Web-Based DICOM Viewers: A Survey and a Performance Classification.

The standard for managing image data in healthcare is the DICOM (Digital Imaging and Communications in Medicine) protocol. DICOM web-viewers provide flexible and accessible platforms for their users to view and analyze DICOM images remotely. This article presents a comprehensive evaluation of various web-based DICOM viewers, emphasizing their performance in different rendering scenarios, browsers, and operating systems. The study includes a total of 16 web-based viewers, of which 12 were surveyed, and 7 were compared performance-wise based on the availability of an online demo. The criteria for examination include accessibility features, such as available information or requirements for usage, interface features, such as loading capabilities or cloud storage, two-dimensional (2D) viewing features, such as the ability to perform measurements or alter the viewing window, and three-dimensional (3D) viewing features, such as volume rendering or secondary reconstruction. Only 4 of the viewers allow for the viewing of local DICOM files in 3D (other than MPR(Multiplanar reconstruction)). Premium software offers a large amount of features with overall good performance. One of the free alternatives demonstrated the best efficiency in both 2D and 3D rendering but faces challenges with missing 3D rendering features in its interface, which is still in development. Other free options exhibited slower performance, especially in 2D rendering but have more ready-to-use features on their web app. The evaluation also underscores the importance of browser choice, with some browsers performing much better than the competition, and highlights the significance of hardware when dealing with rendering tasks.