An image viewer and method for using the same in a medical image management system are described. In one embodiment, the system comprises: a network communication interface to receive compressed image pixel data； an image cache memory to cache the compressed DICOM image pixel data and rendered images； one or more processors coupled to the network connection interface and the memory and configured to implement an image rendering pipeline to perform image rendering in response to opening a healthcare study for review, wherein the image rendering includes determining whether compressed image pixel data associated with an image selected for display is in an image cache memory, and if so, then fetching the compressed image pixel data from an image cache, where the image pixel data represents a pre-rendered version of an image from a series in the healthcare study, and rendering a displayable image for display with a viewer on the display, and if not, then downloading from a remote location a version of the displayable image for display with the viewer； and a display coupled to the one or more processors to display the displayable image with a viewer.
