American Shared Hospital Services (AMS) 10-K 31 Mar 23 2022 FY Annual report Financial data

Document And Entity Information

Document And Entity Information - USD ($)	12 Months Ended
	Dec. 31, 2022	Mar. 22, 2023	Jun. 30, 2022
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	2022
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2022
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			$ 9,837,000
Entity Common Stock, Shares Outstanding		6,184,000
Auditor Firm ID	659
Auditor Name	Moss Adams LLP
Auditor Location	Seattle, WA United States

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($)	Dec. 31, 2022	Dec. 31, 2021
CURRENT ASSETS
Cash and cash equivalents	$ 12,335,000	$ 8,145,000
Restricted cash	118,000	118,000
Accounts receivable, net of allowance for doubtful accounts of $100,000 At December 31, 2022 and December 31, 2021	3,801,000	4,211,000
Other receivables	327,000	613,000
Prepaid maintenance	1,245,000	1,174,000
Prepaid expenses and other current assets	897,000	826,000
Total current assets	18,723,000	15,087,000
PROPERTY AND EQUIPMENT, net	23,467,000	28,254,000
LAND	19,000	19,000
GOODWILL	1,265,000	1,265,000
INTANGIBLE ASSETS	78,000	78,000
RIGHT OF USE ASSETS, net	317,000	654,000
OTHER ASSETS	87,000	73,000
TOTAL ASSETS	43,956,000	45,430,000
CURRENT LIABILITIES
Accounts payable	230,000	318,000
Employee compensation and benefits	735,000	423,000
Other accrued liabilities	1,544,000	1,505,000
Related party liabilities	497,000	1,342,000
Asset retirement obligations, related party (includes $107,000 non-related party at December 31, 2021)	360,000	757,000
Income taxes payable	255,000	96,000
Current portion of lease liabilities	292,000	369,000
Current portion of long-term debt, net	1,262,000	1,081,000
Total current liabilities	5,175,000	5,891,000
LONG-TERM LEASE LIABILITIES, less current portion	59,000	359,000
LONG-TERM DEBT, net, less current portion	12,205,000	14,323,000
DEFERRED REVENUE, less current portion	70,000	140,000
DEFERRED INCOME TAXES	822,000	478,000
TOTAL LIABILITIES	18,331,000	21,191,000
COMMITMENTS AND CONTINGENCIES (See Note 10)
SHAREHOLDERS’ EQUITY
Common stock, no par value (10,000,000 authorized; Issued and outstanding shares – 6,184,000 at December 31, 2022 and 6,049,000 at December 31, 2021	10,763,000	10,758,000
Additional paid-in capital	7,843,000	7,444,000
Retained earnings	3,019,000	1,691,000
Total equity- American Shared Hospital Services	21,625,000	19,893,000
Non-controlling interests in subsidiaries	4,000,000	4,346,000
Total shareholders’ equity	25,625,000	24,239,000
TOTAL LIABILITIES AND SHAREHOLDERS' EQUITY	$ 43,956,000	$ 45,430,000

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parentheticals) - USD ($) $ / shares in Thousands	Dec. 31, 2022	Dec. 31, 2021
Allowance for doubtful accounts	$ 100,000	$ 100,000
Asset retirement obligations		$ 107,000
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)	6,184,000	6,049,000
Common stock, shares outstanding (in shares)	6,184,000	6,049,000

Consolidated Statements of Inco

Consolidated Statements of Income - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Revenues	$ 19,746,000	$ 17,628,000
Costs of revenue:
Maintenance and supplies	1,878,000	1,731,000
Depreciation and amortization	4,726,000	4,856,000
Other direct operating costs	3,666,000	3,556,000
Other direct operating costs, related party	1,094,000	759,000
Cost of Revenue, Total	11,364,000	10,902,000
Gross margin	8,382,000	6,726,000
Selling and administrative expense	5,145,000	4,531,000
Interest expense	806,000	739,000
Loss on write down of impaired assets and associated removal costs	0	105,000
Operating income	2,431,000	1,351,000
(Loss) on early extinguishment of debt	0	(401,000)
Interest and other (loss) income	87,000	(3,000)
Income before income taxes	2,518,000	947,000
Income tax expense	963,000	269,000
Net income	1,555,000	678,000
Less: net (income) attributable to non-controlling interests	(227,000)	(484,000)
Net income attributable to American Shared Hospital Services	$ 1,328,000	$ 194,000
Net income per share attributable to American Shared Hospital Services:
Earnings per common share - basic (in dollars per share)	$ 0.21	$ 0.03
Earnings per common share - diluted (in dollars per share)	$ 0.21	$ 0.03
Weighted average common shares for basic earnings per share (in shares)	6,297,000	6,044,000
Weighted average common shares for diluted earnings per share (in shares)	6,303,000	6,059,000
Rental Income from Medical Services [Member]
Revenues	$ 16,655,000	$ 14,719,000
Patient Income [Member]
Revenues	$ 3,091,000	$ 2,909,000

Consolidated Statement of Share

Consolidated Statement of Shareholders' Equity - USD ($)	Deferred Restricted Stock [Member] Common Stock [Member]	Deferred Restricted Stock [Member] Additional Paid-in Capital [Member]	Deferred Restricted Stock [Member] Retained Earnings [Member]	Deferred Restricted Stock [Member] Parent [Member]	Deferred Restricted Stock [Member] Noncontrolling Interest [Member]	Deferred Restricted Stock [Member]	Restricted Stock [Member] Common Stock [Member]	Restricted Stock [Member] Additional Paid-in Capital [Member]	Restricted Stock [Member] Retained Earnings [Member]	Restricted Stock [Member] Parent [Member]	Restricted Stock [Member] Noncontrolling Interest [Member]	Restricted Stock [Member]	Common Stock [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	Parent [Member]	Noncontrolling Interest [Member]	Total
Balances (in shares) at Dec. 31, 2020													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)													0
Stock-based compensation expense													$ 0	420,000	0	420,000	0	$ 420,000
Options exercised (in shares)													5,000					22,000
Options exercised													$ 5,000	0	0	5,000	0	$ 5,000
Issuance of restricted stock awards (in shares)	123,000						130,000
Issuance of restricted stock awards	$ 0	$ 0	$ 0	$ 0	$ 0	$ 0	$ 0	$ 0	$ 0	$ 0	$ 0	$ 0
Cash distributions to non-controlling interests													0	0	0	0	(514,000)	(514,000)
Net income													$ 0	0	194,000	194,000	484,000	$ 678,000
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
Stock-based compensation expense (in shares)													0
Stock-based compensation expense													$ 0	399,000	0	399,000	0	$ 399,000
Options exercised (in shares)													3,000					4,000
Options exercised													$ 5,000	0	0	5,000	0	$ 5,000
Issuance of restricted stock awards (in shares)							132,000
Issuance of restricted stock awards							$ 0	$ 0	$ 0	$ 0	$ 0	$ 0
Cash distributions to non-controlling interests													0	0	0	0	(573,000)	(573,000)
Net income													$ 0	0	1,328,000	1,328,000	227,000	$ 1,555,000
Balances (in shares) at Dec. 31, 2022													6,184,000					6,184,000
Balances at Dec. 31, 2022													$ 10,763,000	$ 7,843,000	$ 3,019,000	$ 21,625,000	$ 4,000,000	$ 25,625,000

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
OPERATING ACTIVITIES
Net income	$ 1,555,000	$ 678,000
Adjustments to reconcile net income to net cash from operating activities:
Depreciation and amortization	4,783,000	4,972,000
Non cash lease expense	337,000	309,000
Accretion of deferred issuance costs	84,000	59,000
Loss on write down impaired assets	0	105,000
Loss on sublease impairment, net	0	74,000
Loss on extinguishment of debt	0	401,000
Deferred income taxes	344,000	60,000
Stock-based compensation expense	399,000	420,000
Interest expense associated with lease liabilities	29,000	42,000
Changes in operating assets and liabilities:
Receivables	696,000	(519,000)
Prepaid expenses and other assets	(111,000)	14,000
Asset retirement obligations, related party	(397,000)	(618,000)
Related party liabilities	(845,000)	775,000
Lease liability	(406,000)	(351,000)
Accounts payable, accrued liabilities and deferred revenue	608,000	76,000
Income taxes payable	159,000	(230,000)
Net cash provided by operating activities	7,235,000	6,267,000
INVESTING ACTIVITIES
Payment for purchases of property and equipment	(388,000)	(1,674,000)
Net cash (used in) investing activities	(388,000)	(1,674,000)
FINANCING ACTIVITIES
Principal payments on long-term debt	(2,032,000)	(3,927,000)
Principal payments on finance leases	0	(8,919,000)
Long-term debt financing	0	13,897,000
Prepayment penalties	0	(401,000)
Distributions to non-controlling interests	(573,000)	(514,000)
Debt issuance costs long-term debt	(9,000)	(325,000)
Proceeds from options exercised	5,000	5,000
Principal payments on short-term financing prepaid insurance	(48,000)	(471,000)
Net cash (used in) financing activities	(2,657,000)	(655,000)
Net change in cash and cash equivalents	4,190,000	3,938,000
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, beginning of year	8,263,000	4,325,000
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, end of year	12,453,000	8,263,000
SUPPLEMENTAL CASH FLOW DISCLOSURE
Cash paid for interest	722,000	680,000
Cash paid for income taxes	169,000	712,000
SCHEDULE OF NONCASH INVESTING AND FINANCING ACTIVITIES
Right of use assets and lease liabilities	0	151,000
Acquisition of equipment with long-term debt financing	0	1,103,000
DETAIL OF CASH, CASH EQUIVALENTS AND RESTRICTED CASH AT END OF PERIOD
Cash and cash equivalents	12,335,000	8,145,000
Restricted cash	118,000	118,000
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, end of year	$ 12,453,000	$ 8,263,000

Note 1 - Business and Basis of

Note 1 - Business and Basis of Presentation	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block]	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 2022 twelve 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 April 27, 2022 , the Company signed a Joint Venture Agreement (the “Agreement”) with the principal owners of Guadalupe Amor Y Bien (“Guadalupe”) to establish AB of Puebla (“Puebla”) to treat public- and private-paying cancer patients. The Company and Guadalupe will hold 85% and 15% ownership interests, respectively, in Puebla. Under the Agreement, the Company will be responsible for providing a linear accelerator upgrade to an Elekta Versa HD, and Guadalupe will be accountable for all site modification costs. The Company formed on October 3, 2022 December 15, 2022. 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.

Note 2 - Accounting Policies

Note 2 - Accounting Policies	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Significant Accounting Policies [Text Block]	NOTE 2 ACCOUNTING POLICIES Use of estimates in the preparation of financial statements Advertising and marketing d (collectively, marketing costs”). Marketing costs were December 31, 2022 2021 Sales and Service Cash and cash equivalents three not Restricted cash by GKF per it’s financing agreement with the United FC”). 5 Business and credit risk not All of the Company’s revenue was provided by fifteen seventeen 2022 2021 2022 2021 December 31, 2022 December 31, 2021 two 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 October 1, 2022, one October 1, 2022, December 31, 2022 December 31, 2022 seven December 31, 2021 seven 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 leases Gamma Knife and radiation therapy equipment to its customers under arrangements accounted for as operating leases. At December 31, 2022 December 31, 2021 As of December 31, 2022 2021 , the Company recognized a loss on the write down of impaired assets of $0 and $105,000, respectively. The impairment as of December 31, 2021 one December 31, 2020 . See further discussion under Note 2 3 Revenue recognition 842 Leases 842” 606 Revenue from Contracts with Customers 606” Rental income from medical services 842 not third . December 31, 2022 2021 842, Patient income 606, no 30 3 6 not not December 31, 2022 2021 December 31, 2022 2021 December 31, 2022 2021 606, Stock-based compensation 8 Costs of revenue 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 7 Functional currency 830, Foreign Currency Matters 830” 830 December 31, 2022 2021 Asset Retirement Obligations 410, Asset Retirement Obligations 410” asset retirement obligation (“ARO”) December 31, 2020, four four December 31, 2022 three one December 31, 2021 January 2022. December 31, 2022 not Earnings per share not December 31, 2022 2021 20,000 and 31,000 December 31, 2022 2021 The following table illustrates the computations of basic and diluted earnings per share for the years ended December 31, 2022 2021 2022 2021 Numerator for basic and diluted earnings per share $ 1,328,000 $ 194,000 Denominator: Denominator for basic and diluted earnings per share – weighted-average shares 6,297,000 6,044,000 Effect of dilutive securities Employee stock options and restricted stock 6,000 15,000 Denominator for diluted earnings per share – adjusted weighted-average shares 6,303,000 6,059,000 Earnings per common share- basic $ 0.21 $ 0.03 Earnings per common share- diluted $ 0.21 $ 0.03 Business segment information 280 Segment Reporting 280” fifteen fifteen into two reportable segments, domestic and foreign. thirteen two December 31, 2022 An operating segment is defined by ASC 280 may two two For the years ended December 31, 2022 2021 , the PBRT operations represented a significant majority of the domestic profit, disclosed below. December 31, 2022 2021 2022 2021 Revenues Domestic $ 16,655,000 $ 14,719,000 Foreign 3,091,000 2,909,000 Total $ 19,746,000 $ 17,628,000 2022 2021 Net income (loss) attributable to American Shared Hospital Services Domestic $ 1,187,000 $ 245,000 Foreign 141,000 (51,000 ) Total $ 1,328,000 $ 194,000 2022 2021 Total assets Domestic $ 37,575,000 $ 39,322,000 Foreign 6,381,000 6,108,000 Total $ 43,956,000 $ 45,430,000 Long lived asset impairment may not may not, December 31, 2021, one No December 31, 2022 3 Goodwill and intangible assets - June 2020. 350 Intangibles-Goodwill and Other 350” not 350, may December 31, 2022 2021 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 5 Reclassifications December 31, 2021

Note 3 - Property and Equipment

Note 3 - Property and Equipment	12 Months Ended
	Dec. 31, 2022
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, 2022 2021 Medical equipment and facilities $ 73,709,000 $ 73,388,000 Office equipment 422,000 472,000 Construction in progress 106,000 91,000 74,237,000 73,951,000 Accumulated depreciation (50,770,000 ) (45,697,000 ) Net property and equipment $ 23,467,000 $ 28,254,000 As of December 31, 2022 2021 December 31, 2022 2021 , was $4,783,000 and $4,972,000, respectively. As of April 1, 2021, nine October 1, 2022, one October 1, 2022, December 31, 2022 As of December 31, 2022 2021 , the Company recognized a loss on the write down of impaired assets of $0 and $105,000, respectively. The impairment as of December 31, 2021 one December 31, 2020 January 2022 . December 31, 2022 no December 31, 2022 2021

Note 4 - Other Accrued Liabilit

Note 4 - Other Accrued Liabilities	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Other Liabilities Disclosure [Text Block]	NOTE 4 Other accrued liabilities consists of the following: December 31, 2022 2021 Equipment maintenance and upgrades, non-related party $ — $ 367,000 Insurance 591,000 340,000 Professional services 92,000 90,000 Operating costs 539,000 397,000 Other 322,000 311,000 Total other accrued liabilities $ 1,544,000 $ 1,505,000

Note 5 - Long-Term Debt

Note 5 - Long-Term Debt	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Long-Term Debt [Text Block]	NOTE 5 On April 9, 2021 five three first two two first 2021, second third five December 31, 2021, December 31, 2021. December 31, 2022 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, 2022 The loan entered into with DFC in connection with the acquisition of GKCE in June 2020 ( 29 December 31, 2022 December 31, 2022 2021 $15,000 December 31, 2022 2021 The accretion of debt issuance costs for the years ended December 31, 2022 2021 December 31, 2022 2021 The following are contractual maturities of long-term debt by year at December 31, 2022 Year ending December 31, Principal 2023 $ 1,344,000 2024 2,094,000 2025 2,469,000 2026 7,594,000 2027 164,000 $ 13,665,000

Note 6 - Leases

Note 6 - Leases	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Lessee, Operating Leases [Text Block]	NOTE 6 The Company determines if a contract is a lease at inception. Under ASC 842, 842 not 842 842 not not 12 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. 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, 2022 The following table summarizes maturities of lessee operating lease liabilities as of December 31, 2022 Year ending December 31, Operating Leases 2023 $ 301,000 2024 59,000 Total lease payments 360,000 Less imputed interest (9,000 ) Total $ 351,000 Year Ended December 31, 2022 2021 Lease cost Operating lease cost, net of impairment $ 406,000 $ 351,000 Sublease income (174,000 ) (14,000 ) Total lease cost $ 232,000 $ 337,000 Other information Cash paid for amounts included in the measurement of lease liabilities - Operating leases $ 406,000 $ 351,000 Weighted-average remaining lease term - Operating leases in years 1.11 1.39 Weighted-average discount rate - Operating leases 5.65 % 5.80 % The Company’s corporate offices are located at 601 1112, November 2024. 410, $22,011 August 2023. $8,850 January 2024. Net rent expense was $290,000 and $377,000 for the years ended December 31, 2022 2021 December 31, 2021.

Note 7 - Income Taxes

Note 7 - Income Taxes	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Income Tax Disclosure [Text Block]	NOTE 7 INCOME TAXES The components of income before income taxes for the years ended December 31, 2022 2021 YEARS ENDED December 31, 2022 2021 Domestic $ 2,350,000 $ 831,000 Foreign 168,000 116,000 Income before income taxes $ 2,518,000 $ 947,000 For the year ended December 31, 2022 2021 December 31, 2022 The components of the provision for income taxes for the years ended December 31, 2022 2021 YEARS ENDED December 31, 2022 2021 Current: Federal $ 355,000 $ 9,000 State 60,000 93,000 Foreign 204,000 107,000 Total current 619,000 209,000 Deferred: Federal 290,000 98,000 State 48,000 (18,000 ) Foreign 6,000 (20,000 ) Total deferred 344,000 60,000 $ 963,000 $ 269,000 Significant components of the Company’s deferred tax liabilities and assets as of December 31, 2022 2021 December 31, 2022 2021 Deferred tax liabilities: Property and equipment $ (1,255,000 ) $ (1,055,000 ) Total deferred tax liabilities (1,255,000 ) (1,055,000 ) Deferred tax assets: Net operating loss carryforwards 139,000 360,000 Accruals and allowances 167,000 41,000 Lease liabilities 61,000 136,000 Tax credits 3,000 4,000 Other – net 114,000 87,000 Capital loss carryover 646,000 646,000 Total deferred tax assets 1,130,000 1,274,000 Valuation allowance (697,000 ) (697,000 ) Deferred tax assets net of valuation allowance 433,000 577,000 Net deferred tax liabilities $ (822,000 ) $ (478,000 ) The provision for income taxes differs from the amount computed by applying the U.S. federal statutory tax rate (21% in 2022 2021 YEARS ENDED December 31, 2022 2021 Computed expected federal income tax $ 477,000 $ 79,000 State income taxes, net of federal benefit 100,000 69,000 Non-deductible expenses (25,000 ) 28,000 Return to provision true-up 52,000 19,000 Uncertain tax positions (17,000 ) 14,000 AMT tax payable adjustment 208,000 — Change in valuation allowance — 19,000 Other deferred tax adjustments 168,000 41,000 $ 963,000 $ 269,000 As of December 31, 2022 oximately $0 and 2029. Utilization of the net operating loss and credit carryforwards may 1986, may At December 31, 2022 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 increased by $0 and $19,000 for the tax years ended December 31, 2022 2021 The tax return years 2018 2021 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 ’ no As of December 31, 2022 not YEARS ENDED December 31, 2022 2021 Balance at beginning of year $ 295,000 $ 275,000 Additions based on tax positions of prior years (17,000 ) 20,000 Balance at end of year $ 278,000 $ 295,000 The Company’s December 31, 2022 not 12 may

Note 8 - Stock-based Compensati

Note 8 - Stock-based Compensation Expense	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Share-Based Payment Arrangement [Text Block]	NOTE 8 STOCK-BASED COMPENSATION EXPENSE Incentive Compensation Plan In June 2021, five February 22, 2027. No December 31, 2022 , approximately 1,219,000 shares remain available for grant under the Plan. Under the Plan, a total of 752,000 restricted stock units have been granted, consisting o f 53,000 o not 624,000 December 31, 2022 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 2022 2021 Restricted Stock Units Grant Date Weighted- Average Fair Value Outstanding at January 1, 2021 13,000 $ 1.97 Granted 165,000 $ 2.61 Vested (168,000 ) $ 2.57 Outstanding at December 31, 2021 10,000 $ 2.57 Granted 131,000 $ 2.40 Vested (132,000 ) $ 2.40 Forfeited (3,000 ) $ 2.92 Outstanding at December 31, 2022 6,000 $ 2.33 For the year ended December 31, 2022 , total compensation expense recorded in the consolidated statements of income for annual restricted stock units awarded was $6,000, with an offsetting tax benefit of $1,500, as this expense is deductible for income tax purposes. As of December 31, 2022 , there was $11,000 of total unrecognized compensation cost related to annual restricted stock units which is expected to be recognized over a period of three December 31, 2021 Certain Executive Equity Awards Effective May 4, 2020, August 3, 2020. October 1, 2020, December 31, 2021 December 31, 2021 December 31, 2022 December 31, 2022 For the year ended December 31, 2022 Stock-Based Awards Issued Compensation and Vested Expense Options — $ 10,000 Options Exercised 3,000 — Management Bonus Program - vested and issued 11,000 — Management Bonus Program — 92,000 Annual RSU Awards 1,000 6,000 Board RSU Awards - other — 3,000 Executive Compensation 120,000 288,000 135,000 $ 399,000 Total stock-based compensation expense before income tax effect for the Company’s options and restricted stock awards in the amount of $399,000 $420,000 December 31, 2022 2021 Stock Options Changes in stock options outstanding under the Incentive Compensation Plans during 2022 2021 Options Number of Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term (Years) Aggregate Intrinsic Value 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 $ — Granted 50,000 $ 2.72 7.00 $ — Exercised (4,000 ) $ 2.29 — $ — Forfeited (18,000 ) $ 2.64 — $ — Balance at December 31, 2022 95,000 $ 2.76 4.83 $ 25,000 Exercisable at December 31, 2021 58,000 $ 2.72 2.96 $ — Exercisable at December 31, 2022 38,000 $ 2.79 2.38 $ — The weighted average grant-date fair value of the options granted during the years 2022 2021 $1.49 $1.10 December 31, 2022 December 31, 2021 December 2022 2021 The Company received approximately $5,000 from the exercise of 2,000 options under the share-based arrangements in each of the years ended December 31, 2022 2021 2022 2021 At December 31, 2022 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 2022 2021 The fair value of the Compan y’s option grants under the Plan in 2022 and 2021 was estimated using the following assumptions: 2022 2021 Expected life (years) 7.0 7.0 Expected forfeiture rate 0.0 % 0.0 % Expected volatility 50 % 40 % Dividend yield 0 % 0 % Risk-free interest rate 3.3 % 1.2 % The following summarizes the assumption inputs used for the Company’s Black-Scholes calculation: Expected life (years): The expected term represents the weighted average period that the Company’s stock options are expected to be outstanding. Expected forfeiture rate: Forfeitures are recognized as they occur. Expected volatility: The expected volatility was derived from the Company’s historical stock volatility. Dividend yield: The expected dividend yield was assumed to be zero, as the Company has not no Risk-free interest rate: The risk-free interest rate is based on the interest yield in effect at the date of grant for zero Repurchase of Common Stock, Common Stock Warrants and Stock Options In 1999 2001, 2008. 2022 2021

Note 9 - Retirement Plan

Note 9 - Retirement Plan	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Retirement Benefits [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 2022 not December 31, 2022 December 31, 2021

Note 10 - Commitments and Conti

Note 10 - Commitments and Contingencies	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Commitments and Contingencies Disclosure [Text Block]	NOTE 10 COMMITMENTS AND CONTINGENCIES On December 20, 2018, two second third second third not second third no December 2023. December 31, 2020, December 31, 2022 two S250i As of December 31, 2022 four three one second 2023, 2023 2024. 2023, Total Gamma Knife and LINAC commitments as of December 31, 2022 , were . There may s new site in Mexico and the upgrade in Ecuador in the next 12 and a line of credit of $7,000,000 to fund these projects, if necessary. The Company has not no On September 4, 2022, September 2022 April 2026. one one As of December 31, 2022 , 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, 2023 2024. December 31, 2022 The Company’s customer contracts generally contain mutual indemnification provisions. The Company maintains general and professional liability insurance in the United States. The Company is not

Note 11 - Related Party Transac

Note 11 - Related Party Transactions	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Related Party Transactions Disclosure [Text Block]	NOTE 11 – 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 The following summarizes related party activity for the years ended December 31, 2022 2021 December 31, 2022 2021 Equipment purchases and de-install costs $ 1,844,000 $ 1,906,000 Costs incurred to maintain equipment 1,094,000 759,000 Total related party transactions $ 2,938,000 $ 2,665,000 The Company also had related party commitments to purchase one four two two December 31, 2022 Related party liabilities on the consolidated balance sheets consist of the following as of December 31, 2022 2021 December 31, 2022 2021 Accounts payable and other accrued liabilities $ 497,000 $ 1,992,000

Note 12 - Subsequent Event

Note 12 - Subsequent Event	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Subsequent Events [Text Block]	NOTE 12 – SUBSEQUENT EVENT On February 15, 2023, 60 second third 2023. 10

Significant Accounting Policies

Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2022
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 and marketing d (collectively, marketing costs”). Marketing costs were December 31, 2022 2021 Sales and Service
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 by GKF per it’s financing agreement with the United FC”). 5
Concentration Risk, Credit Risk, Policy [Policy Text Block]	Business and credit risk not All of the Company’s revenue was provided by fifteen seventeen 2022 2021 2022 2021 December 31, 2022 December 31, 2021 two 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 October 1, 2022, one October 1, 2022, December 31, 2022 December 31, 2022 seven December 31, 2021 seven 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 leases Gamma Knife and radiation therapy equipment to its customers under arrangements accounted for as operating leases. At December 31, 2022 December 31, 2021 As of December 31, 2022 2021 , the Company recognized a loss on the write down of impaired assets of $0 and $105,000, respectively. The impairment as of December 31, 2021 one December 31, 2020 . See further discussion under Note 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, 2022 2021 842, Patient income 606, no 30 3 6 not not December 31, 2022 2021 December 31, 2022 2021 December 31, 2022 2021 606,
Compensation Related Costs, Policy [Policy Text Block]	Stock-based compensation 8
Cost of Goods and Service [Policy Text Block]	Costs of revenue
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 7
Foreign Currency Transactions and Translations Policy [Policy Text Block]	Functional currency 830, Foreign Currency Matters 830” 830 December 31, 2022 2021
Asset Retirement Obligation [Policy Text Block]	Asset Retirement Obligations 410, Asset Retirement Obligations 410” asset retirement obligation (“ARO”) December 31, 2020, four four December 31, 2022 three one December 31, 2021 January 2022. December 31, 2022 not
Earnings Per Share, Policy [Policy Text Block]	Earnings per share not December 31, 2022 2021 20,000 and 31,000 December 31, 2022 2021 The following table illustrates the computations of basic and diluted earnings per share for the years ended December 31, 2022 2021 2022 2021 Numerator for basic and diluted earnings per share $ 1,328,000 $ 194,000 Denominator: Denominator for basic and diluted earnings per share – weighted-average shares 6,297,000 6,044,000 Effect of dilutive securities Employee stock options and restricted stock 6,000 15,000 Denominator for diluted earnings per share – adjusted weighted-average shares 6,303,000 6,059,000 Earnings per common share- basic $ 0.21 $ 0.03 Earnings per common share- diluted $ 0.21 $ 0.03
Segment Reporting, Policy [Policy Text Block]	Business segment information 280 Segment Reporting 280” fifteen fifteen into two reportable segments, domestic and foreign. thirteen two December 31, 2022 An operating segment is defined by ASC 280 may two two For the years ended December 31, 2022 2021 , the PBRT operations represented a significant majority of the domestic profit, disclosed below. December 31, 2022 2021 2022 2021 Revenues Domestic $ 16,655,000 $ 14,719,000 Foreign 3,091,000 2,909,000 Total $ 19,746,000 $ 17,628,000 2022 2021 Net income (loss) attributable to American Shared Hospital Services Domestic $ 1,187,000 $ 245,000 Foreign 141,000 (51,000 ) Total $ 1,328,000 $ 194,000 2022 2021 Total assets Domestic $ 37,575,000 $ 39,322,000 Foreign 6,381,000 6,108,000 Total $ 43,956,000 $ 45,430,000
Impairment or Disposal of Long-Lived Assets, Policy [Policy Text Block]	Long lived asset impairment may not may not, December 31, 2021, one No December 31, 2022 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, 2022 2021
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 5
Reclassification, Comparability Adjustment [Policy Text Block]	Reclassifications December 31, 2021

Note 2 - Accounting Policies (T

Note 2 - Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	2022 2021 Numerator for basic and diluted earnings per share $ 1,328,000 $ 194,000 Denominator: Denominator for basic and diluted earnings per share – weighted-average shares 6,297,000 6,044,000 Effect of dilutive securities Employee stock options and restricted stock 6,000 15,000 Denominator for diluted earnings per share – adjusted weighted-average shares 6,303,000 6,059,000 Earnings per common share- basic $ 0.21 $ 0.03 Earnings per common share- diluted $ 0.21 $ 0.03
Reconciliation of Revenue from Segments to Consolidated [Table Text Block]	2022 2021 Revenues Domestic $ 16,655,000 $ 14,719,000 Foreign 3,091,000 2,909,000 Total $ 19,746,000 $ 17,628,000
Reconciliation of Operating Profit (Loss) from Segments to Consolidated [Table Text Block]	2022 2021 Net income (loss) attributable to American Shared Hospital Services Domestic $ 1,187,000 $ 245,000 Foreign 141,000 (51,000 ) Total $ 1,328,000 $ 194,000
Reconciliation of Assets from Segment to Consolidated [Table Text Block]	2022 2021 Total assets Domestic $ 37,575,000 $ 39,322,000 Foreign 6,381,000 6,108,000 Total $ 43,956,000 $ 45,430,000

Note 3 - Property and Equipme_2

Note 3 - Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Property, Plant and Equipment [Table Text Block]	December 31, 2022 2021 Medical equipment and facilities $ 73,709,000 $ 73,388,000 Office equipment 422,000 472,000 Construction in progress 106,000 91,000 74,237,000 73,951,000 Accumulated depreciation (50,770,000 ) (45,697,000 ) Net property and equipment $ 23,467,000 $ 28,254,000

Note 4 - Other Accrued Liabil_2

Note 4 - Other Accrued Liabilities (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Other Liabilities [Table Text Block]	December 31, 2022 2021 Equipment maintenance and upgrades, non-related party $ — $ 367,000 Insurance 591,000 340,000 Professional services 92,000 90,000 Operating costs 539,000 397,000 Other 322,000 311,000 Total other accrued liabilities $ 1,544,000 $ 1,505,000

Note 5 - Long-Term Debt (Tables

Note 5 - Long-Term Debt (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Schedule of Maturities of Long-Term Debt [Table Text Block]	Year ending December 31, Principal 2023 $ 1,344,000 2024 2,094,000 2025 2,469,000 2026 7,594,000 2027 164,000 $ 13,665,000

Note 6 - Leases (Tables)

Note 6 - Leases (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Lessee, Operating Lease, Liability, Maturity [Table Text Block]	Year ending December 31, Operating Leases 2023 $ 301,000 2024 59,000 Total lease payments 360,000 Less imputed interest (9,000 ) Total $ 351,000
Lease, Cost [Table Text Block]	Year Ended December 31, 2022 2021 Lease cost Operating lease cost, net of impairment $ 406,000 $ 351,000 Sublease income (174,000 ) (14,000 ) Total lease cost $ 232,000 $ 337,000 Other information Cash paid for amounts included in the measurement of lease liabilities - Operating leases $ 406,000 $ 351,000 Weighted-average remaining lease term - Operating leases in years 1.11 1.39 Weighted-average discount rate - Operating leases 5.65 % 5.80 %

Note 7 - Income Taxes (Tables)

Note 7 - Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Schedule of Income before Income Tax, Domestic and Foreign [Table Text Block]	YEARS ENDED December 31, 2022 2021 Domestic $ 2,350,000 $ 831,000 Foreign 168,000 116,000 Income before income taxes $ 2,518,000 $ 947,000
Schedule of Components of Income Tax Expense (Benefit) [Table Text Block]	YEARS ENDED December 31, 2022 2021 Current: Federal $ 355,000 $ 9,000 State 60,000 93,000 Foreign 204,000 107,000 Total current 619,000 209,000 Deferred: Federal 290,000 98,000 State 48,000 (18,000 ) Foreign 6,000 (20,000 ) Total deferred 344,000 60,000 $ 963,000 $ 269,000
Schedule of Deferred Tax Assets and Liabilities [Table Text Block]	December 31, 2022 2021 Deferred tax liabilities: Property and equipment $ (1,255,000 ) $ (1,055,000 ) Total deferred tax liabilities (1,255,000 ) (1,055,000 ) Deferred tax assets: Net operating loss carryforwards 139,000 360,000 Accruals and allowances 167,000 41,000 Lease liabilities 61,000 136,000 Tax credits 3,000 4,000 Other – net 114,000 87,000 Capital loss carryover 646,000 646,000 Total deferred tax assets 1,130,000 1,274,000 Valuation allowance (697,000 ) (697,000 ) Deferred tax assets net of valuation allowance 433,000 577,000 Net deferred tax liabilities $ (822,000 ) $ (478,000 )
Schedule of Effective Income Tax Rate Reconciliation [Table Text Block]	YEARS ENDED December 31, 2022 2021 Computed expected federal income tax $ 477,000 $ 79,000 State income taxes, net of federal benefit 100,000 69,000 Non-deductible expenses (25,000 ) 28,000 Return to provision true-up 52,000 19,000 Uncertain tax positions (17,000 ) 14,000 AMT tax payable adjustment 208,000 — Change in valuation allowance — 19,000 Other deferred tax adjustments 168,000 41,000 $ 963,000 $ 269,000
Schedule of Unrecognized Tax Benefits Roll Forward [Table Text Block]	YEARS ENDED December 31, 2022 2021 Balance at beginning of year $ 295,000 $ 275,000 Additions based on tax positions of prior years (17,000 ) 20,000 Balance at end of year $ 278,000 $ 295,000

Note 8 - Stock-based Compensa_2

Note 8 - Stock-based Compensation Expense (Tables)	12 Months Ended
	Dec. 31, 2022
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 Outstanding at January 1, 2021 13,000 $ 1.97 Granted 165,000 $ 2.61 Vested (168,000 ) $ 2.57 Outstanding at December 31, 2021 10,000 $ 2.57 Granted 131,000 $ 2.40 Vested (132,000 ) $ 2.40 Forfeited (3,000 ) $ 2.92 Outstanding at December 31, 2022 6,000 $ 2.33
Disclosure of Share-Based Compensation Arrangements by Share-Based Payment Award [Table Text Block]	Stock-Based Awards Issued Compensation and Vested Expense Options — $ 10,000 Options Exercised 3,000 — Management Bonus Program - vested and issued 11,000 — Management Bonus Program — 92,000 Annual RSU Awards 1,000 6,000 Board RSU Awards - other — 3,000 Executive Compensation 120,000 288,000 135,000 $ 399,000
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, 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 $ — Granted 50,000 $ 2.72 7.00 $ — Exercised (4,000 ) $ 2.29 — $ — Forfeited (18,000 ) $ 2.64 — $ — Balance at December 31, 2022 95,000 $ 2.76 4.83 $ 25,000 Exercisable at December 31, 2021 58,000 $ 2.72 2.96 $ — Exercisable at December 31, 2022 38,000 $ 2.79 2.38 $ —
Schedule of Share-Based Payment Award, Stock Options, Valuation Assumptions [Table Text Block]	2022 2021 Expected life (years) 7.0 7.0 Expected forfeiture rate 0.0 % 0.0 % Expected volatility 50 % 40 % Dividend yield 0 % 0 % Risk-free interest rate 3.3 % 1.2 % The following summarizes the assumption inputs used for the Company’s Black-Scholes calculation: Expected life (years): The expected term represents the weighted average period that the Company’s stock options are expected to be outstanding.

Note 11 - Related Party Trans_2

Note 11 - Related Party Transactions (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Schedule of Related Party Transactions [Table Text Block]	December 31, 2022 2021 Equipment purchases and de-install costs $ 1,844,000 $ 1,906,000 Costs incurred to maintain equipment 1,094,000 759,000 Total related party transactions $ 2,938,000 $ 2,665,000 December 31, 2022 2021 Accounts payable and other accrued liabilities $ 497,000 $ 1,992,000

Note 1 - Business and Basis o_2

Note 1 - Business and Basis of Presentation (Details Textual)	Dec. 31, 2022	Apr. 27, 2022
Newco [Member]
Equity Method Investment, Ownership Percentage		85%
OR21, LLC [Member]
Equity Method Investment, Ownership Percentage	50%
Guadalupe [Member] | Newco [Member]
Equity Method Investment, Ownership Percentage		15%
Architectural Design Company [Member] | OR21, LLC [Member]
Equity Method Investment, Ownership Percentage	50%
Gamma Knife Center Ecuador S.A. (GKCE) [Member] | Gamma Knife Units [Member]
Number of Medical Centers	12

Note 2 - Accounting Policies (D

Note 2 - Accounting Policies (Details Textual)		12 Months Ended
	Jun. 12, 2020 USD ($)	Dec. 31, 2022 USD ($) $ / shares shares	Dec. 31, 2021 USD ($) $ / shares shares
Advertising Expense		$ 233,000	$ 211,000
Net Income (Loss) Attributable to Parent, Total		$ 1,328,000	$ 194,000
Earnings Per Share, Diluted, Total (in dollars per share) | $ / shares		$ 0.21	$ 0.03
Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization, Total		$ 74,237,000
Gain (Loss) on Sale of Assets and Asset Impairment Charges		$ 0	$ (105,000)
Lessee, Operating Lease, Term of Contract (Year)		10 years
Weighted Average Number of Shares Outstanding, Basic, Total (in shares) | shares		6,297,000	6,044,000
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]
Weighted Average Number of Shares Outstanding, Basic, Total (in shares) | shares		123,000	123,000
Share-Based Payment Arrangement, Option [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount (in shares) | shares		20,000	31,000
GK Peru [Member]
Accounts Receivable, Related Parties		$ 0	$ 0
GKCE [Member]
Accounts Receivable, Related Parties		862,000	$ 435,000
Gamma Knife Units [Member]
Number of Customer with Intent to Terminate Contract			4
Gamma Knife Units One [Member]
Asset Retirement Obligation, Ending Balance			$ 105,000
Gamma Knife Unit Removed [Member]
Asset Retirement Obligation, Cash Paid to Settle		457,000
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		16,655,000	14,719,000
PBRT Services [Member]
Revenue from Contract with Customer, Including Assessed Tax		8,952,000	6,058,000
Patient Income [Member]
Revenue from Contract with Customer, Including Assessed Tax		3,091,000	2,909,000
Salvage Value [Member]
Net Income (Loss) Attributable to Parent, Total		$ 17,000
Earnings Per Share, Diluted, Total (in dollars per share) | $ / shares		$ 0
Minimum [Member]
Property, Plant, and Equipment, Salvage Value		$ 140,000	175,000
Maximum [Member]
Property, Plant, and Equipment, Salvage Value		$ 300,000	400,000
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		$ 69,306,000	68,994,000
Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, Accumulated Depreciation and Amortization		$ 47,992,000	$ 43,400,000
Customer Concentration Risk [Member] | Revenue Benchmark [Member]
Number of Major Customers		15	17
Customer Concentration Risk [Member] | Revenue Benchmark [Member] | One Customer [Member]
Concentration Risk, Percentage		45%	34%
Customer Concentration Risk [Member] | Accounts Receivable [Member]
Number of Major Customers		4	2
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Customer One [Member]
Concentration Risk, Percentage		12%	31%
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Customer Two [Member]
Concentration Risk, Percentage		14%	10%
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Customer Three [Member]
Concentration Risk, Percentage		16%
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Customer Four [Member]
Concentration Risk, Percentage		22%

Note 2 - Accounting Policies -

Note 2 - Accounting Policies - Computation of Basic and Diluted Earnings Per Share (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Numerator for basic and diluted earnings per share	$ 1,328,000	$ 194,000
Denominator for basic and diluted earnings per share – weighted-average shares (in shares)	6,297,000	6,044,000
Effect of dilutive securities Employee stock options and restricted stock (in shares)	6,000	15,000
Denominator for diluted earnings per share – adjusted weighted-average shares (in shares)	6,303,000	6,059,000
Earnings per common share- basic (in dollars per share)	$ 0.21	$ 0.03
Earnings per common share- diluted (in dollars per share)	$ 0.21	$ 0.03

Note 2 - Accounting Policies _2

Note 2 - Accounting Policies - Revenues Allocations to Reportable Segments (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Revenues	$ 19,746,000	$ 17,628,000
Domestic Segment [Member]
Revenues	16,655,000	14,719,000
Foreign Segment [Member]
Revenues	$ 3,091,000	$ 2,909,000

Note 2 - Accounting Policies _3

Note 2 - Accounting Policies - Profit (Loss) Allocations to Reportable Segments (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Net Income (Loss) Attributable to Parent, Total	$ 1,328,000	$ 194,000
Domestic Segment [Member]
Net Income (Loss) Attributable to Parent, Total	1,187,000	245,000
Foreign Segment [Member]
Net Income (Loss) Attributable to Parent, Total	$ 141,000	$ (51,000)

Note 2 - Accounting Policies _4

Note 2 - Accounting Policies - Property and Equipment Allocations to Reportable Segments (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
TOTAL ASSETS	$ 43,956,000	$ 45,430,000
Domestic Segment [Member]
TOTAL ASSETS	37,575,000	39,322,000
Foreign Segment [Member]
TOTAL ASSETS	$ 6,381,000	$ 6,108,000

Note 3 - Property and Equipme_3

Note 3 - Property and Equipment (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization, Total	$ 74,237,000
Depreciation, Total	4,783,000	$ 4,972,000
Net Income (Loss) Attributable to Parent, Total	$ 1,328,000	$ 194,000
Earnings Per Share, Diluted, Total (in dollars per share)	$ 0.21	$ 0.03
Gain (Loss) on Sale of Assets and Asset Impairment Charges	$ 0	$ (105,000)
Asset Impairment Charges, Total	0	105,000
PBRT Equipment [Member]
Asset Impairment Charges, Total	0	0
Salvage Value [Member]
Net Income (Loss) Attributable to Parent, Total	$ 17,000
Earnings Per Share, Diluted, Total (in dollars per share)	$ 0
Non-US [Member]
Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization, Total	$ 2,201,000	$ 2,697,000

Note 3 - Property and Equipme_4

Note 3 - Property and Equipment - Summary of Property and Equipment (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
Property and equipment, gross		$ 73,951,000
Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization, Total	$ 74,237,000
Accumulated depreciation	(50,770,000)	(45,697,000)
Net property and equipment	23,467,000	28,254,000
Medical Equipment and Facilities [Member]
Property and equipment, gross	73,709,000	73,388,000
Office Equipment [Member]
Property and equipment, gross	422,000	472,000
Construction in Progress [Member]
Property and equipment, gross	$ 106,000	$ 91,000

Note 4 - Other Accrued Liabil_3

Note 4 - Other Accrued Liabilities - Other Accrued Liabilities (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
Equipment maintenance and upgrades, non-related party	$ 0	$ 367,000
Insurance	591,000	340,000
Professional services	92,000	90,000
Operating costs	539,000	397,000
Other	322,000	311,000
Total other accrued liabilities	$ 1,544,000	$ 1,505,000

Note 5 - Long-Term Debt (Detail

Note 5 - Long-Term Debt (Details Textual)		3 Months Ended	12 Months Ended
	Apr. 09, 2021 USD ($)	Mar. 31, 2021 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Finance Lease, Principal Payments			$ 0	$ 8,919,000
Gain (Loss) on Extinguishment of Debt, Total			0	(401,000)
Long-Term Debt, Total			13,665,000
Amortization of Debt Issuance Costs			84,000	59,000
Debt Issuance Costs, Net, Total			198,000	294,000
Gamma Knife Debt and Finance Leases [Member]
Short-term Debt, Refinanced, Amount	$ 6,774,000
Notes Payable, Other Payables [Member]
Debt Issuance Costs, Net, Total			198,000
The Credit Agreement [Member] | Fifth Third Bank, N.A. [Member]
Debt Instrument, Term (Year)	5 years
Line of Credit Facility, Maximum Borrowing Capacity	$ 22,000,000
Number of Debt Instruments	3
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
Gain (Loss) on Extinguishment of Debt, Total				(401,000)
Debt Issuance Costs, Gross				310,000
Long-Term Debt, Total			12,624,000	$ 14,437,000
Debt Instrument, Interest Rate, Stated Percentage				48%
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%
DFC Loan [Member]
Debt Issuance Costs, Gross			9,000	$ 15,000
Long-Term Debt, Total			$ 1,041,000	$ 1,261,000
Debt Instrument, Interest Rate, Stated Percentage			3.67%

Note 5 - Long-Term Debt - Long-

Note 5 - Long-Term Debt - Long-term Debt Maturities (Details)	Dec. 31, 2022 USD ($)
2023	$ 1,344,000
2024	2,094,000
2025	2,469,000
2026	7,594,000
2027	164,000
Long-Term Debt, Total	$ 13,665,000

Note 6 - Leases (Details Textua

Note 6 - Leases (Details Textual)		1 Months Ended	12 Months Ended
	Nov. 03, 2021 USD ($) ft²	Dec. 01, 2021 USD ($)	Dec. 31, 2022 USD ($) ft²	Dec. 31, 2021 USD ($)
Operating Lease, Right-of-Use Asset			$ 317,000	$ 654,000
Operating Lease, Liability, Total			351,000	351,000
Operating Lease, Expense			$ 290,000	377,000
Condominium Space for Gamma Knife Facility in Guayaquil, Ecuador [Member]
Area of Real Estate Property (Square Foot) | ft²			864
Land and Parking Spaces for Gamma Knife Facility in Guayaquil, Ecuador [Member]
Area of Real Estate Property (Square Foot) | ft²			10,135
Minimum [Member]
Lessee, Operating Lease, Discount Rate			4%
Lessee, Operating Lease, Remaining Lease Term (Year)			1 year
Maximum [Member]
Lessee, Operating Lease, Discount Rate			6%
Lessee, Operating Lease, Remaining Lease Term (Year)			2 years
Sublease Office in San Francisco, California [Member]
Area of Real Estate Property (Square Foot) | ft²	3,253		3,253
Operating Lease, Monthly Expense	$ 22,011		$ 22,011
Lessee, Operating Sublease, Monthly Income	$ 16,195		$ 16,195
Operating Lease, Impairment Loss		$ 77,000
Lease Agreement for New Corporate Office [Member]
Area of Real Estate Property (Square Foot) | ft²	900
Operating Lease, Monthly Expense	$ 4,500
Operating Lease, Right-of-Use Asset		$ 151,000
Corporate Office in San Francisco [Member]
Area of Real Estate Property (Square Foot) | ft²			900
Operating Lease, Monthly Expense			$ 4,500
Stand-alone Facility in Lima, Peru [Member]
Area of Real Estate Property (Square Foot) | ft²			1,600
Operating Lease, Monthly Expense			$ 8,850
Operating Lease, Impairment Loss				$ 77,000

Note 6 - Leases - Summary of Ma

Note 6 - Leases - Summary of Maturities of Lessee Operating Lease Liabilities (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
2023	$ 301,000
2024	59,000
Total lease payments	360,000
Less imputed interest	(9,000)
Total	$ 351,000	$ 351,000

Note 6 - Leases - Lease Cost an

Note 6 - Leases - Lease Cost and Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Operating lease cost, net of impairment	$ 406,000	$ 351,000
Sublease income	(174,000)	(14,000)
Total lease cost	232,000	337,000
Cash paid for amounts included in the measurement of lease liabilities - Operating leases	$ 406,000	$ 351,000
Weighted-average remaining lease term - Operating leases in years (Year)	1 year 1 month 9 days	1 year 4 months 20 days
Weighted-average discount rate - Operating leases	5.65%	5.80%

Note 7 - Income Taxes (Details

Note 7 - Income Taxes (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax Expense (Benefit), Total		$ 963,000	$ 269,000
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent		21%	21%
Valuation Allowance, Deferred Tax Asset, Increase (Decrease), Amount		$ 0	$ 19,000
Unrecognized Tax Benefits, Ending Balance		278,000	$ 295,000	$ 275,000
Unrecognized Tax Benefits, Income Tax Penalties Accrued		43,000
Unrecognized Tax Benefits, Interest on Income Taxes Accrued		0
Forecast [Member] | Maximum [Member]
Unrecognized Tax Benefits, Decrease Resulting from Foreign Taxes	$ 100,000
Domestic Tax Authority [Member]
Operating Loss Carryforwards		0
Domestic Tax Authority [Member] | Capital Loss Carryforward [Member]
Tax Credit Carryforward, Amount		2,679,000
State and Local Jurisdiction [Member]
Operating Loss Carryforwards		2,604,000
State and Local Jurisdiction [Member] | Capital Loss Carryforward [Member]
Tax Credit Carryforward, Amount		$ 129,000

Note 7 - Income Taxes - Compone

Note 7 - Income Taxes - Components of Income Before Income Taxes (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Domestic	$ 2,350,000	$ 831,000
Foreign	168,000	116,000
Income before income taxes	$ 2,518,000	$ 947,000

Note 7 - Income Taxes - Compo_2

Note 7 - Income Taxes - Components of Provision (Benefit) for Income Taxes (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Federal	$ 355,000	$ 9,000
State	60,000	93,000
Foreign	204,000	107,000
Total current	619,000	209,000
Federal	290,000	98,000
State	48,000	(18,000)
Foreign	6,000	(20,000)
Total deferred	344,000	60,000
Income Tax Expense (Benefit), Total	$ 963,000	$ 269,000

Note 7 - Income Taxes - Signifi

Note 7 - Income Taxes - Significant Components of Deferred Tax Liabilities and Assets (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
Property and equipment	$ (1,255,000)	$ (1,055,000)
Total deferred tax liabilities	(1,255,000)	(1,055,000)
Net operating loss carryforwards	139,000	360,000
Accruals and allowances	167,000	41,000
Lease liabilities	61,000	136,000
Tax credits	3,000	4,000
Other – net	114,000	87,000
Capital loss carryover	646,000	646,000
Total deferred tax assets	1,130,000	1,274,000
Valuation allowance	(697,000)	(697,000)
Deferred tax assets net of valuation allowance	433,000	577,000
Net deferred tax liabilities	$ (822,000)	$ (478,000)

Note 7 - Income Taxes - Reconci

Note 7 - Income Taxes - Reconciliation of Income Tax Provision (Benefit) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Computed expected federal income tax	$ 477,000	$ 79,000
State income taxes, net of federal benefit	100,000	69,000
Non-deductible expenses	(25,000)	28,000
Return to provision true-up	52,000	19,000
Uncertain tax positions	(17,000)	14,000
AMT tax payable adjustment	208,000	0
Change in valuation allowance	0	19,000
Other deferred tax adjustments	168,000	41,000
Income Tax Expense (Benefit), Total	$ 963,000	$ 269,000

Note 7 - Income Taxes - Recon_2

Note 7 - Income Taxes - Reconciliation of Unrecognized Tax Benefit (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Balance at beginning of year	$ 295,000	$ 275,000
Additions based on tax positions of prior years	(17,000)
Additions based on tax positions of prior years		20,000
Balance at end of year	$ 278,000	$ 295,000

Note 8 - Stock-based Compensa_3

Note 8 - Stock-based Compensation Expense (Details Textual) - USD ($)			12 Months Ended
	Aug. 03, 2020	May 04, 2020	Dec. 31, 2022	Dec. 31, 2021	Jun. 30, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period (in shares)			135,000
Share-Based Payment Arrangement, Expense			$ 399,000
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Grants in Period, Weighted Average Grant Date Fair Value (in dollars per share)			$ 1.49	$ 1.10
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Exercises in Period (in shares)			4,000	22,000
Options Issued During Period, Cashless Stock Options Exercised (in shares)			3,000	5,000
Proceeds from Stock Options Exercised			$ 5,000	$ 5,000
Share-based Compensation Arrangement by Share-based Payment Award, Options, Exercises in Period Using Cash (in shares)			2,000	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)			131,000	165,000
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period (in shares)			132,000	168,000
Share-Based Compensation Arrangement by Share-Based Payment Award, Non-Option Equity Instruments, Outstanding, Number, Ending Balance (in shares)			6,000	10,000		13,000
Restricted Stock Units (RSUs) [Member] | Selling, General and Administrative Expenses [Member]
Share-Based Payment Arrangement, Expense				$ 420,000
Share-Based Payment Arrangement, Expense, after Tax			$ 399,000
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)			120,000
Share-Based Payment Arrangement, Expense			$ 288,000
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)			1,000
Share-Based Payment Arrangement, Expense			$ 6,000
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)			3,000
Share-Based Payment Arrangement, Expense			$ 10,000	2,000
Share-Based Payment Arrangement, Nonvested Award, Option, Cost Not yet Recognized, Amount			$ 80,000
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year)			4 years
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)			1,219,000
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)			752,000
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)			624,000
Share-Based Compensation Arrangement by Share-Based Payment Award, Non-Option Equity Instruments, Outstanding, Number, Ending Balance (in shares)			6,000
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount, Total			$ 11,000
Share-based Compensation Arrangement by Share-based Payment Award, Non-Option Equity Instruments, Vested, Deferred for Issuance (in shares)			38,000
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)			31,000
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)			340,000
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			$ 6,000
Share-Based Payment Arrangement, Expense, Tax Benefit			$ 1,500
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
Executive Equity Awards [Member] | Restricted Stock Units (RSUs) [Member]
Share-Based Payment Arrangement, Expense			$ 288,000	$ 331,000
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, Award Vesting Period (Day)	30 days
Stock Issued During Period, Shares, Issued for Services (in shares)			120,000	120,000

Note 8 - Stock-based Compensa_4

Note 8 - Stock-based Compensation Expense - Changes in Restricted Stock Units (Details) - $ / shares	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Vested (in shares)	(135,000)
Restricted Stock Units (RSUs) [Member]
Outstanding (in shares)	10,000	13,000
Outstanding, grant date weighted average fair value (in dollars per share)	$ 2.57	$ 1.97
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Grants in Period (in shares)	131,000	165,000
Granted, grant date weighted average fair value (in dollars per share)	$ 2.40	$ 2.61
Vested (in shares)	(132,000)	(168,000)
Vested, grant date weighted average fair value (in dollars per share)	$ 2.40	$ 2.57
Forfeited (in shares)	(3,000)
Forfeited, grant date weighted average fair value (in dollars per share)	$ 2.92
Outstanding (in shares)	6,000	10,000
Outstanding, grant date weighted average fair value (in dollars per share)	$ 2.33	$ 2.57

Note 8 - Stock-based Compensa_5

Note 8 - Stock-based Compensation Expense - Stock Compensation Expense (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Share-Based Payment Arrangement, Expense	$ 399,000
Awards issued and vested (in shares)	135,000
Stock-based compensation expense	$ 399,000
Management Bonus Program [Member]
Share-Based Payment Arrangement, Expense	$ 92,000
Awards issued and vested (in shares)	11,000
Stock-based compensation expense	$ 92,000
Share-Based Payment Arrangement, Option [Member]
Share-Based Payment Arrangement, Expense	$ 10,000	$ 2,000
Awards issued and vested (in shares)	3,000
Stock-based compensation expense	$ 10,000	$ 2,000
Restricted Stock Units (RSUs) [Member]
Awards issued and vested (in shares)	132,000	168,000
Restricted Stock Units (RSUs) [Member] | Board Member [Member]
Share-Based Payment Arrangement, Expense	$ 3,000
Stock-based compensation expense	3,000
Restricted Stock Units (RSUs) [Member] | Chief Executive Officer [Member]
Share-Based Payment Arrangement, Expense	$ 288,000
Awards issued and vested (in shares)	120,000
Stock-based compensation expense	$ 288,000
Restricted Stock Units (RSUs) [Member] | Non Employee Directors and Corporate Secretary [Member]
Share-Based Payment Arrangement, Expense	$ 6,000
Awards issued and vested (in shares)	1,000
Stock-based compensation expense	$ 6,000

Note 8 - Stock-based Compensa_6

Note 8 - Stock-based Compensation Expense - Summary of Stock Option Activity (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Balance (in shares)	67,000	417,000
Balance, grant date weighted-average exercise price (in dollars per share)	$ 2.72	$ 2.79
Balance, weighted average remaining contractual life (Year)	4 years 9 months 29 days	3 years 3 months 29 days	1 year 7 months 9 days
Granted (in shares)	50,000	6,000
Granted, grant date weighted-average exercise price (in dollars per share)	$ 2.72	$ 2.92
Granted, weighted average remaining contractual life (Year)	7 years	7 years
Exercised (in shares)	(4,000)	(22,000)
Exercised, grant date weighted-average exercise price (in dollars per share)	$ 2.29	$ 2.65
Forfeited (in shares)	(18,000)	(334,000)
Forfeited, grant date weighted-average exercise price (in dollars per share)	$ 2.64	$ 2.81
Balance, aggregate intrinsic value	$ 25,000	$ 0
Balance (in shares)	95,000	67,000	417,000
Balance, grant date weighted-average exercise price (in dollars per share)	$ 2.76	$ 2.72	$ 2.79
Exercisable (in shares)	38,000	58,000
Exercisable, grant date weighted-average exercise price (in dollars per share)	$ 2.79	$ 2.72
Exercisable, weighted average remaining contractual life (Year)	2 years 4 months 17 days
Minimum [Member]
Exercisable, weighted average remaining contractual life (Year)		2 years 11 months 15 days

Note 8 - Stock-based Compensa_7

Note 8 - Stock-based Compensation Expense - Assumptions (Details)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Expected life (years) (Year)	7 years	7 years
Expected forfeiture rate	0%	0%
Expected volatility	50%	40%
Dividend yield	0%	0%
Risk-free interest rate	3.30%	1.20%

Note 9 - Retirement Plan (Detai

Note 9 - Retirement Plan (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Defined Contribution Plan, Employer Matching Contribution, Percent of Employees' Gross Pay	4%
Defined Contribution Plan, Cost	$ 36,000	$ 41,000

Note 10 - Commitments and Con_2

Note 10 - Commitments and Contingencies (Details Textual) - USD ($)			12 Months Ended
	Sep. 04, 2022	Sep. 05, 2017	Dec. 31, 2022
Leksell Gamma Knife Icon Systems and Linear Accelerator System [Member]
Long-term Install Service and Purchase Commitment, Amount			$ 13,243,000
Long-term Commitment, Cash on Hand to Fund			12,453,000
Long-term Commitment, Line of Credit to Fund			7,000,000
LINAC System [Member]
Long-Term Service Commitment, Amount			$ 15,374,000
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
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]
Purchase Agreement Annual Prepayment	$ 1,800,000
Long-term Purchase Commitment, Period (Year)	1 year	1 year

Note 11 - Related Party Trans_3

Note 11 - Related Party Transactions (Details Textual)	Dec. 31, 2022 USD ($)
US Subsidiary Of Elekta Member
Purchase Obligation, Total	$ 17,407,000
GKF Subsidiary [Member]
Noncontrolling Interest, Ownership Percentage by Parent	81%
US Subsidiary Of Elekta Member
Noncontrolling Interest, Ownership Percentage by Parent	19%

Note 11 - Related Party Trans_4

Note 11 - Related Party Transactions - Schedule of Related Party Transactions (Details) - US Subsidiary Of Elekta Member - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Equipment purchases and de-install costs	$ 1,844,000	$ 1,906,000
Costs incurred to maintain equipment	1,094,000	759,000
Total related party transactions	2,938,000	2,665,000
Accounts payable and other accrued liabilities	$ 497,000	$ 1,992,000