DICOM Workflows

End-to-end DICOM imaging data flows — acquisition, routing, storage, retrieval, and viewing in VannahHealthCloud.

DICOM Workflow Overview

VannahHealthCloud implements the complete DICOM workflow lifecycle from image acquisition at the modality to diagnostic viewing and long-term archiving.

Supported DICOM Services

Service	Direction	Description
C-ECHO	Bidirectional	Connectivity verification (DICOM ping)
C-STORE	Inbound	Receive images from modalities
C-FIND	Query	Search studies, series, instances
C-MOVE	Retrieve	Transfer images to destinations
C-GET	Retrieve	Direct image retrieval
MWL	Query	Modality Worklist queries

DICOMweb Services

Service	Method	Description
WADO-RS	GET	Retrieve studies/series/instances via HTTP
STOW-RS	POST	Store DICOM objects via HTTP
QIDO-RS	GET	Query DICOM objects via HTTP
WADO-URI	GET	Retrieve single instances (legacy)

Image Acquisition

From Modalities

Imaging modalities (CT, MR, US, CR, DX, etc.) send images to VannahHealthCloud using DICOM C-STORE:

# Orthanc DICOM Configuration
{
  "DicomAet": "VANNAHCLOUD",
  "DicomPort": 4242,
  "RemoteAccessAllowed": true,
  "AuthenticationEnabled": true,
  "DicomTlsEnabled": true
}

Supported Modalities

CT — Computed Tomography
MR — Magnetic Resonance Imaging
US — Ultrasound
CR — Computed Radiography
DX — Digital Radiography
MG — Mammography
NM — Nuclear Medicine
PT — PET Scan
XA — Angiography
RF — Fluoroscopy

Image Routing

VannahHealthCloud supports intelligent DICOM routing based on configurable rules:

Routing Rules

{
  "rules": [
    {
      "name": "Route CT to AI Pipeline",
      "condition": {
        "modality": "CT",
        "bodyPart": "CHEST"
      },
      "destination": {
        "aet": "AI_ENGINE",
        "host": "ai.internal",
        "port": 4243
      }
    },
    {
      "name": "Archive All Studies",
      "condition": { "modality": "*" },
      "destination": {
        "type": "s3",
        "bucket": "vhc-archive",
        "region": "af-south-1"
      }
    }
  ]
}

Routing Capabilities

Modality-based routing — Route by CT, MR, US, etc.
Body part routing — Route chest studies to AI, brain to neuro
Referring physician routing — Route to specific radiologist
Time-based routing — After-hours routing to tele-radiology
Priority routing — STAT studies get priority processing

Image Storage

Storage Tiers

Tier	Technology	Use Case	Retrieval Time
Hot	Local SSD + PostgreSQL	Active studies (0–30 days)	< 1 second
Warm	MinIO Object Storage	Recent archive (30–365 days)	1–5 seconds
Cold	S3 Glacier / Deep Archive	Long-term archive (1+ years)	Minutes to hours

Data Lifecycle

New Study Arrives
    │
    ▼
Hot Storage (SSD)  ─── 30 days ──→  Warm Storage (MinIO)
                                          │
                                     365 days
                                          │
                                          ▼
                                    Cold Storage (S3 Glacier)

Image Retrieval & Viewing

MedDream Viewer Integration

VannahHealthCloud uses MedDream as its primary DICOM viewer:

Zero-footprint HTML5 viewer (no plugins required)
Diagnostic-quality rendering
Multi-planar reconstruction (MPR)
3D volume rendering
Measurement and annotation tools
Hanging protocol support
Side-by-side prior comparison

Viewer Launch URL

https://{viewer-host}/viewer?studyUID={StudyInstanceUID}&token={auth-token}

Worklist Management

Modality Worklist (MWL)

VannahHealthCloud provides a DICOM Modality Worklist server:

# Worklist Query Example
findscu -W -k "ScheduledProcedureStepSequence" \
  -k "PatientName" \
  -k "PatientID" \
  -k "AccessionNumber" \
  -k "Modality=CT" \
  vannahcloud.example.com 4242

Worklist Fields

Patient Name, ID, DOB, Sex
Accession Number
Scheduled Procedure Step (date, time, modality, station)
Referring Physician
Study Description
Requested Procedure ID

DICOM Workflows

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