Operating an open source PACS

Avram Adam is Network/Systems Administrator at Arizona State Radiology group, which operates 13 locations and provides radiology services to four hospitals in the Tucson area. Adam has been working in PACS for radiology for about two years and before that worked with the City of Tucson and at a credit union primarily in systems administrator and network administrator roles. As chief technology officer as well the HIPAA security officer for Arizona State Radiology he manages all the networking systems, which handle about a half a million studies a year.

Q. What prompted you to seek open source PACS solutions?

Because current offerings don’t have all of the functionality we are looking for.
Most PACS vendors offer out-of-date solutions, lacking modern frameworks, and old unmaintainable code. Not to mention the lack of updates and security issues. Cost is a big factor as well.

Q. What open source components have you put together?
We are currently using dcm4chee-arc-light (PACS), Mirth Connect (HL7), CentOS (Operating System), Oviyam (Non-daignostic Viewer), OHIF (Non-daignostic Viewer), Horos (DICOM Medical Image Viewer), docker (containerization), JBOSS (Application Server), Apache (HTTP Server)

Q. Which ones do you find the easiest to work with in terms of just taking the basic open source application and then working with it to make it work for your group?
Horos is very easy to use. We us it to transfer DICOM files to various destinations, and to edit metadata.

Q. What are some of the unique modifications you have made to adapt these open source applications to your practice?

One of the founding doctors for the practice developed RMAN (Worklist), it was built around Mirth and dcm4chee 2, in addition to a RIS for scheduling. We are starting to adapt RMAN and the RIS to dcm4chee-arc-light, that has a full featured API and WADO implementation.

Q. Is the biggest advantage to using open source primarily the cost or the adaptability to what you need or your group needs?

Definitely adaptability and security. You have to understand, most of the closed source vendors are using code that was developed a long time ago, by staff that is no longer employed. Updates are not common, and security is an issue with all the ransomware floating around.

Q. What are some examples of issues that have come up and you’ve solved yourself?

Typically I don’t run into issues with dcm4chee-arc-light. Updates and bug fixes usually take care of whatever issue I have experienced.

Q. Do you talk to other PACS administrators or practice groups of your size, do they also use open source?

We have deployed dcm4chee-arc-light and Mirth Connect at the hospitals and practices where our radiologists read, it makes it easier to get the studies into our platform. We will setup a router locally, and a VM instance in gcloud for long term storage.

Q. I was getting at maybe you go to symposiums or you go to conferences and talk to other PACS administrators, do they also use open source?

I have not run across any radiology groups or practices that use dcm4chee-arc-light in the US.

Q. What do you do when you get stumped by a problem? Is there anyone you can call?

Dcm4chee Google groups is a great place to start. You will find answers to common issues, and it is monitored by j4care (developers of dcm4chee).

Q. What would you say is the biggest challenge to going open source?

I think the technical challenge all depends on your in-house expertise. A lot of radiology groups don’t have the expertise in-house, so a commercial vendor makes sense.

Q. Do you have any advice for PACS administrators who might be considering going to open source applications for their PACS?

Use docker to deploy dcm4chee-arc-light, it will save tons of time.

Q. Do you recommend DCM4CHEE?

Yes, I would recommend dcm4chee. It is a solid application with tons of enterprise features. J4care is constantly updating the application fixing security issues and bug fixes, a new update is published about every 6 months.