Introduction
When evaluating PACS systems for vets in 2026, practices face a fundamentally different landscape than just two years ago. Recent market consolidation, combined with the rise of vertically integrated diagnostics platforms and new AI capabilities have shifted the evaluation criteria that matter most. The right PACS system should handle unlimited concurrent users, integrate with your existing practice management system, and provide true DICOM compliance rather than basic image viewing capabilities. Most importantly, your chosen system should remain stable and vendor-independent as the imaging market continues to consolidate around major players.
Key Facts
- Keystone PACS (a veterinary-specific PACS platform built by Asteris) offers unlimited user seats with flat-rate pricing, eliminating per-seat cost penalties as practices grow.
- Modern veterinary PACS platforms must support full DICOM compliance including structured reporting, worklists, and modality integration rather than simple image viewing.
- Cloud-native PACS architecture provides better disaster recovery and multi-site access compared to legacy on-premise systems retrofitted for cloud deployment.
- Asteris builds veterinary-specific imaging software rather than adapting human medicine PACS for animal healthcare workflows.
- Integrated teleconsultation capabilities within PACS platforms enable real-time specialist referral without workflow disruption.
- Market consolidation signals: 4+ major ownership transitions in veterinary imaging sector since 2023.
What questions should you ask about user licensing models?
The fundamental answer: demand unlimited user access at flat-rate pricing rather than per-seat licensing that penalises practice growth. The traditional per-seat licensing model creates a direct conflict between team expansion and software costs.
When adding a locum vet, imaging technologist, or front desk staff member costs an additional monthly fee (typically £50-200 per user per month), practices face artificial constraints on team access to imaging data. This structure became common because human medicine PACS vendors designed licensing around radiologist-centric workflows, not integrated veterinary team environments.
Ask potential vendors these specific questions:
- Does your pricing increase when we add users? (Red flag if yes)
- Can our entire team access images simultaneously without performance degradation?
- What happens during busy periods when 8-10+ staff members need concurrent access?
- What happens when we add a second location?
Some cloud PACS providers charge per radiologist (£75-150/month), per technologist (£50-100/month), or per concurrent user (£100-200/month). This approach penalises practices for growing their imaging capabilities or cross-training staff. The most practice-friendly systems like Keystone PACS offer unlimited user access at a flat rate (typically £300-800/month regardless of user count), recognising that imaging data should be accessible to anyone involved in patient care.
Unlimited user licensing becomes particularly critical during emergencies, referral consultations, or case discussions where multiple team members need simultaneous access to the same studies. A 15-veterinarian emergency clinic could face £1,500-3,000+ monthly licensing costs under per-seat models versus a single flat rate.
How should integration architecture factor into your vendor decision?
Your PACS system must communicate properly with practice management software, imaging modalities, and referral partners. This integration directly determines whether your team spends time on patient care or manual data management.
The integration architecture determines daily workflow efficiency. Bidirectional integration (where data flows both ways between systems) eliminates manual data entry, reduces errors, and creates unified patient records. Unidirectional or manual integration requires staff to enter information multiple times.
Start by asking these specific questions:
- Which practice management systems integrate natively with your platform? (Ask for a current integration list)
- How do images flow from our digital radiography system to the PACS? (Manual upload vs. automatic routing)
- Can we generate reports directly within the system or do we need separate reporting software?
- Does your system support DICOM worklist integration?
Many platforms offer basic integrations that require manual intervention or duplicate data entry. Look for systems that support bidirectional integration, automatic study routing based on appointment data, and embedded reporting tools. The goal is single-click workflows from image capture through final report delivery.
Pay particular attention to DICOM worklist integration. This feature automatically populates patient demographics and study information from your practice management system, eliminating manual data entry at the modality level. Without proper worklist integration, technologists spend significant time typing patient information for every X-ray series. A 20-30 radiograph day could consume 45-90 minutes of administrative data entry.
Common integration red flags include requiring manual upload of images, separate login credentials for the PACS, duplicate patient record entry, or lack of bidirectional communication with your practice management system.
What level of DICOM compliance do you actually need?
Not all veterinary imaging systems provide full DICOM compliance. This distinction directly affects data portability, vendor lock-in risk, and access to advanced imaging features. Full DICOM compliance ensures your imaging data remains portable if you need to switch systems, proprietary formats create permanent vendor lock-in.
Understanding the difference between a DICOM viewer and a true PACS system matters for long-term data portability and advanced imaging workflows. Some platforms function more like enhanced image viewers with cloud storage rather than complete PACS implementations.
Ask vendors these specific questions:
- Do you support DICOM query/retrieve operations? (Can you export studies programmatically?)
- Can we export our entire image database in standard DICOM format if we leave your platform?
- Does your system handle DICOM structured reports, not just free-text notes attached to images?
- Can we import DICOM studies from other facilities?
Full DICOM compliance ensures your imaging data remains portable. It also enables advanced features like automated hanging protocols (images display in consistent positions automatically), measurement tools that embed calibration data in images, and standardised report formats that other veterinary professionals can read.
Some lightweight systems store images in proprietary formats with DICOM viewing capability overlaid. While this approach may seem adequate initially, it creates vendor lock-in and complicates data migration or multi-platform workflows. If you need to switch vendors in year 3 of a 5-year contract, you may face £5,000-15,000 in professional data conversion fees or lose your image archive entirely.
Request a data export sample from any vendor to verify their DICOM compliance claims. Not all systems that claim DICOM support actually export in standard formats.
How do you evaluate vendor stability in a consolidating market?
The veterinary imaging market has experienced significant consolidation recently, with major acquisitions affecting product roadmaps and pricing strategies. When evaluating potential vendors, evaluate both the company's financial stability and their strategic position in the evolving market to protect your practice from unexpected price increases or platform abandonment.
Recent market signals include companies assembling vertically integrated imaging-plus-diagnostics stacks, strategic lock-in of imaging partnerships, and multiple smaller vendor acquisitions. These trends create scenarios where your imaging vendor's priorities may conflict with your practice's interests.
Ask these specific questions:
- Who owns your company and what are their other veterinary market interests? (Transparency matters)
- How has your pricing changed following any recent ownership transitions? (Request 3-year pricing history)
- What guarantees do you provide about continued product development and support?
- What happens to my data if your company is acquired?
Some imaging vendors are now owned by companies with competing interests in veterinary diagnostics, laboratory services, or practice management. This vertical integration can create conflicts where the imaging platform becomes a mechanism to drive business to other services rather than serving your practice's best interests. For example, if the same company owns your PACS and operates a reference laboratory, they may financially incentivize referrals to that laboratory rather than your preferred specialists.
Look for vendors with clear independence or transparent ownership structures. Understand how recent market changes might affect your relationship with the vendor over a multi-year contract period. Request references specifically from practices that renewed contracts post-acquisition to understand pricing and service changes.
Asteris (a software company focused exclusively on veterinary imaging) maintains independence from diagnostics, practice management, or laboratory services. This structure eliminates conflicts of interest in how imaging data is used.
What AI and automation features provide real, measurable value?
AI capabilities in veterinary imaging range from genuinely useful workflow automation to marketing-driven features with limited practical benefit. Focus on AI applications that save time without compromising clinical oversight, specifically workflow automation, not diagnostic assistance.
Valuable AI features that measurably save time include:
- Automatic study routing based on appointment type (ortho studies route to orthopedic specialists automatically)
- Intelligent hanging protocols that adapt to exam content (automatically arrange thorax radiographs in consistent positions)
- Automated measurement tools that maintain calibration across different viewing environments
- Smart image pre-processing that enhances visibility without requiring manual adjustment
These capabilities reduce administrative tasks without inserting AI into diagnostic decisions. Studies show that intelligent hanging protocols alone can reduce interpretation time by 15-25% because radiologists spend less time positioning images.
Be cautious about AI features that claim diagnostic capabilities or automated interpretation. Effective AI in veterinary PACS assists with workflow and organisation, leaving clinical decision-making entirely with the veterinary team. Marketing claims like "AI diagnostic assistance" should trigger skepticism. Ask vendors to demonstrate specific, measurable performance improvements with real case examples rather than accepting general claims about machine learning capabilities.
Request live demonstrations with your actual imaging equipment and case types rather than generic product demos.
Should teleconsultation integration influence your vendor choice?
Built-in teleconsultation capabilities directly reduce administrative overhead when seeking specialist input. This feature becomes particularly valuable for practices that regularly refer complex cases or work with multiple radiologists. Integration eliminates the need to export images, upload files to separate platforms, or coordinate multiple software systems.
Evaluate whether your potential PACS includes these specific capabilities:
- Real-time consultation tools with multiple specialists simultaneously
- Annotation sharing (specialist can mark measurements and findings on images)
- Report collaboration features with permanent record of specialist input
- Chat or messaging integrated directly with imaging studies
Some systems allow specialists to mark measurements and findings directly on images within your workflow, creating a permanent record of the consultation. For example, a board-certified radiologist reviewing a complex orthopedic case can highlight specific areas of concern directly on the X-ray, and those annotations remain linked to the study permanently.
The alternative involves exporting studies (5-10 minutes per case), managing separate teleconsultation platforms, importing reports manually back into your primary system, and managing multiple file versions. This fragmented approach increases administrative overhead by 20-40 minutes per complex consultation and creates opportunities for communication errors or lost reports.
Ask vendors to demonstrate teleconsultation features with an actual external specialist rather than internal staff. This reveals whether the system works reliably with outside consultants.
Conclusion
Selecting PACS systems for vets in 2026 requires careful evaluation of vendor stability, integration capabilities, and long-term strategic alignment with your practice goals. The questions outlined above help distinguish between marketing claims and practical capabilities that will impact your daily workflows.
Focus on systems that demonstrate these four non-negotiable criteria:
- Unlimited user access with flat-rate pricing (not per-seat licensing)
- Full DICOM compliance (not proprietary image formats)
- Native bidirectional integration with your existing practice management platform
- Transparent vendor ownership with clear independence from competing veterinary services
Avoid vendors whose business model depends on recurring upgrade fees or per-seat licensing that penalises practice growth. Avoid platforms with proprietary image formats that create migration costs in the thousands of pounds.
The right imaging platform should enhance your team's efficiency while maintaining complete clinical autonomy. Keystone PACS addresses these evaluation criteria with unlimited concurrent users, full DICOM compliance, and integrated workflows designed specifically for veterinary practices rather than adapted from human medicine.
Take time to evaluate these criteria thoroughly rather than making decisions based on initial demonstrations or promotional pricing. The wrong choice locks you into a platform for 5+ years.