FILIPE RAMOS BARRARENATO RAMOS BARRA

ALAOR BARRA SOBRINHO

Free PACS clients: what is available?

HUB/UNB – UNIVERSITY HOSPITAL OF BRASÍLIA, BRAZILIMEB – 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 ResonancePACS: 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

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

Table 1 – Free PACS clients found

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, on-board 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

MPR MIP VR Image fusion Series synchronization Reference lines Add comments Cine

Use of multiple monitor PACS server Create CDs Anonymize studies Export in JPG, BMP e

DICOM Windows 7

compatibility

Functions evaluated were:

MPR: multiplanar reformation MIP: maximum-intensity projectionVR: volume rendering

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 CDsCan work as a PACS serverThere 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 analyzedIncompatible with Windows 7Buttons are big and inferiorly placedCan work as a PACS serverAllows 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 softwareNumber of patients in database is limited to

15On demand capability (can open DICOM files

directly from the server or CD without downloading them)

Performs MPR, oblique MPR and 3D-MIPCreate CDs with built-in viewerVery 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 clientDifferent interface with buttons placed

inferiorlyISO 9001 and ISO 13485 certificatesPerforms MPR, MIP and min-MIP with the

possibility to increase thicknessMajor 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 softwareIt is the only one able to perform image

fusionAlso performs VR and MIPCompared 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 functionsRequire Java Runtime Environment

instalationDoes not perform MPR, MIP or VREnable the use of 3 monitorsCan be integrate with ImageJ, increasing its

functions

Tudor Dicom Viewer screen capture. Two series are shown. Note that there is no reference line.

ClearCanvas Workstation

2.0

KPACS 1.6.0

Onis 2.2

Synedra View Personal 1.0.12.3

Mito 1.0

Tudor DicomViewe

r 1.3

MPR X X X

MIP X

VR MIP X

PACS Server X X

Create CD X X

Anonymize X X X X X

Export Images X X X X (a)

Export Videos X X

DICOM Export X X X X

Windows 7 X X X X X

Image fusion X

Comments (b)

Mutiple monitors X X X

Cine X X X X

Reference lines X X X

Series synchronization X X

(a): one image at time (b): need specific plugin

Table 2 – Software functions

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: MitoOn demand: OnisThick MIP: SynedraBig database and more functions:

ClearCanvasPACS server: ClearCanvas, KPACSSimple PACS client: Tudor, KPACSMultiple monitors: Tudor, Syndra, KPACSCD creation: Onis, KPACS

References

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

Software information

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/