The amount of medical images that are generated, analyzed and exchanged by hospitals is dramatically increasing. Medical imaging is indeed the first step to the treatment of more and more illnesses, such as cancers or cardiovascular diseases.

In turn, the data management of clinical images and the administration of the computer network of a medical imaging department imply continuously growing technological challenges. Tasks such as autorouting between imaging modalities, exchanging data between clinical departments or hospitals, or anonymizing images are still hard to achieve in practice. This is a direct consequence of the lack of interoperability software that could bring technological independence to hospitals by creating low-cost gateways between proprietary ecosystems.

In this talk, I will explain the pains behind modern medical imaging, from the perspective of the hospitals. The DICOM standard will be introduced, together with free and open-source software supporting this standard.

I will then put emphasis on the free software Orthanc, a lightweight, versatile DICOM server. Thanks to its REST API and to its Lua scripting engine, Orthanc is primarily conceived as a central, robust building block to bring technological independence to clinical departments by automating their very specific imaging flows. Orthanc was nominated at the Zénobe Award 2013 for social innovation.

Table of Contents

• Introduction: Imaging flows for radiology and radiotherapy
• DICOM and the pains of medical imaging
• Free and open-source software for DICOM
• Orthanc:
  • Description and architecture
  • Automating imaging flows with Orthanc
  • The present and the future of Orthanc
• Conclusion

The exploitation of multiple imaging modalities is central to the radiotherapy routine. As a consequence, the flows of biomedical images inside the RT departments are at the same time numerous and complex. This has motivated the development of the Orthanc open-source software that is designed to improve such workflows. Orthanc is a free, Web-based DICOM store. Orthanc features rich scripting capabilities that makes it scalable and flexible: Thanks to its RESTful API, Orthanc can be driven from any computer language to automate the imaging workflows that are very specific to each hospital. Orthanc is deployed in our Institution to optimize several real-world clinical processes by improving the interconnection between various DICOM modalities and by simplifying the data management of medical images.