Evaluating Cloud PACS at RSNA 2026?
Ask These 7 Questions.
The Brief
The word “cloud” will be everywhere. The better questions go deeper. Use the time to understand what the architecture changes in practice.
RSNA gives imaging teams a rare opportunity to compare PACS vendors side by side. You can see the technology. Talk directly with the people behind it. Ask detailed questions. And get a clearer sense of what each platform would actually mean for your organization.
But when it comes to cloud PACS, the conversation can become vague very quickly.
Many vendors will use similar language. So if cloud PACS is part of your RSNA 2026 agenda, do not spend the conversation only confirming that a platform is “in the cloud.”
Use the time to understand what the architecture changes in practice.
Here are seven questions worth taking with you.
When you say “cloud,” what exactly do you mean?
Start with the terminology.
Ask whether the PACS was designed specifically for cloud operations, whether an existing application was moved into cloud infrastructure, or whether the deployment uses a combination of cloud and local components.
You do not need a deep architecture lesson at the booth. You need enough clarity to understand what the word “cloud” actually represents.
A useful follow-up is:
What is fundamentally different about how this platform operates compared with a traditional PACS?
If you want to go deeper before the show, we break down the distinction between cloud-based and cloud-native PACS here:
Read: Not All Cloud PACS Is Built the Same →
What still has to live or be managed locally?
A cloud PACS may still depend on components inside your environment. Ask what remains on-site.
What happens if one of those components becomes unavailable? And who is responsible for maintaining them?
There may be good reasons for local components. The important thing is understanding what the organization is still responsible for after moving to the cloud.
A simple question can reveal a lot:
If we add another site, what do we need to install, configure, and maintain?
What would moving from our current PACS actually involve?
Cloud evaluations often spend a lot of time talking about the future platform and not enough time talking about the transition. But migration is part of the decision.
- Ask how historical imaging is moved.
- How long does the transition usually take?
- Can old and new environments operate in parallel?
- What happens to prior studies during the migration?
- What does the organization need to provide?
- How much disruption should radiologists and clinical teams expect?
- And what happens if the migration does not go exactly as planned?
A platform may look attractive in a demonstration. The transition path tells you how realistic the move will be for your organization.
Show me what actually changes for the radiologist.
At some point, move away from the architecture slides. Ask to see the workflow. Not a feature checklist. The actual reading experience.
- How does a radiologist find the next study?
- How are relevant priors surfaced?
- How many places do they need to look?
- How does reporting fit into the workflow?
- What happens when they read from another location?
- How quickly can they get to the information they need?
Cloud architecture matters. But eventually, someone has to use the system.
The value should show up in the radiologist's day, not only in the infrastructure diagram.
Explore: Radiology PACS Built Around the Way Radiologists Work →
What will actually drive our cost over the next five years?
Do not stop at the initial quote. Ask what changes the bill over time.
Then introduce a realistic scenario:
What happens if our imaging volume grows significantly faster than expected? Or: What happens if we add three more locations during the contract term?
The goal is not simply to find the lowest number. It is to understand whether the commercial model remains predictable as the imaging operation changes.
If a cloud proposal looks expensive, ask what is driving that cost. The answer may tell you as much about the architecture and operating model as the price itself.
What happens when the primary environment is unavailable?
Every vendor will talk about uptime. That matters. But an uptime percentage does not tell you everything you need to know about a disruption.
Ask what actually happens if the primary environment becomes unavailable.
- Can radiologists still access studies?
- Can clinicians still retrieve imaging?
- What happens to new exams?
- What happens to the worklist?
- How is the organization notified?
- How does the team transition into a fallback workflow?
- And how is that process tested?
The more useful question is not only: How quickly can the system recover?
It is: What can our imaging operation continue doing while it recovers?
If our needs change, how difficult is it to change direction?
You are not only choosing a PACS for today. You may be committing to an environment for several years. During that time, a lot can change.
Your organization may acquire another practice. Volumes may increase. New workflows may emerge. Your AI approach may change. A different integration may become important. Your commercial priorities may shift.
So ask how much flexibility you retain.
- Can your imaging data move easily?
- What does exporting it involve?
- Are there contract restrictions?
- How difficult is it to add or remove services?
- Can you introduce another vendor where needed?
- What happens if you decide to take a different direction later?
Cloud should create more options.
It should not simply move the same constraints somewhere else.
AI on your RSNA agenda too?
AI will be part of many PACS conversations at RSNA. But rather than turning this into another AI checklist, ask one practical question:
How does AI fit into the radiologist's existing workflow?
If the answer involves another destination, another queue, another screen, or another process to manage, understand what that means for the people expected to use it.
Our view is simple: AI should remove work, not create another layer of it.
Do not leave RSNA with only a cloud checkbox
Most vendors you meet will be able to tell you they have a cloud story. Your job is to understand what that story means for your organization. Before you leave the booth, you should have a clearer answer to questions like:
Those answers will tell you much more than the word “cloud” alone.
Bring the questions that matter to RSNA 2026
If cloud PACS is part of your RSNA agenda, bring your current environment, your constraints, and the questions you are trying to answer. At AdvaHealth, we can walk through how AdvaPACS approaches cloud imaging. No generic cloud conversation required.
Meet AdvaHealth at RSNA 2026Preparing before the show?
Dive deeper into the architectural differences and what they mean for the people running your imaging operation.
Approaching a PACS renewal?
A contract renewal is the perfect time to evaluate if your current environment still supports where your organization is going.
Take the Contract Renewal Check
