American Shared Hospital Services (AMS) operates in a niche segment providing stereotactic radiosurgery and advanced radiation therapy through medical equipment leasing and direct patient services. The company’s growth has been pressured by contract expirations, declining procedure volumes in key segments, and significant liquidity challenges exacerbated by covenant defaults on its credit agreements. While procedure volume growth was seen in some areas like LINAC treatments post-acquisition, AMS faces substantial risks related to debt maturities, customer concentration, and operational disruptions. The ability to refinance debt and stabilize cash flow will be critical as it navigates these combined headwinds.