Ginkgo CADx is an open-source extensible image acquisition, viewing and analysis application, available for Windows, Mac and Linux platforms. Built on the Ginkgo CADx Framework, it has a plug-in architecture for specialized analysis. It is DICOM compliant with PACS integration to send and receive images, and has HL7 support. The 2D viewer has image manipulation and annotation tools, and can open multiple simultaneous studies.