Top 10 Best Pacs Medical Imaging Software of 2026

Orthanc is a free, open-source, lightweight DICOM server designed as a mini-PACS for medical imaging, enabling efficient storage, routing, and retrieval of DICOM files across modalities. It features a full REST API for easy integration with web applications, databases, and third-party tools, making it highly extensible through a rich plugin ecosystem including web viewers like OHIF and Stone. Ideal for bridging imaging devices in research, telemedicine, or small clinics, Orthanc supports DICOMweb standards and runs on minimal hardware with cross-platform compatibility.

dcm4chee, built on the dcm4che DICOM toolkit from dcm4che.org, is a mature open-source PACS (Picture Archiving and Communication System) designed for storing, managing, and distributing medical images compliant with DICOM standards. It features a high-performance archive (dcm4chee-arc-light), web-based viewers, and supports advanced workflows like MPPS, storage commitment, and integration with HL7 FHIR/RIS/HIS systems. Highly scalable for enterprise use, it excels in query/retrieve operations, AI model integration, and distributed deployments via Docker/Kubernetes.

OsiriX is a powerful DICOM viewer and PACS workstation exclusively for macOS, enabling radiologists to view, manipulate, and analyze medical images from various modalities like CT, MRI, PET, and ultrasound. It supports PACS integration for querying, retrieving, and sending studies, with advanced tools including multi-planar reconstruction (MPR), 3D/4D rendering, and image fusion. The software offers a free Lite version for research and education, alongside a paid MD version cleared for clinical diagnostic use.

Horos is a free, open-source DICOM viewer and medical imaging workstation for macOS, forked from OsiriX, designed for radiologists and clinicians. It excels in viewing, processing, and analyzing 2D, 3D, and 4D medical images with tools for segmentation, fusion, and advanced reconstructions. As a PACS client, it supports querying, retrieving, and sending studies to PACS servers but lacks native server-side archiving or full enterprise PACS functionality.

OHIF Viewer is an open-source, web-based medical imaging platform designed for viewing, analyzing, and manipulating DICOM images with zero-footprint deployment. It supports advanced features like multi-planar reconstruction, hanging protocols, measurements, annotations, and image fusion, making it suitable for integration into PACS workflows or standalone clinical use. As a highly extensible solution, it powers many enterprise-level imaging applications through its plugin architecture.

3D Slicer is a free, open-source software platform for medical image informatics, visualization, and analysis, supporting DICOM import/export and advanced processing workflows. As a PACS-adjacent tool, it excels in 3D reconstruction, segmentation, registration, and quantitative analysis but lacks native enterprise-level archiving, multi-user access, or seamless HL7/PACS server integration without extensions. It's widely used in research and clinical settings for tasks beyond basic storage and retrieval, such as surgical planning and radiotherapy.

RadiAnt DICOM Viewer is a lightweight, high-performance Windows-based DICOM image viewer tailored for medical professionals to view, process, and analyze 2D/3D medical images from CT, MRI, ultrasound, and other modalities. It supports advanced visualization tools like MPR, MIP, VR, and cine playback, while offering PACS connectivity for querying (C-FIND), retrieving (C-MOVE/C-GET), and basic database management of local studies. Though not a full server-based PACS system, it excels as a client-side solution for efficient image review and manipulation.

Weasis is an open-source, web-based DICOM viewer and PACS client that enables healthcare professionals to view, analyze, and manipulate medical images directly in a browser without requiring desktop installations. It supports integration with various PACS systems like Orthanc and dcm4chee, offering tools for measurements, annotations, hanging protocols, and report generation. As a lightweight solution, it excels in zero-footprint deployment for remote access to imaging studies.

Ginkgo CADx is an open-source, cross-platform DICOM viewer and workstation designed for medical imaging professionals, supporting comprehensive viewing, annotation, and analysis of radiology images. It functions as a PACS client with capabilities for querying, retrieving, and archiving studies from PACS servers, alongside advanced tools like multi-planar reconstruction (MPR), 3D volume rendering, and fusion imaging. The software emphasizes extensibility through a plugin architecture, enabling custom CAD (Computer-AI ded Detection) modules for enhanced diagnostic workflows.

MicroDicom is a lightweight, free DICOM viewer for Windows primarily designed for viewing, annotating, measuring, and converting medical images from various modalities. It supports basic DICOM operations like fusion, 3D rendering (in advanced modes), and simple image sharing via a built-in server. While positioned as a PACS solution, it excels as a personal viewer but falls short on enterprise archiving, workflow integration, and multi-user scalability.