What different PACS systems have you used? What was good about them? What did you hate? What do you miss?

I've used a couple of different PACS in my time. A few versions of GE Centricity, GE UniversalViewer, and Sectra IDS7. I occasionally need to use Intelliviewer to review outside scans, but have never reported off them. I'm curious what features people have found to be beneficial or painful in their PACS. I'm mainly thinking about PACS here, but feel free to vent on your RIS too.

For myself:

CentricityPACS is hot garbage.

UniversalViewer I actually liked a lot.
Pros:
* The automatic learning hanging protocols were amazing. After a while, I had it dialled in to the point where it knew to invert my layout on a left foot study vs a right. Even down to which viewing station I was logged in to. Massive time saver.
* Very configurable per user. Lots of ways to tweak things the way you liked.
* Automatic cross-registration and linking, across multiple old studies, using anatomical markers. It made comparing multiple old liver studies (for example) really easy.
* It felt easy to save presentation states, either for MDT prepping or just when you get interrupted and have to switch to something else.
* This is more to do with the latest GE RIS, but I found their latest VR implementation to be really good.

Cons:
* The fact that it had to relaunch the whole viewer every time you started a new case made things feel clunky, and probably slower than it should be.
* Limitations with custom hanging protocols - you can never extend a window past the midline of the duplex viewing monitor, even though it's a single screen.
* The MPR functionality was okay, but a little slow and bloated - most of the time I don't want fancy tools, I just want to oblique the views.

Sectra is growing on me, but somethings still boggle the mind.
Pros:
* The MPR functionality is fast and relaible. Extra applications (like vessel analysis) are fast and accurate enough that I don't feel the need to use anything else.
* Very configurable, though some of the settings are not where I'd expect to find them, or may be missing entirely.
* I find it really easy to create new series for documenting lung nodules, or making my own 3D or curved-MPR for illustrative purposes.
* Setting up your own teaching/interesting case files is pretty painless.
* Built-in chat is amazing for teaching feedback.

Cons - most of these are daily irritations in one form or another:
* Weird behaviour: If you're on a case in full-screen MPR and leave to look at another, when you come back, the MPR will be shrunk down into one of the usual frames. Have to close the MPR then restart it to get it back properly.
* Odd UI choices: It's harder than it should be to tell which old study you're currently looking at in the film strip.
* Inconsistency: Arrows and notes in a standard view show up as one colour, but in MPR they show another. Hotkeys in a standard view don't always work in MPR and vice versa. It's impossible to do a perpendicular measurement in MPR for some reason. You can bind right-click-drag to MPR functions, but not standard view functions.
* VR is garbage. The PACS guys claim it's learning, but I swear it seems to be getting worse. They claim an accuracy on my account of 99%. Which means that even on a normal CT brain report, I'm going to average just over 1 mistake for every 2 cases. Most of my reports are at least 100 words, which means every case has a mistake. That's unacceptable.

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source https://www.reddit.com/r/Radiology/comments/k4bsv6/what_different_pacs_systems_have_you_used_what/