Skip to main content

A Survey of DICOM Viewer Software to Integrate Clinical Research and Medical Imaging


The digital imaging and communications in medicine (DICOM) protocol is the leading standard for image data management in healthcare. Imaging biomarkers and image-based surrogate endpoints in clinical trials and medical registries require DICOM viewer software with advanced functionality for visualization and interfaces for integration. In this paper, a comprehensive evaluation of 28 DICOM viewers is performed. The evaluation criteria are obtained from application scenarios in clinical research rather than patient care. They include (i) platform, (ii) interface, (iii) support, (iv) two-dimensional (2D), and (v) three-dimensional (3D) viewing. On the average, 4.48 and 1.43 of overall 8 2D and 5 3D image viewing criteria are satisfied, respectively. Suitable DICOM interfaces for central viewing in hospitals are provided by GingkoCADx, MIPAV, and OsiriX Lite. The viewers ImageJ, MicroView, MIPAV, and OsiriX Lite offer all included 3D-rendering features for advanced viewing. Interfaces needed for decentral viewing in web-based systems are offered by Oviyam, Weasis, and Xero. Focusing on open source components, MIPAV is the best candidate for 3D imaging as well as DICOM communication. Weasis is superior for workflow optimization in clinical trials. Our evaluation shows that advanced visualization and suitable interfaces can also be found in the open source field and not only in commercial products.

This is a preview of subscription content, access via your institution.

Fig. 1






  1. Mildenberger P, Eichelberg M, Martin E: Introduction to the DICOM standard. Eur Radiol 12(4):920–7, 2002

    Article  PubMed  Google Scholar 

  2. Sung NS, Crowley WF, Genel M, Salber P, Sandy L, Sherwood LM, et al: Central challenges facing the national clinical research enterprise. JAMA 289(10):1278–87, 2003

    Article  PubMed  Google Scholar 

  3. Ghosh S, Matsuoka Y, Asai Y, Hsin K, Kitano H: Software for systems biology: from tools to integrated platforms. Nat Rev Genet 12:821–32, 2011

    CAS  PubMed  Google Scholar 

  4. Wang X, Liu BJ, Martinez C, Zhang X, Winstein CJ: Development of a novel imaging informatics-based system with an intelligent workflow engine (IWEIS) to support imaging-based clinical trials. Comput Biol Med 2015. Epub ahead of print.

  5. Haak D, Page C, Reinartz S, Krüger T, Deserno TM: DICOM for clinical research: PACS-integrated electronic data capture in multi-center trials. J Digit Imaging 28(5):558–66, 2015

  6. Deserno TM, Haak D, Brandenburg V, Deserno V, Classen C, Specht P: Integrated image data and medical record management for rare disease registries. A general framework and its instantiation to the German Calciphylaxis Registry. J Digit Imaging 27(6):702–13, 2014

    Article  PubMed  PubMed Central  Google Scholar 

  7. Honea R, McCluggage CW, Parker B, O’Neall D, Shook KA: Evaluation of commercial PC-based DICOM image viewer. J Digit Imaging 11(S1):151–5, 1998

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Horii C: DICOM image viewers: a survey. In: Medical Imaging 2003: SPIE; 2003. (SPIE Proceedings) p 251–9

  9. Nagy P: Open source in imaging informatics. J Digit Imaging 20(S1):1–10, 2007

    Article  PubMed  PubMed Central  Google Scholar 

  10. Liao W, Deserno TM, Spitzer K. Evaluation of free non-diagnostic DICOM software tools. In: Medical Imaging: SPIE; 2008. (SPIE Proceedings) p. 691903–12

  11. Bernarding J, Thiel A, Grzesik A: A JAVA-based DICOM server with integration of clinical findings and DICOM-conform data encryption. Int J Med Inform 64(2-3):429–38, 2001

    Article  CAS  PubMed  Google Scholar 

  12. Hernandez JA, Acuna CJ, de Castro M, Marcos E, Lopez M, Malpica N: Web-PACS for multicenter clinical trials. IEEE Trans Inf Technol Biomed 11(1):87–93, 2007

    Article  CAS  PubMed  Google Scholar 

  13. Luccichenti G, Cademartiri F, Pichiecchio A, Bontempi E, Sabatini U, Bastianello S: User Interface of a teleradiology system for the MR assessment of multiple sclerosis. J Digit Imaging 23(5):632–8, 2010

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Haak D, Page CE, Kabino K, Deserno TM. Evaluation of DICOM viewer software for workflow integration in clinical trials. In: Medical Imaging: SPIE; 2015. p. 94180 (SPIE Proceedings).

  15. Deserno TM, Deserno V, Haak D, Kabino K. Digital imaging and electronic data capture in multi-center clinical trials. Stud Health Technol Inform 216:930, 2015

  16. Bidgood WD, Horii SC, Prior FW, Syckle DE: Understanding and using DICOM, the data interchange standard for biomedical imaging. In: Wong STC Ed. Medical image databases. Springer US, Boston, 1998, pp 25–52

    Chapter  Google Scholar 

  17. Koutelakis GV, Lymperopoulos DK: PACS through web compatible with DICOM Standard and WADO Service: advantages and implementation. In: 2006 International Conference of the IEEE Eng Med Biol Soc. p. 2601-5

  18. DeLano WL: The case for open-source software in drug discovery. Drug Discov Today 10(3):213–7, 2005

  19. Leroux H, McBride S, Gibson S: On selecting a clinical trial management system for large scale, multi-centre, multi-modal clinical research study. Stud Health Technol Inform 168:89–95, 2011

  20. Franklin JD, Guidry A, Brinkley JF: A partnership approach for electronic data capture in small-scale clinical trials. J Biomed Inform 44:103–108, 2011

  21. Lo Presti G, Carbone M, Ciriaci D, Aramini D, Ferrari M, Ferrari V: Assessment of DICOM viewers capable of loading patient-specific 3D models obtained by different segmentation platforms in the operating room. J Digit Imaging 28(5):518–527, 2015

  22. Le Maitre A, Fernando J, Morvan Y, Mevel G, Cordonnier E: Comparative performance investigation of DICOM C-STORE and DICOM HTTP-based requests. In: 2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). p. 1350–1353

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Daniel Haak.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Haak, D., Page, CE. & Deserno, T.M. A Survey of DICOM Viewer Software to Integrate Clinical Research and Medical Imaging. J Digit Imaging 29, 206–215 (2016).

Download citation

  • Published:

  • Issue Date:

  • DOI:


  • Software
  • Evaluation
  • Data capture
  • Integration
  • Interfaces
  • Display