American Shared Hospital Services (AMS) 10-Q 14 Nov 23 2023 Q3 Quarterly report Financial data

Document And Entity Information

Document And Entity Information - shares	9 Months Ended
	Sep. 30, 2023	Nov. 09, 2023
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	Q3
Document Fiscal Year Focus	2023
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2023
Document Transition Report	false
Entity File Number	001-08789
Entity Incorporation, State or Country Code	CA
Entity Tax Identification Number	94-2918118
Entity Address, Address Line One	601 Montgomery Street
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	American Shared Hospital Services Common Stock, No Par Value
Trading Symbol	AMS
Security Exchange Name	NYSE
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
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		6,300,000

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets (Current Period Unaudited) - USD ($)	Sep. 30, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 14,537,000	$ 12,335,000
Restricted cash	118,000	118,000
Accounts receivable, net of allowance for doubtful accounts of $100,000 at September 30, 2023 and at December 31, 2022	3,986,000	3,801,000
Other receivables	651,000	327,000
Prepaid maintenance	832,000	1,245,000
Prepaid expenses and other current assets	247,000	897,000
Total current assets	20,371,000	18,723,000
Property and equipment, net	25,178,000	23,467,000
Land	19,000	19,000
Goodwill	1,265,000	1,265,000
Intangible asset	78,000	78,000
Right of use assets, net	94,000	317,000
Other assets	353,000	87,000
Total assets	47,358,000	43,956,000
Current liabilities:
Accounts payable	346,000	230,000
Employee compensation and benefits	805,000	735,000
Other accrued liabilities	1,921,000	1,544,000
Asset retirement obligations, related party	938,000	360,000
Income taxes payable	309,000	255,000
Current portion of lease liabilities	83,000	292,000
Line of credit	1,400,000	0
Current portion of long-term debt, net	1,459,000	1,262,000
Total current liabilities	10,049,000	5,175,000
Long-term lease liabilities, less current portion	11,000	59,000
Long-term debt, net, less current portion	10,454,000	12,205,000
Deferred revenue, less current portion	18,000	70,000
Deferred income taxes	822,000	822,000
Total liabilities	21,354,000	18,331,000
Commitments (see Note 9)
Shareholders' equity:
Common stock, no par value (10,000,000 authorized; Issued and outstanding shares - 6,270,000 at September 30, 2023 and 6,184,000 at December 31, 2022)	10,763,000	10,763,000
Additional paid-in capital	8,134,000	7,843,000
Retained earnings	3,214,000	3,019,000
Total equity-American Shared Hospital Services	22,111,000	21,625,000
Non-controlling interests in subsidiaries	3,893,000	4,000,000
Total shareholders' equity	26,004,000	25,625,000
Total liabilities and shareholders' equity	47,358,000	43,956,000
Related Party [Member]
Current liabilities:
Related party liabilities	$ 2,788,000	$ 497,000

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Current Period Unaudited) (Parentheticals) - USD ($) $ / shares in Thousands	Sep. 30, 2023	Dec. 31, 2022
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)	6,270,000	6,184,000
Common stock, shares outstanding (in shares)	6,270,000	6,184,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations (Unaudited) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Revenues	$ 5,134,000	$ 4,828,000	$ 15,627,000	$ 14,709,000
Costs of revenue:
Maintenance and supplies	518,000	472,000	1,509,000	1,374,000
Depreciation and amortization	1,228,000	1,171,000	3,812,000	3,514,000
Other direct operating costs	1,095,000	956,000	2,997,000	2,889,000
Other direct operating costs, related party	191,000	272,000	781,000	820,000
Cost of Revenue	3,032,000	2,871,000	9,099,000	8,597,000
Gross margin	2,102,000	1,957,000	6,528,000	6,112,000
Selling and administrative expense	1,735,000	1,260,000	5,262,000	3,725,000
Interest expense	277,000	249,000	825,000	546,000
Loss on write down of impaired assets and associated removal costs	0	0	578,000	0
Operating income (loss)	90,000	448,000	(137,000)	1,841,000
Interest and other income	135,000	36,000	318,000	31,000
Income before income taxes	225,000	484,000	181,000	1,872,000
Income tax expense	60,000	176,000	93,000	630,000
Net income	165,000	308,000	88,000	1,242,000
Plus (less): Net (income) loss attributable to non-controlling interests	(47,000)	8,000	107,000	(160,000)
Net income attributable to American Shared Hospital Services	$ 118,000	$ 316,000	$ 195,000	$ 1,082,000
Net income per share:
Income per common share - basic (in dollars per share)	$ 0.02	$ 0.05	$ 0.03	$ 0.17
Income per common share - diluted (in dollars per share)	$ 0.02	$ 0.05	$ 0.03	$ 0.17
Weighted average common shares for basic earnings per share (in shares)	6,366,000	6,234,000	6,336,000	6,223,000
Weighted average common shares for diluted earnings per share (in shares)	6,432,000	6,273,000	6,406,000	6,261,000
Rental Income from Medical Services [Member]
Revenues	$ 3,946,000	$ 4,101,000	$ 12,987,000	$ 12,382,000
Patient Income [Member]
Revenues	988,000	727,000	2,440,000	2,327,000
Equipment Sales [Member]
Revenues	$ 200,000	$ 0	$ 200,000	$ 0

Condensed Consolidated Statem_2

Condensed Consolidated Statement of Shareholders' Equity (Unaudited) - USD ($)	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, 2021							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	87,000	0	87,000	0	87,000
Vested restricted stock awards (in shares)	30,000
Vested restricted stock awards	$ 0	$ 0	$ 0	$ 0	$ 0	$ 0
Net income							0	0	269,000	269,000	125,000	394,000
Stock-based compensation expense							$ 0	87,000	0	87,000	0	87,000
Balances (in shares) at Mar. 31, 2022							6,079,000
Balances at Mar. 31, 2022							$ 10,758,000	7,531,000	1,960,000	20,249,000	4,471,000	24,720,000
Balances (in shares) at Dec. 31, 2021							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
Net income												$ 1,242,000
Options exercised (in shares)												2,000
Balances (in shares) at Sep. 30, 2022							6,153,000
Balances at Sep. 30, 2022							$ 10,763,000	7,679,000	2,773,000	21,215,000	4,212,000	$ 25,427,000
Balances (in shares) at Mar. 31, 2022							6,079,000
Balances at Mar. 31, 2022							$ 10,758,000	7,531,000	1,960,000	20,249,000	4,471,000	24,720,000
Stock-based compensation expense (in shares)							0
Stock-based compensation expense							$ 0	72,000	0	72,000	0	72,000
Vested restricted stock awards (in shares)							31,000
Vested restricted stock awards							$ 0	0	0	0	0	0
Net income							$ 0	0	497,000	497,000	43,000	540,000
Options exercised (in shares)							2,000
Options exercised							$ 5,000	0	0	5,000	0	5,000
Stock-based compensation expense							$ 0	72,000	0	72,000	0	72,000
Balances (in shares) at Jun. 30, 2022							6,112,000
Balances at Jun. 30, 2022							$ 10,763,000	7,603,000	2,457,000	20,823,000	4,514,000	25,337,000
Stock-based compensation expense							$ 0	76,000	0	76,000	0	76,000
Vested restricted stock awards (in shares)							41,000
Vested restricted stock awards							$ 0	0	0	0	0	0
Net income							0	0	316,000	316,000	(8,000)	308,000
Cash distributions to non-controlling interests							0	0	0	0	(294,000)	(294,000)
Stock-based compensation expense							$ 0	76,000	0	76,000	0	76,000
Balances (in shares) at Sep. 30, 2022							6,153,000
Balances at Sep. 30, 2022							$ 10,763,000	7,679,000	2,773,000	21,215,000	4,212,000	$ 25,427,000
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
Stock-based compensation expense							0	96,000	0	96,000	0	96,000
Net income							0	0	188,000	188,000	(88,000)	100,000
Stock-based compensation expense							$ 0	96,000	0	96,000	0	96,000
Balances (in shares) at Mar. 31, 2023							6,184,000
Balances at Mar. 31, 2023							$ 10,763,000	7,939,000	3,207,000	21,909,000	3,912,000	$ 25,821,000
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
Net income												$ 88,000
Balances (in shares) at Sep. 30, 2023							6,270,000					6,270,000
Balances at Sep. 30, 2023							$ 10,763,000	8,134,000	3,214,000	22,111,000	3,893,000	$ 26,004,000
Balances (in shares) at Mar. 31, 2023							6,184,000
Balances at Mar. 31, 2023							$ 10,763,000	7,939,000	3,207,000	21,909,000	3,912,000	25,821,000
Stock-based compensation expense							$ 0	97,000	0	97,000	0	97,000
Vested restricted stock awards (in shares)							30,000
Vested restricted stock awards							$ 0	0	0	0	0	0
Net income							0	0	(111,000)	(111,000)	(66,000)	(177,000)
Stock-based compensation expense							$ 0	97,000	0	97,000	0	97,000
Balances (in shares) at Jun. 30, 2023							6,214,000
Balances at Jun. 30, 2023							$ 10,763,000	8,036,000	3,096,000	21,895,000	3,846,000	25,741,000
Stock-based compensation expense							$ 0	98,000	0	98,000	0	98,000
Vested restricted stock awards (in shares)							56,000
Vested restricted stock awards							$ 0	0	0	0	0	0
Net income							0	0	118,000	118,000	47,000	165,000
Stock-based compensation expense							$ 0	98,000	0	98,000	0	$ 98,000
Balances (in shares) at Sep. 30, 2023							6,270,000					6,270,000
Balances at Sep. 30, 2023							$ 10,763,000	$ 8,134,000	$ 3,214,000	$ 22,111,000	$ 3,893,000	$ 26,004,000

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($)	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Operating activities:
Net income	$ 88,000	$ 1,242,000
Adjustments to reconcile net income to net cash from operating activities:
Depreciation, amortization, and other	3,874,000	3,557,000
Loss on write down of impaired assets and associated removal costs	578,000	0
Accretion of debt issuance costs	44,000	65,000
Non cash lease expense	223,000	252,000
Deferred income taxes	0	443,000
Stock-based compensation expense	291,000	235,000
Interest expense associated with lease liabilities	8,000	23,000
Changes in operating assets and liabilities:
Receivables	(498,000)	692,000
Prepaid expenses and other assets	799,000	998,000
Asset retirement obligations, related party	578,000	(427,000)
Related party liabilities	2,291,000	(924,000)
Accounts payable, accrued liabilities, and deferred revenue	713,000	(220,000)
Income taxes payable	54,000	0
Lease liabilities	(265,000)	(303,000)
Net cash provided by operating activities	8,778,000	5,633,000
Investing activities:
Payment for purchases of property and equipment	(6,176,000)	(332,000)
Net cash used in investing activities	(6,176,000)	(332,000)
Financing activities:
Principal payments on long-term debt	(1,589,000)	(1,602,000)
Advances on line of credit	1,400,000	0
Principal payments on short-term financing	(202,000)	0
Distributions to non-controlling interests	0	(294,000)
Debt issuance costs long-term debt	(9,000)	(9,000)
Proceeds from options exercised	0	5,000
Net cash used in financing activities	(400,000)	(1,900,000)
Net change in cash, cash equivalents, and restricted cash	2,202,000	3,401,000
Cash, cash equivalents, and restricted cash at beginning of period	12,453,000	8,263,000
Cash, cash equivalents, and restricted cash at end of period	14,655,000	11,664,000
Supplemental cash flow disclosure
Interest	781,000	481,000
Income taxes	277,000	174,000
Detail of cash, cash equivalents and restricted cash at end of period
Cash and cash equivalents	14,537,000	11,546,000
Restricted cash	118,000	118,000
Cash, cash equivalents, and restricted cash at end of period	$ 14,655,000	$ 11,664,000

Note 1 - Basis of Presentation

Note 1 - Basis of Presentation	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block]	Note 1. Basis of Presentation In the opinion of the management of American Shared Hospital Services (“ASHS”), the accompanying unaudited condensed consolidated financial statements contain all adjustments necessary for the fair presentation of ASHS consolidated financial position as of September 30, 2023 three nine September 30, 2023 2022 nine September 30, 2023 2022 three nine September 30, 2023 not December 31, 2022 These unaudited condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements for the year ended December 31, 2022 10 March 31, 2023. These condensed consolidated financial statements include the accounts of ASHS and its subsidiaries (the “Company”) including as follows: ASHS wholly owns the subsidiaries American Shared Radiosurgery Services (“ASRS”), PBRT Orlando, LLC (“Orlando”), ASHS-Mexico, S.A. de C.V. (“ASHS-Mexico”), OR21, The Company (through ASRS) and Elekta AB (“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. As of September 30, 2023 two The Company formed the subsidiaries 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. LBE is not two On April 27, 2022 , October 3, 2022 December 15, 2022 January 2024. three September 30, 2023 The Company continues to develop its design and business model for The Operating Room for the 21st SM OR21, “OR21 OR21 not two All significant intercompany accounts and transactions have been eliminated in consolidation. Accounting pronouncements issued and not yet adopted - March 2020, 2020 04, Reference Rate Reform (Topic 848 2020 04” 2020 04 January 2021, 2021 01, Reference Rate Reform (Topic 848 2021 01” 848 December 2022, 2022 06, Reference Rate Reform (Topic 848 848 2022 06”; 2020 04 2021 01, 848 848 December 31, 2022 December 31, 2024. 848 March 12, 2020, December 31, 2024, 848 not December 31, 2024 December 31, 2024, December 31, 2024 December 31, 2024). 848 may 3 Revenue recognition 842 Leases 842” 606 Revenue from Contracts with Customers 606” Rental income from medical equipment services 842 ten three nine September 30, 2023 842. 842 three nine September 30, 2023 Patient income 606, no 30 three six not 606 September 30, 2023 July 1, 2023 January 1, 2023 606 September 30, 2022 July 1, 2022, January 1, 2022 three nine September 30, 2023 606 During the three September 30, 2023 606 two 60 three nine September 30, 2023 Business segment information 280 Segment Reporting 280” fourteen fourteen two two September 30, 2023 60 three September 30, 2023 280 three 1 may 2 3 two reportable two For the three nine September 30, 2023 two September 30, 2023 2022 Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Revenues Domestic $ 4,146,000 $ 4,101,000 $ 13,187,000 $ 12,382,000 International 988,000 727,000 2,440,000 2,327,000 Total $ 5,134,000 $ 4,828,000 $ 15,627,000 $ 14,709,000 Net income (loss) attributable to American Shared Hospital Services Domestic $ 67,000 $ 287,000 $ 296,000 $ 992,000 International 51,000 29,000 (101,000 ) 90,000 Total $ 118,000 $ 316,000 $ 195,000 $ 1,082,000 Reclassification three nine September 30, 2022

Note 2 - Property and Equipment

Note 2 - Property and Equipment	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Property, Plant and Equipment Disclosure [Text Block]	Note 2. Property and Equipment Property and equipment are stated at cost less accumulated depreciation. Depreciation for Gamma Knife units and other equipment is determined using the straight-line method over the estimated useful lives of the assets, which for medical and office equipment is generally between three ten three nine September 30, 2023 three June 30, 2023, three nine September 30, 2023 no The Company determines salvage value based on the estimated fair value of the equipment at the end of its useful life. As of January 1, 2023, one January 1, 2023, three nine September 30, 2023 Depreciation for PBRT 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 following table summarizes property and equipment as of September 30, 2023 December 31, 2022 September 30, December 31, 2023 2022 Medical equipment and facilities $ 73,884,000 $ 73,709,000 Office equipment 300,000 422,000 Construction in progress 5,436,000 106,000 79,620,000 74,237,000 Accumulated depreciation (54,442,000 ) (50,770,000 ) Net property and equipment $ 25,178,000 $ 23,467,000 Net property and equipment held outside of the United States $ 4,038,000 $ 2,201,000

Note 3 - Long-Term Debt Financi

Note 3 - Long-Term Debt Financing	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Long-Term Debt [Text Block]	Note 3. Long-Term Debt Financing On April 9, 2021 five three first second third September 30, 2023 October 2023. five September 30, 2023 December 31, 2022 As of December 31, 2021, no 1 3 6 September 30, 2024. July 1, 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 September 30, 2023 The loan entered into with United States International Development Finance Corporation (“DFC”) in connection with the acquisition of GKCE in June 2020 ( 17 September 30, 2023 September 30, 2023 December 31, 2022 September 30, 2023 December 31, 2022, The accretion of debt issuance costs for the nine September 30, 2023 2022 September 30, 2023 December 31, 2022 As of September 30, 2023 September 30, 2023 Year ending December 31, Principal 2023 (excluding the nine-months ended September 30, 2023) $ 55,000 2024 2,094,000 2025 2,469,000 2026 7,294,000 2027 164,000 $ 12,076,000

Note 4 - Other Accrued Liabilit

Note 4 - Other Accrued Liabilities	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Other Liabilities Disclosure [Text Block]	N ote 4. Other Accrued Liabilities Other accrued liabilities consist of the following as of September 30, 2023 December 31, 2022 September 30, December 31, 2023 2022 Insurance $ - $ 591,000 Professional services 291,000 92,000 Operating costs 782,000 539,000 Other 848,000 322,000 Total other accrued liabilities $ 1,921,000 $ 1,544,000

Note 5 - Leases

Note 5 - Leases	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Lessee, Operating Leases [Text Block]	Note 5. Leases 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. not not On November 3, 2021, 410, August 2023. 601 1112, November 2024. The Company’s lessee operating leases are accounted for as right of use (“ROU”) assets, other current liabilities, and lease liabilities on the condensed consolidated balance sheets. 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 no September 30, 2023 The following table summarizes the maturities of the Company's lessee operating lease liabilities as of September 30, 2023 Year ending December 31, Operating Leases 2023 (excluding the nine-months ended September 30, 2023) $ 38,000 2024 59,000 Total lease payments 97,000 Less imputed interest (3,000 ) Total $ 94,000 Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Lease cost Operating lease cost $ 59,000 $ 102,000 $ 265,000 $ 303,000 Sublease income (30,000 ) (43,000 ) (129,000 ) (129,000 ) Total lease cost $ 29,000 $ 59,000 $ 136,000 $ 174,000 Other information Cash paid for amounts included in the measurement of lease liabilities - Operating leases $ 59,000 $ 102,000 $ 265,000 $ 303,000 Weighted-average remaining lease term - Operating leases in years 0.89 1.30 0.89 1.30 Weighted-average discount rate - Operating leases 4.99 % 5.71 % 4.99 % 5.71 %

Note 6 - Per Share Amounts

Note 6 - Per Share Amounts	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Earnings Per Share [Text Block]	Note 6. Per Share Amounts Per share information has been computed based on the weighted average number of common shares and dilutive common share equivalents outstanding. The computation for the three nine September 30, 2023 2022 y 118,000 and 91,000, respectively, of the Company’s stock options b three nine September 30, 2023 2022 The following table sets forth the computation of basic and diluted earnings per share for the three nine September 30, 2023 2022 Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Net income attributable to American Shared Hospital Services $ 118,000 $ 316,000 $ 195,000 $ 1,082,000 Weighted average common shares for basic earnings per share 6,366,000 6,234,000 6,336,000 6,223,000 Dilutive effect of stock options and restricted stock awards 66,000 39,000 70,000 38,000 Weighted average common shares for diluted earnings per share 6,432,000 6,273,000 6,406,000 6,261,000 Basic earnings per share $ 0.02 $ 0.05 $ 0.03 $ 0.17 Diluted earnings per share $ 0.02 $ 0.05 $ 0.03 $ 0.17

Note 7 - Stock-based Compensati

Note 7 - Stock-based Compensation	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Share-Based Payment Arrangement [Text Block]	Note 7. Stock-based Compensation In June 2021, five February 22, 2027. No Stock-based compensation expense associated with the Company’s stock options to employees is calculated using the Black-Scholes valuation model. The Company’s stock awards have characteristics significantly different from those of traded options, and changes in the subjective input assumptions can materially affect the fair value estimates. The estimated fair value of the Company’s option grants is estimated using assumptions for expected life, volatility, dividend yield, and risk-free interest rate which are specific to each award. The estimated fair value of the Company’s options is expensed over the period during which an employee is required to provide service in exchange for the award (requisite service period), usually the vesting period. Accordingly, stock-based compensation cost before income tax effect for the Company’s options and restricted stock awards in the amo unt of $98,000 and $291,000 three nine September 30, 2023 $235,000 nine September 30, 2023 o four nine September 30, 2023 The following table summarizes stock option activity for the nine September 30, 2023 2022 Stock Options Grant Date Weighted- Average Exercise Price Weighted- Average Remaining Contractual Life (in Years) Intrinsic Value Outstanding at January 1, 2023 95,000 $ 2.76 4.83 $ 25,000 Granted 70,000 $ 2.82 7.00 $ - Forfeited (19,000 ) $ 2.69 - $ - Outstanding at September 30, 2023 146,000 $ 2.80 5.51 $ - Exercisable at September 30, 2023 38,000 $ 2.86 3.35 $ - Outstanding at January 1, 2022 67,000 $ 2.72 3.33 $ - Granted 50,000 $ 2.72 5.00 $ - Exercised (2,000 ) $ 2.70 - $ - Forfeited (7,000 ) $ 2.58 - $ - Outstanding at September 30, 2022 108,000 $ 2.73 4.85 $ 9,000 Exercisable at September 30, 2022 50,000 $ 2.74 2.74 $ -

Note 8 - Income Taxes

Note 8 - Income Taxes	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Income Tax Disclosure [Text Block]	Note 8. Income Taxes The Company generally calculates its effective income tax rate at the end of an interim period using an estimate of the annualized effective income tax rate expected to be applicable for the full fiscal year. However, when a reliable estimate of the annualized effective income tax rate cannot be made, the Company computes its provision for income taxes using the actual effective income tax rate for the results of operations reported within the year-to-date periods. The Company’s effective income tax rate is highly influenced by relative income or losses reported and the amount of the nondeductible stock-based compensation associated with grants of its common stock options and from the results of international operations. A small change in estimated annual pretax income can produce a significant variance in the annualized effective income tax rate given the expected amount of these items. As a result, the Company has computed its provision for income taxes for the three nine September 30, 2023 2022

Note 9 - Commitments

Note 9 - Commitments	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Commitments and Contingencies Disclosure [Text Block]	Note 9. Commitments On December 20, 2018, two second third second third not second third no December 2023. could forfeit its deposits December 31, 2020, September 30, 2023 two S250i As of September 30, 2023 one one two two one 60 one two one January 2024. September 30, 2023 The Company is also in the process of upgrading its existing Gamma Knife equipment in Ecuador and expects to begin treating patients on the new system in November 2023. October 2023. 11 . in 2024. September 30, 2023 were $15,921,000. There are no September 30, 2023 . It is the Company’s intent to finance substantially all of these commitments. There can be no and a line of credit of $7,000,000 and is actively engaged with financing resources to fund these projects. September 30, 2023, October 2023. On September 4, 2022, September 2022 April 2026. one one As of September 30, 2023 two September 30, 2023

Note 10 - Related Party Transac

Note 10 - Related Party Transactions	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Related Party Transactions Disclosure [Text Block]	Note 10. Related Party Transactions and Balances 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 table summarizes related party activity for the three nine September 30, 2023 2022 Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Equipment purchases and de-install costs $ 2,147,000 $ 231,000 $ 3,565,000 $ 1,594,000 Costs incurred to maintain equipment 191,000 272,000 781,000 820,000 Total related party transactions $ 2,338,000 $ 503,000 $ 4,346,000 $ 2,414,000 The Company also had commitments to purchase or upgrade Gamma Knife units, purchase a LINAC system and service the related equipment of $16,311,000 as of September 30, 2023 Related party liabilities on the condensed consolidated balance sheets consist of the following as of September 30, 2023 December 31, 2022 September 30, December 31, 2023 2022 Accounts payable, asset retirement obligation and other accrued liabilities $ 3,726,000 $ 857,000

Note 11 - Subsequent Events

Note 11 - Subsequent Events	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Subsequent Events [Text Block]	Note 11. Subsequent Events On October 23, 2023, second second 16 3 On November 10, 2023, three 60 The transaction will be accounted for as a business combination under ASC 805 Business Combinations Costs related to legal, financial and due diligence services performed in connection with this transaction are not

Significant Accounting Policies

Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2023
Accounting Policies [Abstract]
Basis of Accounting, Policy [Policy Text Block]	In the opinion of the management of American Shared Hospital Services (“ASHS”), the accompanying unaudited condensed consolidated financial statements contain all adjustments necessary for the fair presentation of ASHS consolidated financial position as of September 30, 2023 three nine September 30, 2023 2022 nine September 30, 2023 2022 three nine September 30, 2023 not December 31, 2022 These unaudited condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements for the year ended December 31, 2022 10 March 31, 2023. These condensed consolidated financial statements include the accounts of ASHS and its subsidiaries (the “Company”) including as follows: ASHS wholly owns the subsidiaries American Shared Radiosurgery Services (“ASRS”), PBRT Orlando, LLC (“Orlando”), ASHS-Mexico, S.A. de C.V. (“ASHS-Mexico”), OR21, The Company (through ASRS) and Elekta AB (“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. As of September 30, 2023 two The Company formed the subsidiaries 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. LBE is not two On April 27, 2022 , October 3, 2022 December 15, 2022 January 2024. three September 30, 2023 The Company continues to develop its design and business model for The Operating Room for the 21st SM OR21, “OR21 OR21 not two All significant intercompany accounts and transactions have been eliminated in consolidation.
New Accounting Pronouncements, Policy [Policy Text Block]	Accounting pronouncements issued and not yet adopted - March 2020, 2020 04, Reference Rate Reform (Topic 848 2020 04” 2020 04 January 2021, 2021 01, Reference Rate Reform (Topic 848 2021 01” 848 December 2022, 2022 06, Reference Rate Reform (Topic 848 848 2022 06”; 2020 04 2021 01, 848 848 December 31, 2022 December 31, 2024. 848 March 12, 2020, December 31, 2024, 848 not December 31, 2024 December 31, 2024, December 31, 2024 December 31, 2024). 848 may 3
Revenue [Policy Text Block]	Revenue recognition 842 Leases 842” 606 Revenue from Contracts with Customers 606” Rental income from medical equipment services 842 ten three nine September 30, 2023 842. 842 three nine September 30, 2023 Patient income 606, no 30 three six not 606 September 30, 2023 July 1, 2023 January 1, 2023 606 September 30, 2022 July 1, 2022, January 1, 2022 three nine September 30, 2023 606 During the three September 30, 2023 606 two 60 three nine September 30, 2023
Segment Reporting, Policy [Policy Text Block]	Business segment information 280 Segment Reporting 280” fourteen fourteen two two September 30, 2023 60 three September 30, 2023 280 three 1 may 2 3 two reportable two For the three nine September 30, 2023 two September 30, 2023 2022 Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Revenues Domestic $ 4,146,000 $ 4,101,000 $ 13,187,000 $ 12,382,000 International 988,000 727,000 2,440,000 2,327,000 Total $ 5,134,000 $ 4,828,000 $ 15,627,000 $ 14,709,000 Net income (loss) attributable to American Shared Hospital Services Domestic $ 67,000 $ 287,000 $ 296,000 $ 992,000 International 51,000 29,000 (101,000 ) 90,000 Total $ 118,000 $ 316,000 $ 195,000 $ 1,082,000
Reclassification, Comparability Adjustment [Policy Text Block]	Reclassification three nine September 30, 2022

Note 1 - Basis of Presentation

Note 1 - Basis of Presentation (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Reconciliation of Revenue from Segments to Consolidated [Table Text Block]	Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Revenues Domestic $ 4,146,000 $ 4,101,000 $ 13,187,000 $ 12,382,000 International 988,000 727,000 2,440,000 2,327,000 Total $ 5,134,000 $ 4,828,000 $ 15,627,000 $ 14,709,000 Net income (loss) attributable to American Shared Hospital Services Domestic $ 67,000 $ 287,000 $ 296,000 $ 992,000 International 51,000 29,000 (101,000 ) 90,000 Total $ 118,000 $ 316,000 $ 195,000 $ 1,082,000

Note 2 - Property and Equipme_2

Note 2 - Property and Equipment (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Property, Plant and Equipment [Table Text Block]	September 30, December 31, 2023 2022 Medical equipment and facilities $ 73,884,000 $ 73,709,000 Office equipment 300,000 422,000 Construction in progress 5,436,000 106,000 79,620,000 74,237,000 Accumulated depreciation (54,442,000 ) (50,770,000 ) Net property and equipment $ 25,178,000 $ 23,467,000 Net property and equipment held outside of the United States $ 4,038,000 $ 2,201,000

Note 3 - Long-Term Debt Finan_2

Note 3 - Long-Term Debt Financing (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Schedule of Maturities of Long-Term Debt [Table Text Block]	Year ending December 31, Principal 2023 (excluding the nine-months ended September 30, 2023) $ 55,000 2024 2,094,000 2025 2,469,000 2026 7,294,000 2027 164,000 $ 12,076,000

Note 4 - Other Accrued Liabil_2

Note 4 - Other Accrued Liabilities (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Other Liabilities [Table Text Block]	September 30, December 31, 2023 2022 Insurance $ - $ 591,000 Professional services 291,000 92,000 Operating costs 782,000 539,000 Other 848,000 322,000 Total other accrued liabilities $ 1,921,000 $ 1,544,000

Note 5 - Leases (Tables)

Note 5 - Leases (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Lessee, Operating Lease, Liability, to be Paid, Maturity [Table Text Block]	Year ending December 31, Operating Leases 2023 (excluding the nine-months ended September 30, 2023) $ 38,000 2024 59,000 Total lease payments 97,000 Less imputed interest (3,000 ) Total $ 94,000
Lease, Cost [Table Text Block]	Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Lease cost Operating lease cost $ 59,000 $ 102,000 $ 265,000 $ 303,000 Sublease income (30,000 ) (43,000 ) (129,000 ) (129,000 ) Total lease cost $ 29,000 $ 59,000 $ 136,000 $ 174,000 Other information Cash paid for amounts included in the measurement of lease liabilities - Operating leases $ 59,000 $ 102,000 $ 265,000 $ 303,000 Weighted-average remaining lease term - Operating leases in years 0.89 1.30 0.89 1.30 Weighted-average discount rate - Operating leases 4.99 % 5.71 % 4.99 % 5.71 %

Note 6 - Per Share Amounts (Tab

Note 6 - Per Share Amounts (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Net income attributable to American Shared Hospital Services $ 118,000 $ 316,000 $ 195,000 $ 1,082,000 Weighted average common shares for basic earnings per share 6,366,000 6,234,000 6,336,000 6,223,000 Dilutive effect of stock options and restricted stock awards 66,000 39,000 70,000 38,000 Weighted average common shares for diluted earnings per share 6,432,000 6,273,000 6,406,000 6,261,000 Basic earnings per share $ 0.02 $ 0.05 $ 0.03 $ 0.17 Diluted earnings per share $ 0.02 $ 0.05 $ 0.03 $ 0.17

Note 7 - Stock-based Compensa_2

Note 7 - Stock-based Compensation (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Share-Based Payment Arrangement, Option, Activity [Table Text Block]	Stock Options Grant Date Weighted- Average Exercise Price Weighted- Average Remaining Contractual Life (in Years) Intrinsic Value Outstanding at January 1, 2023 95,000 $ 2.76 4.83 $ 25,000 Granted 70,000 $ 2.82 7.00 $ - Forfeited (19,000 ) $ 2.69 - $ - Outstanding at September 30, 2023 146,000 $ 2.80 5.51 $ - Exercisable at September 30, 2023 38,000 $ 2.86 3.35 $ - Outstanding at January 1, 2022 67,000 $ 2.72 3.33 $ - Granted 50,000 $ 2.72 5.00 $ - Exercised (2,000 ) $ 2.70 - $ - Forfeited (7,000 ) $ 2.58 - $ - Outstanding at September 30, 2022 108,000 $ 2.73 4.85 $ 9,000 Exercisable at September 30, 2022 50,000 $ 2.74 2.74 $ -

Note 10 - Related Party Trans_2

Note 10 - Related Party Transactions (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Schedule of Related Party Transactions [Table Text Block]	Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Equipment purchases and de-install costs $ 2,147,000 $ 231,000 $ 3,565,000 $ 1,594,000 Costs incurred to maintain equipment 191,000 272,000 781,000 820,000 Total related party transactions $ 2,338,000 $ 503,000 $ 4,346,000 $ 2,414,000 September 30, December 31, 2023 2022 Accounts payable, asset retirement obligation and other accrued liabilities $ 3,726,000 $ 857,000

Note 1 - Basis of Presentatio_2

Note 1 - Basis of Presentation (Details Textual)	3 Months Ended		9 Months Ended
	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Jul. 01, 2023 USD ($)	Jan. 01, 2023 USD ($)	Jul. 01, 2022 USD ($)	Apr. 27, 2022	Jan. 01, 2022 USD ($)
Number of Medical Centers	11		11
Number of Reportable Segments			2
GKCE [Member]
Accounts Receivable, after Allowance for Credit Loss	$ 1,416,000	$ 1,248,000	$ 1,416,000	$ 1,248,000	$ 980,000	$ 1,119,000	$ 1,145,000		$ 668,000
Rental Income from Medical Services [Member]
Revenue from Contract with Customer, Including Assessed Tax	3,946,000	4,101,000	12,987,000	12,382,000
PBRT Services [Member]
Revenue from Contract with Customer, Including Assessed Tax	2,219,000	2,358,000	7,078,000	6,705,000
Patient Income [Member]
Revenue from Contract with Customer, Including Assessed Tax	988,000	$ 727,000	2,440,000	$ 2,327,000
Equipment Sales [Member]
Revenue from Contract with Customer, Including Assessed Tax	$ 200,000		$ 200,000
Gamma Knife and PBRT Equipment [Member]
Number of Medical Centers	12		12
Lima, Peru and Guayaquil, Ecuador [Member]
Number of Single-unit Facilities	2		2
Newco [Member]
Equity Method Investment, Ownership Percentage								85%
Newco [Member] | Guadalupe [Member]
Equity Method Investment, Ownership Percentage								15%
OR21, LLC [Member]
Equity Method Investment, Ownership Percentage	50%		50%
OR21, LLC [Member] | Architectural Design Company [Member]
Equity Method Investment, Ownership Percentage	50%		50%

Note 1 - Basis of Presentatio_3

Note 1 - Basis of Presentation - Revenues and Profit (Loss) Allocations to Reportable Segments (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Revenues	$ 5,134,000	$ 4,828,000	$ 15,627,000	$ 14,709,000
Net Income (Loss) Attributable to Parent	118,000	316,000	195,000	1,082,000
Net income (loss)	118,000	316,000	195,000	1,082,000
Domestic Segment [Member]
Revenues	4,146,000	4,101,000	13,187,000	12,382,000
Net Income (Loss) Attributable to Parent	67,000	287,000	296,000	992,000
Net income (loss)	67,000	287,000	296,000	992,000
Foreign Segment [Member]
Revenues	988,000	727,000	2,440,000	2,327,000
Net Income (Loss) Attributable to Parent	51,000	29,000	(101,000)	90,000
Net income (loss)	$ 51,000	$ 29,000	$ (101,000)	$ 90,000

Note 2 - Property and Equipme_3

Note 2 - Property and Equipment (Details Textual) - USD ($)	3 Months Ended			9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Depreciation	$ 1,265,000		$ 1,182,000	$ 3,874,000	$ 3,557,000
Write Down of Impaired Assets and Associated Removal Costs	0	$ 578,000	0	578,000	0
Gain (Loss) on Sale of Assets and Asset Impairment Charges	0	$ 578,000
Net Income (Loss) Attributable to Parent	$ 118,000		$ 316,000	$ 195,000	$ 1,082,000
Earnings Per Share, Diluted (in dollars per share)	$ 0.02		$ 0.05	$ 0.03	$ 0.17
Salvage Value [Member]
Net Income (Loss) Attributable to Parent	$ (50,000)			$ 151,000
Earnings Per Share, Diluted (in dollars per share)	$ 0.01			$ 0.02
Medical and Office Equipment [Member] | Minimum [Member]
Property, Plant and Equipment, Useful Life (Year)	3 years			3 years
Medical and Office Equipment [Member] | Maximum [Member]
Property, Plant and Equipment, Useful Life (Year)	10 years			10 years
PBRT Equipment [Member]
Property, Plant and Equipment, Useful Life (Year)	20 years			20 years

Note 2 - Property and Equipme_4

Note 2 - Property and Equipment - Summary of Property and Equipment (Details) - USD ($)	Sep. 30, 2023	Dec. 31, 2022
Property and equipment, gross		$ 74,237,000
Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization, Total	$ 79,620,000
Accumulated depreciation	(54,442,000)	(50,770,000)
Net property and equipment	25,178,000	23,467,000
Property and equipment, net	25,178,000	23,467,000
Non-US [Member]
Net property and equipment	4,038,000	2,201,000
Property and equipment, net	4,038,000	2,201,000
Medical Equipment and Facilities [Member]
Property and equipment, gross	73,884,000	73,709,000
Office Equipment [Member]
Property and equipment, gross	300,000	422,000
Construction in Progress [Member]
Property and equipment, gross	$ 5,436,000	$ 106,000

Note 3 - Long-Term Debt Finan_3

Note 3 - Long-Term Debt Financing (Details Textual)		9 Months Ended		12 Months Ended
	Apr. 09, 2021 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Dec. 31, 2021	Dec. 31, 2023	Jun. 30, 2023	Dec. 31, 2022 USD ($)
Long-Term Debt		$ 11,913,000
Amortization of Debt Issuance Costs		44,000	$ 65,000
Debt Issuance Costs, Net		163,000					$ 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
Long-Term Debt		11,200,000					12,624,000
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%
The Credit Agreement, Second Loan Facility [Member] | Fifth Third Bank, N.A. [Member]
Debt Instrument, Face Amount	$ 5,500,000
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
Long-Term Line of Credit		1,400,000
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 [Member]
Debt Instrument, Basis Spread on Variable Rate	3%
DFC Loan [Member]
Long-Term Debt		876,000					1,041,000
Debt Instrument, Interest Rate, Stated Percentage						3.67%
Debt Issuance Costs, Gross		$ 9,000					$ 9,000

Note 3 - Long-Term Debt Finan_4

Note 3 - Long-Term Debt Financing - Long-term Debt Maturities (Details)	Sep. 30, 2023 USD ($)
2023 (excluding the nine-months ended September 30, 2023)	$ 55,000
2024	2,094,000
2025	2,469,000
2026	7,294,000
2027	164,000
Long-Term Debt, Gross	$ 12,076,000

Note 4 - Other Accrued Liabil_3

Note 4 - Other Accrued Liabilities - Other Accrued Liabilities (Details) - USD ($)	Sep. 30, 2023	Dec. 31, 2022
Insurance	$ 0	$ 591,000
Professional services	291,000	92,000
Operating costs	782,000	539,000
Other	848,000	322,000
Total other accrued liabilities	$ 1,921,000	$ 1,544,000

Note 5 - Leases (Details Textua

Note 5 - Leases (Details Textual)	Nov. 03, 2021 USD ($) ft²	Sep. 30, 2023 USD ($)	Dec. 31, 2022 USD ($)
Lessee, Operating Lease, Remaining Lease Term (Year)		14 years
Operating Lease, Right-of-Use Asset		$ 94,000	$ 317,000
Operating Lease, Liability		$ 94,000
Minimum [Member]
Lessee, Operating Lease, Discount Rate		4%
Maximum [Member]
Lessee, Operating Lease, Discount Rate		6%
Sublease Office in San Francisco, California [Member]
Area of Real Estate Property (Square Foot) | ft²	3,253
Operating Lease, Monthly Expense	$ 22,011
Lessee, Operating Sublease, Monthly Income	$ 16,195
Lease Agreement for New Corporate Office [Member]
Area of Real Estate Property (Square Foot) | ft²	900
Operating Lease, Monthly Expense	$ 4,500

Note 5 - Leases - Summary of Ma

Note 5 - Leases - Summary of Maturities of Lessee Operating Lease Liabilities (Details)	Sep. 30, 2023 USD ($)
2023 (excluding the nine-months ended September 30, 2023)	$ 38,000
2024	59,000
Total lease payments	97,000
Less imputed interest	(3,000)
Total	$ 94,000

Note 5 - Leases - Lease Cost an

Note 5 - Leases - Lease Cost and Information (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Operating lease cost	$ 59,000	$ 102,000	$ 265,000	$ 303,000
Sublease income	(30,000)	(43,000)	(129,000)	(129,000)
Total lease cost	29,000	59,000	136,000	174,000
Cash paid for amounts included in the measurement of lease liabilities - Operating leases	$ 59,000	$ 102,000	$ 265,000	$ 303,000
Weighted-average remaining lease term - Operating leases in years (Year)	10 months 20 days	1 year 3 months 18 days	10 months 20 days	1 year 3 months 18 days
Weighted-average discount rate - Operating leases	4.99%	5.71%	4.99%	5.71%

Note 6 - Per Share Amounts (Det

Note 6 - Per Share Amounts (Details Textual) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Incremental Common Shares Attributable to Dilutive Effect of Share-Based Payment Arrangements (in shares)	66,000	39,000	70,000	38,000
Share-Based Payment Arrangement, Option [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount (in shares)	118,000		91,000
Restricted Stock [Member]
Incremental Common Shares Attributable to Dilutive Effect of Share-Based Payment Arrangements (in shares)	123,000	123,000	123,000	123,000

Note 6 - Per Share Amounts - Co

Note 6 - Per Share Amounts - Computation of Basic and Diluted Earnings Per Share (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Net income attributable to American Shared Hospital Services	$ 118,000	$ 316,000	$ 195,000	$ 1,082,000
Weighted average common shares for basic earnings per share (in shares)	6,366,000	6,234,000	6,336,000	6,223,000
Dilutive effect of stock options and restricted stock awards (in shares)	66,000	39,000	70,000	38,000
Weighted average common shares for diluted earnings per share (in shares)	6,432,000	6,273,000	6,406,000	6,261,000
Basic earnings per share (in dollars per share)	$ 0.02	$ 0.05	$ 0.03	$ 0.17
Diluted earnings per share (in dollars per share)	$ 0.02	$ 0.05	$ 0.03	$ 0.17

Note 7 - Stock-based Compensa_3

Note 7 - Stock-based Compensation (Details Textual) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Jun. 30, 2021
Share-Based Payment Arrangement, Expense	$ 98,000	$ 76,000	$ 291,000	$ 235,000
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount	$ 164,000		$ 164,000
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, Options, Grants in Period, Weighted Average Grant Date Fair Value (in dollars per share)			$ 1.57

Note 7 - Stock-based Compensa_4

Note 7 - Stock-based Compensation - Summary of Stock Option Activity (Details) - USD ($)	6 Months Ended	9 Months Ended		12 Months Ended
	Jun. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022	Dec. 31, 2021
Outstanding (in shares)	67,000	95,000	67,000	67,000
Outstanding, grant date weighted-average exercise price (in dollars per share)	$ 2.72	$ 2.76	$ 2.72	$ 2.72
Outstanding, weighted average remaining contractual life (Year)	4 years 10 months 6 days			4 years 9 months 29 days	3 years 3 months 29 days
Outstanding, intrinsic value			$ 9,000	$ 25,000	$ 0
Granted (in shares)		70,000	50,000
Granted, grant date weighted-average exercise price (in dollars per share)		$ 2.82	$ 2.72
weighted average remaining contractual life (Year)		7 years	5 years
Forfeited (in shares)		(19,000)	(7,000)
Forfeited, grant date weighted-average exercise price (in dollars per share)		$ 2.69	$ 2.58
Outstanding (in shares)		146,000	108,000	95,000	67,000
Outstanding, grant date weighted-average exercise price (in dollars per share)		$ 2.8	$ 2.73	$ 2.76	$ 2.72
Exercisable (in shares)		38,000	50,000
Exercisable, grant date weighted-average exercise price (in dollars per share)		$ 2.86	$ 2.74
Exercisable, weighted average remaining contractual life (Year)	2 years 8 months 26 days
Exercised (in shares)			(2,000)
Exercised, grant date weighted-average exercise price (in dollars per share)			$ 2.7
Minimum [Member]
Outstanding, weighted average remaining contractual life (Year)		5 years 6 months 3 days
Exercisable, weighted average remaining contractual life (Year)		3 years 4 months 6 days
Maximum [Member]
Outstanding, intrinsic value		$ 0

Note 9 - Commitments (Details T

Note 9 - Commitments (Details Textual) - USD ($)		9 Months Ended
	Sep. 04, 2022	Sep. 30, 2023
Leksell Gamma Knife Icon Systems and Linear Accelerator System [Member]
Long-term Install Service and Purchase Commitment, Amount		$ 15,921,000
Long-term Commitment, Cash on Hand to Fund		14,655,000
Long-term Commitment, Line of Credit to Fund		7,000,000
Long-Term Line of Credit		1,400,000
LINAC System [Member]
Long-Term Service Commitment, Amount		$ 12,645,000
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	$ 1,865,000
Long-term Purchase Commitment, Period (Year)	1 year

Note 10 - Related Party Trans_3

Note 10 - Related Party Transactions (Details Textual)	Sep. 30, 2023 USD ($)
US Subsidiary Of Elekta Member
Purchase Obligation	$ 16,311,000
GKF Subsidiary [Member]
Noncontrolling Interest, Ownership Percentage by Parent	81%
US Subsidiary Of Elekta Member
Noncontrolling Interest, Ownership Percentage by Parent	19%

Note 10 - Related Party Trans_4

Note 10 - Related Party Transactions - Schedule of Related Party Transactions (Details) - US Subsidiary Of Elekta Member - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Equipment purchases and de-install costs	$ 2,147,000	$ 231,000	$ 3,565,000	$ 1,594,000
Costs incurred to maintain equipment	191,000	272,000	781,000	820,000
Total related party transactions	2,338,000	$ 503,000	4,346,000	$ 2,414,000
Accounts payable, asset retirement obligation and other accrued liabilities	$ 3,726,000		$ 3,726,000		$ 857,000

Note 11 - Subsequent Events (De

Note 11 - Subsequent Events (Details Textual) - USD ($)	Nov. 10, 2023	Oct. 23, 2023	Jun. 30, 2023
Subsequent Event [Member] | Southern New England Regional Cancer Center, LLC and Roger Williams Radiation Therapy, LLC [Member]
Business Acquisition, Percentage of Voting Interests Acquired	60%
Business Combination, Consideration Transferred	$ 2,850,000
DFC Loan [Member]
Debt Instrument, Interest Rate, Stated Percentage			3.67%
DFC Loan [Member] | Subsequent Event [Member]
Proceeds from Loans		$ 1,750,000
Debt Instrument, Interest Rate, Stated Percentage		7.49%