replacing a vendor PACS with Orthanc

Hello everyone,

I am responsible for replacing our vendor PACS with Orthanc and connect it to our HIS system as part of my research project. As I am very new to Orthanc, I have some questions.

In our current situation in the hospital, when a patient comes to the reception, the HIS user sends an order request to our PACS server with a unique number (id). Then when the patient does x-ray, the DICOM file is also sent to the PACS server and relates it with the patient and DICOM with that unique number (id). Later, when the user in the HIS want to check the PACS server for particular patient HIS user can check with this id

First of all, I would like to know how to handle this scenario by replacing our PACS with Orthanc?

Secondly, is there any free image viewer that we can use with Orthanc for diagnostic purposes?


Hi Hamidreza;

Welcome to the Orthanc community!

I guess that the number you are mentioning is the “Accession number”.
From your flow description, it seems that you are looking for a solution to manage worklists, so a good starting point is this link:

As far as I know, viewers certified for diagnostic purposes are not free (because the certification procedure has to be paid)…
Here at Osimis, we work with Softneta (Meddream viewer: and are very happy.


You are looking for quite a bit. A full PACS system does more than storing images. A few questions:

  1. Are you looking for the modality (X-Ray) to query the worklist to get the Accession/Patient ID (Unique Number ID) or does the technician manually enter in the Accession/Patient ID?
  2. You are looking for a Diagnostic Viewer, is this for Radiologists to report? How do you plan on integrating it? Do you have a RIS where reports would go to? Voice Recognition integration, etc.?

Thanks Benoit,

Yes, it is “Accession number”, I think the worklist will solve my issue. I am reading the document and trying to reach a high-level model for this research project. Later I will provide it here.

I should contact Softneta for their pricing list.

Hello Bryan,

I think we should implement both scenarios for the first question. If a modality could query worklist to get the Accession number is perfect, but we want the technician also to enter it manually.

  • Could a modality read the worklist directly from the Orthanc?

Yes, I was looking for a Diagnostic Viewer, but it should be free because the hospital doesn’t have a budget for that. We have RIS and the reports store in this system. According to the Benoit Diagnostic Viewers are not free, so I am looking for a viewer that provides some functionalities but not for diagnostic that we can use in the teaching hospital. If you know an image viewer could satisfy these conditions and work with Orthanc please let me know.



Regarding the support of DICOM worklists in Orthanc, check out the following plugin:

Regarding the available free viewers, check out the dedicated FAQ of the Orthanc Book:


I am very new to the Orthanc and trying to develop a model for this case study.

What I understand from the previous questions and Orthanc book is that for the Worklist, I should have another installed Orthanc that acts as DICOM worklist serve, Is this correct?

Below diagram is the model that so far I designed with Orthanc, Mirth Connect and HIS:


Please let me know your suggestions.



You can have one single Orthanc server with the “modality worklist” plugin to reach this goal :

In other words, Orthanc can combine the “PACS”, “DICOM Worklist Server”, “Image Viewer” boxes in your diagram.