Free PACS clients: what is available?
FILIPE RAMOS BARRA
RENATO RAMOS BARRA
ALAOR BARRA SOBRINHO
HUB/UNB – UNIVERSITY HOSPITAL OF BRASÍLIA, BRAZIL
IMEB – IMAGENS MÉDICAS DE BRASÍLIA, BRAZIL
filipebarra@gmail.com
Introduction
Radiology services are changing its structures
Most of radiology equipments are now integrated
into a network
Number of exams interpretation on workstations is
increasing
Film-less is becoming a reality
Introduction
Eventually, radiologist needs to use exams images
for case databases, lectures or staff meetings
These images are available in DICOM format, the
worldwide standard
Software such as PowerPoint, Word and Paint
cannot import these images without specific plugin
DICOM: Digital Imaging and Communications in Medicine
Introduction
There are software that convert DICOM images in
common formats (JPEG, TIFF, BMP), CDs viewers
and complex viewers that works as PACS clients
As most modern diagnostic imaging services has at
least a small network connecting CT or MR to
workstations, the use of viewers that work as PACS
clients is much more practical and fast
CT: Computer Tomography
MR: Magnetic Resonance
PACS: Picture Archiving and Communication System
Introduction
Technology improves a lot, requiring constantly
updating of viewers
Free and open-source software usually are developed
and not updated. This is a major problem in using
these kind of software
The free program considered the gold standard
among the viewers is the OsiriX. It is the program
with a lot of functions, but is only available to the
operating system MacOS X, reason why we did not
include in our study
Objective
Our objective is to find free Medical Image
Viewers available on the internet capable of work
as PACS client and evaluate its main functions, as
well as the feasibility of its use in personal
computers with Windows
Materials and Methods
We searched at Google and specialized sites
(Idoimaging, RTstudents e Medfloss) for free
software available for Windows
About 70 programs were found, 11 able to work
as PACS client. Six were selected for analysis
(table 1)
Based on authors needs 16 functions were
selected for evaluation
Table 1 – Free PACS clients found
Software
Selection
ClearCanvas Worstation
Included in the study
KPACS
Included in the study
Onis
Included in the study
Synedra View Personal
Included in the study
Mito
Included in the study
Tudor DicomViewer
Included in the study
DicomScope
Difficulty in utilization
Mipav
Difficulty in utilization
Cyclops Medical Station
Download unavailable
DicomVista
Free version with a lot of restrictions
Medwx
Complex installation
Materials and Methods
One of our proposal was analyze the feasibility of PACS
viewers use in personal computers, so as we tested these
software with two computers, a basic and a more powerful
one:
Intel Celeron 1.6GHz, 2GB RAM, 40GB storage, onboard video card, with Windows XP SP2 installed
AMD Athlon 64 Dual Core 2.7GHz, 4GB RAM, 1TB
storage, ATI Radeon HD 4350 video card, with
Windows 7 installed
Materials and Methods
Functions evaluated were:
MPR
MIP
VR
Image fusion
Series synchronization
Reference lines
Add comments
Cine
MPR: multiplanar reformation
VR: volume rendering
Use of multiple monitor
PACS server
Create CDs
Anonymize studies
Export in JPG, BMP e
DICOM
Windows 7 compatibility
MIP: maximum-intensity projection
Results
ClearCanvas Workstation 2.0 SP1
Integrates an open-source project that also includes
an ImageServer and a RIS
It is the only one that has accreditation for clinical
use (Health Canada)
Some functions are: MPR, series synchronization
and spatial localization of a point in different series
Can not export images as DICOM or create CDs
Can work as a PACS server
There are various community plugins allowing study
tagging and comments, for example
RIS: Radiology Information System
ClearCanvas Worskstation creen capture. Two series are displayed. Reference line and spatial
location are shown (arrow head) and a ROI in thyroid (arrow)
KPACS 1.6
The oldest software of those analyzed
Incompatible with Windows 7
Buttons are big and inferiorly placed
Can work as a PACS server
Allows multiple monitors use and create CD with a
built-in viewer but does not perform MIP, MPR or
VR
As PACS client is a little bit slow, sometimes giving
the impression of having stopped working
K-PACS screen capture. Buttons are big and inferiorly placed
Onis 2.1
Free version of a commercial software
Number of patients in database is limited to 15
On demand capability (can open DICOM files
directly from the server or CD without downloading
them)
Performs MPR, oblique MPR and 3D-MIP
Create CDs with built-in viewer
Very fast software
Onis screen capture showing MPR function. It is possible to choose plane of view (arrow)
and layout (arrow head)
Synedra View Personal 1.0.12.3
Powerful PACS client
Different interface with buttons placed inferiorly
ISO 9001 and ISO 13485 certificates
Performs MPR, MIP and min-MIP with the
possibility to increase thickness
Major problem is that does not have a database.
Exams need to be saved manually for future view
Very fast software
Onis screen capture showing MPR function. Slice thickness were changed to 25mm.
Buttons are inferiorly placed (arrow head)
Mito (Medical Imaging Toolkit) 1.0
Open-source software
It is the only one able to perform image fusion
Also performs VR and MIP
Compared to others is a little bit slow
Mito screen capture. A PET-CT is shown with a “hot area” on patient neck (arrow)
Tudor DicomViewer
Simple software with few functions
Require Java Runtime Environment instalation
Does not perform MPR, MIP or VR
Enable the use of 3 monitors
Can be integrate with ImageJ, increasing its
functions
Tudor Dicom Viewer screen capture. Two series are shown. Note that there is no
reference line.
Table 2 – Software functions
MPR
MIP
VR
PACS Server
Create CD
Anonymize
Export Images
Export Videos
DICOM Export
Windows 7
Image fusion
Comments
ClearCanvas
KPACS
Workstation
1.6.0
2.0
X
Onis
2.2
X
Synedra View
Personal
1.0.12.3
X
X
MIP
X
X
X
X
X
X
X
X
X
X
X
Mito
1.0
Tudor
DicomViewer
1.3
X
X
X
X
X
X
X
X
X
X
X
X
X
X
(a)
X
(b)
Mutiple monitors
X
Cine
Reference lines
X
X
Series synchronization
X
X
(a): one image at time
X
X
X
X
X
X
(b): need specific plugin
X
Conclusion
Several free software are available, there is not a
perfect one
Onis, Synedra and ClearCanvas stand out, each
one with its own peculiarity
The user has to analyze and select the software
that best fits their needs
The use of free software is entirely feasible for the
radiologist
Conclusion
PET-CT: Mito
On demand: Onis
Thick MIP: Synedra
Big database and more functions: ClearCanvas
PACS server: ClearCanvas, KPACS
Simple PACS client: Tudor, KPACS
Multiple monitors: Tudor, Syndra, KPACS
CD creation: Onis, KPACS
References
Software information
Size
Website
ClearCanvas Workstation 2.0
46 MB
http://www.clearcanvas.ca
KPACS 1.6.0
7 MB
http://www.k-pacs.net/
Onis 2.2
21 MB
http://www.onis-viewer.com
Synedra View Personal 1.0.12.3
57 MB
http://www.synedra.com
Mito 1.0
11 MB
http://amico.icar.cnr.it/mito.php
Tudor DicomViewer 1.3
15 MB
http://santec.tudor.lu/project/optimage/dicom/start
References
Liao W, Deserno TM, Spitzer K. Evaluation of free non-diagnostic DICOM software tools. vol. 6919. SPIE;
2008. Available from: http://spie.org/x648.html?product_id=770431
Zeman RK, Lyshkow H, Garra BS et al. Viewing DICOM-compliant CT images on a desktop personal
computer: use of an inexpensive DICOM receive agent and freeware image display applications. AJR.
1999:172:305-8.
Escott EJ, Rubinstein D. Free DICOM Image Viewing and Processing Software for Your Desktop Computer:
What’s Available and What It Can Do for You. RadioGraphics. 2003:23:1341-57.
Varma DR. Free DICOM browsers. Indian J of Radiol Imaging. 2008;18:12-6
Rosset A, Spadola L, Ratib O. OsiriX: An Open-Source Software for Navigating in Multidimensional DICOM
Images. J Digit Imaging. 2004;17:205-16.
Andrew Crabb. Free DICOM and Medical Image Viewer / Convert Software, Open Source DICOM
Conversion [Internet]. Baltimore, USA; c2002-2010; [revised 2009 Nov 19; cited 2010 Apr 10]. Available
from: http://www.idoimaging.com/
RTstudents.com. Radiology for Students and Professionals [Internet]. USA: c2004-2010; [revised 2009 Nov
19; cited 2010 Apr 10]. Available from: http://www.rtstudents.com/pacs/free-dicom-viewers.htm
Holger Schmuhl: Medical Free/Libre and Open Source Software [Internet]. Munich, Germany; [cited 2010
Apr 10]. Available from: http://www.medfloss.org/
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