The Best Veterinary PACS Software in 2026: A Buyer's Guide

The best veterinary PACS is the one that fits how your practice actually images, reads and shares studies, which is why "best" has a different answer for a two-doctor small animal clinic, a referral hospital with a CT, and a teleradiology group reading for forty practices. This guide sets out the criteria that separate veterinary PACS software in 2026, the questions that expose the differences on a demo, and the fit by practice type. Asteris makes two PACS products, Keystone Omni on premise and NewLumen in the cloud, so the guide is written from both sides of the architecture question rather than from one.

Key facts

• A veterinary PACS (picture archiving and communication system) receives images from modalities by DICOM, stores them, presents them in a diagnostic viewer, and moves them to whoever has to see them next: a colleague, a radiologist, a referring practice or a client.
• Veterinary-specific data handling matters more than it sounds. Species, breed, owner-patient linking and multiple patients per owner are not edge cases in a vet practice, and a PACS adapted from human medicine often handles them badly.
• Cross-sectional imaging is the dividing line in viewers. Radiography works in almost any browser viewer; CT and MRI need multiplanar reconstruction, 3D and synchronised views, which most browser viewers in veterinary medicine do not provide.
• Deployment is a choice between on premise, cloud and hybrid, and each has a legitimate use case. The wrong choice shows up as either an IT burden the practice cannot carry or an outage that stops imaging.
• The ACVR and ECVDI position statement on artificial intelligence, published in JAVMA in March 2025, holds that no commercial AI product currently meets the bar for primary interpretation. A PACS that positions AI as a radiologist's assistant is aligned with the profession's own guidance; one that positions it as a replacement is not.

What a veterinary PACS has to do

Strip away the feature lists and every PACS has five jobs.

1. Receive studies from every modality in the building, whatever the vendor, and file them against the right patient.
2. Store them securely, with backup, for as long as the practice and its regulator require.
3. Display them in a viewer good enough for the work: windowing and measurement for radiographs, reconstruction and 3D for cross-sectional studies, priors alongside the current study.
4. Move them: to a radiologist for a read, to a referring practice, to a specialist, to a client, and back into the patient record with the report attached.
5. Integrate with the practice management system so patients are entered once and charges are captured when the exam is ordered.

Everything below is about how well a given system does those five things for a given practice.

The eight criteria that separate veterinary PACS software

1. Viewer capability, especially for cross-sectional studies

Ask what the viewer does with a CT. Multiplanar reconstruction in sagittal and dorsal planes, adjustable slab thickness, 3D volume rendering with presets, and windowing, zoom and scroll that stay synchronised across views are the minimum for reading cross-sectional work. If the practice only images radiographs today but plans to add CT or ultrasound, choose for where it is going. NewLumen performs multiplanar reconstruction and 3D rendering in the browser with no install; the web-based DICOM viewer guide explains what to test.

2. Hanging protocols and veterinary data handling

A hanging protocol arranges a study the way a particular reader wants it, every time, with priors matched by view. It is used on every study, so it saves more time than any individual tool. Check that protocols are per user and per modality, that priors align right to right and left to left, and that species and breed are first-class fields rather than free text.

3. Deployment architecture

Three options, each with a real use case, covered in detail in our cloud versus on-premise guide. Cloud removes the server and gives access from anywhere. On premise gives local speed, offline operation and full control. Hybrid, an edge node in NewLumen's terms, caches studies locally for speed and outage resilience while the cloud holds the archive. Decide this with whoever answers when the internet goes down.

4. Integrations with the practice management system and teleradiology

Double entry is where a PACS quietly costs a practice money. The integration should send scheduled patients to the modality worklist, attach images and reports to the patient record, and capture the charge when the exam is ordered. For teleradiology, the request should go from inside the PACS with no separate DICOM send, and the report should come back into the record. Keystone Omni's integrations page lists its practice management and teleradiology partners, each with a page describing what the connection covers; the PACS integration guide sets out what to check.

5. Reporting and the radiologist's place in it

Reporting inside the PACS, with templates, speech to text and key images, closes the loop between viewing and the record. If AI features are offered, look at where they sit: tools that draft, measure, triage or compare priors for a radiologist to review are consistent with the ACVR and ECVDI position; anything presented as a read without a radiologist is not, and vendors should be asked for validation data before any such feature touches a case.

6. Security and data ownership

Encryption in transit and at rest, documented backup and recovery, access control with single sign-on and multi-factor authentication for larger organisations, and a plain written commitment that the practice can export its complete archive in standard DICOM if it leaves. That last point is the one most often skipped and most often regretted.

7. Pricing model

Understand what scales the bill. Per-seat licences penalise practices that give every clinician access. Per-server models front-load cost. Per-case pricing, which NewLumen uses, tracks the imaging the practice is already charging clients for. For on premise, Keystone Omni is offered pay as you go with no extended service or annual maintenance fees. Whichever model, ask what happens to the price when volume doubles.

8. Support and migration

Ask who answers the phone at 2am, in your time zone, and whether the vendor migrates historical studies as part of onboarding or charges for it. A PACS that is excellent in the demo and unreachable in an emergency is not the best PACS.

Compare workflows, not feature lists

Feature lists look alike. The differences show up in the moments a practice cannot afford to lose, so define those first and make every vendor demonstrate them:

• An emergency case lands. Images have to load immediately, at peak hours, with several people in the system, not just on the demo laptop.
• The doctor asks for last year's radiographs. Priors should be one click from the current study, with side-by-side views and synced zoom and pan. If priors are slow or awkward, teams quietly stop comparing.
• A study goes to teleradiology. Sending should be simple and tracked, with the history attached and the report coming back onto the case.
• A patient is searched by half a name. Search by patient, owner, ID or visit, filtered by modality and date, without duplicate-patient chaos.
• Something breaks after hours. Who answers, how fast, and what the practice does in the meantime.

Total cost belongs in the same conversation: charges for storage tiers or large studies, fees for extra users, sites or modalities, what integrations cost, whether support is included, and every price that could change in year two.

Best fit by practice type

Small animal general practice. Radiography and ultrasound, occasional referral, no in-house IT. A browser-based cloud PACS with a solid practice management integration and one-click teleradiology requests covers the need. Keystone Community lets the practice send a study for consultation and receive the report without a contract or membership.

Specialty and referral hospital. CT or MRI in house, radiologists and residents on staff, cases arriving from outside practices. The viewer decides it: multiplanar reconstruction, 3D and hanging protocols per reader are non-negotiable, and supervised resident reporting is worth asking about. NewLumen is built for this work, with an edge node where local caching or outage resilience matters.

Teleradiology group or consulting radiologist. Reading for many clinics means one worklist across all of them, routing rules, claim locking, turnaround tracking against SLAs, and billing codes that roll up by client. A single-clinic PACS stretched to remote reading is the wrong tool; NewLumen's teleradiology workflow was built multi-tenant from the start.

Equine and mixed practice. Field acquisition, large studies and sale imaging add requirements of their own, covered in why equine PACS requirements differ. For auction and sale imaging, Keystone Repository handles submission windows, consolidated studies per lot and buyer access.

Multi-site group. Consolidated billing, consistent protocols across sites, single sign-on and role-based access matter as much as the viewer. Ask how many clinics the vendor runs under one account today.

Ten questions to ask on a demo

1. Can we open our own studies, including our largest recent CT, rather than a sample archive?
2. Does the viewer reconstruct sagittal and dorsal planes and render 3D in the browser, and does interaction stay smooth while scrolling with a thick slab?
3. Are hanging protocols per user, and do priors align by view?
4. Which of our modalities have you connected before, and do you support modality worklist?
5. Which practice management systems do you integrate with, and does the integration create charges, not just links?
6. How does a teleradiology request leave the system, and how does the report come back?
7. What runs locally if the internet fails, and for how long?
8. Where is data stored, how many copies exist, and what is the documented recovery time?
9. What is the price at our current volume, and at double?
10. If we leave, how do we get our archive out, in what format, and at what cost?

Common mistakes

• Buying a human-medicine PACS with a veterinary skin. Species, breed and owner-patient structure are not cosmetic.
• Choosing on radiography alone when CT is two years away.
• Ignoring the integration and paying for it in double entry for a decade.
• Not checking DICOM conformance on the modalities. A survey of 488 veterinary studies found only 5.1% fully carried the recommended identification tags, and no PACS fixes tags written wrong at acquisition. Check yours first.
• Skipping the export question until the day it matters.

Frequently asked questions

See it on your own cases

The fastest way to compare veterinary PACS software is to open your own studies in it. Tell us your modalities, practice type and volume and we will set up a demo account with your recent cases. Talk to the team.