RadNet Aims for 17–19% Imaging Revenue Growth with $140M ARR in Digital Health by 2026 After Gleamer Deal

Earnings Call Insights: RadNet, Inc. (RDNT) Q4 2025

Management View

During the earnings call, Howard Berger, Chairman, President & CEO, highlighted that "It was the strongest quarter in the company's history with record revenue and adjusted EBITDA." The company reported total revenue increased by 14.8% to $547.7 million, while adjusted EBITDA rose by 16.9% to $87.7 million. Digital Health revenue for the quarter saw a significant increase of 48.2%, reaching $27.9 million, with adjusted EBITDA for this segment growing by 8.9% to $4.9 million.

Advanced imaging, including MRI, CT, and PET/CT, contributed over 60% of the company’s revenue. Procedural volume growth was 14.1% overall and 9.6% at same-center locations. The shift toward advanced imaging increased procedural volume share to 28.6%.

Berger described 2025 as "a year of significant investment," noting the opening of 7 de novo facilities and the expansion of joint venture partnerships, now comprising 36.1% of RadNet’s 418 centers. He also announced the acquisition of Paris-based Gleamer, stating, "this morning, we will -- we announced the completion of acq of Gleamer," positioning DeepHealth as the largest provider of radiology clinical AI solutions worldwide.

Berger added, "At the year-end 2025, RadNet's cash balance was $776 million, and the net debt to adjusted EBITDA leverage ratio was approximately 1.0."

Mark Stolper, Executive VP & CFO, reported that "Fourth quarter total company revenue and adjusted EBITDA were both quarterly records." He noted that Digital Health revenue finished at $92.7 million, with adjusted EBITDA of $15.5 million.

Stolper introduced annual recurring revenue (ARR) for Digital Health, stating, "At December 31, 2025, ARR for the Digital Health division was $75.4 million. We are anticipating ARR will approach $140 million at the end of 2026."

Cornelis Wesdorp, President & CEO of Digital Health, said the Gleamer acquisition brings "over 700 customer contracts across 44 countries" and "a compound annual growth exceeding 90% from 2022 to 2025" for ARR.

Outlook

Stolper stated, "2026 guidance anticipates 17% to 19% imaging center revenue growth relative to 2025," with EBITDA growth expected to exceed revenue growth and free cash flow growing 29% to 41% from 2025 levels.

Digital Health 2026 guidance implies revenue growth between 45% and 55% from 2025. ARR is expected to approach $140 million by the end of 2026, with Gleamer contributing about $30 million.

Four FDA clearances are anticipated in 2026, targeting mammography, lung, prostate, thyroid, brain, and musculoskeletal system.

The proportion of Digital Health revenues from Imaging Center is expected to decrease from 45% to about 33% in 2026.

Financial Results

Stolper reported that "Fourth quarter total company revenue and adjusted EBITDA were both quarterly records. Revenue increased 14.8% and adjusted EBITDA increased 16.9% from last year's fourth quarter."

Adjusted earnings per share was $0.23 per share, compared to $0.24 per share in last year's fourth quarter.

Digital Health revenue for 2025 was $92.7 million, with adjusted EBITDA of $15.5 million.

Cash balance at year-end was $767 million, with full availability of a $282 million revolving credit facility and net debt at $323.5 million.

Days sales outstanding reached a company record low of 29.5 days.

Q&A

Brian Tanquilut, Jefferies, asked about the impact of AI and the differentiation from the Gleamer acquisition. Berger replied, "I don't think disruption is the right term... These are tools that will enhance productivity, allow us to continue to grow and match the demands that we have... the quality and capabilities of the new equipment is almost something that could never have been imagined even 3 or 4 years ago."

David MacDonald, Truist, inquired about the upsell opportunity from Gleamer’s 700+ contracts and efficiency gains. Wesdorp responded, "We apply right now a logic of 80% to 90% of those provides given our broad clinical AI portfolio, an upsell opportunity."

Andrew Mok, Barclays, questioned the ARR metric and its alignment with revenue. Stolper explained, "ARR is almost -- it should be thought of as a balance sheet metric... as we continue to grow the SaaS-based business... I would expect that the ARR would exceed the booked revenue."

Yuan Zhi, B. Riley Securities, asked about organic growth. Stolper stated, "We typically build our same-center performance kind of in the 3% to 5% range... we saw advanced imaging on average, be up 9.6% on a same-center basis from the fourth quarter of 2024."

James Sidoti, Sidoti & Company, inquired about cash paid for Florida and Indiana acquisitions. Stolper stated, "For the Florida, Southwest Florida acquisition, we paid roughly about $65 million for that. And then for Indiana, I believe it was about $9 million."

Sentiment Analysis

Analysts showed a positive to slightly positive tone, with high interest in the AI strategy, ARR growth, and Gleamer integration. Questions reflected forward-looking curiosity and confidence in RadNet’s strategic moves.

Management’s tone was confident during prepared remarks, with Berger saying, "It was the strongest quarter in the company's history..." and Stolper emphasizing record metrics and liquidity. The Q&A maintained this confidence, especially around the transformative nature of the Gleamer deal and operational execution. Management directly addressed analysts' questions and provided detailed explanations, reinforcing a positive and transparent sentiment.

Compared to the previous quarter, management’s tone was more assertive about Digital Health leadership and ambitious about operational and financial targets, while analysts’ tone shifted from cautious optimism to more engagement with AI and growth strategies.

Quarter-over-Quarter Comparison

Guidance language shifted to a more aggressive stance on revenue and EBITDA growth for 2026, with new targets for ARR and expanded FDA clearances.

Strategic focus expanded further into AI and global leadership, as evidenced by the Gleamer acquisition and explicit ARR targets.

Analysts’ focus moved from operational efficiency and Digital Health integration in Q3 to detailed questions on ARR growth, cross-selling, and AI portfolio composition.

Key metric changes included higher revenue, EBITDA, and cash balance, as well as a lower days sales outstanding metric.

Management’s confidence has increased, particularly regarding the growth trajectory of Digital Health and the impact of recent acquisitions.

Risks and Concerns

Management cited severe winter weather in the Mid-Atlantic and Northeast regions as a headwind for Q1 2026.

Labor cost increases of about 4% at the same-center level are embedded in guidance, with Stolper stating, "over $30 million of same-center labor increases in 2026."

The company highlighted the ongoing challenge of integrating acquisitions and achieving targeted cost synergies, particularly for Gleamer, which is expected to reach positive adjusted EBITDA by mid-2027.

Analysts raised questions about the pace and realization of efficiency gains from the Gleamer acquisition, the cadence of new center openings, and organic growth sustainability.

Final Takeaway

RadNet’s fourth quarter 2025 earnings call underscored record financial performance, a major acquisition with Gleamer to expand AI leadership, and bold targets for 2026, including 17% to 19% imaging center revenue growth and ARR approaching $140 million in Digital Health. Management emphasized that operational investments, expanded joint ventures, and digital health transformation position the company for further margin and revenue expansion while acknowledging near-term labor and weather-related headwinds. The integration of Gleamer and continued focus on AI and automation are central to the company’s growth strategy for the coming year.