Filipe Ramos Barra

1
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_at_gmail.com
2
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

3
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
4
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
5
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

6
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

7
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

8
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
9
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

10
Materials and Methods
Functions evaluated were

• Use of multiple monitor
• PACS server
• Create CDs
• Anonymize studies
• Export in JPG, BMP e DICOM
• Windows 7 compatibility

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

MPR multiplanar reformation MIP
maximum-intensity projection VR volume
rendering
11
Results
12
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
13
ClearCanvas Worskstation creen capture. Two
series are displayed. Reference line and spatial
location are shown (arrow head) and a ROI in
thyroid (arrow)
14
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

15
K-PACS screen capture. Buttons are big and
inferiorly placed
16
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

17
Onis screen capture showing MPR function. It is
possible to choose plane of view (arrow) and
layout (arrow head)
18
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

19
Onis screen capture showing MPR function. Slice
thickness were changed to 25mm. Buttons are
inferiorly placed (arrow head)
20
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

21
Mito screen capture. A PET-CT is shown with a
hot area on patient neck (arrow)
22
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

23
Tudor Dicom Viewer screen capture. Two series
are shown. Note that there is no reference line.
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Table 2 Software functions
ClearCanvas Workstation 2.0 KPACS 1.6.0 Onis 2.2 Synedra View Personal 1.0.12.3 Mito 1.0 Tudor DicomViewer 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
25
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

26
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

27
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
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