Is Your PACS Pretending to Be Cloud? 5 Questions to Ask Before RSNA
Every year at RSNA, vendors flood the exhibit halls with promises of “cloud,” “AI-powered,” and “next-generation” imaging solutions. However, beyond all the glamorous marketing, many radiology practices end up discovering the same truth: a lot of “cloud” PACS systems aren’t actually cloud-native at all.
Instead, they’re legacy systems lifted into a hosting environment, carrying forward the same operational burdens, infrastructure requirements, and workflow silos that have held radiology back for years. Kate Kovalenko, Chief Product Officer at Sirona Medical, said in a recent interview with the Imaging Wire, “Many companies have tried to create unified solutions by acquisition, but when you bolt together multiple legacy apps — none of which are cloud-native — you can’t deliver innovation quickly or effectively.”
As you prepare for RSNA, this is the moment to look beyond the marketing and focus on the architecture. Radiology’s future ability to scale, innovate, and operate profitably will depend on whether the underlying foundation is truly built for the cloud. Below are five critical questions to ask any PACS or enterprise imaging vendor before you step into their demo.
1. Is it cloud-hosted or cloud-native? (Hint: They’re not the same.)
Many vendors use “cloud” as a label for any system running on remote servers. However, cloud-hosted legacy systems inherit all the limitations of their on-premise origins:
- VPNs and local hardware dependencies
- Manual updates and scheduled downtime
- Siloed modules that replicate existing fragmentation
- High capital costs for hardware refresh cycles
A true cloud-native PACS is built for distributed, elastic operation. It updates continuously without downtime, scales automatically, and works anywhere through a secure browser.
What to ask vendors at RSNA:
Is this system designed natively for the cloud, or is it a legacy PACS that has been lifted into a hosting environment?
2. How unified is your data model?
Radiology’s most significant hidden cost is fragmentation. When images, reports, and workflows reside in separate systems, radiologists are compelled to perform manual, repetitive tasks that erode efficiency and increase the risk of errors. Modern platforms unify data into a single, coherent model, which enables automated prior retrieval, intelligent reporting, and seamless AI integration. As Dr. Jon Masur said during a recent live Sirona webinar, “Everyone talks about speed. But the real gains come from eliminating fragmentation. When everything speaks the same language, you don’t need to ‘go faster.’ You just stop slowing down.”
What to ask vendors at RSNA:
Is your architecture built on a unified data model, or do you maintain separate modules and databases?
3. How quickly can you deploy new features into production?
Legacy PACS upgrades are event-based, involving scheduled downtime, testing windows, and IT coordination across multiple sites. Cloud-native systems update continuously, typically every week, with no downtime and minimal user disruption. That means radiologists receive improvements immediately, not in quarterly or annual cycles.
This matters because the speed of innovation is now a competitive differentiator for efficiency, AI advancement, and economic sustainability.
What to ask vendors at RSNA:
How often is your platform updated, and what does an upgrade require?
4. Can radiologists read from anywhere — without hardware, VPNs, or workarounds?
The future of radiology is distributed; practices are expanding across regions and relying on flexible staffing models. A PACS that requires dedicated workstations, local installs, or VPN connectivity limits how quickly you can scale and how efficiently your team can support distributed workflows.
Modern cloud-native systems enable instant and secure remote reading from any device, with performance equal to or better than on-premises systems.
What to ask vendors at RSNA:
What infrastructure is required for remote reading? Do I need a VPN, a thick client, or special hardware?
5. What’s your approach to downtime prevention?
Downtime is expensive. It’s estimated that imaging departments, on average, experience between 2 and 7 downtime incidents per year, with each episode lasting about 3.5 hours. For a mid-sized facility, a single incident can cost nearly $94,000 in lost revenue, not to mention the downstream costs of rescheduling exams and eroding patient trust. If radiologists can’t continue reading through an outage, the system is not cloud-native.
What to ask vendors at RSNA:
How is continuity maintained during failures or updates?
Why These Questions Matter Now
Radiology is at an inflection point. The demands are increasing — more volume, greater complexity, and increased economic pressure — while staffing and resources remain tight. A genuine cloud-native foundation fundamentally changes the economics of radiology operations. This isn’t just a technical decision; it’s a business decision with direct impact on margins, productivity, and long-term viability.
🔗 Before RSNA: Get the Full Evaluation Guide
If you’re evaluating imaging systems this year, don’t go in unprepared.