Picture Archiving and Communication System (PACS)

(roland w) #21


Great Matthew, just what we’ve been waiting for,
Orthanc seems very good and reliable
wish I were a developer

(Matthew Vita) #22


What an honor to meet you! I have heard great things about your work and I would love to stay in touch. I speak for our newly formed PACS team here on the OpenEMR project when I say your feedback and advice is much appreciated and welcomed!

I appreciate your overview of the technologies and the state of DICOM in the field. I think we are going to focus on the use case where DICOM is used because there will be too much variance and, frankly, pain involved with supporting the other non-standard formats (that is, unless there is a “mirth like” tool for this purpose).

Quick question: are you familiar with DWV? Our team has found that a plugin exists for it in Orthanc, I’m just wondering if you would recommend this for our web solution?


Matthew Vita
OpenEMR Project Administrator

(Matthew Vita) #23

wish I were a developer


As with most large projects, developers are but one slice of the overall “pie” needed to get the software out to the users in a way that will suit their needs and make them happy.

Any talent you can provide is appreciated and it doesn’t mean that you have to pick up programming! Testing, documentation, clinical advising, translating, marketing, and design are other important roles you can fill. Believe me, I would love to have help with documentation and marketing with this and other projects… hard to come by that help in the open source world, unfortunately.

Just let me know what you would like to do on this project and I’ll help you get there!


Matthew Vita
OpenEMR Project Administrator

(Sébastien Jodogne) #24

Hi Matthew,

It’s up to me to be honored by such a warm welcome!

From my point of view, DICOM should be the de facto solution to all the medical imaging needs. Although I know that DICOM is painful to learn, the efforts of the FOSS community should really focus on enhancing cross-software interoperability, and on lowering the barrier to entry with this industrial standard. This is actually my personal motto that led to the development of Orthanc back in 2011.

Regarding DWV, the feedback from the community is generally good, even if I don’t use it personally and the Orthanc plugin needs updates. The Orthanc Book lists free and open-source alternatives, of which the official Orthanc Web viewer (already available as a Debian package) and the contributed Osimis Web viewer.


(Matthew Vita) #25


Very cool. Thanks for the book reference!

I think DWV may be more straightforward than Osimis so we will stick with it for now (will support more workflows as the feature gets more advanced. In MVP mode at the moment!)

Our team would like to use Docker for Orthanc… do you have any tips here?


Matthew Vita
OpenEMR Project Administrator

(Sébastien Jodogne) #26


Regarding Docker, there is a dedicated section in the Orthanc Book.

However, the jodogne/orthanc-plugins image only contains the official plugins: It embeds the Orthanc Web viewer, but not the DWV plugin. Feel free to have a look at our demo server to give you an insight of the features of the Orthanc Web Viewer, which should be sufficient for basic remote viewing.


(Morten Borchorst) #27

On my linux workstations I use Aeskulap, which is a less optimal solution as it does not show 3D datasets very well. So I am still looking for “the right solution”.
I, for the time being, import the images from my cameras with the filemanager into a directory on my file server, using a standardized format. I.e. one directory per patient with a format of SSnumber.FirstnameLastname. Importing the images via the EMR would of course be a great feature, as renaming the images to reflect the character of the image would be an advantage. I.e. Date_IO_Frontal for the intra oral frontal pic.
The viewers I use for clinical photos are IrfanView for Windows and gThumb for linux, thus they communicate via the filesystem protocol.

(Morten Borchorst) #28

One function where DICOM could come in very handy, could be when the need to transfer (or archive) patient information exists. Being able to DICOMize the directory of clinical images into one DICOMDIR to save the image dates with the images would be an advantage.
Another function, no DICOM relevance though, that could be interesting, could be to batchwise read the EXIF information and give the image the relevant timestamp. Not all images get imported the day the picture is taken.

(Matthew Vita) #29

Hi Morten,

Which do you end up using more often? The DICOM viewer or the various photo viewers you pointed out?

Also, maybe give https://ivmartel.github.io/dwv/ a try to see if it is better for your needs. This is the viewer we are interested in implementing.


(Morten Borchorst) #30

I will test the dwv when possible, it seems to offer appr. the same possibilities as aeskulap. One thing both viewers seems to miss, is the possibility to view 2 images next to each other to look for differences.
The other disadvantage seems to be related to 3D datasets where MPR seems not to be part of the available views.

(Matthew Vita) #31

the possibility to view 2 images next to each other to look for differences.

I bet this can be solved by using iframes with DWV. It will be a basic solution, but working with the author may be the best long term solution to support this uscase out of the box.

Great feedback!

(roland w) #32


Hi Matthew,

Just let me know what you would like to do on this project and I’ll help you get there!

ok, I can only give clinical advice on the small and large animal apects of medicine, so that wouldn’t be very useful here.
You humans generally do not have hooves or wings, and miss a third eyelid and tapetum lucidum just to name a few…:grinning:
But one of the reasons that our vet staff won’t switch to O(V)EMR yet is that the translation is not very good in some places, esp. German has many strange unusual or unclear words, some wrong, some way too long for the form labels. Typical machine translation errors.
So I could help out there: my native language is Dutch, but I studied German, French and English. I have already done some of the translations for my copy, but no idea how to include them in the code and not sure how to do it “upgrade-proof”.

Thanks and keep the project alive, I’m getting really fast answers to my adapt openEMR to openVEMR problems… not too usual in the open source world either.


(Jerry P) #33

We’re an unusual bunch:) @brady.miller I bet would be more than willing to help with the translations. If anyone can get you there, it would be him.

(Brady Miller) #34

Hi @roland ,

See here for details on the translation project:

If your interested in helping out with the translations, then just send me an email to brady.g.miller@gmail.com (with your google email account address) and I’ll set you up.(btw, the sql translations tables are build daily from the google translation spreadsheet daily, so it’s very easy to use the translations you change in the google doc; and there’s a mechanism to also keep your local translations even when importing the official set).


(Eric Steven Salosny Lagos) #35

Hello Matthew!

Sorry, i was a little busy… but i am back, working on OpenEMR. About PACS, time ago we evaluate DCM4CHEE and Orthanc, both show similar performance and functions. Finally we choose DCM4CHEE by the next points:

  1. Industry adoption.
  2. Code (our team work with java/php, not C++).
  3. Database (Postgresql native, not SQLLite).
  4. OpenSorurce (full opensource, no pro version).

The DCM4CHEE implementations works nice with 8TB, integrated with a PHP RIS and wasis web viewer. We work with Osiris MD for diagnostics and sometimes for “transitory” server. In Chile, my country, there are several DCM4CHEE implementations. Some hospitals and clinics uses Osiris MD as main DICOM Server (bigger than 20TB) integrated with RIS software.
Rigth now part of our team its testing again Orthanc and DCM4CHEE (new versions). We will tell you about our expirience.
By the way, both solutions are good.
PD: I am busy… but i hope have time soon to work with the OpenEMR community.

(Yves) #36

Hi all, I’m Yves the author of DWV. I just found this thread and wanted to say that I am very interested and would be happy to help. About PACS integrations, DWV can run with Orthanc (the update of the plugin should not take long), it can also run with DCM4CHEE and Conquest (see Pacs support · ivmartel/dwv Wiki · GitHub).

About the side by side image view, what @MatthewVita proposes is possible. DWV also supports to have more than one viewer per page. This solution would be more flexible, you could connect a control to both views to provide a synchronised slice slider for example.

About MPR, it has been on the todo list for a long time (Add MPR · Issue #4 · ivmartel/dwv · GitHub) and deserves to have its priority increased. I just haven’t found the time until now…

(Eric Steven Salosny Lagos) #37

Your workflow it’s ok Matthew.

(Matthew Vita) #38

@esalosny Awesome! Looking forward to your report!

@ivmartel It is an honor to hear from you. I have really enjoyed QAing your DWV software. @kofiav and I are working on getting it into OpenEMR now.


(Sébastien Jodogne) #39


I hereby wish to make two corrections to @esalosny’s post:

  1. Database: Orthanc can also use PostgreSQL, just like DCM4CHEE. There’s a plugin for that.
  2. Open-Source: The entire ecosystem of Orthanc is free and open-source. It is unfair to claim that there’s a “pro” version of the software, there are only professional services available.

Similarly, Orthanc is reported by users to store several TBs of images, just like DCM4CHEE.


(Matthew Vita) #40

Thanks for the clarifications!