Inverted Image received from Konica Minolta CR

Dear Community,

I have configured Orthanc on Ubuntu. We have configured our Konica Minolta CR to send X-ray images to Orthanc. The images are received but they are gray scale inverted i.e. The background is WHITE and the object is BLACK. The vendor says that the problem is inside Orthanc. To confirm this, the vendor installed K-PACs on his laptop and connected Konica Minolta CR to K-PACS. The image received on K-PACS is normal i.e. Background is BLACK and object is WHITE.

Can anyone please guide me how to investigate/resolve this issue.

Thanking you in anticipation.


AFAIK Orthanc does not perform any kind of image manipulation. Can you
test with another viewer, like the Orthanc Web Viewer plugin[1]?

If the image is indeed stored incorrectly, you may try the following:

- Use GDCM to create a quick server to receive data and store it in a
file. Open the file with any viewer to check. Excluding Orthanc from
the equation this way would simplify debugging.

- Analyze the DICOM association (either using GDCM or a tool like
Wireshark with its DICOM dissector). Compare with the connections to K-
PACS. Something may induce the Konica Minolta CR to send the data in a
different format or with different metadata that will have viewers
interpret it differently.



If you were already using it, also feel free to "anonymize"[1] the data
and send it to us, we'll check it against other viewers as well.



As said by Thibault, Orthanc never modifies the content of the DICOM files it receives. You can be reassured that Orthanc does not “corrupt” the graylevels, this is most probably a rendering problem.

We will need a sample file, possibly anonymized, so as to fix the viewers that are built in Orthanc. Please contribute to our open-source project by provided such a DICOM file.


Dear Sebastien and Thibault,

Thank you so much for your kind response and I am extremely sorry for not being able to respond timely as I was busy in implementing other modules of HMIS at our hospital.

The sample file is attached herewith. I have used Ginkgo Cadx and Orthanc web viewer to view this file, but it is always shown inverted.

I read on some forums that if the value of ‘photometricinterpretation’ is changed to ‘Monochrome2’, then it may resolve inversion problem. But, in my case it did not work.

Another strange behavior was observed when the same Orthanc Instance was used to store image from an Ultra Sound machine and the image was received correctly (we are expecting the same inversion issue here too).

I have also set up an Orthanc Instance using the latest source but that too showed the same inverted image.


f02e3a66-9024-4bc7-873f-4e77eaf8f5a2(1).7z (750 KB)

Dear All,

I installed clear canvas on windows and connected to Orthanc. The image viewed through clear canvas is NORMAL; it is not inverted. But, after resolution of this issue, some more issues were observed being:

a) Some images are mirrored/flipped
b) Some images are up-side down

However, some images are fine. A mirrored image is attached herewith. The annotation ‘R’ was on right side but it is shown on left side.

Please note that GinkgoCadx (installed on ubuntu and windows) and Orthanc WebViewer both always showed inverted image.

I hereby request all to help me.


2.25.108810722710698593498797099324432578200.7z (3.79 MB)


I confirm there is an issue in Orthanc 1.2.0 if photometric interpretation is set to “MONOCHROME1”, which should indeed invert the image (the minimal value should be mapped as white). Currently, Orthanc considers “MONOCHROME1” and “MONOCHROME2” as synonyms, which is not true:

We’ll work on a fix. As a temporary workaround, you can use the “invert contrast” button the Orthanc Web Viewer interface (cf. attached screenshot).

Regarding the second image you sent (the chest), Orthanc correctly renders the “R” on the right side of the image. I’m not sure this image is representative of the flipped issue.

Thanks for your contribution,


I have just introduced an issue in our bug tracker to keep track of this problem:

Dear Sebatien,

Thank you for your response.

Looking forward to the next release of Orthanc to have the photometric interpretation issue fixed.

However, is this also an issue with Orthanc Web Viewer which displays the attached image as inverted and Clear Canvas displays is normally (not inverted)?

The second image I sent (the chest) is also not rendered correctly. Before sending the image to Orthanc, the Konica Viewer was showing the “R” on the left side of the image (as “R” was used to mark the RIGTH shoulder of the patient). So, everything as shown on LEFT side by the Konica viewer is rendered on the RIGHT side. Similarly, the vertically RIGHT portion of the sent image was rendered on the right side.

Best Regards,


FYI, your issue with photometric interpretation should be resolved by the two following changesets:

The fix will be included in forthcoming Orthanc 1.2.1.



Thank you so much! These change sets have landed like a blessing for us!




For the record, this has also been fixed on the Osimis Web Viewer latest version (0.9.1).

Kind Regards,

Hi Khurram,
. . . . . Would it be possible to get in touch with you via email? If so can you please share your email address at