Issue with Displaying PR (Presentation State) DICOM Studies via Orthanc DICOMweb and OHIF Viewer

General
1

Hello Orthanc Community,

We are currently integrating Orthanc with the OHIF Viewer for our PACS solution. While most DICOM studies display correctly, we are facing issues when trying to view Presentation State (PR) objects through the OHIF Viewer using Orthanc’s DICOMweb plugin.

Problem:

  • PR studies loaded via OHIF Viewer result in HTTP 400 or 500 errors.
  • This appears related to incomplete support for the /rendered and /frames/{frame} endpoints in Orthanc’s DICOMweb plugin.
  • PR overlays or annotations are critical for our clinical workflows, and the lack of support is a major blocker.

What we know:

  • The Orthanc DICOMweb plugin implements a reference/basic level of WADO-RS but lacks full support for PR modalities.
  • Other backends like DCM4CHEE reportedly handle PR objects properly with OHIF Viewer.
  • Orthanc’s native web viewer can display these studies, but it does not integrate with OHIF’s features.

Our questions:

  1. Are there any plans to enhance Orthanc’s DICOMweb plugin to support full PR modality rendering?
  2. Is there a recommended workaround or plugin to improve PR handling via DICOMweb in Orthanc?
  3. Would you recommend custom development on Orthanc or switching to another backend for full OHIF compatibility?
  4. Any community experience with successfully integrating OHIF Viewer and Orthanc for overlays and PR?

We appreciate any insights, advice, or pointers to ongoing efforts or plugins addressing this issue.

2

Hi @jemitsanghvi

Could you share some sample images. We don’t have any available for testing.

thanks,

Alain.

3

Hi @alainmazy

You can download it from here :- https://drive.google.com/file/d/18I7X0dVICKHgIIBE29n4VNVWrdK8wOj5/view?usp=drive_link

4

What is it supposed to look like in OHIF ?

In my understanding, PRs are referencing images (and you have not shared any images).

Also note that you should anonymize your images before sharing them and make sure the PRs are still referencing the right images.