Despite high adoption rates and a myriad of choices, the complexity of many medical software systems can frustrate even the most technologically literate provider.
Interoperability woes can make it difficult to share and view medical images from disparate systems, especially if providers are using outdated EMR software or don’t have a Picture Archiving and Communication System (PACS). As medicine moves towards a film-less future, providers must have the software tools necessary to share, view, or edit medical images. To accomplish this, many providers are choosing standalone DICOM viewers.
DICOM stands for Digital Imaging and COmmunications in Medicine. It is an international standard file format and network communications protocol developed by the American College of Radiology (ACR) specifically for medical imaging. Most EHR systems support the DICOM standard for viewing and transmitting images. If you can already view DICOM images within your EHR, you likely won’t require a standalone viewer. However, if your system doesn’t support DICOM, you’re having difficulty communicating with a PACS or RIS system, or if you don’t have PACS/RIS access — or even EHR at all — a free DICOM viewer will help you get started viewing images.
The following systems can help you securely view, edit, and share DICOM images. Some offer paid versions intended for commercial applications, which usually include increased functionality — or at least won’t remind you constantly that you’re using a trial version. The software below is listed in no particular order, and represents some of the better systems on the market. (If we’ve left your favorite system off of our list, let us know in the comments.)
A smooth, minimalist graphical user interface makes 3DimViewer easy to use and learn. It’s capable of displaying 3D imaging profiles, including multi-planar and orthogonal displays, but it’s specialty is both volume and surface renderings with thresholding-based tissue segmentation. GPU acceleration is necessary for volume rendering, so don’t try to use this on older computers, or even many newer models with integrated graphics chipsets. Native installers are available for Macintosh, Windows, and Linux-based platforms, making it one of the more flexible systems available. It is also open-source, meaning your developers (if you have them) can use the publicly available C++ code to integrate with it with other programs, or otherwise customize your system. It is a view-only solution — there’s no native editing beyond simple brightness, contrast, etc. Installers for Macintosh and Windows 32 and 64-bit systems are available here — Linux users will have to go to SourceForge.
One of the most advanced systems on our list, Mango — or Multi-image Analysis GUI — is available in three versions, for Windows, Macintosh, or Linux desktops, browser, or iPad. The browser version does require some coding, so you’ll need some development to use it. Developed by Jack Lancaster, Ph.D. and Michael Martinez at the University of Texas Health Science Center’s Research Imaging Institute, Mango supports DICOM, NEMA-DES, MINC, and NIFTI image formats, VTK, GIFTI, and BrainVisa surface rendering formats. It even can create custom imaging formats and filters. It offers a host of analysis, processing, and editing features, and can convert, anonymize, and register images. It offers more functionality than many commercial systems, thanks to initial and ongoing support via grants from the National Institute of Mental Health and the National Institute of Biomedical Imaging and Bioengineering.
Available for both Windows and Macintosh, EMV is a lightweight DICOM viewer that can open most DICOM images and DICOMDIR files from CD/DVD, flash drives, etc. It can access WADO PACS systems to retrieve studies as well. It can handle user objects, like annotations and measurements, and is available in English, French, Italian, Spanish, and Portuguese versions. It does offer anonymizing capabilities, can export images, and the viewer offers various displays, overlays, filters, marking, and colorizations. It does require QuickTime to work, and while you can download and demo the software for free, using it in a commercial environment requires a €245 license for up to three computers.
Yes, that IrfanView, the simple free image viewer you may have downloaded in the early 90s to view .gifs, .tiffs, and other image files now supports DICOM viewing. It is provided as freeware for non-commercial use, so if you want to use it in your medical practice you’ll need to register it and pay a one time, $12 licensing fee, but if all you want is a lightweight program to view simple DICOM images on your Windows desktop, IrfanView is hard to beat.
This is not intended to be a comprehensive list — there are hundreds, if not thousands of software solutions for viewing, editing, and otherwise manipulating DICOM and other medical imaging formats. An ideal DICOM viewing platform would involve access to an in-house or networked PACS server at the radiology center of your choosing, but we recognize that many physicians are not operating under ideal circumstances.