The US imaging market continues to show significant resilience. In my 18 years at KLAS, we have tracked numerous markets as they have come to the forefront and then faded into the background. Other solutions have been commoditized as portions of a broader EHR ecosystem. Through all of that, PACS continues to be one of the most active markets. Between July 2023 and June 2025, outside of PACS, KLAS has only validated more recent decisions in acute care EHR and ambient speech—the current solution du jour.
The market is teeming with solutions vying to solidify their place as the top imaging vendor. Based on KLAS’ Decision Insights, this blog dives into the PACS market for a glimpse at who is being considered, selected, and replaced as well as the drivers behind those decisions.
Points to Know
- Currently, PACS is the most frequently viewed technology page on KLAS’ website and, across all measured areas, is in the top three for the most validated purchase decisions over the past two years.
- The vendor mix in the PACS market is very healthy, with a lot of competitive solutions.
- In the last two years, Sectra has had the most considerations and selections among PACS solutions. Visage Imaging has the second most net-new selections (excluding migrations). Merge by Merative, Fujifilm, Philips, AGFA HealthCare, Optum, and Intelerad follow behind Sectra and Visage Imaging in momentum.
- The Philips, GE HealthCare, and Optum customer bases are most frequently evaluating their options.
Where Does Our Data Come From?: KLAS Decision Insights
For the past 10 years, KLAS has tracked the purchasing trends of various HIT systems. When we learn about a recent or upcoming technology purchase from a healthcare organization, we ask decision-makers specific questions on which vendor is being replaced, which are being or were considered, and which are likely to be or were selected. We publish insights from these discussions as KLAS Decision Insights to highlight where the momentum lies in a market.
To be clear, these insights don’t represent all vendors that responded to an RFP—rather, they represent those that were and are most seriously considered or short-listed in a decision. While KLAS doesn’t have a perfect census of all decisions in a given market, these Decision Insights provide a good relative measure of the most active HIT segments and the vendors with the most energy within those segments. Finally, and perhaps most importantly, the Decision Insights capture why these vendors have momentum.
Below is a snapshot of the most active segments based on the number of KLAS-validated decisions over the last two years. Unsurprisingly, KLAS has validated more recent interest in ambient speech than any other segment as the market scrambles to adopt this nascent technology. Energy for acute care EHRs follows as organizations continue to make their future bets on their core clinical technology. PACS continues to be a top area of focus as all sizes of organizations (from <100K to well over 1M in annual imaging volume) look to future-proof their enterprise imaging (EI) strategy.
What Are Organizations Looking for in Their PACS?
Currently, decision-makers most often say they are looking for the product’s strength and technology when making a new PACS decision. While a number of PACS decisions post-COVID-19 were tied to a lack of support, the pendulum is now swinging toward technology and solutions that will set the organization up for success in the future.
These considerations include:
- The cloud (mentioned in 30% of all PACS decisions)
- Viewing speed for radiologists (time is money, after all)
- More robust worklist tools to reduce cherry-picking of studies and better support image routing
- Zero-footprint viewers and better post-processing tools to reduce reliance on dedicated workstations for things like tomosynthesis
When making a decision, organizations often group their PACS with a VNA and universal viewer (UV) from the same vendor—hopefully enabling the future viewing and storage of all images across the organization.
While over 50% of imaging respondents report using at least one type of AI, less than 4% mention AI as a main consideration for their PACS. This will likely increase over the next few years, as organizations also want more standardized processes for pulling AI into their workflows. But as things stand today, a vendor’s AI strategy is more often viewed as something nice to have than a necessity in a PACS decision.
Other top reasons for considering a solution include a vendor’s reputation, usability, and cost. Additionally, 22% of decisions were tied to consolidation of multiple solutions or replacing a PACS at a recently acquired facility.
Who Has the Most Energy?
Sectra
Currently leading the imaging market in decisions, Sectra was seriously considered in nearly 60% of decisions made by small to very large organizations over the last two years. At least half of those decisions have gone in favor of Sectra because of their technology (such as their cloud/SaaS model) and strong features and usability that enhance radiologists’ workflow and productivity. Prospective customers also frequently take Sectra’s industry reputation into consideration, as they hope to find a vendor that will help them drive success.
Increasingly, Sectra’s VNA and UV are also being selected to facilitate an organization’s EI strategy, though they cannot be selected as standalone options. When organizations opt not to select Sectra, it’s often because they need specific worklist features or a broader enterprise solution (that includes full cardio), they don’t want to move to the cloud, or they made another choice due to cost.
Visage
Visage Imaging is the other vendor with significant momentum thanks to their strong technology and feature set. The solution is especially competitive among medium to very large organizations (300K+). Many organizations say Visage 7 is the radiologists’ preferred solution. This is thanks to a combination of its high speed for loading images, usability, and tools. Most recent deployments of Visage 7 have been in the cloud, another significant plus for organizations looking to future-proof their environments.
When respondents don’t select Visage Imaging, it’s often due to cost. Visage Imaging started the solution out as a diagnostic-grade viewer layered on top of a separate vendor’s VNA or PACS in a deconstructed PACS. So, Visage Imaging doesn’t have as broad of a suite of solutions as other vendors.
Currently, Visage Imaging’s solution is classified as a UV on KLAS’ website. More and more, we hear prospective customers say they are looking to deploy Visage Imaging’s archive as well, making it a full-blown PACS play. When KLAS can validate enough customers using Visage Imaging’s archive with the viewer, we will report its performance with other PACS. Until then, we report Visage Imaging’s performance with other UVs.
Note: Other vendors considered include Canon Medical Systems USA, EvoHealth, Medstrat, Novarad, RamSoft, ScImage, Siemens Healthineers, Sirona Medical, and Synthesis Health.
Other Vendors
Four other vendors fall into the middle tier when it comes to momentum:
- Fujifilm: Has positive momentum in recent decisions, though their growth is small relative to potential losses. Customers point to the consolidated PACS and cardiology platform, strong enterprise play, and overall reputation as reasons for selecting.
- Intelerad: Expanded in recent years thanks to their deployments in large organizations that continue to acquire additional imaging facilities. More than half of the vendor’s selections are a result of M&A, with organizations saying it is more cost-effective to use Intelerad than switch to another solution.
- Merge by Merative: Has a strong selection rate when considered. Half of the validated selections are from legacy customers migrating to Merge PACS or who evaluated the market and decided Merge was the most cost-effective solution for their organization due to its broad enterprise functionality.
- AGFA HealthCare: Has largely stabilized after a reported rough launch to the EI platform. Their performance has jumped significantly (10+ points on a 100-point scale for multiple imaging solutions) over the last two years. Their number of considerations and likely selections have nearly tripled in Decisions Insights data over the last year (compared to the two-year window in this overall data window).
A few other vendors with significant consideration rates have negative momentum, as they have had more potential replacements than likely selections. These include Philips, Optum, and GE HealthCare. While some of these vendors’ customers say the vendors are working to address customer concerns about aging technology and/or support, many organizations feel these changes have come too late as they are already well down the path to replacement.
Reach Out to Learn More
The data from KLAS’ Decision Insights underscores both the vitality of the vendor landscape and the evolving needs of healthcare organizations. Sectra and Visage Imaging may currently lead the market’s momentum, but strong competition from established players and niche entrants requires no complacency from any vendor. Healthcare organizations will continue to evaluate their options closely, looking for solutions that will position them for long-term success for their EI strategies.
In short, PACS remains a cornerstone of healthcare IT, with sustained energy, a diverse set of competitors, and clear opportunities for innovation. The market’s resilience and ongoing transformation signal that imaging will continue to be an area where providers place strategic bets and where vendors need to keep delivering meaningful advancements.
If you’d like to dig deeper into these insights, please reach out to me or to your KLAS representative—we’re here to help.
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