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State of the Practice for Medical Imaging Software Based on Open Source Repositories.

Spencer Smith1, Ao Dong2, Jacques Carette2

  • 1McMaster University.

Critical Reviews in Biomedical Engineering
|October 24, 2025
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Summary
This summary is machine-generated.

This study ranks open-source medical imaging (MI) software, finding 3D Slicer, ImageJ, Fiji, OHIF Viewer, and ParaView lead. While MI software development is generally healthy, improvements in documentation and testing are needed.

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Area of Science:

  • Medical Imaging Software Development
  • Open-Source Software Engineering
  • Software Quality Assessment

Background:

  • Open-source repositories are crucial for medical imaging (MI) software development.
  • Assessing the state of practice in MI software development is vital for advancing the field.
  • Existing research software development guidelines provide a benchmark for evaluating MI projects.

Purpose of the Study:

  • To review and rank the state of practice for medical imaging software development using open-source repositories.
  • To identify strengths and weaknesses in current MI software development methodologies.
  • To provide actionable recommendations for improving MI software quality and maintainability.

Main Methods:

  • Selected 29 MI software projects from 48 candidates in open-source repositories.
  • Assessed nine software qualities using 108 questions per project.
  • Employed the analytic hierarchy process (AHP) for quantitative data analysis and ranking.
  • Conducted developer interviews to identify key concerns.

Main Results:

  • Ranked top MI software: 3D Slicer, ImageJ, Fiji, OHIF Viewer, and ParaView, consistent with community metrics (GitHub stars).
  • Found high adherence to version control (100%) and good documentation artifact presence (88%).
  • Identified gaps in test plans, requirements specifications, continuous integration (17%), and unit testing (~50%).

Conclusions:

  • Medical imaging software development is generally healthy but requires improvements in documentation and testing.
  • Key developer concerns include development time, funding, technology, correctness, usability, maintainability, and reproducibility.
  • Recommendations include enhancing documentation, increasing testing, adopting continuous integration, and improving software design principles.