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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 6 Months Ended
Jun. 30, 2026
Jun. 30, 2025
CASH FLOWS FROM OPERATING ACTIVITIES    
Net loss $ (4,478) $ (6,703)
Adjustments to reconcile net loss to net cash provided by operating activities:    
Depreciation and amortization 90,496 71,476
Noncash operating lease expense 32,658 29,356
Equity in earnings of joint ventures, net of dividends (4,679) (1,267)
Amortization of deferred financing costs and loan discount 1,550 1,471
Loss on sale and disposal of equipment 3,708 2,126
Loss on extinguishment of debt 407 0
Lease abandonment charges 1,306 5,511
Amortization of cash flow hedge 0 2,712
Non-cash change in fair value of interest rate swap 0 4,062
Stock-based compensation 41,915 37,235
Change in fair value of contingent consideration (393) 0
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions:    
Accounts receivable (23,413) (14,159)
Other current assets (1,131) 22,381
Other assets (7,443) (2,544)
Deferred taxes (3,784) (3,511)
Operating leases (29,238) (34,726)
Deferred revenue 1,016 145
Accounts payable, accrued expenses and other 74,574 48,264
Net cash provided by operating activities 173,071 161,829
CASH FLOWS FROM INVESTING ACTIVITIES    
Purchase of imaging facilities and other acquisitions, net of cash acquired (315,707) (31,985)
Purchase of property and equipment and other (126,215) (101,776)
Proceeds from sale of equipment 744 40
Equity contributions in existing and purchase of interest in joint ventures 0 (20,480)
Collection of notes receivable 6,651 0
Net cash used in investing activities (434,527) (154,201)
CASH FLOWS FROM FINANCING ACTIVITIES    
Principal payments on notes and leases payable (11,767) (3,461)
Payments on term loan debt (11,140) (10,252)
Proceeds from issuance of new debt, net of issuance costs 248,937 99,001
Purchase of noncontrolling interests by third party 0 2,389
Distributions paid to noncontrolling interests (3,927) (3,313)
Proceeds from issuance of common stock upon exercise of options 612 554
Net cash provided by financing activities 222,715 84,918
EFFECT OF EXCHANGE RATE CHANGES ON CASH (2,202) 586
NET (DECREASE) INCREASE IN CASH AND CASH EQUIVALENTS (40,943) 93,132
CASH AND CASH EQUIVALENTS, beginning of period 767,215 740,020
CASH AND CASH EQUIVALENTS, end of period 726,272 833,152
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION    
Cash paid during the period for interest 35,632 35,018
Cash paid during the period for income taxes $ 2,143 $ 2,428