1. FILIPE RAMOS BARRA RENATO RAMOS BARRA ALAOR BARRA SOBRINHO Free PACS clients: what is available? HUB/UNB – UNIVERSITY HOSPITAL OF BRASÍLIA, BRAZIL IMEB – IMAGENS MÉDICAS DE BRASÍLIA, BRAZIL filipebarra@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 TomographyMR: 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. SoftwareSelection ClearCanvas WorstationIncluded in the study KPACSIncluded in the study OnisIncluded in the study Synedra View PersonalIncluded in the study MitoIncluded in the study Tudor DicomViewerIncluded in the study DicomScopeDifficulty in utilization MipavDifficulty in utilization Cyclops Medical StationDownload unavailable DicomVistaFree version with a lot of restrictions MedwxComplex installation Table 1 – Free PACS clients found

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  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 reformationMIP: 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.

24. 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 MPRXXX MIPX VRMIPX PACS ServerXX Create CDXX AnonymizeXXXXX Export ImagesXXXX(a) Export VideosXX DICOM ExportXXXX Windows 7XXXXX Image fusionX Comments(b) Mutiple monitorsXXX CineXXXX Reference linesXXX Series synchronizationXX (a): one image at time(b): need specific plugin Table 2 – Software functions

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 SizeWebsite ClearCanvas Workstation 2.046 MBhttp://www.clearcanvas.ca KPACS 1.6.07 MBhttp://www.k-pacs.net/ Onis 2.221 MBhttp://www.onis-viewer.com Synedra View Personal 1.0.12.357 MBhttp://www.synedra.com Mito 1.011 MBhttp://amico.icar.cnr.it/mito.php Tudor DicomViewer 1.315 MBhttp://santec.tudor.lu/project/optimage/dicom/start Software information

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