In veterinary practices, there is rising demand for DICOM-viewer software, based on the spread of digital diagnostic imaging. Veterinary practitioners are often not extensively trained in diagnostic imaging, but commonly need to diagnose animal diseases using medical imaging software. These studies commonly focused on imaging research, image processing, and human medicine and the software was evaluated by imaging or software experts or radiologists. Various surveys assessed freeware and open-source software. An open-source PACS in combination with free DICOM-viewers allows a low-cost digital imaging environment. ![]() Medical imaging freeware from the internet can solve the discrepancy between financial restriction and the need for appropriate technical solutions. Officially approved medical device software for use in human medicine is commercially available but often expensive and not profitable for veterinarians. This also applies for hardware like computer screens used for diagnostic purposes. In most countries, the use of DICOM-viewer software for diagnostic imaging in animals does neither require regulatory medical device approval nor legal licensing, according to the authors’ knowledge. In the European Union, the European Commission is responsible for European legislation and regulates medical devices by Council Directives. In the USA, the Department of Health and Human Services of the Food and Drug Administration regulates radiology devices (Part 892) by the Code of Federal Regulations (21CFR892). For human use, medical imaging software commonly requires medical device approval by national authorities. Single-veterinarian practices and small veterinary clinics have limited financial resources for picture archiving and communication systems (PACS) and medical imaging software. DICOM-viewers are medical software for the display of DICOM image files on computer monitors. DICOM is an open cooperative standard to transmit medical imaging data. The use of self-contained viewer on CD can be cumbersome and can also cause technical problems. Various clinics use different viewer software. Even practices that continue to work with conventional film radiography regularly need to handle digital diagnostic imaging media from other veterinarians, commonly DICOM-data of imaging studies on compact discs (CD). As a consequence, there is increasing exchange of DICOM (Digital Imaging and Communications in Medicine) data among veterinarians. Today, the replacement of conventional hard copy films by digital radiography has reached small veterinary practices. In medicine, the prevalence of digital diagnostic imaging involved a change in workflow. In combination with PACS-freeware, this allows veterinary practices to run a low-budget digital imaging environment. Based on the results of this study, veterinarians will find suitable free DICOM-viewers for their individual needs. An increasing number of tools did not necessarily impair user-friendliness, if the user interface is well designed. The DICOM-viewers offered between 20 and 44 tools of the predefined important tool set and are sufficient for most veterinary purposes. The ranking based on functionality and user-friendliness of 14 core tools (mean score in brackets) was as follows: 1. For each viewer, the total number of a predefined set of 47 important tools was counted. ![]() ![]() Criteria were functionality and user-friendliness. In these DICOM-viewers, 14 core tools were tested and rated on a score from 1 to 10 by multiple observers with different levels of training, using studies of four imaging modalities. Based on this, eight viewers were found: Ginkgo CADx, Horos, K-PACS, MAYAM, MITO, OsiriX Lite, RadiAnt, Synedra personal. Inclusion criteria for the evaluation were free availability, PACS (picture archiving and communication system)-connectivity, and stand-alone and client-based software. ![]() The functionality and user-friendliness of various DICOM-viewers from the internet were analyzed and compared. The aim of this study was to identify and evaluate free DICOM-viewer software for veterinary purposes. As Digital Imaging and Communications in Medicine (DICOM)-viewers for veterinary use do not require medical device approval in many countries, freeware viewers might be a practical alternative. There is increasing prevalence of digital diagnostic imaging in veterinary medicine with a progressive need to use medical imaging software.
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