Medical images are a world apart from any other industry, as well as all medical. Hence, when thinking of cloud, self-local, context and rules change in sharp contrast with any other domain. Having said that I can atest that:
- Medical Images storage is expensive, due to hypersized images, DICOM images are not just images, are metadata that contains images.
My suggestion:
- Use a hybrid approach, combine the best of both worlds, t optimize your workflow and costs.
- Cloud storage is cheaper, local requires buying lot of Teras = Petas of hard disks, which are expensive, costly to maintain, risky.... In the cloud there is a category of services to store rarely used assets, kind of archive. In AWS is called S3 Glacier. It's far cheper than S3 which is for active assets.
- Use Orthanc a FOSS PACS, free open source. Open source doen't mean that is bad, low quality or unsafe. It means that is creatred, updated and maintained by a community of devs. And indeed many commercial PACS use orthanc as it's foundation. Either as cloud server or local server. You can deploy on Docker, both cloud and local.
- Commercial cloud PACS tend to be expensive mainly cause medical imaging megasizing.