Orthanc PACS Implementation

One significant milestone in Klinik Kesihatan Bandar Maharani's was deploying the Orthanc PACS (Picture Archiving and Communication System) for radiology imaging & digitalization process.

Medical Imaging at KKBM

In October–November 2023, KKBM implemented a Picture Archiving and Communication System (PACS) using Orthanc, an open-source platform. This moved the clinic's radiology services from film-based imaging to a fully digital workflow — improving image accessibility, reducing ongoing costs, and eliminating chemical waste from film processing.

The project was led by Dr. Fuad, with support from YM Dr. Zurina (MOIC) and Pn. Noraini (Head Radiographer, PKD Muar). The implementation was done entirely in-house, without external vendors or consultants, using freely available documentation and community resources.

Understanding Orthanc PACS

PACS (Picture Archiving and Communication System) is a medical imaging technology that provides storage, retrieval, distribution, and presentation of medical images. It replaces physical film-based radiology with digital workflows, enabling instant access to imaging studies from any connected workstation.

Orthanc is an open-source, lightweight PACS server designed for medical imaging management. It is DICOM-compliant, HIPAA-ready when properly configured, and widely used globally in healthcare institutions seeking cost-effective, flexible imaging solutions. KKBM leveraged Orthanc to build a professional-grade PACS infrastructure entirely in-house.

Why KKBM Implemented Orthanc PACS

The Film-Based Challenge

• Physical film storage required significant space and proper environmental control
• Film degradation over time compromising long-term image quality
• Difficulty retrieving and comparing previous radiographs for clinical assessment
• Chemical processing creating environmental waste and ongoing costs
• Film and chemical supply expenses accumulating continuously
• Manual film distribution delays between radiology unit and consultation rooms
• Lost or misplaced films disrupting patient care continuity

The Vision for Digital Imaging

• Complete elimination of physical film dependency
• Instant image availability at any clinic workstation via network access
• Permanent, high-quality archival without degradation concerns
• Easy comparison with previous radiographs for longitudinal assessment
• Superior image manipulation capabilities (zoom, contrast, measurements)
• Environmental sustainability through elimination of chemical processing
• Long-term cost savings despite initial infrastructure investment
• Foundation for future advanced capabilities (AI analysis, teleradiology)

Why Orthanc Specifically

• Open-Source: No licensing fees, community-driven development, full source code access
• Cost-Effective: Minimal ongoing costs compared to commercial PACS solutions costing tens of thousands
• DICOM Compliance: Industry-standard medical imaging protocol ensuring interoperability
• Self-Hosted Capability: Complete data sovereignty with on-premise deployment, no cloud dependency
• Active Community: Extensive documentation, forums, and global user community providing support
• Technical Excellence: Lightweight, stable, well-architected software suitable for clinic-scale deployment
• Flexibility: Highly customizable for specific clinic workflows and integration needs

Implementation Journey

The Orthanc PACS implementation was accomplished entirely through in-house technical expertise, utilizing official Orthanc documentation, online community resources & systematic problem-solving. This grassroots approach demonstrated that sophisticated digital health infrastructure is achievable without expensive consultants or commercial vendors.

Planning & Design Phase

Oct-Nov 2023

• Technical assessment of radiology workflow requirements and integration points
• Server hardware specification considering image storage capacity and performance needs
• Network infrastructure evaluation ensuring adequate bandwidth for DICOM transmission
• Storage capacity planning for long-term image archival (initially 5-year projection)
• Security and access control framework design meeting MOH ICT Security Policy requirements
• Budget analysis comparing implementation costs versus ongoing film/chemical expenses

Development & Testing Phase

Nov-Dec 2023

• Existing clinic desktop upgraded with additional storage and hardware improvements to meet Orthanc PACS server requirements
• Windows OS installation and system hardening for healthcare environment
• Orthanc software deployment with production-grade configuration
• DICOM network configuration enabling communication with X-ray imaging equipment
• User access control implementation with role-based permissions
• Web interface customization for clinic-specific workflows
• Network integration via GITN infrastructure for secure cross-unit access
• Comprehensive testing including DICOM send/receive validation and image quality verification

Training & Transition Phase

Jan-Feb 2024

• Radiographer training on digital workflow and Orthanc interface
• Clinical staff familiarization with web-based image viewing
• Standard operating procedure development for digital radiology workflow
• Parallel running period maintaining both film and digital systems
• Confidence building through hands-on experience and troubleshooting support
• Full transition to film-free operations after validation period

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Technical Architecture

System Components

System Components

X-Ray Imaging Equipment

Fujifilm system generating DICOM images from patient examinations

Orthanc PACS Server

Upgraded clinic desktop running Orthanc software, repurposed as PACS server with hardware improvements

Network Infrastructure

GITN-provided secure LAN enabling DICOM transmission and web access

Storage System

High-capacity SSD & HDD providing long-term image archival

Web Interface

Browser-based access allowing image viewing from any clinic workstation

Backup Infrastructure

3-2-1 backup strategy ensuring data resilience (see Backup Strategy↴)

X-Ray Image Process & Workflow

X-Ray Image Process & Workflow

1. Patient Registration

Patient demographic data captured in radiology system

2. Image Acquisition

Digital X-ray performed producing DICOM file

3. Semi-Automatic Transmission

DICOM image saved into a shared folder and sent from imaging equipment to Orthanc server

4. Storage & Indexing

Orthanc receives, validates & stores image with patient metadata

5. Immediate Availability

Image accessible via web interface within seconds of acquisition 💯

6. Clinical Review

Clinicians access images from consultation rooms for diagnostic interpretation

7. Backup

Automated backup processes protect against data loss

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Benefits Realized

Clinical Benefits

• Instant image availability enabling immediate clinical decision-making
• Easy comparison with previous radiographs supporting longitudinal assessment
• Superior image manipulation (zoom, contrast adjustment, measurements) aiding diagnosis
• Reduced need for repeat imaging due to lost or damaged films
• Enhanced diagnostic confidence through high-quality digital images
• Support for multidisciplinary consultations with simultaneous access

Operational Benefits

• Elimination of physical film storage space requirements
• Faster patient throughput with streamlined digital workflow
• No film retrieval delays or lost film incidents
• Remote viewing capability from any clinic workstation
• Simplified workflow for radiographers and clinical staff
• Efficient archival with permanent image accessibility

Cost & Environmental Benefits

• Zero ongoing film purchase costs (significant recurring expense eliminated)
• No chemical processing costs or environmental disposal requirements
• Reduced physical storage infrastructure needs
• Long-term cost savings outweighing initial server investment
• Environmental sustainability through elimination of chemical waste
• Reduced carbon footprint from film production and chemical manufacturing

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Current Status & Performance

Since go-live in late 2023, Orthanc PACS has operated with exceptional stability and minimal technical issues. The system has become an integral component of daily radiology operations and all X-ray examinations (in-house) are now performed entirely film-free, with images immediately available for clinical review.

14,445

DICOM Files Processed & Stored

As of 19 March 2026 — total imaging studies archived in the Orthanc PACS system since implementation.

>95-99%

System Uptime

System reliability since implementation

2

Data Loss Incidents

Across thousands of imaging studies

10%

Film Consumption

Reduced to zero for routine ops. Only use for external referral.

<1s

Image Retrieval

Instantaneous via web interface

High

Staff Satisfaction

Confidence in system reliability

✓

Storage Capacity

Adequate with planned expansion

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Strategic Significance

Beyond its day-to-day clinical use, KKBM's Orthanc PACS implementation serves as a practical example of how a primary care clinic in Malaysia can build a functional digital imaging system using open-source tools, existing hardware & in-house skills — without relying on expensive commercial solutions. The experience gained from this project may be useful for other clinics exploring similar options:

1. Proof of concept for open-source PACS in Malaysian healthcare context
2. Model for other primary care clinics considering digital radiology
3. Demonstration of in-house technical capability development
4. Foundation for advanced imaging capabilities and research initiatives
5. Recognition of KKBM innovation leadership within MOH digital health community
6. Template for sustainable, cost-effective healthcare digitalization