Eur Radiol (2006) 16: 1270–1279 DOI 10.1007/s00330-006-0153-1 COMPUTER APPLICATIONS Elmar Kotter Tobias Baumann Dieter Jäger Mathias Langer Received: 27 September 2005 Revised: 18 December 2005 Accepted: 3 January 2006 Published online: 10 March 2006 # Springer-Verlag 2006 Technologies for image distribution in hospitals Abstract After the establishment of web-based image distribution, three challenges for image distribution can be identified today. Firstly, PACS (picture archiving and communication system) and the distribution of radio- logical images and reports need to be integrated with the emerging elec- tronic medical record. Secondly, report and image data should be available on mobile devices like PDAs (personal digital assistants) or smart- phones in the future. Thirdly, future systems must be available not only to transmit sectional images, but also to allow access to three- and four-di- mensional data that are produced by multidetector CT and modern MR scanners. Keywords PACS . Handheld . Volume rendering . Image distribution Introduction While the first picture archiving and communication systems (PACS) were considered as tools for radiologists to be used only within the radiology department, the first systems distributing images to intensive care units [1], followed by distribution to surgical outpatient clinics [2], have rapidly emerged. In the mid-1990s, the first attempts were made to introduce a wider image distribution in the hospital [3–6]. One of the first hospitals to establish hospital-wide image distribution (on a proprietary basis) was the Danube Hospital in Vienna [6]. With better standardisation of image communication protocols and cheaper hardware, non-proprietary image distribution started in the mid-1990s, and rapidly turned to web-based technologies [7–10]. Since the turn of the millennium, hospital-wide image distribution has become a standard technology. However, there are still several challenges. Firstly, image distribution has to cope with the rapidly increasing amount of data that are produced in radiology. Users have to be able to visualise important findings in an easy manner [11, 12]. Secondly, images and reports pro- duced in radiology have to be integrated into the electronic patient record [13–16]. Thirdly, in the near future, modern visualisation technologies will have to be made available to the clinicians, especially in surgical disciplines [11]. After a short introduction about standard image distribu- tion using web technology, we will describe how a state-of- E. Kotter (*) . T. Baumann . D. Jäger . M. Langer Abteilung Röntgendiagnostik, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany e-mail: elmar.kotter@uniklinik- freiburg.de Tel.: +49-761-2703819 Fax: +49-761-2703950