Note 9 - Commitments	6 Months Ended
Jun. 30, 2023
Notes to Financial Statements
Commitments and Contingencies Disclosure [Text Block]	Note 9. Commitments On December 20, 2018, the Company signed Second Amendments to two System Build Agreements for the Company’s second and third Mevion PBRT units. The Company and Mevion Medical Systems Inc. (“Mevion”) have agreed to upgrade the second and third PBRT units for which the Company has purchase commitments. The Company is actively seeking sites for these units but, to date, has not entered into agreements with any party for either placement of a PBRT unit or the related financing. The Company projects that it will be required to commence delivery of the second and third PBRT units no later than December 2023. In the event the Company is unable to enter into customer agreements within the requisite time frame or receive an extension from Mevion, the Company could forfeit its deposits. During the year-ended December 31, 2020, the Company impaired these deposits and wrote-off the deposits and related capitalized interest. As of June 30, 2023, the Company had commitments, after deposits, to purchase two MEVION S250i PBRT systems for $34,000,000. As of June 30, 2023, the Company had commitments to upgrade four Leksell Gamma Knife systems from Perfexion to Icon Systems (“Icon”), one Gamma Plan workstations, three Esprit Gamma Knife systems, two of which are at existing customer sites, two Linear Accelerator (“LINAC”) systems, two Cobalt- 60 reloads and one Magnetic Resonance imaging guided LINAC (MR LINAC) at a future customer site. One LINAC will be placed at a future customer site and one LINAC system will be placed at the Company’s new site in Puebla, Mexico. This site is expected to begin operations in the second half of 2023 now that it has received regulatory approval. The Gamma Knife units at its stand-alone facility in Ecuador will use a commitments to upgrade to an Icon System. The Company expects to upgrade and install the equipment in Ecuador late in the third quarter of 2023. The Company has a commitment from DFC to finance the majority of this upgrade. The remaining Icon upgrades and LINAC purchases are expected to occur in 2024. Total Gamma Knife and LINAC commitments as of June 30, 2023 were $21,722,000 and include $950,000 for potential removal costs related to leased equipment. A portion of that removal cost is included in the condensed consolidated balance sheets as part of the asset removal obligation. It is the Company’s intent to finance substantially all of these commitments. There can be no assurance that financing will be available for the Company’s current or future projects, or at terms that are acceptable to the Company. However, the Company currently has cash on hand of $13,794,000 and a line of credit of $7,000,000 and is actively engaged with financing resources to fund these projects. On February 15, 2023, the Company executed an equipment sales agreement with a new customer for the sale of a Gamma Knife upgrade and Cobalt-60 reload. The Company expects to complete the sale during the third quarter of 2023. The Company will fulfill this order by exercising its purchase commitments. On September 4, 2022, the Company entered into a Maintenance and Support Agreement (the “Mevion Service Agreement”), which provides for maintenance and support of the Company’s PBRT unit at Orlando Health from September 2022 through April 2026. The agreement requires an annual prepayment of $1,800,000 for the current contractual period ( one year). This payment portion was recorded as a prepaid contract and is being amortized over the one-year service period. As of June 30, 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. In addition, in April 2019, the Company signed agreements to service the Icon upgrades which will be installed at various dates between 2023 and 2024. The Company’s commitments to purchase two LINAC systems also include a 9-year and 5-year agreement to service the equipment, respectively. Total service commitments as of June 30, 2023 were $14,962,000. The Gamma Knife and certain other service contracts are paid monthly, as service is performed. The Company believes that cash flow from cash on hand and operations will be sufficient to cover these payments.

On December 20, 2018, the Company signed Second Amendments to two System Build Agreements for the Company’s second and third Mevion PBRT units. The Company and Mevion Medical Systems Inc. (“Mevion”) have agreed to upgrade the second and third PBRT units for which the Company has purchase commitments. The Company is actively seeking sites for these units but, to date, has not entered into agreements with any party for either placement of a PBRT unit or the related financing. The Company projects that it will be required to commence delivery of the second and third PBRT units no later than December 2023. In the event the Company is unable to enter into customer agreements within the requisite time frame or receive an extension from Mevion, the Company could forfeit its deposits. During the year-ended December 31, 2020, the Company impaired these deposits and wrote-off the deposits and related capitalized interest. As of June 30, 2023, the Company had commitments, after deposits, to purchase two MEVION S250i PBRT systems for $34,000,000.

As of June 30, 2023, the Company had commitments to upgrade four Leksell Gamma Knife systems from Perfexion to Icon Systems (“Icon”), one Gamma Plan workstations, three Esprit Gamma Knife systems, two of which are at existing customer sites, two Linear Accelerator (“LINAC”) systems, two Cobalt- 60 reloads and one Magnetic Resonance imaging guided LINAC (MR LINAC) at a future customer site. One LINAC will be placed at a future customer site and one LINAC system will be placed at the Company’s new site in Puebla, Mexico. This site is expected to begin operations in the second half of 2023 now that it has received regulatory approval. The Gamma Knife units at its stand-alone facility in Ecuador will use a commitments to upgrade to an Icon System. The Company expects to upgrade and install the equipment in Ecuador late in the third quarter of 2023. The Company has a commitment from DFC to finance the majority of this upgrade. The remaining Icon upgrades and LINAC purchases are expected to occur in 2024. Total Gamma Knife and LINAC commitments as of June 30, 2023 were $21,722,000 and include $950,000 for potential removal costs related to leased equipment. A portion of that removal cost is included in the condensed consolidated balance sheets as part of the asset removal obligation. It is the Company’s intent to finance substantially all of these commitments. There can be no assurance that financing will be available for the Company’s current or future projects, or at terms that are acceptable to the Company. However, the Company currently has cash on hand of $13,794,000 and a line of credit of $7,000,000 and is actively engaged with financing resources to fund these projects.

On February 15, 2023, the Company executed an equipment sales agreement with a new customer for the sale of a Gamma Knife upgrade and Cobalt-60 reload. The Company expects to complete the sale during the third quarter of 2023. The Company will fulfill this order by exercising its purchase commitments.

On September 4, 2022, the Company entered into a Maintenance and Support Agreement (the “Mevion Service Agreement”), which provides for maintenance and support of the Company’s PBRT unit at Orlando Health from September 2022 through April 2026. The agreement requires an annual prepayment of $1,800,000 for the current contractual period ( one year). This payment portion was recorded as a prepaid contract and is being amortized over the one-year service period.

As of June 30, 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. In addition, in April 2019, the Company signed agreements to service the Icon upgrades which will be installed at various dates between 2023 and 2024. The Company’s commitments to purchase two LINAC systems also include a 9-year and 5-year agreement to service the equipment, respectively. Total service commitments as of June 30, 2023 were $14,962,000. The Gamma Knife and certain other service contracts are paid monthly, as service is performed. The Company believes that cash flow from cash on hand and operations will be sufficient to cover these payments.