That "zero footprint" viewer over Citrix is susprisingly resource-intensive, even at 1080p with lossy compression. If everyone used it (say, if every workstation were a Citrix client), it quickly adds up. During peak hours, it positively chugs. Not sure if networking or compute is the bottleneck here. Perhaps you're right: some institutions have not caught up to this day and age of 4K streaming, and their pre-Netflix infrastructure is buckling under the weight of all these Citrix streams.

At my current institution the bottleneck is compute - Epic slows to a crawl midday no matter off prem or on. And unfortunately the only constant is academic healthcare IT is a trash fire.

> If everyone used it

Like many large facilities I’ve been in the US, the EMR and PACS viewer (for non rads) are often over Citrix (ie every workstation is a Citrix client). But how many people are simultaneously viewing images - it’s only a minority of users (both in general - the ancillary staff is not) and at any given time (most clinicians are not viewing images at any moment)

This is a large university affiliated center - the bandwidth used by the medical center is a drop in the bucket compared to the size of the pipes they (the uni) have.