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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2026
Sep. 30, 2025
CASH FLOWS FROM OPERATING ACTIVITIES    
Net income $ 14,673 $ 7,186
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation and amortization 137,506 111,275
Noncash operating lease expense 49,425 44,605
Equity in earnings of joint ventures, net of dividends (4,244) (4,590)
Amortization of deferred financing costs and loan discount 2,355 2,242
Loss on sale and disposal of equipment 9,067 3,168
Loss on extinguishment of debt 407 0
Gain on contribution of imaging centers into joint venture (7,528) 0
Lease abandonment charges 3,358 8,330
Amortization of cash flow hedge 0 2,273
Non-cash change in fair value of interest rate swap 0 6,433
Stock-based compensation 51,933 46,276
Change in fair value of contingent consideration 7,864 0
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions:    
Accounts receivable (30,461) (20,476)
Other current assets (4,292) 2,093
Other assets (7,478) (2,764)
Deferred taxes 4,334 2
Operating leases (45,252) (48,760)
Deferred revenue 581 3,934
Accounts payable, accrued expenses and other 81,393 53,429
Net cash provided by operating activities 263,641 214,656
CASH FLOWS FROM INVESTING ACTIVITIES    
Purchase of imaging facilities and other acquisitions, net of cash acquired (315,708) (66,464)
Purchase of property and equipment and other (181,721) (162,221)
Proceeds from sale of equipment 1,270 75
Equity contributions in existing and purchase of interest in joint ventures 0 (4,147)
Collection of notes receivable 8,541 2,832
Net cash used in investing activities (487,618) (229,925)
CASH FLOWS FROM FINANCING ACTIVITIES    
Principal payments on notes and leases payable (13,993) (5,229)
Payments on term loan debt (17,028) (15,504)
Proceeds from issuance of new debt, net of issuance costs 248,937 99,001
Purchase of noncontrolling interests by third party 0 2,389
Payments on contingent consideration and holdbacks (2,198) 0
Distributions paid to noncontrolling interests (8,362) (3,313)
Proceeds from issuance of common stock upon exercise of options 2,517 2,258
Net cash provided by financing activities 209,873 79,602
EFFECT OF EXCHANGE RATE CHANGES ON CASH (2,504) 363
NET (DECREASE) INCREASE IN CASH AND CASH EQUIVALENTS (16,608) 64,696
CASH AND CASH EQUIVALENTS, beginning of period 767,215 740,020
CASH AND CASH EQUIVALENTS, end of period 750,607 804,716
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION    
Cash paid during the period for interest 53,635 53,679
Cash paid during the period for income taxes $ 3,908 $ 3,480