American Shared Hospital Services (ASHS) provides radiation therapy services for cancer treatment through two models: leasing specialized equipment to hospitals and cancer centers, and directly owning and operating freestanding cancer treatment centers. On the leasing side, ASHS owns Gamma Knife radiosurgery systems and a proton beam radiation therapy (PBRT) system, placing them at hospital partners who pay ASHS a fee per procedure or a share of reimbursements. On the direct patient services side, ASHS owns and operates freestanding clinics — primarily in Rhode Island and internationally in Peru, Ecuador, and Mexico — billing Medicare and private insurers directly for treating patients. Equipment leasing and direct patient services each account for roughly half of revenue. The leasing segment is capital-intensive but generates recurring income with a largely fixed cost base; the direct patient services segment carries lower margins but is growing faster as newly acquired and opened facilities ramp up patient volumes. ASHS is shifting its strategic focus toward owning and operating treatment centers, arguing this gives it more control over volumes and growth. The company is expanding domestically in Rhode Island, where it acquired three radiation therapy centers in 2024 and holds permits to build additional facilities, and internationally through a new LINAC center in Puebla, Mexico and a planned Gamma Knife joint venture in Guadalajara. ASHS is currently in default on its primary credit facility and faces substantial doubt about its ability to continue as a going concern.