Feature | May 04, 2015 | Jeff Zagoudis

Remote Image Viewing Systems Head Toward Zero-footprint

This article appeared as an introduction to a Comparison Chart on Remote Viewing Systems in the May 2015 issue.

As the saying goes, sometimes less is more — a maxim that is proving true in the world of medical imaging as remote viewing systems continue to advance. While some manufacturers are still utilizing software-based systems for reading and sharing imaging data, many are embracing browser-based models, otherwise known as zero-footprint viewers. You can view the Remote Viewing Systems comparison chart here.

The reasons for the shift toward zero-footprint viewing systems are numerous. First and foremost they are, in many ways, the gateway to the new patient-centered world emerging in U.S. healthcare. The shift has been a slow, often painful one, as the radiology departments of hospitals feature a mosaic of equipment from different vendors; hospitals are having to find ways for all of these disparate elements — including scanners, picture archiving and communications system (PACS) and electronic medical records (EMR) — to work together to improve workflow and interconnectivity, both within the hospital and between different hospitals. 

In addition, the browser-based nature of the systems means that any updates are handled completely on the vendor’s end, and all subscribers receive them automatically and simultaneously. This scenario eliminates financial and time costs from the end user’s considerations. 

One For All

Remote viewing systems help forge this connection by providing a neutral interface through which various imaging platforms can communicate with each other. In some ways, they are an extension of vendor neutral archives (VNA), which provide a centralized storehouse for all imaging data. Instead, the remote viewer will most often provide a link to a patient’s EMR, where the user will be able to view and/or download the image or series of images they desire. 

Key to working these exchanges is being able to translate between DICOM (Digital Imaging and Communication in Medicine) and non-DICOM data, as some imaging systems have yet to embrace the pervading standard. Agfa’s Enterprise Imaging Xero Viewer, for example, allows multimedia uploading of both image types directly into the patient’s EMR, guiding the user to create calibrated reference measurements for the non-DICOM objects that don’t already contain such.1 The system debuted at the 2014 Radiological Society of North America (RSNA) annual meeting.

Brit Systems’ QC (quality control) module for the WebWorks remote viewer operates on the emerging Imaging Object Change Management (IOCM) standard. Under the IOCM protocol, any updates or changes made to images in the QC module are automatically made to the original image file in each place it is stored, ensuring consistency across the network.2

Viewing On the Go

By now, the vast majority of people, including healthcare professionals, own a smartphone, tablet or both. These mobile devices are opening the possibility for doctors, radiologists and the rest of the medical team to treat their patients whenever and wherever they are — be it another hospital, a conference or even at home. This includes expanded access to medical images. 

Fujifilm’s Synapse Mobility 3.0 is one such viewing system that is fully integrated for mobile devices. Through their device of choice, users have full access to diagnostic images in any Synapse PACS or RIS (radiology information system) network.3 Calgary Scientific added mobile compatibility to version 5.0 of its ResolutionMD viewing system, while still offering precision measurement capabilities on the smaller screen.4 And Siemens launched the syngo.via WebViewer mobile app in late 2014, allowing users of its syngo.via PACS to access their stored images from anywhere.5

As the technology continues to evolve, vendors are beginning to push the limits of what’s possible with mobile devices. Version 4.0 of Claron’s Nil reader, for example, includes advanced visualization capabilities such as an automated vessel analysis package (for investigational use only), which can automatically separate vessels from bones in a computed tomography (CT) angiography study while identifying and naming specific vessels.6 

A side benefit of the mobile revolution is the ability to increase patient engagement, as they often have many of the same devices. Two-way patient engagement is a critical component of Stage 2 Meaningful Use requirements, which aim to facilitate expanded use of EMRs as a means for moving toward more patient-centered care.7 

Jack Of All Trades

Beyond traditional viewing and sharing capabilities, several remote viewing systems are now offering more advanced functionalities to further improve workflow. The latest edition of Carestream’s Vue RIS features a built-in scheduling module for future imaging exams; users can schedule thousands of exams simultaneously by establishing specific criteria (ex: “all women in the system between the ages of 40 and 60 who have not had a screening exam in the last 12 months”). Once the criteria are determined, the system will automatically send an e-mail reminder to all patients fitting those criteria.8 

Viewers are also helping to facilitate greater communication between healthcare professionals, and not just through sharing of images. Agfa introduced a series of chat and share services into its Enterprise Imaging Xero Viewer. Users are now able to connect to each other through voice, text or video messaging directly in the application, allowing doctors to consult with each other while both looking at the same images simultaneously. Note-taking is also becoming voice-enabled as well, thanks to dictation features like in Calgary Scientific’s ResolutionMD 5.0. 

These capabilities, along with increasing mobile integration and one-size-fits-all interoperability, will continue to drive the utility of remote viewing systems in the transforming worlds of healthcare and radiology.


1. “Agfa to Show Latest Enterprise Imaging Xero Viewer at RSNA 2014,” www.itnonline.com, Nov. 21, 2014. Accessed March 22, 2015.

2. “WebWorks QC Corrects Studies with Emerging IOCM Standard,” www.itnonline.com, Dec. 30, 2014. Accessed March 22, 2015. 

3. “Fujifilm Synapse Mobility 3.0 Now Available in the United States,” www.itnonline.com, June 14, 2012. Accessed March 24, 2015.  

4. “Calgary Scientific Launches ResolutionMD 5.0,” www.itnonline.com, Feb. 19, 2015. Accessed March 12, 2015.

5. “Siemens Mobile Viewing App Now Available for syngo.via Users,” www.itnonline.com, Nov. 10, 2014. Accessed March 25, 2015. 

6. “Claron Debuts Diagnostic Imaging Foundation for PACS 3.0 at RSNA 2014,” www.itnonline.com, Dec. 23, 2014. Accessed March 22, 2015. 

7. Fornell, D. “Understanding Remote Image Access Systems,”
www.itnonline.com/article/understanding-remote-image-access-systems. Accessed March 13, 2015. 

8. “Carestream Introduces Upgrades to Vue RIS Platform,” www.itnonline.com, Nov. 10, 2014. Accessed March 23, 2015. 

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