American Shared Hospital Services (AMS) 10-K 1 Apr 24 2023 FY Annual report Financial data

Document And Entity Information

Document And Entity Information - USD ($)	12 Months Ended
	Dec. 31, 2023	Mar. 22, 2024	Mar. 30, 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	FY
Document Fiscal Year Focus	2023
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2023
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
Document Financial Statement Error Correction [Flag]	false
Entity Shell Company	false
Entity Public Float			$ 11,205,000
Entity Common Stock, Shares Outstanding		6,330,000
Auditor Firm ID	659
Auditor Name	Moss Adams LLP
Auditor Location	Seattle, WA United States

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($)	Dec. 31, 2023	Dec. 31, 2022
CURRENT ASSETS
Cash and cash equivalents	$ 13,690,000	$ 12,335,000
Restricted cash	118,000	118,000
Accounts receivable, net of allowance for credit losses of $100,000 At December 31, 2023 and December 31, 2022	4,343,000	3,801,000
Other receivables	504,000	327,000
Prepaid maintenance	1,275,000	1,245,000
Prepaid expenses and other current assets	526,000	897,000
Total current assets	20,456,000	18,723,000
PROPERTY AND EQUIPMENT, net	25,844,000	23,467,000
LAND	19,000	19,000
GOODWILL	1,265,000	1,265,000
INTANGIBLE ASSETS	78,000	78,000
RIGHT OF USE ASSETS, net	57,000	317,000
OTHER ASSETS	443,000	87,000
TOTAL ASSETS	48,162,000	43,956,000
CURRENT LIABILITIES
Accounts payable	315,000	230,000
Employee compensation and benefits	757,000	735,000
Other accrued liabilities	1,226,000	1,544,000
Asset retirement obligations, related party (includes $250,000 and $120,000 non-related party at December 31, 2023 and 2022, respectively)	650,000	360,000
Income taxes payable	1,229,000	255,000
Current portion of lease liabilities	57,000	292,000
Line of credit	2,500,000	0
Current portion of long-term debt, net	2,084,000	1,262,000
Total current liabilities	10,779,000	5,175,000
LONG-TERM LEASE LIABILITIES, less current portion	0	59,000
LONG-TERM DEBT, net, less current portion	11,041,000	12,205,000
DEFERRED REVENUE, less current portion	0	70,000
DEFERRED INCOME TAXES	63,000	822,000
TOTAL LIABILITIES	21,883,000	18,331,000
COMMITMENTS AND CONTINGENCIES (See Note 10)
SHAREHOLDERS’ EQUITY
Common stock, no par value (10,000,000 authorized shares; Issued and outstanding shares – 6,300,000 at December 31, 2023 and 6,184,000 at December 31, 2022	10,763,000	10,763,000
Additional paid-in capital	8,232,000	7,843,000
Retained earnings	3,629,000	3,019,000
Total equity- American Shared Hospital Services	22,624,000	21,625,000
Non-controlling interests in subsidiaries	3,655,000	4,000,000
Total shareholders’ equity	26,279,000	25,625,000
TOTAL LIABILITIES AND SHAREHOLDERS' EQUITY	48,162,000	43,956,000
Related Party [Member]
CURRENT LIABILITIES
Accounts payable and other accrued liabilities	$ 1,961,000	$ 497,000

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parentheticals) - USD ($) $ / shares in Thousands	Dec. 31, 2023	Dec. 31, 2022
Allowance for doubtful accounts	$ 100,000	$ 100,000
Asser retirement obligations, non-related party	$ 250,000	$ 120,000
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)	6,300,000	6,184,000
Common stock, shares outstanding (in shares)	6,300,000	6,184,000

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Revenues	$ 21,325,000	$ 19,746,000
Costs of revenue:
Maintenance and supplies	2,032,000	1,878,000
Depreciation and amortization	5,073,000	4,726,000
Other direct operating costs	4,025,000	3,666,000
Other direct operating costs, related party	851,000	1,094,000
Cost of Revenue	11,981,000	11,364,000
Gross margin	9,344,000	8,382,000
Selling and administrative expense	7,022,000	5,145,000
Interest expense	1,112,000	806,000
Loss on write down of impaired assets	940,000	0
Operating income	270,000	2,431,000
Interest and other income, net	426,000	87,000
Income before income taxes	696,000	2,518,000
Income tax expense	431,000	963,000
Net income	265,000	1,555,000
Less (plus): net loss (income) attributable to non-controlling interests	345,000	(227,000)
Net income attributable to American Shared Hospital Services	$ 610,000	$ 1,328,000
Net income per share attributable to American Shared Hospital Services:
Earnings per common share - basic (in dollars per share)	$ 0.1	$ 0.21
Earnings per common share - diluted (in dollars per share)	$ 0.1	$ 0.21
Weighted average common shares for basic earnings per share (in shares)	6,358,000	6,297,000
Weighted average common shares for diluted earnings per share (in shares)	6,393,000	6,303,000
Rental Income from Medical Services [Member]
Revenues	$ 17,772,000	$ 16,655,000
Patient Income [Member]
Revenues	3,353,000	3,091,000
Equipment Sales [Member]
Revenues	$ 200,000	$ 0

Consolidated Statement of Share

Consolidated Statement of Shareholders' Equity - USD ($)	Restricted Stock [Member] Common Stock [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				399,000		399,000		$ 399,000
Options exercised (in shares)			3,000					4,000
Options exercised			$ 5,000			5,000		$ 5,000
Vested restricted stock awards (in shares)	132,000
Vested restricted stock awards		$ 0
Cash distributions to non-controlling interests							(573,000)	(573,000)
Net income					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
Stock-based compensation expense				389,000		389,000		$ 389,000
Options exercised (in shares)								0
Vested restricted stock awards (in shares)			116,000
Vested restricted stock awards								$ 0
Net income					610,000	610,000	(345,000)	$ 265,000
Balances (in shares) at Dec. 31, 2023			6,300,000					6,300,000
Balances at Dec. 31, 2023			$ 10,763,000	$ 8,232,000	$ 3,629,000	$ 22,624,000	$ 3,655,000	$ 26,279,000

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
OPERATING ACTIVITIES
Net income	$ 265,000	$ 1,555,000
Adjustments to reconcile net income to net cash from operating activities:
Depreciation and amortization	5,165,000	4,783,000
Non cash lease expense	(34,000)	(40,000)
Accretion of deferred issuance costs	46,000	84,000
Loss on write down of impaired assets	940,000	0
Deferred income taxes	(759,000)	344,000
Stock-based compensation	389,000	399,000
Changes in operating assets and liabilities:
Receivables	(719,000)	696,000
Prepaid expenses and other assets	21,000	(111,000)
Asset retirement obligations, related party	0	(397,000)
Related party liabilities	(491,000)	(845,000)
Accounts payable, accrued liabilities and deferred revenue	(79,000)	608,000
Income taxes payable	974,000	159,000
Net cash provided by operating activities	5,718,000	7,235,000
INVESTING ACTIVITIES
Payment for purchases of property and equipment	(6,273,000)	(388,000)
Net cash (used in) investing activities	(6,273,000)	(388,000)
FINANCING ACTIVITIES
Principal payments on long-term debt	(2,129,000)	(2,032,000)
Principal payments on line of credit	(1,400,000)	0
Long-term debt financing on purchase of property and equipment	1,750,000	0
Advances on line of credit	3,900,000	0
Distributions to non-controlling interests	0	(573,000)
Debt issuance costs long-term debt	(9,000)	(9,000)
Proceeds from options exercised	0	5,000
Principal payments on short-term financing prepaid insurance	(202,000)	(48,000)
Net cash provided by (used in) financing activities	1,910,000	(2,657,000)
Net change in cash and cash equivalents	1,355,000	4,190,000
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, beginning of year	12,453,000	8,263,000
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, end of year	13,808,000	12,453,000
SUPPLEMENTAL CASH FLOW DISCLOSURE
Cash paid for interest	1,066,000	722,000
Cash paid for income taxes	297,000	169,000
SCHEDULE OF NONCASH INVESTING AND FINANCING ACTIVITIES
Equipment included in accounts payable and accrued liabilities	1,955,000	0
DETAIL OF CASH, CASH EQUIVALENTS AND RESTRICTED CASH AT END OF PERIOD
Cash and cash equivalents	13,690,000	12,335,000
Restricted cash	118,000	118,000
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, end of year	$ 13,808,000	$ 12,453,000

Insider Trading Arrangements

Insider Trading Arrangements	12 Months Ended
	Dec. 31, 2023
Insider Trading Arr Line Items
Material Terms of Trading Arrangement [Text Block]	9B. None
Rule 10b5-1 Arrangement Terminated [Flag]	false
Rule 10b5-1 Arrangement Adopted [Flag]	false
Non-Rule 10b5-1 Arrangement Terminated [Flag]	false
Non-Rule 10b5-1 Arrangement Adopted [Flag]	false

Note 1 - Business and Basis of

Note 1 - Business and Basis of Presentation	12 Months Ended
	Dec. 31, 2023
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 2023 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 Radioterapia Guadalupe Amor y Bien S.A. de C.V. (“Guadalupe”) to establish AB of Puebla (“Puebla”) to treat public- and private-paying cancer patients and provide radiation therapy and radiosurgery services locally in Mexico. The Company and Guadalupe hold 85% and 15% ownership interests, respectively, in Puebla. Under the Agreement, the Company is responsible for providing a linear accelerator and Guadalupe will be accountable for all site modification costs. The Company formed on October 3, 2022 December 15, 2022 June 2024. December 31, 2023 by Puebla, are included in the consolidated statement of operations. 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 On November 10, 2023, three March 1, 2024, not March 10, 2024 April 30, 2024. April 2024. The transaction will be accounted for as a business combination under ASC 805 Costs related to legal, financial and due diligence services performed in connection with this transaction recorded in the consolidated statement of operations were $432,000 for the year ended December 31, 2023 All intercompany accounts and transactions have been eliminated in consolidation.

Note 2 - Accounting Policies

Note 2 - Accounting Policies	12 Months Ended
	Dec. 31, 2023
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, 2023 2022 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 15 locations or 1 14 2023 2022 2023 2022 December 31, 2023 December 31, 2022 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 allowance for credit losses Non-controlling interests Property and equipment June 2020. October 1, 2022, one December 31, 2023 2022 seven As of January 1, 2023, one January 1, 2023, December 31, 2023 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, 2023 December 31, 2022 As of December 31, 2023 2022 , the Company recognized a loss on the write down of impaired assets of $940,000 and $0, respectively. December 31, 2023 one 2023. second 2023 2023, not June 2023. fourth 2023 December 31, 2023 fourth 2023 third December 31, 2023 See further discussion under Note 2 3 Revenue recognition 842 Leases 842” 606 Revenue from Contracts with Customers 606” Rental income from medical equipment leasing ( leasing ) 842 not ten third December 31, 2023 2022 842, Revenue sharing arrangements amounted to approximately 70 % December 31, 2023 2022 Direct patient services income ( retail ) 606, no 30 three six not 606 December 31, 2023 606 January 1, 2022 December 31, 2022 December 31, 2023 2022 606, Equipment sales December 31, 2023 606 two 60 December 31, 2023 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, 2023 2022 Asset Retirement Obligations 410, Asset Retirement Obligations 410” ARO December 31, 2023 two second 2023. December 31, 2023 not Earnings per share not December 31, 2023 2022 144 ,000 December 31, 2023 2022 December 31, 2023 2022 2023 2022 Numerator for basic and diluted earnings per share $ 610,000 $ 1,328,000 Denominator: Denominator for basic earnings per share – weighted-average shares 6,358,000 6,297,000 Effect of dilutive securities employee stock options and restricted stock 35,000 6,000 Denominator for diluted earnings per share – adjusted weighted-average shares 6,393,000 6,303,000 Earnings per common share- basic $ 0.10 $ 0.21 Earnings per common share- diluted $ 0.10 $ 0.21 Business segment information 280 Segment Reporting 280” two reportable segments, leasing and retail. During 2023, thirteen two December 31, 2023 An operating segment is defined by ASC 280 may two two For the years ended December 31, 2023 2022 , the PBRT operations represented a significant majority of the net income attributable to American Shared Hospital Services from the leasing segment, disclosed below. December 31, 2023 2022 2023 2022 Revenues Leasing $ 17,772,000 $ 16,655,000 Retail 3,553,000 3,091,000 Total $ 21,325,000 $ 19,746,000 2023 2022 Depreciation expense Leasing $ 4,429,000 $ 4,268,000 Retail 736,000 515,000 Total $ 5,165,000 $ 4,783,000 2023 2022 Interest expense Leasing $ 1,087,000 $ 806,000 Retail 25,000 — Total $ 1,112,000 $ 806,000 2023 2022 Interest income Leasing $ 458,000 $ 103,000 Retail — — Total $ 458,000 $ 103,000 2023 2022 Income tax expense Leasing $ 306,000 $ 753,000 Retail 125,000 210,000 Total $ 431,000 $ 963,000 2023 2022 Net income attributable to American Shared Hospital Services Leasing $ 518,000 $ 1,187,000 Retail 92,000 141,000 Total $ 610,000 $ 1,328,000 2023 2022 Total assets Leasing $ 39,854,000 $ 37,575,000 Retail 8,308,000 6,381,000 Total $ 48,162,000 $ 43,956,000 Long lived asset impairment may not may not, December 31, 2023 one No December 31, 2022. 3 Goodwill and intangible assets - June 2020. 350 Intangibles-Goodwill and Other 350” not 350, may December 31, 2023 2022 Accounting pronouncements issued and not yet adopted - November 2023, 2023 07 Segment Reporting (Topic 280 2023 07” 2023 07 December 15, 2023 December 15, 2024. 2023 07 may In December 2023, 2023 09 Income Taxes (Topic 740 2023 09” 2023 09 December 31, 2024. 2023 09 may Reclassifications

Note 3 - Property and Equipment

Note 3 - Property and Equipment	12 Months Ended
	Dec. 31, 2023
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, 2023 2022 Medical equipment and facilities $ 77,150,000 $ 73,709,000 Office equipment 306,000 422,000 Construction in progress 3,771,000 106,000 81,227,000 74,237,000 Accumulated depreciation (55,383,000 ) (50,770,000 ) Net property and equipment $ 25,844,000 $ 23,467,000 As of December 31, 2023 2022 December 31, 2023 2022 , was $5,165,000 and $4,783,000, respectively. As of October 1, 2022, one January 1, 2023, one January 1, 2023, December 31, 2023 As of December 31, 2023 2022 , the Company recognized a loss on the write down of impaired assets of $940,000 and $0, respectively. The impairment as of December 31, 2023 was one two . December 31, 2022 no December 31, 2023 2022

Note 4 - Other Accrued Liabilit

Note 4 - Other Accrued Liabilities	12 Months Ended
	Dec. 31, 2023
Notes to Financial Statements
Other Liabilities Disclosure [Text Block]	NOTE 4 Other accrued liabilities consists of the following: December 31, 2023 2022 Insurance financing $ — $ 591,000 Professional services 472,000 92,000 Operating costs 450,000 539,000 Other 304,000 322,000 Total other accrued liabilities $ 1,226,000 $ 1,544,000

Note 5 - Long Term Debt

Note 5 - Long Term Debt	12 Months Ended
	Dec. 31, 2023
Notes to Financial Statements
Long-Term Debt [Text Block]	NOTE 5 On April 9, 2021 five three first second third December 31, 2023 January 2024. five December 31, 2023 2022 The Revolving Line is charged an unused line fee of 0.25% per annum. The Term Loan and DDTL have interest and principal payments due quarterly. Principal amortization on an annual basis for the Term Loan and DDTL equates to 48% of the original principal loan commitments in years 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, 2023 . January 25, 2024, 12 The loan entered into with DFC in connection with the acquisition of GKCE in June 2020 ( first June 2020. fourth 2023, second first 29 second 16 December 31, 2023 2022 December 31, 2023 2022 The DFC Loan contains customary covenants among other covenants and obligations, requirements that the Company maintain certain financial ratios related to liquidity and cash flow as well as depository requirements. On March 28, 2024 December 31, 2023 December 31, 2024 March 31, 2024. The accretion of debt issuance costs for the years ended December 31, 2023 2022 December 31, 2023 2022 The following are contractual maturities of long-term debt by year at December 31, 2023 Year ending December 31, Principal 2024 $ 2,157,000 2025 2,907,000 2026 7,732,000 2027 493,000 $ 13,289,000

Note 6 - Leases

Note 6 - Leases	12 Months Ended
	Dec. 31, 2023
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 The Company’s lessee operating leases are accounted for as ROU assets, current portion of lease 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, 2023 The following table summarizes maturities of lessee operating lease liabilities as of December 31, 2023 Year ending December 31, Operating Leases 2024 $ 58,000 Total lease payments 58,000 Less imputed interest (1,000 ) Total $ 57,000 Year Ended December 31, 2023 2022 Lease cost Operating lease cost, net of impairment $ 302,000 $ 406,000 Sublease income (129,000 ) (174,000 ) Total lease cost $ 173,000 $ 232,000 Other information Cash paid for amounts included in the measurement of lease liabilities - Operating leases $ 302,000 $ 406,000 Weighted-average remaining lease term - Operating leases in years 0.80 1.11 Weighted-average discount rate - Operating leases 4.65 % 5.65 % 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 $234,000 and $290,000 for the years ended December 31, 2023 2022

Note 7 - Income Taxes

Note 7 - Income Taxes	12 Months Ended
	Dec. 31, 2023
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, 2023 2022 YEARS ENDED December 31, 2023 2022 Domestic $ 666,000 $ 2,350,000 Foreign 30,000 168,000 Income before income taxes $ 696,000 $ 2,518,000 For the year ended December 31, 2023 2022 The components of the provision for income taxes for the years ended December 31, 2023 2022 YEARS ENDED December 31, 2023 2022 Current: Federal $ 940,000 $ 355,000 State 115,000 60,000 Foreign 135,000 204,000 Total current 1,190,000 619,000 Deferred: Federal (672,000 ) 290,000 State (77,000 ) 48,000 Foreign (10,000 ) 6,000 Total deferred (759,000 ) 344,000 $ 431,000 $ 963,000 Significant components of the Company’s deferred tax liabilities and assets as of December 31, 2023 2022 December 31, 2023 2022 Deferred tax liabilities: Property and equipment $ (323,000 ) $ (708,000 ) Prepaid expenses (409,000 ) (493,000 ) ROU asset (12,000 ) (54,000 ) Total deferred tax liabilities (744,000 ) (1,255,000 ) Deferred tax assets: Net operating loss carryforwards 155,000 139,000 Accruals and allowances 438,000 167,000 Lease liabilities 12,000 61,000 Tax credits 4,000 3,000 Other 140,000 114,000 Capital loss carryover 646,000 646,000 Total deferred tax assets 1,395,000 1,130,000 Valuation allowance (714,000 ) (697,000 ) Deferred tax assets net of valuation allowance 681,000 433,000 Net deferred tax liabilities $ (63,000 ) $ (822,000 ) NOTE 7 INCOME TAXES (CONTINUED) The provision for income taxes differs from the amount computed by applying the U.S. federal statutory tax rate (21% in 2023 2022 YEARS ENDED December 31, 2023 2022 Computed expected federal income tax $ 218,000 $ 477,000 State income taxes, net of federal benefit 12,000 100,000 Foreign rate differential 38,000 — Stock compensation 7,000 — Non-deductible expenses 6,000 (25,000 ) Return to provision true-up 18,000 52,000 Uncertain tax positions 9,000 (17,000 ) Alternative minimum tax payable adjustment — 208,000 Change in valuation allowance 17,000 — Other deferred tax adjustments 106,000 168,000 $ 431,000 $ 963,000 As of December 31, 2023 oximately and $2,586,000 2029. Utilization of the net operating loss and credit carryforwards may 1986, may At December 31, 2023 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 $17,000 and $0 for the years ended December 31, 2023 2022 The tax return years 2019 2022 1999 2004, 2009, 2010, 2012, 2014, 2015, 2016, 2017 2018 NOTE 7 INCOME TAXES (CONTINUED) 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, 2023 not YEARS ENDED December 31, 2023 2022 Balance at beginning of year $ 278,000 $ 295,000 Additions based on tax positions of prior years 9,000 (17,000 ) Balance at end of year $ 287,000 $ 278,000 The Company’s December 31, 2023 not 12 may

Note 8 - Stock-based Compensati

Note 8 - Stock-based Compensation Expense	12 Months Ended
	Dec. 31, 2023
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, 2023 , approximately 935,000 shares remain available for grant under the Plan. Under the Plan, a total of 898,000 restricted stock units have been granted, consisting o f 53,000 o not 742 ,000 December 31, 2023 Changes in restricted stock units, consisting primarily of annual automatic grants, deferred compensation to non-employee directors, shares issued to employees as part of the Company’s 2023 2022 Restricted Stock Units Grant Date Weighted- Average Fair Value Outstanding at January 1, 2022 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 Granted 146,000 $ 2.97 Vested (119,000) $ 2.94 Outstanding at December 31, 2023 33,000 $ 2.88 NOTE 8 STOCK-BASED COMPENSATION EXPENSE (CONTINUED) Certain Executive Equity Awards Effective May 4, 2020, “CEO” August 3, 2020. October 1, 2020 March 7, 2023. December 31, 2022 December 31, 2022 December 31, 2023 December 31, 2023 For the year ended December 31, 2023 Stock-Based Awards Issued Compensation and Vested Expense Options — $ 34,000 Management Bonus Program - vested and issued 26,000 — Board RSU Awards - other — 4,000 Executive Compensation 90,000 351,000 116,000 $ 389,000 Total stock-based compensation expense before income tax effect for the Company’s options and restricted stock awards in the amount of $389,000 and $399,000 for the years ended December 31, 2023 2022 Stock Options Changes in stock options outstanding under the Incentive Compensation Plans during 2023 2022 Options Number of Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term (Years) Aggregate Intrinsic Value 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 Granted 70,000 $ 2.89 7.00 $ — Forfeited (19,000 ) $ 2.69 — $ — Balance at December 31, 2023 146,000 $ 2.83 5.44 $ — Exercisable at December 31, 2022 38,000 $ 2.79 2.38 $ — Exercisable at December 31, 2023 31,000 $ 2.84 3.38 $ — NOTE 8 STOCK-BASED COMPENSATION EXPENSE (CONTINUED) The weighted average grant-date fair value of the options granted during the years 2023 2022 $2.89 $1.49 December 31, 2023 December 31, 2022 December 2023 2022 $10,000, The Company received approximately $5,000 from the exercise of 2,000 options under the share-based arrangements during the year ended December 31, 2022 2022 At December 31, 2023 $156,000 four The Company’s stock option 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 2023 2022 The fair value of the Compan y’s option grants under the Plan in 2023 and 2022 was estimated using the following assumptions: 2023 2022 Expected life (years) 7.0 7.0 Expected forfeiture rate 0.0 % 0.0 % Expected volatility 50 % 50 % Dividend yield 0 % 0 % Risk-free interest rate 3.6 % 3.3 % 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. 2023 2022

Note 9 - Retirement Plan

Note 9 - Retirement Plan	12 Months Ended
	Dec. 31, 2023
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 2023 not 2023, December 31, 2023 December 31, 2023 2023, December 31, 2022

Note 10 - Commitments and Conti

Note 10 - Commitments and Contingencies	12 Months Ended
	Dec. 31, 2023
Notes to Financial Statements
Commitments and Contingencies Disclosure [Text Block]	NOTE 10 COMMITMENTS AND CONTINGENCIES On December 20, 2018, two second third January 2024 not December 31, 2020, As of December 31, 2023 three one 60 one one one one 60 2024 one Company’s December 31, 2023 2023. January 2024, December 31, 2023 Total Gamma Knife and LINAC commitments as of December 31, 2023 , were $15,925,000. There are no December 31, 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 to fund these projects, if necessary. The Company borrowed $2,500,000 on the Revolving Line as of December 31, 2023 , which was paid off in January 2024. On September 4, 2022, September 2022 April 2026. one one As of December 31, 2023 , 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. The Company’s commitments to purchase t December 31, 2023 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, 2023
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 and other radiation therapy equipment. Since the Company purchases the majority of its equipment 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, 2023 2022 December 31, 2023 2022 Equipment purchases and de-install costs $ 6,918,000 $ 1,844,000 Costs incurred to maintain equipment 851,000 1,094,000 Total related party transactions $ 7,769,000 $ 2,938,000 The Company had related party commitments to install three one 60 one one two December 31, 2023 Related party liabilities on the consolidated balance sheets consist of the following as of December 31, 2023 2022 December 31, 2023 2022 Accounts payable and other accrued liabilities $ 1,961,000 $ 497,000

Note 12 - Subsequent Events

Note 12 - Subsequent Events	12 Months Ended
	Dec. 31, 2023
Notes to Financial Statements
Subsequent Events [Text Block]	NOTE 12 – SUBSEQUENT EVENT On January 25, 2024 ( January 25, 2024, January 25, 2030 ( twelve twelve

Significant Accounting Policies

Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2023
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, 2023 2022 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 15 locations or 1 14 2023 2022 2023 2022 December 31, 2023 December 31, 2022 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 allowance for credit losses
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. October 1, 2022, one December 31, 2023 2022 seven As of January 1, 2023, one January 1, 2023, December 31, 2023 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, 2023 December 31, 2022 As of December 31, 2023 2022 , the Company recognized a loss on the write down of impaired assets of $940,000 and $0, respectively. December 31, 2023 one 2023. second 2023 2023, not June 2023. fourth 2023 December 31, 2023 fourth 2023 third December 31, 2023 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 equipment leasing ( leasing ) 842 not ten third December 31, 2023 2022 842, Revenue sharing arrangements amounted to approximately 70 % December 31, 2023 2022 Direct patient services income ( retail ) 606, no 30 three six not 606 December 31, 2023 606 January 1, 2022 December 31, 2022 December 31, 2023 2022 606, Equipment sales December 31, 2023 606 two 60 December 31, 2023
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, 2023 2022
Asset Retirement Obligation [Policy Text Block]	Asset Retirement Obligations 410, Asset Retirement Obligations 410” ARO December 31, 2023 two second 2023. December 31, 2023 not
Earnings Per Share, Policy [Policy Text Block]	Earnings per share not December 31, 2023 2022 144 ,000 December 31, 2023 2022 December 31, 2023 2022 2023 2022 Numerator for basic and diluted earnings per share $ 610,000 $ 1,328,000 Denominator: Denominator for basic earnings per share – weighted-average shares 6,358,000 6,297,000 Effect of dilutive securities employee stock options and restricted stock 35,000 6,000 Denominator for diluted earnings per share – adjusted weighted-average shares 6,393,000 6,303,000 Earnings per common share- basic $ 0.10 $ 0.21 Earnings per common share- diluted $ 0.10 $ 0.21
Segment Reporting, Policy [Policy Text Block]	Business segment information 280 Segment Reporting 280” two reportable segments, leasing and retail. During 2023, thirteen two December 31, 2023 An operating segment is defined by ASC 280 may two two For the years ended December 31, 2023 2022 , the PBRT operations represented a significant majority of the net income attributable to American Shared Hospital Services from the leasing segment, disclosed below. December 31, 2023 2022 2023 2022 Revenues Leasing $ 17,772,000 $ 16,655,000 Retail 3,553,000 3,091,000 Total $ 21,325,000 $ 19,746,000 2023 2022 Depreciation expense Leasing $ 4,429,000 $ 4,268,000 Retail 736,000 515,000 Total $ 5,165,000 $ 4,783,000 2023 2022 Interest expense Leasing $ 1,087,000 $ 806,000 Retail 25,000 — Total $ 1,112,000 $ 806,000 2023 2022 Interest income Leasing $ 458,000 $ 103,000 Retail — — Total $ 458,000 $ 103,000 2023 2022 Income tax expense Leasing $ 306,000 $ 753,000 Retail 125,000 210,000 Total $ 431,000 $ 963,000 2023 2022 Net income attributable to American Shared Hospital Services Leasing $ 518,000 $ 1,187,000 Retail 92,000 141,000 Total $ 610,000 $ 1,328,000 2023 2022 Total assets Leasing $ 39,854,000 $ 37,575,000 Retail 8,308,000 6,381,000 Total $ 48,162,000 $ 43,956,000
Impairment or Disposal of Long-Lived Assets, Policy [Policy Text Block]	Long lived asset impairment may not may not, December 31, 2023 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, 2023 2022
New Accounting Pronouncements, Policy [Policy Text Block]	Accounting pronouncements issued and not yet adopted - November 2023, 2023 07 Segment Reporting (Topic 280 2023 07” 2023 07 December 15, 2023 December 15, 2024. 2023 07 may In December 2023, 2023 09 Income Taxes (Topic 740 2023 09” 2023 09 December 31, 2024. 2023 09 may
Reclassification, Comparability Adjustment [Policy Text Block]	Reclassifications

Note 2 - Accounting Policies (T

Note 2 - Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2023
Notes Tables
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	2023 2022 Numerator for basic and diluted earnings per share $ 610,000 $ 1,328,000 Denominator: Denominator for basic earnings per share – weighted-average shares 6,358,000 6,297,000 Effect of dilutive securities employee stock options and restricted stock 35,000 6,000 Denominator for diluted earnings per share – adjusted weighted-average shares 6,393,000 6,303,000 Earnings per common share- basic $ 0.10 $ 0.21 Earnings per common share- diluted $ 0.10 $ 0.21
Reconciliation of Revenue from Segments to Consolidated [Table Text Block]	2023 2022 Revenues Leasing $ 17,772,000 $ 16,655,000 Retail 3,553,000 3,091,000 Total $ 21,325,000 $ 19,746,000
Segment, Reconciliation of Other Items from Segments to Consolidated [Table Text Block]	2023 2022 Depreciation expense Leasing $ 4,429,000 $ 4,268,000 Retail 736,000 515,000 Total $ 5,165,000 $ 4,783,000 2023 2022 Interest expense Leasing $ 1,087,000 $ 806,000 Retail 25,000 — Total $ 1,112,000 $ 806,000 2023 2022 Interest income Leasing $ 458,000 $ 103,000 Retail — — Total $ 458,000 $ 103,000 2023 2022 Income tax expense Leasing $ 306,000 $ 753,000 Retail 125,000 210,000 Total $ 431,000 $ 963,000
Reconciliation of Operating Profit (Loss) from Segments to Consolidated [Table Text Block]	2023 2022 Net income attributable to American Shared Hospital Services Leasing $ 518,000 $ 1,187,000 Retail 92,000 141,000 Total $ 610,000 $ 1,328,000
Reconciliation of Assets from Segment to Consolidated [Table Text Block]	2023 2022 Total assets Leasing $ 39,854,000 $ 37,575,000 Retail 8,308,000 6,381,000 Total $ 48,162,000 $ 43,956,000

Note 3 - Property and Equipme_2

Note 3 - Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2023
Notes Tables
Property, Plant and Equipment [Table Text Block]	December 31, 2023 2022 Medical equipment and facilities $ 77,150,000 $ 73,709,000 Office equipment 306,000 422,000 Construction in progress 3,771,000 106,000 81,227,000 74,237,000 Accumulated depreciation (55,383,000 ) (50,770,000 ) Net property and equipment $ 25,844,000 $ 23,467,000

Note 4 - Other Accrued Liabil_2

Note 4 - Other Accrued Liabilities (Tables)	12 Months Ended
	Dec. 31, 2023
Notes Tables
Other Liabilities [Table Text Block]	December 31, 2023 2022 Insurance financing $ — $ 591,000 Professional services 472,000 92,000 Operating costs 450,000 539,000 Other 304,000 322,000 Total other accrued liabilities $ 1,226,000 $ 1,544,000

Note 5 - Long Term Debt (Tables

Note 5 - Long Term Debt (Tables)	12 Months Ended
	Dec. 31, 2023
Notes Tables
Schedule of Maturities of Long-Term Debt [Table Text Block]	Year ending December 31, Principal 2024 $ 2,157,000 2025 2,907,000 2026 7,732,000 2027 493,000 $ 13,289,000

Note 6 - Leases (Tables)

Note 6 - Leases (Tables)	12 Months Ended
	Dec. 31, 2023
Notes Tables
Lessee, Operating Lease, Liability, to be Paid, Maturity [Table Text Block]	Year ending December 31, Operating Leases 2024 $ 58,000 Total lease payments 58,000 Less imputed interest (1,000 ) Total $ 57,000
Lease, Cost [Table Text Block]	Year Ended December 31, 2023 2022 Lease cost Operating lease cost, net of impairment $ 302,000 $ 406,000 Sublease income (129,000 ) (174,000 ) Total lease cost $ 173,000 $ 232,000 Other information Cash paid for amounts included in the measurement of lease liabilities - Operating leases $ 302,000 $ 406,000 Weighted-average remaining lease term - Operating leases in years 0.80 1.11 Weighted-average discount rate - Operating leases 4.65 % 5.65 %

Note 7 - Income Taxes (Tables)

Note 7 - Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2023
Notes Tables
Schedule of Income before Income Tax, Domestic and Foreign [Table Text Block]	YEARS ENDED December 31, 2023 2022 Domestic $ 666,000 $ 2,350,000 Foreign 30,000 168,000 Income before income taxes $ 696,000 $ 2,518,000
Schedule of Components of Income Tax Expense (Benefit) [Table Text Block]	YEARS ENDED December 31, 2023 2022 Current: Federal $ 940,000 $ 355,000 State 115,000 60,000 Foreign 135,000 204,000 Total current 1,190,000 619,000 Deferred: Federal (672,000 ) 290,000 State (77,000 ) 48,000 Foreign (10,000 ) 6,000 Total deferred (759,000 ) 344,000 $ 431,000 $ 963,000
Schedule of Deferred Tax Assets and Liabilities [Table Text Block]	December 31, 2023 2022 Deferred tax liabilities: Property and equipment $ (323,000 ) $ (708,000 ) Prepaid expenses (409,000 ) (493,000 ) ROU asset (12,000 ) (54,000 ) Total deferred tax liabilities (744,000 ) (1,255,000 ) Deferred tax assets: Net operating loss carryforwards 155,000 139,000 Accruals and allowances 438,000 167,000 Lease liabilities 12,000 61,000 Tax credits 4,000 3,000 Other 140,000 114,000 Capital loss carryover 646,000 646,000 Total deferred tax assets 1,395,000 1,130,000 Valuation allowance (714,000 ) (697,000 ) Deferred tax assets net of valuation allowance 681,000 433,000 Net deferred tax liabilities $ (63,000 ) $ (822,000 )
Schedule of Effective Income Tax Rate Reconciliation [Table Text Block]	YEARS ENDED December 31, 2023 2022 Computed expected federal income tax $ 218,000 $ 477,000 State income taxes, net of federal benefit 12,000 100,000 Foreign rate differential 38,000 — Stock compensation 7,000 — Non-deductible expenses 6,000 (25,000 ) Return to provision true-up 18,000 52,000 Uncertain tax positions 9,000 (17,000 ) Alternative minimum tax payable adjustment — 208,000 Change in valuation allowance 17,000 — Other deferred tax adjustments 106,000 168,000 $ 431,000 $ 963,000
Schedule of Unrecognized Tax Benefits Roll Forward [Table Text Block]	YEARS ENDED December 31, 2023 2022 Balance at beginning of year $ 278,000 $ 295,000 Additions based on tax positions of prior years 9,000 (17,000 ) Balance at end of year $ 287,000 $ 278,000

Note 8 - Stock-based Compensa_2

Note 8 - Stock-based Compensation Expense (Tables)	12 Months Ended
	Dec. 31, 2023
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, 2022 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 Granted 146,000 $ 2.97 Vested (119,000) $ 2.94 Outstanding at December 31, 2023 33,000 $ 2.88
Disclosure of Share-Based Compensation Arrangements by Share-Based Payment Award [Table Text Block]	Stock-Based Awards Issued Compensation and Vested Expense Options — $ 34,000 Management Bonus Program - vested and issued 26,000 — Board RSU Awards - other — 4,000 Executive Compensation 90,000 351,000 116,000 $ 389,000
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, 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 Granted 70,000 $ 2.89 7.00 $ — Forfeited (19,000 ) $ 2.69 — $ — Balance at December 31, 2023 146,000 $ 2.83 5.44 $ — Exercisable at December 31, 2022 38,000 $ 2.79 2.38 $ — Exercisable at December 31, 2023 31,000 $ 2.84 3.38 $ —
Schedule of Share-Based Payment Award, Stock Options, Valuation Assumptions [Table Text Block]	2023 2022 Expected life (years) 7.0 7.0 Expected forfeiture rate 0.0 % 0.0 % Expected volatility 50 % 50 % Dividend yield 0 % 0 % Risk-free interest rate 3.6 % 3.3 %

Note 11 - Related Party Trans_2

Note 11 - Related Party Transactions (Tables)	12 Months Ended
	Dec. 31, 2023
Notes Tables
Schedule of Related Party Transactions [Table Text Block]	December 31, 2023 2022 Equipment purchases and de-install costs $ 6,918,000 $ 1,844,000 Costs incurred to maintain equipment 851,000 1,094,000 Total related party transactions $ 7,769,000 $ 2,938,000 December 31, 2023 2022 Accounts payable and other accrued liabilities $ 1,961,000 $ 497,000

Note 1 - Business and Basis o_2

Note 1 - Business and Basis of Presentation (Details Textual)	Nov. 10, 2023 USD ($)	Dec. 31, 2023 USD ($)	Apr. 27, 2022
Number of Medical Centers		12
Southern New England Regional Cancer Center, LLC and Roger Williams Radiation Therapy, LLC [Member]
Business Combination, Consideration Transferred	$ 2,850,000
Business Acquisition, Percentage of Voting Interests Acquired	60%
Business Acquisition, Transaction Costs		$ 432,000
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%
OR21, LLC [Member] | Architectural Design Company [Member]
Equity Method Investment, Ownership Percentage		50%

Note 2 - Accounting Policies (D

Note 2 - Accounting Policies (Details Textual)		12 Months Ended
	Jun. 12, 2020 USD ($)	Dec. 31, 2023 USD ($) $ / shares shares	Dec. 31, 2022 USD ($) $ / shares shares	Jan. 01, 2022 USD ($)
Advertising Expense		$ 165,000	$ 233,000
Net Income (Loss) Attributable to Parent		$ 610,000	$ 1,328,000
Earnings Per Share, Diluted (in dollars per share) | $ / shares		$ 0.1	$ 0.21
Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization		$ 81,227,000
Gain (Loss) on Sale of Assets and Asset Impairment Charges		(940,000)	$ 0
Asset Retirement Obligation		290,000
Asset Impairment Charges		$ 650,000
Lessee, Operating Lease, Term of Contract (Year)		10 years
Weighted Average Number of Shares Outstanding, Basic, Total (in shares) | shares		6,358,000	6,297,000
Number of Reportable Segments		2	2
Goodwill and Intangible Asset Impairment		$ 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		144,000	20,000
GKCE [Member]
Accounts Receivable, after Allowance for Credit Loss		$ 1,626,000	$ 1,119,000	$ 668,000
Gamma Knife Units [Member]
Asset Retirement Obligation		$ 650,000
Number of Customer with Intent to Terminate Contract		2
Other Gamma Knife Units [Member]
Asset Retirement Obligation		$ 0
Rental Income from Medical Services [Member]
Revenue from Contract with Customer, Including Assessed Tax		17,772,000	16,655,000
PBRT Services [Member]
Revenue from Contract with Customer, Including Assessed Tax		$ 10,133,000	$ 8,952,000
Revenue Sharing Arrangements [Member]
Percentage of Revenues		70%	67%
Patient Income [Member]
Revenue from Contract with Customer, Including Assessed Tax		$ 3,553,000	$ 3,091,000
Equipment Sales [Member]
Revenue from Contract with Customer, Including Assessed Tax		200,000
Salvage Value [Member]
Net Income (Loss) Attributable to Parent		$ (207,000)
Earnings Per Share, Diluted (in dollars per share) | $ / shares		$ 0.03
Minimum [Member]
Property, Plant, and Equipment, Salvage Value		$ 140,000	140,000
Maximum [Member]
Property, Plant, and Equipment, Salvage Value		$ 300,000	300,000
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		$ 70,635,000	69,306,000
Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, Accumulated Depreciation and Amortization		$ 52,302,000	$ 47,992,000
Customer Concentration Risk [Member] | Revenue Benchmark [Member]
Number of Major Customers		15	15
Customer Concentration Risk [Member] | Revenue Benchmark [Member] | One Customer [Member]
Concentration Risk, Percentage		48%	45%
Customer Concentration Risk [Member] | Accounts Receivable [Member]
Number of Major Customers		2	4
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Customer One [Member]
Concentration Risk, Percentage		30%	12%
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Customer Two [Member]
Concentration Risk, Percentage		31%	14%
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, 2023	Dec. 31, 2022
Numerator for basic and diluted earnings per share	$ 610,000	$ 1,328,000
Denominator for basic earnings per share – weighted-average shares (in shares)	6,358,000	6,297,000
Effect of dilutive securities employee stock options and restricted stock (in shares)	35,000	6,000
Denominator for diluted earnings per share – adjusted weighted-average shares (in shares)	6,393,000	6,303,000
Earnings per common share- basic (in dollars per share)	$ 0.1	$ 0.21
Earnings per common share- diluted (in dollars per share)	$ 0.1	$ 0.21

Note 2 - Accounting Policies _2

Note 2 - Accounting Policies - Revenues Allocations to Reportable Segments (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Revenues	$ 21,325,000	$ 19,746,000
Medical Equipment Leasing [Member]
Revenues	17,772,000	16,655,000
Direct Patient Services [Member]
Revenues	$ 3,553,000	$ 3,091,000

Note 3 - Accounting Policies -

Note 3 - Accounting Policies - Allocations to Reportable Segments (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Depreciation and amortization	$ 5,165,000	$ 4,783,000
Interest expense	1,112,000	806,000
Interest income	458,000	103,000
Income tax expense	431,000	963,000
Medical Equipment Leasing [Member]
Depreciation and amortization	4,429,000	4,268,000
Interest expense	1,087,000	806,000
Interest income	458,000	103,000
Income tax expense	306,000	753,000
Direct Patient Services [Member]
Depreciation and amortization	736,000	515,000
Interest expense	25,000	0
Interest income	0	0
Income tax expense	$ 125,000	$ 210,000

Note 2 - Accounting Policies _3

Note 2 - Accounting Policies - Profit (Loss) Allocations to Reportable Segments (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Net Income (Loss) Attributable to Parent	$ 610,000	$ 1,328,000
Medical Equipment Leasing [Member]
Net Income (Loss) Attributable to Parent	518,000	1,187,000
Direct Patient Services [Member]
Net Income (Loss) Attributable to Parent	$ 92,000	$ 141,000

Note 2 - Accounting Policies _4

Note 2 - Accounting Policies - Property and Equipment Allocations to Reportable Segments (Details) - USD ($)	Dec. 31, 2023	Dec. 31, 2022
TOTAL ASSETS	$ 48,162,000	$ 43,956,000
Medical Equipment Leasing [Member]
TOTAL ASSETS	39,854,000	37,575,000
Direct Patient Services [Member]
TOTAL ASSETS	$ 8,308,000	$ 6,381,000

Note 3 - Property and Equipme_3

Note 3 - Property and Equipment (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization	$ 81,227,000
Depreciation	5,165,000	$ 4,783,000
Net Income (Loss) Attributable to Parent	$ 610,000	$ 1,328,000
Earnings Per Share, Diluted (in dollars per share)	$ 0.1	$ 0.21
Gain (Loss) on Sale of Assets and Asset Impairment Charges	$ (940,000)	$ 0
Asset Impairment Charges	650,000
PBRT Equipment [Member]
Asset Impairment Charges	0	0
Salvage Value [Member]
Net Income (Loss) Attributable to Parent	$ (207,000)
Earnings Per Share, Diluted (in dollars per share)	$ 0.03
Non-US [Member]
Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization	$ 3,966,000	$ 2,201,000

Note 3 - Property and Equipme_4

Note 3 - Property and Equipment - Summary of Property and Equipment (Details) - USD ($)	Dec. 31, 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	$ 81,227,000
Accumulated depreciation	(55,383,000)	(50,770,000)
Net property and equipment	25,844,000	23,467,000
Medical Equipment and Facilities [Member]
Property and equipment, gross	77,150,000	73,709,000
Office Equipment [Member]
Property and equipment, gross	306,000	422,000
Construction in Progress [Member]
Property and equipment, gross	$ 3,771,000	$ 106,000

Note 4 - Other Accrued Liabil_3

Note 4 - Other Accrued Liabilities - Other Accrued Liabilities (Details) - USD ($)	Dec. 31, 2023	Dec. 31, 2022
Insurance financing	$ 0	$ 591,000
Professional services	472,000	92,000
Operating costs	450,000	539,000
Other	304,000	322,000
Total other accrued liabilities	$ 1,226,000	$ 1,544,000

Note 5 - Long Term Debt (Detail

Note 5 - Long Term Debt (Details Textual)		12 Months Ended
	Apr. 09, 2021 USD ($)	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021
Long-Term Debt		$ 13,289,000
Amortization of Debt Issuance Costs		46,000	$ 84,000
Debt Issuance Costs, Net		164,000	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		$ 10,825,000	12,624,000
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		$ 2,500,000
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, Tranche One [Member]
Debt Instrument, Interest Rate, Stated Percentage		3.67%
DFC Loan, Tranche Two [Member]
Debt Instrument, Interest Rate, Stated Percentage		7.49%
DFC Loan [Member]
Long-Term Debt		$ 2,464,000	$ 1,041,000
Debt Issuance Costs, Gross		$ 9,000

Note 5 - Long Term Debt - Long-

Note 5 - Long Term Debt - Long-term Debt Maturities (Details)	Dec. 31, 2023 USD ($)
2024	$ 2,157,000
2025	2,907,000
2026	7,732,000
2027	493,000
Long-Term Debt	$ 13,289,000

Note 6 - Leases (Details Textua

Note 6 - Leases (Details Textual)		12 Months Ended
	Nov. 03, 2021 USD ($) ft²	Dec. 31, 2023 USD ($) a	Dec. 31, 2022 USD ($)
Lessee, Operating Lease, Remaining Lease Term (Year)		1 year
Operating Lease, Right-of-Use Asset		$ 57,000	$ 317,000
Operating Lease, Expense		234,000	$ 290,000
Operating Lease, Liability		$ 57,000
Condominium Space for Gamma Knife Facility in Guayaquil, Ecuador [Member]
Area of Real Estate Property (Square Foot) | a		864
Land and Parking Spaces for Gamma Knife Facility in Guayaquil, Ecuador [Member]
Area of Real Estate Property (Square Foot) | a		10,135
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)	3,253	3,253
Operating Lease, Monthly Expense	$ 22,011	$ 22,011
Lessee, Operating Sublease, Monthly Income	$ 16,195	$ 16,195
Lease Agreement for New Corporate Office [Member]
Area of Real Estate Property (Square Foot) | ft²	900
Operating Lease, Monthly Expense	$ 4,500
Corporate Office in San Francisco [Member]
Area of Real Estate Property (Square Foot) | a		900
Operating Lease, Monthly Expense		$ 4,500
Stand-alone Facility in Lima, Peru [Member]
Area of Real Estate Property (Square Foot) | a		1,600
Operating Lease, Monthly Expense		$ 8,850

Note 6 - Leases - Summary of Ma

Note 6 - Leases - Summary of Maturities of Lessee Operating Lease Liabilities (Details)	Dec. 31, 2023 USD ($)
2024	$ 58,000
Total lease payments	58,000
Less imputed interest	(1,000)
Total	$ 57,000

Note 6 - Leases - Lease Cost an

Note 6 - Leases - Lease Cost and Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Operating lease cost, net of impairment	$ 302,000	$ 406,000
Sublease income	(129,000)	(174,000)
Total lease cost	173,000	232,000
Cash paid for amounts included in the measurement of lease liabilities - Operating leases	$ 302,000	$ 406,000
Weighted-average remaining lease term - Operating leases in years (Year)	9 months 18 days	1 year 1 month 9 days
Weighted-average discount rate - Operating leases	4.65%	5.65%

Note 7 - Income Taxes (Details

Note 7 - Income Taxes (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Expense (Benefit)		$ 431,000	$ 963,000
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent		21%	21%
Valuation Allowance, Deferred Tax Asset, Increase (Decrease), Amount		$ 17,000	$ 0
Unrecognized Tax Benefits		287,000	$ 278,000	$ 295,000
Unrecognized Tax Benefits, Income Tax Penalties Accrued		58,000
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		2,586,000
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, 2023	Dec. 31, 2022
Domestic	$ 666,000	$ 2,350,000
Foreign	30,000	168,000
Income before income taxes	$ 696,000	$ 2,518,000

Note 7 - Income Taxes - Compo_2

Note 7 - Income Taxes - Components of Provision (Benefit) for Income Taxes (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Federal	$ 940,000	$ 355,000
State	115,000	60,000
Foreign	135,000	204,000
Total current	1,190,000	619,000
Federal	(672,000)	290,000
State	(77,000)	48,000
Foreign	(10,000)	6,000
Total deferred	(759,000)	344,000
Income Tax Expense (Benefit)	$ 431,000	$ 963,000

Note 7 - Income Taxes - Signifi

Note 7 - Income Taxes - Significant Components of Deferred Tax Liabilities and Assets (Details) - USD ($)	Dec. 31, 2023	Dec. 31, 2022
Property and equipment	$ (323,000)	$ (708,000)
Prepaid expenses	(409,000)	(493,000)
ROU asset	(12,000)	(54,000)
Total deferred tax liabilities	(744,000)	(1,255,000)
Net operating loss carryforwards	155,000	139,000
Accruals and allowances	438,000	167,000
Lease liabilities	12,000	61,000
Tax credits	4,000	3,000
Other	140,000	114,000
Capital loss carryover	646,000	646,000
Total deferred tax assets	1,395,000	1,130,000
Valuation allowance	(714,000)	(697,000)
Deferred tax assets net of valuation allowance	681,000	433,000
Net deferred tax liabilities	$ (63,000)	$ (822,000)

Note 7 - Income Taxes - Reconci

Note 7 - Income Taxes - Reconciliation of Income Tax Provision (Benefit) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Computed expected federal income tax	$ 218,000	$ 477,000
State income taxes, net of federal benefit	12,000	100,000
Foreign rate differential	38,000	0
Stock compensation	7,000	0
Non-deductible expenses	6,000	(25,000)
Return to provision true-up	18,000	52,000
Uncertain tax positions	9,000	(17,000)
Alternative minimum tax payable adjustment	0	208,000
Change in valuation allowance	17,000	0
Other deferred tax adjustments	106,000	168,000
Income Tax Expense (Benefit)	$ 431,000	$ 963,000

Note 7 - Income Taxes - Recon_2

Note 7 - Income Taxes - Reconciliation of Unrecognized Tax Benefit (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Balance at beginning of year	$ 278,000	$ 295,000
Additions based on tax positions of prior years	9,000
Additions based on tax positions of prior years		(17,000)
Balance at end of year	$ 287,000	$ 278,000

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, 2023	Dec. 31, 2022	Dec. 31, 2021	Jun. 30, 2021
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period (in shares)			116,000
Share-Based Payment Arrangement, Expense			$ 389,000
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Grants in Period, Weighted Average Grant Date Fair Value (in dollars per share)			$ 2.89	$ 1.49
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Exercises in Period (in shares)			0	4,000
Options Issued During Period, Cashless Stock Options Exercised (in shares)				3,000
Proceeds from Stock Options Exercised			$ 0	$ 5,000
Share-based Compensation Arrangement by Share-based Payment Award, Options, Exercises in Period Using Cash (in shares)				2,000
Stock Repurchase Program, Number of Shares Authorized to be Repurchased (in shares)			1,000,000
Stock Repurchased During Period, Shares (in shares)			0	0
Stock Repurchase Program, Remaining Number of Shares Authorized to be Repurchased (in shares)			72,000
Restricted Stock Units (RSUs) [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Grants in Period (in shares)			146,000	131,000
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period (in shares)			119,000	132,000
Share-Based Compensation Arrangement by Share-Based Payment Award, Non-Option Equity Instruments, Outstanding, Number (in shares)			33,000	6,000	10,000
Restricted Stock Units (RSUs) [Member] | Selling, General and Administrative Expenses [Member]
Share-Based Payment Arrangement, Expense, after Tax			$ 389,000	$ 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)			90,000
Share-Based Payment Arrangement, Expense			$ 351,000
Share-Based Payment Arrangement, Option [Member]
Share-Based Payment Arrangement, Expense			34,000	10,000
Share-Based Payment Arrangement, Expense, after Tax			$ 156,000
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)			935,000
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)			898,000
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)			742,000
Share-Based Compensation Arrangement by Share-Based Payment Award, Non-Option Equity Instruments, Outstanding, Number (in shares)			33,000
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)			57,000
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)			460,000
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
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			$ 351,000	$ 288,000
Executive Equity Awards [Member] | Restricted Stock Units (RSUs) [Member] | Chief Executive Officer [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Grants in Period (in shares)	10,000	50,000
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period (in shares)			90,000
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period (Day)	30 days
Stock Issued During Period, Shares, Issued for Services (in shares)			120,000	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, 2023	Dec. 31, 2022
Vested (in shares)	(116,000)
Restricted Stock Units (RSUs) [Member]
Outstanding (in shares)	6,000	10,000
Outstanding, grant date weighted average fair value (in dollars per share)	$ 2.33	$ 2.57
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Grants in Period (in shares)	146,000	131,000
Granted, grant date weighted average fair value (in dollars per share)	$ 2.97	$ 2.4
Vested (in shares)	(119,000)	(132,000)
Vested, grant date weighted average fair value (in dollars per share)	$ 2.94	$ 2.4
Forfeited (in shares)		(3,000)
Forfeited, grant date weighted average fair value (in dollars per share)		$ 2.92
Outstanding (in shares)	33,000	6,000
Outstanding, grant date weighted average fair value (in dollars per share)	$ 2.88	$ 2.33

Note 8 - Stock-based Compensa_5

Note 8 - Stock-based Compensation Expense - Stock Compensation Expense (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Share-Based Payment Arrangement, Expense	$ 389,000
Awards issued and vested (in shares)	116,000
Stock-based compensation expense	$ 389,000
Management Bonus Program [Member]
Awards issued and vested (in shares)	26,000
Share-Based Payment Arrangement, Option [Member]
Share-Based Payment Arrangement, Expense	$ 34,000	$ 10,000
Stock-based compensation expense	$ 34,000	$ 10,000
Restricted Stock Units (RSUs) [Member]
Awards issued and vested (in shares)	119,000	132,000
Restricted Stock Units (RSUs) [Member] | Board Member [Member]
Share-Based Payment Arrangement, Expense	$ 4,000
Stock-based compensation expense	4,000
Restricted Stock Units (RSUs) [Member] | Chief Executive Officer [Member]
Share-Based Payment Arrangement, Expense	$ 351,000
Awards issued and vested (in shares)	90,000
Stock-based compensation expense	$ 351,000

Note 8 - Stock-based Compensa_6

Note 8 - Stock-based Compensation Expense - Summary of Stock Option Activity (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Jan. 01, 2022
Balance (in shares)	95,000	67,000
Balance, grant date weighted-average exercise price (in dollars per share)	$ 2.76	$ 2.72
Balance, weighted average remaining contractual life (Year)	5 years 5 months 8 days	4 years 9 months 29 days	3 years 3 months 29 days
Balance, aggregate intrinsic value	$ 0	$ 25,000		$ 0
Granted (in shares)	70,000	50,000
Granted, grant date weighted-average exercise price (in dollars per share)	$ 2.89	$ 2.72
Granted, weighted average remaining contractual life (Year)	7 years	7 years
Exercised (in shares)	0	(4,000)
Exercised, grant date weighted-average exercise price (in dollars per share)		$ 2.29
Forfeited (in shares)	(19,000)	(18,000)
Forfeited, grant date weighted-average exercise price (in dollars per share)	$ 2.69	$ 2.64
Balance (in shares)	146,000	95,000	67,000
Balance, grant date weighted-average exercise price (in dollars per share)	$ 2.83	$ 2.76	$ 2.72
Exercisable (in shares)	31,000	38,000
Exercisable, grant date weighted-average exercise price (in dollars per share)	$ 2.84	$ 2.79
Exercisable, weighted average remaining contractual life (Year)	3 years 4 months 17 days
Minimum [Member]
Exercisable, weighted average remaining contractual life (Year)		2 years 4 months 17 days

Note 8 - Stock-based Compensa_7

Note 8 - Stock-based Compensation Expense - Assumptions (Details)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Expected life (years) (Year)	7 years	7 years
Expected forfeiture rate	0%	0%
Expected volatility	50%	50%
Dividend yield	0%	0%
Risk-free interest rate	3.60%	3.30%

Note 9 - Retirement Plan (Detai

Note 9 - Retirement Plan (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Defined Contribution Plan, Employer Matching Contribution, Percent of Employees' Gross Pay	4%
Defined Contribution Plan, Cost	$ 43,000	$ 47,000
Deferred Compensation Liability, Current and Noncurrent	$ 17,000

Note 10 - Commitments and Con_2

Note 10 - Commitments and Contingencies (Details Textual) - USD ($)		12 Months Ended
	Sep. 04, 2022	Dec. 31, 2023
Leksell Gamma Knife Icon Systems and Linear Accelerator System [Member]
Long-term Install Service and Purchase Commitment, Amount		$ 15,925,000
Long-term Commitment, Cash on Hand to Fund		13,808,000
Long-term Commitment, Line of Credit to Fund		7,000,000
Long-Term Line of Credit		2,500,000
Maintenance And Support Agreement, Mevion Service Agreement [Member] | Mevion Medical Systems Inc [Member]
Purchase Agreement Annual Prepayment	$ 1,865,000
Long-term Purchase Commitment, Period (Year)	1 year
LINAC System [Member]
Long-Term Service Commitment, Amount		$ 14,805,000
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

Note 11 - Related Party Trans_3

Note 11 - Related Party Transactions (Details Textual)	Dec. 31, 2023 USD ($)
US Subsidiary Of Elekta Member
Purchase Obligation	$ 18,968,000
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) - Related Party [Member] - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Equipment purchases and de-install costs	$ 6,918,000	$ 1,844,000
Costs incurred to maintain equipment	851,000	1,094,000
Total related party transactions	7,769,000	2,938,000
Accounts payable and other accrued liabilities	$ 1,961,000	$ 497,000

Note 12 - Subsequent Events (De

Note 12 - Subsequent Events (Details Textual) - Subsequent Event [Member] - Fifth Third Bank, N.A. [Member] - The Credit Agreement, 2024 Supplemental Term Loan [Member]	Jan. 25, 2024 USD ($)
Debt Instrument, Face Amount	$ 2,700,000
Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate [Member]
Debt Instrument, Basis Spread on Variable Rate	3%
Debt Instrument, Variable Rate, Floor	0%