Good questions, and I don&#x27;t claim to fully know the answers.<p>Some such software is released open-source, e.g. NifTK, FSL, MedINRIA. Some is spun out and then sold through vendors as a service, e.g. Siemens, icoMetrix, many others.<p>Why aren&#x27;t things used more? I&#x27;d say the main bottlenecks are monetary, political and cultural. Doctors are often set in their ways, and hospital management staff are risk-averse.  Moreover, because of legal liability issues, a lot of this stuff has not been formally approved for clinical use -- so hospitals won&#x27;t touch it. This is especially true of the open-source software. Getting approved is an expensive and time-consuming process. Service contracts with approved software are expensive, mostly as a result of this.<p>Heck, look at the struggle involved in digital patient records, which is supposedly a simpler problem than imaging. In the UK, we&#x27;ve spent billions on that without getting anything usable. There are uniquely bad political reasons for that, but it&#x27;s illustrative nonetheless.