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

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
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
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
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
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
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
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