American Shared Hospital Services

What they do

The company leases Gamma Knife and Proton Beam Radiation Therapy (PBRT) systems to hospitals under fee-per-use or revenue-sharing contracts. It also owns and operates radiation therapy facilities in Peru, Ecuador, Mexico, and Rhode Island, providing direct patient services. As of December 31, 2025, it had eight leasing sites (seven Gamma Knife, one PBRT) and six direct patient service sites.

Revenue drivers

• Direct Patient Services — Revenue from company-owned radiation therapy facilities in Rhode Island, Peru, and Mexico; Q2 2026 revenue increased 40% year-over-year to $4.9 million.
• Proton Beam Radiation Therapy (PBRT) — Leased PBRT system generates revenue via fee-per-use; Q2 2026 revenue increased 22% to $2.3 million due to higher volumes and reimbursement.
• Gamma Knife Leasing — Fee-per-use and revenue-sharing contracts with hospitals; Q2 2026 revenue was $2.7 million, roughly flat as domestic volumes declined but international volumes improved.
• International Gamma Knife — Company-owned facilities in Lima, Peru and Guayaquil, Ecuador; first half 2026 revenue increased 56% to $2.7 million following Esprit upgrade in Peru.

Recent performance

Second quarter 2026 total revenue rose 19% year-over-year to $8.4 million, up from $7.1 million in Q2 2025. Direct Patient Services revenue grew 40% to $4.9 million, while PBRT revenue increased 22% to $2.3 million. Cash provided by operating activities was $4.4 million in the first half of 2026. Cash and restricted cash totaled $6.8 million at June 30, 2026, up from $3.7 million at December 31, 2025. Fiscal 2025 revenue was $28.1 million with a net loss of $1.6 million.

Strategy

Management emphasizes expanding treatment capabilities and geographic footprint, citing investments in the Esprit upgrade in Peru and the 2024 acquisition of a 60% interest in Rhode Island radiation therapy centers. The company aims to improve operating efficiencies and expand patient access across its Gamma Knife, PBRT, and LINAC facilities. It also continues to address financing initiatives and strengthen its balance sheet, as noted by the Executive Chairman.

Risks

• Customer contract expirations — Leasing revenue is affected by contract terminations and expirations; one contract was terminated in February 2025, another expired in April 2025, and a third is expected to expire in Q2 2026.
• Reimbursement rate changes — CMS reimbursement rates for Gamma Knife and PBRT treatments can decline; the 2026 Gamma Knife rate is $7,525, down from $7,645 in 2025.
• Volume volatility — Procedure volumes can fluctuate due to equipment downtime and cyclicality; Gamma Knife volumes fell 13.6% in 2025, and PBRT volumes dropped 21.1%.
• High debt levels — As of June 30, 2026, the company had $16.2 million in current long-term debt and total liabilities of $26.7 million, with cash of $6.5 million.

Outlook

Management expects continued growth in Direct Patient Services, improved PBRT performance, and increasing contributions from international operations. The company is focused on executing its long-term growth strategy while addressing financing initiatives and balance sheet strength. No specific forward guidance was provided.