreement Annual Prepayment		$ 1,649,000
Long-term Purchase Commitment, Period (Year)	1 year

Note 13 - Commitments and Con_4

Note 13 - Commitments and Contingencies - Contractual Obligations (Details)	Dec. 31, 2021USD ($)
Contractual Obligations	$ 71,584,000
Contractual Obligations, 2021	4,510,000
Contractual Obligations, 2022-2023	50,352,000
Contractual Obligations, 2024-2025	13,923,000
Contractual Obligations, After 5 years	2,799,000
Long-term Debt [Member]
Contractual Obligations	17,650,000
Contractual Obligations, 2021	1,651,000
Contractual Obligations, 2022-2023	4,672,000
Contractual Obligations, 2024-2025	11,156,000
Contractual Obligations, After 5 years	171,000
Equipment [Member]
Contractual Obligations	44,760,000
Contractual Obligations, 2021	2,000,000
Contractual Obligations, 2022-2023	42,760,000
Contractual Obligations, 2024-2025	0
Contractual Obligations, After 5 years	0
Equipment Service Contracts [Member]
Contractual Obligations	8,408,000
Contractual Obligations, 2021	453,000
Contractual Obligations, 2022-2023	2,618,000
Contractual Obligations, 2024-2025	2,709,000
Contractual Obligations, After 5 years	2,628,000
Operating Leases [Member]
Contractual Obligations	766,000
Contractual Obligations, 2021	406,000
Contractual Obligations, 2022-2023	302,000
Contractual Obligations, 2024-2025	58,000
Contractual Obligations, After 5 years	$ 0

Note 14 - Related Party Trans_2

Note 14 - Related Party Transactions (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
US Subsidiary Of Elekta Member
Related Party Transaction, Purchases from Related Party	$ 1,906,000	$ 1,103,000
Related Party Transaction, Expenses from Transactions with Related Party	759,000	701,000
Purchase Obligation, Total	6,624,000	8,397,000
Due to Related Parties, Total	$ 1,992,000	$ 1,382,000
GKF Subsidiary [Member]
Noncontrolling Interest, Ownership Percentage by Parent	81.00%
US Subsidiary Of Elekta Member
Noncontrolling Interest, Ownership Percentage by Parent	19.00%