American Shared Hospital Services's

The Company's Gamma Knife radiosurgery competes with conventional neurosurgery, radiation therapy, and other radiosurgery devices. It is recognized as an alternative or adjunct to conventional surgery due to favorable morbidity outcomes and its non-invasive nature. Utilization depends on acceptance by neurosurgeons, radiation oncologists, referring physicians, and the proximity to competing Gamma Knife centers and providers using other radiosurgery devices. Conventional LINAC-based radiation therapy is the primary competitor to the Company's proton therapy system at Orlando Health Cancer Institute. Proton beam radiation therapy is considered a beneficial alternative for certain tumors but is less widely available than conventional radiation therapy, with fewer than 50 proton beam centers in the U.S. The Company competes against manufacturers selling systems directly to customers and other companies outsourcing these services. It does not have exclusive relationships with manufacturers and has lost sales to customers purchasing directly from manufacturers, a trend that may continue. The Medicare program and regulatory requirements also influence the competitive environment.