Starviewer and its comparison with other open-source DICOM viewers using a novel hierarchical evaluation framework.

The aim of the paper is twofold. First, we present Starviewer, a DICOM viewer developed in C++ with a core component built on top of open-source libraries. The viewer supports extensions that implement functionalities and front-ends for specific use cases. Second, we propose an adaptable evaluation framework based on a set of criteria weighted according to user needs. The framework can consider different user profiles and allow criteria to be decomposed in subcriteria and grouped in more general categories making a multi-level hierarchical structure that can be analysed at different levels of detail to make scores interpretation more comprehensible. Different examples to illustrate Starviewer functionalities and its extensions are presented. In addition, the proposed evaluation framework is used to compare Starviewer with four open-source viewers regarding their functionalities for daily clinical practice. In a range from 0 to 10, the final scores are: Horos (7.7), Starviewer (6.2), Weasis (6.0), Ginkgo CADx (4.1), and medInria (3.8). Starviewer provides basic and advanced features for daily image diagnosis needs as well as a modular design that enables the development of custom extensions. The evaluation framework is useful to understand and prioritize new development goals, and can be easily adapted to express different needs by altering the weights. Moreover, it can be used as a complement to maturity models.

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