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The best free software solutions for DICOM images

Sometimes it's useful to be able to view and manipulate medical images such as X-rays, CT or MRI scans on your own PC, laptop or tablet.  This is particularly important when preparing teaching files or practising for your radiology exams.  Finding a good free DICOM viewer can be tricky, especially as there are so many options out there.  We have tested may different applications (so you don't have to) and the following are our best picks.  We grouped them according to the operating system used because unfortunately there aren't any free viewers that run on both!

A popular software for radiologists working in the UK is currently a programme called 'Horos'.  This is a free open source version of the software used by the Royal College of Radiologists for the viva part of the Final FRCR 2B exam, so obviously it makes sense to use it for teaching as well.  This programme is only available on Apple computers, hence why so many radiologists own MacBooks.

There is a paid version of Horos called 'OsiriX MD', which is produced by Pixmeo, however it is expensive so not ideal for basic teaching purposes, although has great functionality.  Pixemo also produce a free demo version called 'OsiriX Lite', however there are major limitations placed on this including pop-ups asking you to upgrade to the paid version, performance restrictions, image viewing restrictions and inability to edit the meta-data attached to DICOM images - for example you can't easily re-order series within a study, which may be important if you are preparing cases for teaching or examinations.  It is for these reasons that we do not list OsiriX Lite in our recommendations.

Software for Apple MacOS

Radiology Cafe's top pick:

Main features

• Intuitive user interface and customisable toolbars
• bit
• Advanced manipulation and measurement tools
• Multi-planar reconstruction (MPR) with thick slab (Mean, MIP, Volume Rendering)
• 3D MIP, 3D Volume rendering, 3D surface rendering
• Image fusion for PET-CT & SPECT-CT
• Reads and displays all DICOM files
• DICOM Editing
• OsiriX migration assistant
• Separate iOS app to view DICOM on mobile devices (requires iOS or later)
• more feature details

System requirements

• OS:  MacOS or later

Horos should run on any Mac brought within the last 3 years.

Why we like it

We really like Horos as it is a free open source version of the same software as that used by The Royal College of Radiologists for the viva part of the final FRCR (Part B) exam.  Becoming familiar with Horos will help radiology trainees when preparing for this exam.  Horos is easy to use and as a full bit medical image viewer for Mac there is a huge amount of functionality contained within.  It is updated regularly.  We believe Horos is the best free DICOM viewer for Apple MacOS.

Interestingly, Horos is named after the Egyptian god Horus, son of Osiris and Isis.  Horos is a based on OsiriX (a similar paid-for medical viewer), named after Osiris.  The developers obviously appreciate Egyptian and greek mythology!

Visit the Horos website to download the Horos DICOM viewer!

Software for Microsoft Windows

Radiology Cafe's top pick:

Main features

• Simple and intuitive interface with full-screen mode
• Standard manipulation and measurement tools
• Browse several series concurrently in multiple windows with automatic synchronization between series and cross reference lines in series with different image planes
• Display of dynamic sequences/series (CINE)
• Multiplanar Reconstruction (MPR)
• Fusion of series with different modalities (e.g. PET-CT) or different protocols (e.g. MRI T1/T2–DWI)
• Huge range of DICOM file types supported and support for DICOM overlays
• Export DICOM files to JPEG, BMP and WMV.
• Copy and paste directly into Word or PowerPoint documents
• Read DICOM studies from CD/DVD/BluRay disks and local or network folders
• Asynchronous reading (browse images while they are being opened)
• Multi-core and multi-processor support, and advanced memory management system which facilitates concurrent opening of studies with thousands of images
• Universal installer (32 and bit)
• Multilingual interface (>20 languages)
• Multi-touch support
  more feature details

System requirements

• OS:  Windows 10//8/7/Vista/XP (SP3)
• Processor:  Intel or AMD 1GHz or faster (multicore Intel processor recommended)
• Memory:  MB of RAM (2GB recommended)
• Hard Disk Space:  9MB of available hard-disk space for installation; additional free space required for image caching
• Screen Resolution:  x minimum

Why we like it

We really like RadiAnt as it is free, simple, easy to use and very fast.  Watch this YouTube demonstration video to see RadiAnt in action. It is downloaded as a single compact application with an installer size of approximately 5MB. The application can even run directly from a USB stick!  This basic DICOM viever does all the things you would expect and is perfect for revision purposes for radiology trainees.

Visit the RadiAnt website to download the RadiAnt DICOM viewer!

Radiology Cafe's one to watch:

Main features

• Designed mainly for CT and MR DICOM modalities
• 3D reconstruction and volume rendering
• Multi-planar and oblique slicing
• Easily anonymize and de-identify patient scans
• Fast surface extraction and export to STL and PLY formats
• Load DICOM data directly from PACS, CD/DVD, USB or local computer
• Patient search to locate patient data on your PACS
• Loads common non-DICOM file formats: NifTi (.nii), Visualization Toolkit (.vtk), and ANALYZE (.hdr)
• Window/level (brightness and contrast) presets
• Screen capture
• Axis-aligned cropping with context
• Side-by-side comparative assessment
  more feature details

System requirements

• OS:  Windows 10/
• Processor:  Intel i3 or AMD Ryzen 3 (bit CPU for data sizes over MB)
• Memory:  8+ GB of RAM
• Hard Disk Space:  1GB of available hard-disk space for installation; additional free space required for image caching
• Screen Resolution:  x or better

Why we like it

We like Pro Surgical 3D as it is fast and easy to use.  Although it is designed for surgeons, it's easy to view patient scans quickly.  It works well with studies on CD/DVDs, USB sticks and local DICOM files.

Visit the Pro Surgical 3D website to download the Pro Surgical 3D DICOM viewer!

Online Software

Radiology Cafe's top pick:

Main features

• Free 50GB cloud space to store medical images and clinical documents
• Multi-platform (Windows, MacOS, Linux, IOS, and Android) Support
• Upload, store and view DICOM files
• Upload, store and view non-DICOM clinical documents which are in PDF, BMP, PNG, JPG, MP4 and AVI formats
• Automatic synchronization of compatible series with showing cross-reference lines
• Standard measurement tools
• Ability to anonymize patient data before uploading
• Share patient images with doctors, medical groups, and patients by sending a viewing link and password
• Organize patients into folders and enter custom descriptions to them
• Multiplanar Reconstruction (MPR)
• Maximum Intensity Projection (MIP), Minimum Intensity Projection (MinIP), Average Intensity Projection (AvgIP)
• 3D Reconstruction
• PET-CT, and PET-MR fusion
• Create user groups and manage user Authorizations
• Recycle Bin to prevent accidental deletion
  more feature details

System requirements

• The following operating systems and internet browsers are supported:
  • Windows:  Google Chrome, Mozilla Firefox
  • Mac OS:  Apple Safari, Google Chrome
  • Linux:  Google Chrome
  • iOS:  Apple Safari
  • Android:  Google Chrome

Why we like it

We really like PostDICOM as it is free (up to 50GB online storage), simple, easy to use and fast once the DICOM images are uploaded.  As it is cloud based, you can access it on pretty much any device.  This DICOM viever does all the things you would expect and is great for sharing studies.

Visit the PostDICOM website to use the PostDICOM viewer!

Radiology Cafe's alternative recommendation:

Main features

• Unlimited cloud storage space to store medical images
• Multi-platform (Windows, MacOS, Linux, IOS, and Android) Support
• Upload, store and view DICOM files
• Fast Cloud DICOM imaging loading
• Automatic synchronization of compatible series with showing cross-reference lines
• Standard measurement tools
• Multiplanar Reconstruction (MPR)
• View DICOM metadata
• Share, tag and comment on cases with other professionals
• Enter custom descriptions to cases
• WebGL browser rendering
• PACS integration using the Collective Minds® Proxy
• One click case upload using the Collective Minds® Proxy
  more feature details

System requirements

• The following operating systems and internet browsers are supported:
  • Windows:  Google Chrome, Mozilla Firefox
  • Mac OS:  Apple Safari, Google Chrome
  • Linux:  Google Chrome
  • iOS:  Apple Safari, Google Chrome
  • Android:  Google Chrome

Why we like it

We really like Collective Minds Radiology as it is a bit different to other sites. It's a radiology collaboration service and centered around sharing cases with other professionals for expertise, advice or teaching.  It is free with unlimited storage, easy to use and fast.  As it is cloud based, you can access it on pretty much any device.  The service is restricted to medical professionals and sharing can be done to specific groups e.g. your hospital community.  The ability for users to comment and tag images is particularly unique and great for learning and teaching.

Visit the Collective Minds website to use the Collective Minds Radiology viewer!

So there you have it!

Radiology Cafe's 'top pick' and 'one to watch' free DICOM viewers for Microsoft Windows, Apple MacOS and online.  Please send us your suggestions for other great free DICOM viewers!

Nowadays Many doctors and medical professionals prefer Mac OSX, Though finding medical open source/ free professional software is not easy task, which forces many users into commercial solutions, That's ok if the user is located a country with such software service provider as US, but for other countries MacOSX  software market is not that friendly so as medical software service providers which push their product into certain countries.

In this article we have collected the best DICOM viewers for Mac OSX, starting with the native ones that uses Apple's native programming languages, libraries, and frameworks, then we proceed to the cross-platform projects.

If you are looking for iOS (iPhone/ iPad) DICOM/ PACS Viewers, We have covered the most used free DICOM/ PACS Viewers for iOS in this:

Open Source Free DICOM Viewers and PACS Workstations for macOS

1- Horos: Native DICOM viewer for macOS

Horos is a native macOSX DICOM viewer.  Horos is the only DICOM viewer in this list that comes with comprehensive tutorials, training courses and full functional enterprise-ready cloud platform. As Horos is a native macOSX app expect the best performance regarding speed, and compatibility with the older/ newer versions of macOSX versions.

Horos features

Horos comes with advanced DICOM displaying features including many manipulation and measurement tools, 3D surface rendering, image fusion for PET-CT/ SPECT-CT.  It comes with OsiriX migration assistant tool which makes it easy for doctors to migrate their docs/ configurations from OsiriX to Horos with ease.

Horos project is a free open source project that released under LGPL V

2- Miele-lxiv: Free Native Open source DICOM workstation  

Miele-LXIV   is an open source/ free DICOM workstation that built on OsiriX. I comes with multi-languages support ( English, German, French, Chinese, German, Italian, Japanese, Spanish).

Features

Miele-lxiv features include exporting DICOM images to multiple formats including still images (JPEG, PNG), It has simple native look and feel for macOSX that integrates DICOM display options seamlessly with the interface.  It supports all DICOM formats, DICOM metadata, writing to DICOM CD/DVD and supports many PACS/ DICOM networks.

The viewer supports 2D with multiple view layouts, 3D rendering including 3D surface and volume rendering, and 3D exports to Quicktime videos or still images.

Miele-lxiv has many Hardware acceleration improvements for mac OSX which includes:

• Multi-threaded for multi-processors and multi-core processors support
• Asyncronous reading
• OpenGL for 2D Viewer and all 3D Viewers
• Graphic board accelerated, with 3D texture mapping support

It was upgraded this month to support macOSX Mojave with the dark mode as it supports many macOSX versions as macOS to later versions.

Miele-lxiv was released first under OsiriX-lxiv by Alex Bettarini a freelance software engineer from Italy.

Miele-LXIV @ iTune Appstore

3- mRay

mRay is a free DICOM viewer program created by a german company that released it for Mac OSX other platforms. mRay provides PACS compatibility to many PACS platforms,  which makes it easier for hospitals with different radiology stack to adapt it.

Features

mRay supports viewing most of the DICOM modalities (like: computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), fluoroscopy (XA), digital x-ray (CR), ultrasound (US) ) , It comes with usable clean user-interface, packed with advanced query/ retrieve options.

mRay is not just for macOSX it is also supports iOS platforms ( iPad/ iPhone), Windows platforms and Android devices which makes it portable to ease the work for radiologists and save time.  Though mRay is built for the enterprise, Its not totally free, it requires mRay Server to be able to use mRay with PACS, mRay Server can be installed for free and used for an evaluation period.

4- 3Dim Viewer

3Dim Viewer is a  free lightweight DICOM viewer by a company from Czech Republic that released it for free under Apache License V  It is written in C++ and uses Qt library.

Features

3Dim Viewer basic features: 3D visualization of volumetric medical images,  Multiplanar and orthogonal XY, XZ and YZ views, Adjustable density window, Density and distance measuring, DICOM dataset import., Volume rendering using shaders running on NVidia and ATI graphic cards, Tissue segmentation based on thresholding, Surface modeling of any segmented tissue, and 3D surface rendering.

The most important feature for 3Dim viewer is hardware rendering as using graphic cards to render high detailed 3D images with shaders with makes it the best choice for researchers, and radiologists who wanna use advanced 3D rendering with gaming-grade gears like Nvidia and ATI cards.

5- Weasis DICOM viewer

Weasis is a multipurpose standalone desktop and web DICOM viewer project, that is released to provide PACS-ready support that works on many platforms as macOSX, Windows and Linux.

Weasis is aiming to provide a complete integrated open source solution for hospital information systems (HIS), and Radiology Information Systems (RIS).

On technical note Weasis uses OpenCV, the open source computer vision library that provides real-time processing with best performance as it was built with C/ C++.

Weasis requires Java to run on macOSX and other platforms (Windows, Linux), for the new macOSX versions it requires disabling GateKeeper to run.

6- Amide

AMIDE is an open source DICOM viewer that works for MacOSX/ Windows and Linux.  I have used Amide for years on Linux, It has an amazing performance on almost all platforms including mac OSX/ Windows, all are in true Libre/ open source packed.

AMIDE DICOM viewer has advanced enterprise-grade viewing features with measurement and manipulation tools. It imports the modern DICOM files, raw data files and legacy DICOM files without issue. AMIDE supports images file exports in multiple formats and video format as Fly-through-movie can be generated as MPEG1 video file.

7- Ginkgo CADx

Ginkgo CADx is an advanced DICOM viewer and dicomizer (converts png, jpeg, bmp, pdf, tiff to DICOM).

Ginkgo CADs is an open source DICOM viewer that supports many desktop environments including mac OSX, Windows (PC), and Linux. It provides .dmg (disk image file) that contain the compiled application.

Ginkgo supports many DICOM modalities and file manipulation tool that supports DICOM files conversions to still images. Note that Ginkgo has not been updated since 3 years so it may not be compatible with the new releases of macOSX.

8- Open DICOM viewer (JAVA)

Open DICOM viewer is a lightweight cross-platform application to display/ view DICOM images in a web page or CD/ DVD.   It's built with Java so it works on mac OSX, Windows and Linux but requires Java to work. Though it was not updated since but it works great and getting thousands of download hits every month.

9- Dicompyler

Dicompyler is a lightweight  extensible open source radiation therapy research platform based on the DICOM standard. It also functions as a cross-platform DICOM RT viewer.

Dicompyler was written in Python which makes it run smoothly on other platforms as MacOSX, Linux (Debian, Ubuntu, Fedora, OpenSUSE), and Windows.

Dicompyler imports many DICOM modalities display them with 2D image viewer , It has a plugin system that allow developers to extend its functionalities by building their own plugins

For the new versions of macOSX as and above it has to bypass GateKeeper to run.

SMILI

SMILI (Simple Medical Imaging Library Interface) is a DICOM library/ program that contains a large set of functionalities to process, convert DICOM files. It is built to work on all known platforms including Mac OSX, Linux and Windows.

Features:

DICOM image processing, surface processing, DICOM viewer with measurement tools and advancing display options, Surface/Model Visualisation, anonymizing tool to remove the sensitive data, shape modelling and analysis, animation for surfaces, and n-D Image Visualisation.

SMILI's UI is built with Qt library, but it provides a command-line interface as well for experienced users, which can take advantage of extending its default functionalities with python scripting.

SMILI is the development-ready framework for building a features-rich DICOM viewer/ workstation.

SMILI uses several powerful open source libraries and frameworks like: Qt for the interface, Insight Toolkit (ITK), and Visualization Toolkit (VTK).

DICOM Image Reader

DICOM Image Reader is a DICOM viewer that built with Web technologies: JavaScript, HTML5, NodeJS that packed in a desktop application using Electron Framework. It can open, read DICOM files (.dcm) files with ease as they load into the viewer which comes with image manipulation tools contrast, zoom, drag, and filters.

DICOM Image Reader has a disk image (.dmg) file that contain the application for MacOSX, It also provides Windows executable and Linux ready files.

InVesalius

InVesalius  Is a free open source 3D medical imaging reconstruction that generates a 3D image from a sequence of 2D DICOM images (CT or MRI). It works for Windows, Linux, & macOS. The project is in active development since , to fulfill the demand for a medical imaging solution for Brazilian hospitals and clinics.

Read more about InVesalius in here

Conclusion:

The most compatible macOSX native DICOM apps I would recommend are: Horos and Miele-lxiv as both are mac Native apps and open source. Horos is providing training and  comprehensive documentation for its users as it has growing community of users and doctors including developers and researchers. However, I would recommend 3Dim Viewer for its better 3D capabilities. If you are a developer and looking to build your own DICOM system that integrates with RIS or HIS Weasis and SIMLI are the best choice, I would go for Weasis  as they provide multi-platform support, and it's in fairly new with active development and support.

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