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Any medical image viewer that is capable of communicating via DICOM should be able to easily integrate with dcm4chee as shown by (A) in the image above. This mode of communication would use DICOM Query (C-FIND), and DICOM Retrieve (C-MOVE) to locate and fetch the images to the local machine. The images may then be viewed, manipulated, and potentially re-stored (via DICOM C-STORE) back into the archive if they have been modified. This is a very well known, and common manner of integrating a viewer with a DICOM-capable PACS or archive system such as dcm4chee. See here for a list of DICOM viewers that are known to work with dcm4chee. dcm4chee also supports such things as the storage and retrieval of hanging protocols, and a General Purpose Worklist (GPWL) which can have a positive effect on the viewing environment - providing the viewer supports the integration of these standards.
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